ICU Pharmacists e-Group
UKCPA-Critical Care
Hosted by www.ukcpa.org
Critical Care Journal Club Bulletin
February 2014
AND
An opportunity to inform critical care
professionals:
Can you
If so……
?
* Are you a critical care pharmacist
with an eye on the literature, keen
to make an impact?
* Would you be willing to use your
skills to help the (increasing)
number of followers of
@icujournalclub?
* We are looking for a team of 3-4
to further improve the output of
an account with a growing
interprofessional and international
profile.
If you can help - contact Emma
Graham-Clarke
emma.graham-clarke@nhs.net
Collated By Patricia Ging
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
Therapeutic Hypothermia and the Risk of Infection: A Systematic Review and Meta-Analysis*
Critical Care Medicine February 2014
A review of 23 RCTs showing that for patients treated with hypothermia, the prevalence of all infections was not
increased (rate ratio, 1.21 [95% CI, 0.95–1.54]), but there was an increased risk of pneumonia and sepsis (risk
ratios, 1.44 [95% CI, 1.10–1.90]; 1.80 [95% CI, 1.04–3.10], respectively).
Incidence and Outcomes Associated With Early Heart Failure Pharmacotherapy in Patients With Ongoing
Cardiogenic Shock
Critical Care Medicine February 2014
The final study population included 240 patients. A total of 66 patients (27.5%) had either [beta] blocker or reninangiotensin-aldosterone system blocker administered within the first 24 hours after the diagnosis of cardiogenic
shock. The administration of [beta] or renin-angiotensin-aldosterone system blockers is common in North America
and Europe in patients with myocardial infarction and cardiogenic shock prior to cardiogenic shock resolution.
This therapeutic practice was independently associated with higher 30-day mortality, although a statistically
significant difference was only observed in the subgroup of patients administered [beta]-blockers.
Adjuvant Treatment With a Mammalian Target of Rapamycin Inhibitor, Sirolimus, and Steroids Improves
Outcomes in Patients With Severe H1N1 Pneumonia and Acute Respiratory Failure
Critical Care Medicine February 2014
Open-label prospective randomized controlled trial H1N1-infected patients. In patients with severe H1N1
pneumonia, early adjuvant treatment with corticosteroids and an mTOR inhibitor (sirolimus) was associated with
improvement in outcomes, such as hypoxia, multiple organ dysfunction, virus clearance, and shortened liberation
of ventilator and ventilator days. The accompanying editorial suggests caution in applying this to critical care due
to the significant body of data documenting that steroids and immunosuppressive therapy result in worse
outcomes with influenza infection.
Inhaled Nitric Oxide Does Not Reduce Mortality in Patients With Acute Respiratory Distress Syndrome
Regardless of Severity: Systematic Review and Meta-Analysis
Critical Care Medicine February 2014
Nitric oxide does not reduce mortality in adults or children with acute respiratory distress syndrome, regardless of
the degree of hypoxemia. Given the lack of related ongoing or recently completed randomized trials, new data
addressing the effectiveness of nitric oxide in patients with acute respiratory distress syndrome and severe
hypoxemia will not be available for the foreseeable future.
Macrolides and Mortality in Critically Ill Patients With Community-Acquired Pneumonia: A Systematic Review
and Meta-Analysis
Critical Care Medicine February 2014
In observational studies of almost 10,000 critically ill patients with community-acquired pneumonia, macrolide
use was associated with a significant 18% relative (3% absolute) reduction in mortality compared with nonmacrolide therapies. After pooling data from studies that provided adjusted risk estimates, an even larger
mortality reduction was observed. These results suggest that macrolides be considered first-line combination
treatment in critically ill patients with community-acquired pneumonia and support current guidelines.
Contributed by John Warburton Bristol Royal Infirmary
28/02/14
Reduction of adverse effects from intravenous acetylcysteine treatment for paracetamol poisoning: a
randomised controlled trial.
