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Critical Care Reviews Newsletter

May 12th 2013

Welcome

Hello

Welcome to the 75th 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.

This week's research studies include evaluations of red cell transfusion, methods of cooling for therapeutic hypothermia, fluid boluses, prophylactic platelet transfusion in severe thrombocytopaenia, target oxygenation in preterm babies and programming for internal cardioverter-defibrillators. 

This week's guideline is from the European Society of Anaesthesiology, on perioperative haemorrhage, and the definition of stroke is also updated. There is a study critique a paper from Annals of Internal Medicine evaluating ICU admission practice, as well as an editorial on statistical analysis in research publications. There are 5 commentaries, including papers on H7N9 influenza and longterm ventilation.

The clinical review articles cover delirium, acute heart failure, circulatory monitoring, blood volume monitoring, lung ischaemia reperfusion injury, ascites, acute kidney injury, anti-platelet agents, haemorrhage on anti-thrombotics, and an entire free book on severe sepsis and septic shock. This weeks general interest paper is the remarkable production of a insect-scale robot, which hovers and flys like a bee.

The topic for This Week's Papers is pulmonary hypertension, starting with a general paper on the ICU management of pulmonary hypertension in tomorrow's Paper of the Day.

 

Research

Clinical Research in Cardiology:     Therapeutic Hypothermia Post-Cardiac Arrest

Pittl et al undertook a prospective, randomized, single center study in 80 patients undergoing therapeutic hypothermia after  in-hospital and out-of-hospital cardiac arrest to compare the efficacy of non-invasive with invasive cooling. There was no difference in levels of neuron-specific enolase, the primary endpoint, between the 2 groups at 72 hours (non-invasive cooling: 16.5 ng/ml, IQR 11.8–46.5 versus invasive cooling: 19.0 ng/ml, IQR 11.0–42.0, p = 0.99). Similarly, there were no differences in neurological or clinical outcomes. Target temperature of 33.0 °C were more stable in the invasive group (33.0 versus 32.7 °C, p < 0.001). Bleeding complications were more frequent with invasive cooling (n=17, 43.6% versus n=7, 17.9%; p = 0.03).

Abstract:  Pittl. Invasive versus non-invasive cooling after in- and out-of-hospital cardiac arrest: a randomized trial. Clinical Research in Cardiology 2013

 

BMJ Open:     Recent Cell Transfusion

Hopewell and colleagues completed a systematic review of recently published large-scale (>1000 subjects) observational studies assessing the effects of red blood cell transfusion (RBCT) on mortality. 32 studies were included; 23 assessed the effects of RBCT versus no RBCT; 5 assessed different volumes and 4 older versus newer RBCT. There was a considerable variability in the patient populations, study designs and level of statistical adjustment. Overall, most studies showed a higher rate of mortality when comparing patients who received RBCT with those who did not, even when these rates were adjusted for confounding; the majority of these increases were statistically significant. The same pattern was observed in studies where protection from bias was likely to be greater, such as prospective studies.

Full Text:  Hopewell. A systematic review of the effect of red blood cell transfusion on mortality: evidence from large-scale observational studies published between 2006 and 2010. BMJ Open 2013;3(5):e002154

 

Shock:     Fluid Boluses

Bihari and colleagues completed a prospective study to estimate the prevalence and efficacy of fluid boluses post initial resuscitation in septic patients. 50 patients were recruited, 47 of whom received a total of 184 fluid boluses over 3 days. The most common indications for fluid boluses were low blood pressure (76%) and increased vasopressor requirements (60%), while the most common indicators of success were low filling pressure (71%) and clinical signs (79%). The effects of fluid boluses one hour post therapy were small increases in mean arterial pressure (p<0.01) and central venous pressure (p<0.01), but at the expense at an increase in noradrenaline dose, and reduced PaO2/FiO2 ratio, haemoglobin concentration and temperature, with urinary output remaining unchanged. Cumulative fluid balance had a weak correlation with delta SOFA score(r=0.32,p=0.001) and lung injury score(r=0.13,p=0.02) and negative correlation with PaO2/FiO2 ratio(r=-0.28,p=0.001).

Abstract:  Bihari. Post Resuscitation Fluid Boluses In Severe Sepsis Or Septic Shock: Prevalence And Efficacy (Price Study). Shock 2013;epublished April 30th

 

Annals of Internal Medicine:     Pulmonary Fibrosis

Raghu et al undertook a randomized, double-blind, placebo-controlled, trial to investigate whether ambrisentan, an ETA receptor–selective antagonist, reduces the rate of progression of idiopathic pulmonary fibrosis. The study was stopped early for futility after enrollment of 492 patients (75% recruitment target). Ambrisentan-treated patients were more likely to suffer disease progression (n=90, 27.4% versus n=28, 17.2%; P = 0.010; hazard ratio 1.74, 95% CI 1.14 to 2.66). Lung function decline was greater with ambrisentan therapy (n=55, 16.7% versus 19, 11.7%; P = 0.109). Respiratory hospitalizations were also more common with the intervention (n=44, 13.4% versus n=9, 5.5%; P = 0.007). There was no difference in mortality (ambrisentan n=26, 7.9% versus placebo n=6, 3.7%; P = 0.100) or presence of pulmonary hypertension. 

