Newsletter 130 / June 1st 2014

Welcome

 

Hello

Welcome to the 130th Critical Care Reviews Newsletter, bringing you the best critical care research published in the past week, plus a wide range of free full text review articles, guidelines, commentaries and editorials from hundreds of clinical and scientific journals.

This week's research studies include a before-and-after study on oxygenation during mechanical ventilation; meta analyses on prone position ventilation, high frequency oscillatory ventilation and hyperoxia after cardiac arrest; and two post cardiac arrest observational studies on glucose levels and blood gas tensions. Additional studies investigate candida infections, long-term severe sepsis outcomes, fluid challenge, delirium, physician end-of-life preferences, pulmonary embolism, non-invasive ventilation, and acute lung injury.

This week's guidelines address clostridium difficile colitis, idiopathic pulmonary fibrosis and developing performance measures from clinical practice guidelines. There is one study critique on the Proseva study. Editorials discuss social media, open access research, stroke and nutrition, while commentaries focus on ARDS, artificial pancreas, post-operative cognitive dysfunction, opioid overdose, capital punishment, pre-hospital care, infection control and spinal cord disorders. There are two case reports on locked-in patients and upper airway oedema.

Amongst the numerous clinical review articles are papers on cerebral protection post cardiac arrest, intra-operative goal-directed therapy, extra-corporeal life support, prone position ventilation, pancreatic necrosectomy, acute liver failure, liver transplantation, compartment syndrome and paediatric septic shock.

The topic for This Week's Papers is acute coronary syndromes, starting with a paper on the electrocardiogram in ACS in tomorrow's Paper of the Day.

Critical Care Reviews Meeting

The latest speaker to be announced for the Critical Care Reviews Meeting is Dr John Hinds, an anaesthetic intensivist and prehospital motor sports expert, who recently stole the show at the smaccGOLD conference. Check out his pro-con debate on the use of Cricoid Pressure, with his incredible "Cases from the Races" talk due out soon.

Big Announcement

Critical Care Reviews continues to grow, with news of an exciting big announcement out next week.....

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Research

Before and After Study

Suzuki and colleagues compared a conservative approach to oxygen therapy (target Spo₂ of 90–92%) with conventional oxygen therapy in 105 adult patients requiring mechanical ventilation for more than 48 hours, and found:

1. basic data
   • 3,169 datasets on 799 mechanical ventilation days
2. conservative oxygen therapy was associated with
   • a lower
     • median time-weighted average Spo₂
       
       • 95.5% (IQR 94.0 to 97.3) versus 98.4% (97.3 to 99.1) (p < 0.001)
     • partial pressure of oxygen
       • 83 torr (71–94) versus 107 torr (94–131) (p < 0.001)
     • median Fio₂
       
       • 0.27 (0.24–0.30) versus 0.40 (0.35–0.44) (p < 0.001).
     • median total amount of oxygen delivered during mechanical ventilation
       •  5,122 L (1,837–10,499 L) vs 15,580 L (8,263–29,351 L), p < 0.001
3. no difference
   • in the evolution of the Pao₂/Fio₂ ratio
   • biochemical or clinical outcomes

Abstract:  Suzuki. Conservative Oxygen Therapy in Mechanically Ventilated Patients: A Pilot Before-and-After Trial. Crit Care Med 2014;42(6):1414-1422

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Meta Analyses

Sud pooled data from 11 randomized controlled trials comparing prone with supine positioning during mechanical ventilation in a total of 2,341 patients with the acute respiratory distress syndrome, and found:

Full Text:  Sud. Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis. CMAJ 2014;epublished May 26th

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Hu et al reviewed data from nine randomized controlled trials (n=2,242) evaluating the interaction between prone positioning and both PEEP and duration of proning in the acute respiratory distress syndrome, and found:

1. compared with supine positioning, prone positioning was associated with a decrease in mortality in patients with severe ARDS (PaO₂/FiO₂ <=100 mmHg) at days
   • 28- to 30
     • RR 0.71; 95% CI 0.57 to 0.89; P = 0.003; n = 508
     • when duration of prone positioning was greater than 12 hours/day
       • RR 0.73; 95% CI 0.54 to 0.99; P = 0.04; n = 1,067
   • 60-day
     • when PEEP > 10 cmH₂O
       • RR 0.82; 95% CI 0.68 to 0.99; P = 0.04; n = 518
   • 90-day
     • when PEEP > 10 cmH₂O
       • RR 0.57; 95% CI 0.43 to 0.75; P <0.0001; n = 516

