Pharmacy to Dose: The Critical Care Podcast

First Round votes are in — and Second Round Voting is here!
VOTE NOW at this link

Let’s preview the 2nd Round matchups, while highlighting what happened in the First Round.

1900’s Region aka the Region of Chaos

4 upsets in the first round with the #9, #10, #11, & #12 seeds all advancing!
#9 Nimodipine and #10 GUSTO are less upsets just based on the ranking/discussion going in

But #11 Octreotide in Variceal Bleeding and #12 Meduri Steroids in Unresolving ARDS are big upsets

#1 NINDS v. #9 Nimodipine(s)

#1 NINDS had the biggest blowout victory in the entire first round. And now #1 faces off against #9 Nimodipine, two practice-changing articles in their neuro-specific disease states go head to head.
Alteplase in acute ischemic stroke v. Nimodipine in aneurysmal subarachnoid hemorrhage.

“The Brain Battle”
#1 NINDS: https://pubmed.ncbi.nlm.nih.gov/7477192/
#9 Nimodipine — NEJM: https://pubmed.ncbi.nlm.nih.gov/6338383/
BMJ: https://pubmed.ncbi.nlm.nih.gov/2496789/

#4 ISIS-2 v. #12 Meduri Steroids Unresolving ARDS

Will the Meduri-ella story continue? Or will the study supporting a cornerstone of ACS treatment advance? The 12 seed advanced on a game-winning 3 pointer, in a great first-round matchup

#4 ISIS-2: ASA in AMI https://pubmed.ncbi.nlm.nih.gov/2899772/
#12 Meduri Steroids in Unresolving ARDS https://pubmed.ncbi.nlm.nih.gov/9669790/

#3 LMWH v. UFH in Trauma VTE Prophylaxis v. #11 Octreotide for Variceal Bleeding

The 3 seed VTE prophylaxis in Trauma needed a buzzer beating dunk to advance against the 14 seed. On the other side, #11 Octreotide did pull off the upset over #6 GIB Risk Factors.

#3 LMWH v. UFH VTE Prophylaxis in Trauma: https://pubmed.ncbi.nlm.nih.gov/8703169/
#11 Octreotide for Variceal Bleeding: https://pubmed.ncbi.nlm.nih.gov/7623904/

#2 TRICC v. #10 GUSTO

The 10 seed GUSTO technically upset #7, but it was such a large margin of victory you’d never know. With the #2 TRICC also advancing easily.

“The Thrombolytic v. Transfusion Trigger Throwdown”
#2 TRICC: Transfusion Requirements in Critical Care – https://pubmed.ncbi.nlm.nih.gov/9971864/
#10 GUSTO: Four Thrombolytic Dosing Strategies in AMI – https://pubmed.ncbi.nlm.nih.gov/8204123/

2000’s Region AKA The Region of Toughness

Because the matchups start to get VERY tough as we advance into the Second Round.

But the first round was filled with double-digit victories, only one close game: #8 v. #9 with the 9-seed CORTICUS advancing.
The other upset was the BIGGEST upset in the First Round with #13 SEDCOM advancing after upsetting #4 SAFE (and putting the first major crack in my bracket)

#1 Rivers EGDT v. #9 CORTICUS

Arguably the most influential, well-known, but also controversial and not used as much today is the #1 seed Rivers EGDT. Going against the most well-known study researching steroids in sepsis, #9 CORTICUS.

“The Sepsis Showdown”
#1 Rivers Early Goal-Directed Therapy in Septic Shock: https://pubmed.ncbi.nlm.nih.gov/11794169/
#9 CORTICUS: Hydrocortisone in Septic Shock – https://pubmed.ncbi.nlm.nih.gov/18184957/

#5 VASST v. #13 SEDCOM

What was supposed to be the battle of albumin v. vasopressin, was spoiled by #13 SEDCOM and their dominating win over #4 SAFE. Meanwhile #5 VASST had the biggest blowout of the first round in the 2000’s region. Instead, sedation with dexmedetomidine is battling against vasopressin in septic shock.

#5 VASST: Vasopressin vs. Norepinephrine in Septic Shock – https://pubmed.ncbi.nlm.nih.gov/18305265/
#13 SEDCOM: Dexmedetomidine vs. Midazolam for ICU Sedation – https://pubmed.ncbi.nlm.nih.gov/19188334/

#3 Awake & Breathe v. #6 NICE-SUGAR

The matchup the people have been waiting for! The basis for the AF bundle battles against the reason we don’t use tight glycemic control in the ICU.

#3 Awakening and Breathing trial: Paired sedation and ventilator weaning protocol – https://pubmed.ncbi.nlm.nih.gov/18191684/
#6 NICE-SUGAR: Intensive v conventional BG control – https://pubmed.ncbi.nlm.nih.gov/19318384/

#2 ARDSNet Low Tidal Volume v. #7 FACTT

Two of our most infamous and influential pulmonary studies battle off in the 2 v. 7 matchup. Both trials won their first-round matchup very easily, so will we get an upset into the Sweet 16? Or will ARDSNet continue dominating the 2000’s region?

“The ARDS Attack”
#2 ARDSNet Low Tidal Volume Ventilation in ARDS – https://pubmed.ncbi.nlm.nih.gov/10793162/
#7 FACTT: Fluid Management Strategies in ARDS – https://pubmed.ncbi.nlm.nih.gov/16714767/

2010’s Region AKA The Region of Death

And it is certainly living up to it’s name, with some heavyweight battles in the Second Round.

