Critical Care Trailblazers: The CHEST Trial
Introduction In the late 19th century, physiologists were fascinated by the movement of fluid between the intravascular and interstitial compartments and its effect on the circulating volume. Ernest Starling, working from his laboratory at Guy’s Hospital in London, proposed that the net transudation of fluid depends on two forces. The capillary pressure tends to drive fluid…
Do you need prophylactic platelets before CVC insertion in thrombocytopenic patients?
Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia (the PACER trial) Van Baarle FLF, Van De Weerdt EK, Van Der Velden WJFM, Ruiterkamp RA, Tuinman PR, Ypma PF, et al. Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia. N Engl J Med. 2023 May 25;388(21):1956–65. Background The risk of major bleeding complications associated…
Critical Care Trailblazers: The CRASH-2 trial
Introduction Back in the 1950s, in war-torn Japan, a husband-and-wife team of researchers, Shosuke and Utako Okamoto were scripting medical history. They were passionately focused on identifying an antagonist of clot breakdown that might arrest severe hemorrhage. Exsanguinating postpartum hemorrhage was a leading cause of maternal mortality in Japan during this period. They realized that…
Critical Care Trailblazers: The PAC-Man Trial
The concept of the floatation catheter On a bright autumn afternoon of 1967, Jeremy Swan stood by the beach at Santa Monica, watching sailboats pass by. He was a cardiologist at the Cedars of Lebanon Hospital, Los Angeles, and had taken time off following a particularly difficult cardiac catheterization just a few days ago. As…
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