2011 Apr 14 - NEJM Editorial: Time for a Culture Change?

Richard Platt, M.D. N Engl J Med 2011; 364:1464-1465, April 14, 2011
Health care–associated infections are important, often preventable, causes of poor outcomes and unnecessary costs of medical care.1 To address this public health problem, professional societies, quality-improvement organizations, accrediting bodies, and federal advisory committees and agencies have issued guidelines and recommendations aimed at preventing these infections.2

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2011 Apr 14 - Veterans Affairs Initiative to Prevent Methicillin-Resistant Staphylococcus aureus Infections

Rajiv Jain, M.D., Stephen M. Kralovic, M.D., M.P.H., Martin E. Evans, M.D., Meredith Ambrose, M.H.A., Loretta A. Simbartl, M.S., D. Scott Obrosky, M.S., Marta L. Render, M.D., Ron W. Freyberg, M.S., John A. Jernigan, M.D., Robert R. Muder, M.D., LaToya J. Miller, M.P.H., and Gary A. Roselle, M.D. N Engl J Med 2011; 364:1419-1430, April 14, 2011
Background
Health care–associated infections with methicillin-resistant Staphylococcus aureus (MRSA) have been an increasing concern in Veterans Affairs (VA) hospitals.

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2011 Apr 14 - Intervention to Reduce Transmission of Resistant Bacteria in Intensive Care

W. Charles Huskins, M.D., Charmaine M. Huckabee, M.S., Naomi P. O'Grady, M.D., Patrick Murray, Ph.D., Heather Kopetskie, M.S., Louise Zimmer, M.A., M.P.H., Mary Ellen Walker, M.S.N., Ronda L. Sinkowitz-Cochran, M.P.H., John A. Jernigan, M.D., Matthew Samore, M.D., Dennis Wallace, Ph.D., and Donald A. Goldmann, M.D. for the STAR*ICU Trial Investigators. N Engl J Med 2011; 364:1407-1418, April 14, 2011
Background
Intensive care units (ICUs) are high-risk settings for the transmission of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE).

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2011 Apr 7 - NEJM Editorial: The Burden of Functional Recovery from ARDS

Jesse B. Hall, M.D., and John P. Kress, M.D. N Engl J Med 2011; 364:1358-1359, April 7, 2011
The acute respiratory distress syndrome (ARDS) is commonly a cause for admission to the intensive care unit (ICU) and for mechanical ventilation. Within the past decade, research has shown not only that the need for acute supportive care is extensive and protracted, but also that the arc of recovery can be long, and the burden for survivors of ARDS is actually psychological and neuromuscular dysfunction.1,2

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2011 Apr 7 - Functional Disability 5 Years after Acute Respiratory Distress Syndrome

Margaret S. Herridge, M.D., M.P.H., Catherine M. Tansey, M.Sc., Andrea Matté, B.Sc., George Tomlinson, Ph.D., Natalia Diaz-Granados, M.Sc., Andrew Cooper, M.D., Cameron B. Guest, M.D., C. David Mazer, M.D., Sangeeta Mehta, M.D., Thomas E. Stewart, M.D., Paul Kudlow, B.Sc., Deborah Cook, M.D., Arthur S. Slutsky, M.D., and Angela M. Cheung, M.D., Ph.D. for the Canadian Critical Care Trials Group. N Engl J Med 2011; 364:1293-1304April 7, 2011

Background
There have been few detailed, in-person interviews and examinations to obtain follow-up data on 5-year outcomes among survivors of the acute respiratory distress syndrome (ARDS).

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2011 Mar 25 - NEJM Editorial: Clinical Value of Decompressive Craniectomy

Franco Servadei, M.D. NEJM March 25, 2011 (10.1056/NEJMe1102998)
Patients with a variety of intracranial disorders — including traumatic brain injury, stroke, subarachnoid hemorrhage, intracerebral hemorrhage, and brain tumors — often present with a progressive increase in intracranial pressure, leading to clinical deterioration and ultimately to death.

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2011 Mar 25 - Decompressive Craniectomy in Diffuse Traumatic Brain Injury

D. James Cooper, M.D., Jeffrey V. Rosenfeld, M.D., Lynnette Murray, B.App.Sci., Yaseen M. Arabi, M.D., Andrew R. Davies, M.B., B.S., Paul D'Urso, Ph.D., Thomas Kossmann, M.D., Jennie Ponsford, Ph.D., Ian Seppelt, M.B., B.S., Peter Reilly, M.D., and Rory Wolfe, Ph.D. for the DECRA Trial Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group. N Engl J Med 2011; 364:1493-1502. April 21, 2011; Published online on March 25, 2011 (10.1056/NEJMoa1102077)
BACKGROUND
It is unclear whether decompressive craniectomy improves the functional outcome in patients with severe traumatic brain injury and refractory raised intracranial pressure.
Full Text of Background...

