Hot Articles

The following articles have been chosen as the most noteworthy publications in critical care since December 2011.

2018

Randomised Controlled Trials

Guidelines & Position Statements

{slider=August}

Randomised Controlled Trials

Guidelines & Position Statements

Randomised Controlled Trials

Observational Studies

Guidelines & Position Statements

Randomised Controlled Trials


Guidelines & Position Statements

2017

Randomised Controlled Trials

Guidelines & Position Statements

Laptook. Effect of Therapeutic Hypothermia Initiated After 6 Hours of Age on Death or Disability Among Newborns With Hypoxic-Ischemic Encephalopathy. A Randomized Clinical Trial. JAMA 2017;318(16):1550-1560

Stöckl. Continuous versus intermittent neuromuscular blockade in patients during targeted temperature management after resuscitation from cardiac arrest—A randomized, double blinded, double dummy clinical trial. Resuscitation 2017;120:14-19

Koster. Safety of mechanical chest compression devices AutoPulse and LUCAS in cardiac arrest: a randomized clinical trial for non-inferiority. European Heart Journal 2017;38(40):3006–3013

The Implementation of Targeted Temperature Management: An Evidence-Based Guideline from the Neurocritical Care Society. Neurocrit Care 2017;epublished October 16th

Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2017;epublished October 16th

Koch. A Randomized Clinical Trial of Red Blood Cell Transfusion Triggers in Cardiac Surgery. Ann Thorac Surg 2017;104(4):1243-1250

Jaillette. Impact of tapered-cuff tracheal tube on microaspiration of gastric contents in intubated critically ill patients: a multicenter cluster-randomized cross-over controlled trial. Intensive Care Med 2017;43(11):1562–1571

Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part II): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Intnsive Care Med 2017;epublished October 31st

Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association / American Stroke Association. Stroke 2017;epublished November 2nd

Thiele. PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock (CULPRIT-SHOCK). N Engl J Med 2017;epublished October 30th

van Brunschot. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet 2017;epublished November 3rd

European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – endorsed by the European Academy of Neurology. Eur J Neurol 2017;24:1203–1213

30th Annual ESICM Congress (LIVES2017, Vienna) 

New Engl J Med - Age of Transfused Red Cells

JAMA - Alveolar Recruitment in ARDS

JAMA - Intra-Operative Blood Pressure Management

JAMA - Systematic ICU Admission for Elderly Sick Patients

JAMA - Early Goal-Directed Sepsis Care in Zambia

Intensive Care Medicine - Early Goal-Directed Nutrition

Intensive Care Medicine - Airway Pressure Release Ventilation

Intensive Care Medicine - Spontaneous Breathing Trials

Intensive Care Medicine - Biomarker-Guided Strategy for Discontinuing Antifungal Therapy

Kneyber. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive Care Med 2017;epublished September 22nd


Intensive Care Medicine - Positioning for VAP


Intensive Care Medicine - Adrenal Insufficiency Guideline


Circulation - Cardiogenic Shock Guideline


Lancet Respiratory Medicine - Sedation Interruption


Chest - Checklists for ICU Intubation


Critical Care Medicine - Nebulized Versus IV Amikacin in VAP


European Respiratory Journal - HAP / VAP Guideline


Annals of Surgery - Transfusion Thresholds in Burns


Critical Care - Loxapine for Agitation


Critical Care - Recombinant ACE 2 in ARDS


J Crit Care - Enteral Nutrition as Stress Prophylaxis


Am J Respir Crit Care Med - Coping Skills in ICU Survivors


European Respiratory Journal - NIV Guideline

NEJM - Oxygen in Acute Myocardial Infarction


Crit Care Resusc - Earplugs for Sleep Quality


Resuscitation - Intermittent vs Continuous Neuromuscular Blockade during Temperature Management post Cardiac Arrest


JAMA - Ganciclovir in CMV-Positive Critically Ill Patients


Critical Care - Serlipressin in Septic Shock


Critical Care Medicine - Simulation for ECMO Emergencies


Critical Care Medicine - Exposure Keratopathy


Critical Care - Software-Guided Glycaemic Control


Thorax - Rehabilitation in the ICU

JAMA - 24 vs 48 Hours of Hypothermia post Cardiac Arrest


JPEN - Paediatric Nutritional Support Guideline


Journal of Intensive Care - Japanese ARDS Guideline


Chinese Medical Journal - EEG Monitoring Guideline


Lancet respiratory Medicine - Simvastatin for Prevention & Treatment of ICU Delirium


Journal of Critical Care - Furosemide in Early Acute Kidney Injury


Lancet - Procalcitonin-Guided Antibiotics in Early Sepsis


Minerva Pneumologica - NIV vs IMV in Hypoxaemic Respiratory Failure


JAMA Cardiology - Spironolactone in Acute Heart Failure


Anaesth Crit Care Pain - French TTM Guideline


World Jounal of Emergency Surgery - Intra-Abdominal Infections Guideline


Critical Care Medicine - Blood flow & CRRT Circuit Lifespan


European Heart Journal - Safety of Mechanical Chest Compression Devices


Journal of Korean medical Science - Mild Hypothermia for Poor Grade Subarachnoid Haemorrhage


