Critical Care Alert – August 1, 2004

August 1, 2004

• Steroids in Septic Shock: Which Patients? What Dose?

  This meta-analysis of clinical trials of steroids in septic shock demonstrates that whereas short-term, high-dose administration actually worsens survival, giving lower doses for a longer period hastens shock resolution and improves survival.

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• Just Say No To NO

  In a randomized, clinical trial involving patients with ALI/ARDS from non-sepsis etiologies, inhaled nitric oxide at 5 ppm failed to improve any of the clinically meaningful outcomes.

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• Improving Care at the End-of-Life: Benefits from Using A Standardized Order Form

  A standardized withdrawal-of-life-support order form was viewed as helpful by physicians and nurses and changed medication delivery in a positive manner.

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• Special Feature: Prevention of Ventilator-Associated Pneumonia

  Ventilator-associated pneumonia (vap) is nosocomial pneumonia occurring in a mechanically ventilated patient > 48 hours after intubation. It is categorized as early-onset (defined by most experts as 48-96 hours after intubation) and late-onset (> 2-96 hours after intubation): these differ with respect to responsible bacterial agents as well as outcomes. With an estimated incidence of 8-28% of intensive care unit (ICU) patients, or 13-35 cases per 1000 ventilator-days, VAP is common.

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• Pharmacology Watch: The Importance of Publishing Negative Clinical Studies

  Cognitive Effects of Estrogen Therapy; Vitamin Therapy and Restenosis; Echinacea and the Common Cold; Effects of Paxil in Children Under 18; FDA Actions.

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• Clinical Briefs in Primary Care supplement

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