September 3rd 2012
Welcome to the 39th Critical Care Reviews Newsletter. After last week's massive email, things are quieter this week. The standout paper is the IABP-SHOCK II trial, published this week in the New England Journal of Medicine, which questions the use of intra-aortic balloon counterpulsation in cardiogenic shock.The European Society of Cardiology have released 3 new guidelines, on ST elevation MI, atrial fibrillation and valvular disorders. And if you ever happen to treat someone struck by lightning, then there's even a guideline for this eventuality.....
I've added a new feature, the top 100 critical care studies. This is more of a draft list, as there is some tweaking to be done - adding studies I've forgotten or missed, removing a few that aren't really so important, and altering the order of others. Let me know what you think. It promises to be a useful resource once finalised. The top studies have also been organised by system, to make it easier to follow a single group of studies. Again, much more work needs to be done to really make it a great resource, but it's a start.
The new continuing medical education / continuing professional development facility should be functional in the next few days. if you need CME/CPD points for appraisal purposes, then collecting these certificates should help.
New England Journal of Medicine: Cardiogenic Shock
To test the efficacy of intra-aortic balloon counterpulsation (IABP) in acute myocardial infarction complicated by cardiogenic shock, Thiele et al performed a prospective, open-label, multicenter trial, randomly assigned 600 patients to IABP (n=301) versus no IABP (n=299). The 30 day mortality rate was (39.7%) in the IABP group (119/301) versus 41.3% in the control group (123/299) (relative risk with IABP, 0.96; 95% CI 0.79 to 1.17; P=0.69). There were no significant differences in secondary end points or in process-of-care measures, including the time to hemodynamic stabilization, the length of stay in the intensive care unit, serum lactate levels, the dose and duration of catecholamine therapy, and renal function. Similarly, there were no difference (IABP vs control) in rates of major bleeding (3.3% vs 4.4%; P=0.51), peripheral ischemic complications (4.3% vs 3.4%, P=0.53), sepsis (15.7% vs 20.5%, P=0.15), and stroke (0.7% vs 1.7%, P=0.28).
European Heart Journal: Dyspnoea Biomarkers
In an observational study of 560 patients attending the emergency department with dyspnoea, Shah and colleagues evaluated the diagnostic and prognostic value of mid-regional pro-atrial natriuretic peptide (MR-proANP), adrenomedullin (MR-proADM) and amino-terminal pro-B type natriuretic peptide. MR-proANP was higher in patients with acute decompensted heart failure than without (median 329 vs. 58 pmol/L; P < 0.001). In time-dependent analyses, MR-proADM had the highest AUC for 1 year mortality; after 1 year, MR-proANP and NT-proBNP had higher AUCs. Both mid-regional peptides were independently prognostic and reclassified risk at 1 year [MR-proANP, hazard ratio (HR) = 2.99, MR-proADM, HR = 2.70; both P < 0.001] and at 4 years (MR-proANP, HR = 3.12, P < 0.001; MR-proADM, HR = 1.51, P = 0.03) and in Kaplan–Meier curves both mid-regional peptides were associated with death out to 4 years, individually or in a multimarker strategy.
Abstract: Shah. Mid-regional pro-atrial natriuretic peptide and pro-adrenomedullin testing for the diagnostic and prognostic evaluation of patients with acute dyspnoea. Eur Heart J 2012;33(17):2197-2205
Clinical Infectious Disease: H1N1 Influenza
Based on Californian surveillance data, Louie et al analyzed 1950 cases of H1N1 influenza requiring ICU admission. 1859 (95%) had information available, with 1676 (90%) receiving neuraminidase inhibitor treatment, and 183 (10%) not receiving this therapy. The median cohort age was 37 years (range, 1 week–93 years), 1473 (79%) had ≥1 comorbidity, and 492 (26%) died. The median time from symptom onset to starting neuraminidase inhibitor treatment was 4 days (range, 0–52 days). NAI treatment was associated with improved survival, with 107 of 183 untreated case patients (58%) surviving, compared with 1260 of 1676 treated case patients (75%) (P ≤ 0.0001). Earlier rather than later treatment (P < 0.0001) and treatment within 5 days after symptom onset compared to no neuraminidase inhibitor treatment (P < 0.05) were both associated with improved survival.
European Heart Journal: STEMI
- Steg. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). Eur Heart J 2012 epublished 24 August 2012
European Heart Journal: Atrial Fibrillation
- Camm. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: An update of the 2010 ESC Guidelines for the management of atrial fibrillation. Eur Heart J 2012 published 24 August 2012
European Heart Journal: Valvular Heart Disease
- Vahanian. Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2012 published 24 August 2012
Wilderness & Environmental Medicine: Lightning Strike
- Davis. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Lightning Injuries. Wilderness and Emergency Medicine 2012;23(3):260-269
Review - Clinical
Open Access Emergency Medicine: Asthma / Acute Respiratory Distress Syndrome
- Hodder. Critical care in the ED: potentially fatal asthma and acute lung injury syndrome. Open Access Emergency Medicine 2012;2012(4):53-68
International Journal of Hepatology: Fungal Infections
- Van Thiel. Fungal Infections: Their Diagnosis and Treatment in Transplant Recipients. International Journal of Hepatology 2012;2012:Article ID 106923
International Journal of Hepatology: Variceal Bleeding
- Maufa. Role of Self-Expandable Metal Stents in Acute Variceal Bleeding. International Journal of Hepatology 2012;2012:Article ID 418369
International Journal of Hepatology: TIPS
- The Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Portal Hypertension: Current Status International Journal of Hepatology 2012;2012:Article 167868
Annals of Intensive Care: Thrombocytopaenia
- Van der Linden. Management of thrombocytopenia in the ICU (pregnancy excluded). Annals of Intensive Care 2012;2:42
Stem Cell International: Stem Cells
- Sng. Emerging Stem Cell Therapies: Treatment, Safety, and Biology. Stem Cells International 2012;2012:Article ID 521343
Gastroenterology: Acute Liver Failure
Circulation: Aortic Regurgitation
Journal of Antibiotics: Post-Antibiotics Era
- Bérdy. Thoughts and facts about antibiotics: Where we are now and where we are heading. J Antibiot 2012;65:385-395
Cardiology Research & Practice: Mechanical Support Devices
- Spiliopoulos. Current Status of Mechanical Circulatory Support: A Systematic Review. Cardiology Research and Practice 2012;2012:Article ID 574198
Review - Basic Science
Indian Journal of Anaesthesiology: Free Radical Scavengers
- Hatwalne. Free radical scavengers in anaesthesiology and critical care. Indian J Anaesth 2012;56(3):227-33
Review - Non-Clinical
Trials: Adaptive Trials
I hope you find these links and brief summaries useful.
Until next week