Critical Care Journals Research Articles

An analysis of citations of publications in anaesthesia journals.

Which journals cite work published in anaesthetic journals is of potential interest to authors, editors and publishers. We analysed citations made in 2017-2018 for articles, reviews, editorials and letters published by 12 anaesthetic journals in 2016, using the Web of Science™ citation index platform. We analysed 12,544 citations made for 3518 items. Citations were most often made by specialist anaesthesia journals and critical care journals, and occurred most commonly in articles, followed by reviews, editorials and letters. The median (IQR [range]) number of citations made per item was 3.3 (2.6-4.1 [1.6-5.1]). The median (IQR [range]) number of journals that cited the 12 source journals was 302 (236-449 [139-671]). The median (IQR [range]) proportion of citations made by the same journal that published the items (i.e. 'self-citations') was 15% (11-17% [5-32%]). There were 1305/1932 (68%) citations made by North American journals for items published in North American journals and 1712/2063 (83%) citations made by European journals for items published in European journals, p<0.0001. Our analysis may inform authors, editors and publishers where to submit work, what editorial policy to pursue and what journal strategy to follow, respectively.

Global contribution of Indian authors in various critical care journals: An Eye-opener.

Global contribution of Indian authors in various critical care journals: An Eye-opener.

A bibliometric analysis of publications on trauma in critical care medicine during 1980-2018: A holistic view.

There is not a holistic bibliometric study evaluating the publications in the literature even though trauma is a paramount subject in the field of critical care. This study aimed to investigate the important articles and journals receiving the most citations and publishing the most articles, revealing international cooperation and uncovering trend topics in this subject as a consequence of analyzing articles on trauma in the field of critical care published between 1980 and 2018 using bibliometric analysis methods. Publication scan in this study was performed using Web of Science (WoS) database. Literature review was limited to only publications indexed in the field of Critical Care. "Trauma" was used as the keyword to reach relevant publications. Linear regression analysis was performed to predict the number of articles foreseen to be published in the upcoming years in the subject of trauma. As a result of the literature review, a total of 10851 publications were found. Six thousand four hundred and eighty-nine (59.8%) of these publications were under the category of article. First three countries with the most publications were respectively as the United States of America (4096) (63.1%), Canada (401) and Germany (380). Turkey ranked 21 with 41 publications. The article titled "Evaluating trauma care - the triss method" published in 1987 had received the most citations. The journal with the most publications and citations was "Journal of Trauma Injury Infection and Critical Care". This study will be a useful guide to all scientists and clinicians conducting research on trauma in critical care.

Controlled trial of budesonide-formoterol as needed for mild asthma: Discussions from @respandsleepjc (#rsjc)

"Controlled trial of budesonide-formoterol as needed for mild asthma: Discussions from @respandsleepjc (#rsjc)." Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 4(1), pp. 68–69

Occupational Therapy in the ICU: A Scoping Review of 221 Documents.

Occupational therapists have specialized expertise to enable people to perform meaningful "occupations" that support health, well-being, and participation in life roles. Given the physical, cognitive, and psychologic disability experienced by ICU survivors, occupational therapists could play an important role in their recovery. We conducted a scoping review to determine the state of knowledge of interventions delivered by occupational therapists in adult ICU patients. Eight electronic databases from inception to 05/2018. We included reports of adult patients receiving direct patient care from an occupational therapist in the ICU, all study designs, and quantitative and qualitative traditions. Independently in duplicate, interprofessional team members screened titles, abstracts, and full texts and extracted report and intervention characteristics. From original research articles, we also extracted study design, number of patients, and primary outcomes. We resolved disagreements by consensus. Of 50,700 citations, 221 reports met inclusion criteria, 74 (79%) published after 2010, and 125 (56%) appeared in critical care journals. The three most commonly reported types of interventions were mobility (81%), physical rehabilitation (61%), and activities of daily living (31%). We identified 46 unique original research studies of occupational therapy interventions; the most common study research design was before-after studies (33%). The role of occupational therapists in ICU rehabilitation is not currently well established. Current interventions in the ICU are dominated by physical rehabilitation with a growing role in communication and delirium prevention and care. Given the diverse needs of ICU patients and the scope of occupational therapy, there could be an opportunities for occupational therapists to expand their role and spearhead original research investigating an enriched breadth of ICU interventions.

