ccr logo 246x225 13121Critical Care Reviews Newsletter

July 1st 2012





Welcome to the 30th Critical Care Reviews Newsletter. Every week, now 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.

It's a very interesting newsletter this week, with the landmark Scandanavian 6S study providing further evidence of the dangers of hydroxyethyl starch in the critically ill, with increased mortality and no lower safe dose identified.

The topic for This Week's Papers is temperature disorders, starting with fever due to toxicity in tomorrow's Paper of the Day. It's an easy way to stay up-to-date with your reading.

If you think a colleague may find this newsletter useful, please send it on. It's entirely free.



New England Journal of Medicine:     Fluid Resuscitation

In a large international multi-centre, randomized controlled trial, Perner et al compared fluid resuscitation with 130/0.4 hydroxyethyl starch with Ringer's acetate in 804 patients with severe sepsis. At 90 days more patients treated with HES had died (201/398, 51%) than with RA (172/400, 43%), (relative risk, 1.17; 95% CI, 1.01 to 1.36; P=0.03). Similarly, at 90 days more patients treated with HES required renal replacement therapy (22% versus 16%; RR 1.35; 95% CI 1.01 to 1.80; P=0.04). More patients treated with HES had severe bleeding, although this failed to reach statistical significance  (10% versus 6%, RR 1.52; 95% CI 0.94 to 2.48; P=0.09).

Full Text:  Perner. Hydroxyethyl Starch 130/0.4 versus Ringer's Acetate in Severe Sepsis. (6S Trial). N Eng J Med 2012


New England Journal of Medicine:     Infective Endocarditiis

In a randomized trial Kang et al compared early valve surgery with conventional-treatment in 76 patients with left-sided infective endocarditis, severe valve disease, and large vegetations.  The primary end point, a composite of in-hospital death and embolic events that occurred within 6 weeks after randomization, occurred in 1 patient (3%) in the early-surgery group as compared with 9 (23%) in the conventional-treatment group (hazard ratio 0.10; 95% CI 0.01 to 0.82; P=0.03). Although there was no significant difference in all-cause mortality at 6 months in the early-surgery and conventional-treatment groups (3% and 5%, respectively; hazard ratio, 0.51; 95% CI, 0.05 to 5.66; P=0.59), the rate of the composite end point of death from any cause, embolic events, or recurrence of infective endocarditis at 6 months was 3% in the early-surgery group and 28% in the conventional-treatment group (HR 0.08; 95% CI 0.01 to 0.65; P=0.02).

Abstract:  Kang. Early Surgery versus Conventional Treatment for Infective Endocarditis. N Engl J Med 2012; 366:2466-2473


Critical Care:     Meropenam

As meropenem bactericidal activity depends on the duration of free drug concentration above the minimum inhibitory concentration, Chytra et al compared the clinical and microbiological efficacy of continuous versus intermittent meropenem dosing in 240 critically ill patients. Although clinical cure was similar between the two therapies (infusion: 83.0% versus bolus: 75.0%; P = 0.180),  microbiological success was higher in the infusion group (90.6% vs. 78.4%; P = 0.020), with multivariate logistic regression identifying continuous administration as an independent predictor of microbiological success (OR = 2.977; 95% CI = 1.050 to 8.443; P = 0.040). Additionally, continuous infusion was associated with shorter ICU length-of-stay (10 [7-14] days vs. 12 [7-19] days; P = 0.044), as well as shorter duration of meropenem therapy (7 [6-8] days vs. 8 [7-10] days; P = 0.035) and lower total dose of meropenem (24 [21-32] grams vs. 48 [42-60] grams; P <0.0001).  No severe adverse events related to meropenem administration in either group were observed.

Full Text:  Chytra. Clinical and microbiological efficacy of continuous versus intermittent application of meropenem in critically ill patients: a randomized open-label controlled trial. Critical Care 2012, 16:R113


Critical Care:     Sepsis

In an interetsing paper, Tao et al compile the top 50 most cited clinical studies in sepsis. A large American influence is identified, with the majority of studies being American, published in American journals and being cited by American authors. The most influential journals were NEJM and JAMA. The most cited paper was the PROWESS study, being cited 2932 times.



European Heart Journal:     Heart Failure

Full Text:  McMurray. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012 epublished ahead of print


Anaesthesia:     Tracheostomy

Full Text:  McGrath. Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies. Anaesthesia 2012; epublished ahead of print


Journal of Parenteral & Enteral Nutrition:     Glycaemic Control

Full Text: McMahon. A.S.P.E.N. Clinical Guidelines: Nutrition Support of Adult Patients With Hyperglycemia. J Parenter Enteral Nutr published 2012; epublished ahead of print 


Consensus Statement

Perioperative Medicine:     Fluid Management

Full Text:  Mythen. Perioperative fluid management: Consensus statement from the enhanced recovery partnership. Perioperative Medicine 2012;1:2


Review - Clinical

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine:    Sepsis


Cerebrovascular Diseases:     Stroke


Pulmonary Circulation:     Pulmonary Hypertension


Respirology:     Morbid Obesity


Open Access Emergency Medicine:     Pleural Effusion


Infection and Drug Resistance:     Linezolid


Review - Non-Clinical

Respirology:     Research Grants



I hope you find these links and brief summaries useful.

Until next week