Journal CLUBS

Friday, January 10 , 2025 at 18h30 at BO - 23h30 at BE

ABFL, CORA, AMA, MAAT, DFM, HIBN, AAQC

2018 CID - Renal Dosing of Antibiotics Are We Jumping the Gun (Crass) [r].pdf

Codified by ABFL

Glossary: 

🪲 = microorganisms;
♾ = renal;
ATB = antibiotics;
Ccr = creatinine clearance;
CKD = chronic kidney disease;

1. EVIDENCE
   - ATB dose adjustments applies for stable CKD
   - May not apply to late late-phase trials and practice.
   - Ceftolozane/tazobactam, ceftazidime/avibactam, and telavancin ➩ all have precautionary

     statements for ↓ clinical response (Ccr 30-50) ➩ no need to adjust doses
2. ATB elimination is mostly relevant in acute cases during the 1st 48h
3. Toxicity + efficacy should be considered in every ATB
4. FDA ➩ inferior EFFICACY in moderate ♾ impairment.
5. GOAL ➩ Keep efficacy with the ↓ toxicity possible.
6. CKD studies available in CKD are small, early phase of healthy
7. “Antibiotics do not fit cleanly into this paradigm due to overwhelmingly episodic, rather than

    chronic, use.” Crass 2018

⏳ TIME MANAGEMENT.
01:22:41
Round: 5 01:11:57 Comments
Round: 4 27:19:13 JC main points
Round: 3 32:18:27 JC intro
Round: 2 12:30:77 Codification discussion

Round: 1 09:21:62 Past JC

2024 CC - Feasibility and safety of ultra-low volume ventilation (≤ 3 mlkg) combined w_ECCO2R in ARF (monet) [R].pdf

Codified by MAAT

Glossary:  🫁 = lungs; 🤔 = analysis; ⏎ = return; ARDS = acute respiratory distress syndrome; BLUE = The American Journal of Respiratory and Critical Care Medicine.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, BLUE, FR ➖ retro_prag_🤔 - cohort ➕ 41pxs ➕ 8y (2014 - 2022) ➖ P I C O:
   - P: adults + ECCO2R
   - I: Vt ≤3mL/Kg (ultra-protective vent)
   - C: NA
   - O: p_OC = feasibiliy (proportion of sessions) ➖ s_OC = efficacy + safety + others (adverse

     events, SS90)
3. EVIDENCE:    - …

Friday, January 3 , 2025 at 18h30 at BO - 23h30 at BE

ABFL, CORA, AMA, MAAT, DFM, HIBN, AAQC

⏳ TIME MANAGEMENT.
01:13:20

Round: 4 10:34:78 Comments
Round: 3 51:30:02 ART ultra-low volume ventilation
Round: 2 05:36:00 Select ART
Round: 1 05:39:31 Past JC

Friday, January 24 , 2025 at 18h30 at BO - 23h30 at BE

ABFL, MAAT, JCAU, HIBN, MACR, GMC, AMA, AAQC

2021 HHP - How many fruits+vegetables do we really need (Circulation).pdf
2021 CIRCULATION - Fruit and Vegetable Intake and Mortality, 2 Prospective Cohort Studies + MA of 26 Studies (wang) [MA]

Codified by ABFL
Codified by ACE ᵗᵉᵃᵐ

Glossary: 

🫁 = lungs, COPD; 🧠 = brain, stroke; 🫀 = heart, cardiovascular disease; WHO = World Health Organization; WCRF = World Cancer Research Fund; NHSE = National Health Service of England

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2021, CIRCULATION, USA ➖ obs_PROS + MA ➕ 2M | pros = >66k in ♀ (1984-2014) – >42k iin ♂ (1986-2014) ▶ MA = 1.8M ➕ 30y ➖ P I C O:
   - P: adults
   - I: pooled self-reported health and diet information
   - C: NA
   - O: MM ➩ Results:
            • 10%. ↓r CA - (0.90)
            • 12%. ↓r 🧠 🫀 (HR 0.88)
            • 13%. ↓r MM (HR 0.87)
            • 15 35%. ↓r 🫁 COPD (0.65)
3. EVIDENCE:
  - Leafy green vegetables: kale + spinach
  - Fruits & vegetables: vitamin C + beta carotene (ANTIOXIDANTS)
  - NO BENEFIT in MM ➩ >5 servings OR starchy veggies OR potatoes OR drinking fruit juices.
  - Veggies only = no ↓ CA (p=0.62)
  - RECCO diver among countries ➩
       * 8.5 servings in AUS
       * 6 servings in DEN
       * 5 servings in WHO, WCRF, NHSE

  - Fruit juices + potatoes = ↑ glycemic load (various DIETARY RECOMM include them)

  - How much you eat in average MATTERS ➩ if NOT achieved THE GOAL, you can

    compensate the day after.

