The Latest in Critical Care, 3/18/24 (Issue #34)
Ceftriaxone prophylaxis for VAP (PROPHY-VAP); Midlines vs. PICCs; Anticoagulation + thrombolytics for stroke (MOST)
Ceftriaxone for all vented brain injured patients? (PROPHY-VAP)
Patients with strokes and traumatic brain injuries who require mechanical ventilation due to coma are at very high risk for developing ventilator associated pneumonia. Prophylactic antibiotics, given enterally or intravenously, have been shown to reduce the rate of VAP, but with unproven clinically meaningful benefits like survival. Secondary consequenc…
Are midline catheters or PICCs safer? A randomized trial
Midline catheters are long (8 to 20 cm) peripherally inserted lines that terminate in or just distal to the axillary vein. They’re shorter than peripherally inserted central catheters (PICCs), which usually terminate in the superior vena cava. Midlines have become widely adopted, but there's been very little quality data to guide their use.
Adding anticoagulation to thrombolytics for acute ischemic stroke (MOST trial)
There were lingering hopes that for patients with ischemic stroke, adding parenteral anticoagulation after thrombolytic therapy might improve outcomes. That line of inquiry might be at an end after the Multi-arm Optimization of Stroke Thrombolysis (MOST trial)