Hemodynamics Management

Immediate versus staged complete revascularisation in patients presenting with acute coronary syndrome and multivessel coronary disease (BIOVASC): a prospective, open-label, non-inferiority, randomised trial:

• The article reports the results of a randomised trial that compared two strategies of complete revascularisation for patients with acute coronary syndrome and multivessel coronary disease: immediate or staged.

• The trial enrolled 1525 patients from 29 hospitals across four European countries and randomly assigned them to either receive complete revascularisation (including non-culprit lesions) during the index procedure (immediate group) or within 30 days after the index procedure (staged group).

• The primary outcome was a composite of all-cause mortality, myocardial infarction, and unplanned ischaemia-driven revascularisation at 1 year after the index procedure.

• The trial found that immediate complete revascularisation was non-inferior to staged complete revascularisation for the primary outcome, with a hazard ratio of 0·78 (95% CI 0·55–1·11, p non-inferiority =0·0011).

• The trial also found that immediate complete…

Systolic blood pressure (SBP) variation with respiratory movement on the ventilator can be used to assess fluid responsiveness in the ICU. The higher the variation above 13% the more likely to respond to fluid. Make sure the rhythm is sinus and tidal volume on the ventilator is adequate to reflect a change in the intrathoracic pressure.

Dopamine use and its consequences in the intensive care unit: a cohort study utilizing the Japanese Intensive care PAtient Database

• This study aimed to identify the current practice of dopamine use in Japan and investigate its consequences in a large Asian population.

• Data from the Japanese Intensive Care Patient Database was used, with 14,594 records from 56 facilities included for analysis.

• Patients receiving dopamine had higher cardiovascular diagnosis codes, more post-elective surgery status and lower APACHE III scores compared to those given noradrenaline alone.

• Multivariable analysis showed an increased risk of mortality associated with higher doses of dopamine administration; this was further confirmed by a 1:1 propensity score matching which also revealed longer ICU stays among patients on high dose dopaminergic therapy.

• The results suggest that while still widely used in Japan, there may be detrimental effects associated with high dose dopaminergic therapy.

Systolic pressure variation in a ventilated patient with hypovolemic shock!