Studies & trials

Question 1

Studies & trials

Blood transfusion

Answer 1

• TRICC: restrictive vs. liberal blood transfusion strategy in ICU
• TRISS: restrictive vs. liberal blood transfusion strategy in septic shock

Question 2

Studies & trials

Steroid in refractory shock

Answer 2

• ADRENAL study
• In mechanically ventilated patients with septic shock, low dose hydrocortisone administered via an infusion for up to 7 days does not reduce or increase mortality at 90 days
• Secondary outcomes demonstrated that patients in the hydrocortisone group had a reduced time to resolution of shock, reduced duration of ICU but not hospital stay, reduced time to cessation of mechanical ventilation and a reduction in the use of blood transfusion. Adverse events were low, but significantly increased in the hydrocortisone group

Question 3

Studies & trials

Fluids

Answer 3

• 6S: starch fluid
• CHEST: starch fluid
• CRYSTMAS, CHEST, 6S, CRYSTAL

Question 4

Studies & trials

Glucose

Answer 4

NICE-SUGAR trial: conventional (144 - 180) versus intensive (81 and 108 mg/dL) control
This trial demonstrates better survival if a conventional blood glucose target of less than 10.0 mmol/L (180 mg/dL) is used in critically ill patients.

Question 5

Studies & trials

Tranexamic acid in trauma

Answer 5

• CRASH – 3
• In patients with traumatic brain injury (TBI), does the administration of tranexamic acid (TXA) under 3 hours from injury, compared with placebo, reduce head injury associated in-hospital mortality within 28 days?
• Authors’ conclusions: TXA safe in TBI and that treatment within three hours reduces head injury associated deaths

Question 6

Studies & trials

Massive transfusion ratio

Answer 6

• PROPPR study: 1:1:1 better than 1:1:2 of units of blood in achieving hemostasis and fewer exeer experience death due to exsanguination by 24 hrs.
• A ratio of 1:1:1 resulted in reduced mortality from exsanguination within the 1st 24 hours, with similar complication rates to a lower ratio protocol. Therefore, I will continue to aim for a 1:1:1 ratio in this population.

Question 7

Studies & trials

Decompressive craniectomy in all cases presenting with TBI

Answer 7

• The DECRA trial: In adults with severe diffuse TBI and refractory intracranial hypertension, early decompressive craniectomy decreased intracranial pressure and the length of stay in the ICU but was associated with more unfavorable outcomes at 6 months
• The RESCUEicp trial: At 6 months, decompressive craniectomy in patients with TBI and refractory intracranial hypertension resulted in lower mortality and higher rates of vegetative state, lower severe disability, and upper severe disability than medical care

Acceptable answer: it might improve mortality, however, could leads to poor neurological outcomes for survivors

Question 8

Studies & trials

Proning

Answer 8

• PROSEVA
• Patients with severe ARDS have improved mortality with early and long proning sessions
• Strong recommendation
• Proning at least for 16 consecutive hours
• Improves oxygenation and decreases mortality, possible decrease in mechanical ventilation days (Proseva trial), optimal timing of initiation early in the course (36 hours)

Question 9

Studies & trials

ARDS

Answer 9

• Paralysis (ACURASYS): The early use of a neuromuscular blocking agent in severe ARDS may improve outcomes.
• Proning (PROSEVA)
• Conservative fluid management (FACTT)
• Driving pressure < 15 (amato trial)

Question 10

Studies & trials

Mention what ventilatory strategies that improve mortality supported by evidence and mention if the evidence is positive or negative?

Answer 10

• ARDS NET PROTOCOL ARMA TRIAL
• ‏LUNG PROTECTIVE STRATEGY TV 6-4
• ‏PEEP /FIO TABLE FOR OPTIMUM OXYGENATION
• ‏pPlat <30
• ‏Driving pressure <15 (amato )
• ‏Permissive hypercapnia
• ‏Muscle relaxant (ACURASYS +ve/Rose -ve)
• ‏Prone ( PROSEVA)
• ‏ECMO ( cesar, eiola)
• الى آخر اللستة
  *

Question 11

Studies & trials

Study of high flow nasal cannula vs niv

Answer 11

• Study of high flow nasal cannula vs niv
• FLORALI?

Question 12

Studies & trials

ECMO

Answer 12

• CESAR trial
• Recommend transferring adult patients with severe but potentially reversible respiratory failure, whose Murray score > 3 or who have a pH < 7.2 on optimum conventional management, to a centre where ECMO-based management is available.
• Cesar trial mortality benefit for tertiary center transfer, new study still in recruiting
• EOLIA new study for ecmo to answer mortality benefit
• EOLIA: ECMO for severe ARDS showed no significant benefit of mortality at day 60 as compared with a strategy of conventional mechanical ventilation, which included crossover to ECMO (used by 28% of the patients in the control group)
  *

Question 13

Studies & trials

ICH - BP target

Answer 13

• Keep SBP < 140 in INTERACT-2 study more intensive reduce hematoma growth / improve disability

Question 14

Studies & trials

SAH aneurysm

Answer 14

• The ISAT trial: neurosurgical clipping vs endovascular coiling
• endovascular coiling demonstrated a 23% relative risk and 7% absolute risk reduction in significant disability or death compared to surgical clipping

Question 15

Studies & trials

PE

Answer 15

• MAPPETT 3: submassive thrombolysis reduce need of esclat of rx no mortality
• MAPPETT modert PE with thrompolysis improve morbidity reduce PHT no mortality
• 3-PETHO submassive no mortality and bleeding and CVa highr
• 4- met analysis improve mortality with out bleed in age <65
• what is the indication of thrombolysis in submassive PE ? Name the study ?