Tag Archives: research

The Efficacy of Platelet Transfusion

Platelet transfusion after acute spontaneous primary intracerebral hemorrhage in people taking antiplatelet therapy might reduce death or dependence by reducing the extent of the hemorrhage. Baharoglu et al therefore aimed to investigate whether platelet transfusion with standard care, compared with standard care alone, reduced death or dependence after intracerebral hemorrhage associated with antiplatelet therapy use.

They found that platelet transfusion seems inferior to standard care for people taking antiplatelet therapy before intracerebral hemorrhage.

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Sedatives and Their Associations with VAEs and Time to Extubation

Sedative selection is crucial to outcomes in critically ill patients. While benzodiazepines are known to be associated with a longer duration of mechanical ventilation compared to propofol and dexmedetomidine, little data exist comparing these sedatives in association with ventilator-associated events (VAEs). Klompas et al therefore aimed to evaluate the association between these sedatives, VAEs and time to extubation.

They found that sedatives vary in their associations with VAEs and time to extubation but not in their associations with time to hospital discharge or mortality.

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Peak Lactate and Patient Outcome Following High-Risk Gastrointestinal Surgery

The association between hyperlactatemia and adverse outcome in patients admitted to intensive care units (ICUs) following gastrointestinal surgery has not been reported. Creagh-Brown et al therefore set out to explore the hypothesis that in a large cohort of gastrointestinal surgical patients, the peak serum lactate (in the first 24 hours) observed in patients admitted to the ICU following surgery is associated with unadjusted and severity-adjusted acute hospital mortality and that the strength of association is greater in patients admitted following emergency surgery than in patients admitted following elective surgery.

They found that elevated lactate is independently associated with in-hospital mortality in the postoperative gastrointestinal surgical patient and is no less significant in the context of elective surgery.

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Delirium and the Efficacy of Dexmedetomidine

Some contend that effective therapy has not been established for patients with agitated delirium receiving mechanical ventilation. Therefore, Reade et al set out to determine the effectiveness of dexmedetomidine when added to standard care in patients with agitated delirium receiving mechanical ventilation.

They found that among patients with agitated delirium receiving mechanical ventilation in the intensive care unit, the addition of dexmedetomidine to standard care (compared with standard care alone [placebo]) resulted in more ventilator-free hours at seven days.

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Use of High-Flow Oxygen Therapy in Low-Risk Postextubation Patients

Studies of mechanically ventilated critically ill patients that combine populations that are at high and low risk for reintubation suggest that conditioned high-flow nasal cannula oxygen therapy after extubation improves oxygenation compared with conventional oxygen therapy. However, conclusive data about reintubation are lacking. Therefore, Hernández et al set out to determine whether high-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy for preventing reintubation in mechanically ventilated patients at low risk for reintubation.

They found that among extubated patients at low risk for reintubation, the use of high-flow nasal cannula oxygen compared with conventional oxygen therapy reduced the risk of reintubation within 72 hours.

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Predicting Fluid Responsiveness by Passive Leg Raising

Passive leg raising creates a reversible increase in venous return, allowing for the prediction of fluid responsiveness. However, the amount of venous return may vary in various clinical settings, potentially affecting the diagnostic performance of passive leg raising. Therefore, Cherpanath et al performed a systematic meta-analysis determining the diagnostic performance of passive leg raising in different clinical settings with exploration of patient characteristics, measurement techniques and outcome variables.

They found that passive leg raising retains a high diagnostic performance in various clinical settings and patient groups. They also found that the predictive value of a change in pulse pressure on passive leg raising is inferior to a passive leg raising-induced change in a flow variable.

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Higher Versus Lower Blood Pressure Targets for Vasopressor Therapy in Shock

In shock, hypotension may contribute to inadequate oxygen delivery, organ failure and death. Lamontagne et al conducted the Optimal Vasopressor Titration (OVATION) pilot trial to inform the design of a larger trial examining the effect of lower versus higher mean arterial pressure (MAP) targets for vasopressor therapy in shock.

They concluded that their pilot study supports the feasibility of a large trial comparing lower versus higher MAP targets for shock. Further research may help delineate the reasons for vasopressor dosing in excess of prescribed targets and how individual patient characteristics modify the response to vasopressor therapy.

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ODRC and AOPO Announce RFP for Organ Donation Research

The Organ Donation Research Consortium (ODRC) with additional support from the Association of Organ Procurement Organizations (AOPO) is pleased to offer up to $40,000 in funding to ODRC member(s) (or those willing to join and maintain ODRC membership through the life of the grant) conducting basic, translational or clinical research specifically related to the organization’s mission to advance the science of organ donation.

