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New critical care research presented at CHEST 2008


(Tuesday, October 28, 10:30 AM EST)

New research shows that in-hospital statin use is associated with lower mortality in patients with severe sepsis (SS). In a retrospective study, researchers from AstraZeneca Pharmaceuticals reviewed hospital patient discharges from 500 US hospitals between 2004 and 2006. The number of patients with SS ranged from 64,000 in 2004 to 89,000 in 2006. The percentage of patients with SS among all hospitalizations increased each year from 1.4 percent in 2004 to 1.7 percent in 2006, while in-hospital mortality among all patients with SS decreased each year (35 percent, 2004; 33 percent, 2005; 31 percent, 2006). In-hospital statin use increased each year (13 percent in 2004 to 18 percent in 2006). Each year, patients with SS in the statin group showed a lower mortality rate compared with those discharged from the hospital without a charge for a statin (2004, 28 percent vs. 35 percent; 2005, 26 percent vs. 35 percent; 2006, 23 percent vs. 33 percent). Although a cause and effect relationship could not be determined, researchers conclude that there is a need for further investigation in this area.


(Tuesday, October 28, 1:00 PM EST)

Hospitalized patients who undergo repeated in-hospital CPR have a high mortality rate. Researchers from Western Pennsylvania Hospital in Pittsburgh reviewed the charts of 151 patients, aged 25 to 99 years, who underwent CPR as a consequence of cardiopulmonary arrest. Out of these patients, only 16 (eight men and eight women) required repeated CPR after the first successful attempt. None of these patients survived to the time of hospital discharge. Researchers suggest that patients who are seriously ill, as well as their families, should be well informed regarding the expected outcome of multiple in-hospital resuscitation events.


(Tuesday, October 28, 1:00 PM EST)

Statins may provide a protective effect for patients admitted to the ICU. In a retrospective study, researchers from Saudi Arabia compared 194 ICU patients who received consistent statin therapy for 1 year prior to ICU admission with a control group of 1,188 patients who did not receive statin therapy. The ICU mortality rate for the statin group was 10 percent compared with 12 percent for the control group. The apparent mortality benefit persisted after controlling for differences in age and gender. Researchers speculate that their study demonstrates a potential survival benefit for ICU patients receiving statin therapy.


(Wednesday, October 29, 10:30 AM EST)

Whether located in a neighboring hospital or in a clinic three states away, teleintensivists, physicians who remotely monitor and care for critically ill patients, are saving lives. Researchers from the University of Kansas, Kansas City, MO, compared 700 critically ill patients 1 year prior to remote telemonitoring implementation with 4,592 critically ill patients 2 years after telemonitoring implementation. They evaluated the severity-adjusted ICU and hospital length of stay (LOS) and ICU and hospital mortality. Results showed that remote teleintensivist care correlated with an improvement of severity-adjusted ICU and hospital LOS. Results showed a further trend toward improved mortality.


(Wednesday, October 29, 10:30 AM EST)

Female hospital staff members have more difficulty performing adequate chest compressions (CC) than male hospital staff. Researchers from Albert Einstein College of Medicine in New York compared the CC technique of 28 male and 30 female medical housestaff using a patient simulator, before and after CC training. Subjects also went through a posttraining endurance test where they attempted to perform adequate CC for 120 seconds or until fatigue prevented further effort. Prior to training, 50 percent of the male group performed adequate CC, while none of the female group performed adequate CC. Post-training, 89 percent of the male group performed adequate CC and 37 percent of the female group performed adequate CC. There was no correlation between body mass index and adequate CC in either group, however taller females performed better CC than shorter females. Regardless of gender, only 14 percent of subjects were able to maintain adequate CC for 120 seconds, the recommended guideline for one cycle of compressions.


(Wednesday, October 29, 1:00 PM EST)

The novel agent cobinamide could be an ideal antidote for cyanide poisoning, particularly during fire rescues or mass casualty situations where prolonged fire smoke inhalation may occur. Researchers from the University of California - Irvine infused a New Zealand white rabbit with a sodium cyanide solution followed by cyanide treatment with either high-dose or low-dose cobinamide. Diffuse optical spectroscopy (DOS) measurements and concurrent physiologic measurements, including arterial and venous blood gases, carbon monoxide, and oxygen saturation, were obtained throughout the experiment. Results showed that cobinamide caused rapid and complete reversal of cyanide toxicity effects when administered intravenously or by transpulmonary routes, as demonstrated noninvasively by DOS and confirmed by blood sampling. Researchers suggest that the high potency and solubility of cobinamide make it potentially an ideal agent for treatment of mass casualty cyanide exposures.