In Memoriam: Brian Kavanagh, 1962 to 2019

In Memoriam: Brian Kavanagh, 1962 to 2019

HEART BREAKS TO BREATHE: RECURRENT TAKOTSUBO CARDIOMYOPATHY IN COPD EXACERBATION

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Takotsubo syndrome (TTS) is defined as reversible stress-induced cardiomyopathy presenting as apical ballooning or mid-ventricular, basal, or focal wall motion abnormalities in the absence of coronary artery disease. It can be provoked by a stressful emotional situation or exposure to catecholamine surge. It’s a rare phenomenon to have a lung-heart axis leading to recurrent TTS. Here we present a rare case of recurrent TTS in the setting of COPD exacerbations also termed as bronchogenic TTS CASE PRESENTATION: 64 years old female with presented with dyspnea secondary to COPD exacerbation due to bacterial pneumonia was noted to have EKG changes with T-wave inversion, mild troponin elevation consistent with an ischemic lesion, elevated BNP 6103, followed by urgent cardiac catheterization noted to have non-significant coronary artery disease. Transthoracic echocardiogram (TTE) reported left ventricular ejection fraction (LVEF) of 25-29% with moderate sized apical, septal, posterior and anteroseptal wall motion abnormalities with akinesis of the segment consistent with TTS. Work up was negative for infective endocarditis, neurological and neuroendocrine tumor. She was treated with guideline-directed medical therapy (GDMT). LVEF normalized to 55%-59% in a follow up TTE. Seventeen months later she got readmitted with another episode of acute hypoxic hypercapnic respiratory failure requiring intubation with cardiac collapse. Patient had similar cardiac Catheterization findings but reduced LVEF of 30-34% consistent with TTS, again treated with GDMT, followed by a return of LVEF to normalization in a repeat TTE DISCUSSION: Recurrent TTS in the setting of COPD exacerbation is an extremely rare phenomenon exact cause of which remains unknown. Catecholamine surge causing microvascular dysfunction leading to cardiac stunning is a leading hypothesis. In COPD exacerbation adding beta 2 adrenergic agonists in management might potentiate worsening of cardiac stunning. Recurrent TTS has 19% overall risk for serious complications such as cardiogenic shock similar to acute coronary syndrome. The first step toward treatment is the removal of precipitating etiology like stress and in our case COPD exacerbation. ACE-inhibitors and angiotensin receptor blockers have a protective effect in reducing recurrent TTS while beta blockers have shown limited benefit. Even after recovery patient with TTS remains at high risk for electrical and mechanical complications CONCLUSIONS: Recurrent TTS in setting of COPD exacerbation has unknown incidence yet it highlights the intricate relationship of heart-lung axis. While TTS might be reversible, underlying pathophysiological insult might be permanent. We encourage physicians to not consider TTS as benign pathology and do every effort to reduce its recurrence. COPD exacerbation with TTS has worse prognosis with higher risk of hypoxic injury warranting improved COPD management. Reference #1: Rennyson, S. L., Parker, J. M., Symanski, J. D., & Littmann, L. (2010). Recurrent, severe, and rapidly reversible apical ballooning syndrome in status asthmaticus. Heart & Lung: The Journal of Acute and Critical Care, 39(6), 537-539. Reference #2: Manfredini, R., Fabbian, F., De Giorgi, A., Pala, M., Menegatti, A. M., Parisi, C., ... & Bossone, E. (2014). Heart and lung, a dangerous liaison-Tako-tsubo cardiomyopathy and respiratory diseases: a systematic review. World journal of cardiology, 6(5), 338. DISCLOSURES: No relevant relationships by Sreelatha Naik, source=Web Response No relevant relationships by Muhammad Pir, source=Web Response No relevant relationships by najam saqib, source=Web Response

