A thread 🧵 on trials I think have changed or will change ICU practice (at least my own). #emimcc - ThreadSky

dilipj1.bsky.social • 95 days ago

A thread 🧵 on trials I think have changed or will change ICU practice (at least my own). #emimcc

At the back of Revision Notes In Intensive Care Medicine there is a list of 59 key papers relating to intensive care medicine published between 1998 and 2015 (the book was published in 2016).
I'd like to keep my revision up to date. Are there any equivalent lists of key papers from 2016 to now?

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dilipj1.bsky.social•95 days ago

TTM-2 . This trial has probably been one of the most practice-changing in my short career. I remember debates regarding the optimal duration for targeted temperature management. I now look forward to enrolling patients in STEPCARE and the day it is published. #emimcc https://www.nejm.org/doi/full/10.1056/NEJMoa2100591

dilipj1.bsky.social•95 days ago

TOMAHAWK and COACT. In a hospital I had worked in, the disposition (cardiac vs general ICU) of a patient following an OHCA was dependent on the coronary angiogram they received on arrival. These trials have challenged long-held dogma.

dilipj1.bsky.social•95 days ago

ADRENAL and APPROCHS. I remember strong scepticism about the utility of steroids in septic shock. I believe the scepticism has at least reduced. A special mention to the Dequin study showing a favourable effect in severe pneumonia, which I believe to be the next frontier for corticosteroid use.

dilipj1.bsky.social•95 days ago

SUP-ICU, PEPTIC and REVISE . Stress ulcer prophylaxis particularly with PPIs has been well researched now. PEPTIC's findings interesting suggesting a potential compromise with a less potent acid suppressor that may be less prone to the proposed adverse effects. https://evidence.nejm.org/doi/full/10.1056/EVIDoa2400134

tonyrostron.bsky.social•92 days ago

One of the biggest challenges over SUP is availability of H2RA.

dilipj1.bsky.social•95 days ago

BEST-LIVING with its associated trials (SPLIT, SMART, SALT-ED, SCOPE-DKA, and PLUS). Many arguments are made that fluid tx should be based on physiological parameters such as Na and Cl levels. This IPDMA shows no point estimate favouring saline favouring these parameters (apart from TBI).

dilipj1.bsky.social•95 days ago

STARTT-AKI (along with AKIKI and IDEAL-ICU). The idea of renal supportive tx (early RRT to support kidney fx) was a growing concept. This trial exemplifies that in most cases, doing less is more. Although, waiting too long may have adverse consequences (AKIKI-2) maing me consider urea as well

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