Newsletter 113 / February 2nd 2014
Welcome
Hello
Welcome to the 113th 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, guidelines, commentaries and editorials from over 300 clinical and scientific journals.
This week's research studies include randomized controlled trials on glycaemic control, NIV post lung resection, and β2 agonism for donor lung optimization; meta analyses address starches and red cell transfusion thresholds; while observational studies focus on non-palliative ventilatory support in cancer patients, delayed ICU admission, anidulafungin pharmacokinetics during CRRT and MERS-CoV infection.
This week there are guidelines on brain death, hyponatraemia, tropical fever and cerebral swelling. There is a single study critique, reviewing the TracMan study. There are several editorials, including articles on extracorporeal therapies, acute kidney injury and futile ICU management. In addition to a series of commentaries from The Lancet Respiratory Medicine, there are articles focusing on clinical reasoning and cardiac thrombi.
Amongst the clinical review articles are papers on dexmedetomidine, posttraumatic stress disorder, type II myocardial infarction, pulmonary embolism, cricoid pressure, hepatorenal syndrome, contrast-induced nephropathy, glycopeptide antibiotic biosynthesis, traumatic haemorrhage, military critical care, anaphylaxis, amniotic fluid embolism, and critical care transfer. One basic science review article looks at confounder selection.
If you prefer a break from all the serious reading, take a look at the latest Lemmingaid contribution, from the Journal of the Intensive Care Society.
The topic for This Week's Papers is neurological monitoring, starting with a general paper on brain monitoring in tomorrow's Paper of the Day.
News
Research
Randomized Controlled Trials
Kalfon and colleagues completed a multi-center, randomized controlled trial in 2,684 French ICU patients (results available for 2,646) expected to require treatment in the ICU for at least 3 days, comparing tight computerized glucose control (TGC, 4.4–6.1 mmol/L, n=1,335) with conventional glucose control (CGC, <10.0 mmol/L, n=1,311), and found:
- groups were similar at baseline
- primary outcome
- no difference in all-cause mortality at 90 days
- TGC group 32.3 % versus CGC group 34.1 %
- odds ratio for death in the TGC 0.92; 95 % CI 0.78–1.78; p = 0.32
- no difference in all-cause mortality at 90 days
- secondary outcome
- increased incidence of severe hypoglycaemia (<2.2 mmol/L) with tight glycaemic control
- 13.2 % versus 6.2 %; p < 0.001
- increased incidence of severe hypoglycaemia (<2.2 mmol/L) with tight glycaemic control
Lorut et al conducted a multi-centre study in 360 COPD patients undergoing lung resection surgery, comparing conventional postoperative treatment (n = 179) with conventional postoperative treatment plus prophylactic noninvasive ventilation applied intermittently for 6 hours per day for 48 hours following surgery (n = 181), and found:
- primary outcome
- no difference in rate of acute respiratory events at 30 days
- prophylactic NIV group 31.5% versus control group 30.7 %; p = 0.93
- no difference in rate of acute respiratory events at 30 days
- secondary outcomes
- no difference in
- acute respiratory failure
- prophylactic NIV group 18.8 % versus controls 24.5%; p = 0.20
- re-intubation rates
- prophylactic NIV group 5.5% versus control group 7.2%; p = 0.53
- mortality
- prophylactic NIV groups 2.2% versus control group 5%; p = 0.16
- complications
- infectious
- non-infectious
- durations of stay
- ICU
- hospital stays
- acute respiratory failure
- no difference in
Ware and colleagues undertook a randomized, blinded, placebo-controlled trial comparing aerosolized albuterol (5 mg 4 hourly, n=260) with saline placebo (n=246) during active donor management in 506 organ donors, and found:
- groups were similar at baseline
- primary outcome
- no difference in change in oxygenation (arterial partial pressure of oxygen/fraction of inspired oxygen [PaO2/FiO2] from enrollment to organ procurement)
- p = 0.54
- secondary outcomes
- no difference in
- donor lung utilization
- albuterol 29% vs. placebo 32%, p = 0.44
- albuterol therapy was associated with an increased risk of study drug dose modification due to tachycardia
- reduced (13% vs. 1%, p < 0.001)
- stopped (8% vs. 0%, p < 0.001)
- no difference in
Meta Analysis
- HES organ deposition was common
- skin - 17 studies
- kidney - 12 studies (highest tissued concentration)
- liver - 8 studies
- bone marrow - 5 studies
- plus lymph nodes, spleen, lung, pancreas, intestine, muscle, trophoblast, and placental stroma.
