Critical Care Alert – January 1, 2005

January 1, 2005

• Effect of Kinetic Therapy on Pulmonary Complications

  The primary objective of this study was to determine whether patients receiving mechanical ventilation who tolerate kinetic therapy have better pulmonary function than patients treated with standard turning. A secondary objective was to assess the cost-effectiveness of kinetic therapy.

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• Does Early Tracheostomy Improve Outcomes?

  This prospective, randomized trial evaluated the role of early percutaneous tracheostomy in critically ill adults projected to require more than 14 days of mechanical ventilation. They found significant reductions in ICU length of stay, the incidence of ventilator-associated pneumonia, and mortality.

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• Maximum Sterile Barriers for CVC Insertion Save both Money and Lives

  This cost-effectiveness analysis based on available published data suggests that the routine use of maximum sterile barriers for central venous line insertion would reduce the incidence of line-related infections and save both money and lives.

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• Should Patients with End-Stage Liver Disease be Intubated?

  Mortality among patients with advanced cirrhosis who required intubation and mechanical ventilation was related more to the derangement of liver function than to the severity of critical illness as assessed by APACHE II or SAPS.

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• Special Feature: The Highly Reliable ICU

  Adverse events and hospital deaths are common, and when these are combined, a large proportion of deaths are deemed preventable. Are there organizational approaches we can adopt in the ICU that will create a safer place?

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• Pharmacology Watch: Hypertension: Therapy vs Calcium Channel Antagonists

  GEMINI Trial; CAMELOT Trial; INVEST Trial; The Dangers of Vitamin E; FDA Actions.

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• Clinical Briefs in Primary Care supplement

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