2015 Jan - Gastric tonometry guided therapy in critical care patients: a systematic review and meta-analysis

Zhang X, Xuan W, Yin P, Wang L, Wu X, Wu Q.; Crit Care. 2015 Jan 27;19(1):22. [Epub ahead of print]

Introduction: The value of gastric intramucosal pH (pHi) can be calculated from the tonometrically measured partial pressure of carbon dioxide ( PCO2 ) in the stomach and the arterial bicarbonate content. Low pHi and increase of the difference between gastric mucosal and arterial PCO2 ( PCO2 gap) reflect splanchnic hypoperfusion and are good indicators of poor prognosis. Some randomized controlled trials (RCTs) were performed based on the theory that normalizing the low pHi or PCO2 gap could improve the outcomes of critical care patients. However, the conclusions of these RCTs were divergent. Therefore, we performed a systematic review and meta-analysis to assess the effects of this goal directed therapy on patient outcome in Intensive Care Units (ICUs).

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2015 Feb - Diagnosis and Management of Clostridium difficile Infection

Korman TM. ;Semin Respir Crit Care Med. 2015 Feb;36(1):31-43.

There have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease, attributed to the emergence of a fluoroquinolone-resistant "hypervirulent" strain, ribotype 027. C. difficile is now the most common pathogen causing hospital-acquired infection in U.S. hospitals, and community-acquired infections are increasing...

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2015 Jan - Low-dose hydrocortisone reduces norepinephrine duration in severe burn patients: a randomized clinical trial

Fabienne Venet, Jonathan Plassais, Julien Textoris, Marie-Angélique Cazalis, Alexandre Pachot, Marc Bertin-Maghit, Christophe Magnin, Thomas Rimmelé, Guillaume Monneret, Sylvie Tissot Critical Care 2015, 19:21 (26 January 2015)

Introduction: The aim of this study was to assess the effect of low-dose corticosteroid therapy in reducing shock duration after severe burn.

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2015 Jan - Extracorporeal life support as bridge to lung transplantation: a systematic review

Davide Chiumello, Silvia Coppola, Sara Froio, Andrea Colombo, Lorenzo Del Sorbo Critical Care 2015, 19:19 (22 January 2015)

Introduction: Patients with acute respiratory failure requiring respiratory support with invasive mechanical ventilation while awaiting lung transplantation are at a high risk of death. Extracorporeal membrane oxygenation (ECMO) has been proposed as an alternative bridging strategy to mechanical ventilation. The aim of this study was to assess the current evidence regarding how the ECMO bridge influences patients’ survival and length of hospital stay.

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2015 Jan - Preoperative intra aortic balloon pump to reduce mortality in coronary artery bypass graft: a meta-analysis of randomized controlled trials

Alberto Zangrillo, Federico Pappalardo, Roberto Dossi, Ambra Di Prima, Marta Sassone, Teresa Greco, Fabrizio Monaco, Mario Musu, Gabriele Finco, Giovanni Landoni Critical Care 2015, 19:10 (14 January 2015)

Introduction: The intra-aortic balloon pump is routinely used in cardiac surgery; however its impact on outcome is yet matter of debate and randomized trials were recently published. We perform an updated meta-analysis of randomized controlled trials that investigated the use of preoperative intra-aortic balloon pump in adult patients undergoing coronary artery bypass grafting.

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2014 Dec - Incidence, risk factors and outcomes of new-onset atrial fibrillation in patients with sepsis: a systematic review

Kuipers S, Klein Klouwenberg P, Cremer OL. ;Crit Care. 2014 Dec 15;18(6):688. [Epub ahead of print]

Introduction: Critically ill patients with sepsis are prone to develop cardiac dysrhythmias, most commonly atrial fibrillation (AF). Systemic inflammation, circulating stress hormones, autonomic dysfunction, and volume shifts are all possible triggers for AF in this setting. We conducted a systematic review to describe the incidence, risk factors and outcomes of new-onset AF in patients with sepsis.

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2014 Dec -Choices in fluid type and volume during resuscitation: impact on patient outcomes

Lira A and Pinsky MR Annals of Intensive Care 2014, 4:38 (4 December 2014)

We summarize the emerging new literature regarding the pathophysiological principles underlying the beneficial and deleterious effects of fluid administration during resuscitation, as well as current recommendations and recent clinical evidence regarding specific colloids and crystalloids. This systematic review allows us to conclude that there is no clear benefit associated with the use of colloids compared to crystalloids and no evidence to support the unique benefit of albumin as a resuscitation fluid...