⏳ TIME MANAGEMENT.
01:27:38

Round: 8 00:01:30 The end
Round: 7 06:31:64 Wrap-up
Round: 6 12:09:86 Images + keypoints
Round: 5 37:44:75 ART 1 original
Round: 4 21:01:46 ART 1 prequel
Round: 3 04:19:04 Selection
Round: 2 02:13:15 Past JCRound: 1 03:37:75 Past JC

2024 CC - Comparison of methods to normalize urine output in CIpxs, a multicenter cohort study (monard) [R].pdf

Codified by MAAT

Glossary: 

♾ = kidneys; ABW = actual body weight; AKD = acute kidney disease;

CH = Switzerland; coh = cohort; DE = Germany; h_DIS  =  Hospital discharge; IBW = ideal body weight;

mc = multicentric; UO = urinary output.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, CC, CH + USA ➖ mc_coh ➕ 15,322 + 28,610 (derivation + validation) ➕ CH 2010-2020 ➖ P I C O:
     - P: adults, CI pxs
     - I: CH (Laus’AKI, derivation coh) 🆚 USA (MIMIC-IV, validation coh)
     - C: NA
     - O: best predictor for UO
3. EVIDENCE:
   - Oliguria = <0.5mL/Kg/h in ≥6h
   - Presents in 75% of CI pxs + ↔ MM90
   - Estimation of weight is inaccurate
   - ABW ➩ massive variations (fluid overload + muscle mass loss + obesity + underweight)
   - Types of BW: pre-admission + actual + ideal + adjusted
   - Series (493 pxs = overestimation) + 2 large studies (USA + DE = confirmed)
   - 4th study (S + 569pxs) not influenced by the method (oliguria & MM)
   - The four studies = single center
4. METHODS.
- DEF ➠ Best predictor for UO = most closely ↔ w_mean UO d_UCI
- IN ➠
  * Laus’AKI: ≥18yo, Lausanne, Jan 2010 - Jun 2020
  * MIMIC-IV: Boston, 2008 - 2019
- EX ➠
  * Laus’AKI + MIMIC-IV: refused, u_HD, <6h UO measurement, no sCr, no weight, no height,

    vesical irrigation d_ICU stay.
- RANDOM ➠
- INTERV ➠ 1st. Best predictor was chosen 2nd. Compared OLIGURIA INCIDENCE w_: a. MM90, b. AKD at H+dis ➩ according to ABW or IBW (which normalized better)
6. RESULTS
   - USA cohort: heavier, older, lower in SAPS-II (than CH cohort)
   - Best UO predictor = IBW (‘oliguria incidence’ was constant)

   - IBW ➩ ↗️ association ↔ oliguria w_: MM90 & AKD

   - After correction (sex, SAPS-II): ALL FINDINGS PERSISTED

Friday, January 17 , 2025 at 18h30 at BO - 23h30 at BE

ABFL, MAAT, JCAU, HIBN, MACR, GMC, AMA, AAQC

⏳ TIME MANAGEMENT.
01:18:15
Round: 5 06:07:41 Figures
Round: 4 20:28:69 Content + wu
Round: 3 33:11:79 Article UO

Round: 2 06:06:67 Article choice

Round: 1 12:21:18 Past JC

2025 CC - Changes in pulse pressure variation induced by passive leg raising test to predict preload responsiveness in MV pxs w_low Vt in ICU (mallat) [srMA].pdf

Codified by MAAT

Glossary: 

