Literature at a Glance
- ICU management by critical care physicians may increase the odds of hospital mortality
- Iatrogenic drug overdose common among patients with renal insufficiency
- An educational effort lowers hospital mortality for severe sepsis and septic shock
- SSRI and problem-solving therapy prevents post-stroke depression
- Stop orders for Foley catheters reduce the duration of inappropriate urinary catheterization
- No thromboembolism risk with interrupting anticoagulation in atrial fibrillation patients undergoing surgery
- Obese patients may be initially under-dosed with vancomycin
- Antipsychotic therapy is associated with short-term serious events in older adults with dementia
- Cardiac troponin is associated with worse outcome in acute heart failure
Background: There is variation in the extent of involvement by critical care physicians in managing patients in ICUs. Several small studies have demonstrated improved outcomes when patients are managed by critical care physicians. This study expanded these findings by examining a national database of multiple ICUs.
Study design: Retrospective database analysis.
Setting: 123 ICUs in 100 U.S. hospitals
Synopsis: Using a national database of ICU patients, 101,832 admissions were analyzed. Controlling for ICU characteristics, patient demographics, and severity of illness (SOI), the impact of critical care management (CCM) on the primary outcome of hospital mortality was analyzed. Patients who received CCM had higher SOI, received more procedures, and had higher mortality rates than those who did not receive CCM. After adjustment for these variables, hospital mortality rates were higher for those patients who received CCM.