The edition · Emergency & Critical Care
An Indian ICU trial found chlorhexidine added nothing to a good oral-care bundle
Removing chlorhexidine did not raise pneumonia rates, every hour of delay to antifungals in Candida shock tracked with lower survival, and recommended paediatric CPR ventilation rates were not linked to outcome.
The edition in brief
A cluster-randomised crossover trial in six medical ICUs in Bhubaneswar (Critical Care, 29 October) found adding 0.12% chlorhexidine to a standardised oral-care bundle did not reduce ventilator-associated pneumonia (18.8 vs 16.9 per 1000 ventilator-days; IRR 1.08) or 28-day mortality, and ICU stay was about 0.9 days longer. In 850 patients with culture-positive Candida septic shock across 32 hospitals (Critical Care Medicine, 21 October), survival was 86% when an appropriate antifungal started within two hours of persistent hypotension and fell about 5% per hour of delay thereafter; the median delay was 32 hours. An ICU-RESUS ancillary cohort of 234 paediatric in-hospital arrests (Critical Care Medicine, 14 October) found ventilation rates within the recommended 20 to 30 per minute were not associated with survival; exploratory analysis suggested higher rates may help under-8s. The FDA lists a supplement to an epinephrine new drug application dated 19 October; the record does not state its content. The pearl covers waveform capnography after intubation.
In Candida septic shock, each hour of antifungal delay tracked with lower survival
In septic shock with Candida risk factors, consider starting an appropriate antifungal early rather than waiting for cultures.
Recommended paediatric CPR ventilation rates were not linked to survival
Measure ventilation rate during paediatric CPR and keep to current targets until age-specific thresholds are tested.
FDA lists a supplement to an epinephrine new drug application
Note the epinephrine label supplement, but do not change practice until its content is known.
Confirm every tube with waveform capnography
Confirm tracheal tube placement with a sustained capnography waveform and keep it attached.
Chlorhexidine did not reduce ventilator-associated pneumonia in medical ICUs
In medical ICUs, keep a full oral-care bundle but consider dropping routine chlorhexidine.
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