Newsletter 109 / January 8th 2014
Welcome
Hello
Welcome to the 109th 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. Apologies for the very late delivery of this week's newsletter - I've been busy preparing for a series of three podcasts, reviewing the best critical care literature of 2013, with Chris Nickson from Life in the Fastlane and the SMACCgold conference. These should be available in the near future.
In news this week is the tragic story of American schoolgirl Jahi McMath, pronounced brain dead by her clinical team in California after suffering postoperative complications, yet transferred out of the ICU in which she was being treated after her parents won a court order preventing the withdrawal of mechanical ventilation.
This week's research studies include randomized controlled trials evaluating the utility of limited echocardiography in trauma, salbutamol for the prevention of post oesophagectomy lung injury, and bivalirudin for myocardial infarction PCI; meta analyses address the use of parenteral fish oil lipid emulsions, dexmedetomidine sedation, and urinary kidney injury molecule 1 for the detection of acute kidney injury; while observational studies include investigations into pulse pressure variation monitors, tracheostomy timing in traumatic brain injury and pulmonary dead-space fraction in ARDS.
This week's guidelines focus on renal replacement therapy for AKI, apixaban, and the management of perforated sigmoid diverticulitis. Editorials discuss conflicts of interest, checklists, and scientific writing, while commentaries focus on antibiotics, the total artificial heart and perioperative mortality.
Amongst the clinical review articles are papers on ischaemic stroke, heart failure, CABG, mechanical ventilation, bariatric emergencies, drug-induced liver injury, haemodialysis, the KDIGO guidelines, mitochondrial homeostasis, novel oral anticoagulants, thrombotic thrombocytopenic purpura and atypical haemolytic uraemic syndrome, septic shock, anaphylaxis, major limb injuries, local anaesthetic toxicity and NSAID toxicity. If you work in a rural area, then you'll be interested in a review of swine zoonoses documenting all manner of transmissible infections, including ebola. Non-clinical reviews discuss retractions and plagarism, while general interest articles consider the major scientific advances and setbacks of 2013. The topic for This Week's Papers is interesting review articles of 2013, with today's Paper of the Day examining fluid balance in acute kidney injury.
Critical Care Reviews Meeting
It's just 2 weeks to the 2014 Critical Care Reviews Meeting. This year we discuss the major studies from the past 12 months, hear from our international guest speakers, Prof Alistair Nichol (Dublin/Melbourne), Prof Mervyn Singer (London) and Prof John Marshall (Toronto), and have updates on ICU infections, massive haemorrhage and acute liver failure. The evening session provides an opportunity to chat with our guest speakers in a novel, informal setting - beside a blazing log fire in a beautiful lounge - perfect for a cold winters night. This will be followed by dinner and the chance to meet new colleagues and friends.
If you're a drive or short flight away, it would be great to have you come along. Travel on Thursday, attend the meeting on Friday and see some of the local landmarks over the weekend, before returning home on Sunday evening after a great winter break. On Saturday visit the North Coast: the World Heritage site Giants Causeway, Carrick-a-Rede rope bridge, Dunluce Castle and Bushmills Distillary, the oldest distillary in the world; while on Sunday experience Belfast: the new acclaimed Titanic Centre followed by a famous black taxi tour describing the troubled past of one of Europe's now most vibrant cities. The Galgorm Resort and Spa is one of Northern Ireland's premier hotels and is a 30 minute drive from Belfast International Airport. Special room rates are available, by quoting the meeting. Please feel free to contact me if you're thinking about making the trip - it would be great to hear from you.
This year, the meeting will be run in association with the Northern Ireland Intensive Care Society. Further details, the meeting programme, and registration can be accessed via these links.
News
Research
Randomized Controlled Trials
Ferrada and colleagues randomized 240 trauma patients with an episode of hypotension or tachycardia to either limited transthoracic echocardiography (n=123), consisting of simple evaluations of (1) ventricular contractility, (2) fluid status, and (3) pericardial effusion, or no echo (n=92) and found:
- 25 patients died on arrival and were excluded
- there were no baseline differences between groups
- limited echo was associated with
- less intravenous fluid therapy
- 1.5 L vs. 2.5 L, p < 0.0001
- shorter duration between trauma bay and operating theatre
- 35.6 minutes vs. 79.1 min, p = 0.0006
- higher rate of ICU admission
- 80.4% vs. 67.2%, p = 0.04
- a nonsignificant lower mortality rate
- 11% vs. 19.5%, p = 0.09
- most marked in those with traumatic brain injury patients
- 14.7% vs. 39.5%, p = 0.03
- most marked in those with traumatic brain injury patients
- 11% vs. 19.5%, p = 0.09
- less intravenous fluid therapy
Perkins and colleagues compared inhaled salmeterol (100 mcg twice daily, n=179) or a matching placebo (n=183) on the development of acute lung injury in 362 patients undergoing elective oesophagectomy, and found:
- groups were similar at baseline
- there was no difference in
- early lung injury
- salmeterol 19·2% vs. placebo 16·0%; odds ratio 1·25 (95% CI 0·71 – 2·22)
- organ failure
- survival
- health related quality of life
- early lung injury
- salmeterol was associated with
- less adverse events
- 55 versus 70; odds ratio 0·63 (95% CI 0·39 to 0.99)
- mainly due to less pneumonia
- 7 versus 17; odds ratio 0·39 (95% CI 0·16 to 0·96)
- less adverse events
Meta Analysis
Pasin and colleagues reviewed 28 randomized studies comparing dexmedetomidine (n=1,870) with a comparitor (n=1,778) as a sedative in critically ill, mechanically ventilated patients, and found:
- dexmedetomidine was associated with significant reductions in
- length of ICU stay
- weighted mean difference −0.79 (95% CI −1.17 to −0.40) days, p for effect <0.001
- time to extubation
- weighted mean difference −2.74 (95% CI −3.80 to −1.65) hours, p for effect <0.001
- length of ICU stay
- no mortality difference
- risk ratio 1.00 (0.84 to 1.21), p for effect = 0.9
- high heterogeneity between studies
Manzanares et al pooled data from 6 randomized controlled trials evaluating fish oil-containing emulsions, either parenteral or enteral, in 390 critically ill patients, and found:
- administration of fish oil-containing emulsions were not associated with improvements in
- mortality
- risk ratio 0.71; 95% CI 0.49 to 1.04; P = 0.08; heterogeneity I2 = 0%
- duration of mechanical ventilation
- weighted mean difference −1.41 days; 95% CI −3.43 to 0.61; P = 0.17
- infections
- RR 0.76; 95% CI 0.42 to 1.36; P = 0.35
- intensive care unit length of stay
- weighted mean difference −0.46; 95% CI −4.87 to 3.95; P = 0.84, heterogeneity I2 = 75%
- mortality
Observational Studies
Mahjoub et al investigated the proportion of patients satisfying criteria for valid application of respiratory variation in pulse pressure (ΔPP) as a measure of fluid responsiveness at a given time-point in all patients in 26 French ICUs (n=311) and found:
- only six patients (2%) patients satisfied all validity criteria
- of 170 patients with an arterial line, only five (3%) satisfied the validity criteria
- during the 24 hours preceding the study time-point, fluid responsiveness was assessed for in 79 patients
- ΔPP had been used to assess fluid responsiveness in 15 of these cases (19%)
Using data from the American College of Surgeons’ Trauma Quality Improvement Program, Alali and colleagues compared early tracheostomy (≤8 days) versus late tracheostomy (>8 days) in a propensity-matched cohort of 1,154 patients with isolated traumatic brain injury and found:
- early tracheostomy was associated with
- reduced durations of
- mechanical ventilation
- 10 days vs. 16 days; rate ratio 0.70; 95% CI 0.66 to 0.75
- ICU stay
- 13 days vs. 19 days; RR 0.70; 95% CI 0.66 to 0.75
- hospital stay
- 20 days vs. 27 days; RR 0.80; 95% CI 0.74 to 0.86
- mechanical ventilation
- lower odds of
- pneumonia
- 41.7% vs. 52.7%; odds ratio 0.64; 95% CI 0.51 to 0.80
- deep venous thrombosis
- 8.2% vs. 14.4%; OR 0.53; 95% CI 0.37 to 0.78
- decubitus ulcer
- 4.0% vs. 8.9%; OR 0.43; 95% CI 0.26 to 0.71
- pneumonia
- no significant difference in
- pulmonary embolism
- 1.8% vs. 3.3%; OR 0.52; 95% CI 0.24 to 1.10
- hospital mortality
- 8.4% vs. 6.8%; OR 1.25; 95% CI 0.80 to 1.96
- pulmonary embolism
- reduced durations of
Kallet and colleagues performed a secondary examination of the multi-centre, randomized controlled, β agonist ALTA study, evaluating the association between pulmonary dead-space fraction (VD/VT) and mortality in 126 patients with ARDS, and found:
- differences in VD/VT between non-survivors and survivors:
- at baseline
- 0.62 ± 0.11 vs. 0.56 ± 0.11, p = 0.08
- at day 1
- 0.64 ± 0.12 vs. 0.55 ± 0.11, p = 0.01
- at day 2
- 0.67 ± 0.12 vs. 0.56 ± 0.11, p=0.004
- at baseline
- adjusted associations between VD/VT and mortality:
- day 1
- odds ratio per 0.10 change in VD/VT: 6.84 (95% CI 1.62 to 28.84); p = 0.01
- day 2:
- odds ratio per 0.10 change in VD/VT: 4.90 (95% CI 1.28 to 18.73); p = 0.02
- day 1
- VD/VT was associated with a trend towards higher mortality
- HR 4.37 (95% CI 0.99 to 19.32); p = 0.052
- adjusted for daily oxygenation index
- HR 1.74 (95% CI 1.12 to 3.35); p = 0.04
- HR 4.37 (95% CI 0.99 to 19.32); p = 0.052
Other Studies of Interest
Randomized Controlled Trial
Meta Analysis
Observational Studies
- Full Text: Nakahira. Circulating Mitochondrial DNA in Patients in the ICU as a Marker of Mortality: Derivation and Validation. PLoS Med 2013;10(12):e1001577
- Abstract: Reilly. ABO Blood Type A is Associated with Increased Risk of Acute Respiratory Distress Syndrome in Caucasians Following both Major Trauma and Severe Sepsis. Chest 2014;epublished January 2nd
- Abstract: Bernal. Survival of hematological patients after discharge from the intensive care unit: a prospective observational study. Critical Care 2013;17:R302
- Abstract: Takase. Kidney function crucially affects BNP, NT-proBNP and their relationship. European Journal of Clinical Investigation 2013;epublished December 31st
Guidelines & Position Statements
- Jörres. A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines on Acute Kidney Injury: part 2: renal replacement therapy. Nephrol Dial Transplant 2013;28(12):2940-2945
- Ward . Practical management of patients on apixaban: a consensus guide. Thrombosis Journal 2013;11:27
- Moore. Position paper: management of perforated sigmoid diverticulitis. World Journal of Emergency Surgery 2013;8:55
Editorials
- Mahajan. Conflicts of interest in medical journals. Rev Colomb Anestesiol 2013;41:179-81
- Buitrago. The checklist: A standard of care. Rev Colomb Anestesiol 2013;41:182-3
- Eslava-Schmalbach. Scientific writing, a neglected aspect of professional training. Rev Colomb Anestesiol 2013;41:79-8
Commentaries
- Gómez. Blood flow and pulmonary ventilation: New paradigm? Rev Colomb Anestesiol 2013;41:280-2
- McDonough. Realizing the Promise of the Affordable Care Act—January 1, 2014. JAMA 2013;epublished January 2nd
- Gupta. Dry antibiotic pipeline: Regulatory bottlenecks and regulatory reforms. J Pharmacol Pharmacother 2014;5:4-7
- Goel. Bedaquiline: A novel drug to combat multiple drug-resistant tuberculosis. J Pharmacol Pharmacother 2014;5:76-8
- Rosengart. Cardiac Cellular Reprogramming. Tex Heart Inst J 2013;40(5):581–582
- Copeland. SynCardia Total Artificial Heart: Update and Future. Tex Heart Inst J 2013;40(5):587–588
- Scudellari. Outwitting the Perfect Pathogen. Scientist 2013;epublished January 1st
- McDonough. Realizing the Promise of the Affordable Care Act—January 1, 2014. JAMA 2013;epublished January 2nd
- Giovanni. Perioperative mortality: an emergent global public health problem. Egypt J Cardiothorac Anesth 2013;7:41-2
