ICU Pharmacists e-Group
UKCPA-Critical Care
Hosted by www.ukcpa.org
Critical Care Journal Club Bulletin
November 2014
Selected Bottom Lines:
Large retrospective cohort study in hospitals across Canada, US and Saudi Arabia;
low-dose corticosteroids may provide a small but significant mortality benefit only in
the most severely ill patients (APACHE II > 30).
Critical Care Medicine 2014, 42(11): 2333 – 2341
Risk of mortality rises with each hour delay of administering appropriate antibiotics
and reaches significance after 3 hours.
Critical Care Medicine 2014, 42(11): 2409 – 2417
Collated By Alastair Raynes
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
Low-Dose Corticosteroid Treatment in Septic Shock: A Propensity-Matching Study*
Funk D, Doucette S, Pisipati A. Critical Care Medicine 2014, 42(11): 2333 – 2341 link
Bottom line: large retrospective cohort study in hospitals across Canada, US and Saudi Arabia; low-dose
corticosteroids may provide a small but significant mortality benefit only in the most severely ill patients
(APACHE II > 30)
Related editorial providing a quick historical overview of corticosteroids in sepsis: The Pendulum of
Corticosteroids in Sepsis Swings Again?*
The Changing Role of Palliative Care in the ICU
Aslakson R, Curtis JR, Nelson J. Critical Care Medicine 2014, 42(11): 2418 – 2428 link
Bottom line: written in the US but probably worth a read for all
Delayed Antimicrobial Therapy Increases Mortality and Organ Dysfunction Duration in Pediatric Sepsis*
Weiss S, Fitzgerald J, Balamuth F. Critical Care Medicine 2014, 42(11): 2409 – 2417 link
Bottom line: risk of mortality rises with each hour delay of administering appropriate antibiotics and reaches
significance after 3 hours
Anaesthesia contributed by Alan Timmins, Queen Margaret Hospital
Green light for liver function monitoring using indocyanine green? An overview of current clinical applications.
Vos JJ et al
Anaesthesia 69 (12) 1364-1376
A review of the place of indocyanine green during hepatic surgery and in the critical care unit. The conclusion
is that there is insufficient “hard” evidence of its benefit in routine practice to justify it use currently.
Hypersensitivity associated with sugammadex administration: a systematic review.
Tsur A, Kalansky A
Anaesthesia 69 (12) 1251-1257
Analysis of reports of hypersensitivity associated with sugammadex showing a close time relationship, and 11
of 15 cases met WHO criteria for anaphylaxis. The authors highlight the need for awareness of the potential
for hypersensitivity reactions in the five minutes following administration, but don’t consider the denominator
to produce an event rate.
Safety guideline: skin antisepsis for central neuraxial blockade
Association of Anaesthetists of GB&I
Anaesthesia 69 (11) 1279-1286
A consensus publication on the subject from AAGBI. The main message is to use chlorhex 0.5% in alcohol.
New England Journal of Medicine contributed by Patricia Ging, MMUH
*Goal-Directed Resuscitation for Patients with Early Septic Shock
The ARISE Investigators and the ANZICS Clinical Trials Group
N Engl J Med 2014;371:1496-506.
EGDT did not reduce mortality! (Mortality in the control group was lower than in the ProCESS trial)
*Disorders of Fluids and Electrolytes - Integration of Acid–Base and Electrolyte Disorders
Julian L. Seifter
N Engl J Med 2014;371:1821-31.
This review describes a method of analyzing acid–base disorders incorporating the traditional bicarbonate
model and the Stewart (strong ion model). This is not an easy read (especially the theory section), but there is
a set of case studies with explanations which I highly recommend.
Early versus On-Demand Nasoenteric Tube Feeding in Acute Pancreatitis
O.J. Bakker et al
N Engl J Med 2014;371:1983-93
Patients at high risk of complications from acute pancreatitis were randomly assigned to nasoenteric tube
feeding within 24 hours after randomization (early group) or to an oral diet initiated 72 hours after
presentation (on-demand group), with tube feeding provided if the oral diet was not tolerated. The primary
end point was a composite of major infection (infected pancreatic necrosis, bacteremia, or pneumonia) or
death during 6 months of follow-up. No statistically significant difference found between the groups.
