Hyperchloremia and Pediatric Septic Shock Mortality

Albeit an observational study, and the link to fluid type administration not proven to be causal, a pediatric study associates hyperchloremia >110mmol/l to increased mortality and complicated courses in septic shock. It joins an increasing adult literature on the potential harmful effects of hyperchloremia on renal function, immune function, coagulation and cardiac contractility. ‘Normal’ saline 0.9% may be a poor choice for resuscitation or Critical Care with the posssible exception of brain injury, and increasingly suggestions occur to use Lactated Ringer’s or to replace Chloride with Acetate.   link

 

Incentive Spirometry

Despite the still very omnipresent blue incentive spirometer especially after abdominal or thoracic surgery, there is just about no evidence that supports it. Structured deep breathing as well as prehabilitation inspiratory muscle strength training, aerobic and resistance training are more important.

The Choosing Wisely item no. 4 provides Cochrane references in this link

 

Cognitive/ Memory Decline after Surgery / Anesthesia

A headline grabbing study in Anaesthesia suggests middle age memory decline after surgery and anesthesia. The effect was small and says anesthesia and surgery. As always it is unclear how much baseline condition was a marker for decline in this observational study but it joins the growing literature in adults and infants/children (link) on the potential link between anesthesia/surgery and the entire spectrum of delirium/post-op cognitive dysfunction/cognitive decline and even dementia.  link

 

ARDS Chest X-Ray Diagnosis

“The ability of clinicians from various backgrounds and years of experience to correctly identify ARDS according to CXRs is extremely poor, bringing the current ARDS definition into question. An educational intervention did not improve this. Better diagnostic tools for ARDS need to be developed, which may include biomarkers, ultrasound or CT imaging”.

Lke ASA physical status, something subjective is prone to variability and/or error.

Dr. Ferguson’s slide illustrates concisely the 2012 Berlin ARDS definition:

Acute Coronary Syndrome in Non-Cardiac Surgery

This study confirms our feeling that demand ischemia is the predominant etiology after noncardiac surgery rather than thrombotic obstruction or plaque rupture. So our focus should be to ensure prompt treatment of low MAP and volume status to maintain coronary perfusion, adequate oxygenation and anemia correction, sufficient analgesia and perhaps B-Blockers. (An interesting finding was a sizeable “stress-induced Takotsubo cardiomyopathy” incidence).  link

 

Weekly General Medical News

School intervention trial failed to curb childhood obesity. Doing all the right things but the problem goes deeper than schools alone  link bmj

Women with AFib have more symptoms, lower quality of life and higher stroke risk but lower overall and cardiovascular death risk  link

Netherlands to introduce presumed consent for organ donation in 2020 unless people opt out ink

Adolescent cannabis (and to a lesser degree, tobacco) use increase subsequent psychotic episodes  link

Curb your enthusiasm for Vitamin D mass screening and treatment for unproven indications link

New initiation of LABA or LAMAs in COPD increases severe cardiovascular risk  link

PE rule out criteria accurate for diagnosis – that is in extremely low risk patients  link

No benefit reported from Hydroxychloroquine in hand osteoarthritis  link

Measles immunization rates a concern as cases on the rise  link

Tdap and Influenza vaccines safe during pregnancy  link

Tooth decay is the most common chronic disease in US children  link

Managing cases of Tidepod ingestion  link

Canadian resident matching leaves many unmatched  link

Very preterm infants’ (<32 weeks) intelligence deficits largely associated with bronchopulmonary dysplasia have not improved   link

Alcohol use disorders a major risk factor for onset of all types of dementia, and especially early-onset dementia link

Low fat or low carb diets for weight loss no difference link

After 5 days Rivaroxaban in hip or knee arthroplasty, subsequent aspirin for 9(knee) or 30(hip)days was equivalent to continued Rivaroxaban for thromboembolism prevention  link

Carotid plaque volume correlated with symptoms of cerebral ischaemia, but not carotid stenosis. It could be a potential indicator for CEA. Plaque volume means more embolic potential  link

Oral contraceptives protect women against ovarian and endometrial cancer without raising risk for breast cancer.  link

Cranial electrical stimulation (not to be confused with transcranial magnetic stimulation) for various conditions not backed up by good quality evidence  link

WHO new guidelines on intrapartum care WHO   Or a quick summary here

Yes antidepressants do work  link

FDA warns of cardiac patient risks wth Clarithromycin (Biaxin)  fda

CABG has  mortality benefit over PCI only in multivessel or complex disease, especially in diabetes, and not in left main disease.  link

PPIs not linked to dementia link