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Sepsis & Septic Shock
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Hi@Everyone This meta-analysis aimed to evaluate the efficacy of methylene blue in patients with distributive shock, following PRISMA guidelines and examining randomized controlled trials from PubMed, Embase, and the Cochrane Library until April 19, 2023. The study, which included six RCTs with a total of 265 participants, found no significant difference in mortality rates between the methylene blue and placebo groups. However, methylene blue was associated with reduced durations of mechanical ventilation, ICU length of stay, and hospital length of stay. These findings suggest that while methylene blue does not significantly impact mortality in distributive shock patients, it may contribute to shorter mechanical ventilation periods and hospital stays, indicating the need for further clinical research in this area.
62-year-old male with history of IgM myeloma with significant extramedullary disease complicated by renal failure, previously on daratumumab and lenalitomide with progression, now status post hyperCVAD. Presented with respiratory distress, neutropenic sepsis, streptococcus agalactiea, oral thrush, and bilateral pulmonary infiltrates. Patient was initially placed on BiPAP but required to be intubated and placed on mechanical ventilation with protective lung strategy 🫁.
Chest x-ray is shown below:
Bronchoscopy was done and BAL was sent for PJP and other tests. There were multiple mucosal white spots scattered in trachea and throughout the bronchial tree bilaterally as shown in these images:
What do you think?
A very good review article on prevention of Central Line Associated Bloodstream Infections (CLABSI) was published last week in NEJM at Prevention of Central Line–Associated Bloodstream Infections | NEJM
Risk factors for CLABSIs and strategies to prevent them are discussed in detail.
Which of the followings are risk factors for CLABSI? (select all that apply)
0%BMI >40
0%Emergency catheter insertion
0%Failure to remove unnecessary catheters
0%Low nurse-patient ratio
You can vote for more than one answer.
Which of the followings are proven strategies to prevent CLABSI? (select all what apply)
0%Using checklists
0%Using all-inclusive catheter-insertion kits or carts
0%Appropriate hand hygiene
0%Skin antisepsis with an alcoholic chlorhexidine preparation
You can vote for more than one answer.
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Dear Mazen,
Thanks for sharing this updated article.
Regards ;