- HES tissue deposition
- uptake into intracellular vacuoles occurred within 30 minutes
- was cumulative, increasing with dose
- occurred at the lowest cumulative doses (0.4 g kg−1) in 15%
- could be extremely long-lasting,
- persisting for
- 8 years in skin
- 10 years in kidney
- persisting for
- was associated with
- pruritus in 17 studies
- renal dysfunction in ten studies
- was generally similar in animals and humans
Salpeter and colleagues reviewed data from 3 randomized trials (n=2,364) comparing a restrictive hemoglobin transfusion trigger of <7 g/dL, with a more liberal trigger, and found:
- a restrictive hemoglobin transfusion trigger of <7 g/dL was associated with reduced
- in-hospital mortality (risk ratio 0.74; 95% CI 0.60-0.92)
- total mortality (RR 0.80; 95% CI 0.65-0.98)
- number needed to treat to prevent a death was 33
- rebleeding (RR 0.64; 95% CI 0.45-0.90)
- acute coronary syndrome (RR 0.44; 95% CI 0.22-0.89)
- pulmonary oedema (RR 0.48; 95% CI 0.33-0.72)
- bacterial infections (RR 0.86; 95% CI 0.73-1.00)
- less restrictive transfusion strategies were not superior to liberal transfusion strategies
Observational Studies
Azevedo and colleagues performed a secondary analysis of a Brazilian multi-centre, prospective cohort study assessing clinical characteristics and outcomes of 263 cancer patients requiring non-palliative ventilatory support, and found:
- cancer characteristics
- solid tumors, n=227
- hematological malignancies, n=36
- initial use of mechanical ventilation was
- NIV: 32%
- 53% of this cohort subsequently required invasive ventilation
- invasive mechanical ventilation: 68%
- NIV: 32%
- hospital mortality rates were significantly different (p<0.001)
- all patients: 67%
- NIV only: 40%
- NIV was followed by IMV: 69%
- IMV only: 73%
- Adjusting for the type of admission, hospital mortality was associated with
- newly diagnosed malignancy (OR 3.59; 95% CI 1.28-10.10)
- recurrent or progressive malignancy (OR 3.67; 95% CI 1.25-10.81)
- tumoral airway involvement (OR 4.04; 95% CI 1.30-12.56)
- performance status (PS) 2-4 (OR 2.39; 95% CI 1.24-4.59)
- NIV followed by MV (OR 3.00; 95% CI 1.09-8.18)
- MV as initial ventilatory strategy (OR 3.53; 95% CI 1.45-8.60)
- SOFA score (each point, excluding respiratory domain) (OR 1.15, 95% CI 1.03-1.29)
Yu et al performed a retrospective single centre study evaluating if a delay in ICU admission, waiting in a post anesthesia care unit and managed by anesthetists, affected ICU outcome for 2,279 critically ill surgical patients, and found:
- ICU admission characteristics
- immediate admission - 91.9%
- delayed ICU admission - 8.1%
- delayed admission was associated with
- increased ICU mortality (p < 0.001)
- prolonged waiting hours in PACU (≥6 hours) was associated with higher ICU mortality
- adjusted odds ratio 5.32; 95% CI 1.25 to 22.60, p = 0.024
- longer PACU waiting times were not associated with
- mechanical ventilation days
- ICU length of stay
- ICU cost
Aguilar and colleagues reviewed anidulafungin pharmacokinetic data (200mg day 1, 100mg days 2 & 3) from 12 critically ill patients receiving continuous venovenous haemodiafiltration for acute renal failure, and found:
- on day 3, peak plasma concentrations were
- arterial: 6.2 ± 1.7 mg/L
- venous: 7.1 ± 1.9 mg/L
- mean pre-filter trough concentration was 3.0 ± 0.6 mg/L
- mean AUC0–24 plasma anidulafungin levels
- arterial: 93.9 ± 19.4 mg·h/L
- venous: 104.1 ± 20.3 mg·h/L
