Critical Care Alert – March 1, 2003

March 1, 2003

• Reducing Ventilator-Associated Pneumonia Rates Through Staff Education

  The purpose of this pre- and postintervention observation study was to evaluate the effect of an educational initiative on ventilator-associated pneumonia (VAP) rate. The educational program was directed towards respiratory therapists and critical care nurses.

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• Decision Rule Improves Cardiac Triage

  Synopsis: The clinical decision rule tested in this study reduced unnecessary hospital admissions in patients with suspected acute cardiac ischemia without affecting safety.

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• Intensivist Care Improves ICU Outcomes

  Synopsis: This carefully done systematic review of the existing literature shows that overall mortality and ICU length of stay are better with increasing involvement of critical care physicians in patient care.

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• Special Feature: Current Antifungal Treatment in the ICU

  In a recent issue of Critical Care Alert I discussed the epidemiology and pathophysiology of invasive fungal infections that afflict patients in the ICU. In this issue, I review the current treatment options.

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• Critical Care Plus: Eight ICU Core Measures Move Forward

  The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is pilot testing 8 of the 11 standardized intensive care core measures initially put forth for public comment.

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• Critical Care Plus: VAP: High Costs in More Ways than One, says CDC Guideline

  The fatality rates for hospital-associated pneumonia in general, and of ventilator-associated pneumonia (VAP) in particular, are high. For hospital-associated pneumonia, attributable mortality rates of 20% to 33% have been reported, according to the draft pneumonia prevention guideline by the Centers for Disease Control and Prevention (CDC).

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• Critical Care Plus: Deaths, Injuries Often Come From Multiple Failures

  Ventilator-related deaths and injuries often are caused by multiple system failures, especially in the ICU, according to a recent report from the Joint Commission on Accreditation of Healthcare Organizations.

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• Critical Care Plus: CDC Catheter Guide Cites Change-Out Frequency

  The centers for disease control and prevention (CDC) has issued updated guidance to help infection control professionals prevent costly intravascular catheter-related bloodstream infections (BSIs).

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• Clinical Briefs in Primary Care Supplement

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• Pharmacology Watch: Smallpox Vaccination Guidelines Published by CDC

  The Centers for Disease Control and Prevention published Smallpox Vaccination and Adverse ReactionsGuidance for Clinicians in the Jan. 24th edition of Morbidity and Mortality Weekly Report. The guidance is a thorough review of the smallpox vaccine with a well-illustrated compendium of complications.

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