The edition · Emergency & Critical Care
Starting newborn resuscitation in air rather than 100% oxygen may reduce deaths
An updated Cochrane review of 12 trials supports air for term and late preterm infants, while a septic shock analysis shows that capillary refill and lactate sharpen what vasopressor dose alone predicts.
The edition in brief
An updated Cochrane review of 12 trials and 2,054 term and late preterm infants found that starting resuscitation at birth with air rather than 100% oxygen may reduce death before discharge (RR 0.72, 0.57–0.91; low-certainty evidence), with little or no difference in moderate to severe hypoxic-ischaemic encephalopathy. No included trial titrated oxygen to saturation targets. A secondary analysis of ANDROMEDA-SHOCK-2 in 1,363 patients with septic shock found that, after six hours of resuscitation, a high noradrenaline-equivalent dose combined with abnormal capillary refill and a non-falling lactate identified a small group with 74% mortality (adjusted HR 4.68 against the rest). A review in Intensive Care Medicine sets out principles for dosing drugs in critically ill patients with extreme obesity, centred on choosing the right weight. A meta-analysis of 20 trials found virtual reality associated with less anxiety, depression and post-traumatic stress in ICU patients, but not less pain, on low to moderate-certainty evidence. The pearl covers checking capillary refill properly.
Capillary refill and lactate sharpen risk in refractory septic shock
At six hours of septic shock, combine vasopressor dose with capillary refill and lactate trend to identify patients at very high risk.
Dosing drugs in critically ill patients with extreme obesity
For critically ill patients with extreme obesity, choose the right weight for each drug and involve a pharmacist.
Virtual reality linked to less anxiety and distress in ICU patients
Virtual reality may ease anxiety and improve sleep in ICU patients, but do not use it in place of analgesia.
Measuring capillary refill so it means something
Standardise capillary refill technique so repeat readings in shock can be compared.
Air rather than 100% oxygen to start newborn resuscitation may reduce deaths
Begin resuscitation of term and late preterm newborns in air, titrating oxygen to saturations where equipment allows.
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