ICU Pharmacists e-Group
UKCPA-Critical Care
Hosted by www.ukcpa.org
Critical Care Journal Club Bulletin
January 2015
Selected Bottom Lines:
There are several articles related to delirium this month:
1) A Systematic Review of Risk Factors for Delirium in the ICU*
Zaal IJ, Devlin JW, Peelen LM. Critical Care Medicine 2015, 43(1): 40 – 47
2) Delirium Transitions in the Medical ICU: Exploring the Role of Sleep Quality and
Other Factors*
Kamdar BB, Niessen T, Colantuoni E. Critical Care Medicine 2015, 43(1): 135 – 141
3) Pharmacologic Agents for the Prevention and Treatment of Delirium in Patients
Undergoing Cardiac Surgery: Systematic Review and Metaanalysis*
Mu JL, Lee A, Joynt G. Critical Care Medicine 2015, 43(1): 149 – 204
4) The Association between Acute Respiratory Distress Syndrome, Delirium, and InHospital Mortality in Intensive Care Unit Patients
Hsieh S.J., Soto G.J., Hope A.A. et al. Am J Respir Crit Care Med 2015,191:71–78
Collated By Louise Dunsmure
No stars = Paper highlighted for general interest (read only if of particular interest or relevance to you)
One star = Highlighted paper of particular note with relevance to most ICU pharmacists (should be read)
Two stars = Ground breaking or keynote paper of direct relevance to all (essential reading for all ICU pharmacists)
Contributions
Critical Care Medicine contributed by Claudia Brocke, University Hospital Southampton NHS FT
Surviving Sepsis Campaign: Association Between Performance Metrics and Outcomes in a 7.5-Year Study
Levy M, Rhodes A, Philips GS. Critical Care Medicine 2015, 43(1): 3 – 12 link
Bottom line: compliance with the resuscitation bundle increases the likelihood of surviving sepsis, as well as
ITU and hospital mortality – overall mortality was 29% in high compliance sites and 39% in low compliance
sites
Influence of n-3 Polyunsaturated Fatty Acids Enriched Lipid Emulsions on Nosocomial Infections and Clinical
Outcomes in Critically Ill Patients: ICU Lipids Study*
Grau-Carmona T, Bonet-Saris A, Garcia-de-Lorenzo A. Critical Care Medicine 2015, 43(1): 31 – 39 link
Bottom line: TPN prepared with a lipid emulsion containing 10% fish oil reduced the number of patients with
nosocomial infections significantly compared to PN containing a 1:1 mix of LCT/MCT (21% vs 37%, p = 0.035)
A Systematic Review of Risk Factors for Delirium in the ICU*
Zaal IJ, Devlin JW, Peelen LM. Critical Care Medicine 2015, 43(1): 40 – 47 link
Bottom line: only 11 putative risk factors for delirium are supported by either a strong or moderate level of
evidence – none of which are medication related; dexmedetomidine, however, was associated with a lower
delirium prevalence
Multicenter, Randomized, Placebo-Controlled Phase III Study of Pyridoxalated Hemoglobin Polyoxyethylene
in Distributive Shock (PHOENIX)*
Vincent J-L, Privalle CT, Sinver M. Critical Care Medicine 2015, 43(1): 57 – 64 link
Bottom line: study stopped after interim analysis due to higher mortality and increased prevalence of adverse
events in the pyridoxylated haemoglobin polyoxyethylene (haemoglobin-based nitric oxide scavenger) group
Delirium Transitions in the Medical ICU: Exploring the Role of Sleep Quality and Other Factors*
Kamdar BB, Niessen T, Colantuoni E. Critical Care Medicine 2015, 43(1): 135 – 141 link
Bottom line: no association between perceived sleep quality and transition to delirium, but benzo or opioid
infusions were strongly associated with transition to delirium in ventilated patients
Pharmacologic Agents for the Prevention and Treatment of Delirium in Patients Undergoing Cardiac
Surgery: Systematic Review and Metaanalysis*
Mu JL, Lee A, Joynt G. Critical Care Medicine 2015, 43(1): 149 – 204 link
Bottom line: predominantly based on one large RCT which supports use of medication to prevent delirium
after cardiac surgery; evidence for treatment of delirium was inconclusive – except for haloperidol, which
appeared to be ineffective.
