April 2019 Journal Club

Hi Everyone
Have a look at this months paper here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3914350/
AF is something that we encounter everyday on the ICU and we all think we know how to manage it but it’s one of those areas where there seems to be a wide variation in practice…
Have a look at this paper and feel free to share your thoughts!
If you don’t want to reply all then send me your comments and I’ll anonymise them and send it out for you.
Cheers
Rob
“Hi Everyone

Hope you found the paper useful?

It’s very much an opinion piece on best practice as opposed to a robust, evidenced based systematic review but that’s probably because there’s not really much robust evidence out there about managing AF in critical illness.

Beta Blockers are increasingly seen as the most appropriate first line option (especially in sepsis) for reasons we’ve previously talked about https://yorkshireicm.wordpress.com/2018/07/20/july-2018-journal-club/

and in our own HDFT specific demographic digoxin is helpful when there’s an element of LV impairment and frailty. Also as most critically ill patients have impaired enteral function it would seem sensible to administer these IV to begin with.

Amiodarone is very much a double edged sword and comes with difficult to ignore side effects so is probably best left as a rescue therapy.

Obviously it goes without saying that rate control trumps rhythm control and it’s very difficult to achieve that in practice if you haven’t corrected the potassium and magnesium.

Anticoagulation is more nuanced, all AF patients will have an increased risk of stroke without it but in the critical care setting (particularly the acute, organ support phase) you could argue that the risks outweigh the benefits. That said once the “critical” phase is over we should consider it as guided by the CHADS-VASc score.

There’s a nice summary of various Yorkshire intensivists opinions here https://yorkshireicm.wordpress.com/2016/04/14/af-in-sepsis/.

 

So there you go nothing flashy this month but hopefully relevant!

 

While you’re here though I’m conscious of the fact that there hasn’t been much in the way of comments on the last few journal clubs which does beg the question whether people want it to carry on? The last thing I want is to clutter up your in boxes with my inane thoughts…..

It would be a big help therefore if you could provide some feedback on how I can try and improve things

https://www.surveymonkey.com/r/8W9XJL5

It will only take 2 minutes I promise!

Thanks as ever

Rob

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