2013 April 11 - Human Infection with a Novel Avian-Origin Influenza A (H7N9) Virus

Rongbao Gao, M.D., Bin Cao, M.D., Yunwen Hu, M.D., Zijian Feng, M.D., M.P.H., Dayan Wang, M.D., Wanfu Hu, M.D., et al.  April 11, 2013 NEJM

Background
Infection of poultry with influenza A subtype H7 viruses occurs worldwide, but the introduction of this subtype to humans in Asia has not been observed previously. In March 2013, three urban residents of Shanghai or Anhui, China, presented with rapidly progressing lower respiratory tract infections and were found to be infected with a novel reassortant avian-origin influenza A (H7N9) virus.

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2013 March 19 - Reduced Cortisol Metabolism during Critical Illness

Eva Boonen, M.D., Hilke Vervenne, Ph.D., Philippe Meersseman, M.D., Ruth Andrew, Ph.D., Leen Mortier, Ph.D., Peter E. Declercq, Pharm.D., Ph.D., Yoo-Mee Vanwijngaerden, M.D., Isabel Spriet, Pharm.D., Ph.D., Pieter J. Wouters, M.Sc., Sarah Vander Perre, B.Sc., Lies Langouche, Ph.D., Ilse Vanhorebeek, Ph.D., Brian R. Walker, M.D., and Greet Van den Berghe, M.D., Ph.D. March 19, 2013
Background
Critical illness is often accompanied by hypercortisolemia, which has been attributed to stress-induced activation of the hypothalamic–pituitary–adrenal axis. However, low corticotropin levels have also been reported in critically ill patients, which may be due to reduced cortisol metabolism.

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2013 March 14 - Long-Term Outcomes in Elderly Survivors of In-Hospital Cardiac Arrest

Paul S. Chan, M.D., Brahmajee K. Nallamothu, M.D., M.P.H., Harlan M. Krumholz, M.D., John A. Spertus, M.D., M.P.H., Yan Li, Ph.D., Bradley G. Hammill, M.S., and Lesley H. Curtis, Ph.D. for the American Heart Association Get with the Guidelines–Resuscitation Investigators. N Engl J Med 2013; 368:1019-1026 March 14, 2013
Background
Little is known about the long-term outcomes in elderly survivors of in-hospital cardiac arrest. We determined rates of long-term survival and readmission among survivors of in-hospital cardiac arrest and examined whether these outcomes differed according to demographic characteristics and neurologic status at discharge.

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2013 March 14 - Family Presence during Cardiopulmonary Resuscitation

Patricia Jabre, M.D., Ph.D., Vanessa Belpomme, M.D., Elie Azoulay, M.D., Ph.D., Line Jacob, M.D., Lionel Bertrand, M.D., Frederic Lapostolle, M.D., Ph.D., Karim Tazarourte, M.D., Ph.D., Guillem Bouilleau, M.D., Virginie Pinaud, M.D., Claire Broche, M.D., Domitille Normand, M.S., Thierry Baubet, M.D., Ph.D., Agnes Ricard-Hibon, M.D., Ph.D., Jacques Istria, M.D., Alexandra Beltramini, M.D., Armelle Alheritiere, M.D., Nathalie Assez, M.D., Lionel Nace, M.D., Benoit Vivien, M.D., Ph.D., Laurent Turi, M.D., Stephane Launay, M.D., Michel Desmaizieres, M.D., Stephen W. Borron, M.D., Eric Vicaut, M.D., Ph.D., and Frederic Adnet, M.D., Ph.D. N Engl J Med 2013; 368:1008-1018March 14, 2013
Background
The effect of family presence during cardiopulmonary resuscitation (CPR) on the family members themselves and the medical team remains controversial.

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2013 Jan 22 - High-Frequency Oscillation for Acute Respiratory Distress Syndrome

Duncan Young, D.M., Sarah E. Lamb, D.Phil., Sanjoy Shah, M.D., Iain MacKenzie, M.D., William Tunnicliffe, M.Sc., Ranjit Lall, Ph.D., Kathy Rowan, D.Phil., and Brian H. Cuthbertson, M.D. for the OSCAR Study Group. January 22, 2013.
Background
Patients with the acute respiratory distress syndrome (ARDS) require mechanical ventilation to maintain arterial oxygenation, but this treatment may produce secondary lung injury. High-frequency oscillatory ventilation (HFOV) may reduce this secondary damage.

