Efforts to Improve Intensive-Care Outcomes Produce Mixed Results
WEDNESDAY Oct. 9, 2013 -- Three different efforts to improve outcomes among patients in intensive-care units have produced mixed results.
Using statins and trying different intravenous fluids made little difference for these sickest of patients, but giving beta blockers to those in severe septic shock provided some protection for their hearts, the studies showed.
All three reports were published online Oct. 9 in the Journal of the American Medical Association to coincide with presentations at the European Society of Intensive Care Medicine annual meeting in Paris.
The first report found that statins do not reduce the risk of death for adult patients in ICUs with ventilator-associated pneumonia. Some previous research had suggested that statins were effective against certain types of infections, according to the study.
The latest research included 300 patients at 16 ICUs in France with ventilator-associated pneumonia, which is the most common infection among ICU patients, affecting between 8 percent and 28 percent of those on mechanical ventilation. Half of the patients received simvastatin and half were given a placebo.
After 28 days, the death rates were 21.2 percent in the simvastatin group and 15.2 percent in the placebo group. There were no differences in ICU or hospital death rates, or in the length of time that patients remained on mechanical ventilation.
The findings do not support the use of statins in patients with ventilator-associated pneumonia, Dr. Laurent Papazian, of Hospital Nord in Marseille, said in a journal news release.
A second study found the risk of death was the same among ICU patients who received two different types of fluid-replacement therapy.
It's common for ICU patients to receive intravenous fluids, which include a wide number of products categorized as crystalloids or colloids. Crystalloids are salts, while colloids are salts and gelatin, starch or protein. Many doctors believe crystalloids are better than colloids for treating critically ill patients, according to background information included in the study.
Researchers looked at more than 2,800 critically ill patients at 57 ICUs in France, Belgium, North Africa and Canada. About half of them received crystalloids and half received colloids.
Both groups had similar death rates after 28 days (25.4 percent in the colloids group and 27 percent in the crystalloids group) and after 90 days (30.7 percent in the colloids group and 34.2 percent in the crystalloids group).
The findings are "exploratory" and further research is needed before reaching any conclusions about the use of either type of fluid therapy in ICU patients, Dr. Djillali Annane, of Raymond Poincare Hospital in France, said in the news release.
A third study found that the beta blocker esmolol helped achieve the target heart rate in ICU patients with severe septic shock and a high risk of death. Septic shock can affect heart function and beta blockers are meant to control heart rate and improve heart function.
In this study, 77 patients received standard treatment and 77 others received a continuous infusion of esmolol to maintain their heart rate between 80 and 94 beats per minute throughout their ICU stay.
After 28 days, the death rates were 80.5 percent in the standard treatment group and 49.4 percent in the esmolol group.
"Further investigation of the effects of esmolol on clinical outcomes is warranted," Dr. Andrea Morelli, of the University of Rome, wrote in the news release.
The American Thoracic Society has more about intensive-care units.
Posted: October 2013