Critical Care Alert – August 1, 2003

August 1, 2003

• Which Patients with Acute COPD Exacerbation Need NPPV?

  Although noninvasive positive-pressure ventilation (NPPV) has become a standard of care for acute-on-chronic ventilatory failure in patients with chronic obstructive pulmonary disease (COPD), the numerous reported studies have left uncertain how the clinician should select patients who should receive this therapy.

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• Delay in Transfer to the ICU Leads to Poorer Clinical Outcomes

  A time lapse of > 4 hours in ICU transfer after the development of 1 or more physiologic threshold criteria was associated with greater mortality, longer hospital length of stay, and higher costs.

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• The Downside of Accepting Critically Ill Patients in Transfer

  Patients who were transferred directly to the authors medical ICU from other hospitals were sicker and had worse outcomes than those who were directly admitted. Benchmarking data generated without taking referral source into account erroneously indicated an excessive death rate and other adverse outcomes.

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• Special Feature: Randomized, Controlled Trials — Strengths and Weaknesses

  The randomized, controlled trial (RCT) is believed to provide the strongest evidence for verifying both effectiveness and ineffectiveness of a given treatment. Once the RCT judges the proposed treatment as ineffective, it is rare that the treatment is ever evaluated again.

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• Critical Care Plus: Networks More Important as Rural Emergency Rooms Close

  Good ED/ICU networks are becoming more important as more rural hospitals close due to lack of funding, says Janet Williams, MD, FACEP, director of the Center for Rural Emergency Medicine and Professor of Emergency Medicine at West Virginia University in Morgantown.

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• Critical Care Plus: Clinical Pathways Making Some Inroads

  Advancing technology continues to reshape the way care management is practiced in the ICU and elsewhere, but early experience shows that technology is no guarantee for physician buy-in at the front end, much less patient compliance at the back end.

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• Pharmacology Watch: Nasally Administered Flu Vaccine Comes to United States

  The FDA has approved the first nasally administered flu vaccine to be marketed in this country. Medimmunes FluMist is also the first influenza vaccine to use live virus.

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• Clinical Briefs in Primary Care Supplement

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