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Critical Care & Emergencies (all articles)

PRINCIPLE RCT: Inhaled budesonide improves time to recovery from COVID-19 in people at high risk of complications in the community.

11 Aug, 2021 | 08:52h | UTC

Inhaled budesonide for COVID-19 in people at high risk of complications in the community in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial – The Lancet

Invited Commentary: The use of inhaled corticosteroids in early-stage COVID-19

 

BaSICS RCT: Among critically ill patients requiring fluid therapy, there was no difference in mortality with slower (333 mL/h) vs. faster (999 mL/h) intravenous fluid bolus rates.

11 Aug, 2021 | 08:37h | UTC

Effect of Slower vs Faster Intravenous Fluid Bolus Rates on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial – JAMA (free for a limited period)

Editorial: Does Crystalloid Composition or Rate of Fluid Administration Make a Difference When Resuscitating Patients in the ICU? – JAMA (free for a limited period)

Video: Balanced Solution vs. Saline in Intensive Care Study

 

Review: Clinical characteristics and pharmacological management of COVID-19 vaccine–induced immune thrombotic thrombocytopenia with cerebral venous sinus thrombosis.

11 Aug, 2021 | 08:44h | UTC

Clinical Characteristics and Pharmacological Management of COVID-19 Vaccine–Induced Immune Thrombotic Thrombocytopenia With Cerebral Venous Sinus Thrombosis: A Review – JAMA Cardiology

Related:

NICE COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis.

Vaccine-induced immune thrombotic thrombocytopenia: what we know and do not know.

Very rare cases of thrombosis with thrombocytopenia syndrome (TTS) after AstraZeneca vaccine: a global safety database analysis – the estimated rate of TTS after the first dose was 8.1 per million vaccinees; after the second dose, the estimated rate was 2.3 per million vaccinees. (several articles and resources on the subject)

 

Commentary on Twitter

https://twitter.com/JohnGRizk/status/1425126093288353800

 

BaSICS RCT: Among critically ill patients requiring fluid therapy, treatment with a balanced solution did not lead to reduced mortality compared to a 0.9% saline solution.

11 Aug, 2021 | 08:39h | UTC

Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill PatientsThe BaSICS Randomized Clinical Trial – JAMA (free for a limited period)

Editorial: Does Crystalloid Composition or Rate of Fluid Administration Make a Difference When Resuscitating Patients in the ICU? – JAMA (free for a limited period)

Video: Balanced Solution vs. Saline in Intensive Care Study

 

Commentary on Twitter

 

Hemodynamics for the Heart Failure Clinician: A State-of-the-Art Review.

11 Aug, 2021 | 08:32h | UTC

Hemodynamics for the Heart Failure Clinician: A State-of-the-Art Review – Journal of Cardiac Failure

 

RCT: Triaging acute pulmonary embolism for home treatment by Hestia vs. simplified PESI criteria – the tools were similarly effective, and more than a third of patients were treated at home with a low incidence of complications.

11 Aug, 2021 | 08:27h | UTC

Triaging acute pulmonary embolism for home treatment by Hestia or simplified PESI criteria: the HOME-PE randomized trial – European Heart Journal

 

Commentary on Twitter

 

RCT: Computer-assisted individualized hemodynamic management reduces intraoperative hypotension in intermediate- and high-risk surgery – larger trials with patient-relevant outcomes are required.

11 Aug, 2021 | 08:25h | UTC

Computer-assisted Individualized Hemodynamic Management Reduces Intraoperative Hypotension in Intermediate- and High-risk Surgery: A Randomized Controlled Trial – Anesthesiology

Video: Computer-assisted individualized hemodynamic management reduces intraoperative hypotension

 

Update on medical management of acute hip fracture.

10 Aug, 2021 | 08:50h | UTC

Update on medical management of acute hip fracture – Cleveland Clinical Journal of Medicine

 

Commentary on Twitter

 

Evidence-based approach to nailbed injuries: ED presentations, evaluation, and management.

10 Aug, 2021 | 08:47h | UTC

Evidence-based Approach to Nailbed Injuries: ED Presentations, Evaluation, and management – emDocs

 

Case report: Systemic capillary leak syndrome after ChAdOx1 nCOV-19 (Oxford–AstraZeneca) vaccination.

