2009 A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines?

Sjauw KD, Engström AE, Vis MM, van der Schaaf RJ, Baan J Jr, Koch KT, de Winter RJ, Piek JJ, Tijssen JG, Henriques JP.
Eur Heart J. 2009 Feb;30(4):459-68. Epub 2009 Jan 23.


Aims: Intra-aortic balloon counterpulsation (IABP) in ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock is strongly recommended (class IB) in the current guidelines. We performed meta-analyses to evaluate the evidence for IABP in STEMI with and without cardiogenic shock.

Read more ...

2009 Rapid sequence induction in the emergency department: induction drug and outcome of patients admitted to the intensive care unit

Baird CR, Hay AW, McKeown DW, Ray DC, Emerg Med J. 2009 Aug;26(8):576-9.

OBJECTIVES: Etomidate is used widely for rapid sequence induction (RSI) of anaesthesia in the emergency department (ED) as a result of its relative cardiovascular stability. There is concern over possible adrenal suppression and also that outcomes could be worse than in patients given other induction drugs. This possible association has not been studied in ED patients undergoing RSI.

Read more ...

2009 ACADEMIA AND CLINIC: The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration

Alessandro Liberati, MD, DrPH; Douglas G. Altman, DSc; Jennifer Tetzlaff, BSc; Cynthia Mulrow, MD, MSc; Peter C. Gøtzsche, MD, DrMedSci, MSc; John P.A. Ioannidis, MD; Mike Clarke, BA, DPhil; P. J. Devereaux, MD, BSc, PhD; Jos Kleijnen, MD, PhD; and David Moher, PhD
18 August 2009 | Volume 151 Issue 4

Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users.

Read more ...

2009 Management of massive peptic ulcer bleeding [Review]

Recommended by Dr SHUM Hoi Ping, ICU, Pamela Youde Nethersole Eastern Hospital, Hong Kong, on 9 July 2009
Cheung FK, Lau JY. Gastroenterol Clin North Am. 2009 Jun;38(2):231-43.
Massive bleeding from a peptic ulcer remains a challenge. A multidisciplinary team of skilled endoscopists, intensive care specialists, experienced upper gastrointestinal surgeons, and intervention radiologists all have a role to play. Endoscopy is the first-line treatment. Even with larger ulcers, endoscopic hemostasis can be achieved in the majority of cases.

Read more ...

2009 Improved patient survival using a modified resuscitation protocol for out-of-hospital cardiac arrest

Recommended by Dr SHUM Hoi Ping, ICU, PYNEH, Hong Kong, on 26 June 2009
Garza AG, Gratton MC, Salomone JA, Lindholm D, McElroy J, Archer R. Circulation. 2009 May 19;119(19):2597-605. Epub 2009 May 4.

BACKGROUND: Cardiac arrest continues to have poor survival in the United States. Recent studies have questioned current practice in resuscitation. Our emergency medical services system made significant changes to the adult cardiac arrest resuscitation protocol, including minimizing chest compression interruptions, increasing the ratio of compressions to ventilation, deemphasizing or delaying intubation, and advocating chest compressions before initial countershock.

Read more ...

2009 Terlipressin vs. octreotide in bleeding esophageal varices as an adjuvant therapy with endoscopic band ligation: a randomized double-blind placebo-controlled trial

Recommended by Dr SHUM Hoi Ping, ICU, PYNEH, Hong Kong, on 26 June 2009
Abid S, Jafri W, Hamid S, Salih M, Azam Z, Mumtaz K, Shah HA, Abbas Z. Am J Gastroenterol. 2009 Mar;104(3):617-23. Epub 2009 Feb 17.

OBJECTIVES: Data are scarce on the head-to-head efficacy of terlipressin and octreotide as an adjuvant therapy to endoscopic management of variceal bleed. The aim of this study was to compare the efficacy and safety of terlipressin with octreotide as an adjuvant therapy to endoscopic variceal band ligation in patients with esophageal variceal bleeding.

METHODS: Cirrhotic patients with esophageal variceal bleed were randomized on admission to receive terlipressin (group A) or octreotide (group B) along with the placebo in the other arm in a double-blind fashion. The two groups were compared for efficacy, safety, overall survival, and length of hospital stay. "Control of variceal bleed" was the measure of efficacy of terlipressin and octreotide. Factors predicting length of stay were also assessed.

