Author Interviews, Critical Care - Intensive Care - ICUs, Dermatology / 16.06.2015

MedicalResearch.com Interview with: Rémi Coudroy MD CHU de Poitiers, Service de Réanimation Médicale CIC 1402 (ALIVE group), Université de Poitiers, Poitiers, France Medical Research: What is the background for this study? What are the main findings? Dr. Coudroy: Skin mottling is characterized by a red-violaceous discoloration of the skin. Its occurrence, as impaired consciousness and decreased urinary output are well-known clinical signs of shock. Skin mottling has been investigated only in patients with septic shock and recent studies have found that the extent and the persistence of skin mottling for more than 6 hours were associated with mortality. However, in daily clinical practice, we noticed that skin mottling occurred in patients without septic shock, and there was no data supporting the impact of skin mottling on the prognosis of critically ill patients. In a retrospective monocentric observational study over a 1-year period in a 15-bed tertiary medical ICU where skin mottling over the knees is assessed by nurses, we found that skin mottling occurred in 29% of patients admitted to ICU. Nurses’ evaluation of skin mottling was highly reliable. In 60% of cases, mean arterial pressure was ≥ 65 mmHg without vasopressors. The occurrence of skin mottling was associated with mortality independently from calculated severity scores at admission (i.e. Simplified Acute Physiology Score II). Similarly, the persistence of skin mottling for more than 6 hours was associated with mortality independently from organ failure at the onset of skin mottling (i.e. the use of vasopressors, the need for mechanical ventilation and hyperlactatemia).
Author Interviews, Critical Care - Intensive Care - ICUs, Hand Washing, Hospital Acquired / 25.04.2015

Ojan Assadian, M.D., DTMH Professor for Skin Integrity and Infection Prevention Institute for Skin Integrity and Infection Prevention School of Human & Health Sciences University of Huddersfield Queensgate, Huddersfield UKMedicalResearch.com Interview with: Ojan Assadian, M.D., DTMH Professor for Skin Integrity and Infection Prevention Institute for Skin Integrity and Infection Prevention School of Human & Health Sciences University of Huddersfield Queensgate, Huddersfield UK MedicalResearch: What is the background for this study? What are the main findings? Prof. Assadian: Although medical gloves serve as an important mechanical barrier to prevent healthcare workers’ hands from getting contaminated with potentially pathogenic microorganisms, their inappropriate and incorrect use may support microbial transmission, eventually resulting in indirect horizontal cross-contamination of other patients. We conducted a clinical study designed to determine the efficacy of a newly developed synthetic antibacterial nitrile medical glove coated with an antiseptic, polyhexamethylen-biguanid hydrochloride (PHMB), on its external surface, and compared this antibacterial glove to an identical non-antibacterial glove in reducing surface contamination after common patient care measures in an intensive care unit. We found significantly lower numbers of bacteria on surfaces after performing typical clinical activities such as intravenous fluid handling, oral toilet, or physiotherapy, if touched with antibacterial gloves.
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, Mayo Clinic, Outcomes & Safety, Pediatrics, Pediatrics / 11.03.2015

Marc Ellsworth, M.D Neonatology fellow at the Mayo Clinic Children’s CenterMedicalResearch.com Interview with: Marc Ellsworth, M.D Neonatology fellow at the Mayo Clinic Children’s Center MedicalResearch: What is the background for this study? Dr. Ellsworth: Inhaled Nitric Oxide (iNO) is a drug that has FDA approval for use in neonates >34 weeks gestational age. It is used for severe respiratory failure secondary to pulmonary hypertension. However, it has been previously shown that neonatologists have been using this medication off-label and especially in the most premature neonates. Over the last 10 years there have been multiple large studies trying to determine a clinical use (ie long term benefit) for iNO in preterm neonates (patients where there is no FDA approval for iNO use currently). Despite evidence of short term benefit (improved clinical stability) use of this drug has not been shown to improve long-term outcomes (death and chronic lung disease) in premature neonates. As a result of these findings the National Institute of Child Health and Human Development (NICHD) released a consensus guideline in 2011 indicated that available evidence did not support the routine use of iNO in preterm neonates and discouraged this use of this expensive therapy in preterm neonates. Similarly, in 2014 the American Academy of Pediatrics issued a similar statement with similar recommendations. In 2014 a group of NICUs (collectively called the Neonatal Research Network) associated with the NICHD published a report showing that the use of Inhaled Nitric Oxide in preterm infants (ie off-label) decreased following the report in 2011. However, I did not feel that these NICUs were representative of the United States alone as the Neonatal Research Network consists of only a handful of NICUs (~15) and is directly associated with the NICHD. As a result I wanted to get a better idea of Inhaled Nitric Oxide use in a population based study to see if the trends were similar (ie use of iNO has been decreasing) on a much larger, more representative scale. (Editorial comment: My anecdotal experience was that rates of iNO use off-label have not decreased in preterm neonates since the 2011 report).
Author Interviews, Critical Care - Intensive Care - ICUs, Hospital Readmissions, Infections, JAMA, University of Michigan / 11.03.2015

