American Thoracic Society (ATS): International Conference 2011

DENVER – Exacerbations of chronic obstructive pulmonary disease show distinctly different temporal patterns of onset and resolution, which may have implications for treatment and prognosis, researchers reported.

In a prospective cohort study among patients with COPD who kept daily diaries for at least 2 years, 56% of exacerbations started suddenly; the rest began gradually.

The sudden-onset type were 18% shorter in duration than were the gradual-onset type, reported presenting author Gavin C. Donaldson, Ph.D., a senior lecturer and respiratory medicine specialist at the University College London.

The nature of onset of an exacerbation "is of particular interest because it is the prodrome that is reported to the physician when the patient comes into the clinic and dictates the courses of therapy that they receive," he noted at the International Conference of the American Thoracic Society. Hence, a better understanding of these events could help physicians to time therapy more appropriately, to patient benefit.

Study results additionally showed that patients frequently had episodes of symptom worsening that resolved without ever turning into exacerbations.

"We have all had this concept of ‘a patient is either exacerbating or is stable,’ " Dr. Donaldson commented. "There is increasing evidence coming out that patients actually fluctuate around a level which is not clinically significant, and we are finding that these sorts of symptom episodes are really part of that fluctuation. They are not particularly clinically important [that is, the patient doesn’t report it], but it may be important in terms of their disease progression."

Patients participating in the London COPD study recorded peak flow readings and various symptoms – including major (dyspnea, sputum purulence, and sputum volume) and minor (nasal discharge/congestion, wheeze, sore throat, and cough) symptoms – on a daily basis.

The investigators used the diary data to identify episodes of worsening symptoms and to identify exacerbations (defined according to standard criteria as requiring an increase in at least two symptoms, one of them major, on 2 consecutive days).

Results were based on 212 patients who had an average age of 68 years. In all, 64% were men, and 33% were current smokers. Their FEV₁ (forced expiratory volume in 1 second) was 45% of that predicted.

All patients had at least 2 years of follow-up, and the total follow-up for the cohort was 890 patient-years.

The patients experienced 4,439 episodes of worsening symptoms, slightly more than half of which resolved spontaneously and the rest of which resulted in a defined COPD exacerbation. The median number of exacerbations was 2.33 per patient per year.

Analyses revealed two distinct patterns of exacerbation onset, according to Dr. Donaldson. With the sudden-onset pattern (seen in 56%), the median time between initial worsening of symptoms and exacerbation was 0 days. With the gradual-onset pattern (seen in 44%), the time to exacerbation was 4 days.

In addition, the time between the start of an exacerbation and recovery to baseline health status was a significant 18% shorter for sudden-onset vs. gradual-onset exacerbations (11 days vs. 13 days; P less than .001).

The treatments that patients received did not seem to affect these onset or recovery patterns, he noted. If anything, there was a greater tendency for treatment in the exacerbations that went on longer.

Multiple logistic regression analyses showed that certain factors predicted the nature of onset and recovery, according to Dr. Donaldson. Exacerbations were more likely to have a sudden onset in patients who were current smokers (odds ratio, 1.28), had cold symptoms (OR, 1.27), and – especially – had purulent sputum at the time (OR, 13.47). There was less likelihood of a sudden onset in patients with a higher body mass index (OR, 0.98) or cardiovascular disease (OR, 0.78), or if the exacerbations occurred during the spring (OR, 0.71).

Exacerbations were more likely to have a long recovery time (defined as recovery taking more than 12 days) if they had a gradual onset (OR, 1.39) and also if patients were male (OR, 1.27) or had cold symptoms (OR, 1.30), and if they occurred in the winter (OR, 1.36). There was less likelihood of a long recovery time in patients having purulent sputum (OR, 0.91).

Dr. Donaldson did not report any relevant conflicts of interest.

DENVER – Exacerbations of chronic obstructive pulmonary disease show distinctly different temporal patterns of onset and resolution, which may have implications for treatment and prognosis, researchers reported.

In a prospective cohort study among patients with COPD who kept daily diaries for at least 2 years, 56% of exacerbations started suddenly; the rest began gradually.

The sudden-onset type were 18% shorter in duration than were the gradual-onset type, reported presenting author Gavin C. Donaldson, Ph.D., a senior lecturer and respiratory medicine specialist at the University College London.

The nature of onset of an exacerbation "is of particular interest because it is the prodrome that is reported to the physician when the patient comes into the clinic and dictates the courses of therapy that they receive," he noted at the International Conference of the American Thoracic Society. Hence, a better understanding of these events could help physicians to time therapy more appropriately, to patient benefit.

Study results additionally showed that patients frequently had episodes of symptom worsening that resolved without ever turning into exacerbations.

"We have all had this concept of ‘a patient is either exacerbating or is stable,’ " Dr. Donaldson commented. "There is increasing evidence coming out that patients actually fluctuate around a level which is not clinically significant, and we are finding that these sorts of symptom episodes are really part of that fluctuation. They are not particularly clinically important [that is, the patient doesn’t report it], but it may be important in terms of their disease progression."

Patients participating in the London COPD study recorded peak flow readings and various symptoms – including major (dyspnea, sputum purulence, and sputum volume) and minor (nasal discharge/congestion, wheeze, sore throat, and cough) symptoms – on a daily basis.

The investigators used the diary data to identify episodes of worsening symptoms and to identify exacerbations (defined according to standard criteria as requiring an increase in at least two symptoms, one of them major, on 2 consecutive days).

Results were based on 212 patients who had an average age of 68 years. In all, 64% were men, and 33% were current smokers. Their FEV₁ (forced expiratory volume in 1 second) was 45% of that predicted.

All patients had at least 2 years of follow-up, and the total follow-up for the cohort was 890 patient-years.

The patients experienced 4,439 episodes of worsening symptoms, slightly more than half of which resolved spontaneously and the rest of which resulted in a defined COPD exacerbation. The median number of exacerbations was 2.33 per patient per year.

Analyses revealed two distinct patterns of exacerbation onset, according to Dr. Donaldson. With the sudden-onset pattern (seen in 56%), the median time between initial worsening of symptoms and exacerbation was 0 days. With the gradual-onset pattern (seen in 44%), the time to exacerbation was 4 days.

In addition, the time between the start of an exacerbation and recovery to baseline health status was a significant 18% shorter for sudden-onset vs. gradual-onset exacerbations (11 days vs. 13 days; P less than .001).

The treatments that patients received did not seem to affect these onset or recovery patterns, he noted. If anything, there was a greater tendency for treatment in the exacerbations that went on longer.

Multiple logistic regression analyses showed that certain factors predicted the nature of onset and recovery, according to Dr. Donaldson. Exacerbations were more likely to have a sudden onset in patients who were current smokers (odds ratio, 1.28), had cold symptoms (OR, 1.27), and – especially – had purulent sputum at the time (OR, 13.47). There was less likelihood of a sudden onset in patients with a higher body mass index (OR, 0.98) or cardiovascular disease (OR, 0.78), or if the exacerbations occurred during the spring (OR, 0.71).

Exacerbations were more likely to have a long recovery time (defined as recovery taking more than 12 days) if they had a gradual onset (OR, 1.39) and also if patients were male (OR, 1.27) or had cold symptoms (OR, 1.30), and if they occurred in the winter (OR, 1.36). There was less likelihood of a long recovery time in patients having purulent sputum (OR, 0.91).

Dr. Donaldson did not report any relevant conflicts of interest.

DENVER – Exacerbations of chronic obstructive pulmonary disease show distinctly different temporal patterns of onset and resolution, which may have implications for treatment and prognosis, researchers reported.

In a prospective cohort study among patients with COPD who kept daily diaries for at least 2 years, 56% of exacerbations started suddenly; the rest began gradually.

The sudden-onset type were 18% shorter in duration than were the gradual-onset type, reported presenting author Gavin C. Donaldson, Ph.D., a senior lecturer and respiratory medicine specialist at the University College London.

The nature of onset of an exacerbation "is of particular interest because it is the prodrome that is reported to the physician when the patient comes into the clinic and dictates the courses of therapy that they receive," he noted at the International Conference of the American Thoracic Society. Hence, a better understanding of these events could help physicians to time therapy more appropriately, to patient benefit.

Study results additionally showed that patients frequently had episodes of symptom worsening that resolved without ever turning into exacerbations.

"We have all had this concept of ‘a patient is either exacerbating or is stable,’ " Dr. Donaldson commented. "There is increasing evidence coming out that patients actually fluctuate around a level which is not clinically significant, and we are finding that these sorts of symptom episodes are really part of that fluctuation. They are not particularly clinically important [that is, the patient doesn’t report it], but it may be important in terms of their disease progression."

Patients participating in the London COPD study recorded peak flow readings and various symptoms – including major (dyspnea, sputum purulence, and sputum volume) and minor (nasal discharge/congestion, wheeze, sore throat, and cough) symptoms – on a daily basis.

The investigators used the diary data to identify episodes of worsening symptoms and to identify exacerbations (defined according to standard criteria as requiring an increase in at least two symptoms, one of them major, on 2 consecutive days).

Results were based on 212 patients who had an average age of 68 years. In all, 64% were men, and 33% were current smokers. Their FEV₁ (forced expiratory volume in 1 second) was 45% of that predicted.

All patients had at least 2 years of follow-up, and the total follow-up for the cohort was 890 patient-years.

The patients experienced 4,439 episodes of worsening symptoms, slightly more than half of which resolved spontaneously and the rest of which resulted in a defined COPD exacerbation. The median number of exacerbations was 2.33 per patient per year.

Analyses revealed two distinct patterns of exacerbation onset, according to Dr. Donaldson. With the sudden-onset pattern (seen in 56%), the median time between initial worsening of symptoms and exacerbation was 0 days. With the gradual-onset pattern (seen in 44%), the time to exacerbation was 4 days.

In addition, the time between the start of an exacerbation and recovery to baseline health status was a significant 18% shorter for sudden-onset vs. gradual-onset exacerbations (11 days vs. 13 days; P less than .001).

The treatments that patients received did not seem to affect these onset or recovery patterns, he noted. If anything, there was a greater tendency for treatment in the exacerbations that went on longer.

Multiple logistic regression analyses showed that certain factors predicted the nature of onset and recovery, according to Dr. Donaldson. Exacerbations were more likely to have a sudden onset in patients who were current smokers (odds ratio, 1.28), had cold symptoms (OR, 1.27), and – especially – had purulent sputum at the time (OR, 13.47). There was less likelihood of a sudden onset in patients with a higher body mass index (OR, 0.98) or cardiovascular disease (OR, 0.78), or if the exacerbations occurred during the spring (OR, 0.71).

Exacerbations were more likely to have a long recovery time (defined as recovery taking more than 12 days) if they had a gradual onset (OR, 1.39) and also if patients were male (OR, 1.27) or had cold symptoms (OR, 1.30), and if they occurred in the winter (OR, 1.36). There was less likelihood of a long recovery time in patients having purulent sputum (OR, 0.91).

Dr. Donaldson did not report any relevant conflicts of interest.

DENVER – Exacerbations of chronic obstructive pulmonary disease show distinctly different temporal patterns of onset and resolution, which may have implications for treatment and prognosis, researchers reported.

In a prospective cohort study among patients with COPD who kept daily diaries for at least 2 years, 56% of exacerbations started suddenly; the rest began gradually.

The sudden-onset type were 18% shorter in duration than were the gradual-onset type, reported presenting author Gavin C. Donaldson, Ph.D., a senior lecturer and respiratory medicine specialist at the University College London.

The nature of onset of an exacerbation "is of particular interest because it is the prodrome that is reported to the physician when the patient comes into the clinic and dictates the courses of therapy that they receive," he noted at the International Conference of the American Thoracic Society. Hence, a better understanding of these events could help physicians to time therapy more appropriately, to patient benefit.

Study results additionally showed that patients frequently had episodes of symptom worsening that resolved without ever turning into exacerbations.

"We have all had this concept of ‘a patient is either exacerbating or is stable,’ " Dr. Donaldson commented. "There is increasing evidence coming out that patients actually fluctuate around a level which is not clinically significant, and we are finding that these sorts of symptom episodes are really part of that fluctuation. They are not particularly clinically important [that is, the patient doesn’t report it], but it may be important in terms of their disease progression."

Patients participating in the London COPD study recorded peak flow readings and various symptoms – including major (dyspnea, sputum purulence, and sputum volume) and minor (nasal discharge/congestion, wheeze, sore throat, and cough) symptoms – on a daily basis.

The investigators used the diary data to identify episodes of worsening symptoms and to identify exacerbations (defined according to standard criteria as requiring an increase in at least two symptoms, one of them major, on 2 consecutive days).

Results were based on 212 patients who had an average age of 68 years. In all, 64% were men, and 33% were current smokers. Their FEV₁ (forced expiratory volume in 1 second) was 45% of that predicted.

All patients had at least 2 years of follow-up, and the total follow-up for the cohort was 890 patient-years.

The patients experienced 4,439 episodes of worsening symptoms, slightly more than half of which resolved spontaneously and the rest of which resulted in a defined COPD exacerbation. The median number of exacerbations was 2.33 per patient per year.

Analyses revealed two distinct patterns of exacerbation onset, according to Dr. Donaldson. With the sudden-onset pattern (seen in 56%), the median time between initial worsening of symptoms and exacerbation was 0 days. With the gradual-onset pattern (seen in 44%), the time to exacerbation was 4 days.

In addition, the time between the start of an exacerbation and recovery to baseline health status was a significant 18% shorter for sudden-onset vs. gradual-onset exacerbations (11 days vs. 13 days; P less than .001).

The treatments that patients received did not seem to affect these onset or recovery patterns, he noted. If anything, there was a greater tendency for treatment in the exacerbations that went on longer.

