General Critical Care

Hepatology (lww.com)

A 47-year-old man with past medical history significant for tobacco use, prior alcohol use, presumed COPD, and recent evaluation for a possible esophageal mass status post EGD on 7/22 with findings of stenosis and circumferential ulceration involving the distal esophagus status post dilation and biopsy.

Patient was admitted on 7/29 for acute hypoxic respiratory failure, ARDS, and septic shock with findings of left-sided pleural effusion and pneumothorax confirmed to be esophageal perforation. S/P chest tubes, EGD, and stenting.

CT of the chest confirming extravasation of water-soluble contrast from the left lateral wall of the esophagus at the level of the GE junction.

The area of extravasation distal esophigus

https://journals.lww.com/hep/abstract/9900/tranexamic_acid_in_upper_gastrointestinal_bleed_in.771.aspx

Role of Terlipressin in Patients With Hepatorenal Syndrome-Acute Kidney Injury Admitted to the ICU: A Substudy of the CONFIRM Trial

1. 📚 This research is a post hoc analysis of the CONFIRM trial, focusing on the use of terlipressin in ICU patients with hepatorenal syndrome-acute kidney injury (HRS-AKI). 💊

2. 👥 Of the 300 patients randomized in the original CONFIRM study, 31 of the 199 patients in the terlipressin group and 14 of the 101 in the placebo group received ICU care. 🏥

3. 📊 The primary endpoints were changes in renal function, the need for organ support such as renal replacement therapy (RRT), and ICU length of stay (LOS). 🎯

4. 📉 Patients in the terlipressin group had larger improvements in renal function compared to the placebo group (-0.7 vs +0.2mg/dL; p = 0.001). 📈

5. 🧪 The need for RRT was not significantly different between the two groups (10/31 (32%) in terlipressin vs.…

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