Critical Care & Emergencies (all articles)
Perspective | Trials on oxygen targets in the critically ill patients: do they change our knowledge and practice?
20 Mar, 2023 | 13:26h | UTCTrials on oxygen targets in the critically ill patients: do they change our knowledge and practice? – Intensive Care Medicine (if the link is paywalled, try this one)
Commentary on Twitter
💨 Trials on liberal/conservative O2 targets in #ICU: conflicting results! Many studies in progress. Waiting for evidence, consider O2 as powerful drug to be carefully titrated, for most of critically ill pts in normoxia-mild hyperoxaemia range. #FOAMcc
🖇️ https://t.co/ECWgmQkmAZ pic.twitter.com/gIwB9ax0k1— Intensive Care Medicine (@yourICM) March 15, 2023
Brief Review | High-risk pulmonary embolism in the ICU
20 Mar, 2023 | 13:24h | UTCHigh-risk pulmonary embolism in the intensive care unit – Intensive Care Medicine (free for a limited period)
Review | Neuromonitoring in critically ill patients
20 Mar, 2023 | 13:18h | UTCNeuromonitoring in Critically Ill Patients – Critical Care Medicine (free for a limited period)
Related: The importance of neuromonitoring in non-brain injured patients – Critical Care
Review | Surviving sepsis campaign
20 Mar, 2023 | 13:17h | UTCSurviving Sepsis Campaign – Critical Care Medicine
Review | Neurogenic shock: definition, identification, and management in the ED
20 Mar, 2023 | 13:09h | UTCNeurogenic Shock: Definition, Identification, and Management in the ED – emDocs
Cohort Study | COVID-19 outpatients mostly at low risk for VTE, but age, being male, and obesity are risk factors
17 Mar, 2023 | 13:11h | UTCSummary: The article discusses a cohort study that aimed to assess the risk of venous thromboembolism (VTE) among outpatients with COVID-19 and identify independent predictors of VTE.
The study used data from two integrated healthcare delivery systems in California and included 398.530 nonhospitalized adults aged 18 years or older with COVID-19 diagnosed between January 1, 2020, and January 31, 2021, with follow-up through February 28, 2021.
The results showed that the overall risk of VTE among outpatients with COVID-19 is low, but higher in the first 30 days after diagnosis. Factors associated with a higher risk of VTE in COVID-19 outpatients included:
- Age 55 years or older.
- Being male.
- history of VTE or thrombophilia.
- Body mass index greater than or equal to 30.0.
The study’s results could inform future randomized trials to explore targeted VTE preventive strategies and more intensive short-term surveillance for patients with COVID-19 who are at a higher risk of developing VTE.
Commentary: Venous blood clots rare among COVID-19 outpatients, study finds – CIDRAP
Commentary on Twitter
The rate of VTE was low in outpatients with #COVID19 in the first 30 days, and even lower >30 days. Factors associated with a higher risk of VTE in included age ≥55, male, prior VTE/thrombophilia, and BMI ≥30. https://t.co/3hwfDW88k4
— JAMA Network Open (@JAMANetworkOpen) March 13, 2023
Guidelines for the management of patients with substance intoxication presenting to the ED
17 Mar, 2023 | 13:09h | UTC
RCT | Pre-hospital rule-out of NSTE-ACS by ambulance paramedics with point-of-care troponin is feasible and cost-saving
16 Mar, 2023 | 13:27h | UTCSummary: Using a point-of-care (POC) troponin measurement, this randomized trial in the Netherlands assessed the safety and healthcare costs of a pre-hospital rule-out strategy for patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
The study included only patients considered at low risk with a HEAR (History, ECG, Age, Risk factors) score ≤3. A total of 863 low-risk participants were randomized to direct transfer to the ED or a pre-hospital rule-out strategy with POC troponin measurement.
The trial found that pre-hospital rule-out of NSTE-ACS in low-risk patients using a single POC troponin measurement is feasible, significantly reduces healthcare costs, and is associated with a low incidence of major adverse cardiac events.
The HEAR score, combined with a POC troponin measurement by ambulance paramedics, accurately identifies low-risk patients for whom ED evaluation is unnecessary. Implementing this pre-hospital rule-out strategy in low-risk patients could significantly reduce healthcare costs through more efficient use of ambulance services and fewer ED visits. It is worth noting, however, that further studies in other localities are necessary before the widespread use of this strategy can be implemented.
Commentaries:
JC: Can we rule out ACS by a single prehospital troponin measurement? – St. Emyln’s
Rule-Out of NSTE-ACS by a Prehospital Troponin Measurement – American College of Cardiology
RCT | Preliminary study suggests early methylene blue administration reduces vasopressor duration in septic shock patients
16 Mar, 2023 | 13:25h | UTCSummary: The study aimed to evaluate the efficacy and safety of early adjunctive methylene blue (MB) administration in patients with septic shock. In this single-center randomized controlled trial, 91 patients were randomly assigned to receive MB or placebo, with the primary outcome being the time to vasopressor discontinuation at 28 days.
The study found that the MB group had a significantly shorter time to vasopressor discontinuation, one more day of vasopressor-free days at day 28, a shorter length of stay in the ICU and hospital, and no serious adverse effects related to MB administration.
However, the study was limited by its small sample size and single-center design. Therefore, larger multicenter randomized clinical trials are needed to confirm the potential benefit of MB as an early adjunctive therapy in patients with septic shock.
