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.
2011 Mar 23 - Association of Episodic Physical and Sexual Activity With Triggering of Acute Cardiac Events: Systematic Review and Meta-analysis
Context Evidence has suggested that physical and sexual activity might be triggers of acute cardiac events.
2011 Mar 23 - Implementation of a Sensitive Troponin I Assay and Risk of Recurrent Myocardial Infarction and Death in Patients With Suspected Acute Coronary Syndrome
Context Although troponin assays have become increasingly more sensitive, it is unclear whether further reductions in the threshold of detection for plasma troponin concentrations will improve clinical outcomes in patients with suspected acute coronary syndrome (ACS).
2011 Mar 23 - Hydrocortisone Therapy for Patients With Multiple Trauma: The Randomized Controlled HYPOLYTE Study
Christelle Volteau; Damien Masson, PharmD, PhD; Jean Michel Nguyen, MD, PhD; Corinne Lejus, MD, PhD; Karim Asehnoune, MD, PhD. JAMA. 2011;305(12):1201-1209. doi: 10.1001/jama.2011.360
Context The role of stress-dose hydrocortisone in the management of trauma patients is currently unknown.
2011 Jan 24 - Current and Potential Usefulness of Pneumococcal Urinary Antigen Detection in Hospitalized Patients With Community-Acquired Pneumonia to Guide Antimicrobial Therapy
Roger Sordé, MD; Vicenç Falcó, MD; Michael Lowak, MD; Eva Domingo, MD; Adelaida Ferrer, MD; Joaquin Burgos, MD; Mireia Puig, MD; Evelyn Cabral, MD; Oscar Len, MD; Albert Pahissa, MD. Arch Intern Med. 2011;171(2):166-172. Vol. 171 No. 2, January 24, 2011 Online Only
Background The role of pneumococcal urinary antigen detection in the treatment of adults with community-acquired pneumonia (CAP) is not well defined. We assessed the usefulness of pneumococcal urinary antigen detection in the diagnosis and antimicrobial guidance in patients hospitalized with CAP.
2011 Jan 19 - A Multifaceted Intervention for Quality Improvement in a Network of Intensive Care UnitsA Cluster Randomized Trial
Context Evidence-based practices improve intensive care unit (ICU) outcomes, but eligible patients may not receive them. Community hospitals treat most critically ill patients but may have few resources dedicated to quality improvement.
The provision of intensive care to patients in the throes of life-threatening acute illness is one of the most important and most expensive parts of US health care. Today, adults in the United States are increasingly likely to receive intensive care unit (ICU) care compared with previous generations, with the greatest ICU resource use occurring among older patients and those at the end of life. 1
Background Patients in intensive care units (ICUs) often acquire infections, which impose a heavy human and financial burden. The use of private rooms may reduce the acquisition of certain pathogens, but the limited evidence on this topic is inconsistent.
2010 Dec 15 - Effect of a Lung Protective Strategy for Organ Donors on Eligibility and Availability of Lungs for TransplantationA Randomized Controlled Trial
AbstractContext Many potential donor lungs deteriorate between the time of brain death and evaluation for transplantation suitability, possibly because of the ventilatory strategy used after brain death.
Matthew R. Pipeling, MD; Eddy Fan, MD. JAMA. 2010;304(22):2521-2527. doi: 10.1001/jama.2010.1752
Acute respiratory distress syndrome (ARDS) is a common and severe form of acute lung injury, resulting from both direct (eg, pneumonia) and indirect (eg, sepsis) pulmonary insults. It is a common cause of admission to the intensive care unit due to hypoxemic respiratory failure requiring mechanical ventilation, and is associated with significant morbidity and mortality.
2010 Nov 17 - JAMA Editorial: Automated External Defibrillators and the Law of Unintended Consequences
Sudden cardiac arrest remains a significant public health problem. Successful resuscitation from tachyarrhythmic cardiac arrest increases if time to defibrillation is reduced.1-2 Therefore, early detection of life-threatening arrhythmias followed by rapid initiation of effective therapy has been the goal. Patients requiring hospitalization benefit from being admitted to a facility where special resuscitation equipment and trained personnel are in close proximity around the clock.
