Poor adherence to CLABSI prevention guidelines worldwide

Cristina Valencia, Naïma Hammami et el published a worldwide survey of healthcare professionals in this month’s Antimicrobial Resistance & Infection Control journal. Overall, only 23% of the ICUs strictly adhere to the guidelines to prevent CLABSI. Just for review, here are the components of CLABSI prevention bundle by the Joint Commission  Hand hygiene Hands are …

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Guidelines for reversal of antithrombotics in intracranial hemorrhage

Neurocritical Care Society and Society of Critical Care Medicine just published guidelines for the reversal of antithrombotics in intracranial hemorrhage. Summary is here in this table.     Antithrombotic agent Reversal agent Vitamin K antagonists If INR more than 1.4   vitamin K 10 mg IV, plus 3- or 4-factor PCC IV (dosing based on …

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Effective communication with mechanically ventilated patients

S. Ten Hoorn, P. W. Elbers and A. R. Girbes published a systemic review in critical care journal in Sept, 2016 about how to communicate with patients on mechanical ventilation.  Summary of the review is in this picture In the US, many ICUs use commercially available communication boards. One below is from Vidatak. In the current technology driven era, there are many …

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New recommendations for liberation from mechanical ventilation

Chest/ American thoracic society released new guidelines for liberation from mechanical ventilation. There are six key recommendations. They all are applicable to patients who are mechanically ventilated for more than 24 hours. For all recommendations, strength is conditional except recommendation for NIV after extubation where it is strong. Initial SBT or spontaneous breathing trial should …

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Should you extubate during night ? Yes, if you are there!

Gershengorn et al published in JAMA a very large retrospective cohort study of 97 844 patients from 165 US ICUs who participate in Project Impact from October 1, 2000, to March 29, 2009. Authors created  4518 propensity-matched pairs of patients with less than 12 hours of Mechanical ventilation and 5761 propensity-matched pairs of patients with mechanical ventilation of more …

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Adjunctive early hydrocortisone therapy does not prevent the development of septic shock in patients with severe sepsis

The Hydrocortisone  for Prevention of Septic Shock (HYPRESS) study was published in JAMA on Oct 3, 2016. 380 patients with sepsis (with evidence of infection plus at least 2 systemic inflammatory response syndrome criteria and evidence of organ dysfunction ) were  randomized either to receive a continuous infusion of 200 mg of hydrocortisone for 5 days or placebo. There …

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Inform Trial : No effect of blood storage time on mortality after transfusion

Inform trial results were published in NEJM on Oct 24, 2016. 31,497 adult patients  at six hospitals in four countries (Australia, Canada, Israel and the U.S) were randomized to receive short or long term stored blood. There was no difference in mortality among two groups. Earlier, a meta analysis of 12 randomized trials showed no …

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THRACE TRIAL : Mechanical thrombectomy is better than Alteplase alone in Stroke

Bracard S et el  in recently published THRACE trial compared mechanical thrombectomy in addition to standard Alteplase for stroke. Mechanical thrombectomy in addition to standard care improved clinical outcomes (functional independence at 3 months (odds ratio 1.55, 95% CI 1.05-2.30; p=0.028). There was no difference in mortality or symptomatic intracranial hemorrhage in two groups. Common adverse …

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Pulmonary Embolism presenting as Syncope : Scare mongering at best

PESIT INVESTIGATORS published in this week of NEJM, reported that 17.3% of patients had PE who were admitted with first syncope to the hospital. This study has been circulated in various newspapers (1, 2, 3) as if  physicians are missing the big deadly cause of fainting spells, which is plain scare mongering. Emergency room physicians are already overusing …

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New Nomogram to predict Surgical ICU readmission

Martin et el  from the University of Utah School of Medicine, Salt Lake City developed a new nomogram to predict Surgical ICU readmission. What they did Studied 3,109 SICU admissions, with 141 patients readmissions within 72 hours of discharge from ICU. Came up with following risk factors patient age respiratory rate (breaths per minute) history of …

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