Hallie Prescott, MD, MSc Clinical Lecturer, Internal Medicine Division of Pulmonary & Critical Care Medicine University of Michigan Health System Ann Arbor, MI 48109-2800MedicalResearch.com Interview with: Hallie Prescott, MD, MSc Clinical Lecturer, Internal Medicine Division of Pulmonary & Critical Care Medicine University of Michigan Health System Ann Arbor, MI 48109-2800   Medical Research: What is the background for this study? What are the main findings? Dr. Prescott: The post-hospital period has been widely recognized as a vulnerable time for patients. In particular, patients who survive sepsis are frequently readmitted to the hospital in the following three months. In this study, we examined data from 2,600 survivors of sepsis, a severe infection that leads to organ failure. About 42% of the sepsis patients were readmitted in the next 90 days, similar to the rate seen for patients hospitalized for other acute conditions. However, the reasons for hospital readmission after sepsis are different. A greater number of patients are re-hospitalized for “ambulatory-care sensitive conditions”, which are conditions that could potentially be prevented or treated early in the outpatient setting to avoid a hospital stay.
Author Interviews, Cancer Research, Critical Care - Intensive Care - ICUs, Infections / 12.02.2015

Dr. Cornejo-Juárez Department of Infectious Disease, Instituto Nacional de Cancerología Tlalpan MexicoMedicalResearch.com Interview with: Dr. Cornejo-Juárez Department of Infectious Disease, Instituto Nacional de Cancerología Tlalpan Mexico MedicalResearch: What is the background for this study? Dr. Cornejo: Critically ill patients in the intensive care unit are at major risk of hospital-acquired infections. Immunosuppressed patients have a higher risk related with continuous exposure to the hospital setting, mucositis and disruption of skin integrity, presence of indwelling catheters and abnormal immune system because of primary malignancy or chemotherapy. Our aimed was to investigate prevalence and outcome of hospital-acquired infections in an oncology ICU. MedicalResearch: What are the main findings? Dr. Cornejo: We found that hospital-acquired infections are a major problem in the ICU. Hospital-acquired infections are related with higher mortality. Multidrug resistant bacteria are frequently involved in these infections, and are associated with increased mortality.
Author Interviews, Critical Care - Intensive Care - ICUs, Hospital Acquired, Vanderbilt / 21.01.2015

Michael Noto, MD, PhD Pulmonary and Critical Care Medicine Vanderbilt University Medical CenterMedicalResearch.com Interview with: Michael Noto, MD, PhD Pulmonary and Critical Care Medicine Vanderbilt University Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Noto: Health care-associated infections are the most common complication for hospitalized patients and several studies have suggested that bathing critically ill patients with the antimicrobial chlorhexidine reduces health care-associated infections.  In the largest study of chlorhexidine bathing to date, however, we were unable to demonstrate a reduction in infections.
Author Interviews, Critical Care - Intensive Care - ICUs, Kidney Disease, University of Pittsburgh / 22.12.2014

