January 14th 2012
Welcome to the 58th 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 and guidelines from over 300 clinical and scientific journals. Apologies for being a day late.
There's hasn't been much major research published in the past week. In a systematic review and meta analysis ω-3 fatty acid supplemented parenteral nutrition proved to be of little benefit, as did nebulised magnesium in acute exacerbations of COPD. Ultra-low tidal volume ventilation combined with extra-corporeal CO2 removal also failed to demonstrate any additional benefit over standard ARDS ventilation, although in a post hoc analysis there was a small reduction in the duration of ventilation in the most hypoxaemic group. Also, the US Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients present their 21st annual report based largely on data pertaining to the period 1998-2011.
This week's guidelines include an update on the previously influential SCCM paper on the management of pain, agitation and delirium in the critically ill. There are also guidelines on the management of intra-abdominal sepsis and the development of protocols for clinical trials.
There is a commentary from JAMA, comparing the US healthcare system with other international systems.
Amongst the clinical review articles are papers on protection for ischaemic stroke, haemorrhagic and circulatory shock, postoperative pulmonary oedema, TEG in liver disease, disaster medicine, and studying sepsis.
Many thanks to those of you who were able to complete the survey on Critical Care Reviews. The comments were overwhelmingly positive and very helpful for the development of the site. Some useful feedback included a request for more rheumatological/neurological/immunological papers, more pharmacology topics, a conclusion to the research abstracts, podcasts, a mobile app, plus the option to store CPD certificates on the site. Most were happy with the look of the site, but it was a bit dated for some. Several asked for the newsletters to be archived on the site. The newsletter seems to largely ok, although some thought my including articles from some of the more obscure journals didn't add much. A large majority requested that review articles from the major journals (Chest, AJRCCM, Anesthesiology, Critical Care, BJA etc) that are 6 months old or older, and recently made open access, be added to the newsletter.
I'll get to work on these features over the next few weeks, but unfortunately don't have the resources to produce a mobile application at present.
Critical Care Medicine: ω-3 Fatty Acid Supplemented Parenteral Nutrition
Palmer and colleagues performed a systematic review and meta analysis of randomized controlled trials (n=8), comparing parenteral nutrition with ω-3 fatty acid supplementation to parenteral nutrition without this supplement in 391 critically ill patients. There was no difference in mortality between the two groups (relative risk for death: 0.83; 95% CI 0.57, 1.20; p = 0.320), infectious complications (5 studies, 337 subjects; relative risk for infection: 0.78; 95% CI 0.43, 1.41; p = 0.41), or ICU length of stay (6 studies, 305 subjects; 0.57 days in favor of the ω-3 fatty acid group; 95% CI –5.05, 3.90; p = 0.80). ω-3 fatty acid supplementation reduced hospital length of stay (3 studies, 117 subjects; by 9.49 days; 95% CIl –16.51, –2.47; p = 0.008), although these results were strongly influenced by one small study. Conclusion: Based on this systematic review and meta-analysis, ω-3 fatty acid supplementation of parenteral nutrition appears to have little effect on outcomes in the critically ill.
Intensive Care Medicine: ARDS
Bein performed a randomized trial in 79 patients with ARDS comparing a low tiidal volume ventilation (≈3 ml/kg) combined with extracorporeal CO2 elimination, or to a standard ≈6 ml/kg ARDSNet strategy. There were no differences in any of the major endpoints, including the primary endpoint of ventilator free days at 28 days (10 ± 8 vs 9.9 ± 9; p=0.779); non-pulmonary organ free days at day 60 (21.0 ± 14 vs 23.9 ± 15; p=0.447); length of ICU stay (31.3 ± 23 vs 22.9 ± 11; p=0.144) or length of hospital stay (46.7 ± 33 vs 35.1 ± 17, p=0.113) or in-hospital mortality (7/40 (17.5 %) vs 6/39 (15.4 %); p≈1.0). In a post-hoc analysis the most hypoxaemic group treated with combined ultra-low tidal volume/extracorporeal CO2 elimination had improved duration of ventilation at both day 28 and day 60.
Full Text: Bein. Lower tidal volume strategy (≈3 ml/kg) combined with extracorporeal CO(2) removal versus 'conventional' protective ventilation (6 ml/kg) in severe ARDS : The prospective randomized Xtravent-study. Intensive Care Med 2013; epublished January 10th
Edwards et al performed a randomised double-blind placebo-controlled trial in 116 patients with an acute exacerbation of COPD in the emergency department, comparing 2.5 mg salbutamol mixed with either 2.5 ml isotonic magnesium sulphate (151 mg per dose) or 2.5 ml isotonic saline (placebo) on three occasions at 30 min intervals via nebuliser. At 90 min the mean (SD) FEV1 in the magnesium group (N=47) was 0.78 (0.33) l compared with 0.81 (0.30) l in the saline group (N=61) (difference −0.026 l (95% CI −0.15 to 0.095, p=0.67). No patients required non-invasive ventilation. There were 43/48 admissions to hospital in the magnesium group and 56/61 in the saline group (RR 0.98, 95% CI 0.86 to 1.10, p=0.69). Conclusion: Nebulised magnesium sulphate had no additonal effect on FEV1 over that of standard bronchodilator therapy in ED patients with an acute exacerbation of COPD.
