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Articles from Other Journals

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New Drugs: Where Did We Go Wrong and What Can We Do Better? Wieseler B, McGauran N, Kaiser T. BMJ. 2019 Jul 10;366:l4340. (7-20-19)

C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations. Butler CC, Gillespie D, White P, et al. N Engl J Med. 2019 Jul 11;381(2):111-120. (7-12-19)

Effect of Pressure Support vs T-Piece Ventilation Strategies During Spontaneous Breathing Trials on Successful Extubation Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial. Subirà C, Hernández G, Vázquez A. et al. JAMA. 2019;321(22):2175-82. (6-11-19)

Derivation, Validation, and Potential Treatment Implications of Novel Clinical Phenotypes for Sepsis. Seymour CW, Kennedy JN, Wang S, et al. JAMA. 2019 May 19. (5-30-19)

Association of Unrecognized Obstructive Sleep Apnea with Postoperative Cardiovascular Events in Patients Undergoing Major Noncardiac Surgery. Chan MTV, Wang CY, Seet E, et al. JAMA. 2019 May 14;321(18):1788-98. (5-21-19)

CPAP Adherence May Slow 1-Year Cognitive Decline in Older Adults with Mild Cognitive Impairment and Apnea.  Richards KC, Gooneratne N, Dicicco B, et al. J Am Geriatr Soc. 2019 Mar;67(3):558-64. (5-12-19)

Almost Half of Physicians Say EHRs Have Hurt Quality of Care. Frellick M. Medscape. May 01, 2019. (5-2-19)

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S. Am J Respir Crit Care Med. 2019 Feb 1. [Epub ahead of print] (4-15-19)

Association of Positive Airway Pressure Prescription with Mortality in Patients with Obesity and Severe Obstructive Sleep Apnea: The Sleep Heart Health Study. Lisan Q, Van Sloten T, Marques Vidal P, Haba Rubio J, Heinzer R, Empana JP. JAMA Otolaryngol Head Neck Surg. 2019 Apr 11. (4-12-19)

Effect of Glucose Improvement on Spirometric Maneuvers in Patients with Type 2 Diabetes: The Sweet Breath Study. Gutiérrez-Carrasquilla L, Sánchez E, Barbé F, et al. Diabetes Care. 2019 Apr;42(4):617-24. (4-12-19)

Whole-Genome Sequencing of Pharmacogenetic Drug Response in Racially Diverse Children with Asthma. Mak ACY, White MJ, Eckalbar WL, et al. Am J Respir Crit Care Med. 2018 Jun 15;197(12):1552-64. (3-26-19)

Patient Safety Outcomes under Flexible and Standard Resident Duty-Hour Rules and Sleep and Alertness in a Duty-Hour Flexibility Trial in Internal Medicine. Silber JH, Bellini LM, Shea JA, et al. N Engl J Med 2019; 380:905-14 and 915-23. (3-7-19)

Factors Associated with High-Quality Guidelines for the Pharmacologic Management of Chronic Diseases in Primary Care: A Systematic Review. Molino CGRC, Leite-Santos NC, Gabriel FC, et al. JAMA Intern Med. 2019 Feb 18. (2-25-19)

Effect of Titrating Positive End-Expiratory Pressure (PEEP) With an Esophageal Pressure-Guided Strategy vs an Empirical High PEEP-Fio2 Strategy on Death and Days Free from Mechanical Ventilation Among Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. Beitler JR, Sarge T, Banner-Goodspeed VM, et al. JAMA. 2019 Feb 18. [Epub ahead of print] (2-21-19)

Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals. Rhee C, Jones TM, Hamad Y, et al. JAMA Netw Open. 2019 Feb 1;2(2):e187571. (2-19-19)

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S. Am J Respir Crit Care Med. 2019 Feb 1 [Epub ahead of print].  (2-4-19)

A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. Hajek P, Phillips-Waller A, Przulj D, et al. N Engl J Med. 2019 Jan 30. [Epub ahead of print]. (1-31-19)

Pantoprazole in Patients at Risk for Gastrointestinal Bleeding in the ICU. Krag M, Marker S, Perner A, et al. N Engl J Med. 2018 Dec 6;379(23):2199-2208. (1-30-19)

Comparison of Wait Times for New Patients Between the Private Sector and United States Department of Veterans Affairs Medical Centers. Penn M, Bhatnagar S, Kuy S, Lieberman S, Elnahal S, Clancy C, Shulkin D. JAMA Netw Open. 2019 Jan 4;2(1):e187096. (1-21-19)  

The Importance of Smoking Cessation on Surgical Outcome in Primary Lung Cancer. Fukui M, Suzuki K, Matsunaga T, Oh S, Takamochi K. Ann Thorac Surg. 2019 Jan 2. pii: S0003-4975(18)31871-X. (1-20-19)

FDA Warns About Increased Risk of Ruptures or Tears in the Aorta Blood Vessel With Fluoroquinolone Antibiotics in Certain Patients. US Food and Drug Administration. December 20, 2018. (12/22/18).

