2011 Aug - Succinylcholine versus rocuronium for rapid sequence intubation in intensive care: a prospective, randomized controlled trial

Marsch SC, Steiner L, Bucher E, Pargger H, Schumann M, Aebi T, Hunziker PR, Siegemund M.; Crit Care. 2011 Aug 16;15(4):R199. [Epub ahead of print]
Introduction: Succinylcholine and rocuronium are widely used to facilitate rapid sequence induction (RSI) intubation in intensive care. Concerns relate to side effects of succinylcholine and to a slower onset and inferior intubation conditions associated with rocuronium. So far succinylcholine and rocuronium have not been compared in an adequately powered randomized trial in intensive care. Accordingly, the aim of the present study was to compare the incidence of hypoxemia after rocuronium or succinylcholine in critically ill patients requiring an emergent RSI.

Read more ...

2011 Aug - Assessing left ventricular systolic function in shock: evaluation of echocardiographic parameters in intensive care

Bergenzaun L, Gudmundsson P, Ohlin H, During J, Ersson A, Ihrman L, Willenheimer R, Chew M.; Crit Care. 2011 Aug 16;15(4):R200. [Epub ahead of print]
Introduction:  Assessing left ventricular (LV) systolic function in a rapid and reliable way can be challenging in the critically ill patient. The purpose of this study was to evaluate the feasibility and reliability of, as well as the association between commonly used LV systolic parameters, using serial transthoracic echocardiography (TTE).

Read more ...

2011 Aug - Update on hemodynamic monitoring - a consensus of 16 [Review]

Vincent JL, Rhodes A, Perel A, Martin GS, Rocca GD, Vallet B, Pinsky MR, Hofer CK, Teboul JL, de Boode WP, Scolletta S, Vieillard-Baron A, De Backer D, Walley KR, Maggiorini M, Singer M.; Crit Care. 2011 Aug 18;15(4):229. [Epub ahead of print]
Hemodynamic monitoring plays a fundamental role in the management of acutely ill patients. With increased concerns about the use of invasive techniques, notably the pulmonary artery catheter, to measure cardiac output, recent years have seen an influx of new, less-invasive means of measuring hemodynamic variables, leaving the clinician somewhat bewildered as to which technique, if any, is best and which he/she should use.

Read more ...

2011 Jul - Impact of different types of organ failure on outcome in intensive care unit patients with acute kidney injury

Ostermann M, Chang RW.;J Crit Care. 2011 Jul 26. [Epub ahead of print]
Purpose: The aim of this study was to explore the impact of different types of associated organ failure in patients with acute kidney injury (AKI).

Read more ...

2011 Jul - Clinical factors associated with initiation of renal replacement therapy in critically ill patients with acute kidney injury-A prospective multicenter observational study

Bagshaw SM, Wald R, Barton J, Burns KE, Friedrich JO, House AA, James MT, Levin A, Moist L, Pannu N, Stollery DE, Walsh MW.;J Crit Care. 2011 Jul 26. [Epub ahead of print]
Purpose: Our objective was to describe the current practice for initiation of RRT in this population. There is uncertainty regarding the optimal time to initiate renal replacement therapy (RRT) in critically ill patients with acute kidney injury (AKI).

Read more ...

2011 Aug - The safety of synthetic colloid in critically ill patients with severe traumatic brain injuries

Sekhon MS, Dhingra K V, Sekhon IS, Henderson WR, McLean N, Griesdale DE.; J Crit Care. 2011 Aug;26(4):357-62. Epub 2011 Jan 26.
Purpose: Although 4% albumin is associated with increased mortality in patients with traumatic brain injury (TBI), evidence concerning the safety of synthetic colloids is lacking. We aimed to determine if there is an association between synthetic colloids and mortality in patients with severe TBI.

Read more ...

2011 Aug - Risk of cardiac arrhythmias and conduction abnormalities in patients with acute myocardial infarction receiving packed red blood cell transfusions

Athar MK, Bagga S, Nair N, Punjabi V, Vito K, Schorr C, Gerber DR.; J Crit Care. 2011 Aug;26(4):335-41. Epub 2010 Sep 23.
Purpose: Although transfusion has been linked to the development of atrial fibrillation (AF) in cardiac surgical patients, this association has not been investigated in patients with acute myocardial infarction (AMI). Evidence supports an inflammatory mechanism in the development of AF, and red cell transfusions also elicit an inflammatory response. We therefore sought to evaluate whether packed red blood cell transfusion increases the risk of AF, ventricular tachycardia (VT), and other arrhythmias and conduction abnormalities in patients with AMI.

Read more ...

