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.

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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.

Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults

This article by Casey and others was published in the New England Journal of Medicine in February 2019 (Volume 380 issue 9).
Background:  Hypoxemia is the most common complication during tracheal intubation of critically ill adults and may increase the risk of cardiac arrest and death. Whether positive-pressure ventilation with a bag-mask device (bag-mask ventilation) during tracheal intubation of critically ill adults prevents hypoxemia without increasing the risk of aspiration remains controversial.
Methods:  In a multicentre, randomized trial conducted in seven intensive care units in the United States, we randomly assigned adults undergoing tracheal intubation to receive either ventilation with a bag-mask device or no ventilation between induction and laryngoscopy. The primary outcome was the lowest oxygen saturation observed during the interval between induction and 2 minutes after tracheal intubation. The secondary outcome was the incidence of severe hypoxemia, defined as an oxygen saturation of less than 80%.
Results:  Among the 401 patients enrolled, the median lowest oxygen saturation was 96% (interquartile range, 87 to 99) in the bag-mask ventilation group and 93% (interquartile range, 81 to 99) in the no-ventilation group (P = 0.01). A total of 21 patients (10.9%) in the bag-mask ventilation group had severe hypoxemia, as compared with 45 patients (22.8%) in the no-ventilation group (relative risk, 0.48; 95% confidence interval [CI], 0.30 to 0.77). Operator-reported aspiration occurred during 2.5% of intubations in the bag-mask ventilation group and during 4.0% in the no-ventilation group (P = 0.41). The incidence of new opacity on chest radiography in the 48 hours after tracheal intubation was 16.4% and 14.8%, respectively (P = 0.73).
Conclusions:  Among critically ill adults undergoing tracheal intubation, patients receiving bag-mask ventilation had higher oxygen saturations and a lower incidence of severe hypoxemia than those receiving no ventilation.
The printed copy of the New England Journal of Medicine is available in the Health Care Library on D Level of Rotherham Hospital.

Critical Care Reviews Newsletter 375 19th February 2019

The 375th Critical Care Reviews Newsletter highlights the best critical care research articles from the medical literature during the previous seven days.
“The highlights of this week’s edition are two randomised controlled stroke trials on blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke & minimally invasive surgery with thrombolysis in intracerebral haemorrhage; systematic reviews and meta analyses on fever control in critically ill adults & tranexamic acid in cerebral hemorrhage; and observational studies on the association of left ventricular ejection fraction with mortality after elective non cardiac surgery & sepsis-associated mortality in US acute care hospitals.”
The full text of the newsletter is available via this link.

Critical Care Reviews Newsletter 374 16th February 2019

The 374th Critical Care Reviews Newsletter highlights the best critical care research articles from the medical literature during the previous seven days.
“The highlights of this week’s edition are randomised controlled trials on EEG-guided anesthetic administration on postoperative delirium among older adults undergoing major surgery & high-flow nasal cannula versus oxygen face mask for environmental bacterial contamination in critically ill pneumonia patients; systematic reviews and meta analyses on assessing intubation difficulty and intravenous IgM-enriched immunoglobulin (pentaglobin) in sepsis or septic shock; observational studies on andexanet alfa for bleeding associated with factor Xa inhibitors & synergy between norepinephrine and terlipressin during septic shock”.
The full text of the newsletter is available via this link.

Acute respiratory distress syndrome in leptospirosis

This research by Vandroux and colleagues was published online in the Journal of Critical during February 2019.
Purpose: Acute Respiratory Distress Syndrome is a major complication of leptospirosis, leading to the majority of fatalities.
Methods:  Retrospective, descriptive and single-centre cohort study. The primary outcome was the Standardized Mortality Ratio (SMR) for ARDS in leptospirosis based on the quartiles of the SAPS2 score in the reference population of 1683 patients hospitalized for ARDS. The second outcomes were to determine the risk factors of mortality of ARDS in leptospirosis and to describe the cases requiring Extracorporeal Membrane Oxygenation (ECMO).
Results:  Of 172 leptospirosis patients from January 2004 to October 2017, 39 (23%) presented a moderate or severe ARDS with a mortality rate of 23% (9 cases). Among patients with ARDS, the SMR with regards to Simplified Acute Physiology Score II was 0.49 (CI95%: 0.21; 0.96). Risk factors associated with mortality found by bivariate analysis were Severity Acute Physiology Score II (p = 0.01), Sequential Organ Failure Assessment (p = 0.01), base excess (p = 0.002), kaliemia (p = 0.004), bilirubinemia (p = 0.01) and level of aspartate aminotransferase (p = 0.01). Eight patients underwent ECMO for refractory ARDS and six survived.
Conclusions:  Leptospirosis can induce serious but transient ARDS with a better prognosis than that of other causes of ARDS. Several patients have been successfully treated with ECMO.
The full text of this article is available to subscribers via this link to the journal’s homepage.  The full text of articles from issues older than sixty days is available via this link to an archive of issues of Journal of Critical Care A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link Please speak to the library staff for more details.