ACCELERATED DEVELOPMENT OF PULMONARY ARTERIAL HYPERTENSION IN THE SETTING OF ABATACEPT THERAPY

SESSION TITLE: Pulmonary Vascular Disease SESSION TYPE: Fellow Case Reports PRESENTED ON: 10/22/2019 3:45 PM - 4:45 PM INTRODUCTION: Pulmonary arterial hypertension (PAH) is a rare and debilitating disease, commonly related to connective tissue disease (CTD), idiopathic or hereditary in nature or due to certain drugs. New medications have been acknowledged as being a risk factor for developing PAH.There are case reports of some biologic drugs as a possible risk factor. Abatacept is a chimeric protein that inhibits T-lymphocyte activation and is used as a biologic drug to treat autoimmune diseases. We present a patient with PAH and acceleration of symptoms after initiation of Abatacept for underlying autoimmune disease. CASE PRESENTATION: We present a 46-year-old woman with mixed connective tissue disease and rheumatoid arthritis for 5 years, who presented with six weeks of rapidly progressed dyspnea on exertion, orthopnea and pedal edema. She had been evaluated 2 months prior, while on Infliximab, for mild intermittent dyspnea for the past 6 months and noted to have normal pulmonary function and echocardiogram. She was subsequently switched to Abatacept due to a intolerance with Infliximab. A month after initiation of this medication her dyspnea worsen and she presented 10 weeks after with severe dyspnea. Echocardiogram revealed moderate right ventricle (RV) dilation and estimated pulmonary artery systolic pressure (PASP) of 93 mmHg and right atrial pressure (RAP) of 15 mmHg. Pulmonary embolism was ruled out. Right heart catheterization (RHC) measured a mean PAP of 50 mmHg and PVR of 20 Woods units. PAH was diagnosed with WHO functional class 3. Abatacept was discontinued as a potential risk factor that accelerated symptoms.Combination therapy was initiated with Tadalafil, Ambrisentan and Furosemide, and her WHO functional class improved to 1. Repeat echocardiogram at 6 months showed PASP: 35 mmHg, RAP: 3 mmHg with normal RV size and function and markedly improved six-minute walk distance. DISCUSSION: PAH is an uncommon debilitating disease with nonspecific symptoms, making early diagnosis challenging. This makes identification of risk factors for development and progression of PAH crucial. CTD is a well-established risk factor as are certain medications. With the growing use of biologic drugs for CTD therapy, these drugs as risk factors for PAH might grow as well. To the best of our knowledge this is the second case reported with Abatacept potentially accelerating PAH symptoms in the setting of treatment for CTD. CONCLUSIONS: In an era of increasing biologic agents use in patients with CTD, who are already at risk for PAH, physicians need to be aware of this potential association. Reference #1: Promislow, S. et al. Pulmonary arterial hypertension associated with abatacept treatment for rheumatoid arthritis: A case report. Canadian Journal of Respiratory, Critical Care, and Sleep Medicine. 2018 Reference #2: Gibbson, E. et al Reversible pulmonary arterial hypertension associated with interferon-beta treatment for multiple sclerosis. Can Respir J. 2015 DISCLOSURES: No relevant relationships by Selvin Jacob, source=Web Response No relevant relationships by Ginny Marmolejos, source=Web Response No relevant relationships by Kartik Ramakrishna, source=Web Response

