Hospital Medicine Alert – February 1, 2009
February 1, 2009
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Growth of Intensive Care Unit Use and Costs
Through a retrospective analysis, this study examined ICU resource use and costs for 121,747,260 inpatient hospitalizations, and found a rapid rise in Medicare ICU use with stable adjusted daily critical care costs, but increasing costs for care outside the ICU. -
Thrombophilia and Recurrent DVT
The risk of recurrent venous thromboembolism (VTE) during extended anticoagulant therapy for thrombophilia remains poorly defined. Investigators analyzed 661 patients with idiopathic VTE who had been randomized to extended prophylaxis after three months of initial anticoagulation using either low-intensity (INR 1.5-1.9) or standard-intensity (INR 2.0-3.0) anticoagulation. Thrombophilic defects were identified in 42% of patients. The rate of recurrent VTE of only 0.9% per patient year was not influenced by thrombophilic abnormalities. Antiphospholipid antibodies trended toward increased recurrence (HR, 2.9; 95% CI: 0.9-10.5). The presence of thrombophilic defects did not increase the risk of recurrent VTE during extended anticoagulation relative to patients with idiopathic VTE without thrombophilic defects. -
Is It Time to Jump off the Intensive Insulin Therapy Bandwagon?
This single-center, randomized controlled trial demonstrated that intensive insulin therapy targeting blood glucose values of 80-110 mg/dL does not improve mortality, but does increase the incidence of hypoglycemia in a group of critically ill medical and surgical patients. -
Pulmonary Vein Isolation vs AV Node Ablation Plus Pacing
Khan et al report a multicenter trial comparing pulmonary vein isolation vs AV junctional ablation with biventricular pacing in patients with atrial fibrillation and heart failure. -
Improving Palliative Care in the ICU
A quality improvement intervention aimed at improving palliative care in the ICU resulted in improvements of nurse-assessed quality of dying and a reduction in ICU length of stay, but no changes in family perceptions of quality of dying or satisfaction with care.