August 6th 2012
Welcome to the 35th Critical Care Reviews Newsletter. Every week over three 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.
Some of the more important critical care research papers published this week include a suggestion that early deep sedation may be harmful, the ability of common ward tests to predict death within 1 day and a depressingly high prevalence of depressive symptoms in French intensivists. This week's review articles encompass the spectrum of critical care, with papers on neuro, circulatory, respiratory, infectious and obstetric topics. There is also a excellently written paper on the basics of statistics for clinicians.
Staying on this subject, and forming the first part of a 2 week focus, the topic for This Week's Papers is statistics, starting with the basics of data in today's Paper of the Day. This 2 part series is based on an excellent set of papers published in critical care in 2003.
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American Journal of Respiratory & Critical Care Medicine: Sedation
Shehabi ad colleagues, in association with the ANZICS Clinical Trials Group, performed a multi-centre cohort study to investigate the effects of early sedation in 251 ventilated critically ill ICU patients sedated for at least 24 hours. 251 patients were assessed (mean age: 61.7±15.9 years; mean APACHE II score: 20.8±7.8), and had an in-hospital mortality of 21.1%(n=53) and a 180 day mortality of 25.8%(n=64). Over the study period of 2678 days, 14736 RASS assessments were performed, with deep sedation occurred in 76.1% (n=191) patients within 4 hours of commencing ventilation and in 68% (n=171) patients at 48 hours. Delirium occurred in 50.7% (n=111) patients with a duration (median/inter-quartile range) of 2/1-4 days. After adjusting multiple confounders, early deep sedation was an independent predictor of time to extubation (HR 0.90, 95% CI 0.87-0.94,P <0.001), hospital death (HR 1.11, 95%CI 1.02-1.20, P=0.01), and 180-day mortality (HR 1.08,95% CI 1.01-1.16,P=0.026), but not delirium occurring after 48 hours (P=0.19).
Abstract: Shehabi. Early Intensive Care Sedation Predicts Long-Term Mortality in Ventilated Critically Ill Patients:Sedation Practice in Intensive Care Evaluation (SPICE) Study.Am. J. Respir Crit Care Med 2012;epublished ahead of print
Resuscitation: Death Prediction
To estimate the ability of commonly measured laboratory variables to predict death within 1 day in ward patients, Loekito et al performed a retrospective study evaluating an inception cohort of 42,701 patients and a subsequent external validation cohort of 13,137 patients. In the primary cohort, analysis was made on 418,897 batches of tests in 42,701 patients (males 55%; average age 65.8±17.6 years, 1596 number of deaths), for a total of >2.5 million individual measurements. In the secondary cohort, analysis was performed on 105,074 batches from 13,137 patients. Multivariable logistic modelling achieved an AUC-ROC of 0.87 (95% CI: 0.85-0.89) in the inception cohort and an AUC-ROC of 0.88 (95% CI: 0.85-0.90) in the validation cohort, for the prediction of death within 1 day.
Clinical Infectious Disease: Voriconazole Monitoring
Park et al performed a single-centre, blinded, randomized controlled trial in 110 patients to determine whether routine therapeutic drug monitoring of voriconazole reduces drug adverse events or improves treatment response in invasive fungal infections. In the monitored group, voriconazole dosage was adjusted according to a serum target range of 1.0–5.5 mg/L measured on the fourth day after initiation of voriconazole, while the non-monitored group received a fixed, standard dosage. The incidence of adverse events was similar between groups (both 42%; P = .97), while the proportion of voriconazole discontinuation due to adverse events was significantly lower in the monitored group (4% vs 17%; P = .02). A complete or partial response was observed in 81% (30 of 37) of patients in the monitored group compared to 57% (20 of 34) in the non-monitored group (P = .04).
Abstract: Park. The Effect of Therapeutic Drug Monitoring on Safety and Efficacy of Voriconazole in Invasive Fungal Infections: A Randomized Controlled Trial. Clin Infect Dis 2012 epublished ahead of print
Annals of Intensive Care: Depressive Symptoms in Intensivists
Embriaco et al performed a one-day national survey of 189 ICUs in French public hospitals to evaluate the prevalence and associated risk factors of depressive symptoms in intensivists. 901 surveys were returned (75.8% response rate). Symptoms of depression were found in 23.8%, with 58% of these wishing to leave their job compared with only 33% of those who did not exhibit signs of depression (p < 0.0001). Multiple logistic regression showed that organizational factors, including workload, impaired relationships with other intensivists and burnout, were associated with the presence of depressive symptoms. Good relationships with non-intensive care colleagues had a protective effect.
Critical Care: Antibiotic Resistance
- Carlet. The Barcelona Declaration from the World Alliance against Antibiotic Resistance: engagement of intensivists. Critical Care 2012, 16:145
Review - Clinical
Minerva Anestesiologica: MRSA
- Karampela. Community acquired methicillin resistant Staphylococcus aureus pneumonia: an update for the emergency and intensive care physician. Minerva Anestesiologica 2012;78(8):930-40
Minerva Anestesiologica: ARDS
- Repessé. Right ventricular failure in acute lung injury and acute respiratory distress syndrome. Minerva Anestesiologica 2012;78(8):941-8
Minerva Anestesiologica: Traumatic Brain Injury
- Feyen. Neuromonitoring in traumatic brain injuryFeyen. Neuromonitoring in traumatic brain injury. Minerva Anestesiologica 2012;78(8):949-58
Minerva Anestesiologica: Oesophageal Pressure Monitoring
- Hedenstierna. Esophageal pressure: benefit and limitations. Minerva Anestesiologica 2012;78(8):959-66
Journal of Obstetric Anaesthesia & Critical Care: Obstetric Trauma
Scandanavian Journal of Trauma, Resuscitation and Emergency Medicine: Cervical Spine Injury
- Voss. Methods for evaluating cervical range of motion in trauma settings. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2012;20:50
Clevland Clinic Journal of Medicine: Cellulitis
Clevland Clinic Journal of Medicine: Autoinflammatory Syndromes
- Zeft. Autoinflammatory syndromes: Fever is not always a sign of infection. Cleve Clin J Med 2012;79: 569-581
Clevland Clinic Journal of Medicine: Atrial Fibrillation
Annals of Intensive Care: Beta-Lactam Pharmacokinetics
- Sime. Does Beta-lactam Pharmacokinetic Variability in Critically Ill Patients Justify Therapeutic Drug Monitoring? A Systematic Review. Annals of Intensive Care 2012;2:35
Review - Basic Science
Indian Journal of Pharmacology: Statistics
I hope you find these brief summaries and links useful.
Until next week