Newsletter 96 / October 6th 2013
Welcome
Hello
Welcome to the 96th 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. It's a big week for Critical Care Reviews, with the opening of registration for the 2014 Meeting. In keeping with this, the newsletter contains a massive 86 free, full text articles, some new studies of importance, and a warning from the FDA regarding tigecycline.
After a couple of quiet weeks, there has been some major research publications in the past seven days, including a large interventional infection control study, an investigation into medium term cognitive outcomes post critical illness and temporal improvements in out-of-hospital cardiac arrest outcomes in a large Danish database study. Other studies include meta analyses addressing ruptured abdominal aortic aneurysm repair and mono- or dual-antiplatelet therapy for both CABG and stroke, as well as observational studies examining fresh frozen plasma post for bleeding post cardiac surgery, enteral feeding during haemodynamic failure, and ICU discharge outcomes. If you drink coffee, especially lots of it, you might be disappointed to read the latest paper on coffee consumption.
This week's guidelines focus on perioperative transoesophageal echo and platelet function testing for percutaneous coronary intervention. There are interesting commentaries on organ donation, influenza, teaching ethics and stellate ganglion block for cardiac surgery. Case reports are rarely highlighted, and the topic isn't new, but this report of a brain-dead preganant woman being supported until fetal maturation raises many ethical points.
Amongst the clinical review articles are papers on levobupivicaine, vasopressor dependent shock, ventilator-associated pneumonia, ventilator-associated lung injury, gastric variceal haemorrhage, cirrhosis, renal replacement therapy, contrast-induced nephropathy, fluid resuscitation in septic shock, aerosolised antibacterials, anaesthetic management of peritonitis, swine trauma models and ultrasound in critical care.
The latest articles recenty made open access from the major critical care journals are included and include papers from Anaesthesiology, Anesthesia & Analgesia, Critical Care, Chest, British Journal of Anaesthesia, Anaesthesia and Continuing Education in Anaesthesia, Critical Care and Pain.
The topic for This Week's Papers is minimally invasive cardiac output monitors, starting with a paper on the technology behind the Nexfin device in tomorrow's Paper of the Day.
There are three meetings coming up that might be of interest to you:
Critical Care Reviews Meeting January 24th, 2014 - Belfast, Northern Ireland
- If you are in Ireland or Great Britain (or a short flight away), Critical Care Reviews will be hosting it's second meeting outside Belfast, Northern Ireland. It's an all-day event with a fantastic programme consisting of local intensivists, local non-critical care specialists, and outstanding international guest speakers. The programme has been finalised and registration is now open.
Intensive Care Society State-of-the-Art Meeting, December 16th - 18th, London
- The ICS will be holding their annual State-of-the-Art meeting in London this December. It's the largest meeting of its kind in the UK and attracts a host of big names from the world of critical care.
SMACC GOLD March 19-21st, 2014 Gold Coast, Queensland, Australia
- This major international conference, also in it's second year, is a must for those active in the online critical care community. Webmasters of the most prominent critical care websites and blogs will descend on the beautiful Gold Coast for an amazing get together of like-minded people in a totally different style of conference. Registration is currently open.
News
Food and Drug Administration: Tigecycline
The American FDA have issued a recommendation that tigecycline should be reserved for use only when alternative therapies are not available. A new Boxed Warning describes an increased risk of death with tigecycline use following new data showing a higher risk of death among patients receiving tigecycline compared to other antibacterial drugs: 2.5% (66/2640) vs. 1.8% (48/2628), respectively. The adjusted risk difference for death was 0.6% (95% CI 0.0% - 1.2%). In general, the deaths resulted from worsening infections, complications of infection, or other underlying medical conditions. Presently, tigecycline is licensed to treat complicated skin and skin structure infections, complicated intra-abdominal infections, and community-acquired bacterial pneumonia.
