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Society of Critical Care Medicine’s 2012 Annual Congress

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New research was presented at the 2012 Society of Critical Care Medicine’s Critical Care Congress from February 4-8 in Houston. The features below highlight just some of the studies that emerged from the conference.

>> Analyzing Short-Course Antibiotic Use for VAP
>> Caloric Restrictions & Acute Lung Injury
>> Assessing VTE Prophylaxis After Intracranial Hemorrhage

Analyzing Short-Course Antibiotic Use for VAP

The Particulars: Antibiotic treatment for ventilator-associated pneumonia (VAP) caused by organisms other than non–lactose-fermenting Gram-negative bacilli (NLFGNB) is typically stopped after 8 days. Data suggest that infections persist at Day 8 when VAP is caused by NLF-GNB. It is unknown if an 8-day course of antibiotics for NLF-GNB infection would be adequate or result in persistent primary infection.

Data Breakdown: A retrospective review of 77 patients with VAP showed that persistent primary infection was present in 60% of patients with NLF-GNB infection after 8 days of antimicrobial therapy. Among those with NLF-GNB, only 56% of pathogens obtained on repeat bronchoalveolar lavage remained sensitive to the antimicrobial therapy.

Take Home Pearls: An 8-day course of antimicrobial therapy for VAP caused by NLF-GNB infection appears to be insufficient. Study results suggest this course of treatment may result in persistent primary infection.

 Caloric Restrictions & Acute Lung Injury

The Particulars: Mechanically ventilated patients are generally provided some form of artificial nutrition, but the optimal nutritional strategy in critically ill patients is undetermined. Some studies suggest better outcomes with initial full enteral feeding, while others indicate that hypocaloric feeding improves short-term outcomes.

Data Breakdown: A study of mechanically ventilated patients randomized participants to receive trophic feeding (400 kcal/ day) or full enteral feeding (1,300 kcal/day) for 6 days. After 28 days, the full enteral feeding group spent 15.0 days on a ventilator, compared with 14.9 days for the trophic feeding group. The 60-day mortality rates were 22.2% for the full enteral group and 23.2% for the trophic group. No differences were observed in infectious complications between groups.

Take Home Pearls: In ventilator-dependent patients with acute lung injury, caloric restriction does not appear to improve outcomes when compared with full enteral feeding. Infection rates and 60-day mortality were not significantly different between feeding strategies.

 Assessing VTE Prophylaxis After Intracranial Hemorrhage

The Particulars: Venous thromboembolism (VTE) occurs frequently in neurologic and neurosurgical ICU patients. While VTE prophylaxis is often used, protocols vary widely, mostly due to a lack of strong clinical data.

Data Breakdown: Researchers conducted a record review of 400 patients who received pharmacologic VTE prophylaxis within 30 days of intracranial hemorrhage, 35.5% of whom began it within 48 hours (early treatment). When comparing those who received early treatment with those who received treatment after 48 hours (delayed treatment), re-bleeding and hematoma rates were nearly identical. Among those who subsequently developed VTE, time to first dose of VTE prophylaxis was significantly delayed.

Take Home Pearls: The risk of re-bleeding following intracranial hemorrhage appears to be the same whether VTE prophylaxis is initiated early or delayed. While early VTE prophylaxis did not appear to significantly reduce risk, patients who developed VTE had longer delays from admission to first dose prophylactic therapy.

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