2011 Jul - Relationship between the timing of administration of IgM and IgA enriched immunoglobulins in patients with severe sepsis and septic shock and the outcome: A retrospective analysis

Berlot G, Vassallo MC, Busetto N, Bianchi M, Zornada F, Rosato I, Tartamella F, Prisco L, Bigotto F, Bigolin T, Ferluga M, Batticci I, Michelone E, Borelli M, Viviani M, Tomasini A.; J Crit Care. 2011 Jul 5. [Epub ahead of print]
PURPOSE: Because the use of IgM and IgA enriched polyclonal intravenous immunoglobulins (eIg) is a standard of care in critically ill patients admitted to our intensive care unit (ICU) with the diagnosis of severe sepsis or septic shock, we investigated if the delay from the onset of severe sepsis and septic shock and their administration could influence the outcome.

Read more ...

2011 Jun - Recommended beta-lactam regimens are inadequate in septic patients treated with continuous renal replacement therapy

Seyler L, Cotton F, Taccone FS, De Backer D, Macours P, Vincent JL, Jacobs F. Crit Care. 2011 Jun 7;15(3):R137.
INTRODUCTION: Sepsis is responsible for important alterations in the pharmacokinetics (PK) of antibiotics. Continuous renal replacement therapy (CRRT), which is commonly used in septic patients, may further contribute to PK changes. Current recommendations for antibiotic doses during CRRT combine data obtained from heterogeneous patient populations in which different CRRT devices and techniques have been used. We studied whether these recommendations met optimal PK criteria for broad-spectrum antibiotic levels in septic shock patients undergoing CRRT.

Read more ...

2011 Jun - Levosimendan and mortality after coronary revascularisation: a meta-analysis of randomised controlled trials

Maharaj R, Metaxa V.; Crit Care. 2011 Jun 8;15(3):R140.
INTRODUCTION: Patients undergoing coronary revascularization often require inotropic support that has been associated with an increased risk for death and morbidity. The purpose of this study was to evaluate the effect of levosimendan versus control on survival after coronary revascularization.

Read more ...

2011 Jun - Enteral nutrition with eicosapentaenoic acid, gamma-linolenic acid and antioxidants in the early treatment of sepsis: results from a multicenter, prospective, randomized, double blinded and controlled Study - INTERSEPT study

Pontes-Arruda A, Martins LF, de Lima SM, Isola AM, Toledo D, Rezende E, Maia M, Magnan GB, Gla And Antioxidants Role In Sepsis Treatment Study Group II.; Crit Care. 2011 Jun 9;15(3):R144.
INTRODUCTION: Enteral nutrition (EN) with eicosapentaenoic acid (EPA)/ gamma-linolenic acid (GLA) is recommended for mechanically ventilated patients with severe lung injury. EPA/GLA has anti-inflammatory benefits as is evident by its association with reduction in pulmonary inflammation, improvements in oxygenation, and clinical outcomes in severe forms of acute lung injury. This study was a prospective, multicenter, randomized, double-blinded and controlled trial designed to investigate if EPA/GLA could play a role in patients with early sepsis (SIRS with confirmed or presumed infection and without any organ dysfunction), by reducing the progression of the disease to severe sepsis (sepsis associated with at least one organ failure) or septic shock (sepsis associated with hypotension despite adequate fluid resuscitation). Secondary outcomes included development of individual organ failures, ICU and hospital stay, use of mechanical ventilation, and 28-days all-cause mortality.

Read more ...

2011 Mar - A systematic review of short courses for nonspecialist education in intensive care

Joynt GM, Zimmerman J, Li TS, Gomersall CD.; J Crit Care. 2011 Mar 29. [Epub ahead of print]
PURPOSE: The availability of reliable and accessible educational material for the training of nonspecialist intensive care physicians is potentially advantageous. We assessed the availability, cost, and content of generic short courses designed to teach basic critical care skills to junior physicians or nonspecialist intensive care physicians taking up duties in intensive care units.

Read more ...

2011 Jun 9 - Critical care services and the H1N1 (2009) influenza epidemic in Australian and New Zealand in 2010: the impact of the second winter epidemic

The ANZIC Influenza Investigators. Critical Care 2011, 15:R143doi:10.1186/cc10266. Published: 9 June 2011
Abstract (provisional)
Introduction During the first winter of exposure, the H1N1 2009 influenza virus placed considerable strain on intensive care unit (ICU) services in Australia and New Zealand (ANZ). We assessed the impact of the H1N1 2009 influenza virus on ICU services during the second (2010) winter, following the implementation of vaccination.

Read more ...