Multiple logistic regression analyses showed that certain factors predicted the nature of onset and recovery, according to Dr. Donaldson. Exacerbations were more likely to have a sudden onset in patients who were current smokers (odds ratio, 1.28), had cold symptoms (OR, 1.27), and – especially – had purulent sputum at the time (OR, 13.47). There was less likelihood of a sudden onset in patients with a higher body mass index (OR, 0.98) or cardiovascular disease (OR, 0.78), or if the exacerbations occurred during the spring (OR, 0.71).

Exacerbations were more likely to have a long recovery time (defined as recovery taking more than 12 days) if they had a gradual onset (OR, 1.39) and also if patients were male (OR, 1.27) or had cold symptoms (OR, 1.30), and if they occurred in the winter (OR, 1.36). There was less likelihood of a long recovery time in patients having purulent sputum (OR, 0.91).

Dr. Donaldson did not report any relevant conflicts of interest.

DENVER – Exacerbations of chronic obstructive pulmonary disease show distinctly different temporal patterns of onset and resolution, which may have implications for treatment and prognosis, researchers reported.

In a prospective cohort study among patients with COPD who kept daily diaries for at least 2 years, 56% of exacerbations started suddenly; the rest began gradually.

The sudden-onset type were 18% shorter in duration than were the gradual-onset type, reported presenting author Gavin C. Donaldson, Ph.D., a senior lecturer and respiratory medicine specialist at the University College London.

The nature of onset of an exacerbation "is of particular interest because it is the prodrome that is reported to the physician when the patient comes into the clinic and dictates the courses of therapy that they receive," he noted at the International Conference of the American Thoracic Society. Hence, a better understanding of these events could help physicians to time therapy more appropriately, to patient benefit.

Study results additionally showed that patients frequently had episodes of symptom worsening that resolved without ever turning into exacerbations.

"We have all had this concept of ‘a patient is either exacerbating or is stable,’ " Dr. Donaldson commented. "There is increasing evidence coming out that patients actually fluctuate around a level which is not clinically significant, and we are finding that these sorts of symptom episodes are really part of that fluctuation. They are not particularly clinically important [that is, the patient doesn’t report it], but it may be important in terms of their disease progression."

Patients participating in the London COPD study recorded peak flow readings and various symptoms – including major (dyspnea, sputum purulence, and sputum volume) and minor (nasal discharge/congestion, wheeze, sore throat, and cough) symptoms – on a daily basis.

The investigators used the diary data to identify episodes of worsening symptoms and to identify exacerbations (defined according to standard criteria as requiring an increase in at least two symptoms, one of them major, on 2 consecutive days).

Results were based on 212 patients who had an average age of 68 years. In all, 64% were men, and 33% were current smokers. Their FEV₁ (forced expiratory volume in 1 second) was 45% of that predicted.

All patients had at least 2 years of follow-up, and the total follow-up for the cohort was 890 patient-years.

The patients experienced 4,439 episodes of worsening symptoms, slightly more than half of which resolved spontaneously and the rest of which resulted in a defined COPD exacerbation. The median number of exacerbations was 2.33 per patient per year.

Analyses revealed two distinct patterns of exacerbation onset, according to Dr. Donaldson. With the sudden-onset pattern (seen in 56%), the median time between initial worsening of symptoms and exacerbation was 0 days. With the gradual-onset pattern (seen in 44%), the time to exacerbation was 4 days.

In addition, the time between the start of an exacerbation and recovery to baseline health status was a significant 18% shorter for sudden-onset vs. gradual-onset exacerbations (11 days vs. 13 days; P less than .001).

The treatments that patients received did not seem to affect these onset or recovery patterns, he noted. If anything, there was a greater tendency for treatment in the exacerbations that went on longer.

Multiple logistic regression analyses showed that certain factors predicted the nature of onset and recovery, according to Dr. Donaldson. Exacerbations were more likely to have a sudden onset in patients who were current smokers (odds ratio, 1.28), had cold symptoms (OR, 1.27), and – especially – had purulent sputum at the time (OR, 13.47). There was less likelihood of a sudden onset in patients with a higher body mass index (OR, 0.98) or cardiovascular disease (OR, 0.78), or if the exacerbations occurred during the spring (OR, 0.71).

Exacerbations were more likely to have a long recovery time (defined as recovery taking more than 12 days) if they had a gradual onset (OR, 1.39) and also if patients were male (OR, 1.27) or had cold symptoms (OR, 1.30), and if they occurred in the winter (OR, 1.36). There was less likelihood of a long recovery time in patients having purulent sputum (OR, 0.91).

Dr. Donaldson did not report any relevant conflicts of interest.

DENVER – Exacerbations of chronic obstructive pulmonary disease show distinctly different temporal patterns of onset and resolution, which may have implications for treatment and prognosis, researchers reported.

In a prospective cohort study among patients with COPD who kept daily diaries for at least 2 years, 56% of exacerbations started suddenly; the rest began gradually.

The sudden-onset type were 18% shorter in duration than were the gradual-onset type, reported presenting author Gavin C. Donaldson, Ph.D., a senior lecturer and respiratory medicine specialist at the University College London.

The nature of onset of an exacerbation "is of particular interest because it is the prodrome that is reported to the physician when the patient comes into the clinic and dictates the courses of therapy that they receive," he noted at the International Conference of the American Thoracic Society. Hence, a better understanding of these events could help physicians to time therapy more appropriately, to patient benefit.

Study results additionally showed that patients frequently had episodes of symptom worsening that resolved without ever turning into exacerbations.

"We have all had this concept of ‘a patient is either exacerbating or is stable,’ " Dr. Donaldson commented. "There is increasing evidence coming out that patients actually fluctuate around a level which is not clinically significant, and we are finding that these sorts of symptom episodes are really part of that fluctuation. They are not particularly clinically important [that is, the patient doesn’t report it], but it may be important in terms of their disease progression."

Patients participating in the London COPD study recorded peak flow readings and various symptoms – including major (dyspnea, sputum purulence, and sputum volume) and minor (nasal discharge/congestion, wheeze, sore throat, and cough) symptoms – on a daily basis.

The investigators used the diary data to identify episodes of worsening symptoms and to identify exacerbations (defined according to standard criteria as requiring an increase in at least two symptoms, one of them major, on 2 consecutive days).

Results were based on 212 patients who had an average age of 68 years. In all, 64% were men, and 33% were current smokers. Their FEV₁ (forced expiratory volume in 1 second) was 45% of that predicted.

All patients had at least 2 years of follow-up, and the total follow-up for the cohort was 890 patient-years.

The patients experienced 4,439 episodes of worsening symptoms, slightly more than half of which resolved spontaneously and the rest of which resulted in a defined COPD exacerbation. The median number of exacerbations was 2.33 per patient per year.

Analyses revealed two distinct patterns of exacerbation onset, according to Dr. Donaldson. With the sudden-onset pattern (seen in 56%), the median time between initial worsening of symptoms and exacerbation was 0 days. With the gradual-onset pattern (seen in 44%), the time to exacerbation was 4 days.

In addition, the time between the start of an exacerbation and recovery to baseline health status was a significant 18% shorter for sudden-onset vs. gradual-onset exacerbations (11 days vs. 13 days; P less than .001).

The treatments that patients received did not seem to affect these onset or recovery patterns, he noted. If anything, there was a greater tendency for treatment in the exacerbations that went on longer.

Multiple logistic regression analyses showed that certain factors predicted the nature of onset and recovery, according to Dr. Donaldson. Exacerbations were more likely to have a sudden onset in patients who were current smokers (odds ratio, 1.28), had cold symptoms (OR, 1.27), and – especially – had purulent sputum at the time (OR, 13.47). There was less likelihood of a sudden onset in patients with a higher body mass index (OR, 0.98) or cardiovascular disease (OR, 0.78), or if the exacerbations occurred during the spring (OR, 0.71).

Exacerbations were more likely to have a long recovery time (defined as recovery taking more than 12 days) if they had a gradual onset (OR, 1.39) and also if patients were male (OR, 1.27) or had cold symptoms (OR, 1.30), and if they occurred in the winter (OR, 1.36). There was less likelihood of a long recovery time in patients having purulent sputum (OR, 0.91).

Dr. Donaldson did not report any relevant conflicts of interest.

DENVER – Patients with pneumonia may be at risk of sudden cardiovascular collapse within the first 72 hours after admission to the hospital, according to the preliminary findings of a large retrospective analysis.

In addition, almost one in five of those in-hospital cardiac arrests (IHCA) occurred outside of the intensive care unit, and many of the patients were not receiving critical care interventions prior to the cardiac arrest, the study investigators found.

The findings "may indicate that current triage practices or other processes of care are inadequate," the researchers noted (Am. J. Respir. Crit. Care Med. 2011;183:A6339).

The new study is the first of its kind to analyze the characteristics of in-hospital cardiac arrest among pneumonia patients, Dr. Gordon E. Carr, the study’s lead author, said during a briefing at an international conference of the American Thoracic Society.

The sudden and rapid decline in pneumonia patients "is a problem that may happen in 1 in 10 patients but hasn’t received due attention, in part because it’s hard to study," said Dr. Carr, pulmonary and critical care fellow at the University of Chicago Medical Center. "There’s an unmet need to know more about what’s going on with these patients."

More than 1 million patients with pneumonia are admitted to hospitals each year, and 3.4% of in-hospital patient deaths are due to pneumonia, according to national data.

Patients with pneumonia are at risk of following a progressive pathway of severe sepsis, septic shock, and multiple organ failure before having a cardiac arrest, Dr. Carr noted. However, some patients go from developing severe infection straight to cardiopulmonary collapse, without developing severe sepsis or septic shock. Several clinical and epidemiologic studies have shown that not all patients with sepsis go down the typical progressive pathway (Curr. Opin. Anaesthesiol. 2008;21:128-40).

Dr. Carr and his colleagues at the University of Chicago Medical Center conducted the retrospective analysis using the American Heart Association’s Get With The Guidelines Resuscitation database, formerly known as the National Registry of Cardiopulmonary Resuscitation. The data covered 9 years and included 10% of hospitals (approximately 500) in North America.

The team analyzed 166,919 cardiopulmonary arrest events, 44,416 of which occurred within 72 hours after admission. They focused on 5,367 events in which patients had pneumonia as a preexisting condition (12% of the 44,416 events) prior to having their first pulseless event within 72 hours of hospital admission.

The median time from hospital admission to IHCA was 20.7 hours. Only 14.7% of patients with pneumonia and IHCA survived to hospital discharge, according to the analysis. Also, 19.3% of the IHCA events occurred in a general inpatient area, while 77.2% of IHCA events occurred in an intensive care or step-down unit.

At the time of IHCA, 40% of the patients were receiving mechanical ventilation, 12.2% had a central venous catheter in place, and 36.3% were receiving continuous infusions of vasoactive medications.

The analysis showed that arrhythmia was the most common cause of IHCA (65%) among that group of patients, followed by respiratory insufficiency (53.9%), and hypotension/hypoperfusion (49.8%).

In addition, the majority of the rhythms were not "shockable," said Dr. Carr, including pulseless electrical activity (45.2% of cases), asystole (38.4%), and ventricular fibrillation or tachycardia (16.4%).

The study had several limitations, Dr. Carr said. It is based on a large database, and "any huge set of data is going to have the inherent problem in terms of bias," he said. Also, the researchers couldn’t adjust for the severity of pneumonia, and they had no information on the processes of care, such as antibiotic administration.

Given the preliminary nature of the data, it is hard to draw firm conclusions, he noted. However, the study highlights the need for more research on cardiac arrest in pneumonia patients.

The take-away message for physicians is "to be alert to the possibility of abrupt collapse in pneumonia patients," and monitor those patients with comorbidities carefully, Dr. Carr cautioned.

Dr. Carr had no disclosures.

DENVER – Patients with pneumonia may be at risk of sudden cardiovascular collapse within the first 72 hours after admission to the hospital, according to the preliminary findings of a large retrospective analysis.

In addition, almost one in five of those in-hospital cardiac arrests (IHCA) occurred outside of the intensive care unit, and many of the patients were not receiving critical care interventions prior to the cardiac arrest, the study investigators found.

The findings "may indicate that current triage practices or other processes of care are inadequate," the researchers noted (Am. J. Respir. Crit. Care Med. 2011;183:A6339).

The new study is the first of its kind to analyze the characteristics of in-hospital cardiac arrest among pneumonia patients, Dr. Gordon E. Carr, the study’s lead author, said during a briefing at an international conference of the American Thoracic Society.

The sudden and rapid decline in pneumonia patients "is a problem that may happen in 1 in 10 patients but hasn’t received due attention, in part because it’s hard to study," said Dr. Carr, pulmonary and critical care fellow at the University of Chicago Medical Center. "There’s an unmet need to know more about what’s going on with these patients."

More than 1 million patients with pneumonia are admitted to hospitals each year, and 3.4% of in-hospital patient deaths are due to pneumonia, according to national data.

Patients with pneumonia are at risk of following a progressive pathway of severe sepsis, septic shock, and multiple organ failure before having a cardiac arrest, Dr. Carr noted. However, some patients go from developing severe infection straight to cardiopulmonary collapse, without developing severe sepsis or septic shock. Several clinical and epidemiologic studies have shown that not all patients with sepsis go down the typical progressive pathway (Curr. Opin. Anaesthesiol. 2008;21:128-40).

Dr. Carr and his colleagues at the University of Chicago Medical Center conducted the retrospective analysis using the American Heart Association’s Get With The Guidelines Resuscitation database, formerly known as the National Registry of Cardiopulmonary Resuscitation. The data covered 9 years and included 10% of hospitals (approximately 500) in North America.

The team analyzed 166,919 cardiopulmonary arrest events, 44,416 of which occurred within 72 hours after admission. They focused on 5,367 events in which patients had pneumonia as a preexisting condition (12% of the 44,416 events) prior to having their first pulseless event within 72 hours of hospital admission.

