Critical Care Reviews Newsletter 364 3rd December 2018

Critical Care Reviews Newsletter, bringing you the best critical care research and open access articles from across the medical literature over the past seven days.  “The highlights of this week’s edition are a randomised controlled trial on APRV in paediatric ARDS; a systematic review and meta analysis on non-pharmacological interventions in reducing the incidence and duration of delirium; and an observational study looking at the mortality changes associated with mandated public reporting for sepsis in New York. There are also multiple guidelines, including a series from the American Society of Hematology on venothromboembolism; as well as narrative reviews on decompressive craniectomy in traumatic brain injury & what’s new in heart failure therapy 2018; editorials on guiding ventilation with transpulmonary pressure &chloride; and commentaries on hemoadsorption with CytoSorb & management of victims contaminated with radionuclides after a “dirty bomb” attack.”
The full text of the newsletter is available via this link.


Characteristics, management, and in-hospital mortality among patients with severe sepsis in intensive care units in Japan: the FORECAST study.

This article by Abe and colleagues appeared in the November 2018 issue of Critical Care.
Background:  Sepsis is a leading cause of death and long-term disability in developed countries. A comprehensive report on the incidence, clinical characteristics, and evolving management of sepsis is important. Thus, this study aimed to evaluate the characteristics, management,and outcomes of patients with severe sepsis in Japan.
Methods:  This is a cohort study of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome,Sepsis, and Trauma (FORECAST) study, which was a multicentre, prospective cohort study conducted at 59 intensive care units (ICUs) from January 2016 to March 2017. We included adult patients with severe sepsis based on the sepsis-2 criteria.
Results:  In total, 1184 patients (median age 73 years,inter quartile range (IQR) 64-81) with severe sepsis were admitted to the ICU during the study period. The most common comorbidity was diabetes mellitus(23%). Moreover, approximately 63% of patients had septic shock. The median Sepsis-related Organ Failure Assessment (SOFA) score was 9 (IQR 6-11). The most common site of infection was the lung (31%). Approximately 54% of the participants had positive blood cultures. The compliance rates for the entire 3-h bundle, measurement of central venous pressure, and assessment of central venous oxygen saturation were 64%, 26%, and 7%, respectively. A multi level logistic regression model showed that closed ICUs and non-university hospitals were more compliant with the entire 3-h bundle. The in-hospital mortality rate of patients with severe sepsis was 23% (21-26%). Older age, multiple co-morbidities, suspected site of infection, and increasing SOFA scores correlated with in-hospital mortality, based on the generalized estimating equation model. The length of hospital stay was 24 (12-46) days. Approximately 37% of the patients were discharged home after recovery.
Conclusion:  Our prospective study showed that sepsis management in Japan was characterized by a high compliance rate for the 3-h bundle and low compliance rate for central venous catheter measurements. The in-hospital mortality rate in Japan was comparable to that of other developed countries. Only one third of the patients were discharged home, considering the aging population with multiple co-morbidities in the ICUs in Japan.
The full text of the article is freely available via this link.

TroponinI at admission in the intensive care unit predicts the need of dialysis in septic patients

This article by de Almeida Thiengo and colleagues was published in BMC Nephrology in November 2018.
Background:  In a previous study we showed that troponin I (TnI) > 0.42 ng/mL predicted the need of dialysis in a group of 29 septic patients admitted to the intensive care unit (ICU). We aimed to confirm such finding in a larger independent sample.
Methods:  All septic patients admitted to an ICU from March 2016 to February 2017 were included if age between 18 and 90 years, onset of sepsis  0.42 ng/mL. These patients had serum creatinine slightly higher (1.66 ± 0.34 vs. 1.32 ± 0.39 mg/dL; P <  0.0001)than those with lower TnI and similar urine output (1490 ± 682 vs. 1406 ± 631 mL;P = 0.44). At the end of the follow-up period, 70.0% of the patients with lower TnI were alive in comparison with 38.6% of those with higher TnI (p = 0.0014).After 30 days, 69.3 and 2.9% of the patients with lower and higher TnI levels remained free of dialysis, respectively (p  0.42 ng/mL persisted as a strong predictor of dialysis need (hazard ratio 3.48 [95%CI 1.69-7.18]).
Conclusions:  TnI levels at ICU admission are a strong independent predictor of dialysis need in sepsis.
The full text of the article is freely available via this link.