RCTs have shown no benefit from IABP in acute ischemic cardiogenic shock, an observatiobal trial isn’t even hypothesis generating. No grounds for new IABP trials in this population in my opinion.
#cardiosky #cccsky #emimccIntra-aortic balloon pump vers...Bayesian reanalysis can be a great way to assess a contested trial, by showing how strong a prior you need to nullify or inverse the results. I don't understand why they did not include a pessimistic prior here though (even as I see a sceptical one more realistic).
#emimcc #cardiosky #cccsky #stats
RE: https://bsky.app/profile/did:plc:77cp7kgakti2uthqnkkdaqum/post/3mkpw474mis2qIn a patient with high-risk pulmonary embolism, but no sign of hypoperfusion, would you start LMWH or UFH?
#emimcc #cardisky #cccsky #critcareskyThis should be the death of Impella outside of severe cardiogenic shock.
High probability it increases mortality.
#cardiosky #cccsky
RE: https://bsky.app/profile/did:plc:yrhfut7mmcbabz6mgjqcyums/post/3mi7xwmgjrs2kCan we please stop referring to lactate as a perfusion marker? It’s no more so and no better than blood pressure.
#emimcc #cccskyOne point that isn't mentioned here but too often forgotten when noradrenaline seemingly isn't working:
Are you actually using a representative blood pressure? Not so rare that a better (more central or better line) fixes the problem. Look at the whole patient, not just a number!
#emimcc #cccsky
RE: https://bsky.app/profile/did:plc:vmwckmxogx3lipqxlmn76mbe/post/3mh67jqfw3z2hCan't wrap my head around how this is even possible! TAVI in mechanical valves.
#cardiosky #cccsky
academic.oup.com/eurheartj/ad...Transcatheter aortic valve-in-...
Vasopressin in septic shock: an individual patient data meta-analysis of randomised controlled trials - Intensive Care Medicine
Purpose We performed an individual patient data meta-analysis to investigate the possible benefits and harms of vasopressin therapy in adults with septic shock both overall and in pre-defined subgroups. Methods Our pre-specified study protocol is published on PROSPERO, CRD42017071698. We identified randomised clinical trials up to January 2019 investigating vasopressin therapy versus any other vasoactive comparator in adults with septic shock. Individual patient data from each trial were compiled. Conventional two-stage meta-analyses were performed as well as one-stage regression models with single treatment covariate interactions for subgroup analyses. Results Four trials were included with a total of 1453 patients. For the primary outcomes, there was no effect of vasopressin on 28-day mortality [relative risk (RR) 0.98, 95% CI 0.86–1.12] or serious adverse events (RR 1.02, 95% CI 0.82–1.26). Vasopressin led to more digital ischaemia [absolute risk difference (ARD) 1.7%, 95% CI 0.3%–3.2%] but fewer arrhythmias (ARD − 2.8%, 95% CI − 0.2% to − 5.3%). Mesenteric ischaemia and acute coronary syndrome events were similar between groups. Vasopressin reduced the requirement for renal replacement therapy (RRT) (RR 0.86, 95% CI 0.74–0.99), but this finding was not robust to sensitivity analyses. There were no statistically significant interactions in the pre-defined subgroups (baseline kidney injury severity, baseline lactate, baseline norepinephrine requirement and time to study inclusion). Conclusions Vasopressin therapy in septic shock had no effect on 28-day mortality although the confidence intervals are wide. It appears safe but with a different side effect profile from norepinephrine. The finding on reduced RRT should be interpreted cautiously. Future trials should focus on long-term outcomes in select patient groups as well as incorporating cost effectiveness analyses regarding possible reduced RRT use.
To write a "state-of-the-art review" of diastolic dysfunction in acute and critical illness with an emphasis on SGLT2-inhibition and not mention the DEFENDER trial is quite something.
#cardisky #emimcc #cccsky www.jacc.org/doi/10.1016/...Diastolic Dysfunction in Acute...
Lars Mølgaard Saxhaug