- regarding CRRT effects
- there was no adsorption to synthetic surfaces
- anidulafungin concentration in the ultradiafiltrate was below the limit of detection
Khaldi and colleagues reported data on 12 patients with confirmed or probable MERS-CoV infection from 3 Saudi Arabian ICUs, and found:
- 114 patients were tested for suspected MERS-CoV
- 11 ICU patients (10%) met the definition of confirmed or probable cases
- three of these patients were part of a healthcare-associated cluster that also included 3 healthcare workers
- 1 infected healthcare worker became critically ill
- All 12 patients
- had underlying comorbid conditions
- presented with acute severe hypoxemic respiratory failure
- median APACHE II score was 28 (range 16-36)
- 92% had
- extrapulmonary manifestations including
- shock
- acute kidney injury
- thrombocytopenia
- extrapulmonary manifestations including
- 90 day mortality was 58%
- 1% of healthcare workers were infected (4/520)
Other Studies of Interest
Randomized Controlled Trials
- Abstract: Roceto. Continuous positive airway pressure (CPAP) after lung resection: a randomized clinical trial. Sao Paulo Med J 2014;132(1):41-7
- Abstract: Cohen. D-dimer as a predictor of venous thromboembolism in acutely ill, hospitalized patients: a subanalysis of the randomized controlled MAGELLAN trial. Journal of Thrombosis and Haemostasis 2014;epublished January 27th
- Full Text: Hausenloy. The effect of cyclosporin-A on peri-operative myocardial injury in adult patients undergoing coronary artery bypass graft surgery: a randomised controlled clinical trial. Heart 2014;epublished January 31st
- Full Text: von Birgelen. Third-generation zotarolimus-eluting and everolimus-eluting stents in all-comer patients requiring a percutaneous coronary intervention (DUTCH PEERS): a randomised, single-blind, multicentre, non-inferiority trial. Lancet 2014;383(9915):413-423 (free registration required)
- Commentary: Byrne. Drug-eluting stent trials: too much non-inferiority, too little progress? Lancet 2014;383(9915):386-388 (free registration required)
- Abstract: Derdeyn. Final SAMMPRIS Results: Aggressive Medical Treatment +/- Stenting for High-Risk Intracranial Artery Stenosis. Lancet; 2014;383(9914)333-341
Observational Studies
- Abstract: Moore. Evaluation of noninvasive hemoglobin measurements in trauma patients. Am J Surg 2013;206(6):1041-7
- Abstract: Jiménez. Derivation and Validation of Multimarker Prognostication for Normotensive Patients with Acute Symptomatic Pulmonary Embolism. Am J Respir Crit Care Med 2014;epublished January 29th
- Full Text: Loonen. Biomarkers and Molecular Analysis to Improve Bloodstream Infection Diagnostics in an Emergency Care Unit. PLoS One 2014;9(1):e87315
- Abstract: Hong. A cluster of lung injury associated with home humidifier use: clinical, radiological and pathological description of a new syndrome. Thorax 2014;epublished January 28th
- Full Text: Arabi. Clinical Course and Outcomes of Critically Ill Patients With Middle East Respiratory Syndrome Coronavirus Infection. Ann Intern Med 2014;epublished January 28th
Guidelines
- Verbalis. Diagnosis, Evaluation, and Treatment of Hyponatremia: Expert Panel Recommendations. The American Journal of Medicine 2013;126(10)Suppl 1:S1-S42
- Singhi. Tropical fevers: Management guidelines . Indian J Crit Care Med 2014;18:62-9
