Hemicraniectomy should be the Destiny2 for patients with malignant MCA infarct

  • April 28, 2014

Destiny IIHemicran was stopped early because of the huge benefit of hemicraniectomy for ‘malignant’ MCA (NIHSS score >14) so long as they were good before-hand (Modified Rankin <2)!

Another reason not to top up Hb

  • April 28, 2014

bloodWith an NNT of 38,  this meta-analysis won’t be the whole reason not to transfuse just yet, but it adds weight to the low target strategists’ opinion.

More ICM feeding mythology

  • April 28, 2014

Master debunker Paul Marik fires some shots at nutrition traditions in the ICU. Interesting set against the Singer/Doig opinion from February.

Predicting neurological outcome post arrest and TTM

  • April 15, 2014

3-brain-of-a-cardiac-arrest-victim-medical-body-scansA meta-analysis of predicting outcome after arrest. The eyes still have it prior to 72hr. SSEP and status myoclonus remain strong indicators.

SODD or SDD but don’t just clean

  • April 12, 2014

oral swabs

Could oropharyngeal chlorhexidine alone be useless, or even harmful? SuDICCU are back with this meta-analysis, and Klompas is back with that meta-analysis. Does benefit depend on your local resistant bugs etc? Or whether you’re post cardiac surgery. Are these just hypothesis-generating or will you change your care bundle?

Not persuaded yet? Thrombolysis for intermediate PE

  • April 12, 2014

PE

We’ve seen before that thrombolysis for intermediate PE (‘sub-massive’ with struggling right heart) doesn’t seem to save lives in the short term. PEITHO confirms that but there’s no long term data (cf MOPETT).

Dry lungs get less VAP

  • March 29, 2014

VAPUsing a ‘depletive’ strategy reduces VAP incidence says a study using data from a previous trial on the benefit of BNP in weaning.

3 sepsis papers at once

  • March 19, 2014

sepsis hand

1. First of the 3 attempts to confirm goal-directed therapy benefit, PROCESS, has arrived and shows no benefit of a protocolised approach ‘v’ usual care. Look carefully at the details, particularly at the protocol changes.

2. MAP targeting in septic shock. 65-70 or 80-85 mmHg? No mortality difference in 776 patients but less kidney injury in the higher group,in SEPSISPAM.

3. Albumin as part of fluid resuscitation in sepsis and septic shock patients lead to no outcome difference in ALBIOS. But maybe save it just for septic shock.