The median time from hospital admission to IHCA was 20.7 hours. Only 14.7% of patients with pneumonia and IHCA survived to hospital discharge, according to the analysis. Also, 19.3% of the IHCA events occurred in a general inpatient area, while 77.2% of IHCA events occurred in an intensive care or step-down unit.

At the time of IHCA, 40% of the patients were receiving mechanical ventilation, 12.2% had a central venous catheter in place, and 36.3% were receiving continuous infusions of vasoactive medications.

The analysis showed that arrhythmia was the most common cause of IHCA (65%) among that group of patients, followed by respiratory insufficiency (53.9%), and hypotension/hypoperfusion (49.8%).

In addition, the majority of the rhythms were not "shockable," said Dr. Carr, including pulseless electrical activity (45.2% of cases), asystole (38.4%), and ventricular fibrillation or tachycardia (16.4%).

The study had several limitations, Dr. Carr said. It is based on a large database, and "any huge set of data is going to have the inherent problem in terms of bias," he said. Also, the researchers couldn’t adjust for the severity of pneumonia, and they had no information on the processes of care, such as antibiotic administration.

Given the preliminary nature of the data, it is hard to draw firm conclusions, he noted. However, the study highlights the need for more research on cardiac arrest in pneumonia patients.

The take-away message for physicians is "to be alert to the possibility of abrupt collapse in pneumonia patients," and monitor those patients with comorbidities carefully, Dr. Carr cautioned.

Dr. Carr had no disclosures.

DENVER – Patients with pneumonia may be at risk of sudden cardiovascular collapse within the first 72 hours after admission to the hospital, according to the preliminary findings of a large retrospective analysis.

In addition, almost one in five of those in-hospital cardiac arrests (IHCA) occurred outside of the intensive care unit, and many of the patients were not receiving critical care interventions prior to the cardiac arrest, the study investigators found.

The findings "may indicate that current triage practices or other processes of care are inadequate," the researchers noted (Am. J. Respir. Crit. Care Med. 2011;183:A6339).

The new study is the first of its kind to analyze the characteristics of in-hospital cardiac arrest among pneumonia patients, Dr. Gordon E. Carr, the study’s lead author, said during a briefing at an international conference of the American Thoracic Society.

The sudden and rapid decline in pneumonia patients "is a problem that may happen in 1 in 10 patients but hasn’t received due attention, in part because it’s hard to study," said Dr. Carr, pulmonary and critical care fellow at the University of Chicago Medical Center. "There’s an unmet need to know more about what’s going on with these patients."

More than 1 million patients with pneumonia are admitted to hospitals each year, and 3.4% of in-hospital patient deaths are due to pneumonia, according to national data.

Patients with pneumonia are at risk of following a progressive pathway of severe sepsis, septic shock, and multiple organ failure before having a cardiac arrest, Dr. Carr noted. However, some patients go from developing severe infection straight to cardiopulmonary collapse, without developing severe sepsis or septic shock. Several clinical and epidemiologic studies have shown that not all patients with sepsis go down the typical progressive pathway (Curr. Opin. Anaesthesiol. 2008;21:128-40).

Dr. Carr and his colleagues at the University of Chicago Medical Center conducted the retrospective analysis using the American Heart Association’s Get With The Guidelines Resuscitation database, formerly known as the National Registry of Cardiopulmonary Resuscitation. The data covered 9 years and included 10% of hospitals (approximately 500) in North America.

The team analyzed 166,919 cardiopulmonary arrest events, 44,416 of which occurred within 72 hours after admission. They focused on 5,367 events in which patients had pneumonia as a preexisting condition (12% of the 44,416 events) prior to having their first pulseless event within 72 hours of hospital admission.

The median time from hospital admission to IHCA was 20.7 hours. Only 14.7% of patients with pneumonia and IHCA survived to hospital discharge, according to the analysis. Also, 19.3% of the IHCA events occurred in a general inpatient area, while 77.2% of IHCA events occurred in an intensive care or step-down unit.

At the time of IHCA, 40% of the patients were receiving mechanical ventilation, 12.2% had a central venous catheter in place, and 36.3% were receiving continuous infusions of vasoactive medications.

The analysis showed that arrhythmia was the most common cause of IHCA (65%) among that group of patients, followed by respiratory insufficiency (53.9%), and hypotension/hypoperfusion (49.8%).

In addition, the majority of the rhythms were not "shockable," said Dr. Carr, including pulseless electrical activity (45.2% of cases), asystole (38.4%), and ventricular fibrillation or tachycardia (16.4%).

The study had several limitations, Dr. Carr said. It is based on a large database, and "any huge set of data is going to have the inherent problem in terms of bias," he said. Also, the researchers couldn’t adjust for the severity of pneumonia, and they had no information on the processes of care, such as antibiotic administration.

Given the preliminary nature of the data, it is hard to draw firm conclusions, he noted. However, the study highlights the need for more research on cardiac arrest in pneumonia patients.

The take-away message for physicians is "to be alert to the possibility of abrupt collapse in pneumonia patients," and monitor those patients with comorbidities carefully, Dr. Carr cautioned.

Dr. Carr had no disclosures.

DENVER – Patients with pneumonia may be at risk of sudden cardiovascular collapse within the first 72 hours after admission to the hospital, according to the preliminary findings of a large retrospective analysis.

In addition, almost one in five of those in-hospital cardiac arrests (IHCA) occurred outside of the intensive care unit, and many of the patients were not receiving critical care interventions prior to the cardiac arrest, the study investigators found.

The findings "may indicate that current triage practices or other processes of care are inadequate," the researchers noted (Am. J. Respir. Crit. Care Med. 2011;183:A6339).

The new study is the first of its kind to analyze the characteristics of in-hospital cardiac arrest among pneumonia patients, Dr. Gordon E. Carr, the study’s lead author, said during a briefing at an international conference of the American Thoracic Society.

The sudden and rapid decline in pneumonia patients "is a problem that may happen in 1 in 10 patients but hasn’t received due attention, in part because it’s hard to study," said Dr. Carr, pulmonary and critical care fellow at the University of Chicago Medical Center. "There’s an unmet need to know more about what’s going on with these patients."

More than 1 million patients with pneumonia are admitted to hospitals each year, and 3.4% of in-hospital patient deaths are due to pneumonia, according to national data.

Patients with pneumonia are at risk of following a progressive pathway of severe sepsis, septic shock, and multiple organ failure before having a cardiac arrest, Dr. Carr noted. However, some patients go from developing severe infection straight to cardiopulmonary collapse, without developing severe sepsis or septic shock. Several clinical and epidemiologic studies have shown that not all patients with sepsis go down the typical progressive pathway (Curr. Opin. Anaesthesiol. 2008;21:128-40).

Dr. Carr and his colleagues at the University of Chicago Medical Center conducted the retrospective analysis using the American Heart Association’s Get With The Guidelines Resuscitation database, formerly known as the National Registry of Cardiopulmonary Resuscitation. The data covered 9 years and included 10% of hospitals (approximately 500) in North America.

The team analyzed 166,919 cardiopulmonary arrest events, 44,416 of which occurred within 72 hours after admission. They focused on 5,367 events in which patients had pneumonia as a preexisting condition (12% of the 44,416 events) prior to having their first pulseless event within 72 hours of hospital admission.

The median time from hospital admission to IHCA was 20.7 hours. Only 14.7% of patients with pneumonia and IHCA survived to hospital discharge, according to the analysis. Also, 19.3% of the IHCA events occurred in a general inpatient area, while 77.2% of IHCA events occurred in an intensive care or step-down unit.

At the time of IHCA, 40% of the patients were receiving mechanical ventilation, 12.2% had a central venous catheter in place, and 36.3% were receiving continuous infusions of vasoactive medications.

The analysis showed that arrhythmia was the most common cause of IHCA (65%) among that group of patients, followed by respiratory insufficiency (53.9%), and hypotension/hypoperfusion (49.8%).

In addition, the majority of the rhythms were not "shockable," said Dr. Carr, including pulseless electrical activity (45.2% of cases), asystole (38.4%), and ventricular fibrillation or tachycardia (16.4%).

The study had several limitations, Dr. Carr said. It is based on a large database, and "any huge set of data is going to have the inherent problem in terms of bias," he said. Also, the researchers couldn’t adjust for the severity of pneumonia, and they had no information on the processes of care, such as antibiotic administration.

Given the preliminary nature of the data, it is hard to draw firm conclusions, he noted. However, the study highlights the need for more research on cardiac arrest in pneumonia patients.

The take-away message for physicians is "to be alert to the possibility of abrupt collapse in pneumonia patients," and monitor those patients with comorbidities carefully, Dr. Carr cautioned.

Dr. Carr had no disclosures.

DENVER – Patients with pneumonia may be at risk of sudden cardiovascular collapse within the first 72 hours after admission to the hospital, according to the preliminary findings of a large retrospective analysis.

In addition, almost one in five of those in-hospital cardiac arrests (IHCA) occurred outside of the intensive care unit, and many of the patients were not receiving critical care interventions prior to the cardiac arrest, the study investigators found.

The findings "may indicate that current triage practices or other processes of care are inadequate," the researchers noted (Am. J. Respir. Crit. Care Med. 2011;183:A6339).

The new study is the first of its kind to analyze the characteristics of in-hospital cardiac arrest among pneumonia patients, Dr. Gordon E. Carr, the study’s lead author, said during a briefing at an international conference of the American Thoracic Society.

The sudden and rapid decline in pneumonia patients "is a problem that may happen in 1 in 10 patients but hasn’t received due attention, in part because it’s hard to study," said Dr. Carr, pulmonary and critical care fellow at the University of Chicago Medical Center. "There’s an unmet need to know more about what’s going on with these patients."

More than 1 million patients with pneumonia are admitted to hospitals each year, and 3.4% of in-hospital patient deaths are due to pneumonia, according to national data.

Patients with pneumonia are at risk of following a progressive pathway of severe sepsis, septic shock, and multiple organ failure before having a cardiac arrest, Dr. Carr noted. However, some patients go from developing severe infection straight to cardiopulmonary collapse, without developing severe sepsis or septic shock. Several clinical and epidemiologic studies have shown that not all patients with sepsis go down the typical progressive pathway (Curr. Opin. Anaesthesiol. 2008;21:128-40).

Dr. Carr and his colleagues at the University of Chicago Medical Center conducted the retrospective analysis using the American Heart Association’s Get With The Guidelines Resuscitation database, formerly known as the National Registry of Cardiopulmonary Resuscitation. The data covered 9 years and included 10% of hospitals (approximately 500) in North America.

The team analyzed 166,919 cardiopulmonary arrest events, 44,416 of which occurred within 72 hours after admission. They focused on 5,367 events in which patients had pneumonia as a preexisting condition (12% of the 44,416 events) prior to having their first pulseless event within 72 hours of hospital admission.

The median time from hospital admission to IHCA was 20.7 hours. Only 14.7% of patients with pneumonia and IHCA survived to hospital discharge, according to the analysis. Also, 19.3% of the IHCA events occurred in a general inpatient area, while 77.2% of IHCA events occurred in an intensive care or step-down unit.

At the time of IHCA, 40% of the patients were receiving mechanical ventilation, 12.2% had a central venous catheter in place, and 36.3% were receiving continuous infusions of vasoactive medications.

The analysis showed that arrhythmia was the most common cause of IHCA (65%) among that group of patients, followed by respiratory insufficiency (53.9%), and hypotension/hypoperfusion (49.8%).

In addition, the majority of the rhythms were not "shockable," said Dr. Carr, including pulseless electrical activity (45.2% of cases), asystole (38.4%), and ventricular fibrillation or tachycardia (16.4%).

The study had several limitations, Dr. Carr said. It is based on a large database, and "any huge set of data is going to have the inherent problem in terms of bias," he said. Also, the researchers couldn’t adjust for the severity of pneumonia, and they had no information on the processes of care, such as antibiotic administration.

Given the preliminary nature of the data, it is hard to draw firm conclusions, he noted. However, the study highlights the need for more research on cardiac arrest in pneumonia patients.

The take-away message for physicians is "to be alert to the possibility of abrupt collapse in pneumonia patients," and monitor those patients with comorbidities carefully, Dr. Carr cautioned.

Dr. Carr had no disclosures.

DENVER – Patients with pneumonia may be at risk of sudden cardiovascular collapse within the first 72 hours after admission to the hospital, according to the preliminary findings of a large retrospective analysis.

In addition, almost one in five of those in-hospital cardiac arrests (IHCA) occurred outside of the intensive care unit, and many of the patients were not receiving critical care interventions prior to the cardiac arrest, the study investigators found.

The findings "may indicate that current triage practices or other processes of care are inadequate," the researchers noted (Am. J. Respir. Crit. Care Med. 2011;183:A6339).

The new study is the first of its kind to analyze the characteristics of in-hospital cardiac arrest among pneumonia patients, Dr. Gordon E. Carr, the study’s lead author, said during a briefing at an international conference of the American Thoracic Society.

The sudden and rapid decline in pneumonia patients "is a problem that may happen in 1 in 10 patients but hasn’t received due attention, in part because it’s hard to study," said Dr. Carr, pulmonary and critical care fellow at the University of Chicago Medical Center. "There’s an unmet need to know more about what’s going on with these patients."

More than 1 million patients with pneumonia are admitted to hospitals each year, and 3.4% of in-hospital patient deaths are due to pneumonia, according to national data.

Patients with pneumonia are at risk of following a progressive pathway of severe sepsis, septic shock, and multiple organ failure before having a cardiac arrest, Dr. Carr noted. However, some patients go from developing severe infection straight to cardiopulmonary collapse, without developing severe sepsis or septic shock. Several clinical and epidemiologic studies have shown that not all patients with sepsis go down the typical progressive pathway (Curr. Opin. Anaesthesiol. 2008;21:128-40).

