For those who did not witness the start of the HIV pandemic, this was the first report!
And here is the progress made in relation to antiretroviral medications (ART) over the past 40 years or so!
This shows the life cycle of HIV and the different mechanisms of ART medications.
What is the most common empiric broad-spectrum antibiotic regimen you prescribe in the ICU?
0%Vancomycin + meropenem
0%Vancomycin + cefepime
0%Vancomycin + piperacillin/tazobactam
In this retrospective cohort study, researchers investigated the association between commonly prescribed empiric antibiotics on ICU admission and the risk of acute kidney injury (AKI). The study included 35,654 patients who received either vancomycin and piperacillin-tazobactam, vancomycin and cefepime, or vancomycin and meropenem exclusively. AKI was defined based on the Kidney Disease: Improving Global Outcomes stage 2 or 3 criteria using serum creatinine levels.
The results indicated that vancomycin and piperacillin-tazobactam were associated with a higher risk of AKI and initiation of dialysis compared to both vancomycin and cefepime and vancomycin and meropenem. The odds of AKI were particularly significant in patients without renal insufficiency who received a longer duration of vancomycin and piperacillin-tazobactam therapy compared to vancomycin and meropenem therapy.
This systematic review and meta-analysis examined the use of ultrashort-acting β-blockers (esmolol and landiolol) in patients with sepsis and septic shock and persistent tachycardia despite initial resuscitation. Seven randomized controlled trials with 613 patients were analyzed. The results showed that using esmolol or landiolol was associated with significantly lower 28-day mortality (RR: 0.68, 95% CI: 0.54-0.85, P < .001). The absolute risk reduction was 0.18, and the number needed to treat to prevent one death was 5.5.
The meta-analysis reported that ultrashort-acting β1-blockers can increase stroke volume index and reduce heart rate without changing the cardiac index, mean arterial pressure, or norepinephrine requirement at 24 hours. This suggests that these drugs can improve cardiovascular efficiency in septic patients and may improve mortality outcomes in such patients. However, the exact mechanisms behind these effects and…
In this retrospective cohort study, the researchers aimed to investigate the association between left ventricular (LV) systolic function and in-hospital mortality in patients with sepsis and septic shock. They included all adult patients admitted to the medical ICU with sepsis or septic shock who underwent transthoracic echocardiography within 3 days of admission. The patients were divided into five groups based on LV ejection fraction (LVEF). The results revealed a U-shaped association between LVEF and in-hospital mortality, with both severely reduced LV systolic dysfunction (LVEF < 25%) and hyperdynamic LV (LVEF ≥ 70%) being independently associated with significantly higher mortality compared to the reference group (LVEF 55% to 70%). The study highlights the complexity of LV systolic function's impact on mortality in sepsis and septic shock, indicating the need for personalized resuscitation and vasopressor…
Shall we considered septic patients with EF more than 55% for beta blocker ? Any specific trial on this population ? If no why not to consider it there is a good room for mortality improvement ?
I thin cL the main mechanism behind stroke volume and cardiac index improvement and mortality improvement is the control of HR that allows better LV filling and increases the SV and COP and also optimise the diastolic time and myocardial perfusion
we know from the HR SV curve that the cardiac output significantly reduced with HR more than 120/min as well as myocardial perfusion