Review | Improving vasopressor use in cardiac arrest
16 Mar, 2023 | 13:08h | UTCImproving vasopressor use in cardiac arrest – Critical Care
M-A | Active fluid de-resuscitation in critically ill patients with septic shock
16 Mar, 2023 | 13:09h | UTC
ESC Consensus Statement | Inotropic therapy in patients with advanced heart failure
15 Mar, 2023 | 15:14h | UTC
Out-of-hospital cardiac arrest – review of recent practice-informing trials
15 Mar, 2023 | 15:09h | UTCOut-of-hospital cardiac arrest – Intensive Care Medicine (if the link is paywalled, try this one)
Commentary on Twitter
#OHCA? 6 trials with potential to influence guidelines/practice:
💉 COCA: Calcium for #OHCA
⚡️ DOSE VF: double sequential external defib
🩸 INCEPTION: early #ECLS
💨 EXACT: ⬇️ O2
❄️ TTM2: targeted hypo vs normothermia
🩸 BOX: BP & O2 targets post #resus
🖇️ https://t.co/xtGmuYtXKF pic.twitter.com/3BOlfl5hRd— Intensive Care Medicine (@yourICM) March 13, 2023
Review | Approach to the patient with adrenal hemorrhage
15 Mar, 2023 | 15:03h | UTCApproach to the Patient With Adrenal Hemorrhage – The Journal of Clinical Endocrinology & Metabolism
Review | Prehospital stroke management and mobile stroke units
15 Mar, 2023 | 14:54h | UTCPrehospital stroke management and mobile stroke units – Current Opinion in Neurology
M-A | Pretest probability assessment and D-Dimer are preferred for the initial evaluation of suspected PE in pregnant women
15 Mar, 2023 | 14:50h | UTC
AHA Scientific Statement | Atrial fibrillation occurring during acute hospitalization
14 Mar, 2023 | 14:04h | UTC
Mortality rates and clinical manifestations of severe hypothyroidism in the ICU: a French multicenter cohort study
14 Mar, 2023 | 13:44h | UTCSummary: This article presents the findings of a retrospective multicenter cohort study conducted over 18 years in 32 French ICUs to investigate severe hypothyroidism (SH) requiring ICU admission.
The study included 82 patients with SH, with thyroiditis and thyroidectomy being the primary causes, and levothyroxine discontinuation, sepsis, and amiodarone-related hypothyroidism being the most frequent triggers.
Patients with SH presented with various clinical symptoms, including hypothermia, hemodynamic failure, and coma, with in-ICU and 6-month mortality rates being 26% and 39%, respectively. The study also found that patients with hemodynamic and respiratory failure on admission to the ICU had a higher likelihood of mortality.
Levothyroxine replacement was provided to all patients, but the administration route and loading dose varied. The authors recommend early diagnosis, prompt levothyroxine administration, and close monitoring of cardiac and hemodynamic parameters for SH patients admitted to the ICU.
Risk factors for Carbapenem-Resistant Enterobacterales infections: a matched case-control study
14 Mar, 2023 | 13:43h | UTCSummary: The study aimed to investigate risk factors for infections caused by carbapenem-resistant Enterobacterales (CRE) and identify variables that increase the probability of CRE infection among admitted patients in hospitals with high CRE incidence.
The study was performed in 50 hospitals in Southern Europe from March 2016 to November 2018 and included patients with complicated urinary tract infection, complicated intraabdominal infection, pneumonia, or bacteremia from other sources due to CRE. Control groups were patients with infection caused by carbapenem-susceptible Enterobacterales and non-infected patients, matched according to the same criteria as the CRE group (type of infection, ward, and duration of hospital admission).
The results showed that the main risk factors for CRE infections were previous colonization with CRE, use of urinary catheters, and exposure to broad-spectrum antibiotics.
The study’s findings offer evidence to inform decisions about preventive measures and empirical treatment for patients with suspected CRE infections. Additionally, the study can guide the efficient design of future randomized trials focusing on high-risk patients.
Related:
RCT | Colistin monotherapy vs. combination therapy for carbapenem-resistant organisms
Ultrasound-guided nerve blocks | Suggested procedural guidelines for emergency physicians
14 Mar, 2023 | 13:41h | UTC
Podcast and Brief Review | TIA/Stroke pearls for the hospitalist
14 Mar, 2023 | 13:36h | UTC#385 TIA/Stroke for the Hospitalist featuring Dr. Karima Benameur – The Curbsiders
Perspective | Embracing complexity in sepsis
14 Mar, 2023 | 13:31h | UTCEmbracing complexity in sepsis – Critical Care
Perspective | How I prescribe prolonged intermittent renal replacement therapy
14 Mar, 2023 | 13:26h | UTCHow I prescribe prolonged intermittent renal replacement therapy – Critical Care
Review | Guideline-based management of acute respiratory failure and acute respiratory distress syndrome
14 Mar, 2023 | 13:17h | UTC
Findings of daily point-of-care ultrasound assessment of CVC-related thrombosis in critically ill patients
14 Mar, 2023 | 13:19h | UTCDaily point-of-care ultrasound-assessment of central venous catheter-related thrombosis in critically ill patients: a prospective multicenter study – Intensive Care Medicine (free for a limited period)
Commentary on Twitter
#POCUS assessment of CVC related thrombosis in #ICU
➡️ common (16.9%) mostly in IJV
➡️ can occur soon: 12% 1st day, 82% in 7 days
➡️ ⅓ small, ⅓ extensive
➡️ often nonprogressive, rarely occlusive; gradual ⬇️ after removal
⬆️ #ICU LoS but = mortality
🖇️ https://t.co/AyBrMOTyBb pic.twitter.com/qMmxuNYdvT— Intensive Care Medicine (@yourICM) March 10, 2023