Category Archives: Pulmonary and Critical Care

Beta blockers may improve sepsis mortality

This small trial of 150 patients with sepsis and tachycardia found those randomized to an esmolol infusion (with heart rate goals 80-94) had significantly lower mortality than those in the control group (49% versus 81% at 28 days) (abstract).

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Delirium common and affects long-term cognition

In this cohort of ICU patients, 3/4 developed ICU delirium; at 3 months 40% had cognition scores 1.5 SD below the mean, and 25% were 2 SD below the mean. By 12 months, ~1/3 had scores similar to mild traumatic … Continue reading

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Vasopressin-steroid-epi in cardiac arrest

In this trial of patients with in-hospital cardiac arrest, they were randomized to vasopressin-steroid-epi combo or epi alone; those in the combination group had significantly higher chance of survival to discharge with good neurologic outcomes (21%) versus the epi group … Continue reading

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Frequency and cost of futile ICU care

This single center study found ~20% of patients in the ICU were deemed to be receiving futile care at some point, which accounted for ~7% of all ICU days. Of those deemed futile, 6 month mortality was 85%; those still … Continue reading

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Scheduled haldol does not reduce the incidence of delirium

In this trial of intubated critically ill patients, they were randomized to IV haldol (2.5mg IV q8) or placebo for a maximum of 14 days, and delirium was assessed by the CAM-ICU. ┬áThere were no differences between the groups in … Continue reading

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I-COUGH reduces post-surgical complications

This simple evidence-based bundle reduced post operative pneumonia and reintubations (I:Incentive spirometry; C:Coughing-deep breathing; O:Oral care; U:Understanding from the patient-family; G:Getting out of bed at least tid; H:Head of bed >30 degrees) (abstract).

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Universal MRSA decolonization in ICUs

The large multi-center ICU trial randomized ICUs to 1 of 3 strategies: MRSA screening/isolation, MRSA screening/isolation/decolonization, or global decolonization (5 days BID nasal mupiricin and daily chlorhexidine bathing). The hazard ratios for MRSA isolates in the 3 groups were 0.92, … Continue reading

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No benefit to intensivist staffing overnight in academic ICUs

This trial found no difference in patient outcomes (mortality or LOS) if admitted during a time of 24/7 intensivist coverage, or during a time with only daytime intensivist coverage (with home call at night) in a medical ICU. This study … Continue reading

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Prone best for severe ARDS

This trial of patients with severe ARDS randomized them to prone (at least 16 hours a day) or supine positioning. Those in the prone position had significantly lower 28 day mortality (16% vs 33%), and 90 day mortality (24% vs … Continue reading

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Music for ICU patients

This study of patients intubated in the ICU randomized them to patient-initiated/directed music, noise canceling headsets, or usual care. Those in the music group had significantly lower anxiety scores and use of sedatives compared to usual care. Those in the … Continue reading

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