The First Round featured SOAP II having the biggest blowout victory on it’s path to try and go back-to-back. Two upsets, with the 9 seed SMART trial, and the #12 PRO/MIDEX study continues it’s run from the Play-In Game. With a last-second victory over the #5 ROSE trial (putting another crack in my bracket predictions).

#6 DOSE also escaped against the 11 seed REDUCE trial with a game-winning basket to advance.

#1 SOAP II v. #9 SMART

The overall tournament 1 seed showed it’s strength in the first round matchup. But the #9 SMART trial upset the #8 BICAR-ICU. Setting up the other sepsis showdown: “Fluids v. Vasopressors”

#1 SOAP II: Norepinephrine v. Dopamine in Septic Shock – https://pubmed.ncbi.nlm.nih.gov/20200382/
#9 SMART: Balanced Fluids v. Normal Saline in Critically Ill – https://pubmed.ncbi.nlm.nih.gov/29485925/

#4 PROSEVA v. #12 PRODEX/MIDEX

The biggest upset of the 1st Round in the 2010’s Region was the 12 seed PRODEX/MIDEX getting a last-minute victory against #5 ROSE. Meanwhile, #4 PROSEVA cruised to an easy win over #13 ALPS. It’s light sedation vs. prone positioning in this second round matchup.

#4 PROSEVA: prone positioning in severe ARDS – https://pubmed.ncbi.nlm.nih.gov/23688302/
#12 PRODEX/MIDEX: Dexmedetomidine vs. Propofol/Midazolam – https://pubmed.ncbi.nlm.nih.gov/22436955/

#3 CRASH-2 v. #6 DOSE

#6 DOSE needed a buzzer-beater 3 pointer to beat #11 REDUCE. And 3-seed CRASH-2 looks to avenge it’s Elite Eight upset last year and dominated their opponent #14 ADRENAL. It’s Anti-fibrinolytics v. Diuretics in this heavyweight matchup.

#3 CRASH-2: Effects of TXA in trauma – https://pubmed.ncbi.nlm.nih.gov/20554319/
#6 DOSE: Diuretic strategies in ADHF – https://pubmed.ncbi.nlm.nih.gov/21366472/

#2 ESETT v. #7 ATACH-2

#2 ESETT had a tough matchup on paper against #15 PROWESS-SHOCK, but it certainly didn’t play out that way, as #2 cruised to an easy win. #10 ATHOS-3 was a popular upset pick, but #7 ATACH-2 spoiled that in a double-digit victory. Setting up a Neuro Showdown we’ve been waiting for!

“The Brain Crusade”
#2 ESETT: 3 ASM for SE – https://pubmed.ncbi.nlm.nih.gov/32203691/
#7 ATACH-2: Intensive BP lowering in acute ICH – https://pubmed.ncbi.nlm.nih.gov/27276234/

2020’s Region AKA The Region of Fresh

So many new trials featured in the 2020’s region, it was hard to predict what might happen. But the first round went fairly chalk except for one key matchup. The only upset, but also the biggest margin of victory, was #10 DoReMi beating #7 DanGer Shock. This region featured #8 DEXA-ARDS advancing, the only 8 seed in the entire bracket to do that. The most entertaining game of the First Round in the 2020 Region was the 2 v. 15 matchup. #2 ACORN escaped against #15 ANNEXa-I in what would have been one of the biggest shockers of the tournament!

#1 RECOVERY v. #8 DEXA-ARDS

Both the #1 RECOVERY and #8 DEXA-ARDS won their first-round matchups fairly easily. Setting up the steroid showdown we were hoping for after the bracket was revealed!

“The Dexamethasone Duel”
#1 RECOVERY: Dexamethasone in Covid-19 – https://pubmed.ncbi.nlm.nih.gov/32678530/
#8 DEXA-ARDS: Dexamethasone in Severe ARDS – https://pubmed.ncbi.nlm.nih.gov/32043986/

#4 CAPE COD v. #5 AcT

Many predicted #13 TTM would upset #4 CAPE COD, but that didn’t play out with the favorite advancing. The ACT trial had a closer game than they wanted against #12 INTERACT3 but ultimately won. Setting up this great matchup between two practice-changing trials.

#4 CAPE COD: Hydrocortisone in severe CAP – https://pubmed.ncbi.nlm.nih.gov/36942789/
#5 ACT: TNK v tPA in AIS in Canada – https://pubmed.ncbi.nlm.nih.gov/35779553/

#3 BLING III v. #6 MENDS2

Two studies with some of the best Pharmacist researchers on the planet. And although it’s not this simple, it feels like this matchup is “Antibiotics v. Sedation”

#3 BLING III: Continuous v Intermittent Beta Lactams – https://pubmed.ncbi.nlm.nih.gov/38864155/
#6 MENDS2: Dexmedetomidine v Propofol for Sedation – https://pubmed.ncbi.nlm.nih.gov/33528922/

#2 ACORN v. #10 DoReMi

The only upset in the 2020 Region was also the biggest blowout, with #10 DoReMi dominating the 7-seed DanGer Shock. Meanwhile, the ACORN trial barely escaped against #15 ANNEXa-I. An unexpected matchup, but this Nature v. Music matchup will be a great one.

#2 ACORN: Cefepime v. Pip/tazo – https://pubmed.ncbi.nlm.nih.gov/37837651/
#10 DoReMi: Dobutamine v. Milrinone in Cardiogenic Shock – https://pubmed.ncbi.nlm.nih.gov/34347952/

Don’t forget to vote on who YOU think should advance to the Sweet Sixteen!
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