Delirium in the ICU, management of: Schiemann A, Curr Opin Crit Care 2011;17:131-140.
A systematic review of 3 trials (n=337) by the Bed Head Elevation Study Group (not to be confused with the Bedhead photo group) found no good evidence that head-of-bed (HOB) elevation to 45′ helps or harms in any way (pneumonia, decubiti, mortality, VTE, or hemodynamic instability). Nevertheless, a consensus panel of 22 experts agrees with previous [… read more]
After implementing an “MRSA bundle” in 2007 including nasal surveillance, contact precautions for positive patients, hand hygiene, and culture-indoctrination of employees, MRSA infections among all VA hospital ICUs fell from 1.64 to 0.62 per 1000 patient-days (a 62% reduction, p<0.001). MRSA infections on the wards fell from 0.47 to 0.26 per 1000 patient-days (45% reduction, [… read more]
Huskins et al cluster-randomized 18 ICUs to an intervention of surveillance cultures with contact precautions for positive patients, or a control of no cultures and universal precautions (gloves). The intervention ICUs used contact precautions more frequently (51% vs. 38%), but had the same MRSA/VRE colonization/infection rates, the primary endpoint (40 vs 35%, p=0.35). Clinician compliance [… read more]
Trouillet et al randomized patients requiring mechanical ventilation 4 days after cardiac surgery to either immediate perc-trach, or delayed percutaneous tracheostomy at 15 days. There were no differences in ventilator-free days at 60 days, nor in survival at 28, 60, or 90 days, nor in rates of VAP; however, the early-trach group had a lower [… read more]
Post cardiac arrest syndrome: Review of therapies: Stub D, Circulation 2011;123:1428-1435.
Pressors and inotropes in circulatory shock: Hollenberg SM, AJRCCM 2011;183:847-855. Vasopressors review.
Status epilepticus, refractory, treatment of: Holtkamp M, Curr Opin Crit Care 2011;17:94-100.
Analyzing 50,481 victims of prolonged mechanical ventilation in Taiwan 1997-2007, Hung et al report outcomes were frankly terrible, with median survival of about 4 months. Those with a primary indication of neurologic damage fared significantly better. Those with a PMV indication of COPD, younger than 85, had 6-18 months median survival. Authors take the additional [… read more]
Serious Infections in Intensive Care Units: 100+ pages, 12 articles reflecting the state of the art on managing infections and antibotic usage in the ICU. Sem Resp Crit Care Med, April 2011. Review.
Combating antimicrobial resistance; Policy recommendations to save lives: Clin Infect Dis 2011;52 (supplement 5). ** COMMENTARY by Brad Spellberg, MD **
Candida urinary tract infections: Clin Infect Dis 2011;52 (supplement 6).
An excess amount of the chaos and stress endemic to ICUs is due to poor systems engineering (think alarm fatigue); a rational, integrated approach to design & technology selection is needed to make ICUs more effective and safer for patients, argue Mathews & Pronovost. Academic health systems should fill the leadership vacuum, organize stakeholders and [… read more]
Long-term complications of critical care: Desai SV, Crit Care Med 2011;39:371-379.
Sadaka et al add their two cents and a cohort study to the Xigris efficacy/safety debate. In their retrospective, propensity-matched analysis of 563 patients sourced from the Project IMPACT database, the 108 who received activated protein C had 35% mortality, vs 54% for the 108 who did not (p=0.005). There were unusually low rates of [… read more]
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]
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]
Critical care for patients with stroke. Lukovits TG, CHEST 2011;139:694-700.
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]