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Newsletter 100 / November 3rd 2013

Welcome

Hello

Welcome to the 100th Critical Care Reviews Newsletter, bringing you the best critical care research published in the past week, plus a wide range of free full text review articles and guidelines from over 300 clinical and scientific journals. It's a mixed newsletter, with no major research published this week, but still contains 46 review articles, 6 guidelines, 4 editorials and 7 commentaries, as well as links to 16 articles from the major critical care journals which have now been made open access. In addition, the latest CPD quiz, on minimally invasive cardiac output monitors is now available. Read the article, complete the MCQ, and print your personalised certificate for revalidation/CPD purposes. Registration is required to take the quiz, as your name is needed for the certificate.

This week's guidelines address airway management, faecal incontinence, alcoholic liver disease, anti-platelet therapy, cardiac resynchronization and cath lab radiation exposure. Editorials focus on acute heart failure, open access publication and tranexamic acid. Commentaries look at conflict-of-interest, clinical errors, septic shock and contrst-induced nephropathy.

Amongst the clinical review articles are papers on sedation in the neurological ICU, cardiopulmonary resuscitation, catheter-related bloodstream infection, airway clearance, fulminant clostridium difficile colitis, hepatopulmonary syndrome, nutrition in trauma, diabetes insipidus, C-reactive protein and traumatic colonic injuries. Non-clinical review articles include a paper on managing an emergency department.

The topic for This Week's Papers is extracorporeal therapies, starting with a paper on liver support in tomorrow's Paper of the Day.

There are three meetings coming up that might be of interest to you:

Critical Care Reviews Meeting January 24th, 2014 - Belfast, Northern Ireland

If you are in Ireland or Great Britain (or a short flight away), Critical Care Reviews will be hosting it's second meeting outside Belfast, Northern Ireland. It's an all-day event with a fantastic programme consisting of local intensivists, local non-critical care specialists, and outstanding international guest speakers. The programme has been finalised and approved for 5 CPD points by the Royal College of Anaesthetists. Registration is now open.

Intensive Care Society State-of-the-Art Meeting, December 16th - 18th, London

The ICS will be holding their annual State-of-the-Art meeting in London this December. It's the largest meeting of its kind in the UK and attracts a host of big names from the world of critical care.

SMACC GOLD March 19-21st, 2014 Gold Coast, Queensland, Australia

This major international conference, also in it's second year, is a must for those active in the online critical care community. Webmasters of the most prominent critical care websites and blogs will descend on the beautiful Gold Coast for an amazing get together of like-minded people in a totally different style of conference. Registration is currently open.

Research

Interventional Trials

Critical Care: Acute Kidney Injury

Kim and colleagues completed a single-centre, randomized, case-controlled, double-blind study comparing erythropoietin (300 IU/kg post anesthetic induction, n=49) with control (n=49) on the incidence of postoperative acute kidney injury (defined as increase in serum creatinine >0.3 mg/dl or >50% from baseline) in the setting of complex cardiac surgery, and found:

no difference in
- group baseline values
- incidence of postoperative AKI (control 32.7% vs eyrthropoietin 34.7%; P = 0.831)
- levels of renal injury biomarkers, including cystatin C and neutrophil gelatinase-associated lipocalin
- postoperative increase in interleukin-6 or myeloperoxidase
erythropoietin was not associated with any complications, including thromboembolic events

Full Text: Kim. Effect of erythropoietin on the incidence of acute kidney injury following complex valvular heart surgery: a double blind, randomized clinical trial of efficacy and safety. Critical Care 2013;17:R254

Journal of the American Medical Association: Anti-Platelet Therapy

Feres and colleagues performed an open-label, active-controlled, 1:1 randomized, noninferiority study assessing the clinical noninferiority of 3 months (n = 1,563) vs 12 months (n = 1,556) of dual antiplatelet therapy (aspirin 100-200 mg daily and clopidogrel 75 mg daily) in patients with stable coronary artery disease or history of low-risk acute coronary syndrome undergoing percutaneous coronary intervention with zotarolimus-eluting stents, and found:

no difference in (short term versus long term)
- the primary outcome, a composite of all-cause death, myocardial infarction, stroke, or major bleeding
  - 93 [6.0%] versus 90 patients [5.8%]; risk difference 0.17 (95% CI −1.52 to 1.860); P = 0.002 for noninferiority
- Kaplan-Meier estimates of a composite of all-cause death, myocardial infarction, emergent coronary artery bypass graft surgery, or target lesion revascularization rates at 1 year of
  - 128 [8.3%] versus 114 [7.4%]; HR 1.12 (95% CI 0.87-1.45)
- between 91 and 360 days
  - a composite of all-cause death, myocardial infarction, stroke, or major bleeding
    - 39 [2.6%] vs 38 [2.6%], HR 1.03 (95% CI 0.66-1.60)
  - a composite of all-cause death, myocardial infarction, emergent coronary artery bypass graft surgery, or target lesion revascularization
    - 78 [5.3%] vs 64 [4.3%]; HR 1.22 (95% CI 0.88-1.70)
  - stent thrombosis
    - 4 [0.3%] vs 1 [0.1%]; HR 3.97 (95% CI 0.44-35.49)

Full Text: Feres. Three vs Twelve Months of Dual Antiplatelet Therapy After Zotarolimus-Eluting Stents. The OPTIMIZE Randomized Trial. JAMA 2013;epublished October 31st

Clinical Infectious Disease: Influenza

Lee and colleagues completed a dual site, prospective, interventional study, comparing 150 mg (n=41) with 75 mg (n=114) oseltamivir twice daily for 5 days, commenced within 96 hours of presentation, with allocated by site, which switched after 2 influenza seasons, in 165 adults with laboratory-confirmed influenza (85 A/H3N2, 34 A/H1N1pdm09, 36 B), and found:

higher trough oseltamivir carboxylate levels in the 150-mg group (501.0 ± 237.0 vs 342.6 ± 192.7 ng/mL)
no significant differences in
- day 5 viral RNA (44.7% vs 40.2%)
- culture negativity (100.0% vs 98.1%)
- RNA decline rate
- durations of fever, oxygen supplementation, and hospitalization
subanalysis of influenza B patients showed faster
- RNA decline rate (analysis of variance, F = 4.14; P = 0.05) and clearance (day 5, 80.0% vs 57.1%) with higher-dose treatment.
there was no oseltamivir resistance
treatments were generally well tolerated

Abstract: Lee. A Prospective Intervention Study on Higher-Dose Oseltamivir Treatment in Adults Hospitalized With Influenza A and B Infections. Clin Infect Dis 2013;57:1511-1519

Meta Analysis

Critical Care: Percutaneous Tracheostomy

Simon and colleagues analyzed cases of lethal outcome due to complications from percutaneous dilatational tracheostomy, including 68 published cases (1985 - 2013) and 3 of their own patients, and found:

lethal complications occurred in 0.17%
of the fatal complications
- 31.0% occurred during the procedure
- 49.3% within seven days of the procedure
main causes of death were
- hemorrhage (38.0%)
- airway complications (29.6%)
- tracheal perforation (15.5%)
- pneumothorax (5.6%)
specific risk factors for complications in 73.2% of patients, with 25.4% of patients having more than one risk factor
bronchoscopic guidance was used in only 46.5% of cases