2013 May - Continuous renal replacement therapy with regional citrate anticoagulation: do we really know the details?

Lanckohr C, Hahnenkamp K, Boschin M.; Curr Opin Anaesthesiol. 2013 May 13. [Epub ahead of print]

PURPOSE OF REVIEW: A significant proportion of critically ill patients with acute kidney injury require continuous renal replacement therapy (CRRT). This article summarizes current evidence on the diagnosis and treatment of acute kidney injury. Regional citrate anticoagulation (RCA) is an emerging but complex technique. A variety of solutions and systems are currently used for RCA. Descriptions of the dosage and methods differ significantly and may cause confusion in everyday practice. This article reviews important scientific findings and highlights pharmacological and pathophysiological aspects of RCA, with a special emphasis on practical clinical issues regarding dosage and available citrate solutions.

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2013 Jun - Troponin Elevation in Subarachnoid Hemorrhage Does not Impact In-hospital Mortality

Gupte M, John S, Prabhakaran S, Lee VH.; Neurocrit Care. 2013 Jun;18(3):368-73.

BACKGROUND: Cardiac dysfunction is a well-known complication of subarachnoid hemorrhage (SAH). Our objective was to determine the frequency of troponin abnormalities in SAH and determine its impact on in-hospital mortality.

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2013 Jun - Hyponatremia and brain injury: historical and contemporary perspectives

Kirkman MA, Albert AF, Ibrahim A, Doberenz D.; Neurocrit Care. 2013 Jun;18(3):406-16.

Hyponatremia is common in neurocritical care patients and is associated with significant morbidity and mortality. Despite decades of research into the syndrome of inappropriate antidiuretic hormone (SIADH) and cerebral salt wasting (CSW), their underlying pathophysiological mechanisms are still not fully understood...

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2013 Jun - First clinical experience with intranasal cooling for hyperthermia in brain-injured patients

Springborg JB, Springborg KK, Romner B.; Neurocrit Care. 2013 Jun;18(3):400-5.

INTRODUCTION: Hyperthermia is common in brain-injured patients and associated with a worse outcome. As brain rather than body temperature reduction, theoretically, is the most important in cerebral protection, there is logic in targeting cooling at the brain. Selective brain cooling can, in theory, be obtained by cooling the skull or by heat loss from the upper airways. In this preliminary safety and efficacy study, we report clinical data from brain-injured patients who because of hyperthermia were treated with intranasal cooling.

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2013 May - Early antibiotics improve survival following out-of hospital cardiac arrest

Davies KJ, Walters JH, Kerslake IM, Greenwood R, Thomas MJ.; Resuscitation. 2013 May;84(5):616-9.

INTRODUCTION: Therapeutic hypothermia (TH) has become standard management following out of hospital cardiac arrest (OHCA). Recent evidence suggests TH increases the incidence of pneumonia. We retrospectively assessed infective indicators after OHCA and evaluated the effect of antibiotics on survival.

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2013 Apr - Effects of continuous renal replacement therapy on renal inflammatory cytokines during extracorporeal membrane oxygenation in a porcine model.

Yimin H, Wenkui Y, Jialiang S, Qiyi C, Juanhong S, Zhiliang L, Changsheng H, Ning L, Jieshou L.; J Cardiothorac Surg. 2013 Apr 29;8(1):113. [Epub ahead of print]

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been recommended for the treatment of patients with acute, potentially reversible, life-threatening respiratory failure which unresponsive to conventional therapy. But it is unclear about how ECMO affects renal tissue.

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2013 May - Critical Care Management ofVerapamil and Diltiazem Overdose With a Focus on Vasopressors: A 25-Year Experience at a Single Center

Levine M, Curry SC, Padilla-Jones A, Ruha AM.; Ann Emerg Med. 2013 May 1. [Epub ahead of print]

STUDY OBJECTIVE: Verapamil or diltiazem overdose can cause severe morbidity and death, and there exist limited human data describing management and outcome of a large number of such patients. This article describes the management and outcome of patients with nondihydropyridine calcium-channel blocker overdose, with an emphasis on vasopressor dosing, at a single center.

