Jun 122011

Pileggi et al analyzed 28 studies and concluded that decontaminating the GI/respiratory tract with antiseptics reduced ventilator-associated pneumonia by 27%; decontamination with antibiotics reduced VAP by 36%. Antibiotic decontamination also reduced ICU infections in general, by 29%. Critical Care 2011;15:R155. FREE FULL TEXT Also see last month’s “Oral / gastric antibiotic decontamination reduced bacteremias in [… read more]

Jun 102011

Free et al randomized 5,800 UK ready-to-quit smokers to get regular motivational text messages and help-line access, vs. placebo (texts thanking them for participating). At 6 months, those getting motivational text messages had biochemically-verified continuous abstinence of 11%, vs. 5% in the controls. Verification was by salivary cotinine at 6 months (& showed that 28% [… read more]

Jun 072011

Meijvis et al randomized 304 people hospitalized with CAP in the Netherlands to receive dexamethasone (5 mg) or placebo daily for 4 days on admission. Those getting steroids had a ~1 day shorter length of stay and no adverse effects, besides hyperglycemia. Patients were ill, with almost half having a pneumonia severity index/PORT class of [… read more]

Jun 062011

TNF-alpha can be elevated in severe asthmatics’ sputum and bronchial tissue. Could blocking it help? Holgate et al randomized 132 people with moderate or severe persistent asthma to receive 25 mg etanercept or placebo injections for 12 weeks. There was no difference in the primary endpoint (change in FEV1 at 12 weeks) nor in exacerbations, [… read more]

Jun 062011

Seyler et al prospectively observed 53 patients with sepsis and renal failure on CRRT. Measured at a single point in time after infusion, the concentrations of Zosyn, Ceftaz, and Cefepime at standard dosing regimens were all deemed suboptimal by the authors. Meropenem performed slightly better. Critical Care 2011;15:R137. FREE FULL TEXT

Jun 042011

Elliott et al (of ANZICS) randomized 195 survivors of >24h mechanical ventilation to get 3 home physical therapy visits and telephone support, or usual care, over the 8 weeks after hospital discharge. At 26 weeks, there was no difference in 6-minute walk, quality-of-life measures, or objective physical function measures. (n=195) Critical Care 2011;15:R142. FREE FULL [… read more]

Jun 042011

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]

Jun 032011

Lee et al report phase III trial results for this prodrug of gabapentin. It improved symptoms in people with moderate-to-severe RLS at the end of 12 weeks, compared to placebo. However, time (placebo) also worked well. The FDA approved the drug for moderate-to-severe RLS in April 2011. J Clin Sleep Med 2011;7:282-292.

Jun 022011

Sharma et al retrospectively observed >200,000 total patient-days for 9 months before and 27 months after implementation of a rapid response team at a single institution (U of Texas Galveston). Code rates and mortality did not change. CHEST 2011;139:1361-1367. Many cohort studies with historical controls over the past decade suggested benefits of RRTs, although others [… read more]