Critical Care Reviews Meeting 2020

The meeting has added two major clinical trials to its programme for early 2020. 
Firstly, the ANZICS Clinical Trials Group PEPTIC trial, comparing proton pump inhibitors with histamine 2 receptor blockers in mechanically ventilated ICU patients. This huge multi-centre, cluster randomised, crossover, registry trial has recruited 26,733 patients.
Secondly VITAMINS, another great ANZICS trial, to the CCR20 programme. This phase IIb trial investigates vitamin C, thiamine and hydrocortisone in patients with septic shock. It will be presented by Dr Tomoko Fujii from Melbourne.
Registration for CCR20 is open with details available via this link.

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Critical Care Reviews Newsletter 401 18th August 2019

The Critical Care Reviews Newsletter lists the best critical care research and open access articles from across the medical literature during the last seven days.  It includes experimental research such as “Effects of Serelaxin in Patients with Acute Heart Failure”, secondary research including “Effects of different methods of cooling for targeted temperature management on outcome after cardiac arrest: a systematic review and meta-analysis” and observational research such as “Levosimendan in septic shock in patients with biomedical evidence of cardiac dysfunction”.
The full text of the newsletter is available via this link.

Critical Care Reviews Newsletter 400 11th August 2019

Welcome to the 400th 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 randomised controlled trials on personalised mechanical ventilation tailored to lung morphology versus low PEEP for patients with ARDS efficacy of albumin treatment for patients with cirrhosis and infections unrelated to spontaneous bacterial peritonitis; systematic reviews and meta analyses on therapeutic interventions and lung protective ventilation in patients with moderate to severe ARDS blood pressure control and clinical outcomes in acute intracerebral haemorrhage; and observational studies on core outcome measures for research in critically ill patients receiving ECMO & emergency department sedation for mechanically ventilated patients.
There are also guidelines on pediatric post–cardiac arrest care opioid minimization in opioid-naïve patients; narrative reviews on seizures in ICUvasopressors for cardiogenic shock acute kidney injury and fluid resuscitation in septic patients; editorials on blood pressure targets and vasopressors & harmful effects of mechanical ventilation on neurocognitive functions; and commentaries on liberal versus restrictive fluid therapy machine learning.

Critical Care Reviews Newsletter 399 4th August 2019

The 399th Critical Care Reviews Newsletter, brings 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 two papers reporting the TRACT RCT (being discussed at CCR20), as well as the long awaited publication of the PHARLAP RCT, which we hosted the results presentation of at CCR19 (the video should be out very soon); systematic reviews and meta analyses on liberal versus restrictive red blood cell transfusion strategy in sepsis or septic shock & functional hemodynamic tests; and observational studies reporting of the core outcome set for critical care ventilation trials & vitamin A deficiency in critically ill children with sepsis. There are also guidelines on procalcitonin-guided antibiotic stewardship & acute liver failure; narrative reviews on perioperative haemodynamic monitoring & antibiotic stewardship in the ICU; and commentaries on less monitoring and diagnostic testing & pulmonary complications in liver disease
Full text of the 399th newsletter is available via this link.

Critical Care Reviews Newsletter 382 8th April 2019

The 382th Critical Care Reviews Newsletter, delivers the best critical care research and open access articles from the medical literature in the last week.
This week’s edition includes randomised controlled trials on “Cytokine clearance with CytoSorb® during cardiac surgery: a pilot randomized controlled trial” and “Multicentre pilot randomised clinical trial of early in-bed cycle ergometry with ventilated patients”.  Also included is secondary research such as “Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis” and guidelines including “Effects of Albumin Treatment on Systemic and Portal Hemodynamics and Systemic Inflammation in Patients With Decompensated Cirrhosis”.
The full text of the newsletter is available via this link.

Critical Care Reviews Newsletter 377 4th March 2019

Welcome to the 377th Critical Care Reviews Newsletter, which brings 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 comparing nasal high-flow oxygen with Venturi face mask oxygen therapy after lung resection; systematic reviews and meta analyses on the effects of hyperoxia on mortality in critically ill patients & dexmedetomidine on delirium and agitation in patients in intensive care; and observational studies on sleep and pathological wakefulness at time of liberation from mechanical ventilation & the effect of age of transfused red blood cells on neurologic outcome after traumatic brain injury.”
The full text of the newsletter is available via this link.

Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial.

This article by Hernandez and others was published in JAMA in February 2019 (volume 321 number 7 pages 654-664)
Importance:  Abnormal peripheral perfusion after septic shock resuscitation has been associated with organ dysfunction and mortality. The potential role of the clinical assessment of peripheral perfusion as a target during resuscitation in early septic shock has not been established.
Objective:  To determine if a peripheral perfusion-targeted resuscitation during early septic shock in adults is more effective than a lactate level-targeted resuscitation for reducing mortality.
Design, Setting, and Participants:  Multi-centre, randomized trial conducted at 28 intensive care units in 5 countries. Four-hundred twenty-four patients with septic shock were included between March 2017 and March 2018. The last date of follow-up was June 12, 2018.
Interventions: Patients were randomized to a step-by-step resuscitation protocol aimed at either normalizing capillary refill time (n = 212) or normalizing or decreasing lactate levels at rates greater than 20% per 2 hours (n = 212), during an 8-hour intervention period.
Main Outcomes and Measures:  The primary outcome was all-cause mortality at 28 days. Secondary outcomes were organ dysfunction at 72 hours after randomization, as assessed by Sequential Organ Failure Assessment (SOFA) score (range, 0 [best] to 24 [worst]); death within 90 days; mechanical ventilation-, renal replacement therapy-, and vasopressor-free days within 28 days; intensive care unit and hospital length of stay.
Results:  Among 424 patients randomized (mean age, 63 years; 226 [53%] women), 416 (98%) completed the trial. By day 28, 74 patients (34.9%) in the peripheral perfusion group and 92 patients (43.4%) in the lactate group had died (hazard ratio, 0.75 [95% CI, 0.55 to 1.02]; P = .06; risk difference, -8.5% [95% CI, -18.2% to 1.2%]). Peripheral perfusion-targeted resuscitation was associated with less organ dysfunction at 72 hours (mean SOFA score, 5.6 [SD, 4.3] vs 6.6 [SD, 4.7]; mean difference, -1.00 [95% CI, -1.97 to -0.02]; P = .045). There were no significant differences in the other 6 secondary outcomes. No protocol-related serious adverse reactions were confirmed.
Conclusions and Relevance:  Among patients with septic shock, a resuscitation strategy targeting normalization of capillary refill time, compared with a strategy targeting serum lactate levels, did not reduce all-cause 28-day mortality
The print copy of this issue JAMA is available in the Healthcare Library on D Level of Rotherham General Hospital.