Editors' Picks: Free Access to the Top Sixteen Articles from ICM (2012-13)
Dear ICM Readers,
We are happy to present you this special selection of our editors top picks of articles published in 2012 and 2013. In order to ensure everyone can access these important articles, all 16 are now temporarily available with free access under the “Editors’ Picks” section of the ICM Springer page (access here).
We hope that you will appreciate (re)discovering the following papers:
Importance of informed consent in critical care research I: substitute decision makers perspectives 
The major motivations when substitute decision makers agree to have a critically ill relative participate in a research study are potential patient benefit, altruism, and the desire to advance medical progress. Substitute decision makers who decline are not opposed to research in principle, but are too apprehensive about their loved ones to consider research.
Importance of informed consent in critical care research II: delayed consent in the NICE-SUGAR study 
This study supports the continued use of delayed consent in randomised controlled trials that evaluate available standard intensive care treatments in critically ill patients. Most former ICU patients enrolled in the NICE-SUGAR study would have agreed to participate in the study had they been able to consent directly. Most reported that consent had been sought from the preferred person and that they were content with the decision made.
Importance of informed consent in critical care research III: consent in paediatric critical care research 
The consent rates described in this study provide paediatric critical care researchers with a source of data for determination of recruitment rates, sample size calculations, budget estimations, and study timelines. We should be aware of the lower consent rates in the cardiac surgery population. We should also consider routine research assistant involvement prior to attempting consent.
Safety and quality of care for critically ill patients 
A European Society of Intensive Care Medicine Task Force on Quality and Safety identified nine indicators that could be used to improve quality in routine intensive care practice. These indicators are related to the structures (ICU fulfils national requirements to provide intensive care, 24-hour availability of a consultant-level intensivist, adverse event reporting system), processes (presence of routine multi-disciplinary clinical ward rounds and standardised handover procedure for discharging patients) and outcomes of intensive care (reporting and analysis of SMR, ICU re-admission rate within 48 hours of ICU discharge, the rate of central venous catheter-related blood stream infection and the rate of unplanned endotracheal extubations).
Variability in critical care bed numbers in Europe 
Critical care bed numbers vary considerably between countries in Europe. On average, there are 11.5 critical care beds per 100,000 people, with marked differences between countries (Germany 29.2; Portugal 4.2). Better understanding of these numbers should facilitate improved planning for critical care capacity and utilisation in the future.
Lung ultrasound guidelines 
This is the first document reporting 73 evidence-based recommendations on clinical use of point-of-care lung ultrasound. The advantages of correct use of bedside lung ultrasound in the emergency setting are striking, particularly in terms of saving from radiation exposure, delaying or even avoiding transportation to the radiology department, and guiding life-saving therapies in extreme emergency.
Ultrasound-guided vascular access: a “third eye” for ICU clinicians 
There is a clear advantage of 2D vascular screening prior to cannulation and a real-time ultrasound needle guidance with an in-plane/long-axis technique optimises the probability of needle placement. Ultrasound guidance can be used not only for central venous cannulation, but also in peripheral and arterial cannulation. Ultrasound can be used in order to check for immediate and life-threatening complications as well as the catheter’s tip position.
Visual anatomical lung CT scan assessment of lung recruitability 
The computation of lung recruitability in acuterespiratory distress syndrome (ARDS) is advocated to set positive end-expiratory pressure (PEEP) for preventing lung collapse. The quantitative lung CT scan, obtained by manual image processing, is the reference method but it is time consuming. Visual anatomical analysis can classify patients into those with high and low lung recruitability allowing more intensivists to get access to lung recruitability assessment.
The Berlin Definition in infancy: multicenter evaluation and expert consensus 
This retrospective study demonstrates the validity of the Berlin Definition in infancy and early childhood. The good performance seems to be mainly related to the “severe” ARDS category. The Berlin Definition must not be thought of as a prognostic tool, but it may be useful for optimising clinical assistance, research, and health services planning in paediatric critical care.
Etomidate increases susceptibility to pneumonia in trauma patients 
In this sub-study of the HYPOLYTE trial, etomidate was found to be an independent risk factor for hospital-acquired pneumonia in intubated trauma patients, and hydrocortisone was found to significantly decrease the rate of HAP and the duration of MV for etomidate-exposed patients. These results should alert physicians to limit the use of etomidate for the intubation of severe trauma patients unless they use hydrocortisone to counteract the deleterious effects of the drug.
Extracorporeal membrane oxygenation (ECMO) in severe paediatric pneumonia: an evaluation 
Survival in children with pneumonia supported with ECMO can reach up to 90 % and is almost comparable to patients only requiring invasive mechanical ventilation. Venoarterial ECMO may be associated with more serious complications and should be reserved for children with profound haemodynamic instability and severe ventricular dysfunction. Risk factors for poor outcome include the need to change the ECMO circuit and the need for renal replacement therapy.
Old and very old 
Elderly and very elderly patients will continue to be a significant and increasing proportion of ICU patients. With advancing age, the proportion of various preexisting comorbidities as well as the primary reason for ICU admission change. Mortality in this cohort is substantial, and advanced age should be regarded as a significant independent risk factor specifically for ICU patients older than 75.