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2014 Dec - Proton pump inhibitors increase the risk for hospital-acquired Clostridium difficile infection in critically ill patients

Jeffrey F Barletta, David A Sclar Critical Care 2014, 18:714 (24 December 2014)

Introduction: Proton pump inhibitors (PPI) have been linked to Clostridium difficile infection (CDI) but there are few data specific to ICU patients. We evaluated duration of PPI exposure as a potential risk factor for hospital-acquired CDI in the ICU.

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2014 Dec - The efficacy and safety of plasma exchange in patients with sepsis and septic shock: a systematic review and meta-analysis

Rimmer E, Houston BL, Kumar A, Abou-Setta AM, Friesen C, Marshall JC, Rock G, Turgeon AF, Cook DJ, Houston DS, Zarychanski R.; Crit Care. 2014 Dec 20;18(6):699. [Epub ahead of print]

Introduction: Sepsis and septic shock are leading causes of intensive care unit (ICU) mortality. They are characterized by excessive inflammation, upregulation of procoagulant proteins and depletion of natural anticoagulants. Plasma exchange has the potential to improve survival in sepsis by removing inflammatory cytokines and restoring deficient plasma proteins. The objective of this study is to evaluate the efficacy and safety of plasma exchange in patients with sepsis.

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2014 Dec - Evaluation of urinary tissue inhibitor of metalloproteinase-2 in acute kidney injury: a prospective observational study

Yamashita T, Doi K, Hamasaki Y, Matsubara T, Ishii T, Yahagi N, Nangaku M, Noiri E.; Crit Care. 2014 Dec 19;18(6):716. [Epub ahead of print]

Introduction: Tissue inhibitor of metalloproteinase-2 (TIMP-2) is an emerging acute kidney injury (AKI) biomarker. We evaluated the performance of urinary TIMP-2 in an adult mixed ICU by comparison with other biomarkers that reflect several different pathways of AKI.

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2014 Nov - Pre-hospital identification of trauma patients with early acute coagulopathy and massive bleeding: results of a prospective non-interventional clinical trial evaluating the Trauma Induced Coagulopathy Clinical Score (TICCS)

Martin L Tonglet, Jean Minon, Laurence Seidel, Jean Poplavsky, Michel Vergnion Critical Care 2014, 18:648 (26 November 2014)

Introduction: Identifying patients in need for Damage Control Resuscitation (DCR) early after trauma, is pivotal for adequate management of their critical condition. Several trauma-scoring systems have been developed to identify such patients but most of them are not simple enough to be used in the pre-hospital settings at the early post-traumatic phase. The Trauma Induced Coagulopathy Clinical Score (TICCS) is an easy-to-measure and strictly clinical trauma score developed to meet this medical need.

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2014 Nov - Neurally adjusted non-invasive ventilation in patients with chronic obstructive pulmonary disease: does patient–ventilator synchrony matter?

Stefano Nava, Lara Pisani Critical Care 2014, 18:670 (28 November 2014)

Patient–ventilator interaction represents an important clinical challenge during non-invasive ventilation (NIV). Doorduin and colleagues’ study shows that non-invasive neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction compared with pressure support ventilation in patients with chronic obstructive pulmonary disease. There is no doubt nowadays that NAVA is the most effective mode of improving the synchrony between patient and machine, but the key question for the clinicians is whether or not this will make a difference to the patient’s outcome...

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2014 Nov - Chloride-liberal fluids are associated with acute kidney injury after liver transplantation

Ashraf Nadeem, Nawal Salahuddin, Alyaa ElHazmi, Mini Joseph, Balsam Bohlega, Hend Sallam, Yasser Sheikh, Dieter Broering Critical Care 2014, 18:625 (19 November 2014)

Introduction: Acute Kidney Injury (AKI) occurs frequently after liver transplantation and is associated with significant morbidity and mortality. Recent evidence has linked the predominant usage of `chloride-liberal? intravenous fluids, such as 0.9% saline to the development of renal dysfunction in general critically ill patients. We compared the effects of perioperative fluid types on AKI in liver transplant recipients.

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2014 Nov - TEG®- or ROTEM®-based individualized goal-directed coagulation algorithms: don’t wait - act now!

Donat R Spahn Critical Care 2014, 18:637 (24 November 2014)

In trauma patients, TEG® and ROTEM® allow prediction of massive transfusion requirement and mortality, and creation of goal-directed, individualized coagulation algorithms that may improve patient outcome. This outcome benefit has been shown for cardiac surgery in prospective randomized trials. For trauma, only non-randomized studies have been performed. Nevertheless, TEG® and ROTEM® are highly promising monitoring techniques to guide coagulation management in all types of major bleeding, including trauma.

