Critical Care Reviews Newsletter
August 11th 2013
Welcome
Hello
Welcome to the 88th 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 week's research studies include interventional investigations into intra-aortic balloon pump use in cardiac surgery, sepsis biomarker guided therapy, extubation in traumatic brain injury and immunoglobulin therapy in severe influenza; meta analyses compare dexmedetomidine with propofol for ICU sedation and evaluate the efficacy of artificial liver support systems; while observational studies examine the effect of anaesthesia and surgery on the development of dementia, the perioperative effect of unexpected quantitative platelet disorders, the utility of adrenomedullin for sepsis prediction, the association of enterocyte injury with outcomes, the benefit of correcting haemostatic disorders pre-thoracocentesis and the association of blood transfusions with mortality in cardiac surgery.
This week's guidelines focus on mechanical circulatory support and theatre safety. There are editorials on septic shock and publishing, as well as commentaries on hydroxyethyl starches and clinical reasoning.
Amongst the clinical review articles are papers on intracerebral haemorrhage, delirium, status epilepticus, heart failure biomarkers, extracorporeal CO2 removal, ventilator-associated pneumonia, renal failure, massive haemorrhage, MERS CoV, haemostasis, resuscitation fluids, anaphylaxis, snakebite envenomation, pre-eclampsia and intra-operative management of the critically ill patient. There is a basic science article on bioengineering, a non-clinical paper on preparing an abstract for a scientific meeting, and an intriguing science paper describing how worms glow immediately before dying. There are also the latest papers made open access from the major critical care journals.
If you are in need of CPD points, there is a new CPD quiz, on airway pressure release ventilation.
The topic for This Week's Papers is critical care gases, starting with a paper on nitric oxide in tomorrow's Paper of the Day.
If you only read one of this week's 92 articles, try the commentary by Chappel on hydroxyethyl starches in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.
Research
Interventional Trials
Critical Care Medicine: Coronary Artery Bypass Grafting
In a single-center prospective randomized controlled trial, comparing preincision intra-aortic balloon pump with no intervention in 110 subjects undergoing coronary operations, with a poor left ventricular ejection fraction (< 35%) and no hemodynamic instability, Rannucci and colleagues demonstrated, with IABP therapy, no improvement in the primary outcome of major postoperative morbidity rate (IABP 40% versus control 31%; odds ratio 1.49, 95% CI 0.68-3.33) and no differences in cardiac index either pre- or post-operatively. Interestingly, although systemic mean arterial blood pressure was lower in the IABP treated group on arrival in ICU (80.1 +/- 15.1 mmHg versus 89.2 +/- 17.9 mmHg; p=0.01), fewer IABP treated patients required a dopamine infusion (24% versus 44%; p=0.043).
Critical Care Medicine: Sepsis Biomarker Guided Therapy
In a dual centre open clinical trial, 94 patients with severe sepsis or septic shock were randomized to procalcitonin (n=49) or C-reactive protein (n=45) guided antibiotic therapy. There was no difference in the median duration of antibiotic therapy for the first episode of infection (procalcitonin 7.0 days (Q1-Q3, 6.0-8.5) versus CRP 6.0 days (Q1-Q3, 5.0-7.0), p = 0.13; hazard ratio 1.206, 95% CI, 0.774-1.3, p = 0.13). There were 21 deaths in each group (p = 0.836).
American Journal of Respiratory and Critical Care Medicine: Extubation in Traumatic Brain Injury
Chest: Influenza A (H1N1)
In a multicenter, prospective, double-blind, randomized controlled trial, Hung et al demonstrated in 35 patients with severe A(H1N1) influenza being treated with standard antiviral treatment and requiring ventilatory support, hyperimmune IV immunoglobulin (n=17), sourced from patients convalescing from 2009 pandemic influenza A(H1N1), in comparison with normal IV immunoglobulin (n=18), was associated with reduced respiratory viral load at days 5 (p=0.04) and 7 (p=0.02), as well as reduced mortality in the subgroup who received treatment within 5 days of symptom onset (OR 0.14; 95% CI 0.02-0.92; p=0.04)
Meta Analysis
Journal of Surgical Research: Dexmedetomidine versus Propofol
Pooling 10 randomized controlled trials (n = 1,202), dexmedetomidine, in comparison with propofol, was associated with decreased ICU length of stay (five studies, n=655; mean difference, −0.81 d; 95% CI −1.48 to −0.15), decreased incidence of delirium (three studies, n=658; RR 0.40; 95% CI 0.22–0.74), with no difference in either duration of mechanical ventilation (five studies, n=895; mean difference 0.53 h; 95% CI −2.66 to 3.72) or ICU mortality (five studies, n=267; RR 0.83; 95% CI 0.32–2.12). Dexmedetomidine was associated with an increased risk of hypertension (three studies, n=846 patients; RR 1.56; 95% CI 1.11–2.20).
