ICU Renal Replacement and Long term Morbidity

Renal replacement therapy in ICU may predict increased cardiovascular morbidity in the long term compared to those who did not receive it. This Korean study showed a higher major cardiovascular event rate, mortality and rate of end stage renal disease. Where renal replacement has been used in ICU survivors, increased vigilance is needed long term as well as management of risk factors.



Optic nerve sheath diameter and intracranial pressure

There have been a number of studies on the use of ocular ultrasound measurement of optic nerve sheath diameter to non-invasively diagnose raised intracranial pressure. This meta-analysis shows that while it seems to be reasonable, wide confidence intervals suggest caution in its use. It can be employed as an aid certainly, and to dictate further assessment.



Transfusion Related Acute Lung Injury

Restrictive transfusion is today the norm. Transfusion related acute lung injury (TRALI) is reported as the main cause of transfusion related mortality. This study is reassuring in finding “The incidence of TRALI was estimated to be 1 case per 47,000 units of any blood product or 1 case per 20,000 units of plasma”.

It is felt that the HLA related antibodies in plasma are implicated and increasing use of male plasma may play a role in declining rates of TRALI. Given the latest approach to trauma involves early plasma and platelets, or whole blood, the findings are important, albeit a retrospective and single center study.



Medical News Weekly

For ADHD, methylphenidate in kids and amphetamines in adults  link

Bariatric surgery in diabetes associated with lower overall incidence of microvascular disease (including lower risk for neuropathy, nephropathy, and retinopathy) than usual care link

Induction at 39 weeks may reduce Cesarean rate  link

Sodium intake was associated with cardiovascular disease and strokes only in communities where mean intake was greater than 5 g/day – less restrictive appropriate?  link

Men who reported most frequently wearing boxers had higher sperm concentration and total count! link

Saudi medical trainees ordered home, will impact Canada link

After so much on too little sleep, too much – more than 8 hours – may be worse  link

Aim for healthy diets rather than merely dietary diversity  link

Notifying doctors of their patients’ overdose death reduces opioid prescribing  link


Local vs. general anaesthesia for carotid endarterectomy

A new review may not ultimately settle the debate on general vs. local anesthesia for carotid endarterectomy. Only in analysis of observational studies showed reduced risk of stroke, TIA, MI and mortality. Randomized trial analysis did not show these benefits. LA decreased shunt insertion which may in itself increased embolic stroke.

All in all they conclude “Although randomised studies have not confirmed any advantage for local anaesthesia, this may be due to a lack of pooled statistical power in these trials”. Nonetheless as the gold standard, further randomized studies may be needed to settle the debate to account for confounding and other variables.

Pre-operative Oral Care and Cancer Surgery Outcome

Oral hygiene may be linked to aspiration of oro-pharyngeal secretions and this study concludes that preoperative oral care by a dentist significantly reduced postoperative complications in patients who underwent cancer surgery.They found reduced pneumonia and even mortality rates. Limitations of the study include its retrospective nature and analysis of an administrative claims database. It clearly deserves further study.



Spinal Hip Fracture Surgery and Sedation

A randomized study suggests limiting sedation, at least in those with low comorbidity scores, during hip fracture repair under spinal anesthesia to reduce delirium.  They conclude: “In the primary analysis, limiting the level of sedation provided no significant benefit in reducing incident delirium. However, in a prespecified subgroup analysis, lighter sedation levels benefitted reducing postoperative delirium for persons with a Charlson comorbidity index of 0“.

Whereas benzodiazepines are increasingly out of favour, this study used Propofol for sedation. The current winner for sedation is Dexmedetomidine and needs further study, as does the relationship of comorbidity to delirium, a serious issue linked to outcome and mortality.