MEGA-ROX Panel Discussion at CCR20
Welcome to the 396th Critical Care Reviews Newsletter, bringing you the best critical care research and open access articles from across the medical literature over the past seven days.
The highlights of this week's edition are randomised controlled trials on anticonvulsants for status epilepticus & ScvO2 monitoring in children with septic shock; systematic reviews and meta analyses on left ventricular venting during VA ECMO in cardiogenic shock & do‑not‑intubate orders in patients with acute respiratory failure; and observational studies on transfusion-related acute lung injury (TRALI) after intravenous immunoglobulins & mortality risk over time after early fluid resuscitation in African children. There are also guidelines on severe adult traumatic brain injury with polytrauma & prone positioning; narrative reviews on invasive pulmonary aspergillosis & extra‑cardiac endovascular infections in the critically ill; editorials on trials on oxygen supplementation in sepsis & early neuromuscular blockade in moderate to severe ARDS; and commentaries on perfusion monitoring in septic shock after the ANDROMEDA-SHOCK trial & whether physicians require consent to withhold CPR that they determine to be nonbeneficial; as well as correspondence on a provocative letter - fake news on euthanasia and organ donation.
Continuing our focus on presentations at the Critical Care Reviews Meeting next month, this week's Topic of the Week is the MEGA-ROX trial, starting with a paper on routinely collected data for randomized trials in tomorrow's Paper of the Day.
If you only have time to read one review article this week, try this one on right ventricular failure.
- Abstract: Kapur. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. N Engl J Med 2019;381:2103-2113
- Abstract: Sankar. 'Intermittent' versus 'continuous' ScvO2 monitoring in children with septic shock: a randomised, non-inferiority trial. Intensive Care Med 2019;epublished November 28th
- Full Text: Cisneros. Colistin versus meropenem in the empirical treatment of ventilator-associated pneumonia (Magic Bullet study): an investigator-driven, open-label, randomized, noninferiority controlled trial. Crit Care 2019;23(1):383
- Abstract: Reiterer. Effect of goal-directed crystalloid- versus colloid-based fluid strategy on tissue oxygen tension: a randomised controlled trial. Br J Anaesth 2019;123(6):768-776
- Full Text: Wolf. Safety and efficacy of fidaxomicin and vancomycin in children and adolescents with Clostridioides (Clostridium) difficile infection: a phase 3, multicenter, randomized, single-blind clinical trial (SUNSHINE). Clin Infect Dis 2019;epublished November 27th
- Abstract: Kollef. Ceftolozane–tazobactam versus meropenem for treatment of nosocomial pneumonia (ASPECT-NP): a randomised, controlled, double-blind, phase 3, non-inferiority trial. Lancet Infect Dis 2019;19(12):1299-1311
- Full Text: Mulangu. A Randomized, Controlled Trial of Ebola Virus Disease Therapeutics. N Engl J Med 2019;epublished November 27th
- Abstract: Al-Fares. Optimal Strategy and Timing of Left Ventricular Venting During Veno-Arterial Extracorporeal Life Support for Adults in Cardiogenic Shock. A Systematic Review and Meta-Analysis. Circulation: Heart Failure 2019;12:e006486
- Full Text: Palleschia. Lung transplantation from donation after controlled cardiocirculatory death. Systematic review and meta-analysis. Transplantation Reviews 2020;34(1):100513
- Full Text: Wösten-van Asperen. PICU mortality of children with cancer admitted to pediatric intensive care unit a systematic review and meta-analysis. Crit Rev Oncol Hematol 2019;142:153-163
- Full Text: Wilson. Do‑not‑intubate orders in patients with acute respiratory failure: a systematic review and meta‑analysis. Intensive Care Med 2019;epublished October 28th
- Abstract: Baudel. Transfusion-related acute lung injury (TRALI) after intravenous immunoglobulins: French multicentre study and literature review. Clin Rheumatol 2019;epublished November 23rd
- Full Text: Gao. Predictive value of transabdominal intestinal sonography in critically ill patients: a prospective observational study. Critical Care 2019;23:378
- Full Text: George. Mortality risk over time after early fluid resuscitation in African children. Critical Care 2019;23:377
- Full Text: Gurunathan. Association of Obesity With Septic Complications After Major Abdominal Surgery. A Secondary Analysis of the RELIEF Randomized Clinical Trial. JAMA Netw Open 2019;2(11):e1916345
- Full Text: Gastine. Pharmacokinetics of Micafungin in Critically Ill Patients. Sci Rep 2019;9(1):17741