Experimental and Therapeutic Medicine: Artificial Liver Support
In 19 randomized controlled trials, including 566 patients with acute liver failure (ALF) and 371 patients with acute-on-chronic liver failure (AOCLF), artificial liver support systems were associated with reduced mortality and reduced bridging to liver transplantation in patients with AOCLF, but not in patients with ALF. Bioartificial liver support systems were correlated with decreased mortality in patients with AHF. Artificial liver support systems were associated with reductions in total bilirubin in both liver failure groups, with neither bioartificial or artificial systems affecting the incidence of hepatic encephalopathy or bleeding.
Observational Studies
British Journal of Psychiatry: Post-Operative Dementia
In a retrospective study utilising data from the Taiwan National Health Insurance Research database, comparing a cohort of 24,901 patients aged 50 years and older who underwent anaesthesia and surgery with a control group of 110,972 randomly selected age- and sex-matched patients, in the 2- to 7-year follow-up period, more anesthetized patients were diagnosed with dementia (2.65% versus 1.39%; hazard ratio 1.99; 95% CI 1.81 - 2.17). This group also had a reduced mean interval to dementia diagnosis.
Abstract: Chen. Risk of dementia after anaesthesia and surgery. Br J Psychiatry 2013;epublished July 25th
Anesthesiology: Perioperative Thrombocytopaenia
In a retrospective study utilising data from the American College of Surgeons National Surgical Quality Improvement database, Glance and colleagues showed in 316,644 patients having noncardiac surgery who did not have clinical indications for preoperative coagulation testing, thrombocytopenia or thrombocytosis occurred in 1 in 14 patients. The degree of thrombocytopaenia was relevant, with patients with mild thrombocytopenia (101-150 × 103/mm3), moderate-to-severe thrombocytopenia (<100 × 103/mm3), and thrombocytosis (≥450 × 103/mm3) being more likely to be transfused than normocytopaenic patients (7.3%, 11.8%, 8.9%, 3.1%, respectively - I think, it's poorly described) and had significantly higher 30-day mortality rates (1.5%, 2.6%, 0.9%, 0.5%, respectively). Mild thrombocytopenia (adjusted odds ratio 1.31, 95% CI 1.11-1.56) and moderate-to-severe thrombocytopenia (AOR 1.93, 95% CI, 1.43-2.61) were associated with increased risk of 30-day mortality.
BioMed Research International: Sepsis Prediction
In a prospective observational study assessing adrenomedullin as a predictor for the development of severe sepsis and septic shock within 3 days in 372 emergency department patients, adrenomedullin levels were higher in those who developed sepsis (41.63 ± 6.55 versus 31.31 ± 7.71 ng/L, p<0.001; AUC 0.847) and was the only independent predictor of outcome. With a cutoff value of 41.24 ng/L, the sensitivity was 67.6%, the specificity was 90.0%, the positive predictive value was 61.5%, the negative predictive value was 92.2%, the positive likelihood ratio was 6.78, and the negative likelihood ratio was 0.36.
Critical Care Medicine: Enterocyte Damage
In a single centre, prospective observational study in 103 critically ill patients, at ICU admission increased intestinal fatty acid-binding protein (a marker of enterocyte damage) was associated with catecholamine support, higher lactate concentration, higher SOFA score, and higher INR (all p ≤ 0.001); while a reduced plasma citrulline (a marker of functional enterocyte mass) ≤ 10 μmol/L was associated with higher intra-abdominal pressure, higher plasma CRP, and more frequent antibiotic use (all p ≤ 0.005). At ICU admission, SOFA score >12, plasma citrulline <12.2 μmol/L, and plasma intestinal fatty acid-binding protein concentration >355 pg/mL were all independently associated with 28-day mortality (odds ratio 4.39, 95% CI 1.48-13.03; odds ratio 5.17, 95% CI 1.59-16.86; and odds ratio 4.46, 95% CI 1.35-14.74, respectively).
Chest: Procedures during Coagulopathy
In 1,009 ultrasound-guided thoracenteses, consisting of 706 procedures in 538 patients with abnormal preprocedural coagulation parameters (INR > 1.6, serum platelet values < 50 × 109/L, or both) which were not corrected before the thoracentesis, and 303 procedures in 235 patients who received a transfusion of platelets or fresh frozen plasma prior to thoracentesis, there were no complications in those without preprocedure therapy (0 of 706 or 0.0%; 95% CI 0%-0.68%) and four in those who did receive haemostatic therapy (four of 303 or 1.32%; 95% CI 0.51%-3.36%).
