ICU Pharmacists e-Group
UKCPA-Critical Care
Hosted by www.ukcpa.org
Critical Care Journal Club Bulletin
May 2012
Selected Bottom Lines: Intravenous lipid emulsion for reversal of local anaesthetic toxicity: The ongoing debate:
Anesth Analg 2012;114 710-712
No significant difference in mortality from ARDS in patients given statins but further data
to follow:
Crit Care Med 40 (5): 1470-1477; Editorial: 1661-1663
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)
Collated By Philip Moore
Contributions
“Propofol and remifentanil versus midazolam and fentanyl for sedation during
therapeutic hypothermia after cardiac arrest: a randomised trial.”
Bjelland T.W, Dale O, Kaisen K, Haugen B.O, Lysersen S et al
Intensive Care Medicine 2012; 38: 959-967
“Adverse cardiac events during catecholamine vasopressor
prospective observational study.”
Schmittinger C.A, Torgersen C, Luckner G, Schroder D.C.H, Lorez I
Intensive Care Medicine 2012; 38: 950-958
therapy:
a
“An ESICM systematic review and meta-analysis of procalcitonin-guided antibiotic
therapy algorithms in adult critically ill patients”
Matthaiou D.K, Ntani G, Kontogiorgi M, Poulakou G, Armaganidis A et al.
Intensive Care Medicine 2012; 38: 940-949
“Chlorhexidine body washing to control antimicrobial-resistant bacteria in
intensive care units: a systematic review.”
Derde L.P.G, Dautzenberg M.J.D, Bonten M.J.M
Intensive Care Medicine 2012; 38: 931-939
“Increased unbound drug fraction in acute carbamazepine intoxication: suitability
and effectiveness of high-flux haemodialysis.”
Sikma M.A, van den Broek M.P.H, Meulenbelt J.
Intensive Care Medicine 2012; 38: 916-917
“Skin necrosis in patients with arterial catheters flushed with a solution
containing heparin.”
Stelfox H. T, Kushner B.
Intensive Care Medicine 2012; 38: 918-919
“Classification of sepsis, severe sepsis and septic shock: the impact of minor
variations in data capture and definition of SIRS criteria.”
Klouwenberg P.M.C.K, Ong D.S.Y, Bonten M.J.M, Cremer O.L.
Intensive Care Medicine 2012; 38: 811-819
“Does patient volume affect clinical outcomes in adult intensive care units?”
Kanhere M.H, Kranhere H.A, Cameron A, Maddern G.J.
Intensive Care Medicine 2012; 38: 741-751
“Sepsis induced acute kidney injury – is there a lack of energy?”
Frithiof R.
Intensive Care Medicine 2012; 38: 735-737
Contributed by: Matt Elliot, Royal Derby Hospital. 18/5/12
‘New hope for sepsis’ – editorial
Lancet 2012; 379(9825): 1462
12 studies investigating the detection, diagnosis and treatment of sepsis have received
government funding – which will be supported by further grants from industry.
Contributed by: Emma Graham-Clarke, Sandwell and West Birmingham Hospitals
NHS Trust, 21/5/12
"She's Out of the ICU Now." "That's a Relief, Isn't It?": The Growing Problem of
ICU Recidivism.
James A Russell
Am. J. Respir. Crit. Care Med. 2012: 185; 906
“Neuromuscular Blockade and Skeletal Muscle Weakness in Critically Ill Patients:
Time to Rethink the Evidence?”
Zudin Puthucheary, Jaikirty Rawal, Gamunu Ratnayake, Stephen Harridge, et al
Am. J. Respir. Crit. Care Med. 2012: 185; 911-916
Contributed by: Gillian Mulherron Newcastle Upon Tyne Hospitals NHS Foundation
Trust 24/5/12
“Antibiotic strategies in severe nosocomial sepsis: Why do we not de-escalate
more often?”
Heene, S. et al
Crit Care Med 40 (5): 1404-1409; Editorial: 1345-1646
“Evaluating the use of recombinant human activated protein C in adult severe
sepsis: Results of the Surviving Sepsis Campaign.”
Casserly, B. et al
Crit Care Med 40 (5): 1417-1426; Editorial: 1468-1469
“Statin therapy as prevention against development of acute respiratory distress
syndrome: An observational study.”
