Was gibt es Neues in der Intensivmedizin - eine Übersicht

Zusammenfassung

Die vorliegende Arbeit gibt eine Zusammenfassung wichtiger Untersuchungen zu Fragen der Intensivmedizin, die in intensivmedizinischen oder chirurgischen Fachzeitschriften im Jahr 2004 publiziert worden sind. Hierbei wurden ausschließlich klinische Studien berücksichtigt, überwiegend Metaanalysen und randomisierte Studien, sowie einzelne besonders wichtige oder interessante Beobachtungsstudien. Neben der Darstellung der wichtigsten Ergebnisse wurde auch eine Bewertung versucht, die jedoch nicht umfassend und vollständig sein kann, sondern als Denkanstoß für die kritische Würdigung durch den Leser gedacht ist. Bei der großen Zahl hochwertiger und relevanter Studien fällt auf, dass hierin auch eine signifikante Anzahl von Untersuchungen mit negativem Ergebnis enthalten ist und auf diese Weise ganz erheblich zur Festlegung des aktuellen Erkenntnisstandes beigetragen wird. Einige dargestellte Fragestellungen seien hier angesprochen: Vasopressin als Alternative zu Adrenalin bei der kardiopulmonalen Reanimation, Spezifizierung der Indikationen für den Einsatz von aktiviertem Protein C in der Sepsis, Bedeutung der Steroidtherapie bei Sepsis und Schädel-Hirn-Trauma, Epidemiologie des ARDS, Rolle von Sedierungsprotokollen, Weaningprotokollen und dem Zeitpunkt einer Tracheotomie für die Beatmungsdauer, Nutzen antibakteriell beschichteter Katheter zur Vermeidung der Katheter-assoziierten Sepsis und der Nutzen einer enteralen Ernährung im Vergleich zur parenteralen Applikation.

Abstract

This manuscript gives a review about important studies addressing problems in intensive care medicine that have been published in journals focussing on critical care medicine and surgery in 2004. Only clinical studies are included in this review, mostly metaanalyses, randomized controlled trials and a few important or interessting observational studies. In addition to describing major results a critical appraisal of each study is undertaken, which, however, is neither comprehensive nor complete. It is merely intentioned to address some important aspects for the reader that should be accounted for while interpreting the results. It is important to note that among the large number of excellent studies there is a substantial proportion of trials with negative results that significantly add to our knowledge. Some of the topics addressed in this manuscript include vasopressin as an alternative to epinephrine during cardipulmonary resuscitation, a specification concerning the use of activated protein C in patients with sepsis, the role of steroids in the treatment of sepsis and traumatic brain injury, the epidemiolody of ALI and ARDS, the role of sedation protocols, weaning protocols and the timing of tracheostomy for the duration of mechanical ventilation, the potential benefit of catheters with antimicrobial coating to reduce catheter-related sepsis, and the benefit of enteral nutrition as compared to the parenteral application.

Schlüsselwörter

Intensivmedizin - klinische Studien - randomisierte Studien - Metaanalysen

Key words

intensive care medicine - critical care - clinical trials - randomized trials - metaanalysis - outcome