- Wijdicks. Recommendations for the Management of Cerebral and Cerebellar Infarction With Swelling: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2014;epublished January 30th
- Brain Injury Evaluation Quality Control Centre of National Health,Family Planning Commission. Criteria and practical guidance for determination of brain death in adults (BQCC version). Chinese Medical Journal 2013;126(24):4786-4790
Study Critique
Editorial
- Noble. Problem solving in intensive care — the role of extracorporeal technologies. JICS 2014;15(1):4-7
- Levy. Improving the hospital management of acute kidney injury. JICS 2014;15(1):8-9
- Danbury. Futile treatment in intensive care. JICS 2014;15(1):10-11
- Boudoulas. Essays on Citation Classics in Cardiology. Cardiology 2014;127:263-264
- Alspach. Slowing the Revolving Door of Hospitalization for Acute Heart Failure. Crit Care Nurse 2014;34:8-12
- Sunavala. Preventability of death in a medical ICU in a developing country . Indian J Crit Care Med 2014;18:59-61
- Mariani. Observational studies: why are they so important? Sao Paulo Med J 2014;132(1):1-2
Commentaries
- Akkermans. ICU bed utilisation and demand elasticity. Lancet Respiratory Medicine 2014;epublished January 20th (free registration required)
- Gerges. Changing perceptions in pulmonary hypertension. Lancet Respiratory Medicine 2014;2(1):21-23 (free registration required)
- Bear. Early feeding during critical illness. Lancet Respiratory Medicine 2014;2(1):15-17 (free registration required)
- Al-Tawfiq . Emerging respiratory viral infections: MERS-CoV and influenza. Lancet Respiratory Medicine 2014;2(1):15-17 (free registration required)
- Ekström. The rise and fall of COPD mortality. Lancet Respiratory Medicine 2014;2(1):4-6 (free registration required)
- Calverley. New treatments for COPD: many miles still to go. Lancet Respiratory Medicine 2014;2(1):6-7 (free registration required)
- Bouros. Idiopathic pulmonary fibrosis: on the move. Lancet Respiratory Medicine 2014;2(1):17-19 (free registration required)
- Carmont. BMC medicine editorial board members on open access publishing. BMC Medicine 2014;12:10
- Mullard. 2013 FDA drug approvals. Nature Reviews Drug Discovery 2014;13:85-89 (free registration required)
- Sklar. How Do We Think? Can We Learn to Think Better? Academic Medicine 2014;89(2):191–193
- Croskerry. Deciding About Fast and Slow Decisions. Academic Medicine 2014;89(2):197–200
- Bynum. Why Physicians Need to Be More Than Automated Medical Kiosks. Academic Medicine 2014;89(2):212–214
- Alkindi. Cardiac thrombi in different clinical scenarios. Heart Views 2013;14:101-5
Clinical Review
Neurological
- Chowdhury. Pre-hospital and initial management of head injury patients: An update. Saudi J Anaesth 2014;8:114-20
- Pantoni. Thrombolysis in Acute Stroke Patients with Cerebral Small Vessel Disease. Cerebrovasc Dis 2014;37:5-13
- Naqvi. Transcranial Doppler Ultrasound: A Review of the Physical Principles and Major Applications in Critical Care. International Journal of Vascular Medicine
- Rock. Sedation and Its Association With Posttraumatic Stress Disorder After Intensive Care. Crit Care Nurse 2014;34:30-37
- Wujtewicz. Use of dexmedetomidine in the adult intensive care unit. Anaesthesiology Intensive Therapy 2013;45(4):235–240
- Barone. Brain Monitoring: Do We Need a Hole? An Update on Invasive and Noninvasive Brain Monitoring Modalities. The Scientific World Journal 2014;2014:795762
Circulatory
- Alpert. Diagnostic and Therapeutic Implications of Type 2 Myocardial Infarction: Review and Commentary. The American Journal of Medicine 2014;127(2):105-108