MedicalResearch.com Interview with: Florentina E. Sileanu BS Center for Critical Care Nephrology and Clinical Research, Investigation, and Systems Modeling of Acute Illness Center Departments of Critical Care Medicine and Department of Biostatistics, University of Pittsburgh Graduate School of Public Health and Dr. John A. Kellum, MD, MCCM Professor of Medicine, Bioengineering and Clinical & Translational Science Vice Chair for Research Center for Critical Care Nephrology, University of Pittsburgh School of Medicine Pittsburgh, PA Medical Research: What is the background for this study? What are the main findings? Response: Acute Kidney Injury (AKI) affects millions of Americans each year resulting in increased short and long-term complications including need for dialysis and death. Many trials recruiting subjects at risk for AKI have focused on those with other (e.g. cardiovascular and respiratory) organ failures because these patients are at highest for AKI. However, patients without these conditions might not be at low-risk for AKI. We explored whether Acute Kidney Injury occurring as a single organ failure or occurring before other organ failures would be associated with the same outcomes as in sicker patients. Using a large, academic medical center database, with records from July 2000 through October 2008, we identified a "low-risk" cohort as patients without cardiovascular and respiratory organ failures defined as not receiving vasopressor support or mechanical ventilation within the first 24 hours of ICU admission. We were able to show that low-risk patients have a substantial likelihood of developing AKI and that the relative impact on mortality of AKI is actually greater for low-risk patients (OR, 2.99; 95% 2.62-3.41) than for high-risk patients (OR, 1.19; 95% 1.09-1.3).
Author Interviews, Biomarkers, Brigham & Women's - Harvard, Critical Care - Intensive Care - ICUs, PLoS / 19.12.2014

Daniel Irimia, M.D., Ph.D. Assistant Professor Division of Surgery, Science & Bioengineering Massachusetts General Hospital and Harvard Medical School Associate Director, BioMEMS Resource Center Boston, MA 02129MedicalResearch.com Interview with: Daniel Irimia, M.D., Ph.D. Assistant Professor Division of Surgery, Science & Bioengineering Massachusetts General Hospital and Harvard Medical School Associate Director, BioMEMS Resource Center Boston, MA 02129 Medical Research: What is the background for this study? What are the main findings? Response: Sepsis is affecting more than half of the patients with major burn injuries (20 percent of body surface) and is the leading cause of death among these patients.  Sepsis is also a significant complication for other critically ill patients. More than one million Americans are affected and it has been estimated that approximately 30% of these people die, despite significant advances in life support and antibiotics.  Early diagnosis is essential, and it has been calculated that every 6 hours of delay in a sepsis diagnosis decreases the chances of survival by 10 percent. We have found that the motility of the white blood cells called neutrophils, inside a microfluidic device, is significantly altered two to three days before sepsis develops.
Author Interviews, Critical Care - Intensive Care - ICUs / 01.12.2014

Christopher E. Dandoy, MD, MSc Divisions of Bone Marrow Transplantation and Immunodeficiency, and James M. Anderson Center for Health Systems Excellence Cincinnati Children's Hospital Medical CenterMedicalResearch.com Interview with: Christopher E. Dandoy, MD, MSc Divisions of Bone Marrow Transplantation and Immunodeficiency, and James M. Anderson Center for Health Systems Excellence Cincinnati Children's Hospital Medical Center MedicalResearch.com Editor’s Note: Dr. Dandoy discusses a novel program to reduce the frequency of cardiac alarms in the setting of a large inpatient intensive care unit. Medical Research: What is the background for this study? Why did you decide to do this study? Dr. Dandoy: During our three month investigation period we had roughly a million alarms go off in our intensive care unit. Our unit nurses reported spending 30-40 minutes per day responding to the various alarms. We first looked to see if there were established guidelines in the literature for cardiac monitors and found there were none. The alarms were a source of frustration and anxiety not just for the unit staff but also for patients and family members. Medical Research: What are the elements of your alarm reduction program? Dr. Dandoy: The first element was simply to have a plan or a process for initial ordering of monitor parameters based on age-appropriate standards. In our case, we established a standard order set in Epic, our electronic records program. Epic Cardiac Monitor Order Set Epic Cardiac Monitor Order Set
Author Interviews, Critical Care - Intensive Care - ICUs, NEJM, Nutrition / 26.11.2014