Changes in Medical Errors after Implementation of a Handoff Program
A.J. Starmer et al
N Engl J Med 2014;371:1803-12
Implementation of a structured handover procedure for doctors in 9 US sites (including training) reduced
preventable adverse effects by 30%, reduced the medical-error rate by 23%. Across sites, significant
increases were observed in the inclusion of all prespecified key elements in written documents and oral
communication during handoff (nine written and five oral elements; P<0.001 for all 14 comparisons). There
were no significant
changes from the preintervention period to the postintervention period in the duration of oral handoffs (2.4
and 2.5 minutes per patient, respectively; P=0.55) or in resident workflow, including patient–family contact
and computer time.
Lower versus Higher Hemoglobin Threshold for Transfusion in Septic Shock
Lars B. Holst,
N Engl J Med 2014;371:1381-91
In this multicenter, parallel-group trial, we randomly assigned patients in the intensive care unit (ICU) who had
septic shock and a hemoglobin concentration of 9 g per deciliter or less to receive 1 unit of leukoreduced red
cells when the haemoglobin level was 7 g per deciliter or less (lower threshold) or when the level was 9 g per
deciliter or less (higher threshold) during the ICU stay. The primary outcome measure was death by 90 days
after randomization.
Intensive Care Medicine contributed by Matthew Elliot
De-escalation versus continuation of empirical antimicrobial treatment in severe sepsis: a multicentre nonblinded ranadomized noninferiority trial
Leone M, Bechis C, Lefrant J et al
Intensive Care Medicine 2014;40:1399-1408
Editorials: 1580-1585
Effect of the use of low and high potency statins and sepsis outcomes
Shu-Yu O, Chu H, Chao P et al
Intensive Care Medicine 2014;40:1509-1517
A 10 year retrospective analysis of Taiwanese patients showing that patients on high potency statins
(Atorvastatin 20mg/Simvastatin 40mg or higher) for 1month pre-admission did better than those lower
potency statins or none. The authors attribute this to the pleiotropic effects of statins.
What is new in the use of aminoglycosides in critically ill patients?
Matthaiou D.K, Waele J, Dimopoulos G.
Intensive Care Medicine 2014;40:1553-1555
Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5year study
Levy M.M, Rhodes A, Phillips G.S et al
Intensive Care Medicine 2014;40:1623-1633
Adhering to the surviving sepsis campaign guidelines reduces patient mortality. Significant factors associated
with this seem to be length of time the guidelines are used and compliance levels.
The impact of using estimated GFR versus creatinine clearance on the evaluation of recovery from acute
kidney injury in the ICU
Schetz M, Gunst J, Van den Berge G.
Intensive Care Medicine 2014;40:1709-1717
In a secondary analysis of the EPaNIC data; eGFR tends to overestimate renal function compared to creatinine
clearance determined by 24hour urine collection.
Understanding clinical trials: emerging methodological issues.
Doig G.S, Simpson F.
Intensive Care Medicine 2014;40:1755-1757
Early therapy with IgM-enriched polyclonal immunoglobulin in patients with septic shock.
Cavazzuti I, Serafini G, Busani S et al.
Intensive Care Medicine 2014;40:1888-1896
Editorial: 1957-1959
Retrospective study showing IgM (20mg/kg/hour for 72hours) may be associated with a survival benefit in
septic shock. However larger, higher quality randomised studies are definitely required.
Overoptimism in the interpretation of statistics
Poole D, Nattino G, Bertolini G.
Intensive Care Medicine 2014;40:1927-1929
Published Early:
Linezolid plasma and intrapulmonary concentrations in critically ill obese patients with ventilator-associated
pneumonia: intermittent vs continuous administrations
De Pascale G, Fortuna S, Tumbarello M et al.
Intensive Care Medicine 2014; DOI 10.1007/s00134-014-3550-y
Editorial: DOI 10.1007/s00134-014-3572-5
The Annals of Pharmacotherapy contributed by Chris Jay, Hutt Valley Hospital
Nothing of note
Journal of the Intensive Care Society contributed by Sanchia Pickering, CMFT Manchester
Nothing of note
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)
Next Bulletin scheduled to go out on: 19th December 2014 and will be collated by: Chris Jay:
chris.jay@huttvalleydhb.org.nz
Quality and Safety
in Healthcare
Anaesthesia
Anaesthesia and
Analgesia
The Annals of
Pharmacotherapy