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Newsletter 100 / November 3rd 2013




Welcome to the 100th 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. It's a mixed newsletter, with no major research published this week, but still contains 46 review articles, 6 guidelines, 4 editorials and 7 commentaries, as well as links to 16 articles from the major critical care journals which have now been made open access. In addition, the latest CPD quiz, on minimally invasive cardiac output monitors is now available. Read the article, complete the MCQ, and print your personalised certificate for revalidation/CPD purposes. Registration is required to take the quiz, as your name is needed for the certificate.

This week's guidelines address airway management, faecal incontinence, alcoholic liver disease, anti-platelet therapy, cardiac resynchronization and cath lab radiation exposure. Editorials focus on acute heart failure, open access publication and tranexamic acid. Commentaries look at conflict-of-interest, clinical errors, septic shock and contrst-induced nephropathy.

Amongst the clinical review articles are papers on sedation in the neurological ICU, cardiopulmonary resuscitation, catheter-related bloodstream infection, airway clearance, fulminant clostridium difficile colitis, hepatopulmonary syndrome, nutrition in trauma, diabetes insipidus, C-reactive protein and traumatic colonic injuries. Non-clinical review articles include a paper on managing an emergency department.

The topic for This Week's Papers is extracorporeal therapies, starting with a paper on liver support in tomorrow's Paper of the Day.


There are three meetings coming up that might be of interest to you:

Critical Care Reviews Meeting January 24th, 2014 - Belfast, Northern Ireland

  • If you are in Ireland or Great Britain (or a short flight away), Critical Care Reviews will be hosting it's second meeting outside Belfast, Northern Ireland. It's an all-day event with a fantastic programme consisting of local intensivists, local non-critical care specialists, and outstanding international guest speakers. The programme has been finalised and approved for 5 CPD points by the Royal College of Anaesthetists. Registration is now open. 

Intensive Care Society State-of-the-Art Meeting, December  16th - 18th, London

  • The ICS will be holding their annual State-of-the-Art meeting in London this December. It's the largest meeting of its kind in the UK and attracts a host of big names from the world of critical care.

SMACC GOLD March 19-21st, 2014 Gold Coast, Queensland, Australia

  • This major international conference, also in it's second year, is a must for those active in the online critical care community. Webmasters of the most prominent critical care websites and blogs will descend on the beautiful Gold Coast for an amazing get together of like-minded people in a totally different style of conference. Registration is currently open.



Interventional Trials

Critical Care:     Acute Kidney Injury

Kim and colleagues completed a single-centre, randomized, case-controlled, double-blind study comparing erythropoietin (300 IU/kg post anesthetic induction, n=49) with control (n=49) on the incidence of postoperative acute kidney injury (defined as increase in serum creatinine >0.3 mg/dl or >50% from baseline) in the setting of complex cardiac surgery, and found:

  1. no difference in
    • group baseline values
    • incidence of postoperative AKI (control 32.7% vs eyrthropoietin 34.7%; P = 0.831)
    • levels of renal injury biomarkers, including cystatin C and neutrophil gelatinase-associated lipocalin
    • postoperative increase in interleukin-6 or myeloperoxidase
  2. erythropoietin was not associated with any complications, including thromboembolic events

Full Text:  Kim. Effect of erythropoietin on the incidence of acute kidney injury following complex valvular heart surgery: a double blind, randomized clinical trial of efficacy and safety. Critical Care 2013;17:R254  


Journal of the American Medical Association:     Anti-Platelet Therapy

Feres and colleagues performed an open-label, active-controlled, 1:1 randomized, noninferiority study assessing the clinical noninferiority of 3 months (n = 1,563) vs 12 months (n = 1,556) of dual antiplatelet therapy (aspirin 100-200 mg daily and clopidogrel 75 mg daily) in patients with stable coronary artery disease or history of low-risk acute coronary syndrome undergoing percutaneous coronary intervention with zotarolimus-eluting stents, and found:

  1. no difference in (short term versus long term)
    • the primary outcome, a composite of all-cause death, myocardial infarction, stroke, or major bleeding
      • 93 [6.0%] versus 90 patients [5.8%]; risk difference 0.17 (95% CI −1.52 to 1.860); P = 0.002 for noninferiority
    • Kaplan-Meier estimates of a composite of all-cause death, myocardial infarction, emergent coronary artery bypass graft surgery, or target lesion revascularization rates at 1 year of
      • 128 [8.3%] versus 114 [7.4%]; HR 1.12 (95% CI 0.87-1.45)
    • between 91 and 360 days
      • a composite of all-cause death, myocardial infarction, stroke, or major bleeding
        • 39 [2.6%] vs 38 [2.6%], HR 1.03 (95% CI 0.66-1.60)
      • a composite of all-cause death, myocardial infarction, emergent coronary artery bypass graft surgery, or target lesion revascularization
        • 78 [5.3%] vs 64 [4.3%]; HR 1.22 (95% CI 0.88-1.70) 
      • stent thrombosis
        • 4 [0.3%] vs 1 [0.1%]; HR 3.97 (95% CI 0.44-35.49) 

Full Text:  Feres. Three vs Twelve Months of Dual Antiplatelet Therapy After Zotarolimus-Eluting Stents. The OPTIMIZE Randomized Trial. JAMA 2013;epublished October 31st


