Evidence | CritKit

CritKit Notes:

20 mg methylprednisolone 12 h before extubation and every 4 h until tube removal.

TheBottomLine:

Author Conclusion:

Methylprednisolone started 12 h before a planned extubation substantially reduced the incidence of postextubation laryngeal oedema and reintubation. Such pretreatment should be considered in adult patients before a planned extubation that follows a tracheal intubation of more than 36 h.

Lancet 2007

12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema: a randomised double-blind trial

European Society of Cardiology (ESC) 2016

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

CritKit Notes:

TheBottomLine:

Author Conclusion:

Society of Critical Care Medicine (SCCM) 2024

2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia

CritKit Notes:

RPA & St Vincent's in Sydney. Follow up to CHEER study. Observational.

TheBottomLine:

Author Conclusion:

ECMO for refractory cardiac arrest shows promising survival rates if protocolised care is applied in conjunction with predefined selection criteria.

Prospective observational study of mechanical cardiopulmonary resuscitation, extracorporeal membrane oxygenation and early reperfusion for refractory cardiac arrest in Sydney: the 2CHEER study

Critical Care and Resuscitation

2020

Dennis et al.

OneTwoThree

Critical Care and Resuscitation 2020

2CHEER

CritKit Notes:

IV = 2g in 20 mins, or neb 500mg x3 over 1 hr. Increased incidence of side effects reported in IV Mg group but most minor / unclear

TheBottomLine:

This is the largest trial looking at the role of MgSO4 in the treatment of acute severe asthma in adults. I have never used nebulised MgSO4 to treat asthma in adults and this won’t change. The use of intravenous MgSO4 in severe acute asthmatics is not without its side effects but I would still continue to use it in patients with life-threatening asthma. My expectation of achieving any significant clinical impact by giving 2g magnesium will remain low

Author Conclusion:

Our findings suggest nebulised MgSO4 has no role in the management of severe acute asthma in adults and at best suggest only a limited role for intravenous MgSO4 in this setting.

Lancet 2013

3Mg

CritKit Notes:

TheBottomLine:

This study confirmed conventional wisdom that the use of subclavian veins for CVC catheterisation was associated with low risk of infection but highest risk of pneumothoraces. However, in this study, the use of ultrasound for subclavian CVC was relatively low.
This study has not changed my practice and I will continue using ultrasound guided internal jugular lines as my first choice technique. I would choose the femoral route over subclavian. If a subclavian line is needed, I would continue using ultrasound to guide insertion accepting that the risk might be higher.

Author Conclusion:

In this trial, subclavian-vein catheterization was associated with a lower risk of bloodstream infection and symptomatic thrombosis and a higher risk of pneumothorax than jugular-vein or femoral-vein catheterization.

NEJM 2015

3SITES

CritKit Notes:

60/60 sign = Pulmonary valve acceleration time ≤60ms and tricuspid regurgitation pressure gradient ≤60mmHg

McConnell sign = Normokinesia +/or hyperkinesia of the apical segment of the RV free wall despite hypokinesia +/or akinesia of the remaining parts of the RV free wall

Signs of RV pressure overload, defined as 1 or more of the following signs =
- Right sided cardiac thrombus
- RV diastolic dimension on parasternal view of >30mm or a ratio of RV to left ventricle of >1
- Systolic flattening of the interventricular septum
- Pulmonary valve acceleration time <90ms or tricuspid regurgitation pressure gradient >30mmHg in absence of RV hypertrophy

TheBottomLine:

In patients seen at a tertiary referral centre with a high pre-test probability of acute pulmonary embolism, the McConnell Sign had a very high positive likelihood ratio. In patients without previous cardiorespiratory disease the 60/60 sign also demonstrated a very high positive likelihood ratio. A negative McConnell or 60/60 sign added little diagnostic information
In patients presenting to the ED/ICU with a high probability of acute pulmonary embolism who cannot immediately undergo CT, I will use bedside echo to assess the 60/60 and McConnell’s signs. A positive test result will give me greater confidence for the diagnosis of acute pulmonary embolism, where as a negative result will neither help confirm or repute the diagnosis of acute pulmonary embolism

