The 291st issue of the Critical Care Reviews Newsletter includes the latest research from across the medical literature during the last week. This includes a randomised controlled trial from JAMA on “Effect of Depth and Duration of Cooling on Death or Disability at Age 18 Months Among Neonates With Hypoxic-Ischemic Encephalopathy”, from Intensive Care Medicine “The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis” and from Resuscitation “Protocol-driven neurological prognostication and withdrawal of life-sustaining therapy after cardiac arrest and targeted temperature management.”
The 290th issue of the Critical Care Reviews Newsletter includes the “best critical care research and open access articles from across the medical literature over the past seven days”. The “Topic of the Week” is critical care in resource limited settings including a paper on Intensive Care Unit Capacity in Low Income Counties
The 289th issue of the Critical Care Reviews Newsletter includes the “best critical care research and open access articles from across the medical literature over the past seven days”.
Research linked to from this issue include “Efficacy and safety of ridinilazole compared with vancomycin for the treatment of Clostridium difficile infection: a phase 2, randomised, double-blind, active-controlled, non-inferiority study” from Lancet Infectious Diseases, “The practice of tracheostomy decannulation—a systematic review” from the Journal of Intensive Care and “Wengenmayer. Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR) from Critical Care.
This paper by the PRISM investigators led by Kathryn Rowan was published in the New England Journal of Medicine in June 2017 Volume 376 number 23. The full text of the article is available to subscribers to this journal via this link. The Library and Knowledge Service can obtain the full text of the article for registered members by requesting it via the library website document request form.
BACKGROUND: After a single-center trial and observational studies suggesting that early, goal-directed therapy (EGDT) reduced mortality from septic shock, three multicenter trials (ProCESS, ARISE, and ProMISe) showed no benefit. This meta-analysis of individual patient data from the three recent trials was designed prospectively to improve statistical power and explore heterogeneity of treatment effect of EGDT.
METHODS: We harmonized entry criteria, intervention protocols, outcomes, resource-use measures, and data collection across the trials and specified all analyses before unblinding. After completion of the trials, we pooled data, excluding the protocol-based standard-therapy group from the ProCESS trial, and resolved residual differences. The primary outcome was 90-day mortality. Secondary outcomes included 1-year survival, organ support, and hospitalization costs. We tested for treatment-by-subgroup interactions for 16 patient characteristics and 6 care-delivery characteristics.
RESULTS: We studied 3723 patients at 138 hospitals in seven countries. Mortality at 90 days was similar for EGDT (462 of 1852 patients [24.9%]) and usual care (475 of 1871 patients [25.4%]); the adjusted odds ratio was 0.97 (95% confidence interval, 0.82 to 1.14; P=0.68). EGDT was associated with greater mean (±SD) use of intensive care (5.3±7.1 vs. 4.9±7.0 days, P=0.04) and cardiovascular support (1.9±3.7 vs. 1.6±2.9 days, P=0.01) than was usual care; other outcomes did not differ significantly, although average costs were higher with EGDT. Subgroup analyses showed no benefit from EGDT for patients with worse shock (higher serum lactate level, combined hypotension and hyperlactatemia, or higher predicted risk of death) or for hospitals with a lower propensity to use vasopressors or fluids during usual resuscitation.
CONCLUSIONS: In this meta-analysis of individual patient data, EGDT did not result in better outcomes than usual care and was associated with higher hospitalization costs across a broad range of patient and hospital characteristics.
The 287th issue of the Critical Care Reviews Newsletter includes the latest research from across the medical literature from the previous week. Highlights include “the pilot TOP-UP and SPIRIT randomised controlled trials, a worrying study on data fabrication in anaesthetic and general medical journals, a guideline on acute kidney injury reviews on fluid responsiveness, clinical examination in circulatory shock, continuous renal replacement therapy forty year anniversary and an interesting discussion on the management of septic shock”.
The full text of the newsletter can be accessed via this link.
The 286th issue of the Critical Care Reviews Newsletter contains the latest research from across the medical literature of the last seven days.
These include a randomised clinical trial on “Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults”, a meta analysis on “Effort to breathe with various spontaneous breathing trial techniques”, a cohort study on “Short course adjunctive gentamicin as empirical therapy in patients with severe sepsis and septic shock” and a Cochrane Review on “High flow nasal cannulae for respiratory support in adult intensive care patients”
On Sunday the 284th Critical Care Reviews Newsletter was published provides the best critical care research from across the medical literature over the past week.
The highlights of this week’s newsletter are the KARE randomised controlled trial, investigating keratinocyte growth factor in ARDS; guidelines on oxygen use, hemodynamic support of paediatric and neonatal septic shock, & management of the potential organ donor, as well as narrative reviews on the ICM research agenda on extracorporeal life support, high protein intake and central venous access device–related upper extremity deep vein thrombosis.