Dr. Carr and his colleagues at the University of Chicago Medical Center conducted the retrospective analysis using the American Heart Association’s Get With The Guidelines Resuscitation database, formerly known as the National Registry of Cardiopulmonary Resuscitation. The data covered 9 years and included 10% of hospitals (approximately 500) in North America.

The team analyzed 166,919 cardiopulmonary arrest events, 44,416 of which occurred within 72 hours after admission. They focused on 5,367 events in which patients had pneumonia as a preexisting condition (12% of the 44,416 events) prior to having their first pulseless event within 72 hours of hospital admission.

The median time from hospital admission to IHCA was 20.7 hours. Only 14.7% of patients with pneumonia and IHCA survived to hospital discharge, according to the analysis. Also, 19.3% of the IHCA events occurred in a general inpatient area, while 77.2% of IHCA events occurred in an intensive care or step-down unit.

At the time of IHCA, 40% of the patients were receiving mechanical ventilation, 12.2% had a central venous catheter in place, and 36.3% were receiving continuous infusions of vasoactive medications.

The analysis showed that arrhythmia was the most common cause of IHCA (65%) among that group of patients, followed by respiratory insufficiency (53.9%), and hypotension/hypoperfusion (49.8%).

In addition, the majority of the rhythms were not "shockable," said Dr. Carr, including pulseless electrical activity (45.2% of cases), asystole (38.4%), and ventricular fibrillation or tachycardia (16.4%).

The study had several limitations, Dr. Carr said. It is based on a large database, and "any huge set of data is going to have the inherent problem in terms of bias," he said. Also, the researchers couldn’t adjust for the severity of pneumonia, and they had no information on the processes of care, such as antibiotic administration.

Given the preliminary nature of the data, it is hard to draw firm conclusions, he noted. However, the study highlights the need for more research on cardiac arrest in pneumonia patients.

The take-away message for physicians is "to be alert to the possibility of abrupt collapse in pneumonia patients," and monitor those patients with comorbidities carefully, Dr. Carr cautioned.

Dr. Carr had no disclosures.

DENVER – Patients with pneumonia may be at risk of sudden cardiovascular collapse within the first 72 hours after admission to the hospital, according to the preliminary findings of a large retrospective analysis.

In addition, almost one in five of those in-hospital cardiac arrests (IHCA) occurred outside of the intensive care unit, and many of the patients were not receiving critical care interventions prior to the cardiac arrest, the study investigators found.

The findings "may indicate that current triage practices or other processes of care are inadequate," the researchers noted (Am. J. Respir. Crit. Care Med. 2011;183:A6339).

The new study is the first of its kind to analyze the characteristics of in-hospital cardiac arrest among pneumonia patients, Dr. Gordon E. Carr, the study’s lead author, said during a briefing at an international conference of the American Thoracic Society.

The sudden and rapid decline in pneumonia patients "is a problem that may happen in 1 in 10 patients but hasn’t received due attention, in part because it’s hard to study," said Dr. Carr, pulmonary and critical care fellow at the University of Chicago Medical Center. "There’s an unmet need to know more about what’s going on with these patients."

More than 1 million patients with pneumonia are admitted to hospitals each year, and 3.4% of in-hospital patient deaths are due to pneumonia, according to national data.

Patients with pneumonia are at risk of following a progressive pathway of severe sepsis, septic shock, and multiple organ failure before having a cardiac arrest, Dr. Carr noted. However, some patients go from developing severe infection straight to cardiopulmonary collapse, without developing severe sepsis or septic shock. Several clinical and epidemiologic studies have shown that not all patients with sepsis go down the typical progressive pathway (Curr. Opin. Anaesthesiol. 2008;21:128-40).

Dr. Carr and his colleagues at the University of Chicago Medical Center conducted the retrospective analysis using the American Heart Association’s Get With The Guidelines Resuscitation database, formerly known as the National Registry of Cardiopulmonary Resuscitation. The data covered 9 years and included 10% of hospitals (approximately 500) in North America.

The team analyzed 166,919 cardiopulmonary arrest events, 44,416 of which occurred within 72 hours after admission. They focused on 5,367 events in which patients had pneumonia as a preexisting condition (12% of the 44,416 events) prior to having their first pulseless event within 72 hours of hospital admission.

The median time from hospital admission to IHCA was 20.7 hours. Only 14.7% of patients with pneumonia and IHCA survived to hospital discharge, according to the analysis. Also, 19.3% of the IHCA events occurred in a general inpatient area, while 77.2% of IHCA events occurred in an intensive care or step-down unit.

At the time of IHCA, 40% of the patients were receiving mechanical ventilation, 12.2% had a central venous catheter in place, and 36.3% were receiving continuous infusions of vasoactive medications.

The analysis showed that arrhythmia was the most common cause of IHCA (65%) among that group of patients, followed by respiratory insufficiency (53.9%), and hypotension/hypoperfusion (49.8%).

In addition, the majority of the rhythms were not "shockable," said Dr. Carr, including pulseless electrical activity (45.2% of cases), asystole (38.4%), and ventricular fibrillation or tachycardia (16.4%).

The study had several limitations, Dr. Carr said. It is based on a large database, and "any huge set of data is going to have the inherent problem in terms of bias," he said. Also, the researchers couldn’t adjust for the severity of pneumonia, and they had no information on the processes of care, such as antibiotic administration.

Given the preliminary nature of the data, it is hard to draw firm conclusions, he noted. However, the study highlights the need for more research on cardiac arrest in pneumonia patients.

The take-away message for physicians is "to be alert to the possibility of abrupt collapse in pneumonia patients," and monitor those patients with comorbidities carefully, Dr. Carr cautioned.

Dr. Carr had no disclosures.

DENVER – Patients with pneumonia may be at risk of sudden cardiovascular collapse within the first 72 hours after admission to the hospital, according to the preliminary findings of a large retrospective analysis.

In addition, almost one in five of those in-hospital cardiac arrests (IHCA) occurred outside of the intensive care unit, and many of the patients were not receiving critical care interventions prior to the cardiac arrest, the study investigators found.

The findings "may indicate that current triage practices or other processes of care are inadequate," the researchers noted (Am. J. Respir. Crit. Care Med. 2011;183:A6339).

The new study is the first of its kind to analyze the characteristics of in-hospital cardiac arrest among pneumonia patients, Dr. Gordon E. Carr, the study’s lead author, said during a briefing at an international conference of the American Thoracic Society.

The sudden and rapid decline in pneumonia patients "is a problem that may happen in 1 in 10 patients but hasn’t received due attention, in part because it’s hard to study," said Dr. Carr, pulmonary and critical care fellow at the University of Chicago Medical Center. "There’s an unmet need to know more about what’s going on with these patients."

More than 1 million patients with pneumonia are admitted to hospitals each year, and 3.4% of in-hospital patient deaths are due to pneumonia, according to national data.

Patients with pneumonia are at risk of following a progressive pathway of severe sepsis, septic shock, and multiple organ failure before having a cardiac arrest, Dr. Carr noted. However, some patients go from developing severe infection straight to cardiopulmonary collapse, without developing severe sepsis or septic shock. Several clinical and epidemiologic studies have shown that not all patients with sepsis go down the typical progressive pathway (Curr. Opin. Anaesthesiol. 2008;21:128-40).

Dr. Carr and his colleagues at the University of Chicago Medical Center conducted the retrospective analysis using the American Heart Association’s Get With The Guidelines Resuscitation database, formerly known as the National Registry of Cardiopulmonary Resuscitation. The data covered 9 years and included 10% of hospitals (approximately 500) in North America.

The team analyzed 166,919 cardiopulmonary arrest events, 44,416 of which occurred within 72 hours after admission. They focused on 5,367 events in which patients had pneumonia as a preexisting condition (12% of the 44,416 events) prior to having their first pulseless event within 72 hours of hospital admission.

The median time from hospital admission to IHCA was 20.7 hours. Only 14.7% of patients with pneumonia and IHCA survived to hospital discharge, according to the analysis. Also, 19.3% of the IHCA events occurred in a general inpatient area, while 77.2% of IHCA events occurred in an intensive care or step-down unit.

At the time of IHCA, 40% of the patients were receiving mechanical ventilation, 12.2% had a central venous catheter in place, and 36.3% were receiving continuous infusions of vasoactive medications.

The analysis showed that arrhythmia was the most common cause of IHCA (65%) among that group of patients, followed by respiratory insufficiency (53.9%), and hypotension/hypoperfusion (49.8%).

In addition, the majority of the rhythms were not "shockable," said Dr. Carr, including pulseless electrical activity (45.2% of cases), asystole (38.4%), and ventricular fibrillation or tachycardia (16.4%).

The study had several limitations, Dr. Carr said. It is based on a large database, and "any huge set of data is going to have the inherent problem in terms of bias," he said. Also, the researchers couldn’t adjust for the severity of pneumonia, and they had no information on the processes of care, such as antibiotic administration.

Given the preliminary nature of the data, it is hard to draw firm conclusions, he noted. However, the study highlights the need for more research on cardiac arrest in pneumonia patients.

The take-away message for physicians is "to be alert to the possibility of abrupt collapse in pneumonia patients," and monitor those patients with comorbidities carefully, Dr. Carr cautioned.

Dr. Carr had no disclosures.

DENVER – Patients with pneumonia may be at risk of sudden cardiovascular collapse within the first 72 hours after admission to the hospital, according to the preliminary findings of a large retrospective analysis.

In addition, almost one in five of those in-hospital cardiac arrests (IHCA) occurred outside of the intensive care unit, and many of the patients were not receiving critical care interventions prior to the cardiac arrest, the study investigators found.

The findings "may indicate that current triage practices or other processes of care are inadequate," the researchers noted (Am. J. Respir. Crit. Care Med. 2011;183:A6339).

The new study is the first of its kind to analyze the characteristics of in-hospital cardiac arrest among pneumonia patients, Dr. Gordon E. Carr, the study’s lead author, said during a briefing at an international conference of the American Thoracic Society.

The sudden and rapid decline in pneumonia patients "is a problem that may happen in 1 in 10 patients but hasn’t received due attention, in part because it’s hard to study," said Dr. Carr, pulmonary and critical care fellow at the University of Chicago Medical Center. "There’s an unmet need to know more about what’s going on with these patients."

More than 1 million patients with pneumonia are admitted to hospitals each year, and 3.4% of in-hospital patient deaths are due to pneumonia, according to national data.

Patients with pneumonia are at risk of following a progressive pathway of severe sepsis, septic shock, and multiple organ failure before having a cardiac arrest, Dr. Carr noted. However, some patients go from developing severe infection straight to cardiopulmonary collapse, without developing severe sepsis or septic shock. Several clinical and epidemiologic studies have shown that not all patients with sepsis go down the typical progressive pathway (Curr. Opin. Anaesthesiol. 2008;21:128-40).

Dr. Carr and his colleagues at the University of Chicago Medical Center conducted the retrospective analysis using the American Heart Association’s Get With The Guidelines Resuscitation database, formerly known as the National Registry of Cardiopulmonary Resuscitation. The data covered 9 years and included 10% of hospitals (approximately 500) in North America.

The team analyzed 166,919 cardiopulmonary arrest events, 44,416 of which occurred within 72 hours after admission. They focused on 5,367 events in which patients had pneumonia as a preexisting condition (12% of the 44,416 events) prior to having their first pulseless event within 72 hours of hospital admission.

The median time from hospital admission to IHCA was 20.7 hours. Only 14.7% of patients with pneumonia and IHCA survived to hospital discharge, according to the analysis. Also, 19.3% of the IHCA events occurred in a general inpatient area, while 77.2% of IHCA events occurred in an intensive care or step-down unit.

At the time of IHCA, 40% of the patients were receiving mechanical ventilation, 12.2% had a central venous catheter in place, and 36.3% were receiving continuous infusions of vasoactive medications.

The analysis showed that arrhythmia was the most common cause of IHCA (65%) among that group of patients, followed by respiratory insufficiency (53.9%), and hypotension/hypoperfusion (49.8%).

In addition, the majority of the rhythms were not "shockable," said Dr. Carr, including pulseless electrical activity (45.2% of cases), asystole (38.4%), and ventricular fibrillation or tachycardia (16.4%).

The study had several limitations, Dr. Carr said. It is based on a large database, and "any huge set of data is going to have the inherent problem in terms of bias," he said. Also, the researchers couldn’t adjust for the severity of pneumonia, and they had no information on the processes of care, such as antibiotic administration.

Given the preliminary nature of the data, it is hard to draw firm conclusions, he noted. However, the study highlights the need for more research on cardiac arrest in pneumonia patients.

The take-away message for physicians is "to be alert to the possibility of abrupt collapse in pneumonia patients," and monitor those patients with comorbidities carefully, Dr. Carr cautioned.

Dr. Carr had no disclosures.

DENVER – Shorter combination therapy was at least as efficacious as conventional longer monotherapy for preventing tuberculosis in patients with latent infection, according to final results of the phase III PREVENT TB trial.

The trial, also known as TB Trials Consortium Study 26, was conducted among more than 8,000 patients with latent TB infection who were at high risk for progression.

After 33 months, the cumulative rate of TB disease was 0.19% in the group given 3 months of weekly rifapentine plus isoniazid under direct observation (3HP), compared with 0.43% in the group given 9 months of daily isoniazid on a self-administered basis (9H).

The difference between groups was well within the trial’s boundary set for noninferiority, lead investigator Dr. Timothy R. Sterling reported at an international conference of the American Thoracic Society.

In addition, although patients in the group given the shorter combination therapy were more likely to stop treatment specifically because of adverse events, they were still far more likely to complete treatment.

Taken together, the trial’s findings suggest that "3HP is an alternative to 9H for treatment of latent [TB] infection in persons at high risk for progression to tuberculosis," he said.

