Critical Care Alert – June 1, 2013

June 1, 2013

• Palliative Care in the ICU: Benefits and Controversies

  The quality of care provided to patients and their families at end-of-life has become a key element in discussions on U.S. health care system reform.

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• Noninvasive Ventilation: Still Underused in Acute Respiratory Failure

  Nationwide from 2000-2009, there was a steady increase in the use of noninvasive ventilation (NIV) in managing acute respiratory failure, although the percentage of potentially eligible patients who receive it remains small. Importantly, the proportional increase was less for chronic obstructive pulmonary disease ([COPD] in which the evidence is compelling and NIV is the standard of care) than for non-COPD causes of respiratory failure (in which the evidence is weaker or conflicting).

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• Are Morbidly Obese Patients Receiving Invasive Mechanical Ventilation at Higher Risk of Death?

  Using a national database, the authors found that morbidly obese patients undergoing invasive mechanical ventilation had a similar risk of in-hospital mortality compared to non-obese individuals, despite having higher rates of invasive mechanical ventilation and tracheostomy.

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• Adverse Effects of Deep Sedation in Mechanically Ventilated Patients

  Deep sedation during the early period of mechanical ventilatory support delays extubation and increases mortality, yet is a modifiable risk factor that requires innovative intervention to reduce these adverse outcomes.

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• Pharmacology Watch: Do Perioperative Beta-Blockers Reduce Mortality?

  Beta-blockers and noncardiac surgery; prenatal medication exposure and risk of autism; reasons for statin discontinuations; and FDA actions.

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• Clinical Briefs in Primary Care Supplement

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