Tag Archives: research

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.

Effects of Epinephrine on Cerebral Oxygenation during CPR

Epinephrine has been presumed to improve cerebral oxygen delivery during cardiopulmonary resuscitation (CPR), but animal and registry studies suggest that epinephrine-induced capillary vasoconstriction may decrease cerebral capillary blood flow and worsen neurological outcome. The effect of epinephrine on cerebral oxygenation during CPR has not been documented in the clinical setting. Therefore, Deakin et al examined the effect of epinephrine on cerebral brain oxygenation during in-hospital cardiac arrest.

They found that 1 mg intravenous epinephrine, administered during advanced life support resuscitation, was not associated with a clinically significant change in cerebral tissue oxygenation.

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.

Airway Driving Pressure and Lung Stress in ARDS Patients

Since the first description of acute respiratory distress syndrome (ARDS) in the 1960s, numerous studies have sought the optimal tidal volume, positive end-expiratory pressure, plateau pressure, and inspired fraction of oxygen to reduce ventilator-induced lung injury. Chiumello et al set out to evaluate if airway driving pressure could accurately predict lung stress in ARDS patients.

They found that airway driving pressure can detect lung overstress with an acceptable accuracy.

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.

EIP Prolongation in ARDS Patients

End-inspiratory pause (EIP) prolongation decreases dead space-to-tidal volume ratio and partial pressure of carbon dioxide in arterial blood (PaCO2). We do not know the physiological benefits of this approach to improve respiratory system mechanics in acute respiratory distress syndrome (ARDS) patients when mild hypercapnia is of no concern. Aguirre-Bermeo et al, therefore, set out to address this unknown.

They found that prolonging EIP allowed a significant decrease in tidal volume without changes in PaCO2 in passively ventilated ARDS patients. This produced a significant decrease in plateau pressure and driving pressure and significantly increased respiratory system compliance, which suggests less overdistension and less dynamic strain.

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 Pantoprazole or Placebo for Stress Ulcer Prophylaxis

Pantoprazole is frequently administered to critically ill patients for prophylaxis against gastrointestinal bleeding. However, comparison to placebo has been inadequately evaluated, and pantoprazole has the potential to cause harm. Therefore, Selvanderan and colleagues set out to evaluate benefit or harm associated with pantoprazole administration.

They found no evidence of benefit or harm with the prophylactic administration of pantoprazole to mechanically ventilated critically ill patients anticipated to receive enteral nutrition.

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.

Assessing Impact of Conservative vs. Conventional Oxygen Therapy

Among critically ill patients, is a conservative oxygenation strategy aimed to maintain arterial saturation within physiologic limits more beneficial than a conventional strategy? Girardis et al set out to answer this question.

They found that among critically ill intensive care unit patients with a length of stay of 72 hours or longer, a conservative protocol for oxygen therapy may be beneficial; however, because the trial they initiated was terminated early, these findings must be considered preliminary.

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.

Assessing Tissue Oxygenation and Microvascular Reactivity in ICU Patients

Impaired microcirculatory perfusion and tissue oxygenation during critical illness are associated with adverse outcome. The aim of a study by Donati et al was to detect alterations in tissue oxygenation or microvascular reactivity and their ability to predict outcome in critically ill patients using thenar near-infrared spectroscopy (NIRS) with a vascular occlusion test (VOT).

They found that in critically ill patients, NIRS with a VOT enables identification of alterations in tissue oxygen extraction capacity and microvascular reactivity that can predict 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.