Critical Care Reviews Newsletter 398 29th July 2019

The Critical Care Reviews Newsletter lists the best critical care research and open access articles from the medical literature during the last week.  This issue contains randomised controlled trials such as Intensive vs Standard Treatment of Hyperglycemia and Functional Outcome in Patients With Acute Ischemic Stroke. The SHINE Randomized Clinical Trial, systematic reviews including Diagnostic accuracy of eFAST in the trauma patient; a systematic review and meta analysis and guidelines such as Non-invasive ventilation education and training: a narrative analysis and an international consensus document.  It also includes details of the latest additions to the Critical Care Reviews Meeting 2020 programme.
Full text of the 398th newsletter is available via this link.

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Critical Care Reviews Newsletter 397 23rd July 2019

The Critical Care Reviews Newsletter lists the best critical care research and open access articles from the medical literature during the last week.
The highlights of this edition are randomised controlled trials on the effects of flexible family visitation on delirium ICU diaries on posttraumatic stress disorder; systematic reviews and meta analyses on driving pressure for ventilated ARDS patients & procalcitonin-guided antibiotic treatment in patients with positive blood cultures; and observational studies on the association between state-mandated protocolized sepsis care and in-hospital mortality in sepsis time to treatment with endovascular reperfusion therapy and outcomes in patients with acute ischemic stroke.
Full text of the 397th newsletter is available via this link.

Right ventricular dysfunction in neurologically deceased organ donors: An observational study in a tertiary-care organ donor referral centre

This research by Frenette and other was published online during 2019 in the Journal of Critical Care.
Purpose:  Right ventricular RV dysfunction among transplant recipients correlates with transplant outcome, but its frequency in donors is unknown. The purpose of this study was to describe the epidemiology of RV dysfunction in potential heart donors.”
Methods:  In a seven-year retrospective study of potential heart donors, we explored the incidence of RV dysfunction as observed on echocardiography and explored the association of four distinct factors with RV dysfunction: brain injury diagnosis, thoracic trauma, vasopressin infusion and left ventricular (LV) dysfunction.
Results:  All 123 potential heart donors underwent echocardiography: 55 had RV dysfunction (44.7%). Fourty-one (33.3%) had LV dysfunction. Isolated RV dysfunction was present in 27 subjects (22%). LV dysfunction was the only factor significantly associated with RV dysfunction (OR = 4.6 (95% CI 1.9–11.4)). We observed no difference in heart acceptance between subjects with or without RV dysfunction.
Conclusion:  We observed a high frequency of RV dysfunction in a sample of potential heart donors. However, the temporal evolution of RV dysfunction, the hemodynamic predictors of RV dysfunction, as well the link between donor RV dysfunction and recipient outcomes need to be assessed with further prospective studies.
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.

Critical Care Reviews Newsletter 396 22nd July 2019

The Critical Care Reviews Newsletter brings you the best critical care research and open access articles from across the medical literature from the last week.  
The highlights of this week’s edition are randomised controlled trials investigating internal jugular & subclavian ultrasound-guided central venous catheterization, an incentive spirometer patient reminder after CABG & the effect of alirocumab on mortality after acute coronary syndromes; systematic reviews and meta analyses on erythropoiesis-stimulating agents in critically ill patientsextending thrombolysis using perfusion imaging the west Africa (2013-16) Ebola virus disease epidemic; and observational studies on herpes simplex encephalitisthe effect of the route of nutrition on gut mucosa in ventilated adults with shock multimorbidity states associated with higher mortality rates in organ dysfunction and sepsis.
Full text of the 396th newsletter is available via this link.

Cardiac output during targeted temperature management and renal function after out-of-hospital cardiac arrest

This article by Grand and colleagues was published online in the Journal of Critical Care during July 2019.
Purpose:  After resuscitation from out-of-hospital cardiac arrest (OHCA), renal injury and hemodynamic instability are common. We aimed to assess the association between low cardiac output during targeted temperature management (TTM) and acute kidney injury (AKI) after OHCA.
Materials and methods:  Single-center substudy of 171 patients included in the prospective, randomized TTM-trial. Hemodynamic evaluation was performed with serial measurements by pulmonary artery catheter. AKI was the primary endpoint and was defined according to the KDIGO-criteria.
Results:  Of 152 patients with available hemodynamic data, 49 (32%) had AKI and 21 (14%) had AKI with need for renal replacement therapy (RRT) in the first three days. During targeted temperature management, patients with AKI had higher heart rate (11 beats/min, pgroup < 0.0001), higher mean arterial pressure (MAP) (4 mmHg, pgroup = 0.001) and higher lactate (1 mmol/L, pgroup < 0.0001) compared to patients without AKI. However, there was no difference in cardiac index (pgroup = 0.25). In a multivariate logistic regression model, adjusting for potential confounders, MAP (p = .03), heart rate (p = .01) and lactate (p = .006), but not cardiac output, were independently associated with AKI.
Conclusions:  Blood pressure, heart rate and lactate, but not cardiac output, during 24 h of TTM were associated with AKI in comatose OHCA-patients.
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.

Critical Care Reviews Newsletter 395 13th July 2019

The Critical Care Reviews Newsletter brings you the best critical care research and open access articles from across the medical literature from the week of July 1st to 7th.  “The highlights of this week’s edition are randomised controlled trials on transesophageal echocardiography in critically ill patients with shock, early TIPS with covered stents versus standard treatment for acute variceal bleeding in patients with advanced cirrhosis, & aggressive versus slow rehydration in gastroenteritis; systematic reviews and meta analyses on corticosteroids in septic shock, family support interventions in the ICU, & endovascular thrombectomy in acute ischemic stroke; observational studies on trends in sepsis mortality over time in randomised trials & rehospitalization and resource use after extracorporeal life support in the USA; & the statistical and health economic analysis plan for 65, one of our big trials at CCR20 in January.”
Full text of the 395th newsletter is available via this link.

Rescue stem cell allograft in intensive care unit patients during septic shock with multi-organ failure

This research by Lepretre and colleagues was first published online in the Journal of Critical Care during July 2019.
Purpose:  We describe what we believe to be the first two cases of patients who received an allograft in intensive care unit (ICU) despite severe septic shock with multi-organ failure (MOF).
Results:  One patient had aggressive large B-cell lymphoma. After allograft, the patient initially improved after withdrawing norepinephrine and renal replacement therapy but he subsequently died thirty-two days later because of a new relapse of the disease. The second patient had acute myeloid leukemia type 1 with a need for an allograft after a first complete remission. She was discharged from ICU at D23 after allograft and still alive 7 months later with complete remission. For the two patients, allograft conditioning was performed before admission to our ICU. These two cases highlight one major problem in such situations which is to find the best time to perform the allograft, particularly in ventilated patients with septic shock and MOF. We performed the allograft when we thought that the risk-benefit ratio was in favor of restoring immunity.
Conclusion:  Allograft should be considered as a rescue therapy in ICU for patients with aplasia, during septic shock with multi-organ failure, however close multidisciplinary discussion is required between intensivists and onco-hematologists.
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.