2013 June 19 - Time to Treatment With Intravenous Tissue Plasminogen Activator and Outcome From Acute Ischemic Stroke
Jeffrey L. Saver, MD; Gregg C. Fonarow, MD; Eric E. Smith, MD, MPH; Mathew J. Reeves, PhD; Maria V. Grau-Sepulveda, MD, MPH; Wenqin Pan, PhD; DaiWai M. Olson, PhD; Adrian F. Hernandez, MD, MHS; Eric D. Peterson, MD, MPH; Lee H. Schwamm, MD. JAMA. 2013;309(23):2480-2488.
Importance Randomized clinical trials suggest the benefit of intravenous tissue-type plasminogen activator (tPA) in acute ischemic stroke is time dependent. However, modest sample sizes have limited characterization of the extent to which onset to treatment (OTT) time influences outcome; and the generalizability of findings to clinical practice is uncertain.
2013 May 20 - Effects of Patient-Directed Music Intervention on Anxiety and Sedative Exposure in Critically Ill Patients Receiving Mechanical Ventilatory Support:
Linda L. Chlan, PhD, RN; Craig R. Weinert, MD, MPH; Annie Heiderscheit, PhD, MT-BC; Mary Fran Tracy, PhD, RN; Debra J. Skaar, PharmD; Jill L. Guttormson, PhD, RN; Kay Savik, MS . JAMA. 2013;():1-10. doi:10.1001/jama.2013.5670. Published online May 20, 2013.
Objective To test whether listening to self-initiated patient-directed music (PDM) can reduce anxiety and sedative exposure during ventilatory support in critically ill patients.
2013 May 20 - Early Parenteral Nutrition in Critically Ill Patients With Short-term Relative Contraindications to Early Enteral Nutrition:
Gordon S. Doig, PhD; Fiona Simpson, MND; Elizabeth A. Sweetman, MHM; Simon R. Finfer, FCICM; D. Jamie Cooper, FCICM; Philippa T. Heighes, MN; Andrew R. Davies, FCICM; Michael O’Leary, FCICM; Tom Solano, FCICM; Sandra Peake, FCICM; for the Early PN Investigators of the ANZICS Clinical Trials Group. JAMA. 2013;309(20):2130-2138.
Importance Systematic reviews suggest adult patients in intensive care units (ICUs) with relative contraindications to early enteral nutrition (EN) may benefit from parenteral nutrition (PN) provided within 24 hours of ICU admission.
Bridget M. Kuehn, MSJ. JAMA. 2013;309(10):969-970. doi:10.1001/jama.2013.1295.
A new guideline aims to boost sepsis survival rates by reminding physicians to treat suspected cases early and aggressively and refining targets for such therapy (http://www.sccm.org/Documents/SSC-Guidelines.pdf).
The guideline was created as part of the Surviving Sepsis Campaign (http://www.survivingsepsis.org/), a 10-year-old initiative directed by US and European critical care specialists working to reduce sepsis deaths by improving care for the potentially fatal condition.
To describe the incidence, characteristics, and outcomes of surgical patients who experience cardiac arrest requiring cardiopulmonary resuscitation (CPR).
2013 Jan 22 - Effect of Pressure Support vs Unassisted Breathing Through a Tracheostomy Collar on Weaning Duration in Patients Requiring Prolonged Mechanical Ventilation: A Randomized Trial
Patients requiring prolonged mechanical ventilation (>21 days) are commonly weaned at long-term acute care hospitals (LTACHs). The most effective method of weaning such patients has not been investigated.
Bacterial coinfection complicated nearly all influenza deaths in the 1918 influenza pandemic and up to 34% of 2009 pandemic influenza A(H1N1) infections managed in intensive care units worldwide. More than 65 000 deaths attributable to influenza and pneumonia occur annually in the United States. Data from 683 critically ill patients with 2009 pandemic influenza A(H1N1) infection admitted to 35 intensive care units in the United States reveal that bacterial coinfection commonly occurs within the first 6 days of influenza infection, presents similarly to influenza infection occurring alone, and is associated with an increased risk of death.
Jean Reignier, MD, PhD; Emmanuelle Mercier, MD; Amelie Le Gouge, MSc; Thierry Boulain, MD; Arnaud Desachy, MD; Frederic Bellec, MD; Marc Clavel, MD; Jean-Pierre Frat, MD; Gaetan Plantefeve, MD; Jean-Pierre Quenot, MD; Jean-Baptiste Lascarrou, MD; for the Clinical Research in Intensive Care and Sepsis (CRICS) Group JAMA. 2013;309(3):249-256.
Importance Monitoring of residual gastric volume is recommended to prevent ventilator-associated pneumonia (VAP) in patients receiving early enteral nutrition. However, studies have challenged the reliability and effectiveness of this measure.
Published online December 24.
The benefit of blood transfusion in patients with myocardial infarction is controversial, and a possibility of harm exists.
A systematic search of studies published between January 1, 1966, and March 31, 2012, was conducted using MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases. English-language studies comparing blood transfusion with no blood transfusion or a liberal vs restricted blood transfusion strategy were identified. Two study authors independently reviewed 729 originally identified titles and abstracts and selected 10 for analysis. Study title, follow-up period, blood transfusion strategy, and mortality outcomes were extracted manually from all selected studies, and the quality of each study was assessed using the strengthening Meta-analysis of Observational Studies in Epidemiology checklist.
