High-flow oxygen therapy may have a role in treating infants with more severe bronchiolitis
A randomised controlled trial of 1,472 infants with bronchiolitis found that more children improved when started on high-flow oxygen therapy than with standard oxygen therapy.
Those who failed to improve on standard therapy were switched to high flow oxygen. Most then improved - overall, similar numbers were transferred to intensive care. There was also no difference between the groups in the proportion of infants needing intubation, length of time on oxygen therapy or days spent in hospital.
A reminder that too much oxygen increases mortality in acutely ill adults
In acutely ill adults, liberal use of oxygen supplementation is found to increase the risk of death compared with more conservative oxygen strategies. More liberal oxygen therapy increases patient mortality in hospital by about 11 deaths amongst every 1,000 people exposed. Deaths also increase after 30 days follow-up, without improving other important health outcomes, such as disability, infection or length of hospital stay.
Oxygen is routinely used for acutely ill patients and is widely consid...
Early, intense rehabilitation helps recovery after serious traumatic head injury
Early, intensive rehabilitation aids recovery and improves outcomes for people with moderate to severe traumatic brain injury.
A review of 11 studies found that starting rehabilitation early, while people were still in intensive care, or offering more intensive treatments helped patients with brain injury regain function compared with usual care. Early rehabilitation often included multisensory stimulation while the patient was still in a coma. The intensive multidisciplinary programmes mostly ...
Balanced electrolyte solutions give marginal benefit over saline for very ill patients
About 14% of critically ill patients receiving electrolyte-balanced crystalloids either developed kidney failure, needed kidney-replacement therapy or died compared with 15% receiving normal saline. This small but statistically significant benefit was only apparent when combining outcomes; there was no difference between fluids for the three individual outcomes analysed separately.
A solution of 0.9% sodium chloride (normal saline) is the most commonly used intravenous (IV) fluid, but it can ca...
Plastic wraps or bags keep pre-term infants warm immediately after birth
Cheap and simple plastic wrapping used in the first 10 minutes after birth helps pre-term and low birth weight infants avoid hypothermia. Infants treated in this way are likely to be warmer when admitted to neonatal intensive care than those treated according to standard care. Pre-term infants are most likely to benefit.
Routine infant care usually involves ensuring the delivery room is warm, drying the infant immediately after birth, wrapping the infant in pre-warmed dry blankets and pre-warmi...
Statins are of no benefit in acute respiratory distress syndrome
Giving statins to patients with acute respiratory distress syndrome made no difference to the number of days they spent on a ventilator. It also had no effect on mortality or the length of time spent in intensive care or in hospital compared with placebo.
In acute respiratory distress syndrome, the lungs become severely inflamed, fill with fluid (pulmonary oedema) and can no longer function. The person needs mechanical ventilation and is at high risk of multiple organ failure and mortality. Thi...
Intravenous antibiotics, administered over 3 hours, are linked to lower death rates in sepsis
The risk of death in adults with sepsis was 30% lower when each dose of antibiotic was given intravenously over three hours compared to a bolus or less than 60 minutes.
This systematic review included adults on intensive care units with a range of ages, severity of sepsis and other symptoms. A variety of antibiotics of the anti-pseudomonal beta-lactam class were used in the trials. These included carbapenems, penicillins and cephalosporins.
In the UK, current guidance for intravenous use of th...
Transfusing blood close to its use-by date does not increase deaths in critically ill adults
Transfusing more recently-collected red blood cells does not improve the chance of survival for critically-ill people who need blood transfusions, compared with blood that has been stored for longer.
This large international study included almost 5,000 critically ill people in intensive care units. Participants were transfused with either the freshest compatible blood available (mean storage 11.8 days) or the oldest compatible stored blood within its use-by date (mean storage time 22.4 days).
Blood test could shorten antibiotic treatment in newborns with suspected sepsis
Measuring procalcitonin levels in newborns with suspected sepsis in the first days of life reduced antibiotic duration by 10 hours compared with standard care. There was no increase in the risk of re-infection or death.
Systemic infection can be rapidly life-threatening in newborn babies, so those with risk factors are often treated pre-emptively with intravenous antibiotics. If sepsis is not confirmed by blood culture the decision whether to discontinue antibiotics needs to be made, but result...
Checklists are no substitute for experience in spotting patients who are deteriorating
Experience was found to count in recognising and acting on patient deterioration. National guidelines recommend the use of “track and trigger” systems to monitor seriously ill patients for the signs of deterioration. Following their identification, prompt referral to critical care teams is suggested, for example, but this does not always happen reliably. This realist review explored the organisational factors within UK hospitals that influence how and why these alert systems work in ...