Critical Care Alert – November 1, 2010

November 1, 2010

• Should We Paralyze Patients with Severe Acute Respiratory Distress Syndrome?

  Paralytic agents such as vecuronium and cis-atracurium have been used as "rescue therapies" in patients with ARDS for many years, but, as with other rescue strategies including prone mechanical ventilation or inhaled vasodilators, evidence of a mortality benefit from this intervention has been lacking.

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• Abstract & Commentary: Preventing Unplanned Extubations: Pulling out the Evidence

  This web-based survey assessed 1976 critical care practitioners' perceptions of the risks for unplanned extubation. Members of the American Association for Respiratory Care, the American Association of Critical Care Nurses, and the Society of Critical Care Medicine reported a number of factors associated with unplanned extubation, including outward migration of the endotracheal tube (ETT; reported by 73% of respondents), the patient tugging on the ETT (87%), removing a nasogastric tube (71%), absence of physical restraints (72%), a nurse/patient ratio of 1:3 (60%), trips out of the ICU for tests (59%), and light sedation (42%).

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• Abstract & Commentary: Is Hyperoxia Harmful After Resuscitation from Cardiac Arrest?

  Project IMPACT, a proprietary database originally created by the Society for Critical Care Medicine and now maintained by Cerner Corp., collects data from a voluntary consortium of ICUs across America.

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• Abstract & Commentary: Steroids for COPD Exacerbations: Is High-dose IV Administration Really Necessary?

  Although corticosteroids are beneficial in treating severe exacerbations of chronic obstructive pulmonary disease (COPD), studies to date have not shown high-doses (such as methylprednisolone, 2 mg/kg or more per 24 h) administered intravenously (IV) to be superior to lower doses (e.g., prednisone, 40 mg/day) given orally, with respect to clinically important outcomes.

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• Pharmacology Watch: Dabigatran Leading Race to Replace Warfarin

  In this issue: FDA Advisory Committee recommends approval of dabigatran, safety of proton pump inhibitors, effectiveness of glucosamine and chondroitin, FDA Actions.

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• Clinical Briefs in Primary Care supplement

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