Critical Care Medicine - Shenfu Injection post Cardiac Arrest


JAMA - Cooling post Neonatal Hypoxic-Ischaemic Encephalopathy

Circulation - N-Acetylcysteine & Nitrate Therapy in STEMI


Thorax - Post ICU Rehabilitation

McDowell. Effectiveness of an exercise programme on physical function in patients discharged from hospital following critical illness: a randomised controlled trial (the REVIVE trial) Thorax 2017;72:594-595


JAMA - FAST Scan in Paediatric Trauma


J Allergy Clin Immunol Pract - Icatibant for ACE Inhibitor-Induced Angioedema


Ann Emerg Med - High Flow Nasal Oxygen in Cardiogenic Pulmonary Oedema


Critical Care - Supplementary Parenteral Nutrition


JAMA Surgery - Intraoperative Dexmedetomidine & Post-Op Cognitive Dysfunction


Intensive Care Med - AKI Guideline

American Thoracic Society Conference

NEJM - Angiotensin II for Septic Shock


NEJM - Time to Treatment in Sepsis


JAMA - Outcome Prediction ICU



Thorax - BTS Oxygen Use Guideline


Crit Care Medicine - Paediatric & Neonatal Septic Shock Guideline


Neurology - Brain Injury after CPR Guideline


Chest - Positioning for Endotracheal Intubation


Resuscitation - Video versus Direct Laryngoscopy for Paramedic Endotracheal Intubation


European Journal of Anaesthesiology - Severe Perioperative Bleeding Guideline


Annals of Intensive Care - Post Extubation High Flow Nasal Oxygen


Crit Care Medicine - Stress Ulcer Prophylaxis


American Heart Journal - Nitric Oxide in Acute PE


N Eng J Med - Bystander Efforts in Out-of-Hospital Cardiac Arrest

Lancet - Tranexamic Acid for Post Partum Haemorrhage


Lancet Haematology - FFP vs Coagulation Factor Concentrates for Traumatic Coagulopathy


JAMA Internal Medicine - Antiviral Therapy for CMV Reactivation


Annals of Thoracic Surgery - Corticosteroids in Neonatal Cardiac Operations


JAMA - Postoperative Troponin Elevation in Noncardiac Surgery


Intensive Care Medicine - Immunoglobulin for Necrotising Soft Tissue Infection


New England Journal of Medicine - Ularitide in Acute Heart Failure


Intensive Care Medicine - NIV Post Extubation in Chronic Respiratory Disorders


Intensive Care Medicine - IV Chloride Restriction in Cardiac Surgery

Critical Care Medicine - Transfusion in Critically Ill Oncology Patients


J Trauma - Damage Control Resuscitation Guideline


J Crit Care - Tracheostomy Guideline


Intensive Care Med - Condolence Letter


JPEN J Parenter Enteral Nutr - Parenteral Nutrition Guideline


Intensive Care Medicine - Early Enteral Nutrition Guideline


Critical Care Medicine - Contrast-Induced Nephropathy


Critical Care - Pseudomonas Vaccine

Society of Critical Care Medicine Annual Congress

JAMA - Video vs Direct Laryngoscopy for Intubation in ICU

N Engl J Med - Therapeutic Hypothermia for Paediatric Cardiac Arrest

N Engl J Med - Paediatric Glycaemic Control

JAMA - Intubation during Cardiac Arrest


Crit Care Med - Surviving Sepsis Campaign Guidelines


Crit Care Med - Family-Centred Care Guidelines


Chest - Liberation from Mechanical Ventilation Guidelines

2016

NEJM - Age of Transfused Blood


NEJM - Tranexamic Acid for Coronary Artery Surgery


Intensive Care Medicine - High Flow Nasal Oxygen post Abdominal Surgery


Intensive Care Medicine - Balanced versus Unbalanced Crystalloids


Intensive Care Medicine - HFNO vs NIV for Pre-Oxygenation in Hypoxic ICU patients


