For 10 years, Zahar et al prospectively observed 3,588 patients developing severe sepsis & septic shock who ended up in French ICUs. Their sample captured a broad array of infections acquired in the community, the hospital ward, or the ICU (about 1/3 each). After multivariate assessment, they could not find an independent influence on mortality [... read more]
Johnson et al reviewed charts in a retrospective case-control cohort study on 754 consecutive patients at Barnes-Jewish with severe sepsis or shock due to Gram-negative bacteremia. The exposure was receipt of antibiotics in the previous 90 days. 310 of the bacteremic patients had received antibiotics previously. Compared to unexposed controls, the previously antibiotic-exposed had a [... read more]
3% saline infusions have become standard care for increased intracranial pressure at many centers, based on mostly anecdotal evidence. Hauer et al looked retrospectively at 100 patients receiving 3% saline for severe stroke in 2008-2009 (intracerebral hemorrhage, subarachnoid hemorrhage, or ischemic) and compared them to 115 historical controls, 2007-2008 with “equal” underlying disease. Hypertonic saline [... read more]
Hyperbaric oxygen in the critically ill. Weaver LK. Crit Care Med 2011;39(7):1784-1791.
Fragou et al randomized 401 ICU patients to undergo subclavian vein central line placement with guidance either by ultrasound or anatomic landmarks. All cannulations were with an infraclavicular approach. The ultrasound group had a higher success rate (100% vs 87.5%), shorter time to access and fewer number of attempts, and a lower rate of complications. [... read more]
Stapleton et al report results of a phase II trial of 14 days of omega-3 fish oil vs. placebo in 90 people with acute lung injury or ARDS. There was no difference in the primary endpoint (inflammatory marker IL-8 in BAL fluid), nor in any clinical outcome. Crit Care Med 2011;39:1655-1662.
That’s what Banerjee et al argue, after retrospectively comparing ICU costs before/after implementation of 24-hour in-house intensivist coverage. They found that total costs for patients admitted at night declined by 61%, while daytime costs were unchanged. Crit Care Med 2011;39:1257-1262.
Potential metabolic consequences of statins in sepsis. Brealy DA et al. Crit Care Med 2011;39:1514-1520.
Survival of trauma patients after massive red blood cell transfusion using a high or low red blood cell to plasma transfusion ratio. Rajasekhar et al. Crit Care Med 2011;39:1507-1513. Meta-analysis.
Toxic epidermal necrolysis and Stevens-Johnson syndrome. Gerull et al. Crit Care Med 2011;39:1507-1513.
Of 421 patients admitted to ICUs after cardiac arrest, 281 (67%) developed 373 infections, mostly pneumonias, report Mongardon et al. Crit Care Med 2011;39:1359-1364.
Bafadhel et al collected procalcitonin and CRP on 161 people admitted for COPD exacerbations, 96 for asthma exacerbations, and 62 for pneumonia (groups were discriminated by presence of consolidation on chest film), at 2 UK hospitals. The assays performed extremely well (area under the curve >0.93 for each) at differentiating pneumonia from non-infectious causes of [... read more]
Rice et al randomized 200 mechanically ventilated patients to either trophic feedings (10 mL/hr) or full enteric feedings for 6 days. There were no differences in mortality or ventilator-free days. The trophic-fed patients had fewer episodes of “high residuals.” (n=200) Crit Care Med 2011;39:967-974.
End-stage liver disease, critical care management of: Al-Khafaji A et al. Crit Care Med 2011;39:1157-1166. Hepatic failure review.
De Smet et al reheat the data from their 2009 NEJM study, in which they cluster-randomized and crossed-over 5,939 patients staying >48hrs in 13 Dutch ICUs to receive either 1) standard care; 2) selective oropharyngeal decontamination (topical amphotericin B, colistin, and tobramycin in the oropharynx), or 3) selective digestive tract decontamination (the same drugs in the mouth, stomach, [... read more]
As part of their landmark Keystone MHA project in Michigan ICUs (that previously demonstrated a 0% catheter-related bloodstream infection rate with adherence to a central-line bundle), Sexton, Pronovost et al also implemented the CUSP intervention to create a climate of continuous quality improvement and safety. Based on surveys of the staff in 71 ICUs, mean safety scores rose from 42.5% in 2004 to [... read more]
Clinical research is hamstrung by slow, labor-intensive data collection, necessitated by disparate technologies (or lack of them) in the ICU. Saeed et al announce MIMIC II, a free, public access database that includes nearly all the relevant data from 25,328 ICU stays at Beth Israel 2001-2007 (including hourly vital signs, all labs, and some ECG waveforms). The quantum leap here [... read more]
Maki et al randomized 407 patients at 25 dialysis units to have their catheters “locked” for up to 6 months with either heparin, or “C-MB-P solution” (citric acid, methylene blue, and propylparaben). The patients getting the antimicrobial potion had a 0.29 relative risk for bloodstream infection (BSI) without loss of catheter patency. (n=407) Crit Care Med 2011;39:613-620.
Looking retrospectively at 2,399 ICU patients with preadmission vitamin D measurements on file, those with vitamin D deficiency had an odds ratio of ~1.7 for 30, 90, and 365-day mortality after ICU admission, after multivariate analysis. Braun et al, Crit Care Med 2011;39:671-677.
Long-term complications of critical care: Desai SV, Crit Care Med 2011;39:371-379.