May 9th 2012
Welcome to the 22nd 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.
Apologies for the late delivery of this week's Newsletter.
New England Journal of Medicine
Annals of Intensive Care
- Lipcsey. Near infrared spectroscopy (NIRS) of the thenar eminence in anesthesia and intensive care. Annals of Intensive Care 2012, 2:11
International Journal of Critical Illness and Injury Science
- Bajwa. Delivering obstetrical critical care in developing nations. Int J Crit Illn Inj Sci 2012;2:32-9
Israeli Medical Association Journal
- Samokhvalov. Glycemic Control in the Intensive Care Unit: Between Safety and Benefit. IMAI 2012;14: 260–266
Cardiology Research & Practice
- Giraud. Cell Therapies for Heart Function Recovery: Focus on Myocardial Tissue Engineering and Nanotechnologies. Cardiology Research and Practice 2012;2012: 971614
Clinical Kidney Journal
- de Geus. Biomarkers for the prediction of acute kidney injury: a narrative review on current status and future challenges. Clin Kidney J (2012) 5(2):102-108
Thrombosis and Haemostasis
- Armstrong. GPIIb/IIIa inhibitors: From bench to bedside and back to bench again. Thrombosis and Haemostasis 2012 107 5: 808-814
Intensive Care Medicine: Sepsis Biomarkers
Rosjo et al used the FINNSEPSIS dataset to assess the prognostic information of chromogranin A (CgA), a marker associated with adrenergic tone and myocardial function, in 232 patients with severe sepsis. CgA levels at inclusion and after 72 h correlated with several established indices of risk in sepsis. Patients who died during the hospitalization had higher baseline CgA levels than hospital survivors: 14.0 (Q1–3, 7.4–27.4) versus 9.1 (5.9–15.8) nmol/l, P = 0.002, and after 72 h: 16.2 (9.0–31.1) versus 9.8 (6.0–18.0) nmol/l, P = 0.001. CgA levels on study inclusion and after 72 h were independently associated with hospital mortality by logistic regression: OR (logarithmically transformed CgA levels) 1.95 (95 % CI 1.01–3.77), P = 0.046 and OR 2.03 (95 % CI 1.18–3.49), P = 0.01, respectively.
Intensive Care Medicine: Patient Volume
In asystematic review, Kanhere investigated the influence of patient volume affect clinical outcomes in adult intensive care units. Thirteen studies including 596,259 patients across 1,068 ICU were identified. The authors concluded that outcomes of certain subsets of ICU patients—especially those on mechanical ventilation, high-risk patients, and patients with severe sepsis—are better in high volume centres within the constraints of risk adjustments.
Journal of Intensive Care Medicine: Vasopressors for Septic Shock
In a systematic review and meta-analysis Vasu et al compared the effects of noradrenaline with dopamine for the treatment of septic shock. They identifed 6 studies totaling 2043 participants, with 995 in the norepinephrine and 1048 in the dopamine groups. There were 479 (48%) deaths in the norepinephrine group and 555 (53%) deaths in the dopamine group. Noradrenaline was associated with a lower in-hospital or 28-day mortality: pooled relative risk: 0.91 (95% CI 0.83 to 0.99; P = .028); and also a lower rate of cardiac arrhythmias: pooled RR: 0.43 (95% CI 0.26 to 0.69; P ≤ .001).
JAMA: GKI Infusions in Out-of-Hospital Acute Coronary Syndromes
In a randomized, placebo-controlled, double-blind effectiveness study in 13 US cities, Selker et al compared the effectivness of glucose-insulin-potassium infusion (GIK) (n=411) versus placebo (n=460) in out-of-hospital acute coronary syndromes. There was no difference in the rate of progression to MI among patients who received GIK (odds ratio [OR], 0.88; 95% CI, 0.66-1.13; P = .28); or 30 day mortality (hazard ratio [HR], 0.72; 95% CI, 0.40-1.29; P = .27). The composite of cardiac arrest or in-hospital mortality occurred in 4.4% with GIK vs 8.7% with placebo (OR, 0.48; 95% CI, 0.27-0.85; P = .01). Among patients with ST-segment elevation, there was no difference in progression to MI (OR, 0.74; 95% CI, 0.40-1.38; P = .34); or 30-day mortality (HR, 0.63; 95% CI, 0.27-1.49; P = .29). The composite outcome of cardiac arrest or in-hospital mortality was 6.1% with GIK vs 14.4% with placebo (OR, 0.39; 95% CI, 0.18-0.82; P = .01). Serious adverse events did not differ between the 2 groups (P = .26).
