2011 Nov 29 - Low-Molecular-Weight Heparin and Mortality in Acutely Ill Medical Patients

Ajay K. Kakkar, M.B., B.S., Ph.D., Claudio Cimminiello, M.D., Samuel Z. Goldhaber, M.D., Rajiv Parakh, M.D., Chen Wang, M.D., Ph.D., and Jean-François Bergmann, M.D. for the LIFENOX Investigators. N Engl J Med 2011; 365:2463-2472December 29, 2011
Background
Although thromboprophylaxis reduces the incidence of venous thromboembolism in acutely ill medical patients, an associated reduction in the rate of death from any cause has not been shown.

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2011 Dec 22 - Pneumopericardium Associated with a Peptic Ulcer

Alexandre Andrianov, M.D., and Michael A. Nissenbaum, M.D. N Engl J Med 2011; 365:2412December 22, 2011
A 63-year-old man with a history of peptic ulcer and recent use of nonsteroidal antiinflammatory medications presented to the emergency room with an acute onset of shortness of breath and chest pain.

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2011 Dec 8 - Apixaban versus Enoxaparin for Thromboprophylaxis in Medically Ill Patients

Samuel Z. Goldhaber, M.D., Alain Leizorovicz, M.D., Ajay K. Kakkar, M.D., Ph.D., Sylvia K. Haas, M.D., Ph.D., Geno Merli, M.D., Robert M. Knabb, Ph.D., and Jeffrey I. Weitz, M.D. for the ADOPT Trial Investigators. N Engl J Med 2011; 365:2167-2177December 8, 2011
Background
The efficacy and safety of prolonging prophylaxis for venous thromboembolism in medically ill patients beyond hospital discharge remain uncertain. We hypothesized that extended prophylaxis with apixaban would be safe and more effective than short-term prophylaxis with enoxaparin.

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2011 Nov 17 - Extracorporeal Membrane Oxygenation for ARDS in Adults

Daniel Brodie, M.D., and Matthew Bacchetta, M.D. N Engl J Med 2011; 365:1905-1914November 17, 2011
A 41-year-old woman presents with severe community-acquired pneumococcal pneumonia. Chest radiography reveals diffuse bilateral infiltrates, and hypoxemic respiratory failure develops despite appropriate antibiotic therapy.

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2011 Oct 6 - NEJM Images in Medicine: Traumatic Diaphragmatic Hernia

Edoardo Picetti, M.D., and Mario Mergoni, M.D. N Engl J Med 2011; 365:e30October 6, 2011.
A 6-year-old boy presented to our hospital after several hours of vomiting and dyspnea. He had been in a motor vehicle accident 6 months earlier and sustained a seatbelt injury that necessitated surgical repair of a right diaphragmatic hernia, accessed through the right thorax.

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2011 Sep 1 - NEJM Editorial: Cardiac Arrest and the Limitations of Clinical Trials

Arthur B. Sanders, M.D., M.H.A. N Engl J Med 2011; 365:850-851September 1, 2011
Out-of hospital cardiac arrest accounts for more than 330,000 deaths annually in the United States and Canada. Despite regular updates of guidelines for the management of these arrests, the rate of survival has been stagnant at 7.6% for more than 30 years.1,2 In this issue of the Journal, the Resuscitation Outcomes Consortium reports the results of two randomized comparisons3,4 from the Prehospital Resuscitation Impedance Valve and Early Versus Delayed Analysis (ROC PRIMED) trial (ClinicalTrials.gov number, NCT00394706), which evaluated potential improvements in the management of out-of hospital cardiac arrest.

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2011 Sep 1 - A Trial of an Impedance Threshold Device in Out-of-Hospital Cardiac Arrest

Tom P. Aufderheide, M.D., Graham Nichol, M.D., Thomas D. Rea, M.D., Siobhan P. Brown, Ph.D., Brian G. Leroux, Ph.D., Paul E. Pepe, M.D., Peter J. Kudenchuk, M.D., Jim Christenson, M.D., Mohamud R. Daya, M.D., Paul Dorian, M.D., Clifton W. Callaway, M.D., Ph.D., Ahamed H. Idris, M.D., Douglas Andrusiek, M.Sc., Shannon W. Stephens, E.M.T.-P., David Hostler, Ph.D., Daniel P. Davis, M.D., James V. Dunford, M.D., Ronald G. Pirrallo, M.D., M.H.S.A., Ian G. Stiell, M.D., Catherine M. Clement, R.N., Alan Craig, M.S., Lois Van Ottingham, B.S.N., Terri A. Schmidt, M.D., Henry E. Wang, M.D., Myron L. Weisfeldt, M.D., Joseph P. Ornato, M.D., and George Sopko, M.D., M.P.H. for the Resuscitation Outcomes Consortium (ROC) Investigators. N Engl J Med 2011; 365:798-806September 1, 2011
Background
The impedance threshold device (ITD) is designed to enhance venous return and cardiac output during cardiopulmonary resuscitation (CPR) by increasing the degree of negative intrathoracic pressure. Previous studies have suggested that the use of an ITD during CPR may improve survival rates after cardiac arrest.

