Top 2017 Critical Care Trials

If you’ve spent the entire year viewing CNN’s coverage of Trump, here’s a quick catch up of the year in Critical Care.

The main points:

Restrictive blood transfusion still rules. Fresh blood is no better. Antibiotics are time critical in sepsis.

No oxygen for MIs – unless hypoxic. Routine recruitment maneuvers in ARDS not indicated.

Acetylcysteine and bicarbonate for contrast angiography in high renal risk not helpful.

ICU routine admission for over 75 year old not always necessary.

Individual systolic BP targeting with Norepinephrine reduces organ dysfunction.

Angiotensin II may be next therapy for vasodilatory shock.

You’re welcome. Now back to CNN! Or read the summaries and links at thebottomline.org

ICU Intubation

Unfamiliar environments, inadequate equipment and protocol deviation all contribute to a higher risk in airway management outside the OR.  The full range of support devices, like supraglottic  airways, videolaryngoscopy and cricothyrotomy devices must be available as in the OR. And dark X-ray departments are even scarier!

Of interest they note the use of nasal cannula oxygen under your pre-oxygenation mask increased to 15l/min during intubation attempts as shown effective in other recent studies. And the continuing debate on the effectiveness of cricoid pressure, releasing if it impedes the procedure

Guidelines BJA

Excessive Fluids Ups Mortality

Yet another article on the dangers of the past practice of excessive fluids in abdominal surgery to fill the imaginary and dated concept of “third space”. How to tailor this and avoid hypovolemia remains to be optimized but some ideas include pulse (or systolic) pressure variation or inferior vena cava diameter variation with respiration.

Duke study

Maybe colloids are fighting back

Colloid less complications

Colloids and Renal outcome

But however, a more draconian advisory from Europe on “banning” hydroxyethyl starches that may not apply to those not critically ill  EMA statement

 

 

Renal Injury

Anaesthesia Journal on the renal complications of anesthesia. Risk factors include  acute surgery, sepsis, age, anemia, diabetes, hypertension, vascular disease, cardiac failure, hepatic disease, pre-existing renal disease, trauma, abdominal hypertension, nephrotoxic drugs.

Small increases in Creatinine can have dramatic impacts on mortality.

A review of risk and management strategies

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