Critical Care & Emergencies (all articles)
RCT | Immediate complete revascularization non-inferior to staged approach in ACS patients with multivessel disease
13 Mar, 2023 | 15:10h | UTCSummary: Patients with an acute coronary syndrome and multivessel disease not presenting with cardiogenic shock usually benefit from complete revascularization by percutaneous coronary intervention (PCI). Complete revascularization involves treating all significant blockages in the coronary arteries, including those not causing symptoms (non-culprit lesions).
The BIOVASC randomized non-inferiority trial investigated whether patients with acute coronary syndrome and multivessel coronary disease should undergo immediate complete revascularization during the index procedure or undergo a staged approach with PCI of the culprit lesion only during the index procedure followed by another procedure within 6 weeks of all non-culprit lesions deemed to be clinically significant. The exclusion criteria were:
- Previous coronary artery bypass surgery.
- Cardiogenic shock.
- Single-vessel coronary disease.
- The presence of a chronic coronary total occlusion.
A total of 1525 patients with acute coronary syndrome and multivessel coronary disease were randomly assigned to either an immediate complete revascularization group (764 patients) or a staged complete revascularization group (761 patients). The primary outcome was a composite of all-cause mortality, myocardial infarction, unplanned ischemia-driven revascularization, or cerebrovascular events at 1 year after the index procedure. The study found that immediate complete revascularization was non-inferior to staged complete revascularization for the primary outcome.
Article: Immediate versus staged complete revascularisation in patients presenting with acute coronary syndrome and multivessel coronary disease (BIOVASC): a prospective, open-label, non-inferiority, randomised trial – The Lancet (free registration required)
Commentaries:
Revascularisation in acute coronary syndromes: change in practice? – The Lancet (free registration required)
No Downside to Immediate Complete Revascularization in ACS: BIOVASC – TCTMD
Immediate Complete Revascularization Non-Inferior to Staged Procedure in BIOVASC Trial – HCP Live
Related:
One-Year Outcomes after PCI Strategies in Cardiogenic Shock – New England Journal of Medicine
Review | Commonly missed findings on chest radiographs: causes and consequences
13 Mar, 2023 | 15:07h | UTCCommonly Missed Findings on Chest Radiographs: Causes and Consequences – CHEST (free for a limited period)
See also: Reducing Errors Resulting From Commonly Missed Chest Radiography Findings – CHEST (free for a limited period)
Review | Reducing errors resulting from commonly missed chest radiography findings
13 Mar, 2023 | 15:06h | UTCReducing Errors Resulting From Commonly Missed Chest Radiography Findings – CHEST (free for a limited period)
See also: Commonly Missed Findings on Chest Radiographs: Causes and Consequences – CHEST (free for a limited period)
M-A | Routine anaerobic coverage for aspiration pneumonia: limited evidence of benefit
13 Mar, 2023 | 15:03h | UTCSummary: Treating aspiration pneumonia with antibiotics that cover anaerobic bacteria has become common practice in many services, but recent studies suggest that this may not necessarily improve prognosis.
Out of 2523 publications, this systematic review and meta-analysis only included one randomized control trial and two observational studies. The study found no clear benefit of anaerobic coverage and concluded that there is not enough data to evaluate the necessity of anaerobic coverage in the antibiotic treatment of aspiration pneumonia.
The authors suggest that covering anaerobic bacteria with antibiotics may not be needed as an initial treatment for aspiration pneumonia if there is no formation of abscess or empyema and the patient has good oral hygiene.
Related: BTS clinical statement on aspiration pneumonia – Thorax
Brief Review | How we escalate vasopressor and corticosteroid therapy in patients with septic shock
13 Mar, 2023 | 15:04h | UTCHow We Escalate Vasopressor and Corticosteroid Therapy in Patients With Septic Shock – CHEST (free for a limited period)
M-A | Age, tracheal intubation time, tracheostomy, and APACHE II score are risk factors for post-extubation dysphagia in ICU patients
13 Mar, 2023 | 14:59h | UTCSummary: Post-extubation dysphagia is a common complication in ICU patients who have undergone intubation and mechanical ventilation, leading to a risk of aspiration and pneumonia.
The review included 15 studies involving 50,669 patients and found that: 1 – age; 2 – duration of tracheal intubation; 3 – tracheostomy; and 4 – APACHE II score were significant risk factors for post-extubation dysphagia.
By identifying these risk factors, clinicians can better identify patients at risk of developing dysphagia after extubation and take measures to prevent and manage the condition.
