Critical Care Alert – April 1, 2009

April 1, 2009

• Use of Normal Saline Instillation with Suctioning: The Debate Continues

  The use of normal saline instillation with suctioning has been debated over the years due to uncertainty about the benefits of use. Caruso and colleagues assessed the use of the instillation of 8 mL of saline before tracheal suctioning and compared VAP rates among control and treatment patients receiving mechanical ventilation for > 72 hours who had an orotracheal or tracheo-tomy tube.

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• Neuromuscular Weakness After ARDS

  Hough et al set out to determine incidence and outcomes of early neuromyopathy in patients with persistent acute respiratory distress syndrome (ARDS), and to evaluate the association of neuromyopathy with the use of methylprednisolone in this population.

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• Selective Digestive Tract or Oropharyngeal Decontamination and ICU Outcomes

  The effects of selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD; SDD without systemic antibiotics), which are measures for preventing ICU-acquired infections, on patient outcomes and microbial resistance patterns remain unsettled and controversial.

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• Greater Use of Clinical IT in Hospital Is Associated with Better Patient Outcomes

  To determine whether relationships existed between the use of clinical information technology (CIT) and measures of patient outcomes, Amarasingham and colleagues conducted a cross-sectional study of urban hospitals in Texas using the questionnaire-based Clinical Information Technology Assessment Tool, which measures a hospital's level of automation based on the interactions of its physicians with the information system.

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• Successful Implementation of a Model Designed to Increase Use of Patient Safety Measures

  The goals of this study were fourfold: 1) to increase implementation rates of evidence-based interventions that have been shown to reduce ICU mortality and morbidity; 2) to design tools to promote team communication and team building; 3) to develop prompts that could be incorporated into an ICU progress note to promote consistent use of these measures; and 4) to provide "real time"' feedback regarding progress.

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• Does Chest Physiotherapy Prevent Ventilator-Associated Pneumonia in Brain-Injured Patients?

  Patman and associates at the Lung Institute of Western Australia in Perth undertook this study to determine whether the routine, intensive administration of chest physiotherapy (PT) to mechanically ventilated patients with severe acute brain injury would prevent the occurrence of ventilator-associated pneumonia (VAP), or speed its resolution once it was present.

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• Pharmacology Watch: Warfarin May Be First to Apply Pharmacogenetics

  In this issue: Individualization of therapy with pharmacogenetics; the rate vs rhythm debate; the FDA's Risk Evaluation and Mitigation Strategy; FDA actions.

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• Clinical Briefs in Primary Care supplement

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