"3HP was as effective as 9H in this clinical trial, but in operational settings, 3HP could be more effective than 9H, particularly if 3HP is given under direct observation and 9H has completion rates of approximately 30%-60%," Dr. Sterling further noted. "And, with greater effectiveness, there would be more tuberculosis prevented."

The trial enrolled 8,053 patients older than 2 years of age from the United States, Canada, Brazil, and Spain who had a positive tuberculin skin test (or alternately, in the case of young children, close contact with someone with TB), plus factors putting them at high risk for progression.

The patients were randomly assigned in nearly equal numbers to two groups treated on an open-label basis.

The 3HP group was given once-weekly, directly observed treatment with rifapentine (brand name Priftin; 900 mg) plus isoniazid (brand name Nydrazid, also known as isonicotinic acid hydrazide or INH; 15-25 mg/kg) for 3 months. The 9H group was given daily self-administered isoniazid (5-15 mg/kg) for 9 months.

All patients also received vitamin B₆. They were followed up for 33 months from the time of enrollment.

The patients had a median age of 37 years and 58% were white, reported Dr. Sterling, who is a professor of medicine and director of epidemiology research in the division of infectious diseases at the Vanderbilt Institute for Global Health in Nashville, Tenn. Overall, 3% were HIV positive.

In modified intention-to-treat analyses, the cumulative rate of culture-confirmed TB was 0.19% in the rifapentine plus isoniazid group, compared with 0.43% in the isoniazid-only group. The upper bound of the 95% confidence interval for the difference between these rates was 0.01% – far below the trial’s predefined noninferiority margin of 0.75%.

In per-protocol analyses, the cumulative rates were 0.13% and 0.32%, respectively. The upper bound of the 95% confidence interval for the difference between these rates was 0.06%, again well below the noninferiority margin.

In additional findings, compared with the 9H isoniazid-only regimen, the 3HP rifapentine plus isoniazid regimen was associated with a higher treatment completion rate (82% vs. 69%) and a lower rate of hepatotoxicity caused by the drug(s) (0.5% vs. 2.7%).

However, the 3HP regimen was also associated with higher rates of any adverse event attributable to the drug(s) (8.1% vs. 5.5%) and of permanent drug discontinuation because of adverse events (4.7% vs. 3.6%). These findings might have been caused by the decreased tolerability of the combination regimen, Dr. Sterling speculated, or to this group’s more frequent contact with study personnel or the trial’s open-label design with a novel regimen.

Neither rates of grade 3 and 4 toxicity nor rates of death differed significantly between groups, he noted.

The Centers for Disease Control and Prevention and the American Thoracic Society will be updating their TB recommendations when the data are published, according to Dr. Sterling.

"Uptake of the [3HP] regimen will depend on availability of rifapentine; but the manufacturer, Sanofi-Aventis, is committed to this," he added.

It will be important for TB treatment programs to be able to monitor for adverse events, Dr. Sterling, cautioned, given that previous experience suggests some TB regimens have poorer tolerability when used in the general population than when used in a clinical trial.

The shorter, more potent TB treatment regimen might improve patient adherence, said Dr. Kenneth Castro, director of the Division of TB Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), at the Centers for Disease Control and Prevention.

"As someone who has been in the business of fighting TB for a long time, I can’t tell you how pleased I am to be able to offer a 3-month regimen: 12 doses and you are done," Dr. Castro said in a telebriefing May 16. Practitioners are always struggling to get patients to complete a 9-month regimen for TB, but with limited success, he said.

"This provides a fantastic opportunity to have the desired impact as a preventive therapy regimen [for TB]," Dr. Castro said.

Dr. Sterling reported that he had no relevant conflicts of interest. Sanofi-Aventis, manufacturer of rifapentine, provided the drug for the trial. Dr. Castro also had no relevant conflicts of interest.

DENVER – Shorter combination therapy was at least as efficacious as conventional longer monotherapy for preventing tuberculosis in patients with latent infection, according to final results of the phase III PREVENT TB trial.

The trial, also known as TB Trials Consortium Study 26, was conducted among more than 8,000 patients with latent TB infection who were at high risk for progression.

After 33 months, the cumulative rate of TB disease was 0.19% in the group given 3 months of weekly rifapentine plus isoniazid under direct observation (3HP), compared with 0.43% in the group given 9 months of daily isoniazid on a self-administered basis (9H).

The difference between groups was well within the trial’s boundary set for noninferiority, lead investigator Dr. Timothy R. Sterling reported at an international conference of the American Thoracic Society.

In addition, although patients in the group given the shorter combination therapy were more likely to stop treatment specifically because of adverse events, they were still far more likely to complete treatment.

Taken together, the trial’s findings suggest that "3HP is an alternative to 9H for treatment of latent [TB] infection in persons at high risk for progression to tuberculosis," he said.

"3HP was as effective as 9H in this clinical trial, but in operational settings, 3HP could be more effective than 9H, particularly if 3HP is given under direct observation and 9H has completion rates of approximately 30%-60%," Dr. Sterling further noted. "And, with greater effectiveness, there would be more tuberculosis prevented."

The trial enrolled 8,053 patients older than 2 years of age from the United States, Canada, Brazil, and Spain who had a positive tuberculin skin test (or alternately, in the case of young children, close contact with someone with TB), plus factors putting them at high risk for progression.

The patients were randomly assigned in nearly equal numbers to two groups treated on an open-label basis.

The 3HP group was given once-weekly, directly observed treatment with rifapentine (brand name Priftin; 900 mg) plus isoniazid (brand name Nydrazid, also known as isonicotinic acid hydrazide or INH; 15-25 mg/kg) for 3 months. The 9H group was given daily self-administered isoniazid (5-15 mg/kg) for 9 months.

All patients also received vitamin B₆. They were followed up for 33 months from the time of enrollment.

The patients had a median age of 37 years and 58% were white, reported Dr. Sterling, who is a professor of medicine and director of epidemiology research in the division of infectious diseases at the Vanderbilt Institute for Global Health in Nashville, Tenn. Overall, 3% were HIV positive.

In modified intention-to-treat analyses, the cumulative rate of culture-confirmed TB was 0.19% in the rifapentine plus isoniazid group, compared with 0.43% in the isoniazid-only group. The upper bound of the 95% confidence interval for the difference between these rates was 0.01% – far below the trial’s predefined noninferiority margin of 0.75%.

In per-protocol analyses, the cumulative rates were 0.13% and 0.32%, respectively. The upper bound of the 95% confidence interval for the difference between these rates was 0.06%, again well below the noninferiority margin.

In additional findings, compared with the 9H isoniazid-only regimen, the 3HP rifapentine plus isoniazid regimen was associated with a higher treatment completion rate (82% vs. 69%) and a lower rate of hepatotoxicity caused by the drug(s) (0.5% vs. 2.7%).

However, the 3HP regimen was also associated with higher rates of any adverse event attributable to the drug(s) (8.1% vs. 5.5%) and of permanent drug discontinuation because of adverse events (4.7% vs. 3.6%). These findings might have been caused by the decreased tolerability of the combination regimen, Dr. Sterling speculated, or to this group’s more frequent contact with study personnel or the trial’s open-label design with a novel regimen.

Neither rates of grade 3 and 4 toxicity nor rates of death differed significantly between groups, he noted.

The Centers for Disease Control and Prevention and the American Thoracic Society will be updating their TB recommendations when the data are published, according to Dr. Sterling.

"Uptake of the [3HP] regimen will depend on availability of rifapentine; but the manufacturer, Sanofi-Aventis, is committed to this," he added.

It will be important for TB treatment programs to be able to monitor for adverse events, Dr. Sterling, cautioned, given that previous experience suggests some TB regimens have poorer tolerability when used in the general population than when used in a clinical trial.

The shorter, more potent TB treatment regimen might improve patient adherence, said Dr. Kenneth Castro, director of the Division of TB Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), at the Centers for Disease Control and Prevention.

"As someone who has been in the business of fighting TB for a long time, I can’t tell you how pleased I am to be able to offer a 3-month regimen: 12 doses and you are done," Dr. Castro said in a telebriefing May 16. Practitioners are always struggling to get patients to complete a 9-month regimen for TB, but with limited success, he said.

"This provides a fantastic opportunity to have the desired impact as a preventive therapy regimen [for TB]," Dr. Castro said.

Dr. Sterling reported that he had no relevant conflicts of interest. Sanofi-Aventis, manufacturer of rifapentine, provided the drug for the trial. Dr. Castro also had no relevant conflicts of interest.

DENVER – Shorter combination therapy was at least as efficacious as conventional longer monotherapy for preventing tuberculosis in patients with latent infection, according to final results of the phase III PREVENT TB trial.

The trial, also known as TB Trials Consortium Study 26, was conducted among more than 8,000 patients with latent TB infection who were at high risk for progression.

After 33 months, the cumulative rate of TB disease was 0.19% in the group given 3 months of weekly rifapentine plus isoniazid under direct observation (3HP), compared with 0.43% in the group given 9 months of daily isoniazid on a self-administered basis (9H).

The difference between groups was well within the trial’s boundary set for noninferiority, lead investigator Dr. Timothy R. Sterling reported at an international conference of the American Thoracic Society.

In addition, although patients in the group given the shorter combination therapy were more likely to stop treatment specifically because of adverse events, they were still far more likely to complete treatment.

Taken together, the trial’s findings suggest that "3HP is an alternative to 9H for treatment of latent [TB] infection in persons at high risk for progression to tuberculosis," he said.

"3HP was as effective as 9H in this clinical trial, but in operational settings, 3HP could be more effective than 9H, particularly if 3HP is given under direct observation and 9H has completion rates of approximately 30%-60%," Dr. Sterling further noted. "And, with greater effectiveness, there would be more tuberculosis prevented."

The trial enrolled 8,053 patients older than 2 years of age from the United States, Canada, Brazil, and Spain who had a positive tuberculin skin test (or alternately, in the case of young children, close contact with someone with TB), plus factors putting them at high risk for progression.

The patients were randomly assigned in nearly equal numbers to two groups treated on an open-label basis.

The 3HP group was given once-weekly, directly observed treatment with rifapentine (brand name Priftin; 900 mg) plus isoniazid (brand name Nydrazid, also known as isonicotinic acid hydrazide or INH; 15-25 mg/kg) for 3 months. The 9H group was given daily self-administered isoniazid (5-15 mg/kg) for 9 months.

All patients also received vitamin B₆. They were followed up for 33 months from the time of enrollment.

The patients had a median age of 37 years and 58% were white, reported Dr. Sterling, who is a professor of medicine and director of epidemiology research in the division of infectious diseases at the Vanderbilt Institute for Global Health in Nashville, Tenn. Overall, 3% were HIV positive.

In modified intention-to-treat analyses, the cumulative rate of culture-confirmed TB was 0.19% in the rifapentine plus isoniazid group, compared with 0.43% in the isoniazid-only group. The upper bound of the 95% confidence interval for the difference between these rates was 0.01% – far below the trial’s predefined noninferiority margin of 0.75%.

In per-protocol analyses, the cumulative rates were 0.13% and 0.32%, respectively. The upper bound of the 95% confidence interval for the difference between these rates was 0.06%, again well below the noninferiority margin.

In additional findings, compared with the 9H isoniazid-only regimen, the 3HP rifapentine plus isoniazid regimen was associated with a higher treatment completion rate (82% vs. 69%) and a lower rate of hepatotoxicity caused by the drug(s) (0.5% vs. 2.7%).

However, the 3HP regimen was also associated with higher rates of any adverse event attributable to the drug(s) (8.1% vs. 5.5%) and of permanent drug discontinuation because of adverse events (4.7% vs. 3.6%). These findings might have been caused by the decreased tolerability of the combination regimen, Dr. Sterling speculated, or to this group’s more frequent contact with study personnel or the trial’s open-label design with a novel regimen.

Neither rates of grade 3 and 4 toxicity nor rates of death differed significantly between groups, he noted.

The Centers for Disease Control and Prevention and the American Thoracic Society will be updating their TB recommendations when the data are published, according to Dr. Sterling.

"Uptake of the [3HP] regimen will depend on availability of rifapentine; but the manufacturer, Sanofi-Aventis, is committed to this," he added.

It will be important for TB treatment programs to be able to monitor for adverse events, Dr. Sterling, cautioned, given that previous experience suggests some TB regimens have poorer tolerability when used in the general population than when used in a clinical trial.

The shorter, more potent TB treatment regimen might improve patient adherence, said Dr. Kenneth Castro, director of the Division of TB Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), at the Centers for Disease Control and Prevention.

"As someone who has been in the business of fighting TB for a long time, I can’t tell you how pleased I am to be able to offer a 3-month regimen: 12 doses and you are done," Dr. Castro said in a telebriefing May 16. Practitioners are always struggling to get patients to complete a 9-month regimen for TB, but with limited success, he said.

"This provides a fantastic opportunity to have the desired impact as a preventive therapy regimen [for TB]," Dr. Castro said.

Dr. Sterling reported that he had no relevant conflicts of interest. Sanofi-Aventis, manufacturer of rifapentine, provided the drug for the trial. Dr. Castro also had no relevant conflicts of interest.

DENVER – Shorter combination therapy was at least as efficacious as conventional longer monotherapy for preventing tuberculosis in patients with latent infection, according to final results of the phase III PREVENT TB trial.

The trial, also known as TB Trials Consortium Study 26, was conducted among more than 8,000 patients with latent TB infection who were at high risk for progression.

After 33 months, the cumulative rate of TB disease was 0.19% in the group given 3 months of weekly rifapentine plus isoniazid under direct observation (3HP), compared with 0.43% in the group given 9 months of daily isoniazid on a self-administered basis (9H).

