Thursday, Dec 8, 2023 at 23h BE (17h BO)

VFP, HIBN, AAQC

2023 CC - Prognostic value of capillary refill time in adult patients (Jacquet-Lagrèze) [srMA]
CRT = capillary refill time, ACF = acute circulatory failure, AE = adverse events. BS: brief scope,

1. 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ BS: 2023, CC, ALL ➖ srMA ➕ 23 studies ➕ up to Feb 2022 ➖ PICO:
- P: G1 = ACF, G2 = ACF (‘at risk or confirmed’ for sOC)
- I: srMA
- C: NA
- O: pOC = MM ➖ sOC = MM or AE ➩ low prediction ➕ greater signal in High quality CRT
2. IN = PXS w_ACF (use of vasopressors 0R inotropes + ↓ perf) ➕ pxs AT RISK of ACF (CRT used as a triage method without restriction) ➕ AE (icu ADMISSION, long LOS ➕ scale Clavien-Dindo)

3. EX = animals ➕ not published in EN ➕ relationship CRT-prognosis NOT studied ➕ device use ➕ localized perfusion (free lap or ischemic limb)
4. They used MEDLINE, EMBASE, Google Scholar
5. They contacted the authors by email
6. High-quality CRT = standardized (mean of ≥2 CRT values) + stopwatch
7. CRT was predictive of death; pooled AUC = 0.663 (95%CI [0.591; 0.756]).
8. Pooled sensitivity = 54% (95%CI [43; 64])
9. Pooled specificity was 72% (95%CI [55; 84]).
10. Overall the CRT poorly predicted death or adverse events
11. CRT ➩ prognostic value remains low BUT comparable to lactate levels.
12. Accuracy is greater when high-quality CRT measurement is performed
13. Efforts should be focused on standardizing the technique in clinical practice.

⏳ TIME MANAGEMENT.
1h10 in total

Friday, Dec 15, 2023 at 23h BE (17h BO)

HIBN, AAQC

2023 CC - Positive single-center randomized trials and subsequent multicenter randomized trials in CIpxs (kotani) [sr]

RCT: randomized controlled trial, SL: strengths & limitations, CC: critical care, sRCT: single-center RCT, mRCT: multi center RCT, GL: guidelines, SS: survival, MM: mortality, J: justification, stSIG: statistically significant.
1. 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ brief scope: Y, J, C ➖ T ➕ N ➕ t ➖ PICO:
2. 2023, CC, IT-AUS ➖ sr ➕ 19 RCT ➕ up to Dic 31, 2016 ➖ PICO:
a. P: CIpxs
b. I: various (sRCT w_⊕SS)
c. C: various
d. O: statistically significant MM
3. R ➩ 16 sRCT = 16 mRCT ➩ 1 mRCT ⊕ ➕ 14 mRCT NEUTRAL ➕ 1 mRCT ⊖
4. IN: stat. Significant + >48h ➕ PubMed (NEJM, JAMA, LANCET)
5. sOC: Careful with GL: 19 sRCT = 14 GL ➩ 6 USE ➕ 2 INSUF. EVIDENCE ➕ 6 CONTRAINDICATED

6.sRCTs was rarely confirmed by mRCT in ICU settings.

7. SL:
a. S: 1st to identify sRCT w_stsig ↓ MM
b. S: Novel approach to evaluate impact on GL
c. L: Just in ICU, not translated to other disciplines
d. L: Published until 2016, recent excluded
e. J: median duration between sRCT and mRCT publication was 8 years,
f. L: Specialty journals were excluded
g. L: Small number of studies
h. L: Confined to international GL
8. sRCTs need to be perceived as hypothesis-generating
9. Clinicians should be cautious in altering routine clinical practices until well-conducted multicenter randomized trials are available.

10. Careful with RECOMMENDATION based on SOLELY ⊕ sRCTs

⏳TIME MANAGEMENT

42:10:10 in total 
Round: 6  00:02:96 Final
Round: 5  04:37:34 Final notes
Round: 4  20:41:18 Conclusions + wrap-up
Round: 3  07:04:24 Images + tables
Round: 2  09:28:78 Structure
Round: 1  00:15:57 45 min ➩ article overview

Friday, Dec 22, 2023 at 23h BE (17h BO)

VFP, HIBN, AAQC

2023 CC - Prognostic value of capillary refill time in adult patients (Jacquet-Lagrèze) [srMA]

1. 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ brief scope: Y, J, C ➖ T ➕ N ➕ t ➖ PICO:
2. 2023, NEJM, CH ➖ srMA ➕ 38 RCT (>2500px) ➕ to Oct, 2022 ➖ PICO
a. P: CI pxs w_AKI
b. I: AC options for RRT
c. C: various
d. O: RCA more effective in PROLONGING filter lifespan + ↓ r_BLEEDING
e. R ➩ regional UFH + PGI2 outperformed RCA + others (OC: prolonging lifespan) ➕ no statSIG in: ICU LOS, allMM, d_CRRT, recovery KIDNEY function, advEVE, COSTS
3. The SUCRA analysis and forest plot of Regional-UFH + PGI2 are limited, as only a single study was included
4. IN ➩
a. A. RCT w_pharma antiCOAG.
b. B. OCs: filter lifespan or clotting occurrence + allMM + H+ & ICU LOS + d_CRRT + recovKIDNEY function + ADVeve + costs
c. C. RRs + MDs + 95CIs
5. EX
a. No relevant data
b. Conference abstracts
c. Nonhuman studies, pediatrics
d. Dialysis before ICU
e. Same antiCOAG drug
6. Included in qualitative synthesis = 37 of 38 trials
7. UFH + PGI2 was a single center study (Australia)
8. COSTS ➩ only 4 RCTs reported cost-effectiveness ➕ Gao, et al = RCA < no AC (slightly lower) ➕ Schilder et al = RCA < UFH (slightly lower) = RCA was found to prolong filter lifespan, which resulted in an economic benefit ➕ Fealy et al = gain in circuit life did not OFFSET/compensated the COST of citrate. ➕ Joannidis 🆚 Reeves et al = LMWH costs less and more, respectively. (contradictory)
9. C ➩ Between the RCA and UFH groups, RCA is the priority anticoagulant in prolonging filter lifespan and reduc- ing the risk of bleeding.

⏳ TIME MANAGEMENT.
01:41:57 in total
Round: 5  18:45:00 Conclusions + wrap-up
Round: 4  16:14:84 Images
Round: 3  36:32:91 Subtitles & paragraphs
Round: 2  22:53:76 Article overview
Round: 1  07:31:45 Refresh