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2011 Mar 22 - Dalteparin versus Unfractionated Heparin in Critically Ill Patients

The PROTECT Investigators for the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group. NEJM March 22, 2011 (10.1056/NEJMoa1014475)
BACKGROUND
The effects of thromboprophylaxis with low-molecular-weight heparin, as compared with unfractionated heparin, on venous thromboembolism, bleeding, and other outcomes are uncertain in critically ill patients.

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2011 Mar 3 - Diuretic Strategies in Patients with Acute Decompensated Heart Failure

G. Michael Felker, M.D., M.H.S., Kerry L. Lee, Ph.D., David A. Bull, M.D., Margaret M. Redfield, M.D., Lynne W. Stevenson, M.D., Steven R. Goldsmith, M.D., Martin M. LeWinter, M.D., Anita Deswal, M.D., M.P.H., Jean L. Rouleau, M.D., Elizabeth O. Ofili, M.D., M.P.H., Kevin J. Anstrom, Ph.D., Adrian F. Hernandez, M.D., Steven E. McNulty, M.S., Eric J. Velazquez, M.D., Abdallah G. Kfoury, M.D., Horng H. Chen, M.B., B.Ch., Michael M. Givertz, M.D., Marc J. Semigran, M.D., Bradley A. Bart, M.D., Alice M. Mascette, M.D., Eugene Braunwald, M.D., and Christopher M. O'Connor, M.D. for the NHLBI Heart Failure Clinical Research Network. N Engl J Med 2011; 364:797-805March 3, 2011
Background
Loop diuretics are an essential component of therapy for patients with acute decompensated heart failure, but there are few prospective data to guide their use.

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2011 Feb 17 - Review Article: Hypoxia and Inflammation

Holger K. Eltzschig, M.D., Ph.D., and Peter Carmeliet, M.D., Ph.D. N Engl J Med 2011; 364:656-665February 17, 2011
Mammals have oxygen-sensing mechanisms that help them adapt quickly to hypoxia by increasing respiration, blood flow, and survival responses. If an inadequate supply of oxygen persists, additional mechanisms attempt to restore oxygenation or help the body adapt to hypoxia.1 These other mechanisms rely on oxygen-sensing prolyl hydroxylases (PHDs), which hydroxylate prolines in the alpha subunit of the hypoxia-inducible transcription factor (HIF). This transcription factor is a heterodimer with two subunits: HIF-1α or HIF-2α and HIF-1β (or aryl hydrocarbon receptor nuclear translocator [ARNT] protein). HIF-1α is ubiquitous, whereas HIF-2α is restricted to certain tissues.1

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2011 Feb 3 - Videos in Clinical Medicine: Arterial Puncture for Blood Gas Analysis

Shelly P. Dev, M.D., Melinda D. Hillmer, M.D., BSc.Phm., and Mauricio Ferri, M.D. N Engl J Med 2011; 364:e7, February 3, 2011
Arterial Puncture for Blood Gas Analysis Overview Radial arterial puncture for arterial blood gas analysis is a common procedure performed in medicine. It is a fundamental skill that all medical trainees need to acquire. This video will review radial arterial puncture in the adult population. Indications Puncture of the radial artery is the preferred method of obtaining an arterial blood sample for blood gas analysis.

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2011 Feb 3 - Review Article: Myocardial Infarction Due to Percutaneous Coronary Intervention

Abhiram Prasad, M.D., and Joerg Herrmann, M.D. N Engl J Med 2011; 364:453-464February 3, 2011
Approximately 1.5 million patients undergo percutaneous coronary intervention (PCI) in the United States every year.1 Depending on local practices and the diagnostic criteria used, 5 to 30% of these patients (75,000 to 450,000) have evidence of a periprocedural myocardial infarction.2,3 At the higher estimate, the incidence of these events is similar to the annual rate of major spontaneous myocardial infarction.1

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2011 Feb 3 - NEJM Editorial: The Search for Effective Treatment of Clostridium difficile Infection

Herbert L. DuPont, M.D. N Engl J Med 2011; 364:473-475, February 3, 2011
Since 1996, the incidence of Clostridium difficile infection has more than doubled. Some estimates suggest that there may be up to 3 million cases each year in the United States. If that statistic is correct, it would make C. difficile infection the most common bacterial cause of diarrhea in the United States. With the rising incidence, we are seeing higher mortality associated with the disease, related to at least two factors: increasing virulence of the C. difficile strains and increasing host vulnerability.