Author Conclusion:

In 17 of 67 patients, 60/60 sign correctly suggested APE, whereas 2 false-positive results were noted: in pulmonary fibrosis and in acute respiratory distress syndrome following lung resection. McConnell sign was fully specific but was noted in only 13 of 67 patients. Sensitivity and specificity were 81% and 45% for “RV-pressure overload” signs, 25% and 94% for 60/60 sign, and 19% and 100% for McConnell sign. When combined, the 2 latter signs were 94% specific and 36% sensitive in diagnosing APE. Thus, RV overload at echocardiography is not specific for APE. The 60/60 and McConnell signs are insensitive, but are reliable and helpful in bedside diagnosis of APE when direct visualization of the pulmonary arteries is impossible. Combining these 2 signs may increase the sensitivity without compromising the specificity of echocardiographic diagnosis of APE.

The American Journal of Cardiology 2002

60/60 sign for PE

CritKit Notes:

TheBottomLine:

Author Conclusion:

Among patients 65 years or older receiving vasopressors for vasodilatory hypotension, permissive hypotension compared with usual care did not result in a statistically significant reduction in mortality at 90 days. However, the confidence interval around the point estimate for the primary outcome should be considered when interpreting the clinical importance of the study.

JAMA 2020

65 Trial

CritKit Notes:

TheBottomLine:

Author Conclusion:

Patients with severe sepsis assigned to fluid resuscitation with HES 130/0.42 had an increased risk of death at day 90 and were more likely to require renal-replacement therapy, as compared with those receiving Ringer's acetate.

NEJM 2012

6S Trial

CritKit Notes:

TheBottomLine:

Author Conclusion:

British Society for Haematology (BSH) 2023

A BSH Guideline: Diagnosis and management of TTP & TMAs

Spine 2024

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on Hemodynamic Management

CritKit Notes:

TheBottomLine:

Author Conclusion:

The effects of vasopressin were similar to those of epinephrine in the management of ventricular fibrillation and pulseless electrical activity, but vasopressin was superior to epinephrine in patients with asystole. Vasopressin followed by epinephrine may be more effective than epinephrine alone in the treatment of refractory cardiac arrest.

NEJM 2004

A Comparison of Vasopressin and Epinephrine for Out-of-Hospital Cardiopulmonary Resuscitation

CritKit Notes:

High cutoff (HCO) filters (pore size 60-150kDa vs typical 30-60 kDa) aka super high flux filters have higher permeability - theorised to improve clearance of middle molecules (e.g. most inflammatory mediators). Pilot study indicated they might reduce vasopressor requirement. \n\n Single centre (Austin Australia) = no decrease in norad requirement / duration / dialysis duration, no difference in outcomes. Possible trend towards better outcomes with standard dialysis (more time off norad and less mortality but ~p 0.06)

TheBottomLine:

This trial is very informative. There does not seem to be a benefit in using high cutoff filters. There is a signal toward harm. \nOutside the setting of a larger clinical trial, I will not use high cutoff filters in my vasoplegic patients with AKI.

Author Conclusion:

In critically ill patients with acute kidney injury, continuous venovenous hemofiltration-high cutoff did not reduce the duration of vasopressor support or mortality or change albumin levels compared with continuous venovenous hemofiltration-standard.

