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Intravenous epinephrine

[black small square] A study from the Department of Emergency Medicine, UCLA Medical Center, assessed the safety of intravenous epinephrine on adults with life-threatening asthma. Researchers reviewed the records of 27 emergency department patients, ages 19 to 58, whose medical record met the defined criteria.

 

Researchers found no cases of cardiac ischemia, neurologic deficit, hypotension, or death. None of the patients experienced an arrhythmia other than sinus tachycardia. The study asserts that while intravenous epinephrine was safe for this sample of younger adults with acute life-threatening asthma, a further investigation to clearly define an efficacy and risk-benefit relationship would be reasonable.

 

Source: Smith, D., et al.: "Intravenous Epinephrine in Life-threatening Asthma," Annals of Emergency Medicine. 41 ( 5 ): 706-711, 2003.

 

ICU infections

[black small square] A recent study examined the incidence of infection in intensive care units (ICUs). Researchers stated that ICU patients have a higher risk of acquiring hospital-associated infections than non-critical care patients. The most common hospital-acquired ICU infections are pneumonias, urinary tract infections, and bloodstream infections (BSIs), most likely because invasive devices are used. Incidence of fungal urinary tract sepsis have increased in frequency, as well as coagulase-negative staphylococcus BSIs.

 

Researchers noted that while crude mortality and a high level of costs are associated with these infections, experts still debate over the degree of mortality that may be assigned to them.

 

Source: Richards, M., et al.: "Epidemiology, Prevalence, and Sites of Infections in Intensive Care Units," Seminars in Respiratory and Critical Care Medicine. 24 ( 1 ): 3-22, 2003.

 

Preventing brain damage

[black small square] A recent report examined intracranial hypertension and cerebral ischemia after severe traumatic brain injury (TBI). Researchers determined that the optimal cerebral perfusion pressure (CPP) for treatment of TBI is unclear, though artificial elevation of CPP has been touted as a way to maintain adequate cerebral blood flow (CBF).

 

CBF may vary from patient to patient, and evolves significantly as time passes after TBI. Consequently, health care providers should consider maintaining the best possible CPP in a patient at each specific moment, rather than having an arbitrary goal for all patients. Monitoring intracranial pressure, assessing the adequacy of CBF through the use of global indicators, and gathering appropriate local data can help to achieve CPP optimization.

 

Source: Hlatky, R., et al.: "Intracranial Hypertension and Cerebral Ischemia After Severe Traumatic Brain Injury," Neurosurgical Focus. 14 ( 4 ), 2003.

 

Heart failure after MI

[black small square] Previous studies have found that a large number of congestive heart failure (CHF) cases with mixed etiologies have preserved left ventricular systolic function. A new study examined the incidence and characteristics associated with CHF in patients with preserved left ventricular ejection fraction (LVEF) after myocardial infarction (MI).

 

Out of a sample of 1,658 patients who had an MI, 644 had CHF during approximately 5 to 7 years of follow-up. Of that number, LVEF assessment was performed on 395 patients, or 61%. Thirty percent of the patients had preserved LVEF, which didn't change over time. The number of women with CHF and preserved LVEF was greater than that of men. Since there was a notable proportion of cases of CHF after MI with preserved LVEF, the findings emphasize the burden of CHF with preserved LVEF in a defined group of patients with documented coronary disease.

 

Source: Hellerman, J., et al.: "Heart Failure After Myocardial Infarction: Prevalence of Preserved Left Ventricular Systolic Function in the Community," American Heart Journal. 145 ( 4 ): 742-748, 2003.

 

Thrombolytic therapy

[black small square] Information related to early outcome after I.V. application of tissue-type plasminogen activator (tPA) for stroke patients treated in community settings is hard to find. A recent study examined the link between tPA therapy and in-hospital mortality with the cooperation of the German Stroke Registers Study Group.

 

Ischemic stroke patients numbering 13,440 were included in the study, of which 384 were treated with tPA. Inpatient mortality rates were significantly higher for patients treated with tPA compared to patients not treated with the procedure. After examining the frequency with which the hospitals administered tPA, the researchers determined that in-hospital mortality rates following tPA use varied between hospitals with different experience in tPA treatment. Those who received tPA in hospitals with limited experience had a higher risk of in-hospital mortality.

 

Source: Heuschmann, P., et al.: "Frequency of Thrombolytic Therapy in Patients With Acute Ischemic Stroke and the Risk of In-Hospital Mortality," Stroke. 34:1106-1113, 2003.

 

Spirituality is significant

[black small square] Spirituality shouldn't be ignored as a component of critical care. A recent study sought to determine the relationship between spiritual well being, depression, and end-of-life despair in terminally ill cancer patients. Patients with a life expectancy of less than 3 months were interviewed with a number of standardized instruments. The 160 candidates resided in a palliative care hospital. Important correlations were found between spiritual well-being and desire for hastened death, hopelessness, and suicidal ideation. The outcome of multiple regression analyses pointed to spiritual well-being as the strongest predictor of each outcome variable. In addition, depression was highly correlated with a desire to die in patients with low spiritual well-being, not in those with high spiritual well-being.

 

While their findings showed spiritual well-being provided some protection against end-of-life despair, researchers concluded that controlled research to determine the effect of spirituality-based interventions would establish the methods that can help bring about a sense of peace and tranquility.

 

Source: McClain, C., et al.: "Effect of Spiritual Well-being on End-of-life Despair in Terminally-ill Cancer Patients," The Lancet. 361:1603-1607, 2003.

 

Advancing HIV prevention

[black small square] The Centers for Disease Control and Prevention (CDC) recently announced the launch of a new initiative, Advancing HIV Prevention: New Strategies for a Changing Epidemic. The program's purpose is to reduce barriers to early diagnosis of HIV and to increase access to services. The key strategies of the initiative are to:

 

[white diamond suit] make HIV testing a routine part of medical care

 

[white diamond suit] implement new models for diagnosing HIV infections outside medical settings

 

[white diamond suit] prevent new infections by working with persons diagnosed with HIV and their partners

 

[white diamond suit] further decrease perinatal HIV transmission.

 

 

The CDC's aim is that every HIV infected person will have the opportunity to be tested and have access to advanced medical care and services needed to prevent further transmission of the disease.

 

Source: CDC. "Advancing HIV Prevention: New Strategies for a Changing Epidemic - United States, 2003," Morbidity and Mortality Weekly Report. 52 ( 15 ): 329-332, 2003.

 

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