July 23rd 2012
Welcome to the 33rd Critical Care Reviews Newsletter. Every week over three hundred clinical and scientific journals are monitored and the most important and interesting research publications in critical care are highlighted. These studies are added to the Current Articles section of the website on a daily basis, as publication occurs. A link to either the full text or abstract, depending on the publishers degree of open access, is attached. Also, links to other important papers, such as guidelines or consensus statements are included. Free review articles from across the medical literature are also highlighted.
This week's newsletter is busy and wide-ranging, with review articles on conditions as diverese as haemolytic uraemic syndrome and post transplantation plasma exchange. The new ACCF/AHA guidelines on the management of unstable angina/NSTEMI are included, as are several important research studies.
For those who use social media, links the most popular sites are now included, including facebook and twitter. This will enable bookmarking as well as making friends and colleagues aware of this free resource.
Critical Care Medicine: Feeding
The ANZICS trial group performed a randomized, controlled trial in 17 ICUs across Australia comparing early nasojejunal (n=92) with nasogastric (n=89) in critically ill patients mechanically ventilated patients with mildly elevated gastric residual volumes and already receiving nasogastric nutrition. There was no difference in the proportion of targeted energy delivered from enteral nutrition between the early nasojejunal nutrition group and the continued nasogastric nutrition group (72% vs 71% respectively, mean difference 1%, 95% CI −3% to 5%, p = .66). Complications such as ventilator-associated pneumonia (20% vs. 21%, p = .94), vomiting, witnessed aspiration, diarrhea, and mortality were similar, although minor gastrointestinal hemorrhage was more common in the early nasojejunal nutrition group (12 [13%] vs. 3 [3%], p = .02).
Critical Care Medicine: Procalcitonin
In a single centre, randomized, controlled study Layios et al compared outcomes from procalcitonin guided antibiotic therapy with standard care in 509 critically ill patients with suspected infection. Although patients in the procalcitonin guided cohort had more withheld anbibiotic therapy, it did not result in reduced antibiotic consumption. The ability of procalcitonin to differentiate between certain or probable infection and possible or no infection, upon initiation of antibiotic treatment was low, as confirmed by the receiving operating curve analysis (area under the curve = 0.69).
Critical Care Medicine: Sepsis
In a randomized, double-blind, placebo controlled study, Bruno et al investigated the safety, pharmacokinetics and ability to prevent ventilator-associated pneumonia in 39 critically ill mechanically ventilated patients colonized with Pseudomonas aeruginosa. Participants received either 2 different doses of KB100, a recombinant monoclonal antibody directed against the PcrV epitope of Pseudomonas aeruginosa, or placebo. The intervention was safe, had a half-life of approximately 8 to 9 days, was measurable in tracheal aspirates as early as day 1 after administration, and was associated with lower rates of VAP (33%, 31% versus 60%).
Abstract: Bruno. Safety and pharmacokinetics of an anti-PcrV PEGylated monoclonal antibody fragment in mechanically ventilated patients colonized with Pseudomonas aeruginosa: A randomized,double-blind, placebo-controlled trial. Criti Care Med 2012;40(8):2320-2326
Clinical Infectious Diseases: Ventilator Associated Pneumonia
In a systematic review and meta analysis of 21 studies, O'Horo et al determined that a negative gram stain has a high negative predictive value for the presence of VAP, but the positive predictive value of a positive stain was only 40%. The authors recommend that culture results, but not a positive gram stain, be used to narrow antimicrobial therapy.
Critical Care: Telemedicine
In a systematic review and meta analysis of 11 observational studies, Wilcox et al found that telemedicine, compared to standard care, was associated with lower ICU mortality (risk ratio 0.79; 95% CI 0.65-0.96; 9 studies, n=23526; I2=70%) and hospital mortality (RR 0.83; 95% CI 0.73-0.94; 9 studies, n=47943; I2=72%). Interventions with continuous patient data monitoring, with or without alerts, appeared to be superior and reduced ICU mortality (RR 0.78; 95% CI 0.64-0.95; 6 studies, n=21384; I2=74%) compared with remote intensivist consultation only (RR 0.64; 95% CI 0.20-2.07; 3 studies, n=2142; I2=71%), but effects were statistically similar (interaction p=0.74). Effects were also similar in higher (RR 0.83, 95% CI 0.68-1.02) vs. lower (RR 0.69; 95% CI 0.40-1.19; interaction p=0.53) quality studies. ICU and hospital length of stay were also reduced with telemedicine intervention.