Critical Care Medicine 2018

A Double-Blind RCT of High Cutoff Versus Standard Hemofiltration in Critically Ill Patients With AKI

CritKit Notes:

Royal Perth Hospital single centre, <100 patients total.
Complications related to the IVC filters:
- Clots on filter at first removal attempt: 4.9%
- Adherent to IVC wall at first removal attempt: 1.6%
- More than one attempt needed for removal: 5.7%
- Surgical removal required 0.9%
- Filter not removed due to technical reason or lost to follow up: 31.5%

TheBottomLine:

There is a limited role for the early use of IVC filters in the context of trauma
Proactive and individualised consideration for the commencement of anticoagulation remains my current practice

Author Conclusion:

Early prophylactic placement of a vena cava filter after major trauma did not result in a lower incidence of symptomatic pulmonary embolism or death at 90 days than no placement of a filter.

NEJM 2019

A Multicenter Trial of Vena Cava Filters in Severely Injured Patients

American Journal of Respiratory and Critical Care Medicine 2023

A New Global Definition of ARDS

CritKit Notes:

TheBottomLine:

In patients needing continuous renal replacement therapy, regional anticoagulation with citrate and calcium extends filter life in comparison with regional heparin and systemic reversal with protamine. \n\nGiven the greater efficiency and safety of citrate, serious consideration should be given to its use as first line anticoagulation in continuous renal replacement.

Author Conclusion:

Regional citrate and calcium anticoagulation prolongs continuous renal replacement therapy circuit life compared with regional heparin and protamine anticoagulation, does not affect cytokine levels, and is associated with fewer adverse events.

Critical Care Medicine 2015

A RCT of Regional Citrate Versus Regional Heparin Anticoagulation for CRRT in Critically Ill Adults

CritKit Notes:

TheBottomLine:

Author Conclusion:

Our pilot study suggested no differences in the clinical efficacy of enteral and intravenous nimodipine after aSAH. However, a much larger phase III clinical trial would be needed to show or exclude meaningful clinical differences.

World Neurosurgery 2012

A Randomized Outcome Study of Enteral versus Intravenous Nimodipine in 171 Patients After aSAH

CritKit Notes:

TheBottomLine:

Author Conclusion:

The use of systemic corticosteroids and IVIg is still contested. However, an increasing number of recent studies have suggested the effectiveness of cyclosporine or biologic anti-TNF-α. Accumulation of more data of these treatments is desirable. Finally, the pathogenesis of SJS/TEN has been elucidated in recent years and the breakthrough of these studies may help identify promising targets for the discovery of novel therapeutic agents.

Biomedicines 2022

A Review of the Systemic Treatment of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

CritKit Notes:

Vast majority of cases were for clinical AND radiological flail (7 out of 9 RCTs).

TheBottomLine:

Author Conclusion:

Although this meta-analysis including large-scale RCTs demonstrated a reduction in the duration of mechanical ventilation and the incidence of pneumonia, improvement in mortality rates was challenging to establish. TSA indicated the need for a larger number of cases, and the low certainty observed in the GRADE system assessment highlights the necessity for more focused RCTs, particularly among patients requiring mechanical ventilation.

World Journal of Emergency Surgery 2024

A meta-analysis and trial sequential analysis of randomised controlled trials comparing nonoperative and operative management of chest trauma with multiple rib fractures

CritKit Notes:

TheBottomLine:

Author Conclusion:

In patients with ALF at high risk of ICH, MH at 33–34°C did not confer a benefit above management at 36°C in prevention of ICH or in overall survival. This study did not confirm advantage of its prophylactic use.

Journal of Hepatology 2016

A multicentre randomized controlled trial of moderate hypothermia to prevent intracranial hypertension in acute liver failure

CritKit Notes:

More agitated delirium in no sedation group. Needed additional staff to comfort awake patients. If sedated, propofol for 48 hrs then changed to midaz (?more long acting). 4 days less ventilation, also less ICU duration in no sedation group. Bolus morphine in both groups 2.5-5mg

TheBottomLine:

This study should make clinicians question the dogma of sedation in ICUs, but clinical practice should not change immediately because of this study alone. \nA strategy of ‘no sedation’ may be feasible in ICUs, but may require additional staffing. \nFurther multi-centre trials are required with patient-centred outcomes and cost-analyses.