The difference between groups was well within the trial’s boundary set for noninferiority, lead investigator Dr. Timothy R. Sterling reported at an international conference of the American Thoracic Society.

In addition, although patients in the group given the shorter combination therapy were more likely to stop treatment specifically because of adverse events, they were still far more likely to complete treatment.

Taken together, the trial’s findings suggest that "3HP is an alternative to 9H for treatment of latent [TB] infection in persons at high risk for progression to tuberculosis," he said.

"3HP was as effective as 9H in this clinical trial, but in operational settings, 3HP could be more effective than 9H, particularly if 3HP is given under direct observation and 9H has completion rates of approximately 30%-60%," Dr. Sterling further noted. "And, with greater effectiveness, there would be more tuberculosis prevented."

The trial enrolled 8,053 patients older than 2 years of age from the United States, Canada, Brazil, and Spain who had a positive tuberculin skin test (or alternately, in the case of young children, close contact with someone with TB), plus factors putting them at high risk for progression.

The patients were randomly assigned in nearly equal numbers to two groups treated on an open-label basis.

The 3HP group was given once-weekly, directly observed treatment with rifapentine (brand name Priftin; 900 mg) plus isoniazid (brand name Nydrazid, also known as isonicotinic acid hydrazide or INH; 15-25 mg/kg) for 3 months. The 9H group was given daily self-administered isoniazid (5-15 mg/kg) for 9 months.

All patients also received vitamin B₆. They were followed up for 33 months from the time of enrollment.

The patients had a median age of 37 years and 58% were white, reported Dr. Sterling, who is a professor of medicine and director of epidemiology research in the division of infectious diseases at the Vanderbilt Institute for Global Health in Nashville, Tenn. Overall, 3% were HIV positive.

In modified intention-to-treat analyses, the cumulative rate of culture-confirmed TB was 0.19% in the rifapentine plus isoniazid group, compared with 0.43% in the isoniazid-only group. The upper bound of the 95% confidence interval for the difference between these rates was 0.01% – far below the trial’s predefined noninferiority margin of 0.75%.

In per-protocol analyses, the cumulative rates were 0.13% and 0.32%, respectively. The upper bound of the 95% confidence interval for the difference between these rates was 0.06%, again well below the noninferiority margin.

In additional findings, compared with the 9H isoniazid-only regimen, the 3HP rifapentine plus isoniazid regimen was associated with a higher treatment completion rate (82% vs. 69%) and a lower rate of hepatotoxicity caused by the drug(s) (0.5% vs. 2.7%).

However, the 3HP regimen was also associated with higher rates of any adverse event attributable to the drug(s) (8.1% vs. 5.5%) and of permanent drug discontinuation because of adverse events (4.7% vs. 3.6%). These findings might have been caused by the decreased tolerability of the combination regimen, Dr. Sterling speculated, or to this group’s more frequent contact with study personnel or the trial’s open-label design with a novel regimen.

Neither rates of grade 3 and 4 toxicity nor rates of death differed significantly between groups, he noted.

The Centers for Disease Control and Prevention and the American Thoracic Society will be updating their TB recommendations when the data are published, according to Dr. Sterling.

"Uptake of the [3HP] regimen will depend on availability of rifapentine; but the manufacturer, Sanofi-Aventis, is committed to this," he added.

It will be important for TB treatment programs to be able to monitor for adverse events, Dr. Sterling, cautioned, given that previous experience suggests some TB regimens have poorer tolerability when used in the general population than when used in a clinical trial.

The shorter, more potent TB treatment regimen might improve patient adherence, said Dr. Kenneth Castro, director of the Division of TB Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), at the Centers for Disease Control and Prevention.

"As someone who has been in the business of fighting TB for a long time, I can’t tell you how pleased I am to be able to offer a 3-month regimen: 12 doses and you are done," Dr. Castro said in a telebriefing May 16. Practitioners are always struggling to get patients to complete a 9-month regimen for TB, but with limited success, he said.

"This provides a fantastic opportunity to have the desired impact as a preventive therapy regimen [for TB]," Dr. Castro said.

Dr. Sterling reported that he had no relevant conflicts of interest. Sanofi-Aventis, manufacturer of rifapentine, provided the drug for the trial. Dr. Castro also had no relevant conflicts of interest.

DENVER – Shorter combination therapy was at least as efficacious as conventional longer monotherapy for preventing tuberculosis in patients with latent infection, according to final results of the phase III PREVENT TB trial.

The trial, also known as TB Trials Consortium Study 26, was conducted among more than 8,000 patients with latent TB infection who were at high risk for progression.

After 33 months, the cumulative rate of TB disease was 0.19% in the group given 3 months of weekly rifapentine plus isoniazid under direct observation (3HP), compared with 0.43% in the group given 9 months of daily isoniazid on a self-administered basis (9H).

The difference between groups was well within the trial’s boundary set for noninferiority, lead investigator Dr. Timothy R. Sterling reported at an international conference of the American Thoracic Society.

In addition, although patients in the group given the shorter combination therapy were more likely to stop treatment specifically because of adverse events, they were still far more likely to complete treatment.

Taken together, the trial’s findings suggest that "3HP is an alternative to 9H for treatment of latent [TB] infection in persons at high risk for progression to tuberculosis," he said.

"3HP was as effective as 9H in this clinical trial, but in operational settings, 3HP could be more effective than 9H, particularly if 3HP is given under direct observation and 9H has completion rates of approximately 30%-60%," Dr. Sterling further noted. "And, with greater effectiveness, there would be more tuberculosis prevented."

The trial enrolled 8,053 patients older than 2 years of age from the United States, Canada, Brazil, and Spain who had a positive tuberculin skin test (or alternately, in the case of young children, close contact with someone with TB), plus factors putting them at high risk for progression.

The patients were randomly assigned in nearly equal numbers to two groups treated on an open-label basis.

The 3HP group was given once-weekly, directly observed treatment with rifapentine (brand name Priftin; 900 mg) plus isoniazid (brand name Nydrazid, also known as isonicotinic acid hydrazide or INH; 15-25 mg/kg) for 3 months. The 9H group was given daily self-administered isoniazid (5-15 mg/kg) for 9 months.

All patients also received vitamin B₆. They were followed up for 33 months from the time of enrollment.

The patients had a median age of 37 years and 58% were white, reported Dr. Sterling, who is a professor of medicine and director of epidemiology research in the division of infectious diseases at the Vanderbilt Institute for Global Health in Nashville, Tenn. Overall, 3% were HIV positive.

In modified intention-to-treat analyses, the cumulative rate of culture-confirmed TB was 0.19% in the rifapentine plus isoniazid group, compared with 0.43% in the isoniazid-only group. The upper bound of the 95% confidence interval for the difference between these rates was 0.01% – far below the trial’s predefined noninferiority margin of 0.75%.

In per-protocol analyses, the cumulative rates were 0.13% and 0.32%, respectively. The upper bound of the 95% confidence interval for the difference between these rates was 0.06%, again well below the noninferiority margin.

In additional findings, compared with the 9H isoniazid-only regimen, the 3HP rifapentine plus isoniazid regimen was associated with a higher treatment completion rate (82% vs. 69%) and a lower rate of hepatotoxicity caused by the drug(s) (0.5% vs. 2.7%).

However, the 3HP regimen was also associated with higher rates of any adverse event attributable to the drug(s) (8.1% vs. 5.5%) and of permanent drug discontinuation because of adverse events (4.7% vs. 3.6%). These findings might have been caused by the decreased tolerability of the combination regimen, Dr. Sterling speculated, or to this group’s more frequent contact with study personnel or the trial’s open-label design with a novel regimen.

Neither rates of grade 3 and 4 toxicity nor rates of death differed significantly between groups, he noted.

The Centers for Disease Control and Prevention and the American Thoracic Society will be updating their TB recommendations when the data are published, according to Dr. Sterling.

"Uptake of the [3HP] regimen will depend on availability of rifapentine; but the manufacturer, Sanofi-Aventis, is committed to this," he added.

It will be important for TB treatment programs to be able to monitor for adverse events, Dr. Sterling, cautioned, given that previous experience suggests some TB regimens have poorer tolerability when used in the general population than when used in a clinical trial.

The shorter, more potent TB treatment regimen might improve patient adherence, said Dr. Kenneth Castro, director of the Division of TB Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), at the Centers for Disease Control and Prevention.

"As someone who has been in the business of fighting TB for a long time, I can’t tell you how pleased I am to be able to offer a 3-month regimen: 12 doses and you are done," Dr. Castro said in a telebriefing May 16. Practitioners are always struggling to get patients to complete a 9-month regimen for TB, but with limited success, he said.

"This provides a fantastic opportunity to have the desired impact as a preventive therapy regimen [for TB]," Dr. Castro said.

Dr. Sterling reported that he had no relevant conflicts of interest. Sanofi-Aventis, manufacturer of rifapentine, provided the drug for the trial. Dr. Castro also had no relevant conflicts of interest.

DENVER – Shorter combination therapy was at least as efficacious as conventional longer monotherapy for preventing tuberculosis in patients with latent infection, according to final results of the phase III PREVENT TB trial.

The trial, also known as TB Trials Consortium Study 26, was conducted among more than 8,000 patients with latent TB infection who were at high risk for progression.

After 33 months, the cumulative rate of TB disease was 0.19% in the group given 3 months of weekly rifapentine plus isoniazid under direct observation (3HP), compared with 0.43% in the group given 9 months of daily isoniazid on a self-administered basis (9H).

The difference between groups was well within the trial’s boundary set for noninferiority, lead investigator Dr. Timothy R. Sterling reported at an international conference of the American Thoracic Society.

In addition, although patients in the group given the shorter combination therapy were more likely to stop treatment specifically because of adverse events, they were still far more likely to complete treatment.

Taken together, the trial’s findings suggest that "3HP is an alternative to 9H for treatment of latent [TB] infection in persons at high risk for progression to tuberculosis," he said.

"3HP was as effective as 9H in this clinical trial, but in operational settings, 3HP could be more effective than 9H, particularly if 3HP is given under direct observation and 9H has completion rates of approximately 30%-60%," Dr. Sterling further noted. "And, with greater effectiveness, there would be more tuberculosis prevented."

The trial enrolled 8,053 patients older than 2 years of age from the United States, Canada, Brazil, and Spain who had a positive tuberculin skin test (or alternately, in the case of young children, close contact with someone with TB), plus factors putting them at high risk for progression.

The patients were randomly assigned in nearly equal numbers to two groups treated on an open-label basis.

The 3HP group was given once-weekly, directly observed treatment with rifapentine (brand name Priftin; 900 mg) plus isoniazid (brand name Nydrazid, also known as isonicotinic acid hydrazide or INH; 15-25 mg/kg) for 3 months. The 9H group was given daily self-administered isoniazid (5-15 mg/kg) for 9 months.

All patients also received vitamin B₆. They were followed up for 33 months from the time of enrollment.

The patients had a median age of 37 years and 58% were white, reported Dr. Sterling, who is a professor of medicine and director of epidemiology research in the division of infectious diseases at the Vanderbilt Institute for Global Health in Nashville, Tenn. Overall, 3% were HIV positive.

In modified intention-to-treat analyses, the cumulative rate of culture-confirmed TB was 0.19% in the rifapentine plus isoniazid group, compared with 0.43% in the isoniazid-only group. The upper bound of the 95% confidence interval for the difference between these rates was 0.01% – far below the trial’s predefined noninferiority margin of 0.75%.

In per-protocol analyses, the cumulative rates were 0.13% and 0.32%, respectively. The upper bound of the 95% confidence interval for the difference between these rates was 0.06%, again well below the noninferiority margin.

In additional findings, compared with the 9H isoniazid-only regimen, the 3HP rifapentine plus isoniazid regimen was associated with a higher treatment completion rate (82% vs. 69%) and a lower rate of hepatotoxicity caused by the drug(s) (0.5% vs. 2.7%).

However, the 3HP regimen was also associated with higher rates of any adverse event attributable to the drug(s) (8.1% vs. 5.5%) and of permanent drug discontinuation because of adverse events (4.7% vs. 3.6%). These findings might have been caused by the decreased tolerability of the combination regimen, Dr. Sterling speculated, or to this group’s more frequent contact with study personnel or the trial’s open-label design with a novel regimen.

Neither rates of grade 3 and 4 toxicity nor rates of death differed significantly between groups, he noted.

The Centers for Disease Control and Prevention and the American Thoracic Society will be updating their TB recommendations when the data are published, according to Dr. Sterling.

"Uptake of the [3HP] regimen will depend on availability of rifapentine; but the manufacturer, Sanofi-Aventis, is committed to this," he added.

It will be important for TB treatment programs to be able to monitor for adverse events, Dr. Sterling, cautioned, given that previous experience suggests some TB regimens have poorer tolerability when used in the general population than when used in a clinical trial.

The shorter, more potent TB treatment regimen might improve patient adherence, said Dr. Kenneth Castro, director of the Division of TB Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), at the Centers for Disease Control and Prevention.

"As someone who has been in the business of fighting TB for a long time, I can’t tell you how pleased I am to be able to offer a 3-month regimen: 12 doses and you are done," Dr. Castro said in a telebriefing May 16. Practitioners are always struggling to get patients to complete a 9-month regimen for TB, but with limited success, he said.

"This provides a fantastic opportunity to have the desired impact as a preventive therapy regimen [for TB]," Dr. Castro said.

Dr. Sterling reported that he had no relevant conflicts of interest. Sanofi-Aventis, manufacturer of rifapentine, provided the drug for the trial. Dr. Castro also had no relevant conflicts of interest.

DENVER – Shorter combination therapy was at least as efficacious as conventional longer monotherapy for preventing tuberculosis in patients with latent infection, according to final results of the phase III PREVENT TB trial.

The trial, also known as TB Trials Consortium Study 26, was conducted among more than 8,000 patients with latent TB infection who were at high risk for progression.