SYNTHETIC CANNABINOIDS: A LESS UNDERSTOOD CAUSE OF ACUTE CORONARY SYNDROME

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Current research suggests there is an association between natural cannabinoid use and acute coronary syndrome (ACS). Via an extensive literature review we will describe how synthetic marijuana can cause ACS in patients lacking typical cardiac risk factors. METHODS: Cardiology, critical care, and emergency medicine journals were searched for keywords including marijuana, tetrahydrocannabinol (THC), K2/spice in addition to ACS, myocardial infarction and sudden death. Inclusion criteria were topic relevance, peer review, and recent publication. RESULTS: A Norwegian study revealed THC as the only drug present in six postmortem patients with unexplained sudden death. Another larger study identified a 4.8-fold increase in acute myocardial infarction risk within an hour of marijuana use. Multiple case reports have linked synthetic derivatives, known as K2/spice, with ACS in young patients with no known health issues including three cases of myocardial infarction in teenage boys as well as several ACS events in healthy adults. CONCLUSIONS: An active component of both natural and synthetic marijuana is THC. It blocks parasympathetic pathways via norepinephrine release and is thought to be the cause of most cardiovascular effects. One study found a 6-53% increase in heart rate and a 4-9% rise in cardiac output after smoking marijuana, while another found a 30% increase in cardiac output and a dose-dependent increased heart rate of 20-100%. Both factors can lead to oxygen demand/delivery mismatch, which marijuana exacerbates further by increasing carboxyhemoglobin. THC can also disrupt oxygen delivery via vasospasm of the coronary vessels, increased shear stress of the arterial walls, and by forming a procoagulant state due to increased tissue factor expression in monocytic cells. Cannabinoid receptor type 1 (CB1R) is one of two receptors found abundantly in the central and peripheral nervous systems. When bound by THC, CB1R triggers autonomic responses which directly affect the vascular endothelial and smooth muscles, myocardium, and circulating erythrocytes. A recent study found CB1R leads to p38 and JNK mitogen-activated protein kinase (MAPK) activation. This increases reactive oxygen species (ROS) generation and contributes to endothelial and cardiomyocyte cell dysfunction or death. Synthetic cannabinoids are mixtures of several synthetic CB1R agonists. They can be up to 170-times more potent, leading to severe cardiac outcomes. CLINICAL IMPLICATIONS: More research is needed to fully understand effects of synthetic cannabinoids on the cardiovascular system, as synthetic marijuana may be much more dangerous than natural cannabis. It is paramount for both emergency and critical care physicians to be cognizant of the possible detrimental effects of synthetic marijuana in order to prevent ACS related events in the future. DISCLOSURES: No relevant relationships by Gary Esper, source=Web Response No relevant relationships by Peter Nesbitt, source=Web Response No relevant relationships by Ravi Patel, source=Web Response No relevant relationships by Heidi Storer, source=Web Response No relevant relationships by O'Rell Williams, source=Web Response No relevant relationships by Thijs Wolf, source=Web Response

A CASE OF TROPICAL ILLNESS MANAGED IN THE MEDICAL ICU WITH AN INVESTIGATIONAL NEW DRUG

SESSION TITLE: Case Report Semifinalists 3 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Rates of international travel are increasing along with increasing exposure to tropical diseases. It is of importance to maintain knowledge of common tropical diseases and treatment options. CASE PRESENTATION: A 30-year-old male, who returned a week prior from admission, from a vocational trip to Nigeria. Patient presented with symptoms of headache, fever, nausea, vomiting, abdominal pain and diarrhea. Patient was septic but otherwise hemodynamically stable, with presenting labs demonstrating profound thrombocytopenia with low haptoglobin (table 1) and presence of malaria on Wright-Giemsa stain. Blood smear demonstrated 17% Plasmodium Falciparum paracitemia. The Center of Disease Control(CDC) was contacted. Patient was started on treatment with intravenous(IV) quinidine and doxycycline and admitted to the Medical Intensive Care Unit(MICU) for further monitoring. Due to lack of available IV quinidine to complete therapy the decision was made to transition to IV artesunate and continued on doxycycline. Hospital course remained uncomplicated with quick resolution of parasitic loads (<1%). DISCUSSION: Malaria with Plasmodium Falciparum occurring in certain geographical areas, including Nigeria, are categorized by the CDC as a chloroquine resistant. Four applicable pharmacological therapies are available in such cases: atovaquone-proguanil, artemether-lumefantrine, quinine in combination with doxycycline, tetracycline or clindamycin and mefloquine. Quinine is the only FDA approved IV medication for treatment of severe malaria. The CDC defines severe malaria by the presence of one of more specifically defined clinical signs and symptoms and/or parasitemia of >5%. Our patient was stratified into a category of severe malaria by presence of a paracitemia of 17%. Per CDC recommendations severe malaria should be treated with IV antimalarial medication. World Health Organization recommends artesunate over quinine therapy for severe malaria. The FDA has approved artesunate as an investigational option in certain individuals who qualify. CONCLUSIONS: Artesunate is an effective alternative treatment option for individuals with severe malaria. We demonstrate a case of successful treatment of severe chloroquine resistant plasmodium falciparum malaria with artesunate. Reference #1: Centers for Disease Control and Prevention. (2018). Treatment of Malaria: Guidelines For Clinicians (United States) Reference #2: Dilip R. Karnad, MD, Guy A. Richards, MD PhD, Gisele Sampaio Silva, MD, Pravin Amin, MD. Tropical diseases in the ICU: A syndromic approach to diagnosis and treatment. Journal of Critical Care 46(2018)119-126 DISCLOSURES: No relevant relationships by Shozab Ahmed, source=Web Response No relevant relationships by Monika Kakol, source=Web Response

