Critical Care Reviews Newsletter

May 16th 2012



Welcome to the 23rd 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 Journal Watch 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.

Apologies for the late delivery of these briefer than usual newsletters. I'm travelling and have both limited internet access and time.



JAMA:     Acute Kidney Injury



Stem Cell International:     Stem Cell Therapy in ALI



Critical Care:     Fluid Resuscitation in Septic Shock

To investigate the optimum amount of fluid required to treat septic shock, Smith et al performed a prospective, multicenter, observational study in 146 patients. The median volume of fluid received during the first day in the entire cohort was 4.0 l (IQR 2.3-6.3), with patients receiving >4 l having higher lactate (3.4 (2.2-5.5) vs. 2.0 (1.6-3.0) mmol l-1, P < 0.0001) than those receiving < 4 l. Despite this difference in administered fluid, simplified acute physiology score (SAPS) II (54 (45-64) vs. 54 (45-67), p = 0.73), sequential organ failure assessment (SOFA) score (11 (9-13) vs. 11 (9-13), P = 0.78) and 90-day mortality (48 vs. 53%, P = 0.27) did not differ between groups. By day 3, the 95 patients who still had shock had received 7.5 l (4.3 - 10.8) of fluid. Patients receiving higher volumes (>7.5 l) had higher lactate (2.6 (1.7-3.4) vs. 1.9 (1.6-2.4) mmol l-1, P < 0.01) on day 3 and lower 90-day mortality (40 vs. 62%, P = 0.03) than those receiving lower volumes in spite of comparable admission SAPS II and SOFA scores.

Full Text: Smith. Higher vs. lower fluid volume for septic shock: clinical characteristics and outcome in unselected patients in a prospective, multicenter cohort. Critical Care 2012, 16:R76


Nephron Clinical Practice:     Initiation of RRT in Chronic Renal Failure

Pan and colleagues performed a meta-analysis to determine the relationship between the risk of death and early initiation of dialysis, as defined by a higher GFR. 15 cohort studies, of combined prospective and retorspective nature, and totaling 15 1,285,747 patients met the inclusion criteria and were analyzed. Early start of dialysis was associated with increased risk of mortality (OR = 1.33, 95% CI: 1.18–1.49, p < 0.00001. However several cofounders may have influenced this result. Subgroup analysis indicated that early starters were 6.61 years older (p < 0.00001) and more likely to have diabetes (OR = 2.23, 95% CI: 1.83–2.71, p < 0.00001) than late starters. Analysis of pooled results of early and late starters indicated that older age (OR = 1.18, 95% CI: 1.05–1.33, p = 0.006), diabetes (OR = 1.61, 95% CI: 1.38–1.87, p < 0.00001), and high comorbidity index score (OR = 2.38, 95% CI: 1.75–3.25, p < 0.00001) were strongly associated with increased risk of death.

Abstract: Pan. Association of Early versus Late Initiation of Dialysis with Mortality: Systematic Review and Meta-Analysis.Nephron Clin Pract 2012;120:c121-c131


Journal of Cardiothoracic and Vascular Anaesthesia:     Fenoldopram in Cardiac Surgery AKI

Zangrillo and coleagues conducted a systematic review and meta analysis of the efficacy of fenoldopram in cardiac surgery associated acute kidney injury.Six tudies totaling 440 patients were included in the analysis, which showed that while fenoldopram reduced the risk of AKI (odds ratio [OR] = 0.41; 95% CI: 0.23-0.74; p = 0.003), with a higher rate of hypotensive episodes and/or use of vasopressors (30/109 [27.5%] v 21/112 [18.8%]; OR = 2.09; 95% CI, 0.98-4.47; p = 0.06), it had no effect on renal replacement therapy, survival, and length of intensive care unit or hospital stay.

Abstract: Zangrillo. Fenoldopam and Acute Renal Failure in Cardiac Surgery: A Meta-Analysis of Randomized Placebo-Controlled Trials. Journal of Cardiothoracic and Vascular Anesthesia 2012;26(3):407-413


Study Critique

Critical Care:     Stenting for Intracranial Arterial Stenosis

Comment on: Chimowitz. Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis: the SAMMPRIS Trial Investigators. N Engl J Med 2011;365:993-1003


I hope you find these brief summaries and links useful.

Until next week