Read more ...

2009 Safety and efficacy of alteplase in the treatment of acute ischemic stroke - Review

Recommended by Dr SHUM Hoi Ping, ICU, PYNEH, Hong Kong, on 22 June 2009
Micieli G, Marcheselli S, Tosi PA. Vasc Health Risk Manag. 2009;5(1):397-409.


After publication of the results of the National Institute of Neurological Disorders and Stroke study, the application of intravenous thrombolysis for ischemic stroke was launched and has now been in use for more than 10 years. The approval of this drug represented only the first step of the therapeutic approach to this pathology. Despite proven efficacy, concerns remain regarding the safety of recombinant tissue-type plasminogen activator for acute ischemic stroke used in routine clinical practice.

Read more ...

2009 The impact of a Critical Care Information System (CCIS) on time spent charting and in direct patient care by staff in the ICU: a review of the literature.

Recommended by Dr SHUM Hoi Ping on 17 June 2009; Mador RL, Shaw NT. Int J Med Inform. 2009 Jul;78(7):435-45. Epub 2009 Mar 3.

PURPOSE: The introduction of a Critical Care Information System (CCIS) into an intensive care unit (ICU) is purported to reduce the time health care providers (HCP) spend on documentation and increase the time available for direct patient care. However, there is a paucity of rigorous empirical research that has investigated these assertions. Moreover, those studies that have sought to elucidate the relationship between the introduction of a CCIS and the time spent by staff on in/direct patient care activities have published contradictory findings. The objective of this literature review is to establish the impact of a CCIS on time spent documenting and in direct patient care by staff in the ICU.

Read more ...

2009 Can we improve neurological outcomes in severe traumatic brain injury? Something old (early prophylactic hypothermia) and something new (erythropoietin)

Recommended by Dr SHUM Hoi Ping on 17 June 2009; Nichol AD, Cooper DJ; POLAR Study Investigators on behalf of the ANZICS-Clinical Trials Group; EPO Study Investigators on behalf of the ANZICS-Clinical Trials Group; Injury. 2009 May;40(5):471-8. Epub 2009 Apr 15.

Traumatic brain injury is a leading cause of mortality and long-term morbidity, particularly affecting young people. With our best therapies, one half of the patients with severe traumatic brain injury are never capable of living independently.

Read more ...

2009 Medication errors in critical care: risk factors, prevention and disclosure [Review]

Recommended by Dr SHUM Hoi Ping on 12 June 2009
Camiré E, Moyen E, Stelfox HT.
CMAJ. 2009 Apr 28;180(9):936-43

The case: Mr. S, a 63-year-old man with a recent history of peptic ulcer disease who is taking proton pump inhibitor therapy (his only medication) as an outpatient, is admitted to the intensive care unit (ICU) with respiratory distress. Community-acquired pneumonia is diagnosed, although pulmonary embolism was considered in the differential diagnosis. Treatment with both antibiotics and intravenous heparin is initiated. Over the next 24 hours, the patient’s clinical condition improves, and his care is transferred to the medical teaching unit. Before discharge from the ICU, a computed tomography chest scan with contrast confirms the absence of a pulmonary embolism. On day 4 after admission, hematemesis, hypotension and respiratory distress develop. The patient is intubated, readmitted to the ICU and given 6 units of blood. Endoscopy shows an actively bleeding peptic ulcer. The patient’s intravenous heparin therapy is stopped. Protamine is administered because his partial thromboplastin time is greater than 150 seconds, and a proton pump inhibitor is prescribed.

Why did this medication error occur? What could have been done to prevent this error? How should the medical team proceed?

Read more ...

2009 Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study

Recommended by Dr SHUM Hoi Ping on 12 June 2009
Rathore SS, Curtis JP, Chen J, Wang Y, Nallamothu BK, Epstein AJ, Krumholz HM; National Cardiovascular Data Registry. BMJ. 2009 May, 19;338:b1807

OBJECTIVE: To evaluate the association between door-to-balloon time and mortality in hospital in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction to assess the incremental mortality benefit of reductions in door-to-balloon times of less than 90 minutes.

