2017 May - The Prognostic Value of Central Venous-to-Arterial CO2 Difference/Arterial-Central Venous O2 Difference Ratio in Septic Shock Patients with Central Venous O2 Saturation ≥80
He H, Long Y, Liu D, Wang X, Tang B.; Shock. 2017 May 10. doi: 10.1097/SHK.0000000000000893.
BACKGROUND: It is a great challenge for physician to assess the relationship between O2 delivery and O2 consumption in septic shock patients with high ScvO2. Recently, the venous-to-arterial CO2 difference/arterial-central venous O2 difference ratio (P(v-a)CO2/C(a-v)O2) has shown potential for reflecting anaerobic metabolism. Therefore, we evaluated the value of using the P(v-a)CO2/C(a-v)O2 ratio to predict mortality and assess anaerobic metabolism in septic shock patients with high ScvO2 (≥ 80%).
2017 Mar - Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation of non-asphyxial out-of-hospital cardiac arrest
Zhan L, Yang LJ, Huang Y, He Q, Liu GJ. Cochrane Database Syst Rev. 2017 Mar
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a major cause of death worldwide. Cardiac arrest can be subdivided into asphyxial and non asphyxial etiologies. An asphyxia arrest is caused by lack of oxygen in the blood and occurs in drowning and choking victims and in other circumstances. A non asphyxial arrest is usually a loss of functioning cardiac electrical activity. Cardiopulmonary resuscitation (CPR) is a well-established treatment for cardiac arrest. Conventional CPR includes both chest compressions and 'rescue breathing' such as mouth-to-mouth breathing. Rescue breathing is delivered between chest compressions using a fixed ratio, such as two breaths to 30 compressions or can be delivered asynchronously without interrupting chest compression. Studies show that applying continuous chest compressions is critical for survival and interrupting them for rescue breathing might increase risk of death. Continuous chest compression CPR may be performed with or without rescue breathing.
Ludwig C, Koryllos A.; J Thorac Dis. 2017 Apr;9(Suppl 3):S172-S177
Trauma is the leading cause of death worldwide. Approximately 2/3 of the patients have a chest trauma with varying severity from a simple rib fracture to penetrating injury of the heart or tracheobronchial disruption. Blunt chest trauma is most common with 90% incidence, of which less than 10% require surgical intervention of any kind. Mortality is second highest after head injury, which underlines the importance of initial management. Many of these deaths can be prevented by prompt diagnosis and treatment. What is the role of the thoracic surgeon in the management of chest trauma in severely injured patients? When should the thoracic surgeon be involved? Is there a place for minimal invasive surgery in the management of severely injured patients? With two case reports we would like to demonstrate how the very specific knowledge of thoracic surgeons could help in the care of trauma patients.
Hayman EG, Wessell A, Gerzanich V, Sheth KN, Simard JM. Neurocrit Care. 2017 Apr;26(2):301-310.
A growing body of clinical literature emphasizes the impact of cerebral edema in early brain injury following aneurysmal subarachnoid hemorrhage (aSAH). Aneurysm rupture itself initiates global cerebral edema in up to two thirds of cases. Although cerebral edema is not a universal feature of aSAH, it portends a poor clinical course, with quantitative analysis revealing a direct correlation between cerebral edema and poor outcome, including mortality and cognitive deficits. Mechanistically, global cerebral edema has been linked to global ischemia at the time of aneurysm rupture, dysfunction of autoregulation, blood breakdown products, neuroinflammation, and hyponatremia/endocrine abnormalities. At a molecular level, several culprits have been identified, including aquaporin-4, matrix metalloproteinase-9, SUR1-TRPM4 cation channels, vascular endothelial growth factor, bradykinin, and others. Here, we review these cellular and molecular mechanisms of global cerebral edema formation in aSAH. Given the importance of edema to the outcome of patients with aSAH and its status as a highly modifiable pathological process, a better understanding of cerebral edema in aSAH promises to hasten the development of medical therapies to improve outcomes in this frequently devastating disease.
Miller JB, Lewandowski C, Wira CR, Taylor A, Burmeister C, Welch R.; Neurocrit Care. 2017 Apr;26(2):191-195.
BACKGROUND: Plasma expansion in acute ischemic stroke has potential to improve cerebral perfusion, but the long-term effects on functional outcome are mixed in prior trials. The goal of this study was to evaluate how the magnitude of plasma expansion affects neurological recovery in acute stroke.
2017 Apr - Risks of Routinely Clamping External Ventricular Drains for Intrahospital Transport in Neurocritically Ill Cerebrovascular Patients
Chaikittisilpa N, Lele AV, Lyons VH, Nair BG, Newman SF, Blissitt PA, Vavilala MS.; Neurocrit Care. 2017 Apr;26(2):196-204.
BACKGROUND: Current guidelines recommend routine clamping of external ventricular drains (EVD) for intrahospital transport (IHT). The aim of this project was to describe intracranial hemodynamic complications associated with routine EVD clamping for IHT in neurocritically ill cerebrovascular patients.