MedicalResearch.com Interview with: Sheila E. Harvey, Ph.D. CTU Manager/Senior Research Fellow ICNARC Napier House London Medical Research: What is the background for this study? Dr. Harvey: The CALORIES trial was set-up in the context of concerns about malnutrition in critically ill patients in NHS hospitals and conflicting evidence as to the optimal route for delivery of early nutritional support to critically ill patients. The enteral route is the mainstay of nutritional support in the critically ill but it is frequently associated with gastrointestinal intolerance and underfeeding. In contrast, the parenteral route, though more invasive and expensive, is more likely to secure delivery of the intended nutrition but has been associated with more risks and complications (e.g. infectious complications) compared with the enteral route. In light of the uncertainty surrounding the most effective route for delivery of early nutritional support and, given recent improvements in the delivery, formulation and monitoring of parenteral nutrition, the UK National Institute of Health Research (NIHR) Health Technology Assessment (HTA) Programme put out a “call” for a large pragmatic randomised controlled trial to be conducted in critically ill patients to determine the optimal route of delivery of early nutritional support. CALORIES was set up to test the hypothesis that early nutritional support delivered via the parenteral route is superior to early nutritional support delivered via the enteral route in adults who had an unplanned admission to an intensive care unit and who could be fed via either route. The primary outcome was all-cause mortality at 30 days. The secondary outcomes included infectious and non-infectious complications (hypoglycaemia, elevated liver enzymes, nausea requiring treatment, abdominal distension, vomiting, new or substantially worsened pressure ulcers).
Author Interviews, Critical Care - Intensive Care - ICUs, Outcomes & Safety / 25.11.2014

Alexandra Laurent Maître de conférences de psychologie clinique et psychopathologie Laboratoire de psychologie EA3188 Université de Franche-ComtéMedicalResearch.com Interview with : Alexandra Laurent Maître de conférences de psychologie clinique et psychopathologie Laboratoire de psychologie EA3188 Université de Franche-Comté Medical Research : What is the background for this study? What are the main findings? Dr. Laurent: Human error among healthcare professionals is a subject of current affairs and especially in ICUs which are among the services with a high risk of error. If the error affects the patient and his/her family, it will also have an impact on the caregivers involved, their colleagues, and even the entire service. In an editorial in the BMJ, Wu introduced the term “the second victim” to define a caregiver implicated in and traumatised by an medical error for which he/she feels personally responsible. Therefore, it’s important to improve understanding of the psychological repercussions of error on professionals in ICUs, and to identify the defense mechanisms used by professionals to cope with errors. In the month following the error, We found that the professionals (doctors and nurses) described feelings of guilt and shame. These feelings were associated with: anxiety states with rumination and fear for the patient; a loss of confidence; an inability to verbalize one’s error; questioning oneself at a professional level; and anger towards the team.
Author Interviews, Critical Care - Intensive Care - ICUs, Hospital Readmissions, Infections, University of Pennsylvania / 10.11.2014

Mark E Mikkelsen, MD, MSCE Assistant Professor of Medicine Hospital of the University of PennsylvaniaMedicalResearch.com Interview with: Mark E Mikkelsen, MD, MSCE Assistant Professor of Medicine Hospital of the University of Pennsylvania Medical Research: What is the background for this study? What are the main findings? Dr. Mikkelsen: Sepsis is common, afflicting as many as 3 million Americans each year. It is also costly, both in terms of health care expenditures that exceed $20 billion for acute care and in terms of the impact it has on patients and their families. To date, studies have focused on what happens to septic shock patients during the initial hospitalization. However, because more patients are surviving sepsis than ever, we sought to examine the enduring impact of septic shock post-discharge. We focused on the first 30 days after discharge and asked several simple questions. First, how often did patients require re-hospitalization after septic shock? And second, why were patients re-hospitalized? We found that 23% of septic shock survivors were re-hospitalized within 30 days, many of them within 2 weeks. A life-threatening condition such as recurrent infection was the reason for readmission and 16% of readmissions resulted in death or a transition to hospice.
Author Interviews, Critical Care - Intensive Care - ICUs, General Medicine / 01.10.2014

Nick Lonardo, PharmD Pharmacy, Clinical Coordinator Department of Pharmacy Services Salt Lake City, Utah 84132MedicalResearch.com Interview with: Nick Lonardo, PharmD Pharmacy, Clinical Coordinator Department of Pharmacy Services Salt Lake City, Utah 84132 Medical Research: What are the main findings of the study? Dr. Lonardo: To our knowledge, this is the first, large, multicenter, retrospective cohort study to show that continuous infusion benzodiazepines are independently associated with increased mortality in mechanically ventilated ICU patients. In addition, benzodiazepines were associated with an increased time of mechanical ventilation and ICU length of stay.
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA / 10.09.2014

