2009 The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial.
Climo MW, Sepkowitz KA, Zuccotti G, Fraser VJ, Warren DK, Perl TM, Speck K, Jernigan JA, Robles JR, Wong ES. Crit Care Med. 2009 Jun;37(6):1858-65. Hospital Epidemiologist (MWC), Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, VA, USA.
OBJECTIVE: Spread of multidrug-resistant organisms within the intensive care unit (ICU) results in substantial morbidity and mortality. Novel strategies are needed to reduce transmission. This study sought to determine if the use of daily chlorhexidine bathing would decrease the incidence of colonization and bloodstream infections (BSI) because of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) among ICU patients.
2009 Fever in the critically ill medical patient
Recommended by Dr SHUM Hoi Ping, ICU, Pamela Youde Nethersole Eastern Hospital, Hong Kong, on 9 July 2009
Laupland KB. Crit Care Med. 2009 Jul;37(7 Suppl):S273-8.
Fever, commonly defined by a temperature of >or=38.3 degrees C (101 degrees F), occurs in approximately one half of patients admitted to intensive care units.
2009 Principles of antibacterial dosing in continuous renal replacement therapy [Review]
Recommended by Dr SHUM Hoi Ping, ICU, Pamela Youde Nethersole Eastern Hospital, Hong Kong, on 9 July 2009
Choi G, Gomersall CD, Tian Q, Joynt GM, Freebairn R, Lipman J. Crit Care Med. 2009 Jul;37(7):2268-82.
OBJECTIVES: To outline the concepts involved in optimizing antibacterial dosing in critically ill patients with acute renal failure undergoing continuous renal replacement therapy (CRRT), provide a strategy for optimizing dosing, and summarize the data required to implement the strategy.
2009 Intravenous diltiazem is superior to intravenous amiodarone or digoxin for achieving ventricular rate control in patients with acute uncomplicated atrial fibrillation
Presented by Dr CY YUNG at the Daily Journal Club of ICU, PYNEH, Hong Kong, on 19 June 2009
Siu, Chung-Wah MBBS; Lau, Chu-Pak MD; Lee, Wai-Luen MBBS; Lam, Kwok-Fai PhD; Tse, Hung-Fat MD, PhD. Critical Care Medicine. 37(7):2174-2179, July 2009.
Objectives: To compare the clinical efficacy of intravenous diltiazem, digoxin, and amiodarone for acute ventricular rate (VR) control in patients with acute symptomatic atrial fibrillation (AF) necessitating hospitalization.
Design: Randomized control trial.
Setting: Acute emergency medical admission unit in a regional teaching hospital in Hong Kong.
Patients: One hundred fifty adult patients with acute AF and rapid VR (>120 bpm).
Interventions: Patients were randomly assigned in 1:1:1 ratio to receive intravenous diltiazem, digoxin, or amiodarone for VR control.
2009 Active cytomegalovirus infection is common in mechanically ventilated medical intensive care unit patients
Presented by Dr CHU Po Ngai Alvin at the Daily Journal Club of ICU, PYNEH, Hong Kong, on 8 June 2009
Chiche, Laurent MD; Forel, Jean-Marie MD; Roch, Antoine MD, PhD; Guervilly, Christophe MD; Pauly, Vanessa PhD; Allardet-Servent, Jerome MD; Gainnier, Marc MD, PhD; Zandotti, Christine MD; Papazian, Laurent MD, PhD. Critical Care Medicine. 37(6):1850-1857, June 2009.
Abstract:
Objective: To assess the incidence, risk factors, and outcome of active cytomegalovirus (CMV) infection in nonimmunosuppressed intensive care unit (ICU) patients.
Design: Prospective epidemiologic study.
Setting: A medical ICU in a university hospital.
Patients: Two hundred forty-two nonimmunosuppressed ICU patients mechanically ventilated for >=2 days.
Interventions: Routine pp65 antigenemia and serology for CMV were performed at admission, and then weekly. Bronchoalveolar lavage viral cultures were done when pneumonia was suspected.
2009 A systematic review on clinical benefits of continuous administration of [beta]-lactam antibiotics [Review]
Critical Care Medicine. 37(6):2071-2078, June 2009.