BLINDED BY THE LIGHT: A CASE OF MALIGNANT PLEURAL EFFUSION WITH TRANSUDATIVE PROPERTIES

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Light’s criteria is routinely used to help aid in the diagnosis and treatment of pleural effusions by categorizing them into transudates or exudates. Pleural effusions due to malignancy and infection are classically exudative, while effusions from heart failure, cirrhosis, and renal failure are examples of usual transudates (1). When exceptions to this pattern do occur, it is most often that a transudate is misclassified as an exudate (1). Presented is a case where a transudative effusion was later discovered to be malignant due to likely concurrent hepatic hydrothorax. CASE PRESENTATION: A 59 year-old male with a history of alcoholic cirrhosis presented with respiratory distress and right upper quadrant pain was found to have complete opacification of the left hemithorax on chest X-ray. Upon admission, the pulmonary service was consulted where bedside evaluation confirmed a large right pleural effusion anechoic by ultrasound. Diagnostic thoracentesis was consistent with a transudative effusion with pleural protein 1.1, serum protein 5.6, pleural lactate dehydrogenase 76, and serum lactate dehydrogenase 269. Hepatic hydrothorax was considered to be the likely etiology given presence of ascites and a history of cirrhosis. Medical cytology however later revealed atypical neoplastic cells. Abdominal imaging revealed a large mass in the right hepatic lobe. IR-guided biopsy revealed metastatic adenocarcinoma with a primary cholangiocarcinoma. Prior to oncologolical evaluation for chemotherapeutic options, the patient decompensated with worsening encephalopathy and respiratory distress from re-accumulation of pleural fluid and abdominal ascites. Given overall grave prognosis, goals of care discussions were held and comfort care was initiated with the patient passing comfortably shortly thereafter. DISCUSSION: Light’s criteria are routinely used to help aid in the diagnosis and treatment of pleural effusions by categorizing them into transudates or exudates. Certain etiologies of pleural effusions are classically transudative, while others are exudative (1). When pleural studies do not meet Light’s criteria for an exudative effusion, physicians will tend to consider that malignancy and infection are ruled out (2, 3). This can lead to a missed or incorrect diagnosis since malignant effusions have been described in the literature to be transudative in as much 10.6% (4) of cases. We describe a case where pleural studies did not meet criteria for an exudative effusion, so a malignant etiology was initially considered to be unlikely. However, medical cytology later showed malignant cells, leading to further work-up revealing the primary underlying cholangiocarcinoma. CONCLUSIONS: When an effusion is transudative, one cannot assume that malignancy is ruled out, otherwise a deadly diagnosis may be missed. Reference #1: Light RW. “The Light criteria. The beginning and why they are useful 40 years later.” Clinical Chest Medicine 2013; 34(1): 21-6. Reference #2: McGrath EE, Anderson PB. “Diagnosis of pleural effusion: a systematic approach.” American Journal of Critical Care 2011; 20(2): 119-27. Reference #3: Thomas R, Cheah HM, Creaney J, Turlach BA, Lee YCG. “Longitudinal measurement of pleural fluid biochemistry and cytokines in malignant pleural effusions.” Chest 2016; 149(6): 1494-500. DISCLOSURES: no disclosure on file for Alfredo Astua; No relevant relationships by Dawn Maldonado, source=Web Response No relevant relationships by Michael Megally, source=Web Response

