Other bulletins in this series include:

Breast Surgery

Tuesday, 30 June 2015

Persistently elevated Osteopontin serum levels predict mortality in critically ill patients

Critical Care 2015, 19:271  doi:10.1186/s13054-015-0988-4

Roderburg C et al

Inflammatory, autoimmune and metabolic disorders have been associated with alterations in Osteopontin (OPN) serum levels. Furthermore, elevated serum levels of OPN were reported from a small cohort of patients with sepsis. We therefore analyzed OPN serum-concentrations in a large cohort of critically ill medical patients.
Methods: 159 patients (114 with sepsis, 45 without sepsis) were studied prospectively upon admission to the medical intensive care unit (ICU) as well as after three days of ICU treatment and compared to 50 healthy controls. Clinical data, various laboratory parameters as well as investigational inflammatory cytokine profiles were assessed. Patients were followed for approximately one year. 

Selective decontamination and antibiotic resistance in ICUs

Critical Care 2015, 19:259  doi:10.1186/s13054-015-0967-9

Plantinga NL and Bonten MJM

Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) have been associated with reduced mortality and lower ICU-acquired bacteremia and ventilator-associated pneumonia rates in areas with low levels of antibiotic resistance. However, the effect of selective decontamination (SDD/SOD) in areas where multidrug-resistant Gram-negative bacteria are endemic is less clear. It will be important to determine whether SDD/SOD improves patient outcome in such settings and how these measures affect the epidemiology of multidrug-resistant Gram-negative bacteria. Here we review the current evidence on the effects of SDD/SOD on antibiotic resistance development in individual ICU patients as well as the effect on ICU ecology, the latter including both ICU-level antibiotic resistance and antibiotic resistance development during long-term use of SDD/SOD.

Influence of a strict glucose protocol on serum potassium and glucose concentrations and their association with mortality in intensive care patients

Critical Care 2015, 19:270  doi:10.1186/s13054-015-0959-9

Uijtendaal EV et al

Tight glucose control therapy (TGC) has been implemented to control hyperglycemia in ICU patients. TGC may also influence serum potassium concentrations. We therefore investigated the influence of TGC on both serum glucose and serum potassium concentrations and associated mortality.
We performed a retrospective analysis including all patients admitted to the ICU of a tertiary hospital for 24 hours or more and with at least three serum glucose and serum potassium concentrations between 1999–2001 (conventional period), 2002–2006 (implementation period) or 2007–2009 (TGC period)....................... 

Association Between Arterial Hyperoxia and Outcome in Subsets of Critical Illness: A Systematic Review, Meta-Analysis, and Meta-Regression of Cohort Studies

Critical Care Medicine: July 2015 - Volume 43 - Issue 7 - p 1508–1519 doi:10.1097/CCM.0000000000000998

Helmerhorst, HJF et al

Objective: Oxygen is vital during critical illness, but hyperoxia may harm patients. Our aim was to systematically evaluate the methodology and findings of cohort studies investigating the effects of hyperoxia in critically ill adults.  A meta-analysis and meta-regression analysis of cohort studies published between 2008 and 2015 was conducted.

Endotracheal intubation in the ICU

Critical Care 2015, 19:258  doi:10.1186/s13054-015-0964-z

Lapinsky S, SE et al

Endotracheal intubation in the ICU is a high-risk procedure, resulting in significant morbidity and mortality. Up to 40% of cases are associated with marked hypoxemia or hypotension. The ICU patient is physiologically very different from the usual patient who undergoes intubation in the operating room, and different intubation techniques should be considered......... 

Comparative Effectiveness of Noninvasive and Invasive Ventilation in Critically Ill Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Comparative Effectiveness of Noninvasive and Invasive Ventilation in Critically Ill Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Critical Care Medicine: July 2015 - Volume 43 - Issue 7 - p 1386–1394 doi: 10.1097/CCM.0000000000000945

Stefan, MS. Et al
Objectives: To compare the characteristics and hospital outcomes of patients with an acute exacerbation of chronic obstructive pulmonary disease treated in the ICU with initial noninvasive ventilation or invasive mechanical ventilation.
Design: Retrospective, multicenter cohort study of prospectively collected data. We used propensity matching to compare the outcomes of patients treated with noninvasive ventilation to those treated with invasive mechanical ventilation. We also assessed predictors for noninvasive ventilation failure. 

