Critical Care Reviews Newsletter

April 9th 2012



Welcome to the 18th 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.



American Journal of respiratory and Critical Care Medicine:     ARDS

Mikkelsen et al performed a telephone survey of 213 of the 406 survivors from the ARDSnet FACTT trial, to determine neuropsychological function at 2 and 12 months post hospital discharge. Memory, verbal fluency and executive function were impaired in 13% (12/92), 16% (15/96), and 49% (37/76) of long-term survivors. Long-term cognitive impairment was present in 41 of the 75 (55%) survivors who completed cognitive testing. Depression, post-traumatic stress disorder, or anxiety was present in 36% (37/102), 39% (40/102), and 62% (63/102) of long-term survivors. Enrollment in a conservative fluid-management strategy (p=0.005) was associated with cognitive impairment and lower partial pressure of arterial oxygen during the trial was associated with cognitive (p=0.02) and psychiatric impairment (p=0.02).

Abstract: Mikkelsen. The ARDS Cognitive Outcomes Study (ACOS): Long-Term Neuropsychological Function in Acute Lung Injury Survivors.Am. J. Respir. Crit. Care Med 2012; epublished ahead of print


Clinical Infectious Diseases:     Tigecycline

Prasad et al performed a meta analysis of 10 published and 3 unpublished studies (N = 7434) examining excess deaths and non-cure rates for both approved and non-approved indications for tigecycline. Across randomized controlled trials, tigecycline was associated with increased mortality [risk difference (RD) 0.7%; 95% CI (0.1% to 1.2%), p = 0.01] and non-cure rates [RD 2.9%; 95% CI (0.6% to 5.2%), p = 0.01]. Effects were not isolated to one type of infection or comparator antibiotic regimen and the impact on survival remained significant when limited to trials of approved indications (I2 = 0%; RD 0.6%, p = 0.04). A pooled analysis of the five trials completed by early 2005 before tigecycline was approved would have demonstrated a similar harmful effect of tigecycline on survival (I2 = 0%; RD 0.7%, p = 0.06).

Abstract: Prasad. Excess Deaths Associated with Tigecycline After Approval Based on Non-Inferiority Trials. Clin Infect Dis 2012; epublished ahead of print


Gastroenterology:     Prometheus

Kribben et al performed a randomised controlled trial comparing fractionated plasma seperation and adsorption (Prometheus) plus standard medical therapy (n=77) with standard medical therapy alone (n=68). In an intention-to-treat analysis, the probabilities of survival on day 28 were 66% in the FPSA group and 63% in the SMT group (P = .70); on day 90, they were 47% and 38%, respectively (P = .35). Serum bilirubin level decreased significantly in the FPSA group but not in the SMT group. Factors independently associated with poor prognosis were high SOFA score, bleeding, female sex, spontaneous bacterial peritonitis, intermediate increases in serum creatinine concentration, and combination of alcoholic and viral etiology of liver disease. There were no differences between the 2 groups in the incidence of side effects.

Abstract: Kribben. Effects of Fractionated Plasma Separation and Adsorption on Survival in Patients With Acute-on-Chronic Liver Failure (HELIOS study). Gastroenterology 2012;142(4)782-789

Associated Editorial:  Leckie. Albumin Regeneration for Extracorporeal Liver Support Using Prometheus: A Step in the Right Direction. Gastroenterology 2012;142(4):690-692


Journal of Hepatology:     Cirrhosis & Renal Failure

Fede et al report a systematic review of 74 trials in 8088 patients reporting mortality occuring in cirrhotic patients with renal failure. Overall median mortality for renal failure patients was 67%: 58% at 1month and 63% (IQR 54–79) at 12months. Pooled odds ratio for death renal failure vs. non-renal failure patients was 7.6 (95%CI 5.4–10.8).

Abstract: Fede. Renal failure and cirrhosis: A systematic review of mortality and prognosis. Journal of Hepatology 2012;56(4):810-818


British Medical Journal:     Mechanical Ventilation in ARDS

Needham and colleagues performed an observational study evaluating 2 year outcomes in 485 consecutive mechanically ventilated patients with acute lung injury. They found that after adjusting for the total duration of ventilation and other relevant covariates, each additional ventilator setting adherent to lung protective ventilation was associated with a 3% decrease in the risk of mortality over two years (hazard ratio 0.97, 95% CI 0.95 to 0.99, P=0.002). Compared with no adherence, the estimated absolute risk reduction in two year mortality for a prototypical patient with 50% adherence to lung protective ventilation was 4.0% (0.8% to 7.2%, P=0.012) and with 100% adherence was 7.8% (1.6% to 14.0%, P=0.011).

Full Text: Needham. Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study. BMJ 2012; 344


New England Journal of Medicine:     Pulmonary Embolism

In a randomized, open-label, event-driven, noninferiority trial involving 4832 patients who had acute symptomatic pulmonary embolism with or without deep-vein thrombosis,  rivaroxaban (15 mg twice daily for 3 weeks, followed by 20 mg once daily) was compared with standard therapy with enoxaparin followed by an adjusted-dose vitamin K antagonist for 3, 6, or 12 months. Rivaroxaban was noninferior to standard therapy (noninferiority margin, 2.0; P=0.003) for the primary outcome of symptomatic recurrance, with 50 events in the rivaroxaban group (2.1%) versus 44 events in the standard-therapy group (1.8%) (hazard ratio, 1.12; 95% CI, 0.75 to 1.68). The principal safety outcome occurred in 10.3% of patients in the rivaroxaban group and 11.4% of those in the standard-therapy group (hazard ratio, 0.90; 95% CI, 0.76 to 1.07; P=0.23). Major bleeding was observed in 26 patients (1.1%) in the rivaroxaban group and 52 patients (2.2%) in the standard-therapy group (hazard ratio, 0.49; 95% CI, 0.31 to 0.79; P=0.003). Rates of other adverse events were similar in the two groups.

Abstract: The EINSTEIN–PE Investigators. Oral Rivaroxaban for the Treatment of Symptomatic Pulmonary Embolism. N Engl J Med 2012; 366:1287-1297



Archives of Internal Medicine:     Pulmonary Embolism



Scandanavian Journal of Trauma, Resuscitation and Emergency Medicine:     Abdominal Compartment Syndrome


Scandanavian Journal of Trauma, Resuscitation & Emergency Medicine:     Burr Holes


Cardiology:     Aortic Function


World Journal of Cardiology:     Bleeding & Anticoagulation

Medical Science Monitor:     Pulmonary Hypertension


Annals Academy Medicine Singapore:     Healing


Singapore Medical Journal:     ECG Interpretation


Israeli Medical Association Journal:     Beta Blockade in Decompensated Heart Failure


Indian Journal of Critical Care Medicine:     Acute Liver Failure


Therapeutics and Clinical Risk:     MRSA



I hope you find these updates useful.

Until next week