Latest Issue of Journal of Critical Care Volume 31 Issue 1 February 2016

journal of critical careThe contents page of the latest issue of Journal of Critical Care is available via the following link.

Articles include a survey on the current practice of the determination of death after circulatory arrest and a cross sectional study comparing different methods of predicting mortality rates.

The full text of the articles is only available if you have a personal subscription.  Alternatively contact the Rotherham NHS Foundation Trust Library and Knowledge Service who can obtain articles for you.

The full text of articles in the Journal of Critical Care is available to those with a Rotherham NHS Athens password two months after publication.  Please contact the Library and Knowledge Service for more details.

Latest Issue of Journal of Intensive Care Medicine Volume 31 Issue 1 January 2016

The contents page of the latest issue of the Journal of Intensive Care Medicine is available via the following link.

The issue includes a review on the Evidence-Based Management of Common Gallstone-Related Emergencies and an article covering the Chest Radiological Findings of Patients with Severe H1N1 Pneumonia Requiring Intensive Care.

Only those who have a personal subscription can access the full text of the article from the journal’s own homepage.  Alternatively contact the Rotherham NHS Foundation Trust Library and Knowledge Service who can obtain articles for you.

Intensive Supportive Care plus Immunosuppression in IgA Nephropathy

Rauen T et al The New England journal of medicine, Dec 2015, vol. 373, no. 23, p. 2225-2236

The outcomes of immunosuppressive therapy, when added to supportive care, in patients with IgA nephropathy are uncertain.

We conducted a multicenter, open-label, randomized, controlled trial with a two-group, parallel, group-sequential design. During a 6-month run-in phase, supportive care (in particular, blockade of the renin-angiotensin system) was adjusted on the basis of proteinuria. Patients who had persistent proteinuria with urinary protein excretion of at least 0.75 g per day were randomly assigned to receive supportive care alone (supportive-care group) or supportive care plus immunosuppressive therapy (immunosuppression group) for 3 years. The primary end points in hierarchical order were full clinical remission at the end of the trial (protein-to-creatinine ratio <0.2 [with both protein and creatinine measured in grams] and a decrease in the estimated glomerular filtration rate [eGFR] of <5 ml per minute per 1.73 m(2) of body-surface area from baseline) and a decrease in the eGFR of at least 15 ml per minute per 1.73 m(2) at the end of the trial. The primary end points were analyzed with the use of logistic-regression models.

The run-in phase was completed by 309 of 337 patients. The proteinuria level decreased to less than 0.75 g of urinary protein excretion per day in 94 patients. Of the remaining 162 patients who consented to undergo randomization, 80 were assigned to the supportive-care group, and 82 to the immunosuppression group. After 3 years, 4 patients (5%) in the supportive-care group, as compared with 14 (17%) in the immunosuppression group, had a full clinical remission (P=0.01). A total of 22 patients (28%) in the supportive-care group and 21 (26%) in the immunosuppression group had a decrease in the eGFR of at least 15 ml per minute per 1.73 m(2) (P=0.75). There was no significant difference in the annual decline in eGFR between the two groups. More patients in the immunosuppression group than in the supportive-care group had severe infections, impaired glucose tolerance, and weight gain of more than 5 kg in the first year of treatment. One patient in the immunosuppression group died of sepsis.

The addition of immunosuppressive therapy to intensive supportive care in patients with high-risk IgA nephropathy did not significantly improve the outcome, and during the 3-year study phase, more adverse effects were observed among the patients who received immunosuppressive therapy, with no change in the rate of decrease in the eGFR.

A paper copy of this issue of the New England Journal of Medicine is available in the Healthcare Library in Rotherham Hospital.   Subscribers to NEJM can access the full text of the article via this link.

