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.
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.
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.
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.
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.