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2013 May - Mild Therapeutic Hypothermia After Out-Of-Hospital Cardiac Arrest Complicating ST-Elevation Myocardial Infarction: Long-term Results in Clinical Practice

Zimmermann S, Flachskampf FA, Schneider R, Dechant K, Alff A, Klinghammer L, Rittger H, Achenbach S.; Clin Cardiol. 2013 May 6. doi: 10.1002/clc.22131. [Epub ahead of print]

BACKGROUND: Recently, mild therapeutic hypothermia (MTH) has been integrated into the European resuscitation guidelines to improve outcomes after out-of-hospital cardiac arrest (OHCA). Data on long-term results are limited, especially in patients with acute ST-elevation myocardial infarction (STEMI).

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2013 Apr - Severe hypertriglyceridemia-related acute pancreatitis

Stefanutti C, Labbadia G, Morozzi C.; Ther Apher Dial. 2013 Apr;17(2):130-7. Epub 2013 Feb 28.

Acute pancreatitis is a potentially life-threatening complication of severe hypertriglyceridemia. In some cases, inborn errors of metabolism such as lipoprotein lipase deficiency, apoprotein C-II deficiency, and familial hypertriglyceridemia have been reported as causes of severe hypertriglyceridemia. More often, severe hypertriglyceridemia describes various clinical conditions characterized by high plasma levels of triglycerides (>1000 mg/dL), chylomicron remnants, or intermediate density lipoprotein like particles, and/or chylomicrons. International guidelines on the management of acute pancreatitis are currently available...

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2013 Mar - Mechanical ventilation for amyotrophic lateral sclerosis/motor neuron disease

Radunovic A, Annane D, Rafiq MK, Mustfa N.  Cochrane Database Syst Rev. 2013;3:CD004427.

BACKGROUND: Amyotrophic lateral sclerosis, also known as motor neuron disease, is a fatal neurodegenerative disease. Neuromuscular respiratory failure is the commonest cause of death, usually within two to five years of the disease onset. Supporting respiratory function with mechanical ventilation may improve survival and quality of life. This is the first update of a review first published in 2009.

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2013 Feb - Pulmonary artery catheters for adult patients in intensive care

Rajaram SS, Desai NK, Kalra A, Gajera M, Cavanaugh SK, Brampton W, Young D, Harvey S, Rowan K.; Cochrane Database Syst Rev. 2013 Feb 28;2:CD003408.

BACKGROUND: Since pulmonary artery balloon flotation catheterization was first introduced in 1970, by HJ Swan and W Ganz, it has been widely disseminated as a diagnostic tool without rigorous evaluation of its clinical utility and effectiveness in critically ill patients. A pulmonary artery catheter (PAC) is inserted through a central venous access into the right side of the heart and floated into the pulmonary artery. PAC is used to measure stroke volume, cardiac output, mixed venous oxygen saturation and intracardiac pressures with a variety of additional calculated variables to guide diagnosis and treatment. Complications of the procedure are mainly related to line insertion. Relatively uncommon complications include cardiac arrhythmias, pulmonary haemorrhage and infarct, and associated mortality from balloon tip rupture.

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2013 Apr - Apnea Test for Brain Death Determination in a Patient on Extracorporeal Membrane Oxygenation

Smilevitch P, Lonjaret L, Fourcade O, Geeraerts T.; Neurocrit Care. 2013 Apr 25. [Epub ahead of print]

BACKGROUND: Apnea test is a key component to confirm brain death. For patients receiving extracorporeal membrane oxygenation (ECMO), apnea test remains challenging. Brain death (BD) diagnosis is often made without apnea test.

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2013 Apr - Cardiovascular Protection to Improve Clinical Outcomes After Subarachnoid Hemorrhage: Is There a Proven role?

Okabe T, Kanzaria M, Rincon F, Kraft WK.; Neurocrit Care. 2013 Apr;18(2):271-84.

Cardiac abnormalities seen in patients with subarachnoid hemorrhage (SAH) are considered to be a neurally mediated process rather than a manifestation of coronary artery disease. In patients with SAH, myocardial injury evidenced by troponin elevation appears to predict short and long-term outcomes independently of other conventional risk...