2017 Jan - Haemodynamic monitoring in the peri-operative period: the past, the present and the future
Watson X, Cecconi M. Anaesthesia. 2017 Jan;72 Suppl 1:7-15. doi: 10.1111/anae.13737. Review.
Over recent years there has been an increase in the implementation of goal-directed therapy using minimally invasive haemodynamic monitoring techniques to guide peri-operative care. Since the introduction of the pulmonary artery flotation catheter in the 1980s, various haemodynamic monitors have been developed, each associated with their own benefits and limitations.
2017 Mar - Prehospital Hypertonic Fluid Resuscitation for Trauma Patients: a Systematic Review and Meta-analysis
de Crescenzo C, Gorouhi F, Salcedo ES, Galante JM.; J Trauma Acute Care Surg. 2017 Mar 2.
BACKGROUND: Prehospital assessment of a patient's circulation status and appropriate resuscitation with intravenous fluids plays a critical role in patients with obvious hemorrhage or systolic blood pressure below 90 mmHg.
2016 Nov - Recruitment manoeuvres for adults with acute respiratory distress syndrome receiving mechanical ventilation
Hodgson C, Goligher EC, Young ME, Keating JL, Holland AE, Romero L, Bradley SJ, Tuxen D.; Cochrane Database Syst Rev. 2016 Nov 17;11:CD006667. Review.
BACKGROUND: Recruitment manoeuvres involve transient elevations in airway pressure applied during mechanical ventilation to open ('recruit') collapsed lung units and increase the number of alveoli participating in tidal ventilation. Recruitment manoeuvres are often used to treat patients in intensive care who have acute respiratory distress syndrome (ARDS), but the effect of this treatment on clinical outcomes has not been well established. This systematic review is an update of a Cochrane review originally published in 2009.
2016 Oct - β-Blockade use for Traumatic Injuries and Immunomodulation: A Review of Proposed Mechanisms and Clinical Evidence
Loftus TJ, Efron PA, Moldawer LL, Mohr AM.; Shock. 2016 Oct;46(4):341-51.
Sympathetic nervous system activation and catecholamine release are important events following injury and infection. The nature and timing of different pathophysiologic insults have significant effects on adrenergic pathways, inflammatory mediators, and the host response. Beta adrenergic receptor blockers (β-blockers) are commonly used for treatment of cardiovascular disease, and recent data suggests that the metabolic and immunomodulatory effects of β-blockers can expand their use. β-blocker therapy can reduce sympathetic activation and hypermetabolism as well as modify glucose homeostasis and cytokine expression. It is the purpose of this review to examine either the biologic basis for proposed mechanisms or to describe current available clinical evidence for the use of β-blockers in traumatic brain injury, spinal cord injury, hemorrhagic shock, acute traumatic coagulopathy, erythropoietic dysfunction, metabolic dysfunction, pulmonary dysfunction, burns, immunomodulation, and sepsis.
2017 Jan - Systematic review of β blocker, aspirin, and statin in critically ill patients: importance of severity of illness and cardiac troponin
Rothenberg FG, Clay MB, Jamali H, Vandivier-Pletsch RH.; J Investig Med. 2017 Jan 30. [Epub ahead of print]
Non-cardiac critically ill patients with type II myocardial infarction (MI) have a high risk of mortality. There are no evidence-based interventions to mitigate this risk. We systematically reviewed the literature regarding the use of medications known to reduce mortality in patients with cardiac troponin (cTn) elevation due to type I MI (β blockers, statin, and aspirin) in studies of critically ill patients without Type I MI. All PubMed publications between 1976-2/19/16 were reviewed. Search terms included: β blocker or aspirin or statin and intensive care unit (ICU) or critically ill or sepsis; 497 primary references were obtained. Inclusion criteria were as follows: (1) study population consisted of critically ill patients in the ICU with non-cardiovascular illnesses, (2) mortality end point, (3) severity of illness (or injury) was measured, and (4) the antiplatelet agent was primarily aspirin.
2016 Dec - Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis
Debaty G, Babaz V, Durand M, Gaide-Chevronnay L, Fournel E, Blancher M, Bouvaist H, Chavanon O, Maignan M, Bouzat P, Albaladejo P, Labarère J.; Resuscitation. 2016 Dec 19;112:1-10
PURPOSE: Association estimates between baseline characteristics and outcomes are imprecise and inconsistent among extracorporeal cardiopulmonary resuscitation (ECPR) recipients following refractory out-of-hospital cardiac arrest (OHCA). This systematic review and meta-analysis aimed to investigate the prognostic significance of pre-specified characteristics for OHCA treated with ECPR.
2016 Dec - Prophylactic versus clinically-driven antibiotics in comatose survivors of out-of-hospital cardiac arrest—A randomized pilot study
Ribaric SF, Turel M, Knafelj R, Gorjup V, Stanic R, Gradisek P, Cerovic O, Mirkovic T, Noc M.; Resuscitation. 2017 Feb;111:103-109.
