February 2008

Positive Results for “Wake Up and Breathe”
Researchers from Vanderbilt University report good outcomes for a protocol that paired spontaneous awakening trials (SATs) with spontaneous breathing trials (SBTs) in mechanically ventilated patients. The 28-day study was conducted among 336 patients who were randomly assigned to the SAT/SBT group or a control group that received sedation per usual care plus a daily SBT. Patients in the SAT/SBT group spent more days breathing without assistance, fewer days in the ICU, and fewer days in the hospital than those in the control group. The researchers also followed the patients for one year after enrollment, finding fewer deaths among patients in the SAT/SBT group. The authors conclude, “Our results suggest that a wake up and breathe protocol that pairs daily spontaneous awakening trials . . . with daily spontaneous breathing trials results in better outcomes for mechanically ventilated patients in intensive care than current standard approaches and should become routine practice.” The study appeared in the Jan. 12 edition of The Lancet. READ ABSTRACT

Delayed Defibrillation More Common in Some
Delayed defibrillation following in-hospital cardiac arrest caused by ventricular arrhythmia is more common in some patients and some hospitals than others, report researchers publishing in the Jan. 3 issue of The New England Journal of Medicine. They analyzed data on 6,789 patients who were treated at 369 hospitals. The overall median time to defibrillation was 1 minute, which was well under the 2 minutes recommended by expert guidelines. But delayed defibrillation occurred in about 30% of the cases. Delayed defibrillation was more likely to occur in patients who were black and those with a noncardiac admitting diagnosis; and in hospitals with fewer than 250 beds, in unmonitored hospital units, and during evening and weekends. Delayed defibrillation was linked to a lower probability of survival to hospital discharge. READ ABSTRACT

New Palliative Care Guideline Calls for Treatment of Dyspnea
The American College of Physicians has published a new evidence-based clinical practice guideline on interventions to improve palliative care at the end of life. The recommendations call for clinicians to regularly assess the patient for pain, dyspnea, and depression and treat these conditions accordingly. For dyspnea, the recommendation states: “In patients with serious illness at the end of life, clinicians should use therapies of proven effectiveness to manage dyspnea, which include opioids in patients with unrelieved dyspnea and oxygen for short-term relief of hypoxemia.” The guideline was published in the Jan. 15 edition of the Annals of Internal Medicine. READ FULL PAPER

Study Looks at Adult ECMO
British researchers found extracorporeal membrane oxygenation (ECMO) outperformed conventional ventilation in a study of 190 adults age 18 to 65 with severe but potentially reversible respiratory failure. Patients were randomly assigned to either transfer to the only center in England performing adult ECMO or usual care, which generally consisted of low volume ventilation but could encompass any other ventilation strategy besides ECMO. At six months, ECMO was linked to a 31% lower incidence of death or severe disability than conventional ventilation. Fewer ECMO patients died of respiratory failure as well, and time to death was longer with ECMO than with conventional ventilation. The authors suggest 1 life could be saved for every 6 patients treated with ECMO versus conventional ventilation. The study was presented at a recent meeting of the Society of Critical Care Medicine. READ ARTICLE

Aerosol delivery during mechanical ventilation