- Full Text: Mousseaux. Epidemiology, clinical features, and management of severe hypercalcemia in critically ill patients. Ann Intensive Care 2019;9(1):133
- Full Text: Coppola. Dynamic hyperinflation and intrinsic positive end-expiratory pressure in ARDS patients. Critical Care 2019;23:375
- Full Text: Bellissimo-Rodrigues. Oral mucositis as a pathway for fatal outcome among critically ill patients exposed to chlorhexidine: post hoc analysis of a randomized clinical trial. Critical Care 2019;23:382
- Huber. Prophylactic plasma transfusion for patients without inherited bleeding disorders or anticoagulant use undergoing non-cardiacsurgery or invasive procedures. Cochrane Database of Systematic Reviews 2019, Issue 11. Art. No.: CD012745
- Barbateskovic. Higher versus lower fraction of inspired oxygen or targets of arterial oxygenation for adults admitted to the intensive care unit. Cochrane Database of Systematic Reviews 2019, Issue 11. Art. No.: CD012631
- Picetti. WSES consensus conference guidelines: monitoring and management of severe adult traumatic brain injury patients with polytrauma in the first 24 hours. World Journal of Emergency Surgery 2019;14:53
- Goodman. Challenges in the diagnosis of paediatric pneumonia in intervention field trials: recommendations from a pneumonia field trial working group. Lancet Respir Med 2019;7(12):1068-1083
- Performance Measure Development, Use, and Measurement of Effectiveness Using the Guideline on Mechanical Ventilation in Acute Respiratory Distress Syndrome. An Official American Thoracic Society Workshop Report. Ann Am Thorac 2019;16(12):1463–1472
- Intensive Care Society. Guidance For: Prone Positioning in Adult Critical Care. Published November 29th, 2019Critical Care. Published November 29th, 2019
- Denny. Extra‑cardiac endovascular infections in the critically ill. Intensive Care Med 2019;epublished November 22nd
- Arrigo. Right Ventricular Failure: Pathophysiology, Diagnosis and Treatment. Card Fail Rev 2019;5(3):140–146
- Park. State-of-the-art Structural Interventions in Heart Failure. Card Fail Rev 2019;5(3):147–154
- Agostoni. Haemodynamic Balance in Acute and Advanced Heart Failure: An Expert Perspective on the Role of Levosimendan. Card Fail Rev 2019;5(3):155–161
- Van Iterson. Left Ventricular Assist Device Support Complicates the Exercise Physiology of Oxygen Transport and Uptake in Heart Failure. Card Fail Rev 2019;5(3):162–168
- Bistola. Inotropes in Acute Heart Failure: From Guidelines to Practical Use: Therapeutic Options and Clinical Practice. Card Fail Rev 2019;5(3):133–139
- Cholley. Levosimendan in the light of the results of the recent randomized controlled trials: an expert opinion paper. Critical Care 2019;23:385
- Jamil. Infective endocarditis: trends, surgical outcomes, and controversies. J Thorac Dis 2019;11(11):4875-4885
- Peck. Recent advances in the understanding and management of ARDS. F1000Research 2019, 8(F1000 Faculty Rev):1959
- Chang. Acute Respiratory Distress Syndrome as an Organ Phenotype of Vascular Microthrombotic Disease: Based on Hemostatic Theory and Endothelial Molecular Pathogenesis. Clin Appl Thromb Hemost 2019;25:1076029619887437
- Serin. Atelectasis in Bariatric Surgery: Review Analysis and Key Practical Recommendations. Turk J Anaesthesiol Reanim 2019;47(6):431-438
- Shen. Diagnosis of invasive pulmonary aspergillosis in the intensive care unit: what we should concern and how to do better. J Emerg Crit Care Med 2019;3:54
- Soo. Optimizing organs for transplantation; advancements in perfusion and preservation methods. Transplantation Reviews 2020;34(1):100514
- Soo. Molecular strategies used by hibernators: Potential therapeutic directions for ischemia reperfusion injury and preservation of human donor organs. Transplantation Reviews 2020;34(1):100512
- Lambden. The SOFA score—development, utility and challenges of accurate assessment in clinical trials. Critical Care 2019;23:374
- Owston. The anaesthetic management of the airway after blunt and penetrating neck injury. Trauma 2019;epublished November 20th
- Saia. Shifting the attention from devices to treatment: the lesson from IABP-SHOCK II and other trials in cardiogenic shock. J Thorac Dis 2019;11(11):E206-E209
- Park. Early neuromuscular blockade in moderate to severe acute respiratory distress syndrome: do not throw the baby out with the bathwater! J Thorac Dis 2019;11(11):E231-E234
- Dimopoulos. Infections in the ICU—the big problem! J Emerg Crit Care Med 2019;3:55
- Sato. How should we decide the optimum intraoperative fluid and colloid usage in pulmonary resection? J Thorac Dis 2019;11(11):E204-E205
- Perner. Trials on oxygen supplementation in sepsis: better late than never. Intensive Care Med 2019;epublished November 26th
