Gotta read II


 

One question that popped up here in Brazil after Sepsis 3.0 was how the new definition would perform in low–middle-income countries, since it was only validated in the ,so called, “first world countries”. Here, Besen and colleagues [1], compared ICU mortality across categories of Sepsis 2.0 (sepsis, severe sepsis and septic shock) vs Sepsis 3.0 (infection, sepsis and septic shock). It’s beautiful to see how Sepsis 3.0 discriminates mortality across its 3 categories when Sepsis 2.0 only discriminates mortality of septic shock, but not between sepsis and severe sepsis. Another point for Sepsis 3.0.

 

Every other day we see a truck full of amikacin parking at our hospital’s pharmacy, so we can feed our KPCs. See, we use amikacin a lot and I’m not proud of it. A recent article published in Annals of intensive Care [2] discuss the impact of a high loading dose of amikacin (30mg/kg). Ok, it was a observational cohort but it can give us some new perspectives: 42% of patients achieved a Cmax target between 60-80 mg/L and had lower mortality rate. Even with high dose, 40% had a Cmax < 60 mg/L with higher mortality rate, also patients with a Cmax > 80mg/L (18%) had higher mortality rate. It might be not that easy do balance the right dose for each patient, but maybe 15 mg/kg, which is our standard dose, is not enough, and unfortunately 30 mg/Kg is too much for 18% of our patients. Should we try something between 20-25 mg/kg?

 

I won’t make a fuzz around the Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis [3] because we’re planning a more surgical discussion in the next few weeks. So, instead of spend 30 minutes on Youtube watching funny cat videos, take a look. Not only a conservative fluid strategy seems safe, but also, we have signs it might be beneficial.

 

Imagine you after a 24h shift, more tired than Santa Claus on Christmas eve, and when you get to your bike you notice that you forgot the lock combination. Now you have to walk 4 kilometers with your bike on your back. Not anymore, pal! Here is the solution to your problem, and all you gonna need is an available CT scan. According to a letter published in Radiology [4], you just have to scan the lock, do a reconstruction, and BOOM! There is your combination. Easy peasy lemon squeezy! Thank you. You’re welcome.

 

Do you know if you have an itch on one side of your body you just need to go in front of a mirror and scratch the contralateral side [5]? How crazy is that?!

 

1. Besen BA, Romano TG, Nassar AP, et al. Sepsis-3 definitions predict ICU mortality in a low–middle-income country. Ann. Intensive Care. 2016; 6:107

2. Allou N, Bouteau A, Allyn J, et al. Impact of a high loading dose of amikacin in patients with severe sepsis or septic shock. Ann. Intensive Care. 2016; 6:106

3. Silversides JA, Major E, Ferguson AJ, et al. Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis. Intensive Care Med. 2016.

4. Meyer H, Dewey M, Issever AS, Rogalla P. How multidetector CT can help open bike locks. Radiology. 2007;245(3):921.

5. Helmchen C, Palzer C, Münte TF, Anders S, Sprenger A. Itch relief by mirror scratching. A psychophysical study. PLoS One. 2013;8(12):e82756.

 

Photo Credit

Professor Bop


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