Critical Care Alert – November 1, 2004

November 1, 2004

• Visiting Hours in the ICU: Too Restrictive? Too Liberal?

  In this article, a leading expert in the area of improving health care quality argues that restricting visiting hours in ICUs is neither caring, compassionate, nor necessary.

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• Intra-Hospital Transport of ICU Patients: Traveler Beware!

  In this study of anonymously reported adverse occurrences related to intra-hospital transportation of critically ill patients, problems were related to equipment in 39% and to patient/staff management issues in 61%; 31% of the incidents had serious adverse outcomes.

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• ACE-Inhibitor Angioedema: How Common? How Serious?

  During a 5-year period, 45 patients were admitted to an inner-city teaching hospital with angioedema caused by angiotensin-converting inhibitor medications, and 18 (40%) of them required ICU admission for potential upper-airway compromise.

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• Special Feature: Sedation During Mechanical Ventilation

  Clinicians have been criticized for prescribing too much, as well as too little, sedation for critically ill patients, especially patients who require mechanical ventilation. Over-sedation may prolong weaning from ventilatory support, increase ICU and hospital lengths of stay, and predispose to development of ventilator-associated pneumonia. Inadequate sedation predisposes the patient to pain and discomfort and can evoke a stress response that compromises recovery.

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• Pharmacology Watch: The FDA and Merck Fielding Concerns About Vioxx

  Erythromycin and the Risk of Sudden Death; Vaccine Shortage Putting Americans At Risk; FDA Actions.

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• Clinical Briefs in Primary Care supplement

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