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Critical Care Reviews Newsletter

February 3rd 2013



Welcome to the 61st Critical Care Reviews Newsletter, bringing you the best critical care research published in the past week, plus a wide range of free full text review articles and guidelines from over 300 clinical and scientific journals.

This has been a quiet week for research publications, with just a few articles of major significance. A systematic review and meta analysis suggests intravenous selenium supplementation is associated with a large reduction in mortality in critically ill septic patients; a small pilot study suggests compliance guided PEEP, rather than FiO2 guided PEEP, might be associated with reduced organ dysfunction; no dose or type of macronutrient in parenteral nutrition was found to be associated with improved outcome; and lastly, in an autopsy study, the Berlin Definition of ARDS had reasonable correlation with the pathological findings of ARDS.

Following on from your suggestions from the end of year survey last month, I have made three new additions to the site. Firstly, you asked for podcasts and vodcasts - I have added about 1000 hours of material, including vodcasts of presentations from the latest ESICM and Brussels ICM meetings, as well as podcasts from SCCM, Chest and several other journals. These are probably the best additions to the site yet - they're free, contemporary and from the leading researchers in their fields. Secondly, as requested, I've added the latest review articles made free available from the major critical care journals. These articles are usually between 6 and 12 months old, and come from AJRCCM, Chest, Critical Care, Anesthesiology, Anesthesia & Analgesia, BJA, CEACCP, Critical Care & Resuscitation and Anaesthesia. I'll add these monthly in future. Thirdly, as you may have noticed, I've added a one line conclusion to each of the abbreviated abstracts in the research section of the newsletter. I'll keep working on your suggestions and am preparing an archive of the newsletters, although it will be a few weeks before it's ready.

This week there are 38 review articles which have been published in the past week or so, in addition to the 33 recently made open access articles from the major critical care journals. Together, it's roughly equivalent to a new large textbook.

The topic for This Week's Papers is antiplatelet and anticoagulant drugs, starting with a paper on the new oral anticoagulants in tomorrow's Paper of the Day.



American Journal of Respiratory and Critical Care Medicine:    Berlin Definition of ARDS

Thille et al performed a retrospective study of all autopsies in their unit over a 20 year period (n=712), to evaluate the accuracy of the new Berlin Definition of ARDS for identifying the pathological findings of ARDS, diffuse alveolar damage. 356 patients had clinical criteria for ARDS at the time of death, and were classified as mild (N=49, 14%), moderate (N=141, 40%) and severe (N=166, 46%). Sensitivity was 89% and specificity 63% to identify ARDS. Diffuse alveolar damage was found in 159 of 356 (45%) patients with clinical criteria for ARDS (in 12%, 40% and 58% of mild, moderate and severe ARDS patients, respectively). Diffuse alveolar damage was more frequent in patients who met clinical criteria for ARDS during more than 72h and was found in 69% of severe ARDS ≥ 72h. Conclusion: In a retrospective study over a 20 year period, The Berlin definition for ARDS correlated reasonably well with the pathological findings of ARDS.

Abstract:  Thille. Comparison of the Berlin Definition for Acute Respiratory Distress Syndrome with Autopsy. Am J Respir Crit Care Med 2013;epublished January 31st  


American Journal of Respiratory and Critical Care Medicine:    Nutrition

In a secondary analyses of the randomized controlled EPaNIC trial (n = 4,640), Casaer and colleagues sought to determine whether the deleterious effects of early parenteral relate to severity of illness or to the dose or type of macronutrients. In no subgroup defined by type or severity of illness was a beneficial effect of early PN observed. The lowest dose of macronutrients was associated with the fastest recovery and any higher dose, administered parenterally or enterally, was associated with progressively more delayed recovery. The amount of proteins/amino acids rather than of glucose appeared to explain delayed recovery with early feeding. Conclusion: In a two-centre study comparing early or late parenteral supplementation of insufficient enteral nutrition, combined parenteral/enteral nutrition delayed recovery irrespective of severity of critical illness. No dose or type of macronutrient was found to be associated with improved outcome.

