Crit-IQ Newsletter

  • Publish date : 26-04-2016
  • Dear Crit-IQ Member

    Welcome to your fortnightly newsletter!

    Following on from a few weeks break we are back to deliver the latest news and views from the critical care world. To start lets have a look at the literature from the past few weeks.

     

    THE LITERATURE

    Effect of restrictive versus liberal transfusion strategies on outcomes in patients with cardiovascular disease in a non-cardiac surgery setting: systematic review and meta-analysis

    A Docherty, R O'Donnell, S Brunskill, et al BMJ, 2016, 352:i1351. This systematic review and meta-analysis of restrictive versus liberal red cell transfusion strategies restricted to adults with cardiovascular disease, excluding those who had cardiac surgery suggests it may not be safe to use a restrictive transfusion threshold of less than 80 g/L in these patients.

    Determinants of Citation Impact in Large Clinical Trials in Critical Care: The Role of Investigator-Led Clinical Trials Groups

    J Marshall, W Kwong, K Kommaraju, K Burns Crit Care Med, 2016, 44:663–670. This review sought to understand the factors that influence the impact of RCTs in critical care by assessing the roles of industry funding, research focus, and research organizational model over the last 20-year period. Even if you are not interested in the factors, this paper provides an interesting helicopter view of critical care RCTs over the last two decades.

    Changes in Bone Mineral Density in the Year after Critical Illness

    Neil R. Orford, Stephen E. Lane, Michael Bailey, et al Am J Resp Crit Care Med, 2016, 193(7);36-744. This prospective observational study describes a significant increase in bone loss in survivors of intensive care, compared to matched community controls in the 12 months after index illness. Furthermore there was a significant increase in 10-year fracture risk for major fractures.

    A Binational Multicenter Pilot Feasibility Randomized Controlled Trial of Early Goal-Directed Mobilization in ICU

    C Hodgson, M Bailey, R Bellomo, et al for the TEAM Investigators Crit Care Med, 2016, online first 2016. This multicentre, pilot, feasibility, RCT conducted in Australia and New Zealand from the TEAM investigators follows on from their 2013 observational inception cohort study, by setting out to establish if individualised EGDM was feasible, to inform the design of a definitive trial of EGDM vs standard care. Overall this study shows that the application of EGDM by a mobility team is feasible, and results in a significant increase in intensity and duration of physical activity in ICU, and improved mobility in ICU. What it doesn’t show us is the right ‘dose’ or ‘timing’, more to come come then.

    Effect of Postextubation High-Flow Nasal Cannula vs Conventional Oxygen Therapy on Reintubation in Low-Risk Patients -A Randomized Clinical Trial

    G Hernandez, C Vaquero, P Gonzalez, et al JAMA, 2016, online 15th Mar 2016. Studies have reported benefits of HFNC for acute respiratory failure in critically ill populations generally. However the low risk of re-intubation population have not been studied. This multicentre, RCT conducted in 7 ICUs in Spain, set out to answer this.

    Effect of Noninvasive Ventilation on Tracheal Reintubation Among Patients With Hypoxemic Respiratory Failure Following Abdominal Surgery -A Randomized Clinical Trial

    S Jaber, T Lescot, E Futier, et al for the NIVAS Study Group JAMA, 2016, online first 15th Mar.Overall this study reports that the use of NIV in patients with acute respiratory failure developing within 7-days of surgery (average 5-days) was associated with significant decrease in reintubation, requirement for invasive MV, pneumonia, and hospital LOS.

    Why not have your say on any of our papers in Recent Comments?

    These articles and many more can be found in our Journal Club. A sure way of keeping up to date is with our free Journal Club Podcast Wrap: Dr Neil Orford summarises the key literature from the last month. Staying up to date has never been easier.

     

    POSITION STATEMENTS

    New position statements released by The Cochrane Library:

    Interventions for necrotising pancreatitis

    Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults 

    Early removal versus expectant management of central venous catheters in neonates with bloodstream infection

     

    WHAT’S ON

    ANZCA ASM – Closer to the edge; Auckland, New Zealand; April 30th – May 4th 2016: There are 60 days to go to the ANZCA ASM. Early bird registration closes March 18th. This event is claimable by ANZCA CPD participants within the knowledge and skills, and emergency responses categories. Check out the full details here.

