The edition · Internal Medicine
Five things to do before a sepsis survivor goes home
An expert panel prioritises the discharge steps that matter after sepsis; an alert doubled echocardiography after pulmonary embolism; night-time care contacts tracked with ICU delirium; and alcohol-use medicines still leave hospital with one patient in nine.
The edition in brief
A RAND/UCLA expert panel rated 18 practices to support recovery from sepsis and prioritised five as valid, important and only moderately resource-intensive: booking follow-up before discharge, screening for limits in daily activities and equipment needs, teaching the signs of recurrent sepsis, warning about common after-effects such as fatigue and brain fog, and counselling on discharge medicines. In CTEPH-DETECT, a quasi-cluster randomised trial of 400 outpatients with prior pulmonary embolism and suggestive symptoms, an electronic alert raised echocardiography ordering from 17.5% to 32.5% (aOR 2.23) and pulmonary hypertension detection from 5.0% to 10.5%; no new chronic thromboembolic pulmonary hypertension was diagnosed. A target-trial emulation in 12,922 ICU stays associated higher early night-time care contacts with incident delirium (aHR 1.43, 1.27–1.60), most for vital-sign charting and blood draws; reverse causation is possible. In two US hospitals, only 11% of 4,232 admissions with alcohol use disorder ended with a new prescription for an alcohol-use medicine; longer stays, care-management input and teaching or family medicine teams were associated with higher prescribing.
An alert doubled echocardiography for possible pulmonary hypertension after embolism
Consider echocardiography for a patient still breathless months after a pulmonary embolism; most eligible patients here never had one.
More night-time care contacts early in an ICU stay tracked with delirium
Consider clustering or deferring non-urgent night-time checks in stable patients; frequent overnight contacts were associated with delirium.
Only one in nine admissions with alcohol use disorder ended with a medicine for it
Treat the admission as a chance to start medicine for alcohol use disorder; most eligible patients here left without it.
Give thiamine before glucose in a patient who drinks heavily
Give parenteral thiamine before or with glucose to any patient at risk from heavy drinking or malnutrition.
Five discharge steps an expert panel prioritised for sepsis survivors
Before a sepsis survivor goes home, book follow-up, check daily function, teach warning signs and after-effects, and go through each medicine.
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