2010 May 24 - β-Blockers May Reduce Mortality and Risk of Exacerbations in Patients With Chronic Obstructive Pulmonary Disease
Background Physicians avoid the use of β-blockers in patients with chronic obstructive pulmonary disease (COPD) and concurrent cardiovascular disease because of concerns about adverse pulmonary effects. We assessed the long-term effect of β-blocker use on survival and exacerbations in patients with COPD.
2010 May 26 - Reporting and Interpretation of Randomized Controlled Trials With Statistically Nonsignificant Results for Primary Outcomes
Context Previous studies indicate that the interpretation of trial results can be distorted by authors of published reports.
2010 May 26 - Antibiotic Therapy and Treatment Failure in Patients Hospitalized for Acute Exacerbations of Chronic Obstructive Pulmonary Disease
Context Guidelines recommend antibiotic therapy for acute exacerbations of chronic obstructive pulmonary disease (COPD), but the evidence is based on small, heterogeneous trials, few of which include hospitalized patients.
2010 Apr 20 - Early vs Late Tracheotomy for Prevention of Pneumonia in Mechanically Ventilated Adult ICU Patients: A Randomized Controlled Trial
Figure. Percutaneous tracheostomy being performed by the percutaneous dilatational method using the Griggs forceps, another common method is using the Blue Rhino (Photo courtesy of ICU, PYNEH)
Context Tracheotomy is used to replace endotracheal intubation in patients requiring prolonged ventilation; however, there is considerable variability in the time considered optimal for performing tracheotomy. This is of clinical importance because timing is a key criterion for performing a tracheotomy and patients who receive one require a large amount of health care resources.
Endotracheal intubation is the most common procedure for airway control for patients requiring mechanical ventilation. Extubation is performed once patients have improved so that mechanical ventilation can be discontinued. For patients who require prolonged mechanical ventilation, replacement of the endotracheal tube with a tracheotomy is often considered.
2010 Apr 21 - Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States
Context Early data on pandemic 2009 influenza A(H1N1) suggest pregnant women are at increased risk of hospitalization and death.
2010 Mar - Effect of Chlorhexidine Whole-Body Bathing on Hospital-Acquired Infections Among Trauma Patients
Objective To demonstrate whether daily bathing with cloths impregnated with 2% chlorhexidine gluconate will decrease colonization of resistant bacteria and reduce the rates of health care–associated infections in critically injured patients.
Context Although hospital mortality has decreased over time in the United States for patients who receive intensive care, little is known about subsequent outcomes for those discharged alive.
Acute lung injury (ALI) is a common, lethal, and complex syndrome. Estimates of attributable mortality from ALI or its more severe form, acute respiratory distress syndrome (ARDS), in the United States place it above asthma and human immunodeficiency virus infection as a cause of death.1
2010 Mar 3 - Higher vs Lower Positive End-Expiratory Pressure in Patients With Acute Lung Injury and Acute Respiratory Distress Syndrome: Systematic Review and Meta-analysis
Context Trials comparing higher vs lower levels of positive end-expiratory pressure (PEEP) in adults with acute lung injury or acute respiratory distress syndrome (ARDS) have been underpowered to detect small but potentially important effects on mortality or to explore subgroup differences.
Context Recent trends in hours worked by physicians may affect workforce needs but have not been thoroughly analyzed.
2010 Feb 8 - Association Between Acute Care and Critical Illness Hospitalization and Cognitive Function in Older Adults
Context Studies suggest that many survivors of critical illness experience long-term cognitive impairment but have not included premorbid measures of cognitive functioning and have not evaluated risk for dementia associated with critical illness.
In this issue of JAMA, Jones et al1 report the results of a randomized, noninferiority trial comparing 2 strategies for guiding the use of inotropes and red blood cell transfusions during early goal-directed therapy for patients with severe sepsis or septic shock.
2010 Feb 8 - Lactate Clearance vs Central Venous Oxygen Saturation as Goals of Early Sepsis Therapy: A Randomized Clinical Trial
Context Goal-directed resuscitation for severe sepsis and septic shock has been reported to reduce mortality when applied in the emergency department.
2010 Feb 10 - JAMA Commentary: Perioperative β-Blockers for Cardiac Risk Reduction: Time for Clarity
Perioperative cardiac events are common and thought to result from coronary plaque rupture, myocardial oxygen supply-demand mismatch, or a combination of these processes.1 In theory, β-blockers are ideal for preventing these events, because they decrease myocardial oxygen requirements (by lowering heart rate and reducing blood pressure) and are thought to stabilize atherosclerotic plaque.2 However, perioperative β-blockade has become controversial because of conflicting results of recent studies. Based on the latest evidence, the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) restricted the once-broad class I indication for perioperative β-blockers to only patients already receiving this therapy.3 Why has the evidence not provided clarity?
2010 Jan 27 - JAMA Editorial: Should Glucocorticoid-Induced Hyperglycemia Be Treated in Patients With Septic Shock?
Critical illness, in particular severe sepsis, induces insulin resistance and hyperglycemia. Corticosteroids are often used for reversal of fluid- and vasopressor-resistant septic shock. Such an adjuvant treatment aggravates illness-induced hyperglycemia, even in a low-dose steroid regimen.1
2010 Jan 27 - Corticosteroid Treatment and Intensive Insulin Therapy for Septic Shock in Adults. A Randomized Controlled Trial.
Context Corticosteroid therapy induces potentially detrimental hyperglycemia in septic shock. In addition, the benefit of adding fludrocortisone in this setting is unclear.
Telemedicine, defined as the use of electronic information and communication technologies to provide health care when the caregiver and patient are geographically distanced,1 is an increasing trend in inpatient medicine. One of the most common applications is in the intensive care unit (ICU), where ICU telemedicine (tele-ICU) can be used to increase access to intensivist physicians.
2009 Dec 23/30 - Association of Telemedicine for Remote Monitoring of Intensive Care Patients With Mortality, Complications, and Length of Stay
Context Telemedicine technology, which can enable intensivists to simultaneously monitor several intensive care units (ICUs) from an off-site location, is increasingly common, but there is little evidence to support its use.
2009 Dec 2 - JAMA Editorial: Antibiotic Usage and Resistance - Gaining or Losing Ground on Infections in Critically Ill Patients?
In this issue of JAMA, Vincent and colleagues1 report the results of a remarkable point prevalence survey of infections in intensive care units (ICUs) worldwide and the association of these infections with outcomes of critically ill patients.