Research
Randomized Controlled Trials
Journal of the American Medical Association: ICU Infections
Harris and colleagues performed a multi-centre cluster-randomized trial in 20 American ICUs (26,180 patients, 92,241 swabs) comparing the intervention of wearing of gloves and gown for all patient contact and when entering any patient room with the control of following current Centers for Disease Control and Prevention guidelines for infection control measures, and found:
- for the primary outcome
- no difference in the rates of acquisition of MRSA or VRE (difference −1.71 acquisitions per 1000 person-days, 95% CI −6.15 to 2.73; P = 0.57)
- intervention ICUs had a decrease in the primary outcome of MRSA or VRE from 21.35 acquisitions per 1000 patient-days (95% CI 17.57 to 25.94) in the baseline period to 16.91 acquisitions per 1000 patient-days (95% CI, 14.09 to 20.28) in the study period
- control ICUs had a decrease in MRSA or VRE from 19.02 acquisitions per 1000 patient-days (95% CI 14.20 to 25.49) in the baseline period to 16.29 acquisitions per 1000 patient-days (95% CI 13.48 to 19.68) in the study period
- for secondary outcomes
- no difference in VRE acquisition with the intervention (difference 0.89 acquisitions per 1000 person-days; 95% CI −4.27 to 6.04, P =0 .70)
- for MRSA, there were fewer acquisitions with the intervention (difference −2.98 acquisitions per 1000 person-days; 95% CI −5.58 to −0.38; P = 0.046)
- universal glove and gown use decreased health care worker room entry (4.28 vs 5.24 entries per hour, difference −0.96; 95% CI −1.71 to −0.21, P = 0.02)
- increased room-exit hand hygiene compliance (78.3% vs 62.9%, difference 15.4%; 95% CI 8.99% to 21.8%; P = 0.02)
- no difference in adverse events (58.7 events per 1000 patient days vs 74.4 events per 1000 patient days; difference −15.7; 95% CI −40.7 to 9.2, P = 0.24)
- Commentary: Malani. Preventing Infections in the ICU: One Size Does Not Fit All. JAMA 2013;epublished October 4th
- Video Interview: Prof Harris Discusses his study "Universal Glove and Gown Use and Acquisition of Antibiotic-Resistant Bacteria in the ICU: A Randomized Trial"
Meta Analysis
Journal of Vascular Surgery: Emergency Abdominal Aortic Repair
Antoniou and colleagues pooled data from 41 studies (n=59,941; EVAR n=8,201, open repair n=51,740) comparing endovascular repair with open repair for ruptured abdominal aortic aneurysm, and found EVAR was associated with:
- decreased
- in-hospital mortality (OR 0.56; 95% CI 0.50-0.64; P < 0.01)
- respiratory complications (OR 0.59; 95% CI 0.49-0.69; P < 0.01)
- acute renal failure (OR 0.65; 95% CI 0.55-0.78; P < 0.01)
- intraoperative blood transfusion (standardized mean difference −0.88; 95% CI −1.06 to −0.70; P < 0.01)
- a trend toward a reduced
- cardiac complications (OR −0.02; 95% CI −0.03 to 0.00; P = 0.05)
- mesenteric ischemia (OR 0.66; 95% CI 0.44-1.00; P = 0.05)
American Journal of Cardiology: Antiplatelet Therapy for CABG
Using a fixed-effects model, Nocerino and colleagues reviewed data from 5 randomized controlled trials, (n=958, 2,919 grafts with treatment up to 1 year) assessing single versus dual antiplatelet therapy after coronary artery bypass grafting, and found:
- early occlusion
- occurred in 165 (6.5%) of 2,526 bypass grafts
- was more common with single-agent therapy (7.7% versus 5.0%; p = 0.005; odds ratio 1.59, 95% CI 1.16 to 2.17)
- single-agent therapy was associated with increased loss of venous grafts (10.8% versus 6.6%; odds ratio 1.70, 95% CI 1.20 to 2.40, p = 0.003)
- there was no effect on arterial grafts
- bleeding was noted in 3.3% and 4.9% of single and dual therapy treated patients (3 studies)
Annals of Internal Medicine: Antiplatelet Therapy for Ischaemic Stroke
Using data from 7 randomized controlled trials (n=39,574), Lee and colleagues compared the risk for recurrent stroke and intracranial hemorrhage between long-term single- or dual-antiplatelet therapy in patients with ischemic stroke or transient ischemic attack, and found:
- no difference in
- risk of recurrent stroke
- dual-antiplatelet therapy versus aspirin monotherapy (RR 0.89, 95% CI 0.78 - 1.01)
- dual-antiplatelet therapy versus clopidogrel monotherapy (RR 1.01, 95% CI 0.93 - 1.08
- risk of intracranial haemorrhage
- dual-antiplatelet therapy versus aspirin monotherapy (RR 0.99, CI 0.70 - 1.42)
- risk of recurrent stroke
