A multicentre, randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of early nutritional support via the parenteral versus the enteral route in critically ill patients (CALORIES)

National Institute for Health Research

RCT (n=2313) found no significant difference in all-cause mortality at 30 days for early nutritional support via parenteral vs. enteral route among adults admitted to critical care units in England.

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Incidence, Risk Factors, and Attributable Mortality of Secondary Infections in the Intensive Care Unit After Admission for Sepsis

Journal of the American Medical Association, 2016;315(14):1469-1479

This hospital epidemiology study conducted to determine the incidence, risk factors, and attributable mortality of ICU-acquired infections in patients admitted with sepsis found that infections occurred more commonly in patients with sepsis with higher disease severity.

Nice Guideline update – Major Trauma: Assessment and Initial Management

This guideline covers the rapid identification and early management of major trauma in pre‑hospital and hospital settings, including ambulance services, emergency departments, major trauma centres and trauma units. It aims to reduce deaths and disabilities in people with serious injuries by improving the quality of their immediate care. It does not cover care for people with burns.

This guideline includes recommendations on:

Read the full guideline here

Attention deficit after kids’ critical illness linked to plasticizers in medical tubes

ScienceDaily, 1 April 2016

11484-2

Children who are often hospitalized in intensive care units are more likely to have attention deficit disorders later, and new research finds a possible culprit: a high level of plastic-softening chemicals called phthalates circulating in the blood. The researchers, who will present their study results Friday at The Endocrine Society’s 98th annual meeting in Boston, suggest these chemicals, which are added to indwelling medical devices such as plastic tubes and catheters, seep into the child’s bloodstream.

Their study included 100 healthy children and 449 children who received treatment in a pediatric intensive care unit (PICU) and underwent neurocognitive testing four years later. Most of the PICU patients were recovering from heart surgery, but some had sustained accidental injuries or had severe infections. The researchers measured blood levels of DEHP metabolites, or byproducts. Initially they performed the blood tests in the healthy children and 228 of the patients while they were in the PICU. Patients had one to 12 medical tubes in the PICU and ranged in age from newborn to 16 years.

The investigators found that DEHP metabolite levels were not detectable in the blood samples of healthy children. However, at admission to the PICU, the critically ill children, already connected to catheters, had levels that Verstraete called “sky-high.” Although the DEHP levels decreased rapidly, they remained 18 times higher until discharge from the PICU compared with those of healthy children, he said.

Read the full commentary here

Effect of Inhaled Xenon on Cerebral White Matter Damage in Comatose Survivors of Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial

 

Evidence from preclinical models indicates that xenon gas can prevent the development of cerebral damage after acute global hypoxic-ischemic brain injury but, thus far, these putative neuroprotective properties have not been reported in human studies.

To determine the effect of inhaled xenon on ischemic white matter damage assessed with magnetic resonance imaging (MRI). A randomized single-blind phase 2 clinical drug trial conducted between August 2009 and March 2015 at 2 multipurpose intensive care units in Finland. One hundred ten comatose patients (aged 24-76 years) who had experienced out-of-hospital cardiac arrest were randomized. Patients were randomly assigned to receive either inhaled xenon combined with hypothermia (33°C) for 24 hours (n = 55 in the xenon group) or hypothermia treatment alone (n = 55 in the control group). The primary end point was cerebral white matter damage as evaluated by fractional anisotropy from diffusion tensor MRI scheduled to be performed between 36 and 52 hours after cardiac arrest. Secondary end points included neurological outcome assessed using the modified Rankin Scale (score 0 [no symptoms] through 6 [death]) and mortality at 6 months.

Among the 110 randomized patients (mean age, 61.5 years; 80 men [72.7%]), all completed the study. There were MRI data from 97 patients (88.2%) a median of 53 hours (interquartile range [IQR], 47-64 hours) after cardiac arrest. The mean global fractional anisotropy values were 0.433 (SD, 0.028) in the xenon group and 0.419 (SD, 0.033) in the control group. The age-, sex-, and site-adjusted mean global fractional anisotropy value was 3.8% higher (95% CI, 1.1%-6.4%) in the xenon group (adjusted mean difference, 0.016 [95% CI, 0.005-0.027], P = .006). At 6 months, 75 patients (68.2%) were alive. Secondary end points at 6 months did not reveal statistically significant differences between the groups. In ordinal analysis of the modified Rankin Scale, the median (IQR) value was 1 (1-6) in the xenon group and 1 (0-6) in the control group (median difference, 0 [95% CI, 0-0]; P = .68). The 6-month mortality rate was 27.3% (15/55) in the xenon group and 34.5% (19/55) in the control group (adjusted hazard ratio, 0.49 [95% CI, 0.23-1.01]; P = .053).

Among comatose survivors of out-of-hospital cardiac arrest, inhaled xenon combined with hypothermia compared with hypothermia alone resulted in less white matter damage as measured by fractional anisotropy of diffusion tensor MRI.  However, there was no statistically significant difference in neurological outcomes or mortality at 6 months. These preliminary findings require further evaluation in an adequately powered clinical trial designed to assess clinical outcomes associated with inhaled xenon among survivors of out-of-hospital cardiac arrest.

The article by Laitio and colleagues was published in the JAMA 15 Mar 2016, vol. 315, no. 11, p. 1120-1128.  The full text can be seen in the Healthcare Library on D Level of Rotherham Hospital or via this link.  Please note that most articles from JAMA are not available freely full text hence the library has a subscription to the physical journal.