(Wednesday, October 29, 1:00 PM EST)

In the ICU, nursing task interruptions are most often caused by device alarms or other nurses and can lead to nurses switching their focus or multitasking. Researchers from the University of Utah analyzed nursing task interruptions, other error producing conditions, and actual or potential medical device related harm, as documented in 59 observation sessions totaling more than 140 hours. Direct care, indirect care, and medical device use constituted 15.3 percent, 70.3 percent, and 14.4 percent of the nurses' task hours, respectively. Overall, 7,382 nursing tasks were observed, of which 886 (12 percent) were interrupted. The two most frequent causes of interruption were device alarms (35 percent) and other nurses (17 percent); physicians caused 10 percent of interruptions. When interrupted, the nurses switched focus to the interrupting task (30 percent) or multitasked (31 percent), most commonly in response to a device alarm. They did not immediately attend to a majority of device alarms.


(Wednesday, October 29, 1:00 PM EST)

Religious faith and ethnicity seem to have a positive effect on the perceptions of critically ill patients. Researchers from the Medical University of South Carolina surveyed 100 sequential medical ICU patients and/or their surrogate using five perception domains: timeline, consequences, control, illness coherence, and emotional representation. Demographics, illness severity, and survival status were obtained from the medical record and/or respondent self-report. Results showed that African-Americans tended to perceive the critical illness as less chronic and less serious, they felt more personal control and more confidence in treatments, and they felt less emotional impact from the illness compared with Caucasian respondents. African-Americans, however, tended to report lower illness comprehension compared with Caucasians. In addition, "being active in faith/church" was associated with a perception of less serious consequences, more confidence in treatments, and less emotional impact of critical illness.


(Wednesday, October 29, 1:00 PM EST)

Families of Indian origin experience a high prevalence of anxiety and depression related to loved ones being in the ICU. Researchers from Ben Taub General Hospital in Houston compared the prevalence of anxiety, depression, and posttraumatic stress disorder in relatives of critically ill patients in the ICUs of a public hospital in India (n=47 relatives) and the United States (n=43 relatives). Anxiety and/or depression were more prevalent in relatives of Indian ICU patients (87.23 percent) than in a similar cohort in the US (18.6 percent). Researchers suggest that further studies correlating these responses to cultural, as well as patient-related, family-related, and ICU environment-related factors, can help ICU staff better understand these differences and provide improved targeted support and coping strategies to affected families.


(Wednesday, October 29, 1:00 PM EST)

The use of herbal remedies may be an effective supportive therapy to control symptoms and improve quality of life in patients with advanced stage lung cancer. Researchers from Jafary Medical Clinics in West Virginia followed 15 patients with end-stage primary lung cancer who failed to improve with a conventional treatment of chemotherapy and radiation therapy. Patients were treated with American ginseng for fatigue, morphine sulfate for control of severe dyspnea and pain, licorice root powder for control of severe coughing spells, and bilevel pressure ventilation for respiratory depression related to IV morphine. Two patients also were taking oldenlandia, a Chinese herb for lung cancer. Results showed that licorice and ginseng were effective therapies for the majority of patients, and morphine, used as nebulizer in two patients, was effective in the control of marked dyspnea and pain. One patient lived 4 months using the supportive therapy, while the remaining patients lived 6 to 12 weeks.


(Wednesday, October 29, 1:00 PM EST)

Nurses who work the night shift have better reaction times toward the end of their shifts than the beginning of their shifts. Researchers at Texas A&M University compared reaction times between day-shift and night-shift nurses by having them complete two sets of reaction time measurements, at the beginning of their shift, and at the end of the same 12-hour shift. Among day-shift nurses, the reaction times were unchanged across the shift; however, night-shift nurses performed better on reaction tests towards the end of the shift. Researchers speculate that circadian influences may play a role in nurse reaction time.


Contact: Jennifer Stawarz
American College of Chest Physicians

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