- the risk of intracranial haemorrhage was greater with dual-antiplatelet therapy compared with clopidogrel monotherapy (RR 1.46, CI 1.17 - 1.82)
Observational Studies
New England Journal of Medicine: Long-Term Cognitive Impairment after Critical Illness
Pandharipande and colleagues observed 821 critically ill adults with respiratory failure or shock to examine the effects of critical illness on cognitive function, and found:
- cognitive impairment was present in 6% at baseline
- delirium developed in 74% during the hospital stay
- at 3 months
- 40% had global cognition scores 1.5 SD below population means (similar to patients with moderate traumatic brain injury)
- 26% had scores 2 SD below population means (similar to patients with mild Alzheimer's disease)
- at 12 months
- deficits persisted in both older and younger patients
- 34% of all assessed patients had scores similar to patients with moderate traumatic brain injury
- 24% of all assessed patients had scores similar to patients with mild Alzheimer's disease
- a longer duration of delirium was independently associated with worse
- global cognition at 3 (p=0.001) and 12 months (P=0.04)
- executive function at 3 (P=0.004) and 12 months (P=0.007)
- sedative or analgesic medications was not consistently associated with cognitive impairment at 3 and 12 months
Journal of the American Medical Association: Out-of-Hospital Cardiac Arrest
Wissenberg and colleagues examined the Danish Cardiac Arrest Registry from 2001 to 2010, comprising 19,468 patients with out-of-hospital cardiac arrest of presumed cardiac origin and not witnessed by emergency medical services, and found:
- from 2001 to 2010, use of prehospital therapeutic interventions increased
- bystander CPR: 21.1% (95% CI 18.8%-23.4%) to 44.9% (95% CI 42.6% - 47.1%) (P < 0.001)
- bystander defibrillation: 1.1% (95% CI 0.6%-1.9%) to 2.2% (95% CI 1.5% - 2.9%) (P = 0.003)
- from 2001 to 2010, clinical outcomes improved
- survival on hospital arrival: 7.9% (95% CI 6.4%-9.5%) to 21.8% (95% CI 19.8% - 23.8%) (P < 0.001)
- 30-day survival: 3.5% (95% CI 2.5% - 4.5%) to 10.8% (95% CI 9.4% - 12.2%) (P <0 .001)
- 1-year survival: 2.9% (95% CI 2.0% - 3.9%) to 10.2% (95% CI 8.9% - 11.6%) (P <0.001)
- increased number of survivors per 100 000 persons (P <0 .001)
- There was a decreased incidence of out-of-hospital cardiac arrests during the study period (40.4 to 34.4 per 100 000 persons, P = 0.002)
- For the entire study period, bystander CPR was positively associated with 30-day survival, regardless of whether the arrest was witnessed or not
Transfusion: Fresh Frozen Plasma
In a multi-centre French study, Doussau and colleagues investigated the effects of fresh-frozen plasma therapy in 967 patients who underwent on-pump cardiac surgery and experienced excessive bleeding in the 48-hour perioperative period, and found:
- 58.1% received FFP
- median dose was 11.3 mL/kg (IQR 7.6 - 19.5)
- cumulative 30-day mortality rate was 11.3% (95% CI 9.5 - 13.5)
- in univariate analysis, FFP was associated with a higher 30-day mortality (HR 3.2; 95% CI 1.7 - 6.1)
- after adjusting for prognostic factors, FFP was not associated with 30-day mortality (HR 1.5; 95% CI 0.8 - 3.0, p = 0.20).
- a propensity score sensitivity analysis was consistent with the adjusted analysis
Journal of Parenteral and Enteral Nutrition: Enternal Nutrition during Haemodynamic Failure
Lasierra and colleagues examined the provision of enteral nutrition in patients with haemodynamic failure after cardiac surgery and found:
- 37/642 patients (5.8%) met the inclusion criteria
- 11 (29.7%) required mechanical circulatory support
- 25 (68.0%) met the criteria for early multiorgan dysfunction
- mortality was 13.5%
- Regarding enteral nutrition
- mean duration was 12.3 days (95% CI 9.6–15.0)
- mean diet volume delivered per patient per day was 1199 mL (95% CI 1118.7–1278.8)
- mean energy delivered per patient per day was 1228.4 kcal (95% CI 1145.8–1311)
- set energy target was achieved in 15 patients (40.4%)
- most common EN-related complication was constipation
- no case of mesenteric ischemia was detected
Other studies of interest
Circulation: Dabigatran
Kidney International: Acute Kidney Injury
Annals of Internal Medicine: ICU Discharge
European Heart Journal: Reperfusion Procedure Outcomes by Training Status
