The edition · Emergency & Critical Care
In Candida septic shock, each hour's delay to the right antifungal was linked to about 5% lower survival
A 32-hospital cohort on antifungal timing, ventilation rates during paediatric in-hospital CPR, music therapy during ventilator weaning, and an FDA supplement for an adrenaline product.
The edition in brief
A retrospective cohort of 850 adults with culture-positive Candida septic shock at 32 hospitals found survival of 86% when an appropriate antifungal was given within two hours of persistent hypotension, falling about 5% for each further hour; the adjusted odds of death rose 4.5% per hour. Median time to appropriate therapy was 32 hours, and fewer than one in five were treated within six hours. An observational analysis of 234 paediatric in-hospital cardiac arrests with advanced airways found that guideline ventilation rates of 20 to 30 a minute were not associated with survival, while in children under eight, rates of 26 or more were associated with better survival in exploratory analysis. A Spanish randomised trial of 100 ventilated adults found daily music therapy did not shorten weaning but was associated with less agitation, less propofol use and fewer tracheostomies. The FDA recorded a supplement on 19 October to an approved epinephrine (Adrenalin) application; the record does not describe the change. The pearl covers the risk factors that should prompt early antifungal cover.
Guideline ventilation rates during paediatric in-hospital CPR were not linked to survival
Continue to ventilate at guideline rates during paediatric CPR with an advanced airway; the higher rates suggested here for under-eights need confirmation first.
Music therapy during weaning reduced agitation and tracheostomy but not weaning time
Music therapy may be worth considering as a low-risk adjunct to reduce agitation during ventilator weaning.
FDA records a supplement to an approved epinephrine (Adrenalin) application
No change to how adrenaline is used in anaphylaxis or cardiac arrest follows from this record.
Know who needs early antifungal cover in septic shock
In septic shock with major risk factors for invasive candidiasis, discuss empirical antifungal therapy early rather than waiting for cultures.
Each hour's delay to appropriate antifungal therapy in Candida septic shock was linked to lower survival
In septic shock with risk factors for Candida, consider starting an appropriate antifungal within the first hours of persistent hypotension rather than waiting for cultures.
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