Search results for "Critical Care"
Teleintensivist care didn't reduce ICU length of stay in Brazilian trial
In Brazilian ICUs without an on-site intensivist, an intervention in which a teleintensivist provided daily multidisciplinary rounds, monthly audit and feedback meetings, and evidence-based clinical protocols did not change patient outcomes compared to usual care.
https://acphospitalist.acponline.org/archives/2024/10/16/teleintensivist-care-didnt-reduce-icu-length-of-stay-in-brazilian-trial.htm
16 Oct 2024
Hypoxemia risk lower with noninvasive ventilation before intubation
Hypoxemia occurred in 9.1% of critically ill patients randomized to noninvasive ventilation before tracheal intubation, compared to 18.5% of those who got an oxygen mask instead, a trial in 24 U.S. EDs and ICUs found.
https://acphospitalist.acponline.org/archives/2024/06/26/hypoxemia-risk-lower-with-noninvasive-ventilation-before-intubation.htm
26 Jun 2024
Survey details significant rise in intensivists working in U.S. ICUs
More than 90% of all U.S. ICUs have intensivists available, according to a survey that measured prepandemic ICU staffing. In comparison, research from 1997 shows less than 40% of ICU patients received care from an intensivist.
https://acphospitalist.acponline.org/archives/2024/05/29/survey-details-significant-rise-in-intensivists-working-in-us-icus.htm
29 May 2024
Early mobilization associated with worse outcomes in ICU patients with diabetes
Patients with diabetes in the ICU who received minimized sedation and physiotherapy were at higher risk for death at 180 days than those without, a recent study found.
https://acphospitalist.acponline.org/archives/2024/05/29/early-mobilization-associated-with-worse-outcomes-in-icu-patients-with-diabetes.htm
29 May 2024
Antipsychotic medications not effective in ICU patients with delirium
A systematic review and meta-analysis found no improvements in delirium- or coma-free days, mortality, duration of mechanical ventilation, or ICU or hospital length of stay in critically ill patients with delirium who received antipsychotics versus those who did not.
https://acphospitalist.acponline.org/archives/2024/03/27/antipsychotic-medications-not-effective-in-icu-patients-with-delirium.htm
27 Mar 2024
Study finds ECMO patient selection inconsistent, offers lessons for decision makers
Reviewing records of 81 patients considered for venovenous extracorporeal membrane oxygenation (ECMO) at a single center, researchers identified a total of 15 contraindications. All but four contraindications that were invoked to decline one patient were present in a patient determined to be a candidate for ECMO.
https://acphospitalist.acponline.org/archives/2024/03/06/study-finds-ecmo-patient-selection-inconsistent-offers-lessons-for-decision-makers.htm
6 Mar 2024
American Heart Association issues scientific statement on cardiogenic shock in older adults
The statement provides suggestions for clinical practice, highlighting the crucial role of individualized risk assessment, an interdisciplinary approach, and patient-centered decision making in the management of cardiogenic shock among older adults.
https://acphospitalist.acponline.org/archives/2024/03/06/american-heart-association-issues-scientific-statement-on-cardiogenic-shock-in-older-adults.htm
6 Mar 2024
Oxygen saturation targets not related to long-term outcomes in critically ill adults
Cognition, quality of life, and related outcomes did not differ at 12 months among patients with lower, intermediate, or higher oxygen saturation targets while on mechanical ventilation, a retrospective study found.
https://acphospitalist.acponline.org/archives/2024/02/07/oxygen-saturation-targets-not-related-to-long-term-outcomes-in-critically-ill-adults.htm
7 Feb 2024
Updated recommendations on corticosteroids in sepsis, ARDS, CAP
New guidance from the Society of Critical Care Medicine includes conditional recommendations to administer corticosteroids to patients with septic shock or acute respiratory distress syndrome (ARDS), and a strong recommendation for severe community-acquired pneumonia (CAP).
https://acphospitalist.acponline.org/archives/2024/01/31/updated-recommendations-on-corticosteroids-in-sepsis-ards-cap.htm
31 Jan 2024
Sedation practices worsened during pandemic among patients without COVID-19
The percentage of mechanically ventilated patients treated with sustained deep sedation following intubation rose during the pandemic and did not improve after its peak, a single-center study found.
