Would you discharge a patient with a substance use disorder home with a peripherally inserted central catheter?
0%Yes
0%No
0%It depends!
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General Critical Care
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This systematic review evaluated proton-pump inhibitors (PPIs) for stress ulcer prophylaxis in critically ill patients. Twelve trials with 9,533 patients were included. PPIs reduced clinically significant upper gastrointestinal bleeding (RR, 0.51; 95% CI, 0.34 to 0.76; high certainty). PPIs showed little to no effect on mortality (RR, 0.99; 95% CI, 0.93 to 1.05; low certainty). Subgroup analysis indicated possible reduced 90-day mortality in less severely ill patients (RR, 0.89; 95% CI, 0.80 to 0.98) but increased mortality in more severely ill patients (RR, 1.08; 95% CI, 0.96 to 1.20).
Society of Critical Care Medicine Guidelines on Glycemic Control for Critically Ill Children and Adults 2024
Based on available randomized controlled trial data, in critically ill adults, we โsuggest againstโ titrating an insulin infusion to a lower BG target INT: 4.4โ7.7 mmol/L (80โ139โmg/dL) as compared with a higher BG target range, CONV: 7.8โ11.1 mmol/L (140โ200โmg/dL) to reduce the risk of hypoglycemia (Conditional recommendation; moderate certainty of evidence).โObservational data suggest a potential benefit of personalized glucose targets that more closely match chronic prehospital glycemic control. We recommend high-quality interventional trials of individualized glycemic targets in critically ill adults, stratified by prior glycemic control (such as indicated by glycosylated hemoglobin) (research statement).
2012 Statement
In adult critically ill patients, we suggest that a BG โฅ 150โmg/dL should trigger initiation of insulin therapy, titrated to keep BG < 150โmg/dL for most adult ICU patients and to maintain BG values absolutely <180โmg/dL using aโฆ
Pharmacotherapy for Reducing RBC Transfusion for Patients in... : Critical Care Medicine (lww.com)
This systematic review and network meta-analysis in Critical Care Medicineย (April 2024) assessed therapies to reduce RBC transfusion needs in ICU patients. Searching MEDLINE, CENTRAL, and Embase until July 2023, it included 75 studies with 15,091 patients. Combination therapy of erythropoiesis-stimulating agents (Epo) and iron was found to notably decrease transfusion requirements (RR: 0.60; moderate confidence), outperforming Epo or iron monotherapy (RR: 0.81 and 0.83; low confidence, respectively). No significant increase in venous thromboembolism or infection risks was associated with combination therapy. In contrast, Epo alone might increase infection risks. The efficacy of vitamin D3 and HIF-PHI remains unclear.
Are you using any of these agents routinely in your ICU?
Erythropoiesis-stimulating agents (Epo)
Iron
Both
None
In a systematic review of 15 randomized clinical trials comparing the efficacy and safety of early active mobilization with usual care in critically ill adults. The primary outcome was days alive and out of hospital within 180 days, with a result of an increase of 4.28 days in the active mobilization group. The intervention also improved physical function in survivors at 6 months with a 95.1% probability. However, there is a possibility of increased adverse events and 6-month mortality with early active mobilization.
https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200234
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- Hussain Al-shabib
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Can I Safely Discharge a Patient with a Substance Use Disorder Home with a Peripherally Inserted Central Catheter? | NEJM Evidence
The rising incidence of serious injection-related infections, such as endocarditis and skin infections, among people who use drugs (PWUD) presents a clinical challenge, particularly regarding the safe discharge of these patients with peripherally inserted central catheters (PICCs) for prolonged outpatient parenteral antibiotic therapy (OPAT). This review evaluates the complications associated with PICC use in PWUD, explores combined infection and substance use disorder treatment models, and discusses risk assessment tools to guide clinical decisions. Despite limited high-quality evidence, data suggest that some PWUD can safely complete OPAT with a PICC, highlighting the importance of patient-centered care and shared decision-making to mitigate stigma and ensure the provision of gold-standard treatment.