Top Hot Critical Care Trials, Papers and Shouts!
Here is edition 3 of the hottest critical care trials and papers. These papers are generating buzz across sites like Critical Care Reviews, EMCrit/PulmCrit, and REBEL EM. You can also find discussions on LITFL, The Bottom Line, and others.
There are many fantastic sites. They are run by some very dedicated people who are constantly curating information. This effort makes all of this noise listenable! You know who you are…….thank you!
Jump Links!
Click the buttons, then the pics for the trial to read more!
Minocycline in Acute Ischaemic Stroke (EMPHASIS)
Minocycline is reported as a multi-target anti-neuroinflammatory drug. It has potential benefits for ischaemic stroke in preclinical models. Small-scale clinical studies support these findings. The EMPHASIS trial was designed to provide robust evidence regarding its efficacy and safety in patients with acute ischaemic stroke.
Recombinant Factor VIIa vs Placebo in Spontaneous ICH (FASTEST)
Recombinant factor VIIa has been shown to slow bleeding in patients with intracerebral haemorrhage (ICH). However, no haemostatic agent has demonstrated an improvement in clinical outcomes. They aimed to evaluate the safety and clinical efficacy of recombinant factor VIIa. Additionally, they assessed its effect on the growth of ICH and intraventricular haemorrhage (IVH). This was done for patients with acute spontaneous ICH who were most likely to benefit from treatment with this agent.
Tenecteplase for Non-LVO Ischaemic Stroke 4.5-24h (OPTION)
RCT. Does intravenous tenecteplase administered 5 to 24 hours after onset improve clinical outcomes? Is it effective among patients with non–large vessel occlusion acute ischemic stroke and salvageable brain tissue?
Individualized Flow-Controlled vs Pressure-Controlled Ventilation in Cardiac Surgery
RCT. Patients undergoing on-pump cardiac surgery are at risk of lung injury. The team formed a hypothesis. They investigated whether flow-controlled ventilation (FCV) reduces the inflammatory stimulus. This was compared to conventional pressure-controlled ventilation (PCV) in this patient cohort. They used IL-8 as the indicator.
Nitric Oxide to Reduce AKI in Endothelial Dysfunction During Prolonged CPB
RCT: Prolonged cardiopulmonary bypass (CPB) causes hemolysis. This reduces nitric oxide availability and increases the risk of acute kidney injury (AKI) after cardiac surgery. Previous studies suggest inhaled nitric oxide may reduce AKI in certain populations. However, its effect in patients with preexisting endothelial dysfunction is unknown. This condition is marked by impaired nitric oxide production. This trial investigates whether perioperative nitric oxide administration reduces AKI in patients with preexisting endothelial dysfunction undergoing prolonged CPB.
Endovascular vs Medical Treatment of Basilar Artery Occlusion: 3-Year Outcomes (ATTENTION)
Long-term follow-up RCT: Does endovascular thrombectomy provide sustained clinical benefit at 3 years? Is it more effective compared with best medical management alone in patients with acute basilar artery occlusion?
Device-Assisted vs Standard Valsalva for Supraventricular Tachycardia
Can a Valsalva assist device achieve greater rates of sinus rhythm restoration during SVT, than a standard Valsalva? .
Prognostic Factors Associated with Mortality in Septic Shock
Septic shock is associated with high mortality rates ranging from 30% to 50%. In this systematic review and meta-analysis, prognostic factors associated with early mortality in septic shock were flagged.
Conservative Oxygen Targets in Mechanically Ventilated Patients (OXY-BREATHES)
A meta analysis evaluating the efficacy and safety of conservative oxygen levels (Spo2 88-94% or Pao2 < 80 mm Hg) Vs liberal oxygen targets. (Spo2 ≥ 94% or Pao2 ≥ 90 mm Hg), in mechanically ventilated critically ill adults.
Hypophosphatemia as Biomarker in PICU Enhanced Nutrition (PEPaNIC Secondary)
The PEPaNIC RCT showed that early supplementation of insufficient enteral nutrition by parenteral nutrition (early-PN) worsened outcomes in critically ill children. In adults, declining phosphate levels may identify patients who are particularly harmed by early-PN. This secondary branch to the study aimed to ascertain the effect of early hypophosphataemia on metabolic intolerance to nutrition?
Survival effect of prehospital emergency anaesthesia with intubation in risk-stratified patients with major trauma: a causal modelling study
Trauma is among the top 10 most common causes of disability worldwide. It accounts for more than 100 million disability-adjusted life-years (DALYs) per year. The value of prompt management in severe injury is undisputed. However, the benefit of prehospital emergency anaesthesia with intubation remains uncertain. Using a machine learning model, the team aimed to estimate the causal effect of prehospital intubation on survival.
Cerebral blood flow estimation using NIRS in cardiac arrest patients: correlation with ROSC outcomes
Elevated mean arterial pressure (MAP) would be expected to enhance cerebral blood flow (CBF) during cardiopulmonary resuscitation (CPR). However, direct clinical data remain limited. This study examined how CBF responds to varying MAP levels during CPR in OHCA patients, utilising near infrared spectrometry (NIRS)
Efficacy and Safety of IV Antiplatelet in AMI with Cardiogenic Shock
The aim of this study was to evaluate the effectiveness and safety of IV antiplatelet therapy in patients with AMI-CS.
Outcomes of Severe Mpox in ICU (NYC 2022-2024)
This series from NYC, informs informs on the clinical management of mpox in intensive care settings, its demographics, clinical features, and outcomes
Recommendations for Post-ECMO Resuscitation Care
Modified Delphi: The global adoption of extracorporeal cardiopulmonary resuscitation (ECPR) for cardiac arrest is accelerating. But what are the best practices in post‐ECPR resuscitation management. This study aimed to identify key knowledge gaps and develop consensus‐based recommendations to inform clinical decision‐making in the post‐ECPR setting
Peri-operative Fasting in Adults: Multidisciplinary Consensus
International consensus: Updated evidence-based fasting guidelines for adults. Link: Anaesthesia
Strategies for Rational Use of Opioids in Critical Care
Review: this narrative review aims to evaluate the clinical impact of opioid use in critically ill patients. It includes post-ICU outcomes. The review also explores the role of opioid stewardship in optimizing patient care.
Frailty Assessment in Perioperative Geriatric Patients
Narrative review: This review offers a comprehensive overview of frailty in geriatric patients. It highlights its definition, pathophysiology, assessment methods, and clinical impact.
Bedside Pulmonary Embolism Detection via Electrical Impedance Tomography
Review: This review aims to provide clinicians and researchers with a reference. It facilitates broader adoption of electrical Impedance technology (EIT) in the bedside monitoring of PE.
Non-invasive ICP Monitoring in Acute Brain Injury When Invasive Available
This article proposes the extension of the B-ICONIC algorithm to a wider population. This applies regardless of the decision to insert an ICP sensor. The aim is to guide their management using this multimodal approach. B-ICONIC involves repeated neurological evaluation and neuroimaging. It uses non-invasive ICP monitoring tools, such as transcranial Doppler, automated pupillometry, and ultrasound optic nerve sheath diameter measurement. These tools help to titrate interventions aimed at controlling ICP.
Stay tuned for Episode 3!
JW and Team x
