ccr logo 246x225 13121Critical Care Reviews Newsletter

September 3rd 2012





Welcome to the 39th Critical Care Reviews Newsletter. After last week's massive email, things are quieter this week. The standout paper is the IABP-SHOCK II trial, published this week in the New England Journal of Medicine, which questions the use of intra-aortic balloon counterpulsation in cardiogenic shock.The European Society of Cardiology have released 3 new guidelines, on ST elevation MI, atrial fibrillation and valvular disorders. And if you ever happen to treat someone struck by lightning, then there's even a guideline for this eventuality.....

I've added a new feature, the top 100 critical care studies. This is more of a draft list, as there is some tweaking to be done - adding studies I've forgotten or missed, removing a few that aren't really so important, and altering the order of others. Let me know what you think. It promises to be a useful resource once finalised. The top studies have also been organised by system, to make it easier to follow a single group of studies. Again, much more work needs to be done to really make it a great resource, but it's a start.

The topic for This Week's Papers is conventional mechanical ventilation, starting with the basics of mechanical ventilation in today's Paper of the Day

The new continuing medical education / continuing professional development facility should be functional in the next few days. if you need CME/CPD points for appraisal purposes, then collecting these certificates should help.



New England Journal of Medicine:     Cardiogenic Shock

To test the efficacy of intra-aortic balloon counterpulsation (IABP) in acute myocardial infarction complicated by cardiogenic shock, Thiele et al performed a prospective, open-label, multicenter trial, randomly assigned 600 patients to IABP (n=301) versus no IABP (n=299). The 30 day mortality rate was (39.7%) in the IABP group (119/301) versus 41.3% in the control group (123/299) (relative risk with IABP, 0.96; 95% CI 0.79 to 1.17; P=0.69). There were no significant differences in secondary end points or in process-of-care measures, including the time to hemodynamic stabilization, the length of stay in the intensive care unit, serum lactate levels, the dose and duration of catecholamine therapy, and renal function. Similarly, there were no difference (IABP vs control) in rates of major bleeding  (3.3% vs 4.4%; P=0.51), peripheral ischemic complications (4.3% vs 3.4%, P=0.53), sepsis (15.7% vs 20.5%, P=0.15), and stroke (0.7% vs 1.7%, P=0.28).

Full Text:  Thiele. Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock (IABP-SHOCK II Trial). NEJM epublished ahead of print August 27th 2012

Associted Editorial:  O'Connor. Evidence for Overturning the Guidelines in Cardiogenic Shock. NEJM epublished ahead of print August 27th 2012


European Heart Journal:     Dyspnoea Biomarkers

In an observational study of 560 patients attending the emergency department with dyspnoea, Shah and colleagues evaluated the diagnostic and prognostic value of mid-regional pro-atrial natriuretic peptide (MR-proANP), adrenomedullin (MR-proADM) and amino-terminal pro-B type natriuretic peptide. MR-proANP was higher in patients with acute decompensted heart failure than without (median 329 vs. 58 pmol/L; P < 0.001).  In time-dependent analyses, MR-proADM had the highest AUC for 1 year mortality; after 1 year, MR-proANP and NT-proBNP had higher AUCs. Both mid-regional peptides were independently prognostic and reclassified risk at 1 year [MR-proANP, hazard ratio (HR) = 2.99, MR-proADM, HR = 2.70; both P < 0.001] and at 4 years (MR-proANP, HR = 3.12, P < 0.001; MR-proADM, HR = 1.51, P = 0.03) and in Kaplan–Meier curves both mid-regional peptides were associated with death out to 4 years, individually or in a multimarker strategy.

Abstract:  Shah. Mid-regional pro-atrial natriuretic peptide and pro-adrenomedullin testing for the diagnostic and prognostic evaluation of patients with acute dyspnoea. Eur Heart J 2012;33(17):2197-2205


Clinical Infectious Disease:     H1N1 Influenza

Based on Californian surveillance data, Louie et al analyzed 1950 cases of H1N1 influenza requiring ICU admission. 1859 (95%) had information available, with 1676 (90%) receiving neuraminidase inhibitor treatment, and 183 (10%) not receiving this therapy. The median cohort age was 37 years (range, 1 week–93 years), 1473 (79%) had ≥1 comorbidity, and 492 (26%) died. The median time from symptom onset to starting neuraminidase inhibitor treatment was 4 days (range, 0–52 days). NAI treatment was associated with improved survival, with 107 of 183 untreated case patients (58%) surviving, compared with 1260 of 1676 treated case patients (75%) (P ≤ 0.0001). Earlier rather than later treatment (P < 0.0001) and treatment within 5 days after symptom onset compared to no neuraminidase inhibitor treatment (P < 0.05) were both associated with improved survival.

Abstract:  Louie. Treatment With Neuraminidase Inhibitors for Critically Ill Patients With Influenza A (H1N1). Clin Infect Dis 2012 epublished 31 August



European Heart Journal:     STEMI


European Heart Journal:     Atrial Fibrillation


European Heart Journal:     Valvular Heart Disease


Wilderness & Environmental Medicine:     Lightning Strike


Review - Clinical

Open Access Emergency Medicine:     Asthma / Acute Respiratory Distress Syndrome


International Journal of Hepatology:     Fungal Infections


International Journal of Hepatology:     Variceal Bleeding


International Journal of Hepatology:     TIPS


Annals of Intensive Care:     Thrombocytopaenia


Stem Cell International:     Stem Cells


Gastroenterology:     Acute Liver Failure


Circulation:     Aortic Regurgitation


Journal of Antibiotics:     Post-Antibiotics Era


Cardiology Research & Practice:     Mechanical Support Devices


Review - Basic Science

 Indian Journal of Anaesthesiology:     Free Radical Scavengers


Review - Non-Clinical

Trials:     Adaptive Trials



I hope you find these links and brief summaries useful.

Until next week