Talk of the town

Recent guideline summary

European guidelines on perioperative venous thromboembolism prophylaxis: Intensive care (November 2017)

Recommendations for critically ill patients (minor abridgements):
  • don’t routinely use of compression DUS (Duplex ultrasound) screening of DVT (Grade 1B).
  • do use a protocol for the prevention of VTE that includes the use of mechanical Thromboprophylaxis (IPC) (1B).
  • do use thromboprophylaxis with LMWH or LDUH (1B) and (recommend LMWH over LDUH) (1B).
  • in severe renal insufficiency, use LDUH (2C), dalteparin (2B) or reduced-dose enoxaparin (2C). Consider monitoring anti-Xa activity (2C).
  • pharmacological prophylaxis in patients with severe liver dysfunction needs balancing against bleeding risk. If administered, use LDUH or LMWH (2C).
  • do use prophylaxis or the use of IPC in patients with a platelet count less than 50 000mm3 and a high risk of bleeding (2C).
  • don’t routinely use IVC filters (IVCFs) for the primary prevention of VTE (1C).
  • consider IVCF in patients who can neither receive pharmacological prophylaxis nor IPC (2C).
  • in suspected or confirmed diagnosis of heparin-induced thrombocytopenia (HIT),
    1. discontinue all forms of heparin (1B).
    2. use immediate anticoagulation with a non-heparin anticoagulant unless there is a strong contraindication to anticoagulation (1C).
  • selection of non-heparin anticoagulants should be based on patient characteristics:
    • argatroban is the first choice in patients with renal insufficiency
    • bivalirudin in patients undergoing or after cardiac surgery (2C)
    • fondaparinux can also be considered (2C).

Recent ICM trials/studies – updated 17/9/17

  1. Severity of Hypoxemia and Effect of High-Frequency Oscillatory Ventilation in Acute Respiratory Distress Syndrome. (Sept)
  2. The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. (August)

  3. The impact of disability in survivors of critical illness. (August)
  4. Targeted Temperature Management for 48 vs 24 Hours and Neurologic Outcome After Out-of-Hospital Cardiac Arrest – An RCT (July)

  5. Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. (June) and the BottomLine summary
  6. The Septic Shock 3.0 Definition and Trials: A Vasopressin and Septic Shock Trial Experience. ((June)
  7. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock. (September)
  8. Early, Goal-Directed Therapy for Septic Shock — A Patient-Level Meta-Analysis. (June)
  9. Discriminative Accuracy of Physician and Nurse Predictions for Survival and Functional Outcomes 6 Months After an ICU Admission (June)
  10. Angiotensin II for the Treatment of Vasodilatory Shock. (August)
  11. Favorable Neurocognitive Outcome with Low Tidal Volume Ventilation after Cardiac Arrest. (May)
  12. Association Between US Norepinephrine Shortage and Mortality Among Patients With Septic Shock. (April)
  13. Sodium Bicarbonate Versus Sodium Chloride for Preventing Contrast-Associated Acute Kidney Injury in Critically Ill Patients:an RCT (April)
  14. Effect of Dexmedetomidine on Mortality and Ventilator-Free Days in Patients Requiring Mechanical Ventilation With Sepsis: An RCT. (Apirl)

Recent FOAMcc selection – updated 17/9/17

Recent guidelines

Updated 31/12/17

Severe traumatic brain injury reguidelined

Guidelines for the management of severe traumatic brain injury Brain trauma foundation: 4th edition, 2016   This is a brief summary and some of the wording is changed for brevity, hopefully without too much loss of accuracy. Although not explicitly stated on the guidelines, ‘Severe brain injury’ is generally defined as a brain injury resulting …

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Sepsis 3: rise of the SOFA

Sepsis remains a syndrome without a validated criterion or standard diagnostic test but increasingly comprehensive data sets are making it easier to test validity of  potential criteria. The current instalment of this work in progress has refined the definition of sepsis in light of recent analyses and opinion. Sepsis is life-threatening organ dysfunction caused by a dysregulated …

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