    Beyond BASIC; ACT, Australia; September 20th – 21st 2016: The Beyond BASIC MV is an advanced mechanical ventilation course comprising pre-reading, lectures and workshops delivered by experienced practitioners, conducted over 1 and ½ days at The Canberra Hospital.

    The link for this and many other conferences can be found on the Crit-IQ conference calendar here.   

     

    CRIT-IQ SITE HIGHLIGHT

    Logbook & Tablet Login

    We have now released the second major stage of the Crit-IQ redevelopment. Check out our new look logbook! This has been optimised for a very simple input system of either your procedures or professional development. You can see this beautifully displayed with procedures in a timeline or professional development in a pie style chart. The result is instant knowledge of your achievements over the last 12 months and where you may need to focus going forwards. In addition to the logbook we have streamlined our login and dashboard so you can access and input data from your smart phone or tablet. We are already working on the next release and have lots more in store for both the logbook and site in general.

    Please go and have a look and send us your feedback - admin@crit-iq.com Thank you for your continued support making these and future site developments possible.

     

    until next time..

    The Crit-IQ team.

  • Publish date : 11-02-2016
  • Dear Crit-IQ Member

    Lets have a look at the latest news and views in the critical care world:

    THE LITERATURE

    Here are the essentials direct from our journal club.

    The Effects of Alternative Resuscitation Strategies on Acute Kidney Injury in Patients with Septic Shock.

    J Kellum, L Chawla, C Keener, et al for the ProCESS and ProGReSS-AKI Investigators Am J Resp Crit Care Med, 2016, 193(3);281-287. This ancillary study to the ProCESS trial, a 31-site, 1351 patient RCT, examined the occurrence of AKI, the course of AKI across treatment arms, novel biomarkers, and use of RRT. Overall there was no difference in development or severity of AKI or renal outcomes, in patients receiving protocolised management for septic shock, results that were consistent across subgroups. What is noted is that AKI is common and strongly associated with 60-day mortality, so the search for effective therapy for AKI continues.

    Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations.

    C Fleischmann, A Schirag, N Adhikara, et al on behalf of the International Forum of Acute Care Trialists Am J Resp Crit Care Med, 2016, 193 (3);259-272. To reduce the global burden of sepsis “one of the oldest and most elusive syndromes in medicine”, we first need to understand the incidence and outcomes on a global scale. This study systematically searched 15 international citation databases from 1979 to 2015. They found 27 studies from 7 high-income countries for meta-analysis revealing hospital mortality of 17% (sepsis) and 26% (severe sepsis). Of concern is the absence of population level sepsis incidence and outcome estimates form lower-income countries.

    Randomized Trial of Apneic Oxygenation during Endotracheal Intubation of the Critically Ill

    M Semler, D Janz, R Lentz, et al for the FELLOW Investigators and the Pragmatic Critical Care Research Group Am J Resp Crit Care Med, 2016, 193(3);273-280. This prospective RCT compared the effect of apneic oxygenation to usual care on lowest oxygen saturations during endotracheal intubation in 150 critically ill adults in a MICU. They report no different in SpO2 <90% (44.7% vs 47.2%, p=0.87), whilst there are limitations this study suggests apneic oxygenation was neither beneficial or harmful.

    Effect of Acetazolamide vs Placebo on Duration of Invasive Mechanical Ventilation Among Patients With Chronic Obstructive Pulmonary Disease - A Randomized Clinical Trial.

    C Faisy, F Meziani, B Blanquette, et al for the DIABOLO Investigators JAMA, 2016, 315(5):480-818. The use of acetazolamide as a respiratory stimulant for ventilated patients with metabolic alkalosis and COPD is a scenario many will be familiar with, and perhaps equally familiar with the lack of certainty if it is of any benefit. So finally, the DIABOLO investigators have tried to answer this for us with a prospective RCT. Primary outcome was duration of MV, and there as no significant difference acetazolamide vs placebo  (−16.0 hours; 95% CI, −36.5 to 4.0 hours; P = .17). The authors suggest the magnitude of the difference was clinically important, and it is possible that the study was underpowered to establish statistical significance.

    Why not have your say on any of our papers in Recent Comments?

    These articles and many more can be found in our Journal Club.

    Havn’t the time this month to read through the latest literature? Listen to Our Journal Club Wrap: Dr Neil Orford summarises the key literature from the last month. Staying up to date has never been easier.