2011 Jun - Ventilator-associated pneumonia in critically ill stroke patients: Frequency, risk factors, and outcomes

Kasuya Y, Hargett JL, Lenhardt R, Heine MF, Doufas AG, Remmel KS, Ramirez JA, Akça O.; J Crit Care. 2011 Jun;26(3):273-9.
PURPOSE: Our main objective was to assess incidence, risk factors, and outcomes of ventilator-associated pneumonia (VAP) in stroke patients.

Read more ...

2011 Jun - A polyurethane cuffed endotracheal tube is associated with decreased rates of ventilator-associated pneumonia

Miller MA, Arndt JL, Konkle MA, Chenoweth CE, Iwashyna TJ, Flaherty KR, Hyzy RC.; J Crit Care. 2011 Jun;26(3):280-6.
PURPOSE: The aim of this study was to determine whether the use of a polyurethane-cuffed endotracheal tube would result in a decrease in ventilator-associated pneumonia rate.

Read more ...

2011 May - Sedation and renal impairment in critically ill patients: a post hoc analysis of a randomized trial

Strom T, Johansen RR, Prahl JO, Toft P.; Crit Care. 2011 May 4;15(3):R119. [Epub ahead of print]
Introduction: Not sedating critically ill patients reduces the time patients receive mechanical ventilation, decreases the time in the intensive care department and reduces the total hospital length of stay. We hypothesized that no sedation improves hemodynamic stability, decreases the need for vasoactive drugs, diminishes the need for extra fluids and lowers the risk of acute kidney injury.

Read more ...

2011 May - Early fluid resuscitation in patients with rhabdomyolysis

Better OS, Abassi ZA.; Nat Rev Nephrol. 2011 May 17. [Epub ahead of print]
Extensive rhabdomyolysis is often lethal unless treated immediately. Early mortality arises from hypovolemic shock, hyperkalemia, acidosis and myoglobinuric acute kidney injury (AKI). Many individuals with rhabdomyolysis could be saved, and myoglobinuric AKI prevented, by early vigorous fluid resuscitation with ≥12 l daily intravenous infusion of alkaline solution started at the scene of injury. This regimen stabilizes the circulation and mobilizes edema fluids sequestered in the injured muscles into the circulation, corrects hyperkalemia and acidosis, and protects against the nephrotoxic effects of myoglobinemia and hyperuricosuria.

Read more ...

2011 Apr - Age of red blood cells and mortality in the critically ill

Pettila V, Westbrook AJ, Nichol AD, Bailey MJ, Wood EM, Syres G, Phillips LE, Street A, French C, Murray L, Orford N, Santamaria JD, Bellomo R, Cooper DJ, Blood Observational Study Investigators T, Anzics-Clinical Trials Group T.; Crit Care. 2011 Apr 15;15(2):R116
INTRODUCTION: In critically ill patients, it is uncertain whether exposure to older red blood cells (RBCs) may contribute to mortality. Therefore, we aimed to evaluate the association between the age of RBCs and outcome in a large unselected cohort of critically ill patients in Australia and New Zealand. We hypothesized that exposure to even a single unit of older RBCs may be associated with an increased risk of death.

Read more ...

2011 Apr 22 - Interaction between fluid balance and disease severity on patient outcome in the critically ill

Hoi Ping Shum, FHKCP, FHKAM (Medicine), Frank Man Hon Lee, King Chung Chan, FHKCA, FHKAM (Anaesthesiology), Wing Wa Yan, FRCP, FHKCP, FHKAM (Medicine). Pamela Youde Nethersole Eastern Hospital. Journal of Critical Care, published online 22 April 2011. Corrected Proof
Purpose
There is evidence in literature regarding the benefits of immediate aggressive fluid resuscitation together with conservative fluid management approach after initial stabilization. This retrospective study assesses the relationship between fluid balance during intensive care unit (ICU) stay and outcomes among general critically ill patients. In addition, we also aim to see the effect of fluid gain among patients with different disease severity.

Read more ...

2011 Mar - Accuracy of ultrasonography performed by critical care physicians for the diagnosis of DVT

Kory PD, Pellecchia CM, Shiloh AL, Mayo PH, DiBello C, Koenig S.;Chest. 2011 Mar;139(3):538-42. Epub 2010 Oct 28
BACKGROUND: DVT is common among critically ill patients. A rapid and accurate diagnosis is essential for patient care. We assessed the accuracy and timeliness of intensivist-performed compression ultrasonography studies (IP-CUS) for proximal lower extremity DVT (PLEDVT) by comparing results with the formal vascular study (FVS) performed by ultrasonography technicians and interpreted by radiologists.

Read more ...