New research presented at the Society of Critical Care Medicine, Critical Care Congress from January 9-13, 2010, in Miami Beach addressed key issues in critical care. The features highlight just some of the studies that emerged from the congress.
NRT: Assessing Mortality in Critically Ill Smokers
The Particulars: Nicotine replacement therapy (NRT) is often given to smokers admitted to the ICU to prevent withdrawal symptoms, but the safety of NRT in the critically ill has not been well studied.
Data Breakdown: A study evaluated 330 active smokers, 174 of whom received NRT upon admission to the ICU. NRT was not associated with increased hospital mortality after adjusting for severity of disease, pack-years of smoking, and do-not-resuscitate status upon ICU admission (odds ratio, 1.6). About 23.0% of NRT patients experienced delirium compared with a 13.1% rate for non-NRT recipients.
Take Home Pearls: NRT does not appear to be associated with increased hospital mortality in critically ill active smokers. However, NRT recipients appear to experience more delirium than the non-NRT group. The decision to use NRT in critically ill patients should be balanced individually between risks and benefits for patients.
Fresh Blood Better for Transfusing Children in ICUs
The Particulars: Transfusion with red blood cells (RBCs) is a common treatment in pediatric intensive care. Past studies conducted with adults have suggested that prolonged length of RBC unit storage is associated with worse clinical outcomes, but data are lacking in children.
Data Breakdown: An analysis from a large observational study evaluated 447 children who stayed 48 hours or longer in a pediatric ICU. Results showed an adjusted odds ratio of 1.87 for increased incidence of multiple organ failure for patients receiving blood stored for 14 or more days. About 30% of patients who received blood older than 14 days had new or progressive multiple organ dysfunction syndrome. These patients also had longer total pediatric ICU stays (3.7 days).
Take Home Pearl: Critically-ill children who are transfused with RBC units stored longer than 14 days appear to have increased incidences of multiple organ failure and longer stays in pediatric ICUs when compared with those receiving fresher blood.
Reducing SIRS Mortality in Pediatric ICUs
The Particulars: The use of inline filtration with microfilters has been known to help prevent particulate infusion. Researchers examined the effect of inline filtration on reducing major complications in critically ill children, including sepsis, thrombosis, organ failure, and systemic inflammatory response syndrome (SIRS).
Data Breakdown: Researchers assessed 401 children in whom infusion filters were used throughout their complete infusion therapy and compared them with a control group of 406 children in whom no filters were used. A significant reduction in the incidence of SIRS was observed in the intervention group when compared with the control group. A high trend in reducing mortality in the intervention group was also observed. No significant differences were found in the occurrence of circulatory, acute renal, or liver failure, or in sepsis or thrombosis.
Take Home Pearl: Pediatric ICUs appear to be able to reduce the incidence of SIRS by using inline filtration.