Critical Care - Steroids in Early Sepsis-Associated ARDS


Am J Respir Crit Care Med - Helium / Oxygen in Exacerbations of COPD


Intensive Care Medicine - Intravascular Catheter Dressings


J Crit Care - Intensity of Feeding

ESICM 2016

NEJM - Levosimendan in Sepsis

JAMA - HFNO vs NIV

JAMA - OXYGEN-ICU

JAMA - EMPIRICUS

JAMA - Intubation during Paediatric Cardiac Arrest

Therapeutic Hypothermia & Cardiac Arrest

JAMA - Steroids in Sepsis

Intensive Care Medicine - Fluid Resuscitation in Sepsis


Intensive Care Medicine - Nitric Oxide during Cardiopulmonary Bypass


Intensive Care Medicine - NAVA


Intensive Care Medicine - IV Iron for Anaemia


Intensive Care Medicine - Recovery Programme


Lancet - Early, Goal-Directed Mobilisation


Critical Care Medicine - Dopamine vs Adrenaline in Septic Shock


 Neurosurgery - 4th Brain Trauma Foundation TBI Guideline


NEJM - High Flow Nasal Oxygen for Preterm Infants


Crit Care Med - Stress Ulcer Prophylaxis


Liver International - Vasopressor Support for Cirrhosis & Septic Shock


NEJM - Decompressive Craniotomy


Am J Respir Crit Care Med - Sevoflurane for Sedation ARDS


Chinese Medical Journal - Evaluation of Coma after Cardiac Arrest


N Engl J Med - Factor Xa Inhibitor Related Bleeding

Lancet Respiratory Medicine - Sedation & Analgesia


JAMA Cardiology - Nonshockable Out-of-Hospital Cardiac Arrest


Shock - Hydrocortisone in Septic Shock


JAMA Internal Medicine - Sodium Selenite & Procalcitonin in Sepsis


Journal of Critical Care - Heparin for Pneumonia in Ventilated Patients


European Heart Journal - Acute Heart Failure Guideline


Clinical Infectious Diseases - HAP & VAP Guideline


Am J Respir & Crit Care Med - Burnout Syndrome in Critical Care Professionals


JAMA - Palliative Care-Led Meetings

Lancet - Platelet Transfusion in Haemorrhagic Stroke


JAMA - Timing of Renal Replacement Therapy in AKI


American Thoracic Society Meeting

New England Journal of Medicine:     Timing of Renal Replacement Therapy in AKI

JAMA:     Aspirin for the Prevention of ARDS

JAMA:     Helmet NIV for ARDS

American Journal of Kidney Disease:     Renal Replacement Therapy Dose


Journal of the American College of Cardiology:     Early Aldosterone Blockade in Acute MI


Resuscitation:     Video Laryngoscopy during CPR


Critical Care:     European Guideline on Bleeding & Coagulopathy post Trauma


JAMA:     Checklists


Resuscitation:     Hypercapnoea post Cardiac Arrest


NEJM:     Antiarrhythmics in Out-of-Hospital Cardiac Arrest


Critical Care:     Steroids for Refractory Shock post Cardiac Arrest


Intensive Care Medicine:     Probiotics for the Prevention of VAP

Brussel's International Symposium on Intensive Care & Emergency Medicine

JAMA:  Dexmedetomidine Sedation in ICU

JAMA: High-Flow Nasal Oxygen post Extubation

JAMA: Non-Invasive Ventilation post Extubation after Abdominal Surgery

JAMA: Secondary Infections post Sepsis

NEJM: Early TPN in Childern


Critical Care Medicine:  Fragility Index in Critical Care


Journal of Infection - UK Meningitis Guidelines


JAMA - Sepsis Definition


JAMA - Statins for AKI


JAMA - ARDS Epidemiology

Lancet Respiratory Medicine - Effect of Light on Delirium


Intensive Care Medicine - Blood Pressure Targets in Shock


NICE Trauma Guideline


JAMA - Acetazolamide for COPD


Intensive Care Medicine - Percutaneous Dilational Tracheostomy


Pediatric Crit Care Med - Aminophylline for Prevention of AKI

Blue Journal - End-of-Life Communication


JPEN J Parenter Enteral Nutr - Nutritional Support in the Critically Ill


Intensive Care Medicine - Continuous vs Intermittent Beta Lactam Infusion


Chest - Antithrombotic Therapy for VTE


Resuscitation - TTM post Cardiac Arrest


German Medical Society - Delirium, Analgesia & Sedation Guideline


Annals of Intensive Care - Renal Replacement Therapy Guideline


ANZICS - Acute Pain Management Scientific Evidence

2015

Journal of Thrombosis and Haemostasis - Guideline on Antidotes for Direct Oral Anticoagulants


American Journal of Respiratory & Critical Care Medicine:     Physical Therapy for Respiratory Failure


NICE Guideline on Acute Heart Failure


NICE Guideline on IV Fluid Therapy in Young People


Journal of Trauma:  Western Trauma Guidelines


Critical Care Medicine:     SCCM Guideline on Ultrasound in Critical Care


Critical Care Medicine: SCCM Guideline on Organ Procurement


Critical Care Medicine:    SCCM Guideline on ICU Process & Structures


Lancet Infectious Diseases:     Body Surface Decolonization & UTIs


JAMA:     Transfusion in Anaemic Children with Elevated Lactate

Intensive Care Medicine:  Post-Resuscitation Care Guideline


American Heart Association:  ST-Elevation MI Guideline Update


American Heart Association:  Infective Endocarditis Guideline


2015 Cardiac Arrest Guidelines

  1. Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S315-S367
  2. Part 2: Evidence Evaluation and Management of Conflicts of Interest: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S368-S382
  3. Part 3: Ethical Issues: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S383-S396
  4. Part 4: Systems of Care and Continuous Quality Improvement: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S397-S413
  5. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S414-S435
  6. Part 6: Alternative Techniques and Ancillary Devices for Cardiopulmonary Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S436-S443
  7. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S444-S464
  8. Part 8: Post–Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S465-S482
  9. Part 9: Acute Coronary Syndromes: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S483-S500
  10. Part 10: Special Circumstances of Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S501-S518
  11. Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S519-S525
  12. Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
  13. Circulation 2015;132:S526-S542
  14. Part 13: Neonatal Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S543-S560
  15. Part 14: Education: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S561-S573