MANAGEMENT OF SECONDARY HYPERFIBRINOLYSIS IN EXTRACORPOREAL MEMBRANE OXYGENATION AS IDENTIFIED BY THROMBOELASTOGRAPHY

SESSION TITLE: Clinical Conundrums in ECMO SESSION TYPE: Fellow Case Reports PRESENTED ON: 10/20/2019 01:00 pm - 02:00 pm INTRODUCTION: Hemorrhagic and thrombotic complications are the leading cause of morbidity and mortality in patients on Extracorporeal Membrane Oxygenation (ECMO). Pinpointing the cause of hemostasis-related complications is very challenging. Identifying the etiology of the coagulopathy in a timely manner is crucial so as to be able to prevent fatal complications. We describe a group of six patients in which Thromboelastography (TEG) was utilized to identify secondary hyperfibrinolysis as the cause of bleeding. Establishing this diagnosis led to rapid changes in management with quick resolution of bleeding. CASE PRESENTATION: Six ECMO patients in the MICU at Banner University Medical Center-Phoenix, all at variable times during their ECMO run, suffered clinical hemorrhage. Four patients were anticoagulated with unfractionated heparin (UFH) while two were off anticoagulation completely. A TEG was obtained at time of bleeding and we observed elevated LY-30 levels greater than 7.5%, an indication of lysis. Upon identification of the fibrinolytic state, these patients were treated either by initiating anticoagulation or by switching anticoagulant class to a direct thrombin inhibitor. This decision was made with the understanding that the fibrinolysis was a manifestation of hypercoagulability secondary to intravascular or ECMO related clot that must be treated with anticoagulation, despite the clinical bleeding. With this approach, we observed resolution of hemorrhage as the anticoagulant was titrated to normalization of LY-30 levels targeting resolution of the underlying secondary hyperfibrinolysis. DISCUSSION: TEG has long been used in the Trauma and Surgical ICU’s however its use in the MICU, particularly in ECMO, is not yet common practice. Most ECMO centers use UFH as their anticoagulant of choice. Generally, aPTT is the standard assay used for monitoring UFH levels. As a value obtained from plasma however, aPTT may not reflect the coagulation cascade comprehensively. TEG, a test of whole blood, better allows for examination of platelet function and provides details regarding time to fibrin formation and clot lysis. This is of great utility in patients during ECMO given the complexity of coagulation disorders associated with it. CONCLUSIONS: After extensive literature review, we find this approach to be novel in that management of bleeding was targeted at the treatment of secondary hyperfibrinolysis during ECMO with the use of TEG. Further, blood product transfusions were minimized and inappropriate interruption in anticoagulation was avoided in a thrombus prone circuit. Anticoagulation is often reflexively decreased or discontinued when hemorrhage is observed. Given that secondary hyperfibrinolysis is truly a manifestation of systemic hypercoagulability and treated with anticoagulation, we find this final point to be of ultimate importance. Reference #1: Panigada M, Iapichino GE, Brioni M, Panrello G, Protti A, Grasselli G, Occhipinti GO, Novembrino C, Consonni D, Arcadipine A, Gattinoni L, Presenti, A. Thromboelastography-based anticoagulation management during extracorporeal membrane oxygenation: a safety and feasibility pilot study. Annals Intensive Care. 2018; 16;8(1):7. Reference #2: Mulder, M.M.G, Fawzy, G, Lance, M.D.ECMO and anticoagulation: a comprehensive review. Netherlands Journal of Critical Care. 2017; 26(1). Reference #3: Kreyer S, Muders T, Theuerkauf N, Spitzhuttl J, Schellhaas T, Schewe JC, Guenther U, Wrigge H, Putense C. Hemorrhage under veno-venous extracorporeal membrane oxygenation in acute respiratory distress syndrome patients: a retrospective data analysis. Journal of Thoracic Disease. 2017; 9(12): 5017–5029. DISCLOSURES: No relevant relationships by Thomas Ardiles, source=Web Response No relevant relationships by Sarika Savajiyani, source=Web Response

Evidence-Based Review and Discussion Points

Evidence-Based Review and Discussion Points

Contemporary Academic Contributions From Anesthesiologists in Adult Critical Care Medicine.