Bajwa, E. K. et al
Crit Care Med 40 (5): 1470-1477; Editorial: 1661-1663
Bottom line: We’ll need to await the results of the HARP-2 study to see if they
contradict those of this trial, which demonstrated no significant difference in mortality
from ARDS in patients given statins.
“Variability of antibiotic concentrations in critically ill patients receiving
continuous renal replacement therapy: A multicentre pharmacokinetic study.”
Roberts. D. M. et al
Crit Care Med 40 (5): 1523-1528; Editorial: 1671-1672
Bottom line: Small study demonstrating that using empirical antibiotic doses in CRRT
can produce both subtherapeutic and toxic drug concentrations.
“A systematic review and meta-analysis of clinical trials of thyroid hormone
administration to brain dead potential organ donors.”
Macdonald, P. S. et al
Crit Care Med 40 (5): 1635-1644
Bottom line: Use of T3 or T4, in this cohort of patients, is based on low-level evidence
and has no significant effect on donor cardiac index according to the meta-analysis of
RCTs; all the non-RCTs disagreed with this!
Contributed by Nicola Rudall, Newcastle Upon Tyne Hospitals NHS Trust, 24/5/2012
“Lipid Resuscitation: Listening to Our Patients and Learning from Our Models”
(Editorial).
Guy Weinberg and Lisa Warren
Anesth Analg 2012;114 710-712
Based on case reports, intravenous lipid emulsion infusion has been included in practice
advisories of the Association of Anesthetists of Great Britain and Ireland, the American
Society of Regional Anesthesia and Pain Medicine, and endorsed by the American Heart
Association Advanced Cardiac Life Support recommendations.
It has also been reported to reverse acute toxicity from a variety of lipophilic drug
overdoses.
However, randomized trials are not ethical or feasible in studying lipid infusion for local
anesthetic toxicity in humans.
“The Comparative Effects of Lipid, Epinephrine, and Their Combination in the
Reversal of Bupivacaine-Induced Asystole in the Isolated Rat Heart”
Le Liu, Yun Xia, Ying Chen, Quanguang Wang, Tong Shi, Fangyan Wang, Robert H.
Small, and Xuzhong Xu
Anesth Analg 2012;114 886-893
Lipid combined with epinephrine resulted in better recovery of cardiac function than
either drug alone in reversal of bupivacaine-induced asystole in the isolated rat heart
model.
“The Effect of Lipid Emulsion Infusion on Postmortem Ropivacaine
Concentrations in Swine: Endeavoring to Comprehend a Soldier's Death”
Chester C. Buckenmaier, III, John Capacchione, Arthur R. Mielke, Saiid Bina, Cynthia
Shields, Kyung H. Kwon, Geselle McKnight, David A. Fish, and Peter Bedocs
Anesth Analg 2012;114 894-900
Intravenous ropivicaine infusions were administered to 11 anesthetized Yorkshire swine
and continued to asystole. Five swine received ropivacaine only, and 6 swine received
ropivacaine plus a single bolus dose of 20% lipid emulsion (1 mg/kg) when the mean
arterial blood pressure reached 50 mm Hg. Analysis of postmortem serum ropivacaine
concentrations in control and lipid-treated animals indicated that both the total and free
ropivacaine concentrations were significantly higher in the lipid-treated animals.
Furthermore, time had a significant effect on increasing the postmortem free ropivacaine
concentrations. The lipid group had a statistically significant earlier onset of death
(asystole) compared with the control group. Tissue analysis indicated that the
ropivacaine concentration significantly decreased postmortem in the lung, kidney, and
brain tissues of the lipid-treated animals. Tissue drug concentrations in the control
animals remained unchanged after death.
Intravenous Lipid Emulsion Only Minimally Influences Bupivacaine and
Mepivacaine Distribution in Plasma and Does Not Enhance Recovery from
Intoxication in Pigs
Erik S. Litonius, Tomohisa Niiya, Pertti J. Neuvonen, and Per H. Rosenberg
Anesth Analg 2012;114 901-906
Lipid emulsion neither had any measurable effect on the disposition of the studied local
anesthetics in plasma, nor did it improve the rate of recovery from intoxication by either
local anesthetic as measured by hemodynamic variables.