ESICM Hot Topics and New Trials

N Engl J Med:     Plasmalyte vs Saline

JAMA:     Paracetamol for Fever in Critically ill with Suspected Infection

Lancet:     Erythropoietin for Traumatic Brain Injury

N Engl J Med:     Hypothermia for Intracranial Hypertension in Traumatic Brain Injury


Am J Respir Crit Care Med:     Apnoeic Oxygenation

JAMA:     ICU Admission for Older Adults with Pneumonia


JAMA:     Do-Not-Resuscitate Status


 

NEJM:     CVC Insertion Site


Clinical Drug Investigation:  Esmolol for Sepsis


Lancet:     Methylprednisolone for Cardiopulmonary Bypass


Lancet:     Sigmoid Diverticulitis

Lancet:  CVC Line Infection Prevention


American Journal of Respiratory & Crit Care Med:     End-of-Life Care


Critical Care:     Laxative Therapy


Lancet:  Oxyenation Target in Bronchiolitis


Lancet:  Bubble CPAP for Paediatric Pneumonia


European Journal of Anesthesiology:     Pre-Oxygenation


Critical Care Medicine:     Vasopressors for Paediatric Septic Shock


Blue Journal:     Oxygenation Targets in Mechanically Ventilated Patients


Journal of Hepatology:     Plasma Exchange for Acute Liver Failure


Circulation:     ESC Guidelines on Pulmonary Hypertension | Pericardial Disease | Non-Persistent ST Elevation Coronary Syndromes | Infective Endocarditis

British Journal of Haematology:     Guideline on Admission for Haematology Cancer Patients


Journal of Trauma:  Early Surgery in Traumatic Brain Injury


Annals of Surgery:     Cryopreserved Packed Red Cells


NEJM / Lancet:     Idarucizumab for Dabigatran


Lancet:     Bioprosthetic Total Artificial Heart Heart


New England Journal of Medicine:     Hypothermia for Deceased Kidney Donor Graft

JAMA:     Bystander CPR


Blue Journal:     β-Lactam Infusion in Severe Sepsis


Perioperative Medicine:     Stroke Volume Variation


Critical Care Medicine:    Critical Care Interventions


Blue Journal:     Haemofiltration for Postcardiac Surgery Shock


Annals of Surgery:     Abdominal Vacuum Therapy post Laparotomy


Annals of Intensive Care:     Guideline on Cardiogenic Shock

Journal of Trauma:     Guideline on ED Thoracotomy


Critical Care Medicine:     Hypothermia for Paediatric Traumatic Brain Injury


Circulation:     Targeted Temperature Management


New England Journal of Medicine:     Out-of-Hospital CPR


New England Journal of Medicine:     Stroke Thrombolysis


New England Journal of Medicine:     Stroke Thrombectomy


Blue Journal:     Guideline on Requests for Inappropriate ICU Therapy


Blue Journal:     Guideline on Managing Conscientious Objections in ICM


Journal of Cardiac Failure:     Statement on Percutaneous Mechanical Circulatory Support

European Heart Journal:     Guideline on Acute Heart Failure


Stroke:     Guideline on Spontaneous Intracerebral Haemorrhage


Critical Care Medicine:     Talactoferrin for Sepsis


New England Journal of Medicine:     Intra-Abdominal Infection


American Thoracic Society Meeting 2015

New England Journal of Medicine:     Underfeeding

New England Journal of Medicine:     High Flow Nasal Oxygen

Journal of the American Medical Association:     High Flow Nasal Oxygen


Lancet:     Red Cell Transfusion in Upper GI Haemorrhage


 British Medical Journal:     MRSA Therapy


AJRCCM:     GUIDELINE - Conscientious Objections in ICU

Intensive Care Society:     Provision of Intensive Care Servces


Neurocritical Care:     Hemispheric Infarction


Neurocritical Care:     Devastating Brain Injury


Swiss Medical Weekly:     Ethics in ICU


New England Journal of Medicine:     Paediatric Therapeutic Hypothermia post Cardiac Arrest


New England Journal of Medicine:     Alcoholic Hepatitis


Intensive Care Medicine:     High Flow Nasal Cannulae Oxygen for Intubation


JAMA Internal Medicine:     Post ICU Rehabilitation


Intensive Care Medicine:     Polymyxin B Hemoperfusion


Chest:     Surfactant in ARDS


Intensive Care Medicine:    Early Rehabilitation


Critical Care Medicine:     Regional Citrate Anticoagulation for RRT


NEJM:     Age of Transfused Red Cells

NEJM:     ARDS Driving Pressure


JAMA:     Steroids for Community-Acquired Pneumonia


Acta Anaesthesiologica Scandinavica:     Fluid Resuscitation Guideline


NEJM:     Endovascular Stroke Therapy


Journal of Trauma:     EAST Guideline on Clearing the Cervical Spine in the Obtunded Patient


