Internal Medicine
RSSArticles
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Treatment of Gram-Negative Bacteremia: How Long Is Long Enough?
Antibiotic administration for seven days is sufficient in stable patients with Gram-negative bacteremia.
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Are Frequent PVCs Causing Left Ventricular Dysfunction?
Premature ventricular contraction-induced cardiomyopathy was phenotypically different than a tachycardia-mediated cardiomyopathy in a swine model. Paced ventricular bigeminy led to left ventricular dyssynchrony, a decline in left ventricular ejection fraction associated with biventricular myocardial fibrosis, and a widening of the sinus QRS.
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In-Ambulance Troponin Measurements
A study of triaging suspected non-ST-elevation acute coronary syndrome patients by employing in-ambulance troponin measurements augmented the predictive value for 45-day major adverse cardiac events. This could help identify very high-risk patients who would benefit from urgent coronary angiography.
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The Natural History of Tricuspid Regurgitation
A retrospective analysis of patients with moderate or severe tricuspid valve regurgitation (TR) and who underwent an earlier echo with no or mild TR showed that progression of TR was independently associated with age, female sex, new device leads, and right ventricular or tricuspid annular dilation.
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TAVR Beneficial for Patients With Severely Reduced Ejection Fraction
In patients with low-flow, low-gradient aortic stenosis and severe left ventricular dysfunction, transcatheter aortic valve replacement was associated with significant improvement in left ventricular ejection fraction and similar mortality compared to patients with milder left ventricular dysfunction.
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Late Mortality With Paclitaxel-Coated Balloons and Stents in Peripheral Arterial Disease
A newly published meta-analysis of randomized, controlled trials concerning paclitaxel-coated balloons and stents in femoral popliteal disease patients revealed a marked increase in all-cause death at two and five years.
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Early Extubation to Noninvasive Ventilation Does Not Reduce Time to Liberation From All Mechanical Ventilation
In this multicenter, randomized, open-label trial of patients who failed a spontaneous breathing trial, those who were extubated to noninvasive ventilation did not have a shorter time to liberation from any form of mechanical ventilation compared to those who were randomized to protocolized standard weaning.
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Thiamine for Septic Shock: Is There a Benefit?
Based on a retrospective review, septic shock patients who were administered thiamine within 24 hours of admission showed improved lactate clearance and reduced 28-day mortality.
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Liberal Oxygen Therapy in the ICU: Time to Change Practice?
Over the last decade, more clinical studies have shown adverse effects of hyperoxia in different patient populations and its association with increased mortality. In a meta-analysis, investigators synthesized data from 25 randomized, controlled trials comparing a liberal oxygen approach to a conservative approach. They included thousands of patients with sepsis, critical illness, stroke, trauma, myocardial infarction, cardiac arrest, and emergency surgery. The authors found that liberal oxygen therapy was associated with increased in-hospital mortality, 30-day mortality, and mortality at longest follow-up. Read on to learn more details about specific subgroups relevant to ICU practice and to see a review of the current data on oxygen therapy in these patients.
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A ‘Detective’ Diagnosis
The ECG in the figure was obtained from a 40-year-old man. Without the benefit of any history, how might one interpret this tracing? Is there evidence of an acute coronary syndrome? Is there a common diagnosis that potentially explains all the findings?