Pulmonary and Critical Care

Further confirmation of negative predictive value of Ddimer in PE

In this validation study of 627 ED patients with possible PE, all underwent risk assessment (with the revised Geneva score, abstract), Ddimer testing, and CTA. All of the low / intermediate risk patients with negative Ddimers had negative CTA tests. This is further validation of the excellent (100%) negative predictive value of Ddimer in patients at low or intermediate clinical risk of PE (abstract).

Non-invasive ventilation after extubation

In this trial of 106 intubated patients (with hypercarbic respiratory failure), they were randomized after extubation to 24 hours of non-invasive positive pressure ventilation (NIPPV) or oxygen. Those in the NIPPV group had significantly less respiratory failure at 72 hours (15% vs 48%) and lower mortality at 90 days (11% vs 31%). NIPPV should be considered for all patients post-extubation from hypercarbic respiratory failure (abstract).

Variability in hospital defibrillation times

It is well known that delayed defibrillation results in reduced survival in cardiac arrest patients. Researchers analyzed outcomes from 7479 adult inpatient cardiac arrests victims in 200 hospitals from the National Registry of Cardiopulmonary Resuscitation. The prevalence of delayed defibrillation (>2 minutes) varied widely between hospitals, ranging from 2-51%. There was also wide variability in survival to discharge, ranging from 5-50%. Larger hospitals and ICU location had shorter times, but no other hospital characteristics were associated with delays. Hospitals need to design systems to ensure rapid defibrillation for hospitalized cardiac arrest patients (abstract).

Delirium, common and costly

In this multi-center evaluation of mechanically ventilated ICU patients (trauma/surgical), with a median age of only 50 years, almost 2/3 developed delirium. Delirious patients stayed longer in the ICU (10 vs 5 days) and in the hospital (19 vs 12 days). Delirium is both common and costly, and preventive measures are essential (abstract).

More hospital deaths preceded by CPR

In this national database of Medicare patients >age 65, from 1992 to 2005, the incidence of in-hospital CPR remained steady, but the proportion of hospital deaths preceded by CPR increased from 3.8% to 5.2%. This indicates that CPR is increasingly being performed in patients unlikely to survive, escalating the need for discussions about futility (abstract).