Incidence of and risk factors for severe cardiovascular collapse after endotracheal intubation in the ICU: a multicenter observational study

Critical Care 2015, 19:257  doi:10.1186/s13054-015-0975-9

Perbet S et al

Severe cardiovascular collapse (CVC) is a life-threatening complication after emergency endotracheal intubation (ETI) in ICU. Many factors may interact with hemodynamic conditions during ETI, but no study to date has focused on factors associated with severe CVC occurrence. This study assessed the incidence of severe CVC after ETI in the ICU and analyzed the factors predictive of severe CVC. Methods: This was a secondary analysis of a prospective multicenter-study of 1400 consecutive intubations at 42 ICUs. 

Early dynamic left intraventricular obstruction is associated with hypovolemia and high mortality in septic shock patients

Critical Care 2015, 19:262  doi:10.1186/s13054-015-0980-z

Chauvet – et al

Based on previously published case reports demonstrating dynamic left intraventricular obstruction (IVO) triggered by hypovolemia or catecholamines, this study aimed to establish: (1) its occurrence in septic-shock patients; (2) correlation between this intraventricular gradient (IVG) with volume status and fluid responsiveness; (3) mortality rate.

A positive fluid balance is an independent prognostic factor in patients with sepsis

Critical Care 2015, 19:251  doi:10.1186/s13054-015-0970-1

Acheampong , A and Vincent, J-L

Introduction Intravenous fluid administration is an essential component of sepsis management, but a positive fluid balance has been associated with worse prognosis. We analyzed whether a positive fluid balance and its persistence over time was an independent prognostic factor in septic patients. 

Effects of fluid administration on renal perfusion in critically ill patients

Critical Care 2015, 19:250  doi:10.1186/s13054-015-0963-0

Mouhamed Djahoum Moussa et al

Fluid administration is a first-line therapy for acute kidney injury associated with circulatory failure. Although aimed at increasing renal perfusion in these patients, this intervention may improve systemic hemodynamics without necessarily ameliorating intra-renal flow distribution or urine output. We used Doppler techniques to investigate the effects of fluid administration on intra-renal hemodynamics and the relationship between changes in renal hemodynamics and urine output. We hypothesized that, compared to systemic hemodynamic variables, changes in renal hemodynamics would better predict increase in urine output after fluid therapy. 

Burn wound healing and treatment: review and advancements

Burn wound healing and treatment: review and advancements

Critical Care 2015, 19:243  doi:10.1186/s13054-015-0961-2

Rowan MP et al

Burns are a prevalent and burdensome critical care problem. The priorities of specialized facilities focus on stabilizing the patient, preventing infection, and optimizing functional recovery. Research on burns has generated sustained interest over the past few decades, and several important advancements have resulted in more effective patient stabilization and decreased mortality, especially among young patients and those with burns of intermediate extent. However, for the intensivist, challenges often exist that complicate patient support and stabilization. Furthermore, burn wounds are complex and can present unique difficulties that require late intervention or life-long rehabilitation. In addition to improvements in patient stabilization and care, research in burn wound care has yielded advancements that will continue to improve functional recovery. This article reviews recent advancements in the care of burn patients with a focus on the pathophysiology and treatment of burn wounds.

Smart Care ™ versus respiratory physiotherapy driven manual weaning for critically ill adult patients: a randomized and controlled trial

Critical Care 2015, 19:246  doi:10.1186/s13054-015-0978-6

Taniguch C et al

Recent meta-analysis showed that weaning with SmartCareTM (Dräger, Germany) significantly decreased weaning time in critically ill patients. However, its’ utility when compared with respiratory physiotherapist protocolized weaning is still a matter of debate. We hypothesized that weaning with SmartCareTM should be as effective as respiratory physiotherapy driven weaning in critically ill patients. 

Neutrophil CD64 expression as a diagnostic marker for sepsis in adult patients: a meta-analysis

Critical Care 2015, 19:245  doi:10.1186/s13054-015-0972-z

Xiao Wang et al

Recently, neutrophil CD64 (nCD64) expression appears to be a promising marker of bacterial infections. The aim of this meta-analysis was to assess the accuracy of nCD64 expression for the diagnosis of sepsis in critically ill adult patients. 

