In this large retrospective cohort of 88,074 patients admitted with a COPD flare, researchers determined 3 variables (BUN>25, HR>109, and acute mental status change) predicted risk of mortality and intubation. In those with all 3 factors, mortality was 13%-15% (in the derivation and validation cohorts). In those with none of those factors and <age 65, mortality was 0.3% in both cohorts. The AUROC for mortality and intubation ranged from 0.71 to 0.77. This simple risk score can predict mortality and intubation risk in patients admitted with COPD flares (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 […]