Anesthesiology has a long relationship with critical care medicine (CCM). However, US anesthesiologists are less likely to practice CCM than non-US anesthesiologists. To date, no studies have compared academic contributions in CCM between US anesthesiologists and non-US anesthesiologists. The objective of our study was to use recent trends in critical care publications as a surrogate for academic contribution among US and non-US anesthesiologists. Research articles published between 2010 and 2015 in 3 anesthesiology journals (Anesthesiology, Anesthesia & Analgesia, and British Journal of Anaesthesia) and 3 multidisciplinary CCM journals (Critical Care Medicine, Intensive Care Medicine, and Journal of Critical Care) were reviewed. Author information, including the primary department appointment and geographic location for the first and senior author(s), and article details, including topic and publication type, were collected. Odds ratios for having a first or senior author from the United States were calculated. Anesthesiologists' contributions in individual journals were summarized, as were trends in anesthesiology CCM publications during the 6-year study period. A total of 3831 articles were reviewed, with 1050 (27.4%) having US authors. Eighty-two and one-half percent of CCM articles in anesthesiology journals had a US anesthesiologist as first author, and 81% had a US anesthesiologist as senior author, while fewer CCM articles in multidisciplinary journals had a US anesthesiologist as first (12.1%) or senior (12.3%) author. When considering all publications, 16.3% and 16.4% of articles had a US anesthesiologist as the first or senior author compared with articles for which non-US anesthesiologists were first (23.8%) or senior (20.9%) authors. The odds of having a US anesthesiologist as first or senior author compared to a non-US anesthesiologist for all publications were 0.6 (0.5-0.7) and 0.7 (0.6-0.9). The number of publications trended downward for both US anesthesiologists and non-US anesthesiologists during the study period. When compared to non-US anesthesiologists, US anesthesiologists had more CCM publications in anesthesiology journals and fewer publications in multidisciplinary CCM journals. The number of anesthesiology CCM publications decreased for both US and non-US anesthesiologists throughout the study period.

Study Comparing Traditional Versus Alternative Metrics to Measure the Impact of the Critical Care Medicine Literature.

Our objective was to evaluate the association between traditional metrics such as Impact Factor and Eigenfactor with respect to alternative metrics. The Altmetric Attention Score for the top nine pulmonary and critical care journals was compared with Impact Factor, Eigenfactor, and citations over two time periods (2007-2011 and 2012-2016). There was a significant increase in the Altmetric Attention Score (52 from 2007 to 2011 vs 1,061 from 2012 to 2016; p < 0.001) but no significant differences in Total Citations, Impact Factor, or Eigenfactor. There was a strong positive correlation between citations and Altmetric Attention Score, negative correlations between Eigenfactor and Altmetric Attention Score for most journals, and no clear association between Impact Factor and Altmetric Attention Score. Over time, the digital reach of traditional publications has increased significantly, while no significant increase was noted for the traditional metrics. These findings likely reflect discussions of articles online that are not captured by traditional metrics and hence their impact on the community at large.

Evidence-Based Review and Discussion Points

Evidence-Based Review and Discussion Points

Trabajos originales en Colombia de lesión renal aguda ¿Qué hay disponible a nivel nacional?

Introducción: la lesión renal aguda (LRA) es una entidad sindromática con múltiples etiologías cuyas estrategias de prevención y tratamiento se deben basar en los datos epidemiológicos locales. En América Latina los trabajos originales son escasos y no hay certeza del estado de la investigación sobre LRA en Colombia. Objetivo: conocer la literatura colombiana disponible sobre LRA. Metodología: se realizó la búsqueda en Embase, Medline-Cochrane Library y Lilacs por medio electrónico y físico en los índices de las revistas más representativas a nivel nacional desde 1970. Se excluyeron las relacionadas con enfermedad renal crónica, trasplante renal y enfermedad glomerular primaria. Resultados: Se identificaron 46 trabajos de investigación colombiana en LRA de los cuales 16 (34,7%) son originales, 11 (23,9%) reportes y series de casos, 10 (21,7%) revisiones de tema, 7 (15,2%) póster de congreso y 2 (4,3%) guías y consensos. De los trabajos originales, 11 (68,7%) pertenecen a pacientes en unidades de cuidado intensivo (UCI). La revista nacional con más publicaciones en el tema es Acta Colombiana de Cuidado Crítico. Conclusiones: la literatura colombiana en LRA es heterogénea, la mayoría de los trabajos originales se enfocan en el paciente crítico hospitalizado en UCI. Son escasas las publicaciones sobre epidemiología de la enfermedad y no existen datos unificados a nivel nacional.