💨 = flow = perfusion; 🫁 = lungs; 🫀 = heart; FC = fluid challenge; FR = fluid responsiveness; PPV = pulse pressure variation.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, CC, UAE ➖ srMA ➕ 5 studies (474 pxs) ➕ PROSPERO - publication (1y) ➖ P I C O:
     - P: ↓Vt 
     - I: ∆PPV & ∆PPV% a_PLR following ‘…not a drop of fluid’
     - C: fluid challenge or response to PLR
     - O: ability to predict FR in ↓ Vt MV
3. EVIDENCE:
   - 1st line therapy = fluid administration ➩ tissue hypoperfusion context
   - FC AIM = ↑ preload + CI ➩ 🔝 DO2 + tissue 💨
   - Excessive fluid ➩ peripheral + 🫁 edema + poor OC
   - Deficient fluid ➩ MOF + MM
   - 50% are fluid responsive- PPV accurately predicts FR in MV pxs ➩ only if Vt ≥8 ➩

     OTHERWISE (Vt <8), insufficient to induce changes in THORACIC PRESSURE &

     PRELOAD.

Friday, January 31 , 2025 at 18h30 at BO - 23h30 at BE

AMA, HIBN, AAQC

⏳ TIME MANAGEMENT.
01:28:32
Round: 4 06:18:93 Comments
Round: 3 01:07:40 ART
Round: 2 09:17:00 ART selection
Round: 1 05:16:43 Past JC

Friday, February 14, 2025 at 18h30 at BO - 23h30 at BE

AMA, MACR, DFM, JQB, MAAT, HIBN, AAQC

2025 CC - Cardiovascular effects of lactate in healthy adults (berg-hansen) [R].pdf

Codified by MAAT

Glossary: 

🫀 = heart; AHF = acute heart failure; CABG = coronary artery bypass graft; eo_PER = end organ perfusion; GFR = glomerular filtration rate; GLS = global longitudinal strain; Ea = effective arterial elastance; HEC = hyperinsulinemic-euglycemic clamp; LAC = half-molar lactate; Lac 45g/L + Na 15g/L; MAP = mean arterial pressure; SAL = sodium-matched hypertonic sodium chloride; Na 15g/L, Cl 23 g/L; SV = stroke volume; SVR = systemic vascular resistance. .

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, CC, DK ➖ RCT, single-blinded, crossover ➕ 8 ➕ March - June 2021 ➖ P I C O:
   - P: healthy
   - I: LAC (4h infusion)
   - C: SAL
   - O: CO (by ECHO); sOC = SV, LVEF, GLS, Ea, SVR
3. EVIDENCE:
   - Usually large amounts of fluids are needed to ↑ CO + ↗ eo_PER
   - No consensus about the optimal type of fluid resuscitation.
   - MORTALITY = ↑ fluids OR ↓ fluids
   - Small-volume resuscitation w_hypertonic saline ➩ proposal ➩
        * ➕ : ↗ CO + vascular tone + microcirculation.
        * ➖ : Careful w_hyperchloremia + metabolic acidosis
        * ➖ : ♾ vasoconstriction + ↓ GFR
   - Hypertonic crystalloid solutions
        * ➕ : ↗ HD effects wo_chloride + ↗ eo_PER & CO (AHF + af_CABG)
4. METHODS.
   - IN ➠ ♂ + ≥18yo + BMI 18-30
   - EX ➠ daily med + abnormalities in routine screening tests + acute or chronic disease

     (known 🫀 failure)
   - RANDOM ➠ 14 day interval (minimum) = washout
        * ⊖ strenuous physical activity + alcohol
        * ⊕ regular diet for 48h before each study day
   - INTERV ➠ ECHO + blood samples
        * T0, 60, 120, 240
        * HEC was used at 180 min (main study) ➩ 240min was w_HEC
        * HEC = insulin (0.6mU/Kg/min) + glucose (20%)
   - CONSORT was used (as stated by Equator)
6. RESULTS. LAC 🆚 SAL
   - LAC ↑ :
        1. Lactate = ↑ 1.9mmol/L 
        2. CO = ↑ 1L/min = due to SV of 11mL
        3. LVEF = ↑ 5 percentage points
        4. GLS = ↑ 1.5 percentage points
        5. Contractility = ↗
   - LAC = :
       1. HR = no change
       2. MAP = similar
   - LAC ↓ :
       1. Afterload (SVR + Ea)= ↓
   - SAL:
       1. Preload indicator = ↑
7. RATIONALE
   - ↗ 🫀 function ➩ ↑ CO, SV, LVEF in LAC

