Masclans et al followed 38 patients with ARDS in 3 ICUs for 6 months. Health-related quality of life (Nottingham Test Profile) was lower than expected at 6 months, with 40% reporting limitations in daily activities mainly due to low energy, mobility and social functioning. Mild radiographic abnormalities and restrictive physiology were usually present on HRCT [… read more]
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.
Gershengorn et al retrospectively compared two MICUs at Beth Israel: one with “midlevels” (nurse practitioners and physician assistants during the day with attending coverage overnight) and one that was all house staff 24/7. There were no differences in important outcomes (mortality, MICU or hospital LOS), although the study was nonrandomized and subject to bias. CHEST [… read more]
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]
Toxic epidermal necrolysis and Stevens-Johnson syndrome. Gerull et al. Crit Care Med 2011;39:1507-1513.
Cardiopulmonary arrest and cardiopulmonary monitoring. Sixteen articles, 104 pages. Curr Opin Crit Care 2011;17:211-315. Cardiac arrest review.
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.
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]
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
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]
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]
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.
Acute lung injury & critical care update for 2010: Vadasz I, Sznajder J, AJRCCM 2011;183:1147-1152. ARDS review. Critical care review.
Prone positioning improves oxygenation in ARDS patients without improving outcome. Recruitment maneuvers do too. Rival et al prospectively tested the effects of both strategies together in 16 ARDS patients. Two extended sighs of 45 cm H2O in pressure control mode while lying prone improved PaO2/FiO2 from 98 to 166 mm Hg, without obvious adverse (or positive) effects. Critical [… read more]
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.