Related editorial: Pharmacologic Approach for Delirium After Cardiac Surgery: There Is No Magic Bullet*
American journal of respiratory and critical care medicine – first fortnight contributed by Gillian Mulherron,
Newcastle Upon Tyne Hospitals NHS Foundation Trust
The Association between Acute Respiratory Distress Syndrome, Delirium, and In-Hospital Mortality in
Intensive Care Unit Patients
Hsieh S.J., Soto G.J., Hope A.A. et al. Am J Respir Crit Care Med 2015,191:71–78
Suggests that ARDS is associated with a greater risk for ICU delirium than mechanical ventilation alone, and
that the association between ARDS and in-hospital mortality is weakened after adjusting for delirium and
coma. Future studies are needed to determine if prevention and reduction of delirium in ARDS patients can
improve outcomes.
Critical Care contributed by Annie Egan Nelson Hospital, NZ
Vancomycin-Associated Nephrotoxicity in the Critically Ill: A Retrospective Multivariate Regression
Analysis*
Hanrahan TP, Harlow G, Hutchinson J, Dulhunty J, Lipman J, Whitehouse T, Roberts J A. Critical Care Medicine.
December 2014 - Volume 42 - Issue 12 - p 2527–2536. doi: 10.1097/CCM.0000000000000514
Conclusions: In a large dataset, higher serum vancomycin concentrations and greater duration of therapy are
independently associated with increased odds of nephrotoxicity. Furthermore, continuous infusion is
associated with a decreased likelihood of nephrotoxicity compared with intermittent infusion. This large
dataset supports the use of continuous infusion of vancomycin in critically ill patients.
The combined effects of extracorporeal membrane oxygenation and renal replacement therapy on
meropenem pharmacokinetics: a matched cohort study
Shekar K, Fraser J F, Taccone F S, Welch S, Wallis S C, Mullany D V , Lipman J and Roberts J A. On behalf of the
ASAP ECMO Study Investigators. Critical Care 2014, 18:565 doi:10.1186/s13054-014-0565-2
Conclusions
ECMO patients exhibit high PK variability. Decreased meropenem CL on ECMO appears to
compensate for ECMO and critical illness related increases in volume of distribution. Routine
target concentrations >2 mg/L are maintained with standard dosing (1 g IV 8-hourly).
However, an increase in dose may be necessary when targeting higher concentrations or in
patients with elevated creatinine clearance.
Influenza treatment with oseltamivir outside of labeled recommendations
McQuade B and Blair M. American Journal of Health-System Pharmacy 2015, 72(2):112-116
Purpose Published evidence regarding the use of the antiinfluenza agent oseltamivir outside of the standard
dosing recommendations is reviewed.
Summary Oseltamivir is a neuraminidase inhibitor indicated for the treatment of uncomplicated influenza in
patients two weeks of age or older who have been symptomatic for no more than two days; the
recommended dosage is 75 mg twice daily by mouth for five days. A literature search identified six studies
evaluating the effects of administering oseltamivir 48 hours or more after the onset of influenza symptoms,
administering the drug at double the standard dose, or continuing therapy for more than five days. Two
randomized controlled trials found that double-dose oseltamivir therapy conferred no significant survival
benefit. The results of one retrospective study of intensive care unit (ICU) patients infected with the influenza
H1N1 strain suggested improved survival among those who received oseltamivir no later than five days after
symptom onset.
Conclusion Oseltamivir may increase survival when used within five days of symptom onset in influenza
H1N1–infected patients who require ICU admission. There appears to be no benefit in starting treatment
more than 48 hours after symptom onset in hospitalized general medicine patients or outpatients infected
with either H1N1 or other influenza strains or in doubling the dose of oseltamivir in hospitalized patients or
outpatients. There are scant data supporting the use of oseltamivir for longer than five days in any patient
population, with the possible exception of critically ill H1N1-infected ICU patients, who may benefit from
extended treatment in some cases.
