Critical Care Alert – September 1, 2003

September 1, 2003

• Predicting Post-Extubation Stridor

  Jaber and colleagues report a series of 112 intubations of patients in their multidisciplinary ICU in Montpellier, France, during a 14-month period. Every ventilated patient underwent a cuff-leak test prior to extubation, and the incidence of post-extubation stridor was determined.

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• ‘Normal’ Hemoglobin Decline in ICU Patients

  In a cohort of 91 ICU patients without known causes for hemoglobin decline other than blood draws and critical illness, serum hemoglobin levels declined by an average of 0.52 g/dL/d. The decline was more rapid during the first 3 days in the ICU and among patients who were septic.

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• Lower Than Expected In-Hospital Mortality of COPD Exacerbations

  In this study of a large nationwide database, mortality during hospitalization for acute exacerbation of COPD was 2.5%, which is substantially lower than that reported in previous studies.

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• A Universal Consent Form for 8 Common ICU Procedures

  Providing a universal consent form to patients, proxies, and staff increased the frequency with which consent was obtained without compromising understanding of the process.

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• Computer Keyboards: A Reservoir for Nosocomial Pathogens

  Of 100 keyboards in 29 clinical areas tested for bacterial contamination, 95% were positive for microorganisms, including one with vancomycin-resistant Enterococcus.

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• Aerosol Delivery During Mechanical Ventilation

  Inhaled drugs are commonly used during mechanical ventilation. The physiologic effects of bronchodilators delivered by nebulizer or pressurized metered dose inhaler (pMDI) are virtually equivalent.

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• Critical Care Plus: Who Gets What in Critical Care? Task Force Tackles Care Rationing

  Two severely ill patients in the emergency department of your hospital need admission to the ICU, but only one bed is available. Who gets admitted first? Another critical care patient is severely ill, with several coexisting conditions.

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• Critical Care Plus: Billing and Documenting Critical Care

  When does critical care become just another emergency department (ED) visit? When you fail to document it properly. You may do all the right things and have a patient in crisis, but if the paperwork isnt done properly, you dont get paid for your efforts.

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• Clinical Briefs in Primary Care Supplement

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• Pharmacology Watch: Study Shows Oral IIb/IIIa Receptors Increase Mortality

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