2009 Dec 2 - International Study of the Prevalence and Outcomes of Infection in Intensive Care Units

Jean-Louis Vincent, MD, PhD; Jordi Rello, MD; John Marshall, MD; Eliezer Silva, MD, PhD; Antonio Anzueto, MD; Claude D. Martin, MD; Rui Moreno, MD, PhD; Jeffrey Lipman, MD; Charles Gomersall, MD; Yasser Sakr, MD, PhD; Konrad Reinhart, MD; for the EPIC II Group of Investigators. JAMA. 2009;302(21):2323-2329.
Context Infection is a major cause of morbidity and mortality in intensive care units (ICUs) worldwide. However, relatively little information is available about the global epidemiology of such infections.

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2009 Nov 15 - Intravenous Drug Administration During Out-of-Hospital Cardiac Arrest: A Randomized Trial

Theresa M. Olasveengen, MD; Kjetil Sunde, MD, PhD; Cathrine Brunborg, MSc; Jon Thowsen; Petter A. Steen, MD, PhD; Lars Wik, MD, PhD. JAMA. 2009;302(20):2222-2229.
Context Intravenous access and drug administration are included in advanced cardiac life support (ACLS) guidelines despite a lack of evidence for improved outcomes. Epinephrine was an independent predictor of poor outcome in a large epidemiological study, possibly due to toxicity of the drug or cardiopulmonary resuscitation (CPR) interruptions secondary to establishing an intravenous line and drug administration.

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2009 Nov 11 - CLINICIAN’S CORNER: A 66-Year-Old Man With an Abdominal Aortic Aneurysm - Review of Screening and Treatment

Marc Schermerhorn, MD, Discussant. JAMA. 2009;302(18):2015-2022
Ruptured abdominal aortic aneurysm (AAA) is a common cause of death. Abdominal aortic aneurysms tend to be asymptomatic until the time of rupture, which has a mortality rate of greater than 80%.

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2009 Nov 11 - Prone Positioning in Patients With Moderate and Severe Acute Respiratory Distress Syndrome: A Randomized Controlled Trial

Paolo Taccone, MD; Antonio Pesenti, MD; Roberto Latini, MD; Federico Polli, MD; Federica Vagginelli, MD; Cristina Mietto, MD; Luisa Caspani, MD; Ferdinando Raimondi, MD; Giovanni Bordone, MD; Gaetano Iapichino, MD; Jordi Mancebo, MD; Claude Guérin, MD; Louis Ayzac, MD; Lluis Blanch, MD; Roberto Fumagalli, MD; Gianni Tognoni, MD; Luciano Gattinoni, MD, FRCP; for the Prone-Supine II Study Group. JAMA. 2009;302(18):1977-1984.

Figure. CoCo Cay, Bahamas, 2007 (Photo courtesy of Dr Arthur CW Lau)
Context Post hoc analysis of a previous trial has suggested that prone positioning may improve survival in patients with severe hypoxemia and with acute respiratory distress syndrome (ARDS).

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2009 Nov 4 - JAMA Editorial: Influenza in 2009 - New Solutions, Same Old Problems

Julie Louise Gerberding, MD, MPH. JAMA. 2009;302(17):1907-1908
In 1941, the Commission on Influenza of the Armed Forces Epidemiological Board (AFEB) established a comprehensive national research plan to address the most important unanswered scientific questions about influenza.1 The commission prioritized assessment of vaccine and immune serum prophylaxis efficacy but also defined a much broader scope of collaborative work across the academic, public health, and military sectors.

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2009 Nov 4 - JAMA Editorial: Preparing for the Sickest Patients With 2009 Influenza A(H1N1)

Douglas B. White, MD, MAS; Derek C. Angus, MD, MPH. JAMA. 2009;302(17):1905-1906. Published online October 12, 2009
Despite an enormous global investment in preparing for the reemergence of 2009 influenza A(H1N1), preparations proceeded largely without empirical data about the nature and severity of disease. This paucity of data is particularly problematic for clinicians in intensive care units (ICUs), who will shoulder a heavy burden for the clinical response to H1N1. In this issue of JAMA, 3 reports provide data that begin to fill this empirical void.

