Therapeutic novelties in acute heart failure and practical perspectives

CCR Journal Watch - tracking the critical care literature daily
https://criticalcarereviews.com/latest-evidence/journal-watch

Four-factor prothrombin complex concentrate proved superior in both hemostatic response & safety to frozen plasma for coagulation factor replacement for bleeding during cardiac surgery, according to FARES-II trial presented at #ACC25.

Read more: bit.ly/4iFMGNo

#CardioSky #MedSky

#APICAT trial at #ACC25 #LBCT #cardioonc

🩸apixaban low 2.5 mg vs full dose 5mg in patients with cancer+VTE: primary endpoint recurrent VTE
🩸more than half female! 👏🏽👏🏽
🩸the low dose was significant for noninferiority for efficacy & ⤵️ bleed
🩸no increase in deaths

Love it!

Diuresis and fluid status comes up on almost every single ICU patient (especially in a cardiac ICU🫀)

It’s very important to understand how each diuretic works, how they can be combined to augment urine output & their limitations

Check out my starter guide for diuresis in the ICU

#MedSky #Nephsky

Read our review on mixed shock published today in @jaccjournals.bsky.social Advances - www.sciencedirect.com/science/arti.... Congratulations to all collaborators within @accintouch.bsky.social Interventional and Critical Care Cardiology Councils. @brownmedicine.bsky.social

I remember as an intern getting calls in the night to give unfamiliar patients intravenous hydralazine for their asymptomatic elevated blood pressure.

Decades later, I'd have thought we know this is harmful and nonsensical, but apparently not entirely. #medsky

jamanetwork.com/journals/jam...

Thanks for following!

Kudos to the researchers and the studies' godparents!

References:

www.nejm.org/doi/full/10....

journals.lww.com/shockjournal...

www.anzctr.org.au/Trial/Regist...

bmjopen.bmj.com/content/13/1...

Rule #1 always check with your surgical team regarding anticoagulation. They know every single suture placed in their patient, their anatomy, their bleeding risk etc

I personally like this suggested algorithm published in the Cleveland Clinic J of Medicine for anticoagulation post cardiac surgery👇🏼

Great summary on post op Atrial Fibrillation

Other pearls:
🔺A fib is the most common arrhythmia post CV surgery, with peak incidence post-op days 2 & 3
🔺Associated with increased risk of CVA
❓Should you start anticoagulation for new onset A Fib post cardiac surgery? It depends ➡️ next post

Intubating patients with elevated ICP can be very tricky.

Your goal: protect cerebral perfusion & avoid big swings in blood pressure

Check out my infographic summarizing some pearls to performing a “neuro protective” intubation🧠

🔗 www.emdocs.net/visual-wedne...

Today's Paper of the Day is on oliguria during renal replacement therapy
criticalcarereviews.com/latest-evide...

Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2024

Viscoelastic haemostatic assay-guided therapy was associated with:
⬇️ RBC, platelet & FFP transfusion
⬇️ operating theatre & ICU duration of stay

NO difference in:
• rates of surgical reintervention
• total duration of stay
• mortality

#AnSky #HemeSky #MedSky 🧪

https://buff.ly/3AOYR9U

One of my favorite reviews to share with learners

Cardiogenic shock can be difficult to diagnose, specially if patient has normal-ish vitals

🫀Know the stages cardiogenic shock with the corresponding physical exam and lab findings

🔗 www.jacc.org/doi/10.1016/...

One of my favorite review articles on management of cardiogenic shock published in JACC in 2020.

They go over diagnosis, early management and advanced hemodynamic monitoring.

I especially like the table summarizing different MCS options.

🔗 www.jacc.org/doi/abs/10.1...

👋🏼👋🏼

As doctors we know that RFKJr's misinformation poses great danger to public health. We need to tell our Senators to protect and defend our patients' access to quality health care -Reject his appointment!
#MedSky
Please sign if a Dr, and everyone please share. committeetoprotect.org/stop-rfk-jr/

My first post will be to repost this tip by @mkittlesonmd.bsky.social

Finding myself frequently on both sides in the ED & ICU, it’s infinitely better for everyone involved to be pleasant and helpful during a consult.

If someone is calling for help, don’t be unpleasant, angry or condescending.