Looking for a book that covers all things inpatient medicine? One-Pagers for the Wards is a concise, high-yield resource offering single-page summaries of internal medicine workups, treatments, and clinical pearls tailored for inpatient medicine.
Does thoracocentesis improve outcomes in acute heart failure with pleural effusion?
A Randomized Controlled Trial of Thoracentesis in Acute Heart Failure (TAP-IT)
Glargaard S et al. Circulation (April 2025)
Bottom Line: TAP-IT is a multicenter, unblinded, randomized controlled trial conducted from August 31, 2021, to March 22, 2024, involving 135 patients (median age, 81 years [25th; 75th percentile, 75; 83]; 33% female; median left ventricular ejection fraction, 25% [25th; 75th percentile, 20%; 35%]) with acute heart failure, left ventricular ejection fraction ≤45%, and non-negligible pleural effusion. Participants were assigned 1:1 to either ultrasound-guided pleural pigtail catheter thoracentesis plus standard medical therapy or standard medical therapy alone. The primary outcome was days alive out of the hospital over 90 days, with the thoracentesis group achieving a median of 84 days (77; 86) compared to 82 days (73; 86) in the control group (P=0.42). The mortality rate was 13% in both groups, with no difference in survival probability (P=0.90). Major complications occurred in 1% of thoracenteses. The study concluded that thoracentesis did not improve outcomes compared to standard therapy.
Does Reldesemtiv for ALS slow disease progression?
Reldesemtiv in Amyotrophic Lateral Sclerosis: Results From the COURAGE-ALS Randomized Clinical Trial
Shefner JM et al. JAMA (March 2025)
Bottom line: The COURAGE-ALS trial was a double-blind, placebo-controlled phase 3 randomized clinical trial conducted from August 2021 to July 2023, involving 486 participants with ALS. Participants received either oral reldesemtiv (300 mg twice daily) or placebo during the first 24 weeks, followed by reldesemtiv for all in the second period. The primary outcome was the change in ALS Functional Rating Scale-Revised (ALSFRS-R) total score from baseline to week 24, showing a mean difference of -1.1 favoring placebo (0.53; 95% CI, -2.17 to -0.08; P = .04). The trial was terminated early due to futility. The trial concluded that reldesemtiv did not demonstrate efficacy in slowing functional decline in ALS.
What is the difference between 60 L/min and 40 L/min HFNC in postextubation outcomes?
Effect of Flow Rates of High-Flow Nasal Cannula on Extubation Outcomes: A Randomized Controlled Trial
Ruan S-Y et al. CHEST (May 2025)
Bottom Line: This randomized controlled trial evaluated the effects of high-flow nasal cannula (HFNC) settings of 60 L/min versus 40 L/min for extubated patients over a 24-hour period. A total of 169 patients were analyzed (86 in the 40 L/min group and 83 in the 60 L/min group). The primary outcome, a composite of reintubation or noninvasive ventilation (NIV) use within 48 hours, showed 14 patients (16.9%) in the 60 L/min group and 19 patients (22.1%) in the 40 L/min group, with a risk difference of 5.2% (95% CI, -6.7% to 17.1%; P = .39). Secondary outcomes indicated a higher risk of escalation in respiratory support for the 40 L/min group (27.9% vs 9.6%; P = .002). The study concluded that 60 L/min does not reduce reintubation risk or NIV use compared to 40 L/min.
Trial Files Issue #2025-14