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.....
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:
- basic data
- 3,169 datasets on 799 mechanical ventilation days
- 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
- median time-weighted average Spo2
- a lower
- no difference
- in the evolution of the Pao2/Fio2 ratio
- biochemical or clinical outcomes
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:- In 6 trials (n = 1,016) that used a protective ventilation strategy with reduced tidal volumes
- prone positioning significantly reduced mortality
- risk ratio 0.74, 95% CI 0.59 to 0.95; I2 = 29%
- prone positioning significantly reduced mortality
- a high overall quality of evidence
- a low risk of bias in all trials except one, which was small
- low statistical heterogeneity (I2 < 50%) for most of the clinical and physiologic outcomes
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:
- 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
- when PEEP > 10 cmH2O
- 90-day
- when PEEP > 10 cmH2O
- RR 0.57; 95% CI 0.43 to 0.75; P <0.0001; n = 516
- when PEEP > 10 cmH2O
- 28- to 30
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:
- 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)
- at day 28 / 30
- 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)
- mortality
- reduced risk of
- oxygenation failure
- RR 0.557 (95% CI 0.351 to 0.884)
- oxygenation failure
- no difference in
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:
- hyperoxia was
- associated with
- increased in-hospital mortality
- OR 1.40; 95% CI 1.02 to 1.93; I2 69.27%; 8 studies
- increased in-hospital mortality
- not associated with
- worsened neurological outcome
- OR 1.62; 95% CI 0.87 to 3.02; I2 55.61%; 2 studies
- worsened neurological outcome
- associated with
- the results were inconsistent in subgroup and sensitivity analyses
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:
- 36% had a favorable outcome (cerebral performance category 1–2)
- 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)
- lower median blood glucose level
- 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
- increased median blood glucose level over the first 48 hours
Vaahersalo and colleagues performed a prospective cohort study in 21 Finnish ICUs, assessing the effects of mean and time-weighted oxygen and carbon dioxide levels, divided into predefined categories from lowest to highest, during the first 24 hours of postcardiac arrest care in 409 patients, and found:
- basic data
- average of 8 Pao2 and Paco2 measurements per patient
- mean 24 hours Paco2 level was an independent predictor of good outcome
- OR 1.054; 95% CI 1.006 to 1.104; p = 0.027
- mean 24 hours Pao2 value was not an independent predictor of good outcome
- odds ratio 1.006; 95% CI 0.998 to 1.014; p = 0.149
- time spent in the Paco2 band higher than 45 mm Hg was associated with good outcome
- OR 1.015; 95% CI 1.002 to 1.029; p = 0.024, for each percentage point increase in time
- time spent in different oxygen categories were not associated with good outcome
Additional Studies
Observational Studies
- Abstract: Basetti. A multicenter study of septic shock due to candidemia: outcomes and predictors of mortality. Intensive Care Med 2014;40(6):839-845
- Abstract: Prescott. Increased one-year health care utilization in survivors of severe sepsis. Am J Respir Crit Care Med 2014;epublished May 28th
- Full Text: Wu. A 10 second fluid challenge guided by transthoracic echocardiography can predict fluid responsiveness. Critical Care 2014;18:R108
- Full Text: Ritter. Inflammation biomarkers and delirium in critically ill patients. Critical Care 2014;18:R106
- Full Text: Periyakoil. Do Unto Others: Doctors' Personal End-of-Life Resuscitation Preferences and Their Attitudes toward Advance Directives. PLoS ONE 9(5): e98246
- Abstract: Nazerian. Accuracy of Point-of-Care Multiorgan Ultrasonography for the Diagnosis of Pulmonary Embolism. Chest 2014;145(5):950-957
- Abstract: Ugurlu. Use and Outcomes of Noninvasive Positive Pressure Ventilation in Acute Care Hospitals in Massachusetts. Chest 2014;145(5):964-971
- Full Text: Turnbull. Age and decisions to limit life support for patients with acute lung injury: a prospective cohort study. Critical Care 2014;18:R107
Guidelines & Position Statements
- 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
Study Critique
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
Commentary
- Mikkelsen. Can We Optimize Long-Term Outcomes in Acute Respiratory Distress Syndrome by Targeting Normoxemia? Ann Am Thorac Soc 2014;11(4):613–618
- Hampton. Fully Automated Artificial Pancreas Finally Within Reach. JAMA 2014;epublished May 28th
- Koh. Healthy People 2020: A Report Card on the Health of the Nation. JAMA 2014;epublished May 28th
- Hua. Leptin: New hope for the treatment of post-operative cognitive dysfunction? Med Sci Monit 2014;20:866-868
- Volkow. Medication-Assisted Therapies — Tackling the Opioid-Overdose Epidemic. N Engl J Med 2014;370:2063-2066
- Sawicki. Clinicians' Involvement in Capital Punishment — Constitutional Implications. New Engl J Med 2014;epublished May 28th
- Rehn. Quality improvement in pre-hospital critical care: increased value through research and publication. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2014;22:34
- Alspach. About That Health Care Icon Dangling Around Your Neck: Do We Have Some Cleaning Up to Do? Crit Care Nurse 2014;34:11-14
- Scheyerer. The clinical rehabilitation of spine and spinal cord disorders: detection and evaluation using SPECT/CT. Neural Regen Res 2014;9:795-7
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
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
Metabolic
Haematological
Sepsis
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
I hope you find these brief summaries and links useful.
Until next week
Rob