Newsletter 118 / March 9th 2014
Welcome
Hello
Welcome to the 118th 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, guidelines, commentaries and editorials from hundreds of clinical and scientific journals.
This week's research studies include a randomized controlled trial on cognitive therapy early in critically illness; meta analyses address proning in ARDS, videolaryngoscopy in ICU, β lactam infusions and right ventricular dilatation on CT in pulmonary embolism; observational studies focus on the effect of hospital case volume in sepsis, outcomes in terminal cancer patients receiving palliative chemotherapy, sedation and analgesia protocols and long term outcomes after mild acute kidney injury, while additional studies investigate pneumonia diagnosis and fluid costs in resuscitation.
This month's Cochrane reviews includes one new analysis on automated weaning and several updated analyses on fluid resuscitation in haemorrhage, hepatic encephalopathy, mechanical chest compression devices for CPR and antifungals for the neutropaenic cancer patient.
There is one guideline this week, from the AHA/ACC on the management of valvular heart disease. Editorials address mechanical ventilation provision, ICU bed provision, ARDS outcomes and rehabilitation; commentaries focus on news drugs for myocardial infarction, prediction models, and regret, in addition to an entire issue of ICU Management. There is one case report on acute kidney injury. Amongst the clinical review articles are papers on traumatic brain injury, early mobilization in ICU, goal directed fluid resuscitation, a series of airway articles from the International Journal of Critical Illness and Injury Science, tracheal tube cuffs, idiopathic pulmonary fibrosis, obesity, protein calorie targets, variceal bleeding, red cell transfusion, massive obstetric haemorrhage, and care bundles.
There is one basic science review article on mitochondria, as well as two non-clinical reviews on staffing models and leadership. The topic for This Week's Papers is drainage of abscesses and collections, starting with a general paper on abscess drainage in tomorrow's Paper of the Day.
Next week's newsletter will be out early (hopefully) as I will be travelling to SMACCgold over the weekend.
Research
Randomized Controlled Trials
Brummel and colleagues examined the feasibility and safety of administering combined cognitive and physical therapy early during critical illness in 87 ICU patients with respiratory failure and/or shock to three groups: usual care (n=22), early once-daily physical therapy (n=22), or early once-daily physical therapy plus twice-daily cognitive therapy (n=43), and found:
- early cognitive therapy was a delivered to 95 % of cognitive plus physical therapy patients on 100 % (92–100 %) of study days beginning 1.0 (1.0–1.0) day following enrollment
- physical therapy was received by
- 77 % of usual care patients on 17 % (10–26 %) of study days
- 95 % of physical therapy only patients on 67 % (46–87 %) of study days
- 98 % of cognitive plus physical therapy patients on 75 % (59–88 %) of study days
- at three months there was no inter-group differences in various outcomes:
- cognitive
- functional
- health-related quality of life
Meta Analyses
Beitler et al pooled data from seven randomized controlled trials (n=2,119) investigating prone positioning for patients with ARDS and found:
- overall, prone positioning was not associated with a reduced risk ratio of death
- RR 0.83; 95 % CI 0.68 to 1.02; p = 0.073; I 2 = 64 %
- stratified by high or low tidal volume, prone positioning was associated with
- a significant decrease in risk ratio of death only among studies with low baseline tidal volume
- RR 0.66; 95 % CI 0.50 to 0.86; p = 0.002; I 2 = 25 %
- stratification by tidal volume explained over half the between-study heterogeneity observed in the unstratified analysis
