Critical Care Reviews Newsletter
January 23rd 2012
Welcome to the seventh Critical Care Reviews Newsletter. Every weekend some of the more important studies in critical care, which were published that week, are highlighted. These studies are added to the News section of the website on a daily basis, as publication occurs.
Renal Replacement Therapy
In Critical Care, Vaara presents a nationwide retrospective cohort study from Finland examining the incidence of RRT-treated AKI, including in-hospital and six-month mortality. In a cohort of 24904 patients, of whom 1686 received RRT due to AKI, the incidence of RRT-treated AKI was 6.8% (95% CI 6.5-7.1%) among ≥15 year old general ICU patients, which corresponds to a yearly population-based incidence of 19.2 per 100000 (95% CI 17.9-20.5/100000). According to RIFLE (Risk, Injury, Failure) classification 26.6% (95% CI 26.0-27.2%) of patients had AKI (RIFLE R-F). Hospital and six-month mortality of RRT patients were 35.0% and 49.4%.
Full Text. Vaara. Population-based incidence, mortality and quality of life in critically ill patients treated with renal replacement therapy - A nationwide retrospective cohort study in Finnish ICUs . Critical Care 2012, 16:R13
Thyroid Hormone Measurement
Wang recruited 480 consecutive patients without known thyroid diseases to assess the prognostic value of the complete thyroid indicators (FT3, TT3, FT4, TT4, TSH and rT3). FT3 had the greatest power for predicting ICU mortality, with an under the curve (AUC) of 0.762+/-0.028. The AUC for FT3 was less than that for APACHE-II score (0.829 +/-0.022), but greater than that for NT-proBNP (0.724+/-0.030) or CRP (0.689+/-0.030). Multiple regression revealed that FT3, APACHE- score, NT-proBNP or CRP could independently predict primary outcome. Addition of FT3 to APACHE- score gave an NRI of 54.29% (P<0.001) and IDI of 36.54% (P<0.001). The level of FT3 was significantly correlated with. NT-proBNP (r=-0.344, P<0.001) or CRP (r=-0.408, P<0.001) levels.
January 19th 2012
In this week's Annals of Internal Medicine, Wichmann investigated the value of postmortem multidetector computed tomography as an alternative to medical autopsy in 285 patients. Of 196 clinical diagnoses made before death, 173 (88%) were identified by virtual autopsy and 183 (93%) by medical autopsy. Cancer (9/72) and Cardiovascular deaths (12/30) were the main diagnoses missed by virtual autopsy. Medical autopsy missed 13 traumatic fractures and 2 pneumothoraces. Among 115 additional patients in whom only virtual autopsy was performed, 11 new major diagnoses were made.
Traumatic Brain Injury
In a prospective cohort study in Academic Emergency Medicine, Papa reports equivalence between the Canadian CT Head Rule and the New Orleans Criteria for predicting intracranial injury in traumatic brain injury. In 431 subjects with initial GCS of 13-15, sensitivites were similar (100%), but the Canadian CT Head Rule proved much more specific.
Abstract. Papa. Performance of the Canadian CT Head Rule and the New Orleans Criteria for Predicting Any Traumatic Intracranial Injury on Computed Tomography in a United States Level I Trauma Center. Academic Emergency Medicine 2012;19(1):2-10
Central Venous Catheterization
Epublished ahead of print in Anesthesia & Analgesia, Lamperti demonstrated, in a prospective, randomized controlled, nonblinded study in 1332 patient that a neutral neck position is equivalent to 45% for ultrasound assisted internal jugular vein cannulation. Complication rates (13%) and time to achieve success were similar.
Abstract. Lamperti. Is a Neutral Head Position Safer than 45-Degree Neck Rotation During Ultrasound-Guided Internal Jugular Vein Cannulation? Results of a Randomized Controlled Clinical Trial. Anesth Analg 2012
The Cochrane Collaboration have published a new review on the utility of the anti-influenza neuraminidase inhibitors. Due to publication bias, the authors decided to analyse data submitted to regulatory authorities rather than formal publications. Despite repeated requests Roche, manufacturers of oseltamivir, did not release data for this study. Data from 25 studies (15 oseltamivir and 10 zanamivir) were analysed, but a further 42 studies were excluded due to methodological concerns or incomplete results. These agents were associated with modest effects, including reduction of duration of symptoms by 21 hours, but no effect on person-to-person tranmission. Both drugs were associated with potentially harmful effects.
I hope you find these brief summaries useful.
Until next week