AIM: To investigate benefits of prophylactic antibiotics in comatose survivors of out-of-hospital cardiac arrest (OHCA).
METHODS: Patients without evidence of tracheobronchial aspiration on admission bronchoscopy were randomized to prophylactic Amoxicillin-Clavulanic acid 1.2g every 8h (P) or clinically-driven antibiotics (C) administered if signs of infection developed during initial 7days of intensive care unit (ICU) stay.
Veltkamp R, Gill D.; Neurotherapeutics. 2016 Oct;13(4):791-800
Inflammatory mechanisms are currently considered as a prime target for stroke therapy. There is evidence from animal studies that immune signals and mediators can have both detrimental and beneficial effects in particular stages of the disease process. Moreover, several of these mechanisms are turned on with sufficient delay after ischemia onset to make them amenable to therapeutic intervention. Several clinical proof-of concept trials have investigated the efficacy of different immunomodulatory approaches in patients with stroke.
2016 Oct - Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery
Duceppe E, Parlow J, MacDonald P, Lyons K, McMullen M, Srinathan S, Graham M, Tandon V, Styles K, Bessissow A, Sessler DI, Bryson G, Devereaux PJ.; Can J Cardiol. 2016 Oct 4.
The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery.
Bougouin W, Aissaoui N, Combes A, Deye N, Lamhaut L, Jost D, Maupain C, Beganton F, Bouglé A, Karam N, Dumas F, Marijon E, Jouven X, Cariou A; SDEC Investigators..; Resuscitation. 2016 Nov 17;110:126-132.
PURPOSE: Cardiogenic shock due to post-resuscitation myocardial dysfunction is a major cause of mortality among patients hospitalized after cardiac arrest (CA). Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been proposed in the most severe cases but the level of evidence is very low. We assessed characteristics, outcome and prognostic factors of patients treated with VA-ECMO for post-CA shock.
2016 Dec - Empirical mono- versus combination antibiotic therapy in adult intensive care patients with severe sepsis – A systematic review with meta-analysis and trial sequential analysis
Sjövall F, Perner A, Møller MH.; J Infect. 2016 Dec 2. pii: S0163-4453(16)30312-7.
OBJECTIVES: To assess benefits and harms of empirical mono- vs. combination antibiotic therapy in adult patients with severe sepsis in the intensive care unit (ICU).
2016 Nov - Impella CP Versus Intra-Aortic Balloon Pump in Acute Myocardial Infarction Complicated by Cardiogenic Shock: The IMPRESS trial
Ouweneel DM, Eriksen E, Sjauw KD, van Dongen IM, Hirsch A, Packer EJ, Vis MM, Wykrzykowska JJ, Koch KT, Baan J, de Winter RJ, Piek JJ, Lagrand WK, de Mol BA, Tijssen JG, Henriques JP.; J Am Coll Cardiol. 2016 Oct 27. pii: S0735-1097(16)36767-5.
BACKGROUND: Despite advances in treatment, mortality in acute myocardial infarction complicated by cardiogenic shock remains high. Short-term mechanical circulatory support devices acutely improve hemodynamic conditions. The Impella CP is a new percutaneous circulatory support device that provides more hemodynamic support than the intra-aortic balloon pump (IABP).
2016 Nov - High-Flow Nasal Cannula in Critically Ill Subjects With or at Risk for Respiratory Failure: A Systematic Review and Meta-Analysis
Nedel WL, Deutschendorf C, Moraes Rodrigues Filho E.; Respir Care. 2016 Nov 22. pii: respcare.04831.
High-flow nasal cannula (HFNC) oxygen delivery has been gaining attention as an alternative means of respiratory support for critically ill patients, with recent studies suggesting equivalent outcomes when compared with other forms of oxygen therapy delivery. The main objective of this review was to extract current data about the efficacy of HFNC in critically ill subjects with or at risk for respiratory failure. We performed a systematic review of publications (from database inception to October 2015) that evaluated HFNC in critically ill subjects with or at risk for acute respiratory failure and performed a meta-analysis comparing HFNC with noninvasive ventilation (NIV) and with standard oxygen therapy regarding major outcomes: incidence of invasive mechanical ventilation and ICU mortality.
2016 Nov - Early initiation of renal replacement treatment in patients with acute kidney injury: A systematic review and meta-analysis
Wang H, Li L, Chu Q, Wang Y, Li Z, Zhang W, Li L, He L, Ai Y.; Medicine (Baltimore). 2016 Nov;95(46):e5434.
Background: Acute kidney injury (AKI) is associated with a substantially increased risk of mortality for many hospitalized patients. It has been suggested that early initiation of renal replacement treatment has a favorable outcome in critically ill patients complicated with AKI. However, results of studies evaluating the effect of early initiation strategy of renal replacement treatment on AKI have been controversial and contradictory. The aim of this meta-analysis is to examine the effect of early initiation of renal replacement treatment on patients with AKI.