Hayley Gershengorn MD Assistant Professor, Department of Medicine (Critical Care) Assistant Professor, The Saul R. Korey Department of Neurology Albert Einstein College of Medicine Bronx, NY 10461MedicalResearch.com Interview with: Hayley Gershengorn MD Assistant Professor, Department of Medicine (Critical Care) Assistant Professor, The Saul R. Korey Department of Neurology Albert Einstein College of Medicine Bronx, NY 10461 Medical Research:  What are the main findings of the study? Dr. Gershengorn: Using a large national database, we found there to be no association between the use of arterial catheters and mortality in mechanically ventilated medical intensive care unit patients. Similarly, we found no beneficial association between arterial catheters and mortality in any of the eight other critically ill subgroups evaluated.
Author Interviews, CHEST, Critical Care - Intensive Care - ICUs, Ebola, General Medicine / 29.08.2014

The American College of Chest Physicians released an expert consensus statement, Care of the Critically Ill and Injured During Pandemics and Disasters while the global health-care community cares for patients with the Ebola virus.Three of the authors discussed this important statement with MedicalResearch.com. Asha V. Devereaux, MD, MPH Sharp Hospital, Coronado, CAAsha V. Devereaux, MD, MPH Sharp Hospital Coronado, CA Jeffrey R. Dichter, MD Allina Health, Minneapolis, MN, and Aurora Health, Milwaukee, WIJeffrey R. Dichter, MD Allina Health, Minneapolis, MN and Aurora Health, Milwaukee, WI   Niranjan Kissoon, MBBS, FRCP(C) BC Children's Hospital and Sunny Hill Health Centre University of British Columbia, Vancouver, CanadaNiranjan Kissoon, MBBS, FRCP(C) BC Children's Hospital and Sunny Hill Health Centre University of British Columbia, Vancouver, Canada Medical Research: What are the main ethical concerns and criteria for evaluating who may be eligible for treatment during a pandemic or disaster? Dr. Asha Devereaux: The main ethical concerns regarding eligibility for treatment during a pandemic will be access to limited or scarce resources. Who should get treatment and who decides will be some significant questions whenever there is a scarcity of healthcare resources. Transparency and the fairness of the ethical framework for decision-making will need to be made public and updated based upon the changing dynamics of resources and disease process. Dr. Niranjan Kissoon: There is work to be done in this area and engagement of citizens, government, medical community, ethicists and legal experts in the process is important.
Author Interviews, CHEST, Critical Care - Intensive Care - ICUs, Thromboembolism / 10.07.2014

Dr. Colin Cooke MD, MSc, MS Assistant Professor, Department of Internal Medicine University of Michigan Center for Healthcare Outcomes and Policy Ann Arbor, MIMedicalResearch.com Interview with: Dr. Colin Cooke MD, MSc, MS Assistant Professor, Department of Internal Medicine University of Michigan Center for Healthcare Outcomes and Policy Ann Arbor, MI Medical Research: What are the main findings of the study? Dr. Cooke: We determined that when patients who are hospitalized for pulmonary embolism (PE), a blood clot in the lung, approximately 1 in 5 will be admitted to an intensive care unit (ICU). However, the chances that a patient will go to an ICU is highly dependent upon which hospital they are admitted to. For example, some hospitals admitted only 3% of patients with pulmonary embolism to an ICU while others admitted almost 80%. Importantly, the differences in how hospitals use their ICU for patients with pulmonary embolism was not entirely related to the patient’s need for life support measures, the things that the ICU is designed to deliver. For example, the ICU patients in high ICU-use hospitals tended to receive fewer procedures, including mechanical ventilation, arterial catheterization, central lines, and medications to dissolve blood clots. This suggest that high utilizing hospitals are admitting patients to the ICU with weaker indications for ICU admission.
Author Interviews, CHEST, Critical Care - Intensive Care - ICUs / 27.06.2014

