2012 Oct 4 - Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock
Background
In current international guidelines, intraaortic balloon counterpulsation is considered to be a class I treatment for cardiogenic shock complicating acute myocardial infarction. However, evidence is based mainly on registry data, and there is a paucity of randomized clinical trials.
2012 Sep 20 - Hypoglycemia and Risk of Death in Critically Ill Patients
Background
Whether hypoglycemia leads to death in critically ill patients is unclear.
Methods
We examined the associations between moderate and severe hypoglycemia (blood glucose, 41 to 70 mg per deciliter [2.3 to 3.9 mmol per liter] and ≤40 mg per deciliter [2.2 mmol per liter], respectively) and death among 6026 critically ill patients in intensive care units (ICUs). Patients were randomly assigned to intensive or conventional glucose control. We used Cox regression analysis with adjustment for treatment assignment and for baseline and postrandomization covariates.
2012 Aug 23 - Hyperosmolar Therapy for Raised Intracranial Pressure
A 49-year-old female passenger was thrown against the doorframe during an automobile accident. After being pulled from the car, she opened her eyes intermittently, moaned, and had flexion withdrawal of her limbs (Glasgow Coma Scale score, 8).
2012 July 12 - Management of Opioid Analgesic Overdose
Opioid analgesic overdose is a preventable and potentially lethal condition that results from prescribing practices, inadequate understanding on the patient's part of the risks of medication misuse, errors in drug administration, and pharmaceutical abuse.
2012 June 28 - Hydroxyethyl Starch 130/0.4 versus Ringer's Acetate in Severe Sepsis
June 27, 2012 (10.1056/NEJMoa1204242)
Background
Hydroxyethyl starch (HES) 130/0.4 is widely used for fluid resuscitation in intensive care units (ICUs), but its safety and efficacy have not been established in patients with severe sepsis.
2012 June 7 - Clinical Practice Acute Limb Ischemia
Stage
A 57-year-old man presents with an acute onset of left foot pain, numbness, and partial loss of motor function. Four months ago, he underwent endovascular treatment for disabling claudication, which included placement of overlapping polytetrafluoroethylene-coated stents in the left superficial femoral and popliteal arteries. His popliteal and pedal pulses are absent, and the foot is cool and mottled. Angiography reveals complete occlusion of the stent, with thrombosis extending distally into the popliteal and tibial arteries below the knee. How should his case be managed?
2012 May 31 - Drowning
According to the World Health Organization (WHO), 0.7% of all deaths worldwide — or more than 500,000 deaths each year — are due to unintentional drowning. Since some cases of fatal drowning are not classified as such according to the codes of the International Classification of Disease, this number underestimates the real figures, even for high-income countries, and does not include drownings that occur as a result of floods, tsunamis, and boating accidents.
2012 May 31 - Nighttime Intensivist Staffing and Mortality among Critically Ill Patients
Background
Hospitals are increasingly adopting 24-hour intensivist physician staffing as a strategy to improve intensive care unit (ICU) outcomes. However, the degree to which nighttime intensivists are associated with improvements in the quality of ICU care is unknown.
2012 May 17 - Azithromycin and the Risk of Cardiovascular Death
N Engl J Med 2012; 366:1881-1890May 17, 2012
Background
Although several macrolide antibiotics are proarrhythmic and associated with an increased risk of sudden cardiac death, azithromycin is thought to have minimal cardiotoxicity. However, published reports of arrhythmias suggest that azithromycin may increase the risk of cardiovascular death.
2012 May 22 - Drotrecogin Alfa (Activated) in Adults with Septic Shock
May 22, 2012 (10.1056/NEJMoa1202290)
Background
There have been conflicting reports on the efficacy of recombinant human activated protein C, or drotrecogin alfa (activated) (DrotAA), for the treatment of patients with septic shock.
2012 March 15 - Westermark Sign in Pulmonary Embolism
Anant Subramanian Krishnan, M.D., and Tristan Barrett, M.D. N Engl J Med 2012; 366:e16March 15, 2012
A 47-year-old woman presented to the emergency department with acute shortness of breath and hypoxemia. Her medical history included sex reassignment, for which she was taking estrogen, and a deep-vein thrombosis on the left side, for which she had required treatment with warfarin. She had a family history of fatal pulmonary emboli.
2012 March 1 - Placebo-Controlled Trial of Amantadine for Severe Traumatic Brain Injury
Joseph T. Giacino, Ph.D., John Whyte, M.D., Ph.D., Emilia Bagiella, Ph.D., Kathleen Kalmar, Ph.D., Nancy Childs, M.D., Allen Khademi, M.D., Bernd Eifert, M.D., David Long, M.D., Douglas I. Katz, M.D., Sooja Cho, M.D., Stuart A. Yablon, M.D., Marianne Luther, M.D., Flora M. Hammond, M.D., Annette Nordenbo, M.D., Paul Novak, O.T.R., Walt Mercer, Ph.D., Petra Maurer-Karattup, Dr.Rer.Nat., and Mark Sherer, Ph.D. N Engl J Med 2012; 366:819-826, March 1, 2012
Background
Amantadine hydrochloride is one of the most commonly prescribed medications for patients with prolonged disorders of consciousness after traumatic brain injury. Preliminary studies have suggested that amantadine may promote functional recovery.
