Current issue of Critical Care Reviews Newsletter 284 21st May 2017

The 286th issue of the Critical Care Reviews Newsletter contains the latest research fromcritcal care reviews across the medical literature of the last seven days.

These include a randomised clinical trial on “Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults”, a meta analysis on “Effort to breathe with various spontaneous breathing trial techniques”, a cohort study on “Short course adjunctive gentamicin as empirical therapy in patients with severe sepsis and septic shock” and a Cochrane Review on “High flow nasal cannulae for respiratory support in adult intensive care patients”

The full text of the newsletter can be accessed via this link.

Advertisements

Current issue of Critical Care Reviews Newsletter 284 21st May 2017

On Sunday the 284th Critical Care Reviews Newsletter was published provides the best critical care research from across the medical literature over the past week.critcal care reviews

The highlights of this week’s newsletter are the KARE randomised controlled trial, investigating keratinocyte growth factor in ARDS; guidelines on oxygen use, hemodynamic support of paediatric and neonatal septic shock, & management of the potential organ donor, as well as narrative reviews on the ICM research agenda on extracorporeal life support, high protein intake and central venous access device–related upper extremity deep vein thrombosis.

The full text of the newsletter can be accessed via this link.

Latest issue of “Journal of Critical Care” Volume 39 June 2017

This issue includes articles on the “Effect of ulinastatin combined with thymosin alpha 1 on sepsis: a systematic review and meta-analysis of Chinese and Indian patients”, “The accuracy of the bedside swallowing evaluation for detecting aspiratiojournal of critical care.pngn in survivors of acute respiratory failure” and “Acute kidney injury is an independent risk factor for myocardial injury after non cardiac surgery in critical patients”.

The contents page of this latest issue can be accessed via this link

To access the full text of these articles direct from the journal’s homepage you require a personal subscription to the journal.  Individual articles can be ordered via the Rotherham NHS Foundation Trust Library and Knowledge Service.  Registered members of the library can make article requests online via this link.

Latest issue of Critical Care Reviews Newsletter 283 14th May 2017

The 283rd Critical Care Reviews Newsletter includes randomised controlled trials on poscritcal care reviewsitioning for endotracheal intubation of critically ill adults and video versus direct laryngoscopy for paramedic endotracheal intubation.  Also included is an observational study reporting patterns of intravenous fluid resuscitation use in adult intensive care patients, a worldwide perspective on decision-making on withholding or withdrawing life-support in the ICU. There is a guideline from the American Academy of Neurology on reducing brain injury following cardiopulmonary resuscitation and a review article on albumin administration in sepsis.
The full text of the newsletter can be accessed via this link.

 

Effect of Dexmedetomidine on Mortality and Ventilator-Free Days in Patients Requiring Mechanical Ventilation with Sepsis

This randomised clinical trial by Kawazoe and colleagues is part of the Dexmedetomidine for Sepsis in Intensive Care Unit Randomized Evaluation (DESIRE) Trial.  It was published in the Journal of the American Medical Association (JAMA) in April 2017.  The physical journal is available in Rotherham Health Care Library.  The electronic version of this article is available via this link with a Rotherham NHS Athens Password.

Importance:  Dexmedetomidine provides sedation for patients undergoing ventilation; however, its effects on mortality and ventilator-free days have not been well studied among patients with sepsis.

Objectives:  To examine whether a sedation strategy with dexmedetomidine can improve clinical outcomes in patients with sepsis undergoing ventilation.

Design, Setting, and Participants:  Open-label, multicenter randomized clinical trial conducted at 8 intensive care units in Japan from February 2013 until January 2016 among 201 consecutive adult patients with sepsis requiring mechanical ventilation for at least 24 hours.

Interventions:  Patients were randomized to receive either sedation with dexmedetomidine (n = 100) or sedation without dexmedetomidine (control group; n = 101). Other agents used in both groups were fentanyl, propofol, and midazolam.

Main Outcomes and Measures:  The co-primary outcomes were mortality and ventilator-free days (over a 28-day duration). Sequential Organ Failure Assessment score (days 1, 2, 4, 6, 8), sedation control, occurrence of delirium and coma, intensive care unit stay duration, renal function, inflammation, and nutrition state were assessed as secondary outcomes.

