Top ten articles in venous thromboembolism

Emerging literature about venous thromboembolism (VTE) increased our understanding of the risk factors, diagnosis, therapy and prophylaxis of this serious medical condition. In this review, we examine new studies on the incidence and the risk factors for VTE in the critically ill patients, diagnostic approaches to VTE, the relation between VTE and cardiovascular risk and duration of therapy. Also, we will review the new evidence on the use of electronic reminders to improve the adherence to VTE prophylaxis and the risk of heparin-induced thrombocytopenia in patients receiving pharmacologic prophylaxis for VTE

Impact of empirical antimicrobial therapy on the outcome of critically ill patients with Acinetobacter bacteremia

Rationale: Empirical antimicrobial therapy (EAT) for Acinetobacter infections may not be appropriate as it tends to be multidrug-resistant. This study evaluated the relationship between appropriate EAT and the outcomes of Intensive Care Unit (ICU) patients with Acinetobacter bacteremia. Methods: This is a retrospective study of patients admitted to a medical-surgical ICU (2005-2010) and developed Acinetobacter bacteremia during the stay. Patients were categorized according to EAT appropriateness, defined as administration of at least one antimicrobial agent to which the Acinetobacter was susceptible before susceptibility results were known. The relation between EAT appropriateness and outcomes was evaluated. Results: Sixty patients developed Acinetobacter bacteremia in the 6-year period (age = 50 ± 19 years; 62% males; Acute Physiology and Chronic Health Evaluation II score = 28 ± 9; 98.3% with central lines; 67% in shock and 59% mechanically ventilated) on average on day 23 of ICU and day 38 of hospital stay. All isolates were resistant to at least three of the tested antimicrobials. Appropriate EAT was administered to 60% of patients, mostly as intravenous colistin. Appropriate EAT was associated with lower ICU mortality risk (odds ratio: 0.15; 95% confidence interval: 0.03-0.96) on multivariate analysis. Conclusions: In this 6-year cohort, Acinetobacter bacteremia was related to multidrug-resistant strains. Appropriate EAT was associated with decreased ICU mortality risk

Building capacity for quality and safety in critical care: A roundtable discussion from the second international patient safety conference in April 9-11, 2013, Riyadh, Saudi Arabia

This paper summarizes the roundtable discussion from the Second International Patient Safety Conference held in April 9-11, 2013, Riyadh, Saudi Arabia. The objectives of the roundtable discussion were to: (1) review the conceptual framework for building capacity in quality and safety in critical care. (2) examine examples of leading international experiences in building capacity. (3) review the experience in Saudi Arabia in this area. (4) discuss the role of building capacity in simulation for patient safety in critical care and (5) review the experience in building capacity in an ongoing improvement project for severe sepsis and septic shock