The “PIRO” classification system was developed to stratify sepsis patients based on their PREDISPOSING conditions, nature/extent of the INSULT, nature/extent of the host RESPONSE, and degree of ORGAN dysfunction. This study sought to identify the predictive power of a “PIRO” score for ICU patients with CAP, compared to both the APACHE II score and the 2007 ATS/IDSA pneumonia severity criteria. They found the 8 point PIRO score predicted 28 day mortality better than either, with an AUC of 0.88 (1 point each for COPD/immunocompromise, age>70, bacteremia, multilobar involvement, shock, hypoxemia, renal failure, or ARDS) (abstract). Mortality ranged from 4% (score 0-2) to 76% (score 5-8). This easy to calculate score can be very useful in stratifying risk in CAP patients admitted to the ICU.
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 […]