ccr logo 246x225 13121Critical Care Reviews Newsletter

December 31st 2011





Welcome to the fourth 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. As expected, it was a relatively quiet week for critical care publications, with substantial studies being found in just JAMA and NEJM.


Thursday 29th December 2011

There were two interesting papers in this week's issue of The New England Journal of Medicine, in addition to the previously highlighted FOCUS study.


Venous Thromboembolism Proplylaxis

An international double-blind, placebo-controlled, randomized trial in 8307 acutely ill medical patients was performed to assess the effect of subcutaneous enoxaparin (40 mg daily) as compared with placebo — both administered for 10±4 days in patients who were wearing elastic stockings with graduated compression — on the rate of death from any cause.  There was no difference in either the rate of death at 30 days (4.9% versus 4.8%, p=0.83) or major bleeding (0.4% versus 0.3%, p=0.35). (The LIFENOX study)

Abstract. Kakkar. Low-Molecular-Weight Heparin and Mortality in Acutely Ill Medical Patients. N Engl J Med 2011; 365:2463-2472


Facial Transplantation

The results, including images and videos, of three subjects who underwent facial transplantation have been reported. The boundaries of transplantation continue to be pushed and offer hope to all with disfiguring injuries.

Full Article.Pomahac. Brief Report -Three Patients with Full Facial Transplantation. December 28, 2011


Wednesday 28th December 2011

Two studies and a drug interaction warning of interest to critical care were published in yesterday's JAMA.

Appropriateness of Critical Care

As intensivists who perceive the care they provide as inappropriate experience moral distress and are at risk for burnout, a point-prevalence survey of 1953 intensivists and critical care nurses in 82 adult ICUs in 9 European countries and Israel was performed to determine the prevalence of perceived inappropriateness of care. Perceptions of inappropriate care, including futile therapy and poor distribtion of resources, were reported in approximately one quarter of respondents and were inversely associated with factors indicating good teamwork. (APPROPRICUS study)

Abstract. Piers. Perceptions of Appropriateness of Care Among European and Israeli Intensive Care Unit Nurses and Physicians. JAMA 2011; 306:2694-2703.


Troponin Testing for Myocardial Infarction

The diagnostic performance of a highly sensitive troponin I (hsTnI) assay was compared with a contemporary troponin I (cTnI) assay, and their serial changes in the diagnosis of acute myocardial infarction (AMI), in 1818 patients with suspected acute coronary syndromes in Germany.  For discrimination of AMI, the area under the receiver operating characteristic curve was 0.96 (95% CI, 0.95-0.97) for hsTnI on admission and 0.92 (95% CI, 0.90-0.94) for cTnI on admission. Both were superior to the other evaluated diagnostic biomarkers. Among patients with suspected acute coronary syndrome, hsTnI or cTnI determination 3 hours after admission may facilitate early rule-out of AMI. A serial change in hsTnI or cTnI levels from admission to 3 hours after admission may facilitate an early diagnosis of AMI.

Abstract. Keller. Keller. Serial Changes in Highly Sensitive Troponin I Assay and Early Diagnosis of Myocardial Infarction. JAMA. 2011; 306:2684-2693.


Serotonin Syndrome

Abstract. The FDA has announced the use of linezolid or methylene blue in patients taking selective serotonin reuptake inhibitors (SSRIs), or serotonin norepinephrine reuptake inhibitors (SNRIs), might trigger serotonin syndrome.

Kuehen. Health Agencies Update: Serotonin Syndrome Update. JAMA. 2011;306(24):2661



I hope you find these brief summaries useful.

Until next week