Month: January 2019

Immunonutrition for ARDS

Much expert opinion has debated the potential value of immunonutrition in critical illness. This Cochrane review was a meta‐analysis of 10 studies of varying quality examining effects of omega‐3 fatty acids and/or antioxidants in adults with ARDS.

The conclusion showed the intervention may produce little or no difference in all‐cause mortality. The low quality evidence could not lead to conclusion on benefits in terms of oxygenation, ICU or ventilation duration, or other adverse effects.

link

Hydrocortisone and Bronchopulmonary Dysplasia

Concern regarding the longer term effects of Dexamethasone for bronchopulmonary dysplasia in premature infants despite its efficacy in reducing mortality. This has led to Hydrocortisone being used instead.

This randomized trial does not support that practice, showing no difference from placebo. “These findings do not support the practice of initiating hydrocortisone between 7 and 14 days after birth to reduce the risk of the composite outcome of death or bronchopulmonary dysplasia in mechanically ventilated very preterm infants“.

link

Low flow Sevoflurane Pediatric Induction

A study supports reducing fresh gas flow to 1L/min after priming with 8% Sevoflurane for 30secs at 6L/min in pediatric inhalational anesthesia induction.

Despite the tendency to maximize gas flow for a presumably faster induction, it was found that anesthesia induction at low‐fresh gas flow using a circle system significantly reduces sevoflurane consumption, without compromising the quality of induction or increasing induction time.

link

Oliguria and Acute Renal Injury in Pediatric Critical Care

Post hoc analysis of Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology study: it draws attention to the fact that oliguria is as or more important than Creatinine. It concluded: “Nearly one in five critically ill children with acute kidney injury do not experience increase in serum creatinine. These acute kidney injury events, which are only identified by urine output criteria, are associated with comparably poor outcomes as those diagnosed by changes in creatinine. Children meeting both criteria had worse outcomes than those meeting only one”.

link

Antidepressant and Antianxiety Medications and Post-op Length of Stay

Preoperative antidepressants and anti anxiety medications were studied in this administrative database study and linked to increased postoperative hospital length of stay. They conclude that either due to underlying psychiatric disease or medication effects, patients on preoperative antidepressant and antianxiety medication stay in the hospital longer after surgery and may require greater attention to hasten recovery, including preoperative counseling, postoperative psychiatric consults, or holistic recovery approaches.

link

Extubation in Difficult-to-Wean Patients

This systematic review and meta-analysis aimed to identify strategies for extubating patients deemed difficult to wean from mechanical ventilation due to delirium, agitation or anxiety.

The overall quality of the heterogeneous studies was poor, but Dexmedetomidine seems to be associated with a shorter time to extubation and ICU length of stay. The authors conclude that low quality evidence supports the use of Dexmedetomidine in patients deemed difficult-to-wean due to agitation, delirium, or anxiety.

link

Red Cell Transfusion and Storage Duration

Debate has occurred over the years speculating on the benefits of fresher (short storage duration) blood. This Cochrane review included 22 trials across a wide variety of scenarios, e.g. anemia, critical care, general and cardiac surgery, and hematology.

No difference in hospital, ICU, or 30 day mortality was discernible. The conclusion is: “There appears to be no evidence of an effect on mortality that is related to length of storage of transfused RBCs. However, the quality of evidence in neonates and children is low”. Blood bank practice of using the oldest blood first appears appropriate.

link

Medical and Health News Weekly

Looks like urologists are big over-prescribers of antibiotics link

Just when studies had questioned aspirin primary prevention benefits, a new meta-analysis says: in individuals without cardiovascular disease, the use of aspirin was associated with a lower risk of cardiovascular events but an increased risk of major bleeding link

And it’s here, the new Canada Food Guide. It stops short of advocating vegan diets, just about! link

The potential role of pharmaceutical industry marketing in contributing to opioid prescribing and mortality from overdoses merits ongoing examination… link

No spanking, hitting, or slapping to discipline children. The American Academy of Pediatrics says it doesn’t work and may harm link

The ‘gene-editing’ scientist in China is fired link

Johnson & Johnson to pay $120M for falsely advertising and misrepresentation of their metal hip implant’s durability (you’ll remember them for vaginal mesh and asbestos baby powder lawsuits) link

Fried food associated with increased all cause mortality link

Immigrant status was an independent predictor of inadequate prenatal care, coinciding with anti-immigrant rhetoric in US link

New ADA guidelines for Diabetes care in hospital link

There is increased risk of death following application of paclitaxel‐coated balloons and stents in the femoropopliteal artery of the lower limbs. FDA investigating link

Colloid and Crystalloid for Cesarean Spinal

There seems (yet again) little rationale for giving colloids, this time in co-loading fluid for Cesarean Section under spinal anesthesia. This study found that the combination of 500-mL colloid preload and 500-mL crystalloid coload did not reduce the total ephedrine dose or improve other maternal outcomes compared with 1000-mL crystalloid coload, although vena caval diameter changes were noted with ultrasound. Neither were there any significant differences in the incidence of hypotension and severe hypotension, the time to the first ephedrine dose, and neonatal Apgar scores at 1 and 5 minutes.

link