8 Aug, 2021 | 23:49h | UTC

Systemic capillary leak syndrome afer ChAdOx1 nCOV-19 (Oxford–AstraZeneca) vaccination – Canadian Medical Association Journal

 

[Preprint] RCT: non-invasive respiratory strategies in acute respiratory failure in patients with COVID-19 – CPAP reduced the composite outcome of intubation or death within 30 days; high-flow nasal oxygenation was not associated with better outcomes.

6 Aug, 2021 | 10:18h | UTC

An adaptive randomized controlled trial of non-invasive respiratory strategies in acute respiratory failure patients with COVID-19 – medRxiv

Commentary: Covid: Pressured oxygen reduces ventilator need – BBC

 

Commentary on Twitter (thread – click for more)

 

Review: Transmission of infections during cardiopulmonary resuscitation.

8 Aug, 2021 | 23:16h | UTC

Transmission of Infections during Cardiopulmonary Resuscitation – Clinical Microbiology Reviews

 

Systematic Review: “Remdesivir probably has little or no effect on all‐cause mortality at up to 28 days in hospitalized adults with SARS‐CoV‐2 infection. We are uncertain about the effects of remdesivir on clinical improvement and worsening”.

6 Aug, 2021 | 10:15h | UTC

Remdesivir for the treatment of COVID‐19 – Cochrane Library

Summary: Remdesivir for the treatment of COVID-19 – Cochrane Library

 

Commentary on Twitter (thread – click for more)

 

Dexamethasone and tocilizumab treatment considerably reduces the value of C-reactive protein and procalcitonin to detect secondary bacterial infections in COVID-19 patients.

6 Aug, 2021 | 10:13h | UTC

Dexamethasone and tocilizumab treatment considerably reduces the value of C-reactive protein and procalcitonin to detect secondary bacterial infections in COVID-19 patients – Critical Care

 

Clinical Picture: Mucormycosis after COVID-19 in a patient with diabetes.

6 Aug, 2021 | 10:09h | UTC

Mucormycosis after COVID-19 in a patient with diabetes – The Lancet

Related:

COVID-19 and mucormycosis superinfection: the perfect storm.

ECMM/ISHAM recommendations for clinical management of COVID -19 associated mucormycosis in low- and middle-income countries.

The “Black Fungus” in India: The Emerging Syndemic of COVID-19–Associated Mucormycosis – careful use of antibiotics and corticosteroids and closely monitoring blood glucose levels are some of the strategies suggested by the authors.

Multicenter Epidemiologic Study of Coronavirus Disease–Associated Mucormycosis, India – Uncontrolled diabetes mellitus was the most common underlying disease; improper glucocorticoid use was independently associated with the disease.

Opinion | “Doctors have been blamed for the rise in black fungus in India, but the COVID treatment guidelines could be contributing” – improper use of antibiotics and higher than usual doses of corticosteroids may be contributing to the emergence of mucormycosis and other fungal co-infections.

What is mucormycosis, the fungal infection affecting COVID patients in India?

[Preprint] The Emergence of COVID-19 Associated Mucormycosis: Analysis of Cases From 18 Countries.

Mucormycosis: The ‘black fungus’ maiming Covid patients in India

Global Guideline for the Diagnosis and Management of Mucormycosis

 

ESPEN practical guideline: Clinical nutrition in surgery – “Preoperative fasting from midnight is unnecessary in most patients. Patients undergoing surgery, who are considered to have no specific risk of aspiration, shall drink clear fluids until 2 h before anesthesia. Solids shall be allowed until 6 h before anesthesia.”

6 Aug, 2021 | 09:59h | UTC

ESPEN practical guideline: Clinical nutrition in surgery – Clinical Nutrition

 

Review: Rational fluid resuscitation in sepsis for the hospitalist.

6 Aug, 2021 | 09:53h | UTC

A Narrative Review Rational Fluid Resuscitation in Sepsis for the Hospitalist: A Narrative Review – Mayo Clinic Proceedings

 

Researchers tell doctors to avoid routine urinary tests for older patients with delirium.