NEJM:     Stroke Neuroprotection


JAMA:     Trauma Transfusion Ratios

2014

Lancet Respiratory Medicine:     Perioperative Goal-Directed Oxygen Delivery


JAMA:     Hypoxaemic Ischaemic Encephalopathy


New England Journal of Medicine:     Endovascular Stroke Therapy


New England Journal of Medicine:     Traumatic Brain Injury


Stroke:     Statins for Subarachnoid Haemorrhage


Lancet:     Red Cell Transfusion Triggers


 Lancet:     IV Fluid Therapy


Intensive Care Medicine:     Therapeutic Hypothermia for Cardiac Arrest

Intensive Care Medicine:    Balanced Crystalloid Solutions


Cell Transplantation:     Spinal Cord Regeneration


Resuscitation:     Refractory Cardiac Arrest


Journal of Clinical Epidemiology:     Fragility Index


ESICM Congress Studies

New England Journal of Medicine:     ARISE Study

The ARISE study Investigators completed a large, international, multi-centre, parallel group, randomized controlled trial, comparing early goal-directed therapy (n=796) with usual care (n=804) in 1600 patients presenting to the emergency department with early septic shock, and found:

  1. groups were similar at baseline
  2. no significant differences in
    • 90 day mortality
      • EGDT 18.6% vs UC 18.8%
      • absolute risk difference with EGDT vs UC, −0.3%; 95% CI -4.1 to 3.6; P = 0.90
    • survival time
    • mortality
      • ICU
        • 10.9 vs 12.9; RR 0.85, 95% CI 0.64 to 1.13; P=0.28
      • hospital
        • 14.5 vs 15.7; RR 0.92, 95% CI 0.73 to 1.17; 0.53
      • day 28 
        • 14.8 vs 15.9; RR 0.93 95% CI 0.73 to 1.17; P=0.53
    • duration of organ support
    • length of
      • ICU stay
        • 2.8 vs 2.8 days; p=0.81
      • hospital stay
        • 8.2 vs 8.5 days; p=0.89
  3. EGDT was associated with
    • greater fluid administration in the first 6 hours
      • 1964±1415 ml vs 1713±1401 ml
    • increased liklihood of receiving
      • vasopressors
        • 66.6% vs. 57.8%; P<0.001
      • red-cell transfusions
        • 13.6% vs. 7.0%; P<0.001
      • dobutamine
        • 15.4% vs. 2.6%; P<0.001

New England Journal of Medicine:     TRISS Study

Holst and colleagues completed a Scandanavian multicenter, randomized, parallel-group trial in 1,005 patients (998 analyzed) with shock and a haemoglobin concentration ≤ 9g/dL, comparing a red cell transfusion trigger of ≤ 7g/dL with ≤ 9g/dL and found

  1. both groups were similar at baseline (≤ 7 g/d vs <9 g/dL)
    • SOFA median 10 vs 10; SAPS II median 51 vs 52
  2. the more restrictive transfusion trigger was associated with
    • less units of transfused red cells (median/IQR)
      • 1 (0-3) vs 4 (2-4)
  3. there was no statistically significant difference in (≤ 7 g/d vs <9 g/dL)
    • 90 day mortality
      • 43% vs 45%; RR 0.94; 95% CI 0.78 to 1.09; P = 0.44
    • ischemic events 
      • 7.2% vs 8%, RR 0.90, 95% CI 0.58 to 1.39, P=0.64
    • severe adverse reactions
      • 0 vs 0.2%, P≈1.0
    • requiring life support
      • at day 5: 64.4% vs 62.2%, RR 1.04, 95% 0.93 to 1.14; P=0.47
      • at day 14: 36.8% vs 36.8%, RR 0.99, 95% 0.81 to 1.19; P=0.95
      • at day 28: 7.2% vs 8.0%, RR 0.90, 95% CI 0.58 to 1.39; P=0.64
    • alive without vasopressor or inotropic therapy (mean % of days)
      • 73% vs 75%; P=0.93
    • alive without mechanical ventilation (mean % of days)
      • 65% vs 67%; P=0.49
    • alive without renal-replacement therapy (mean % of days)
      • 85% vs 83%; P=0.54
    • alive and out of the hospital (mean % of days)
      • 30% vs 31%; P=0.89

Unpublished:     EPO ACR 02

Cariou and colleagues completed a French, multi-centre, parallel group, randomised controlled trial, comparing early, high-dose erythropoietin (40,000 IU immediately after ROSC and 12 hourly for 48 hours, n=234) with placebo (n=242) in 476 patients with return of spontaneous circulation after out-of-hospital cardiac arrest, and found:

