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Critical Care Reviews Newsletter

May 29th 2012



Welcome to the 25th 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 articles 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.



Critical Care:     Fluids

Guidet and colleagues performed a prospective, multicenter, double-blind, randomized study in 196 patients with severe sepsis, comparing the haemodynamic effects and safety of 6% hydroxyethyl starch 130/0.4 with NaCl 0.9%. Less volume was required with HES to achieve haemodynamic stability {1,379 (886) ml HES vs 1,709 (1,164) ml NaCL; mean difference -331 (1,033) ml, 95% CI -640 to -21, p=0.0185). There were no differences between total 4 day volume of study fluid infused,  incidence of acute kidney injury and ICU and hospital length of stay.

Full Text: Guidet. Assessment of hemodynamic efficacy and safety of 6% hydroxyethylstarch 130/0.4 versus 0.9% NaCl fluid replacement in patients with severe sepsis: The CRYSTMAS study. Critical Care 2012;16:R94


Lancet:     Stroke Thrombolysis

Wardlaw et al performed a systematic review and meta analysis, comprising 12 trials containing 7012 patients, examining the effects of recombinant tissue plasminogen activator administered within 6 hours of the onset of ischaemic stroke. rt-PA  increased the odds of being alive and independent (modified Rankin Scale, mRS 0—2) at final follow-up (1611/3483 [46·3%] vs 1434/3404 [42·1%], OR 1·17, 95% CI 1·06—1·29; p=0·001), absolute increase of 42 (19—66) per 1000 people treated, and favourable outcome (mRS 0—1) absolute increase of 55 (95% CI 33—77) per 1000.

Abstract: Wardlaw. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet 2012; epublished ahead of print


Lancet:     Stroke Thrombolysis

The IST-3 Collaborative group performed an international, multicentre, randomised, open-treatment trial, comparing 0·9 mg/kg intravenous recombinant tissue plasminogen activator (rt-PA) with control, in 3035 patients within 6 hours of acute ischaemic stroke. An increase in early deaths and complications was offset by a late decrease in deaths and improved functional outcomes, such that by 6 months an adjusted odds ratio ([OR] 1·13, 95% CI 0·95—1·35, p=0·181) was not significantly different between the two groups. However, an ordinal analysis showed a significant shift in functional outcome scores (common OR 1·27 (95% CI 1·10—1·47, p=0·001).

Full Text: The IST-3 collaborative group. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet 2012;epublished ahead of print     (free registration required)


British Journal of Anaesthesia:     Troponin I

In an observational study of 663 ICU patients, Reynolds et al measured plasma toponin I levels and found 345 patients had raised levels (>0.04 ng/ml) which was associated with reduced odds of hospital survival (adjusted odds ratio 0.25, 95% confidence interval 0.08–0.75, P=0.014).

Abstract: Reynolds. Raised serum cardiac troponin I concentrations predict hospital mortality in intensive care unit patients. Br J Anaesth 2012 epublished of print


Critical Care:     Gender Related Outcomes

Mahmood et al performed a retrospective review of 261,255 consecutive patients from the APACHE IV database (Cerner Corporation, USA), to determine the influence of gender on mortality and other outcomes in critically ill patients. ICU mortality was 7.2% for men and 7.9% for women, with the odds ratio (OR) for death for women being 1.07 (95% confidence interval [CI]: 1.04-1.1). Below the gae of 50, women had a lower ICU mortality, with no difference moted for the over 50s. Women were more likely to die after CABG surgery, less likely to die during an exacerbation of COPD. There was no difference in mortality in acute coronary syndrome, sepsis and trauma.

Abstract: Mahmood. Association of gender with outcomes in critically ill patients. Critical Care 2012, 16:R92


Journal of the Intensive Care Society:     Liver Disease

Full Text: Flood. Mortality of patients with alcoholic liver disease admitted to critical care: a systematic review. JICS 2012;13(2):130-5



Journal of the Intensive Care Society:     Ethics


Quarterly Journal of Medicine:     Inflammation & Fibrosis


Nature Reviews Nephrology:     Organ Donation


Study Critique

Journal of the Intensive Care Society:     Sedation

Critique: Helliwell. Inhaled sevoflurane for long-term sedation. JICS 2012;13(2):163-4

Original Study: Mesnil. Long-term sedation in intensive care unit: a randomized comparison between inhaled sevoflurane and intravenous propofol or midazolam. Intensive Care Med 2011; 37:933-41


Journal of the Intensive Care Society:     Post-Traumatic Stress Disorder

Critique: Lubeigt. Do intensive care diaries reduce the incidence of post-traumatic stress disorder following discharge from intensive care units? JICS 2012;13(2):165-6

Original Study: Jones. Intensive care diaries reduce new onset post-traumatic stress disorder following critical illness: a randomised, controlled trial. Crit Care 2010;14:R168


Critical Care:     Pleural Effusions

Critique: Safiyeh. New strategies to manage complicated pleural effusions . Critical Care 2012, 16:312

Original Study: Rahman. Intrapleural Use of Tissue Plasminogen Activator and DNase in Pleural Infection. N Engl J Med 2011; 365:518-526



European Heart Journal:     Heart Failure

Full Text: Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012;epublished ahead of print



Nature News:     Creativity

It's not critical care related, but it's interesting reading. Here is a quick summary of a study undertaken in Santa Barbara, suggesting a method of increasing your creativity - useful for the next problem you can't quite manage to figure out, first time round at least.

Full Text: Kaplan. Why great ideas come when you aren’t trying. Nature News 21/5/12



I hope you find these brief summaries and links useful.

Until next week