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The risk of relapse after effective therapy with plasma exchange for thrombotic thrombocytopenic purpura (TTP) has not been well-characterized. Among 376 patients with an initial episode of TTP treated with plasma exchange, overall survival was around 68%, with a survival of 78% among the subset with idiopathic TTP. Survival did not differ on those having a low (< 10%) ADAMTS13 level. Relapse was greater for those with a low ADAMTS13 level at the time of presentation.
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In this large retrospective cohort study of more than 100,000 patients in 112 hospitals, after correction for illness severity and other factors, daily rounds by a multidisciplinary care team were associated with lower mortality in the ICU, regardless of whether an intensivist model of physician staffing was in use.
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Consensus guidelines recommend the use of either dopamine or norepinephrine as first-line therapy for patients with shock, but recent observational evidence suggests norepinephrine may be associated with better outcomes.
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Intensive care practitioners are constantly faced with questions about their patients' hemodynamic issues, including the volume status, fluid responsiveness, and the need for vasopressors or inotropic support.
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In this issue: Fractures and bisphosphonate therapy, warfarin anticoagulation and influenza vaccine and cotrimoxazole, antiplatelet therapy with clopidogrel and aspirin, FDA Actions.
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Casey and colleagues compared the effects on pain, level of consciousness, and vital signs of 2 different doses of remifentanil and placebo for removal of chest drains after cardiac surgery in 60 patients.
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Raurich and colleagues studied 80 patients with acute respiratory distress syndrome (ARDS) to determine whether the alveolar dead-space fraction (VD/VT, the proportion of each breath that does not participate in gas exchange) was a predictor of ultimate survival. The patients were ages 18 years or older, acutely ill in the investigators' ICU, and met the current international diagnostic criteria for ARDS.
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This study from a surgical ICU in a french university hospital sought to determine the effect on catheterization duration of a daily reminder notifying physicians that the patient had a central venous catheter (CVC) or urinary tract catheter (UTC) and asking whether there was continued need for that catheter.
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