Background
Amantadine hydrochloride is one of the most commonly prescribed medications for patients with prolonged disorders of consciousness after traumatic brain injury. Preliminary studies have suggested that amantadine may promote functional recovery.
2012 Jan 19 - Pulmonary Cement Embolism after Vertebroplasty
A 61-year-old man with spinal cord compression caused by a vertebral hemangioma underwent therapeutic laminectomy of the fifth vertebra and laminectomy and vertebroplasty of the fourth vertebra. During the vertebroplasty, polymethylmethacrylate cement leaked into the paravertebral vascular system. In the recovery room, the patient was mildly hypoxemic but otherwise asymptomatic.
2012 Jan 19 - Cognitive and Neurologic Outcomes after Coronary-Artery Bypass Surgery
N Engl J Med 2012; 366:250-257January 19, 2012
Patients referred for coronary revascularization procedures are older and are likely to have more extensive extracardiac vascular disease than those referred for such procedures in the past. Despite these trends, mortality rates for coronary-artery bypass grafting (CABG), without concurrent procedures, have continued to decline.1 Nevertheless, adverse neurologic outcomes, including stroke and cognitive decline, remain a major concern for these older patients.
2012 Jan 19 - Preliminary Study of Two Antiviral Agents for Hepatitis C Genotype 1
Anna S. Lok, M.D., David F. Gardiner, M.D., Eric Lawitz, M.D., Claudia Martorell, M.D., Gregory T. Everson, M.D., Reem Ghalib, M.D., Robert Reindollar, M.D., Vinod Rustgi, M.D., Fiona McPhee, Ph.D., Megan Wind-Rotolo, Ph.D., Anna Persson, Ph.D., Kurt Zhu, Ph.D., Dessislava I. Dimitrova, M.D., Timothy Eley, Ph.D., Tong Guo, Ph.D., Dennis M. Grasela, Pharm.D., Ph.D., and Claudio Pasquinelli, M.D., Ph.D.
N Engl J Med 2012; 366:216-224January 19, 2012
Background
Patients with chronic hepatitis C virus (HCV) infection who have not had a response to therapy with peginterferon and ribavirin may benefit from the addition of multiple direct-acting antiviral agents to their treatment regimen.
2012 Jan 12 - Subclinical Atrial Fibrillation and the Risk of Stroke
Background
One quarter of strokes are of unknown cause, and subclinical atrial fibrillation may be a common etiologic factor. Pacemakers can detect subclinical episodes of rapid atrial rate, which correlate with electrocardiographically documented atrial fibrillation. We evaluated whether subclinical episodes of rapid atrial rate detected by implanted devices were associated with an increased risk of ischemic stroke in patients who did not have other evidence of atrial fibrillation.
2012 Jan 12 - Cardiac Arrest during Long-Distance Running Races
Background
Approximately 2 million people participate in long-distance running races in the United States annually. Reports of race-related cardiac arrests have generated concern about the safety of this activity.
2012 Jan 5 - Thrombin-Receptor Antagonist Vorapaxar in Acute Coronary Syndromes
Pierluigi Tricoci, M.D., Ph.D., Zhen Huang, M.S., Claes Held, M.D., Ph.D., David J. Moliterno, M.D., Paul W. Armstrong, M.D., Frans Van de Werf, M.D., Harvey D. White, D.Sc., Philip E. Aylward, M.D., Lars Wallentin, M.D., Ph.D., Edmond Chen, M.D., Yuliya Lokhnygina, Ph.D., Jinglan Pei, M.S., Sergio Leonardi, M.D., Tyrus L. Rorick, R.N., Ann M. Kilian, B.S., Lisa H.K. Jennings, Ph.D., Giuseppe Ambrosio, M.D., Ph.D., Christoph Bode, M.D., Angel Cequier, M.D., Jan H. Cornel, M.D., Rafael Diaz, M.D., Aycan Erkan, M.D., Ph.D., Kurt Huber, M.D., Michael P. Hudson, M.D., Lixin Jiang, M.D., J. Wouter Jukema, M.D., Ph.D., Basil S. Lewis, M.D., A. Michael Lincoff, M.D., Gilles Montalescot, M.D., José Carlos Nicolau, M.D., Ph.D., Hisao Ogawa, M.D., Matthias Pfisterer, M.D., Juan Carlos Prieto, M.D., Witold Ruzyllo, M.D., Peter R. Sinnaeve, M.D., Ph.D., Robert F. Storey, M.D., D.M., Marco Valgimigli, M.D., Ph.D., David J. Whellan, M.D., Petr Widimsky, M.D., Dr.Sc., John Strony, M.D., Robert A. Harrington, M.D., and Kenneth W. Mahaffey, M.D. for the TRACER Investigators
N Engl J Med 2012; 366:20-33 January 5, 2012
Background
Vorapaxar is a new oral protease-activated–receptor 1 (PAR-1) antagonist that inhibits thrombin-induced platelet activation.