Critical Care Alert – January 1, 2019
January 1, 2019
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Antipsychotics Do Not Shorten the Duration of ICU Delirium
These results support minimizing the use of haloperidol and ziprasidone in delirious patients who are not agitated. Current best practice is to adhere to the ABCDE bundle, remove causative agents when possible, and continue antipsychotics (only if they appear effective and for the minimum time necessary). The jury is still out regarding how to manage agitated delirium.
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A Combination of Commonly Measured Clinical Variables May Predict Prolonged Mechanical Ventilation
The results of this study validate a clinical tool using common ICU variables for predicting prolonged mechanical ventilation. However, one must consider both the implications and strength of any predictive model for clinical decision-making.
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Diagnosis Sepsis: Is Newer Better?
Sepsis-3 criteria may be the favored method for prognostication, whereas SIRS-based criteria may be the preferred method to screen patients for consideration of ICU admission. Future studies are necessary to continue to explore the benefits of qSOFA and potentially reveal a more precise and reliable screening tool. Most importantly, it is paramount to remember that neither set of criteria is diagnostic. Using clinical judgment along with these guides remains the ideal approach.
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Early Rehospitalization Among ICU Survivors: How Can We Do Better?
Based on inductive analysis of a large sample of patients and caregivers, this study provides an organizational framework on which to focus efforts to develop complex healthcare interventions aimed at reducing readmission after critical illness.