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Critical Care Reviews Newsletter

September 30th 2012





Welcome to the 43rd 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 and guidelines from over 300 clinical and scientific journals.

This week's issue of The Lancet features three important studies, demonstrating a European non-cardiac operative mortality of 4%, an association between the duration of resuscitation and outcome in cardiac arrest, and the lack of benefit of routine peripheral cannula replacement. The review articles are wide ranging as ever and include papers on mechanical circulatory support, ARDS, mechanical ventilation, septic cardiomyopathy and several on burns.

The topic for This Week's Papers is fungal infections, starting with a paper on the management of invasive fungal infections in tomorrow's Paper of the Day. It's a free and easy way to stay up-to-date with your reading.

The new CPD / CME facility is ready to go, but frustratingly I'm still awaiting official approval. Hopefully I'll be able to release it this week.



Novartis:     Acute Heart Failure

In a press release prior to presentation at the American Heart Association congress in Los Angeles in November, Novartis announced the primary results of the RELAX-AHF study. This was an international randomized, double-blind, placebo-controlled study in 1,161 patients with acute heart failure (AHF). Patients with AHF and a systolic pressure > 125 mmHg received either a 48-hour intravenous infusion of RLX030 (serelaxin), a recombinant form of the human hormone relaxin-2, or placebo. The study intervention reduced both shortness of breath and all-cause mortality at 6 months compared with placebo plus standard of care. More detailed results are awaited.

Press ReleaseNovartis. Results from Novartis phase III study show that RLX030 reduced deaths in patients with acute heart failure [press release]. September 24, 2012.


Lancet:     Cardiac Arrest

Using registry data Goldberger et al evaluated whether the duration of resuscitation attempts varied between hospitals and whether patients at hospitals that attempted resuscitation for longer had higher survival rates than do those at hospitals with shorter durations of resuscitation.  efforts.  64 339 patients with cardiac arrests were identified at 435 US hospitals.  31 198 of 64 339 (48·5%) patients achieved return of spontaneous circulation and 9912 (15·4%) survived to discharge. For patients achieving return of spontaneous circulation, the median duration of resuscitation was 12 min (IQR 6—21) compared with 20 min (14—30) for non-survivors. Compared with patients at hospitals in the quartile with the shortest median resuscitation attempts in non-survivors (16 min [IQR 15—17]), those at hospitals in the quartile with the longest attempts (25 min [25—28]) had a higher likelihood of return of spontaneous circulation (adjusted risk ratio 1·12, 95% CI 1·06—1·18; p<0·0001) and survival to discharge (1·12, 1·02—1·23; 0·021).

Abstract: Goldberger. Duration of resuscitation efforts and survival after in-hospital cardiac arrest: an observational study. Lancet 2012; epublished ahead of print


Lancet:     Surgical Mortality

Pearse et al performed an international cohort study over 7 days to assess outcomes after non-cardiac surgery in Europe. 46 539 consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations, were recruited. 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9—3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0—3·0] for Iceland to 21·5% [16·9—26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19—1·05; p=0·06] for Finland to 6·92 [2·37—20·27; p=0·0004] for Poland).

Abstract: Pearse. Mortality after surgery in Europe: a 7 day cohort study. Lancet 2012;380(9847):1059-1065


The Lancet:     Peripheral Cannulation

Rickard et al performed a multicentre, randomised, non-blinded equivalence trial in 3283 patients to test the utility of routine replacement of peripheral cannulae after three days use (n=1690) versus replacement when clinically indicated (n=1593). 5907 catheters were placed, with a mean dwell time for catheters in situ on day 3 was 99 h (SD 54) in the clinically indicated group and 70 h (13) in the routinely replaced group. Phlebitis occurred in 114 of 1593 (7%) patients in the clinically indicated group and in 114 of 1690 (7%) patients in the routine replacement group, an absolute risk difference of 0·41% (95% CI −1·33 to 2·15%), which was within the prespecified 3% equivalence margin. No serious adverse events related to study interventions occurred.

Abstract: Rickard. Routine versus clinically indicated replacement of peripheral intravenous catheters: a randomised controlled equivalence trial. Lancet 2012;380(9847):1066-1074


Journal of Trauma:     Cervical Spine Clearance

Ross et al assessed the utility of clinical examination for screening of cervical spine (c-spine) injury in awake and alert blunt trauma patients with concomitant distracting injuries. 761 blunt trauma patients with GCS ≥14 and at least one distracting injury were identified. Two-hundred ninety-six (39%) of the patients with distracting injuries had a positive c-spine clinical examination, 85 (29%) of whom were diagnosed with c-spine injury. Four hundred sixty-four (61%) of the patients with distracting injuries were initially clinically cleared, with one patient (0.2%) diagnosed with a c-spine injury. This yielded an overall sensitivity of 99% (85/86) and negative predictive value greater than 99% (463/464) for cervical spine clinical examination in awake and alert blunt trauma patients with distracting injuries.

Abstract:  Ross. Clinical clearance of the cervical spine in patients with distracting injuries: It is time to dispel the myth. J Trauma Acute Care Surg. 2012 Aug;73(2):498-502


Review - Clinical

Cardiology Research & Practice:     Mechanical Circulatory Support


International Journal of Hepatology:     Portal Hypertension


Critical Care Research and Practice:     ARDS


Critical Care Research and Practice:     Mechanical Ventilation


Pathobiology:     Septic Cardiomyopathy


Emergency Medicine International:     Neurological Emergencies


Core Evidence:     Angioedema


International Journal of General Medicine


Drug Design, Development and Therapy:     Pulmonary Fibrosis


Scientific World Journal:     Renal Transplantation


QJM:     Pulmonary Fibrosis


Indian Journal of Plastic Surgery:     Pressure Ulcers


Indian Journal of Plastic Surgery:     Burns


Indian Journal of Plastic Surgery:     Wound Healing


Indian Journal of Plastic Surgery:     Radiation Injury


Indian Journal of Plastic Surgery:     Skin Substitutes


Indian Dermatology Online Journal


Review - Basic Science

Clinical and Developmental Immunology:     Sepsis


I hope you find these brief summaries useful.

Until next week