R&R In The FASTLANE 037

Welcome to the 37th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.

This edition contains 10 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the : Overview; Archives and Contributors

This Edition’s R&R Hall of Famer

Traumatic Intracranial Hypertension. Nino Stocchetti, M.D., and Andrew I.R. Maas, M.D., Ph.D.
N Engl J Med 2014; 370:2121-2130May 29, 2014. PMID: 24869722

• An excellent review on how to monitor and treat intracranial hypertension secondary to trauma. Includes a wonderful graphic demonstrating a staircase approach to the treatment of intracranial hypertension. This tiered approach is accompanied by level’s of evidence and risks of individual treatment. A must read!
• Recommended by: Nudrat Rashid, Jeremy Fried

Otten D et al. Comparison of Bag-Valve-Mask Hand-Sealing Techniques in a Simulated Model. Ann of EM 2014; 63: 6-12. PMID: 23937957

• 2-handed BVM delivers a larger portion of the intended tidal volume to the lungs in comparison to 1-handed BVM in simulation mannequins. Although this study is not on actual patients or even on human beings, it makes a strong argument for 2-handed BVM being standard instead of 1-handed BVM.
• Recommended by: Anand Swaminathan

Iserson KV. An hypnotic suggestion: review of hypnosis for clinical emergency care. J Emerg Med. 2014 Apr;46(4):588-96. doi: 10.1016/j.jemermed.2013.09.024. PMID: 24472351

• Fascinating review on the history and possible application of clinical hypnosis in the ED setting. Advantages are that it is safe, fast and cost-effective.  Training is required before you add this non-pharmacologic skill to your clinical armamentarium.
• Recommended by: Jeremy Fried

Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials.  Coxib and traditional NSAID Trialists’ (CNT) Collaboration. The Lancet – 31 August 2013 ( Vol. 382, Issue 9894, Pages 769-779 ). PMID: 23726390

•  Everyone loves NSAIDs! But they do have risks, and this paper was a good reminder of not just the well-known upper GI effects, but the increased risk of vascular events. Even good, old ibuprofen showed a significant increase in major coronary events. Naproxen was the big winner, as it showed no increase in vascular events. All NSAIDs significantly increased risk of upper GI problems. NSAIDs: Use them. Prescribe them. Love them. But remember they are not entirely benign!
• Recommended by: Zack Repanshek

Ghareeb PA, Bourlai T, Dutton W, McClellan WT. Reducing pathogen transmission in a hospital setting. Handshake verses fist bump: a pilot study. J Hosp Infect. 2013 Dec;85(4):321-3. PMID: 24144553

• Fist bump instead of handshake in the clinical setting to reduce the risk of bacterial transmission between healthcare providers. Works by reducing the overall contact time and total surface area exposed compared to the standard handshake. Don’t be surprised if this takes off in your institution.
• Recommended by: Anand Swaminathan

High versus low blood-pressure target in patients with septic shock. Asfar P et al.N Engl J Med. 2014 Apr 24;370(17):1583-93. doi: 10.1056/NEJMoa1312173. Epub 2014 Mar 18, PMID: 24635770

• This study suggests that amongst patients with septic shock, there is no significant difference in 28-day or 90-day mortality between those treated to reach a target mean arterial pressure of 80-85 mm Hg and those who were treated to reach a target of 65-70 mm Hg. The results support the guidelines of the Surviving Sepsis Campaign, which recommend targeting a mean arterial pressure of at least 65 mmHg.
• Recommended by: Nudrat Rashid

Futier E1, Constantin JM, Jaber S .Protective lung ventilation in operating room: a systematic review. Minerva Anestesiol. 2014 Jun;80(6):726-35. PMID: 24226493

• Well written review on lung protective ventilation during general anesthesia offering some recommendations for mechanical ventilation in the surgical context. Time to change! – at least during abdominal surgery
• Recommended by: Søren Steemann Rudolph

Wik L et al. Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial. Resuscitation 2014. PMID: 24642406

• Mechanical CPR offers no benefit over manual CPR in patients with OHCA in terms of survival to discharge. Although a number of physicians have argued the merits of these devices in terms of freeing up hands, ensuring adequate compression’s etc, this is an expensive device ($15,000/unit) to adopt without proof of benefit.
• Recommended by: Anand Swaminathan

Assessment of the safety and efficiency of using an age-adjusted d-dimer threshold to exclude suspected pulmonary embolism. Chest. 2014 May 15. doi: 10.1378/chest.13-2386. PMID : 24831769

• Authors Conclusion: Use of an age-adjusted d-dimer threshold reduces imaging among patients age <50 years with a Revised Geneva Score ≤ 10. While the adoption of an age-adjusted d-dimer threshold is probably safe, the confidence intervals surrounding the additional 1.5% of PE that was missed using an age-adjusted threshold necessitate a prospective study before this practice can be adopted into routine clinical care.
• Recommended by: Salim R. Rezaie,  Jeremy Fried
• Read More: The Adventure of the Golden Standard (Rory Spiegel)

ICU-Acquired Weakness and Recovery from Critical Illness.John P. Kress, M.D., and Jesse B. Hall, M.D.
N Engl J Med 2014; 370:1626-1635April 24, 2014. PMID: 24758618

• ICU acquired weakness contributes significantly to the considerable functional impairment survivors of critical illness face. This excellent review provides a nice summary and emphasizes the importance of aggressive and early treatment of sepsis and of BSL control with insulin therapy. In addition to this, early mobilization and minimizing sedation may contribute to the reduction in deconditioning and debility faced by this group.
• Recommended by: Nudrat Rashid