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2013 Jan 22 - High-Frequency Oscillation in Early Acute Respiratory Distress Syndrome

Niall D. Ferguson, M.D., Deborah J. Cook, M.D., Gordon H. Guyatt, M.D., Sangeeta Mehta, M.D., Lori Hand, R.R.T., Peggy Austin, C.C.R.A., Qi Zhou, Ph.D., Andrea Matte, R.R.T., Stephen D. Walter, Ph.D., Francois Lamontagne, M.D., John T. Granton, M.D., Yaseen M. Arabi, M.D., Alejandro C. Arroliga, M.D., Thomas E. Stewart, M.D., Arthur S. Slutsky, M.D., and Maureen O. Meade, M.D. for the OSCILLATE Trial Investigators and the Canadian Critical Care Trials Group. January 22, 2013.
Background
Previous trials suggesting that high-frequency oscillatory ventilation (HFOV) reduced mortality among adults with the acute respiratory distress syndrome (ARDS) were limited by the use of outdated comparator ventilation strategies and small sample sizes.

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2013 Jan 30 - Use of Health IT for Higher-Value Critical Care

Lena M. Chen, M.D., Edward H. Kennedy, M.S., Anne Sales, Ph.D., R.N., and Timothy P. Hofer, M.D. January 30, 2013.
The patient had not yet coded but was spiraling downward, prompting a request for a bed in the intensive care unit (ICU). But the ICU had no available beds. Hours passed before the decision was made that another patient could safely be “bumped” out of the unit to accommodate our patient...

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2013 Jan 17 - Simulation-Based Trial of Surgical-Crisis Checklists

Alexander F. Arriaga, M.D., M.P.H., Sc.D., Angela M. Bader, M.D., M.P.H., Judith M. Wong, M.D., M.P.H., Stuart R. Lipsitz, Sc.D., William R. Berry, M.D., M.P.H., M.P.A., John E. Ziewacz, M.D., M.P.H., David L. Hepner, M.D., Daniel J. Boorman, B.S., Charles N. Pozner, M.D., Douglas S. Smink, M.D., M.P.H., and Atul A. Gawande, M.D., M.P.H. N Engl J Med 2013; 368:246-253 January 17, 2013
Background
Operating-room crises (e.g., cardiac arrest and massive hemorrhage) are common events in large hospitals but can be rare for individual clinicians. Successful management is difficult and complex. We sought to evaluate a tool to improve adherence to evidence-based best practices during such events.

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2013 Jan 3 - Transfusion Strategies for Acute Upper Gastrointestinal Bleeding

Càndid Villanueva, M.D., Alan Colomo, M.D., Alba Bosch, M.D., Mar Concepción, M.D., Virginia Hernandez-Gea, M.D., Carles Aracil, M.D., Isabel Graupera, M.D., María Poca, M.D., Cristina Alvarez-Urturi, M.D., Jordi Gordillo, M.D., Carlos Guarner-Argente, M.D., Miquel Santaló, M.D., Eduardo Muñiz, M.D., and Carlos Guarner, M.D. N Engl J Med 2013; 368:11-21January 3, 2013
Background
The hemoglobin threshold for transfusion of red cells in patients with acute gastrointestinal bleeding is controversial. We compared the efficacy and safety of a restrictive transfusion strategy with those of a liberal transfusion strategy.

