CHEST 2006 Abstract Briefs: Critical Care

Telemedicine Provides Support and Enhances Physician Compliance(Monday, October 23, 2006, 4:30 PM EST)A new study from Indiana's Parkview Hospital Indiana suggests intensive care unit (ICU) telemedicine programs can extend intensivist care. Researchers evaluated the preliminary outcomes and nursing satisfaction at five hospitals, by involving a remote tele- intensivist in 64 rapid response team (RRT) calls. During the 16-week program, the tele-intensivist provided immediate care orders in 70 percent of cases, cardiac arrests declined by ten percent, and nursing satisfaction improved. Researchers conclude the tele-intensivists can successfully provide expert support to multiple hospital RRTs.

Lack of Communication Is Frequent in ICU and End-of-Life Care(Wednesday, October 25, 2006, 2:30 PM EST)A new study shows families of patients in the intensive care unit (ICU) are not satisfied with the amount or kind of communication they receive from health-care providers. Researchers from Harvard Medical School administered 25 open-ended questions to 50 ICU patient families. Qualitative analysis revealed an overall 40 percent communication failure rate between the families and the health-care team. Only 35 percent of families were satisfied with the information about the current status of their loved one. In a similar study, researchers interviewed family members of patients who died in the ICU. While 54 percent of family member comments were classified as positive regarding the ICU dying experience, 71 percent of the comments showed a poor experience when related to communication. Both studies suggest that communication is problematic in the ICU and end-of-life ICU situations.

Diaphragm Atrophy Occurs Within Two Weeks of Mechanical Ventilation(Wednesday, October 25, 2006, 2:30 PM EST)Ventilated, acutely critically ill patients may experience significant diaphragmatic atrophy within the first two weeks of mechanical ventilation, according to a new Mt. Sinai School of Medicine study. Researchers used bedside ultrasound and charts to determine the diaphragm thickness of 20 intensive care unit (ICU) patients, within 48 hours of intubation. Weekly follow-up images were obtained until patients were either removed from the ventilator or died. Researchers found a significant decrease in thickness from baseline, showing a 17 percent reduction by week one and 20 percent reduction by week two. No further loss was shown from week three and beyond. Researchers suggest that the diaphragmatic atrophy may contribute to difficulty in weaning patients from mechanical ventilation.

Pre-existing Medical Conditions Common in Pregnant Women in ICU(Wednesday, October 25, 2006, 2:30 PM EST)A large proportion of pregnant women admitted to the ICU are shown to have pre-existing medical conditions, according to a new study. Researchers from Rhode Island described obstetric ICU admissions by collecting and reviewing data, such as age, race, and pre-existent conditions. In all, 47 percent of the women had major pre-existing medical problems, with cardiac diseases being the most common. Twenty percent of the women had asthma and 65 percent of the admissions were for non-obstetric causes. Researchers also found that 17 percent of the total population was African-American, representing a disproportionate number.

Computerized Physician Order Entry May Improve ICU Care(Wednesday, October 25, 2006, 2:30 PM EST)Intensive care unit (ICU) safety protocols may be improved with use of the computerized physician order entry (CPOE) systems, says a new study. The system, which allows physicians to order medications or laboratory results via a computer, alerts physicians when a potential error is made. Researchers from Baystate Medical Center evaluated medication use in ICU patients, one year proceeding and one year following CPOE implementation. In the year following CPOE transitioning, medication administration for deep vein thrombosis (DVT) increased by 12 percent. In addition, the use of compression devices for stress ulcers increased by eight percent. Researchers concluded that CPOE systems might be associated with improved ICU care.

Obesity Associated With Bloodstream Infection Survival(Wednesday, October 25, 2006, 2:30 PM EST)Bloodstream infections have a high mortality rate among intensive care unit (ICU) patients. However, a new study shows that obese patients may have a survival advantage in this condition. The relationship between body mass index (BMI), survival, and hospital outcomes was evaluated in 183 critically ill patients with bloodstream infections. Researchers from Geisinger Medical Center grouped patients by their BMI ranges and made between-group comparisons for survival with hospital discharge. Researchers found that 38 percent of patients died during hospitalization. Of those who survived, obese patients were shown to have increased survival, compared with non-obese patients. Researchers concluded that the response to bloodstream infections in obese patients might lead to development of effective treatment for patients of all body types.