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2009 Nov 4 - JAMA Editorial: Respiratory Protection Against Influenza

Arjun Srinivasan, MD; Trish M. Perl, MD, MSc. JAMA. 2009;302(17):1903-1904. Published online October 1, 2009 
The 2009 influenza A(H1N1) pandemic has revived debate about the role of respiratory protection in preventing the transmission of influenza to health care personnel (HCP). The Centers for Disease Control and Prevention (CDC) guidelines for preventing transmission of seasonal influenza are intended to limit exposure to large respiratory droplets and recommend the use of a medical (surgical) mask during the care of a patient with influenza as part of a comprehensive infection control strategy.1-2

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2009 Nov 4 - CLINICIAN'S CORNER: Factors Associated With Death or Hospitalization Due to Pandemic 2009 Influenza A(H1N1) Infection in California

Janice K. Louie, MD, MPH; Meileen Acosta, MPH; Kathleen Winter, MPH; Cynthia Jean, MPH; Shilpa Gavali, MPH; Robert Schechter, MD, MPH; Duc Vugia, MD; Kathleen Harriman, PhD; Bela Matyas, MD; Carol A. Glaser, MD, DVM; Michael C. Samuel, DrPH; Jon Rosenberg, MD; John Talarico, DO, MPH; Douglas Hatch, MD; for the California Pandemic (H1N1) Working Group. JAMA. 2009;302(17):1896-1902.
Context Pandemic influenza A(H1N1) emerged rapidly in California in April 2009. Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A(H1N1) disproportionately affects younger ages and causes generally mild disease.

Objective To describe the clinical and epidemiologic features of pandemic 2009 influenza A(H1N1) cases that led to hospitalization or death.

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2009 Oct 14 - Effect of High Perioperative Oxygen Fraction on Surgical Site Infection and Pulmonary Complications After Abdominal Surgery: The PROXI Randomized Clinical Trial

Christian S. Meyhoff, MD, PhD; Jørn Wetterslev, MD, PhD; Lars N. Jorgensen, MD, DMSc; et al; for the PROXI Trial Group. JAMA. 2009;302(14):1543-1550. Context Use of 80% oxygen during surgery has been suggested to reduce the risk of surgical wound infections, but this effect has not been consistently identified. The effect of 80% oxygen on pulmonary complications has not been well defined.

Objective To assess whether use of 80% oxygen reduces the frequency of surgical site infection without increasing the frequency of pulmonary complications in patients undergoing abdominal surgery.

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2009 Oct 14 - Outcomes Following Endovascular vs Open Repair of Abdominal Aortic Aneurysm: A Randomized Trial

Frank A. Lederle, MD; Julie A. Freischlag, MD; Tassos C. Kyriakides, PhD; Frank T. Padberg Jr, MD; Jon S. Matsumura, MD; Ted R. Kohler, MD; Peter H. Lin, MD; Jessie M. Jean-Claude, MD; Dolores F. Cikrit, MD; Kathleen M. Swanson, MS, RPh; Peter N. Peduzzi, PhD; for the Open Versus Endovascular Repair (OVER) Veterans Affairs Cooperative Study Group. JAMA. 2009;302(14):1535-1542.
Context Limited data are available to assess whether endovascular repair of abdominal aortic aneurysm (AAA) improves short-term outcomes compared with traditional open repair.

Objective To compare postoperative outcomes up to 2 years after endovascular or open repair of AAA in a planned interim report of a 9-year trial.

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2009 Oct 12 - Critically Ill Patients With 2009 Influenza A(H1N1) Infection in Canada

Anand Kumar, MD; Ryan Zarychanski, MD; Ruxandra Pinto, et al; for the Canadian Critical Care Trials Group H1N1 Collaborative. JAMA. 2009;302(17):(doi:10.1001/jama.2009.1496). Early Release Article, posted October 12, 2009 JAMA-EXPRESS
Context Between March and July 2009, the largest number of confirmed cases of 2009 influenza A(H1N1) infection occurred in North America.