Leonard L. L. Yeo, MBBS, MRCP; Prakash Paliwal, MBBS, MRCP; Hock L. Teoh, MBChB, MRCP; Raymond C. Seet, MBBS, MRCP; Bernard P. L. Chan, MBChB, MRCP; Shen Liang, PhD; Narayanaswamy Venketasubramanian, MBBS, MRCP; Rahul Rathakrishnan, MD, MRCP; Aftab Ahmad, MBBS, MRCP; Kay W. P. Ng, MBBS, MRCP; Pei K. Loh, MBBS, MRCP; Jonathan J. Y. Ong, MBBS, MRCP; Benjamin R. Wakerley, MD, PhD; Vincent F. Chong, MBBS, FRCR; Girish Bathla, MD, FRCR; Vijay K. Sharma, MBBS, MRCP
Arch Neurol. 2012;():1-6. Published online December 10, 2012
Recanalization of occluded intracranial arteries remains the aim of intravenous (IV) tissue plasminogen activator (tPA) therapy in acute ischemic stroke (AIS).
Enoxaparin sodium has predictable pharmacokinetics that allow for simplified dosing without laboratory monitoring. Reliance on renal function for excretion may lead to accumulation of enoxaparin in patients with moderate renal impairment. However, there is no dose adjustment recommended for these patients. We conducted a review to compare bleeding events in patients with moderate renal impairment compared with those with normal renal function.
John B. Holcomb, MD; Deborah J. del Junco, PhD; Erin E. Fox, PhD; Charles E. Wade, PhD; Mitchell J. Cohen, MD; Martin A. Schreiber, MD; Louis H. Alarcon, MD; Yu Bai, MD, PhD; Karen J. Brasel, MD, MPH; Eileen M. Bulger, MD; Bryan A. Cotton, MD, MPH; Nena Matijevic, PhD; Peter Muskat, MD; John G. Myers, MD; Herb A. Phelan, MD, MSCS; Christopher E. White, MD; Jiajie Zhang, PhD; Mohammad H. Rahbar, PhD; for the PROMMTT Study Group. Arch Surg. 2012;():1-10. doi:10.1001/2013.jamasurg.387.
Objective To relate in-hospital mortality to early transfusion of plasma and/or platelets and to time-varying plasma:red blood cell (RBC) and platelet:RBC ratios.
2012 Oct 17 - Daily Sedation Interruption in Mechanically Ventilated Critically Ill Patients Cared for With a Sedation Protocol: A Randomized Controlled Trial
Protocolized sedation and daily sedative interruption are 2 strategies to minimize sedation and reduce the duration of mechanical ventilation and intensive care unit (ICU) stay. We hypothesized that combining these strategies would augment the benefits.
Objective To compare protocolized sedation with protocolized sedation plus daily sedation interruption in critically ill patients.
Context Lung-protective mechanical ventilation with the use of lower tidal volumes has been found to improve outcomes of patients with acute respiratory distress syndrome (ARDS). It has been suggested that use of lower tidal volumes also benefits patients who do not have ARDS.
Arch Neurol. 2012;():1-6. doi:10.1001/archneurol.2013.578.
Objective To further characterize the demographics, outcomes, and prognostic factors for refractory status epilepticus (RSE).
Design Retrospective analysis of all the episodes of RSE treated between January 1, 1999, and August 30, 2011.
Setting Neurointensive care unit within a tertiary referral center, Mayo Clinic, Rochester, Minnesota.
Dan Hanfling, MD; Bruce M. Altevogt, PhD; Lawrence O. Gostin, JD. JAMA. 2012;308(7):675-676.
The Japanese tsunami, Haitian earthquake, and Gulf Coast hurricane offered stark reminders of how vulnerable organized societies are to catastrophic events.
Background When curative treatments are no longer options for patients dying of cancer, the focus of care often turns from prolonging life to promoting quality of life (QOL). Few data exist on what predicts better QOL at the end of life (EOL) for advanced cancer patients. The purpose of this study was to determine the factors that most influence QOL at the EOL, thereby identifying promising targets for interventions to promote QOL at the EOL.
An 85-year-old woman with multiple medical problems, including dementia, coronary artery disease, renal insufficiency, and peripheral vascular disease, was admitted to our hospital with urosepsis. Her hospital course was complicated by the development of dry gangrene of her left foot, Candida sepsis, Clostridium difficile enterocolitis, and multiple deep sacral and trochanteric pressure ulcers. When housestaff asked her son if he wanted us “to do everything,” he always answered yes. She was able to be weaned from the ventilator and was transferred to a medical unit for continued treatment of hospital-acquired C difficile enterocolitis and wound care of her multiple stage 4 ulcers. She underwent 4 surgical debridements under general anesthesia in the operating room over a several-month period but remained persistently febrile despite continuous treatment with broad spectrum antibiotics.
Coburn B, Morris AM, Tomlinson G, Detsky AS.; JAMA. 2012 Aug 1;308(5):502-11.
CONTEXT: Clinicians order blood cultures liberally among patients in whom bacteremia is suspected, though a small proportion of blood cultures yield true-positive results. Ordering blood cultures inappropriately may be both wasteful and harmful.
Background Critical care resource use accounts for almost 1% of US gross domestic product and varies widely among hospitals. However, we know little about the initial decision to admit a patient to the intensive care unit (ICU).