April 16th 2012
Welcome to the 19th Critical Care Reviews Newsletter. Every week over two 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 Journal Watch 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. Additionally, any relevant new guidelines or open access review articles, commentaries or editorials are also included.
Brain: Spinal Cord Injury
In a single-centre, double-blind, randomized, placebo-controlled study, Casha and colleagues evaluated the effects of 7 days intravenous administration of minocycline in 52 subjects after spinal cord injury. Patients treated with minocycline experienced six points greater motor recovery than those receiving placebo (95% CI −3 to 14; P = 0.20, n = 44). No difference in recovery was observed for thoracic spinal cord injury (n = 16). A difference of 14 motor points that approached significance was observed in patients with cervical injury (95% confidence interval 0–28; P = 0.05, n = 25).
Brain: Determining Consciousness
Rosanova and colleagues assessed whether transcranial magnetic stimulation & electroencephalogram measures of effective connectivity (multiple, specialized cortical areas engaging in rapid causal interactions) were (1) able to discriminate between unconscious (vegetative state) and conscious (minimally conscious state, locked-in syndrome) patients with a clear, stable clinical diagnosis, and (2) by means of repeated measures, whether changes in effective connectivity are also detectable over time in the brains of individual patients who recover consciousness.
In patients in a vegetative state, who were open-eyed, behaviourally awake but unresponsive, transcranial magnetic stimulation triggered a simple, local response indicating a breakdown of effective connectivity, similar to the one previously observed in unconscious sleeping or anaesthetized subjects. In contrast, in minimally conscious patients, who showed fluctuating signs of non-reflexive behaviour, transcranial magnetic stimulation invariably triggered complex activations that sequentially involved distant cortical areas ipsi- and contralateral to the site of stimulation, similar to activations we recorded in locked-in, conscious patients. Longitudinal measurements performed in patients who gradually recovered consciousness revealed that this clear-cut change in effective connectivity could occur at an early stage, before reliable communication was established with the subject and before the spontaneous electroencephalogram showed significant modifications.
Critical Care: Candida Prophylaxis
In a prospective, randomized, placebo-controlled trial, Giglio evalutaed the effects of oral prophylaxis with nystatin on candida colonization and infection in 99 patients in a surgical/trauma ICU. At admission, 69 patients were colonized: the most frequently colonized body sites were the stomach and the pharynx. The most frequent isolated spp was C. albicans. The candida colonization index was similar in the two groups at day 0 (p=0.36) while a significant statistical difference was observed between treatment (median 0.14) and control group (median 0.33, p=0.0016) at day 6, at day 9 (nystatin group, median 0.00 vs control group, median 0.28, p=0.0001), at day 12 (median 0.00 vs 0.41, p=0.0008) and at day 15 (median 0.00 vs 0.42, p<0.0003). The same results were obtained in the sub-group of patients already colonized at ICU admission.
Journal of Trauma: Outcome after Unconsciousness
In a single centre observational study, Weiwei et al investigated the predictive power of somatosensory evoked potentials (SEPs) for minimally conscious state (MCS) in 58 long-term unconscious patients after traumatic brain injury. 22 of 58 were minimally conscious, 3 of 58 dead, and 33 of 57 were still in vegetative state at 12 months after TBI. SEPs grade (p = 0.001) and GCS (p = 0.010) were significantly associated with the outcome. The area under the receiver operator characteristic curve of SEPs was 0.891 ± 0.048 (p < 0.001; 95% CI, 0.798–0.984) for predicting outcome, and of GCS score was only 0.746 ± 0.066 (p = 0.002; 95% CI, 0.616–0.876). The accuracy of the whole model for predicting unconscious and MCS was 91.7% and 86.4%, respectively. The overall correct prediction was as high as 89.7% (p < 0.001).
- Fink. Myths and facts in neuromuscular pharmacology. New developments in reversing neuromuscular blockade. Minerva Anestesiologica 2012;78(4):473-82
- Gross. Humidification of inspired gases during mechanical ventilation. Minerva Anestesiologica 2012;78(4):496-502
Interactive Cardiovascular & Thoracic Surgery
- Pucher. Is heparin needed for patients with an intra-aortic balloon pump? Interact CardioVasc Thorac Surg 2012
British Journal of Anaesthesia: Dysrhythmias
- Staikou. Perioperative management of hereditary arrhythmogenic syndromes. Br J Anaesth 2012;108:730-744
International Journal of Critical Illness & Injury Science
- Saseedharan. Upper extremity deep vein thrombosis. Int J Crit Illn Inj Sci 2012;2:21-6
- Trappe. Role of music in intensive care medicine. Int J Crit Illn Inj Sci 2012;2:27-31
Revista Brasileira de Anestesiologia
Journal of Anaesthesiology Clinical Pharmacology
Journal of Emergencies, Trauma & Shock
- Goodman. The role of bedside ultrasound in the diagnosis of pericardial effusion and cardiac tamponade. J Emerg Trauma Shock 2012;5:72-5
- Husain. Sonographic diagnosis of pneumothorax. J Emerg Trauma Shock 2012;5:76-81
- Corr. Sonography of gangrenous cholecystitis. J Emerg Trauma Shock 2012;5:82-3
- Hefny. The role of ultrasound in the management of intestinal obstruction. J Emerg Trauma Shock 2012;5:84-6
I hope you find this brief update useful.
Until next week