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Expertise in airway management is a vital skill for any provider caring for critically ill patients. A growing body of literature has identified the stark difference in periprocedural outcomes of elective intubation in the operating room when compared with emergency intubation in the ICU. A number of strategies to reduce the morbidity and mortality associated with airway management in the critically ill have been described. In this review, we provide an updated framework for airway assessment before direct laryngoscopy and video laryngoscopy, and use of newer pharmacologic agents; comment on current concepts in tracheal intubation in the ICU; and address human factors around critical decision-making during ICU airway management.

The rates of central line-associated bloodstream infections (CLABSIs) in U.S. ICUs have decreased significantly, and a parallel reduction in the rates of total hospital-onset bacteremias in these units should also be expected. We report 10-year trends for total hospital-onset ICU-associated bacteremias at a tertiary-care academic medical center.

Immobilisation predicts adverse outcomes in patients in the surgical intensive care unit (SICU). Attempts to mobilise critically ill patients early after surgery are frequently restricted, but we tested whether early mobilisation leads to improved mobility, decreased SICU length of stay, and increased functional independence of patients at hospital discharge.

Published ahead of print October 22, 2013

Airway management in the ICU can be complicated due to many factors including the limited physiologic reserve of the patient. As a consequence, the likelihood of difficult mask ventilation and intubation increases. The incidence of failed airways and of cardiac arrest related to airway instrumentation in the ICU is much higher than that of elective intubations performed in the operating room. A thorough working knowledge of the devices available for the management of the difficult airway and recommended rescue strategies is paramount in avoiding bad patient outcomes. In this review, we will provide a conceptual framework for airway assessment, with an emphasis on assessment of the patient with limited cervical spine movement or injury and of morbidly obese patients. Furthermore, we will review the devices that are available for airway management in the ICU, and discuss controversies surrounding interventions like cricoid pressure and the use of muscle relaxants in the critically ill patient. Finally, strategies for the safe extubation of patients with known difficult airways will be provided.

HYPOTHESIS We sought to determine whether the administration of preoperative antibiotics, intraoperative transfusion of blood products, and intraoperative hypothermia has any impact on the incidence of postoperative surgical site infections (SSIs) in a heterogeneous patient population undergoing bowel surgery. DESIGN Retrospective analysis. SETTING From September through December 2002, data on 1472 patients undergoing bowel surgery at 31 academic medical centers in the United States were collected. PATIENTS Patients were included in the analysis if they were older than 17 years of age and underwent any surgery involving the small bowel, colon, or rectum. MAIN OUTCOME MEASURE Postoperative SSI. Variables that might affect the risk for developing SSIs were analyzed using multivariate logistic regression analysis. RESULTS Perioperative transfusion (P = .04; odds ratio, 1.64), and the presence of any infection at the time of surgery (P = .05; odds ratio, 2.46) were independent risk factors for SSI. Patients with a lower intraoperative temperature nadir had a lower risk for SSI (P = .05; odds ratio, 1.33), although this difference is not clinically significant (35.8°C ± 0.8°C vs 36.0°C ± 0.9°C, P<.05). There was a trend toward statistical significance for wound class when added to the multivariate model (P = .09; odds ratio, 1.41). The administration of antibiotics within 120 minutes prior to incision or within 120 minutes prior to and 120 minutes after incision had no effect on SSIs in this patient population. CONCLUSIONS This study validates perioperative transfusion as an independent risk factor for SSI. The lack of effectiveness of perioperative antibiotic prophylaxis is surprising because it is discordant with the previous literature, and this finding needs further evaluation.Arch Surg. 2006;141:1014-1018--

We compared the duration of antimicrobial effectiveness of 2 different antimicrobial catheters. The baseline activity of minocycline-rifampin catheters was greater than that of silver-platinum-carbon catheters against Staphylococcus aureus, Staphylococcus epidermidis, and Enterococcus faecalis. The antimicrobial activity of the minocycline-rifampin catheters against these pathogens persisted for up to 12 days, while that of the silver-platinum-carbon catheters was depleted by day 10 (P< .05).