June 2014 Adult Acute Care Newsletter

June 2014 Adult Acute Care Newsletter

Specialty Practitioner of the Year: Nominations Underway Now

Do you know a fellow section member who’s gone above and beyond for the section or the specialty? Nominate him or her for our 2014 Specialty Practitioner of the Year Award! The deadline is July 31 and nominations can be made right on our SECTION WEBSITE.

Blood Eosinophil Levels May Predict Asthma Exacerbations

Kaiser Permanente researchers who presented their findings at the recent American Thoracic Society (ATS) meeting suggest elevated blood eosinophil levels may be used to predict which adults with asthma are at greatest risk for exacerbations of the disease. The investigators measured blood eosinophil levels in 2392 patients in 2010, then looked at the relationship between these levels and the rate of exacerbations in 2011. A baseline eosinophil level of >400/mm3 was associated with future asthma exacerbations after adjustment for baseline features such as demographics, comorbidities, and asthma burden and care. Other factors that were significantly associated with an increased risk of exacerbations included a history of prior asthma exacerbations, GINA steps-4/5 care, dispensing of seven or more short-acting beta-agonist canisters, female gender, black ethnicity, and obesity. READ PRESS RELEASE

Sepsis Accounts for Up to Half of Hospital Deaths

Another Kaiser Permanente study presented at the ATS meeting finds sepsis accounts for up to half of all hospital deaths in the U.S., despite the fact that it is found in only a tenth of the patients. The researchers arrived at that conclusion after conducting a retrospective analysis of 6.5 million hospital discharge records derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample in 2010. Using diagnosis and procedure codes, they identified hospital admissions and deaths of patients with sepsis and estimated the percentage of total hospital charges associated with sepsis hospitalizations. Results showed sepsis patients had a hospital mortality rate of 10.4% vs. 1.1% in patients who did not have sepsis. As many as 52% of hospital deaths nationwide were among patients diagnosed with sepsis, and these hospitalizations contributed to 21.2% of all hospital charges. READ PRESS RELEASE

ARDS Outcomes for Rescue, Non Rescue Therapy Patients

A new study out of the University of Washington takes a closer look at outcomes for acute respiratory distress syndrome patients who do and do not require rescue therapy in the hospital. The researchers reviewed data on 428 patients, 62 of whom were initiated on rescue therapy. Results showed —

  • PaO2/FIO2 ratios were comparable at admission between patients treated with a rescue therapy and those treated conventionally, but were substantially lower by 72 hours in those who received rescue therapies.
  • For the entire cohort, estimated survival probability at three years was 55%; among 280 hospital survivors three year survival was 85%.
  • The relative hazard of in-hospital mortality was 68% higher among patients who received rescue therapy compared with patients treated conventionally.
  • The hazard ratio of death following ICU admission was 1.56, comparing rescue vs. conventional treatment.

The study was published ahead of print by Critical Care Medicine on April 11. READ ABSTRACT

Nighttime Extubations Found Safe and Effective

Delaying extubation to the daytime doesn’t do patients who are ready to be extubated at night any favors, report Albert Einstein College of Medicine investigators publishing ahead of print in the Journal of Intensive Care Medicine on April 24. They compared outcomes for 1555 patients extubated during the day and 685 extubated at night. Overall, 119 (7.7%) patients extubated during the day and 26 (3.8%) extubated at night were reintubated within 24 hours, with the likelihood of reintubation significantly lower for nighttime than daytime extubation after multivariable adjustment; a similar trend was noted for reintubation within 72 hours. Patients extubated at night trended toward decreased mortality as well, and these patients also had a significantly lower length of stay (LOS). No significant difference in reintubation proportion or mortality was noted in a confirmatory frequency-matched analysis, but LOS remained significantly lower in those extubated at night. “Since patients should be extubated as soon as they meet parameters in order to potentially decrease complications of mechanical ventilation, these data provide no support for delaying extubation until daytime,” conclude the authors. READ ABSTRACT