Transfusion: Blood Transfusion
In a propensity-matched cohort study, comparing 857 cardiac surgical patients who received a blood transfusion with 857 matched cardiac surgical patients who were not transfused, blood transfusion was associated with higher operative mortality (2.3% versus 0.4%, p < 0.0001), as well as decreased survival at 5 years (82.0% versus 89.3%, p < 0.007), although not during the first 2 postoperative years. Patients receiving cryoprecipitate havd twice the mortality risk (adjusted hazard ratio 2.106, p = 0.002).
Guideline
Journal of Heart and Lung Transplantation: Mechanical Circulatory Support
Circulation: Theatre Safety
Editorial
Intensive Care Medicine: Septic Shock
Indian Journal of Medical Research: Publishing
Commentary
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine: Hydroxyethyl Starches
Academic Medicine: Clinical Reasoning
Review - Clinical
Neurological
Journal of Neurosurgical Anesthesiology: Intracerebral Haemorrhage
Revista Brasileira de Terapia Intensiva: Delirium
- Faria. Delirium in intensive care: an under-diagnosed reality. Rev bras ter intensiva 2013;25(2):137-147
- Carvalho. Delirium rating scales in critically ill patients: a systematic literature review. Rev bras ter intensiva 2013;25(2):148-154
- Shinotsuka. Perceptions and practices regarding delirium, sedation and analgesia in critically ill patients: a narrative review. Rev bras ter intensiva 2013;25(2):155-161
Frontiers in Neurology: Status Epliepticus
Circulatory
Journal of Investigative Medicine: Heart Failure Biomarkers
Research Reports in Clinical Cardiology: Trancatheter Aortic Valve Replacement
Heart Failure Reviews: Nitric Oxide
Respiratory
Current Respiratory Care Reports: Extracorporeal CO2 Removal
Current Respiratory Care Reports: Pleural Conditions
Revista Brasileira de Terapia Intensiva: Ventilator-Associated Pneumonia
Medical Gas Research: Helium
Renal
Lancet: Renal Failure
- Remuzzi. Kidney failure: aims for the next 10 years and barriers to success. Lancet 2013;382(9889):353-62 (free registration required)
Haematological
Anesthesiology Clinics: Massive Haemorrhage
Sepsis
Science China Life Science: MERS CoV
Frontiers in Immunology: Secretory IgA
Indian Journal of Medical Research: Indian Infectious Diseases
Trauma
Anesthesiology Clinics: Haemostasis
Anesthesiology Clinics: Resuscitation Fluids
Immunology
Allergy: Anaphylaxis
Envenomation
Indian Journal of Medical Research: Venomics
Obstetrics
Indian Journal of Medical Research: Pre-Eclampsia
Miscellaneous
Anesthesiology Clinics: Intraoperative Management of the Critically Ill
Recently Made Open Access Articles from Major Journals
American Journal of Respiratory and Critical Care Medicine
- Selman. Hypersensitivity Pneumonitis. Am J Respir Crit Care Med 2012;186(4):314-324
- Bandschapp. The Path of a Pulmonary Artery Catheter Visualized through a Beating Human Heart. Am J Respir Crit Care Med 2012;186(3):385
- Peters-Golden. The Case for Increased Funding for Research in Pulmonary and Critical Care. Am J Respir Crit Care Med 2012;186(3):213-215
- Frankel. The Pulmonary Vasculitides. Am J Respir Crit Care Med 2012;186(3):216-224
Chest
- Tucker. Aid in Dying: Guidance for an Emerging End-of-Life Practice. Chest 2012;142(1):218-224
- Lacasse. Recent Advances in Hypersensitivity Pneumonitis. Chest 2012;142(1):208-217
- Shorr. Antibiotics in the Critically Ill: The Bug, Drug, Host Triad. Chest 2012;142(1):8-10
Critical Care
- Flynn & Shehabi. Pro/con debate: Is etomidate safe in hemodynamically unstable critically ill patients? Critical Care 2012;16:227
- Kempker. Vitamin D in sepsis: from basic science to clinical impact. Critical Care 2012;16:316
- Beynon. Traumatic brain injury in patients receiving antiplatelet medication. Critical Care 2012;16:228
- Patel. Erythropoietin and its derivatives as therapies in critical care. Critical Care 2012;16:229
- Chawla. Permissive hypofiltration. Critical Care 2012;16:317
- Prowle. Volume of fluid resuscitation and the incidence of acute kidney injury - a systematic review. Critical Care 2012;16:230
