ProMISe Trial for Sepsis: Usual Care 3, Goal-Directed Therapy 0*

* (since 2014) The ARISE (Australasia) and ProCESS (U.S.) trials, published in 2014, each demonstrated no advantage of protocolized care for sepsis over conscientious usual care. For those remaining unconvinced, the U.K.-based ProMISe trial is available in the New England Journal of Medicine. ProMISe extends the growing global footprint of what some will call the [... read more]

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ICU Physiology in 1,000 Words: The Right Ventricular Afterload (Part 2 of 2)

ICU Physiology in 1000 Words The Right Ventricular Afterload [Part 2 of 2] Jon-Emile S. Kenny M.D. [@heart_lung] Having considered the short-comings of Laplace’s Law and the PVR with respect to the RV afterload in part 1, we will now turn to each of the following in turn: the pulmonary arterial input impedance, a measureable [... read more]

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How safe is thoracentesis? Giant case series sheds light

Thoracentesis for pleural effusion — that is, inserting a long needle between someone's ribs to drain a fluid collection from the chest — has always come with a scary menu of potential risks, including pneumothorax, hemothorax and pulmonary edema. A new study reports a low complication rate from thousands of thoracenteses. But debate will remain whether the safety results -- achieved [... read more]

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ICU Physiology in 1,000 Words: Right Ventricular Afterload (Part 1 of 2)

ICU Physiology in 1,000 Words: The Right Ventricular Afterload (Part 1 of 2) By Jon-Emile S. Kenny M.D. With my trusted-resident – Dr. Lina Miyakawa – at my side we watched as our patient could not maintain his oxygen saturation above 82%. The patient had terrible aspiration pneumonia superimposed upon horrendous methamphetamine-related pulmonary arterial hypertension [... read more]

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FDA: Chantix + Alcohol can make you more drunk and angry than usual

The U.S. Food and Drug Administration announced today that varenicline (Chantix) can alter people's reaction when drinking alcohol, potentially causing a lowered tolerance, blackouts, and aggressive behavior. Oh, and watch out for seizures too (these were rare). The warnings come as advance notice of a label change, based on FDA's review of cases reported over time by Pfizer [... read more]

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Chlorhexidine baths in ICU don’t prevent infections in large trial

Throwing the Baby out with the (Chlorhexidine) Bathwater? New Data on Disinfectant Baths By Lekshmi Santhosh, MD As a critical care community, we’ve been forever searching for a magic bullet to eradicate healthcare-acquired infections. So when the pair of 2013 NEJM trials on daily chlorhexidine bathing showed statistically significant reductions on the incidence of hospital-acquired [... read more]

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