In This Edition
Literature at a Glance
A guide to this month’s studies
- Risk of infection with arterial and central venous catheters
- Rifaximin and prevention of hepatic encephalopathy
- Tracheotomy to prevent ventilator-associated pneumonia
- Coagulopathy and risk of VTE in patients with cirrhosis
- Use of age-adjusted D-dimer for PE diagnosis
- Continuation of anti-hypertensive medications after stroke
- Number of lumen cultures and detection of CRBSIs
- Timing of anticoagulation and outcomes in PE
Arterial and Central Venous Catheters Have Similar Rates of Colonization and Blood Stream Infections
Clinical question: Are arterial catheters (ACs) safer than central venous catheters (CVCs) in terms of colonization and catheter-related infections?
Background: Unlike CVCs, only a few studies have addressed blood-stream infections (BSI) related to AC usage, probably due to the traditional perception that ACs pose a lesser risk of colonization and BSI than CVC.
Study design: Randomized, controlled trial.
Setting: Three university hospitals and two general hospitals in France.
Synopsis: The study included 3,532 catheters (1,915 CVC and 1,617 AC) with 27,541 catheter-days from seven ICU settings. The same standard procedures were followed for catheter insertion and site dressing change at the various centers. Catheters were removed when they no longer were needed or when catheter-related infection (CRI) was suspected.
Colonization and CRI rates were similar in both arterial and venous catheters: 7.9% vs. 9.6% and 0.68% vs. 0.94%, respectively. The daily risk of colonization over time was stable for CVC, but appeared to increase for AC.
One important limitation to this study is that many patients had both arterial and venous catheters, leading to difficulty attributing infection to either one. Hospitalists caring for ICU patients should weigh the risks and benefits of prolonged use of AC due to similar rates of colonization and CRI as CVC.
Bottom line: Arterial and central venous catheters are equally prone to colonization and cause similar rates of CRI, but AC daily risk tends to increase with time; thus, AC should receive the same precautions as CVC.
Citation: Lucet JC, Bouadma L, Zahar JR, et. al. Infectious risk associated with arterial catheters compared with central venous catheters. Crit Care Med. 2010;38(4):1030-1005.
Rifaximin Prevents Recurrence of Hepatic Encephalopathy Episodes and Reduces Associated Risk for Hospitalization
Clinical question: What is the efficacy of rifaximin for the prevention of hepatic encephalopathy?
Background: Hepatic encephalopathy is a chronic, debilitating complication of liver cirrhosis. The efficacy of treatment of acute episodes with rifaximin is well documented in the literature; however, prevention of such episodes using rifaximin is poorly studied.
Study design: Randomized, double-blinded, placebo-controlled trial.
Setting: Seventy centers in the U.S., Canada, and Russia.
Synopsis: A total of 299 chronic liver disease patients, in remission from recurrent hepatic encephalopathy, randomly were assigned to receive either oral rifaximin (140 patients) or placebo (159 patients) for six months.