Long-term survival following in-hospital cardiac arrest: A matched cohort study.

Background: Each year, 200,000 patients undergo an in-hospital cardiac arrest (IHCA), with approximately 15-20% surviving to discharge. Little is known, however, about the long-term prognosis of these patients after discharge. Previous efforts to describe out-of-hospital survival of IHCA patients have been limited by small sample sizes and narrow patient populations

Methods: A single institution matched cohort study was undertaken to describe mortality following IHCA.

Hospitalists and intensivists in the medical ICU: a prospective observational study comparing mortality and length of stay between two staffing models.

Background: A shortage of critical care specialists or intensivists, coupled with expanding United States critical care needs, mandates identification of alternate qualified physicians for intensive care unit (ICU) staffing.

Objective: To compare mortality and length of stay (LOS) of medical ICU patients cared for by a hospitalist or an intensivist-led team.

Design: Prospective observational study.

Comparison of 1.5 and 3.0 T for contrast-enhanced pulmonary magnetic resonance angiography.

Objective: In a recent multi-center trial of gadolinium contrast-enhanced magnetic resonance angiography (Gd-MRA) for diagnosis of acute pulmonary embolism (PE), two centers utilized a common MRI platform though at different field strengths (1.5T and 3T) and realized a signal-to-noise gain with the 3T platform. This retrospective analysis investigates this gain in signal-to-noise of pulmonary vascular targets.

Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III).

Background: The accuracy of gadolinium-enhanced magnetic resonance pulmonary angiography and magnetic resonance venography for diagnosing pulmonary embolism has not been determined conclusively.

Objective: To investigate performance characteristics of magnetic resonance angiography, with or without magnetic resonance venography, for diagnosing pulmonary embolism.

Design: Prospective, multicenter study from 10 April 2006 to 30 September 2008.

SPECT in acute pulmonary embolism.

The purpose of this review was to evaluate the accuracy of SPECT in acute pulmonary embolism. Sparse data are available on the accuracy of SPECT based on an objective reference test. Several investigations were reported in which the reference standard for the diagnosis of pulmonary embolism was based in part on the results of SPECT or planar ventilation-perfusion (V/Q) imaging.

Methods of Prospective Investigation of Pulmonary Embolism Diagnosis III (PIOPED III).

In this work, the methods of the Prospective Investigation of Pulmonary Embolism Diagnosis III (PIOPED III) are described in detail. PIOPED III is a multicenter collaborative investigation sponsored by the National Heart, Lung and Blood Institute. The purpose is to determine the accuracy of gadolinium-enhanced magnetic resonance angiography in combination with venous phase magnetic resonance venography for the diagnosis of acute pulmonary embolism (PE).

Reconstructed 4-chamber views compared with axial imaging for assessment of right ventricular enlargement on CT pulmonary angiograms.

Purpose: To test the hypothesis that right enlargement assessed from right ventricular/left ventricular (RV/LV) dimension ratios of computed tomographic (CT) angiograms are equivalent irrespective of whether measured on axial views or reconstructed 4-chamber views.

Methods: RV/LV dimension ratios were calculated from measurements on axial views, manually reconstructed 4-chamber views and computer generated reconstructed 4-chamber views of CT angiograms in 152 patients with PE.

Results: Paired readings of the axial view and manually reconstructed 4-chamber view showed agreement with RV/LV > or =1 or RV/LV <1 in 114 of 127 (89.

Diagnosis of pulmonary embolism in the coronary care unit.

The clinical diagnosis of pulmonary embolism (PE) is difficult in coronary care units (CCUs) because many findings of PE are similar to those of acute coronary syndromes and heart failure. Immobilization of only 1 or 2 days may predispose to PE. Heart failure and acute myocardial infarction add to the risk.

Early microbiological response to linezolid vs vancomycin in ventilator-associated pneumonia due to methicillin-resistant Staphylococcus aureus.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of ventilator-associated pneumonia (VAP). This prospective, open-label, multicenter clinical trial compared the early microbiological efficacy of linezolid (LZD) therapy with that of vancomycin (VAN) therapy in patients with MRSA VAP.

Methods: A total of 149 patients with suspected MRSA VAP were randomized to receive either LZD, 600 mg, or VAN, 1 g every 12 h.

Health care-associated pneumonia: identification and initial management in the ED.

Traditionally, pneumonia is categorized by epidemiologic factors into community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP). Microbiologic studies have shown that the organisms which cause infections in HAP and VAP differ from CAP in epidemiology and resistance patterns. Patients with HAP or VAP are at higher risk for harboring resistant organisms.

Challenges in the diagnosis of acute pulmonary embolism.

