ATS Reading List

Question 1

Acute respiratory distress syndrome: the Berlin Definition (2012) - what did they define?

Answer 1

Severity of ARDS using P/f ratio, and four variables to evaluate radiographic severity, respiratory system compliance (≤40 mL/cm H2O), positive end-expiratory pressure (≥10 cm H2O), and corrected expired volume per minute (≥10 L/min) (the four variables were removed from the definition)

Question 2

Acute respiratory distress syndrome: the Berlin Definition (2012) - ventilator days per mild, moderate and severe ARDS?

Answer 2

5, 7, 9 days

Question 3

Dexamethasone Treatment for the Acute Respiratory Distress Syndrome: A Multicentre, Randomised Controlled Trial (DEXA ARDS, 2020) - experiment set up

Answer 3

Dexamethasone 20mg IV daily for Days 1-5, then 10mg from days 6-10, drug discontinued upon extubation VS SOC (population was moderate to severe ards)

Question 4

Dexamethasone Treatment for the Acute Respiratory Distress Syndrome: A Multicentre, Randomised Controlled Trial (DEXA ARDS, 2020) - findings

Answer 4

Vent free days (12 vs 7), all cause mortality at 60 days (21 vs 36), ICU mortality (19 vs 30%), decreased duration in mechanical ventilation (14 vs 19 days)

Question 5

Dexamethasone Treatment for the Acute Respiratory Distress Syndrome: A Multicentre, Randomised Controlled Trial (DEXA ARDS, 2020) - excluded which patients

Answer 5

already on steroids, CHF, pregnant, severe copd

Question 6

Neuromuscular blockers in early acute respiratory distress syndrome (2010, ACURASYS) - purpose

Answer 6

Does administration of cisatracurium improve survival when compared to placebo in ICU patients undergoing mechanical ventilation for early severe ARDS?

Question 7

Neuromuscular blockers in early acute respiratory distress syndrome (2010, ACURASYS) - findings

Answer 7

Paralysis with cisatracurium for 48 hours in patients with early severe ARDS improves 90 day survival and increases ventilator-free days.

Question 8

Neuromuscular blockers in early acute respiratory distress syndrome (2010, ACURASYS) - guidelines

Answer 8

Suggest using a neuromuscular blockade agent for ≤48 hours in adults with ARDS from sepsis and PaO2/FIO2 ratio <150 mm Hg (weak recommendation, moderate quality of evidence)

Question 9

Timing of renal-replacement therapy in patients with acute kidney injury and sepsis (IDEAL ICU, 2018) - purpose

Answer 9

Among ICU with septic shock and AKI without urgent need for dialysis, does an initiation of renal replacement therapy (RRT) using an early-initiation strategy reduce all-cause mortality at 90 days when compared to a delayed-initiation strategy?

Question 10

Timing of renal-replacement therapy in patients with acute kidney injury and sepsis (IDEAL ICU, 2018) - findings

Answer 10

Among ICU with septic shock and AKI without urgent need for dialysis, there was no difference in 90-day all cause mortality when comparing early-initiation vs. delayed-initiation RRT strategies. Overall use of RRT was lower in the delayed-initiation strategy group. There was no difference in ICU stay between groups, but the delayed-initiation group had more days free of RRT.

Question 11

“Initiation strategies for renal-replacement therapy in the intensive care unit (AKIKI, 2016) - purpose

Answer 11

Among ICU patients with AKI, does early renal replacement therapy (RRT) reduce mortality as compared to delayed RRT?

Question 12

“Initiation strategies for renal-replacement therapy in the intensive care unit (AKIKI, 2016) - findings

Answer 12

Among ICU patients with AKI, there is no mortality difference between early or delayed RRT.

Question 13

Trial of short-course antimicrobial therapy for intraabdominal infection (STOP IT, 2015) - question

Answer 13

In patients with intraabdominal infections, does a shorter course of antibiotics (3-5 days) increase the risk of surgical-site infection, recurrent intraabdominal infection, or death within 30 days?

Question 14

Trial of short-course antimicrobial therapy for intraabdominal infection (STOP IT, 2015) - findings

Answer 14

Among patients with intraabdominal infections who have achieved source control, a 3-5 day course of antibiotics was not found to lead to higher rates of surgical-site infection, recurrent intra-abdominal infection, or death as compared with continuing antibiotics until 2 days after resolution of fever, leukocytosis, and ileus.

Question 15

Trial of short-course antimicrobial therapy for intraabdominal infection (STOP IT, 2015) - background, why done?

Answer 15

The optimal duration of antibiotics for intraabdominal infections is not known. Traditionally therapy is continued until SIRS markers have resolved (typically 7-14 days), but courses as short as 3-5 days may be equally efficacious and more in keeping with antibiotic stewardship, cost containment, and other goals. IDSA guidelines in 2010 recommended 4-7 days, though this recommendation was based on relatively low-quality evidence. There was a critical need to assess varying durations of anticoagulation in this patient population.

Question 16

The NACSTOP Trial: A Multicenter, Cluster-Controlled Trial of Early Cessation of Acetylcysteine in Acetaminophen Overdose (2019) - question

Answer 16

In adult patients that present to the emergency department following acetaminophen toxic exposure and normal ALT and serum creatinine at presentation and at 12 hours, how does a reduced dose (250mg/kg over 12 hours) of N-acetylcysteine compare to standard dose (300mg/kg over 20hours) in terms of liver injury and death.

Question 17

The NACSTOP Trial: A Multicenter, Cluster-Controlled Trial of Early Cessation of Acetylcysteine in Acetaminophen Overdose (2019) - bottom line

Answer 17

In a relatively small pilot study of patients presenting with acetaminophen toxicity without signs of liver toxicity and low acetaminophen levels at 12 hours after initiation of NAC, a 12-hour infusion of N-acetylcysteine was not associated with more hepatic injury when compared to a 20-hour infusion.