     

    POSITION STATEMENTS

    New position statements released by The Cochrane Library:

    Biphasic versus monophasic waveforms for transthoracic defibrillation in out-of-hospital cardiac arrest

    Enhanced recovery protocols for major upper gastrointestinal, liver and pancreatic surgery

    Frequency of dressing changes for central venous access devices on catheter-related infections

    Updated position statements include:

    Antihrombin III for critically ill patients

     

    WHAT’S ON

    45th Critical Care Conference; Florida; USA; Feb 20th – 24th 2016: Connect with colleagues, experience leading-edge innovations in critical care medicine, and stretch your imagination at the Society of Critical Care Medicine’s (SCCM) 45th Critical Care Congress. The Society’s Congress is the largest critical care event that brings together all members of the multiprofessional, multidisciplinary team. This five-day event will offer unique opportunities to explore breakthroughs in research, share creative and stimulating ideas, network with leadership in critical care, and share in a diverse range of perspectives.

    36th International Symposium on Intensive Care and Emergency Medicine; Brussels; Mar 15th-18th 2016: The ISICEM is organized by the Departments of Intensive Care and Emergency Medicine of Erasme University Hospital, Université Libre de Bruxelles, in association with the Belgian Society of Intensive Care and Emergency Medicine (SIZ). The meeting is held every year in March. Started in 1980, this meeting has become established as one of the largest in its field, now attracting more than 6200 participants from countries worldwide.

The objectives of this four day symposium are to provide participants with an up to date review of the most recent, clinically relevant, developments in research, therapy, and management of the critically ill. The meeting is open to all physicians, nurses and other health professionals with an interest in critical care or emergency medicine.

    The link for this and many other conferences can be found on the Crit-IQ conference calendar here.   

     

    CRIT-IQ HIGHLIGHT: ECHO

    Critical care ultrasound is now well established as a must have skill for the critical care physician. Furthermore as intensive care curriculums are revised around the word we see some form of ultrasound training becoming mandated.  The ability to perform a rapid assessment of cardiac function has significant impact on patient management. Crit-IQ has a comprehensive ECHO module. Whether you are a complete beginner or have an intermediate to advanced skill level there is something for you in our ECHO section. Learn the basics with sections categorised by structure or test yourself and have a go at reporting one of our ECHO loops before viewing a formal report. 

    View the ECHO section here.

     

    until next time..

    The Crit-IQ team.

  • Publish date : 20-01-2016
  • Dear Crit-IQ Member

    Lets have a look at the latest news and views in the critical care world:

    THE LITERATURE

    Here are the essentials direct from our journal club.

    Being Overweight Is Associated With Greater Survival in ICU Patients: Results From the Intensive Care Over Nations Audit

    Y Sakr, I Alhussami, R NAnchal, et al on behalf of the Intensive Care Over Nations Investigators Crit Care Med, 2015, 43(12);2623-2632.  This substudy of the Intensive Care Over Nations (ICON) audit of 10,069 patients from European, Asian, and American ICUs, describes the epidemiology of obesity, and association between BMI and morbidity/mortality in ICU. So this adds to the evidence supporting the obesity-survival paradox and the reasons remain unclear.

    A Multicenter Evaluation of Prolonged Empiric Antibiotic Therapy in Adult ICUs in the United States

    Z Thomas, F Bandali, J Sankaranarayanan, et al on behalf of the Critical Care Pharmacotherapy Trials Network Crit Care Med, 2015, 43(12);2527-2534. This national, prospective, multicenter assessed the rate of prolonged empirical antibiotic therapy (PEAT) in 67 ICUs in the US. Overall this study tells us that there is a high rate of prolonged administration of empiric antibiotics, which by definition were patients that did not meet infection criteria. It is patients with higher of severity of illness who are more like to have PEAT.

    A Multicenter Randomized Trial of Continuous versus Intermittent B-Lactam Infusion in Severe Sepsis

    J Delahunty, J Roberts, J Davis, et al for the BLING II Investigators for the ANZICS Clinical Trials Group Am J Resp Crit Care Med, 2015, 192 (11); 1298-1305. This prospective multi-centre RCT conducted in 25 ICUs in Australia, New Zealand, and Hong Kong, randomised 432 patients with severe sepsis who were within 24-hrs of being commenced on piperacillin–tazobactam, ticarcillin–clavulanate, or meropenem by the treating doctor. Participants were randomised to continuous infusion or intermittent infusion over 30-minutes. There was no difference in outcomes following severe sepsis with intermittent compared to continuous dosing of B-lactams.

