What is the treatment for Ventricular Tachycardia (Vt)?

From the Guidelines

Ventricular tachycardia (VT) runs treatment should prioritize the use of beta blockers, with nadolol being the preferred option, to reduce adverse cardiac events, as supported by the 2018 AHA/ACC/HRS guideline 1. The treatment approach for VT runs, particularly in the context of catecholaminergic polymorphic ventricular tachycardia (CPVT), involves a combination of pharmacological and non-pharmacological interventions.

• The primary goal is to prevent sudden cardiac death (SCD) and reduce the frequency of ventricular arrhythmias.
• Beta blockers, specifically nadolol, are recommended as the first-line treatment for CPVT, as they have been shown to reduce adverse cardiac events 1.
• Additional treatment options for CPVT include the use of nondihydropyridine calcium channel blockers, flecainide in combination with a beta blocker, and verapamil or propafenone for refractory cases 1.
• Implantable cardioverter-defibrillators (ICDs) may be considered for patients with prior SCA or refractory ventricular arrhythmias on combination medical therapy, but their use should be optimized to minimize inappropriate shocks and the risk of electrical storms 1.
• Left cardiac sympathetic denervation may be an option for patients with recurrent ICD shocks, but it should be performed in centers with expertise in this procedure 1.

From the Research

Treatment of Ventilator-Associated Pneumonia (VAP)

• The treatment of VAP typically involves the use of antibiotics, with the selection of initial antibiotic therapy being important to ensure appropriate treatment 2.
• The American Thoracic Society recommends antibiotic therapy based on the patient's risk of colonization by an organism with multidrug resistance 2.
• A study found that carbapenems may result in better clinical cure than other tested antibiotics, but the quality of evidence for this comparison was downgraded to moderate 2.
• Another study suggested that continuous infusion of piperacillin/tazobactam may be effective in achieving optimal drug concentrations in patients with VAP, with a favorable impact on costs 3.

Duration of Treatment

• The ideal duration of treatment for VAP is typically 8 days, except in situations where Pseudomonas may be suspected or the patient's comorbidities dictate otherwise 4.
• A study found that de-escalation of antibiotics once microbiological results become available or as the patient starts responding clinically may be beneficial in reducing the use of broad-spectrum antibiotics 4, 5.

Prevention of VAP

• Prevention remains a key aspect of reducing the burden of VAP, with measures such as noninvasive ventilation, semirecumbent patient positioning, continuous aspiration of subglottic secretions, and oral chlorhexidine washes being effective in preventing VAP 4, 5.
• The use of antiseptic-coated endotracheal tubes and new cuff shapes may also be beneficial in preventing VAP 5.