Hospital Medicine Alert – June 1, 2010
June 1, 2010
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Can We Make Intubation a Safer Procedure for Patients?
This two-phase, prospective, multicenter study demonstrated that implementation of an intubation management protocol reduced the incidence of severe hypoxemia and cardiovascular collapse during endotracheal intubation when compared to standard practice, but did not improve other patient outcomes such as ICU mortality or duration of mechanical ventilation. -
Admitted from the ED
In a prospective, observational study, > 50% of patients identified and treated for severe sepsis in the emergency department (ED) had negative cultures; 18% of patients had a noninfectious diagnosis that mimicked sepsis. -
Outcomes for Plasma Exchange to Treat TTP
The risk of relapse after effective therapy with plasma exchange for thrombotic thrombocytopenic purpura (TTP) has not been well-characterized. Among 376 patients with an initial episode of TTP treated with plasma exchange, overall survival was around 68%, with a survival of 78% among the subset with idiopathic TTP. Survival did not differ on those having a low (< 10%) ADAMTS13 level. Relapse was greater for those with a low ADAMTS13 level at the time of presentation. -
Don't Treat Superficial Thrombophlebitis Superficially
Superficial venous thrombosis is not a benign condition and deserves close attention. -
Daily Multidisciplinary ICU Rounds Improve Patient Outcomes
In this large retrospective cohort study of more than 100,000 patients in 112 hospitals, after correction for illness severity and other factors, daily rounds by a multidisciplinary care team were associated with lower mortality in the ICU, regardless of whether an intensivist model of physician staffing was in use. -
Frail Elderly and Cardiac Surgery
Although age is a risk factor for morbidity and mortality with cardiac surgery, chronologic age does not always reflect biological age. Although frailty has been shown to predict falls, hospitalization, institutionalization, and mortality in geriatric populations in the community, it has not been systematically studied in patients undergoing surgery.