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General Critical Care
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Vasodilators for Acute Heart Failure — A Systematic Review with Meta-Analysis | NEJM Evidence
This systematic review and meta-analysis evaluated the effects of vasodilators in acute heart failure through 46 RCTs involving 28,374 patients. Vasodilators did not significantly reduce all-cause mortality (RR, 0.95; 95% CI, 0.87-1.04; P=0.26). There was no significant difference in serious adverse events (RR, 1.01; 95% CI, 0.97-1.05) or length of hospital stay (mean difference, –0.10 days; 95% CI, –0.28 to 0.08).
However, vasodilators were associated with a lower risk of tracheal intubation (RR, 0.54; 95% CI, 0.30-0.99).
Vasodilators for Acute Heart Failure — A Systematic Review with Meta-Analysis | NEJM Evidence
Mazen Kherallah
Jul 22
This comprehensive synthesis revealed no statistical difference in primary outcomes between vasodilator and control groups. The heterogeneity in patient populations and variability in LV ejection fraction likely influenced results. Future research should target specific phenotypes, considering parameters like systolic BP, mitral regurgitation, and concomitant therapies, to identify subgroups that may benefit from vasodilators. I think patient with conditions that increase arterial elastance would still benefit from vasodilator therapy.
Edited
Atrial fibrillation (AF) is observed to be 15 times more common in patients with cirrhosis compared to the general population. Despite this high incidence, individuals with cirrhosis have been systematically excluded from randomized clinical trials evaluating anticoagulants in AF patients. To address this gap, researchers utilized two extensive U.S. insurance databases comprising nearly 25,000 patients with cirrhosis and new-onset nonvalvular AF. They conducted a propensity score–matched comparison between patients who began treatment with apixaban and those who initiated either rivaroxaban or warfarin.
Which anticoagulant do you use for atrial fibrillation in patients with cirrhosis
0%Warfarin
0%Apixaban
0%Rivaroxaban
The findings revealed that patients treated with apixaban had a significantly lower risk of major bleeding compared to those treated with rivaroxaban (5.1% vs. 8.7% annually) or warfarin (5.1% vs. 7.9% annually). There were no observed differences in the rates of ischemic embolic events (such as stroke) or all-cause mortality among the different oral anticoagulant groups.
This retrospective study, which emulates a randomized study design through the use…
Videolaryngoscope versus conventional technique for insertion of a transesophageal echocardiography probe in intubated ICU patients (VIDLARECO trial): A randomized control trial
In a clinical trial with 100 intubated critically ill patients, using a videolaryngoscope for transesophageal echocardiogram probe insertion resulted in a higher first-attempt success rate (90% vs. 58%) and overall success rate (100% vs. 72%) compared to conventional techniques. It also reduced pharyngeal complications (14% vs. 52%).
https://www.sciencedirect.com/science/article/abs/pii/S2352556824000043
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- Hussain Al-shabib
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Thank you for posting this summary. it is probably sealing options to conisder any kind of thrombolytics in catheter directed approach of therapies for submassive PE. An interesting question would be which catheter directed thrombectomy is preferred.