De Jong reviewed data from 9 studies (n = 2,133; DL: 1,067 & VL: 1,066), comparing videolaryngoscopy with direct laryngoscopy in the ICU, and found:
- videolaryngoscopy was associated with
- reduced risk of
- difficult orotracheal intubation
- OR 0.29, 95 % CI 0.20 to 0.44, p < 0.001
- Cormack 3/4 grades
- OR 0.26, 95 % CI 0.17 to 0.41, p < 0.001
- esophageal intubation
- OR 0.14, 95 % CI 0.02 to 0.81, p = 0.03
- difficult orotracheal intubation
- increased
- first-attempt success
- OR 2.07, 95 % CI 1.35 to 3.16, p < 0.001
- first-attempt success
- reduced risk of
- There was no difference in
- severe hypoxemia
- severe cardiovascular collapse
- airway injury
Teo et al performed a meta analysis of 29 studies (18 RCTs and 11 observational studies; n=2,206) comparing prolonged infusion with intermittent bolus administration of ß-lactam antibiotics in hospitalised adult patients, and found:
- use of prolonged infusion was associated with a
- significant reduction in mortality
- relative risk 0.66, 95% CI 0.53 to 0.83
- improvement in clinical success
- RR 1.12, 95% CI 1.03 to 1.21
- significant reduction in mortality
- statistically significant benefit was supported by
- non-randomised studies
- mortality
- RR 0.57, 95% CI 0.43 to 0.76
- clinical success
- RR 1.34, 95% CI 1.02 to 1.76
- mortality
- but not by RCTs
- mortality
- RR 0.83, 95% CI 0.57 to 1.21
- clinical success
- RR 1.05, 95% CI 0.99 to 1.12
- mortality
- non-randomised studies
Becattini and colleagues examined 36 studies (9 prospective, 27 retrospective) evaluating whether right ventricular dilatation at CT angiography predicts the risk of death in patients with acute pulmonary embolism, and found:
- CT-detected right ventricular dilatation was associated with
- increased 30 day-mortality in
- all-comers with pulmonary embolism
- OR 2.08, 95% CI 1.63 to 2.66; p<0.00001
- haemodynamically stable patients
- OR 1.64, 95% CI 1.06 to 2.52; p = 0.03
- all-comers with pulmonary embolism
- death due to pulmonary embolism
- OR 7.35, 95% CI 3.59 to 15.09; p<0.00001
- 3-month mortality
- OR 4.65, 95% CI 1.79 to 12.07; p = 0.002
- increased 30 day-mortality in
Observational Studies
Walkey and colleagues assessed the associations between hospital severe sepsis caseload and outcomes in 56,997 patients with severe sepsis admitted to 124 U.S. academic hospitals during 2011, using the University HealthSystem Consortium’s sepsis mortality model (c-statistic, 0.826) for risk adjustment, and found:
- basic data
- hospitals admitted 460 ± 216 patients with severe sepsis
- median length of stay 12.5 days (IQR 11.1 to 14.2)
- median direct costs $26,304 (IQR $21,900 to $32,090)
- hospital mortality 25.6 ± 5.3%
- higher severe sepsis case volume was associated with lower
- unadjusted severe sepsis mortality (R2 = 0.10, P = 0.01)
- risk-adjusted severe sepsis mortality (R2 = 0.21, P < 0.001)
- adjusted absolute 7% (95% CI 2.4 to 11.6%) lower hospital mortality (highest versus lowest quartile)
- there was no association between case volume and resource use
Wright et al completed a secondary analysis of a prospective, multi-centre study of 386 terminally ill cancer patients, analysing whether receipt of chemotherapy at enrollment was associated with patients’ subsequent intensive medical care and place of death, and found:
- palliative chemotherapy
- was received by 56%
- a median of 4.0 months before death
- was associated with (propensity analysis)
- higher rates of
- cardiopulmonary resuscitation
- mechanical ventilation
- both in the last week of life
- 14% v 2%; adjusted risk difference 10.5%, 95% CI 5.0% to 15.5%
- late hospice referrals
- 54% v 37%; adjusted risk difference 13.6%, 95% CI 3.6% to 23.6%
- no difference in survival
- hazard ratio 1.11, 95% CI 0.90 to 1.38
- higher rates of
- patients receiving palliative chemotherapy were
- more likely to die in an intensive care unit
