ccr logo 246x225 13121Critical Care Reviews Newsletter

July 9th 2012





Welcome to the 31st Critical Care Reviews Newsletter. Every week, now over three hundred clinical and scientific journals are monitored and the most important and interesting research publications in critical care are highlighted. These studies are added to the Current Articles section of the website on a daily basis, as publication occurs. A link to either the full text or abstract, depending on the publishers degree of open access, is attached. Also, links to other important papers, such as guidelines or consensus statements are included. Free review articles from across the medical literature are also highlighted.

It's a relatively quiet week for research this week, with no major studies being published, although colloids continue to suffer. However, there is a wide variety of new review articles linked to, including a great debate on PEEP in ARDS from Chest.

The topic for This Week's Papers is imaging, starting with a fascinating review on the biological hazards of ultrasound in today's Paper of the Day. It's an easy way to stay up-to-date with your reading.

If you think a colleague may find this newsletter useful, please send it on. It's entirely free.



American Journal of Respiratory & Critical care Medicine:     Sepsis

Gibot and colleagues sought to determine the usefulness of a serum biomarker score, consisting of measurements of soluble triggering receptor expressed on myeloid cells-1, procalcitonin, and the expression of the high-affinity immunoglobulin-Fc fragment receptor I (FcγRI) CD64 on neutrophils (polymorphonuclear [PMN] CD64 index), in diagnosing sepsis. Three hundred consecutive patients were enrolled to construct a biologic score that was then validated in an independent prospective cohort of 79 critically ill patients from another center. Serum concentrations of these 3 biomarkers were higher in patients with sepsis compared with all others (P < 0.001 for the three markers). Also, these biomarkers were all independent predictors of infection, with the best receiver-operating characteristic curve being obtained for the PMN CD64 index. The performance of the bioscore was superior to that of each individual biomarker.

Abstract:  Gibot. Combination Biomarkers to Diagnose Sepsis in the Critically Ill Patient. Am J Respir Crit Care Med 2012;186:65-71


Intensive Care Medicine:     Religion

Bülow and colleagues performed an international, multi-centre survey of 304 physicians, 386 nurses, 248 patients and 330 family members to determine the effect of strength of religious belief on end-of-life decisions in the ICU. Patients and family members were more likely to want treatment than professionals. Those with stronger religious beliefs wanted more treatment, were more in favour of life prolongation and less in favour of euthanaisa than those of less religious belief.

Abstract:  Bülow. Are religion and religiosity important to end-of-life decisions and patient autonomy in the ICU? The Ethicatt study. Intensive Care Med 2012;38(7):1126-1133  


Intensive Care Medicine:     Gelatin Solutions

Thomas-Ruddel et al performed a systematic review of 40 randomized controlled trials (n=3725) in patients receiving gelatin for resuscitation in comparison to albumin or crystalloids. No study was adequately powered to investigate the frequency of patient-important outcomes. Risks were not statistically significantly different for mortality (RR 1.12, 95 % CIl, 0.87–1.44) and exposure to allogeneic transfusion (RR 1.28, 0.89–1.83). The authors conclude the safety and efficacy of gelatin solutions is undetermined in some settings.

Abstract:  Thomas-Rueddel. Safety of gelatin for volume resuscitation—a systematic review and meta-analysis. Intensive Care Medicine 2012;38(7):1134-1142


Critical Care:     Delirium

Gusmao-Flores et al performed a systematic review and meta analysis of the accuracy of the Confusion Assessment Method for Intensive Care Unit (CAM-ICU; 9 studies totalling 969 patients) and the Intensive Care Delirium Screening Checklist (ICDSC; 4 studies totalling 361 patients) for the diagnosis of delirium in critically ill patients. For the CAM-ICU method, the pooled sensitivity, specificity, C-statistic and diagnostic odds ratio were 80.0% (95% CI: 77.1 - 82.6%),  95.9% (95% IC: 94.8 - 96.8%), 0.97 and 103.2 (95% IC: 39.6 - 268.8), respectively. For the ICDSC the pooled sensitivity, specificity, C-statistic and diagnostic odds ratio were 74% (95% IC: 65.3 - 81.5%), 81.9% (95% IC: 76.7 - 86.4%), 0.89 and 21.5 (95% IC: 8.51 - 54.4), respectively.

Full Text:  Gusmao-Flores. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies. Critical Care 2012; 16:R115



Chest:     Positive End-Expiratory Pressure

  • Should Positive End-Expiratory Pressure in Patients With ARDS Be Set on Oxygenation? Chest June 2012 141:6 1379-1388

Pro - Miller; Con - Schmidt; Rebuttal - Miller; Rebuttal - Schmidt.


Review - Clinical

Chest:    Acute Kidney Injury


Drug Design, Development & Therapy:     Scorpion Sting


Perioperative Medicine:     Acute Kidney Injury


Annals of Intensive Care:     Acute Kidney Injury


Gut:     End-Stage Liver Disease


Journal of the American Medical Association:     Delirium


Annals of Cardiac Anaesthesia:     Cardiopulmonary Bypass


Annals of Intensive Care:     Antimicrobial Administration


Saudi Journal of Kidney Diseases & Transplantation:     Transplantation


Review - Basic Science

Cardiology:     Beta-Adrenergic Receptors


Review - Non-Clinical

Canadian Medical Association Journal:     Professionalism



I hope you find these links and brief summaries useful.

Until next week