ICU

Use of beta-blocker helps achieve target heart rate level among patients in septic shock
The researchers found that the target range for heart rate was achieved in all patients in the esmolol group, which was significantly lower throughout the intervention period than what was achieved in the control group. In addition, the esmolol group had a 28-day mortality rate of 49.4 percent vs. 80.5 percent in the control group. Overall survival was higher in the esmolol group. There was no clinically relevant differences between groups in other investigated cardiopulmonary variables nor in rescue therapy requirements. Eurekalert!

Study compares risk of death of fluid replacement therapies for critically ill patients
The study reports no difference in outcomes between groups; there were 359 deaths (25.4 percent) among patients treated with colloids vs. 390 deaths (27.0 percent) among patients treated with crystalloids. At 90 days, there were 434 deaths (30.7 percent) among patients treated with colloids vs. 493 deaths (34.2 percent) among patients treated with crystalloids. Eurekalert!

Use of statin does not improve survival among adults with ventilator-associated pneumonia
The study was stopped for futility at the first scheduled interim analysis after enrollment of the 300 patients. The researchers found that day-28 mortality was not lower in the simvastatin group (21.2 percent) than in the placebo group (15.2 percent). There were no differences in day-14, ICU, or hospital mortality rates, or in duration of mechanical ventilation. Eurekalert!

Among critically ill patients, muscle wasting occurs rapidly
The researchers found reductions in the rectus femoris CSA observed at day 10 (-17.7 percent). Decrease in the rectus femoris CSA was greater in patients who experienced multiorgan failure compared with single organ failure: -15.7 vs. -3.0 percent by day 7; -8.7 percent vs. -1.8 percent by day 3.

In addition, muscle protein synthesis was depressed to levels equivalent to the healthy fasted state on day 1. It increased to rates similar to the healthy fed state by day 7; but the net balance remained negative (i.e., destructive metabolism). "Importantly, these overall effects occurred despite the administration of enteral nutrition. Unexpectedly, higher protein delivery in the first week was associated with greater muscle wasting," the authors write. Eurekalert!