Roberts, Jason A. PhD; Webb, Steven FJFICM, PhD; Paterson, David FRACP, PhD; Ho, Kwok M. FJFICM, PhD; Lipman, Jeffrey FJFICM, MD
Objective: The clinical benefits of extended infusion or continuous infusion of [beta]-lactam antibiotics remain controversial. We systematically reviewed the literature to determine whether any clinical benefits exist for administration of [beta]-lactam antibiotics by extended or continuous infusion.
Data Source: PubMed (January 1950 to November 2007), EMBASE (1966 to November 2007), and the Cochrane Controlled Trial Register were searched (updated November 2007).
Study Selections: Randomized controlled trials (RCTs) were meta-analyzed, and observational studies were described by two unblinded reviewers.
Data Extraction: A total of 846 patients from eligible prospective randomized controlled studies were included in the meta-analysis. Two observational studies were deemed appropriate for description.
Data Synthesis: A meta-analysis of prospective RCTs was undertaken using Review Manager. Among a total of 59 potentially relevant studies, 14 RCTs involving a total of 846 patients from nine countries were deemed appropriate for meta-analysis. The use of continuous infusion of a [beta]-lactam antibiotic was not associated with an improvement in clinical cure (n = 755 patients; odds ratio: 1.04, 95% confidence interval: 0.74-1.46, p = 0.83, I2 = 0%) or mortality (n = 541 patients; odds ratio: 1.00, 95% confidence interval: 0.48-2.06, p = 1.00, I2 = 14.8%). All RCTs except one used a higher antibiotic dose in the bolus administration group. Two observational studies, not pooled because they did not meet the a priori criteria for meta-analysis, showed that [beta]-lactam administration by extended or continuous infusion was associated with an improvement in clinical cure. The difference in the results between the meta-analysis results and the observational studies could be explained by the bias created by a higher dose of antibiotic in the bolus group in the RCTs and because many of the RCTs only recruited patients with a low acuity of illness.
Conclusions: The limited data available suggest that continuous infusion of [beta]-lactam antibiotics leads to the same clinical results as higher dosed bolus administration in hospitalized patients.
2009 Comparison of delirium assessment tools in a mixed intensive care unit
Recommended by Dr SHUM Hoi Ping, ICU, PYNEH, on 31 May 2009
van Eijk, Maarten M. J. MD; van Marum, Rob J. MD, PhD; Klijn, Ine A. M. MD; de Wit, Nelleke RN; Kesecioglu, Jozef MD, PhD; Slooter, Arjen J. C. MD, PhD. Critical Care Medicine. 37(6):1881-1885, June 2009.
Objective: Delirium is a frequent problem in the intensive care unit (ICU) associated with poor prognosis. Delirium in the ICU is underdiagnosed by nursing and medical staff. Several detection methods have been developed for use in ICU patients. The aim of this study was to compare the value of three detection methods (the Confusion Assessment Method for the ICU [CAM-ICU], the Intensive Care Delirium Screening Checklist [ICDSC] and the impression of the ICU physician with the diagnosis of a psychiatrist, neurologist, or geriatrician).
2009 Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition: Executive Summary
Recommended by Dr Shum Hoi Ping on 10 May 2009; ICU, PYNEH, Hong Kong
Crit Care Med. 2009 May;37(5):1757-61. Review.
Martindale RG, McClave SA, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci G; American College of Critical Care Medicine; A.S.P.E.N. Board of Directors
The guidelines offer basic recommendations that are supported by review and analysis of the pertinent available current literature, by other national and international guidelines, and by the blend of expert opinion and clinical practicality.
2009 Cardiac arrest survival after implementation of automated external defibrillator technology in the in-hospital setting
Crit Care Med. 2009 Apr;37(4):1229-36.
Forcina MS, Farhat AY, O'Neil WW, Haines DE.
HKSCCM Editor's note: Results quite unexpected, but interesting to investigate further why. Is it because of the longer time taken for an AED to interpret asystole or PEA for us (> 10 sec) than we do it ourselves, during which cardiac massage has to be stopped? Click Read More below to add your comments.
BACKGROUND: Survival from ventricular tachycardia (VT) or ventricular fibrillation (VF) arrest is inversely related to delay to defibrillation. The automated external defibrillator (AED) has improved survival after out-of-hospital VT/VF arrest by decreasing time to defibrillation. The purpose of this study was to determine whether survival to discharge after in-hospital cardiac arrest caused by VT/VF could be improved via an institution-wide change from a standard monophasic defibrillator to a biphasic defibrillator with AED capability.