DESIGN: Prospective cohort study of patients enrolled in the American College of Cardiology National Cardiovascular Data Registry, 2005-6.

SETTING: Acute care hospitals.

PARTICIPANTS: 43 801 patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention.

MAIN OUTCOME MEASURE: Mortality in hospital.

Read more ...

2009 Perspective: Glucose Control in the Intensive Care Unit: A Roller Coaster Ride or a Swinging Pendulum?

Richard J. Comi, MD; Annals of Internal Medicine, 2 June 2009, Volume 150, Issue 11, Pages 809-811

Figure. The insulin administration form used in ICU, PYNEH, Hong Kong

Many studies of tight control of blood glucose in critically ill patients are associated with poor outcomes. However, randomized studies of tight glucose control in patients admitted to coronary care or surgical intensive care units showed a reduction in mortality rates; supported by recommendations from professional organizations, many intensive care units implemented protocols for tight glucose control.

Read more ...

2009 Research: Use of non-invasive ventilation to wean critically ill adults off invasive ventilation: meta-analysis and systematic review

Recommended by Dr Chu Po Ngai, Alwin; presented at the daily Journal Club of ICU, PYNEH, Hong Kong on 27 May 2009

Published 21 May 2009, doi:10.1136/bmj.b1574; Cite this as: BMJ 2009;338:b1574
Karen E A Burns, clinical scientist, scientist, assistant professor of medicine1,2,3, Neill K J Adhikari, intensivist, associate scientist, lecturer4,5,6, Sean P Keenan, head, clinical assistant professor of medicine7,8, Maureen Meade, associate professor of medicine9

Objective To summarise the evidence for early extubation with immediate application of non-invasive ventilation compared with continued invasive weaning on important outcomes in intubated adults with respiratory failure.

Design Systematic review and meta-analysis of randomised and quasi-randomised controlled trials.

Setting Intensive care units.

Read more ...

2009 Traumatic brain injury is associated with the development of deep vein thrombosis independent of pharmacological prophylaxis

Authors: Reiff DA, Haricharan RN, Bullington NM, Griffin RL, McGwin G Jr, Rue LW: J Trauma. 2009 May;66(5):1436-40.
Recommended by Dr SHUM Hoi Ping, ICU, PYNEH, Hong Kong, on 21 May 2009

INTRODUCTION:

Deep venous thrombosis (DVT) is common among trauma patients. If left untreated it may result in lethal pulmonary thromboembolism. Previous studies have suggested that intracranial hemorrhage serves as an independent risk factor for the development of DVT. These studies were not able to exclude anticoagulation therapy as a confounding variable in their analysis. Our objective was to determine the association of traumatic brain injury (TBI) to the formation of DVT irrespective of the use of anticoagulation therapy.

Read more ...

2009 Critical care management of cancer patients: cause for optimism and need for objectivity

Authors: Darmon M, Azoulay E. Current opinion of Oncology 2009 May 11. [Epub ahead of print]
Recommended by Dr SHUM Hoi Ping, ICU, PYNEH, Hong Kong, on 21 May 2009

PURPOSE OF REVIEW:

In the 1990s, cancer patients were described as poor candidates for ICU admission on the basis of high mortality rates and management costs. Over the last decade, however, advances in the management of malignancies and organ failures have led to substantial increases in survival. This review discusses current outcomes of critically ill cancer patients and recent insights into prognostic factors. Persistent areas of uncertainty are emphasized.

Read more ...

2009 Intravenous Esomeprazole for Prevention of Recurrent Peptic Ulcer Bleeding: A Randomized Trial

Authors: Joseph J.Y. Sung, MD; Alan Barkun, MD; Ernst J. Kuipers, MD; Joachim Mössner, MD; Dennis M. Jensen, MD; Robert Stuart, MD; James Y. Lau, MD; Henrik Ahlbom, BSc; Jan Kilhamn, MD; and Tore Lind, MD, for the Peptic Ulcer Bleed Study Group*

Annals of Internal Medicine: 7 April 2009 | Volume 150 Issue 7 | Pages 455-464

esomeprazole

Figure. Chemical structure of esomeprazole

Abstract

Background: Use of proton-pump inhibitors in the management of peptic ulcer bleeding is controversial because discrepant results have been reported in different ethnic groups.

