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For all the blood lovers: New study published in NEJM [1] evaluating blood age on mortality after transfusion. The results are in accordance to our beliefs, and no mortality benefit was found among patients receiving transfusions with the freshest blood available vs standard practice of transfusing the oldest available blood. Interesting strategy was the randomization strategy performed by the blood bank staff, waive of consent and electronic-data capture allowing the investigator to enroll more than 31000 patients at a cost of 40 bucks each.

 

A meta-analysis was published in the American Journal of Respiratory and Critical Care Medicine comparing Continuous versus Intermittent beta-Lactam Infusion in Severe Sepsis [2] showing hight probability of survival for patients in the continuous infusion group after adjusting for covariates. The downside was only three studies (4 countries) included (632 patients total) which can limit our generalizability. There is a pharmacokinetic background behind continuous infusions and it makes a lot of sense. Of course a large RCT is needed. And just to keep in mind, 6 out of 10 patients with pneumonia will survive without antibiotics.

 

Sepsis 3.0 still a good discussion in every pub table. Josh Farkas did a great discussion on PulmCrit about the qSOFA, SIRS, and early warning scores for detecting clinical deterioration in infected patients outside the ICU [3] article ( link ). SOFA rocks, qSOFA might not be perfect, but SIRS sucks.

 

Also steroids in ARDS [4] with no mortality benefit and signs that it might improve lung function. Insanely around 37% of patients in both groups were ventilated with a tidal volume > 8 ml/kg! Really? C’mon!

 

Our fellow blog author Fabio published an interesting case report of a patient with blood hyperviscosity and some amazing vascular ultrasound images [5] ( link ).

 

Action bias! Are you one of those “It’s better do something than nothing” kinda guy? I found a perfect position for you: goalkeeper. Stay away from patients and go catch some balls. This article shows that this misconception very common among doctors is also shared by our fellow soccer players [6]. Really worth reading!

 

1.    Heddle NM, Cook RJ, Arnold DM, et al. Effect of Short-Term vs. Long-Term Blood Storage on Mortality after Transfusion. N Engl J Med. 2016.
2.    Roberts JA, Abdul-Aziz MH, Davis JS, et al. Continuous versus Intermittent beta-Lactam Infusion in Severe Sepsis. A Meta-analysis of Individual Patient Data from Randomized Trials. Am J Respir Crit Care Med. 2016;194(6):681-691.
3.    Churpek MM, Snyder A, Han X, et al. qSOFA, SIRS, and Early Warning Scores for Detecting Clinical Deterioration in Infected Patients Outside the ICU. Am J Respir Crit Care Med. 2016.
4.    Tongyoo S, Permpikul C, Mongkolpun W, et al. Hydrocortisone treatment in early sepsis-associated acute respiratory distress syndrome: results of a randomized controlled trial. Crit Care. 2016;20(1):329.
5.    Lacerda FH et al. Routine ultrasound-guided central venous access catheterization: A window to new findings! Journal of Critical Care.
6.    Bar Eli M, Azar OH, Ritov I, et al. Action Bias Among Elite Soccer Goalkeepers: The Case of Penalty Kicks. Journal of Economic Psychology. 2007. Vol. 28, No. 5.

Photo Credit

franciscogonzaga


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