2011 Dec 28 - Perceptions of Appropriateness of Care Among European and Israeli Intensive Care Unit Nurses and Physicians
Objective To determine the prevalence of perceived inappropriateness of care among ICU clinicians and to identify patient-related situations, personal characteristics, and work-related characteristics associated with perceived inappropriateness of care.
Objectives To determine the association of sepsis with changes in host innate and adaptive immunity and to examine potential mechanisms for putative immunosuppression.
2011 Nov 13 - JAMA Editorial: Is Severe Sepsis Associated With New-Onset Atrial Fibrillation and Stroke?
Severe sepsis is a major health problem in the United States and around the world, with hospital mortality rates ranging from 18% to 50%.1,2 Patients with severe sepsis are defined as a subset of patients with sepsis who have acute organ dysfunction in the setting of a systemic inflammatory response due to an infection.3
2011 Nov 13 - Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis
Objective To determine the in-hospital stroke and in-hospital mortality risks associated with new-onset AF in patients with severe sepsis.
2011 Oct 5 - Referral to an Extracorporeal Membrane Oxygenation Center and Mortality Among Patients With Severe 2009 Influenza A(H1N1)
Context Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients with severe acute respiratory distress syndrome (ARDS), but its role has remained controversial. ECMO was used to treat patients with ARDS during the 2009 influenza A(H1N1) pandemic.
2011 Oct 5 - Extracorporeal Membrane Oxygenation as a First-Line Treatment Strategy for ARDS: Is the Evidence Sufficiently Strong?
The 2009 influenza A(H1N1) pandemic was associated with a high attributable mortality among critically ill patients who developed acute respiratory distress syndrome (ARDS) and required mechanical ventilation. In this issue of JAMA, Noah and colleagues1 present evidence in support of extracorporeal membrane oxygenation (ECMO) in combination with lung protective ventilation as a treatment strategy early in the course of ARDS related to H1N1 infection.
During the last decade, there has been a major conceptual shift in thinking about artificial nutrition provided to critically ill patients. Because of its modulating effect on pathophysiology and emerging evidence about potential effects on clinical outcomes, nutrition is now considered “therapy” and not simply “supportive care.”
2011 Oct 5 - Enteral Omega-3 Fatty Acid, γ-Linolenic Acid, and Antioxidant Supplementation in Acute Lung Injury
Objective To determine if dietary supplementation of these substances to patients with acute lung injury would increase ventilator-free days to study day 28.
2011 Aug 29 - JAMA Editorial: Need for Critical Reappraisal of Intra-aortic Balloon Counterpulsation
Despite considerable organizational, technological, and pharmacological advancements in the treatment of patients with acute ST-segment elevation myocardial infarction (STEMI) and even with percutaneous coronary intervention (PCI), the efficacy of reperfusion is still suboptimal, mortality remains high, and novel therapeutic interventions are needed.
2011 Aug 29 - Intra-aortic Balloon Counterpulsation and Infarct Size in Patients With Acute Anterior Myocardial Infarction Without Shock
Context Intra-aortic balloon counterpulsation (IABC) is an adjunct to revascularization in patients with cardiogenic shock and reduces infarct size when placed prior to reperfusion in animal models.
2011 Aug 24/31 - Association of ICU or Hospital Admission With Unintentional Discontinuation of Medications for Chronic Diseases
2011;306(8):840-847. doi: 10.1001/jama.2011.1206
AbstractContext Patients discharged from acute care hospitals may be at risk for unintentional discontinuation of medications prescribed for chronic diseases. The intensive care unit (ICU) may pose an even greater risk because of the focus on acute events and the presence of multiple transitions in care.
2011 Jul 20 - Clinical Characteristics and Cardiovascular Magnetic Resonance Findings in Stress (Takotsubo) Cardiomyopathy
AbstractContext Stress cardiomyopathy (SC) is a transient form of acute heart failure triggered by stressful events and associated with a distinctive left ventricular (LV) contraction pattern. Various aspects of its clinical profile have been described in small single-center populations, but larger, multicenter data sets have been lacking so far. Furthermore, it remains difficult to quickly establish diagnosis on admission.
Abstract: Infections that result in shock and organ failure are a major public health problem worldwide. Severe sepsis and septic shock affect patients of all ages and often complicate chronic diseases.
2011 Jun 22 - Association of Door-In to Door-Out Time With Reperfusion Delays and Outcomes Among Patients Transferred for Primary Percutaneous Coronary Intervention
AbstractContext Patients with ST-elevation myocardial infarction (STEMI) requiring interhospital transfer for primary percutaneous coronary intervention (PCI) often have prolonged overall door-to-balloon (DTB) times from first hospital presentation to second hospital PCI. Door-in to door-out (DIDO) time, defined as the duration of time from arrival to discharge at the first or STEMI referral hospital, is a new clinical performance measure, and a DIDO time of 30 minutes or less is recommended to expedite reperfusion care.
More than 25 years have passed since the original description of intensive care unit (ICU) telemedicine, a technological strategy to improve critical care outcomes by expanding the reach and availability of intensivist clinicians.1
2011 May 16 - Hospital Mortality, Length of Stay, and Preventable Complications Among Critically Ill Patients Before and After Tele-ICU Reengineering of Critical Care Processes
Context The association of an adult tele-intensive care unit (ICU) intervention with hospital mortality, length of stay, best practice adherence, and preventable complications for an academic medical center has not been reported.
2011 May 11 - Intravenous Erythropoietin in Patients With ST-Segment Elevation Myocardial Infarction - REVEAL: A Randomized Controlled Trial
Context Acute ST-segment elevation myocardial infarction (STEMI) is a leading cause of morbidity and mortality. In experimental models of MI, erythropoietin reduces infarct size and improves left ventricular (LV) function.
2011 Mar - Trends in Central Line–Associated Bloodstream Infections in a Trauma-Surgical Intensive Care Unit
Objective To report the impact of hospital-wide interventions on central line–associated bloodstream infection (CLABSI) rates in a 24-bed trauma-surgical intensive care unit.
2011 Mar 28 - Contemporary Mortality Differences Between Primary Percutaneous Coronary Intervention and Thrombolysis in ST-Segment Elevation Myocardial Infarction
Background Current ST-segment elevation myocardial infarction guidelines regarding reperfusion strategy are based on trials conducted before the application of routine invasive evaluation after thrombolysis. Modern thrombolysis may affect the previously observed mortality difference between primary percutaneous coronary intervention (PPCI) and thrombolysis.
In this issue of JAMA, Roquilly and colleagues1 report the results of the HYPOLYTE (Hydrocortisone Polytraumatise) study, a randomized controlled trial of early hydrocortisone administration to severely injured patients with a primary outcome of hospital-acquired pneumonia within 28 days of injury.