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When study data were used to perform a formal analysis of costs associated with use of erythropoietin, the total cost to avoid one transfusion-related adverse event was $4.7 million.
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Both intra-abdominal hypertension and evidence for its adverse physiologic effects were common in this retrospective series of ICU patients with severe acute pancreatitis, although there was no association with mortality, and 3 of 4 patients subjected to decompressive laparotomy died.
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In a randomized, controlled trial, patients with stroke or head injury who required mechanical ventilation were less likely to develop ventilator-associated pneumonia if they underwent early percutaneous gastrostomy for nutritional support than if they continued to be fed via nasogastric tube.
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Airway Management is an integral and frequent component of care of the critically ill.
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This prospective 10-year study of 7356 patients with ST-elevation MI who presented in cardiogenic shock showed once again that early mechanical revascularization (as recommended by current guidelines) substantially increases survival; it also suggests that adherence to the guidelines needs to be further improved.
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Bacterial resistance to antibiotic treatment has concerned the medical community since the introduction of the first antibiotics in the 1920s. Development of new anti-infective agents has been precipitated by increasing resistance to older agents and classes of agents. While high rates of resistant organisms have been particularly problematic in hospital intensive care units, serious resistance now is being encountered in community-acquired infections. This review will focus on the clinical aspects of antibiotic resistance in community-acquired respiratory infections, pharyngitis, skin infections, and urinary tract infections.
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In 2001, the PROWESS trial of 1690 patients with severe sepsis1 demonstrated that a 96-hour infusion of activated protein C, or drotrecogin alfa (activated) (DrotAA, Xigris®) at 24 g/kg/h decreased mortality at 28 days from 30.8% to 24.4% (P = 0.005).
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Standard teaching advocates placing a chest tube on water seal in patients with a prior hemothorax or pneumothorax and obtaining a chest radiograph (CXR) the following morning.
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Uncontrolled hemorrhage remains an important cause of death in the ICU. Patients with severe traumatic injuries, gastrointestinal hemorrhage, and ruptured abdominal aortic aneurisms are but a few examples of those who develop coagulopathy and hemorrhage that is not amenable to surgical control and may not respond to traditional approaches to blood product transfusion.
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Studies using computed tomography have shown that patients with the acute respiratory distress syndrome (ARDS) typically have a cephalocaudal gradient in the distribution of lung density, with the greatest density (and collapse) in the lung bases adjacent to the diaphragm.