Paul S. Chan, MD, MSc; Harlan M. Krumholz, MD, SM; John A. Spertus, MD, MPH; Philip G. Jones, MS; Peter Cram, MD; Robert A. Berg, MD; Mary Ann Peberdy, MD; Vinay Nadkarni, MD; Mary E. Mancini, RN, PhD; Brahmajee K. Nallamothu, MD, MPH; for the American Heart Association National Registry of Cardiopulmonary Resuscitation (NRCPR) Investigators. JAMA. 2010;304(19):2129-2136. doi:10.1001/jama.2010.1576
Context Automated external defibrillators (AEDs) improve survival from out-of-hospital cardiac arrests, but data on their effectiveness in hospitalized patients are limited.
Background The effects of hospital-acquired Clostridium difficile infection (CDI) on patient outcomes are incompletely understood. We conducted this study to determine the independent impact of hospital-acquired CDI on in-hospital mortality after adjusting for the time-varying nature of CDI and baseline mortality risk at hospital admission.
Hypothesis In an emergency medical system with established rapid-sequence intubation protocols, prehospital (PH) intubation of patients with trauma is not associated with a higher rate of ventilator-associated pneumonia (VAP) than emergency department (ED) intubation.
2010 Nov 10 - Quality of Traditional Surveillance for Public Reporting of Nosocomial Bloodstream Infection Rates
Y. Lin, MD, MPH; Bala Hota, MD, MPH; Yosef M. Khan, MBBS, MPH; Keith F. Woeltje, MD, PhD; Tara B. Borlawsky, MA; Joshua A. Doherty, BS; Kurt B. Stevenson, MD, MPH; Robert A. Weinstein, MD; William E. Trick, MD; for the CDC Prevention Epicenter Program. JAMA. 2010;304(18):2035-2041. doi:10.1001/jama.2010.1637
Context Central line–associated bloodstream infection (BSI) rates, determined by infection preventionists using the Centers for Disease Control and Prevention (CDC) surveillance definitions, are increasingly published to compare the quality of patient care delivered by hospitals. However, such comparisons are valid only if surveillance is performed consistently across institutions.
2010 Oct 27 - JAMA Editorial: The Lingering Consequences of Sepsis: A Hidden Public Health Disaster?
Sepsis, the syndrome of infection complicated by vital organ dysfunction, is a medical emergency that affects more than 750 000 patients in the United States each year and remains one of the world's leading causes of death.1 Without prompt resuscitation, antibiotics, and institution of life support, patients can quickly develop shock, multisystem organ failure, and death.
2010 Oct 27 - Long-term Cognitive Impairment and Functional Disability Among Survivors of Severe Sepsis
Context Cognitive impairment and functional disability are major determinants of caregiving needs and societal health care costs. Although the incidence of severe sepsis is high and increasing, the magnitude of patients' long-term cognitive and functional limitations after sepsis is unknown.
Ludhmila A. Hajjar, MD, PhD; Jean-Louis Vincent, MD, PhD; Filomena R. B. G. Galas, MD, PhD; Rosana E. Nakamura, MD; Carolina M. P. Silva, MD; Marilia H. Santos, MD, PhD; Julia Fukushima, MSc; Roberto Kalil Filho, MD, PhD; Denise B. Sierra, MD; Neuza H. Lopes, MD, PhD; Thais Mauad, MD, PhD; Aretusa C. Roquim, MD; Marcia R. Sundin, MD; Wanderson C. Leão, MD; Juliano P. Almeida, MD; Pablo M. Pomerantzeff, MD, PhD; Luis O. Dallan, MD, PhD; Fabio B. Jatene, MD, PhD; Noedir A. G. Stolf, MD, PhD; Jose O. C. Auler Jr, MD, PhD. JAMA. 2010;304(14):1559-1567. doi:10.1001/jama.2010.1446
Context Perioperative red blood cell transfusion is commonly used to address anemia, an independent risk factor for morbidity and mortality after cardiac operations; however, evidence regarding optimal blood transfusion practice in patients undergoing cardiac surgery is lacking.
For more than a decade, cardiopulmonary resuscitation (CPR) using only chest compressions, forgoing ventilations by rescue breathing, has been described as an option in the out-of-hospital management of sudden cardiac arrest when bystanders are unwilling or unable to provide standard CPR that combines chest compressions with rescue breathing. The "Guidelines 2005" CPR standards promulgated by the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR) indicate that "the best method of CPR is compressions coordinated with ventilations."1 However,
2010 Oct 6 - Use of Advanced Radiology During Visits to US Emergency Departments for Injury-Related Conditions, 1998-2007
Context Excessive use of medical imaging increases health care costs and exposure to ionizing radiation (a potential carcinogen) without yielding significant benefits to all patients.