In this large retrospective analysis of patients hospitalized with acute COPD exacerbations with respiratory failure, the use of noninvasive ventilation increased from 14% to 16% from 2006 to 2008, but variation in use between hospitals was great (ranging from 0 to 100%, with a median of 11%). Noninvasive ventilation was associated with better outcomes than invasive ventilation, including lower inpatient mortality (risk ratio 0.54, CI 0.50 to 0.59), shorter LOS (-3.2 days, CI -3.4 to -2.9), lower hospital charges (-$35,012, CI -$36,848 to -$33,176), and fewer iatrogenic pneumothorax (0.05% vs 0.5%, p<0.001). Noninvasive ventilation is probably underutilized, and associated with better outcomes compared to invasive ventilation, in patients with acute COPD with respiratory failure (abstract).
My patient was a 69 year old lady with metastatic small cell lung cancer. She was on experimental chemotherapy and was admitted from clinic with worsening lower extremity edema and a new oxygen requirement. She underwent a chest and abdominal CT that revealed new pulmonary masses, tumor and a mass invading her right pulmonary artery, […]
The large multi-center ICU trial randomized ICUs to 1 of 3 strategies: MRSA screening/isolation, MRSA screening/isolation/decolonization, or global decolonization (5 days BID nasal mupiricin and daily chlorhexidine bathing). The hazard ratios for MRSA isolates in the 3 groups were 0.92, 0.75, 0.63 respectively. The hazard ratios for any bloodstream infection in the 3 groups were […]
This trial found no difference in patient outcomes (mortality or LOS) if admitted during a time of 24/7 intensivist coverage, or during a time with only daytime intensivist coverage (with home call at night) in a medical ICU. This study does not show a patient benefit to a 24/7 intensivist staffing model in an academic […]