Critical Care Roundup: Issue #1
Welcome to issue #1 of the Critical Care Roundup, a new occasional feature on PulmCCM. Here we'll touch briefly on all the interesting stuff there wasn't time to thoroughly review. Got a study that should go in the next roundup? Post a link in the comments or by emailing email@example.com. Or, browse all the PulmCCM Roundups. Without further ado:
"Low dose" dopamine or nesiritide for acute CHF both debunked ... again. Chen et al randomized 360 patients with acute heart failure and renal dysfunction to receive either low-dose dopamine, nesiritide (Natrecor), or placebo in addition to diuretic therapy. Neither dopamine nor nesiritide added any benefit to placebo in diuresis, renal function, or clinical outcomes. Nesiritide was previously shown not to help CHF in a randomized trial of >7,000 patients. (ROSE trial, JAMA Nov 2013)
Pulmonary artery catheter use has fallen by half. Pulmonary artery catheter use has steadily declined over the past decade or so, from being used in about 4% of all ICU patients in ~2002 to about 2% in ~2007. PA catheter use is on the decline outside ICUs, as well, falling from ~11% to about ~6% of all patients over the same period. Hayley Gershengorn and Hannah Wunsch used the Project IMPACT data mining tool to examine pulmonary artery catheter use at multiple U.S. ICUs. (Crit Care Med December 2013)
How's your ICU bedside manner? In a survey at 4 San Francisco ICUs, conflict between doctors and families was described 63% of the time by either or both parties. Doctors were more often oblivious to the families' bad feelings than the other way around. The better a family perceived the doctor's bedside manner to be, the less likely they were to perceive a conflict. MRSA colonization dramatically worsens infection risk. MRSA colonization is common, and does not seem to be benign. People colonized with MRSA on ICU entry were 8 times more likely to develop a clinical MRSA infection, and 1 in 4 MRSA colonized patients developed an MRSA infection during their ICU stays, in a meta-analysis including 63,000 patients. Diabetes prevents ARDS. This surprising finding has been shown multiple times, most recently by Shun Yu, David Christiani and Taylor Thompson here. No one has explained the apparent protection against ARDS conferred by diabetes, so don't start chugging Cokes yet. "Futile" codes and CPR may result in lifesaving organ donations. 1,000 or more organs transplanted each year in the United States -- more than 5% of all transplanted organs coming from brain-dead patients -- come from patients who previously received CPR. Although often perceived as futile, worthless, or unethical by the treatment teams in apparently doomed patients, CPR in a few of these patients may have a beneficial outcome after all. The Critical Care Roundup will return when you least expect it. Suggest articles for inclusion with a web link in the comments below. Browse all the PulmCCM Roundups here.