MedicalResearch.com Interview with: James R. Klinger, MD, FCCP Professor of Medicine, Brown University Darren Taichman, MD, PhD, FCCP Adjunct Associate Professor of Medicine, University of Pennsylvania Greg Elliott, MD, MACP, FCCP Professor of Medicine, University of Utah School of Medicine Background: The authors discuss the June 17, 2014 CHEST publication: Pharmacological Therapy for Pulmonary Arterial Hypertension in Adults: CHEST Guideline MedicalResearch: How widespread is the problem of Pulmonary Arterial Hypertension (PAH)? Greg Elliott: PAH is an uncommon, but important disorder because untreated it is usually progressive and fatal, AND there are effective treatments. This makes the guidelines important for physicians, patients and insurers. MedicalResearch: What are the most common causes of PAH? Greg Elliott: Common causes are connective tissues diseases like scleroderma, toxins like methamphetamine and cases for which the cause is not known, i.e. idiopathic. Some (about 20 %) idiopathic cases are caused by gene mutations.
Author Interviews, Cancer Research, CHEST, Critical Care - Intensive Care - ICUs, University of Michigan / 22.06.2014

Colin R. Cooke, MD, MSc, MS; Assistant Professor of Medicine, Division of Pulmonary & Critical Care Medicine Faculty, Center for Healthcare Outcomes & Policy University of MichiganMedicalResearch.com Interview with: Colin R. Cooke, MD, MSc, MS; Assistant Professor of Medicine, Division of Pulmonary & Critical Care Medicine Faculty, Center for Healthcare Outcomes & Policy University of Michigan MedicalResearch: What are the main findings of the study? Dr. Cooke: There were three primary findings from our study. First, we determined that between 1992 and 2005 there was almost a 40% increase in the number of admissions to an intensive care unit (ICU) among patients with lung cancer who were hospitalized for reasons other than surgical removal of their cancer. Second, most of this increase was because doctors were admitting these patients to intermediate intensive care units. These are units that provide greater monitoring and nurse staffing than typically available in general hospital wards, but usually also have less ability to provide life support measures than full service ICUs. Third, over the same period the reasons for ICU admission have changed. Although the most common reason for admission continues to be for problems related to the patients’ lung cancer, problems such as breathing difficulties requiring a ventilator and severe infections are increasingly common. These findings suggest that although overall use of the ICU for patients with lung cancer is increasing over time, providers may be shifting some of the intensive care for lung cancer patients toward less aggressive settings such as the intermediate care unit.
Author Interviews, Critical Care - Intensive Care - ICUs, NEJM, Statins / 22.05.2014

Jonathon D. Truwit, MD, MBA Enterprise Chief Medical Officer Sr. Administrative Dean Froedtert-Medical College of Wisconsin Milwaukee, WI 53226MedicalResearch.com Interview with: Jonathon D. Truwit, MD, MBA Enterprise Chief Medical Officer Sr. Administrative Dean Froedtert-Medical College of Wisconsin Milwaukee, WI 53226 MedicalResearch.com: What are the main findings of the study? Dr. Truwit: Rosuvastatin did not reduce mortality, nor days free of the breathing machine, in patients with sepsis-associated acute respiratory distress syndrome (ARDS). One in four patients with ARDS die.
Author Interviews, Critical Care - Intensive Care - ICUs, Mayo Clinic, Outcomes & Safety / 09.05.2014

MedicalResearch Interview with: Dr. David Cook MD Professor in the Department of Anesthesiology Division of Cardiovascular Anesthesiology Center for the Science of Health Care Delivery Mayo Clinic College of Medicine Rochester, Minnesota. MedicalResearch: What are the main findings of the study? Dr. Cook: The main finding of the study was that segmentation of a population of surgical patients into groups of higher and lower complexity allowed us to apply a standardized practice, focused factory model to surgical care delivery. A standardized care model improved care process measures such as time on mechanical ventilation or duration of a bladder catheter indwelling. The model reduced resource utilization, decreasing patient time in all care environments (operating room, ICU and on ?the floor?). The care model improved outcomes at 30 days and reduced the costs overall and in every care environment. In addition to the absolute improvements in quality and in cost, the standardized care model reduced variation in all measured variables. That reduction in variation may be even more important than the improved outcomes or reduced costs because we now know it is possible to make the health care experience predictable for these patients. That predictability is critically important to patients and providers, but it also has implications for health care metrics and payment models.
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Pharmacology, Psychological Science / 19.03.2014

