Tag Archives: research

Sepsis and Therapeutic Interventions

The global burden of sepsis is substantial. Therefore, in a retrospective before-after clinical study, Marik et al compared the outcome and clinical course of consecutive septic patients treated with intravenous vitamin C, hydrocortisone and thiamine during a seven-month period (treatment group) at an intensive care unit (ICU) at Sentara Norfolk General Hospital compared to a control group treated (without intravenous vitamin C or thiamine) during the preceding seven months at the same ICU. The primary outcome was hospital survival.

The study’s results suggest that the early use of intravenous vitamin C, together with corticosteroids and thiamine, may prove to be effective in preventing progressive organ dysfunction and in reducing the mortality of patients with severe sepsis and septic shock.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Sevoflurane for Sedation

Sevoflurane improves gas exchange, and reduces alveolar edema and inflammation in preclinical studies of lung injury, but its therapeutic effects have never been investigated in acute respiratory distress syndrome (ARDS). Jabaudon et al set out to assess whether sevoflurane would improve gas exchange and inflammation in ARDS.

They found that in patients with ARDS, use of inhaled sevoflurane improved oxygenation and decreased levels of a marker of epithelial injury and of some inflammatory markers, compared with midazolam.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Molecular Detection of Pathogens

Microbiological diagnosis of infections remains insufficient. The resulting empirical antimicrobial therapy leads to multidrug resistance and inappropriate treatments. Cambau et al therefore evaluated the cost-effectiveness of direct molecular detection of pathogens in blood for patients with severe sepsis, febrile neutropenia, and suspected infective endocarditis.

They found that the addition of molecular detection to standard care improves microbiological diagnosis and thus efficiency of healthcare resource usage in patients with severe sepsis.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Examining Tracheal Intubation

Tracheal intubation is common during adult in-hospital cardiac arrest, but little is known about the association between tracheal intubation and survival in this setting. Andersen et al set out to determine whether tracheal intubation during adult in-hospital cardiac arrest is associated with survival to hospital discharge.

They found that among adult patients with in-hospital cardiac arrest, initiation of tracheal intubation within any given minute during the first 15 minutes of resuscitation, compared with no intubation during that minute, was associated with decreased survival to hospital discharge.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Prognostic Accuracy of Sepsis-3

Does the quick Sequential Organ Failure Assessment (qSOFA) score more accurately predict in-hospital mortality than the systemic inflammatory response syndrome (SIRS) or severe sepsis criteria among emergency department patients with suspected infection? Freund et al set out to answer this question.

They found that among patients presenting to the emergency department setting with suspected infection, the use of qSOFA resulted in greater prognostic accuracy for in-hospital mortality than either SIRS or severe sepsis.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Resources for Researchers

The National Heart, Lung and Blood Institute (NHLBI) awarded a large 5-year R-24 research infrastructure grant to Society member Dale Needham, FCPA, MD, PhD, for a project entitled “Improving Long-Term Outcomes Research for Acute Respiratory Failure.”

Dr. Needham is Director of the Outcomes After Critical Illness and Surgery (OACIS) Group, a multidisciplinary clinical and research group focused on understanding and improving patient outcomes after critical illness and surgery, at Johns Hopkins University School of Medicine.

This NIH-funded project has completed the development of many resources for researchers conducting long-term follow-up of patients surviving acute respiratory failure and acute respiratory distress syndrome (ARF/ARDS), including:

  • Recommendations for long-term outcomes and associated measurement instruments for research in this patient population. A database of recommended survey instruments and clinical testing methods for evaluating the long-term physical, cognitive, and mental health outcomes of survivors of ARF/ARDS is available at www.improvelto.com/instruments.
  • Practical tools for maximizing patient cohort retention for longitudinal long-term outcomes research studies. Cohort retention tools are available at www.improvelto.com/cohort-retention-tools.
  • Statistical tools and programs to appropriately address the competing risk of mortality in analyzing long-term functional outcomes in this patient population. A software tool that imputes missing data among survivors and then implements statistical approaches for addressing mortality when evaluating long-term functional outcomes is available at www.improvelto.com/stats-tools.

Visit www.improvelto.com to learn more about this project and stay up to date on its progress.

PANGEA Study Findings

The April 2017 issue of Pediatric Critical Care Medicine (PCCM) released the latest findings from the Prevalence of Acute critical Neurological disease in children: a Global Epidemiological Assessment (PANGEA) study.

This study offers a worldwide snapshot of acute neurologic conditions among critically ill children. One-hundred-seven hospital ICUs participated by providing information on children with acute neurologic conditions, contributing information on a total of 924 patients.

Overall, 16.2% of children in the reporting ICUs had acute neurologic conditions. Many children had preexisting medical conditions, but 61% had normal neurologic status before their current hospitalizations.

Cardiac arrest, resulting in lack of blood flow to the brain, was the most common overall cause of acute neurologic conditions (23%). Other causes included traumatic brain injury (19%), central nervous system infection or inflammation (16%), and stroke or a mass, such as a brain tumor (9% each).

The study found that regions differed in terms of most common condition reported. Infection/inflammation was the most common cause in Asia, South America, and the sole African hospital contributing to the study. In all other regions, cardiac arrest was the main cause.

Ericka L. Fink, MD, MS, and coauthors believe that the PANGEA data “suggest a vital need for resources to assist in the challenge of improving outcomes for these children throughout the span of the periods of emergency care through to rehabilitation.”

Society of Critical Care Medicine members who are also part of the Pediatrics Section can access the full content of PCCM online by logging into MySCCM.