Objective: To determine whether intravenous esomeprazole prevents recurrent peptic ulcer bleeding better than placebo in a multiethnic patient sample.

Design: Randomized trial conducted between October 2005 and December 2007; patients, providers, and researchers were blinded to group assignment.

Setting: 91 hospital emergency departments in 16 countries.

Patients: Patients 18 years or older with peptic ulcer bleeding from a single gastric or duodenal ulcer showing high-risk stigmata.

Intervention: Intravenous esomeprazole bolus, 80 mg, followed by 8-mg/h infusion, over 72 hours or matching placebo, each given after successful endoscopic hemostasis. Intervention was allocated by computer-generated randomization. After infusion, both groups received oral esomeprazole, 40 mg/d, for 27 days.

Measurements: The primary end point was rate of clinically significant recurrent bleeding within 72 hours. Recurrent bleeding within 7 and 30 days, death, surgery, endoscopic re-treatment, blood transfusions, hospitalization, and safety were also assessed.

Read more ...

2009 Hypothermia for traumatic head injury

Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001048
Sydenham E, Roberts I, Alderson P.


BACKGROUND:
Hypothermia has been used in the treatment of head injury for many years. Encouraging results from small trials and laboratory studies led to renewed interest in the area and some larger trials.

OBJECTIVES:
To estimate the effect of mild hypothermia for traumatic head injury on mortality and long-term functional outcome complications.

Read more ...

2009 Cooling therapy for acute stroke

Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001247
Den Hertog HM, van der Worp HB, Tseng MC, Dippel DW


BACKGROUND:
Increased body temperatures are common in patients with acute stroke and are associated with poor outcome. In animal models of focal cerebral ischaemia, temperature-lowering therapy reduces infarct volume. In patients with acute stroke, lowering temperature may therefore improve outcome. This is an update of a Cochrane review first published in 1999.

OBJECTIVES:
To assess the effects of pharmacological and physical strategies to reduce body or brain temperature in patients with acute stroke.

Read more ...

2008 Prophylactic antibiotics cannot reduce infected pancreatic necrosis and mortality in acute necrotizing pancreatitis: evidence from a meta-analysis of randomized controlled trials

Am J Gastroenterol. 2008 Jan;103(1):104-10
Bai Y, Gao J, Zou DW, Li ZS.


BACKGROUND:
There is no agreement whether intravenous prophylactic antibiotics can reduce infected pancreatic necrosis and mortality in acute necrotizing pancreatitis (ANP). We performed a meta-analysis comparing intravenous antibiotics with placebo or no treatment in randomized controlled trials (RCTs).

METHODS:
Databases including MEDLINE, EMBASE, the Cochrane controlled trials register, the Cochrane Library, and Science Citation Index were searched to find relevant trials. Outcome measures were infected necrosis and mortality.

Read more ...

2008 Impact of fever on outcome in patients with stroke and neurologic injury: a comprehensive meta-analysis

Stroke. 2008 Nov;39(11):3029-35. Epub 2008 Aug 21

Greer DM, Funk SE, Reaven NL, Ouzounelli M, Uman GC.


BACKGROUND AND PURPOSE:
Many studies associate fever with poor outcome in patients with neurological injury, but this relationship is blurred by divergence in populations and outcome measures. We sought to incorporate all recent scholarship addressing fever in brain-injured patients into a comprehensive meta-analysis to evaluate disparate clinical findings.

METHODS:
We conducted a Medline search for articles since January 1, 1995 (in English with abstracts, in humans) and hand searches of references in bibliographies and review articles. Search terms covered stroke, neurological injury, thermoregulation, fever, and cooling. A total of 1139 citations were identified; we retained 39 studies with 67 tested hypotheses contrasting outcomes of fever/higher body temperature and normothermia/lower body temperature in patients with neurological injury covering 14431 subjects. A separate meta-analysis was performed for each of 7 outcome measures. Significance was evaluated with Zc developed from probability values or t values. Correlational effect size, r (es), was calculated for each study and used to derive Cohen's d unbiased combined effect size and relative risk.

Read more ...