After 33 months, the cumulative rate of TB disease was 0.19% in the group given 3 months of weekly rifapentine plus isoniazid under direct observation (3HP), compared with 0.43% in the group given 9 months of daily isoniazid on a self-administered basis (9H).

The difference between groups was well within the trial’s boundary set for noninferiority, lead investigator Dr. Timothy R. Sterling reported at an international conference of the American Thoracic Society.

In addition, although patients in the group given the shorter combination therapy were more likely to stop treatment specifically because of adverse events, they were still far more likely to complete treatment.

Taken together, the trial’s findings suggest that "3HP is an alternative to 9H for treatment of latent [TB] infection in persons at high risk for progression to tuberculosis," he said.

"3HP was as effective as 9H in this clinical trial, but in operational settings, 3HP could be more effective than 9H, particularly if 3HP is given under direct observation and 9H has completion rates of approximately 30%-60%," Dr. Sterling further noted. "And, with greater effectiveness, there would be more tuberculosis prevented."

The trial enrolled 8,053 patients older than 2 years of age from the United States, Canada, Brazil, and Spain who had a positive tuberculin skin test (or alternately, in the case of young children, close contact with someone with TB), plus factors putting them at high risk for progression.

The patients were randomly assigned in nearly equal numbers to two groups treated on an open-label basis.

The 3HP group was given once-weekly, directly observed treatment with rifapentine (brand name Priftin; 900 mg) plus isoniazid (brand name Nydrazid, also known as isonicotinic acid hydrazide or INH; 15-25 mg/kg) for 3 months. The 9H group was given daily self-administered isoniazid (5-15 mg/kg) for 9 months.

All patients also received vitamin B₆. They were followed up for 33 months from the time of enrollment.

The patients had a median age of 37 years and 58% were white, reported Dr. Sterling, who is a professor of medicine and director of epidemiology research in the division of infectious diseases at the Vanderbilt Institute for Global Health in Nashville, Tenn. Overall, 3% were HIV positive.

In modified intention-to-treat analyses, the cumulative rate of culture-confirmed TB was 0.19% in the rifapentine plus isoniazid group, compared with 0.43% in the isoniazid-only group. The upper bound of the 95% confidence interval for the difference between these rates was 0.01% – far below the trial’s predefined noninferiority margin of 0.75%.

In per-protocol analyses, the cumulative rates were 0.13% and 0.32%, respectively. The upper bound of the 95% confidence interval for the difference between these rates was 0.06%, again well below the noninferiority margin.

In additional findings, compared with the 9H isoniazid-only regimen, the 3HP rifapentine plus isoniazid regimen was associated with a higher treatment completion rate (82% vs. 69%) and a lower rate of hepatotoxicity caused by the drug(s) (0.5% vs. 2.7%).

However, the 3HP regimen was also associated with higher rates of any adverse event attributable to the drug(s) (8.1% vs. 5.5%) and of permanent drug discontinuation because of adverse events (4.7% vs. 3.6%). These findings might have been caused by the decreased tolerability of the combination regimen, Dr. Sterling speculated, or to this group’s more frequent contact with study personnel or the trial’s open-label design with a novel regimen.

Neither rates of grade 3 and 4 toxicity nor rates of death differed significantly between groups, he noted.

The Centers for Disease Control and Prevention and the American Thoracic Society will be updating their TB recommendations when the data are published, according to Dr. Sterling.

"Uptake of the [3HP] regimen will depend on availability of rifapentine; but the manufacturer, Sanofi-Aventis, is committed to this," he added.

It will be important for TB treatment programs to be able to monitor for adverse events, Dr. Sterling, cautioned, given that previous experience suggests some TB regimens have poorer tolerability when used in the general population than when used in a clinical trial.

The shorter, more potent TB treatment regimen might improve patient adherence, said Dr. Kenneth Castro, director of the Division of TB Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), at the Centers for Disease Control and Prevention.

"As someone who has been in the business of fighting TB for a long time, I can’t tell you how pleased I am to be able to offer a 3-month regimen: 12 doses and you are done," Dr. Castro said in a telebriefing May 16. Practitioners are always struggling to get patients to complete a 9-month regimen for TB, but with limited success, he said.

"This provides a fantastic opportunity to have the desired impact as a preventive therapy regimen [for TB]," Dr. Castro said.

Dr. Sterling reported that he had no relevant conflicts of interest. Sanofi-Aventis, manufacturer of rifapentine, provided the drug for the trial. Dr. Castro also had no relevant conflicts of interest.

DENVER – Shorter combination therapy was at least as efficacious as conventional longer monotherapy for preventing tuberculosis in patients with latent infection, according to final results of the phase III PREVENT TB trial.

The trial, also known as TB Trials Consortium Study 26, was conducted among more than 8,000 patients with latent TB infection who were at high risk for progression.

After 33 months, the cumulative rate of TB disease was 0.19% in the group given 3 months of weekly rifapentine plus isoniazid under direct observation (3HP), compared with 0.43% in the group given 9 months of daily isoniazid on a self-administered basis (9H).

The difference between groups was well within the trial’s boundary set for noninferiority, lead investigator Dr. Timothy R. Sterling reported at an international conference of the American Thoracic Society.

In addition, although patients in the group given the shorter combination therapy were more likely to stop treatment specifically because of adverse events, they were still far more likely to complete treatment.

Taken together, the trial’s findings suggest that "3HP is an alternative to 9H for treatment of latent [TB] infection in persons at high risk for progression to tuberculosis," he said.

"3HP was as effective as 9H in this clinical trial, but in operational settings, 3HP could be more effective than 9H, particularly if 3HP is given under direct observation and 9H has completion rates of approximately 30%-60%," Dr. Sterling further noted. "And, with greater effectiveness, there would be more tuberculosis prevented."

The trial enrolled 8,053 patients older than 2 years of age from the United States, Canada, Brazil, and Spain who had a positive tuberculin skin test (or alternately, in the case of young children, close contact with someone with TB), plus factors putting them at high risk for progression.

The patients were randomly assigned in nearly equal numbers to two groups treated on an open-label basis.

The 3HP group was given once-weekly, directly observed treatment with rifapentine (brand name Priftin; 900 mg) plus isoniazid (brand name Nydrazid, also known as isonicotinic acid hydrazide or INH; 15-25 mg/kg) for 3 months. The 9H group was given daily self-administered isoniazid (5-15 mg/kg) for 9 months.

All patients also received vitamin B₆. They were followed up for 33 months from the time of enrollment.

The patients had a median age of 37 years and 58% were white, reported Dr. Sterling, who is a professor of medicine and director of epidemiology research in the division of infectious diseases at the Vanderbilt Institute for Global Health in Nashville, Tenn. Overall, 3% were HIV positive.

In modified intention-to-treat analyses, the cumulative rate of culture-confirmed TB was 0.19% in the rifapentine plus isoniazid group, compared with 0.43% in the isoniazid-only group. The upper bound of the 95% confidence interval for the difference between these rates was 0.01% – far below the trial’s predefined noninferiority margin of 0.75%.

In per-protocol analyses, the cumulative rates were 0.13% and 0.32%, respectively. The upper bound of the 95% confidence interval for the difference between these rates was 0.06%, again well below the noninferiority margin.

In additional findings, compared with the 9H isoniazid-only regimen, the 3HP rifapentine plus isoniazid regimen was associated with a higher treatment completion rate (82% vs. 69%) and a lower rate of hepatotoxicity caused by the drug(s) (0.5% vs. 2.7%).

However, the 3HP regimen was also associated with higher rates of any adverse event attributable to the drug(s) (8.1% vs. 5.5%) and of permanent drug discontinuation because of adverse events (4.7% vs. 3.6%). These findings might have been caused by the decreased tolerability of the combination regimen, Dr. Sterling speculated, or to this group’s more frequent contact with study personnel or the trial’s open-label design with a novel regimen.

Neither rates of grade 3 and 4 toxicity nor rates of death differed significantly between groups, he noted.

The Centers for Disease Control and Prevention and the American Thoracic Society will be updating their TB recommendations when the data are published, according to Dr. Sterling.

"Uptake of the [3HP] regimen will depend on availability of rifapentine; but the manufacturer, Sanofi-Aventis, is committed to this," he added.

It will be important for TB treatment programs to be able to monitor for adverse events, Dr. Sterling, cautioned, given that previous experience suggests some TB regimens have poorer tolerability when used in the general population than when used in a clinical trial.

The shorter, more potent TB treatment regimen might improve patient adherence, said Dr. Kenneth Castro, director of the Division of TB Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), at the Centers for Disease Control and Prevention.

"As someone who has been in the business of fighting TB for a long time, I can’t tell you how pleased I am to be able to offer a 3-month regimen: 12 doses and you are done," Dr. Castro said in a telebriefing May 16. Practitioners are always struggling to get patients to complete a 9-month regimen for TB, but with limited success, he said.

"This provides a fantastic opportunity to have the desired impact as a preventive therapy regimen [for TB]," Dr. Castro said.

Dr. Sterling reported that he had no relevant conflicts of interest. Sanofi-Aventis, manufacturer of rifapentine, provided the drug for the trial. Dr. Castro also had no relevant conflicts of interest.

DENVER – Shorter combination therapy was at least as efficacious as conventional longer monotherapy for preventing tuberculosis in patients with latent infection, according to final results of the phase III PREVENT TB trial.

The trial, also known as TB Trials Consortium Study 26, was conducted among more than 8,000 patients with latent TB infection who were at high risk for progression.

After 33 months, the cumulative rate of TB disease was 0.19% in the group given 3 months of weekly rifapentine plus isoniazid under direct observation (3HP), compared with 0.43% in the group given 9 months of daily isoniazid on a self-administered basis (9H).

The difference between groups was well within the trial’s boundary set for noninferiority, lead investigator Dr. Timothy R. Sterling reported at an international conference of the American Thoracic Society.

In addition, although patients in the group given the shorter combination therapy were more likely to stop treatment specifically because of adverse events, they were still far more likely to complete treatment.

Taken together, the trial’s findings suggest that "3HP is an alternative to 9H for treatment of latent [TB] infection in persons at high risk for progression to tuberculosis," he said.

"3HP was as effective as 9H in this clinical trial, but in operational settings, 3HP could be more effective than 9H, particularly if 3HP is given under direct observation and 9H has completion rates of approximately 30%-60%," Dr. Sterling further noted. "And, with greater effectiveness, there would be more tuberculosis prevented."

The trial enrolled 8,053 patients older than 2 years of age from the United States, Canada, Brazil, and Spain who had a positive tuberculin skin test (or alternately, in the case of young children, close contact with someone with TB), plus factors putting them at high risk for progression.

The patients were randomly assigned in nearly equal numbers to two groups treated on an open-label basis.

The 3HP group was given once-weekly, directly observed treatment with rifapentine (brand name Priftin; 900 mg) plus isoniazid (brand name Nydrazid, also known as isonicotinic acid hydrazide or INH; 15-25 mg/kg) for 3 months. The 9H group was given daily self-administered isoniazid (5-15 mg/kg) for 9 months.

All patients also received vitamin B₆. They were followed up for 33 months from the time of enrollment.

The patients had a median age of 37 years and 58% were white, reported Dr. Sterling, who is a professor of medicine and director of epidemiology research in the division of infectious diseases at the Vanderbilt Institute for Global Health in Nashville, Tenn. Overall, 3% were HIV positive.

In modified intention-to-treat analyses, the cumulative rate of culture-confirmed TB was 0.19% in the rifapentine plus isoniazid group, compared with 0.43% in the isoniazid-only group. The upper bound of the 95% confidence interval for the difference between these rates was 0.01% – far below the trial’s predefined noninferiority margin of 0.75%.

In per-protocol analyses, the cumulative rates were 0.13% and 0.32%, respectively. The upper bound of the 95% confidence interval for the difference between these rates was 0.06%, again well below the noninferiority margin.

In additional findings, compared with the 9H isoniazid-only regimen, the 3HP rifapentine plus isoniazid regimen was associated with a higher treatment completion rate (82% vs. 69%) and a lower rate of hepatotoxicity caused by the drug(s) (0.5% vs. 2.7%).

However, the 3HP regimen was also associated with higher rates of any adverse event attributable to the drug(s) (8.1% vs. 5.5%) and of permanent drug discontinuation because of adverse events (4.7% vs. 3.6%). These findings might have been caused by the decreased tolerability of the combination regimen, Dr. Sterling speculated, or to this group’s more frequent contact with study personnel or the trial’s open-label design with a novel regimen.

Neither rates of grade 3 and 4 toxicity nor rates of death differed significantly between groups, he noted.

The Centers for Disease Control and Prevention and the American Thoracic Society will be updating their TB recommendations when the data are published, according to Dr. Sterling.

"Uptake of the [3HP] regimen will depend on availability of rifapentine; but the manufacturer, Sanofi-Aventis, is committed to this," he added.

It will be important for TB treatment programs to be able to monitor for adverse events, Dr. Sterling, cautioned, given that previous experience suggests some TB regimens have poorer tolerability when used in the general population than when used in a clinical trial.

The shorter, more potent TB treatment regimen might improve patient adherence, said Dr. Kenneth Castro, director of the Division of TB Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), at the Centers for Disease Control and Prevention.

"As someone who has been in the business of fighting TB for a long time, I can’t tell you how pleased I am to be able to offer a 3-month regimen: 12 doses and you are done," Dr. Castro said in a telebriefing May 16. Practitioners are always struggling to get patients to complete a 9-month regimen for TB, but with limited success, he said.

"This provides a fantastic opportunity to have the desired impact as a preventive therapy regimen [for TB]," Dr. Castro said.

Dr. Sterling reported that he had no relevant conflicts of interest. Sanofi-Aventis, manufacturer of rifapentine, provided the drug for the trial. Dr. Castro also had no relevant conflicts of interest.

