Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial Lancet Respir Med 2020; 8: 267–76 P：moderate〜severe ARDS（≧18 years, PF≦200） I：DEXを10日間 C：usual practice O：28日目のven…
Penicillin Allergy N Engl J Med 2019;381:2338-51. また、秀逸なレビューがNEJMからです。途中病態生理などわからないことが多かったけどまとめると ・ペニシリンアレルギーの90%で安全にペニシリンを使用できる ・ペニシリンアレルギーがあると個人にも社…
Early High-Dose Vitamin D3 for Critically Ill, Vitamin D–Deficient Patients DOI: 10.1056/NEJMoa1911124 the Vitamin D to Improve Out- comes by Leveraging Early Treatment (VIOLET) trial 先行研究( JAMA 2014; 312:1520-30.)で効果がありそうであ…
Metoprolol for the Prevention of Acute Exacerbations of COPD the BLOCK COPD (Beta-Blockers for the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease) trial N Engl J Med 2019;381:2304-14. 観察研究からはmoderate or s…
Effect of Thoracoscopic Talc Poudrage vs Talc Slurry via Chest Tube on Pleurodesis Failure Rate Among Patients With Malignant Pleural Effusions A Randomized Clinical Trial JAMA. doi:10.1001/jama.2019.19997 The TAPPS (Evaluating the efficac…
Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability Pulmonary Embolism Graduated D-Dimer (PEGeD) study N Engl J Med 2019;381:2125-34. low clinical pretest probability(C-PTP)+D-dimer<1000ng/ml or moderate C-PTP+D-d…
Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial N Engl J Med 2019;381:2199-208. ○PICO P：displaced femoral neck frac…
Acute Upper Airway Obstruction N Engl J Med 2019;381:1940-9. DOI: 10.1056/NEJMra1811697 Review 非常に実臨床に即したレビュー。解剖→疾患各論→difficult airway managementの順番でまとまっている。救急・ICU医であると各病態の知識が乏しいし、非救急…
JAMA Diagnostic Test Interpretation Point-of-Care Urine Pregnancy Tests JAMA 全く知りませんでした。救急で尿中hCGを測定して陰性確認してCT撮像していましたが完全に安全というわけではないのですね。疑えば血中hCGを測定すること。 ○以下本文抜粋 ・O…
From The Medical Letter on Drugs and Therapeutics Influenza Vaccine for 2019-2020 JAMA JAMAのLetterから。インフルエンザワクチンについて実務的なことがまとまっている。非常に多くの医師が関わる可能性があるため行う場合は目を通しておくとよいかも…
From The Medical Letter on Drugs and Therapeutics Influenza Vaccine for 2019-2020 JAMA JAMAのLetterから。インフルエンザワクチンについて実務的なことがまとまっている。非常に多くの医師が関わる可能性があるため行う場合は目を通しておくとよいかも…
Conservative Oxygen Therapy during Mechanical Ventilation in the ICU ICU-ROX(Intensive Care Unit Random- ized Trial Comparing Two Approaches to Oxygen Therapy) trial NEJM ○PICO P：All adults (≥18 years of age) who were expected to receive …
Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus NEJM The Established Status Epilepticus Treatment Trial (ESETT) ○PICO P：Patients were eligible for participation if they were 2 years of age or older, had been tr…
Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial JAMA ○PICO P：no major extracranial bleedingで…
Ticagrelor with or without Aspirin in High-Risk Patients after PCI the Ticagrelor with Aspirin or Alone in High-Risk Patients after Coronary Intervention (TWILIGHT) trial NEJM P：DESでPCIを受けて3ヶ月のticagrelor+aspirin投与した後major ble…
Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest the Antibio-therapy during Therapeutic Hypothermia to Prevent Infectious Complications (ANTHARTIC) trial. NEJM P：初期波形がshockable rhythmの院外心停止で32-34度のTTM…
Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease NEJM ○PICO P： left main coronary artery disease of low or intermediate anatomical complexity (according to assessment at the participating centers)(N=1905) eligible：sten…
Effect of Postextubation High-Flow Nasal Oxygen With Noninvasive Ventilation vs High-Flow Nasal Oxygen Alone on Reintubation Among Patients at High Risk of Extubation Failure A Randomized Clinical Trial JAMA ○PICO P：high risk of extubatio…
Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm The objective of the Therapeutic Hypothermia after Cardiac Arrest in Nonshockable Rhythm (HYPERION) trial NEJM ○PICO P：18歳以上のnonshockable rhythm(院内でも院外…
Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years the Arterial Revascularization Trial (ART) NEJM Abstract ◯背景 ・multiple arterial graftsはsingle arterial graftsよりもCABG後長期生存となるかもしれない ・われわれはbilater…
Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis NEJM Abstract ◯背景 ・左心系のIEの患者は典型的には6 weeksまで抗生剤の静注薬で典型的には治療される ・一旦患者の状態が落ち着いてから静注から経口へのシフトの効果と安全性につ…
Association of Aspirin Use for Primary Prevention With Cardiovascular Events and Bleeding Events A Systematic Review and Meta-analysis JAMA. 2019;321(3):277-287. Abstract ◯重要 ・心血管の1次予防としてのアスピリンの役割はcontroversialで、潜…
Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial Intensive Care Med (2019) 45:62–71 Abstract ◯目的 ・NIVは高二酸化炭素血症の患者でinvasive mechanical …
Intraaortic Balloon Pump in Cardiogenic Shock Complicating Acute Myocardial Infarction Long-Term 6-Year Outcome of the Randomized IABP-SHOCK II Trial Circulation. 2019;139:395–403. Abstract ◯背景 ・心原性ショックにおけるIABPはIABP-SHOCKⅡ t…
Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura NEJM Abstract ◯背景 ・後天性TTPにおいて、 the von Willebrand factor–cleaving protease ADAMTS13のimmune-mediated deficiencyは血小板や微小血栓に対するvon Willebrand fact…
Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts Intensive Care Med (2018) 44:1914–1922 Abstract ◯目的 ・mechanical power(MP)はventilator-induced …
Ultrasound Assessment of the Change in Carotid Corrected Flow Time in Fluid Responsiveness in Undifferentiated Shock Crit Care Med 2018; 46:e1040–e1046 Abstract ◯目的 ・passive leg raise maneuverによりcarotid corrected flow timeの変化をpoi…
Lower Glucose Target Is Associated With Improved 30-Day Mortality in Cardiac and Cardiothoracic Patients CHEST 2018; 154(5):1044-1051 Abstract ◯背景 ・practical guidelinesでは重度の低血糖が高い比率で起きたtrialsから重症患者に対してintensiv…
Randomized Trial of Endoscopic or Open Vein- Graft Harvesting for Coronary-Artery Bypass the Randomized Endovein Graft Prospective (REGROUP) trial NEJM Abstract ◯背景 ・大伏在静脈グラフとはCABGでもっともよく使用される ・静脈グラフとの採取…
Effect of Early Sustained Prophylactic Hypothermia on Neurologic Outcomes Among Patients With Severe Traumatic Brain Injury The POLAR Randomized Clinical Trial JAMA Abstract ◯重要 ・重症頭部外傷後に、予防的低体温の導入は神経保護的で長期神…
