JAMA Clinical Guidelines Synopsis  August 8, 2022 Treatment of Clostridioides difficile Infection Kanika Sehgal, Adam S. Cifu, Sahil Khanna JAMA. Published online August 8, 2022. doi:10.1001/jama.2022.12251 Guideline title ACG Clinical Guidelines: Prevention, Diagnosis, and Treatment of Clostridioides difficile Infections Release date May 18, 2021 Prior version 2013 Developer American College o...

ICU Management & Practice, Volume 22 - Issue 2, 2022 The Alphabet Book of Sepsis In this article, the author provides the alphabet review of sepsis and septic shock based on personal clinical experience and choice. Sepsis and septic shock have been defined in 2016 (Singer et al. 2016) and the management of patients is framed by the Surviving Sepsis Campaign guidelines with its renewed version in 2021 (Evans et al. 2021). Using PubMed, around 15,000 hits ...

ORIGINAL ARTICLE Efficacy and Safety of an Extravascular Implantable Cardioverter–Defibrillator Paul Friedman, Francis Murgatroyd, Lucas V.A. Boersma, et al N Engl J Med August 28, 2022DOI: 10.1056/NEJMoa2206485 Abstract BACKGROUND The extravascular implantable cardioverter–defibrillator (ICD) has a single lead implanted substernally to enable pause-prevention pacing, antitachycardia pacing, and defibrillation energy similar to that of transvenous ICDs. ...

ORIGINAL ARTICLE Fractional Flow Reserve or Intravascular Ultrasonography to Guide PCI Bon-Kwon Koo, Xinyang Hu, Jeehoon Kang, et al N Engl J Med 2022; 387:779-789DOI: 10.1056/NEJMoa2201546 Abstract BACKGROUND In patients with coronary artery disease who are being evaluated for percutaneous coronary intervention (PCI), procedures can be guided by fractional flow reserve (FFR) or intravascular ultrasonography (IVUS) for decision making regarding revascula...

ICU Management & Practice, Volume 22 - Issue 2, 2022 Symmetrical Peripheral Gangrene In this article, the authors describe the presentation, pathophysiology, and potential treatment options for symmetrical peripheral gangrene. Limitations in the current literature and a possible strategy for future study are highlighted. Introduction Symmetrical peripheral gangrene (SPG) refers to the development of tissue necrosis in an acral distribution without vas...

ORIGINAL ARTICLE Routine Functional Testing or Standard Care in High-Risk Patients after PCI Duk-Woo Park, Do-Yoon Kang, Jung-Min Ahn, et al N Engl J Med August 28, 2022DOI: 10.1056/NEJMoa2208335 Abstract BACKGROUND There are limited data from randomized trials to guide a specific follow-up surveillance approach after myocardial revascularization. Whether a follow-up strategy that includes routine functional testing improves clinical outcomes among high-...

ORIGINAL ARTICLE Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction Scott D. Solomon, John J.V. McMurray, Brian Claggett, et al N Engl J Med August 27, 2022DOI: 10.1056/NEJMoa2206286 Abstract BACKGROUND Sodium–glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of hospitalization for heart failure and cardiovascular death among patients with chronic heart failure and a left ventricular ejection fraction of 40% or les...

ICU Management & Practice, Volume 22 - Issue 2, 2022 Sepsis Surveillance (Sepsis Sniffer): Where We Are Now and Where We Are Going Timely recognition of sepsis is the foundation of improved patient survival. This article discusses opportunities to improve this in multiple areas and the use of sepsis screening tools to improve surveillance and treatment of sepsis. Sepsis is a critical healthcare problem, associated with high mortality rates, and considera...

ORIGINAL ARTICLE Acetazolamide in Acute Decompensated Heart Failure with Volume Overload Wilfried Mullens, Jeroen Dauw, Pieter Martens, et al N Engl J Med August 27, 2022DOI: 10.1056/NEJMoa2203094 Abstract BACKGROUND Whether acetazolamide, a carbonic anhydrase inhibitor that reduces proximal tubular sodium reabsorption, can improve the efficiency of loop diuretics, potentially leading to more and faster decongestion in patients with acute decompensated h...

ORIGINAL ARTICLE Rivaroxaban in Rheumatic Heart Disease–Associated Atrial Fibrillation Stuart J. Connolly, Ganesan Karthikeyan, Mpiko Ntsekhe, et al N Engl J Med August 28, 2022DOI: 10.1056/NEJMoa2209051 Abstract BACKGROUND Testing of factor Xa inhibitors for the prevention of cardiovascular events in patients with rheumatic heart disease–associated atrial fibrillation has been limited. METHODS We enrolled patients with atrial fibrillation and echo...