American Thoracic Society Journal news tips for March (first issue)

February 26, 2003

INCIDENCE AND COST OF SEVERE SEPSIS IN U.S. CHILDREN

Severe sepsis is a major health problem in young children with over 42,000 cases and 4,400 associated deaths per year in the United States. Researchers pointed out that this incidence results in use of an estimated 1.3 million hospital days annually at a cost of $1.97 billion (adjusted to 2001 dollars.) The authors said that infants were at the highest risk, especially low birth weight babies. Also, boys were more likely to develop sepsis and to die from the disease. Severe sepsis is a systemic inflammation syndrome that occurs in response to infection associated with acute organ dysfunction. The primary infections causing severe sepsis in this study were either respiratory (over 37 percent) or primary bacteremia (25 percent). (Bacteremia is the presence of bacteria in the bloodstream.) In this study, 40 percent of the total hospital days and 31 percent of the costs were incurred by very low birth weight babies. They were in the hospital 74 days, as compared with 24 days for other young sepsis patients. Their costs averaged $86,910 versus $35,340. The study appears in the first issue for March 2003 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.

IMPORTED MALARIA CONSIDERED A SERIOUS HEALTH THREAT IN EUROPE

In a retrospective study of 188 cases of imported P. falciparum malaria acquired in sub-Saharan Africa, French investigators noted that the disease is growing health problem in many nonendemic countries. Approximately 16,000 cases are diagnosed each year in Europe, with 5,000 last year in France alone. In this study, the largest group of severe malaria patients was made up of occasional travelers, mostly to Africa, who were of European descent and considered nonimmune and either did not take chemoprophylaxis or received an insufficient dose. All 10 deaths in the severe malaria group (11 percent mortality rate) took place in Europeans, none of whom had take prophylaxis. A serious infectious illness, malaria is spread by mosquitoes. It causes both chills and severe fever, and has complications that can affect the kidneys, liver, and brain. In the total study group, 93 patients had strictly defined severe malaria and 95 had less severe disease. About 94 percent suffered from P. falciparum malaria, which is fatal almost 100 percent of the time unless treatment is provided in the hospital. The study is published in the first issue for March 2003 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.

SLEEP DISRUPTION IN THE INTENSIVE CARE UNIT

Although loud noises and frequent patient-care activities were prevalent in this intensive care unit (ICU) environment, these factors were responsible for only a small proportion of the observed sleep disruption in the unit. Studies have shown that noise levels in ICUs considerably exceed Environmental Protection Agency recommendations for hospitals. In this research, seven mechanically-ventilated patients and six health subjects were studied using continuous 24-hour polysomnography coupled with time-synchronized environmental monitoring in the ICU. The authors point out that both noises and patient care activities accounted for only 30 percent of the observed sleep disruptions. For the majority of healthy subjects, total arousals and awakenings in the open area of the ICU were caused by sound peaks. However, only a minority of ventilator patient arousals could be attributed to this cause. (Sound peaks were considered abrupt elevations of over 10 decibels and occurred approximately 37 times per hour of sleep.) Patient-care activities, which included nursing visits, assessment of vital signs, and the administration of medications occurred approximately 8 times per hour of sleep. The researchers noted that approximately 20 percent of patient-care activities resulted in arousals or awakenings. But this incidence accounted for only 7 percent of observed sleep disruption. The researchers noted that a significant proportion of sleep disruption in mechanically-ventilated patients remains unexplained. The study appears in the first issue for March 2003 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
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For the complete text of these articles, please see the American Thoracic Society Online Web Site at http://www.atsjournals.org. For either contact information or to request a complimentary journalist subscription to ATS journals online, or if you would like to add your name to the Society's twice monthly journal news mailing list, contact Cathy Carlomagno at 212-315-6442, or by e-mail at ccarlomagno@thoracic.org.

American Thoracic Society

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