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2011 Feb 3 - Fidaxomicin versus Vancomycin for Clostridium difficile Infection

Thomas J. Louie, M.D., Mark A. Miller, M.D., Kathleen M. Mullane, D.O., Karl Weiss, M.D., Arnold Lentnek, M.D., Yoav Golan, M.D., Sherwood Gorbach, M.D., Pamela Sears, Ph.D., and Youe-Kong Shue, Ph.D. for the OPT-80-003 Clinical Study Group. N Engl J Med 2011; 364:422-431February 3, 2011
Background
Clostridium difficile infection is a serious diarrheal illness associated with substantial morbidity and mortality. Patients generally have a response to oral vancomycin or metronidazole; however, the rate of recurrence is high. This phase 3 clinical trial compared the efficacy and safety of fidaxomicin with those of vancomycin in treating C. difficile infection.

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2011 Jan 27 - Ventricular Tachyarrhythmias after Cardiac Arrest in Public versus at Home

Myron L. Weisfeldt, M.D., Siobhan Everson-Stewart, Ph.D., Colleen Sitlani, M.S., Thomas Rea, M.D., Tom P. Aufderheide, M.D., Dianne L. Atkins, M.D., Blair Bigham, M.Sc., Steven C. Brooks, M.D., M.H.Sc., Christopher Foerster, M.Sc., Randal Gray, M.A.Ed., Joseph P. Ornato, M.D., Judy Powell, B.S.N., Peter J. Kudenchuk, M.D., and Laurie J. Morrison, M.D. for the Resuscitation Outcomes Consortium (ROC) Investigators. N Engl J Med 2011; 364:313-321January 27, 2011
Background
The incidence of ventricular fibrillation or pulseless ventricular tachycardia as the first recorded rhythm after out-of-hospital cardiac arrest has unexpectedly declined. The success of bystander-deployed automated external defibrillators (AEDs) in public settings suggests that this may be the more common initial rhythm when out-of-hospital cardiac arrest occurs in public. We conducted a study to determine whether the location of the arrest, the type of arrhythmia, and the probability of survival are associated.

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2011 Jan 27 - Images in Clinical Medicine: A Photosensitive Dermatitis in the Intensive Care Unit

Marco Mercieri, M.D., and Angelo Mercieri, M.D. N Engl J Med 2011; 364:361January 27, 2011
An 88-year-old man with long-standing obstructive lung disease was admitted to the intensive care unit with pneumonia and acute respiratory failure requiring mechanical ventilation. He was noted to have a symmetric, scaly, sunburn-like, hyperpigmented rash extending from his hands to a clearly demarcated border midway up the arm, suggesting a photosensitive distribution in a patient accustomed to wearing short sleeves.

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2011 Jan 20 - Review Article: Necrotizing Enterocolitis

Josef Neu, M.D., and W. Allan Walker, M.D. N Engl J Med 2011; 364:255-264January 20, 2011
Necrotizing enterocolitis is among the most common and devastating diseases in neonates. It has also been one of the most difficult to eradicate1 and thus has become a priority for research.2 Conditions closely resembling necrotizing enterocolitis were described before the 1960s, but the entity was not widely recognized until after the advent of modern neonatal intensive care.1

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2011 Jan 13 - NEJM Correspondence: Therapeutic Hypothermia after Cardiac Arrest

N Engl J Med 2011; 364:185-188. January 13, 2011
The midazolam dose of 0.15 mg per kilogram of body weight per hour described in the article by Holzer (Sept. 23 issue)1 and in other articles on therapeutic hypothermia2 is very similar to the recommended dose of midazolam used to adapt critically ill patients without neurologic problems to mechanical ventilation.3

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2010 Dec 30 - Review Article: General Anesthesia, Sleep, and Coma

Emery N. Brown, M.D., Ph.D., Ralph Lydic, Ph.D., and Nicholas D. Schiff, M.D. N Engl J Med 2010; 363:2638-2650, December 30, 2010
In the United States, nearly 60,000 patients per day receive general anesthesia for surgery.1 General anesthesia is a drug-induced, reversible condition that includes specific behavioral and physiological traits — unconsciousness, amnesia, analgesia, and akinesia — with concomitant stability of the autonomic, cardiovascular, respiratory, and thermoregulatory systems.2 General anesthesia produces distinct patterns on the electroencephalogram (EEG), the most common of which is a progressive increase in low-frequency, high-amplitude activity as the level of general anesthesia deepens3,4 (Figure 1). How anesthetic drugs induce and maintain the behavioral states of general anesthesia is an important question in medicine and neuroscience.6 Substantial insights . . .

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2010 Dec 23 - NEJM Correspondence: Emergency Treatment of Asthma

N Engl J Med 2010; 363:2567-2569, December 23, 2010
In the article by Lazarus (Aug. 19 issue),1 the author provides a comprehensive and balanced review of the emergency treatment of asthma but does not discuss the controversy around the use of epinephrine for acute severe asthma exacerbations.2

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