Acetaminophen for Fever in Critically Ill Patients with Suspected Infection

Young P et al. The New England journal of medicine, Dec 2015, vol. 373, no. 23, p. 2215-2224

Acetaminophen is a common therapy for fever in patients in the intensive care unit (ICU) who have probable infection, but its effects are unknown. We randomly assigned 700 ICU patients with fever (body temperature, ≥38°C) and known or suspected infection to receive either 1 g of intravenous acetaminophen or placebo every 6 hours until ICU discharge, resolution of fever, cessation of antimicrobial therapy, or death. The primary outcome was ICU-free days (days alive and free from the need for intensive care) from randomization to day 28. The number of ICU-free days to day 28 did not differ significantly between the acetaminophen group and the placebo group: 23 days (interquartile range, 13 to 25) among patients assigned to acetaminophen and 22 days (interquartile range, 12 to 25) among patients assigned to placebo (Hodges-Lehmann estimate of absolute difference, 0 days; 96.2% confidence interval [CI], 0 to 1; P=0.07). A total of 55 of 345 patients in the acetaminophen group (15.9%) and 57 of 344 patients in the placebo group (16.6%) had died by day 90 (relative risk, 0.96; 95% CI, 0.66 to 1.39; P=0.84). Early administration of acetaminophen to treat fever due to probable infection did not affect the number of ICU-free days.

A paper copy of this issue of the New England Journal of Medicine is available in the Healthcare Library in Rotherham Hospital.   Subscribers to NEJM can access the full text of the article via this link.

Latest Issue of Intensive and Critical Care Nursing Volume 32 P 1-76

The contents page of the latest issue of Intensive and Critical Care Nursing is available via the following link

Articles include a review on interventions for the prevention of catheter related urinary tract infection and a RCT on parental stress management using relaxation techniques in a neonatal intensive care unit.

The full text of the articles is only available if you have a personal subscription.  Alternatively contact the Rotherham NHS Foundation Trust Library and Knowledge Service who can obtain articles for you.

Aminophylline for bradyasystolic cardiac arrest in adults

Aminophylline is a drug that might help resuscitate patients in cardiac arrest when electrical activity is very slow or absent. Aminophylline may restore blood flow to the heart, improve electrical activity and make other drugs used in resuscitation more effective. cochrane library logoWe found five studies that included 1254 patients who had this type of cardiac arrest in the prehospital setting. Four of the five studies (1186 patients) were well-designed studies with low risk of bias. Although no adverse events were reported, aminophylline showed no advantage when it was added to the standard resuscitation practice of paramedics when compared with placebo in these patients. It is not known whether giving aminophylline sooner would be helpful.

This Cochrane systematic review was undertaken by staff at Dalhouise University, Halifax Canada and published on line on 23rd November 2015.  More information including the full text can be found via this link.

The reliability of the Glasgow Coma Scale: a systematic review

Introduction
The Glasgow Coma Scale (GCS) provides a structured method for assessment of the level of consciousness. Its derived sum score is applied in research and adopted in intensive care unit scoring systems. Controversy exists on the reliability of the GCS. The aim of this systematic review was to summarize evidence on the reliability of the GCS.

Methods
A literature search was undertaken in MEDLINE, EMBASE and CINAHL. Observational studies that assessed the reliability of the GCS, expressed by a statistical measure, were included. Methodological quality was evaluated with the consensus-based standards for the selection of health measurement instruments checklist and its influence on results considered. Reliability estimates were synthesized narratively.

Results
We identified 52 relevant studies that showed significant heterogeneity in the type of reliability estimates used, patients studied, setting and characteristics of observers. Methodological quality was good (n = 7), fair (n = 18) or poor (n = 27). In good quality studies, kappa values were ≥0.6 in 85 %, and all intraclass correlation coefficients indicated excellent reliability. Poor quality studies showed lower reliability estimates. Reliability for the GCS components was higher than for the sum score. Factors that may influence reliability include education and training, the level of consciousness and type of stimuli used.

Conclusions
Only 13 % of studies were of good quality and inconsistency in reported reliability estimates was found. Although the reliability was adequate in good quality studies, further improvement is desirable. From a methodological perspective, the quality of reliability studies needs to be improved. From a clinical perspective, a renewed focus on training/education and standardization of assessment is required.

Take-home message
The overall reliability of the GCS is adequate, but can be improved by a renewed focus on adequate training and standardization. The methodological quality of reliability studies should be improved.

This article was published in Intensive Care Medicine Volume 42 Number 1.  If you subscribe to Intensive Care Medicine then the full text can be obtained via this link or alternatively contact the Library and Knowledge Service who can order it for you.