Antibiotic dosing in multiple organ dysfunction syndrome: Ulldemolins et al, CHEST 2011;139:1210-1220.
Protti et al ventilated 29 healthy pigs for 2 days, each at a point on a range of “strain” (tidal volume divided by functional residual capacity). Ventilator-induced lung injury only occurred at strains 1.5-2 or greater (tidal volumes in the >30 mL/kg range). Although pigs’ lungs are inherently different than ours, authors make the argument that mechanical [… read more]
Diagnostic value of halo and reversed-halo signs in immune-compromised hosts. Georgiadou SP et al, Clin Infect Dis 2011;52:1144-1155. Review.
Using PCR testing on BAL fluid, Denning et al (in Manchester UK) found Aspergillus DNA in 4 of 11 (36%) healthy volunteers; 21 of 22 patients with culture/microscopy-proven invasive aspergillosis; and 70-80% of patients with allergic bronchopulmonary aspergillosis or chronic pulmonary aspergillosis. Culture was positive in none of the ABPA patients, and only 17% of the CPA [… read more]
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]
Pseudomonas pneumonia part II, antibiotic therapy, resistance, pharmacodynamics, Sun H et al, CHEST 2011;139:1172-1185. Review.
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]
In a review of the charts of 3,138 patients who died in 15 ICUs, Muni et al report that the 21% nonwhite patients (incl. 9% Asians, 7% blacks, 3% Hispanics) had odds ratios of 0.41 for having a living will; 1.59 for having full life support at the time of death; 1.57 for having a physician recommend [… 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]
Databases suggest that 60-70% of patients with severe respiratory failure due to H1N1 received steroids. Brun-Buisson et al looked back at a French registry including 208 patients with H1N1 and ARDS, 83 of whom received steroids. They found a hazard ratio of 2.4 for death associated with steroid administration, rising to 2.8 after applying their propensity scoring [… read more]
Year in Review 2010 in pulmonary & critical care: Heuser et al, Arch Int Med 2011;154:614-621.
Those patients with severe acute lung injury due to pneumonia or aspiration who received the rSP-C surfactant product did no better on important outcomes (28-day survival, need for ventilation, organ-failure-free days) than those receiving usual care, report Spragg et al.(n=843). AJRCCM 2011;183:1055-1061.
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]
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.
In a 5-week prospective observational study in 47 Australian & New Zealand ICUs, Pettila et al (the ANZICS group) followed 757 ICU patients receiving red blood cell transfusions for anemia of any cause. Those in the quartile receiving the youngest RBCs (mean age 7.7 days) had an absolute 8% lower mortality than the other 3 [… read more]
In 1998, Dr. Cheryl Misak survived organ failure in the ICU; this month, she shares her story of a long and difficult recovery from debility. Although highly educated and motivated, and in top pre-admission physical shape, her struggle was formidable. Twelve years later, are we doing any better at adequately informing and preparing patients like [… read more]
Stanworth et al previously showed that 30% of ICU patients have prothrombin time prolongation at some point. Here, they examined FFP transfusion In an 8-week-long prospective observational study in 29 ICUs in the UK. Fully 31% of FFP units were given to patients with INR < 1.5. About half the FFP units went to patients [… read more]
Interviewing 100 patients or their surrogates in the ICU, 85% of whom were “full code,” Gehlbach et al found 16% of patients’ code status in the chart did not correlate with their expressed preferences during the interview (10 wanted less care, 6 wanted more). Respondents’ average prediction for their survival should they have a cardiac [… read more]
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.
20% of U.S. deaths now occur during or soon after an ICU stay — but the families live on, often with upsetting memories, depression, and anxiety. Kross et al re-heat data from the IPACC palliative care study in Washington, surveying family members of ICU decedents, showing they had a 14% prevalence of PTSD symptoms and 18% of [… read more]