ccr logo 246x225 13121Critical Care Reviews Newsletter

December 24th 2011






Welcome to the weekly Critical Care Reviews Newsletter. Every week some of the more important research publications in critical care are highlighted. These studies are added to the News section of the website on a daily basis, as publication occurs.


Thursday 22nd December 2011

Clostridium Difficile

In this week's Annals of Internal Medicine, Drekonja and colleagues performed a systematic review comparing the effectiveness of therapies for clostridium difficile. 11 trials that included 1463 participants were identified. Three trials compared metronidazole with vancomycin; 8 compared metronidazole or vancomycin with another agent, combined agents, or placebo. No antimicrobial agent is clearly superior for the initial cure of C. difficile infection. Recurrence is less frequent with fidaxomicin than with vancomycin.

Abstract. Drekonja. Comparative Effectiveness of Clostridium difficile Treatments A Systematic Review. Ann Intern Med. 2011;155:839-847.


Tuesday December 20th 2011

Immunosuppression in Critical Illness

In this week's JAMA, Boomer and colleagues, in a pathological case-control study, compared the immune phenotype of spleen and lungs in subjects who either died of active sepsis (n=40) or had their spleens removed after trauma or brain death (n=20) or lungs from transplant donors or lung cancer resection (n=20). Cytokine secretion in sepsis patients was generally less than 10% that in controls, was independent of age, duration of sepsis, corticosteroid use, and nutritional status, and was consistent with immunosuppression.

Abstract. Boomer. Immunosuppression in Patients Who Die of Sepsis and Multiple Organ Failure. JAMA 2011;306(23):2594-2605


Vasopressin in Cardiac Arrest

In January's issue of Resuscitation, Mentzelopoulos reports a meta-analysis of the use of vasopressin in cardiac arrest. Data from 4475 patients in 6 high-methodological quality RCTs were analyzed. Subgroup analyses were conducted according to initial cardiac rhythm and time from collapse to drug administration (TDRUG)20min. Vasopressin vs. control did not improve overall rates of sustained ROSC, long-term survival, or favourable neurological outcome. However, in asystole, vasopressin vs. control was associated with higher long-term survival {odds ratio (OR)=1.80, 95% confidence interval (CI)=1.04–3.12, P=0.04}. In asystolic patients of RCTs with average TDRUG20min, vasopressin vs. control increased the rates of sustained ROSC (data available from 2 RCTs; OR=1.70, 95% CI=1.17–2.47, P=0.005) and long-term survival (data available from 3 RCTs; OR=2.84, 95% CI=1.19–6.79, P=0.02).

Abstract. Mentzelopoulos. Vasopressin for cardiac arrest: Meta-analysis of randomized controlled trials. Resuscitation 2012;83(1):32-39 


Monday December 19th 2011

January's issue of Anesthesia & Analgesia has been released and contains the following articles:


Guidelines on Ultrasound Guided Vascular Cannulation

The American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists  have released a joint guideline on the use of ultrasound for central venous cannulation. Unfortunately as a non-subscriber I can't access this guideline, which seems to defeat the purpose of generating it if dissemination is limited by the need for payment!

Troianos et al. Guidelines for Performing Ultrasound Guided Vascular Cannulation: Recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Anesth Analg 2012;114 46-72


Hydroxyethyl Starch Meta-Analysis

Following the Boldt scandel, Gattas and colleagues performed a systematic analysis comparing the effects of 6% Hydroxyethyl Starch 130/0.4 with other colloid or crystalloid solutions on mortality, acute kidney injury/failure, and bleeding in acutely ill or perioperative patients. 36 studies had initially been reported, of which 11 were subsequently retracted, leaving 19 studies (n = 1246) which were conducted in perioperative patients and 6 (n = 362) in critically ill patients. Published studies were of poor quality and reported too few events to reliably estimate the benefits or risks of administering 6% HES 130/0.4. This same conclusion was reached with or without the retracted studies.

Abstract. Gattas. Fluid Resuscitation with 6% Hydroxyethyl Starch (130/0.4) in Acutely Ill Patients: An Updated Systematic Review and Meta-Analysis. Anesth Analg 2012;114:159-169



I hope you find these brief summaries useful.

Until next week