Archive for the ‘2008’ Tag

Early Mortality Prediction in Acute Pancreatitis

The early prediction of mortality in acute pancreatitis: a large population-based study. Wu Et al. Gut 2008; 57:1698-1703

Back after an extended Christmas break with thanks to Miss. Emma Collins for sharing this recent presentation from QMC’s journal club, a copy of which can be found in the blue box to the right.

This reterospective study used regression analysis to identify risk factors for early mortality within the first 24 hours of admission. The subsequent scoring system was compared against APACHE II and tested against the same database.

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Surgical Management of C.Diff Colitis

Thanks to Dr. Cooper who has reviewed this paper for the QMC journal club. Her presentation can be found in the blue box, called “Outcomes of colectomy for clostrium difficile”.

Weaning & Extubation Protocols in Neuro ICU

Rate of Re-intubation in mechanically ventilated patient neurosurgical patients : An evaluation of a systematic approach to weaning & extubation. Navalesi, P et al. Critical Care Medicine 2008 (36) 11.

This article was recently presented at QMC’s ICM journal club, who have kindly offered their presentation for inclusion on Critical Insight. You can find it in the blue box on the right, named “QMC Neuro Extubation CCM 2008”.  If your journal club would also like to submit presentations please see the “how to post” page for more info.

Tight Glucose Control – A Meta-analysis

Benefits & Risks of Tight Glucose Control in Critically Ill Adults; A Meta-Analysis. Weiner et al. JAMA. 2008;300(8):933-944.

This meta-analysis of 28 studies of “tight glucose control” on AICU inevitably includes papers studying different protocols on different patients and hence is limited in its applicability. I’m not sure that meta-analysis serves any purpose not bettered by a brief reading of the key studies of this concept, as there is significant heterogenity within the studies and the vast majority of the numbers come from a few well known trials. The failure of any study to replicate Van de Berge’s original 30% mortality reduction now begins to suggest that the benefit of tight glucose control is at best marginal and perhaps non-existent. There is of course a potential harm from the well documented increased risk of hypoglyceamia. The meta-analysis generates an RR of 0.93 (0.85-1.03) for tight glycaemic control. They could identify no stratified group that showed a consistent mortality benefit, including medical ICU patients (as in the original study).

The accompanying editorial is more useful and summarises the problems with investigating glucose control. Namely…

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Intensity of Renal Support. NIH ARF Trial Network. NEJM 2008.

Intensity of Renal Support in Critically Ill patients with Acute Kidney Injury. VA/NIH Acute Renal Failure Trial Network. N Engl J Med: May 20, 2008;359.

A copy of this paper is available as a PDF in the file box, or you can click the link above for full text.

Intro : This multicentre, non blinded RCT had 2 arms; High intensity intermittent HD (6/week) or CVVH at 35ml/kg vs low intensity intermittant HD (3/week) or CVVH at 20ml/kg. HD was used if the patient’s were heamodynamically stable (defined by cardiovascular SOFA score <2). 1124 patient’s randomised if ARF + 1 additional organ failure present (CRF excluded). Patients on low intensity treatment were permitted isolated ultra-filtration for volume overload if required . Primary end point was all cause mortality at 60 days.

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