International Journal of Critical Illness & Injury Science: Fluid Resuscitation and Acid-Base Status
Mayo Clinic Proceedings: Coffee Consumption
Guidelines & Position Statements
Annals of Cardial Anaesthesia: Perioperative Transoesophageal Echocardiography
European Heart Journal: Percutaneous Coronary Intervention
Commentary
New England Journal of Medicine: Dead-Donor Rule
- Truog. The Dead-Donor Rule and the Future of Organ Donation. N Engl J Med 2013;369:1287-1289
- Bernat. Life or Death for the Dead-Donor Rule? N Engl J Med 2013;369:1289-1291
Journal of the American Medical Association: Influenza
Journal of Vascular Surgery: Ethics of Teaching
Annals of Cardiac Anaesthesia: Stellate Ganglion Block
Case Report
International Journal of Critical Illness & Injury Science: Brain-Dead Pregnant Woman
Review - Clinical
Neurological
Circulatory
- Bassi. Therapeutic Strategies for High-Dose Vasopressor-Dependent Shock. Critical Care Research and Practice 2013;2013:654708
- Patangi. Management issues during HeartWare left ventricular assist device implantation and the role of transesophageal echocardiography. Ann Card Anaesth 2013;16:259-67
- Gutierrez. Goal-directed therapy in intraoperative fluid and hemodynamic management. J Biomed Res 2013;27(5):357–365
Respiratory
- Choudhuri. Ventilator-associated pneumonia: When to hold the breath?. Int J Crit Illn Inj Sci 2013;3:169-74
- Kuchnicka. Ventilator-associated lung injury. Anaesthesiol Intensive Ther 2013;45(3):164–170
- Morris. Tracheostomy Care and Complications in the Intensive Care Unit. Crit Care Nurse October 2013;33(5):18-30
- Greene. Asthma Essentials. African Journal of Emergency Medicine 2013;3(4):182-188
- Kudo. Pathology of asthma. Front. Microbiol 2013;4:263
- Chen. Image-guided lung tumor ablation: Principle, technique, and current status. Journal of the Chinese Medical Association 2013;76:(6):303-311
Gastrointestinal
Hepatobiliary
- Lee. Assessing liver dysfunction in cirrhosis: Role of the model for end-stage liver disease and its derived systems. Journal of the Chinese Medical Association 2013;76(8):419-424
- Hsu. Management of ascites in patients with liver cirrhosis: Recent evidence and controversies. Journal of the Chinese Medical Association 2013;76(3):123-130
- Lata. Hepatobiliary diseases during pregnancy and their management: An update. Int J Crit Illn Inj Sci 2013;3:175-82
Renal
- Ferreira. Renal replacement therapy in critically ill patients – what modality should we choose? Port J Nephrol Hypert 2013;27(2):83-89
- Lopes. Acute kidney injury: definition and epidemiology. Port J Nephrol Hypert 2013;27(1):15-22
- Krzych. Perioperative management of cardiac surgery patients who are at the risk of acute kidney injury. Anaesthesiol Intensive Ther 2013;45(3):155–163
- Chang. Current concepts of contrast-induced nephropathy: A brief review. Journal of the Chinese Medical Association 2013;epublished September 30th
- Leś. Methods of central vascular access for haemodialysis. Anaesthesiol Intensive Ther 2013;45(3):171–176
Sepsis
- Wiersinga. Host innate immune responses to sepsis. Virulence 2014; 5:0 - -1
- Finfer. Clinical controversies in the management of critically ill patients with severe sepsis: Resuscitation fluids and glucose control. Virulence 2014; 5:0 - -1
- Cross. Anti-endotoxin vaccines: Back to the future. Virulence 2014; 5:6 - 5
- Wittebole. A historical overview of bacteriophage therapy as an alternative to antibiotics for the treatment of bacterial pathogens. Virulence 2014; 5:6 - 5
- Fink. Animal models of sepsis. Virulence 2014; 5:6 - 5
- Delaloye. Invasive candidiasis as a cause of sepsis in the critically ill patient. Virulence 2014; 5:6 - 5
- Pop-Vicas. The clinical impact of multidrug-resistant gram-negative bacilli in the management of septic shock. Virulence 2014; 5:6 - 5;
- De Backer. Pathophysiology of microcirculatory dysfunction and the pathogenesis of septic shock. Virulence 2014; 5:6 - 5
- Christaki. The complex pathogenesis of bacteremia: From antimicrobial clearance mechanisms to the genetic background of the host. Virulence 2014; 5:0 - -1
- Boomer. The changing immune system in sepsis: Is individualized immuno-modulatory therapy the answer?. Virulence 2014; 5:0 - -1
- Sharma. Anesthetic management for patients with perforation peritonitis. J Anaesthesiol Clin Pharmacol 2013;29:445-53
