Wednesday December 7, 2005
Re. Nesiritide (Netrecor)

Netrecor (nesiritide) not only walked into our hospitals for "exacerbation of CHF" but even in out-patient clinics for "tune-up of CHF" with a big bang but over time we realized its not a miracle drug. JAMA article of April 2005 actually showed that it may be associated with an increased 30-day mortality . Later reviews and reports against Netrecor and its association with renal dysfunction intensified the debate. It appears that up to date: Netrecor is indicated only for severe acute decompensated congestive heart failure (CHF) with dyspnea at rest or minimal activity and is NOT indicated for intermittent or scheduled repetitive use, to improve renal function or for diuresis. Using Netrecor merely with BNP level is not advisable.

References: Click here to get article
1. Short-term Risk of Death After Treatment With Nesiritide for Decompensated Heart Failure - A Pooled Analysis of Randomized Controlled Trials - JAMA. 2005;293:1900-1905. (full article available with free registration)
2. Nesiritide — Not Verified - NEJM, Volume 353:113-116, July 2005
3. Scios press releases
4. Scientific papers related to Netrecor


Re. Selective Digestive-tract Decont. - posted yesterday

Response 1: If you look at the bulk of the literature on this topic from Europe, they exclude ICU's with MRSA concerns. This amounts to most US facilities.

Response 2: SDD may not be feasible in ICUs with high prevalence of VRE and MRSA. Click this Medscape article (register free to read).