The document summarizes 90 critical care clinical trials covering important topics in intensive care. It focuses on the randomization method, excluded populations, and conclusions of each trial. The summaries are brief and not meant to replace reading the full text, but to provide a quick overview of the currently available evidence in critical care medicine.
Scalp block is simple and easy to perform. It has the advantages of minimizing cardiovascular effects and decreasing intraoperative analgesia requirements.
New GCS, the GCS-P was adopted in 2018 by the same person who proposed GCS. It gives better prognosticate outcomes compared to GCS.
Assessment of haemodynamics a critically ill patient and its management has always been a matter if debate. Over time a lot of studies and therapeutic interventions have been carried out. This presentation is a review of such interventions and their impact on the outcome.
Introduction of organ donation .
Introduction of brain death and pathophysiology following it.
Perioperative problems in organ retrieval .
Goals of management of these patients .
Anesthetic management of the cadaver during organ harvesting.
Scalp block is simple and easy to perform. It has the advantages of minimizing cardiovascular effects and decreasing intraoperative analgesia requirements.
New GCS, the GCS-P was adopted in 2018 by the same person who proposed GCS. It gives better prognosticate outcomes compared to GCS.
Assessment of haemodynamics a critically ill patient and its management has always been a matter if debate. Over time a lot of studies and therapeutic interventions have been carried out. This presentation is a review of such interventions and their impact on the outcome.
Introduction of organ donation .
Introduction of brain death and pathophysiology following it.
Perioperative problems in organ retrieval .
Goals of management of these patients .
Anesthetic management of the cadaver during organ harvesting.
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
Erector spinae plane block is a relatively novel approach to pain management for a variety of surgical procedures. ESP block is a challenging anesthesia and analgesia technique that needs more research.
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
Erector spinae plane block is a relatively novel approach to pain management for a variety of surgical procedures. ESP block is a challenging anesthesia and analgesia technique that needs more research.
DISCHARGE SUMMARY PCI IN THE ELDERLY PATIENT1DISCHARGE SUMMAAlyciaGold776
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DISCHARGE SUMMARY: PCI IN THE ELDERLY PATIENT 1
DISCHARGE SUMMARY: PCI IN THE ELDERLY PATIENT
DISCHARGE SUMMARY: PCI IN THE ELDERLY PATIENT 6
DISCHARGE SUMMARY: PCI in the Elderly Patient
Professor: XXXX
Student Name
Grand Canyon University-ANP 654
Date
DISCHARGE SUMMARY
Discharge Summary
Date
XXXX-ANP 654
Patient Name: H.W.
MRN: 123456
Sex: Male
Date of Birth: 12/12/1933
Provider: C.H. APRN/MILLENIUM PHYSICIAN GROUP
Primary Care Provider: Dr. S.B.
Admission Date: xx/xx/xxxx
Discharge Date: xx/xx/xxxx
Admitting Diagnoses:
I25.1 Atherosclerotic heart disease of native coronary artery
R00.1 Bradycardia, unspecified (permanent pacemaker placed by Dr. R 12/28/2019)
I10 Renovascular hypertension
N18.6 End stage renal disease (on peritoneal dialysis)
Discharge Diagnosis:
I25.1 Atherosclerotic heart disease of native coronary artery-elective cardiac catheterization on this admission
R00.1 Bradycardia, unspecified
I10 Renovascular hypertension controlled
I70.1 Atherosclerosis of renal artery
N18.6 End stage renal disease (peritoneal dialysis 1/14/20 prior to discharge)
Admission Procedure:
01/13/20- Cardiac catheterization under moderate sedation with use of IVP contrast for coronary angiography
Impression: Non-dominant RCA without significant obstructive disease <60%. OM with an 80% proximal lesion, Circumflex with mid 90% lesion, LAD is without disease, large diagonals without disease. LV function is normal, EF 50%, no wall motion abnormalities. PCI to the OM and Circumflex were performed with good results.
Consultations:
Dr. R Interventional Cardiologist- performed elective cardiac catheterization 1/13/20
Course of Treatment:
This is an 86 year-old male patient with a complex cardiac history. The patient had a permanent pacemaker placed on 12/28/2019 for severe symptomatic bradycardia. After pacemaker placement, the patient underwent a Lexiscan showing ischemia. A planned cardiac catheterization was scheduled for 1/13/20. Dr. R. performed PCI and placed BM stents to the patientâs OM and Circumflex arteries. His RCA was assessed and was deemed not severe enough for intervention and was a non-dominant vessel. The patient was admitted for further observation overnight post procedure. He had no complaints of chest pain, no shortness of breath, no nausea or vomiting, no dizziness, and no numbness or tingling in his bilateral lower extremities. No hematoma, redness or swelling noted at his right groin catheterization site. Overall, the patient is stable for discharge this evening after his peritoneal dialysis treatment.
Admission Home Medications:
Auryxia 210mg, 2 tabs, po three times daily
Entresto 24/26mg, 1 tab, po twice daily
Thiamine 100mg po daily
Docusate sodium 100mg po twice daily
Discharge Medication:
Auryxia 210mg, 2 tabs, po three times daily
Entresto 24/26mg, 1 tab, po twice daily
Thiamine 100mg po daily
Docusate sodium 100mg po twice daily
New:
Nitroglycerine 0.4mg, one tablet SL ...
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: Whatâs the Latest in Cervical Cancer?bkling
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Are you curious about whatâs new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Womenâs Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Recomendaçþes da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS â Objetivos do Desenvolvimento SustentĂĄvel e a EstratĂŠgia Global para a SaĂşde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pĂłs-natais devem expandir-se para alĂŠm da cobertura e da simples sobrevivĂŞncia, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pĂłs-natais essenciais e de rotina prestados Ă s mulheres e aos recĂŠm-nascidos, com o objetivo final de melhorar a saĂşde e o bem-estar materno e neonatal.
Uma âexperiĂŞncia pĂłs-natal positivaâ ĂŠ um resultado importante para todas as mulheres que dĂŁo Ă luz e para os seus recĂŠm-nascidos, estabelecendo as bases para a melhoria da saĂşde e do bem-estar a curto e longo prazo. Uma experiĂŞncia pĂłs-natal positiva ĂŠ definida como aquela em que as mulheres, pessoas que gestam, os recĂŠm-nascidos, os casais, os pais, os cuidadores e as famĂlias recebem informação consistente, garantia e apoio de profissionais de saĂşde motivados; e onde um sistema de saĂşde flexĂvel e com recursos reconheça as necessidades das mulheres e dos bebĂŞs e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendaçþes novas e jĂĄ bem fundamentadas sobre cuidados pĂłs-natais de rotina para mulheres e neonatos que recebem cuidados no pĂłs-parto em unidades de saĂşde ou na comunidade, independentemente dos recursos disponĂveis.
Ă fornecido um conjunto abrangente de recomendaçþes para cuidados durante o perĂodo puerperal, com ĂŞnfase nos cuidados essenciais que todas as mulheres e recĂŠm-nascidos devem receber, e com a devida atenção Ă qualidade dos cuidados; isto ĂŠ, a entrega e a experiĂŞncia do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendaçþes da OMS de 2014 sobre cuidados pĂłs-natais da mĂŁe e do recĂŠm-nascido e complementam as atuais diretrizes da OMS sobre a gestĂŁo de complicaçþes pĂłs-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências Ê contemplada.
Recomendamos muito.
Vamos discutir essas recomendaçþes no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação sĂł estĂĄ disponĂvel em inglĂŞs atĂŠ o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
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This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
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Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
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Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
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i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowmanâs Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Tom Selleck Health: A Comprehensive Look at the Iconic Actorâs Wellness Journeygreendigital
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Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Prix Galien International 2024 Forum ProgramLevi Shapiro
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June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMENâS HEALTH: FERTILITY PRESERVATION
- WHATâS NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
1. Landmark Critical Care Clinical
Trials
By
Dr. Sherif Badrawy
Landmarks Critical Care
Dr. Sherif Badrawy
2. ď´ Dear colleagues this is a collection of about 90 Critical Care clinical
trials which I think cover many important topics daily faced by us in the
ICU.
ď´ This summary isnât for research purposes as it doesnât contain the full
details of every trial but for quick revision of the currently available
literature in the field of Critical Care Medicine.
ď´ I focused mostly on the randomization method of the trial & the
excluded population out of the trial plus the conclusion of the trial.
ď´ Again thisâs not a replacement of the full text but a trial to sum up some
important data.
ď´ Your valuable comments are highly appreciated.
Landmarks Critical Care
Dr. Sherif Badrawy
3. COMMIT â Chen2005 â Early use
of metoprolol in acute MI
ăRandomizationă
1a
Landmarks Critical Care
Dr. Sherif Badrawy
Dr. Sherif
Badrawy
Digitally signed by Dr. Sherif
Badrawy
DN: cn=Dr. Sherif Badrawy, o,
ou=Critical Care Medicine,
email=sherif_badrawy@yaho
o.com, c=SA
Date: 2015.05.05 01:56:28
+03'00'
4. â Randomized to placebo vs. metoprolol IV
5 mg x 3 doses Q 3min (unless HR <50 or SBP < 90),
then metoprolol 50 mg PO Q 6hr (days 0-1 ), then
metoprolol succinate XL 200 mg daily (days 2-28)
â Excluded those with systolic BP < 100 mmHg,
heart rate < 50 bpm, heart block, cardiogenic shock,
or primary PCI (study was 2x2 factorial with
clopidogrel)
1b
Landmarks Critical Care
Dr. Sherif Badrawy
5. COMMIT â Chen2005 â Early use
of metoprolol in acute MI
ăConclusionă
2a
Landmarks Critical Care
Dr. Sherif Badrawy
6. â The use of early, aggressive-dose metoprolol in
acute MI decreased arrhythmias and reinfarction,
but increased cardiogenic shock especially during
the first day or so after admission.
â Consequently, it might generally be prudent to
consider starting beta-blocker therapy in hospital
only when the haemodynamic condition after Ml
has stabilised
2b
Landmarks Critical Care
Dr. Sherif Badrawy
7. DOSE â Felker 2011 â Furosemide
bolus vs. infusion, low vs. high dose
in decompensated heart failure
ăRandomizationă
3a
Landmarks Critical Care
Dr. Sherif Badrawy
8. â Randomized in 2x2 factorial design to low-dose
furosemide (daily IV dose equal to daily home PO dose) or
high-dose furosemide (daily IV dose equal to 2.5 times daily
home PO dose), and randomized to either bolus (dosed Q1
2h) or continuous infusion for 72 hours. A 50% dose increase
ws optional at 48 hours.
â Excluded patients with systolic BP < 90 mmHg,
creatinine> 3 mg/dL, and thosereceiving IV vasodilators or
inotropic agents (other than digoxin)
3b
Landmarks Critical Care
Dr. Sherif Badrawy
9. DOSE â Felker 2011 â Furosemide
bolus vs. infusion, low vs. high dose
in decompensated heart failure
ăConclusionă
4a
Landmarks Critical Care
Dr. Sherif Badrawy
10. â There is no clinical advantage to a high
dose vs. low-dose furosemide strategy or
bolus vs. continuous infusion furosemide.
â There may be a small signal of
subjective benefit in high-dose patients,
but high dose was more associated with a
small increase in serum creatinine.