    Why not have your say on any of our papers in Recent Comments?

    These articles and many more can be found in our Journal Club.

    Havn’t the time this month to read through the latest literature? Listen to Our Journal Club Wrap: Dr Neil Orford summarises the key literature from the last month. Staying up to date has never been easier.

     

    POSITION STATEMENTS

    New position statements released by The Cochrane Library:

    Needle aspiration versus intercostal tube drainage for pneumothorax in the newborn

    Semi-recumbent position versus supine position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation

     

    WHAT’S ON

    45th Critical Care Conference; Florida; USA; Feb 20th – 24th 2016: Connect with colleagues, experience leading-edge innovations in critical care medicine, and stretch your imagination at the Society of Critical Care Medicine’s (SCCM) 45th Critical Care Congress. The Society’s Congress is the largest critical care event that brings together all members of the multiprofessional, multidisciplinary team. This five-day event will offer unique opportunities to explore breakthroughs in research, share creative and stimulating ideas, network with leadership in critical care, and share in a diverse range of perspectives.

    Canadian Critical Care Conference; Whistler, Canada; March 1st – 5th 2016: What makes our conference different? It’s casual & fun and we like to talk about things that you won’t hear at other conferences. We always feature a former patient who speaks about their experiences in the healthcare system. Registration is limited so that you will have the chance to interact with world renowned International faculty in an informal setting. Plus our event takes place in one of the most beautiful natural environments in the world! The conference is accredited for CME credits with the Royal College, also accredited by AACME and the JFICM.

    The link for this and many other conferences can be found on the Crit-IQ conference calendar here.   

     

    POSITIONS VACANT

    Consultant Position: Central Queensland

    Queensland, Australia: A full time consultant position is available, the job entails requires the provision of high quality clinical services as part of the Intensive Care Unit; education of Medical Staff and Students, Allied Health, interested Community Groups and Nursing Staff; Active participation in patient safety, audit, research and service planning activities and assist the Director of ICU in the general running of the unit. A comprehensive remuneration package is available to the successful candidate.

    Further information regarding this post can be found here.

    Check out our positions vacant page for current vacancies today. Crit-IQ's positions vacant page is a great way for your department to find its next staff member. Anyone can advertise a position on Crit-IQ and our department members receive 4 free posts per year. For more information, contact us via admin@crit-iq.com

     

    CRIT-IQ HIGHLIGHT

    Have you been keeping an eye on our site redevelopment, an exciting time at Crit-IQ as we make our site more user-friendly with greater compatibility across all platforms, improved navigation and design. Check out the newly launched exam resource page. There is much more to come in the next few weeks.

     

    until next time..

    The Crit-IQ team.

  • Publish date : 02-12-2015
  • Dear Crit-IQ Member

    Lets have a look at the latest news and views in the critical care world:

    THE LITERATURE

    Here are the essentials direct from our journal club.

    Early High-Volume Hemofiltration versus Standard Care for Post–Cardiac Surgery Shock. The HEROICS Study

    Alain Combes, Nicolas Bréchot, Julien Amour, et al Am J Resp Crit Care Med, 2015, 192(10);1179-1190. Could high-volume hemofiltration (HVHF) improve outcomes for patients with shock following cardiac surgery through improved myocardial performance and reduced vasopressor dependence following removal of toxins, proinflammatory mediators, and correction of acidosis? This prospective multi-centred RCT conducted in France, randomised 224 patients who developed severe shock within 3-24 hrs of cardiac surgery, to early HVHF vs standard care. No difference was seen and the trail was stopped early due to futility. An important limitation is that the type of shock (vasoplegic vs cardiogenic) was not defined.

    Trial of Continuous or Interrupted Chest Compressions during CPR

    G Nichol, B Leroux, H Wang, et al for the ROC Investigators N Eng J Med, 2015, online first Nov. This cluster-randomised trial conducted in 10 clinical sites (114 EMS agencies) in Nth America randomised 26148 patients continuous chest compressions or interrupted chest compressions for all OHCA. Overall there was not a benefit in hospital survival or favourable neurological outcome from a continuous chest compression strategy compared to traditional interrupted compressions. 

