The Society of Critical Care Medicine's Critical Care Congress was held Jan. 15 to 19 in San Diego and attracted more than 6,000 participants, including nurses, pharmacists, physicians, respiratory therapists, students, and other health care practitioners. The conference highlighted recent advances in critical care medicine, with presentations and abstracts mainly focused on a multidisciplinary approach to the care of critically ill patients. The conference also featured more than 150 exhibiting companies presenting the latest technology, products, and services.
In one study, Raghavan Murugan, M.D., of the University of Pittsburgh School of Medicine, and colleagues found that prior statin use among hospitalized patients with community-acquired pneumonia was not associated with a lower risk for developing acute kidney injury.
"Using an observational study design involving 1,836 patients with community-acquired pneumonia, we found that intake of statins prior to hospitalization does not prevent the risk of acute kidney injury after pneumonia. Furthermore, continued intake of statins during hospitalization for pneumonia in patients with acute kidney injury does not lower the risk of death," Murugan said. "Based on our study, we conclude that statins should not be used to either prevent or treat acute kidney injury after pneumonia."
In another study, Michael Hooper, M.D., of the Vanderbilt University Medical Center in Nashville, Tenn., and colleagues used an electronic surveillance tool to identify 327 critical care patients who met modified systemic inflammatory response syndrome (SIRS) criteria. The tool provided an alert to house staff, who determined whether the modified SIRS criteria were due to infection. The investigators found that electronic detection and alerts to critical care staff improved sepsis recognition; however, not all patients were correctly identified as septic at the time of electronic alert and further analysis is under way to recognize specific characteristics of these patients.
"This abstract is an example of the process we are undertaking. Going forward, we will likely be able to apply this process to a larger patient population. This was a fixed patient population, so it is not really applicable in other settings. However, as our dataset grows, we expand our patient population, and consider additional variables, we may be able to draw conclusions that apply more broadly," Hooper said. "We now have the ability to augment our expertise with the precision of information technology. If used properly, we can improve our recognition of diseases, standardize our treatments, and improve predictions for our patients."
Phoebe Yager, M.D., of the Massachusetts General Hospital in Boston, and colleagues found that a telemedicine approach provides an additional tool to help attending physicians manage critically ill pediatric patients, communicate with the management team, and provide reassurance to families.
"We developed a novel use for telemedicine to enhance communication between at-home attendings and bedside personnel in our pediatric intensive care unit, where fellows provide in-house coverage with an attending on home-call during nights and weekends. We collected data retrospectively on 40 consecutive patient encounters over a seven-month period between May and December 2010," Yager said.
According to the at-home attendings, the reasons for a teleconference were physical assessment of the patient (89 percent); multidisciplinary team communication (49 percent); review of infusion pumps, monitors, and ventilator settings (24 percent); and parental update (46 percent). In addition, at-home attendings reported an impact on medical care in 70 percent of teleconference encounters and a significant change in medical management in 32 percent of encounters. Attendings also reported that telemedicine improved communication between the attending and bedside management team and enabled the attending to provide reassurance and a medical update to parents in 65 percent of encounters.
"This program does not replace the occasional need for attending presence at the patient's bedside. However, whereas in the past when an attending received a phone call about an emergency situation, the attending would jump in their car and drive in, now the attending can have an initial teleconference prior to coming in to bring things under control and start a plan of action and then drive in to provide further assistance. It has also been our experience that issues for which the attending had previously needed to drive into the hospital to address at the bedside can now often be resolved via telemedicine," Yager added.
In a cluster randomized trial published online Jan. 19 in the Journal of the American Medical Association to coincide with presentation of the research at the congress, Damon C. Scales, M.D., Ph.D., of the University of Toronto, and colleagues found that a multicenter quality improvement program improved adoption of care practices among a collaborative network of community intensive care units (ICUs). The investigators implemented a videoconference-based forum, including audit and feedback, expert-led educational sessions, and dissemination of algorithms, to sequentially improve delivery of six practices. The investigators found that the program improved the delivery of evidence-based care practices in community ICUs, with improvements greatest for prevention of catheter-related bloodstream infections and ventilator-associated pneumonia.
"In conclusion, we found that a collaborative network of ICUs linked by a telecommunication infrastructure improved the adoption of care practices. However, improved performance among all practices was not uniform. Future large-scale quality improvement initiatives should choose practices based on measured rather than reported care gaps, consider site-specific (versus aggregated) needs assessments to determine target care practices, and conduct baseline audits to focus on poorly performing ICUs, which have the greatest potential for improvement," the authors write.
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