Complicated intra-abdominal infection is a common case on the units admitting general surgical patients. By definition it is infection that extends beyond the viscus of origin into the peritoneal space, and is associated with abscess or peritonitis. The traditional management approach has been to do the source control and then soak in antibiotics until signs …
Another addition to this year’s flurry of nutrition work. Tradition has us bypassing the stomach and duodenum for nutrition in pancreatitis – intuitively sensible. To challenge this the Dutch PYTHON trial group has recently published its findings. Multicentredly, they randomized 200-ish patients with acute ‘high-risk’ pancreatitis (defined as mGlasgow of >/= 3, CRP >150, APACHE >/=8) …
In this recent re-look at patients from a previous seminal study, a ‘nested’ cohort from the RENAL study with RIFLE ‘I’ acute kidney injury (GFR<50%, creatinine rise to twice baseline, UOP <0.5ml/kg for 12hr).were selected. The APACHE III score for those supported late was significantly lower suggesting there may have been something different (a covariate, so not …
SSC international data from more than 28,000 patients with severe sepsis or septic shock emphasises early source control is paramount (closely followed by BP management). Get antibiotics in within 1 hour (2 at the very most) – the clock is ticking! Here, this was timed from the moment of triage or, on the wards, the …
Tracman said no, but others have shown benefit. Siempos’ meta-analysis of 13 trials suggests thinking again. Depending on which statistical model you use, it appears that early tracheostomy may reduce 30 day mortality, particularly, or exclusively in patients with high baseline risk of death. Less pneumonia and, unsurprisingly, shorter ICU stay is also suggested. However longer …
Proning in ICU is 40 years old now. Meta-analyse 11 high-quality studies in a thorough manner (including blinding to authors!) and it appears strikingly good, with an NNT of 11 – definitely better than protective ventilation alone. Do it in the severely hypoxic (P/F <100 mmHg), do it early (within 72 hours), do it for …
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