General Critical Care

Phase-3 trial of recombinant human alkaline phosphatase for patients with sepsis-associated acute kidney injury (REVIVAL) | Intensive Care Medicine (springer.com)

Ilofotase alfa, a human recombinant alkaline phosphatase with potential reno-protective effects, was evaluated for efficacy and safety in the REVIVAL phase-3 trial involving sepsis-associated acute kidney injury (SA-AKI) patients. The trial was a double-blinded, randomized-controlled study focusing on patients with SA-AKI, enrolled within 72 hours of vasopressor use and 24 hours of AKI onset. Its primary goal was to assess 28-day all-cause mortality, with secondary goals including the Major Adverse Kidney Events within 90 days (MAKE90), days alive and free of organ support, days alive and out of the ICU by day 28, and time to death by day 90.

The trial involved 650 patients (330 treated with ilofotase alfa and 319 with a placebo). The 28-day and 90-day mortality rates were similar in both groups (27.9% and 33.9% for…

Unveiling the Impact of Corticosteroids in Community-Acquired Pneumonia: A Comprehensive Meta-Analysis

A 49-year-old male noted an enlarged lymph node in his right axilla. He had no constitutional symptoms. The node was firm and moveable and slightly tender to palpation. The rest of his exam was unremarkable except for multiple small, healing, linear scratches on both hands that he said were from a new kitten, and a 2 mm papular lesion on the dorsum of his right hand which he hadn’t noticed. A CBC and chest x-ray were normal.

Because of his anxiety about a possible malignancy, the node was resected. Pathology demonstrated granulomas with neutrophilic abscesses in granuloma centers and was read as consistent with “necrotizing granulomatous lymphadenitis.”

Two months before he noticed the axillary node, he visited East Africa where he ate local food, cut his right hand on a plant leaf, and trailed his right hand in river water while in a canoe. He is an avid gardener who…

Mechanical circulatory support for cardiogenic shock: a network meta-analysis of randomized controlled trials and propensity score-matched studies | Intensive Care Medicine (springer.com)

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In this network meta-analysis, they evaluated the effectiveness of various mechanical circulatory support (MCS) devices in patients with refractory cardiogenic shock, a condition associated with high mortality. The comprehensive search across MEDLINE, Embase, and Scopus databases up to August 27, 2023, included 38 studies with 48,749 patients. The primary outcome was mortality, assessed either at 30 days or during hospitalization.

The analysis revealed that only the combination of extracorporeal membrane oxygenation with an intra-aortic balloon pump (ECMO-IABP) was associated with a significant reduction in mortality compared to no MCS. Other MCS configurations (such as ECMO, IABP, microaxial ventricular assist device (mVAD), ECMO-mVAD, centrifugal VAD, or mVAD-IABP) did not show a statistically significant mortality reduction. These findings, derived from a mixture of randomized controlled trials and propensity score-matched…