- Heming. Acetazolamide: a second wind for a respiratory stimulant in the intensive care unit? Critical Care 2012;16:318
Anaesthesiology
- Young. Pain-associated Respiratory Failure in Chest Trauma. Anesthesiology 2013;118(3):701-708
- Schulz. Situation Awareness in Anesthesia: Concept and Research. Anesthesiology 2013;118(3):729-742
- Bagchi. Mashed Potatoes and Maize: Are the Starches Safe? Anesthesiology 2013;118(2):244-247
Anesthesia & Analgesia
- Trudell. Teaching an Old GABA Receptor New Tricks. Anesth Analg 2012;115:270-273
- Schubert. Status of the Anesthesia Workforce in 2011: Evolution During the Last Decade and Future Outlook. Anesth Analg 2012;115:407-427
- Sessler. Departmental and Institutional Strategies for Reducing Fraud in Clinical Research. Anesth Analg 2012;115:474-476
Anaesthesia
- Farrow. Size matters: choosing the right tracheal tube. Anaesthesia 2012;67:815–819
- Weiniger. Extended release formulations for local anaesthetic agents. Anaesthesia 2012;67:906–916
- Farrell. Time for change: traditional audit or continuous improvement?. Anaesthesia 2012;67:699–702
- Gilpin. Medical simulation in ‘my world’. Anaesthesia 2012;67:702–705
- Cook. Non-Luer connectors: are we nearly there yet?. Anaesthesia 2012;67:784–792
British Journal of Anaesthesia
- Ranucci. Supplementation of fibrinogen in acquired bleeding disorders: experience, evidence, guidelines, and licences. Br J Anaesth 2012;109(2):135-137
- Notkina. In vivo microdialysis in pharmacological studies of antibacterial agents in the brain. Br J Anaesth 2012;109(2):155-160
- Hermanides. Failed epidural: causes and management. Br J Anaesth 2012;109(2):144-154
- Rutherford. Non-technical skills of anaesthetic assistants in the perioperative period: a literature review. Br J Anaesth 2012;109(1):27-31
- McIndoe. Modern anaesthesia training: is it good enough? Br J Anaesth 2012;109(1):16-20
- Møller. How to map the evidence: the development of the systematic review in anaesthesia. Br J Anaesth 2012;109(1):32-34
- Carlisle. Assessing fitness, predicting outcome, and the missing axis. Br J Anaesth 2012;109(1):35-39
- Dennehy. Consent, assent, and the importance of risk stratification. Br J Anaesth 2012;109(1):40-46
- Walker. Surgical safety checklists: do they improve outcomes? Br J Anaesth 2012;109(1):47-54
- Shander. Patient blood management in Europe. Br J Anaesth 2012;109(1):55-68
- Doherty. Intraoperative fluids: how much is too much? Br J Anaesth 2012;109(1):69-79
- Benn. Using quality indicators in anaesthesia: feeding back data to improve care. Br J Anaesth 2012;109(1):80-91
- Murphy. Measuring and recording outcome. Br J Anaesth 2012;109(1):92-98
- Adams. Quality and outcomes in anaesthesia: lessons from litigation. Br J Anaesth 2012;109(1):110-122
- Wildsmith. Continuous thoracic epidural block for surgery: gold standard or debased currency? Br J Anaesth 2012;109(1):9-12
- Smith. Guidelines in anaesthesia: support or constraint? Br J Anaesth 2012;109(1):1-4
Continuing Education in Anaesthesia, Critical Care and Pain
- Blayney. Procedural sedation for adult patients: an overview. Contin Educ Anaesth Crit Care Pain 2012;12(4):176-180
- Roberts. Pre-hospital trauma care and aero-medical transfer: a military perspective. Contin Educ Anaesth Crit Care Pain 2012;12(4):186-189
- Wilson. Ultrasound in critical care. Contin Educ Anaesth Crit Care Pain 2012;12(4):190-194
- Parikh. Cations: potassium, calcium, and magnesium. Contin Educ Anaesth Crit Care Pain 2012;12(4):195-198
- Horner. Care bundles in intensive care. Contin Educ Anaesth Crit Care Pain 2012;12(4):199-202
- van Boxel. Cellular oxygen utilization in health and sepsis. Contin Educ Anaesth Crit Care Pain 2012;12(4):207-212
Review - Basic Science
Scientist: Bioengineering
Review - Non-Clinical
Revista Brasileira de Terapia Intensiva: Preparing an Abstract
General Interest
PLoS Biology: Death Fluorescence
I hope you find these brief summaries and links useful.
Until next week
Rob