In this large retrospective analysis of an ICU, the amount of blood transfused significantly decreased from 1997 to 2007. The percent of patients transfused decreased from 31% to 18%, the mean hemoglobin level before transfusion decreased from 7.9 to 7.3, and the mean number of transfusions decreased from 4.3 to 3.0. ICU transfusion practices have become more restrictive in accordance with clinical guideline recommendations (abstract)

In this double dummy trial of 170 patients admitted to the ICU with COPD/respiratory failure (without pneumonia), there were no differences in outcomes (death, need for additional antibiotics, length of stay, or ventilator days) between the 2 groups. This study and others confirms TMP-SMX works just as well as cipro for acute COPD exacerbations (abstract)

In this large retrospective cohort of patients extubated with a terminal illness, the median time to death was less than an hour, and almost all died within 24 hours. Older age and female gender predicted longer time to death. These statistics can help us counsel families on what to expect after withdrawal of mechanical ventilation (abstract)

In this randomized trial of out of hospital cardiac arrest patients, those who were randomized to chest compressions with rescue breathing fared just as well as those without rescue breathing. Survival to hospital discharge and favorable neurologic outcome were not significantly different between the groups. Chest compressions without rescue breathing is as effective as chest compressions alone in cardiac arrest (abstract)

In this large retrospective cohort of patients admitted to a non-ICU with COPD, and who received steroids within 2 days of admission, researchers found that 92% of patients were originally treated with IV steroids (and 8% with oral steroids). After propensity adjustment, they found the risk of treatment failure, LOS, and cost were all lower in those that received oral steroids. Use of oral steroids is not associated with worse outcomes than treatment with IV steroids in patients admitted with COPD (abstract).

This large retrospective cohort of medicare beneficiaries >age 65 found that utilization of LTACs (long term acute care hospitals) after a critical illness increased from 39 to 100 (per 100,000) from 1997 to 2006 (and the number of LTAC facilities increased 9% per year). Annual cost of this care increased from $484 million to $1.325 billion. The 1 year mortality was relatively unchanged throughout the study period, ranging 51-52%. LTAC utilization and cost has dramatically increased in elderly patients post critical illness, and these patients have >50% mortality at 1 year. These patients have a poor prognosis and should be identified and treated as such (abstract).

This large retrospective analysis of >84,000 patients hospitalized with COPD confirms the benefits of antibiotics; antibiotic treated patients had lower risks of mechanical ventilation, inpatient mortality, and COPD readmissions (although higher Cdiff readmission rates). This large analysis confirms guideline recommendations for antibiotic therapy in patients hospitalized with COPD exacerbations (abstract)

In this large observational cohort of >2,000 patients with COPD, the adjusted risk of mortality and COPD exacerbations were both lower in those on beta blockers (both hazard ratios were 0.7, CI 0.6-0.8). These data suggest there is no reason to avoid beta blockers in patients with COPD, and beta blockers may actually be associated with a lower risk of death and COPD exacerbations (abstract)

In this meta-analysis of patients with acute cardiogenic pulmonary edema, researchers found that CPAP reduced mortality and need for intubation, and bi-level ventilation reduced the need for intubation (but not mortality). Either modality of non-invasive ventilation appears to benefit patients with acute cardiogenic pulmonary edema (abstract)

Timing of tracheostomy in mechanically ventilated patients is controversial. This multi-center trial randomized 600  intubated patients to early (6-8 days) or late (13-15 days) tracheostomy. Early tracheostomy did not affect the incidence of pneumonia, but did increase ventilator-free and ICU-free days. Tracheostomy in patients still intubated at 6-8 days may reduce ventilator and ICU days, but not pneumonia incidence (abstract)