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2013 Apr - Antibiotic-impregnated versus silver-bearing external ventricular drainage catheters: preliminary results in a randomized controlled trial

Winkler KM, Woernle CM, Seule M, Held U, Bernays RL, Keller E.; Neurocrit Care. 2013 Apr;18(2):161-5.

BACKGROUND: Evaluation of antibiotic-impregnated (AI) and ionized silver particle coated external ventricular drainage catheters (EVD) in patients with subarachnoid (SAH) or intracranial hemorrhage (ICH).

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2013 Apr - Safety of a DVT Chemoprophylaxis Protocol Following Traumatic Brain Injury: A Single Center Quality Improvement Initiative

Nickele CM, Kamps TK, Medow JE.; Neurocrit Care. 2013 Apr;18(2):184-92.

BACKGROUND: Venous thromboembolism (VTE) is a complication that affects approximately 30 % of moderate and severe traumatic brain injury (TBI) patients when pharmacologic prophylaxis is not used. Following TBI, specifically in the case of contusions, the safety and efficacy of pharmacologic thromboembolism prophylaxis (PTP) has been studied only in small sample sizes. In this study, we attempt to assess the safety and efficacy of a PTP protocol for TBI patients, as a quality improvement (QI) initiative, in the neuroscience intensive care unit (NSICU).

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2013 Apr - Mild prolonged hypothermia for large intracerebral hemorrhage

Staykov D, Wagner I, Volbers B, Doerfler A, Schwab S, Kollmar R.; Neurocrit Care. 2013 Apr;18(2):178-83.

BACKGROUND: Perihemorrhagic edema (PHE) develops after intracerebral hemorrhage (ICH). It can worsen the clinical situation by its additional mass effect. Therapeutic hypothermia (TH) might be an effective method to control PHE, but has not been sufficiently studied in ICH patients.

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2013 Apr - Long-term outcomes of post-thrombolytic intracerebral hemorrhage in ischemic stroke patients

Norby KE, Siddiq F, Adil MM, Chaudhry SA, Qureshi AI.; Neurocrit Care. 2013 Apr;18(2):170-7

BACKGROUND: Intracerebral hemorrhage (ICH) is an infrequent complication of intravenous recombinant tissue plasminogen activator (rt-PA) for the treatment of acute stroke. However, such ICH is an important reason for withdrawal of care because of lack of adequate data regarding long-term patient outcomes.

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2013 Mar - Outcomes in critically ill cancer patients with septic shock of pulmonary origin

de Montmollin E, Tandjaoui-Lambiotte Y, Legrand M, Lambert J, Mokart D, Kouatchet A, Lemiale V, Pène F, Bruneel F, Vincent F, Mayaux J, Chevret S, Azoulay E.; Shock. 2013 Mar;39(3):250-4.
Increased therapeutic intensity has translated into better survival at a price of infectious and toxic life-threatening complications, chiefly affecting the lungs. Yet, no study specifically evaluated outcomes in cancer patients admitted to the intensive care unit (ICU) for septic shock of pulmonary origin. This is a multicenter cohort study of cancer patients admitted to the ICU for septic shock and pneumonia between 1998 and 2008...

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2013 Mar - "How to Guide Volume Expansion in Severe Sepsis and Septic Shock Patients? Possibilities in The Real World"

Westphal GA.; Shock. 2013 Mar 11. [Epub ahead of print]
Early fluid administration is fundamental for the initial treatment of severe sepsis and septic shock patients. A large portion of suspected severe sepsis and septic shock patients can be quickly resuscitated with therapeutic tests until surrogate cardiac output markers, such as heart rate and urinary output, are normalized...

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2013 Mar - Colloids in Sepsis: Evenly Distributed Molecules Surrounded by Uneven Questions

Zampieri FG, Park M, Azevedo LC.; Shock. 2013 Mar 11. [Epub ahead of print]
Colloids are frequently used for fluid expansion in the intensive care unit (ICU), although its use on several clinical scenarios remains unproven of any relevant clinical benefit. The purpose of this manuscript is to carry out a narrative review regarding the safety and efficacy of colloids on patients with sepsis and septic shock, with emphasis on the most commonly used colloids, albumin and starches.

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