Optimizing Home Oxygen Therapy. An Official American Thoracic Society Workshop Report. Jacobs SS, Lederer DJ, Garvey CM, et al. Ann Am Thorac Soc. 2018 Dec;15(12):1369-81. (12-13-18)

FDA Approves First Treatment for Lambert-Eaton Myasthenic Syndrome, A Rare Autoimmune Disorder. FDA News Releast. Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm627093.htm (12-4-18)

Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients with Undifferentiated Hypotension? Atkinson PR, Milne J, Diegelmann L, et al. Ann Emerg Med. 2018 Oct;72(4):478-89. (11-8-18)

E-cigarette Use and Subsequent Smoking Frequency Among Adolescents. Barrington-Trimis JL, Kong G, Leventhal AM, et al. Pediatrics. November 05, 2018. [Epub ahead of print] (11-5-18)

Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals. Magill SS, O'Leary E, Janelle SJ, et al. N Engl J Med. 2018 Nov 1;379(18):1732-1744. (11-1-18)

Benefits and Harms of Antihypertensive Treatment in Low-Risk Patients with Mild Hypertension. Sheppard JP, Stevens S, Stevens R, Martin U, Mant J, Hobbs FDR, McManus RJ. JAMA Intern Med. October 29, 2018. (11-30-18)

Prevalence of Financial Conflicts of Interest Among Authors of Clinical Guidelines Related to High-Revenue Medications. Khan R, Scaffidi MA, Rumman A, Grindal AW, Plener IS, Grover SC. JAMA Intern Med. 2018 Oct 29. and Evaluation of Industry Relationships Among Authors of Clinical Practice Guidelines in Gastroenterology. CombsTR, Scott J, Jorski A, Heavener T, Vassar M. JAMA Intern Med. 2018 Oct 29. (10-30-18).

Baloxavir Marboxil for Uncomplicated Influenza in Adults and Adolescents. Hayden FG, Sugaya N, Hirotsu N, et al. N Engl J Med. 2018 Sep 6;379(10):913-23. (10-25-18)

Assessment of Industry Data on Pulmonary and Immunosuppressive Effects of IQOS. Moazed F, Chun L, Matthay MA, Calfee CS, Gotts J.. Tob Control. 2018 Aug 29. pii: tobaccocontrol-2018-054296. [Epub ahead of print] (9-24-18)

Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. McNeil JJ, Nelson MR, Woods RL, et al. Effect of aspirin on all-cause mortality in the healthy elderly. N Engl J Med. 2018 Sep 16. [Epub ahead of print] (9-20-18)

Improved Empirical Antibiotic Treatment of Sepsis After an Educational Intervention: The ABISS-Edusepsis Study. Ferrer R, Martínez ML, Gomà G, et al. Crit Care. 2018 Jun 22;22(1):167. (8-31-18).

Effect of Azithromycin on Airflow Decline-Free Survival After Allogeneic Hematopoietic Stem Cell Transplant: The ALLOZITHRO Randomized Clinical Trial. Bergeron A, Chevret S, Granata A, et al. JAMA 2017;318(6):557-566. (8-8-18)

Depression, Antidepressant Use, and Risk of Venous Thromboembolism: Systematic Review and Meta-Analysis Of Published Observational Evidence. Kunutsor SK Seidu S, Khunti K. Ann Med. 2018 Jul 12:1-17. (7-30-18)

Electronic Health Records Associated with Lower Hospital Mortality After Systems Have Time to Mature. Lin SC, Jha AK, Adler-Milstein J. Health Aff (Millwood). 2018 Jul;37(7):1128-1135. (7-12-18)

Sodium Bicarbonate Therapy for Patients with Severe Metabolic Acidaemia in the Intensive Care Unit (BICAR-ICU): A Multicentre, Open-Label, Randomised Controlled, Phase 3 Trial. Jaber S, Paugam C, Futier E, et al. Lancet. 2018 Jun 14. pii: S0140-6736(18)31080-8. (7-6-18)

Combined Analysis of Asthma Safety Trials of Long-Acting β2-Agonists. Busse WW, Bateman ED, Caplan AL, Kelly HW, O'Byrne PM, Rabe KF, Chinchilli VM. N Engl J Med. 2018 Jun 28;378(26):2497-2505. (7-5-18)

Continuity of Care with Doctors-A Matter of Life and Death? A Systematic Review of Continuity of Care and Mortality. Pereira Gray D, Sidaway-Lee K, White E, Thorne A, Evans PH. BMJ Open. 2018 Jun 28;8(6):e021161. (7-3-18)

Minimally Invasive Lung Cancer Surgery Performed by Thoracic Surgeons as Effective as Thoracotomy. Boffa DJ, Kosinski AS, Furnary AP, et al. J Clin Oncol. 2018 May 23:JCO2018778977. [Epub ahead of print] (6-30-18)

Serotonergic Antidepressant Use and Morbidity and Mortality Among Older Adults with COPD. Vozoris NT, Wang X, Austin PC, et al. Eur Respir J  2018 Jun 26. [Epub ahead of print] (6-27-18)

Associations Between American Board of Internal Medicine Maintenance of Certification Status and Performance on a Set of Healthcare Effectiveness Data and Information Set Process Measures. Gray B, Vandergrift J, Landon B, Reschovsky J, Lipner R. Ann Intern Med. 2018 Jun 12. [Epub ahead of print] (6-17-18)

Effects on Abstinence of Nicotine Patch Treatment Before Quitting Smoking: Parallel, Two Arm, Pragmatic Randomised Trial. The preloading investigators. BMJ. 2018 Jun 13;361:k2164. (6-15-18)

Associations Between American Board of Internal Medicine Maintenance of Certification Status and Performance on a Set of Healthcare Effectiveness Data and Information Set Process Measures. