February 17th 2013
Welcome to the 63rd 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.
There is little primary research this week, with meta analysis instead dominating this week's research report. However, a small measurement study does question the use of haemglobin and haematocrit values as a means to guide red cell transfusion. Also tedizolid phosphate, a novel oxazolidinone, was shown to be non-inferior to linezolid for the treatment of acute bacterial skin and skin structure infections. There are a couple of study critiques as well as new guidance on the management of subarachnoid haemorrhage.
Amongst the 35 clinical review articles are several from Advances in Chronic Kidney Disease, which provide an excellent update across a range of conditions in critical care. There are a couple of non-clinical review articles also, on negligence and the top journal selectivity index.
Blood Transfusion: Haematocrit as a Transfusion Trigger
Using a non-radioactive double-tracer technique to assess blood volume components in 46 healthy male endurance athletes, Jacob et al demonstrated that red cell volume (2,282±283 mL) did not correlate with either haematocrit (0.42±0.02) or haemoglobin concentration (14.2±0.8, P>0.05), but was predictable from body surface area (red cell volume [mL]=1,547 x body surface area [m2]–723; r=.88, P<0.01). A similar accuracy was unobtainable using any potential predictor for plasma or blood volume, haematocrit or haemoglobin concentration. Red cell volume showed high intra-individual stability when measured again after 4 weeks, whereas plasma volume oscillated in both directions by up to 22%. Conclusion: This small study questions the validity of basing transfusion thresholds on red cell concentrations, rather than blood volumes, although this remains to be tested in a clinically setting.
British Medical Journal: Hydroxyethyl Starch
Haase et al completed a systematic review and meta analysis in 9 trials and 3456 patients, to assess the effects of fluid therapy with hydroxyethyl starch 130/0.38-0.45 versus crystalloid or albumin on mortality, kidney injury, bleeding, and serious adverse events in patients with sepsis. Hydroxyethyl starch 130/0.38-0.45 versus crystalloid or albumin did not affect the relative risk of death (1.04, 95% CI 0.89 to 1.22, 3414 patients, eight trials), but in the predefined analysis of trials with low risk of bias the relative risk of death was 1.11 (1.00 to 1.23, trial sequential analysis (TSA) adjusted 95% CI 0.95 to 1.29, 3016 patients, four trials). In the hydroxyethyl starch group, renal replacement therapy was used more (1.36, 1.08 to 1.72, TSA adjusted 1.03 to 1.80, 1311 patients, five trials), and the relative risk of acute kidney injury was 1.18 (0.99 to 1.40, TSA adjusted 0.90 to 1.54, 994 patients, four trials). More patients in the hydroxyethyl starch group were transfused with red blood cells (1.29, 1.13 to 1.48, TSA adjusted 1.10 to 1.51, 973 patients, three trials), and more patients had serious adverse events (1.30, 1.02 to 1.67, TSA adjusted 0.93 to 1.83, 1069 patients, four trials). The transfused volume of red blood cells did not differ between the groups (mean difference 65 mL, 95% CI −20 to 149 mL, three trials). Conclusion: In sepsis, the use of hydroxyethyl starch 130/0.38-0.45, versus crystalloid or albumin, was associated with increased use of renal replacement therapy, increased red cell transfusion, and more serious adverse events.
Intensive Care Medicine: Hydroxyethyl Starch
Gattas and colleagues undertook a systematic review and meta analysis of 35 trials and 10,391 patients to compare outcomes between acutely ill adults fluid resuscitated with 6 % hydroxyethyl starch (6% HES 130/0.4) or other resuscitation fluids. The mortality rate not-significantly higher (HES:19.8%, 928/4,691 versus control: 18.5%, 871/4,720; relative risk with HES 1.08, 95 % CI: 1.00 to 1.17, I 2 = 0 %). Renal replacement therapy occurred more often with HES therapy (HES: 8.9%, 378/4,236 versus control: 7.2%, 306/4,260;; relative risk with HES 1.25, 95 % CI 1.08 to 1.44, I 2 = 0 %). Conclusion: Fluid resuscitation with 6% HES 130/0.4 is associated with an increased risk of RRT, and with a strong signal of increaed mortality.
Abstract: Gattas. Fluid resuscitation with 6 % hydroxyethyl starch (130/0.4 and 130/0.42) in acutely ill patients: systematic review of effects on mortality and treatment with renal replacement therapy. Intensive Care Med 2013;epublished Febuary 14th
PLoS One: N-Acetylcysteine for Contrast-Induced Nephropathy
Sun et al performed a systematic review and meta analysis, comprising 10 studies and 1916 patients, to assess the efficacy of intravenous N-acetylcysteine for preventing contrast-induced nephropathy. NAC was not associated with a reduction in risk ratio for contrast-induced nephropathy (risk ratio 0.68; 95% CI, 0.46 to 1.02). There was evidence of significant heterogeneity in NAC effect across studies (Q = 17.42, P = 0.04; I2 = 48%). Meta-regression revealed no significant relation between the relative risk of contrast-induced nephropathy and identified differences in participant or study characteristics. Conclusion: The author's conclude that research on intravenous N-acetylcysteine and the incidence of CIN is too inconsistent at present to warrant a conclusion on efficacy.
Critical Care: ECMO
Zangrillo and colleagues completed a aysytematic review and meta analysis, including 8 studies and 1357 patients, to describe the use of extracorporeal membrane oxygenation (ECMO, n=266, 20%) in severe acute lung injury due to confirmed or suspected H1N1 infection. Patients had a median SOFA score of 9, and had received mechanical ventilation before ECMO implementation for a median of 2 days. ECMO was implanted before inter-hospital patient transfer in 72% of cases and in most patients (94%) the veno-venous configuration was used. ECMO was maintained for a median of 10 days. Outcomes were highly variable among the included studies, with in-hospital or short-term mortality ranging between 8% and 65%, mainly depending on baseline patient features. Random-effect pooled estimates suggested an overall in-hospital mortality of 28% (95% CI 18%-37%; I2=64%).
Full Text: Zangrillo. Extracorporeal membrane oxygenation (ECMO) in patients with H1N1 influenza infection: a systematic review and meta-analysis including 8 studies and 266 patients receiving ECMO. Crit Care. 2013 Feb 13;17(1):R30
Journal of the American Medical Association: Tedizolid - a new gram positive antimicrobial
Prokocimer and colleagues undertook an international phase 3, randomized, double-blind, noninferiority trial in 667 patients with acute bacterial skin and skin structure infections to establish the noninferiority of tedizolid phosphate (200 mg orally once daily for 6 days, n=332) versus linezolid (600mg orally 12 hourly for 10 days, n=335). In intent-to-treat analysis, there was no difference in early clinical treatment response rates: tedizolid 79.5% (95% CI 74.8% to 83.7%) versus linezolid 79.4% (95% CI 74.7% to 83.6%); a treatment difference of 0.1%, (95% CI, −6.1% to 6.2%). The sustained day 11 clinical treatment response rates at the end of treatment were also not different: tedizolid 69.3% (95% CI, 64.0% to 74.2%) versus linezolid 71.9% (95% CI, 66.8% to 76.7%); a treatment difference of −2.6%, 95% CI, −9.6% to 4.2%). Similarly, ther were no differences in investigator-assessed clinical treatment success rates at a posttherapy evaluation visit: tedizolid 85.5% (95% CI, 81.3% to 89.1%) versus linezolid 86.0% (95% CI, 81.8% to 89.5%) (a treatment difference of −0.5%, 95% CI, −5.8% to 4.9%, and were similar for 178 patients with methicillin-resistant Staphylococcus aureus isolated from the primary lesion. Conclusions:. Tedizolid phosphate was not inferior to linezolid for treating acute bacterial skin and skin structure infections.
Cerebrovascular Disease: Subarachnoid Haemorrhage
- Steiner. European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid Haemorrhage. Cerebrovasc Dis 2013;35:93–112
Expert Review of Cardiovascular Therapy: Intra-Aortic Balloon Counterpulsation
- Negi. Supporting the failing myocardium: is intra-aortic balloon pump enough? The IABP-SHOCK II trial. Expert Review of Cardiovascular Therapy 2013;11(2):147-149
Critical Care: Immunosuppression in Sepsis
- Sen. Towards personalized medicine in sepsis: Quest for Shangri-La? Critical Care 2013;17:303
New England Journal of Medicine: Critical Care Information Technology
Review - Clinical
Advances in Chronic Kidney Disease: Neurocritical Care
- Hirsch. An Update on Neurocritical Care for the Patient With Kidney Disease. Adv Chronic Kidney Dis 2013;20(1):39-44
Medicina Intensiva: Haemodynamic Monitoring
- Cano. Evidence on the utility of hemodynamic monitorization in the critical patient. Med Intensiva.2012;36:650-5
Advances in Chronic Kidney Disease: Haemodynamic Monitoring
- Busse. Hemodynamic Monitoring in the Critical Care Environment. Adv Chronic Kidney Dis 2013;20(1):21-29
Advances in Chronic Kidney Disease: Cardiorenal Syndrome
- Cruz. Cardiorenal Syndrome in Critical Care: The Acute Cardiorenal and Renocardiac Syndromes. Adv Chronic Kidney Dis 2013;20(1):56-66
Cardiovascular Therapeutics: Clopidogrel Therapeutics
Cardiovascular Therapeutics: Nitrates in Heart Failure
- Vizzardi. When Should We Use Nitrates in Congestive Heart Failure?. Cardiovascular Therapeutics 2013;31:27–31
Advances in Chronic Kidney Disease: Acute Respiratory Distress Syndrome
- Seely. Updates in the Management of Acute Lung Injury: A Focus on the Overlap Between AKI and ARDS. Adv Chronic Kidney Dis 2013;20(1):14-20
Medicina Intensiva: Fibreoptic Bronchoscopy