- Ball. Family override for organ donation. Can J Anaesth 2019;epublished November 26th
- Jung. The Janus faces of bicarbonate therapy in the ICU. Intensive Care Med 2019;epublished November 11th
- De Waele. How I search for a sepsis source. Critical Care 2019;23:386
- Treweek. Protocols—more structure, less ‘Wuthering Heights’. Trials 2019;20:649
- Downar. Do physicians require consent to withhold CPR that they determine to be nonbeneficial? CMAJ 2019;191(47):E1289-E1290
- Hernándeza. Perspectives on perfusion monitoring in septic shock after the ANDROMEDA-SHOCK trial. Medicina Intensiva 2019;43(9):578-581
- Mushtaq. Breakthrough in the treatment of drug-resistant tuberculosis. Lancet Respir Med 2019;7(12):1011
- Aoki. Comment on epinephrine during resuscitation of traumatic cardiac arrest and increased mortality: a post hoc analysis of prospective observational study. Scand J Trauma Resusc Emerg Med 2019;27:107
- Meyfroidt. Fake news on euthanasia and organ donation. Intensive Care Med 2019;epublished October 23rd
- Mongodi. Personalised mechanical ventilation in acute respiratory distress syndrome: the right idea with the wrong tools? Lancet Respir Med. 2019 Dec;7(12):e38
- Constantin. Personalised mechanical ventilation in acute respiratory distress syndrome: the right idea with the wrong tools? – Authors' reply. Lancet Respir Med 2019;7(12):Pe39
- Doig. Thrombotic thrombocytopenic purpura masquerading as a stroke in a young man. CMAJ 2019;191(47):E1306-E1309
- Kanda. Intracardiac Echocardiography Instead of Transesophageal Echocardiography in Surgical Aortic Valve. Journal of Cardiothoracic and Vascular Anesthesia 2019;epublished November 26th
- Hannig. Acute Awake Fiberoptic Intubation in the ICU in a Patient with Limited Mouth Opening and Hypoxemic Acute Respiratory Failure. Case Rep Anesthesiol 2019;23;2019:6421910
- Andres. Acute kidney injury following high-dose vitamin C treatment. Dtsch Arztebl Int 2019;116:756
- Mołek. Simultaneous cardiac free-wall rupture and ventricular septal rupture following acute myocardial infarction treated with emergency balloon inflation. Pol Arch Intern Med 2019;129(11):830-832
Now in it's 8th year, the Critical Care Reviews Meeting brings the chief investigators for the best critical care trials of the previous year to Titanic, Belfast, to discuss their studies. We aim to decide whether these trials are sufficiently robust to support their findings and if we should consider changing practice on the basis of them. To help in this endeavour we invite world leading experts to provide independent editorial overviews and have panel discussions to delve deep into the specifics of each trial. In addition, we also have detailed discussions on research methodology, to encourage critical thinking about the scientific findings which form the basis of our clinical practice. It's not just about specific trials though; for 2020, we have a distinguished panel of trialists, methodologists, statisticians and clinicians provide insight into the mysteries of clinical trial interpretation, as well as a panel discission on the proposed MEGA-ROX trial, potentially a game changer for critical care trials. We are delighted to have the opportunity to conduct a one-on-one interview with the editor-in-chief of JAMA, Prof Howard Bauchner, in discussion with Prof Marion Campbell. As usual, we eound off the formal programme with the annual honorary John Hinds Lecture, to be delivered by Prof Kathryn Maitland, entitled "A Higher Calling: Two Decades of Emergency Research in Africa", and finish the meeting with the incredibly popular "Informal Chat", where the faculty and delegates congregate in the bar and an enormous, meandering discussion about all things critical care takes place.
For CCR20, we are hosting 3 major trial results presentations, PEPTIC, 65 & VITAMINS, as well as discussing 9 of the best trials from 2019 - COACT, TRACT, ICU-ROX, SPICE III, BiRDS, ROSE, CITRIS-ALI, SEPSIS-ACT & HYPERION.
Based on our feedback from last year, we've reverted to keeping everyone on the same floor during breaks. In addition, we will also provide a sleeping area for those post-call to rest for a few hours as needed. As before, we are offering free childcare and a baby feeding area, where the meeting will live streamed. All dietary requirements are catered for also. Please get in touch if you have any specific needs. We sold out last year, so please don't delay if you want to attend. As usual, CPD points will be applied for in due course.
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Until next week
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