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Newsletter 131 / June 8th 2014




Welcome to the 131st 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 hundreds of clinical and scientific journals. I've tried a new look for the website newsletter this week, aiming to simplify location of items of interest. I've left out the introduction to the newsletter, as I'm unsure it adds much. Let me know if this approach doesn't work.

The beginning of each month marks the addition of recently made open access articles from the major critical care journals, with 60 superb papers included in the reviews section. The topic for This Week's Papers is intra-cardiac arrest management, starting with a general paper in tomorrow's Paper of the Day.

Critical Care Reviews Meeting

The guest speaker line up has now been announced. Check out the 2015 meeting webpage for further details. The full programme will be released later in the Summer, with online registration opening October 1st.

SMACC Chicago Conference

The SMACC organisers have been forced to change the dates of the next year's conference in Chicago to June 23rd to 26th. Check out the beautifully designed SMACC website for further details.

Big Announcement

The final preparations for a massive announcement are almost in place. Expect a supplemental newsletter in the next few days explaining a new development in critical care that you'll want to be part of.



PEEP in General Anaesthesia

The PROVE Network Investigators compared high PEEP (median 12 cmH20) plus recruitment maneuvres (n=447) with low PEEP (median 2 cmH20) without recruitment manuevres (n=453) in 900 patients undergoing open abdominal surgery, ventilated with 8 ml/kg and at high risk for postoperative pulmonary complications, and found no difference in post-operative complications (high PEEP 40% vs low PEEP 39%, RR1·01; 95% CI 0·86 to1·20; p=0·86), but increased hypotension with higher PEEP, requiring more vasopressor therapy.

Abstract:  The PROVE Network Investigators. High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial. Lancet 2014;epubished May 30th


In a three centre, single blind study, Puntillo and colleagues found that a thirst bundle (oral swab wipes, sterile ice-cold water sprays, and a lip moisturizer) was superior to standard care in 252 cognitively intact thirsty patients, reducing thirst intensity (2.3 vs 0.6 points) and/or thirst distress (1.8 vs 0.4 points) on 0–10 numeric rating scale (P<0.05), and almost halving the incidence of a dry mouth for each additonal application of the thirst bundle on day 1.

Abstract:  Puntillo. A randomized clinical trial of an intervention to relieve thirst and dry mouth in intensive care unit patients. Intensive Care Med 2014;epublished June 5th

Long-Acting Gram Positive Antibacterial Therapy

Boucher et al pooled two identically designed, industry funded, noninferiority trials, and found once-weekly IV dalbavancin (a long-acting lipoglycopeptide antibiotic active against gram positive bacteria, n=659) was non-inferior to twice-daily IV vancomycin followed by oral linezolid (n=653) for the treatment of acute bacterial skin and skin-structure infection, with no difference in early clinical response indicating treatment success (79.7% vs 79.8%, respectively; weighted difference, −0.1%; 95% CI−4.5 to 4.2%), or side effects. Individual study analyses yielded similar results, as did pooled analysis of clinical status at end of therapy.

Abstract:  Boucher. Once-Weekly Dalbavancin versus Daily Conventional Therapy for Skin Infection (DISCOVER 1 & 2 studies).  N Engl J Med 2014;370:2169-2179

Long-Acting Gram Positive Antibacterial Therapy

Corey and colleagues found a single dose of IV oritavancin (a long-acting lipoglycopeptide with bactericidal activity against gram-positive bacteria, n=475) was non-inferior to a regimen of twice daily IV vancomycin for 7 to 10 days (n=479) in 954 adults with acute bacterial skin and skin-structure infections, for three main outcomes:

  • spreading or reduction in lesion size, absence of fever, and no need for administration of a rescue antibiotic after 48 to 72 hours (82.3% vs 78.9%, respectively;  95% CI for difference −1.6 to 8.4%)
  • clinical cure 7 to 14 days after the end of treatment, as determined by a study investigator (79.6% vs 80.0%, 95% CI for difference −5.5 to 4.7%)
  • reduction in lesion size of 20% or more after 48 to 72 hours (86.9% vs 82.9%, 95% CI for difference −0.5 to 8.6%)

