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Critical Care Reviews Newsletter

January 15th 2012



Welcome to the sixth Critical Care Reviews Newsletter. Every weekend some of the more important studies in critical care, which were published that week, are highlighted. These studies are added to the News section of the website on a daily basis, as publication occurs.


Steroids in Septic Shock

From this week's edition of the American Journal of Respiratory and Critical Care Medicine Patel presents an interesting review on the current evidence for steroid use in septic shock.

Abstract: Patel. Systemic Steroids in Severe Sepsis and Septic Shock. Am. J. Respir. Crit. Care Med. 2012;185 133-139


Commencement RRT

Epublished ahead of print in Nephrology Dialysis Transplantation Ostermann et al address the issue of when to commence RRT in AKI. Using a meta-analytic approach with a mixture of prospective, randomized and observational, and retrospective studies, they determined no single biochemical parameter was sufficient to base the decision on. Instead they propose an algorithm based on trends in the patient’s severity of illness, presence of oliguria, fluid overload and associated non-renal organ failure.

Abstract. Ostermann. Renal replacement therapy in critically ill patients with acute kidney injury—when to start. Nephrol Dial Transplant (2012) 0: 1–7 (epub ahead of print)


24 Hour Intensivist Cover

Epublished ahead of print in the American Journal of Respiratory and Critical Care Medicine, Garland and colleagues report a Canadian pilot study suggesting 24 hour Intensivist cover in ICU makes little difference on clinical outcomes for patients or family satisfaction, results in greater conflicts with nurses and less autonomy for resident staff. However, Intensivists suffered less burnout.

Abstract. Garland.24 Hour Intensivist Presence: A Pilot Study of Effects on ICU Patients, Families, Doctors and Nurses. Am J Resp Crit Care Med 2012 Jan 12; epub ahead of print.


Care of the Dialysis Patient in ICU

Another early publication, this time a review article from the British Journal of Anaesthesia, covering the management of the dialysis patient in the ICU.

Abstract. Arukumaran. Management of the dialysis patient in general intensive care. Br J Anaesth 2012; epublished ahead of print.


Outcome from Acute-on-Chronic Liver Failure

In this months Liver and Digestive Diseases, Garg reports the results of anobservation study of 91 patients admitted to ICU suffering with acute-on-chronic liver failure. Hepatitis B and alcoholic hepatitis were the most common chronic causes of liver disease and exacerbations of these conditions were similarly the most common causes of acute episodes. 90 day mortality was 63%. On multivariate analysis, hepatic encephalopathy, low serum sodium, and high INR were found to be independent baseline predictors of mortality, which could also be predicted by baseline MELD, SOFA or APACHE-II scores.

Abstract. Garg. Clinical profile and predictors of mortality in patients of acute-on-chronic liver failure. Digestive and Liver Disease 2012;44(2):166-171


Potassium levels in Myocardial Infarction

In this week's issue of JAMA Goyal et al describe the results of a retrospective study over 9 years in 38,689 patients with acute myocardial infarction. Those with either a higher or lower potassium level (< 3.5, >4.5 mEq/L) had increased rates of death (10% v 4.8%), while rates of ventricular fibrillation or cardiac arrest were only higher in those with more extreme potassium levels (<3, >5 mEq/L).

Abstract. Goyal. Serum Potassium Levels and Mortality in Acute Myocardial Infarction. JAMA 2012;307(2):157-164


Infective Endocarditis Guidelines

Updated guidelines for the diagnosis and management of infective endocarditis have been published in this month's issue of the Journal of Antimicrobial Chemotherapy.

Full Text. Gould. Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults: a report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2012;67(2):269-289.


Dopamine Antagonists in Traumatic Brain Injury

In January's issue of the Journal of Neurotrauma, Frenette et al performed a systematic review of randomized controlled trials (RCTs) examining the clinical efficacy and safety of dopamine agonists in patients with traumatic brain injury. 20 RCTs examining the utility of methylphenidate, amantadine, and bromocriptine to enhance cognitive recovery were identified but all were significantly limited by the absence of consensus regarding clinical outcome, the lack of safety assessment, and a high risk of bias. Based on this heterogeneity the authors conclude more research is warranted before dopamine agonists can be recommended in critically ill TBI patients

Abstract.Frenette. Efficacy and Safety of Dopamine Agonists in Traumatic Brain Injury: A Systematic Review of Randomized Controlled Trials. Journal of Neurotrauma. 2012;29(1):1-18.


Fresh Frozen Plasma in Massive Blood Transfusion

In January's issue of Injury Mitra reviewed 6 years worth of data fromThe Alfred Trauma Registry and compared 66 patients who received high ratio FFP:PRBC transfusions (≥1:2) in the absence of coagulopathy to 113 patients who received a lower ratio. There was no significant difference in mortality between the two groups (p=0.80), and the FFP:PRBC ratio was not significantly associated with mortality, ICU length of stay or mechanically ventilated hours.

Abstract. Mitra.Aggressive fresh frozen plasma (FFP) with massive blood transfusion in the absence of acute traumatic coagulopathy. Injury 2012;43(1):33-37



I hope you find these brief summaries useful.

Until next week