“Special Article: Pig in a Poke: Species Specificity in Modeling Lipid
Resuscitation”
Guy Weinberg and Israel Rubinstein
Anesth Analg 2012;114 907-909
“Intravenous Lipid Infusion Restores Consciousness Associated with Olanzapine
Overdose” (Letter).
Bulent Serhan Yurtlu, Volkan Hanci, Abdullah Gur, and Isil Ozkocak Turan
Anesth Analg 2012;114 914-915
“Special Article: The Anesthesia Patient Safety Foundation at 25: A Pioneering
Success in Safety, 25th Anniversary Provokes Reflection, Anticipation”
John H. Eichhorn
Anesth Analg 2012;114 791-800
Contributed by: Philip Moore, Bradford Teaching Hospitals, 29/5/12
Reviews and Resources Available on the Internet
MEDSCAPE
Management of the Post-cardiac Arrest Syndrome
Joshua C. Reynolds; Benajmin J. Lawner
Posted: 05/14/2012; J Emerg Med. 2012;42(4):440-449. © 2012 Elsevier Science, Inc.
http://www.medscape.com/viewarticle/762373
Prehospital Epinephrine for Cardiac Arrest Reduces Survival and Worsens
Neurological Outcomes at 1 Month
John A. Marx, MD, FAAEM
Posted: 04/30/2012; Journal Watch © 2012 Massachusetts Medical Society
http://www.medscape.com/viewarticle/761653
Extracorporeal Membrane Oxygenation in Adults
Guillermo Martinez; MD; Alain Vuylsteke MD FRCA FFICM
Posted: 04/13/2012; Cont Edu Anaesth Crit Care & Pain. 2012;12(2):57-61.
http://www.medscape.com/viewarticle/760765
List of Contributors
Contributor
Nicola Rudall
Newcastle Upon Tyne Hospitals NHS
Foundation Trust,
Nicola.Rudall@nuth.nhs.uk
Louise Potts
Newcastle Upon Tyne Hospitals NHS
Foundation Trust
Louise.Potts3@nuth.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
Journal
Critical Care
Medicine
Contributor
Annie Egan
Nelson Hospital, NZ
annie_egan2000@hotmail.com
Journal
Critical Care
Intensive Care
Medicine
Niamh Mc Garry
The Royal Hospitals, Belfast
niamh.mcgarry@belfasttrust.hscni.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
Alan Timmins
Queen Margaret Hospital
alan.timmins@nhs.net
Philip Moore
Bradford Teaching Hospitals NHS Trust
Philip.Moore@bthft.nhs.uk
Chest
Chris Jay
Hutt Valley Hospital, NZ
chris.jay@huttvalleydhb.org.nz
The Annals of
Pharmacotherap
y
Jane Sheldon
Stockport NHS Foundation Trust
Jane.Sheldon@stockport.nhs.uk
Anaesthesia and
Intensive Care
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
Patricia Ging
MMUH
patriciaging@eircom.net
Mark Borthwick
Circulation
Oxford Radcliffe Hospitals
mark.borthwick@orh.nhs.uk
Emma Graham-Clarke
Lancet (Weekly)
Sandwell and West Birmingham
Hospitals NHS Trust
(+ Key articles from
Birmingham
clinical nutrition and
emma.graham-clarke@nhs.net
e-SPEN)
Jane Hylands
JAMA (weekly)
Wrightington, Wigan and Leigh NHS
Trust
jhylands@fsmail.net
Jan Forlow
BMJ (Weekly)
North Cumbria Acute Hospitals NHS
Trust
jan.forlow@ncumbria-acute.nhs.uk
(List last updated 19th December 2011)
Quality and
Safety in
Healthcare
Anaesthesia
Anaesthesia and
Analgesia
This bulletin would not be possible without the valuable help of volunteer contributors. If there is a
journal, article or resource that you would like to contribute a précis for, or just make the newsgroup
aware of, then please e-mail emma.graham-clarke@nhs.net
Next Bulletin scheduled to go out on: Friday 29th June 2012 and will be collated by:
Nicola Rudall: Nicola.Rudall@nuth.nhs.uk