Abstract:  Raghu. Treatment of Idiopathic Pulmonary Fibrosis With Ambrisentan: A Parallel, Randomized Trial. Ann Intern Med 2013;158(9):641-649

 

New England Journal of Medicine:     Prophylatic Platelet Transfusions

Stanworth and colleagues completed a randomized, open-label, noninferiority trial comparing prophylactic platelet transfusion (n=299) with no prophylatic transfusion (n=301) transfusion in patients with haematological malignancies and morning platelet counts less than 10×109 per liter. Bleeding of WHO grade 2, 3, or 4 occurred in 50% in the no-prophylaxis group, as compared with 43% in the prophylaxis group (adjusted difference in proportions, 8.4 percentage points; 90% CI 1.7 to 15.2; P=0.06 for noninferiority). Patients in the no-prophylaxis group had more days with bleeding and a shorter time to the first bleeding episode than did patients in the prophylaxis group. Platelet use was markedly reduced in the no-prophylaxis group. A prespecified subgroup analysis identified similar rates of bleeding in the two study groups among patients undergoing autologous stem-cell transplantation.

Abstract:  Stanworth. A No-Prophylaxis Platelet-Transfusion Strategy for Hematologic Cancers (TOPPS). N Engl J Med 2013; 368:1771-1780

 

Journal of the American Medical Association:     Implantable Cardioverter-Defibrillator Therapy  

Gasparini et al performed a randomized, single-blind, parallel-group trial comparing whether long- (n = 948) or standard-detection (n = 954) intervals to detect ventricular tachyarrhythmias reduces antitachycardia pacing (ATP) and shock delivery. The long-detection group had less delivered therapies  than the standard-detection group (346, 42 therapies per 100 person-years, 95% CI 38-47 versus 557, 67 therapies per 100 person-years, 95% CI 62-73; incident rate ratio [IRR] 0.63, 95% CI 0.51-0.78; P < 0.001). The long- versus the standard-detection group experienced 23 ATPs per 100 person-years (95% CI 20-27) vs 37 ATPs per 100 person-years (95% CI 33-41; IRR 0.58, 95% CI 0.47-0.72; P < 0.001); 19 shocks per 100 person-years (95% CI 16-22) vs 30 shocks per 100 person-years (95% CI 26-34; IRR 0.77, 95% CI 0.59-1.01]; P = 0.06), with a significant difference in the probability of therapy occurrence (P < 0.001); and a reduction in first occurrence of inappropriate shock (5.1 per 100 patient-years, 95% CI 3.7-6.9 vs 11.6, 95% CI 9.4-14.1; IRR 0.55, 95% CI 0.36-0.85; P = 0.008). There was no difference in either mortality (5.5, 95% CI, 4.0-7.2 versus 6.3, 95% CI 4.8-8.2 per 100 patient-years; HR 0.87; P = 0.50) or arrhythmic syncope rates (3.1, 95% CI 2.6-4.6 versus 1.9, 95% CI 1.1-3.1) per 100 patient-years; IRR 1.60, 95% CI 0.76-3.41; P = 0.22).

Abstract:  Gasparini. Effect of Long-Detection Interval vs Standard-Detection Interval for Implantable Cardioverter-Defibrillators on Antitachycardia Pacing and Shock Delivery. The ADVANCE III Randomized Clinical Trial. JAMA 2013;309(18):1903-1911

 

New England Journal of Medicine:     Oxygen Saturation in Preterm Infants

Using data from three international randomized, controlled trials, the BOOST II investigators examined the effects of targeting an oxygen saturation of 85 to 89%, as compared with a range of 91 to 95%, on disability-free survival at 2 years in infants born before 28 weeks' gestation. These studies were disrupted mid-way by a change to oximeter-calibration algorithm. A total of 2448 infants were recruited. Among the 1187 infants whose treatment used the revised oximeter-calibration algorithm, the rate of death was significantly higher in the lower-target group than in the higher-target group (23.1% vs. 15.9%; relative risk in the lower-target group, 1.45; 95% CI 1.15 to 1.84; P=0.002). There was heterogeneity for mortality between the original algorithm and the revised algorithm (P=0.006) but not for other outcomes. In all 2448 infants, those in the lower-target group for oxygen saturation had a reduced rate of retinopathy of prematurity (10.6% vs. 13.5%; relative risk 0.79; 95% CI 0.63 to 1.00; P=0.045) and an increased rate of necrotizing enterocolitis (10.4% vs. 8.0%; relative risk 1.31; 95% CI 1.02 to 1.68; P=0.04). There were no significant between-group differences in rates of other outcomes or adverse events.

