ccr logo 246x225 13121Critical Care Reviews Newsletter

June 10th 2012





Welcome to the 27th Critical Care Reviews Newsletter. Every week over two hundred clinical and scientific journals are monitored and the most important and interesting research publications in critical care are highlighted. These studies are added to the Current Articles section of the website on a daily basis, as publication occurs. A link to either the full text or abstract, depending on the publishers degree of open access, is attached. Also, links to other important papers, such as guidelines or consensus statements are included. Free review articles from across the medical literature are also highlighted.

It's a very interesting newsletter this week, with the study that sank APC having being published, and European Society of Intensive Care Medicine being the first intensive care society to recommend largely avoiding the use of colloids in the critically ill.

The topic for This Week's Papers is brain disorders, starting with status epilepticus in tomorrow's Paper of the Day. It's a free and easy way to stay up-to-date with your reading.



New England Journal of Medicine:     Activated Protein C

Ranieri and colleagues performed a randomized, double-blind, placebo-controlled, multicenter trial, investigating the efficacy of activated protein C in 1697 patients with septic shock. No difference was seen in mortality at 28 days {(APC: 223 of 846 patients (26.4%) vs placebo: 202 of 834 (24.2%) (relative risk with APC 1.09; 95% CI, 0.92 to 1.28; P=0.31)} or at 90 days {APC: 287 of 842 patients (34.1%) vs placebo: 269 of 822 (32.7%) (relative risk, 1.04; 95% CI, 0.90 to 1.19; P=0.56)}. Similarly, there were no differences in subgroups, including those with increased risk of death, or in the incidence of serious bleeding.

Abstract: Ranieri. Drotrecogin Alfa (Activated) in Adults with Septic Shock ( PROWESS-SHOCK Study). N Engl J Med 2012;366:2055-206


New England Journal of Medicine:     ICU Staffing

In a retrospective cohort analysis, Wallace and colleagues examined the effect of a night-time intensivist on patient outcomes in 65,752 patients admitted to 49 ICUs in 25 American hospitals. In both the primary analysis, and a second confirmatory analysis, the addition of a night-time intensivist to ICUs with  low-intensity daytime staffing was associated with reduced mortality (adjusted odds ratio for death, 0.62; P=0.04), while a night-time intensivist had no effect on mortality in ICUs with high-intensity daytime staffing (odds ratio, 1.08; P=0.78).

Full Text: Wallace. Nighttime Intensivist Staffing and Mortality among Critically Ill Patients. N Engl J Med 2012; 366:2093-2101


Intensive Care Medicine:     Dobutamine

Tacon and colleagues performed a systematic review and meta analysis investigating the effects of dobutamine on mortality in  patients with severe heart failure. Fourteen studies totalling 673 patients were identified. The odds ratio for mortality for patients  treated with dobutamine compared with standard care or placebo was 1.47 (95% confidence interval 0.98–2.21, p = 0.06).

JAMA:     Perioperative Prediction

Devereaux and colleagues performed a prospective, international cohort study to determine the relationship between the peak troponin T measurement in the first 3 days after noncardiac surgery and 30-day mortality. In 15,133 patients, the 30-day mortality rate was 1.9% (95% CI, 1.7%-2.1%). Multivariable analysis demonstrated that raised peak troponin values of at least 0.02 ng/mL were associated with higher 30-day mortality with those with a peak troponin value of 0.01 ng/mL or less.  The 30-day mortality rates of troponin T levels of 0.01 ng/mL or less, 0.02, 0.03-0.29, and 0.30 were 1.0%, 4.0%, 9.3%, and 16.9%, respectively.

Full Text: Devereaux. Association Between Postoperative Troponin Levels and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery. JAMA 2012;307(21):2295-2304


Critical Care Medicine:     Central Venous Catheter Patency

Schallom et al undertook a single-center, randomized, open label trial evaluating central venous catheter lumen patency with either heparin or 0.9% sodium chloride flush solutions. In 326 central venous catheters (709 lumens) the nonpatency rate was 3.8% in the heparin group (n = 314) and 6.3% in the 0.9% sodium chloride group (n = 395) ( RR 1.66, 95% CI 0.86–3.22, p = .136).

Abstract: Schallom. Heparin or 0.9% sodium chloride to maintain central venous catheter patency: A randomized trial. Crit Care Med 2012;40(6):1820-1826


Anesthesiology:     Difficult Airway Management

In a multi-centre study, Rosenstock et al examined the time to intubation between awake fibreoptic and awake video larygoscopic techniques in 93 adults with anticipated difficult intubation. Time to tracheal intubation (median [IQR]) was 80 s [58–117] with the fibreoptic technique and 62 s [55–109] with the video larnygoscope (P = 0.17). The first attempt success rate was  79% versus 71%, respectively, with no difference between the techniques for patient comfort. 


Consensus Statement

Intensive Care Medicine:     Colloid Administration

The European Society of Critical Care Medicine has issued a consensus statement on the use of colloids in critically ill patients and recommended not to use HES with molecular weight ≥200 kDa and/or degree of substitution >0.4 in patients with severe sepsis or risk of acute kidney injury and suggest not to use 6% HES 130/0.4 or gelatin in these populations. It is also recommended not to use colloids in patients with head injury or to administer gelatins and HES in organ donors. Hyperoncotic solutions are also not recommended for fluid resuscitation.

Abstract: Reinhart. Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients. Intensive Care Med 2012;38(3):368-383


Intensive Care Medicine:     Abdominal Problems

Full Text: Blaser. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med 2012;38:384–394



Review - Clinical

New England Journal of Medicine:     Drowning


European Heart Journal:    Optical Coherence Tomography


Journal of Antimicrobial Chemotherapy:     Anti-Bacterial Therapy


Minerva Anestesiologica:     Sepsis


Minerva Anestesiologica:     Cirrhosis


Critical Care:     Brain Injury


Intensive Care Medicine:     Year in Review



I hope you find these brief summaries useful.

Until next week