2:15 - Jon Silversides- RADAR2 Trial Results Presentation
31:00 - Marlies Ostermann - Editorial
44:55 - Jon Silversides - Reply to the Editorial
49:00 - Phil Gillen - Questions from Viewers
55:56 - Rob Mac Sweeney chairs the Panel Discussion
The trial is presently unpublished.
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Professors Vincenzo Russotto and Sheila Myatra discuss the INTUBE study, published March 23rd in JAMA, investigating global practice in performing tracheal intubation in critically ill patients.
This is the REMAP-CAP IL-6 receptor antagonist domain results presentation, recorded February 25th. The presentation was accompanied by a simultaneous publication in the New England Journal of Medicine.
Prof Derek Angus (Pittsburgh, USA) & Dr Liz Lorenzi (Berry Consultants, Austin, USA), set the scene with talks on the adaptive platform design of REMAP-CAP, and its underlying Bayesian framework, respectively. Next, Dr Lennie Derde (Utrecht, The Netherlands) presents the full results of the IL-6 receptor antagonist domain, followed by an independent editorial by Prof Tim Walsh (Edinburgh, Scotland). Lennie and her co-investigators reply to the editorial and questions from viewers. The session ends with a panel discussion, including external experts Dr David Harrison (Chief Statistician, ICNARC, London), Prof Anders Perner (Copenhagen, Denmark), and Prof Anthony Gordon (London, England), the lead investigator for the IL-6 RA domain at REMAP-CAP.
1:37 - Derek Angus - The Beauty of Adaptive Designs
19:22 - Liz Lorenzi -.The Statistical Framework of REMAP-CAP
42:50 - Lennie Derde - The Results
1:09:05 - Tim Walsh - The Editorial
1:35:40 - Lennie Derde et al - Reply to the Editorial
1:43:52 - Questions va Chris Nutt
1:54:10 - Panel Discussion
Check out our journal watch, which is updated daily, to stay up-to-date with the latest critical care literature. The weekly newsletter contains a summary of the papers highlighted over the previous 7 days and is emailed to registered users every Sunday night.
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International Weaning Practice
Observational Study
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Sen. Chemical incidents. BJA Education 2021;21(4):126-132
Added March 22nd
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In 777 patients, albumin infusions to increase the albumin level to a target of 30 g per liter or more did not improve the composite primary outcome of new infection, kidney dysfunction, or death between days 3 and 15, but resulted in increased adverse events
Added March 4th
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In 300 adults with cirrhosis and HRS-1, terlipressin was more effective in improving renal function but resulted in less liver transplantation (23% vs 29%) a higher 90-day mortality (51% vs 45%).
Added March 4th
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In 17,470 patients in the Traumatic Brain Injury Model Systems National Database, 7,547 (57%) suffered an initial loss of consciousness, which persisted to rehabilitation in 2,058 patients (12%). Of this group of 2,058 comatose patients, 82% (n = 1674) subsequently recovered consciousness during inpatient rehabilitation.
Added March 1st
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In a systematic review of 4 published trials including 1060 patients with confirmed or treated COVID-19 in any treatment setting, the use of convalescent plasma was not associated with a significant reduction in all-cause mortality; risk ration 0.93 (95% CI, 0.63 to 1.38).
Added February 27th
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This International Collaborative Statement aims at expanding cDCDD in the world to help countries progress towards self-sufficiency in transplantation and offer more patients the opportunity of organ donation.
Added February 27th
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Originally published in provisional format last Summer, the full paper of the RECOVERY trial - dexamethasone arm, is now out. In 6425 hospitalised patients with COVID-19, treatment with 10 mg IV dexamethasone for up to 10 days resulted in a lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone.
Added February 25rd
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The BACLOREA trial, initial presented at eCCR21, reported a decrease in agitation-related events with baclofen in 314 mechanically ventilated patients with alcohol misuse disorder (19.7% vs. 29.7% with placebo), but a longer length of mechanical ventilation (9 vs 8 days) and stay in the ICU (14 vs 11 days.
Added February 23rd
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The VICTAS trial, comparing treatment with vitamin C, thiamine, and hydrocortisone with placebo in 501 patients with septic shock, reported no significant difference in ventilator- and vasopressor-free days (25 vs 26 , respectively) at 30 days. Funding was withdrawn after just 501 out of a planned 2000 patients were recruited.
Added February 23rd
We'll bring these important results to you live and free
The ACTIV4-a, ATTACC, & REMAP-CAP investigators will present the results of this multi-platform trial examining therapeutic & prophylactic anti- coagulation in patients with COVID-19. The interim analysis was released January 28th and is available via the link below.
Originally planned for CCR21, which became eCCR21, but delayed into the Spring, the long awaited results of the follow-up trial to the landmark targeted temperature management after out-of-hospital cardiac arrest is out soon. Is the avoidance of fever the critical aspect of TTM? The results are due very soon.
This massive 11,000 patient trial from Brazil was also scheduled for CCR21, but was unavoidably delayed due to the pandemic. Comparing Plasma-Lyte 148 with 0.9% saline, it's almost ready for release now and we're delighted to be hosting this major trial result later this Spring.
In a Brazilian two-centre, blinded RCT in 240 patients with moderate or severe COVID-19, Murai and colleagues reported that a single oral dose of 200 000 IU vitamin D3 did not significantly change the median (IQR) length of hospitalisation; vitamin D3 group, 7.0 (4.0-10.0) days, vs. placebo group, 7.0 (5.0-13.0) days; log-rank, P = 0.59; unadjusted HR, 1.07; 95% CI, 0.82-1.39; P = 0.62.
