Top Hot Critical Care Trials, Papers & Guidelines!
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 / paper / guideline to read more!
Comparison of Two Different Recruitment Maneuver Patterns in ARDS Patients
RCT comparing the effects of these two RMs on respiratory mechanics (gas exchange, electrical impedance tomography (EIT), derived lung volumes), in mechanically ventilated ARDS patients.
On-Scene Selective Brain Cooling in Ventricular Fibrillation Cardiac Arrest: Pilot Results from PRINCESS2
Pilot phase Trial to confirm previous findings; does on-scene selective brain cooling using a portable trans-nasal cooling method improve complete neurological recovery after out-of-hospital cardiac arrest (OHCA) with initial shockable rhythms (e.g. ventricular fibrillation).
Proportional Assist Ventilation vs Pressure Support Ventilation for Weaning from Mechanical Ventilation
A meta-analysis to compare the efficacy of PAV/PAVโ+โand PSV in adult patients who were weaning from invasive ventilation
Ultrafiltration in the Critically Ill Patient: A Framework for Personalized Careย
This review examines personalised ultrafiltration strategies for fluid overload in the ICU. It balances net ultrafiltration goals with hemodynamics. Additionally, it considers organ support.
Microcirculation in Anaesthesia: What Every Anaesthesiologist Should Know?
Key microcirculatory principles in peri-op and critical care anaesthesia – monitoring and interventions.
Albumin Replacement Therapy in Septic Shock; A Randomized Clinical Trial
Multi-center RCT in adults with septic shock. Can the reported potential mortality reduction by albumin replacement in be confirmed in a randomized clinical trial? Patients received albumin replacement to maintain serum albumin concentrations greater than 3.0 g/dL, or had standard fluid therapy. What happened to 90 day mortality?
Incidence and Predictors of Acute Respiratory Distress Syndrome in Sepsis
ย
Acute respiratory distress syndrome (ARDS) frequently complicates sepsis. It carries a high risk of morbidity and mortality. Despite extensive research on ARDS in patients with sepsis, the reported incidence and associated risk factors remain inconsistent. Findings vary considerably across clinical settings. This mate analysis aimed to systematically evaluate the pooled proportion (cumulative incidence) of ARDS among adult patients with sepsis. Additionally, it aimed to identify independent risk factors associated with its development.
Comparison of Esmolol Versus Landiolol on Mortality in Adult Patients With Sepsis
Systematic review/network meta-analysis: The clinical efficacy of short-acting ฮฒ-blockers in the management of sepsis remains uncertain. This is particularly true for esmolol and Landiolol. This study aimed to systematically evaluate the effects of these beta blockers, and standard of care. It compares their impact on mortality in patients with sepsis.
Electrical Impedance Tomography to Monitor Hypoxemic Respiratory Failure
This review provides an overview of the potential role of Electrical Impedance Technology (EIT) in monitoring patients with acute respiratory failure. Future perspectives for use in intensive care are also addressed.
A Potential Bundle for Preventing Ventilator-Associated Pneumonia in the Emergency Department
In this narrative review, a synthesis of the current evidence on ventilator-associated pneumonia prevention is presented. They assess the feasibility of care bundles in resource-constrained emergency department settings. The strategy includes position, hand hygiene, airway, sedation, and equipment. It is a structured, multicomponent approach for ventilator-associated pneumonia prevention in emergency departments with limited resources. This is supported by enabling strategies such as electronic checklists.
Hyperoxaemia in Acute Brain Injured Patients: Too Much of a Good Thing?
Another paper examining the effects of hyperoxia….now in the brain.
Peri-intubation Cardiovascular Collapse During Emergency Airway Managementย
Review article: Mechanisms, prediction, and mitigation of peri-intubation instability
The Challenge of Staying Up-to-Date in Critical Care
Our good friend Rob MacSweeny talks about how we assimilate the tranches of data/papers/reviews etc to try to stay current!
Careful Ventilation in Acute Respiratory Distress Syndrome: The Protocol of the CAVIARDS Trialย
Protocol: multicentre basket RCT examining ventilator settings through the bedside assessment of various parameters. The goal; potential ARDS prevention strategy.
HostโMicrobiome Interaction in the Intensive Care Unitย
This review presents current evidence on the alterations of the gut microbiota in critically ill patients. It explores the systemic consequences of dysbiosis. It also evaluates the impact of nutritional and microbiota-targeted therapies in improving patient outcomes.
Antibiotic Therapy for Severe Bacterial Infections
Nice summary of the available evidence, emerging options, and unresolved controversies in optimising antibiotic therapy in severe infections.
Critical Care Management of the Patient with Pharmaceutical Poisoning
This state-of-the-art review provides a practical, evidence-based guide to manage pharmaceutical poisoning in the intensive care unit. It emphasises real-world applicability for intensivists.ย
Managing De-Escalation of Acute Renal Replacement Therapy and Optimizing Drug Dosing during Renal Replacement Therapy Transitions
This review focuses on the critical factors to consider during de-escalation of RRT care. It emphasizes modality transition and the role of volume status in guiding the approach to de-escalation of RRT. Also, there’s a focus on drug dosing whilst on RRT.
Expert Recommendations for Setting and Adjusting Airway Pressure Release Ventilation
Fantastic protocol for adjusting the four APRV settings based on expert experience and solid clinical and scientific evidence for patients with ALI and ARDS, or disorders of normal or increased elastance. Optimizing the lung-protective settings in APRV may improve outcomes.
Stay tuned for Episode 4!
JW and Team x