Podcast on Acute Care Research

In the newly available iCritical Care podcast SCCM Pod-338 Building Global Collaboration in Acute Care Research Ludwig Lin, MD, speaks with John C. Marshall, MD, FRCSC, FACS, about his talk given at the 46th Critical Care Congress, “Building Global Collaboration in Acute Care Research.” Listen to the podcast and then watch Dr. Marshall’s Congress talk and familiarize yourself with the Society of Critical Care Medicine’s newest endeavor: Discovery, the Critical Care Research Network.

You can listen to all of the Society’s podcasts at www.sccm.org/iCriticalCare. Here are the latest:

SCCM Pod-337 Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient: 2016 Update

SCCM Pod-336 Surviving Sepsis Campaign Guidelines: 2016 Update

SCCM Pod-335 SCCM President Ruth Kleinpell Discusses the Year Ahead

SCCM Pod-334 Vasopressors: Future Research

Relative Bradycardia and Septic Shock

Tachycardia is common in septic shock, but many patients with septic shock are relatively bradycardic. The prevalence, determinants, and implications of relative bradycardia in septic shock are unknown. Therefore, Beesley et al set out to determine mortality associated with patients who are relatively bradycardic while in septic shock.

They found that relative bradycardia in patients with septic shock is associated with lower mortality, even after adjustment for confounding.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

MCCM Designation

Fellows of the American College of Critical Care Medicine (FCCM) are invited to nominate their FCCM colleagues for the Master of Critical Care Medicine (MCCM) designation. The deadline for submitting nominations is April 30, 2017.

Master members of the College have distinguished themselves through outstanding contributions in research and education, as well as service to the Society of Critical Care Medicine and the field of critical care. They have achieved national and international professional prominence due to personal character, leadership and eminence in clinical practice. Candidates must have been a Fellow for at least 10 years.

For additional information on the MCCM designation, please contact Carol Prendergast at cprendergast@sccm.org or +1 847 827-6826.

Examining Very Short Antibiotic Courses

Many patients started on antibiotics for possible ventilator-associated pneumonia (VAP) do not have pneumonia. Patients with minimal and stable ventilator settings may be suitable candidates for early antibiotic discontinuation. Therefore, Klompas et al set out to compare outcomes amongst patients with suspected VAP but minimal and stable ventilator settings treated with one to three versus more than three days of antibiotics.

Very short antibiotic courses (one to three days) were associated with outcomes similar to longer courses (more than three days) in patients with suspected VAP but minimal and stable ventilator settings.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

High-Flow Nasal Cannula vs. Noninvasive Ventilation

High-flow conditioned oxygen therapy delivered through nasal cannulae and noninvasive mechanical ventilation (NIV) may reduce the need for reintubation. Therefore, Hernández et al set out to test if high-flow conditioned oxygen therapy is noninferior to NIV for preventing postextubation respiratory failure and reintubation in patients at high risk of reintubation.

They found that among high-risk adults who have undergone extubation, high-flow conditioned oxygen therapy was not inferior to NIV for preventing reintubation and postextubation respiratory failure.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Efficacy of Combined Intravenous Thrombolysis and Thrombectomy

Mechanical thrombectomy (MT) improves clinical outcomes in patients with acute ischemic stroke (AIS) caused by a large vessel occlusion. However, it is not known whether intravenous thrombolysis (IVT) is of added benefit in patients undergoing MT. Coutinho et al set out to address this unknown.

The results indicate that treatment of patients experiencing AIS due to a large vessel occlusion with IVT before MT does not appear to provide a clinical benefit over MT alone.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Culture Negative Severe Sepsis: Nationwide Trends and Outcomes

Although 28% to 49% of severe sepsis hospitalizations have been described as being “culture negative,” there are very limited data on the epidemiology and outcomes of those with culture negative severe sepsis (CNSS). The objectives of a study by Gupta et al were to investigate the proportion and trends of CNSS and its association with mortality.

They found that CNSS among hospitalized patients is common, and its proportion is on the rise. They also found that CNSS is associated with greater acute organ dysfunction and mortality.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

SCCM Announces New Critical Care Research Network: Discovery

The Society of Critical Care Medicine (SCCM) recently unveiled its newest endeavor: Discovery, the Critical Care Research Network (#DiscoveryNet).

Through Discovery, SCCM will foster collaborative research to promote the advancement of science in the field to improve outcomes for critically ill and injured patients. Discovery will seek to exponentially increase research in the critical care field and use SCCM’s existing broad base of programs to disseminate its findings into practice.

Joining SCCM for the launch of this endeavor is the United States Critical Illness and Injury Trials (USCIIT) Group and the Critical Care Pharmacotherapy Trials Network (CCPTN), who will become part of the new Discovery program. Bringing together these highly successful existing networks will jump-start Discovery activities. Other existing research networks with a similar focus are also invited to join SCCM in this exciting endeavor.

The Society will support Discovery with a multimillion-dollar investment in professional staff, infrastructure and research grants. In addition, the Discovery Oversight Committee and Discovery Steering Committee have been established to provide guidance for an inclusive, diverse, integrated, and multidisciplinary network for research that improves outcomes across the continuum of care for critically ill patients and their families.

Please consider how Discovery can assist you in your research. Whether by connecting you with fellow investigators or accessing Discovery’s clinical informatics team, data and safety monitoring groups, Health Insurance Portability and Accountability Act (HIPAA)-compliant central registries or new SCCM-Weil research grants, Discovery is eager to engage with you and your investigators.

Join SCCM’s Research Section to keep abreast of Discovery activities and find out more about how you can participate. For further information and inquiries, please email discovery@sccm.org.