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2012 Dec 13 - Ultrafiltration in Decompensated Heart Failure with Cardiorenal Syndrome

Bradley A. Bart, M.D., Steven R. Goldsmith, M.D., Kerry L. Lee, Ph.D., Michael M. Givertz, M.D., Christopher M. O'Connor, M.D., David A. Bull, M.D., Margaret M. Redfield, M.D., Anita Deswal, M.D., M.P.H., Jean L. Rouleau, M.D., Martin M. LeWinter, M.D., Elizabeth O. Ofili, M.D., M.P.H., Lynne W. Stevenson, M.D., Marc J. Semigran, M.D., G. Michael Felker, M.D., Horng H. Chen, M.D., Adrian F. Hernandez, M.D., Kevin J. Anstrom, Ph.D., Steven E. McNulty, M.S., Eric J. Velazquez, M.D., Jenny C. Ibarra, R.N., M.S.N., Alice M. Mascette, M.D., and Eugene Braunwald, M.D. for the Heart Failure Clinical Research Network. N Engl J Med 2012; 367:2296-2304 December 13, 2012
Background
Ultrafiltration is an alternative strategy to diuretic therapy for the treatment of patients with acute decompensated heart failure. Little is known about the efficacy and safety of ultrafiltration in patients with acute decompensated heart failure complicated by persistent congestion and worsened renal function.

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2012 Dec 12 - A Trial of Intracranial-Pressure Monitoring in Traumatic Brain Injury

Randall M. Chesnut, M.D., Nancy Temkin, Ph.D., Nancy Carney, Ph.D., Sureyya Dikmen, Ph.D., Carlos Rondina, M.D., Walter Videtta, M.D., Gustavo Petroni, M.D., Silvia Lujan, M.D., Jim Pridgeon, M.H.A., Jason Barber, M.S., Joan Machamer, M.A., Kelley Chaddock, B.A., Juanita M. Celix, M.D., Marianna Cherner, Ph.D., and Terence Hendrix, B.A. December 12, 2012DOI: 10.1056/NEJMoa1207363
Background
Intracranial-pressure monitoring is considered the standard of care for severe traumatic brain injury and is used frequently, but the efficacy of treatment based on monitoring in improving the outcome has not been rigorously assessed.
Methods

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2012 Dec 6 - Preventing Lethal Hospital Outbreaks of Antibiotic-Resistant Bacteria

Thomas J. Sandora, M.D., M.P.H., and Donald A. Goldmann, M.D. N Engl J Med 2012; 367:2168-2170 December 6, 2012
In 2011, a strain of Klebsiella pneumoniae resistant to multiple antibiotics, including carbapenems, was identified in the intensive care unit (ICU) of the Clinical Center of the National Institutes of Health (NIH).1 This organism has since colonized at least 19 patients and may have caused seven deaths among patients with severe coexisting conditions. Although the spread of the organism was traced through clinical epidemiologic investigation and whole-genome sequencing, it was curtailed by “rigorous infection-control procedures.” What does this episode tell us about how to mitigate the risk of future outbreaks?

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2012 Dec 6 - Review Article Weaning Patients from the Ventilator

John F. McConville, M.D., and John P. Kress, M.D. N Engl J Med 2012; 367:2233-2239 December 6,
In the United States, almost 800,000 patients who are hospitalized each year require mechanical ventilation.1 This estimate excludes neonates, and there is little doubt that mechanical ventilation will be increasingly used as the number of patients 65 years of age or older continues to increase.2,3 The majority of patients who receive mechanical ventilation have acute respiratory failure in the postoperative period, pneumonia, congestive heart failure, sepsis, trauma, or the acute respiratory distress syndrome (ARDS).4

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2012 Nov 22 - Intravenous Immune Globulin in Autoimmune and Inflammatory Diseases

Erwin W. Gelfand, M.D. N Engl J Med 2012; 367:2015-2025November 22, 2012
In an era in which new biologics are being introduced to target inflammation and autoimmunity, some older treatments persist. Immune globulin–replacement therapy has been a lifesaving treatment for patients with antibody deficiency. When immune globulin replacement was introduced in the 1950s for the treatment of primary immunodeficiency diseases, it was administered subcutaneously or by intramuscular injection; subsequently, preparations suitable for intravenous use were developed, and these have undergone progressive changes in composition, particularly the elimination of sugars and normalization of the salt content and osmolarity.

