Critical Care

Ketamine vs Etomidate RCT- Which Causes Higher SOFA Score? 

Spoon Feed
This single center RCT found no difference in maximum Sequential Organ Failure Assessment (SOFA) score between critically ill adult ED patients receiving ketamine vs etomidate for rapid sequence intubation (RSI). 

Source
The Effect of Ketamine Versus Etomidate for Rapid Sequence Intubation on Maximum Sequential Organ Failure Assessment Score: A Randomized Clinical Trial. The Journal of Emergency Medicine, Volume 65, Issue 5, 2023, Pages e371-e382, ISSN 0736-4679, https://doi.org/10.1016/j.jemermed.2023.06.009. 

High or Low Fluid Volume in Sepsis? New Meta-analysis

Spoon Feed
This updated systematic review and meta-analysis showed no statistically significant difference in all-cause mortality or serious adverse events in sepsis patients given low vs higher fluid volumes.

Source
Lower vs Higher Fluid Volumes in Adult Patients With Sepsis: An Updated Systematic Review With Meta-Analysis and Trial Sequential Analysis. Chest. 2023 Oct;164(4):892-912. doi: 10.1016/j.chest.2023.04.036. Epub 2023 May 2.

ACORN RCT – Piperacillin-Tazobactam or Cefepime?

Spoon Feed
In this randomized control trial of patients receiving cefepime or piperacillin-tazobactam, there was no difference in risk of acute kidney injury between the two groups. However, those who received cefepime were more likely to have neurologic side effects.

Source
Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection: The ACORN Randomized Clinical Trial. JAMA. 2023 Oct 14:e2320583. doi: 10.1001/jama.2023.20583. Online ahead of print.

How Useful Is Lactate Clearance Anyway?

Spoon Feed
Don’t hang your hat on lactate clearance to assess therapeutic response to resuscitation in sepsis; there are too many confounders, and initial clearance does not necessarily project clinical course.

Source
Initial Lactate Clearance Is Confounded Highly by Comorbidities and Poorly Predicts Subsequent Lactate Trajectory. Chest. 2023 Sep;164(3):667-669. doi: 10.1016/j.chest.2023.04.023. Epub 2023 Apr 20.

How to Manage Blast Injuries

Spoon Feed
Blast injuries combine common polytrauma mechanisms – blunt, penetrating, burns – with the unique pathophysiology of blast wave injuries, and mass casualty scenarios. While rare, these patients are resource-intensive, prone to delayed yet rapid clinical deterioration, and carry high morbidity and mortality.

Source
High risk and low prevalence diseases: Blast injuries. Am J Emerg Med. 2023 Aug;70:46-56. doi: 10.1016/j.ajem.2023.05.003. Epub 2023 May 5.

Scroll to Top