Article: Risk factors for post-extubation dysphagia in ICU: A systematic review and meta-analysis – Medicine
ISCCM Guidelines | Hemodynamic monitoring in the critically ill
13 Mar, 2023 | 14:58h | UTC
ISCCM Guidelines for the use of procalcitonin for rational use of antibiotics
13 Mar, 2023 | 14:57h | UTC
ISCCM Guidelines on acute kidney injury and renal replacement therapy
13 Mar, 2023 | 14:55h | UTC
ISCCM Consensus Statement | Prevention of venous thromboembolism in the critical care unit
13 Mar, 2023 | 14:53h | UTC
ISCCM Consensus Recommendations | Competencies for point-of-care ultrasonography in ICU
13 Mar, 2023 | 14:51h | UTC
ISCCM Position Statement | Recommendations for evaluation and selection of deceased organ donor
13 Mar, 2023 | 14:50h | UTC
Brief Review | Mechanical power: meaning, uses and limitations
13 Mar, 2023 | 14:44h | UTCMechanical power: meaning, uses and limitations – Intensive Care Medicine
Commentary on Twitter
Mechanical power, meaning, uses & limitations:
➡️ derivation of mechanical power
➡️ components of mechanical power and risk of VILI
➡️ association between MP and outcome
➡️ mechanical power normalisation
Open access #FOAMcc on @ICM
🖇️ https://t.co/nuhPh0qIXn pic.twitter.com/kBSTBdj54o— Intensive Care Medicine (@yourICM) March 8, 2023
Review | How to use nebulized antibiotics in severe respiratory infections
10 Mar, 2023 | 14:31h | UTCHow to Use Nebulized Antibiotics in Severe Respiratory Infections – Antibiotics
Guideline | Management of severe peri-operative bleeding
8 Mar, 2023 | 14:18h | UTC
ESC 0/1-hour algorithm unable to safely exclude 30-day cardiac death or MI in patients with known coronary artery disease, study finds
8 Mar, 2023 | 14:12h | UTCSummary:
The study aimed to determine if the European Society of Cardiology (ESC) 0/1-hour algorithm using high-sensitivity cardiac troponin T (hs-cTnT) could achieve a negative predictive value of 99% or higher for 30-day cardiac death or myocardial infarction (MI) among emergency department patients with chest pain and known coronary artery disease (CAD).
The study included 1430 adults, and the algorithm had a negative predictive value of 96.6% for 30-day cardiac death or MI among patients with known CAD, suggesting that the algorithm may not be able to safely exclude 30-day cardiac death or MI in these patients.
These findings suggest that clinicians should be cautious when using the ESC 0/1-hour hs-cTnT algorithm in patients with known CAD.
Article: Performance of the European Society of Cardiology 0/1-Hour Algorithm With High-Sensitivity Cardiac Troponin T Among Patients With Known Coronary Artery Disease – JAMA Cardiology (link to abstract – $ for full-text)
Related:
Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction: An International Collaborative Meta-analysis – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentary on Twitter
In this diagnostic study of 1430 adults, the high-sensitivity troponin T (hs-cTnT) ESC 0/1-hour algorithm had a negative predictive value of 96.6% for 30-day cardiac death or MI among patients with known coronary artery disease. https://t.co/FnILIazEnU
— JAMA Cardiology (@JAMACardio) March 1, 2023
M-A | Real-time ultrasound guidance as compared to landmark technique for subclavian central venous cannulation
8 Mar, 2023 | 14:04h | UTCReal-Time Ultrasound Guidance as Compared to Landmark Technique for Subclavian Central Venous Cannulation: A Systematic Review and Meta-Analysis With Trial Sequential Analysis – Critical Care Medicine (link to abstract – $ for full-text)
M-A | Comparison of a short vs. long-course antibiotic therapy for ventilator-associated pneumonia
7 Mar, 2023 | 13:18h | UTCSummary:
This systematic review and meta-analysis of randomized controlled trials aimed to compare the rates of recurrence and relapse of ventilator-associated pneumonia (VAP) between short-course (≤8 days) and long-course (≥10-15 days) antibiotic therapy strategies. Five relevant studies involving 1069 patients were identified.
Compared to long-course therapy, short-course therapy increased the number of antibiotic-free days without any impact on recurrence and relapses of VAP, 28 days mortality, mechanical ventilation duration, number of extra-pulmonary infections, and length of ICU stay.
However, the study’s limitations, such as the small sample size and the lack of standardized definitions of the assessed outcomes, should be considered when interpreting the results.
Commentary: Study finds benefits in short-course antibiotics for ventilator-associated pneumonia – CIDRAP
Review | Acquired disorders of hypomagnesemia
7 Mar, 2023 | 13:09h | UTCAcquired Disorders of Hypomagnesemia – Mayo Clinic Proceedings
Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli
7 Mar, 2023 | 13:00h | UTCRelated:
RCT | Colistin monotherapy vs. combination therapy for carbapenem-resistant organisms
SR | The effects of flow settings during high-flow nasal cannula support for adult subjects
7 Mar, 2023 | 12:40h | UTC
M-A | Early vs. delayed coronary angiography after out-of-hospital cardiac arrest without ST-segment elevation
6 Mar, 2023 | 14:12h | UTCSummary:
This systematic review and meta-analysis of randomized controlled trials evaluated the efficacy and safety of early vs. delayed coronary angiography following an out-of-hospital cardiac arrest in patients without ST elevation on the ECG.
The review included six trials with 1,590 patients and found that early angiography probably has no effect on mortality, survival with good neurologic outcomes, and ICU length of stay, indicating that the procedure should not be routinely recommended for these patients.
Related:
Emergency vs Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac Arrest: Results of the Randomized, Multicentric EMERGE Trial – JAMA Cardiology (link to abstract – $ for full-text)
Editorial | Helmet trials: resolving the puzzle
6 Mar, 2023 | 14:05h | UTCHelmet trials: resolving the puzzle – Intensive Care Medicine (if the link is paywalled, try this one in PMC)
Nitrous oxide-induced subacute combined degeneration of the cord: diagnosis and treatment
3 Mar, 2023 | 14:01h | UTC
Review | Practical guide for anticoagulant and antiplatelet reversal in clinical practice
3 Mar, 2023 | 13:42h | UTCPractical Guide for Anticoagulant and Antiplatelet Reversal in Clinical Practice – Pharmacy