Objective To describe characteristics, treatment, and outcomes of critically ill patients in Canada with 2009 influenza A(H1N1) infection.

Design, Setting, and Patients A prospective observational study of 168 critically ill patients with 2009 influenza A(H1N1) infection in 38 adult and pediatric intensive care units (ICUs) in Canada between April 16 and August 12, 2009.

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2009 Oct 12 - Critically Ill Patients With 2009 Influenza A(H1N1) in Mexico

Guillermo Domínguez-Cherit, MD; Stephen E. Lapinsky, MB, BCh, MSc; et al; Alejandro E. Macias, MD; Ruxandra Pinto, PhD(Stat); Lourdes Espinosa-Perez, MD; Alethse de la Torre, MD; Manuel Poblano-Morales, MD; Jose A. Baltazar-Torres, MD; Edgar Bautista, MD; Abril Martinez, MD; Marco A. Martinez, MD; Eduardo Rivero, MD; Rafael Valdez, MD; Guillermo Ruiz-Palacios, MD; Martín Hernández, MD; Thomas E. Stewart, MD; Robert A. Fowler, MD, MS(Epi). JAMA. 2009;302(17):(doi:10.1001/jama.2009.1536). Early Release Article, posted October 12, 2009 JAMA-EXPRESS
Context In March 2009, novel 2009 influenza A(H1N1) was first reported in the southwestern United States and Mexico. The population and health care system in Mexico City experienced the first and greatest early burden of critical illness.

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2009 Oct 12 - Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome

The Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators*. JAMA. 2009;302(17). Early Release Article, posted October 12, 2009 JAMA

Figure. ECMO and hemofiltration in the ICU of PYNEH being used concurrently for the treatment of a human swine influenza patient. Deoxygenated blood is taken out of the patient through a large catheter and part of it is circulated to the hemofiltration machine. Overall nursing manpower is minimized as the ECMO is running itself by the centrifugation pump while replacement fluid for hemofiltration is produced online. (Photo courtesy of Pamela Youde Nethersole Eastern Hospital, Hong Kong, China)   
Context The novel influenza A(H1N1) pandemic affected Australia and New Zealand during the 2009 southern hemisphere winter. It caused an epidemic of critical illness and some patients developed severe acute respiratory distress syndrome (ARDS) and were treated with extracorporeal membrane oxygenation (ECMO).

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2009 Oct 13 - JAMA Editorial: Preparing for the Sickest Patients With 2009 Influenza A(H1N1)

Douglas B. White, MD, MAS; Derek C. Angus, MD, MPH. JAMA. 2009;302(17):(doi:10.1001/jama.2009.1539). Early Release Article, posted October 12, 2009 JAMA
Despite an enormous global investment in preparing for the reemergence of 2009 influenza A(H1N1), preparations proceeded largely without empirical data about the nature and severity of disease. This paucity of data is particularly problematic for clinicians in intensive care units (ICUs), who will shoulder a heavy burden for the clinical response to H1N1. In this issue of JAMA, 3 reports provide data that begin to fill this empirical void.

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2009 Oct 1 - Editorial: Respiratory Protection Against Influenza

Arjun Srinivasan, MD; Trish M. Perl, MD, MSc. JAMA. 2009;302(17):(doi:10.1001/jama.2009.1494).
The 2009 influenza A(H1N1) pandemic has revived debate about the role of respiratory protection in preventing the transmission of influenza to health care personnel (HCP). The Centers for Disease Control and Prevention (CDC) guidelines for preventing transmission of seasonal influenza are intended to limit exposure to large respiratory droplets and recommend the use of a medical (surgical) mask during the care of a patient with influenza as part of a comprehensive infection control strategy.1-2

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2009 Oct 1 - Surgical Mask vs N95 Respirator for Preventing Influenza Among Health Care Workers: A Randomized Trial