Neural versus pneumatic control of pressure support in patients with chronic obstructive pulmonary diseases at different levels of positive end expiratory pressure: a physiological study

Neural versus pneumatic control of pressure support in patients with chronic obstructive pulmonary diseases at different levels of positive end expiratory pressure: a physiological study

Critical Care 2015, 19:244  doi:10.1186/s13054-015-0971-0


Ling Liu et al

Intrinsic positive end-expiratory pressure (PEEPi) is a “threshold” load that must be overcome to trigger conventional pneumatically-controlled pressure support (PSP) in chronic obstructive pulmonary disease (COPD). Application of extrinsic PEEP (PEEPe) reduces trigger delays and mechanical inspiratory efforts. Using the diaphragm electrical activity (EAdi), neurally controlled pressure support (PSN) could hypothetically eliminate asynchrony and reduce mechanical inspiratory effort, hence substituting the need for PEEPe. The primary objective of this study was to show that PSN can reduce the need for PEEPe to improve patient-ventilator interaction and to reduce both the “pre-trigger” and “total inspiratory” neural and mechanical efforts in COPD patients with PEEPi. A secondary objective was to evaluate the impact of applying PSN on breathing pattern.

Coping Strategies and Posttraumatic Stress Symptoms in Post-ICU Family Decision Makers

Coping Strategies and Posttraumatic Stress Symptoms in Post-ICU Family Decision Makers
Critical Care Medicine: June 2015 - Volume 43 - Issue 6 - p 1205–1212

Petrinec, Amy B. et al

Objective: To assess the coping strategies used by family decision makers of adult critical care patients during and after the critical care experience and the relationship of coping strategies to posttraumatic stress symptoms experienced 60 days after hospitalization. Design: A single-group descriptive longitudinal correlational study. Setting: Medical, surgical, and neurological ICUs in a large tertiary care university hospital. Patients: Consecutive family decision makers of adult critical care patients from August 2012 to November 2013. Study inclusion occurred after the patient’s fifth day in the ICU. Interventions: None. 
Measurements and Main Results: Family decision makers of incapacitated adult ICU patients completed the Brief COPE instrument assessing coping strategy use 5 days after ICU admission and 30 days after hospital discharge or death of the patient and completed the Impact of Event Scale-Revised assessing posttraumatic stress symptoms 60 days after hospital discharge. Seventy-seven family decision makers of the eligible 176 completed all data collection time points of this study. The use of problem-focused (p = 0.01) and emotion-focused (p < 0.01) coping decreased over time while avoidant coping (p = 0.20) use remained stable. Coping strategies 30 days after hospitalization (R2 = 0.50, p < 0.001) were better predictors of later posttraumatic stress symptoms than coping strategies 5 days after ICU admission (R2 = 0.30, p = 0.001) controlling for patient and decision-maker characteristics. The role of decision maker for a parent and patient death were the only noncoping predictors of posttraumatic stress symptoms. Avoidant coping use 30 days after hospitalization mediated the relationship between patient death and later posttraumatic stress symptom severity. Conclusions: Coping strategy use is a significant predictor of posttraumatic stress symptom severity 60 days after hospitalization in family decision makers of ICU patients.

Critical care management of systemic mastocytosis: when every wasp is a killer bee

Critical care management of systemic mastocytosis: when every wasp is a killer bee

Critical Care 2015, 19:238 doi:10.1186/s13054-015-0956-z
Hinke Y. van der Weide, David J. van Westerloo and Walter M. van den Bergh

Since the critical care physician will most likely be involved in a life-threatening expression of systemic mastocytosis, recognition of this disease is of utmost importance in the critical care management of these patients. Mastocytosis is a severely under-recognized disease because it typically occurs secondary to another condition and thus may occur more frequently than assumed. In this article, we will review the current knowledge on the treatment of mastocytosis crises with an emphasis on critical care management. Mastocytosis is characterized by the clonal proliferation and accumulation of mast cells in different tissues. Mast cell mediators contain a wide range of biologically active substances that may lead to itching and hives but may ultimately lead to anaphylactic shock caused by the release of histamine and other mediators from mast cells. The mainstay of therapy is the avoidance of potential triggers of mast cell degranulation and, if unsuccessful, blocking the cascade of mast cell mediators. The critical care physician should be well aware of the special precautions which should be kept in mind throughout the management of a mastocytosis crisis to avoid massive mast cell degranulation. Histamine-releasing drugs and certain physical triggers like temperature change should be avoided.