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2014 Nov - Clinical relevance of procalcitonin and C-reactive protein as infection markers in renal impairment: a cross sectional study

Ji Park, Do Kim, Hye Jang, Min-Ji Kim, Sin-Ho Jung, Jung Lee, Wooseong Huh, Yoon-Goo Kim, Dae Kim, Ha Oh Critical Care 2014, 18:640 (19 November 2014)

Introduction: Although the clinical application of procalcitonin (PCT) as an infection marker in patients with impaired renal function (estimated glomerular filtration rate (eGFR) <60?ml/min) has been increasing recently, it is unclear whether PCT is more accurate than C-reactive protein (CRP). We investigated the clinical value of CRP and PCT based on renal function.

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2014 Nov - Multi-drug resistance, inappropriate initial antibiotic therapy and mortality in Gram-negative severe sepsis and septic shock: A retrospective cohort study

Marya D Zilberberg, Andrew F Shorr, Scott T Micek, Cristina Vazquez-Guillamet, Marin H Kollef Critical Care 2014, 18:596 (21 November 2014)

Introduction: The impact of in vitro resistance on initially appropriate antibiotic therapy (IAAT) remains unclear. We elucidated the relationship between non-IAAT and mortality, and between IAAT and multi-drug resistance (MDR) in sepsis due to Gram-negative bacteremia (GNS).

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2014 Oct - When to stop septic shock resuscitation: clues from a dynamic perfusion monitoring

Hernandez G, Luengo C, Bruhn A, Kattan E, Friedman G, Ospina-Tascon GA, Fuentealba A, Castro R et al. Annals of Intensive Care 2014, 4:30 (11 October 2014)

Background: The decision of when to stop septic shock resuscitation is a critical but yet a relatively unexplored aspect of care. This is especially relevant since the risks of over-resuscitation with fluid overload or inotropes have been highlighted in recent years. A recent guideline has proposed normalization of central venous oxygen saturation and/or lactate as therapeutic end-points, assuming that these variables are equivalent or interchangeable. However, since the physiological determinants of both are totally different, it is legitimate to challenge the rationale of this proposal. We designed this study to gain more insights into the most appropriate resuscitation goal from a dynamic point of view. Our objective was to compare the normalization rates of these and other potential perfusion-related targets in a cohort of septic shock survivors.

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2014 Oct - The effects of goal directed fluid therapy based on dynamic parameters on post-surgical outcome: a meta-analysis of randomized controlled trials

Jan Benes, Mariateresa Giglio, Nicola Brienza, Frederic Michard Critical Care 2014, 18:584 (28 October 2014)

Introduction: Dynamic predictors of fluid responsiveness, namely systolic pressure variation, pulse pressure variation, stroke volume variation and pleth variability index have been shown to be useful to identify in advance patients who will respond to a fluid load by a significant increase in stroke volume and cardiac output. As a result, they are increasingly used to guide fluid therapy. Several randomized controlled trial have tested the ability of goal-directed fluid therapy (GDFT) based on dynamic parameters (GDFTdyn) to improve post-surgical outcome. These studies have yielded conflicting results. Therefore we performed this meta-analysis to investigate whether the use of GDFTdyn is associated with a decrease in post-surgical morbidity.

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2014 Oct - Argatroban versus Lepirudin in critically ill patients (ALicia): a randomized controlled trial

Tanja A Treschan, Maximilian S Schaefer, Johann Geib, Astrid Bahlmann, Tobias Brezina, Patrick Werner, Elisabeth Golla, Andreas Greinacher, Benedikt Pannen, Detlef Kindgen-Milles, Peter Kienbaum, Martin Beiderlinden Critical Care 2014, 18:588 (25 October 2014)

Introduction: Critically ill patients often require renal replacement therapy accompanied by thrombocytopenia. Thrombocytopenia during heparin anticoagulation may be due to heparin-induced thrombocytopenia with need for alternative anticoagulation. Therefore, we compared argatroban and lepirudin in critically ill surgical patients.

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2014 Oct - Timing of (supplemental) parenteral nutrition in critically ill patients: a systematic review

Bost RBC, Tjan DHT and van Zanten ARH Annals of Intensive Care 2014, 4:31 (2 October 2014)

Supplemental parenteral nutrition (SPN) is used in a step-up approach when full enteral support is contraindicated or fails to reach caloric targets. Recent nutrition guidelines present divergent advices regarding timing of SPN in critically ill patients ranging from early SPN (<48 h after admission; EPN) to postponing initiation of SPN until day 8 after Intensive Care Unit (ICU) admission (LPN). This systematic review summarizes results of prospective studies among adult ICU patients addressing the best timing of (supplemental) parenteral nutrition (S)PN...

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