Full Text:  The BOOST II United Kingdom, Australia, and New Zealand Collaborative Groups. Oxygen Saturation and Outcomes in Preterm Infants (BOOST II study). N Eng J Med 2013;epublished May 5th

 
 

Guideline

 
 

Study Critique

Critical Care:     ICU Admission

 

Editorial

Critical Care:     Statistical Testing

 

Commentary


Revista Portuguesa de Pneumologia:     Long-Term Ventilator Dependency

 

Interact CardioVasc Thorac Surg:     Cerebral Protection


Journal of the American Medical Association:     H7N9 Influenza

Journal of the American Medical Association:     Opioid Toxicity

 

World Journal of Emergency Surgery:     Acute Surgery Timing

 

Review - Clinical

Neurological


Seminars in Cardiothoracic and Vascular Anesthesia:     Delirium

 

Stem Cells Translational Medicine:     Neural Stem Cells

 

Circulatory


European Heart Journal:     Acute Cardiovascular Care

 

Critical Care:     Circulatory Monitoring

 

Perioperative Medicine:     Perioperative Blood Volume

 

Current Cardiology Reviews:     Right Ventricular Pathophysiology

 

Seminars in Cardiothoracic and Vascular Anesthesia:     Heart Failure in Congenital Heart Disease

 

World Journal of Cardiovascular Diseases:     Acute Heart Failure

 

Respiratory


Seminars in Cardiothoracic and Vascular Anesthesia:     Lung Ischaemia Reperfusion Injury

 

Hepatobiliary


Journal of Gastroenterology and Hepatology:     Ascites

 

Renal


Clinics (Sao Paulo):     Acute Kidney Injury


Endocrine


Pathobiology:     Bioartificial Pancreas

 

Indian Journal of Endocrinology and Metabolism:     Glucagon-like peptide-1 Analogues

 

Metabolic


Antioxidants & Redox Signaling:     Mitochondria

 

Haematological


Blood Transfusion:     Anti-Platelet Agents

 

The Korean Association of Internal Medicine:     Multiple Myeloma

 

British Journal of Haematology:     Haemorrhage on Antithrombotics

 

The Korean Association of Internal Medicine:     Procalcitonin

 

PLoS Pathogens:     Volatile Metabolites

 

InTech:     Sepsis

Severe Sepsis and Septic Shock - Understanding a Serious Killer. Edited by Ricardo Fernandez. Publisher: InTech; ISBN 978-953-307-950-9

  1. Chapter 1. Artero. Epidemiology of Severe Sepsis and Septic Shock. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer." Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012
  2. Chapter 2. Galdiero. Septic Shock by Gram-Negative Infections: Role of Outer Membrane Proteins. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer." Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012
  3. Chapter 3. Korsak. Transfusion-Associated Bacterial Sepsis. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer." Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012
  4. Chapter 4. Lucas. The Autopsy Pathology of Sepsis-Related Death. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer." Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012
  5. Chapter 5. Paramythiotis. Biomarkers and Physiological Agents in Severe Sepsis and Septic Shock. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer". Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012
  6. Chapter 6. Carson. Immune Cell Dysfunction as a Consequence of Severe Sepsis. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer." Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012
  7. Chapter 7. Luciano. Microparticles and Exosomes: Are They Part of Important Pathways in Sepsis Pathophysiology. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer." Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012
  8. Chapter 8. Assenzio. Cellular Mechanisms of MOF During Severe Sepsis and Septic Shock. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer." Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012
  9. Chapter 9. Vázquez. Impact of Severe Sepsis or Septic Shock on Drug Response. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer." Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012
  10. Chapter 10. Boodoosingh. Update in the Treatment of Severe Sepsis and Septic Shock. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer." Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012
  11. Chapter 11. Samaha. Management of Severe Sepsis and Septic Shock. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer." Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012
  12. Chapter 12. McGee. Applied Physiology and the Hemodynamic Management of Septic Shock Utilizing the Physiologic Optimization Program. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer." Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012
  13. Chapter 13. Kneyber. Management of Septic Shock in Children. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer." Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012
  14. Chapter 14. Decembrino. Septic Shock in Neonates. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer." Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012
  15. Chapter 15. Kaponis. Septic Shock in Obstetrics and Gynecology. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer." Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012
  16. Chapter 16. Rech. Alternative Therapies for Septic Shock: Beyond Early Goal-Directed Therapy. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer." Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012
  17. Chapter 17. Choong. Hormonal Therapies in Severe Sepsis. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer." Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012
  18. Chapter 18. Veres. Anti-Inflammatory Role of Natural Polyphenols and Their Degradation Products. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer." Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012
  19. Chapter 19. Monserrat. Cellular and Molecular Markers of Outcome in Septic Shock. In "Severe Sepsis and Septic Shock - Understanding a Serious Killer." Dr Ricardo Fernandez (Ed.), ISBN: 978-953-307-950-9, InTech 2012

 

Miscellaneous


Surgical Neurology International:     Anaesthetic Drug Development

Reports in Medical Imaging:     Cervicothoracic Imaging

 

Review - Basic Science

Stem Cells Translational Medicine:     Tissue Engineering

 

Review - Non-Clinical

Clinical and Translational Medicine:     Research

 

Swiss Medical Weekly:     Relevance in Research

 

General Interest

Science:     Robotic Fly

Abstract:  Ma. Controlled Flight of a Biologically Inspired, Insect-Scale Robot. Science 2013;340:603–607

 

 

I hope you find these brief summaries and links useful.


Until next week

Rob

 

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