https://acphospitalist.acponline.org/archives/2024/01/24/sedation-practices-worsened-during-pandemic-among-patients-without-covid-19.htm
24 Jan 2024
Peripheral administration of norepinephrine may reduce central line use
A protocol for peripheral norepinephrine administration eliminated one central venous catheter (CVC) day in the average patient and made it possible for 51.6% of patients taking the drug to avoid a CVC entirely, an observational cohort study at one ICU found.
https://acphospitalist.acponline.org/archives/2023/08/30/peripheral-administration-of-norepinephrine-may-reduce-central-line-use.htm
30 Aug 2023
U.S. uses mechanical ventilation much more than Canada, England, especially for elderly
Invasive mechanical ventilation was provided to 209 patients ages 80 years or older per 100,000 population in England, compared to 694 in Canada and 1,788 in the U.S., an analysis of 2018 data showed.
https://acphospitalist.acponline.org/archives/2023/07/05/us-uses-mechanical-ventilation-much-more-than-canada-england-especially-for-elderly.htm
5 Jul 2023
Video laryngoscope increased success rate of intubation, ED and ICU study finds
A trial was stopped early for efficacy after an interim analysis found that 85.1% of video-laryngoscope intubations were successful on the first attempt compared to 70.8% of those performed with a direct laryngoscope.
https://acphospitalist.acponline.org/archives/2023/06/21/video-laryngoscope-increased-success-rate-of-intubation-ed-and-icu-study-finds.htm
21 Jun 2023
AHA/ASA update recommendations on aneurysmal subarachnoid hemorrhage
The new guideline from the American Heart Association/American Stroke Association (AHA/ASA) covers diagnosis and management of the condition and replaces the organizations' 2012 guideline.
https://acphospitalist.acponline.org/archives/2023/05/31/ahaasa-update-recommendations-on-aneurysmal-subarachnoid-hemorrhage.htm
31 May 2023
Arterial catheters noninferior to venipuncture for blood cultures in critically ill patients
A prospective multicenter study in Japan found that cultures for suspected bloodstream infection had similar contamination rates when obtained via arterial catheters versus venipuncture.
https://acphospitalist.acponline.org/archives/2023/02/08/arterial-catheters-noninferior-to-venipuncture-for-blood-cultures-in-critically-ill-patients.htm
8 Feb 2023
Early mobilization significantly reduced cognitive impairment in ICU patients, trial finds
Less than a quarter of patients randomized to early occupational and physical therapy while ventilated were cognitively impaired at one year, compared to 43% of those who received usual care, a single-center study found.
https://acphospitalist.acponline.org/archives/2023/02/01/early-mobilization-significantly-reduced-cognitive-impairment-in-ICU-patients-trial-finds.htm
1 Feb 2023
Selective digestive tract decontamination assessed in ventilated ICU patients
A systematic review found that mechanically ventilated ICU patients had lower in-hospital mortality rates with selective digestive tract decontamination versus standard care or placebo, while a trial found improvement in rates of positive blood cultures and antibiotic-resistant organisms, but not mortality, with the intervention.
https://acphospitalist.acponline.org/archives/2022/11/02/selective-digestive-tract-decontamination-assessed-in-ventilated-icu-patients.htm
2 Nov 2022
Lower oxygen saturation target for ventilated patients didn't affect time on ventilation
An ED and ICU at one medical center tested oxygen saturation targets of 90%, 94%, and 98% in mechanically ventilated patients and found no difference in days free of ventilation or 28-day mortality.
https://acphospitalist.acponline.org/archives/2022/11/02/lower-oxygen-saturation-target-for-ventilated-patients-didnt-affect-time-on-ventilation.htm
2 Nov 2022
Pharmacist workload linked to worse outcomes in ICU patients with complex med regimens
Patients with complex medication regimens had increases in mortality risk and ICU length of stay in a retrospective study. They also received more interventions from pharmacists, but a higher patient-to-pharmacist ratio was associated with fewer of these interventions.
https://acphospitalist.acponline.org/archives/2022/06/22/pharmacist-workload-linked-to-worse-outcomes-in-icu-patients-with-complex-med-regimens.htm
22 Jun 2022
IV fluid bolus during intubation does not improve outcomes in the critically ill
A randomized clinical trial at 11 U.S. ICUs found no significant difference in cardiovascular (CV) collapse or death at 28 days between critically ill adults who received a 500-mL IV bolus before induction of anesthesia for tracheal intubation and those who did not.
https://acphospitalist.acponline.org/archives/2022/06/22/iv-fluid-bolus-during-intubation-does-not-improve-outcomes-in-the-critically-ill.htm
22 Jun 2022