Critical Care Reviews Newsletter

March 25th 2012




Welcome to the 16th 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. Also, links are provided to interesting open access review articles, editorials, guidelines and other papers which have been published during the week.



Critical Care:    


Open Access Emergency Medicine


 Quartely Journal of Medicine


Intensive Care Medicine:     Selective Digestive Decontamination



JAMA:     Dexmedetomidine for Sedation in ICU

Jakob and colleagues report the results of two phase 3 international randomized controlled trials evaluating non-inferiority of dexmedetomidine with either midazolam (MIDEX study) or with propofol (PRODEX), for sedation in the ICU.

In the MIDEX study (dexmedetomidine: n = 249, midazolam: n = 251), there was no difference in the time at target sedation {Dex/Mid ratio 1.07 (95% CI, 0.97-1.18)}, although duration of ventilation was shorter {Dex: 123 hours [IQR, 67-337] vs Mid: 164 hours [IQR, 92-380], P = .03}. Patient interaction improved with dexmedetomidine, but there were no differences in length of ICU or hospital stay, or mortality. Dexmedetomidine was associated with more hypotension (51/247 [20.6%] vs 29/250 [11.6%]; P = .007) and bradycardia (35/247 [14.2%] vs 13/250 [5.2%]; P < .001).

In the PRODEX study (dexmedetomidine: n=223, propofol: n=214,), there was no difference in the time spent at target sedation {Dex/Pro ratio 1.00 (95% CI, 0.92-1.08}, or duration of mechanical ventilation {Dex: 97 hours [IQR, 45-257] vs Pro: 118 hours [IQR, 48-327]; P = .24}. Patient interaction was again improved with dexmedetomidine, but similarly, there were no differences in length of ICU or hospital stay, or mortality.

Abstract: Jakob. Dexmedetomidine vs Midazolam or Propofol for Sedation During Prolonged Mechanical Ventilation: Two Randomized Controlled Trials. JAMA 2012;307(11):1151-1160


JAMA:     Adrenaline in Out-Of-Hospital Cardiac Arrest 

Hagihara et al report the association of adrenaline with outcome in out-of-hospital cardiac arrest from 417,188 events recorded in a prospective, nonrandomized, observational study. Return of spontaneous circulation before hospital arrival was observed in 2,786 of 15,030 patients (18.5%) in the adrenaline group and 23,042 of 402,158 patients (5.7%) in the non-adrenaline group (P < .001); it was observed in 2,446 (18.3%) and 1,400 (10.5%) of 13,401 propensity-matched patients, respectively (P < .001). In the total sample, the numbers of patients with 1-month survival and survival with good neurological outcomes, respectively, were 805 (5.4%), 205 (1.4%), and 211 (1.4%) with adrenaline and 18,906 (4.7%), 8,903 (2.2%), and 8,831 (2.2%) without adrenaline (all P <.001). Corresponding numbers in propensity-matched patients were 687 (5.1%), 173 (1.3%), and 178 (1.3%) with adrenaline and 944 (7.0%), 413 (3.1%), and 410 (3.1%) without adrenaline (all P <.001). The authors conclude that the use of prehospital adrenaline was significantly associated with increased chance of return of spontaneous circulation before hospital arrival but decreased chance of survival and good functional outcomes 1 month after the event.

New England Journal of Medicine - Thrombolysis for Stroke

In a phase 2B study, Parsons and colleagues compared tenecteplase (0.1 or 0.25 mg/kg) with alteplase (0.9mg/kg) for thrombolysis in 3 groups of 25 patients with acute cerebral infarction of 6 hours duration or or less. Both tenecteplase groups had greater reperfusion (P=0.004) and clinical improvement (P<0.001) at 24 hours than the alteplase group, with the higher tenecteplase dose being superior to the lower dose.

Abstract: Parsons. A Randomized Trial of Tenecteplase versus Alteplase for Acute Ischemic Stroke. N Engl J Med 2012; 366:1099-1107



I hope you find these brief summaries useful.

Until next week