Author Conclusion:

No sedation of critically ill patients receiving mechanical ventilation is associated with an increase in days without ventilation. A multicentre study is needed to establish whether this effect can be reproduced in other facilities.

Lancet 2010

A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial

CritKit Notes:

Target >1.6mmol/L vs normal. More hypotension and hypocalcaemia in intervention group. Trend towards less vasospasm but not significant

TheBottomLine:

Author Conclusion:

Patients assigned a higher serum magnesium concentration had a reduced incidence of vasospasm as seen by angiography, but the difference was not statistically significant. Clinically significant outcomes were not different between groups. A firm recommendation for induced hypermagnesaemia cannot be made from this study

Critical Care & Resuscitation 2013

A randomised controlled trial of induced hypermagnesaemia following aneurysmal subarachnoid haemorrhage

CritKit Notes:

TheBottomLine:

In this study, in patients immobilised with a semi-rigid cervical collar, the grade of laryngoscopic view and rate of successful intubations was greater when using a McGrath® series 5 videolaryngoscope when compared with a Macintosh blade, in the hands of two anaesthetists experienced in both techniques.

Author Conclusion:

In patients with a simulated difficult airway, the McGrath videolaryngoscope significantly improved the laryngeal view when compared with the Macintosh laryngoscope. Furthermore, the McGrath videolaryngoscope was also superior in terms of intubation success, with a significantly lower intubation failure rate in the McGrath group versus the Macintosh group.

Anaesthesia 2016

A randomised cross-over trial comparing the McGrath® series 5 videolaryngoscope with the Macintosh laryngoscope in patients with cervical spine immobilisation

The Journal of Applied Laboratory Medicine 2021

AACC Guidance Document on Laboratory Investigation of Acute Kidney Injury

The Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) 2013

AANS/CNS Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries

The Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) 2018

AANS/CNS Guidelines on the Evaluation and Treatment of Patients with Thoracolumbar Spine Trauma

American Association for the Study of Liver Diseases & European Association for the Study of the Liver 2014

AASLD Position Paper: The Management of Acute Liver Failure

American Association for the Study of Liver Diseases 2011

AASLD Position Paper: The Management of Acute Liver Failure

American Association for the Study of Liver Diseases 2024

AASLD Practice Guidance on Acute-on-chronic liver failure and the management of critically ill patients with cirrhosis

CritKit Notes:

Spontaenous Awakening Trial (SAT) - up to 4 hrs off sedation, analgesia continued, success if opening eyes to voice with no sustained anxiety, agitation, pain.
Followed by Sponteanous Breathing Trial (SBT) - PSV 7 or less OR CPAP 5 OR T tube circuit. Failure = RR >35, Sats <88%, mental status change, resp distress (HR >130, accessory muscles, abdo use, diaphoresis, dyspnoea)

TheBottomLine:

The use of SATs during this trial appears to expedite weaning from mechanical ventilation, but the study findings may potentially reflect greater levels of oversedation in the control group or a bias towards early extubation in the intervention group. Their use may be associated with greater risk of self-extubation and increased nursing workload

Author Conclusion:

Our results suggest that a wake up and breathe protocol that pairs daily spontaneous awakening trials (ie, interruption of sedatives) with daily spontaneous breathing trials results in better outcomes for mechanically ventilated patients in intensive care than current standard approaches and should become routine practice.

Lancet 2008

ABC

CritKit Notes:

TheBottomLine:

Author Conclusion:

This multicenter randomized controlled study demonstrated a non-significant increase in mortality and no improvement in organ failure with PMX HP treatment compared to conventional treatment of peritonitis-induced SS.

Intensive Care Medicine 2015

ABDOMIX

CritKit Notes:

TheBottomLine:

This study shows that fresh blood which has been stored for < 8 days is no better than blood stored up to 42 days. Transfusion triggers and processes for safe administration of blood are probably more important

Author Conclusion:

Transfusion of fresh red cells, as compared with standard-issue red cells, did not decrease the 90-day mortality among critically ill adults.