American Journal of Transplantation: US Transplant Reports
- Preface. American Journal of Transplantation 2013;13:1–7
- Introduction. American Journal of Transplantation 2013;13:8–10
- Matas. OPTN/SRTR 2011 Annual Data Report: Kidney. American Journal of Transplantation 2013;13:11–46
- Kandaswamy. OPTN/SRTR 2011 Annual Data Report: Pancreas. American Journal of Transplantation 2013;13:47–72
- Kim. OPTN/SRTR 2011 Annual Data Report: Liver. American Journal of Transplantation 2013;13:73–102
- Smith. OPTN/SRTR 2011 Annual Data Report: Intestine. American Journal of Transplantation 2013;13:103–118
- Colvin-Adams. OPTN/SRTR 2011 Annual Data Report: Heart. American Journal of Transplantation 2013;13:119–148
- Valapour. OPTN/SRTR 2011 Annual Data Report: Lung. American Journal of Transplantation 2013;13:149–177
- Israni. OPTN/SRTR 2011 Annual Data Report: Deceased Organ Donation. American Journal of Transplantation 2013;13:179–198
- Kasiske. OPTN/SRTR 2011 Annual Data Report: International Data. American Journal of Transplantation 2013;13:199–225
Critical Care Medicine: Pain, Agitation & Delirium
- Barr. Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit. Crit Care Med 2013; 41:263–306
World Journal of Emergency Surgery: Intra-Abdominal Infection
- Sartelli. 2013 WSES guidelines for management of intra-abdominal infections. World Journal of Emergency Surgery 2013;8:3
Annals of Internal Medicine: Clinical Trials
- Chan. SPIRIT 2013 Statement: Defining Standard Protocol Items for Clinical Trials. Ann Intern Med 2013; epublished January 8th
Journal of the American Medical Association: US Healthcare
Review - Clinical
Saudi Journal of Anaesthesia: Emergency Extracranial Surgery in Neurosurgical Patients
- Chowdhury. Neuroanesthetic considerations for emergent extracranial surgeries: What to know?. Saudi J Anaesth 2012;6:408-11
Medical Gas Research: Hyperbaric Oxygen for Ischaemic Stroke
- Qi. Normobaric hyperoxia-based neuroprotective therapies in ischemic stroke. Medical Gas Research 2013;3:2
Annals of Medical and Health Sciences Research: Neuroprotection for Ischaemic Stroke
Cardiology Research: Heart Failure
Critical Care: Circulatory Shock
Journal of the American College of Cardiology: Out-of-Hospital Cardiac Arrest
Journal of the American Heart Association: Left Mainstem Percutaneous Coronary Intervention
- Park. Unprotected Left Main Percutaneous Coronary Intervention: Integrated Use of Fractional Flow Reserve and Intravascular Ultrasound. J Am Heart Assoc 2012;1:e004556
Texas Heart Institute Journal: Mechanical Circulatory Support
Annals of Medical and Health Sciences Research: Postoperative Pulmonary Oedema
- Bajwa. Diagnosis, prevention and management of postoperative pulmonary edema. Ann Med Health Sci Res 2012;2:180-5
American Journal of Critical Care: Definitions of ARDS & VAP
- Munro. What you call it does matter: new definitions of ARDS and VAP. Am J Crit Care 2012;21(5):305-7
Anaesthesia: Enhanced Thoracic Recovery
- Jones. A review of enhanced recovery for thoracic anaesthesia and surgery. Anaesthesia 2013;68:179–189
Internal Medicine: ANCA-associated Vasculitis
Gastroenterology & Hepatology: Thromboelastography in Liver Disease
- Stravitz. Potential applications of thromboelastography in patients with acute and chronic liver disease. Gastroenterol Hepatol (N Y) 2012;8(8):513-20
Liver International: Hepatitis B
- Jindal. Management of acute hepatitis B and reactivation of hepatitis B. Liver International 2013;33:164–175
Liver International: Delta Hepatitis
Texas Heart Institute Journal: Thrombocytosis & Cardiovascular Surgery
EMBO Molecular Medicine: Studying Sepsis
Annals of Intensive Care: Traumatic Haemorrhagic Shock
Indian Journal of Plastic Surgery: Facial Wounds
Journal of Anaesthesiology Clinical Pharmacology: Opioids & Chronic Pain
New England Journal of Medicine: Post-Hospital Syndrome
- Krumholz. Post-Hospital Syndrome — An Acquired, Transient Condition of Generalized Risk. N Engl J Med 2013;368:100-102
Medical Gas Research: Carbon Monoxide during Transplantation
- Amano. The immunomodulatory role of carbon monoxide during transplantation. Medical Gas Research 2013;3:1
Southern Medical Journal: Disaster Medicine
- Hanfling. When the Bells Toll: Engaging Healthcare Providers in Catastrophic Disaster Response Planning. Southern Medical Journal 2013;106(1):7-12
- Pou. Ethical and Legal Challenges in Disaster Medicine: Are You Ready? Southern Medical Journal 2013; 106(1):27-30
- Iserson. Vertical Hospital Evacuations: A New Method. Southern Medical Journal 2013;106(1):37-42
I hope you find these brief summaries and links useful.
Until next week