Critical Care Newsline — September 24, 2009

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Critical Care Newsline, the electronic newsletter from the American Association of Critical-Care Nurses, contains information selected just for you by our clinical practice experts. In each issue, you’ll find links to resources, research abstracts (individual sites may require registration and a fee to access complete articles) and Web sites that will keep you informed on issues affecting nurses and the nursing profession.

Sept. 24, 2009

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1. NEWS Tamoxifen, raloxifene and tibolone cut risk of breast cancer, increase risk of adverse effects
2. RESEARCH Electronic ICU does not reduce mortality, lengths of stay in community hospitals, according to study
3. RESEARCH Number of days patients spend in ICU with delirium associated with higher likelihood of one-year mortality
4. RECALL Smiths Medical recalls uncuffed pediatric tracheal tubes
5. RESEARCH Low-dose vasopressin fails to benefit pediatric patients with vasodilatory shock, may cause harm
6. PATIENT SAFETY Boxed warning added for promethazine
7. RESEARCH Expediting ICU admission of respiratory failure ED patients in need of mechanical ventilation reduces time on ventilator, lengths of stay
8. CLINICAL PRACTICE RESOURCES
9. AACN RESOURCES
10. REMINDER

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1. NEWS Tamoxifen, raloxifene and tibolone cut risk of breast cancer, increase risk of adverse effects
Tamoxifen, raloxifene and tibolone reduce the risk of breast cancer in women without the disease. However, each drug is associated with higher risks of adverse effects, according to a Sept. 14 report by the Agency for Healthcare Research and Quality. Download Comparative Effectiveness of Medications to Reduce Risk of Primary Breast Cancer in Women

2. RESEARCH: Electronic ICU does not reduce mortality, lengths of stay in community hospitals, according to study
Introduction of electronic intensive care units (eICUs) doesn’t reduce mortality, lengths of stay or costs, according to a study of more than 4,000 patients in two community hospitals. “Although total hospital costs increased over time, the rate of increase was steeper for those patients whose physicians permitted only a low level of eICU involvement,” say authors of the study published Aug. 27 online by Critical Care Medicine. Read here.

3. RESEARCH Number of days patients spend in ICU with delirium associated with higher likelihood of one-year mortality
The number of days patients with delirium spend in the ICU increases the likelihood of death within one year of hospital admission according to a prospective study of 304 patients age 60 and older published Sept. 10 online by the American Journal of Respiratory and Critical Care Medicine. Access AACN’s Self Assessment: Palliative and End-of-Life Care tool .

4. RECALL Smiths Medical recalls uncuffed pediatric tracheal tubes
On Sept. 10, Smiths Medical, Weston, Mass., recalled its Portex Uncuffed Pediatric-Sized Tracheal Tubes (sizes 2.5, 3.0 and 3.5 mm) because of disparities between indicated and actual measurements with the internal diameters of some tubes smaller than indicated on the label. See product codes here.

5. RESEARCH Low-dose vasopressin fails to benefit pediatric patients with vasodilatory shock, may cause harm
Low-dose vasopressin did no better than a placebo in achieving vasoactive-free hemodynamic stability in pediatric patients with vasodilatory shock according to a multicenter trial in the Oct. 1 American Journal of Respiratory and Critical Care Medicine. Although the difference wasn’t statistically significant, “there was a concerning trend toward increased mortality” for patients receiving vasopressin, the authors say. Learn more.

6. PATIENT SAFETY Boxed warning added for promethazine
On Sept. 16, the U.S. Food and Drug Administration announced a box warning for promethazine hydrochloride that describes the risk of severe tissue injury -- including gangrene requiring amputation -- that could result from intravenous injection. Preferred administration of the drug is deep intramuscular injection. Subcutaneous injection is contraindicated. Read more.

7. RESEARCH Expediting ICU admission of ED patients in respiratory failure reduces time on ventilators, lengths of stay
Expediting emergency department patients who need intubation and mechanical ventilation to the ICU within two hours reduces the time spent on ventilators and lengths of stay, according to a study in September’s American Journal of Emergency Medicine. Learn more.

8. CLINICAL PRACTICE RESOURCES
RESEARCH
The National Institutes of Health Stroke Scale helps clinicians predict neurological outcomes -- including stroke, transient ischemic attack, encephalopathy or coma -- after coronary artery bypass graft surgery, according to a study published Sept. 8 online by the Journal of Thoracic and Cardiovascular Surgery. Learn more.

CLINICAL INVESTIGATION
Telemedicine consultation with intensivists can improve critical care of pediatric patients in rural areas say the authors of a study in September’s Pediatric Critical Care Medicine. Learn more.

PATIENT SAFETY
The Institute for Safe Medication Practices (ISMP), Horsham, Pa., will sponsor the teleconferences Beyond the “5 Rights” of Medication Administration: A Safety Bolus for Nursing Leadership, Oct. 6, and Preventing Errors with Insulin: A Multidisciplinary Approach, Oct. 15. Learn more and register. ISMP requests that nurses complete a survey about the effects of the economic downturn on medication safety at their healthcare organization, by Oct. 16.

The Agency for Healthcare Research and Quality offers a free patient education booklet and video (both in English and Spanish) about “blood thinners”.

9. AACN RESOURCES: This month’s AJCC OnlineFirst articles available
This month's Publish Ahead of Print articles are now live on the American Journal of Critical Care Web site. Click the OnlineFirst logo to read an examination of sedation management practices in Australian and New Zealand intensive care units and the case of a 66-year-old patient who developed a spontaneous spinal subdural hematoma without underlying pathological changes. Member log-in required to read articles; abstracts are free to all.

10. REMINDER
Download PDFs of AACN standards.

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