Speaker: Tamas Szakmany, MBE, MD, PhD, EDIC, DESA, FRCA, FFICM, FCCM
Tamas Szakmany, MBE, MD, PhD, EDIC, DESA, FRCA, FFICM, FCCM: Hello, my name is Tamas Szakmany, the Associate Editor for Social Media at Critical Care Explorations. Here are my top reads from Critical Care Explorations this month. Small animal models of new therapeutics in sepsis did not manage to transform the field and it is now acknowledged that large animal models could be better utilized in the preclinical phase. This has been particularly true for pediatric models of sepsis, where there is a real paucity of data from animal experiments. A group of basic scientists and pediatric intensivists in Houston, Texas have developed a piglet model of sepsis, where MRSA induced sepsis has led to coagulopathy, disseminated microvascular thrombosis and early organ injuries. This developed model is clinically relevant and can be used to study mechanistic features of the disease, to trial out the efficacy and usefulness of new biomarkers and also to use it as a test model for new therapeutics. In a narrative review, Dr. Schriner and colleagues investigated the extent to which citrate plays a separate and independent role in the physiology of the massively bleeding patient. They found that historical studies showed increased risk with transfusion of large amounts of citrate but this aspect of the transfusion practice has not been investigated in the modern era. This is despite significant changes including the emphasis on transfusion of plasma and platelets with 1:1:1 model or with red blood cell transfusion which contains a large citrate load. The authors argue that the focus on correcting hypocalcemia in massive transfusion is important, however, may be missing the mark as the part of physiology of hypercalcemia in severe bleeding is poorly understood and the under-appreciated risk of transfusing large citrate loads may be greater than just causing hypocalcemia. Dr. Ethgen and colleagues asked the question if initial continuous renal replacement therapy (CRRT) is cost effective compared to initial intermittent hemodialysis (IHD) in acute kidney injury (AKI) patients with fluid overload? In their model based analysis, the initial CRRT was associated with increased life years (LYs) and quality adjusted life years (QALYs) compared with initial intermittent hemodialysis (IHD). The important savings observed for initial CRRT with a lower rate of dialysis dependency among survivors did not fully offset the incremental cost of CRRT and dialysis independent survival. The incremental cost per life years gained and the incremental cost per quality gained with CRRT over initial intermittent hemodialysis were both below the prevailing willingness-to-pay thresholds in the United States. They concluded that there is an economic rationale for CRRT as the initial modality of choice in AKI patients who have fluid overload and who require renal replacement therapy. Please take time to read these articles and more by visiting ccejournal.org ccejournal.org. Also follow us on social media @criticalexplore. Stay safe everyone.
