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]
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.
End-stage liver disease, critical care management of: Al-Khafaji A et al. Crit Care Med 2011;39:1157-1166. Hepatic failure review.
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]
Acute liver failure: Larsen FS, Curr Opin Crit Care 2011;17:160-164. Fulminant hepatic failure review.
Acute-on-chronic liver failure, concept, natural history, prognosis: Olson JC, Curr Opin Crit Care 2011;17:165-169. Hepatic failure review.