The ODRC seeks to sponsor research efforts that will ultimately improve the numbers and quality of organs available for transplantation in the United States. Applications are encouraged that focus on expanding our knowledge of donor management research, including, but not limited to, consent, organ donation physiology, clinical interventions to improve donor organs, and recipient outcomes. Single-center projects, for example, should specifically address the potential to generalize their findings to multisite settings.

Applications are due by 5:00 p.m. Pacific Standard Time on July 1, 2016. Additional information, including eligibility and submission requirements, are available on the ODRC website.

Rate Control vs. Rhythm Control for Atrial Fibrillation after Cardiac Surgery

Atrial fibrillation continues to plague intensivists managing post-cardiac surgery patients. Large clinical trials in non-surgical populations have demonstrated that rhythm control offers no benefits over a simpler rate control strategy. However, it is unclear if these findings can be extrapolated to the post-cardiac surgical population. As such, Gillinov et al conducted a randomized controlled trial hoping to answer this very question.

They found that strategies for rate control and rhythm control to treat post-operative atrial fibrillation were associated with equal numbers of days of hospitalization, similar complication rates and similarly low rates of persistent atrial fibrillation 60 days after onset.

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Chronic Hypoxemia in Children with CHD Mars Airway Epithelial Na+ Transport

Ambient hypoxia impairs the airway epithelial Na+ transport, which is crucial in lung edema reabsorption. Whether chronic systemic hypoxemia affects airway Na+ transport has remained largely unknown. Kaskinen et al have therefore investigated whether chronic systemic hypoxemia in children with congenital heart defect affects airway epithelial Na+ transport, Na+ transporter-gene expression, and short-term lung edema accumulation.

They found that the impaired airway epithelial amiloride-sensitive Na+ transport activity in profoundly hypoxemic children with cyanotic congenital heart defect may hinder defense against lung edema after cardiac surgery.

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Expediting Transfer of Patients with Time-Sensitive Critical Illness

Time-sensitive, critical surgical illnesses require care at specialized centers. Trauma systems facilitate patient transport to designated trauma centers, but formal systems for nontraumatic critical illness do not exist. Scalea et al created the critical care resuscitation unit to expedite transfers of adult critically ill patients with time-sensitive conditions to a quaternary academic medical center, hypothesizing that this would decrease time to transfer, increase transfer volume, and improve outcomes.

They found that the critical care resuscitation unit dramatically increased the volume of critically ill surgical patients. It decreased transfer times, increased volume, and, for those who required urgent operation, decreased time from initial referral to the operating room.

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Risk Factors for Readmission for Sepsis Survivors

Hospital readmission is common after sepsis, yet the relationship between the index admission and readmission remains poorly understood. Sun et al sought to examine the relationship between infection during the index acute care hospitalization and readmission and to identify potentially modifiable factors during the index sepsis hospitalization associated with readmission.

They confirmed that the majority of unplanned hospital readmissions after sepsis are due to an infection. They also found that patients with sepsis at admission who developed a hospital-acquired infection, and those who received a longer duration of antibiotics, appear to be high-risk groups for unplanned, all-cause 30-day readmissions and infection-related 30-day readmissions.

Read the full Concise Critical Appraisal by logging in to 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.

Impact of Initial CVP on Outcomes of Fluid Management Strategies in ARDS

In acute respiratory distress syndrome, conservative fluid management increases ventilator-free days without affecting mortality. Response to fluid management may differ based on patients’ initial central venous pressure. Semler et al hypothesized that initial central venous pressure would modify the effect of fluid management on outcomes.

They found that conservative fluid management decreases mortality for acute respiratory distress syndrome patients with a low initial central venous pressure.

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The Predictive Power of Mitochondrial DNA and Toll-Like Receptor-9

Cell injury and death leads to the release of intracellular molecules called damage-associated molecular patterns (DAMPs)—mitochondrial DNA (mtDNA) is one of these DAMPs. Krychtiuk et al set out to analyze whether levels of mtDNA are associated with 30-day survival and whether this predictive value is modified by the expression of its receptor (toll-like receptor-9).

They found that circulating levels of mtDNA at intensive care unit admission predict mortality in critically ill patients. This association was in particular present in patients with elevated toll-like receptor-9 expression.

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Tidal Volume and Its Association with Noninvasive Ventilation Outcome

A low or moderate expired tidal volume can be difficult to achieve during noninvasive ventilation for de novo acute hypoxemic respiratory failure. To see if this is a cause for concern, Carteaux et al set out to assess expired tidal volume and its association with noninvasive ventilation outcome.

They found that a low expired tidal volume is almost impossible to achieve in the majority of patients receiving noninvasive ventilation for de novo acute hypoxemic respiratory failure, and a high expired tidal volume is independently associated with noninvasive ventilation failure.
Read the full Concise Critical Appraisal by logging in to 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.