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2011 Sep 1 - Early versus Later Rhythm Analysis in Patients with Out-of-Hospital Cardiac Arrest

Ian G. Stiell, M.D., Graham Nichol, M.D., M.P.H., Brian G. Leroux, Ph.D., Thomas D. Rea, M.D., M.P.H., Joseph P. Ornato, M.D., Judy Powell, B.S.N., James Christenson, M.D., Clifton W. Callaway, M.D., Ph.D., Peter J. Kudenchuk, M.D., Tom P. Aufderheide, M.D., Ahamed H. Idris, M.D., Mohamud R. Daya, M.D., Henry E. Wang, M.D., Laurie J. Morrison, M.D., Daniel Davis, M.D., Douglas Andrusiek, M.Sc., Shannon Stephens, E.M.T.-P., Sheldon Cheskes, M.D., Robert H. Schmicker, M.S., Ray Fowler, M.D., Christian Vaillancourt, M.D., David Hostler, Ph.D., E.M.T.-P., Dana Zive, M.P.H., Ronald G. Pirrallo, M.D., M.H.S.A., Gary M. Vilke, M.D., George Sopko, M.D., and Myron Weisfeldt, M.D. for the ROC Investigators. N Engl J Med 2011; 365:787-797September 1, 2011
Background
In a departure from the previous strategy of immediate defibrillation, the 2005 resuscitation guidelines from the American Heart Association–International Liaison Committee on Resuscitation suggested that emergency medical service (EMS) personnel could provide 2 minutes of cardiopulmonary resuscitation (CPR) before the first analysis of cardiac rhythm. We compared the strategy of a brief period of CPR with early analysis of rhythm with the strategy of a longer period of CPR with delayed analysis of rhythm.

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2011 Aug 11 - Intrapleural Use of Tissue Plasminogen Activator and DNase in Pleural Infection

Najib M. Rahman, D.Phil., Nicholas A. Maskell, D.M., Alex West, M.R.C.P., Richard Teoh, M.R.C.P., Anthony Arnold, M.R.C.P., Carolyn Mackinlay, M.R.C.P., Daniel Peckham, M.D., Chris W.H. Davies, M.D., Nabeel Ali, M.D., William Kinnear, M.D., Andrew Bentley, M.D., Brennan C. Kahan, M.Sc., John M. Wrightson, M.R.C.P., Helen E. Davies, M.R.C.P., Clare E. Hooper, M.R.C.P., Y.C. Gary Lee, Ph.D., Emma L. Hedley, Nicky Crosthwaite, R.G.N., Louise Choo, M.Sc., Emma J. Helm, F.R.C.R., Fergus V. Gleeson, M.D., Andrew J. Nunn, M.Sc., and Robert J.O. Davies, M.D. N Engl J Med 2011; 365:518-526, August 11, 2011
Background
More than 30% of patients with pleural infection either die or require surgery. Drainage of infected fluid is key to successful treatment, but intrapleural fibrinolytic therapy did not improve outcomes in an earlier, large, randomized trial.

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2011 Jun 30 - NEJM Editorial: Fluid Resuscitation in Acute Illness — Time to Reappraise the Basics

John A. Myburgh, M.B., B.Ch., Ph.D. N Engl J Med 2011; 364:2543-2544, June 30, 2011
Fluid resuscitation is a fundamental intervention in the treatment of critically ill patients. However, there is little conclusive evidence to guide clinicians about the best type of resuscitation fluid; the appropriate timing, volume, and rate of fluid administration; and the optimal way to adequately monitor the efficacy and safety of fluid resuscitation in various clinical conditions.1

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2011 Jun 29 - NEJM Editorial: Nutrition Support in Critical Illness — Bridging the Evidence Gap

Thomas R. Ziegler, M.D. NEJM June 29, 2011 (10.1056/NEJMe1106612)
The modern field of specialized nutrition support began with seminal studies showing that parenteral nutrition could stimulate growth and development in infants, as well as wound healing and convalescence in adults with the severe short bowel syndrome, who until that time had been unable to survive with enteral nutrition alone.1,2

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2011 Jun 29 - Early versus Late Parenteral Nutrition in Critically Ill Adults

Michael P. Casaer, M.D., Dieter Mesotten, M.D., Ph.D., Greet Hermans, M.D., Ph.D., Pieter J. Wouters, R.N., M.Sc., Miet Schetz, M.D., Ph.D., Geert Meyfroidt, M.D., Ph.D., Sophie Van Cromphaut, M.D., Ph.D., Catherine Ingels, M.D., Philippe Meersseman, M.D., Jan Muller, M.D., Dirk Vlasselaers, M.D., Ph.D., Yves Debaveye, M.D., Ph.D., Lars Desmet, M.D., Jasperina Dubois, M.D., Aime Van Assche, M.D., Simon Vanderheyden, B.Sc., Alexander Wilmer, M.D., Ph.D., and Greet Van den Berghe, M.D., Ph.D. NEJM Online First, June 29, 2011
Background
Controversy exists about the timing of the initiation of parenteral nutrition in critically ill adults in whom caloric targets cannot be met by enteral nutrition alone.