- 11% v 2%; adjusted risk difference 6.1%, 95% CI 1.1% to 11.1%
- less likely to die
- at home
- 47% v 66%; adjusted risk difference −10.8%, 95% CI −1.0% to −20.6%
- in their preferred place
- 65% v 80%; adjusted risk difference −9.4%, 95% CI −0.8% to −18.1%
- at home
- more likely to die in an intensive care unit
Dale and colleagues performed a single centre, before (n=703) and after (n=708) study, evaluating the implementation of three protocol updates:
- documentation of Richmond Agitation Sedation Scale scores every 4 hours
- documentation of Confusion Assessment Method-ICU twice daily
- systematic, protocolized de-escalation of excess sedation
and found:
- protocol updates were associated with more assessments per day
- RASS
- 5.38 vs. 4.16; difference 1.22, 95% CI 1.05 to 1.39; P <0.01
- CAM-ICU
- 1.49 vs. 0.35; difference 1.15, 95% CI 1.08 to 1.21, P <0.01
- RASS
- decreased
- hourly benzodiazepine dose
- - 34.8%, 0.08 mg lorazepam equivalents/hour; 0.15 vs. 0.23; P <0.01
- duration of mechanical ventilation
- - 17.6%, 95% CI, 0.6-31.7%; P = 0.04
- delirium
- OR 0.67, 95% CI 0.49 to 0.91; P = 0.01
- duration of
- ICU stay
- -12.4%, 95% CI 0.5 to 22.8%; P = 0.04
- hospitalization
- - 14%, 95% CI 2.0 to 24.5%; P = 0.02
- ICU stay
- hourly benzodiazepine dose
- there was no association with mortality
- OR 1.18; 95% CI 0.80 to 1.76, P = 0.40
Linder et al assessed whether a single episode of minimal (stage I KDIGO) acute kidney injury is associated with reduced long-term survival compared to no acute kidney injury in 2,010 patients (1,844 analysed) after recovery from critical illness, and found:
- AKI development rates
- AKI stage 1: 18.4%
- AKI stage 2: 12.1%
- AKI stage 3: 26.5%
- No AKI: 43.0%
- survival rates for patients with stage 1 AKI versus no AKI were (p<0.01)
- 28-day: 67.1%
- 1-year: 51.8%
- 5-year: 44.1%
- 10-year: 36.3%
- increased 10-year mortality hazard ratio for 28-day survivors with stage 1 AKI compared with no AKI
- unadjusted 1.53 (95% CI 1.2 to 2.0)
- adjusted 1.26 (1.0 to 1.6).
- propensity matching (p=0.036)
Additional Studies
- Full Text: Meyer. Evaluation of Blind Nasotracheal Suctioning and Non-bronchoscopic Mini-Bronchoalveolar Lavage in Critically Ill Patients with Infectious Pneumonia: A Preliminary Study. Respir Care 2014;59:345-352
- Abstract: Smith. Cost-minimization analysis of two fluid products for resuscitation of critically injured trauma patients. American Journal of Health-System Pharmacy 2014;71(6):470-475
Cochrane Reviews
New
Updated
- Kwan. Timing and volume of fluid administration for patients with bleeding. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD002245
- Junker. Dopamine agents for hepatic encephalopathy. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD003047
- Brooks. Mechanical versus manual chest compressions for cardiac arrest. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD007260
- Jørgensen. Voriconazole versus amphotericin B or fluconazole in cancer patients with neutropenia. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD004707
Guidelines
Editorials
- Schultz. Should mechanical ventilation care be centralized and should we thus transfer all ventilated patients to high volume units? Take a breath first. Intensive Care Med 2014;40(3):453-455
- Rubenfeld. How many intensive care beds are enough? Intensive Care Med 2014;40(3):451-452
- Guérin. Improved ICU outcomes in ARDS patients: implication on long-term outcomes. Intensive Care Med 2014;40(3):448-450
- Hopkins. Early cognitive and physical rehabilitation: one step towards improving post-critical illness outcomes. Intensive Care Med 2014;40(3):442-444
Commentary
- Roubille. New Drug Avenues for Cardioprotection in Patients with Acute Myocardial Infarction. Am J Cardiovasc Drugs 2014;14:73–77
- Pirracchio. Recalibrating our prediction models in the ICU: time to move from the abacus to the computer. Intensive Care Med 2014;40(3):438-441
