Critical Care Alert
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Longer Antibiotic Courses for Pneumonia Do Not Improve Outcomes, But Cause More Adverse Effects
Two-thirds of general medicine patients with pneumonia received excess antibiotic therapy, with 93.2% of the unnecessary duration occurring after hospital discharge. Excess antibiotic therapy did not improve mortality or morbidity outcomes, although each additional antibiotic day was associated with 3% increased odds of antibiotic-associated adverse drug events.
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Antimicrobial Stewardship in Critical Care
Antimicrobial stewardship is the responsibility of everyone involved in the care of critically ill and hospitalized patients. This review discusses some of the key principles and practices of successful antimicrobial stewardship programs, particularly as they relate to critical care.
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Seven Days of Antibiotics Was Noninferior to 14 Days for Gram-Negative Rod Bacteremia
In patients with gram-negative rod bacteremia, patients receiving seven days of antibiotics had similar 90-day mortality, readmission rates, and rates of recurrent bacteremia as patients receiving 14 days of antibiotic.
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Balanced Crystalloids Reduce Mortality in Critically Ill Adults With Sepsis or Septic Shock
Compared to saline, balanced crystalloids reduced in-hospital mortality and major adverse kidney events within 30 days in critically ill patients with sepsis or septic shock.
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The Epidemic of Vaping-Associated Lung Injury
Since June 2019, there has been a considerable rise in reported cases of vaping-associated lung injury.
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Early Dexmedetomidine Provides Similar 90-Day Mortality Compared to Usual Care in Mechanically Ventilated Critically Ill Adults
When the early use of continuous infusion dexmedetomidine was compared to usual care for sedation in mechanically ventilated critically ill adults, there was no difference in 90-day mortality. Dexmedetomidine may not be an ideal sedative for mechanically ventilated critically ill adults requiring deeper sedation, although its use may result in greater ventilator-free, coma-free, or delirium-free days.
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Acute Kidney Injury in Patients With Cirrhosis
Acute kidney injury and hepatorenal syndrome are common conditions found in patients with cirrhosis, due to the systemic vasodilation and systemic inflammation frequently found in this population.
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Temperature Trajectories to Find Sepsis Subphenotypes
The authors of this study used development and validation cohorts to retrospectively identify temperature trajectories over the first 72 hours from presentation in the setting of sepsis. Patients presenting with hyperthermia that resolved quickly (within the first 24 hours) had lower mortality compared to those with slow resolution or those presenting with hypothermia.
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Vasopressin Use in Septic Shock
Current management of septic shock includes early administration of intravenous fluids, antimicrobial agents, and vasopressor support. While norepinephrine is recommended as the first-line vasopressor for septic shock in the 2016 Surviving Sepsis Campaign guidelines, vasopressin is a second-line vasopressor option that may be added.
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Difficult Airway Intubation With Flexible Bronchoscope as a Guide
In this prospective study, use of a flexible bronchoscope as a flexible stylet and a Glidescope to provide visual guidance while intubating patients in the operating room was associated with shorter time to intubation than the use of Glidescope alone.