Fomepizole as an adjunct in acetylcysteine treated acetaminophen overdose patients: a case series.

Introduction: Acetaminophen (N-acetyl-para-aminophenol or APAP) is the leading cause of acute liver failure worldwide. Standard therapy for APAP overdose is with IV N-acetylcysteine (NAC). However, overdose patients treated with NAC can still incur hepatotoxicity in some circumstances.

Effect of Very Low-Dose Hydrocortisone on Shock Reversal in Patients With Septic Shock.

Unlabelled: In patients with septic shock, hydrocortisone 200-400 mg/d has been shown to reverse shock compared with placebo. Lower doses of hydrocortisone have not previously been studied, and there are no previous studies comparing two different doses of hydrocortisone. At our institution, some clinicians routinely prescribe doses less than 200 mg/d.

Accelerated lymphocyte death in sepsis occurs by both the death receptor and mitochondrial pathways.

Patients with sepsis are immune compromised, as evidenced by their failure to clear their primary infection and their propensity to develop secondary infections with pathogens that are often not particularly virulent in normal healthy individuals. A potential mechanism for immunosuppression in sepsis is lymphocyte apoptosis, which may occur by either a death receptor or a mitochondrial-mediated pathway. A prospective study of blood samples from 71 patients with sepsis, 55 nonseptic patients, and 6 healthy volunteers was undertaken to quantitate lymphocyte apoptosis and determine cell death pathways and mechanisms of apoptosis.

Prevention of pneumonia in the hospital setting.

Although the optimal approach to reducing ventilator-associated pneumonia (VAP) is unclear, recent studies indicate that mandatory education of health care workers caring for mechanically ventilated patients can decrease overall VAP rates. Among the available interventions, shortening the duration of mechanical ventilation and providing measures to prevent the aspiration of contaminated secretions are most important. Given the evidence supporting greater morbidity, hospital mortality, and medical care costs among patients who have VAP, the prevention of this nosocomial infection should be an important priority in the hospital setting.

Reporting of medical errors: an intensive care unit experience.

Objective: To determine the occurrence and type of medical errors in an intensive care setting using a voluntary reporting method.

Design: Prospective, single-center, observational study.

Setting: The medical intensive care unit (19 beds) at an urban teaching hospital.

Hospital mortality for patients with bacteremia due to Staphylococcus aureus or Pseudomonas aeruginosa.

Study Objectives: To evaluate the relationship between hospital mortality and bloodstream infections due to Staphylococcus aureus or Pseudomonas aeruginosa.

Design: Prospective cohort study.

Setting: A 1,400-bed, university-affiliated urban teaching hospital.