Gotta read IV


 

We, at least I, always thought that the dynamics of Staphylococcus aureus transmission in our ICUs was related to health-care workers transmitting the bacterias to the patients. Fortunately, a cohort published on Lancet [1] this week seems to prove us wrong. During one year period they isolated S. aureus samples from health-care workers, the environment and patients, and after some fancy genetic tests they concluded, for better or worse, that we were infrequently the sources of transmission to patients, and the epidemiology of S. aureus “is characterised by continuous ingress of distinct subtypes rather than transmission of genetically related strains”. Alright, now I can pick my nose while I intubate! Of course not, idiot! Wash your damn hands! And stop nose picking, it’s disgusting.

 

My good friend Otavio Ranzani sent me a link (here) and gave me the opportunity of reading the beautiful thoughts of Angela Jarman (@DocJarman) on end of life care. I couldn’t agree more. Every time I see a discussion about end of life care in ICU and someone shares their words, specially when they are filled with such personal experiences, I feel kinda miserable and see that I could be a better doctor. Anyway, we suck!

 

New Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient [2] were published. Pretty much common sense for those who are up to date with their readings. But, since common sense is not so common. A lot of vague recommendations of do not do this, and do not do that, like: “we suggest that neuromuscular-blocking agents be discontinued at the end of life or when life support is withdrawn”! C’mon! Who does that?! The bottom line: NMB agents for ARDS with P/F ratio <150, but please, do not give your patient the dose Papazian did in his study [3]. Maybe NMB for shivering control, if there are no other alternatives left, maybe for “life-threatening situations associated with profound hypoxemia, respiratory acidosis, or hemodynamic compromise”, meaning: you don’t know what’s going on and wanna buy some time.

 

This week is the World Antibiotic Awareness Week, promoted by WHO. Yeah, WHO? That’s what I’m asking. WHO is the answer. I don’t know the answer, I though you knew WHO were promoting. Funny guy! I always wanted to make this joke and now I’m gonna have to wait until next year. The World Health Organization is promoting from 14-20 November the World Antibiotic Awareness Week (link), it’s a great initiative trying to avoid bacterial cataclysm, which might be closer than we think.

 

Probably everybody already saw the fast versus slow bandaid removal: a randomised trial [4], and after reading it It’s funny to think how art imitates life. I always knew that the faster the better! Like I know that you should never drink with an empty stomach, that you’ll yawn after see someone yawning, that old dogs can learn new tricks, and that you can’t lick your own elbow. However, the good discussion here is about external validity and if we can extrapolate the results to other types of dressings. Maybe some review in the future? Is there any study about slow or fast removal for waxing? There is an interesting study field.

 

1. Price JR, Cole K, Bexley A, et al. Transmission of Staphylococcus aureus between healthcare workers, the environment and patients in an intensive care unit: a whole-genome sequencing based longitudinal cohort study. Lancet Infectious Diseases. 2016.

2. Murray MJ, DeBlock H, Erstad B, et al. Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient. Crit Care Med. 2016;44(11):2079-2103.

3. Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363(12):1107-1116.

4. Furyk JS, O’Kane CJ, Aitken PJ, et al. Fast versus slow bandaid removal: a randomised trial. Med J Aust. 2009;191(11-12):682-3.

 

Photo Credit
Betty Montgomery


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Gotta read IV

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