Challenging conventional wisdom is important and frequently useful. Septic shock is a form of distributive shock in which hypotension results from vasodilation. Although myocardial performance may not always be entirely normal, a phenomenon termed septic cardiomyopathy, cardiac output is usually preserved, in part by increased heart rate. Therapy of septic shock refractory to fluid administration entails administration of vasopressor agents; norepinephrine is generally preferred as an initial agent. In those cases in which cardiac output is felt to be low enough to compromise perfusion, inotropic agents may be used. In this context, use of β-blockers may well be regarded as counterintuitive inasmuch as their hemodynamic effects would tend to decrease arterial pressure and cardiac output. Despite this, investigators have challenged conventional wisdom and evaluated the effects of β-blockade for treating sepsis.
Source: JAMA Online First
Occasionally, newspapers report positive stories of animal species believed to be extinct, only to be discovered alive and repopulating their habitats. In this issue of JAMA, Albert and colleagues assessed the role of sigh breaths in ventilated trauma patients at risk of acute respiratory distress syndrome. Though sighs did not result in a significant improvement in the primary outcome, they were well-tolerated and were associated with an improvement in some clinical outcomes. The sigh, believed to be extinct, is back. In 1976, Fairley declared that, “The mechanical ventilation sigh is a Dodo” (the dodo is an extinct flightless bird). Despite this statement, sighs survived in the clinical practice of several centers and were the subject of substantial clinical research. Importantly, they also remained a viable option in various commercial ventilators.
Source: JAMA Online First
This clinical trial assesses whether landiolol for patients with tachycardia and established septic shock requiring prolonged vasopressor support reduces the risk of organ failure.
Source: JAMA Online First
Two randomized clinical trials were harmonized to compare the effect of vitamin C vs control on outcomes in hospitalized patients with COVID-19 who were critically ill or who were not critically ill.
Source: JAMA Online First
This randomized clinical trial compares the efficacy of sighs in addition to usual care vs usual care alone in improving clinical outcomes trauma patients receiving mechanical ventilation and are at risk for developing acute respiratory distress syndrome.
Source: JAMA Online First
In the US Preventive Services Task Force Evidence Review titled “Preexposure Prophylaxis for the Prevention of HIV: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force” published in the August 22, 2023, issue of JAMA, the authors discovered an issue with one of the studies used in the analysis. For the DISCOVER trial, the analysis inconsistently included data from both an interim analysis (for which 100% of patients had completed 48 weeks and 50% had completed 96 weeks) as well as the full 96-week results. The estimates/conclusions are very similar, and both results for HIV infection are within the prespecified noninferiority threshold and both favor TAF-FTC (although the difference is not statistically significant). For harms, the Evidence Review text reported the full 96-week results, but the Tables reported the primary (interim) harms results. As reported in the Supplement, the resistance data also changed slightly—instead of including resistance results for 19 infections, the full 96-week analysis included resistance results for 20 infections. The Evidence Review has been updated to report the full 96-week results in the Abstract, Text, Tables, and Supplement. The updated data do not affect the conclusions of either the Evidence Report or the accompanying Recommendation Statement. This article has been corrected online.
Source: JAMA Online First
This article presents results from a prospective pivotal study in which individuals completed a multitarget stool RNA test prior to undergoing a colonoscopy to determine the sensitivity for detecting colorectal cancer and advanced ademonas.
Source: JAMA Online First
Staphylococcal infections among hospitalized patients, due to both methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus strains, are a substantial problem in the US. S aureus was the leading causative pathogen among health care–associated infections (HAIs) identified during the Centers for Disease Control and Prevention’s (CDC) 2015 national HAI prevalence survey (excluding Clostridioides difficile), accounting for 23% of all health care–associated bloodstream infections. Despite an overall 74% decline in the incidence of hospital-onset MRSA bloodstream infections from 2005 to 2016, these rates did not significantly change between 2013 and 2016. More sobering, strides made in the past 15 years in reducing HAIs in acute care settings, including those due to S aureus, markedly receded during the COVID-19 pandemic.
Source: JAMA Online First
In this narrative medicine essay, an emergency medicine physician felt the full embrace of health care but not before she surmounted communication barriers that could have negatively affected her health.
Source: JAMA Online First
This study provides survey results from state and territorial public health preparedness directors regarding antiviral shortages during the 2022-2023 respiratory viral season.
Source: JAMA Online First