Adjunctive homeopathic treatment in patients with severe sepsis: a randomized, double-blind, placebo-controlled trial in an intensive care unit

BACKGROUND

Mortality in patients with severe sepsis remains high despite the development of several therapeutic strategies. The aim of this randomized, double-blind, placebo-controlled trial was to evaluate whether homeopathy is able to influence long-term outcome in critically ill patients suffering from severe sepsis.

METHODS

Seventy patients with severe sepsis received homeopathic treatment (n = 35) or placebo (n = 35). Five globules in a potency of 200c were given at 12h interval during the stay at the intensive care unit. Survival after a 30 and 180 days was recorded.

RESULTS

Three patients (2 homeopathy, 1 placebo) were excluded from the analyses because of incomplete data. All these patients survived. Baseline characteristics including age, sex, BMI, prior conditions, APACHE II score, signs of sepsis, number of organ failures, need for mechanical ventilation, need for vasopressors or veno-venous hemofiltration, and laboratory parameters were not significantly different between groups. On day 30, there was non-statistically significantly trend of survival in favour of homeopathy (verum 81.8%, placebo 67.7%, P= 0.19). On day 180, survival was statistically significantly higher with verum homeopathy (75.8% vs 50.0%, P = 0.043). No adverse effects were observed.

CONCLUSIONS

Our data suggest that homeopathic treatment may be a useful additional therapeutic measure with a long-term benefit for severely septic patients admitted to the intensive care unit. A constraint to wider application of this method is the limited number of trained homeopaths.

Thrombus formation on the balloon of heparin-bonded pulmonary artery catheters: an ultrastructural scanning electron microscope study

OBJECTIVE

To investigate heparin-bonded pulmonary artery catheters with respect to thrombus formation and platelet aggregation at the balloon and the shaft using a scanning electron microscope in critically ill patients.

DESIGN

Prospective study.

SETTINGS

Critical care unit and research laboratories.

PATIENTS

Pulmonary artery catheters were inserted in critically ill patients (n = 10).

INTERVENTIONS

Pulmonary artery catheters were removed after 24, 48, 72, or 120 hrs, and the ultrastructure was investigated in specialized research laboratories.

MEASUREMENTS AND MAIN RESULTS

Balloon and shaft were investigated using a scanning electron microscopic technique. Area of thrombus formation was quantified using image analysis. Heparin release of the catheters was measured. The frequency of balloon inflations was investigated in in vitro experiments by inflating catheters different times (0, 10, 20, and 30 times). Twenty-four hours after catheter insertion, scanning electron microscopic images showed thrombus formation and platelet aggregation at the site of the balloon. Seventy-two hours after catheter insertion, a thrombus started to detach. The areas of thrombus formation did not differ, but thrombus organization changed dramatically 72 and 120 hrs after catheter insertion. The shaft was colonized by single cells only. Cracks of the balloon could be observed after 72 hrs, whereas no cracks could be found in in vitro controls. In vitro, heparin release of the pulmonary artery catheters decreased significantly after 24 hrs.

CONCLUSIONS

Scanning electron microscopic images of heparin-bonded pulmonary artery catheters demonstrate thrombus formation on the balloon 24 hrs after pulmonary artery catheter insertion, increasing dramatically at 72 and 120 hrs. The shaft was colonized by single cells only. The thrombus size is not significantly different during the observation time, but the grade and quality of thrombus formation differ.

[Effect of various dressings on the point of entry of an intravenous drip]

In modern health care systems nosocomial infection is a major cause of patient suffering and leads to high financial costs. Overall nursing care that is part of nursing staff's daily routine is not brought under scrutiny often enough. The goal of this research project is to look at a small part only of optimal intravenous drip care. The focus of the paper is the influence that the use of two different kinds of dressings and two different types of cleansing methods have on the general appearance, as well as the microbiological results at the point of entry of the i.v. drip into the central veins. In order to examine this, test patients from different types of intensive care units were used for an experiment under highly controlled conditions. The results show that a variation in nursing care of the i.v. drip leads to a variation in germ development and in the general appearance at the point of entry.

Emergency intubation with the Combitube: comparison with the endotracheal airway

STUDY OBJECTIVE

To evaluate the safety and effectiveness of the Combitude as used by ICU nurses under medical supervision compared with endotracheal airway established by ICU physicians during CPR.

DESIGN

Prospective study of ICU patients over a seven-month period.

SETTING

Medical ICU.

PARTICIPANTS

Thirty-seven patients suffering from cardiac arrest.

INTERVENTIONS

Emergency intubation with either the Combitube by nurses or the endotracheal airway by physicians and subsequent mechanical ventilation.

MEASUREMENTS AND MAIN RESULTS

Evaluation of blood gases after 20 minutes of mechanical ventilation. Intubation time was shorter for the Combitube (P < .001). Blood gases for each device showed comparable results; PaO2 was slightly higher during ventilation with the Combitube (P < .001).

CONCLUSION

The Combitube as used by ICU nurses was as effective as establishment of the endotracheal airway by intensivists during CPR. The Combitube may be used whenever endotracheal intubation cannot be performed immediately.