Critical Care Alert – January 1, 2004

January 1, 2004

• Shorter Antibiotic Course Effective in Ventilator-Associated Pneumonia

  Ventilator-associated pneumonia (VAP) remains a difficult problem in critically ill patients, both in diagnosis and treatment.

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• Pulmonary Artery Catheters Unhelpful in Shock and ARDS

  In this randomized, multicenter trial, early use of a pulmonary artery catheter in patients with shock, ARDS, or both did not significantly alter mortality or morbidity.

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• ICU Delirium Common in Older Patients

  Among patients aged 65 or older, 31% were delirious on admission to the ICU, and 70% experienced delirium at some time during their hospitalization.

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• Preventing Contrast Nephropathy

  Meta-analysis of published clinical trials showed that a regimen of oral acetylcysteine administration along with hydration reduced the relative risk of developing contrast nephropathy by 56% among patients with pre-existing renal insufficiency.

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• Dedicated Medication Nurse Did Not Reduce Error Rates

  Use of a dedicated medication nurse had no effect on the total number of medication errors based on observations performed in medical, surgical, and mixed medical-surgical units.

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• Special Feature: Recruitment Maneuvers in ARDS

  Mechanical ventilation (MV) is a supportive life-saving therapy in patients with acute respiratory distress syndrome (ARDS). In the last decade, the possibility that MV can produce alterations in lungs, namely ventilator-induced lung injury, has been recognized.

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• Clinical Briefs in Primary Care Supplement

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• Pharmacology Watch: Vioxx Might Control Postoperative Knee Pain

  Oral rofecoxib (Vioxx) may have a role in controlling postoperative pain patients undergoing knee surgery.

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