Full Text:  Hu. The effect of prone positioning on mortality in patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials. Critical Care 2014;18:R109

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Gu and colleagues pooled data from six randomized controlled trials (n=1,608) comparing high-frequency oscillatory ventilation with conventional mechanical ventilation as the initial mode of ventilation for adult ARDS patients, and found:

1. high-frequency oscillatory ventilation was associated with
   • no difference in
     
     • mortality
       • at day 28 / 30
         • RR 1.051 (95% CI 0.813 to 1.358)
       • in ICU 
         • RR 1.218 (95% CI 0.925 to 1.604)
     • ventilation failure
       • RR 0.892 (95% CI 0.435 to 1.829)
     • duration of mechanical ventilation 
       • RR 0.079 (95% CI -0.045 to 0.203)
     • barotrauma 
       • RR 1.205 (95% CI 0.834 to 1.742)
     • hypotension 
       • RR 1.326 (95% CI 0.271 to 6.476)
   • reduced risk of
     
     • oxygenation failure
       • RR 0.557 (95% CI 0.351 to 0.884)

Full Text:  Gu. In adult acute respiratory distress syndrome patients, is high-frequency oscillatory ventilation more effective and safer than conventional protective ventilation? a meta-analysis of randomized controlled trials. Critical Care 2014;18:R111

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Wang et al reviewed 14  observational studies to examine the effect of hyperoxia on outcomes after return of spontaneous circulation in cardiac arrest patients, and found:

1. hyperoxia was
   • associated with
     • increased in-hospital mortality
       • OR 1.40; 95% CI 1.02 to 1.93; I² 69.27%; 8 studies
   • not associated with
     • worsened neurological outcome
       • OR 1.62; 95% CI 0.87 to 3.02; I² 55.61%; 2 studies
2. the results were inconsistent in subgroup and sensitivity analyses

Abstract:  Wang. The Effect of Hyperoxia on Survival Following Adult Cardiac Arrest: A Systematic Review and Meta-analysis of Observational Studies. Resuscitation 2014;epublished May 31st

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Observational Studies

Daviaud et al conducted a French single centre, database study in in 381 patients resuscitated from out-of-hosptial cardiac arrest between 2006 and 2010, examining the the relationship between blood glucose levels and outcome, and found:

1. 36% had a favorable outcome (cerebral performance category 1–2)
2. a favourable outcome was associated with
   • lower median blood glucose level
     • 7.6 mmol/L (6.3 to  9.8) vs 9.0 mmol/L (IQR 7.1 to 10.6) (P < 0.01)
   • lower median blood glucose level variation
     • 7.1 (4.2 to 11) vs 9.6 (5.9 to 13.6) mmol/L (P < 0.01)
3. independent predictors of poor outcome were
   
   • increased median blood glucose level over the first 48 hours
     
     • OR 0.43, 95% CI 0.24 to 0.78, P = 0.006
   • a progressive increase in median blood glucose level was associated with a progressive increase in the proportion of patients with a poor outcome

Abstract:  Daviaud. Blood glucose level and outcome after cardiac arrest: insights from a large registry in the hypothermia era. Intensive Care Med 2014;40(6):855-862

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Abstract:  Vaahersalo. Arterial Blood Gas Tensions After Resuscitation From Out-of-Hospital Cardiac Arrest: Associations With Long-Term Neurologic Outcome. Critical Care Med 2014;42(6):1463-1470

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• Ferrada. Timing and type of surgical treatment of Clostridium difficile–associated disease: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2014;76(6):1484-1494
• Cottin. Diagnosis and management of idiopathic pulmonary fibrosis: French practical guidelines. Eur Respir Rev 2014;23:193-214
• Kahn. An Official American Thoracic Society Workshop Report: Developing Performance Measures from Clinical Practice Guidelines. Annals of the American Thoracic Society 2014;11(4):S186-S195

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Study Critique

• Tekwani. 'To prone or not to prone’ in severe ARDS: questions answered, but others remain. Critical Care 2014;18:305 

