Hospital Medicine Alert – August 1, 2008
August 1, 2008
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Missed Opportunities for Noninvasive Ventilation in Acute Respiratory Failure
In this review of patients admitted to the ICU with acute respiratory failure secondary to COPD exacerbation or cardiogenic pulmonary edema, nearly two-thirds of patients who apparently met criteria for noninvasive ventilation (NIV) were intubated without a trial of NIV. -
Pharmacist Supervision Aids Patients in Getting off Mechanical Ventilation Faster
Institution of a daily pharmacist-enforced intervention designed to improve adherence to sedation guidelines decreased the duration of mechanical ventilation and ICU stay. -
Elevated Troponin I without ACS
Elevated troponin i is a nonspecific finding, but suggests a poor prognosis regardless of its cause. -
Ceftobiprole: MRSA Coverage Comes to β-Lactams at Last
Ceftobiprole, a novel broad-spectrum cephalosporin with activity against MRSA, was non-inferior to vancomycin plus ceftazidime in a study of complicated skin and skin-structure infections. This is the first β-lactam with reliable activity against methicillin resistant Staphylococcus aureus (MRSA) to be evaluated in advanced-stage clinical trials. -
Recombinant Activated Factor VIIa: Phase III Trial Fails to Show Clinical Benefit
Randomized studies of neuroprotective agents for ischemic stroke have resulted in a series of failures, as multiple agents, promising in animal models, have failed when applied to human subjects. By contrast, intracerebral hemorrhage (ICH) has been somewhat a "neglected stepsister" when compared to ischemic stroke; it has been studied minimally, despite its high morbidity and mortality.