4b
Landmarks Critical Care
Dr. Sherif Badrawy
11. ESCAPE â Binanay 2005 â
Efficacy of PA catheters in
decompensated heart failure
ăRandomizationă
5a
Landmarks Critical Care
Dr. Sherif Badrawy
12. â Randomized patients to receive
clinical assessment only vs. clinical
assessment with a pulmonary
arterial catheter (PAC)
5b
Landmarks Critical Care
Dr. Sherif Badrawy
13. ESCAPE â Binanay 2005 â
Efficacy of PA catheters in
decompensated heart failure
ăConclusionă
6a
Landmarks Critical Care
Dr. Sherif Badrawy
14. â The use of a PA catheter (PAC) as an
adjunct to clinical judgment alone showed
no mortality or hospitalization benefit.
â Patients randomized to PACs had a
transient improvement in symptoms, but
experienced a higher rate of complications
as a result of PAC placement.
6b
Landmarks Critical Care
Dr. Sherif Badrawy
15. IAP-SHOCK II â Thiele 2012 â
lntraaortic balloon support in ACS
with early revascularization
ăRandomizationă
7a
Landmarks Critical Care
Dr. Sherif Badrawy
16. â Randomized to intraaortic balloon
pump (IABP) or no IABP (control)
7b
Landmarks Critical Care
Dr. Sherif Badrawy
17. IAP-SHOCK II â Thiele 2012 â
lntraaortic balloon support in ACS
with early revascularization
ăConclusionă
8a
Landmarks Critical Care
Dr. Sherif Badrawy
18. â In patients with acute coronary
syndromes and cardiogenic shock
with planned early revascularization,
the use of an intraaortic balloon
pump did not improve 30-day
mortality or tissue oxygenation.
8b
Landmarks Critical Care
Dr. Sherif Badrawy
19. MAPPET-3 â Konstantinides 2002
â Alteplase with or without heparin
for submassive PE
ăRandomizationă
9a
Landmarks Critical Care
Dr. Sherif Badrawy
20. â Randomized patients to alteplase
(10 mg IV bolus, then 90 mg over 2
hrs) or placebo. Both groups
received full anticoagulation with
unfractionated heparin
9b
Landmarks Critical Care
Dr. Sherif Badrawy
21. MAPPET-3 â Konstantinides 2002
â Alteplase with or without heparin
for submassive PE
ăConclusionă
10a
Landmarks Critical Care
Dr. Sherif Badrawy
22. â When given in conjunction with
heparin, alteplase can improve the clinical
course of stable patients who have acute
submassive pulmonary embolism and can
prevent clinical deterioration requiring the
escalation of treatment during the hospital
stay.
10b
Landmarks Critical Care
Dr. Sherif Badrawy
23. PROTECT â PROTECT
Investigators 2011 â Dalteparin vs.
unfractionated heparin for DVT
prophylaxis
ăRandomizationă
11a
Landmarks Critical Care
Dr. Sherif Badrawy
24. â Randomized to dalteparin 5000
units daily or unfractionated
heparin (UFH) 5000 units Q 12h (Q
72h heparin may have been a weak
comparator- some favor
Q 8 h heparin)
11b
Landmarks Critical Care
Dr. Sherif Badrawy
25. PROTECT â PROTECT
Investigators 2011 â Dalteparin vs.
unfractionated heparin for DVT
prophylaxis
ăConclusionă
12a
Landmarks Critical Care
Dr. Sherif Badrawy
26. â Dalteparin was comparable to
unfractionated heparin in preventing
proximal leg DVT. There were no
differences in clinical endpoints (length of
stay, mortality), but dalteparin was
associated with less pulmonary embolism.
12b
Landmarks Critical Care
Dr. Sherif Badrawy
27. SHOCK â Hochman 1999 â Early
revascularization versus medical
stabilization in cardiogenic shock
ăRandomizationă
13a
Landmarks Critical Care
Dr. Sherif Badrawy
28. â Randomized patients to early
revascularization (anqioplasty or
bypass within 6 hours of
randomization) or medical
stabilization
13b
Landmarks Critical Care
Dr. Sherif Badrawy
29. SHOCK â Hochman 1999 â Early
revascularization versus medical
stabilization in cardiogenic shock
ăConclusionă
14a
Landmarks Critical Care
Dr. Sherif Badrawy
30. â Compared to medical stabilization, emergent
revascularization in cardiogenic shock did not
improve 30-day mortality, but did confer a survival
benefit at six months.
â Early revascularization should be strongly
considered for patients with acute myocardial
infarction complicated by cardiogenic shock.
â The benefit of early revascularization was most
pronounced in younger patients with previous MI.
14b
Landmarks Critical Care
Dr. Sherif Badrawy
31. TROICA â Bottiger 2009 â
Tenecteplase for OOH cardiac arrest
ăRandomizationă
15a
Landmarks Critical Care
Dr. Sherif Badrawy
32. â Compared weight-based
tenecteplase (30-50 mg) vs. placebo
for 30-day survival
â Excluded patients with high
suspicion of PE
15b
Landmarks Critical Care
Dr. Sherif Badrawy
33. TROICA â Bottiger 2009 â
Tenecteplase for OOH cardiac arrest
ăConclusionă
16a
Landmarks Critical Care
Dr. Sherif Badrawy
34. â When tenecteplase was used without
adjunctive antithrombotic therapy during
advanced life support for out-of-hospital
cardiac arrest, we did not detect an
improvement in outcome, in comparison
with placebo.
16b
Landmarks Critical Care
Dr. Sherif Badrawy
35. 6S â Perner 2012 â HES vs. LR for
fluid resuscitation in severe sepsis
ăRandomizationă
17a
Landmarks Critical Care
Dr. Sherif Badrawy
36. â Randomized to HES 130/0.42
(Tetraspan) or lactated ringers (LR)
as needed up to a maximum of 33
ml/kg/ day, after which open-label
LR was used
17b
Landmarks Critical Care
Dr. Sherif Badrawy
37. 6S â Perner 2012 â HES vs. LR for
fluid resuscitation in severe sepsis
ăConclusionă
18a
Landmarks Critical Care
Dr. Sherif Badrawy
38. â For patients with severe sepsis,
hydroxyethyl starch (HES 130/0.42)
was associated with higher 90-day
mortality, need for renal eplacement
therapy, and the use of blood
products than lactated ringers (LR).
18b
Landmarks Critical Care
Dr. Sherif Badrawy
39. ALBIOS â Caironi 2014 â Daily
albumin replacement in severe
sepsis and septic shock
ăRandomizationă
19a
Landmarks Critical Care
Dr. Sherif Badrawy
40. â Randomized patients to receive either
200-300 ml of 20% albumin daily for a
serum albumin level less than 3 g/dl or no
albumin replacement at all. Replacement
occurred for up to 28 days or untiiiCU
discharge. Both groups received
crystalloids when clinically indicated.
19b
Landmarks Critical Care
Dr. Sherif Badrawy
41. ALBIOS â Caironi 2014 â Daily
albumin replacement in severe
sepsis and septic shock
ăConclusionă
20a
Landmarks Critical Care
Dr. Sherif Badrawy
42. â In patients with severe sepsis, daily
albumin replacement for low serum
albumin in addition to crystalloids,
as compared with crystalloids alone,
did not improve the rate of survival at
28 and 90 days.
20b
Landmarks Critical Care
Dr. Sherif Badrawy
43. ANNANE 2002 â Hydrocortisone
therapy for septic shock
ăRandomizationă
21a
Landmarks Critical Care
Dr. Sherif Badrawy
44. â Included 299 patients with septic shock and
mechanical ventilation within 3-8 hours of
meeting study criteria (CORTI GUS enrolled
within 72 hours
â Compared placebo vs. hydrocortisone 50 mg
IV Q 6h + fludrocortisone 50 meg PO daily x 7
days (no taper)
21b
Landmarks Critical Care
Dr. Sherif Badrawy
45. ANNANE 2002 â Hydrocortisone
therapy for septic shock
ăConclusionă
22a
Landmarks Critical Care
Dr. Sherif Badrawy
46. â Among patients with very early septic shock
who were non-responders to a Cosyntropin stim
test, hydrocortisone / fludrocortisone therapy
improved 28-day survival. Furthermore, steroid
therapy reduced duration of vasopressor therapy
the risk of death in patients with septic shock and
relative adrenal insufficiency without increasing
adverse events.(regardless of stim test response).
22b
Landmarks Critical Care
Dr. Sherif Badrawy
47. CHEST â Myburgh 2012 â HES vs.
saline for fluid resuscitation
ăRandomizationă
23a
Landmarks Critical Care
Dr. Sherif Badrawy
48. â Randomized to 6% HES 130/0.4 (Voluven) or
0.9% normal saline for the duration of the
patient's ICU stay. In patients requiring more
than 50 ml/kg/ day, open-label saline was used
â Excluded patients with dialysisdependent renal
failure or intracranial hemorrhage
23b
Landmarks Critical Care
Dr. Sherif Badrawy
49. CHEST â Myburgh 2012 â HES vs.
saline for fluid resuscitation
ăConclusionă
24a
Landmarks Critical Care
Dr. Sherif Badrawy
50. â For ICU patients requiring fluid
resuscitation, hydroxyethyl starch (HES
130/0.4) was equivalent to normal saline
in 90-day mortality, but HES increased
the risk of renal failure and the need for
blood products.
24b
Landmarks Critical Care
Dr. Sherif Badrawy
51. CORTICUS â Sprung 2008 â
Hydrocortisone therapy for septic
shock
ăRandomizationă
25a
Landmarks Critical Care
Dr. Sherif Badrawy
52. â Included 499 patients with septic shock
within the past 72 hours. (Annane 2002
enrolled patients within 8 hours of shock)
â Randomized patients to placebo or
hydrocortisone (without fludrocortisone)
25b
Landmarks Critical Care
Dr. Sherif Badrawy
53. CORTICUS â Sprung 2008 â
Hydrocortisone therapy for septic
shock
ăConclusionă
26a
Landmarks Critical Care
Dr. Sherif Badrawy
54. â Hydrocortisone therapy did not
improve outcomes among patients with
septic shock (onset within 72 hours),
although it did shorten the duration of
vasopressor dependence.(hastened
reversal of shock in patients in whom
shock was reversed).
26b
Landmarks Critical Care
Dr. Sherif Badrawy
55. CRISTAL â Annane2013 â Colloids
versus crystalloids for ICU
hypovolemia
ăRandomizationă
27a
Landmarks Critical Care
Dr. Sherif Badrawy
56. â Randomized patients to crystalloids or colloids.
Investigators were non-blinded and allowed to select from a
variety of fluid options. In the crystalloid group,
normal saline was used in 85% of cases and Ringers lactate
in 18%. In the colloid group, hydroxyethyl starch was used
in 69% of patients, gelatins in 35%, albumin- 4% in 6%, and
albumin-20% in 14%. The dose of fluid was also at the
discretion of the unblinded investigator.
27b
Landmarks Critical Care
Dr. Sherif Badrawy
57. CRISTAL â Annane2013 â Colloids
versus crystalloids for ICU
hypovolemia
ăConclusionă
28a
Landmarks Critical Care
Dr. Sherif Badrawy
58. â In a heterogeneous ICU population with
hypovolemia, there was no difference in 28- day
mortality between crystalloids and colloids.
â Colloids did demonstrate benefit in duration of
mechanical ventilation, vasopressor use, and 90-
day mortality, although these were secondary
endpoints that are conflicting with previous
literature and deserve further study.
28b
Landmarks Critical Care
Dr. Sherif Badrawy
59. DRAKULOVIC 1999 â Semi
recumbent position for mechancial
ventilation
ăRandomizationă
29a
Landmarks Critical Care
Dr. Sherif Badrawy
60. â Randomized patients to semi recumbent
(45° head of bed) or supine (0°)
â Excluded recent abdominal surgery,
neurosurgery, shock refractory to
vasoactive therapy, and previous
intubation in the past 30 days
29b
Landmarks Critical Care
Dr. Sherif Badrawy
61. DRAKULOVIC 1999 â Semi
recumbent position for mechancial
ventilation
ăConclusionă
30a
Landmarks Critical Care
Dr. Sherif Badrawy
62. â The semirecumbent body position
reduces frequency and risk of nosocomial
pneumonia, especially in patients who
receive enteral nutrition. The risk of
nosocomial pneumonia is increased by
longduration mechanical ventilation and
decreased consciousness.
30b
Landmarks Critical Care
Dr. Sherif Badrawy
63. EPaNIC â Casaer 2011 â Early vs.
late parenteral
nutrition
ăRandomizationă
31a
Landmarks Critical Care
Dr. Sherif Badrawy
64. â Randomized patients to early or late parenteral
nutrition. Early nutrition consisted of 20% dextrose
for 2 days, then full TPN. Late nutrition consisted of
5% dextrose for 7 days, then full TPN. In both groups,
TPN was reduced or stopped based on enteral
nutrition intake
â Excluded those taking oral nutrition and BMI < 17
31b
Landmarks Critical Care
Dr. Sherif Badrawy
65. EPaNIC â Casaer 2011 â Early vs.
late parenteral
nutrition
ăConclusionă
32a
Landmarks Critical Care
Dr. Sherif Badrawy
66. â Early initiation of TPN increased ICU and
hospital stay, the incidence of infection, and total
healthcare costs. Delaying parenteral nutrition
up to 7 days had no effect on mortality.
â [Late initiation of parenteral nutrition was
associated with faster recovery and fewer
complications, as compared with early
initiation].
32b
Landmarks Critical Care
Dr. Sherif Badrawy
67. JONES 2010 â Lactate clearance
vs. Scv02 for Early Goal-Directed
Therapy
ăRandomizationă
33a
Landmarks Critical Care
Dr. Sherif Badrawy
68. â Randomized patients to either central
venous oxygen saturation (Scv02 > 70%)
or lactate clearance (> 1 0% clearance).
This was the third goal of therapy
following maximization of central venous
pressure (CVP > 8 mmHg) and mean
arterial pressure (MAP > 65 mmHg)
33b
Landmarks Critical Care
Dr. Sherif Badrawy
69. JONES 2010 â Lactate clearance
vs. Scv02 for Early Goal-Directed
Therapy
ăConclusionă
34a
Landmarks Critical Care
Dr. Sherif Badrawy
70. â Among patients with septic shock who were
treated to normalize central venous and mean
arterial pressure, additional management to
normalize lactate clearance compared with
management to normalize Scv02 did not result in
significantly different in-hospital mortality.
â lactate clearance is non-inferior to central
venous oxygen saturation for hospital mortality.
34b
Landmarks Critical Care
Dr. Sherif Badrawy
71. PROWESS â Bernard 2001 â
Xigris for severe sepsis
ăRandomizationă
35a
Landmarks Critical Care
Dr. Sherif Badrawy
72. â Included 1690 patients with severe
sepsis or septic shock within 24 hours
â Randomized to receive drotrecogin
alfa (DrotAA) 24 mcg/kg/hr or
placebo x 96 hrs
35b
Landmarks Critical Care
Dr. Sherif Badrawy
73. PROWESS â Bernard 2001 â
Xigris for severe sepsis
ăConclusionă
36a
Landmarks Critical Care
Dr. Sherif Badrawy
74. â Drotrecogin alfa improved mortality
among patients with severe sepsis or septic
shock, particularly those with a high
APACHE II score,and may be associated
with an increased risk of bleeding. but
subsequent trials have failed to show a
similar mortality benefit.
36b
Landmarks Critical Care
Dr. Sherif Badrawy
75. PROWESS-SHOCK â Ranieri 2012
â Xigris for septic shock
ăRandomizationă
37a
Landmarks Critical Care
Dr. Sherif Badrawy
76. â Included 1697 patients with septic shock
(requiring 4+ hrs of vasopressors) and clinical
evidence of hypoperfusion (metabolic acidosis,
renal or hepatic dysfunction).
â Randomized to receive drotrecogin alfa
(DrotAA) 24 mcg/kg/hr or placebo x 96 hrs
37b
Landmarks Critical Care
Dr. Sherif Badrawy
77. PROWESS-SHOCK â Ranieri 2012
â Xigris for septic shock
ăConclusionă
38a
Landmarks Critical Care
Dr. Sherif Badrawy
78. â Drotrecogin alta did not improve
28-day or
90-day mortality compared to
placebo in patients with septic shock
38b
Landmarks Critical Care
Dr. Sherif Badrawy
79. ProCESS â The ProCESS
Investigators 2014 â Protocol-
Based Care for Early Septic Shock
ăRandomizationă
39a
Landmarks Critical Care
Dr. Sherif Badrawy
80. â Randomized patients in a 1:1:1
ratio to protocolized early goal
directed therapy(EGDT),
protocolized standard- therapy, or
usual-care
39b
Landmarks Critical Care
Dr. Sherif Badrawy
81. ProCESS â The ProCESS
Investigators 2014 â Protocol-
Based Care for Early Septic Shock
ăConclusionă
40a
Landmarks Critical Care
Dr. Sherif Badrawy
82. â Traditional early goal-directed
therapy, a new protocolized
standard-therapy, and a no-protocol
usual-therapy approach were all
equally effective in treating early
septic shock patients.
40b
Landmarks Critical Care
Dr. Sherif Badrawy
83. RIVERS 2001 â Early goal-directed
therapy for
severe sepsis and septic shock
ăRandomizationă
41a
Landmarks Critical Care
Dr. Sherif Badrawy
84. â Randomized patients to standard
of care vs. protocolized early goal-
directed therapy (EGDT) prior to ICU
admission. ED team was not blinded,
but accepting ICU team was blinded
to treatment assignment
41b
Landmarks Critical Care
Dr. Sherif Badrawy
85. RIVERS 2001 â Early goal-directed
therapy for
severe sepsis and septic shock
ăConclusionă
42a
Landmarks Critical Care
Dr. Sherif Badrawy
86. â Protocolized early goal-directed
therapy initiated in the ED in severe
sepsis and septic shock patients
improved resuscitation parameters
and reduced mortality.
42b
Landmarks Critical Care
Dr. Sherif Badrawy
87. SAFE â Finfer 2004 â Albumin vs.
saline for fluid resuscitation
ăRandomizationă
43a
Landmarks Critical Care
Dr. Sherif Badrawy
88. â Randomized patients to receive doubleblinded
4% albumin or normal saline 500 ml boluses. All
other aspects of ICU care were left to the
discretion of the treating clinician
â Excluded post-op cardiac surgery, liver
transplantation, and burns
43b
Landmarks Critical Care
Dr. Sherif Badrawy
89. SAFE â Finfer 2004 â Albumin vs.
saline for fluid resuscitation
ăConclusionă
44a
Landmarks Critical Care
Dr. Sherif Badrawy
90. â For all ICU patients requiring fluid resuscitation,
albumin was equivalent to normal saline in 28-day
mortality .Hypothesis-generating subgroup analysis
indicated that trauma patients may benefit from
normal saline whereas septic shock patients may
benefit from albumin.
â use of either 4 percent albumin or normal saline
for fluid resuscitation results in similar outcomes at
28 days.
44b
Landmarks Critical Care
Dr. Sherif Badrawy
91. SEPSISPAM â Asfar 2014 â High
versus low MAP goal in septic shock
ăRandomizationă
45a
Landmarks Critical Care
Dr. Sherif Badrawy
92. â Randomized patients to high-
target (MAP goal 80-85 mmHg) or
low-target (MAP 65-70 mmHg) for
up to 5 days
45b
Landmarks Critical Care
Dr. Sherif Badrawy
93. SEPSISPAM â Asfar 2014 â High
versus low MAP goal in septic shock
ăConclusionă
46a
Landmarks Critical Care
Dr. Sherif Badrawy
94. â In patients with septic shock, a higher MAP goal did not
reduce mortality but did increase the risk of atrial
fibrillation. In a pre-specified subgroup of patients with a
history of hypertension, a higher MAP goal was associated
with a reduction in the need for RRT.
â MAP of 80 to 85 mm Hg, as compared with 65 to 70
mm Hg, in patients with septic shock undergoing
resuscitation did not result in significant differences in
mortality at either 28 or 90 days.
46b
Landmarks Critical Care
Dr. Sherif Badrawy
95. SIC â Angstwurm 2007 â
Selenium in intensive care
ăRandomizationă
47a
Landmarks Critical Care
Dr. Sherif Badrawy
96. â Randomized patients to sodium-
selenite 1000 meg bolus, then 1000
meg/day (2 ml/hr) continuous
infusion for 14 days (total of 6.9 mg
elemental selenium) or placebo (48
ml normal saline per day)
47b
Landmarks Critical Care
Dr. Sherif Badrawy
97. SIC â Angstwurm 2007 â
Selenium in intensive care
ăConclusionă
48a
Landmarks Critical Care
Dr. Sherif Badrawy
98. â Selenium supplementation was
not associated with a decrease in
mortality among a heterogeneous
ICU population with SlRS criteria;
however, a favorable
trend was noted
48b
Landmarks Critical Care
Dr. Sherif Badrawy
99. SOAPII â De Backer 2010 â
Dopamine vs Norepinephrine for
shock
ăRandomizationă
49a
Landmarks Critical Care
Dr. Sherif Badrawy
100. â Randomized to dopamine
(titrated by 2 meg/kg/min to max
20 meg/kg/min) or norepinephrine
(titrated by 0.02 meg/kg/min to
max 0.1 9 meg/kg/min -- 1 5 meg/
min for 80 kg patient)
49b
Landmarks Critical Care
Dr. Sherif Badrawy
101. SOAPII â De Backer 2010 â
Dopamine vs Norepinephrine for
shock
ăConclusionă
50a
Landmarks Critical Care
Dr. Sherif Badrawy
102. â Among patients with all types of shock,
mortality rates were not different between
norepinephrine and dopamine, although
norepinephrine was more effective as a
vasopressor and was less associated with
arrhythmias. Norepinephrine may have a
mortality benefit over dopamine in a subset of
patients with cardiogenic shock.
50b
Landmarks Critical Care
Dr. Sherif Badrawy
103. TRICC â Hebert 1999 â Restrictive
vs. liberal blood transfusion in the
ICU
ăRandomizationă
51a
Landmarks Critical Care
Dr. Sherif Badrawy
104. â Compared a conservative transfusion
strategy (goal Hgb 7-9 g/dL) vs. liberal
strategy (goal 10-12 g/dL)
â Excluded patients with active blood loss
and chronic anemia (Hgb < 9 g/dl more
than one month prior to admission)
51b
Landmarks Critical Care
Dr. Sherif Badrawy
105. TRICC â Hebert 1999 â Restrictive
vs. liberal blood transfusion in the
ICU
ăConclusionă
52a
Landmarks Critical Care
Dr. Sherif Badrawy
106. â Compared to a liberal transfusion
strategy, a conservative transfusion strategy
had no impact on mortality, but did result in
a reduction in RBC transfusions and fewer
cardiac events with the possible exception of
patients with acute myocardial infarction
and unstable angina
52b
Landmarks Critical Care
Dr. Sherif Badrawy
107. VASST â Russell 2008 â
Vasopressin vs additional
norepinephrine for septic shock
ăRandomizationă
53a
Landmarks Critical Care
Dr. Sherif Badrawy
108. â Randomized to additional
norepinephrine (5-15 meg/min) or
vasopressin (0.01- 0.03 units/min)
53b
Landmarks Critical Care
Dr. Sherif Badrawy
109. VASST â Russell 2008 â
Vasopressin vs additional
norepinephrine for septic shock
ăConclusionă
54a
Landmarks Critical Care
Dr. Sherif Badrawy
110. â Vasopressin was comparable to
additional norepinephrine among septic
shock patients receiving norepinephrine.
â Vasopressin may provide some
mortality benefit in a subgroup of patients
with less severe vasopressor requirements.
54b
Landmarks Critical Care
Dr. Sherif Badrawy
111. VILLANUEVA 2013 â Restrictive
vs. liberal blood
transfusion in upper Gl bleed
ăRandomizationă
55a
Landmarks Critical Care
Dr. Sherif Badrawy
112. â Randomized patients to a transfusion threshold
of restrictive (7 g/dL) or liberal (9 g/dL)
â Excluded massive exsanguinating bleeding, ACS,
symptomatic peripheral vasculopathy, stroke/TIA,
transfusion in past 90 days, recent trauma or
surgery, lower Gl bleed, or Rockall score of 0 with
a hemoglobin > 12 g/dl
55b
Landmarks Critical Care
Dr. Sherif Badrawy
113. VILLANUEVA 2013 â Restrictive
vs. liberal blood
transfusion in upper Gl bleed
ăConclusionă
56a
Landmarks Critical Care
Dr. Sherif Badrawy
114. â In patients with an upper Gl
bleed,a restrictive transfusion
strategy reduced mortality and
resulted in fewer RBC transfusions
compared to a liberal transfusion
strategy.
56b
Landmarks Critical Care
Dr. Sherif Badrawy
115. COIITSS â COIITSS Investigators
2010 â Corticosteroids and
intensive insulin for septic shock
ăRandomizationă
57a
Landmarks Critical Care
Dr. Sherif Badrawy
116. â Randomized patients to receive
conventional (<150 mg/dL) vs.
intensive (80-11 0 mg/dL) glucose
control and
fludrocortisone 50 meg PO daily vs.
placebo x 7 days
57b
Landmarks Critical Care
Dr. Sherif Badrawy
117. COIITSS â COIITSS Investigators
2010 â Corticosteroids and
intensive insulin for septic shock
ăConclusionă
58a
Landmarks Critical Care
Dr. Sherif Badrawy
118. â Among patients with septic shock receiving
Hydrocortisone, neither intensive glucose control
nor fludrocortisone improved mortality.
Intensive glucose
control was associated with a higher incidence of
hypoglycemia and fludrocortisone with a higher
incidence of new infections.
58b
Landmarks Critical Care
Dr. Sherif Badrawy
119. LEUVEN I â van den Berghe 2002
â Intensive insulin therapy in the
SICU
ăRandomizationă
59a
Landmarks Critical Care
Dr. Sherif Badrawy
120. â Randomized patients to intensive
insulin (BG goal 80-11 0 mg/dL) or
conventional insulin (BG < 215
mg/dL)
59b
Landmarks Critical Care
Dr. Sherif Badrawy
121. LEUVEN I â van den Berghe 2002
â Intensive insulin therapy in the
SICU
ăConclusionă
60a
Landmarks Critical Care
Dr. Sherif Badrawy
122. â In surgical ICU patients (primarily
cardiac), intensive insulin therapy reduced
ICU mortality, renal impairment, and
bloodstream infections. The rate of severe
hypoglycemia was higher with intensive
insulin.
60b
Landmarks Critical Care
Dr. Sherif Badrawy
123. LEUVEN II â Intensive insulin
therapy in the MICU
ăRandomizationă
61a
Landmarks Critical Care
Dr. Sherif Badrawy
124. â Randomized patients to intensive
insulin (BG goal 80-110 mg/dL) or
conventional insulin (BG < 215 mg/dL)
â Excluded all surgical patients and those
able to receive oral nutrition
61b
Landmarks Critical Care
Dr. Sherif Badrawy
125. LEUVEN II â Intensive insulin
therapy in the MICU
ăConclusionă
62a
Landmarks Critical Care
Dr. Sherif Badrawy
126. â In patients in the medical ICU, intensive
insulin therapy did not improve mortality.
While intensive therapy may have had a
positive effect on duration of mechanical
ventilation and length of ICU stay, it was
associated with a higher incidence of
severe hypoglycemia.
62b
Landmarks Critical Care
Dr. Sherif Badrawy
127. NICE-SUGAR â Intensive insulin
therapy in the MICU/SICU
ăRandomizationă
63a
Landmarks Critical Care
Dr. Sherif Badrawy
128. â Randomized patients to intensive
control (BG 81-108 mg/dL) vs.
conventional control (<180 mg/dL)
63b
Landmarks Critical Care
Dr. Sherif Badrawy
129. NICE-SUGAR â Intensive insulin
therapy in the MICU/SICU
ăConclusionă
64a
Landmarks Critical Care
Dr. Sherif Badrawy
130. â Among critically ill patients, intensive glucose
control increased 90-day mortality and the
incidence of severe hypoglycemia compared to
conventional therapy.
â a blood glucose target of 180 mg or less per
deciliter resulted in lower mortality than did a
target of 81 to 108 mg per deciliter.
64b
Landmarks Critical Care
Dr. Sherif Badrawy
131. VISEP â Brunkhorst 2008 â
Intensive insulin and
pentastarch in severe
sepsisăRandomizationă
65a
Landmarks Critical Care
Dr. Sherif Badrawy
132. â Randomized patients to intensive
or conventional
glycemic control and either
pentastarch or lactated ringer's (LR)
for 21 days or until ICU discharge.
65b
Landmarks Critical Care
Dr. Sherif Badrawy
133. VISEP â Brunkhorst 2008 â
Intensive insulin and pentastarch in
severe sepsisăConclusionă
66a
Landmarks Critical Care
Dr. Sherif Badrawy
134. â In patients with severe sepsis or septic shock
,intensive insulin therapy was associated with a
very high hypoglycemia rate without a mortality
benefit .
Additionally, pentastarch (HES 200/0.5) causes
renal impairment and may have a dose-
dependent detrimental effect on 90-day
mortality.
66b
Landmarks Critical Care
Dr. Sherif Badrawy
135. ANDIRUILLI 2008 â High vs.
standard-dose PPI for upper Gl
bleeding ulcerăRandomizationă
67a
Landmarks Critical Care
Dr. Sherif Badrawy
136. â Randomized patients to omeprazo e or pantoprazole IV
(based on investigator preference) at either "high-dose" (80
mg bolus, then 8 mg/hr x 72 hours) or "standard-dose" (40
mg once daily). Both groups switched to an oral PPI after 72
hours (20 mg PO BID)
â Excluded severe coagulopathy (platelet < 100,000 or INR
> 1.5) and those receiving PPI therapy before index
endoscopy
67b
Landmarks Critical Care
Dr. Sherif Badrawy
137. ANDIRUILLI 2008 â High vs.
standard-dose PPI for upper Gl
bleeding ulcerăConclusionă
68a
Landmarks Critical Care
Dr. Sherif Badrawy
138. â In patients with an upper Gl bleeding
ulcer and successful endoscopic
treatment,a standard-dose IV PPI used
significantly less drug and did not result in
different rebleeding rates compared to a
high-dose infusion.
68b
Landmarks Critical Care
Dr. Sherif Badrawy
139. BESSON 1995 â Octreotide for
acute variceal bleeding
ăRandomizationă
69a
Landmarks Critical Care
Dr. Sherif Badrawy
140. â Randomized patients to
octreotide 25 mcg/hr or placebo for
five total days
69b
Landmarks Critical Care
Dr. Sherif Badrawy
141. BESSON 1995 â Octreotide for
acute variceal bleeding
ăConclusionă
70a
Landmarks Critical Care
Dr. Sherif Badrawy
142. â In patients with variceal
hemorrhage, sclerotherapy with
octreotide is more effective in
reducing rebleeding rates (but not
mortality) compared to
sclerotherapy alone.
70b
Landmarks Critical Care
Dr. Sherif Badrawy
143. LAU 2000 â PPI drip for upper Gl
bleeding ulcer ăRandomizationă
71a
Landmarks Critical Care
Dr. Sherif Badrawy
144. â Randomized patients to placebo or
omeprazole (80 mg bolus, then 8 mg/hr x
72 hours) following endoscopy.
â All patients received omeprazole 20 mg
PO daily x 8 weeks following the 72 hour
study period
71b
Landmarks Critical Care
Dr. Sherif Badrawy
145. LAU 2000 â PPI drip for upper Gl
bleeding ulcer ăConclusionă
72a
Landmarks Critical Care
Dr. Sherif Badrawy
146. â In patients with an upper Gl
bleeding ulcer, a high-dose
omeprazole infusion reduced
recurrent bleeding compared to
placebo following successful
endoscopic treatment.
72b
Landmarks Critical Care
Dr. Sherif Badrawy
147. BERNARD 2002 â Australian
hypothermia study
for out-of-hospital
arrestăRandomizationă
73a
Landmarks Critical Care
Dr. Sherif Badrawy
148. â Randomized patients to
therapeutic hypothermia (33°C) or
normothermia x 12 hrs. Both patient
groups received midazolam and
vecuronium
73b
Landmarks Critical Care
Dr. Sherif Badrawy
149. BERNARD 2002 â Australian
hypothermia study
for out-of-hospital
arrestăConclusionă
74a
Landmarks Critical Care
Dr. Sherif Badrawy
150. â Therapeutic hypothermia in
patients with out-of-hospital VF
arrest improved the incidence of
favorable discharge disposition and
a trend towards improved mortality.
74b
Landmarks Critical Care
Dr. Sherif Badrawy
151. HACA â HACA Study Group 2002
European hypothermia study for
out-of-hospital
arrestăRandomizationă
75a
Landmarks Critical Care
Dr. Sherif Badrawy
152. â Randomized patients to receive normothermia or
hypothermia (32-34°C) with cool air blanket with or
without ice packs x 24 hours, and then rewarmed
over 8 hours.
â Excluded patients responding to verbal commands
post-arrest, known preexisting coagulopathy
75b
Landmarks Critical Care
Dr. Sherif Badrawy
153. HACA â HACA Study Group 2002
European hypothermia study for
out-of-hospital
arrestăConclusionă
76a
Landmarks Critical Care
Dr. Sherif Badrawy
154. â Therapeutic hypothermia improved 6-
month neurologic outcome and mortality
among patients with out-of-hospital VT
/VF cardiac arrest. Note that hypothermia
may be associated with certain
complications, such as increased risk of
bleeding and infection.
76b
Landmarks Critical Care
Dr. Sherif Badrawy
155. TTM â Nielsen 2013 â Therapeutic
hypothermia with 33°C versus
36°CăRandomizationă
77a
Landmarks Critical Care
Dr. Sherif Badrawy
156. â Randomized patients to 33°C or 36°C using chilled fluids,
ice packs, and surface or intravascular cooling for 28 hours.
After the cooling period, both patient groups were
rewarmed at 0.5°C per hour to a temperature of 37°C
â Excluded those with unwitnessed arrest with asystole,
more than 240 minutes between return of spontaneous
circulation and trial screening, intracranial hemorrhage or
stroke, and body temperature < 30°C
77b
Landmarks Critical Care
Dr. Sherif Badrawy
157. TTM â Nielsen 2013 â Therapeutic
hypothermia with 33°C versus
36°CăConclusionă
78a
Landmarks Critical Care
Dr. Sherif Badrawy
158. â In patients with out-of-hospital
cardiac arrest with return of
spontaneous circulation, there was
no difference in longterm mortality
between therapeutic hypothermia
with 36°C and 33°C.
78b
Landmarks Critical Care
Dr. Sherif Badrawy
159. BOZZETTE 1990 â Adjunct
corticosteroids for PJP
ăRandomizationă
79a
Landmarks Critical Care
Dr. Sherif Badrawy
160. â Randomized patients to
prednisone (40 mg BID x 5 days, 40
mg daily x 5 days, 20 mg daily for
duration of antibiotic therapy
[typically 14-21 days]) or placebo
79b
Landmarks Critical Care
Dr. Sherif Badrawy
161. BOZZETTE 1990 â Adjunct
corticosteroids for PJP
ăConclusionă
80a
Landmarks Critical Care
Dr. Sherif Badrawy
162. â Adjunctive corticosteroids in patients with
AIDS and pneumocystis pneumonia improved
mortality and respiratory failure among patients
with moderate-to-severe pneumonia, although
steroid therapy increased the risk of herpes
reactivation and oral thrush.
80b
Landmarks Critical Care
Dr. Sherif Badrawy
163. CHASTER 2003 â 8 vs. 1 5 days of
antibiotics for VAP
ăRandomizationă
81a
Landmarks Critical Care
Dr. Sherif Badrawy
164. â Randomized patients to receive 8
days or 15 days of appropriate
antibiotic therapy
81b
Landmarks Critical Care
Dr. Sherif Badrawy
165. CHASTER 2003 â 8 vs. 1 5 days of
antibiotics for VAP
ăConclusionă
82a
Landmarks Critical Care
Dr. Sherif Badrawy
166. â Among patients with late-onset VAP or early-
onset VAP with recent antibiotic exposure, 8-
days was non-inferior to 15- days of appropriate
antibiotic therapy for mortality and pneumonia
recurrence. In patients with certain non-
fermenting gram negatives, a 15-day course may
be more appropriate.
82b
Landmarks Critical Care
Dr. Sherif Badrawy
167. KUMAR 2006 â Delay in
antibiotics increases
septic shock
mortalityăRandomizationă
83a
Landmarks Critical Care
Dr. Sherif Badrawy
168. â Retrospective cohort of 2,731
septic shock patients from the US
and Canada
â Onset of hypotension to first
appropriate antibiotic very delayed
(median 6 hrs, mean 13.5 hrs)
83b
Landmarks Critical Care
Dr. Sherif Badrawy
169. KUMAR 2006 â Delay in
antibiotics increases
septic shock
mortalityăConclusionă
84a
Landmarks Critical Care
Dr. Sherif Badrawy
170. â Effective antimicrobial administration within the
first hour of documented hypotension was associated
with increased survival to hospital discharge in adult
patients with septic shock. Despite a progressive
increase in mortality rate with increasing delays, only
50% of septic shock patients received effective
antimicrobial therapy within 6 hrs of documented
hypotension.[7.6% increase in mortality/ hour]
84b
Landmarks Critical Care
Dr. Sherif Badrawy
171. PROTRATA â Bouadma 2010 â
Procalcitonin algorithm for guiding
antibiotic
therapyăRandomizationă
85a
Landmarks Critical Care
Dr. Sherif Badrawy
172. â Randomized to procalcitonin (PCT) or
control groups in an open-label design
â Excluded patients who were
immunosuppressed or those with
infections requiring a long-term duration
of treatment (ie, endocarditis)
85b
Landmarks Critical Care
Dr. Sherif Badrawy
173. PROTRATA â Bouadma 2010 â
Procalcitonin algorithm for guiding
antibiotic therapyăConclusionă
86a
Landmarks Critical Care
Dr. Sherif Badrawy
174. â Use of a procalcitonin-guided
algorithm for suspected bacterial
infections reduced antibiotic
exposure but did not directly
improve patient outcomes.
86b
Landmarks Critical Care
Dr. Sherif Badrawy
175. SORT 1999 â Albumin for
spontaneous bacterial
peritonitisăRandomizationă
87a
Landmarks Critical Care
Dr. Sherif Badrawy
176. â Randomized to
cefotaxime/placebo or Cefotaxime/
albumin. Albumin 20% was given as
1.5 gm/kg at enrollment and 1
gm/kg on day 3
87b
Landmarks Critical Care
Dr. Sherif Badrawy
177. SORT 1999 â Albumin for
spontaneous bacterial
peritonitisăConclusionă
88a
Landmarks Critical Care
Dr. Sherif Badrawy
178. â Two doses of concentrated
albumin in patients with
spontaneous bacterial peritonitis
reduced renal impairment and
mortality compared to placebo.
88b
Landmarks Critical Care
Dr. Sherif Badrawy
179. Wunderink 2003 â Linezolid vs
Vancomycin for HAP
ăRandomizationă
89a
Landmarks Critical Care
Dr. Sherif Badrawy
180. â Compared linezolid 600 mg IV
Q12h vs. vancomycin 1 g IV Q12h
(adjusted to local institution's
standard of care) x 7-21 days. Both
study groups received aztreonam 1-
2g IV Q8h
89b
Landmarks Critical Care
Dr. Sherif Badrawy
181. Wunderink 2003 â Linezolid vs
Vancomycin for HAP
ăConclusionă
90a
Landmarks Critical Care
Dr. Sherif Badrawy
182. â In patients with HAP or VAP, linezolid
was associated with higher 28-day survival
compared to vancomycin in pts with
MRSA pneumonia. This survival benefit
was not seen in the entire trial cohort or
even in the S. au reus cohort.
90b
Landmarks Critical Care
Dr. Sherif Badrawy
183. Wunderink 2012 â Linezolid vs.
vancomycin for
MRSA HAPăRandomizationă
91a
Landmarks Critical Care
Dr. Sherif Badrawy
184. â Randomized patients to linezolid
600 mg IV Q12h vs. vancomycin 15
mg/kg Q12h (dosing adjusted by a
local pharmacist) for 7-14 days (21
days if concurrent
bacteremia)
91b
Landmarks Critical Care
Dr. Sherif Badrawy
185. Wunderink 2012 â Linezolid vs.
vancomycin for
MRSA HAPăConclusionă
92a
Landmarks Critical Care
Dr. Sherif Badrawy
186. â In a cohort of patients with MRSA pneumonia,
linezolid was shown to improve clinical cure rate
and cause less nephrotoxicity than vancomycin,
but it did not improve 60-day mortality. The
findings of this study may have been confounded
by unbalanced baseline characteristics.
92b
Landmarks Critical Care
Dr. Sherif Badrawy
187. de Gans 2002 â Dexamethasone for
adult bacterial
meningitisăRandomizationă
93a
Landmarks Critical Care
Dr. Sherif Badrawy
188. â Randomized patients to receive
dexamethasone 1 0 mg IV Q 6h or
placebo x 4 days. Treatment was
started 0-20 minutes PRIOR to
antibiotic administration
93b
Landmarks Critical Care
Dr. Sherif Badrawy
189. de Gans 2002 â Dexamethasone for
adult bacterial
meningitisăConclusionă
94a
Landmarks Critical Care
Dr. Sherif Badrawy
190. â Early, empiric treatment with
dexamethasone in patients with suspected
meningitis improved discharge outcome
and mortality, but this effect was only seen
among patients with confirmed
S.pneumoniae meningitis.
94b
Landmarks Critical Care
Dr. Sherif Badrawy
191. ABC â Awake and breathing
trialăRandomizationă
95a
Landmarks Critical Care
Dr. Sherif Badrawy
192. â Randomized patients to
intervention (SAT +SBT) or control
(SBT alone)
95b
Landmarks Critical Care
Dr. Sherif Badrawy
193. ABC â Awake and breathing
trialăConclusionă
96a
Landmarks Critical Care
Dr. Sherif Badrawy
194. â A sedation awakening trial (SAT) and a
spontaneous breathing trial (SBT) used together
were superior to SBT alone for reducing duration
of mechanical ventilation and 90-day mortality.
The combination of SAT +SBT was associated
with more self extubation, but not more
reintubation following self-extubation.
96b
Landmarks Critical Care
Dr. Sherif Badrawy
195. Kress 2000 â Daily interruption of
sedative infusions
ăRandomizationă
97a
Landmarks Critical Care
Dr. Sherif Badrawy
196. â All patients received morphine
infusions for analgesia, randomized
to either midazolam or propofol
infusions for sedation, and again
randomized to either "daily
interruption" or standard of care
97b
Landmarks Critical Care
Dr. Sherif Badrawy
197. Kress 2000 â Daily interruption of
sedative infusions
ăConclusionă
98a
Landmarks Critical Care
Dr. Sherif Badrawy
198. â Medical ICU patients receiving
continuous infusion sedation with daily
interruption were liberated from
mechanical ventilation and left the ICU
quicker, but this effect did not translate to
a shorter hospital course or a mortality
benefit.
98b
Landmarks Critical Care
Dr. Sherif Badrawy
199. MENDS â Pandharipande 2007 â
Dexmedetomidine vs lorazepam
ăRandomizationă
99a
Landmarks Critical Care
Dr. Sherif Badrawy
200. â Randomized patients to
dexmedetomidine (0.15 to 1.5
meg/kg/ hr) or lorazepam (1 to 1 0
mg/hr) until extubation or up to 5
days. Bolus dosing was not allowed
99b
Landmarks Critical Care
Dr. Sherif Badrawy
201. MENDS â Pandharipande 2007 â
Dexmedetomidine vs lorazepam
ăConclusionă
100a
Landmarks Critical Care
Dr. Sherif Badrawy
202. â In mechanically ventilated patients,
dexmedetomidine improved coma-free
days and time within goal level of sedation
compared to lorazepam, but required
more open-label fentanyl and had a higher
incidence of bradycardia.
100b
Landmarks Critical Care
Dr. Sherif Badrawy
203. OSCAR â Young 2013 â High-
Frequency Oscillation for
ARDSăRandomizationă
101a
Landmarks Critical Care
Dr. Sherif Badrawy
204. â Randomized patients to high-
frequency oscillation ventilation
(HFOV- Nova lung R100) or
conventional low tidal volume
mechanical ventilation.
101b
Landmarks Critical Care
Dr. Sherif Badrawy
205. OSCAR â Young 2013 â High-
Frequency Oscillation for
ARDSăConclusionă
102a
Landmarks Critical Care
Dr. Sherif Badrawy
206. â High-frequency oscillation
ventilation in patients with ARDS
did not improve mortality or length
of stay compared to conventional,
low tidal volume mechanical
ventilation.
102b
Landmarks Critical Care
Dr. Sherif Badrawy
207. OSCILLATE â Ferguson 2013 â
High-frequency oscillation for
ARDSăRandomizationă
103a
Landmarks Critical Care
Dr. Sherif Badrawy
208. â Randomized patients to high-frequency
oscillation ventilation (HFOV Sensor
Medics 3100 B) or conventional low tidal
volume mechanical ventilation.
â Both groups had specific, protocolized
titration and weaning procedures.
103b
Landmarks Critical Care
Dr. Sherif Badrawy
209. OSCILLATE â Ferguson 2013 â
High-frequency oscillation for
ARDSăConclusionă
104a
Landmarks Critical Care
Dr. Sherif Badrawy
210. â High-frequency oscillation
ventilation in patients with early
ARDS increased mortality compared
to conventional, low tidal volume
mechanical ventilation.
104b
Landmarks Critical Care
Dr. Sherif Badrawy
211. PRODEX â Jakob 2012 â
Dexmedetomidine vs.
propofolăRandomizationă
105a
Landmarks Critical Care
Dr. Sherif Badrawy
212. â Randomized patients to receive
propofol (5-66 mcg/kg /min) vs.
dexmedetomidine (0.2-1.4
mcg/kg/hr) for up to 14 days.
Loading doses were not allowed
105b
Landmarks Critical Care
Dr. Sherif Badrawy
213. PRODEX â Jakob 2012 â
Dexmedetomidine vs.
propofolăConclusionă
106a
Landmarks Critical Care
Dr. Sherif Badrawy
214. â In mechanically ventilated patients,
propofol was comparable to
dexmedetomidine with respect to time
within goal sedation, duration of
mechanical ventilation, and ICU length of
stay.
106b
Landmarks Critical Care
Dr. Sherif Badrawy
215. SEDCOM â Riker 2009 â
Dexmedetomidine vs
midazolamăRandomizationă
107a
Landmarks Critical Care
Dr. Sherif Badrawy
216. â Randomized to dexmedetomidine
0.8 mcg/kg/hr (titrated 0.2-1 .4
mcg/kg/hr) or midazolam 0.06
mg/kg/hr (titrated 0.02- 0.1
mg/kg/hr) for up to 30 days
107b
Landmarks Critical Care
Dr. Sherif Badrawy
217. SEDCOM â Riker 2009 â
Dexmedetomidine vs
midazolamăConclusionă
108a
Landmarks Critical Care
Dr. Sherif Badrawy
218. â In mechanically ventilated
patients, dexmedetomidine was
equivalent to midazolam in
achieving sedation goals, but
reduced ICU delirium and duration
of mechanical ventilation.
108b
Landmarks Critical Care
Dr. Sherif Badrawy
219. SLEAP â Mehta 2012 â Light
sedation with and
without daily
interruptionăRandomizationă
109a
Landmarks Critical Care
Dr. Sherif Badrawy
220. â Randomized patients to
protocolized sedation plus daily
interruption ("interruption" group)
or protocolized sedation alone
("control")
109b
Landmarks Critical Care
Dr. Sherif Badrawy
221. SLEAP â Mehta 2012 â Light
sedation with and
without daily
interruptionăConclusionă
110a
Landmarks Critical Care
Dr. Sherif Badrawy
222. â In mechanically ventilated patients with
a light sedation strategy, daily interruption
of sedation did not improve patient
outcomes. In fact, interruption was
associated with higher opioid and
benzodiazepine requirements.
110b
Landmarks Critical Care
Dr. Sherif Badrawy
223. STROM 2010 â Sedationless
mechanical ventilation
ăRandomizationă
111a
Landmarks Critical Care
Dr. Sherif Badrawy
224. â Randomized patients to
intervention ("no sedation") or
control (sedation with daily
interruption)
111b
Landmarks Critical Care
Dr. Sherif Badrawy
225. STROM 2010 â Sedationless
mechanical ventilation
ăConclusionă
112a
Landmarks Critical Care
Dr. Sherif Badrawy
226. â A protocol for little or no sedation
among mechanically ventilated patients
reduced the duration of mechanical
ventilation and ICU length of stay,
although it may increase the incidence of
delirium.
112b
Landmarks Critical Care
Dr. Sherif Badrawy
227. Bellomo 2001 â ANZICS Dopamine
Renally-dosing dopamine in early
renal
dysfunctionăRandomizationă
113a
Landmarks Critical Care
Dr. Sherif Badrawy
228. â Randomized patients to receive
dopamine 2 meg/kg/min or placebo
until renal replacement therapy,
death, discharge from ICU, or renal
dysfunction and SIRS resolved for>
24 hrs
113b
Landmarks Critical Care
Dr. Sherif Badrawy
229. Bellomo 2001 â ANZICS Dopamine
Renally-dosing dopamine in early
renal dysfunctionăConclusionă
114a
Landmarks Critical Care
Dr. Sherif Badrawy
230. â The use of "renal dose" dopamine
did not reduce peak creatinine, the
need for renal replacement therapy,
ICU length of stay, or mortality.
114b
Landmarks Critical Care
Dr. Sherif Badrawy
231. RENAL â RENAL Replacement
Therapy Study Investigators 2009 â
Higher vs. lower-intensity
continuous renal replacement
therapy
ăRandomizationă
115a
Landmarks Critical Care
Dr. Sherif Badrawy
232. â Randomized patients to receive
continuous venovenous
hemodiafiltration (CVVHDF) with
an effluent rate of 40 ml/kg/hr
("higherintensity") or 25 ml/kg/hr
("lower intensity")
115b
Landmarks Critical Care
Dr. Sherif Badrawy
233. RENAL â RENAL Replacement
Therapy Study Investigators 2009 â
Higher vs. lower-intensity
continuous renal replacement
therapy
ăConclusionă
116a
Landmarks Critical Care
Dr. Sherif Badrawy
234. â In patients requiring CRRT, higher-
intensity CVVHDF (40 ml/kg/hr) did not
improve any clinical endpoints compared
to lower intensity (25 ml/k /hr) therapy
but was associated with a higher filter
replacement rate and hypophosphatemia.
116b
Landmarks Critical Care
Dr. Sherif Badrawy
235. Allen 1983 â Nimodipine for
cerebral vasospasm
ăRandomizationă
117a
Landmarks Critical Care
Dr. Sherif Badrawy
236. â Randomized patients to receive
nimodipine 0.7 mg/kg PO bolus,
then 0.35 mg/kg (28 mg for 80 kg
patient) PO Q4h vs. placebo x 21
days
117b
Landmarks Critical Care
Dr. Sherif Badrawy
237. Allen 1983 â Nimodipine for
cerebral vasospasm
ăConclusionă
118a
Landmarks Critical Care
Dr. Sherif Badrawy
238. â Among patients with aneurysmal
SAH, nimodipine reduced
neurologic deficit and mortality
secondary to vasospasm.
118b
Landmarks Critical Care
Dr. Sherif Badrawy
240. â Randomized patients to low or high dose
methylprednisolone x 1 0 days. Low dose was 1
00 mg IV loading dose, then 25 mg IV Q 6h. High
dose was 1 0 times the dose (1 000 mg load, 250
mg IV Q 6h)
â Excluded nerve root or cauda equina only and
gunshot wounds
119b
Landmarks Critical Care
Dr. Sherif Badrawy
241. BrackenI â Bracken 1984 â
Methylprednisolone for acute spinal
cord injuryăConclusionă
120a
Landmarks Critical Care
Dr. Sherif Badrawy
242. â High dose methylprednisolone did not
improve neurologic outcomes compared to
low dose methylprednisolone in patients
with spinal cord injury presenting within
48 hours. High dose was associated with
more wound infections.
120b
Landmarks Critical Care
Dr. Sherif Badrawy
243. BrackenIIâ Bracken 1990 â
Methylprednisolone, naloxone for
acute spinal cord
injuryăRandomizationă
121a
Landmarks Critical Care
Dr. Sherif Badrawy
244. â Randomized patients to
methylprednisolone 30 mg/kg bolus
(over 15 min, then 45 min pause),
then 5.4 mg/kg/hr x 23 hrs,
naloxone infusion or placebo
121b
Landmarks Critical Care
Dr. Sherif Badrawy
245. BrackenIIâ Bracken 1990 â
Methylprednisolone, naloxone for
acute spinal cord
injuryăConclusionă
122a
Landmarks Critical Care
Dr. Sherif Badrawy
246. â In patients with spinal cord injury,
methylprednisolone improved motor and
sensory function if initiated within 8 hours
of initial trauma. Patients receiving
methylprednisolone may be at higher risk
for wound infections and Gl bleeding.
122b
Landmarks Critical Care
Dr. Sherif Badrawy
247. BrackenIIIâ Bracken 1997 â
Methylprednisolone, tirilazad for
acute spinal cord
injuryăRandomizationă
123a
Landmarks Critical Care
Dr. Sherif Badrawy
248. â Randomized patients to 24-hour
methylprednisolone, 48-hour
methylprednisolone, or tirilizad (lipid peroxidase
inhibitor). All patients received 20-40 mg/kg
methylprednisolone bolus
â Excluded patients> 109 kg (concern for fluid
overload), gunshot wounds
123b
Landmarks Critical Care
Dr. Sherif Badrawy
249. BrackenIIIâ Bracken 1997 â
Methylprednisolone, tirilazad for
acute spinal cord
injuryăConclusionă
124a
Landmarks Critical Care
Dr. Sherif Badrawy
250. â In patients with acute spinal cord injury presenting
within 3 hours of injury, 24- hours of
methylprednisolone was equivalent to a 48-hour
infusion. For those presenting 3-8 hours post-injury,
48-hours of methylprednisolone improved motor
function and quality of life measures compared to a
24-hour infusion. Patients with 48-hour infusions
were more likely to develop pneumonia or severe
sepsis.
124b
Landmarks Critical Care
Dr. Sherif Badrawy
251. CAST â CAST Investigators 1997 â
Early aspirin use in acute ischemic
strokeăRandomizationă
125a
Landmarks Critical Care
Dr. Sherif Badrawy
252. â Randomized to aspirin 1 60 mg
PO daily or placebo x 28 days
125b
Landmarks Critical Care
Dr. Sherif Badrawy
253. CAST â CAST Investigators 1997 â
Early aspirin use in acute ischemic
strokeăConclusionă
126a
Landmarks Critical Care
Dr. Sherif Badrawy
254. â In patients with acute ischemic
stroke, aspirin within 48 hours
reduced 28-day mortality and
recurrent ischemic stroke, although
bleeding events were rare but
slightly more common with aspirin.
126b
Landmarks Critical Care
Dr. Sherif Badrawy
255. CATIS â He 2014 â BP reduction
in ischemic stroke
ăRandomizationă
127a
Landmarks Critical Care
Dr. Sherif Badrawy
256. â Randomized patients to antihypertensive
treatment ("treatment") or usual care
("control"). Participants were encouraged to
remain hospitalized for 10 days.
â Excluded patients who received thrombolytic
therapy (TPA), diastolic BP > 120 mmHg, atrial
fibrillation, and unstable angina
127b
Landmarks Critical Care
Dr. Sherif Badrawy
257. CATIS â He 2014 â BP reduction
in ischemic stroke
ăConclusionă
128a
Landmarks Critical Care
Dr. Sherif Badrawy
258. â Among patients with ischemic
stroke who do not receive TPA,
more aggressive blood pressure
reduction during hospitalization
does not improve mortality or major
disability.
128b
Landmarks Critical Care
Dr. Sherif Badrawy
259. DECRA â Cooper 2011 â
Decompressive craniectomy in
traumatic brain injury
ăRandomizationă
129a
Landmarks Critical Care
Dr. Sherif Badrawy
260. â Randomized to bifrontotemporoparietal
decompressive craniectomy (without division of
sagittal sinus and falx cerebri) plus standard of
care or standard of care alone
â Excluded patients with dilated, unreactive
pupils and mass lesions that would normally
require surgical intervention
129b
Landmarks Critical Care
Dr. Sherif Badrawy
261. DECRA â Cooper 2011 â
Decompressive craniectomy in
traumatic brain injury
ăConclusionă
130a
Landmarks Critical Care
Dr. Sherif Badrawy
262. â Bifrontotemporoparietal decompressive
craniectomy reduces ICP in patients with
severe traumatic brain injury without mass
lesions, but does not improve (and may
worsen) functional or unfavorable
outcomes.
130b
Landmarks Critical Care
Dr. Sherif Badrawy
263. ECASS III â Hacke 2008 â
Alteplase 3 to 4.5 hours after acute
ischemic stroke
ăRandomizationă
131a
Landmarks Critical Care
Dr. Sherif Badrawy
264. â Included 821 patients presenting
between 3 and 4.5 hours of ischemic
stroke not meeting a long list of
exclusion criteria, many related to
risk of bleeding.
131b
Landmarks Critical Care
Dr. Sherif Badrawy
265. ECASS III â Hacke 2008 â
Alteplase 3 to 4.5 hours after acute
ischemic stroke
ăConclusionă
132a
Landmarks Critical Care
Dr. Sherif Badrawy
266. â In patients presenting 3 to 4.5 hours of
ischemic stroke (beyond the NINDS 3 hour
window), alteplase improved 3-month
favorable outcome (NNT 14) but increased
the rate of symptomatic ICH (NNH 48).
There were pertinent new exclusion
criteria that were not present in NINDS.
132b
Landmarks Critical Care
Dr. Sherif Badrawy
267. FAST â Mayer 2008 â rFVIIa for
acute ICH
ăRandomizationă
133a
Landmarks Critical Care
Dr. Sherif Badrawy
268. â Randomized to receive 20 or 80 mcg/kg
recombinant activated factor VII (rFVIIa) or placebo.
Treatment was given within 4 hours of symptom
onset
â Excluded deep coma (Glasgow <= 5), aneurysm, AV
malformation, trauma, known coagulopathy, and a
history of thromboembolic disease
133b
Landmarks Critical Care
Dr. Sherif Badrawy
269. FAST â Mayer 2008 â rFVIIa for
acute ICH
ăConclusionă
134a
Landmarks Critical Care
Dr. Sherif Badrawy
270. â Recombinant activated factor VII
reduced hematoma growth at 24 hours,
but did not have a clinical benefit (death
or disability at 90 days). Arterial
thromboembolic events were more
common with rFVIIa.
134b
Landmarks Critical Care
Dr. Sherif Badrawy
272. â 95 patients admitted to a
medicaiiCU for severe alcohol
withdrawal requiring at least 200
mg diazepam in 4 hours or a single
dose of 40 mg diazepam
135b
Landmarks Critical Care
Dr. Sherif Badrawy
273. GOLD 2007 â Adjunct
phenobarbital for
delirium tremens
ăConclusionă
136a
Landmarks Critical Care
Dr. Sherif Badrawy
274. â A protocol emphasizing escalating
diazepam doses and adjunct phenobarbital
in severe alcohol withdrawal reduced the
need for mechanical ventilation compared
to no treatment protocol.
136b
Landmarks Critical Care
Dr. Sherif Badrawy
275. NINDS 1995 â Alteplase within 3
hours for acute ischemic stroke
ăRandomizationă
137a
Landmarks Critical Care
Dr. Sherif Badrawy
276. â Included 624 patients presenting within
3 hours of ischemic stroke not meeting a
long list of exclusion criteria, many related
to risk of bleeding. There was no
exclusion on the basis of severity of stroke
or maximum age.
137b
Landmarks Critical Care
Dr. Sherif Badrawy
277. NINDS 1995 â Alteplase within 3
hours for acute ischemic stroke
ăConclusionă
138a
Landmarks Critical Care
Dr. Sherif Badrawy
278. â In patients presenting within 3 hours of
ischemic stroke, alteplase improved 3- month
neurological function (NNT=9) but did not
impact 24-hour symptoms or mortality. In
patients receiving alteplase, approximately one-
quarter had minor bleeding, and 6.4% had
symptomatic ICH (NNH=17).
138b
Landmarks Critical Care
Dr. Sherif Badrawy
279. Pickard 1989 â British aneurysm
nimodipine trial
ăRandomizationă
139a
Landmarks Critical Care
Dr. Sherif Badrawy
280. â patients with aneurysmal (non-
traumatic) subarachnoid
hemorrhage within 96 hour.
Randomized patients to nimodipine
60 mg PO Q4h or placebo x 21 days
139b
Landmarks Critical Care
Dr. Sherif Badrawy
281. Pickard 1989 â British aneurysm
nimodipine trial
ăConclusionă
140a
Landmarks Critical Care
Dr. Sherif Badrawy
282. â Nimodipine reduced cerebral
infarction and 3-month functional
outcomes in patients with
aneurysmal subarachnoid
hemorrhage.
140b
Landmarks Critical Care
Dr. Sherif Badrawy
283. Temkin1990 â Phenytoin for post-
traumatic seizure prophylaxis
ăRandomizationă
141a
Landmarks Critical Care
Dr. Sherif Badrawy
284. â Randomized patients to receive
phenytoin (20 mg/kg load then
daily doses adjusted based on levels)
or placebo x 12 months. Goal
phenytoin levels were 10-20 mcg/ml
(total) and 0.75-1.5 mcg/ml (free)
141b
Landmarks Critical Care
Dr. Sherif Badrawy
285. Temkin1990 â Phenytoin for post-
traumatic seizure prophylaxis
ăConclusionă
142a
Landmarks Critical Care
Dr. Sherif Badrawy
286. â In patients with severe head
injury, phenytoin reduced seizures
within the first 7 days, but had no
effect in preventing late onset
seizures.
142b
Landmarks Critical Care
Dr. Sherif Badrawy
287. Temkin1999 â Valproate for post-
traumatic seizure prophylaxis
ăRandomizationă
143a
Landmarks Critical Care
Dr. Sherif Badrawy
288. â Randomized patients to receive
phenytoin for 1 week, valproate for 1
month, or valproate for 6 months
143b
Landmarks Critical Care
Dr. Sherif Badrawy
289. Temkin 1999 â Valproate for post-
traumatic seizure prophylaxis
ăConclusionă
144a
Landmarks Critical Care
Dr. Sherif Badrawy
290. â In patients with severe head
injury, valproate does not provide
any benefit over phenytoin in
reducing early or late seizures and
may increase 2-year mortality.
144b
Landmarks Critical Care
Dr. Sherif Badrawy
291. Treiman 1998 â Comparison of four
treatments for status epilepticus
ăRandomizationă
145a
Landmarks Critical Care
Dr. Sherif Badrawy
292. â Randomized to receive lorazepam
(0.1 mg/kg), phenobarbital (15
mg/kg), phenytoin (18 mg/kg), or
diazepam (0.15 mg/kg) with
phenytoin (18 mg/kg)
145b
Landmarks Critical Care
Dr. Sherif Badrawy
293. Treiman 1998 â Comparison of four
treatments for status epilepticus
ăConclusionă
146a
Landmarks Critical Care
Dr. Sherif Badrawy
294. â In patients with overt status epilepticus,
lorazepam was superior to phenytoin but
equivalent to phenobarbital or phenytoin/
diazepam. No agent showed superior
efficacy for subtle status, which had much
worse outcomes compared to overt status.
146b
Landmarks Critical Care
Dr. Sherif Badrawy
295. Devlin 2010 â Quetiapine for ICU
delirium
ăRandomizationă
147a
Landmarks Critical Care
Dr. Sherif Badrawy
296. â Randomized patients to quetiapine or placebo
until delirium has resolved, 10 days had elapsed,
or ICU discharge
â Excluded 86% of screened patients (222/ 258)
limiting external validity and potentially
underpowering any secondary efficacy or safety
analyses
147b
Landmarks Critical Care
Dr. Sherif Badrawy
297. Devlin 2010 â Quetiapine for ICU
delirium
ăConclusionă
148a
Landmarks Critical Care
Dr. Sherif Badrawy
298. â Quetiapine may result in a faster
resolution of delirium and prevent
additional episodes of delirium,
although this effect does not translate
to a shorter length of stay or
mortality benefit.
148b
Landmarks Critical Care
Dr. Sherif Badrawy
299. ACURASYS â Papazian 2010 â
Cisatracurium for early ARDS
ăRandomizationă
149a
Landmarks Critical Care
Dr. Sherif Badrawy
300. â Randomized to placebo vs.
cisatracurium (15 mg bolus+ 37.5
mg/hr x 48 hrs)
149b
Landmarks Critical Care
Dr. Sherif Badrawy
301. ACURASYS â Papazian 2010 â
Cisatracurium for early ARDS
ăConclusionă
150a
Landmarks Critical Care
Dr. Sherif Badrawy
302. â In patients with severe ARDS,
cisatracurium for 48 hours
decreased 90- day mortality,
although the analysis was limited by
unbalanced baseline characteristics.
150b
Landmarks Critical Care
Dr. Sherif Badrawy
303. ARDS Net 2000 â Lower tidal
volumes for ARDS
ăRandomizationă
151a
Landmarks Critical Care
Dr. Sherif Badrawy
304. â Randomized traditional tidal
volume (12 ml/kg ideal weight) or
lower tidal volume (6 ml/kg ideal
weight)
151b
Landmarks Critical Care
Dr. Sherif Badrawy
305. ARDS Net 2000 â Lower tidal
volumes for ARDS
ăConclusionă
152a
Landmarks Critical Care
Dr. Sherif Badrawy
306. â In patients with All/ ARDS, lower
tidal volume mechanical ventilation
improved mortality compared to
traditional tidal volumes.
152b
Landmarks Critical Care
Dr. Sherif Badrawy
307. Bouchard 2005 â Noninvasive
ventilation for
acute COPD exacerbation
ăRandomizationă
153a
Landmarks Critical Care
Dr. Sherif Badrawy
308. â Randomized patients to standard therapy
(oxygen up to 5 L/min with bronchodilators) or
standard therapy with period of noninvasive
ventilation (NIV) via facemask for at least 6 hours
per day
â Patients requiring immediate intubation were
excluded.
153b
Landmarks Critical Care
Dr. Sherif Badrawy
309. Bouchard 2005 â Noninvasive
ventilation for
acute COPD exacerbation
ăConclusionă
154a
Landmarks Critical Care
Dr. Sherif Badrawy
310. â Among a selected group of patients
with acute COPD exacerbation who
do not require immediate intubation,
noninvasive ventilation reduced the
need for endotracheal intubation,
length of stay, and mortality.
154b
Landmarks Critical Care
Dr. Sherif Badrawy
311. CESAR â Peek 2009 â
Conventional vent support vs.
ECMO for ARDS
ăRandomizationă
155a
Landmarks Critical Care
Dr. Sherif Badrawy
312. â Randomized to conventional ventilator
management or referral to Glenfield Hospital
with the intent to initiate ECMO (extracorporeal
membrane oxygenation)
â Excluded those with peak inspiratory pressure
> 30 or Fi02 > 80% for more than 7 days or
those with contra indications to anticoagulation
155b
Landmarks Critical Care
Dr. Sherif Badrawy
313. CESAR â Peek 2009 â
Conventional vent support vs.
ECMO for ARDS
ăConclusionă
156a
Landmarks Critical Care
Dr. Sherif Badrawy
314. â In patients with early ARDS,
transfer to a facility specializing in
ARDS with the ability to initiate
ECMO was associated with an
improvement in 6-month survival
without severe disability.
156b
Landmarks Critical Care
Dr. Sherif Badrawy
315. Esteban 2004 â Noninvasive
ventilation after
extubation failure
ăRandomizationă
157a
Landmarks Critical Care
Dr. Sherif Badrawy
316. â Randomized patients to medical
therapy (supplemental oxygen,
respiratory physiotherapy,
bronchodilators) or noninvasive
positive pressure ventilation with a
full facial mask
157b
Landmarks Critical Care
Dr. Sherif Badrawy
317. Esteban 2004 â Noninvasive
ventilation after
extubation failure
ăConclusionă
158a
Landmarks Critical Care
Dr. Sherif Badrawy
318. â In patients with the onset of respiratory
failure after extubation, noninvasive
positive-pressure ventilation was
associated with increased mortality, likely
due to delayed reintubation, compared to
conventional medical therapy.
158b
Landmarks Critical Care
Dr. Sherif Badrawy
319. FACCT â ARDS Net 2006 â
Conservative vs. liberal fluid
management in ARDS
ăRandomizationă
159a
Landmarks Critical Care
Dr. Sherif Badrawy
320. â Randomized conservative (net
even balance) vs. liberal (fluid-
positive) fluid management
strategies according to a strict
treatment protocol
159b
Landmarks Critical Care
Dr. Sherif Badrawy
321. FACCT â ARDS Net 2006 â
Conservative vs. liberal fluid
management in ARDS
ăConclusionă
160a
Landmarks Critical Care
Dr. Sherif Badrawy
322. â Compared to liberal fluid
management in All/ ARDS,
conservative strategies did not
improve 60-day mortality, but did
improve ventilator-free days and
ICU length of stay.
160b
Landmarks Critical Care
Dr. Sherif Badrawy
323. Meduri 1998 â Meduri protocol for
unresolving ARDS
ăRandomizationă
161a
Landmarks Critical Care
Dr. Sherif Badrawy
324. â Included 24 patients with ARDS who did not have improving lung
injury scores after 7 days, randomized 2:1 to methylprednisolone or
placebo
â Meduri 1998 methylprednisolone protocol (unresolving ARDS):
Doses given as IV infusions and divided into Q 6h. Once able to take
PO, doses given as single oral doses. Protocol: 2 mg/kg loading dose,
then 2 mg/kg/day (days 0- 14), then 1 mg/kg/day (days 15-21), then
0.5 mg/kg/day (days 22-28), then 0.25 mg/kg/day (days 29-30),
then 0.125 mg/ kg/day (days 31-32). If extubated prior to day 14,
treatment was advanced to day 15 of therapy.
161b
Landmarks Critical Care
Dr. Sherif Badrawy
325. Meduri 1998 â Meduri protocol for
unresolving ARDS
ăConclusionă
162a
Landmarks Critical Care
Dr. Sherif Badrawy
326. â Prolonged, low-dose
methylprednisolone in unresolving ARDS
improved ICU survival and lung function;
however, some experts believe that larger
studies are necessary in order to
characterize the efficacy and safety of this
regimen in unresolving ARDS.
162b
Landmarks Critical Care
Dr. Sherif Badrawy
327. Meduri 2007 â Meduri protocol for
early ARDS
ăRandomizationă
163a
Landmarks Critical Care
Dr. Sherif Badrawy
328. â Included 91 patients with ARDS onset within 72 hours,
randomized to methylprednisolone or placebo
â Meduri 2007 methylprednisolone protocol (early ARDS).
Doses given as IV infusions once daily. Once able to take PO,
doses were given as single oral doses. Protocol: 1 mg/kg
loading dose, then 1 mg/kg/day (days 0-14), then 0.5
mg/kg/day (days 15-21 ), then 0.25 mg/ kg/day (days 22-25),
then 0.125 mg/kg/ day (days 26-28). If extubated prior to
day 14, treatment was advanced to day 15 of therapy
163b
Landmarks Critical Care
Dr. Sherif Badrawy
329. Meduri 2007 â Meduri protocol for
early ARDS
ăConclusionă
164a
Landmarks Critical Care
Dr. Sherif Badrawy
330. â Prolonged, low-dose
methylprednisolone in early ARDS
improved lung function, duration of
mechanical ventilation, ICU length
of stay, and ICU survival.
164b
Landmarks Critical Care
Dr. Sherif Badrawy
331. PROSEVA â Guerin 2013 â Prone
positioning in severe
ARDS
ăRandomizationă
165a
Landmarks Critical Care
Dr. Sherif Badrawy
332. â Included 466 patients with early (within 36 hours of
ARDS criteria), severe (Pa02:Fi02 < 150 mmHg) ARDS
â After a 12-24 hour stabilization period to verify inclusion
criteria, randomized patients to supine positioning (control)
or prone positioning (treatment) for up to 28 days. Many
other factors in ARDS management (mechanical ventilator
adjustments, weaning, sedation, and paralytics) were
protocolized
165b
Landmarks Critical Care
Dr. Sherif Badrawy
333. PROSEVA â Guerin 2013 â Prone
positioning in severe
ARDS
ăConclusionă
166a
Landmarks Critical Care
Dr. Sherif Badrawy
334. â In patients with early, severe
ARDS, prone positioning for at least
16 hours per day significantly
reduced mortality.
166b
Landmarks Critical Care
Dr. Sherif Badrawy
335. Yang 1991 â Rapid shallow
breathing index
to predict weaning failure
ăRandomizationă
167a
Landmarks Critical Care
Dr. Sherif Badrawy
336. â Physicians were blinded to study
design the decision to extubate was
made solely based on the physician's
clinical
judgment
167b
Landmarks Critical Care
Dr. Sherif Badrawy
337. Yang 1991 â Rapid shallow
breathing index
to predict weaning failure
ăConclusionă
168a
Landmarks Critical Care
Dr. Sherif Badrawy
338. â In mechanically ventilated medical
ICU patients, a rapid shallow breathing
index (RSBI or f/Vt) cut-off of 100
breaths/min/L was the most sensitive
and specific
objective measure of extubation success.
168b
Landmarks Critical Care
Dr. Sherif Badrawy
339. Niewoehner 1999 â Steroids for
COPD exacerbations
ăRandomizationă
169a
Landmarks Critical Care
Dr. Sherif Badrawy
340. â Randomized patients within 1 2 hours of
presentation to long-term steroids (8
weeks), short-term steroids (2 weeks), or
placebo
Excluded those with asthma or
corticosteroid use in past 30 days
169b
Landmarks Critical Care
Dr. Sherif Badrawy
341. Niewoehner 1999 â Steroids for
COPD exacerbations
ăConclusionă
170a
Landmarks Critical Care
Dr. Sherif Badrawy
342. â In patients with COPD exacerbations,
corticosteroids decreased treatment failure and
hospital length of stay but increased
hyperglycemia and showed a trend towards more
non-COPD hospitalizations. There was no
difference between a 2-week and 8-week
corticosteroid regimen.
170b
Landmarks Critical Care
Dr. Sherif Badrawy
343. TracMan â Young 2013 â Early vs.
late tracheostomy
ăRandomizationă
171a
Landmarks Critical Care
Dr. Sherif Badrawy
344. â Randomized patients to receive
early (within 4 days of ICU
admission) or late (day 10 or later)
tracheostomy
171b
Landmarks Critical Care
Dr. Sherif Badrawy
345. TracMan â Young 2013 â Early vs.
late tracheostomy
ăConclusionă
172a
Landmarks Critical Care
Dr. Sherif Badrawy
346. â In patients likely to require at least 7
days of mechanical ventilation, early
tracheostomy did not improve mortality
but was associated with a higher rate of
unnecessary tracheostomy compared to
late tracheostomy.
172b
Landmarks Critical Care
Dr. Sherif Badrawy
347. CRASH-2 Collaborators 2010 â
Tranexamic acid in trauma patients
ăRandomizationă
173a
Landmarks Critical Care
Dr. Sherif Badrawy
348. â Randomized to receive
tranexamic acid (1 gm loading dose
over 1 0 minutes, then 1 gm infusion
over 8 hrs) or placebo
173b
Landmarks Critical Care
Dr. Sherif Badrawy
349. CRASH-2 Collaborators 2010 â
Tranexamic acid in trauma patients
ăConclusionă
174a
Landmarks Critical Care
Dr. Sherif Badrawy
350. â Tranexamic acid reduced all-
cause mortality in a broad
population of trauma patients
without an increase in vascular
occlusion complications.
174b
Landmarks Critical Care
Dr. Sherif Badrawy
351. CALORIES â Harvey 2014 â Early
enteral vs. parenteral nutrition
ăRandomizationă
175a
Landmarks Critical Care
Dr. Sherif Badrawy
352. â Randomized patients to either 25
kcal/kg of parenteral or enteral
nutrition for 5 total days (or until
transition to exclusive oral feeding or
ICU discharge)
175b
Landmarks Critical Care
Dr. Sherif Badrawy
353. CALORIES â Harvey 2014 â Early
enteral vs. parenteral nutrition
ăConclusionă
176a
Landmarks Critical Care
Dr. Sherif Badrawy
354. â Among a heterogeneous ICU
patient population, there was no
difference in mortality between
exclusive enteral and parenteral
nutrition support.
176b
Landmarks Critical Care
Dr. Sherif Badrawy
355. TRISS â Holst 2014 â Low vs. high
blood transfusion threshold in septic
shock
ăRandomizationă
177a
Landmarks Critical Care
Dr. Sherif Badrawy
356. â Randomized patients to a low (7
g/ dL) or high (9 g/ dL) transfusion
threshold for the duration of the ICU
stay. All transfusions were single
unit with leukoreduced red cells.
177b
Landmarks Critical Care
Dr. Sherif Badrawy
357. TRISS â Holst 2014 â Low vs. high
blood transfusion threshold in septic
shock
ăConclusionă
178a
Landmarks Critical Care
Dr. Sherif Badrawy
358. â In patients with septic shock, there was
no difference in mortality with a lower (7
g/ dL) transfusion threshold compared to
a higher (9 g/ dL) threshold. A lower
threshold was associated with less use of
blood transfusions.
178b
Landmarks Critical Care
Dr. Sherif Badrawy
359. ARISE 2014 â Early goal-directed
therapy versus usual care in early
septic shock
ăRandomizationă
179a
Landmarks Critical Care
Dr. Sherif Badrawy
360. â Randomized patients to a low (7 g/dL) or
high (9 g/dl) transfusion threshold for the
duration of the ICU stay. All transfusions
were single unit with leukoreduced red cells.
â Excluded patients with active bleeding or
acute coronary syndromes
179b
Landmarks Critical Care
Dr. Sherif Badrawy
361. ARISE 2014 â Early goal-directed
therapy versus usual care in early
septic shock
ăConclusionă
180a
Landmarks Critical Care
Dr. Sherif Badrawy
362. â Among patients with early septic shock
in the emergency department, there was
no difference in mortality between usual
care(without SCv02) and early goal-
directed therapy (based on the Rivers
2001 protocol).
180b
Landmarks Critical Care
Dr. Sherif Badrawy