- Surbatovic. Immune Response in Severe Infection: Could Life-Saving Drugs Be Potentially Harmful? The Scientific World Journal 2013;2013:961852
- Zarogoulidis. Clinical experimentation with aerosol antibiotics: current and future methods of administration. Drug Design, Development and Therapy 2013;2013(7):115-1134
- Tang. An overview of the recent outbreaks of the avian-origin influenza A (H7N9) virus in the human. Journal of the Chinese Medical Association 2013;76(5):245-248
Trauma
Miscellaneous
- Hunter. Global Health: Noncommunicable Diseases. N Engl J Med 2013;369:1336-1343
- De Maio. Extracellular Heat Shock Proteins: A New Location, A New Function. Shock 2013;40(4):239-246
- Andruszkiewicz . Ultrasound in critical care. Anaesthesiol Intensive Ther 2013;45(3):177-181
Recently Made Open Access Articles from Major Journals
American Journal of Respiratory and Critical Care Medicine
Review
Chest
Review
- Schmidt. Shock: Ultrasound to Guide Diagnosis and Therapy. Chest 2012;142(4):1042-1048
- Panselinas. Acute Pulmonary Exacerbations of Sarcoidosis. Chest 2012;142(4):827-836
Critical Care
Review
- Cove. Extracorporeal carbon dioxide removal, past present and future. Critical Care 2012;16:232
- Ostermann. Biomarkers of acute kidney injury: where are we now? Critical Care 2012;16:233
- McCook. Erythropoietin in the critically ill: do we ask the right questions? Critical Care 2012;16:319
Anesthesiology
Editorial
Anesthesia & Analgesia
Review
- Spinella. Fresh Whole Blood Use for Hemorrhagic Shock: Preserving Benefit While Avoiding Complications. Anesth Analg 2012;115:751-758
- Stahl. Complement Activation and Cardiac Surgery: A Novel Target for Improving Outcomes. Anesth Analg 2012;115:759-771
- Thong. Clinical Uses of the Bonfils Retromolar Intubation Fiberscope: A Review. Anesth Analg 2012;115:855-866
British Journal of Anaesthesia
Editorial
- Bouwman. Minimal invasive cardiac output monitoring: get the dose of fluid right. Br J Anaesth 2012;109(3):299-302
- Martinez. Prevention of opioid-induced hyperalgesia in surgical patients: does it really matter? Br J Anaesth 2012;109(3):302-304
- Thomson. Value of pilots and the need to choose the right comparator. Br J Anaesth 2012;109(4):485-486
- Skinner. Accreditation in transoesophageal echocardiography in the UK: the initial experience. Br J Anaesth 2012;109(4):487-490
- Fletcher. Critical care echocardiography: cleared for take up. Br J Anaesth 2012;109(4):490-492
Review
- Glossop. Non-invasive ventilation for weaning, avoiding reintubation after extubation and in the postoperative period: a meta-analysis. Br J Anaesth 2012;109(3):305-314
- Reid. Role of microparticles in sepsis. Br J Anaesth 2012;109(4):503-513
Anaesthesia
Editorial
- Cooper. Anaesthetic training: not better, not worse, just different. Anaesthesia 2012;67:937–941
- Smith. Treatment withdrawal and acute brain injury: an integral part of care. Anaesthesia 2012;67:941–945
- Sheraton. Mobile phones and the developing world. Anaesthesia 2012;67:945–950
- Klinck. Lessons from liver transplantation. Anaesthesia 2012;67:1067–1071
- Fredrickson. Death by regional block: can the analgesic benefits ever outweigh the risks? Anaesthesia 2012;67:1071–1075
Continuing Education in Anaesthesia, Critical care and Pain
Review
- Gordon. Physiological changes after brain stem death and management of the heart-beating donor. Contin Educ Anaesth Crit Care Pain 2012;12(5):225-229
- Ashley. Anaesthesia for electrophysiology procedures in the cardiac catheter laboratory. Contin Educ Anaesth Crit Care Pain 2012;12(5):230-236
- Khirwadkar. Neuromuscular physiology and pharmacology: an update. Contin Educ Anaesth Crit Care Pain 2012;12(5):237-244
- Davoudian. Necrotizing fasciitis. Contin Educ Anaesth Crit Care Pain 2012;12(5):245-250
- Thomas. Physiology of haemoglobin. Contin Educ Anaesth Crit Care Pain 2012;12(5):251-256
- Morosan. Anaesthesia and common oral and maxillo-facial emergencies. Contin Educ Anaesth Crit Care Pain 2012;12(5):257-262
- Kirkpatrick. Technology-enhanced learning in anaesthesia and educational theory. Contin Educ Anaesth Crit Care Pain 2012;12(5):263-267
- McIndoe. High stakes simulation in anaesthesia. Contin Educ Anaesth Crit Care Pain 2012;12(5):268-273
Review - Basic Science
Australian Prescriber: Equivalence and Non-Inferiority Trials
I hope you find these brief summaries and links useful.
Until next week
Rob