Miscellaneous

Question 1

Early Mobility in ICU

Answer 1

• Schweickert et al. (2009): Early physical and occupational therapy in mechanically ventilated, critically ill patients was associated with better functional outcomes at hospital discharge, shorter duration of delirium, and more ventilator-free days compared with standard care.
• TEAM Study (2015): Early mobilization and rehabilitation of patients in the ICU, delivered by a dedicated multidisciplinary team, did not reduce hospital length of stay.
• EPICC Trial (2021): Early intensive care unit mobility therapy in the treatment of acute respiratory failure did not result in improved functional status at hospital discharge compared with standard physical therapy.

Question 2

Thresholds for Red Cell Transfusion

Answer 2

• TRICC Trial (1999): Restrictive transfusion strategy was found to be as effective as a liberal strategy in critically ill patients.
• TRISS Trial (2014): Lower transfusion threshold was as safe as a higher threshold in septic shock patients.

Question 3

Intensive Glucose Control in the ICU

Answer 3

• Leuven Study (2001): Intensive insulin therapy to maintain blood glucose at or below 110 mg/dl reduced morbidity and mortality among critically ill patients in the surgical ICU.
• NICE-SUGAR Study (2009): Intensive glucose control increased mortality among adults in the ICU: a blood glucose target of 180 mg/dl or less resulted in lower mortality than a target of 81 to 108 mg/dl.

Question 4

Thrombolytics in strokes

Answer 4

• WAKE-UP trial performed MRI on patients who awoke with stroke symptoms. Thrombolytics were administered if a lesion was seen on diffusion-weighted images and not on fluid-attenuated inversion recovery MRI. Patients receiving thrombolytics had a significantly better outcome.
• The EXTEND trial performed CT/MRI
  perfusion studies on patients presenting between 4.5 and 9 hours after stroke onset. If mismatch lesions were seen, thrombolytic therapy was associated with significantly improved outcome.