New and fun stuff!
DETO2X–SWEDEHEART Trial
This is a big deal. "supplemental oxygen offers no benefit in patients with acute myocardial infarction who have normal oxygen saturation." Time to take away the O from MONA for ACS if the patient doesn't need it.
Quality sleep using earplugs in the intensive care unit: the QUIET pilot randomised controlled trial
You heard it here first, in a couple years we're likely going to be putting earplug in our patients overnight to improve sleep and reduce delirium. This is a pilot/feasibility study. No important data comes from those but it sets up a much bigger trial. Just be aware it exists. Only read if you're really curious.
Continuous versus intermittent neuromuscular blockade in patients during targeted temperature management after resuscitation from cardiac arrest—A randomized, double blinded, double dummy, clinical trial
Now there's data suggesting using continuous drips for paralytics in cardiac arrest pts versus bolus doses.
Enteral nutrition as stress ulcer prophylaxis in critically ill patients: A randomized controlled exploratory study
This study looked to see if early feeding was good enough to prevent GI bleeds in critically ill pts. They had no difference in the two groups of pts but they only enrolled 104 pts. Not enough to change my practice. Next!
Effects of intraoperative and early postoperative normal saline or Plasma-Lyte 148® on hyperkalaemia in deceased donor renal transplantation: a double-blind randomized trial
"Compared with PL, participants receiving NS had a greater incidence of hyperkalaemia and hyperchloraemia and were more acidaemic". I'll just keep dumping the evidence to use plasma-lyte until we finally get it.
Protein delivery and clinical outcomes in the critically ill: a systematic review and meta-analysis
My inherent bias wants there to be a mortality benefit to giving protein via the gut but the data just isn't there..... for now....
Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: a Cochrane Systematic Review
Bottom line: if the RT places the glidescope next to the bed immediately, use it. The first couple days I fought to use DL but I've conceded. VL is just so much easier. This Cochran review reflects that.
Central venous catheter placement in coagulopathic patients: risk factors and incidence of bleeding complication
Platelets of 50? INR of 1.5? PTT of 45? Who cares! Drop that line. Platelets less than 20 and INR > 3, think about it.
The ADRENAL Trial (coming soon... next couple years!)
Statistical analysis plan for the Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock (ADRENAL) trial You all don't need to read this one, but it's really exciting to know that someone is finally going to put the stress dose steroid question to bed as to whether we should or shouldn't do it! Stay tuned!
REFRESH Trial
While we're on the subject of other things that may be complete BS, they've just started a study where they're challenging the 30cc/kg boluses that everyone gets in the ED when they're sick.
I am in the school of thought that every bit of fluid we give a patient needs to be justified and not arbitrary. As it could be life or death in the article right under this....
The Right Ventricle in ARDS
This one is very important and one of my soapbox topics. Please read. I sent you another article on the same topic last week but it goes to show how important all this is, especially with flu season around the corner again. Not to mention, it's quite sexy.
Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice
How to place a central line. This is probably the most important article for those of you who need some experience placing lines. A free full article!
-EJ
Although great care has been taken to ensure that the information in this post is accurate, eddyjoemd, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
DETO2X–SWEDEHEART Trial
This is a big deal. "supplemental oxygen offers no benefit in patients with acute myocardial infarction who have normal oxygen saturation." Time to take away the O from MONA for ACS if the patient doesn't need it.
Quality sleep using earplugs in the intensive care unit: the QUIET pilot randomised controlled trial
You heard it here first, in a couple years we're likely going to be putting earplug in our patients overnight to improve sleep and reduce delirium. This is a pilot/feasibility study. No important data comes from those but it sets up a much bigger trial. Just be aware it exists. Only read if you're really curious.
Continuous versus intermittent neuromuscular blockade in patients during targeted temperature management after resuscitation from cardiac arrest—A randomized, double blinded, double dummy, clinical trial
Now there's data suggesting using continuous drips for paralytics in cardiac arrest pts versus bolus doses.
Enteral nutrition as stress ulcer prophylaxis in critically ill patients: A randomized controlled exploratory study
This study looked to see if early feeding was good enough to prevent GI bleeds in critically ill pts. They had no difference in the two groups of pts but they only enrolled 104 pts. Not enough to change my practice. Next!
Effects of intraoperative and early postoperative normal saline or Plasma-Lyte 148® on hyperkalaemia in deceased donor renal transplantation: a double-blind randomized trial
"Compared with PL, participants receiving NS had a greater incidence of hyperkalaemia and hyperchloraemia and were more acidaemic". I'll just keep dumping the evidence to use plasma-lyte until we finally get it.
Protein delivery and clinical outcomes in the critically ill: a systematic review and meta-analysis
My inherent bias wants there to be a mortality benefit to giving protein via the gut but the data just isn't there..... for now....
Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: a Cochrane Systematic Review
Bottom line: if the RT places the glidescope next to the bed immediately, use it. The first couple days I fought to use DL but I've conceded. VL is just so much easier. This Cochran review reflects that.
Central venous catheter placement in coagulopathic patients: risk factors and incidence of bleeding complication
Platelets of 50? INR of 1.5? PTT of 45? Who cares! Drop that line. Platelets less than 20 and INR > 3, think about it.
The ADRENAL Trial (coming soon... next couple years!)
Statistical analysis plan for the Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock (ADRENAL) trial You all don't need to read this one, but it's really exciting to know that someone is finally going to put the stress dose steroid question to bed as to whether we should or shouldn't do it! Stay tuned!
REFRESH Trial
While we're on the subject of other things that may be complete BS, they've just started a study where they're challenging the 30cc/kg boluses that everyone gets in the ED when they're sick.
I am in the school of thought that every bit of fluid we give a patient needs to be justified and not arbitrary. As it could be life or death in the article right under this....
The Right Ventricle in ARDS
This one is very important and one of my soapbox topics. Please read. I sent you another article on the same topic last week but it goes to show how important all this is, especially with flu season around the corner again. Not to mention, it's quite sexy.
Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice
How to place a central line. This is probably the most important article for those of you who need some experience placing lines. A free full article!
-EJ
Although great care has been taken to ensure that the information in this post is accurate, eddyjoemd, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
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