Mark Loeb, MD, MSc; Nancy Dafoe, RN; James Mahony, PhD; Michael John, MD; Alicia Sarabia, MD; Verne Glavin, MD; Richard Webby, PhD; Marek Smieja, MD; David J. D. Earn, PhD; Sylvia Chong, BSc; Ashley Webb, BS; Stephen D. Walter, PhD. JAMA. 2009;302(17)

Nurses wearing N95 and surgical masks (Photo courtesy of Dr Arthur CW Lau)
Context Data about the effectiveness of the surgical mask compared with the N95 respirator for protecting health care workers against influenza are sparse. Given the likelihood that N95 respirators will be in short supply during a pandemic and not available in many countries, knowing the effectiveness of the surgical mask is of public health importance.

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2009 Sep 9 - Effects of Donor Pretreatment With Dopamine on Graft Function After Kidney Transplantation - A Randomized Controlled Trial

Peter Schnuelle, MD, PhD; Uwe Gottmann, MD; Simone Hoeger, PhD; Detlef Boesebeck, MD; Werner Lauchart, MD, PhD; Christel Weiss, PhD; Michael Fischereder, MD, PhD; Karl-Walter Jauch, MD, PhD; Uwe Heemann, MD, PhD; Martin Zeier, MD, PhD; Christian Hugo, MD, PhD; Przemyslaw Pisarski, MD; Bernhard K. Krämer, MD, PhD; Kai Lopau, MD; Axel Rahmel, MD, PhD; Urs Benck, MD; Rainer Birck, MD, PhD; Benito Antonio Yard, PhD. JAMA. 2009;302(10):1067-1075.
Context Kidney graft function after transplantation can be improved through pharmacological donor pretreatment to limit organ injury from cold preservation.

Objective To determine whether pretreatment of brain-dead donors with low-dose dopamine improves early graft function in human renal transplant recipients.

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2009 Sep 16 - JAMA Editorial: Chronic on Acute Renal Failure: Long-term Implications of Severe Acute Kidney Injury

Sushrut S. Waikar, MD, MPH; Wolfgang C. Winkelmayer, MD, MPH, ScD. JAMA. 2009;302(11):1227-1229.
Every year more than 1 million hospitalizations in the United States are complicated by acute kidney injury, accounting for an estimated $10 billion in excess costs to the health care system.1-4 Acute kidney injury has been shown to be a potent predictor of excess length of stay, morbidity, and mortality in a number of clinical settings.

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2009 Sep 16 - Racial Differences in Survival After In-Hospital Cardiac Arrest

Paul S. Chan, MD, MSc; Graham Nichol, MD, MPH; Harlan M. Krumholz, MD, SM; John A. Spertus, MD, MPH; Philip G. Jones, MS; Eric D. Peterson, MD, MPH; Saif S. Rathore, MPH; Brahmajee K. Nallamothu, MD, MPH; for the American Heart Association National Registry of Cardiopulmonary Resuscitation (NRCPR) Investigators. JAMA. 2009;302(11):1195-1201.
Context Racial differences in survival have not been previously studied after in-hospital cardiac arrest, an event for which access to care is not likely to influence treatment.

Objectives To estimate racial differences in survival for patients with in-hospital cardiac arrests and examine the association of sociodemographic and clinical factors and the admitting hospital with racial differences in survival.

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2009 Sep 16 - Chronic Dialysis and Death Among Survivors of Acute Kidney Injury Requiring Dialysis

Ron Wald, MDCM, MPH, FRCPC; Robert R. Quinn, MD, FRCPC; Jin Luo, MD; Ping Li, PhD; Damon C. Scales, MD, PhD, FRCPC; Muhammad M. Mamdani, PharmD, MPH; Joel G. Ray, MD, MSc, FRCPC; for the University of Toronto Acute Kidney Injury Research Group. JAMA. 2009;302(11):1179-1185.
Context Severe acute kidney injury among hospitalized patients often necessitates initiation of short-term dialysis. Little is known about the long-term outcome of those who survive to hospital discharge.

Objective To assess the risk of chronic dialysis and all-cause mortality in individuals who experience an episode of acute kidney injury requiring dialysis.

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