6 Aug, 2021 | 09:01h | UTC

Researchers tell doctors to avoid routine urinary tests for older patients with delirium – Johns Hopkins University School of Medicine

Original article: Things We Do for No Reason™: Obtaining Urine Testing in Older Adults With Delirium Without Signs or Symptoms of Urinary Tract Infection – Journal of Hospital Medicine ($)

 

Commentary on Twitter (thread – click for more)

 

International, multicenter observational study: Outcomes with percutaneous dilatational tracheotomy in high-risk ICU patients.

6 Aug, 2021 | 08:59h | UTC

Percutaneous dilatational tracheotomy in high-risk ICU patients – Annals of Intensive Care

 

Pre-post study: The implementation of a pathway and care bundle for the management of acute occlusive arterial mesenteric ischemia reduced mortality.

6 Aug, 2021 | 08:55h | UTC

The implementation of a pathway and care bundle for the management of acute occlusive arterial mesenteric ischemia reduced mortality – Journal of Trauma and Acute Care Surgery

 

Commentary on Twitter

 

M-A: Effects of early mobilization on the prognosis of critically ill patients.

6 Aug, 2021 | 08:57h | UTC

Effects of early mobilization on the prognosis of critically ill patients: A systematic review and meta-analysis – International Journal of Nursing Studies (link to abstract – $ for full-text)

 

Commentary on Twitter

 

RCT: In noncritically ill patients hospitalized with Covid-19, therapeutic-dose anticoagulation with heparin increased the probability of survival to hospital discharge compared with usual-care thromboprophylaxis.

5 Aug, 2021 | 09:07h | UTC

Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19 – New England Journal of Medicine

Editorial: Surviving Covid-19 with Heparin?

Commentaries:

Full-dose blood thinners reduce the need for organ support in moderately ill COVID-19 patients, but not in critically ill patients – National Institutes of Health

Therapeutic-Dose Heparin in COVID-19: Who Benefits, Who Doesn’t – TCTMD

Canadian-Led International Study: Full-Dose Blood Thinners Benefit Moderately Ill COVID-19 Patients – University of Manitoba

 

Commentary on Twitter

 

RCT: In critically ill patients with Covid-19, therapeutic anticoagulation with heparin did not result in improved outcomes compared to usual-care pharmacologic thromboprophylaxis.

5 Aug, 2021 | 09:04h | UTC

Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19 – New England Journal of Medicine

Editorial: Surviving Covid-19 with Heparin?

Commentaries:

Full-dose blood thinners reduce the need for organ support in moderately ill COVID-19 patients, but not in critically ill patients – National Institutes of Health

Therapeutic-Dose Heparin in COVID-19: Who Benefits, Who Doesn’t – TCTMD

 

Commentary on Twitter

 

RCT: Subcutaneous REGEN-COV antibody combination prevented symptomatic Covid-19 infection in previously uninfected household contacts of infected persons.

5 Aug, 2021 | 09:01h | UTC

Subcutaneous REGEN-COV Antibody Combination to Prevent Covid-19 – New England Journal of Medicine

Related:

RCT: Bamlanivimab plus Etesevimab reduce mortality and hospitalization in ambulatory patients with early Covid-19 (within 3 days of a positive test) who are at risk for clinical deterioration (i.e., older people, obese, diabetics, immunocompromised, with CV disease).

[Preprint] RECOVERY trial finds Regeneron’s monoclonal antibody combination reduces deaths for hospitalized COVID-19 patients who have not mounted their own immune response.

 

Commentary on Twitter

 

Myocarditis and pericarditis after vaccination for COVID-19.

5 Aug, 2021 | 08:57h | UTC

Myocarditis and Pericarditis After Vaccination for COVID-19 – JAMA

Related:

Analysis finds benefits of COVID-19 vaccination outweigh risks of rare cases of myocarditis.

CDC: Use of mRNA COVID-19 vaccine after reports of myocarditis among vaccine recipients – “Continued use of mRNA COVID-19 vaccines in all recommended age groups will prevent morbidity and mortality from COVID-19 that far exceed the number of cases of myocarditis expected”.

Case Series: Myocarditis following immunization with mRNA COVID-19 vaccines.

CDC: mRNA vaccines are likely linked to cases of myocarditis and pericarditis – 1,226 cases of myocarditis or pericarditis have been reported mostly in people under 30.

 

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