The Annals of Pharmacotherapy contributed by Chris Jay, Hutt Valley Hospital
Nothing of note this month
Journal of the Intensive Care Society contributed by Sanchia Pickering, CMFT Manchester
The next JICS is due in February
Clinical nutrition, contributed by Emma Graham-Clarke, City Hospital Birmingham
Nothing of note this month
List of Contributors
Contributor
Claudia Brocke
University Hospital Southampton NHS FT
Claudia.Brocke@uhs.nhs.uk
John Warburton
Bristol Royal Infirmary
John.Warburton@UHBristol.nhs.uk
Matt Elliott
Royal Derby Hospital
matthew.elliott1@nhs.net
Gillian Mulherron
Newcastle Upon Tyne Hospitals NHS
Foundation Trust
Gillian.Mulherron@nuth.nhs.uk
Olivia Moswela
Radcliffe Infirmary
olivia.moswela@orh.nhs.uk
Patricia Ging
MMUH
pging@mater.ie
Journal
Critical Care
Medicine
Contributor
Annie Egan
Nelson Hospital, NZ
annie_egan2000@hotmail.com
Journal
Critical Care
Intensive Care
Medicine
Rhona Wilson
Raigmore Hospital
rhona.wilson@nhs.net
Clare Crowley
Oxford Radcliffe Hospitals
clare.crowley@orh.nhs.uk
British Journal of
Anaesthesia
John Dade
St. James's University Hospital
john.dade@leedsth.nhs.uk
Thorax
Andreas Fischer
Royal Brompton & Harefield NHS Trust
A.Fischer@rbht.nhs.uk
Snehal Shah
Royal Brompton & Harefield NHS Trust
S.Shah6@rbht.nhs.uk
Alan Timmins
Queen Margaret Hospital
alan.timmins@nhs.net
Jennifer de Val
Guy's & St Thomas' NHS Foundation
Trust
Jennifer.deVal@gstt.nhs.uk
Chris Jay
Hutt Valley Hospital, NZ
chris.jay@huttvalleydhb.org.nz
Chest
BMJ (Weekly)
Fraser Hanks
Guy's & St Thomas’ NHSFT
fraser.hanks@gstt.nhs.uk
Anaesthesia and
Intensive Care
medicine
Key articles from
clinical nutrition and
e-SPEN
Sanchia Pickering
CMFT, Manchester
Sanchia.Pickering@cmft.nhs.uk
Journal of the
Intensive Care
Society
American Journal of
Respiratory and
Critical Care (First
Fortnight)
American Journal of
Respiratory and
Critical Care (Second
Fortnight) and
Neurosciences
journals
New England Journal
of Medicine
Mark Borthwick
Oxford Radcliffe Hospitals
mark.borthwick@orh.nhs.uk
Anja Richter
Whittington Health
anja.richter@nhs.net
Circulation
Internet Resources
Jane Sheldon
Stockport
Jane.Sheldon@stockport.nhs.uk
Niamh Mc Garry
The Royal Hospitals, Belfast
niamh.mcgarry@belfasttrust.hscni.net
Sinan Alsaffar
Doncaster and Bassetlaw Hospitals NHS
Foundation Trust
Sinan.Al-saffar@dbh.nhs.uk
Tony Dunne
CMFT, Manchester
Emma Graham-Clarke
Sandwell and West Birmingham Hospitals
NHS Trust
emma.graham-clarke@nhs.net
(List last updated 12/06/2014)
JAMA (weekly)
Alternating months
Lancet (Weekly)
Quality and Safety
in Healthcare
Anaesthesia
Anaesthesia and
Analgesia
The Annals of
Pharmacotherapy
Next Bulletin scheduled to go out on: 27th February 2015 and will be collated by Patricia Ging
pging@mater.ie