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…

Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness NEJM Abstract ◯背景 ・ICUのせん妄患者に対する抗精神病薬の効果に対してはconflicting data ◯方法 ・randomized, double-blind, placebo-controlled trial ・急性呼吸不全 or …

Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac Surgery NEJM Abstract ◯背景 ・以前にmoderate-high risk for deathがある心臓手術を受ける患者に対してrestrictive transfusion strategyはliberal strategyに対して以下の項目…

Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome ODYSSEY OUTCOMES trial NEJM Abstract ◯背景 ・ACS患者は虚血性心血管イベントの再発の高リスクである ・alirocumab, a human monoclonal antibody to proprotein convertase subtil…

Effect of Human Recombinant Alkaline Phosphatase on 7-Day Creatinine Clearance in Patients With Sepsis-Associated Acute Kidney Injury A Randomized Clinical Trial STOP-AKI trial JAMA Abstract ◯重要 ・Sepsis-associated acute kidney injury (A…

Decontamination Strategies and Bloodstream Infections With Antibiotic-Resistant Microorganisms in Ventilated Patients A Randomized Clinical Trial JAMA Abstract ◯重要 ・抗菌薬耐性のmoderate-high levelsのICU患者のoutcomesについてchlorhexidin…

Effect of Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Weaning on Time to Liberation From Mechanical Ventilation Among Patients With Respiratory Failure The Breathe Randomized Clinical Trial JAMA Abstra…

Effect of High-Flow Nasal Oxygen vs Standard Oxygen on 28-Day Mortality in Immunocompromised Patients With Acute Respiratory Failure The HIGH Randomized Clinical Trial JAMA Abstract ◯重要 ・急性低酸素性呼吸不全(AHRF)に対してhigh-flow nasal…

Energy-Dense versus Routine Enteral Nutrition in the Critically Ill The TARGET Investigators, for the ANZICS Clinical Trials Group* NEJM Abstract ◯背景 ・重症病態でdifferent calorie levelsでの栄養提供の効果は不明で、患者はたいてい推奨され…

Impact of Vasoactive Medications on ICU-Acquired Weakness in Mechanically Ventilated Patients CHEST 2018; 154(4):781-787 Abstract ◯背景 ・vasoactive medicationについては重症患者でよく使用されるが、ICU-acquired weaknessの進展に関してのimpac…

Effect of a Low vs Intermediate Tidal Volume Strategy on Ventilator-Free Days in Intensive Care Unit Patients Without ARDS A Randomized Clinical Trial JAMA Abstract ◯重要 ・侵襲的換気でARDSがない重症患者においてlow tidal volumesを使うべき…

Pantoprazole in Patients at Risk for Gastrointestinal Bleeding in the ICU the Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU) trial NEJM Abstract ◯背景 ・ICU患者にストレス潰瘍予防はよく投与されているが、それによるリスクと利点…

Effect of Genetic Diagnosis on Patients with Previously Undiagnosed Disease NEJM Abstract ◯背景 ・多くの患者がextensive medical evaluationをしても診断がつかない ・The Undiagnosed Diseases Network (UDN)→ほとんどのchallenging casesの評価にお…

Rivaroxaban in Patients with Heart Failure, Sinus Rhythm, and Coronary Disease N Engl J Med. 2018 Oct 4;379(14):1332-1342 The COMMANDER HF trial Abstract ◯背景 ・心不全は血栓関連経路の活性化と関連しており予後不良となる。第Ⅹa因子阻害剤のriv…

Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis N Engl J Med 2018;379:1431-42. DOI: 10.1056/NEJMoa1803213 Abstract ◯方法 ・多施設ランダム化試験 ・RIFLE分類でfailure stageの患者でAKIに関連した致死的合併症…

Effect of Targeted Polymyxin B Hemoperfusion on 28-Day Mortality in Patients With Septic Shock and Elevated Endotoxin LevelThe EUPHRATES Randomized Clinical Trial JAMA. 2018;320(14):1455-1463. Abstract ◯重要性 ・Polymyxin B hemoperfusionは…

A Candida auris Outbreak and Its Control in an Intensive Care Setting N Engl J Med 2018; 379:1322-1331 Abstract ◯背景 ・Candida aurisは新興性の多剤耐性病原体である。Candida aurisのcoloinizationと感染の院内outbreakを報告する。 ◯方法 ・英国…

Effect of aspirin on disability-free survival in the healthy elderly. N Engl J Med. DOI: 10.1056/NEJMoa1800722 the Aspirin in Reducing Events in the Elderly (ASPREE) trial Abstract ◯背景 ・低用量アスピリンを5年服用することで高齢者においてd…

Transcatheter Mitral-Valve Repair in Patients with Heart Failure NEJM the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial Abstract ◯背景…

Rivaroxaban for Thromboprophylaxis after Hospitalization for Medical Illness N Engl J Med 2018;379:1118-27 The Medically Ill Patient Assessment of Rivaroxa- ban versus Placebo in Reducing Post-Discharge Venous Thrombo-Embolism Risk (MARINE…