Bold Voices - March 2013 - (Page 7)

AT THE BEDSIDE New Methods Increase Speed of Sepsis Diagnosis © M olecular testing and mass spectroscopy are rapidly changing how sepsis is diagnosed in blood cultures, providing more specific information faster than conventional methods, according to a review in Critical Care Medicine. “Current Approaches to the Diagnosis of Bacterial and Fungal Bloodstream Infections in the Intensive Care Unit” concludes these methods will be most effective only when ICU physicians recognize and understand the performance characteristics. “Critical care physicians will have to expeditiously learn what information to expect from such systems, and how such information can be used to assure that initial antimicrobial regimens are appropriate, and the unnecessary drugs are discontinued,” the review states. In testing for blood pathogens, nucleic acid amplification and mass spectrometry are among the most common techniques introduced in clinical laboratories in recent years, notes Patrick R. Murray of Becton Dickinson Diagnostic Systems, Sparks, Md., and Henry Masur of the Clinical Center, National Institutes of Health, Bethesda, Md. Missed opportunities to document the cause of bloodstream infections can adversely affect patient outcomes, the review adds, so techniques that are Low-Chloride IV Fluid May Reduce Renal Injury “Association Between a Chloride-Liberal vs. Chloride-Restrictive Intravenous Fluid Administration Strategy and Kidney Injury in Critically Ill Adults,” a six-month study conducted in Australia, tested the hypothesis that the current practice of administering chloride solutions liberally may be associated with a higher incidence and severity of acute kidney injury among critically ill patients. Nor’azim Mohd Yunos, of Study needs U.S. Monash University Malaysia, and colleagues published the results replication because in JAMA: The Journal of the of the difference in IV American Medical Association. fluids used in Australia. The before-and-after study compared a chloride-restrictive IV fluid strategy with a chloride-liberal IV fluid strategy. It found a link between low-chloride IV fluid and a reduced incidence of acute kidney injury and a decrease in the use of renal replacement therapy. Jorge Guzman, of the Cleveland Clinic in Ohio, tells Medscape Medical News the study likely will lead to re-evaluation of the way the medical profession prescribes fluids for critically ill patients and may influence the way physicians practice critical care. The results also point to a need for a U.S. study because of the difference in IV fluids used in Australia. New techniques will benefit antibiotic stewardship and time to appropriate antibiotics. “sensitive, specific and rapid for identifying the microbial cause of sepsis are major operational tools for all critical care units.” With these techniques, certain resistance mutations can be detected within hours, thus providing valuable guidance to clinicians. These methods, the review concludes, are expected to “contribute substantially to improving antibiotic stewardship and to improving ‘time to appropriate antibiotics,’ one of the most pivotal parameters in improving the prognosis of patients with life-threatening infections.” AACN BOLD VOICES MARCH 2013 7

Table of Contents for the Digital Edition of Bold Voices - March 2013

Front/Digital Edition Viewing Guide
Another Angle
Design an NTI Just for You
New Guidelines Set Practice Framework for Tele-ICU NursingPractice
New Methods Increase Speed of Sepsis Diagnosis
High Blood Pressure Can Injure the Brain of Young Adults
Recurrent Hypoglycemia May Not Impair Long-Term Development of Preterm Infants
Superstorm Sandy Hospital Evacuation Decisions Questioned
New STEMI Guidelines Focus on Symptom Recognition, Ease of Use
Early Communication About Resuscitation Improves EOL Quality
Vote Now for AACN Board, Nominating Committee Members
Simple Measures Reduce Pneumonia
Fresh Blood in the ICU
Meeting Veterans’ Healthcare Needs
In Our Journals
Checklists May Reduce Venous Thromboembolism
Certification Capsules
Chapter Leadership Workshop @NTI 2013
Wear Your NTI Pride on May 20
Dare To

Bold Voices - March 2013