Abstract:  Corey. Single-Dose Oritavancin in the Treatment of Acute Bacterial Skin Infections (SOLO I study). N Engl J Med 2014;370:2180-2190 


Physiology after Death

Dhanani et el measured invasive arterial blood pressure, electrocardiogram, and oxygen saturation plethysmography activity for 30 minutes after the declaration of death in 41 subjects after withdrawal of life-sustaining therapy, with complete data for 30 subjects, and found four subjects had resumption of circulatory function (restoration of arterial blood pressure), with the the longest period from cessation to resumption being 89 seconds, and duration of resumption ranging from 1 to 172 seconds. ECG activity continued after loss of blood pressure in 27 of 30 patients. There were no cases of autoresuscitation or sustained circulatory function.

Abstract:  Dhanani. Vital Signs After Cardiac Arrest Following Withdrawal of Life-Sustaining Therapy: A Multicenter Prospective Observational Study. Crit Care Med 2014;epublished  May 7th

Blood Pressure post Cardiac Arrest

Kilgannon and colleagues prospectively measured blood pressure during the postresuscitation period after cardiac arrest, examining its association with neurological outcome in 151 patients and found a mean arterial pressure > 70 mmHg had the strongest association with good neurological outcome (odds ratio 4.11, 95% CI 1.34 to 12.66; p = 0.014).

Abstract:  Kilgannon. Arterial Blood Pressure and Neurological Outcome After Resuscitation From Cardiac Arrest. Critical Care Med 2014;epublished June 4th

Cancer-related ARDS

Azoulay et al performed a retrospective, multicentre, database analysis investigating the outcomes in 1,004 cancer patients with ARDS, as defined by the Berlin definition, and found most patients had haematological malignancies (86%), with almost have having neutropaenia (44%). The majority had infection-related ARDS, either pulmonary (66%) or extra-pulmonary (22%), with just 8% having non-infection-related ARDS and 4% being of undetermined cause. Of the 662 cases of pulmonary infection, 385 were bacterial, 213 invasive aspergillosis, and 64 Pneumocystis pneumonia. Of 39% initially treated with non-invasive ventilation, 71% subsequently required invasive mechanical ventilation. 25% had mild ARDS, 42% moderate ARDS, and 32% severe ARDS, with respective mortalities of 59, 63 and 68.5 % (p = 0.06).

Abstract:  Azoulay. Acute respiratory distress syndrome in patients with malignancies. Intensive Care Med 2014;epublished June 5th

Statins & Delirium

Salottolo and colleagues examined the association between statin usage, both prior to hospitalization and during the ICU stay, and delirium (assessed twice daily using the CAM-ICU) in 763 critically ill patients (median age 61 & APACHE II score 25) and found prehospital use (25%) was not associated with the development of delirium (OR 0.86; 95% CI 0.44 to 1.66; p = 0.18), although if statin therapy was withheld, the odds of developing delirium increased the longer the statin was held. Statin use in the ICU use was associated with an adjusted reduced risk for developing delirium (p < 0.01), although this was context dependent.

Abstract:  Morandi. Statins and Delirium During Critical Illness: A Multicenter, Prospective Cohort Study. Critical Care Med 2014;epublished May 7th


Randomized Controlled Trials

Meta Analyses

Observational Studies


Saudi Guidelines on Management of Pulmonary Hypertension








Miscellaneous Clinical


American Journal of Respiratory and Critical Care Medicine

Review Articles



Review Articles

Case Reports

Critical Care

Review Articles




Review Articles

Anesthesia & Analgesia

Review Articles

Ultrasound Case Report

British Journal of Anaesthesia

Review Articles


Continuing Education in Anaesthesia, Critical Care and Pain

Review Articles


Review Article



I hope you find these brief summaries and links useful.

Until next week.



ps. I will have limited internet access for the next two weeks, so service may be lighter than usual.