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 brain injury, and ~1/4 had scores similar to mild Alzheimers disease. The longer the delirium, the worse the cognitive outcomes (abstract).

Posted in Neurology, Pulmonary and Critical Care | Comments Off

ICU pressures increase transfers to the floor

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).

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Tigecycline black box warning for higher mortality

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).

Posted in ID | Comments Off

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 (8%) (abstract).

Posted in Pulmonary and Critical Care | Comments Off

A guide for managing coagulation in cirrhotics

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).

Posted in GI | Comments Off

No change in pressure ulcer incidence with turning Q2 or Q3-4 hours

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).

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Predicting drug seeking

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).

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“Boarding” better outside the ED

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).

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Rate of preventable death

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).

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Preventive PCI after STEMI

This trial randomized patients with STEMI to undergo PCI only to the culprit artery, or to the culprit artery + any other with major stenosis. The primary outcome occurred significantly less in the culprit + other group (cardiac death, MI, refractory angina) (abstract).

Posted in Cardiology | Comments Off