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2012 Nov 15 - Accidental Hypothermia

Douglas J.A. Brown, M.D., Hermann Brugger, M.D., Jeff Boyd, M.B., B.S., and Peter Paal, M.D. N Engl J Med 2012; 367:1930-1938November 15, 2012
Accidental hypothermia (i.e., an involuntary drop in core body temperature to <35°C [95°F]) is a condition associated with significant morbidity and mortality.1-4 Each year, approximately 1500 patients in the United States have hypothermia noted on their death certificate; however, the incidence of primary and secondary hypothermia and the associated morbidity and mortality remain unknown.5

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2012 Nov 15 - Trends in Survival after In-Hospital Cardiac Arrest

Saket Girotra, M.D., Brahmajee K. Nallamothu, M.D., M.P.H., John A. Spertus, M.D., M.P.H., Yan Li, Ph.D., Harlan M. Krumholz, M.D., and Paul S. Chan, M.D. for the American Heart Association Get with the Guidelines–Resuscitation Investigators
N Engl J Med 2012; 367:1912-1920November 15, 201
Background
Despite advances in resuscitation care in recent years, it is not clear whether survival and neurologic function after in-hospital cardiac arrest have improved over time.

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2012 Oct 17 - Isolation of a Novel Coronavirus from a Man with Pneumonia in Saudi Arabia

Ali Moh Zaki, M.D., Ph.D., Sander van Boheemen, M.Sc., Theo M. Bestebroer, B.Sc., Albert D.M.E. Osterhaus, D.V.M., Ph.D., and Ron A.M. Fouchier, Ph.D. October 17, 2012DOI: 10.1056/NEJMoa1211721

A previously unknown coronavirus was isolated from the sputum of a 60-year-old man who presented with acute pneumonia and subsequent renal failure with a fatal outcome in Saudi Arabia. The virus (called HCoV-EMC) replicated readily in cell culture, producing cytopathic effects of rounding, detachment, and syncytium formation.

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2012 Oct 17 - Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care

John A. Myburgh, M.D., Ph.D., Simon Finfer, M.D., Rinaldo Bellomo, M.D., Laurent Billot, M.Sc., Alan Cass, M.D., Ph.D., David Gattas, M.D., Parisa Glass, Ph.D., Jeffrey Lipman, M.D., Bette Liu, Ph.D., Colin McArthur, M.D., Shay McGuinness, M.D., Dorrilyn Rajbhandari, R.N., Colman B. Taylor, M.N.D., and Steven A.R. Webb, M.D., Ph.D. for the CHEST Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group. October 17, 2012DOI: 10.1056/NEJMoa1209759
Background
The safety and efficacy of hydroxyethyl starch (HES) for fluid resuscitation have not been fully evaluated, and adverse effects of HES on survival and renal function have been reported.

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2012 Oct 4 - Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock

Holger Thiele, M.D., Uwe Zeymer, M.D., Franz-Josef Neumann, M.D., Miroslaw Ferenc, M.D., Hans-Georg Olbrich, M.D., Jörg Hausleiter, M.D., Gert Richardt, M.D., Marcus Hennersdorf, M.D., Klaus Empen, M.D., Georg Fuernau, M.D., Steffen Desch, M.D., Ingo Eitel, M.D., Rainer Hambrecht, M.D., Jörg Fuhrmann, M.D., Michael Böhm, M.D., Henning Ebelt, M.D., Steffen Schneider, Ph.D., Gerhard Schuler, M.D., and Karl Werdan, M.D. for the IABP-SHOCK II Trial Investigators. N Engl J Med 2012; 367:1287-1296 October 4, 2012
Background
In current international guidelines, intraaortic balloon counterpulsation is considered to be a class I treatment for cardiogenic shock complicating acute myocardial infarction. However, evidence is based mainly on registry data, and there is a paucity of randomized clinical trials.

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2012 Sep 20 - Hypoglycemia and Risk of Death in Critically Ill Patients

The NICE-SUGAR Study Investigators. N Engl J Med 2012; 367:1108-1118September 20, 2012
Background
Whether hypoglycemia leads to death in critically ill patients is unclear.
Methods
We examined the associations between moderate and severe hypoglycemia (blood glucose, 41 to 70 mg per deciliter [2.3 to 3.9 mmol per liter] and ≤40 mg per deciliter [2.2 mmol per liter], respectively) and death among 6026 critically ill patients in intensive care units (ICUs). Patients were randomly assigned to intensive or conventional glucose control. We used Cox regression analysis with adjustment for treatment assignment and for baseline and postrandomization covariates.

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