A Bibliometric Analysis of the Most Cited Articles in Neurocritical Care Research.

Bibliometric analyses may indicate the most active journals, authors, countries, institutions and specialties by evaluating the most cited articles in a given research field. To the authors' knowledge, there is no bibliometric analysis regarding neurocritical care research. Thus, the aim of this study is to analyze and to provide a scope of the current scientific production in this area. The 100 most cited articles in the neurocritical care research were retrieved from the research "(neurocritical) AND (care)" in the Scopus database. The variables collected and included in this analysis were: number of citations, article title, first author's name, year and journal of publication and its impact factor (IF), specialty, affiliation and country of the corresponding author at the time of publication, and category of the article. Also, these variables were assessed for primary research only. The articles were published in 34 different journals from 1995 to 2017, with a mean citation number of 109.36, ranging from 44 to 540. Neurocritical Care (23 articles in top 100 and 2190 citations, IF = 3.163) and Critical Care Medicine (20 articles and 2896 citations in top 100, IF = 6.630) were the journals with the greatest number of articles and citations, respectively. Neurocritical Care also had the highest number of primary research papers (15 articles, accounting for 850 citations). Excepting one article from Asia (Singapore) and one from Oceania (Australia), all the other 98 papers were from North America (67) or Europe (31). United States was the country with most articles (60, 35 primary research) and citations (6115) among the top 100. Columbia University (11 articles, being 7 primary research, and 915 citations) was the institution with the highest number of articles and primary research articles in top 100, whereas University of Heidelberg (6 articles and 1220 citations) was the most cited institution. Neurology was the specialty with the greatest number of publications in top 100 and the most cited one (57 articles and 5983 citations). The first author with the greatest number of publications as well as primary research articles was A. I. Qureshi (5 articles, being 4 primary research, and 660 citations), while the most cited was K. H. Polderman (2 articles and 749 citations). Fifty-nine publications were primary and 41 secondary research. Among primary research, treatment/management was the most frequent and most cited topics (33 articles and 4172 citations). To the authors' knowledge, this is the first bibliometric analysis regarding neurocritical care research. Our findings suggest that the neurocritical care research field is more prominent in North America and Europe, more frequently published in specific critical care journals and after 1994. The most discussed topic was related to treatment and/or management within neurocritical care.

Evidence-Based Review and Discussion Points

Evidence-Based Review and Discussion Points

A cross-sectional description of open access publication costs, policies and impact in emergency medicine and critical care journals.

IntroductionFinding journal open access information alongside its global impact requires access to multiple databases. We describe a single, searchable database of all emergency medicine and critical care journals that include their open access policies, publication costs, and impact metrics.MethodsA list of emergency medicine and critical care journals (including citation metrics) was created using Scopus (Citescore) and the Web of Science (Impact Factor). Cost of gold/hybrid open access and article process charges (open access fees) were collected from journal websites. Self-archiving policies were collected from the Sherpa/RoMEO database. Relative cost of access in different regions were calculated using the World Bank Purchasing Power Parity index for authors from the United States, Germany, Turkey, China, Brazil, South Africa and Australia.ResultsWe identified 78 emergency medicine and 82 critical care journals. Median Citescore for emergency medicine was 0.73 (interquartile range, IQR 0.32–1.27). Median impact factor was 1.68 (IQR 1.00–2.39). Median Citescore for critical care was 0.95 (IQR 0.25–2.06). Median impact factor was 2.18 (IQR 1.73–3.50). Mean article process charge for emergency medicine was $2243.04, SD = $1136.16 and for critical care $2201.64, SD = $1174.38. Article process charges were 2.24, 1.75, 2.28 and 1.56 times more expensive for South African, Chinese, Turkish and Brazilian authors respectively than United States authors, but neutral for German and Australian authors (1.02 and 0.81 respectively). The database can be accessed here: http://www.emct.info/publication-search.html.ConclusionsWe present a single database that captures emergency medicine and critical care journal impact rankings alongside its respective open access cost and green open access policies.