DENVER – An intensive care unit telemedicine intervention was associated with lower hospital and ICU mortality and shorter hospital and ICU lengths of stay in a prospective, unblinded study conducted at one academic medical center over a 2-year period.

The intervention also was associated with significantly higher rates of adherence to critical care best practices and lower rates of complications. More rapid responses to alerts for physiologic instability and off-hours, off-site intensivist care plan reviews were identified as critical care process elements that may have contributed to the lower mortality and shorter lengths of stay associated with the tele-ICU intervention, Dr. Craig M. Lilly reported at an international conference of the American Thoracic Society. The study was simultaneously published online in JAMA (2011;305:E1-9 [doi:10.1001/jama.2011.697]).

Tele-ICU is defined as the provision of care to critically ill patients by health care professionals located remotely. Tele-ICU clinicians use audio, video, and electronic links to assist bedside caregivers in monitoring patients, oversee best practice adherence, and help create and execute care plans, said Dr. Lilly of the University of Massachusetts, Worcester.

Unlike previous studies of the effects of tele-ICU programs, this one focused on changes in the process of care rather than the ICU structure. Prior to the study start, best practices were standardized for the prevention of venous thrombosis, cardiovascular complications, ventilator-associated pneumonia, and stress ulcers. For the primary analysis, a representative sample of preintervention cases was obtained by identifying consecutive hospital discharges from an administrative database for cases managed in each of the seven ICUs (three medical, three surgical, and one mixed cardiovascular). Admission, discharge, and laboratory information was abstracted electronically.

The off-site team included an intensivist and used tele-ICU workstations. The tele-ICU team serially reviewed the care of individual patients, performed real-time audits of best practice adherence, performed workstation-assisted care plan reviews for patients admitted at night, monitored system-generated electronic alerts, audited bedside clinician responses to in-room alarms, and intervened when the responses of bedside clinicians were delayed and patients were deemed physiologically unstable. The off-site team was able to communicate with bedside clinicians or directly manage patients by recording clinician orders for tests, treatments, consultations, and management of life-support devices, Dr. Lilly said.

A total of 6,290 qualifying adult patients were identified from 6,465 electronic admission registrations to any of the seven ICUs, with 1,529 admitted during the preintervention period and 4,761 during the tele-ICU intervention period (the periods were staggered between 2005 and 2007).

Unadjusted ICU mortality was significantly lower in the tele-ICU group, compared with the preintervention group (10.7% vs. 8.6%). When adjusted for acuity, locus of care, physiologic parameters, laboratory values, and time trend, the odds ratio was 0.37. Hospital mortality also was reduced with tele-ICU (13.6% vs. 11.8%). The unadjusted difference was not statistically significant, but hospital mortality was significantly lower with tele-ICU after adjustment for acuity, locus of care, physiological parameters, laboratory values, and time trend, with an odds ratio of 0.40.

Both ICU and hospital mean lengths of stay were significantly lower with tele-ICU. The intervention group had a mean hospital stay of 9.8 days, compared with 13.3 days in the preintervention group. After adjustment for acuity, time trends, physiologic parameters, laboratory values, and locus of care, the hazard ratio was 1.44. For ICU stay, the mean was 4.5 days in the tele-ICU group vs. 6.4 days in the preintervention group. After adjustment for all of the previously listed factors, that hazard ratio was 1.26. Results for medical, surgical, and cardiovascular ICUs were similar, Dr. Lilly said.

To understand how tele-ICU team activities affected care processes and to evaluate the degree to which the association of the intervention with changes in mortality could be attributed to these changes in process, another analysis examined adherence to best practices, incidence of common ICU complications, intensivist involvement for cases admitted during nighttime hours, responses to alerts, and ICU type.

The tele-ICU intervention was associated with significantly better adherence to deep vein thrombosis prevention best practices and cardiovascular protection best practices, as well as lower rates of catheter-related bloodstream infection and ventilator-associated pneumonia. These factors also were associated with significantly lower ICU and hospital mortality. The proportion of the tele-ICU association with lower mortality that could be attributed to adherence to these best practices and complication measures was estimated to be 25% for hospital mortality and 30% for ICU mortality.

"This suggests that there are benefits of a tele-ICU intervention beyond what is provided by daytime bedside intensivist staffing and traditional approaches to quality improvement such as the process changes presented," Dr. Lilly commented.

"These findings suggest that critical care programs that implement processes that increase adherence to best practice, lower rates of complications, shorten response times to alerts and alarms, and support early intensivist case involvement will provide better care at a lower cost. ... Our study suggests that the introduction of a tele-ICU program that collaborates with and supports bedside clinicians is one way to accomplish these aims."

All study authors reported having no conflicts of interest.

DENVER – An intensive care unit telemedicine intervention was associated with lower hospital and ICU mortality and shorter hospital and ICU lengths of stay in a prospective, unblinded study conducted at one academic medical center over a 2-year period.

The intervention also was associated with significantly higher rates of adherence to critical care best practices and lower rates of complications. More rapid responses to alerts for physiologic instability and off-hours, off-site intensivist care plan reviews were identified as critical care process elements that may have contributed to the lower mortality and shorter lengths of stay associated with the tele-ICU intervention, Dr. Craig M. Lilly reported at an international conference of the American Thoracic Society. The study was simultaneously published online in JAMA (2011;305:E1-9 [doi:10.1001/jama.2011.697]).

Tele-ICU is defined as the provision of care to critically ill patients by health care professionals located remotely. Tele-ICU clinicians use audio, video, and electronic links to assist bedside caregivers in monitoring patients, oversee best practice adherence, and help create and execute care plans, said Dr. Lilly of the University of Massachusetts, Worcester.

Unlike previous studies of the effects of tele-ICU programs, this one focused on changes in the process of care rather than the ICU structure. Prior to the study start, best practices were standardized for the prevention of venous thrombosis, cardiovascular complications, ventilator-associated pneumonia, and stress ulcers. For the primary analysis, a representative sample of preintervention cases was obtained by identifying consecutive hospital discharges from an administrative database for cases managed in each of the seven ICUs (three medical, three surgical, and one mixed cardiovascular). Admission, discharge, and laboratory information was abstracted electronically.

The off-site team included an intensivist and used tele-ICU workstations. The tele-ICU team serially reviewed the care of individual patients, performed real-time audits of best practice adherence, performed workstation-assisted care plan reviews for patients admitted at night, monitored system-generated electronic alerts, audited bedside clinician responses to in-room alarms, and intervened when the responses of bedside clinicians were delayed and patients were deemed physiologically unstable. The off-site team was able to communicate with bedside clinicians or directly manage patients by recording clinician orders for tests, treatments, consultations, and management of life-support devices, Dr. Lilly said.

A total of 6,290 qualifying adult patients were identified from 6,465 electronic admission registrations to any of the seven ICUs, with 1,529 admitted during the preintervention period and 4,761 during the tele-ICU intervention period (the periods were staggered between 2005 and 2007).

Unadjusted ICU mortality was significantly lower in the tele-ICU group, compared with the preintervention group (10.7% vs. 8.6%). When adjusted for acuity, locus of care, physiologic parameters, laboratory values, and time trend, the odds ratio was 0.37. Hospital mortality also was reduced with tele-ICU (13.6% vs. 11.8%). The unadjusted difference was not statistically significant, but hospital mortality was significantly lower with tele-ICU after adjustment for acuity, locus of care, physiological parameters, laboratory values, and time trend, with an odds ratio of 0.40.

Both ICU and hospital mean lengths of stay were significantly lower with tele-ICU. The intervention group had a mean hospital stay of 9.8 days, compared with 13.3 days in the preintervention group. After adjustment for acuity, time trends, physiologic parameters, laboratory values, and locus of care, the hazard ratio was 1.44. For ICU stay, the mean was 4.5 days in the tele-ICU group vs. 6.4 days in the preintervention group. After adjustment for all of the previously listed factors, that hazard ratio was 1.26. Results for medical, surgical, and cardiovascular ICUs were similar, Dr. Lilly said.

To understand how tele-ICU team activities affected care processes and to evaluate the degree to which the association of the intervention with changes in mortality could be attributed to these changes in process, another analysis examined adherence to best practices, incidence of common ICU complications, intensivist involvement for cases admitted during nighttime hours, responses to alerts, and ICU type.

The tele-ICU intervention was associated with significantly better adherence to deep vein thrombosis prevention best practices and cardiovascular protection best practices, as well as lower rates of catheter-related bloodstream infection and ventilator-associated pneumonia. These factors also were associated with significantly lower ICU and hospital mortality. The proportion of the tele-ICU association with lower mortality that could be attributed to adherence to these best practices and complication measures was estimated to be 25% for hospital mortality and 30% for ICU mortality.

"This suggests that there are benefits of a tele-ICU intervention beyond what is provided by daytime bedside intensivist staffing and traditional approaches to quality improvement such as the process changes presented," Dr. Lilly commented.

"These findings suggest that critical care programs that implement processes that increase adherence to best practice, lower rates of complications, shorten response times to alerts and alarms, and support early intensivist case involvement will provide better care at a lower cost. ... Our study suggests that the introduction of a tele-ICU program that collaborates with and supports bedside clinicians is one way to accomplish these aims."

All study authors reported having no conflicts of interest.

DENVER – An intensive care unit telemedicine intervention was associated with lower hospital and ICU mortality and shorter hospital and ICU lengths of stay in a prospective, unblinded study conducted at one academic medical center over a 2-year period.

The intervention also was associated with significantly higher rates of adherence to critical care best practices and lower rates of complications. More rapid responses to alerts for physiologic instability and off-hours, off-site intensivist care plan reviews were identified as critical care process elements that may have contributed to the lower mortality and shorter lengths of stay associated with the tele-ICU intervention, Dr. Craig M. Lilly reported at an international conference of the American Thoracic Society. The study was simultaneously published online in JAMA (2011;305:E1-9 [doi:10.1001/jama.2011.697]).

Tele-ICU is defined as the provision of care to critically ill patients by health care professionals located remotely. Tele-ICU clinicians use audio, video, and electronic links to assist bedside caregivers in monitoring patients, oversee best practice adherence, and help create and execute care plans, said Dr. Lilly of the University of Massachusetts, Worcester.

Unlike previous studies of the effects of tele-ICU programs, this one focused on changes in the process of care rather than the ICU structure. Prior to the study start, best practices were standardized for the prevention of venous thrombosis, cardiovascular complications, ventilator-associated pneumonia, and stress ulcers. For the primary analysis, a representative sample of preintervention cases was obtained by identifying consecutive hospital discharges from an administrative database for cases managed in each of the seven ICUs (three medical, three surgical, and one mixed cardiovascular). Admission, discharge, and laboratory information was abstracted electronically.

The off-site team included an intensivist and used tele-ICU workstations. The tele-ICU team serially reviewed the care of individual patients, performed real-time audits of best practice adherence, performed workstation-assisted care plan reviews for patients admitted at night, monitored system-generated electronic alerts, audited bedside clinician responses to in-room alarms, and intervened when the responses of bedside clinicians were delayed and patients were deemed physiologically unstable. The off-site team was able to communicate with bedside clinicians or directly manage patients by recording clinician orders for tests, treatments, consultations, and management of life-support devices, Dr. Lilly said.

A total of 6,290 qualifying adult patients were identified from 6,465 electronic admission registrations to any of the seven ICUs, with 1,529 admitted during the preintervention period and 4,761 during the tele-ICU intervention period (the periods were staggered between 2005 and 2007).

Unadjusted ICU mortality was significantly lower in the tele-ICU group, compared with the preintervention group (10.7% vs. 8.6%). When adjusted for acuity, locus of care, physiologic parameters, laboratory values, and time trend, the odds ratio was 0.37. Hospital mortality also was reduced with tele-ICU (13.6% vs. 11.8%). The unadjusted difference was not statistically significant, but hospital mortality was significantly lower with tele-ICU after adjustment for acuity, locus of care, physiological parameters, laboratory values, and time trend, with an odds ratio of 0.40.

Both ICU and hospital mean lengths of stay were significantly lower with tele-ICU. The intervention group had a mean hospital stay of 9.8 days, compared with 13.3 days in the preintervention group. After adjustment for acuity, time trends, physiologic parameters, laboratory values, and locus of care, the hazard ratio was 1.44. For ICU stay, the mean was 4.5 days in the tele-ICU group vs. 6.4 days in the preintervention group. After adjustment for all of the previously listed factors, that hazard ratio was 1.26. Results for medical, surgical, and cardiovascular ICUs were similar, Dr. Lilly said.

To understand how tele-ICU team activities affected care processes and to evaluate the degree to which the association of the intervention with changes in mortality could be attributed to these changes in process, another analysis examined adherence to best practices, incidence of common ICU complications, intensivist involvement for cases admitted during nighttime hours, responses to alerts, and ICU type.

The tele-ICU intervention was associated with significantly better adherence to deep vein thrombosis prevention best practices and cardiovascular protection best practices, as well as lower rates of catheter-related bloodstream infection and ventilator-associated pneumonia. These factors also were associated with significantly lower ICU and hospital mortality. The proportion of the tele-ICU association with lower mortality that could be attributed to adherence to these best practices and complication measures was estimated to be 25% for hospital mortality and 30% for ICU mortality.

"This suggests that there are benefits of a tele-ICU intervention beyond what is provided by daytime bedside intensivist staffing and traditional approaches to quality improvement such as the process changes presented," Dr. Lilly commented.

"These findings suggest that critical care programs that implement processes that increase adherence to best practice, lower rates of complications, shorten response times to alerts and alarms, and support early intensivist case involvement will provide better care at a lower cost. ... Our study suggests that the introduction of a tele-ICU program that collaborates with and supports bedside clinicians is one way to accomplish these aims."

All study authors reported having no conflicts of interest.