JAMA 2021;epublished February 17th
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In 668 patients with acute myocardial infarction and a hemoglobin level between 7 and 10 g/dL, a red cell transfusion threshold of ≤8 g/dL was found to be non-inferior to a threshold of ≤10 g/dL, with the composite MACE outcome (all-cause death, stroke, recurrent myocardial infarction, or emergency revascularization) at 30 days occurring in 11% vs 14%, respectively.
JAMA 2021;325(6):552-560. Published February 9th
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In 715 patients undergoing cardiopulmonary bypass and randomised to a protocol-guided strategy, using stroke volume variation to guide the administration of bolus fluids, or to usual care fluid administration, until desedation or up to 24 hours, there was no difference in the primary outcome of ICU length of stay; (median/IQR) intervention group; 27.9 hr (21.8–53.5 hr) vs control, 25.6 hr (21.9–64.6 hr); p = 0.95.
Crit Care Med 2021;epublished January 28th
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In 432 ventilated adults with sepsis, randomised to receive IV sedation with either dexmedetomidine (0.2 to 1.5 μg/kg/hr) or propofol (5 to 50 μg/kg/min), there was no difference between groups in the primary outcome of days alive without delirium or coma during the 14-day intervention period; 10.7 vs. 10.8 days; OR, 0.96; 95% CI, 0.74 to 1.26; respectively. There were also no differences in secondary outcomes, including mortality.
N Engl J Med 2021;epublished February 2nd
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In adult patients suffering a traumatic brain injury, with a GCS score of 4 to 8, and initial ICP ≥ 25 mm Hg, the implementation of long-term mild hypothermia group (34–35 °C for 5 days), in comparison with normothermia group at 37 °C, did not improve the proportion with a favorable outcome (OR 1·55, 95%CI 0·91–2·64; P = 0·105) or mortality (P = 0·111) at 6 months.
EClinicalMedicine 2021;epublished January 28th
In a prospective study in 20 ICUs in 3 countries, amongst 631 patients who underwent continued monitoring after planned withdrawal of life-sustaining support, 14% of patients had a resumption of cardiac activity after a period of pulselessness. Just 1 percent were observed clinically. The longest period to resumption of cardaic activity was 4 minutes 20 seconds.
N Engl J Med 2021; 384:345-352 | January 28th, 2021
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In a Danish led, international, multi-centre, randomised controlled trial trial in 2928 adults with acute hypoxaemic respiratory failure, targetting a PaO2 of 8 kPa, in comparison with 12 kPa, did not improve the primary outcome of 90-day mortality (42.9% vs 42.4%; adjusted risk ratio, 1.02; 95% CI, 0.94 to 1.11; P=0.64).
Presented at eCCR21. Video available at eCCR21 webpage
N Engl J Med 2021;epublished January 20th
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In a Brazilian randomised controlled trial involving 9 hospitals, the use of tocilizumab as a single intravenous infusion of 8 mg/kg plus standard care (n=65) versus standard care alone (n=64), resulted in suimilar levels of mechanical ventilation at day 15 (28% vs. 20; (odds ratio 1.54, 95% CI0.66 to 3.66; P=0.32).), respectively, and increased mortality (17% vs. 3%; odds ratio 6.42, 95% CI,1.59 to 43.2).
BMJ 2021;372:n84, published January 20th
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In a pre-print paper, the REMAP-CAP trial investigators have reported efficacy with interleukin 6 receptor anatgonists in critically ill patients with COVID-19. Hospital mortality was 28.0% (98/350) for tocilizumab, 22.2% (10/45) for sarilumab and 35.8% (142/397) for control.
Preprint January 7th
In 10,406 randomised patients, with 1873 reported deaths, there was no significant difference in the primary endpoint of 28-day mortality -18% convalescent plasma vs. 18% usual care alone; risk ratio 1.04 [95% confidence interval 0.95-1.14]; p=0.34.
Prof Peter Horby, Tweet, Jan 15th
Three large randomised controlled trials, ATTACC, @ACTIV4a, and REMAP-CAP, have, for futility, halted recruitment to their therapeutic anticoagulation arms in critically ill patients with COVID-19.
In this multi-centre, blinded Australian trial, 25 000 IU of nebulised heparin administered 6 hourly while invasively ventilated, did not significantly alter the primary outcome of functional outcomes (SF-36) at 60 days; survivors in the heparin group (n=97) mean 53·6 vs control 48·7; difference 4·9 [95% CI –4·8 to 14·5]; p=0·32).
In this trial PCT-guided antimicrobial treatment in sepsis was effective in reducing infection-associated adverse events like infections by multidrug-resistant organisms and Clostridioides difficile, as well as in-hospital and 28-day mortality.
Am J Respir Crit Care Med 2021;202(3):202–210
January 17th 2021
Lancet 2020;epublished December 21st
Lancet 2020;396(10266):1905-1913
JAMA Intern Med 2020;epublished October 26th
In 1824 infants born prematurely between 22 and 26 weeks and weighing less than 1000 g, a higher hemoglobin threshold for red-cell transfusion did not improve survival without neurodevelopmental impairment at 22 to 26 months of age, corrected for prematurity
N Engl J Med 2020;383:2639-2651
Crit Care Med 2021;epublished January 28th
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