BMC Infectious Diseases: Sepsis Biomarkers
In a cohort study of 144 critically ill patients Su et al examined the diagnostic value of soluble triggering receptor expressed on myeloid cells 1 (sTREM-1), procalcitonin (PCT), and C-reactive protein (CRP) serum levels for differentiating sepsis from SIRS, identifying new fever caused by bacteremia, and assessing prognosis when new fever occurred. The sepsis group had higher serum sTREM-1, PCT, and CRP levels compared with the SIRS group (P <0.05), with the areas under the curve (AUC) for these indicators being 0.868 (95% CI, 0.798-0.938), 0.729 (95% CI, 0.637-0.821), and 0.679 (95% CI, 0.578- 0.771), respectively. In patients with new fever, there was no difference in serum sTREM-1 or PCT levels between those with positive or negative blood cultures. Nonsurvivors with a bacteraemia had higher levels of serum sTREM-1 and PCT (P <0.05), with a prognostic AUC for serum sTREM-1 of 0.868 (95% CI, 0.740-0.997).
Full Text: Su. Value of soluble TREM-1, procalcitonin, and Creactive protein serum levels as biomarkers for detecting bacteremia among sepsis patients with new fever in intensive care units: a prospective cohort study. BMC Infectious Diseases 2012;12:157
Chest: Ventilator Induced Diaphragmatic Dysfunction
Grosu et al performed an observational study in 7 critically ill mechanical ventilated subjects, songraphically measuring diaphragmatic muscle thickess daily until extubation, tracheostomy or death. Diaphragm thickness decreased by 6% per day of mechanical ventilation. However, the relationship between diaphragm muscle thickness, diaphragm strength and pulmonary function remains to be determined.
Circulation: Acute Coronary Syndrome
- 2012 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction (Updating the 2007 Guideline and Replacing the 2011 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation; epublished 16 July 2012
Review - Clinical
Indian Journal of Anaesthesiology: Inflammation
- Hatwalne. Free radical scavengers in anaesthesiology and critical care. Indian J Anaesth 2012;56:227-33
Asian Journal of Neurosurgery: Telemedicine
QJM: Interstitial Cardiac Disease
- Collier. Diagnostics and therapeutic interventions in myocardial interstitial disease, a previously neglected pathology. QJM 2012;105: 721-724
- Rutkowski. Anaphylaxis: current state of knowledge for the modern physician. Postgrad Med J 2012;88:458e464
Drug Design, Development & Therapy: Haemolytic Uraemic Syndrome
- Keir. Shigatoxin-associated hemolytic uremic syndrome: current molecular mechanisms and future therapies. DRug Design, Development & Therapy 2012;2012(6):195-208
Annals of Intensive Care Medicine: Vasculitis
- Zaidan. Vasculitic emergencies in the intensive care unit: a special focus on cryoglobulinemic vasculitis. Annals of Intensive Care 2012;2:31
Annals of Intensive Care Medicine: Biomarker Guided Antibiotic Therapy
- Póvoa. Biomarker-guided antibiotic therapy in adult critically ill patients: a critical review. Annals of Intensive Care 2012, 2:32
Annals of Intensive Care Medicine: Intra-abdominal Hypertension
- Chun. Intra-abdominal pressure, intra-abdominal hypertension, and pregnancy: a review. Annals of Intensive Care 2012;2(Suppl 1):S5
- Starkopf. Should we measure intra-abdominal pressures in every intensive care patient? Annals of Intensive Care 2012, 2(Suppl 1):S9
Circulation Research: Mitochondria & Heart Failure
- Dorn. Inflame On!: Mitochondrial Escape Provokes Cytokine Storms That Doom the Heart. Circulation Research 2012;111 271-273
Transfusion Medicine & Hemeotherapy: Transplantation
Nephrology Dialysis Tranplantation: Thrombotic Microangiopathy
- Barbour. Thrombotic microangiopathy and associated renal disorders. Nephrol. Dial. Transplant. 2012;27:2673-2685
Review - Non-Clinical
Indian Journal of Anaesthesiology: Internet Resources
(they don't seem to have looked too hard.....)
I hope you find these links and brief summaries useful.
Until next week