Results:  Of the 203 screened patients, 201 were randomized. The mean age was 69 years (SD, 14 years); 63% were male. Mortality at 28 days was not significantly different in the dexmedetomidine group vs the control group (19 patients [22.8%] vs 28 patients [30.8%]; hazard ratio, 0.69; 95% CI, 0.38-1.22; P = .20). Ventilator-free days over 28 days were not significantly different between groups (dexmedetomidine group: median, 20 [interquartile range, 5-24] days; control group: median, 18 [interquartile range, 0.5-23] days; P = .20). The dexmedetomidine group had a significantly higher rate of well-controlled sedation during mechanical ventilation (range, 17%-58% vs 20%-39%; P = .01); other outcomes were not significantly different between groups. Adverse events occurred in 8 (8%) and 3 (3%) patients in the dexmedetomidine and control groups, respectively.

Conclusions and Relevance:  Among patients requiring mechanical ventilation, the use of dexmedetomidine compared with no dexmedetomidine did not result in statistically significant improvement in mortality or ventilator-free days. However, the study may have been underpowered for mortality, and additional research may be needed to evaluate this further.

Effect of Intensive vs Moderate Alveolar Recruitment Strategies Added to Lung-Protective Ventilation on Postoperative Pulmonary Complications: A Randomised Clinical Trial

This randomised clinical trial by Costa Leme et al was published in JAMA: Journal of the American Medical Association in April 2017.  The published copy is available in Rotherham Health Care Library.  The full text of the article can be accessed with a Rotherham NHS Athens Password via this link.

Perioperative lung-protective ventilation has been recommended to reduce pulmonary complications after cardiac surgery. The protective role of a small tidal volume (VT) has been established, whereas the added protection afforded by alveolar recruiting strategies remains controversial.

Objective:  To determine whether an intensive alveolar recruitment strategy could reduce postoperative pulmonary complications, when added to a protective ventilation with small VT.

Design, Setting, and Participants:  Randomized clinical trial of patients with hypoxemia after cardiac surgery at a single ICU in Brazil (December 2011-2014).

Interventions:  Intensive recruitment strategy (n=157) or moderate recruitment strategy (n=163) plus protective ventilation with small VT.

Outcomes and Measures:  Severity of postoperative pulmonary complications computed until hospital discharge, analyzed with a common odds ratio (OR) to detect ordinal shift in distribution of pulmonary complication severity score (0-to-5 scale, 0, no complications; 5, death). Prespecified secondary outcomes were length of stay in the ICU and hospital, incidence of barotrauma, and hospital mortality.

Results:  All 320 patients (median age, 62 years; IQR, 56-69 years; 125 women [39%]) completed the trial. The intensive recruitment strategy group had a mean 1.8 (95% CI, 1.7 to 2.0) and a median 1.7 (IQR, 1.0-2.0) pulmonary complications score vs 2.1 (95% CI, 2.0-2.3) and 2.0 (IQR, 1.5-3.0) for the moderate strategy group. Overall, the distribution of primary outcome scores shifted consistently in favor of the intensive strategy, with a common OR for lower scores of 1.86 (95% CI, 1.22 to 2.83; P = .003). The mean hospital stay for the moderate group was 12.4 days vs 10.9 days in the intensive group (absolute difference, -1.5 days; 95% CI, -3.1 to -0.3; P = .04). The mean ICU stay for the moderate group was 4.8 days vs 3.8 days for the intensive group (absolute difference, -1.0 days; 95% CI, -1.6 to -0.2; P = .01). Hospital mortality (2.5% in the intensive group vs 4.9% in the moderate group; absolute difference, -2.4%, 95% CI, -7.1% to 2.2%) and barotrauma incidence (0% in the intensive group vs 0.6% in the moderate group; absolute difference, -0.6%; 95% CI, -1.8% to 0.6%; P = .51) did not differ significantly between groups.

Conclusions and Relevance:  Among patients with hypoxemia after cardiac surgery, the use of an intensive vs a moderate alveolar recruitment strategy resulted in less severe pulmonary complications while in the hospital.

Current issue of Critical Care Reviews Newsletter 282 7th May 2017

The Critical Care Newsletter 282nd issue provides the best critical care research from the literature in the last week.  Highlights include the latest HFNO trial and RCTs on stress ulcer prophylaxis, inhaled nitric oxide to treat acute pulmonary embolism and an education intervention for anti-infectious measures.  There are also observational studies on bystander efforts in out of hospital cardiac arrest and emergency transfusion of patients with unknown blood type with O positive red blood cells as well as guidelines on severe perioperative bleeding and the prevention of surgical site infection.

The full newsletter can be accessed via this link.