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]
Tranexamic acid has a small beneficial effect on hemorrhage from trauma or surgery. Among 270 subjects with intracranial hemorrhage due to trauma, those randomized to tranexamic acid showed a trend toward improved outcomes (mortality, hemorrhage extension, new bleeding foci) compared to placebo. Authors propose a large trial to explore further. BMJ 2011;343:d3795. FREE FULL TEXT
The Research Agenda in ICU Telemedicine: A Statement From the Critical Care Societies Collaborative. Kahn JM et al. CHEST 2011;140:230-238.
Rapid response teams. Jones DA et al. NEJM 2011;365:139-146. FULL FREE TEXT
Hyperbaric oxygen in the critically ill. Weaver LK. Crit Care Med 2011;39(7):1784-1791.
Glycemic Control in the ICU. Egi M et al. CHEST 2011;140:212-220. Endocrine, hyperglycemia, review.
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.
Improving survival after out-of-hospital cardiac arrest: AHA Consensus Statement. Neumar RW et al. Circulation 2011;123:2898-2910. FREE FULL TEXT. Guideline. Review.
The best approach to nutrition during critical illness is unknown. Casaer et al randomized 4,640 critically-ill patients who could not get enough calories by enteral feeding to receive TPN either on ICU day 3, or to wait until ICU day 8. While waiting for their TPN in the late group, patients got calories in sugar [… read more]
Zager et al examined registry data on 38,917 patients admitted to Beth Israel and Brigham & Women’s hospitals between 1997-2007, and concluded that low socioeconomic status (as determined by census tract neighborhood of residence) did not influence 30- or 365-day mortality after admission to these hospitals’ ICU. CHEST 2011;139:1368-1379.
Peacock et al randomized 226 people in 13 US EDs to either IV nicardipine or IV labetalol for hypertensive emergency (SBP ~215). More patients receiving nicardipine achieving their target BP range within 30 minutes (92% vs. 83%). (n=226) Critical Care 2011;15:R157. FREE FULL TEXT
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.
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.