  1. groups were similar at baseline
  2. there was no difference in
    • neurological recovery
    • cerebral performance category 1 (best outcome) - 32% each
    • mortality (missed the figure)
    • duration mechanical ventilation
      • Epo 5.6 days vs placebo 6.0 days; p=0.61
  3. erythropoietin was associated with increased rates of
    • thrombosis
      • 12.4% vs 5.8%; p=0.01
    • acute stent thrombosis
      • 8 (3.4%) vs 1 (0.4%); p=0.02

New England Journal of Medicine:     CALORIES


Journal of the American Medical Association:     SDD vs SOD

ESICM Congress Studies

Journal of the American Medical Association:     VITdAL-ICU Study

Amrein and colleagues performed a randomized double-blind, placebo-controlled, single-center study in 492 critically ill patients with vitamin D deficiency (≤20 ng/mL), comparing vitamin D3 administration (PO or NG, 540,000 IU followed by monthly maintenance doses of 90,000 IU for 5 months; n=249) with placebo (n=243), and found:

  1. 475 patients were included in the final analysis (vit D n=237; placebo n=238)
  2. there were no significant differences in (median / IQR)
    • length of hospital stay
      • vit D: 20.1 days [11.1-33.3] vs placebo 19.3 days [11.1-34.9]; P = 0.98
    • mortality
      • hospital
        • vit D 28.3% [95% CI 22.6%-34.5%] vs placebo 35.3% [95% CI 29.2%-41.7%]; HR 0.81 [95% CI 0.58-1.11]; P=0.18
      • 6-month
        • vit D 35.0% [95% CI 29.0%-41.5%] vs placebo 42.9% [95% CI 36.5%-49.4%]; HR 0.78 [95% CI 0.58-1.04]; P = 0.09
  3. in the most severe vitamin D deficiency subgroup (n = 200)
    • no significant differences in
      • length of hospital stay
        • vit D 20.1 days (12.9-39.1) vs placebo 19.0 days (11.6-33.8)
      • 6-month mortality
        • vit D 34.7% [95% CI 25.4%-45.0%] vs placebo 50.0% [95% CI 39.9%-60.1%]; HR 0.60 [95% CI 0.39-0.93], P for interaction = 0.12
    • vit D was associated with significantly lower
      • hospital mortality
        • 28.6% [95% CI 19.9%-38.6%] vs 46.1% [95% CI 36.2%-56.2%]; HR 0.56 [95% CI 0.35-0.90], P for interaction = 0.04

Unpublished:     FLORALI Study

In 310 patients with acute hypoxaemic respiratory failure (PaO2 /FiO2 < 300 mmHg), standard oxygen therapy (n=94) was compared with high flow nasal oxygen (n=106) and with a combination of noninvasive ventilation (minimum 8 hours per day) and HFNO (n=110). The authors found:

  1. most patients had either community-acquired pneumonia (≈60%) or hospital-acquired pneumonia (≈10%)
  2. 77% had a PaO2 /FiO2 < 200 mmHg
  3. no difference in the requirement for invasive mechanical ventilation (1° outcome)
    • SOT 46.8 % vs HFNO 37.7% vs NIV/HFNO 50%; p=0.17
      • reduced requirement for invasive mechanical ventilation in those with a PaO2 /FiO2 < 200 mmHg (n=238)
      • SOT 52.7 % vs HFNO 34.9% vs NIV/HFNO 58%; p=0.009
  4. reduced 
    • ICU mortality
      • SOT 19.1 % vs HFNO 11.3 % vs NIV/HFNO 24.5 %; p<0.05
    • 90 day mortality
      • SOT 23.4 % vs HFNO 12.3 % vs NIV/HFNO 28.2 %; p<0.05


New England Journal of Medicine:  Ebola Virus Disease


Critical Care Medicine:  Fatty Acid Supplementation


Anesthesiology:  Erythropoietin & Acute Kidney Injury


European Heart Journal:  STEMI


European Heart Journal:  Guidelines


European Journal of Anaesthesiology:  Cardiovascular Assessment & Management for Non-Cardiac Surgery


Canadian Medical Association Journal:  Melatonin for Delirium


ESC Congress Studies

ESC Congress Studies


European Heart Journal:     ESC Guidelines


Infection Control and Hospital Epidemiology:     Healthcare-Associated Infection Guidelines


Journal of the American Medical Association:     Immunonutrition

Abstract:  van Zanten. High-Protein Enteral Nutrition Enriched With Immune-Modulating Nutrients vs Standard High-Protein Enteral Nutrition and Nosocomial Infections in the ICU. A Randomized Clinical Trial (MetaPlus study). JAMA 2014;312(5):514-524

British Medical Journal:     Albumin in Sepsis

Full Text:  Patel. Randomised trials of human albumin for adults with sepsis: systematic review and meta-analysis with trial sequential analysis of all-cause mortality. BMJ 2014;349:g4561


Annals of Internal Medicine:     Fluid Resuscitation in Sepsis

Abstract:  Rochwerg. Fluid Resuscitation in Sepsis: A Systematic Review and Network Meta-analysis. Ann Intern Med 2014;epublished July 22nd


