Should I Give IV Iron to Critically Ill Trauma Patients?

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Anaemia is a very common finding in critically ill patients and the idea to Supplement IV iron in these patients sounds tempting. Intravenous iron preparations are licensed for patients with iron deficiency anaemia when oral iron preparations are ineffective or contraindicated. The question is whether IV iron is also helpful in the critically ill.

Pieracci et al. have looked at this question more precisely and published their results in Critical Care Medicine. In their multicentre, randomized, single-blind, placebo-controlled study they enrolled a total of 150 critically ill trauma patients in which baseline iron markers were consistent with functional iron deficiency anaemia. They randomized patients to either receive iron sucrose 100mg IV or placebo three times a weeks for up to 2 weeks.

They found that treatment with IV iron increased ferritin concentration significantly but had no effect on transferrin saturation, iron-deficient erythropoiesis, haemoglobin concentration or packed RBC transfusion requirement.
In conclusion: IV iron supplementation in anaemic, critically ill trauma patients cannot be recommended.
Pieracci F et al. Crit Care Med, September 2014 – Volume 42 – Issue 9 – p 2048–2057

Digoxin Fading Away for Treatment of Atrial Fibrillation

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After a pause and thanks to Kuno’s attentiveness following article found it’s way to our website: Although not being very popular in the world of intensive care Digoxin remained a component of our armament and was continued to be used for patients with atrial fibrillation.

After its long era in medicine findings of the TREAT-AF are now about to bring this to a possible end.
Turakhia et al. looked at over 122’000 patients with newly diagnosed, non valvular AF in the U.S. between 2004 to 2008. They specifically looked at the use of Digoxin and the occurrence of death. Residual confounding was assessed by sensitivity analysis. They found a cumulative higher mortality rate for patients treated with Digoxin, which persisted after multivariate adjustment, propensity matching and adjustment for drug adherence.

The findings of this study are impressive and even led Harlan Krumholz, editor-in-chief of NEJM Journal Watch Cardiology, to the statement: ‘It’s time to pause on Digoxin until studies can assure that it’s providing a net benefit to these patients’.

Turakhia et al. JACC, Aug 19 2014; Volume 64, Issue 7

NEJM Journal Watch Cardiology