NEJM 2015

ABLE

CritKit Notes:

TheBottomLine:

Author Conclusion:

2017 ACC / AHA / AAPA / ABC / ACPM / AGS / APhA / ASH / ASPC / NMA / PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Hypertension

2017

Whelton et al.

OneTwoThree

American College of Cardiology/American Heart Association (ACC, AHA) 2017

ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

CritKit Notes:

Trial run in the late 90s, multiple hospitals - using evidence based algorithm to direct feeding.
Intervention arm - "significantly more days of enteral nutrition (6.7 v. 5.4 per 10 patient-days; p = 0.042), had a significantly shorter mean stay in hospital (25 v. 35 days; p = 0.003) and showed a trend toward reduced mortality (27% v. 37%; p = 0.058)"

TheBottomLine:

Author Conclusion:

Implementation of evidence-based recommendations improved the provision of nutritional support and was associated with improved clinical outcomes.

Canadian Medical Association Journal 2004

ACCEPT

American College of Gastroenterology (ACG) 2021

ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding

CritKit Notes:

"Patients in the cefepime group experienced fewer days alive and free of delirium and coma within 14 days (mean [SD], 11.9 [4.6] days vs 12.2 [4.3] days in the piperacillin-tazobactam group; odds ratio, 0.79 [95% CI, 0.65 to 0.95])."

TheBottomLine:

In my practice I have usually used pip-taz unless there is a specific clinical indication to use cefipime and I will continue to do so following this trial
If using cefipime it is important to stay attendant to the potential for neurotoxicity, especially in the critically ill who may have altered pharmacokinetics or blood brain barrier disruption

Author Conclusion:

Among hospitalized adults in this randomized clinical trial, treatment with piperacillin-tazobactam did not increase the incidence of acute kidney injury or death. Treatment with cefepime resulted in more neurological dysfunction.

JAMA 2023

ACORN

CritKit Notes:

TheBottomLine:

Author Conclusion:

In patients with septic shock, the combination of ascorbic acid, corticosteroids, and thiamine, compared with placebo, did not result in a statistically significant reduction in SOFA score during the first 72 hours after enrollment. These data do not support routine use of this combination therapy for patients with septic shock.

JAMA 2020

ACTS

CritKit Notes:

Followed by ROSE study which is superior quality. Cisatricurium for 48 hrs. No difference in weakness, more barotrauma and pneumothorax in placebo group. Average PEEP 9 for both arms - not consistent with current practices. Other interventions not balanced.

TheBottomLine:

This multi-centre randomised controlled trial found a significant improvement in mortality for patients with severe ARDS who were treated with early neuromuscular blocking agents. Further studies to confirm this finding would be beneficial. These trials should ideally have standardised protocols for the use of co-interventions such as proning and the use of steroids. In the mean time I will need a good reason to not use neuromuscular blocking agents in early severe ARDS.

Author Conclusion:

Treatment with the neuromuscular blocking agent cisatracurium for 48 hours early in the course of severe ARDS improved the adjusted 90-day survival rate, increased the numbers of ventilator-free days and days outside the ICU, and decreased the incidence of barotrauma during the first 90 days. It did not significantly improve the overall 90-day mortality.

NEJM 2010

ACURASYS

CritKit Notes:

Reduction of antibiotics duration of around 1 day for PCT. No significant difference in mortality / clinical outcomes.