   - Contractility ↗ ➕ afterload ↓ ➕ preload = (stable)

⏳ TIME MANAGEMENT.
01:29:52
Round: 8 03:32:41 Comments
Round: 7 27:45:06 Wrap-up
Round: 6 15:06:89 Figures
Round: 5 17:55:76 Methods
Round: 4 06:36:59 Intro
Round: 3 11:21:90 Abstract
Round: 2 01:17:91 ART selection
Round: 1 06:16:33 Past JC

Friday, February 7 , 2025 at 18h30 at BO - 23h30 at BE

DFM, AMA, DD, HIBN, AAQC

CC 2015 - Passive leg raising, five rules, not a drop of fluid (monnet, teboul).pdf

1. ↑ 300mL venous blood from ↓body → right 🫀

2. 5 rules:
      - 1st. Start from semi-recumbent position ▶ 1 study = poor reliability if this rule is not

        followed
      - 2nd. Measure CO ▶ not w_BP only (mechs: arterial compliance + pulse wave

        amplication) ▶ HOWEVER, MAP ≥10% could be a good predictor. (2016 CHEST -

        Passive Leg Raise Prediction of Fluid Responsiveness Using Nicom and Flatcar Devices

        in Septic Shock: Preliminary Findings. It worked w_NICOM)

     - 3rd. In 1 min. ▶ Real time CO measurement is needed
     - 4rd. Measure CO a_PLR

     - 5th. Do not touch (avoid adrenergic stimulation) ➕ PLR does not ↑ HR

2025 CC - Changes in pulse pressure variation induced by passive leg raising test to predict preload responsiveness in MV pxs w_low Vt in ICU (mallat) [srMA].pdf

Codified by MAAT

Glossary: 

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, CC, UAE ➖ srMA ➕ 5 studies (474 pxs) ➕ PROSPERO - publication (1y), till Aug 2024 ➖ P I C O:
    - P: ↓Vt
    - I: ∆PPV & ∆PPV% a_PLR following ‘…not a drop of fluid’
    - C: fluid challenge or response to PLR
    - O: ability to predict FR in ↓ Vt MV
3. EVIDENCE:
   - 1st line therapy = fluid administration ➩ tissue hypoperfusion context
   - FC AIM = ↑ preload + CI ➩ 🔝 DO2 + tissue 💨
   - Excessive fluid ➩ peripheral + 🫁 edema + poor OC
   - Deficient fluid ➩ MOD + MM
   - 50% are fluid responsive
   - PPV accurately predicts FR in MV pxs ➩ only if Vt ≥8 ➩ OTHERWISE (Vt <8 of ideal body

     weight), insufficient to induce changes in THORACIC PRESSURE & PRELOAD.
   - PLR is an ACCUTE METHOD to predict FR in ↓ Vt (real-time CI is needed)
   - Real-time CI NOT ALWAYS AVAILABLE ➩ or technically ineligible (ECHO echogenicity)
   - PPV after PLR = good method (predict FR) ➩ SBA + ↓ Vt + MV pxs + PO critILL pxs (2021    - 2024) ▶ ROC curve issues (0.78 to 0.98) + wide 95%CI
4. METHODS.
- IN ➠ PubMed, Embase, Cochrane
- INTERV ➠
  - ∆PPV = end_PPV - baseline_PPV
  - ∆PPV% = end _ PPV - baseline_PPV) / baseline_PPV 1 x 100 ▶ baseline = the patient in

    the 45 semi-recumbent position BEFORE PLR test
  - A PLR test was then performed using an automatic elevation bed by raising the patient’s

    lower limbs to a 45 angle while the patient’s trunk was lowered from a semi-recumbent to

    supine position with no changes in the hip angle

  - …

💨 = flow = perfusion; 🫁 = lungs; 🫀 = heart; CI = cardiac index; FC = fluid challenge; FR = fluid responsiveness; MOD = Multiorgan disfunction; PO = postoperative; PPV = pulse pressure variation; SBA = spontaneous breathing activity.

⏳ TIME MANAGEMENT.
01:38:37
Round: 4 12:19:53 Wrap-up
Round: 3 42:23:90 PLR technique
Round: 2 37:11:54 JC

Round: 1 06:42:31 Past JC