- Alexopoulos. P2Y12 Receptor Inhibitors in Acute Coronary Syndromes: From the Research Laboratory to the Clinic and Vice Versa. Cardiology 2014;127:211-219
- Rajiah. CT and MRI in the Evaluation of Thoracic Aortic Diseases. International Journal of Vascular Medicine 2013;2013:797189
Respiratory
- Various. Pulmonary embolism — the future Optimising the prevention of PE in the critically ill patient. JICS 2014;15(Suppl 3):1
- Morris. Modern protective ventilation strategies: impact upon the right heart. JICS 2014;15(1):28-33
- Ye. Clinical characteristics of septic pulmonary embolism in adults: A systematic review. Respiratory Medicine 2014;108(1):1-8
- Morris. The Importance of Tracheostomy Progression in the Intensive Care Unit. Crit Care Nurse February 2014 34:40-48
- Bhatia. Cricoid pressure: Where do we stand?. J Anaesthesiol Clin Pharmacol 2014;30:3-6
- Schneider. Approach to lung biopsies from patients with pneumothorax. Arch Pathol Lab Med 2014;138(2):257-65
- Gupta. Ambroxol hydrochloride in the management of idiopathic pulmonary fibrosis: Clinical trials are the need of the hour. Lung India 2014;31:43-6
Gastrointestinal
Hepatobiliary
Renal
Sepsis
- Dewar. Emerging clinical role of pivmecillinam in the treatment of urinary tract infection in the context of multidrug-resistant bacteria. J Antimicrob Chemother 2014;69 (2):303-308
- Sewell. Taking aim at wall teichoic acid synthesis: new biology and new leads for antibiotics. The Journal of Antibiotics 2014;67:43–51
- Yim. Glycopeptide antibiotic biosynthesis. The Journal of Antibiotics 2014;67:31–41
- Walsh. Prospects for new antibiotics: a molecule-centered perspective. The Journal of Antibiotics 2014;67:7–22
- Zhang. Persisters, persistent infections and the Yin–Yang model. Emerging Microbes & Infections 2014;3:e3
Trauma
- El Sayad. Recent Advances of Hemorrhage Management in Severe Trauma. Emergency Medicine International 2014;2014:638956
- Chekijian. The Global Burden of Road Injury: Its Relevance to the Emergency Physician. Emergency Medicine International 2014;2014:139219
- Hutchings. Intensive care in the Defence Medical Services. JICS 2014;15(1):24-27
Immunology
- Lieberman. Recognition and First-Line Treatment of Anaphylaxis. The American Journal of Medicine 2014;127(1):S6-S11
- Nowak. Anaphylaxis on the Other Front Line: Perspectives from the Emergency Department. The American Journal of Medicine 2014;127(1):S34-S44
- Uszyński. Amniotic Fluid Embolism (AFE): A Review of the Literature Orientated on Two Clinical Presentations— Typical and Atypical. Open Journal of Obstetrics and Gynecology, 2014;4:54-60
- Wu. Cytokine regulation of immune tolerance. Burn Trauma 2014;2:11-7
Transfer
- Sethi. When place and time matter: How to conduct safe inter-hospital transfer of patients. Saudi J Anaesth 2014;8:104-13
- Dawes. Stabilisation and transport of the critically ill child. JICS 2014;15(1):34-42
Miscellaneous
- Dhir. Antiphospholipid syndrome: A review. J Mahatma Gandhi Inst Med Sci 2014;19:19-27
- Sobczak. The procedure for death notification — ”In Person, In Time...”. Anaesthesiology Intensive Therapy 2013;45(4):241-243
- Rodríguez. Current situation of mechanical CPR devices in donors after cardiac death. Open Journal of Emergency Medicine;1:5-7
Basic Science Reviews
Lemmingaid
I hope you find these brief summaries and links useful.
Until next week
Rob