Category Archives: Journal of Critical Care

Inhaled epoprostenol vs inhaled nitric oxide for refractory hypoxemia in critically ill patients. (Stockwell)

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J Crit Care. 2013 May 14. pii: S0883-9441(13)00067-1. PMID: 23683572

PURPOSE: The purpose of this is to compare efficacy, safety, and cost outcomes inpatients who have received either inhaled epoprostenol (iEPO) or inhaled nitric oxide (iNO) for hypoxic respiratory failure.

MATERIALS AND METHODS: This is a retrospective, single-center analysis of adult, mechanically ventilated patients receiving iNO or iEPO for improvement in oxygenation.

RESULTS: We evaluated 105 mechanically ventilated patients who received iEPO (52patients) or iNO (53 patients) between January 2009 and October 2010. Most patientsreceived therapy for acute respiratory distress syndrome (iNO 58.5% vs iEPO 61.5%; P = .84). There was no difference in the change in the partial pressure of arterial O2/fraction of inspired O2 ratio after 1 hour of therapy (20.58 ± 91.54 vs 33.04 ± 36.19 [P = .36]) in the iNO and iEPO groups, respectively. No difference was observed in duration of therapy (P = .63), mechanical ventilation (P = .07), intensive care unit (P = .67), and hospital lengths of stay (P = .26) comparing the iNO and iEPO groups. No adverse events were attributed to either therapy. Inhaled nitric oxide was 4.5 to 17 times more expensive than iEPO depending on contract pricing.

CONCLUSIONS: We found no difference in efficacy and safety outcomes when comparing iNO and iEPO in hypoxic, critically ill patients. Inhaled epoprostenol is associated with less drug expenditure than iNO.

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A general Critical Care Ultrasonography workshop: results of a novel Web-based learning program combined with simulation-based hands-on training. (Chandler)

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J Crit Care. 2013 Apr;28(2):217.e7-12. PMID: 22762931

PURPOSE: The aim of this study was to facilitate attainment of Critical Care Ultrasonography (CCUS) competence.

MATERIALS AND METHODS: We developed a Web-based learning program followed by simulation-based hands-on training in noncardiac CCUS for novice learners. We administered knowledge and skills tests before and after the workshop and conducted surveys on confidence levels using a 10-point Likert scale. Knowledge tests were conducted online, and skills tests were video-captured for evaluation.

RESULTS: Sixteen physicians participated in a 4-hour combined vascular and thoracic CCUS workshop, and 23 in a 2-hour abdominal CCUS workshop. In the combined vascular and thoracic workshop, the mean (SD) pre-workshop and post-workshop knowledge scores were 24 (4) and 33 (5), respectively, out of 43 (P < .001). The pre-workshop and post-workshop skill scores were 15 (5) and 23 (2), out of 28 (P < .001). In the abdominal workshop, the pre-workshop and post-workshop knowledge scores were 11 (3) and 18 (2), out of 20 (P < .001). The pre-workshop and post-workshop skill scores were 6 (3) and 15 (2), out of 16 (P < .001). Learners’ confidence increased significantly in both workshops (P < .001).

CONCLUSIONS: Our novel hybrid educational workshop on general CCUS significantly improved knowledge, skills, and confidence levels. Our flexibly scheduled module can be a practical option for the busy intensivist.

Copyright © 2013 Elsevier Inc. All rights reserved.

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Correlation of oxygen saturation as measured by pulse oximetry/fraction of inspired oxygen ratio with Pao(2)/fraction of inspired oxygen ratio in a heterogeneous sample of critically ill children. (from Journal of Critical Care, February 2013 – Chandler)

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J Crit Care. 2013 Feb 7. pii: S0883-9441(12)00497-2. PMID: 23395312

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PURPOSE: Oxygen saturation as measured by pulse oximetry (Spo(2))/fraction of inspired oxygen (Fio(2)) (SF) ratio has demonstrated to be an adequate marker for lung disease severity in children under mechanical ventilation. We sought to validate the utility of SF ratio in a population of critically ill children under mechanical ventilation, noninvasive ventilation support, and breathing spontaneously.

MATERIALS AND METHODS: A retrospective database study was conducted in a pediatric intensive care unit of a university hospital. Children with Spo(2) less than or equal to 97% and an indwelling arterial catheter were included. Simultaneous blood gas and pulse oximetry were collected in a database. Derivation and validation data sets were generated, and a linear mixed modeling was used to derive predictive equations. Model performance and fit were evaluated using the validation data set.

RESULTS: Three thousand two hundred forty-eight blood gas and Spo(2) values from 298 patients were included. 1/SF ratio had a strong linear association with 1/Pao(2)/Fio(2) (PF) ratio in both derivation and validation data sets, given by the equation 1/SF = 0.00164 + 0.521/PF (derivation). Oxygen saturation as measured by pulse oximetry/Fio(2) values for PF criteria of 100, 200, and 300 were 146 (95% confidence interval [CI], 142-150), 236 (95% CI, 228-244), and 296 (95% CI, 285-308). Areas under receiver operating characteristic curves for diagnosis of PF ratio less than 100, 200, and 300 with the SF ratio were 0.978, 0.952, and 0.951, respectively, in the validation data set. CONCLUSIONS: Oxygen saturation as measured by pulse oximetry/Fio(2) ratio is an adequate noninvasive surrogate marker for PF ratio. Oxygen saturation as measured by pulse oximetry/Fio(2) ratio may be an ideal noninvasive marker for patients with acute hypoxemic respiratory failure.

Copyright © 2012. Published by Elsevier Inc.