Critical Care Reviews Newsletter

November 4^th 2012

Welcome

Hello

Welcome to the 48th 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 continue to follow recent themes. In probably the only positive study of the year for artificial colloids, Van Der Linden and colleagues report a meta analysis showing modern tetrastarches appear to be safe when used intra-operatively. American clinicians seem to be more compliant with the Surviving Sepsis Campaign Guidelines, and have lower mortality, although whether this is the reason is unadressed. The numerous new acute kidney injury biomarkers under evaluation in the literature continue to be reported as not yet being ready for clinical practice.

There are guidelines on mechanical circulatory devices and rivaroxaban plus a position statement from the European Best Practice Group on the recent KDIGO guideline on acute kidney injury.

The review articles include papers on subarachnoid haemorrhage, open abdomen, clinical reasoning, an entire book on sepsis and, from two colleagues, an extremely comprehensive review of the perioperative management of the obese patient. Nonclinical papers include an article on how to write a medical paper and the potential use of nanoparticles as a drug delivery system.

The topic for This Week's Papers is vascular conditions, starting with a paper on abdominal aortic aneurysm in today's Paper of the Day.

Research

Anesthesiology: Tetrastarches

In light of the recent Chest and 6S studies, which identifyed clear signals of harm with hydroxyethyl starches in critically ill patients, Van Der Linden and colleagues undertook a systematic review and meta analysis to assess the safety of tetrastarches used during surgery. Fifty nine studies were included, totalling 4529 patients with 2139 patients treated with tetrastarch compared with 2390 patients treated with a comparator. Tetrastarches used during surgery were not associated with adverse renal effects as assessed by change or absolute concentrations of serum creatinine or need for renal replacement therapy (39 trials, 3389 patients), increased blood loss (38 trials, 3280 patients), allogeneic erythrocyte transfusion (20 trials, 2151 patients; odds ratio for HES transfusion 0.73 [95% confidence interval = 0.61–0.87], P = 0.0005), or increased mortality (odds ratio for HES mortality = 0.51 [0.24–1.05], P = 0.079).

Abstract: Van Der Linden. Safety of Modern Starches Used During Surgery. Anesthesiology 2012; epublished October 31st

Lancet Infectious Diseases: Surviving Sepsis Campaign

Levy and colleagues performed another analysis of the 25,375 patients in the Surviving Sepsis Campaign database to compare treatment and outcomes between European (n=6609, 26%) and American (n=18 766, 74%) patients with sepsis. Americans were typically admitted to ICU directly from the Emergency Department (n=12 218, 65·1%), while Europeans were more likely to come from the wards (3405, 51·5%), from where they would also have stayed 1 day longer (0.1 vs 1.0 days, difference 0.9, 95% CI 0.8—0.9). Although raw hospital mortality was higher in Europe than in the USA (41·1% vs 28·3%, difference 12·8, 95% CI 11·5—14·7), adjusted mortality was not (32·3% vs 31·3%, 1·0, −1·7 to 3·7, p=0·468). The median length of stay in ICU (7·8 vs 4·2 days, 3·6, 3·3—3·7) and hospital (22·8 vs 10·5 days, 12·3, 11·9—12·8) was longer in Europe than in the USA. Complete compliance with all applicable elements of the sepsis resuscitation bundle was higher in the USA than in Europe (21·6% vs 18·4%, 3·2, 2·2—4·4).

Abstract: Levy. Outcomes of the Surviving Sepsis Campaign in intensive care units in the USA and Europe: a prospective cohort study. Lancet Infectious Diseases 2012; epublished ahead of print 26 October

Nephrology Dialysis Transplantation: AKI Biomarkers

Vanmassenhove et al performed a review of all papers investigating the utility of acute kidney injury biomarkers in 5 clinical settings - paediatrics, cardiac surgery, emergency medicine, critically care and contrast-induced nephropathy. The biomarkers investigated were neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, Cystatin C, interleukin-6, interleukin-8, interleukin-18, N-acetyl-glucosaminidase, glutathione transferases and liver fatty acid binding protein. Of 87 relevant papers identified (74 studies), up to 27 different definitions of AKI were used. Reported diagnostic performance of the different biomarkers was variable from poor to excellent. As no consistent generalizable conclusions could be drawn on their diagnostic value, further research is required before they gain a place in routine clinical practice .

Abstract: Vanmassenhove. Urinary and serum biomarkers for the diagnosis of acute kidney injury: an in-depth review of the literature. Nephrol Dial Transplant 2012 epublished ahead of print Oct 31

Cardiothoracic and Vascular Anesthesia: Central Venous Catheterization

In a prospective randomized controlled study in 80 patients undergoing right internal jugular vein catheterization using a landmark technique, Apiliogullari and colleagues compared the effectiveness of a 45 head turn versus a neutral head position on catheter insertion outcomes. The success rates of finder needle passes into the IJV on the first attempt were 87.5% and 37.5% (p < 0.05), and the cumulative success rates on the first 3 attempts were 97.5% and 57.5% in the rotated and neutral groups, respectively (p < 0.05). Carotid artery puncture occurred in 2 patients in the rotated group.

Abstract: Apiliogullari. Is a Neutral Head Position as Effective as Head Rotation During Landmark-Guided Internal Jugular Vein Cannulation? Results of a Randomized Controlled Clinical Trial. Cardiothor Vasc Anesth 2012;(26)6:985-988