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Mortality in patients with high-risk pulmonary embolism (PE) in the United States increased over the last decade. Surprised? Here’s why this might be true, and what we should do about it.

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A prospective study by the PERT Consortium found an in-hospital mortality rate of 20% in patients with high-risk PE. 41.9% of patients with high-risk PE were treated with advanced therapies (systemic thrombolytics, catheter-directed thrombolysis or embolectomy, surgical embolectomy, ECMO).

Source
Contemporary Management and Outcomes of Patients With High-Risk Pulmonary Embolism. J Am Coll Cardiol. 2024;83(1):35-43. doi:10.1016/j.jacc.2023.10.026

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In patients with suspected acute poisoning who are comatose, a more restrictive intubation approach where intubation is withheld unless an accompanying emergent indication is present, may lead to fewer ICU admissions, decreased ICU length of stay, and decreased requirement for mechanical ventilation, with fewer adverse events.

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Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning: A Randomized Clinical Trial. JAMA. 2023 Dec 19;330(23):2267-2274. doi: 10.1001/jama.2023.24391.

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A conservative (SpO₂ 88-92%) oxygenation target resulted in a small but significant greater probability of better outcome compared to a liberal (SpO₂ >94%) target in children admitted to the PICU on invasive mechanical ventilation.

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Conservative versus liberal oxygenation targets in critically ill children (Oxy-PICU): a UK multicentre, open, parallel-group, randomised clinical trial. Lancet. 2023 Dec 1:S0140-6736(23)01968-2. doi: 10.1016/S0140-6736(23)01968-2. Epub ahead of print.

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High-dose nitroglycerin improves outcomes in patients with sympathetic crashing acute pulmonary edema (SCAPE) without significant side effects when compared to low-dose nitroglycerin.

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Today we are covering a new, joint scientific statement from the American Heart Association and Neurocritical Care Society regarding care of patients who suffered cardiac arrest and subsequently had ROSC.

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Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement From the American Heart Association and Neurocritical Care Society. Circulation. 2023 Nov 28. doi: 10.1161/CIR.0000000000001163. Online ahead of print.

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These are the top articles from 2023. Enjoy!

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The use of balanced crystalloid (PlasmaLyte A) rather than normal saline (0.9% sodium chloride) reduced acute kidney injury and improved other outcomes in these pediatric patients with septic shock.

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Multiple Electrolytes Solution Versus Saline as Bolus Fluid for Resuscitation in Pediatric Septic Shock: A Multicenter Randomized Clinical Trial. Crit Care Med. 2023 Nov 1;51(11):1449-1460. doi: 10.1097/CCM.0000000000005952. Epub 2023 Jun 9.

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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). 

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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. 

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Advanced statistics emulating clinical trial protocols from an ICU database did not identify consistent differences in 30-day mortality when ICU patients were intubated early (within 8 hours of admission) or late (after 48 hours).

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Emulating Target Trials Comparing Early and Delayed Intubation Strategies. Chest. 2023 Oct;164(4):885-891. doi: 10.1016/j.chest.2023.04.048. Epub 2023 May 5.