New critical care research presented at CHEST 2009

November 04, 2009

Increasing Number of ICU Patients Discharged Home
(#8592, Tuesday, November 3, 3:45 PM ET)

An increasing number of patients in the ICU are being discharged home instead of being admitted to a step-down unit. Researchers from Memorial Sloan-Kettering Cancer Center in New York, NY, analyzed data collected from ICU patients discharged home over a 4-year period. During the study, 33 patients, or 1.4 percent of all discharged patients, were discharged home with increasing frequency from year 2 to 4. Of the patients discharged home, the average age was 61.2 (±16.2) years, 61 percent were men, and 72.7 were medical patients. Admitting diagnoses were typical of ICU patients, but invasive support (ie, mechanical ventilation) was minimal. Six-month mortality was 36.4% (12 of 33 patients) and the average time to death was 53 days. Researchers conclude that although the number of ICU patients discharged home is small, the number has been increasing. This trend may have clinical implications in regard to ICU throughput, bed management, and discharge planning. Further studies are needed to better define who could be discharged home.

Rural Tele-ICU Reduces Carbon Footprint and Saves Money
(#9116, Tuesday, November 3, 3:45 PM ET)

The addition of a tele-ICU in rural facilities may reduce the carbon footprint left on the environment and save money in the process. A research team from Via Christi Health System in Kansas calculated that 203 patients were able to stay in their hometown hospital receiving care in collaboration with the tele-ICU physicians and nurses assisting with care delivery. Using 2 days as the minimum a family would visit and travel to their tertiary hospital, the total miles saved was 127,200, amounting to 56.3 tons of CO2 emitted. Researchers estimated that the cost to mitigate the CO2 footprint would be $2,660.The amount of money saved for gasoline was greater than $70,000, savings for lodging is estimated at $23,000, and money saved for meals estimated at $40,000. Overall, researchers estimate that families and communities saved more $133,000 through the implementation of a tele-ICU program.

Extended Use of Propofol Can Lead to Excessive Omega-6 Exposure
(#8486, Tuesday, November 3, 3:45 PM ET)

Patients who are treated with the sedative propofol for more than 6 hours may be exposed to significant levels of omega-6 fatty acids. In a retrospective review, researchers from Saint Joseph Health System in Kentucky identified 35 individual patients that received propofol for more than 6 hours. The minimum amount of propofol infused in a 24-hour period was 39 mL, the maximum was 9,886 mL, and the median was 329 mL. This resulted in omega-6 exposure in a 24-hour period at a minimum of 1.9 grams, a maximum of 504 grams, and a median of 16.8 grams. Therefore, these patients were exposed to nearly two-thirds the amount of omega-6 as in a dose of lipids used in total parenteral nutrition. Researchers conclude that this excessive exposure to omega-6 should raise questions as to the safety of propofol.

ICU Nurses' Abnormal Sleep Habits May Increase Errors
(#9016, Wednesday, November 4, 1:30 PM ET)

Nurses working in the ICU may experience more abnormal sleep and more errors compared with nurses working on the floor. Researchers from Baylor College of Medicine in Houston assessed the overall sleep quality and vigilance among ICU nurses at the beginning and end of their shift, and compared findings with similar measurements in floor nurses. All nurses filled out the Pittsburgh Sleep Quality Index Questionnaire (PSQI) and were assessed for vigilance at the beginning and end of the same 12-hour shift. Results showed that errors at either end of the shift were different only in the ICU group but not in the floor group (2.48±4.18 vs 3.57±6.45). Furthermore, the PSQI score was more abnormal in the ICU group (7.40±3.24) vs the floor group (5.73±2.59). Among both floor and ICU nurses, the slow reaction times were unchanged across the shift; however, there was a significant reduction in fast reaction time between either ends of the shift only in the floor nurses. Researches speculate that the abnormal sleep and fall in vigilance demonstrated among ICU nurses may have implications for patient safety.

Remote TeleIntensivist Program Improves Hospital Mortality
(#9272, Wednesday, November 4, 1:30 PM ET)

Remote teleintensivist programs may have a significant impact on hospital mortality and other patient outcomes. Researchers from Advanced ICU Care in Missouri compared 2005 (pre-introduction) remote telemedicine intensivist services and patient outcomes with the 2006 and 2007 data (post-introduction) in a community hospital with 10 medical-surgical ICU beds. Results indicated a decrease in mortality from 7.7 percent in 2005, to 5.9 percent in 2006, and 2.8 percent in 2007, a 64 percent decrease over 2 years. In addition, the ICU average length of stay decreased from 4.04 days in 2005, to 3.81 in 2006, and 3.05 in 2007, a 25 percent decrease over 2 years. This allowed patient volume to increase from 828 in 2005, to 916 in 2006, and 1,059 in 2007 (a 28 percent increase), while maintaining the average daily census at 9. Researchers conclude that a remote teleintensivist program may be a viable substitute to an on-site intensivist program.

High-Intensity ICU Staffing Reduces Ventilator-Associated Pneumonia
(#7882, Wednesday, November 4, 3:45 PM ET)

New research shows that a high-intensity staffing model in the ICU reduces ventilator-associated pneumonia (VAP). Researchers from Saint Barnabas Medical Center in New Jersey evaluated the efficacy of high-intensity staffing in a medical-surgical ICU to reduce VAP in a community hospital, where an intensivist model was adopted in the 16-bed medical-surgical ICU from mid-2007. When researchers compared pre-intensivist VAP rates to data from 2008, after implementation of the intensivist model, they found that the incidence of VAP decreased from 2.8 to 0 per 1,000 ventilator days. Researchers conclude that their results demonstrate a significant reduction in VAP rates after implementation of a high-intensity staffing model.

Telemedicine for COPD Reduces Hospital Visits
(#8918, Wednesday, November 4, 3:45 PM ET)

A Louisiana-based telemedicine program for patients with chronic obstructive pulmonary disease (COPD) was associated with a reduction in exacerbations and unscheduled hospital visits. A research team at Overton Brooks VA Medical Center assessed the effect of a telemedicine program on the overall health and health-care utilization in 100 patients with COPD. During the intervention period, patients used an in-home electronic device that requests information on a participant's health and transmits responses to a registered nurse. Researchers found that patients tended to have fewer significant COPD exacerbations during the intervention period compared to the year prior, and unscheduled hospital visits for COPD fell from an average of 3.59 visits per year to 1.95 visits per year, a 46 percent relative reduction. The study authors speculate that automated telemedicine programs are useful in the management of advanced COPD and may reduce the cost, both personal and monetary, of this disease.

American College of Chest Physicians

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