    Andexanet Alfa for the Reversal of Factor Xa Inhibitor Activity

    D Siegal, J Curnutte, S Connolly, et al N Eng J Med, 2015, online first. This prospective trial randomised 101 healthy participants receiving apixaban 5mg bd or rivaroxaban 20 mg daily to andexanet as bolus or bolus and infusion. In summary andexanet effectively and rapidly reverses the anticoagulation effect of apixaban and rivaroxaban in healthy adults, with no adverse effects detected, all be it in a small group for a short period under trial conditions. So the next step? A phase 3b-4 study is investigating the safety and efficacy of andexanet in patients with factor Xa inhibitor associated acute major bleeding. 

    Confluence, Not Conflict of Interest - Name Change Necessary

    Anne Cappola, Garret Fitzgerald JAMA, 2015, 314(17):1791-1792. The concerns about secondary gain, commonly financial, has led to policies to minimise, prevent, or manage “conflict of interest”. Could this reduce innovation and delay translation? The Institute for Translational Medicine and Therapeutics at the University of Pennsylvania convened an international meeting on conflict of interest. After discussing several themes they summarised that confluence of interest represents a complex ecosystem that requires development of a uniform approach to minimize bias in clinical research across the academic sector.

    Why not have your say on any of our papers in Recent Comments?

    These articles and many more can be found in our Journal Club.

    Havn’t the time this month to read through the latest literature? Listen to Our Journal Club Wrap: Dr Neil Orford summarises the key literature from October. Staying up to date has never been easier.

     

    POSITION STATEMENTS

    New position statements released by The Cochrane Library:

    Prone position for acute respiratory failure in adults (Review)

    Routine intracranial pressure monitoring in acute coma

    Decision aids for people considering taking part in clinical trials

     

    WHAT’S ON

    State of the Art Meeting; London; Dec 7th – 9th 2015: State of the Art is the flagship conference for UK critical care, with 4 concurrent tracks and over 1,000 delegates, offering great networking opportunities, an unrivalled array of speakers, and 15 CPD points over 3 days.

    45th Critical Care Conference; Florida; USA; Feb 20th – 24th 2016: Connect with colleagues, experience leading-edge innovations in critical care medicine, and stretch your imagination at the Society of Critical Care Medicine’s (SCCM) 45th Critical Care Congress. The Society’s Congress is the largest critical care event that brings together all members of the multiprofessional, multidisciplinary team. This five-day event will offer unique opportunities to explore breakthroughs in research, share creative and stimulating ideas, network with leadership in critical care, and share in a diverse range of perspectives.

    Canadian Critical Care Conference; Whistler, Canada; March 1st – 5th 2016: What makes our conference different? It’s casual & fun and we like to talk about things that you won’t hear at other conferences. We always feature a former patient who speaks about their experiences in the healthcare system. Registration is limited so that you will have the chance to interact with world renowned International faculty in an informal setting. Plus our event takes place in one of the most beautiful natural environments in the world! The conference is accredited for CME credits with the Royal College, also accredited by AACME and the JFICM.

    The link for this and many other conferences can be found on the Crit-IQ conference calendar here.   

     

    CRIT-IQ SITE HIGHLIGHT

    Philanthropy – HINARI network

    What does Crit-IQ give back to the critical care community?

    As Crit-IQ continues to expand as the essential critical care education and quality assurance tool, we are mindful of the need to support the critical care community. Your continuing membership allows us this opportunity. 

    Examples of this include monetary donation to the Intensive Care Foundation. In addition over the years Crit-IQ has been able to support practitioners in communities with limited resources, with Crit-IQ made freely available to several institutions such as the University of the South Pacific. In 2014 Crit-IQ joined the HINARI network. Set up by WHO together with major publishers, this resource makes us available to low-resource areas of the world for free as an act of charity and good will. We join over 13000 journals, 30000 e-books and other on-line education material in over 100 impoverished countries that are participating.

    Check out the HINARI network here.

    More recently we are proud to say that we now provide access to all critical care doctors in Fiji, Vanuatu, Samoa, Tonga, Cook Island, East Timor & The Solomans.

    You can suggest an organisation or critical care unit for us to support by contacting us at admin@crit-iq.com 

     

    With thanks for your continued support, until next time..

    The Crit-IQ team.