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Protocolized early goal-directed therapy initiated in the ED in severe sepsis and septic shock patients improved resuscitation parameters and reduced mortality.
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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.
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The use of “renal dose” dopamine did not reduce peak creatinine, the need for renal replacement therapy, ICU length of stay, or mortality.
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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.
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Therapeutic hypothermia in patients with out-of-hospital VF arrest improved the incidence of favorable discharge disposition and a trend towards improved mortality.
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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.
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Tranexamic acid reduced all-cause mortality in a broad population of trauma patients without an increase in vascular occlusion complications.
Recommend taking at least one antihypertensive medication at night. This simple, cost-effective intervention was recently shown in the MAPEC trial to modestly reduce cardiovascular events and mortality.
As it turns out, patients with ARDS should be belly sleepers. The PROSEVA trial, freshly published in NEJM, examined the role of prone positioning in patients with early, severe acute respiratory distress syndrome (ARDS).
Voluven (hydroxyethyl starch 130/0.4) was heralded to the hospital community as a cheaper alternative to albumin, but safer than previous hydroxyethyl starch (HES) products that were shown to cause bleeding and renal failure.
Although Voluven is likely “safer” than older HES products, it still is NOT safer than traditional volume repletion with normal saline or albumin. It was a good run, Voluven, but it’s time to pull the plug.