The EMShockNet team previously claimed in JAMA that hyperoxia (paO2>300) after cardiac arrest could be deadly (63% in-hospital mortality vs 45% in normoxic patients). After looking at 12,108 database records in Australia/New Zealand, Bellomo et al beg to differ. By applying severity of illness/propensity models, they found no increased risk of death in those with [... read more]
Hooman et al pooled 5 randomized trials with 112 patients, who had 184 episodes of elevated intracranial pressure. They concluded hypertonic saline is better at reducing ICP; but the relative-risk-for-ICP-control confidence interval was 1.0-1.3 and the mean ICP reduction included zero (-1.6 to 5.7 mm Hg). So, maybe. Crit Care Med 2011;39:554-559.
THIS STUDY HAS BEEN RETRACTED. Kupfer et al looked retrospectively at 168 vented patients with transudative pleural effusions at Maimonides in Brooklyn. The half that got chest tubes (with an average of 1,200 mL drained) spent 3.8 days on the vent, vs 6.5 days for the group that got only thoracentesis, with no complications reported. [... read more]
Cochrane systematic review and meta-analysis: Pooling 11 randomized trials, n=1,971, Blackwood et al suggested there are some benefits to using a standardized weaning protocol. There was a reduction in weaning and ventilation time in the groups that had weaning protocols; we won’t report them here, because they would be misleading in this small space. They [... read more]
Drospirenone is the new progesterone analog in heavily marketed new oral contraceptive pills (trade names Yaz, Yasmin, Angelique). Using a large insurance claims database, Jick et al identified 186 cases of DVT or PE in women aged 15-44 taking oral contraceptives and compared them to controls. Those taking drospirenone-containing OCPs had a nonfatal DVT/PE incidence [... read more]
Sara Erickson et al examined data from 9,518 ICU patients in California hospitals, and concluded that race & ethnicity did not influence mortality or length of stay, after adjusting for disease severity and other factors. Crit Care Med 2011;39:429-435.
Autonomy and beneficence, a historical perspective. Will JF, CHEST 2011;139:669-673. ICU ethics review.
Busse et al randomized 419 inner-city kids (age 6-20) with uncontrolled, skin-test-positive, mostly severe allergic asthma and IgE < 1,300 IU/mL to 60 weeks of omalizumab or placebo. The treated group had modest improvements: ~1 fewer day of symptoms per month and a 5% absolute reduction in hospitalizations (1.5% vs 6.3%); 18% fewer of them [... read more]
As Andy Rooney might say, “With all the diagnoses doctors like to make these days, didjever wonder if anyone is actually healthy anymore?” When it comes to heart health, according to Bambs et al, the answer is yes: one person is. Circulation 2011;123:850-857.
Critical care for patients with stroke. Lukovits TG, CHEST 2011;139:694-700.
DVT of the upper extremity: Kucher N, NEJM 2011;364:861-869.
Sacanella et al prospectively observed 230 generally healthy, cognitively intact, highly functional & independently living Spaniards 65 years or older (mean age 75) after urgent admission to a single MICU. About half received mechanical ventilation (54%). Seventy died in-hospital; 48 died within a year, for a one-year survival of 49%. But among the 112 survivors, [... read more]
Heparin-induced thrombocytopenia in the ICU. Sakr Y, Critical Care 2011;15:211.
Roquilly et ses amis francais randomized 150 critically ill victims of severe French trauma to hydrocortisone or placebo for 7 days. The treated group had an absolute 16-19% lower risk for hospital-acquired pneumonia, the primary endpoint (36% vs. 51-54% depending on which intention-to-treat analysis you prefer, p=0.007 to 0.01). (n=150). JAMA 2011;305:1201-1209.
The effect of light on critical illness. Castro R, Critical Care 2011; 15:218
New treatments against gram-negative organisms. Bassetti M, Critical Care 2011;15:215. New antibiotics review.
Lymphangioleiomyomatosis. Harari S, Eur Resp Review 2011;20:34-44. LAM review.
Warfarin is the best drug for stroke prevention in atrial fibrillation. In people with a-fib for whom warfarin was unsuitable (unstable INR, unlikely adherence, etc, but excluding those with prior bleeding on warfarin), twice daily oral direct Xa inhibitor apixaban had a hazard ratio of 0.45 over aspirin for the primary outcome of stroke (absolute [... read more]
Normal sleep in African-Americans and Caucasians: Ruiter ME, Sleep Medicine 2011;12:209-214. Race & racial differences in sleep review.
Valdyanathan et al gave prednisolone 25 mg (equivalent to prednisone) or placebo daily for 2 weeks to sufferers of chronic rhinosinusitis in the UK, followed by 8 months of nasal fluticasone (drops, then spray) for all. The orally-treated group had a 2.1-point fall in their polyp grade and could smell better, at 6 months. Ann [... read more]