Head of the bed up, capillary refill in hand, and a Class I recall of multidose adrenaline vials

The edition in brief

The FDA has classified as Class I a recall of American Regent's 30 mL multiple-dose vials of adrenaline 1 mg/mL, dated 16 September, for particulate matter including glass and plastics and broken or leaking vials; check stock. An updated Cochrane review of 48 trials (7,955 ventilated adults) found semi-recumbent positioning reduced clinically suspected ventilator-associated pneumonia compared with supine (RR 0.42, high certainty) without a clear effect on mortality; 30–45° beat lower angles for suspected pneumonia but probably increased pressure ulcers, and lateral rotation variants may do better still. A meta-analysis of seven trials (2,408 patients) in septic shock found peripheral perfusion-guided resuscitation, usually capillary refill time, gave a 28-day mortality risk ratio of 0.87 (95% CI 0.76 to 1.01), not significant, with a 97% Bayesian probability of some benefit. A network meta-analysis of ward surveillance technologies found no reliable ranking between rule-based alerts, predictive models and continuous monitoring, with very low confidence throughout. The pearl covers how to measure capillary refill time reproducibly.