- McAdam. Regret. Intensive Care Med 2014;40(3):436-437
ICU Management Issue
- Boisson. Prevention of Ventilator-Associated Pneumonia. ICU Management 2014;13(4):
- Pearson. VAP, VAC, IVAC and Ventilator-Associated Events: The Need for Objectivity for Surveillance. ICU Management 2014;13(4):
- Niederman. Inhaled Antibiotics in the ICU. ICU Management 2014;13(4):
- Matejovic. Kidney Attack in Sepsis: The Role of Haemodynamics. ICU Management 2014;13(4):
- Tisherman. Therapeutic Hypothermia in Severe Trauma. ICU Management 2014;13(4):
- Valenzuela. Ischaemic Conditioning for Neuroprotection in Stroke. ICU Management 2014;13(4):
- Marx. Tele-Intensive Care Medicine: High Potential of Enhancing Healthcare Outcomes. ICU Management 2014;13(4):
- Subbe. Impact of Rapid Response Teams on ICU. ICU Management 2014;13(4):
- Bakker. The Role of Blood Lactate. ICU Management 2014;13(4):
- Hallman. ICU Management of Traumatic Brain Injury. Current Anesthesiology Reports 2013;3(2):89-97
- Schober. Early Mobilization in the Intensive Care Unit. Current Anesthesiology Reports 2013;3(2):73-78
- Sunaga. Development of New Neuromuscular Blocking Agents. Current Anesthesiology Reports 2013;3(2):105-113
- Kopman. Is Postoperative Residual Neuromuscular Block Associated with Adverse Clinical Outcomes? What Is the Evidence? Current Anesthesiology Reports 2013;3(2):114-121
- Meistelman. Sugammadex Development and Use in Clinical Practice. Current Anesthesiology Reports 2013;3(2):122-129
- Brull. Management Principles to Reduce the Risk of Residual Neuromuscular Blockade. Current Anesthesiology Reports 2013;3(2):130-138
- Soeding. Effects of Positioning on Cerebral Oxygenation. Current Anesthesiology Reports 2013;3(3):184-196
- Schwarz. Dexmedetomidine for Neurosurgical Procedures. Current Anesthesiology Reports 2013;3(3):205-209
- Scharf. Sleep and Anesthesia Interactions: A Pharmacological Appraisal. Current Anesthesiology Reports 2013;3(1):1-9
- Khan. The Use of Adenosine in Cerebral Aneurysm Clipping: A Review. Current Anesthesiology Reports 2013;3(3):210-213
- Davies. GABAA Receptor Genetics and Clinical Pharmacology. Current Anesthesiology Reports 2014;4(1):42-48
- Ainslie. Why is the neural control of cerebral autoregulation so controversial? F1000Prime Rep2014, 6:14
- Vogelgesang. Immunological consequences of ischemic stroke. Acta Neurol Scand 2014:129:1–12
Circulatory
- Katz. Goal Directed Fluid Resuscitation: A Review of Hemodynamic, Metabolic, and Monitoring Based Goals. Current Anesthesiology Reports 2013;3(2):98-104
- Thompson. Perioperative Management of Cardiovascular Implantable Electronic Devices (CIEDs). Current Anesthesiology Reports 2013;3(3):139-143
- Howard-Quijano. Perioperative Care of Adults with Congenital Heart Disease for Non-cardiac Surgery. Current Anesthesiology Reports 2013;3(3):144-150
- Riedel. Perioperative Implications of Vascular Endothelial Dysfunction: Current Understanding of this Critical Sensor-Effector Organ. Current Anesthesiology Reports 2013;3(3):151-161
- Ferreira. Evolving Role of Three-Dimensional Echocardiography in the Cardiac Surgical Patient. Current Anesthesiology Reports 2013;3(3):162-174
- Roberts. Potentially Fatal Side Effect of ACE Inhibitors: Angioedema. Emergency Medicine News 2014;36(3):8-11
- Díez. Serelaxin: A Novel Therapy for Acute Heart Failure with a Range of Hemodynamic and Non-Hemodynamic Actions. Am J Cardiovasc Drugs 2014;epublished March 5th
- Bouabdallaoui. Acute mitral regurgitation in Takotsubo cardiomyopathy. European Heart Journal: Acute Cardiovascular Care February 2014;epublished February 3rd
- Ghoorah. Obesity and cardiovascular outcomes: a review. European Heart Journal: Acute Cardiovascular Care 2014;epublished February 13th
- Thomas. New hypertension guidelines: One size fits most? Cleve Clin J Med 2014;81:178-188
Airway