PCT guideline:
< 0.25 μg/l: “Protocol STRONGLY SUPPORTS stopping antibiotics”
PCT fall by >80% from baseline or PCT > 0.25 & < 0.50 μg/l: “Protocol SUPPORTS stopping antibiotics”

CRP guideline:
< 25 mg/l: “Protocol STRONGLY SUPPORTS stopping antibiotics”
CRP fall by 50% from baseline: “Protocol SUPPORTS stopping antibiotics”

TheBottomLine:

This trial provides further evidence that a PCT-based antibiotic discontinuation protocol may be a safe and effective way of reducing the duration of antibiotics in critically unwell patients with suspected sepsis
Given the way the intervention was blinded, further process evaluation work will be needed before a real-world implementation plan can be recommended

Author Conclusion:

Care guided by measurement of PCT reduces antibiotic duration safely compared with standard care, but CRP does not. All-cause mortality for CRP was inconclusive.

JAMA 2024

ADAPT-Sepsis

CritKit Notes:

TheBottomLine:

Author Conclusion:

In medically ill patients, an extended course of thromboprophylaxis with apixaban was not superior to a shorter course with enoxaparin. Apixaban was associated with significantly more major bleeding events than was enoxaparin.

NEJM 2011

ADOPT

CritKit Notes:

TheBottomLine:

In mechanically ventilated patients with septic shock, low dose hydrocortisone administered via an infusion for up to 7 days does not reduce or increase mortality at 90 days
Secondary outcomes demonstrated that patients in the hydrocortisone group had a reduced time to resolution of shock, reduced duration of ICU but not hospital stay, reduced time to cessation of mechanical ventilation and a reduction in the use of blood transfusion. Adverse events were low, but significantly increased in the hydrocortisone group

Author Conclusion:

We found that the administration of hydrocortisone did not result in lower 90-day mortality than placebo among patients with septic shock. This effect did not differ in any of the six prespecified subgroups. We observed a more rapid resolution of shock and a lower incidence of blood transfusion among patients who received hydrocortisone than among those who received placebo. Patients who had been assigned to receive hydrocortisone had a shorter time to ICU discharge and earlier cessation of the initial episode of mechanical ventilation than did those who had been assigned to receive placebo. There were no significant between-group differences with respect to mortality at 28 days, the rate of recurrence of shock, the number of days alive and out of the ICU or hospital, the duration and rate of recurrence of mechanical ventilation, the rate of use of renal-replacement therapy, or the rate of new-onset bacteremia or fungemia. Patients who had been assigned to receive hydrocortisone had more adverse events than did those who had been assigned to receive placebo, but these events did not affect patient-centered outcomes.

NEJM 2018

ADRENAL

CritKit Notes:

TheBottomLine:

Increased rates of successful decongestion in acetazolamide group (RR 1.46, 95% CI 1.17 – 1.82)
This seemed to persist to hospital discharge in an exploratory analysis
Increased diuresis (500mls at 48 hours, 95% CI 200 to 800mls) and natriuresis on day 2 in acetazolamide group
No difference in mortality or length of hospital stay
No difference in adverse events

Author Conclusion:

The addition of acetazolamide to loop diuretic therapy in patients with acute decompensated heart failure resulted in a greater incidence of successful decongestion.

NEJM 2022

ADVOR

American Heart Association (AHA) 2023

AF Occurring During Acute Hospitalization: A Scientific Statement

CritKit Notes:

Other trials - PIAF, STAF

TheBottomLine:

Author Conclusion:

Management of atrial fibrillation with the rhythm-control strategy offers no survival advantage over the rate-control strategy, and there are potential advantages, such as a lower risk of adverse drug effects, with the rate-control strategy. Anticoagulation should be continued in this group of high-risk patients.

NEJM 2002

AFFIRM

CritKit Notes:

TheBottomLine:

Author Conclusion:

Amiodarone given as both an intravenous and oral regimen is effective at reducing post-CTS AF but atrial septal pacing is ineffective. Combining amiodarone and pacing is better than placebo with or without pacing but not amiodarone alone.

