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VNA of Care New England

Society of Critical Care Medicine, Jan 9-13

The Society of Critical Care Medicine's 43rd Critical Care Congress (http://www.sccm.org/Education-Center/Annual-Congress/Pages/default.aspx )
The annual congress of the Society of Critical Care Medicine was held from Jan. 9 to 13 in San Francisco and attracted more than 5,500 participants from around the world, including nurses, pharmacists, physicians, respiratory therapists, students, and other health care practitioners. The conference highlighted recent advances in critical care medicine, with presentations and abstracts mainly focusing on the management of critically ill patients.
In the largest cohort of children with traumatic brain injury (TBI) studied to date, Nicole O'Brien, M.D., of Nationwide Children's Hospital in Columbus, Ohio, and colleagues found that 21 percent of children with TBI experienced vasospasm, including 12 percent with moderate TBI and 36 percent with severe TBI.
"Vasospasm may contribute to secondary brain injury by causing decreased cerebral blood flow and ischemia. In fact, we found that children with vasospasm had worse GOS-E Peds [Extended Glasgow Outcome Scale - Pediatric Version] scores at the time of discharge from the hospital," said O'Brien. "We are performing further neurodevelopmental testing on these kids, and if this trend holds true, vasospasm may be a potential preventive and therapeutic target to reduce morbidity following TBI in children."
Abstract No. 9 (http://journals.lww.com/ccmjournal/Abstract/2013/12001/9___Vasospasm_in_Children_With_Moderate_to_Severe.12.aspx )
In another study, Robert Sutton, M.D., of the Children's Hospital of Philadelphia, and colleagues found that cardiopulmonary resuscitation (CPR) may be more effective if the CPR quality is adjusted according to how the patient responds.
"In essence, a 'personalized medicine' approach to CPR may save more lives," said Sutton. "This study provides the first evidence to support this approach and may lead to the development of patient-specific CPR guidelines in the future."
Abstract No. 20 (http://journals.lww.com/ccmjournal/Abstract/2013/12001/20___Diastolic_Blood_Pressure_Predicts_Survival.22.aspx )
Kathleen Ryan, M.D., of the Boston Children's Hospital, and colleagues evaluated whether there was an association with mortality for obese critically ill adults receiving mechanical cardiorespiratory support such as extracorporeal membrane oxygenation (ECMO).
Due to the nature of data collected on weight in the registry, the investigators could not calculate body mass index, which is traditionally used to define obesity. As an alternative, the investigators examined if mortality was higher in patients who had a gender-based body weight that was in the >80th percentile of weights for adult patients reported to the registry (≥90 kg for females and ≥100 kg for males), compared to normal-weight patients (40th to 60th percentile).
"After accounting for differences in illness severity and reasons for ECMO use in the two groups, we found that mortality was higher in patients weighing more (80th percentile group). We did not find an explanation for this association but speculate that the association is not related to differences in ECMO complications or other patient comorbid diseases (the two groups were not significantly different in their rates of both)," said Ryan. "Our take home message is that larger patients supported on ECMO need careful attention to ensure adequate ECMO support is provided to them so as to improve their survival, and that future research should focus on reasons for this association with increased mortality."
Abstract No. 25 (http://journals.lww.com/ccmjournal/Abstract/2013/12001/25___Higher_Body_Weight_Increases_Mortality_in.27.aspx )
In a large nationwide retrospective study, Ashima Das, M.D., of Rainbow Babies and Children's Hospital in Cleveland, and colleagues found that at least 1 percent of all patients undergoing major surgical procedures developed methicillin-resistant Staphylococcus aureus (MRSA) infections that led to increased length of hospital stay (14 versus five days) and in-hospital mortality (3.75 versus 1.16 percent). The investigators also found that African-Americans, Native-Americans, and uninsured populations tended to have an increased risk of MRSA infection and poor outcomes. Presence of comorbid conditions also predicted an increased risk of acquiring MRSA infection.
"Although the occurrence of MRSA infections complicating major surgical procedures is low, it is associated with worse outcomes," said Das. "Identification of certain predictors of MRSA infection may help in generating effective preventive strategies and optimize outcomes."
Abstract No. 43 (http://journals.lww.com/ccmjournal/Abstract/2013/12001/43___Prevalence,_Predictors_and_Outcomes_of_Mrsa.45.aspx )
In patients who receive critical care, Kenneth Christopher, M.D., of Brigham and Women's Hospital in Boston, and colleagues found that an elevated serum iron level (>170 µg/dL) prior to hospitalization is a strong predictor of bloodstream infection, sepsis, and death following admission to the intensive care unit.
"Though our results do not demonstrate cause and effect, most bacteria depend on iron for growth, and excess iron availability decreases the killing of bacteria by the human immune response. Intravenous iron treatment has been associated with increased risk of infections," said Christopher. "Patients with elevated serum iron may represent a high-risk patient population. If our findings are corroborated, practitioners may need to be cautious with iron repletion in critically ill adults."
Abstract No. 42 (http://journals.lww.com/ccmjournal/Abstract/2013/12001/42___The_Association_of_Serum_Iron_Levels_and.44.aspx )
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