Intensive care unit environment and the course of delirium 
As the ICU environment appears to influence the course of delirium, non-pharmacological anti-delirium measures deserve more attention in intensive care medicine. This study is the first to assess the influence of ICU environment on delirium in the ICU.
Dobutamin does not improve mortality of severe heart failure: systematic review 
Dobutamine, despite its wide use in management of severe heart failure, was not found to be associated with improved mortality. Moreover, a trend towards an increase in mortality with use of dobutamine compared with placebo or standard care was evident, although this did not reach statistical significance. Further methodologically sound studies would be beneficial to identify which patient populations are most likely to receive benefit, or indeed harm, from this agent.
Gelatin vs. albumin or crystaloids for volume resuscitation: systematic review and meta-analysis 
Gelatins were introduced into clinical practice before legislation in the aftermath of the thalidomide tragedy made clinical proof of safety mandatory. Among 40 randomised controlled trials published between 1976 and 2010, no study was adequately powered to investigate patient-important outcomes. Despite over 60 years of clinical experience with its use, the safety of gelatin in all settings in which it is used cannot be reliably assessed and confirmed.
Spending a birthday in ICU – a risk for an inappropriate level of care? 
Clinicians must be aware that patients spending their birthday in the ICU are at risk for an inappropriate level of care. These patients are often admitted after unscheduled events and sudden illnesses (e.g., trauma or sepsis), and have greater disease severity than other patients. Decisions to forgo life-sustaining treatment are made later in these patients.
1. Mehta S, Pelletier FQ, Brown M, et al. (2012) Why substitute decision makers provide or decline consent for ICU research studies: a questionnaire study. Intensive Care Med 38:47–54. doi: 10.1007/s00134-011-2411-1
2. Potter JE, McKinley S, Delaney A (2013) Research participants’ opinions of delayed consent for a randomised controlled trial of glucose control in intensive care. Intensive Care Med 39:472–480. doi: 10.1007/s00134-012-2732-8
3. Menon K, Ward RE, Gaboury I, et al. (2012) Factors affecting consent in pediatric critical care research. Intensive Care Med 38:153–159. doi: 10.1007/s00134-011-2412-0
4. Rhodes A, Moreno RP, Azoulay E, et al. (2012) Prospectively defined indicators to improve the safety and quality of care for critically ill patients: a report from the Task Force on Safety and Quality of the European Society of Intensive Care Medicine (ESICM). Intensive Care Med 38:598–605. doi: 10.1007/s00134-011-2462-3
5. Rhodes A, Ferdinande P, Flaatten H, et al. (2012) The variability of critical care bed numbers in Europe. Intensive Care Med 38:1647–1653. doi: 10.1007/s00134-012-2627-8
6. Volpicelli G, Elbarbary M, Blaivas M, et al. (2012) International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 38:577–591. doi: 10.1007/s00134-012-2513-4
7. Lamperti M, Bodenham AR, Pittiruti M, et al. (2012) International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Med 38:1105–1117. doi: 10.1007/s00134-012-2597-x
8. Chiumello D, Marino A, Brioni M, et al. (2013) Visual anatomical lung CT scan assessment of lung recruitability. Intensive Care Med 39:66–73. doi: 10.1007/s00134-012-2707-9
9. De Luca D, Piastra M, Chidini G, et al. (2013) The use of the Berlin definition for acute respiratory distress syndrome during infancy and early childhood: multicenter evaluation and expert consensus. Intensive Care Med 39:2083–2091. doi: 10.1007/s00134-013-3110-x
10. Asehnoune K, Mahe PJ, Seguin P, et al. (2012) Etomidate increases susceptibility to pneumonia in trauma patients. Intensive Care Med 38:1673–1682. doi: 10.1007/s00134-012-2619-8
11. Smalley N, MacLaren G, Best D, et al. (2012) Outcomes in children with refractory pneumonia supported with extracorporeal membrane oxygenation. Intensive Care Med 38:1001–1007. doi: 10.1007/s00134-012-2581-5
12. Fuchs L, Chronaki CE, Park S, et al. (2012) ICU admission characteristics and mortality rates among elderly and very elderly patients. Intensive Care Med 38:1654–1661. doi: 10.1007/s00134-012-2629-6
13. Zaal IJ, Spruyt CF, Peelen LM, et al. (2013) Intensive care unit environment may affect the course of delirium. Intensive Care Med 39:481–488. doi: 10.1007/s00134-012-2726-6
14. Tacon CL, McCaffrey J, Delaney A (2012) Dobutamine for patients with severe heart failure: a systematic review and meta-analysis of randomised controlled trials. Intensive Care Med 38:359–367. doi: 10.1007/s00134-011-2435-6
15. Thomas-Rueddel DO, Vlasakov V, Reinhart K, et al. (2012) Safety of gelatin for volume resuscitation—a systematic review and meta-analysis. Intensive Care Med 38:1134–1142. doi: 10.1007/s00134-012-2560-x
16. Azoulay E, Garrouste M, Goldgran-Toledano D, et al. (2012) Increased nonbeneficial care in patients spending their birthday in the ICU. Intensive Care Med 38:1169–1176. doi: 10.1007/s00134-012-2510-7<Back to the news list