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Editorial

• Jones. Beyond the printed page: Leveraging social media to extend the Journal’s influence. Can J Anesth 2014;61:507–510
• Pandey. Intracerebral Hemorrhage: A Multimodality Approach to Improving Outcome. Translational Stroke Research
• lasziou. The Role of Open Access in Reducing Waste in Medical Research. PLoS Med 2014;11(5):e1001651
• Hatefi. Hemicraniectomy in the management of malignant middle cerebral artery infarction: Lessons from randomized, controlled trials. Surg Neurol Int 2014;5:72
• Rooyackers. Imaging opens possibilities both to target and to evaluate nutrition in critical illness. Critical Care 2014;18:144

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Commentary

 

 

Case Report

• Gallegos-Ayala. Brain communication in a completely locked-in patient using bedside near-infrared spectroscopy. Neurology 2014;82:1930-1932 
• Rossow. A 68-Year-Old Woman with Hoarseness and Upper Airway Edema. Annals of the American Thoracic Society 2014;11(4):668-670

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Clinical Review Articles

Neurological

• Huang. A systematic review of neuroprotective strategies after cardiac arrest: from bench to bedside (part II-comprehensive protection). Medical Gas Research 2014;4:10
• Ghaly. Do neurosurgeons need Neuroanesthesiologists? Should every neurosurgical case be done by a Neuroanesthesiologist? Surg Neurol Int 2014;5:76
• Harris. Neuromonitoring Indications and Utility in the Intensive Care Unit. Crit Care Nurse 2014;34:30-40
• Olmos. Tumor Necrosis Factor Alpha: A Link between Neuroinflammation and Excitotoxicity. Mediators of Inflammation 2014;2014:861231
• Nicholl. Clinical neurology: why this still matters in the 21st century. J Neurol Neurosurg Psychiatry 2014;epublished May 29th
• Kou. Imaging brain plasticity after trauma. Neural Regen Res 2014;9:693-700
• Sun. The potential of endogenous neurogenesis for brain repair and regeneration following traumatic brain injury. Neural Regen Res 2014;9:688-92
• Antoniadis. Iatrogenic Nerve Injuries: Prevalence, Diagnosis and Treatment. Dtsch Arztebl Int 2014;111(16):273-9
• Schulze-Bonhage. The Preoperative Evaluation and Surgical Treatment of Epilepsy. Dtsch Arztebl Int 2014;111(18):313-9
• Buniak. A four-part working bibliography of neuroethics: part 1: overview and reviews - defining and describing the field and its practices. Philosophy, Ethics, and Humanities in Medicine 2014;9:9

Circulatory

• Protasiewicz. Modern antiplatelet therapy - opportunities and risks. Adv Clin Exp Med 2013;22(6):875-85 
• Mehta. A Review of Intraoperative Goal-Directed Therapy Using Arterial Waveform Analysis for Assessment of Cardiac Output. The Scientific World Journal 2014;2014:702964
• Ibrahim. Recovery of the failing heart: emerging approaches and mechanisms in excitation-contraction coupling. F1000Prime Reports 2014 6:(27)
• Ramos. Cardiac Diagnostic Testing: What Bedside Nurses Need to Know.  Crit Care Nurse 2014;34:16-28