The Lancet, Volume 383, Issue 9918 , Pages 697 - 704, 22 February 2014
Contributed by Anja Richter Whittington Health
28/02/14
Labelling syringe plungers to reduce medication errors
Bennett A
Anaesthesia 69 (3) 286-7
Letter suggesting that since syringes used for emergencies during anaesthesia sit on the anaesthetic machine and
have the labels on the barrel, putting a label on the end of the plunger would make the information more visible,
and reduce mis-selection errors.
Co-administering diclofenac with intravenous paracetamol or Hartmann’s solution
Madden GBP
Anaesthesia 69 (2) 191-2
A refreshing letter from an anaesthetist pointing out to colleagues that there are sound physico-chemical reasons
for NOT adding diclofenac to either of the above solutions, and pointing out the liability issues for anyone doing
so. Pin it up in all anaesthetic rooms!
Contributed by: Alan Timmins, Queen Margaret Hospital
30/1/14
Pain Control in the Intensive Care Unit: New Insight into an Old Problem
Bender, Bruce G, PhD
Am. J. Respir. Crit. Care Med.2014:189; 9-10.
Determinants of Procedural Pain Intensity in the Intensive Care Unit: The Europain® Study
Puntillo, Kathleen A; Max, Adeline; Timsit, Jean-Francois et al.
Am. J. Respir. Crit. Care Med.2014:189;39-47.
Contributed by: Gillian Mulherron
Newcastle Upon Tyne Hospitals NHS Foundation Trust 28/02/14
Preventing and Controlling Influenza with Available Interventions
Uyeki TM,
N Engl J Med 2014; 370:789-791
Current influenza surge in USA is with strains covered by the vaccine , author speculates about a few reasons for
the current outbreak- waning immunity from previous vaccinations, unvaccinated populations and poor response
to vaccine in certain populations. A few quick notes on the evidence for oseltamivir and the limitations.
Bleeding and Coagulopathies
in Critical Care
Hunt BJ
N Engl J Med 2014;370:847-59.
Covers all of the basics nicely with algorithms and diagrams
Sedation and Delirium in the Intensive Care Unit
Reade MC, Finfer S, N Engl J Med 2014;370:444-54.
Contributed by: Patricia Ging Mater Misericordiae University Hospital
Dublin
28/2/14
Effects of ex-vivo platelet supplementation on platelet aggregability in blood samples from patients treated
with acetylsalicylic acid, clopidogrel, or ticagrelor.
E.C. Hansson, C Shams Hakimi, K Astrom-Olsson, C. Hesse, H Wallen, M Dellborg, P Albertsson and A. Jeppsson.
Br. J. Anaesth (2014) 112 (3): 563-569
Bottom line: Platelet supplementation improved platelet aggregability independently of antiplatelet therapy. The
effect on ADP-dependent platelet inhibition was limited. Reduced effect of platelet transfusion is more likely
within 2 hours of drug intake in patients treated with ASA plus ticagrelor compared with ASA plus clopidogrel.
Improving teamwork in anaesthesia and critical care: many lessons still to learn.
P.G.Brindley
Br. J. Anaesth (2014) 112 (3) 399-401
Bottom Line: Teamwork is everybody responsibility and we can learn from how other profession work.
Contributed by: Rhona Wilson, Raigmore Hospital
28/2/14
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
Mater Misericordiae University Hospital
Dublin
patriciaging@mater.ie
Mark Borthwick
Oxford Radcliffe Hospitals
mark.borthwick@orh.nhs.uk
Anja Richter
Whittington Health
anja.richter@nhs.net
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 30 January 2014)
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
Circulation
Internet Resources
Lancet (Weekly)
JAMA (weekly)
Alternating months
Quality and Safety
in Healthcare
Anaesthesia
Anaesthesia and
Analgesia
The Annals of
Pharmacotherapy
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 29 March 2014 and will be collated by: Niamh McGarry:
niamh.mcgarry@belfasttrust.hscni.net