Literatur

• 1 Bakker J, Grover R, McLukie A, Holzapfel L, Andersson J, Lodato R, Watson D, Grossmann S, Donaldson J, Takala J. (Glaxo Wellcome International Septic Shock Study Group) . Administration of nitrit oxide synthase inhibitor N^G-methyl-L-arginine hydrochloride (546C88) by intravenous infusion for up to 72 hours can promote the resolution of shock in patients with severe sepsis: Results of a randomized, double-blind, placebo-controlled multicenter study.  Crit Care Med. 2004;  32 1-12
• 2 Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart G, Opdam H, Silvester W, Doolan L, Gutteridge G. Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates.  Crit Care Med. 2004;  32 916-921
• 3 Brower R G, Lanken P N, MacIntyre N, Matthay M A, Morris A, Ancukiewicz M, Schoenfeld D, Thompson T. and the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network . Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome.  N Engl J Med. 2004;  351 327-336
• 4 Brun-Buisson C, Minelli C, Bertolini G, Brazzi L, Pimentel J, Lewandowski K, Bion J, Romand J A, Villlar J, Thorsteinsson A, Damas P, Armaganidis A, Lemaire F. for the ALIVE Study Group . Epidemiology and outcome of acute lung injury in European intensive care units.  Intensive Care Med. 2004;  30 51-61
• 5 Bulger E M, Jurkovich G J, Farver C L, Klotz P, Maier R V. Oxandrolone does not improve outcome of ventilator dependent surgical patients.  Ann Surg. 2004;  240 472-480
• 6 Carrasco M N, Bueno A, de las Cuevas C, Jiminez S, Salinas L, Sartorius A, Recio T, Generelo M, Ruiz-Ocana F. Evaluation of a triple-lumen central venous heparin-coated catheter versus a catheter coated with chlorhexidine and silver sulfadiazine in critically ill patients.  Intensive Care Med. 2004;  30 633-638
• 7 CRASH Trial Collaborators . Effect of intravenous corticosteroids on death within 14 days in 10 008 adults with clinically significant head injury.  Lancet. 2004;  364 1321-1328
• 8 Esteban A, Frutos-Vivar F, Ferguson N D, Arabi Y, Apezteguia C, Gonzalaz M, Epstein S K, Hill N S, Nava S, Soares M A, D'Empaire G, Alia I, Anuzeto A. Non-invasive positive-pressure ventilation for respiratory failure after Extubation.  N Engl J Med. 2004;  350 2452-2460
• 9 Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R. and the SAFE Study Invesitgators . A comparison of albumin and saline for fluid resuscitation in the intensive care unit.  N Engl J Med. 2004;  350 2247-2256
• 10 Hallstrom A, Ornato J P. and the Public Access Defibrillation Trial Investigators . Public-access defibrillation and survival after out-of-hospital cardiac arrest.  N Engl J Med. 2004;  351 637-646
• 11 Keh D, Sprung C L. Use of corticosteroid therapy in patients with sepsis and septic shock.  Crit Care Med. 2004;  32 (Suppl) 527-533
• 12 Kortoglu M, Yanar H, Bisel Y, Guloglu R, Kizilirmak S, Büyükkurt D, Granit V. Venous Thromboembolism Prophylaxis after Head and Spinal Trauma: Intermittent Pneumatic Compression Devices Versus Low Molecular Weight Heparin.  World J Surg. 2004;  28 807-811
• 13 Krishnan J A, Moore D, Robeson C, Rand C S, Fessler H E. A prospective, controlled trial of a protocol-based strategy to discontinue mechanical ventilation.  Am J Respir Crit Care Med. 2004;  169 673-678
• 14 Laterre P F, Levy H, Clermont G, Ball D E, Garg R, Nelson D R, Dhainont J F, Angus D C. Hospital mortality and resource use in subgroups of the Recombinant Human Activated Protein C Worldwide Evaluation in severe Sepsis (PROWESS) trial.  Crit Care Med. 2004;  32 2207-2218
• 15 Leon C, Ruiz-Santana S, Rello J, de la Torre M V, Valles J, Alvarez-Lerma F, Sierra R, Saavedra P, Alvarez-Salgado F. for the Cabana Study Group . Benefits of minocycline and rifampicin-impregnated central venous catheters.  Intensive Care Med. 2004;  30 1891-1899
• 16 Opal S, Laterre P F, Abraham E, Francois B, Wittebole X, Lowry S, Dhainaut J F, Warren B, Dugernier T, Lopez A, Sanchez M, Demeyer I, Jauregui L, Lorente J A, McGee W, Reinhart K, Kljucar S, Sauza S, Pribble J. and COMPASS investigators . Recombinant human platelet-activating factor acetylhydrolase for treatment of severe sepsis: Results of a phase II, multicenter, randomized, double-blind, placebo-controlled, clinical trial.  Crit Care Med. 2004;  32 332-341
• 17 Panacek E A, Marshall J C, Albertson T E, Johnson D H, Johnson S, MacArthur R, Miller M, Barchuk W T, Fischkoff S, Kaul M, Teoh L, Van Meter L, Daum L, L emeshow S, Hicklin G, Doig C. Efficacy and safety of the monoclonal anti-tumor necrosis factor antibody F(ab)₂ fragment afelimomab in patients with sepsis and elevated interleukin-6 levels.  Crit Care Med. 2004;  32 2173-2182
• 18 Rumbak M J, Newtom M, Truncale T, Schwartz S W, Adams J M, Hazard P B. A prospective, randomised, study comparing early percutaneous dilational tracheotomy to prolonged tranlaryngeal intubation (delayed tracheotomy) in critically ill medical patients.  Crit Care Med. 2004;  32 1689-1694
• 19 Salam A, Tilluckdharry L, Amoateng-Adjepong Y, Manthous C A. Neurologic status, cough, secretions and Extubation outcomes.  Intensive Care Med. 2004;  30 1334-1339
• 20 Schweickert W D, Gehlbach B K, Pohlmann A S, Hall J B, Kress J P. Daily interruption of sedative infusions and complications of critical illness in mechanically ventilated patients.  Crit Care Med. 2004;  32 1272-1276
• 21 Simpson F, Doig G S. Parenteral vs. enteral nutrition in the critically ill patient: a metaanalysis of trials using the intention to treat principle.  Intensive Care Med. 2004;  (published online: 9 December 2004)
• 22 Spragg R G, Lewis J F, Walmrath H D, Johanningman J, Bellingan G, Laterre P F, Witte M C, Richards G A, Rippin G, Rathgeb F, Hafner D, Taut F JH, Seeger W. Effect of recombinant surfactant protein C-based surfactant on the acute respiratory distress syndrome.  N Engl J Med. 2004;  351 884-892
• 23 Stiell I G, Wells G A, Field B, Spaite D W, Nesbitt L, De Maio V, Nichol G, Cousineau D, Blackburn J, Munkley D, Luinstra-Toohey L, Campeau T, Dagnone E, Lyver M. and the Ontario Prehospital Advanced Life Support Group . Advanced cardiac life support in out-of-hospital cardiac arrest.  N Engl J Med. 2004;  351 647-656
• 24 Wenzel V, Krismer A C, Arntz H R, Sitter H, Stadlbauer K H, Lindner K H. A comparison of vasopression and epinephrine for out-of-hospital cardiopulmonary resuscitation.  N Engl J Med. 2004;  351 105-113