Respiratory

• Richard. Extracorporeal life support for patients with acute respiratory distress syndrome: report of a Consensus Conference. Annals of Intensive Care 2014;4:15
• Wort. Topics in acute respiratory distress syndrome: the patient needs our tender loving and care. Eur Respir Rev 2014;23:157-60
• Guérin. Number 1 in the Series “Acute Respiratory Distress Syndrome”: Prone ventilation in acute respiratory distress syndrome. Eur Respir Rev 2014;23:249-257
• Pathak. Ventilation and Anesthetic Approaches for Rigid Bronchoscopy. Annals of the American Thoracic Society 2014;11(4):628-634
• Huttmann. Techniques for the Measurement and Monitoring of Carbon Dioxide in the Blood. Annals of the American Thoracic Society 2014;11(4):645-652
• Cherian. Release the Pressure. Annals of the American Thoracic Society 2014;11(4):675-679
• Khoury. From Mouth-to-Mouth to Bag-Valve-Mask Ventilation: Evolution and Characteristics of Actual Devices—A Review of the Literature. BioMed Research International 2014;2014:762053
• Freedman. Improvements in current treatments and emerging therapies for adult obstructive sleep apnea. F1000Prime Rep2014;6:36
• Singh. Non-invasive Ventilation in Acute Respiratory Failure. Acta Medica Indonesiana 2014;46(1):74-80
• Braun. Haemoptysis due to pulmonary venous stenosis. Eur Respir Rev 2014;23:170-179
• Ryu. Idiopathic Pulmonary Fibrosis: Evolving Concepts. Mayo Clinic Proceedings 2014;epublished May 24th
• Devaraj. Imaging: how to recognise idiopathic pulmonary fibrosis. Eur Respir Rev 2014 23:215-219
• Kolb. Staging of idiopathic pulmonary fibrosis: past, present and future.  Eur Respir Rev 2014;23:220-224
• Cottin. Current approaches to the diagnosis and treatment of idiopathic pulmonary fibrosis in Europe: the AIR survey. Eur Respir Rev 2014 23:225-230
• Wuyts. Patient-centred management in idiopathic pulmonary fibrosis: similar themes in three communication models. Eur Respir Rev 2014;23:231-238
• Kreuter. Management of idiopathic pulmonary fibrosis: selected case reports. Eur Respir Rev 2014 23:239-248

Gastrointestinal

• Jürgensen. Endoscopic Necrosectomy as Treatment for Infected Pancreatic Necrosis. EMJ Gastroenterol 2013;1:102-105
• Bitar. Tissue Engineering in the Gut: Developments in Neuromusculature. Gastroenterology 146(7):1614–1624

Hepatobiliary

• Privitera. Acute liver failure: pathophysiologic basis, and the current and emerging therapies. EMJ Hepatol. 2014;1:99-107
• Canbay. Acute Liver Failure: A Dangerous and Challenging Syndrome. EMJ Hepatol 2014;1:91-98
• Clevenger. Transfusion and coagulation management in liver transplantation. World J Gastroenterol 2014;20(20):6146-6158
• Mourad. Aetiology and risk factors of ischaemic cholangiopathy after liver transplantation. World J Gastroenterol 2014;20(20):6159-169
• Desai. Donor transmitted and de novo cancer after liver transplantation. World J Gastroenterol 2014;20(20):6170-6179
• Girometti. Post-operative imaging in liver transplantation: State-of-the-art and future perspectives. World J Gastroenterol 2014;20(20):6180-200
• Santoro-Lopes. Multidrug-resistant bacterial infections after liver transplantation: An ever-growing challenge. World J Gastroenterol 2014;20(20):6201-6210
• Kim. Bacterial infection after liver transplantation. World J Gastroenterol 2014;20(20):6211-6220
• Cheng. Interventional radiology in living donor liver transplant. World J Gastroenterol 2014;20(20):6221-6225

Endocrine

•  van der Zee. Pheochromocytoma: A review on preoperative treatment with phenoxybenzamine or doxazosin. Netherlands Journal of Medicine 2014;72(4):190-201

Metabolic

• Marts. Mind the Gap. Annals of the American Thoracic Society 2014;11(4):671-674 

Haematological

• Shamriz. Methemoglobinemia Induced by Lidocaine-Prilocaine Cream. MAJ 2014;16:250–254

Sepsis

• Wang. Human Antimicrobial Peptides and Proteins. Pharmaceuticals 2014;7(5):545-594

Trauma

• Ivatury. Pressure, perfusion, and compartments: Challenges for the acute care surgeon. AAST 2013 Master Surgeon Lecture. J Trauma Acute Care Surg 2014;76(6):1341-1348
• Karimkhani. Current concepts for oil decontamination of crush injuries: a review. Patient Safety in Surgery 2014;8:22

Paediatrics

• Chong. The Golden Hours in Paediatric Septic Shock—Current Updates and Recommendations.  Ann Acad Med Singapore 2014;43:267-74
• Irving. Nasogastric Tube Placement and Verification in Children: Review of the Current Literature. Crit Care Nurse 2014;34:67-78

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I hope you find these brief summaries and links useful.

 

Until next week

Rob