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Critical Care Reviews Newsletter

December 30th 2012


Happy New Year

Welcome to the 56th 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 includes further evidence questioning the efficacy of red cell transfusion, this time in the setting of acute myocardial infarction; improved outcomes with early tracheostomy in severe stroke requiring prolonged mechanical ventilation and further data from the Relaxin trials, demonstrating decreased organ injury as measured with plasma biomarkers. An interesting case report from The Lancetdetails gain of neurological control over a prothetic limb in a tetraplegic patient, following cortical microelectrode insertion and a 13 week training programme.

This week's guidelines are from the EAST group, published on a subscription only basis in last month's in Journal of Trauma, but now made freely available from the EAST website. I've included 11 of the more relevant guidelines, which include guidance on the management of a number of blunt and penetrating traumatic conditions. Also there is a two-part Brazilian guideline on the management of acute ischaemic stroke.

Amongst the clinical review articles are an entire haematology textbook (American Society of Hematology Education Program Book). I've included the most relevant review articles (34!). Other review articles include papers on delirium, resuscitative thoracotomy, lung transplantation infection, statins for sepsis and hepatic encephalopathy, amongst others.

The topic for This Week's Papers is a selection of review articles from 2012, starting with a paper in tomorrow's Paper of the Day on the demise of beta-2 agonists following the 2011 BALTI-2 and ALTA studies.



As we're at the end of the year, it's a good time to see what you think of Critical Care Reviews. I've produced a very short survey (<2 minutes to complete) to see what works, what could be improved and what your thoughts on the website are. I'd be grateful if you could take a couple of minutes to complete this as it will help shape how the site develops.



Annals of Internal Medicine:     Red Cell Transfusion

Chatterjee performed a systematic review, meta analysis and diversity-adjusted study sequential analysis to investigate whether red cell transfusion is beneficial in the setting of myocardial infarction. Ten studies were included in the analysis. Comparing red cell transfusion with no transfusion during myocardial infarction, transfusion increased all-cause mortality (18.2% vs 10.2%) (risk ratio, 2.91; 95% CI, 2.46-3.44; P < 0.001), with a weighted absolute risk increase of 12% and a number needed to harm of 8 (95% CI, 6-17). Multivariate meta-regression revealed that blood transfusion was associated with a higher risk for mortality independent of baseline hemoglobin level, nadir hemoglobin level, and change in hemoglobin level during the hospital stay. Blood transfusion was also significantly associated with a higher risk for subsequent myocardial infarction (risk ratio, 2.04; 95% CI, 1.06-3.93; P = 0.03).

Abstract:  Chatterjee. Association of Blood Transfusion With Increased Mortality in Myocardial Infarction: A Meta-analysis and Diversity-Adjusted Study Sequential Analysis. Arch Intern Med 2012;epublished December 24th


Stroke:     Tracheostomy in Stroke

Bösel et al completed a single-centre, prospective, randomized, parallel-group, controlled, open, and outcome-masked pilot trial in 60 subjects with severe ischemic or hemorrhagic stroke and an estimated need for at least 2 weeks of ventilation. Subjects were randomized to either early tracheostomy (within day 1–3 from intubation; early) or to standard tracheostomy (between day 7–14 from intubation if extubation could not be achieved). There were no differences were in length of ICU stay (median 18 [interquartile range 16–28] versus 17 [interquartile range 13–22] days, median difference: 1 [−2 to 6]; P=0.38) or to most secondary outcomes, including adverse effects. Use of sedatives (62% versus 42% of ICU stay, median difference 17.5 [3.3–29.2]; P=0.02), ICU mortality (ICU deaths 3 [10%] versus 14 [47%]; P<0.01) and 6-month mortality (deaths 8 [27%] versus 18 [60%]; P=0.02) were lower in the early group than in the standard group, respectively.

Abstract: Bösel. Stroke-Related Early Tracheostomy Versus Prolonged Orotracheal Intubation in Neurocritical Care Trial (SETPOINT): A Randomized Pilot Trial. Stroke 2012;44:21-28


Journal of the American College of Cardiology:     Serelaxin

Based on data from Pre-RELAX-AHF (Relaxin in Acute Heart Failure), a phase II study, and RELAX-AHF, a phase III study, which were international, multicenter, double-blind, placebo-controlled trials evaluating serelaxin in patients hospitalized for acute heart failure, Metra et al investigated the effects of this therapy on organ function. Serelaxin administration improved markers of cardiac (high-sensitivity cardiac troponin T), renal (creatinine and cystatin-C), and hepatic (aspartate transaminase and alanine transaminase) damage and of decongestion (N-terminal pro–brain natriuretic peptide), consistent with the prevention of organ damage and faster decongestion. Serelaxin reduced 180-day mortality, with similar effects in the phase II and phase III studies (combined studies: N = 1,395; hazard ratio: 0.62; 95% confidence interval: 0.43 to 0.88; p = 0.0076)

Full Text:  Metra. Effect of Serelaxin on Cardiac, Renal, and Hepatic Biomarkers in the Relaxin in Acute Heart Failure (RELAX-AHF) Development Program: Correlation With Outcomes. J Am Coll Cardiology 2012; eublished December 26th


The Lancet:     Neuroprostheses

Collinger et al report neurological control of prosthetic upper limb function in a previously tetraplegic patient with insertion of two 96-channel intracortical microelectrodes in the motor cortex followed by brain—machine interface training for 13 weeks.  The participant was able to use the prosthetic limb to do skilful and coordinated reach and grasp movements that resulted in clinically significant gains in tests of upper limb function. No adverse events were reported.


Journal of Trauma and Acute Care Surgery:     Pulmonary Contusion & Flail Chest


Journal of Trauma and Acute Care Surgery:     Blunt Hepatic Injury


Journal of Trauma and Acute Care Surgery:     Blunt Splenic Injury


Journal of Trauma and Acute Care Surgery:     Blunt Cardiac Injury


Journal of Trauma and Acute Care Surgery:     Penetrating Abdominal Trauma


Journal of Trauma and Acute Care Surgery:     Screening for Thoracolumbar Spinal Injuries


Journal of Trauma and Acute Care Surgery:     Emergency Tracheal Intubation in Trauma


Journal of Trauma and Acute Care Surgery:     Antibacterials for Tube Thoracostomy


Journal of Trauma and Acute Care Surgery:     Geriatric Trauma


Journal of Trauma and Acute Care Surgery:     Small-Bowel Obstruction


Journal of Trauma and Acute Care Surgery:     Penetrating Lower Extremity Arterial Trauma


Arquivos de Neuro-Psiquiatria:     Ischaemic Stroke


Review - Clinical


Annals of Intensive Care


Anesthesiology Research and Practice



Annals of the New York Academy of Sciences:     Myocardial Protection


Interactive CardioVascular and Thoracic Surgery:     Resuscitative Thoracotomy



Medical Gas Research:     Carbon Monoxide


Respirology:   Citation Classics 


Respirology:     Interventional Pulmonology


Respirology:     Lung Transplant Infection


The Scientific World Journal:     Acute Respiratory Distress Syndrome



Gastroenterology Research and Practice:     Hepatic Encephalopathy



International Journal of Nephrology



Hematology - American Society of Hematology Education Program Book:    














Pulmonary Circulation:     Statins in Sepsis


Respirology:     Multidrug-Resistant Tuberculosis


Tropical Parisitology:     Cryptosporidiosis


Tropical Parisitology:     Cystic Echinococcosis and Cysticercosis



Thanks for using Critical Care Reviews during 2012.

Until next year