Circulation 2003

AFIST II

CritKit Notes:

TheBottomLine:

Author Conclusion:

American Heart Association (ACC/AHA/SCAI) 2021

AHA Guideline for Coronary Artery Revascularization

American Heart Association 2024

AHA Scientific Statement Cerebral Venous Thrombosis

American Heart Association (AHA) / American College of Cardiology (ACC) 2014

AHA/ACC Guideline for the Management of Patients With NSTE-ACS

CritKit Notes:

TheBottomLine:

Author Conclusion:

American College of Cardiology / American Heart Association Joint Committee (AHA / ACC / HFSA) 2022

AHA/ACC/HFSA Guideline for the Management of Heart Failure

CritKit Notes:

Enrolled if delirium present on screening test (CAM-ICU or ICDSC) 2.5mg IV haloperidol q8hr. No difference in outcomes (mortality, amount of delirium, use of rescue medications)

TheBottomLine:

Author Conclusion:

In this multicenter, blinded, randomized, placebo-controlled trial involving adult patients with delirium in the ICU, we found that the number of days alive and out of the hospital at 90 days did not differ significantly between the haloperidol group and the placebo group.

NEJM 2022

AID-ICU

CritKit Notes:

20 mg methylprednisolone 12 h before extubation and every 4 h until tube removal.

TheBottomLine:

​

Author Conclusion:

Methylprednisolone started 12 h before a planned extubation substantially reduced the incidence of postextubation laryngeal oedema and reintubation. Such pretreatment should be considered in adult patients before a planned extubation that follows a tracheal intubation of more than 36 h.

12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema: a randomised double-blind trial

The Lancet

2007

Francois et al.

Lancet 2007

12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema: a randomised double-blind trial

CritKit Notes:

​

TheBottomLine:

​

Author Conclusion:

​

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

European Heart Journal

2016

Kirchhof et al.

European Society of Cardiology (ESC) 2016

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

CritKit Notes:

​

TheBottomLine:

​

Author Conclusion:

​

2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia

Critical Care Medicine

2024

Chaudhuri et al.

Society of Critical Care Medicine (SCCM) 2024

2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia

CritKit Notes:

RPA & St Vincent's in Sydney. Follow up to CHEER study. Observational.

TheBottomLine:

​

Author Conclusion:

ECMO for refractory cardiac arrest shows promising survival rates if protocolised care is applied in conjunction with predefined selection criteria.

Prospective observational study of mechanical cardiopulmonary resuscitation, extracorporeal membrane oxygenation and early reperfusion for refractory cardiac arrest in Sydney: the 2CHEER study

Critical Care and Resuscitation

2020

Dennis et al.

Critical Care and Resuscitation 2020

2CHEER

CritKit Notes:

IV = 2g in 20 mins, or neb 500mg x3 over 1 hr. Increased incidence of side effects reported in IV Mg group but most minor / unclear

TheBottomLine:

Author Conclusion:

Our findings suggest nebulised MgSO4 has no role in the management of severe acute asthma in adults and at best suggest only a limited role for intravenous MgSO4 in this setting.

Intravenous or nebulised magnesium sulphate versus standard therapy for severe acute asthma (3Mg trial): a double-blind, randomised controlled trial

The Lancet Respiratory Medicine

2013

Goodacre et al.

Lancet 2013

3Mg

CritKit Notes:

​

TheBottomLine:

Author Conclusion:

In this trial, subclavian-vein catheterization was associated with a lower risk of bloodstream infection and symptomatic thrombosis and a higher risk of pneumothorax than jugular-vein or femoral-vein catheterization.

Intravascular Complications of Central Venous Catheterization by Insertion Site

The New England Journal of Medicine

2015

Parienti et al.

NEJM 2015

3SITES

CritKit Notes:

TheBottomLine:

Author Conclusion:

Disturbed right ventricular ejection pattern as a new Doppler echocardiographic sign of acute pulmonary embolism

The American Journal of Cardiology

2002

Kurzyna et al.

The American Journal of Cardiology 2002

60/60 sign for PE

CritKit Notes: