The New England Journal of Medicine released three landmark trials this week. Each trial directly addresses controversies in sepsis management that have been debated for a decade or longer: high versus low MAP goals (SEPSISPAM), a challenge to early goal-directed therapy (ProCESS), and albumin replacement (ALBIOS).
These trials will undoubtedly have a significant impact on future sepsis guidelines from SCCM, which is incredibly exciting. Perhaps even more exciting is to see the dramatic improvement in early sepsis mortality between Rivers in 2001 (30.5 to 46.5%) and ProCESS (18.2 to 21%).
In pouring through each of these trials to provide a timely update to the ICU Trials mobile application, I was absolutely shocked by the failure of the peer review process in the ALBIOS trial.
The newest ACC/AHA ASCVD Pooled Cohort Equations has been a very hot topic lately. Our free web-based ASCVD tool and mobile applications have been very well received. A number of ClinCalc readers have asked for a better understanding of the Pooled Cohort Equations — how is an ASCVD calculated? How “strong” is each risk factor?
To help clinicians understand the new Pooled Cohort Equations, we’ve released a fantastic new visualization and graphing tool. The tool is intended for the advanced clinician who wants to delve deeper into the equations and visualize the tool in a novel, interactive way.
At ClinCalc, we’re very proud to announce the availability of both a web-based 10-year ASCVD Risk Calculator (also termed the Pooled Cohort Equations Calculator). This risk assessment tool is recommended by the newly published 2013 ACC/AHA cholesterol guidelines to estimate 10-year risk of atherosclerotic cardiovascular disease (ASCVD).
We’ve been working hard behind the scenes in preparation for American Pharmacists Month. To celebrate, we’re rolling out four new clinical tools and calculators on ClinCalc.com:
- Benzodiazepine Equivalence Calculator
- Enteral and Parenteral Nutrition Summary
- Number Needed to Treat
- Odds Ratio to Risk Ratio Conversion
Summary of the Kumar 2006 Trial
Among patients with septic shock, every hour of delay in appropriate antibiotic administration was associated with a significant increase in mortality.
Summary of the CORTICUS Trial (Sprung 2008)
Hydrocortisone therapy did not improve outcomes among patients with septic shock (onset within 72 hours), although it did shorten the duration of vasopressor dependence.
Summary of the Annane 2002 Trial
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 in all patients (regardless of stim test response).
Summary of the NICE-SUGAR Trial
Among critically ill patients, intensive glucose control increased 90-day mortality and the incidence of severe hypoglycemia compared to conventional therapy.
Summary of the Leuven I (van den Berghe 2002) Trial
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.
Summary of the NINDS Trial
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).