R&R In The FASTLANE 165

Welcome to the 165th 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 5 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

Gordon AC, et al. Levosimendan for the Prevention of Acute Organ Dysfunction in Sepsis. N Engl J Med. 2016. PMID: 27705084

• This was a double-blind, randomized clinical trial which recruited 516 adult patients with sepsis and looked at whether levosimendan reduced the severity of organ dysfunction. The primary outcome was assessed by the mean daily Sequential Organ Failure Assessment (SOFA) score in the intensive care unit up to day 28. Adding levosimendan to your armament of drugs in this patient population was not associated with less severe organ dysfunction or lower mortality, however, it was associated with less likelihood of weaning your patient off the ventilator and more tachy-arrythmias. This trial shows that even though Levosimendan is safe to administer, widespread use in this patient population is not recommended.
• Recommended by: Nudrat Rashid

Kehrl T, et al. Intraosseous access in the obese patient: assessing the need for extended needle length. Am J Emerg Med 2016. PMID: 27344097

• The IO is a critical tool in resuscitation. This study reveals (using US to determine soft tissue depth) that in obese patients, the standard 25 mm IO may not be adequate to penetrate the soft tissue and get into the bony cortex. If you’re unable to palpate the tibial tuberosity, there’s a good chance your IO won’t be long enough. In obese patients, consider reaching for the 45 mm IO needle instead of the 25 mm one. Remember that the 45 mm one can be used for shallower placement (some of the device will simply protrude from the skin).
• Recommended by: Anand Swaminathan

Juhani-Mehta M, et al. Effect of Cranberry Capsules on Bacteriuria Plus Pyuria Among Older Women in Nursing Homes: A Randomized Clinical Trial. JAMA 2016. PMID: 27787564

• Among older women residing at nursing homes, cranberry capsules vs placebo made no significant differences in presence of bacteriuria plus pyuria, rates of symptomatic UTIs, rates of death, or rates of hospitalization.
• Recommended by: Salim R. Rezaie

Hagan G & Nathani N. Clinical review: tuberculosis on the intensive care unit. Crit Care 2013. PMID: 24093433

• Tuberculosis patients requiring ICU admission have very high mortality. This 2013 review article addresses the key key life-threats from tuberculosis and the specific issues that affect the management of critically ill patients with tuberculosis.
• Recommended by: Chris Nickson

Ong CJ, et al. Early Withdrawal Decision-Making in Patients with Coma After Cardiac Arrest: A Qualitative Study of Intensive Care Clinicians. Neurocrit Care 2016. PMID: 27112149

•  OK qualitative studies using surveys are not my favourite type of paper. However, every now and then I come across one that makes me consider my own practice. This paper, looking at determinants of withdrawal after cardiac arrest makes for sobering reading showing differences in specialties and the potential for self-fulfilling prophecies. Definitely something worth reflecting on when next thinking about withdrawal.
• Recommended by: Virginia Newcombe