Anesthesia & Analgesia:     Perioperative Goal-Directed Therapy

Pestaña and colleagues completed a pragmatic, multi-centre study in 142 patients undergoing general surgery, comparing a noninvasive cardiac output monitor guided hemodynamic protocol, including fluid administration and vasoactive drugs, with standard practice, and found:

  • the interventional protocol was associated with
    • an increase in the number of
      • colloid boluses (2.4 ± 1.8 vs 1.3 ± 1.4; P < 0.001)
      • packed red blood cell units (0.6 ± 1.3 vs 0.2 ± 0.6; P = 0.019)
      • dobutamine use (p < 0.001)
        • intraoperatively: 25% vs 1.4%
        • postoperatively: 19.4% vs 0%
    • reduced
      • reoperations (5.6% vs 15.7%; P = 0.049)
    • no statistically significant differences in
      • overall fluid administration
      • overall complications (40% vs 41%)
        • relative risk 0.99; 95% CI 0.67 to 1.44; P = 0.397
      • length of stay (11.5 [8-15] vs 10.5 [8-16]; P = 0.874)
      • time to first flatus (62 hours [40-76] vs 72 hours [48-96]; P = 0.180)
      • wound infection (7 vs 14; P = 0.085)
      • anastomotic leaks (2 vs 5; P = 0.23)
      • mortality (4.2% vs 5.7%; P = 0.67)

Conclusion: The use of a perioperative goal-directed haemodynamic protocol in major abdominal surgery was not associated with reductions in overall complications, length of hospital stay, or mortality.

Abstract:  Pestaña. Perioperative Goal-Directed Hemodynamic Optimization Using Noninvasive Cardiac Output Monitoring in Major Abdominal Surgery: A Prospective, Randomized, Multicenter, Pragmatic Trial: POEMAS Study (PeriOperative goal-directed thErapy in Major Abdominal Surgery). Anesth Analg 2014;epublished July 9th


JAMA: Red Cell Management in Traumatic Brain Injury

Robertson and colleagues, using a factorial design, compared intravenous erythropoietin (500 IU/kg per dose, n=102) with saline (n=98), plus red cell transfusion at a threshold of either 7 g/dL (n=99) or 10 g/dL (n=101), on Glasgow Outcome Scale score at 6 months postinjury, in 200 patients within 6 hours of closed head injury and unable to follow commands. Erythropoietin or placebo was initially dosed daily for 3 days and then weekly for 2  weeks (group 1, n = 74). The protocol was subsequently amended to (I think, it's remarkably poorly described) a single erythropoietin dose, possibly followed by further doses at 1 and 2 weeks if the patient was still in ICU (n=126). The authors found:

  1. no interaction between erythropoietin and hemoglobin transfusion threshold
  2. no statistical improvement on favorable outcome rate (dichotomized as favorable (good recovery and moderate disability) or unfavorable (severe disability, vegetative, or dead))
    • between placebo and erythropoietin
      • placebo: 38.2%; 95% CI 28.1% to 49.1%
      • erythropoietin
        • first dosing regimen:  48.6%; 95% CI 31.4% to 66.0%, P =0.13
        • second dosing regimen: 29.8%; 95% CI 18.4% to 43.4%; P  < 0.001
    • between haemoglobin transfusion thresholds
      • 7 g/dL:  42.5%
      • 10 g/dL: 33.0%
        • 95% CI for the difference −0.06 to 0.25, P = 0.28
  3. the 10 g/dL transfusion threshold was associated with a
    • higher incidence of thromboembolic events (21.8% vs 8.1%; odds ratio 0.32, 95% CI 0.12 to 0.79; P = 0.009)

Conclusion: In a two centre, factorial, randomized controlled trial, in patients with closed head injury, neither erythropoietin administration nor red blood cell transfusion maintaining a haemoglobin level of ≥10 g/dL versus ≥ 7 g/dL, were statistically associated with improved outcomes, with the higher haemoglobin level associated with more thrombotic events.

Abstract:  Robertson. Effect of Erythropoietin and Transfusion Threshold on Neurological Recovery After Traumatic Brain Injury:  A Randomized Clinical Trial. JAMA 2014;312(1):36 

New Engl J Med:  PEEP in General Anaesthesia

The PROVE Network Investigators compared high PEEP (median 12 cmH20) plus recruitment maneuvres (n=447) with low PEEP (median 2 cmH20) without recruitment manuevres (n=453) in 900 patients undergoing open abdominal surgery, ventilated with 8 ml/kg and at high risk for postoperative pulmonary complications, and found no difference in post-operative complications (high PEEP 40% vs low PEEP 39%, RR1·01; 95% CI 0·86 to1·20; p=0·86), but increased hypotension with higher PEEP, requiring more vasopressor therapy.

