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 brain injury, and ~1/4 had scores similar to mild Alzheimers disease. The longer the delirium, the worse the cognitive outcomes (abstract).
This patient flow study found that as ICU “strain” increases (admissions, acuity, and census), patients are more likely to be transferred to the floor 6 hours earlier, and this increases the risk of ICU readmission by 1%; but there is no evidence that this increases mortality or hospital LOS (abstract).
Due to the black box warning of higher mortality compared to other antibiotics, tigecycline should be reserved only for use when other safer antibiotics are not feasible (FDA warning).
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 (8%) (abstract).
Managing coagulation in cirrhotics is very difficult. A new practical guideline gives the following advice: For invasive procedures, keep platelets >50K, avoid FFP, and consider ddavp for dental extractions; for bleeding varices, also keep Hb around 7, and keep fibrinogen >100. Acute portal vein thrombosis requires anticoagulation, but chronic does not; inpatients should be given prophylaxis for VTE (abstract).
This large trial of nursing home residents found those at risk for pressure ulcer development did not develop ulcers at different rates based on Q2, Q3, or Q4 hour turning. Although this was a short term trial, and was in a nursing home population, it may be applicable to hospitalized patients (abstract).
This large cohort evaluated the difference between subjective (clinical impression) versus objective (4 opiate prescriptions from 4+ providers in 12 months) drug seeking behavior among ED patients. It found only fair agreement between the 2 criteria (kappa = 0.30), indicating clinical impressions are not very accurate in predicting drug seeking behavior (abstract).
This small survey of patients who boarded in the ED or in an inpatient unit (in a hallway) found 85% preferred boarding in an inpatient unit versus in the ED (abstract).
This literature review found by using the Global Trigger Tool to estimate preventable death, there are somewhere between 210,000 and 400,000 cases a year in the US, which is 2-4 times the estimate from the IOM report (abstract).