- Chemsian. Videolaryngoscopy. Int J Crit Illn Inj Sci 2014;4:35-41
- Stewart. Rapid-sequence intubation and cricoid pressure. Int J Crit Illn Inj Sci 2014;4:42-9
- Austin. Airway management in cervical spine injury. Int J Crit Illn Inj Sci 2014;4:50-6
- Diedrich. Airway Management in Cervical Spine Injury. Current Anesthesiology Reports 2013;3(3):197-204
- Jacobs. Advances in prehospital airway management. Int J Crit Illn Inj Sci 2014;4:57-64
- Harless. Pediatric airway management. Int J Crit Illn Inj Sci 2014;4:65-70
- Patel. Surgical Airway. Int J Crit Illn Inj Sci 2014;4:71-6
- Ramaiah. Extraglottic airway devices: A review. Int J Crit Illn Inj Sci 2014;4:77-87
- Henlin. Oxygenation, Ventilation, and Airway Management in Out-of-Hospital Cardiac Arrest: A Review. BioMed Research International 2014;2014:376871
Respiratory
- Jaillette. Optimal care and design of the tracheal cuff in the critically ill patient. Annals of Intensive Care 2014;4:7
- Woodcock. The treatment of idiopathic pulmonary fibrosis. F1000Prime Rep 2014;6:16
- Ding. Therapeutic Implications of Estrogen for Cerebral Vasospasm and Delayed Cerebral Ischemia Induced by Aneurysmal Subarachnoid Hemorrhage. BioMed Research International 2014;2014:727428
- Laratta. Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Cardiovascular Links. BioMed Research International 2014;2014:528789
Nutrition
- Al-Dorzi. Antibiotic therapy of pneumonia in the obese patient: dosing and delivery. Curr Opin Infect Dis 2014;27(2):165-173
- Ingrande. Anesthetic Pharmacology and the Morbidly Obese Patient. Current Anesthesiology Reports 2013;3(1):10-17
- Abdullah. Perioperative Management of Obstructive Sleep Apnea. Curr Anesthesiol Rep 2014;4:19–27
- Singer. Pragmatic approach to nutrition in the ICU: Expert opinion regarding which calorie protein target. Clinical Nutrition 2014;33(2):246-251
Hepatobiliary
- Al Mofleh. Variceal bleeding: Current issues. Saudi J Med Med Sci 2014;2:3-11
- Lee. Role of prophylactic antibiotics in cirrhotic patients with variceal bleeding. World J Gastroenterol. 2014;20(7):1790-1796
- Abenavoli. Pharmacotherapy of acute alcoholic hepatitis in clinical practice. World J Gastroenterol 2014;20(9):2159-2167
- Nassir. Role of mitochondria in alcoholic liver disease. World J Gastroenterol 2014;20(9):2136-2142
- Jaurigue. Therapy for alcoholic liver disease. World J Gastroenterol 2014;20(9):2143-2158
Haematological
- Buelvas. Anemia and transfusion of red blood cells. Colombia Médica 2013;44(4):236-242
- Undas. Anticoagulant effects of statins and their clinical implications. Thromb Haemost 2014;111(3):392-400
Obstetrics
Miscellaneous
- Weavind. Care Bundles in the Adult ICU: Is It Evidence-Based Medicine? Current Anesthesiology Reports 2013;3(2):79-88
- Neckebroek. Automated Drug Delivery in Anesthesia. Current Anesthesiology Reports 2013;3(1):18-26
- Bharati. Anaesthesia in underdeveloped world: Present scenario and future challenges. Niger Med J 2014;55:1-8
- Hoogeboom. Merits of exercise therapy before and after major surgery. Current Opinion in Anaesthesiology 2014;27(2):161-166
- Azoulay. Year in review in Intensive Care Medicine 2013: II. Sedation, invasive and noninvasive ventilation, airways, ARDS, ECMO, family satisfaction, end-of-life care, organ donation, informed consent, safety, hematological issues in critically ill patients. Intensive Care Med 2014;40(3):305-319
- Herrmann. Adult human mesenchymal stromal cells and the treatment of graft versus host disease. Stem Cells and Cloning: Advances and Applications 2014;7;45-52
Review - Basic Science
Review - Non-Clinical
- Gutsche. Staffing Models for the ICU: Open, Closed, MD, NP, or Telemedicine? Current Anesthesiology Reports 2013;3(2):65-72
- Trastek. Leadership Models in Health Care—A Case for Servant Leadership. Mayo Clinic Proceedings 2014;89(3):374-381
I hope you find these brief summaries and links useful.
Until next week
Rob