- Martin-Loeches. Current status of fibreoptic bronchoscopy in intensive care medicine. Med Intensiva 2012;36:644-9
Transplantation Reviews: Intra-operative Ventilation for Lung Transplantation
- Verbeek. Intraoperative protective ventilation strategies in lung transplantation.Transplantation Reviews 2013;27(1):30-35
Postgraduate Medical Journal: Mesenteric Ischaemia
- Upponi. The role of radiology in the diagnosis and treatment of mesenteric ischaemia. Postgrad Med J 2013;89:165-172
Journal of Clinical Medical Research: Enteral Nutrition
World Journal of Hepatology: Decompensated Cirrhosis
- Pleguezuelo. Diagnosis and management of bacterial infections in decompensated cirrhosis. World J Hepatol 2013;5(1):16–25
World Journal of Hepatology: Liver Transplantation
World Journal of Gastroenterology: Liver Cirrhosis
- Trifan. Update on adrenal insufficiency in patients with liver cirrhosis. World J Gastroenterol 2013;19(4):445-56
Advances in Chronic Kidney Disease: Perioperative Acute Kidney Injury
Advances in Chronic Kidney Disease: Renal Replacement Therapy
- Palevsky. Renal Replacement Therapy in Acute Kidney Injury. Adv Chronic Kidney Dis 2013;20(1):76-84
- Fissell. Antimicrobial Dosing in Acute Renal Replacement. Adv Chronic Kidney Dis 2013;20(1):85-93
Advances in Chronic Kidney Disease: End-Stage Renal Failure in ICU
- Szamosfalvi. Considerations in the Critically Ill ESRD Patient. Adv Chronic Kidney Dis 2013;20(1):102-109
InTech: Acute Kidney Injury
- Pickering. Book Chapter: The Metamorphosis of Acute Renal Failure to Acute Kidney Injury. In "Basic Nephrology and Acute Kidney Injury", Prof. Manisha Sahay (Ed.), ISBN: 978-953-51-0139-0, InTech 2012.
- Sahay. Book Chapter: Acute Kidney Injury in Pregnancy. In "Basic Nephrology and Acute Kidney Injury", Prof. Manisha Sahay (Ed.), ISBN: 978-953-51-0139-0, InTech 2012
- Yegenaga. Book Chapter: Evaluation of Acute Kidney Injury in Intensive Care Unit. In "Basic Nephrology and Acute Kidney Injury", Prof. Manisha Sahay (Ed.), ISBN: 978-953-51-0139-0, InTech 2012
- Bilal. Book Chapter: Vancomycin-Induced Nephrotoxicity. In "Basic Nephrology and Acute Kidney Injury", Prof. Manisha Sahay (Ed.), ISBN: 978-953-51-0139-0, InTech 2012
Nephrol Dial Transplant: Biomarkers in Acute Kidney Injury
- Vanmassenhove. Urinary and serum biomarkers for the diagnosis of acute kidney injury: an in-depth review of the literature. Nephrol Dial Transplant 2013;28(2):254-273
Critical Care Research and Practice: Acute Kidney Injury
- Labib. Volume Management in the Critically Ill Patient with Acute Kidney Injury. Critical Care Research and Practice 2013;2013:792830
Critical Care Research and Practice: Biomarkers
- Tsigou. Role of New Biomarkers: Functional and Structural Damage. Critical Care Research and Practice 2013;2013:361078
Advances in Chronic Kidney Disease: Transfusion
- Afshar. Update in Critical Care for the Nephrologist: Transfusion in Nonhemorrhaging Critically Ill Patients. Adv Chronic Kidney Dis 2013;20(1):30-38
Annals of Intensive Care: Albumin
Advances in Chronic Kidney Disease: Sepsis
Brazilian Journal of Infectious Diseases: Japanese Encephalitis
- Tiwari. Japanese encephalitis: a review of the Indian perspective. Braz J Infect Dis 2012;16(6):564-573
Clinical Microbiology and Infection: Antimicrobial Testing
- Leclercq. EUCAST expert rules in antimicrobial susceptibility testing. Clinical Microbiology and Infection 2013;19:141–160
Systematic Reviews in Pharmacy: Tuberculosis
InTech: Thoracic Trauma
- Milisavljević. Book Chapter: Thoracic Trauma. In "Current Concepts in General Thoracic Surgery", Dr. Lucio Cagini (Ed.), ISBN: 978-953-51-0870-2, InTech 2012
- Mouawad. Book Chapter: Thoracic Vascular Trauma. In "Current Concepts in General Thoracic Surgery", Dr. Lucio Cagini (Ed.), ISBN: 978-953-51-0870-2, InTech 2012
Advances in Chronic Kidney Disease: Poisoning
Revista Brasileira de Anestesiologia: Malignant Hyperthermia
- de Carvalho Correia. Malignant hyperthermia: clinical and molecular aspects. Rev Bras Anestesiol 2012;62(6):828-837
Review - Non-Clinical
Journal of General Medicine: Negligence
Drug Design, Development and Therapy: Top Journal Selectivity Index
- Kissin. An early indicator of drug success: Top Journal Selectivity Index. Drug Design, Development and Therapy 2013;7:93-98
I hope you find these brief summaries and links useful.
Until next week