Blood, Guts, & Grapes!
Ambroise Paré, a name perhaps unfamiliar to many, was a true revolutionary in the gruesome world of 16th-century battlefield medicine. Imagine the chaos: soldiers suffering horrific injuries, and the standard "treatment" often involving searing hot irons to cauterize wounds – a barbaric practice that likely caused more agony than relief. Paré, however, dared to challenge these brutal norms. He championed the use of tourniquets during amputations, a seemingly simple innovation that dramatically reduced blood loss and undoubtedly saved countless lives on the battlefield, transforming a procedure that was often a death sentence into one with a fighting chance of survival.
But Paré's pioneering spirit didn't stop there. In an era where understanding of germ theory was centuries away, he instinctively grasped the importance of cleanliness. While others might have dismissed it, Paré advocated for the radical notion of using wine to sterilize surgical instruments. This wasn't just a touch of sophistication; it was a pragmatic approach to reducing infection in a time when sepsis was rampant and often fatal. His forward-thinking methods, born from a desire to alleviate suffering, truly set the stage for modern surgical practices and cemented his legacy as a compassionate and brilliant innovator.
Welcome to the 127th edition of ResusNation!
Are You Using Epinephrine After ROSC? Think Again.
As a Resuscitationist, I've seen firsthand the critical decisions we face in the chaotic moments after achieving Return of Spontaneous Circulation (ROSC). A common pitfall I've observed is the go-to use of epinephrine when a patient remains hypotensive. However, the data overwhelmingly points to a different—and frankly, better—choice: norepinephrine. It's not just my opinion; it’s backed by robust evidence showing that epinephrine, when compared to norepinephrine in this post-ROSC phase, is associated with higher rates of re-arrest, more ventricular abnormalities, increased metabolic complications like lactic acidosis, and crucially, higher all-cause mortality.
This might challenge what many of us have been taught or what feels intuitive, especially given epinephrine's role during cardiac arrest. But consider this: norepinephrine is a superior vasopressor. In the post-cardiac arrest state, patients often experience significant vasoplegia and vasodilation. Norepinephrine simply does a more effective job at contracting those arteries and veins, stabilizing hemodynamics more efficiently. So, the next time you get ROSC and your patient is still hypotensive, reach for norepinephrine—it’s the evidence-based choice that truly optimizes patient outcomes.
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Is Vitamin C Really a Game-Changer for Kids with Sepsis?
Septic shock is life-threatening condition and can cause organ failure. It's especially serious in children, where treatment options are limited and outcomes can be devastatin. For years, there's been growing interest in using intravenous (IV) vitamin C as an additional therapy, with some studies suggesting potential benefits. But does it truly make a difference for our most vulnerable patients? A recent study, "VITACIPS," tackled this critical question, and its findings offer an important answer: IV vitamin C did not significantly improve organ function in children with septic shock.
This study found that children receiving vitamin C experienced similar improvements in organ function over 72 hours as those who received a placebo. Even more importantly, there was no significant difference in survival rates after 28 days between the two groups (21.6% in the Vitamin C group vs. 22.5% in the placebo group), nor were there major differences in other critical outcomes like shock resolution or the need for a ventilator. While this study provides valuable clarity, it's worth noting that it was conducted at a single hospital, potentially limiting its broader applicability. Additionally, the chosen dose of vitamin C was conservative, leaving some questions open about higher doses or different patient groups. Ultimately, these results suggest that routine use of IV vitamin C for children with septic shock is not currently supported, guiding doctors toward treatments with proven benefits and ensuring the best possible care for these young patients.
Here's my Takeaways:
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Finding: Intravenous vitamin C did not significantly improve organ dysfunction (pSOFA score) at 72 hours, nor did it reduce 28-day mortality in children with septic shock.
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Practice Impact: Routine use of intravenous vitamin C as an add-on therapy for children with septic shock is not recommended based on these findings.
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Population: The study focused on pediatric patients (2 months to 17 years old) with septic shock in a tertiary care hospital setting.
- Limitation: The study was conducted at a single center, which may limit how broadly the results apply to other hospitals, and the dose of vitamin C used might have been too low to show a benefit.
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Want to learn more? Read the full study "Vitamin C Versus Placebo in Pediatric Septic Shock (VITACIPS) - A Randomised Controlled Trial" by Jhuma Sankar et al. in Journal of Intensive Care Medicine
Watch the July's Videos Now!
If you're an All-Access Member, you're in for some great content this month. We have FIVE videos hand-picked by our staff that are high-yield and our most highly watched. We're featuring
- Selman on "Brainstorming – Forgotten Causes of Delirium"
- Wydo on "Demystifying the Trauma Exploratory Laparotomy"
- Filkins on "Resus Out Loud"
- Winters on "Recent Articles in Resuscitation & Critical Care"
- Spiegel on "Finding One MAP For Everyone"
Each month we bring you fresh new content from the best of the best in resuscitation. If you're an All-Access member, go watch these videos NOW! If you're not, then sign up here.
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Do you want even more resus content anytime you want? For less than a cup of coffee, you can get even more content from @CriticalCareNow. Digital teaching sessions, free video lectures, grand rounds, and so much more can be your today. Come watch on replay all the content that @CriticalCareNow does live.
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