Pulmonary and Critical Care

Statins for sepsis

This randomized trial of 250 patients with sepsis, who were randomized to 14 days of statin or placebo, found no difference in serum markers of inflammation, organ dysfunction scores or morality between the groups. However, they did find that among prior statin users, those randomized to placebo had significantly higher 28 day mortality than those randomized to a statin (28% vs 5). Although more studies are needed, this study suggests that those already on statins who develop sepsis should be continued on their statin (abstract).

Pneumococcal pneumonia still bad news

This cohort from the VA found those confirmed with pneumococcal pneumonia had a 12% 1 month mortality, and a 10 year mortality rate of~30%, which is higher than age-matched expectations. The prognosis was worse with bacteremic disease, and with higher PORT scores (abstract).

Survival after discharge after in-hospital cardiac arrest

This large cohort of patients age>65 who survived in-hospital cardiac arrest found that 1 year after discharge, 59% were still alive, and 34% had not been readmitted to the hospital. Both mortality and readmission rates were substantially affected by the neurologic status of the patient at the time of discharge from the index hospitalization (abstract).

Family presence during CPR

In this trial of out-of-hospital cardiac arrest, families were randomized to be offered to watch CPR, or not offered. CPR was witnessed by 79% of the intervention families, versus 43% of the control families. The frequency of PTSD symptoms, anxiety, and depression at 90 days was significant higher among those family members that did not, versus those that did, witness the CPR. There was no evidence that family presence interfered with CPR efforts. Family should be offered the opportunity to watch CPR efforts based on this trial (abstract).

Effect of delirium in critically ill

This meta-analysis of critically ill patients found significantly worse outcomes in those that experience delirium compared to those that do not, including higher mortality, more complications, longer vent duration, and longer ICU and hospital LOS (abstract). Continued efforts for prevention and early treatment of delirium is needed.