Journal Club

Every month hundreds of articles of interest to the intensivist are published, and at that pace it is difficult to stay up to date. The SIZ invites its members to share interesting articles with a short review.


Relation between mean arterial pressure and renal function in the early phase of shock: a prospective, explorative cohort study.

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In 217 patients with sustained hypotension, enrolled and followed prospectively, we compared the evolution of the mean arterial pressure (MAP) during the first 24 hours between patients who will show AKI 72 hours after inclusion (AKIh72 as defined as “Injury” or “Failure” classes of the RIFLE classification [using the creatinine and urine output criteria] or need of renal replacement therapy).
The MAP averaged over H6 to H24 or over H12 to H24 was significantly lower in patients who showed AKIh72 than in those who did not , only in septic shock patients with AKIh6 , whereas no link was found between MAP and AKIh72 in the three others subgroups of patients. In these patients, the best level of MAP to prevent AKIh72 was between 72 and 82 mmHg.
Conclusions
MAP about 72-82 mmHg could be necessary to avoid acute kidney insufficiency in patients with septic shock and initial renal function impairment.

Julie Badin et al.


Haemodynamic goal-directed therapy and postoperative infections: earlier is better. A systematic review and meta-analysis

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Twenty-six RCTs (4188 participants) met the inclusion criteria. Perioperative GDT significantly reduced surgical site infections (SSI) (pooled OR 0.58; 95% CI 0.46-0.74; P<0.0001), pneumonia (pooled OR 0.71; 95% CI 0.55-0.92;P=0.009), and urinary tract infections (UTIs) (pooled OR 0.44; 95% CI 0.22-0.84; P=0.02). A significant benefit on total infectious episodes emerged (OR 0.40; 95% CI 0.28-0.58; P<0.00001).

A flow-directed hemodynamic therapy aimed to optimize oxygen delivery protects surgical patients against postoperative hospital-acquired infections and must be strongly encouraged, particularly in the setting of the high-risk surgical population.

Lidia Dalfino et al. Crit Care 2011; 15:R154


Prevention of ventilator-associated pneumonia, mortality and all intensive care unit acquired infections by topically applied antimicrobial or antiseptic agents: a meta-analysis of randomized controlled trials in intensive care units

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Topical selective decontamination of the digestive or respiratory tract (SDRD) using antiseptics or antimicrobial agents is effective in reducing the frequency of VAP in ICU. Unlike antiseptics, the use of topical antibiotics seems to be effective also in preventing all ICU-acquired infections, while the effectiveness on mortality of these two approaches needs to be investigated in further research.

Claudia Pileggi et al Crit Care 2011; 15:R155


The ability of intensive care units to maintain zero central line-associated bloodstream infections.

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Intensive care units that implemented a quality improvement initiative sustained zero central line‚Äďassociated bloodstream infections for up to 2 years.
Investigators found that 60% of the 80 participating ICUs that were evaluated went 1 year or more without a CLABSI, and 26% had zero infections for 2 years or more. Smaller hospitals sustained zero infections longer than larger hospitals.

Arch Intern Med. 2011 May 9;171(9):856-8.