The annual congress of the Society of Critical Care Medicine was held from Jan. 18 to 23 in Puerto Rico and attracted more than 5,500 participants from around the world, 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 focusing on the management of critically ill patients.
In one study, Charles Foster, Pharm.D., of the University of Colorado in Denver, and colleagues found that dexmedetomidine may reduce benzodiazepine requirements, symptoms of alcohol withdrawal as indicated by Clinical Institute Withdrawal Assessment (CIWA) scores, and hyperadrenergic symptoms of withdrawal (hypertension and tachycardia).
"The primary end point of the study showed a 54 percent reduction in mean benzodiazepine requirements (converted to lorazepam equivalents; 39.4 mg versus 18.2 mg; P = 0.018) after patients were started on dexmedetomidine. There was also a significant reduction in average CIWA scores (14.5 versus 9.0; P = 0.004), heart rate (106.8 versus 82.7; P = 0.0001), and systolic blood pressure (135.8 versus 124.6; P = 0.035)," Foster said. "The average dose required of dexmedetomidine was 0.5 mcg/kg/hour, which was started at a mean of 41.7 hours into the patient's intensive care unit stay. Some patients experienced bradycardia (heart rate less than 60) and/or hypotension (systolic blood pressure less than 90) during dexmedetomidine administration."
According to Foster, further research, including randomized controlled trials, is necessary to further define the role of dexmedetomidine for severe cases of alcohol withdrawal. In the process, this agent is being used off-label for adjunctive treatment of alcohol withdrawal in many institutions around the country.
In another study, Amelie Bernier-Jean, M.D., of the University of Montreal, and colleagues evaluated the impact of point-of-care ultrasound in the intensive care unit setting. The investigators collected 1,215 ultrasound studies from three university hospitals in Canada and the United States.
"Our results showed a significant impact of point-of-care ultrasound on diagnosis and treatment of the critically ill. Indeed, a modification in diagnosis was observed following 24.9 percent of the ultrasound studies and an impact on treatment was observed following 44.0 percent," said Bernier-Jean. "We also observed that cardiac ultrasound leads to a change in diagnosis and management more often than general ultrasound, i.e., pleural, abdominal, and vascular ultrasound. Finally, our results showed that assessment of the patient volume status through the ultrasound imaging of the inferior vena cava was the ultrasound application associated with the strongest impact on treatment, i.e., it led to a change in management in over 70 percent of the ultrasound studies we collected."
Overall, Bernier-Jean concluded that ultrasound is a rapid and feasible examination for most intensive care unit patients and, when added to the physical examination, it has the potential of improving patient care.
Andrea Ryan, M.S.N., R.N., of the MedStar Washington Hospital Center in Washington, D.C., and colleagues found that differences in perceptions regarding care delivery in a surgical intensive care unit (SICU) after a do-not-resuscitate order can lead to misunderstandings between attending surgeons and SICU staff. The investigators developed a survey that included 164 providers (105 from four SICUs and 59 surgeons).
The investigators found that surgeons scored significantly lower than SICU providers, with their perception of routine care decreasing after a do-not-resuscitate order. In addition, surgeons scored lower on two sub-scales. However, no differences were found in perceptions between SICU nursing and medical staff.
"Further study is needed on whether care does actually change. SICU team members should be educated on the surgeons' perceptions and perspective on end-of-life care to help ensure open, effective communication at this critical juncture in the patient's SICU stay," the authors write.
SCCM: Earlier Weaning With Tracheostomy Collar
TUESDAY, Jan. 22 (HealthDay News) -- For tracheotomized patients, unassisted breathing through a tracheostomy collar is associated with shorter median weaning time compared to pressure support, according to a study published online Jan. 22 in the Journal of the American Medical Association to coincide with presentation at the annual meeting of the Society of Critical Care Medicine, held from Jan. 18 to 23 in San Juan, Puerto Rico.
SCCM: High-Frequency Oscillatory Volume in ARDS Studied
TUESDAY, Jan. 22 (HealthDay News) -- For patients with acute respiratory distress syndrome (ARDS), treatment with high-frequency oscillatory volume (HFOV) does not reduce mortality, according to two studies published online Jan. 22 in the New England Journal of Medicine to coincide with presentation at the annual meeting of the Society of Critical Care Medicine, held from Jan. 18 to 23 in San Juan, Puerto Rico.
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