Dr. Christian Fynbo Christiansen Clinical Associate Professor Department of Clinical Epidemiology Aarhus University HospitalMedicalResearch.com Interview Invitation Dr. Christian Fynbo Christiansen Clinical Associate Professor Department of Clinical Epidemiology Aarhus University Hospital MedicalResearch.com: What are the main findings of the study? Dr. Christiansen:  We included 24,179 critically ill nonsurgical patients receiving mechanical ventilation in intensive care units in Denmark, and matched comparison groups of hospitalized patients and the general population. We assessed psychiatric diagnoses and medication prescriptions before and after critical illness. We found an increased prevalence of psychiatric diagnoses in the 5 year period before critical illness, compared to both other hospitalized patients and the general population.
Author Interviews, Critical Care - Intensive Care - ICUs, Duke, Flu - Influenza, Vaccine Studies / 11.02.2014

Dr Cameron Wolfe MBBS(Hons), MPH Assistant Professor of Medicine Clinical / Transplant Infectious Diseases Duke University Medical CenterMedicalResearch.com Interview with: Dr Cameron Wolfe MBBS(Hons), MPH Assistant Professor of Medicine Clinical / Transplant Infectious Diseases Duke University Medical Center MedicalResearch.com: What are the main findings of the study? Dr. Wolfe: The major findings of the study were that at least in our center, there was a significant burden of critical illness due to H1N1 influenza infection.  The average age of the patients admitted to the hospital was just 28yrs, consistent with the younger patient age in 2009 when H1N1 emerged.  Most critically, we also observed a significantly lower rate of influenza vaccine uptake in patients admitted to the Intensive Care Units at our center.
Author Interviews, Critical Care - Intensive Care - ICUs, Infections, Outcomes & Safety / 20.01.2014

Allan J. Walkey, M.D., M.Sc Boston University School of Medicine Pulmonary Center Boston, MassachusettsMedicalResearch.com Interview with: Allan J. Walkey, M.D., M.Sc Boston University School of Medicine Pulmonary Center Boston, Massachusetts MedicalResearch.com: What are the main findings of the study? Dr. Walkey: Thank you for the interest in our study.  Current evidence-based treatments for severe sepsis (ie, infection+systemic inflammatory response+ end organ dysfunction) include specific processes of care rather specific therapeutics.  These processes include early administration of antibiotics, early fluid resuscitation, and lung protective ventilation strategies.  We hypothesized that hospitals with more ‘practice’ at treating patients with severe sepsis may have more effective care processes leading to improved patient outcomes.  We examined more than 15,000 severe sepsis admissions from 124 US academic medical centers. Our findings supported our hypothesis. After adjustment for patient severity of illness and hospital characteristics, mortality in the highest quartile severe sepsis case volume hospitals was 22% and  mortality in lowest severe sepsis case volume hospitals was 29%.  The 7% absolute mortality difference would result in an estimated number needed to treat in high severe sepsis volume hospitals to prevent one death in low case volume hospitals of 14 (though we advise caution in interpretation of a number needed to treat in an observational study). Costs and length of stay were not different across levels of severe sepsis case volume.  Results were robust to multiple subgroup and sensitivity analyses.
Author Interviews, CHEST, Critical Care - Intensive Care - ICUs, Respiratory / 02.01.2014

MedicalResearch.com Interview with: Dr Simone Gattarello Vall d’Hebron Hospital, Critical Care Department Universitat Autonoma de Barcelona and Medicine Department, Spain MedicalResearch.com: What are the main findings of the study? Dr. Gattarello: The main findings from the present study are a 15% decrease in ICU mortality due to severe community-acquired pneumonia caused by Streptococcus pneumoniae in the last decade; moreover, several changes in antibiotic prescription practices were detected and an association between improved survival and both earlier antibiotic administration and increased combined antibiotic therapy were identified. In summary, in severe pneumococcal pneumonia combined antibiotic therapy and early antibiotic administration are associated with lower mortality.
Author Interviews, Critical Care - Intensive Care - ICUs, Yale / 09.11.2013