Abstract: Selker. Out-of-Hospital Administration of Intravenous Glucose-Insulin-Potassium in Patients With Suspected Acute Coronary Syndromes. The IMMEDIATE Randomized Controlled Trial. JAMA 2012;307(1):1925-1933
Cochrane Review: Coronary Artery Bypass Grafting
Møller and colleagues performed a systematic review and meta analysis comparing the effects of on-pump versus off-pump coronary artery bypass grafting (CABG). The study included 86 trials, totaling 10,716 participants. Pooled analysis of all trials showed that off-pump CABG increased all-cause mortality compared with on-pump CABG (189/5,180 (3.7%) versus 160/5144 (3.1%); RR 1.24, 95% CI 1.01 to 1.53; P =.04). In the trials at low risk of bias the effect was corroborated (154/2,485 (6.2%) versus 113/2,465 (4.5%), RR 1.35,95% CI 1.07 to 1.70; P =.01). Off-pump CABG resulted in fewer distal anastomoses (mean difference -0.28; 95% CI -0.40 to -0.16, P <.00001). No significant differences in myocardial infarction, stroke, renal insufficiency, or coronary re-intervention were observed. Off-pump CABG reduced post-operative atrial fibrillation compared with on-pump CABG, however, in trials at low risk of bias, the estimated effect was not significantly different.
Cochrane Review: Intra-Aortic Balloon Pump for MI complicated by Cardiogenic Shock
In a systematic review Unverzagt identified 3 studies comparing IABP to standard treatment and 3 to percutaneous left assist devices (LVAD). Data from a total of 190 patients with acute myocardial infarction and cardiogenic shock were included in the meta-analysis: 105 patients were treated with IABP and 85 patients served as controls, 40 of whom had assist devices and 45 with LVADs. The hazard ratio for all-cause 30-day mortality was 1.04 (95% CI 0.62 to 1.73) and provides no evidence for a survival benefit. The authors concluded that the available evidence suggests that IABP may have a beneficial effect on haemodynamics, however there is no convincing randomised data to support the use of IABP in infarct related cardiogenic shock.
Full Text: Unverzagt. Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD007398.
Critical Care: Delirium
In a randomized controlled trial Van Rompaey compared the use of night-time ear plugs (n=69) with no ear plugs (n=67) on the (1) development of delirium or confusion and (2) the quality of sleep in the critically ill. The group sleeping with ear plugs had a lower delirium scores with a median NEECHAM score of 26 (95% CI: 5 to 29) versus the control group 24 (95% CI: 8 to 29) (Mann-Whitney U, P = 0.04). Although the incidence of delirium was similar between the two groups (earplugs: 19% vs no earplugs 20%), when a composite score for delirium and confusion was used 60% of the control group showed cognitive disturbances against only 35% in the study group. Survival analysis showed a strong benefit for the prevention of cognitive disturbances in favor of the earplugs within the first 24 hours (Wilcoxon log rank, P = 0.006) and Cox regression showed the use of earplugs decreased the risk of delirium or confusion by 53% (HR .0.47, CI 0.27 to 0.82). Although patients with earplugs reported better sleep quality on the first study night, this benefit was lost on the second night and reversed on the third night. The generalizability of the study was limited by most subjects staying only 1 night in the ICU.
Critical Care: Brain Natriuretic Peptide
In a systematic review and meta analysis of 12 studies, totaling 1,865 patients, investigating the prediction of BNP or NT-proBNP for mortality in sepsis, Wang et al found raised levels of natriuretic peptides were associated with increased mortality (odds ratio (OR) 8.65, 95% CI 4.94 to 15.13, P < 0.00001). The association was consistent for BNP (OR 10.44, 95% CI 4.99 to 21.58, P < 0.00001) and NT-proBNP (OR 6.62, 95% CI 2.68 to 16.34, P < 0.0001). The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 79% (95% CI 75 to 83), 60% (95% CI 57 to 62), 2.27 (95% CI 1.83 to 2.81) and 0.32 (95% CI 0.22 to 0.46),
Annals of Internal Medicine: Clinical Decision-Support Systems
In a systematic review totalling 148 studies, the authors investigated the effect of clinical decision-support systems and concluded that both commercially and locally developed CDSSs are effective at improving health care process measures across diverse settings, but evidence for clinical, economic, workload, and efficiency outcomes remains sparse.
Critical Care: Acute Lung Injury
I hope you find these links and brief summaries useful.
Until next week