Reviews - Clinical
Neurological
- Tong. The role of imaging in acute ischemic stroke. Neurosurgical Focus 2014;36(1):E3
- Mokin. Endovascular treatment of acute ischemic stroke: the end or just the beginning? Neurosurgical Focus 2014;36(1):E5
- Leithner. The oxygen paradox of neurovascular coupling. Journal of Cerebral Blood Flow & Metabolism 2014;34:19–29
Circulatory
- Bartel. Why is intracardiac echocardiography helpful? Benefits, costs, and how to learn. Eur Heart J 2014;35:69-76
- Diodat. Coronary Artery Bypass Graft Surgery: The Past, Present, and Future of Myocardial Revascularisation. Surgery Research and Practice Volume 2014;726158
- Erturk. Ischemia-Reperfusion Injury and Volatile Anesthetics. BioMed Research International 2014;2014:526301
- Hamm. The Year in Cardiology 2013: acute coronary syndromes. Eur Heart J 2014;epublished January 2nd
- Ertl. The Year in Cardiology 2013: heart failure. Eur Heart J 2014;epublished January 2nd
- Kuck. The Year in Cardiology 2013: arrhythmias. Eur Heart J 2014;epublished January 2nd
- Erbel. The Year in Cardiology 2013: coronary intervention. Eur Heart J 2014;epublished January 2nd
- Kapoor. Cardiopulmonary bypass in pregnancy. Ann Card Anaesth 2014;17:33-9
- Mittnacht AJ, Rodriguez-Diaz C. Multimodal neuromonitoring in pediatric cardiac anesthesia. Ann Card Anaesth 2014;17:25-32
- Tokmaji. Management Strategies in Cardiac Surgery for Postoperative Atrial Fibrillation: Contemporary Prophylaxis and Futuristic Anticoagulant Possibilities. Cardiology Research and Practice 2013;2013:637482
- Komamura. Similarities and Differences between the Pathogenesis and Pathophysiology of Diastolic and Systolic Heart Failure. Cardiology Research and Practice 2013;2013:824135
- Li. Current Treatment of Heart Failure with Preserved Ejection Fraction: Should We Add Life to the Remaining Years or Add Years to the Remaining Life? Cardiology Research and Practice 2013;2013:130724
Respiratory
Gastrointestinal
Hepatobiliary
Renal
- Golper. Hemodialysis: Core Curriculum 2014. American Journal of Kidney Diseases 2014;63(1):153-163
- Okusa. Reading between the (guide)lines—the KDIGO practice guideline on acute kidney injury in the individual patient. Kidney International 2013;85:39–48
Metabolic
Haematological
- Lang. Novel oral anticoagulants for the prevention of thromboembolism in patients with atrial fibrillation. J R Coll Physicians Edinb 2013;43(2):151-8
- Bhanwra. The new factor Xa inhibitor: Apixaban. J Pharmacol Pharmacother 2014;5:12-4
- Cheng. Non-vitamin K antagonist oral anticoagulants in cardiovascular disease management: evidence and unanswered questions. Journal of Clinical Pharmacy and Therapeutics 2014;epublished January 3rd
- Scully. How I treat thrombotic thrombocytopenic purpura and atypical haemolytic uraemic syndrome. British Journal of Haematology 2013;epublished January 6th
Sepsis
- Schorr. Severe sepsis and septic shock: Management and performance improvement. Virulence 2014;5:0-9
- Bloos. Rapid diagnosis of sepsis. Virulence 2014;5
- Lynn. The diagnosis of sepsis revisited - a challenge for young medical scientists in the 21st century. Patient Safety in Surgery 2014;8:1
- Khanna. A Clinician's Primer on the Role of the Microbiome in Human Health and Disease. Mayo Clinic Proceedings 2014;89(1):107-114
- Kahn. Epidemiology, geographical distribution, and economic consequences of swine zoonoses: a narrative review. Emerging Microbes & Infections 2013;2,e92
Immunological
Trauma
Toxicology
Miscellaneous
Reviews - Non-Clinical
- Fanelli. Why Growing Retractions Are (Mostly) a Good Sign. PLoS Med 10(12):e1001563
- Bretag. Challenges in Addressing Plagiarism in Education. PLoS Med 2013;10(12):e1001574
Reviews - General Interest
- Grens. 2013’s Big Advances in Science. Scientist 2013;epublished December 24th
- Grant. Science Setbacks: 2013. Scientist 2013;epublished December 24th
Apologies for the delayed delivery of this newsletter.
Until this weekend
Rob