MedicalResearch.com Interview with: John Ney, MD, MPH Clinical Assistant Professor, Department of Neurology, University of Washington neyj@uw.edu MedicalResearch.com: What are the main findings of the study? Dr. Ney: My colleagues and I used a large, publicly available dataset to examine the usage and effectiveness of electroencephalography (EEG) in adult intensive care units (ICUs) in the United States over a five year period.  We compared routine EEG, which consists of a portable machine hooked up to the patient to record brainwaves for a short duration, usually 20-40 minutes, with continuous EEG monitoring, where a patient’s brainwaves are recorded continuously for 24 hours or more and examined, ideally in real-time.  Because most patients in the ICU are comatose, we have generally poor and crude indicators of their brain function.  ICU patients are particularly at risk for non-convulsive seizures, where the brain is seizing, but there are few outward signs of a seizure.  EEG is the only means of detecting non-convulsive seizures, and is useful in determining the brain’s reactions to drugs, monitoring for stroke and other abnormal activity. Our main finding is that ICU patients receiving continuous EEG monitoring was associated with increased survival relative to those who received routine EEG only.    In our sample, 39% of ICU patients who received routine EEG died compared to only 25% of those with continuous EEG monitoring. This finding was both substantial and statistically significant, even after adjustment for age and other demographics, clinical disease comorbidity severity measures, and hospital factors.  Although continuous EEG monitoring was more expensive, the increase in hospital charges were not significant after adjustment.
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA / 14.10.2013

Professor Djillali Annane MD, PhD Raymond Poincaré Hospital, Garches, France CH d’Etampes, Etampes, FranceMedicalResearch.com with: Professor Djillali Annane MD, PhD Raymond Poincaré Hospital, Garches, France CH d’Etampes, Etampes, France   MedicalResearch.com: What are the main findings of the study? Answer: The CRISTAL trial was designed in 2002 to clarify whether correction of acute hypovolemia in critically ill patients with colloids may increase the risk of death as compared to resuscitation with crystalloids. The trial has enrolled 2857 patients in 57 ICUs in France, Belgium, Canada and North Africa.  The relative risk of death was at 28 day of 0.96 (95% CI: 0.88 to 1.04; P=0.26), and at 90 day of 0.92 (95%CI: 0.86 to 0.99; P=0.03) in favor of colloids. Colloids-treated patients had  more days alive and off mechanical ventilation and off vasopressor both within 7 days and 28 days of randomization. There was no evidence for increased risk of kidney injury with colloids.
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Nutrition, Protein / 10.10.2013

Zudin Puthucheary MBBS B.Med.Sci D.UHM EDICM MRCP FHEA NIHR Research Fellow, Respiratory and Critical Care Institute of Health and Human Performance, UCL Post-CCT Fellow in Trauma and Critical Care, Kings College HospitalMedicalResearch.com Interview with: Zudin Puthucheary MBBS B.Med.Sci D.UHM EDICM MRCP FHEA NIHR Research Fellow, Respiratory and Critical Care Institute of Health and Human Performance, UCL Post-CCT Fellow in Trauma and Critical Care, Kings College Hospital MedicalResearch.com: What are the main findings of the study? Answer: That muscle wasting occurs rapidly and early in critical illness, with up to 2-3% loss of muscle mass per day. This is related to the numbers of organs failed, and is made worse by the degree of acute lung injury, and increased protein delivery. Muscle wasting is the result of both decreased muscle protein synthesis and increased muscle protein breakdown. In addition 40% of these patients developed muscle necrosis over the study period.
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, JAMA / 11.09.2013

Thanh N. Huynh, MD, MSHS Clinical Instructor UCLA Division of Pulmonary Critical CareMedicalResearch.com Interview with: Thanh N. Huynh, MD, MSHS Clinical Instructor UCLA Division of Pulmonary Critical Care MedicalResearch.com: What are the main findings of the study? Dr. Huynh: Our study shows that it is common for ICU doctors to recognize that futile treatment is provided to patients who cannot benefit from it.  In our study, 11% of ICU patients were perceived as receiving futile treatment.  The outcomes of these 123 patients were uniformly poor, with 85% dying within 6 months.  Advances in critical care medicine has allowed us to save lives, but it has also allowed us provide aggressive life-sustaining treatments that may not benefit all patients.  When aggressive treatment is poorly matched with a patient’s prognosis, doctors will consider such treatment as futile and our study shows that this is not an uncommon occurrence in our health system.