The state of the art of diagnostic evaluation of hemodynamically stable patients with suspected acute pulmonary embolism was reviewed. Diagnostic evaluation should begin with clinical assessment using a validated prediction rule in combination with measurement of D-dimer when appropriate. Imaging should follow only when necessary.

Prognostic value of the shock index along with transthoracic echocardiography in risk stratification of patients with acute pulmonary embolism.

The initial clinical presentation and echocardiography have key roles in risk stratification of patients with acute pulmonary embolism (PE). To assess the value of shock index and echocardiographic abnormalities as predictors of in-hospital complications and mortality, echocardiographic features of 159 patients diagnosed with acute PE were reviewed. A shock index > or =1, independent of echocardiographic findings, was associated with increased in-hospital mortality.

Enlarged right ventricle without shock in acute pulmonary embolism: prognosis.

Objective: An unsettled issue is the use of thrombolytic agents in patients with acute pulmonary embolism (PE) who are hemodynamically stable but have right ventricular (RV) enlargement. We assessed the in-hospital mortality of hemodynamically stable patients with PE and RV enlargement.

Methods: Patients were enrolled in the Prospective Investigation of Pulmonary Embolism Diagnosis II.

Newer modalities for detection of pulmonary emboli.

Pulmonary embolism (PE) is the third most common cardiovascular disease after myocardial infarction and stroke in the United States. Early and accurate diagnosis of this condition is imperative because many patients die within hours of presentation. Clinical and laboratory tests can be used to accurately determine the pretest probability of PE.

Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II.

Background: Selection of patients for diagnostic tests for acute pulmonary embolism requires recognition of the possibility of pulmonary embolism on the basis of the clinical characteristics. Patients in the Prospective Investigation of Pulmonary Embolism Diagnosis II had a broad spectrum of severity, which permits an evaluation of the subtle characteristics of mild pulmonary embolism and the characteristics of severe pulmonary embolism.

Methods: Data are from the national collaborative study, Prospective Investigation of Pulmonary Embolism Diagnosis II.

Electrocardiographic score and short-term outcomes of acute pulmonary embolism.

Risk stratification of patients with a diagnosis of acute pulmonary embolism (PE) is crucial in deciding appropriate management. An electrocardiographic (ECG) scoring system may potentially be useful in identifying patients at high risk of increased hospital morbidity and mortality from acute PE. Electrocardiography and echocardiography of 159 patients with a diagnosis of acute PE using ventilation/perfusion scan or spiral computed tomographic scan at 2 Emory-affiliated hospitals were reviewed.

Usefulness of multidetector spiral computed tomography according to age and gender for diagnosis of acute pulmonary embolism.

Data from the Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) were evaluated to test the hypothesis that the performance of multidetector computed tomographic (CT) pulmonary angiography and CT venography is independent of a patient's age and gender. In 773 patients with adequate CT pulmonary angiography and 737 patients with adequate CT pulmonary angiography and CT venography, the sensitivity and specificity for pulmonary embolism for groups of patients aged 18 to 59, 60 to 79, and 80 to 99 years did not differ to a statistically significant extent, nor were there significant differences according to gender. Overall, however, the specificity of CT pulmonary angiography was somewhat greater in women, but in men and women, it was > or =93%.

Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators.

Purpose: To formulate comprehensive recommendations for the diagnostic approach to patients with suspected pulmonary embolism, based on randomized trials.

Methods: Diagnostic management recommendations were formulated based on results of the Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) and outcome studies.

Results: The PIOPED II investigators recommend stratification of all patients with suspected pulmonary embolism according to an objective clinical probability assessment.

Multidetector computed tomography for acute pulmonary embolism.

Background: The accuracy of multidetector computed tomographic angiography (CTA) for the diagnosis of acute pulmonary embolism has not been determined conclusively.

Methods: The Prospective Investigation of Pulmonary Embolism Diagnosis II trial was a prospective, multicenter investigation of the accuracy of multidetector CTA alone and combined with venous-phase imaging (CTA-CTV) for the diagnosis of acute pulmonary embolism. We used a composite reference test to confirm or rule out the diagnosis of pulmonary embolism.

Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia.

Study Objectives: To evaluate clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia (VAP), including the implementation of and outcomes associated with deescalation therapy.

Design: Prospective, observational, cohort study.

Setting: Twenty ICUs throughout the United States.

Epidemiology and microbiology of hospital-acquired pneumonia.

Hospital-acquired pneumonia (HAP) is the second most common nosocomial infection in the critically ill patient and is associated with the greatest mortality and increased morbidity and cost of care. The major risk factor for the development of HAP in intensive care is the occurrence of intubation and mechanical ventilation, giving rise to the term ventilator-associated pneumonia (VAP). Incidence of VAP varies in different populations of critically ill patients and generally ranges from 9 to 20%, with an overall rate of 10 to 15 cases per 1,000 ventilator days.