Clinical Infectious Disease:     Influenza

Lee and colleagues completed a dual site, prospective, interventional study, comparing 150 mg (n=41) with 75 mg (n=114) oseltamivir twice daily for 5 days, commenced within 96 hours of presentation, with allocated by site, which switched after 2 influenza seasons, in 165 adults with laboratory-confirmed influenza (85 A/H3N2, 34 A/H1N1pdm09, 36 B), and found:

  1. higher trough oseltamivir carboxylate levels in the 150-mg group (501.0 ± 237.0 vs 342.6 ± 192.7 ng/mL)
  2. no significant differences in
    • day 5 viral RNA (44.7% vs 40.2%) 
    • culture negativity (100.0% vs 98.1%)
    • RNA decline rate
    • durations of fever, oxygen supplementation, and hospitalization 
  3. subanalysis of influenza B patients showed faster
    • RNA decline rate (analysis of variance, F = 4.14; P = 0.05) and clearance (day 5, 80.0% vs 57.1%) with higher-dose treatment.
  4. there was no oseltamivir resistance 
  5. treatments were generally well tolerated

Abstract:  Lee. A Prospective Intervention Study on Higher-Dose Oseltamivir Treatment in Adults Hospitalized With Influenza A and B Infections. Clin Infect Dis 2013;57:1511-1519


Meta Analysis

Critical Care:     Percutaneous Tracheostomy

Simon and colleagues analyzed cases of lethal outcome due to complications from percutaneous dilatational tracheostomy, including 68 published cases (1985 - 2013) and 3 of their own patients, and found:

  1. lethal complications occurred in 0.17%
  2. of the fatal complications
    • 31.0% occurred during the procedure 
    • 49.3% within seven days of the procedure
  3. main causes of death were
    • hemorrhage (38.0%)
    • airway complications (29.6%)
    • tracheal perforation (15.5%)
    • pneumothorax (5.6%)
  4. specific risk factors for complications in 73.2% of patients, with 25.4% of patients having more than one risk factor
  5. bronchoscopic guidance was used in only 46.5% of cases

Full Text:  Simon. Death after percutaneous dilatational tracheostomy: a systematic review and analysis of risk factors Critical Care 2013;17:R258


Observational Studies

Medicina Intensiva:     Ventilatory Modes

Abstract:  Aguirre-Bermeo. Pressure support ventilation and proportional assist ventilation during weaning from mechanical ventilation. Med Intensiva 2013;epublished October 18th 


Critical Care:     Noisy Pressure Support

Full Text:  Spieth. Short-term effects of noisy pressure support ventilation in patients with acute hypoxemic respiratory failure. Critical Care 2013;17:R261


Journal of Critical Care:     Vasopressor Therapy

Abstract:  Sviri. Does high-dose vasopressor therapy in medical intensive care patients indicate what we already suspect? J Crit Care 2013;epublished October 21st  


Neurocritical Care:     Subarachnoid Haemorrhage

Abstract:  Kowalski. Withdrawal of Technological Life Support Following Subarachnoid Hemorrhage. Neurocrit Care 2013;epublished October 29th   


Critical Care Medicine:     Hyperoxia

Abstract:  Rincon. Association Between Hyperoxia and Mortality After Stroke: A Multicenter Cohort Study. Crit Care Med 2013;epublished October 25th     


Liver International:     Coagulation in Acute Liver Injury

Abstract:  Habib. Evidence of rebalanced coagulation in acute liver injury and acute liver failure as measured by thrombin generation. Liver Int 2013;epublished October 27th  


British Journal of Anaesthesia:     Fluids

Abstract:  Skhirtladze. Comparison of the effects of albumin 5%, hydroxyethyl starch 130/0.4 6%, and Ringer's lactate on blood loss and coagulation after cardiac surgery. Br J Anaesth 2013;epublished October 29th


Critical Care:     Respiratory Failure

Full Text:  de Kretser. Serum activin A and B levels predict outcome in patients with acute respiratory failure: a prospective cohort study. Critical Care 2013;17:R263    



Journal of the Intensive Care Society:     Faecal Incontinence


Clinical & Molecular Hepatology:     Alcoholic Liver Disease


Canadian Journal of Cardiology:     Antiplatelet Therapy


Canadian Journal of Cardiology:     Cardiac Resynchronization Therapy


Canadian Journal of Cardiology:     Radiation Exposure



American Heart Journal:     Acute Decompensated Heart Failure


Medical Journal of Australia:     Tranexamic Acid


PLoS Biology:     Open Access Publishing



Annals of Emergency Medicine:     Social Media 

Nature:     PubMed


The Scientist:     Conflict of Interest


New England Journal of Medicine:     Patient Safety


New England Journal of Medicine:     Clinical Errors


Annals of Emergency Medicine:     Septic Shock


Emergency Medicine News:     Contrast Nephropathy


Review - Clinical












Recently Made Open Access Articles from Major Journals

Critical Care



Study Critique


Anesthesia & Analgesia




British Journal of Anaesthesia




Review - Basic Science

Cerebrovascular Diseases:     Diagnostic Accuracy


Review - Non-Clinical

Journal of Acute Medicine:     Managing an Emergency Department



I hope you find these brief summaries and links useful.

Until next week


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