Abstract:  Casaer. Role of Disease and Macronutrient Dose in the Randomized Controlled EPaNIC Trial. Am J Respir Crit Care Med 2013;187:247-255


Respiratory Care:     PEEP

Pintado et al completed a randomized controlled study in 70 patients with ARDS receiving protective ventilation and compared compliance-guided PEEP with FiO2-guided PEEP. Multi-organ dysfunction-free days (median 6 vs. 20, p=0.02), respiratory failure-free days (median 7 vs. 14, p=0.03) and hemodynamic failure-free days (median 16 vs. 22, p=0.04) at 28 days were significantly lower in patients with compliance-guided PEEP group. There was no difference in PaO2/FiO2 ratio during the first 14 days or 28-day mortality (compliance guided group: 20.6% vs. FiO2 guided group 38.9%, p=0.12). Conclusion:  In a small pilot study, compliance guided PEEP was associated with reduced organ dysfunction.

Full Text:  Pintado. Individualized positive end-expiratory pressure setting in patients with acute respiratory distress syndrome. a randomized controlled pilot. Respir Care 2013;epublsihed January 29th


PLoS One:     Selenium in Sepsis

To assess the efficacy of parenteral selenium supplementation in critically ill septic patients, Huang et al conducted a systematic review and meta-analysis, identifying 12 studies, 9 of which were included in the meta analysis (n=965). Selenium significantly reduced all-cause mortality (selenium group: n=148, 30.7% versus control group n=180, 37.3%; relative risk 0.83, 95% CI 0.70–0.99, p = 0.04, I2 = 0%). Subgroup analyses demonstrated that the administration schedule employing longer duration (RR 0.77, 95% CI 0.63–0.94, p = 0.01, I2 = 0%), loading boluses (RR 0.73, 95% CI 0.58–0.94, p = 0.01, I2 = 0%) or high-dose selenium treatment (RR 0.77, 95% CI 0.61–0.99, p = 0.04, I2 = 0%) might be associated with a lower mortality risk. There was no evidence of adverse events. Conclusion: In a systematic review and meta analysis totalling 965 patients, intravenous selenium supplementation was associated with a 17% relative reduction in mortality in critically ill septic patients.

Full Text:  Huang. Effect of Parenteral Selenium Supplementation in Critically Ill Patients: A Systematic Review and Meta-Analysis. PLoS ONE 2013;8(1):e54431


New Review Articles - Clinical


Trends in Anaesthesia and Critical Care:     Cerebral Haemorrhage

Trends in Anaesthesia and Critical Care



Cleveland Clinic Journal of Medicine:      Cardiac Tamponade

Journal of the American College of Cardiology:     Paravalvular Leak



Respiratory Care

Respirology:     Stem Cell Therapy in Lung Disease

Perfusion:     ECMO

Trends in Anaesthesia and Critical Care

Medical Gas Research:     Xenon



Surgical Infections:     Open Abdomen


Trends in Anaesthesia and Critical Care



Trends in Anaesthesia and Critical Care:    Temperature Monitoring



Blood Transfusion:     Red Cell Transfusion

Blood Transfusion:     Molecular Virology in Transfusion Medicine



Shock:     Sepsis Biomarkers

Cleveland Clinic Journal of Medicine:     Clostridium Difficile

PLoS Pathogen:     Upper Respiratory Tract Infections

PLoS Pathogen:     Invasive Candidiasis

Trends in Anaesthesia and Critical Care



Shock:     Tranexamic Acid in Trauma



Trends in Anaesthesia and Critical Care:     Local Anaesthetic Toxicity



Bomedical Materials:     Bioengineering

Blood Transfusion:     How to Write a Scientific Paper


Ethics in Research

Perspectives in Clinical Research:     Ethics in Research


This Week's Review Articles - Basic Science

Antioxidants & Redox Signaling

Open Access Journal of Clinical Trials:     Bias


Recently Made Open Access Review Articles from Major Journals

American Journal of Respiratory and Critical Care Medicine



Critical Care


Critical Care and Resuscitation




Anesthesia & Analgesia 


Continuing Education in Anaesthesia, Critical Care & Pain




I hope you find these brief summaries and links useful.

Until next week