New summary: TRICOP, Liberal Versus Restrictive Transfusion Strategy in Critically Ill Oncological Patients: The Transfusion Requirements in Critically Ill Oncologic Patients Randomized Controlled Trial

Clinical Question In cancer patients with septic shock does a restrictive vs. a liberal transfusion threshold reduce 28 day mortality? Background A number of papers have investigated what transfusion threshold we should use in critically ill patients. The TRICC study included critically ill patients with acute anaemia, and the TRISS study included patients with septic shock.... Continue Reading →

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Study summary: Empirical Micafungin Treatment and Survival Without Invasive Fungal Infection in Adults With ICU-Acquired Sepsis, Candida Colonization, and Multiple Organ Failure

Timsit J-F. JAMA 2016; 316(5): 1555-1564. Clinical Question In critically ill patients with non-neutropenic sepsis, multiple Candida colonisation and multi organ failure, does empirical micafungin therapy increase invasive fungal infection-free survival at day 28 compared with placebo? Authors’ Conclusions Among non-neutropenic critically ill patients with ICU acquired sepsis, Candida species colonisation at multiple sites, and multiple... Continue Reading →

Podcast: Don’t DSI…Rapid Sequence Airway (RSA)!

Rapid Sequence Airway (RSA) involves the same preparation and pharmacology as RSI with the immediate planned placement of an extraglottic device (EGD) instead of intubation. Like DSI, RSA is an alternative airway management strategy that may be ideal for preoxygenation of hypoxemic patients as well for prehospital and in-flight use. Depending on the chosen EGD,... Continue Reading →

Newsletter: Critical Care Reviews

"It's been a great week for critical care publications, with Gonzalo Hernandez's latest HFNO trial released, as well as other RCTs on stress ulcer prophylaxis, inhaled nitric oxide to treat acute pulmonary embolism and an educational intervention for anti-infectious measures. There are also excellent observational studies on bystander efforts in out-of-hospital cardiac arrest, emergency transfusion... Continue Reading →

New Cochrane Systematic Review: Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation of non-asphyxial out-of-hospital cardiac arrest

Key results: "When CPR was performed by bystanders, we found that more people survived until discharge from hospital after chest compression alone than they did following interrupted chest compression with pauses at a fixed ratio for rescue breathing (15 compressions to 2 breaths) (14% versus 11.6%). For the outcomes of survival to hospital admission and... Continue Reading →

Dynamed summary: Group A streptococcus

Background Group A Streptococcus (GAS) is a major human pathogen associated with a broad spectrum of clinical illnesses including: acute infections such as: pharyngitis skin and soft tissue infections, such as impetigo, cellulitis, and erysipelas severe systemic infections, such as toxic shock syndrome nonsuppurative complications such as: acute rheumatic fever poststreptococcal glomerulonephritis More than 200... Continue Reading →

New summary: The WOMAN Trial (World Maternal Antifibrinolytic Trial): tranexamic acid for the treatment of postpartum haemorrhage: an international randomised, double blind placebo controlled trial

Does the early administration of tranexamic acid (TXA), compared with placebo, reduce death from bleeding in women with post-partum haemorrhage (PPH)? Tranexamic acid may be beneficial in reducing the risk of death due to post-partum haemorrhage. The study has some significant methodological limitations, including a change in power calculation and hypothesis after it was commenced,... Continue Reading →

The Bottom Line: Video Laryngoscopy vs Direct Laryngoscopy on Successful First-Pass Orotracheal Intubation Among ICU patients

In this trial comparing the McGrath VL and the Macintosh DL in intubating intensive care patients, there was no difference seen in the primary outcome of first pass success rate.  An association was seen with improved glottic view, and with a worsening of severe complications – however these are secondary outcomes that the study is... Continue Reading →

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