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Sedation, paralysis do not improve survival of ICU patients
Reversibly paralysing and heavily sedating hospitalized patients with severe breathing problems do not improve outcomes in most cases, according to a National Institutes of Health-funded clinical trial conducted at dozens of North American hospitals and led by clinician-scientists at the University of Pittsburgh and University of Colorado schools of medicine.
The trial—which was stopped early due to futility—settles a long-standing debate in the critical care medicine community about whether it is better to paralyse and sedate patients in acute respiratory distress to aid mechanical ventilation or avoid heavy sedation to improve recovery.
“It’s been a conundrum—on the one hand, really well-done studies have shown that temporarily paralysing the patient to improve mechanical breathing saves lives. But you can’t paralyse without heavy sedation, and studies also show heavy sedation results in worse recovery. You can’t have both—so what’s a clinician to do?” said senior author Derek Angus, M.D., M.P.H., who holds the Mitchell P. Fink Endowed Chair of the Pitt School of Medicine’s Department of Critical Care Medicine. “Our trial finally settles it—light sedation with intermittent, short-term paralysis if necessary is as good as deep sedation with continuous paralysis.”
The Re-evaluation Of Systemic Early neuromuscular blockade (ROSE) trial is the first of the new National Heart, Lung, and Blood Institute’s (NHLBI) Prevention & Early Treatment of Acute Lung Injury (PETAL) Network. PETAL develops and conducts randomized controlled clinical trials to prevent or treat patients who have, or who are at risk for, acute lung injury or acute respiratory distress syndrome. The trial network places particular emphasis on early detection by requiring every network member institute include both critical care and emergency medicine, acute care or trauma principal investigators to ensure that critical health issues are recognized and triaged as fast as possible to improve patients’ odds of recovery before they are even transferred to the intensive care unit.
Angus, who also directs Pitt’s Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, said the trial results make him confident when he says that avoiding paralysis and deep sedation is the best practice for most patients hospitalized with breathing problems. However, he notes that future trials will be needed to tease out whether there is a subpopulation of patients with acute respiratory distress syndrome who still benefit from neuromuscular blockade.
UPMChttps://tinyurl.com/yxc95rrl
Hospital privacy curtains may harbour dangerous germs
Without timely intervention, privacy curtains in hospitals can become breeding grounds for resistant bacteria, posing a threat to patient safety, according to new research published.
The longitudinal, prospective, pilot study tracked the contamination rate of ten freshly laundered privacy curtains in the Regional Burns/Plastics Unit of the Health Services Center in Winnipeg, Canada. While the curtains had minimal contamination when they were first hung, the curtains that were hung in patient rooms became increasingly contaminated over time — and by day 14, 87.5 percent of the curtains tested positive for methicillin-resistant Staphylococcus aureus (MRSA), a pathogen associated with significant morbidity and mortality. In contrast, control curtains that were not placed in patient rooms stayed clean the entire 21 days.
None of the rooms where the curtains were placed were occupied by patients with MRSA. Four curtains were placed in a four-bed room; four were placed in two double rooms; and two controls were placed in areas without direct patient or caregiver contact. Researchers took samples from areas where people hold curtains, suggesting that the increasing contamination resulted from direct contact.
"We know that privacy curtains pose a high risk for cross-contamination because they are frequently touched but infrequently changed," said Kevin Shek, BSc, the study’s lead author in the article. "The high rate of contamination that we saw by the fourteenth day may represent an opportune time to intervene, either by cleaning or replacing the curtains."
By day 21, almost all curtains exceeded 2.5 CFU/cm, the requirement for food processing equipment cleanliness in some locations, such as the United Kingdom.
"Keeping the patient’s environment clean is a critical component in preventing healthcare-associated infections," said 2018 APIC President Janet Haas, PhD, RN, CIC, FSHEA, FAPIC. "Because privacy curtains could be a mode of disease transmission, maintaining a schedule of regular cleaning offers another potential way to protect patients from harm while they are in our care."
ScienceDaily