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2011 Jun 22 - Epidemic Profile of Shiga-Toxin–Producing Escherichia coli O104:H4 Outbreak in Germany — Preliminary Report

Christina Frank, Ph.D., Dirk Werber, D.V.M., Jakob P. Cramer, M.D., Mona Askar, M.D., Mirko Faber, M.D., Matthias an der Heiden, Ph.D., Helen Bernard, M.D., Angelika Fruth, Ph.D., Rita Prager, Ph.D., Anke Spode, M.D., Maria Wadl, D.V.M., Alexander Zoufaly, M.D., Sabine Jordan, M.D., Klaus Stark, M.D., Ph.D., and Gérard Krause, M.D., Ph.D. for the HUS Investigation Team. NEJM June 22, 2011 (10.1056/NEJMoa1106483)
Background
In this report, we provide a preliminary description of an ongoing large outbreak of gastroenteritis and the hemolytic–uremic syndrome caused by Shiga-toxin–producing Escherichia coli in Germany in May and June 2011.

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2011 May 26 - NEJM Editorial: Fluid Resuscitation in Acute Illness — Time to Reappraise the Basics

John A. Myburgh, M.B., B.Ch., Ph.D. NEJM Online, May 26, 2011 (10.1056/NEJMe1105490)
Fluid resuscitation is a fundamental intervention in the treatment of critically ill patients. However, there is little conclusive evidence to guide clinicians about the best type of resuscitation fluid; the appropriate timing, volume, and rate of fluid administration; and the optimal way to adequately monitor the efficacy and safety of fluid resuscitation in various clinical conditions.1

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2011 May 26 - Mortality after Fluid Bolus in African Children with Severe Infection

Kathryn Maitland, M.B., B.S., Ph.D., Sarah Kiguli, M.B., Ch.B., M.Med., Robert O. Opoka, M.B., Ch.B., M.Med., Charles Engoru, M.B., Ch.B., M.Med., Peter Olupot-Olupot, M.B., Ch.B., Samuel O. Akech, M.B., Ch.B., Richard Nyeko, M.B., Ch.B., M.Med., George Mtove, M.D., Hugh Reyburn, M.B., B.S., Trudie Lang, Ph.D., Bernadette Brent, M.B., B.S., Jennifer A. Evans, M.B., B.S., James K. Tibenderana, M.B., Ch.B., Ph.D., Jane Crawley, M.B., B.S., M.D., Elizabeth C. Russell, M.Sc., Michael Levin, F.Med.Sci., Ph.D., Abdel G. Babiker, Ph.D., and Diana M. Gibb, M.B., Ch.B., M.D. for the FEAST Trial Group. May 26, 2011 (10.1056/NEJMoa1101549)
Background
The role of fluid resuscitation in the treatment of children with shock and life-threatening infections who live in resource-limited settings is not established.

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2011 May 19 - NEJM Video in Clinical Medicine: Fiberoptic Intubation

Thomas Heidegger, M.D. N Engl J Med 2011; 364:e42May 19, 2011
Fiberoptic intubation plays an important part in the management of a difficult airway and is recommended by many societies of anesthesia. It is primarily important for the management of the anticipated difficult airway, but can also be used to secure the airway in an unexpected situation.

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2011 May 12 - Review: The Tumor Lysis Syndrome

Scott C. Howard, M.D., Deborah P. Jones, M.D., and Ching-Hon Pui, M.D. N Engl J Med 2011; 364:1844-1854, May 12, 2011
The tumor lysis syndrome is the most common disease-related emergency encountered by physicians caring for children or adults with hematologic cancers.14

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2011 May 5 - NEJM Images in Medicine: Fat Embolism Syndrome

Hsiao-Kan Liu, M.D., and Wen-Chau Chen, M.D. N Engl J Med 2011; 364:1761, May 5, 2011
A 48-year-old man who had sustained a traumatic fracture of the left femoral shaft in a motorcycle accident 20 hours earlier was referred for a deterioration of consciousness that began after the accident. He was unresponsive to verbal stimuli, and no focal neurologic abnormalities were found on examination. An arterial blood gas analysis revealed mild hypoxemia, but a radiograph of the chest was normal.

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2011 Apr 21 - NEJM Editorial: Clinical Value of Decompressive Craniectomy

Franco Servadei, M.D. N Engl J Med 2011; 364:1558-1559, April 21, 2011
Patients with a variety of intracranial disorders — including traumatic brain injury, stroke, subarachnoid hemorrhage, intracerebral hemorrhage, and brain tumors — often present with a progressive increase in intracranial pressure, leading to clinical deterioration and ultimately to death.

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2011 Apr 21 - Pulse Oximetry

Rafael Ortega, M.D., Christopher J. Hansen, M.A., Kelly Elterman, M.D., and Albert Woo, M.D. N Engl J Med 2011; 364:e 33, April 21, 2011
About the Procedure
Pulse oximetry has become the standard of care in operating rooms, intensive care units (ICUs), and hospital wards in the United States and many other nations.1

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