Critical Care Reviews Newsletter
January 7th 2012
Welcome to the fifth 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.
Due to a lack of major clinical trials being published this week in the larger journals, some smaller, interesting studies from the sub-speciality journals make the newsletter.
January 6th 2012
Although not a clinical study, the publication of yesterday's edition of the New England Journal of Medicine proves newsworthy as it marked the 200th anniversary of the journal, the longest continuously published journal in existence. Brandt provides a review of the past 2 centuaries work.
January 5th 2012
From January's issue of Resuscitation:
Leidel and colleagues report an observational study comparing intraosseous access with central venous access in 40 consecutive adults, with inaccessible peripheral venous access, undergoing resuscitation. Each subject received both IO and CVC access simultaneously, with first attempt success being significantly greater (85% versus 60%, p=0.024) and faster (2.0 versus 8.0min, p<0.001) for IO access. First attempt failure rates were greater for IO access with complications being similar for both groups.
Full Text. Leidel. Comparison of intraosseous versus central venous vascular access in adults under resuscitation in the emergency department with inaccessible peripheral veins. Resuscitation 2012;83(1):40-45
From January's issue of Shock:
Outcomes from Sepsis
Mann et al performed a systematic review comparing the incidence and outcome of sepsis in three groups of critical care patients - trauma, burns and general critically ill. Episodes of sepsis were least prevalent in trauma patients (2.4%–16.9%) in comparison with burn patients (8%–42.5%) and general critical care patients (19%–38%). Similarly, trauma patients with sepsis had lower mortality (7%–36.9%) than burn patients (28%–65%) or general critical care (21%–53%) patients.
From the current issue of Neurocritical Care:
In a prospective observational study, Sakada and colleagues compared the utility of the Full Outline of UnResponsiveness (FOUR) score to the Glasgow Coma Scale in 51 patients with TBI patients. In terms of predictive power for in-hospital mortality, predictive power of poor neurologic outcome at 3–6 months, odds ratio (OR) for in-hospital mortality and odds ratio for poor neurologic outcome, the FOUR score was at least as good as the GCS, and has the advantage that all components can be rated in an intubated patient.
Platelet Transfusion in Intracerebral Haemorrhage
45 patients with intracerebral haemorrhage, and reduced platelet activity or receiving anti-platelet therapy, received early or late platelet transfusion. Patients receiving early transfusion (< 12 hours) had smaller haemorrhage on follow-up CT (8.4 [3–17.4] vs. 13.8 [12.3–62.5] ml, P = 0.04) and increased odds of independence (modified Rankin Scale < 4) at 3 months (11 of 20 vs. 0 of 7, P = 0.01).
From the current issue of Injury:
Track and Trigger Warning Systems
Pateland colleagues report the results of a single-centre retrospective study examing the implementation of a track and trigger physiological warning system in 32,149 trauma patients. Comparison was made pre- and post-implementation of the warning system with no difference in mortality being demonstrated.
I hope you find these brief summaries useful.
Until next week