Abstract:  The PROVE Network Investigators. High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial. Lancet 2014;epubished May 30th


New Engl J Med:  Long-Acting Gram Positive Antibacterial Therapy

Boucher et al pooled two identically designed, industry funded, noninferiority trials, and found once-weekly IV dalbavancin (a long-acting lipoglycopeptide antibiotic active against gram positive bacteria, n=659) was non-inferior to twice-daily IV vancomycin followed by oral linezolid (n=653) for the treatment of acute bacterial skin and skin-structure infection, with no difference in early clinical response indicating treatment success (79.7% vs 79.8%, respectively; weighted difference, −0.1%; 95% CI−4.5 to 4.2%), or side effects. Individual study analyses yielded similar results, as did pooled analysis of clinical status at end of therapy.

Abstract:  Boucher. Once-Weekly Dalbavancin versus Daily Conventional Therapy for Skin Infection (DISCOVER 1 & 2 studies).  N Engl J Med 2014;370:2169-2179


New Engl J Med:  Long-Acting Gram Positive Antibacterial Therapy

Corey and colleagues found a single dose of IV oritavancin (a long-acting lipoglycopeptide with bactericidal activity against gram-positive bacteria, n=475) was non-inferior to a regimen of twice daily IV vancomycin for 7 to 10 days (n=479) in 954 adults with acute bacterial skin and skin-structure infections, for three main outcomes:

  • spreading or reduction in lesion size, absence of fever, and no need for administration of a rescue antibiotic after 48 to 72 hours (82.3% vs 78.9%, respectively;  95% CI for difference −1.6 to 8.4%)
  • clinical cure 7 to 14 days after the end of treatment, as determined by a study investigator (79.6% vs 80.0%, 95% CI for difference −5.5 to 4.7%)
  • reduction in lesion size of 20% or more after 48 to 72 hours (86.9% vs 82.9%, 95% CI for difference −0.5 to 8.6%)

Abstract:  Corey. Single-Dose Oritavancin in the Treatment of Acute Bacterial Skin Infections (SOLO I study). N Engl J Med 2014;370:2180-2190 

Brar and colleagues completed a randomised, parallel-group, comparator-controlled, single-blind phase 3 trial, comparing a left ventricular end-diastolic pressure-guided fluid administration protocol with a standard fluid administration protocol in 396 adults undergoing cardiac catheterisation with an estimated glomerular filtration rate of 60 mL/min/1·73 m2 or less, and one or more of several risk factors, and found:

  1. the new fluid protocol was associated with
    • a reduced incidence of contrast-induced acute kidney injury 
    • 6·7% vs. 16·3%; RR 0·41, 95% CI 0·22 to 0·79; p=0·005
  2. hydration treatment was terminated prematurely because of shortness of breath in three patients in each group

Abstract:  Brar. Haemodynamic-guided fluid administration for the prevention of contrast-induced acute kidney injury: the POSEIDON randomised controlled trial. Lancet 2014;383(9931):1814-1823


Kirkpatrick and colleagues completed an international, multicentre, randomised, double-blind trial, comparing simvastatin 40 mg (n=391) with placebo (n=412) once a day for up to 21 days, in 803 adults within 96 hours of  subarachnoid haemorrhage, and found:

  1. no between-group difference in
    • incidence of favourable modified Rankin Scale (mRS) score, obtained by questionnaire at 6 months (1° outcome)
      • simvastatin 271 vs placebo 289
      • OR 0·97, 95% CI 0·75 to 1·25; p=0·803
    • mortality at 6 months
      • simvastatin 10% (n=37) vs placebo 9% (n=35); log-rank p=0·592
    • serious adverse events
      • 18% vs 18%

Abstract:  Kirkpatrick. Simvastatin in aneurysmal subarachnoid haemorrhage (STASH): a multicentre randomised phase 3 trial. Lancet Neurology 2014;epublished May 16th


Pearse and colleagues completed a pragmatic, multicenter, randomized, observer-blinded trial of 734 high-risk UK patients aged 50 years or older, undergoing major gastrointestinal surgery, comparing the effectiveness of a perioperative, cardiac output–guided hemodynamic therapy algorithm consisting of IV fluid and dopexamine infusion during and 6 hours following surgery (n=368) with standard care (n=366), as well as a systematic review and meta analysis evaluating perioperative goal directed care, and found:

  1. in the randomized controlled trial
    • groups were similar at baseline
    • nonadherence was < 10% in each group
    • the hemodynamic therapy algorithm was associated with
      • a trend towards a reduction in composite outcome of 30-day complications and mortality (1° outcome)
        • 36.6% vs 43.4% (RR 0.84, 95% CI 0.71 to 1.01; absolute risk reduction 6.8%, 95% CI −0.3% to 13.9%; P = 0.07)
      • no significant difference between groups for any secondary outcomes.
        • morbidity on day 7
          • 66.2% vs 67.9%; RR 0.97, 95% CI 0.87 to 1.09; P=0.72
        • infectious complications at day 30
          • 23.8% vs 29.7%; RR 0.80, 95% CI 0.63 to 1.02; P=0.08
        • critical care–free days at day 30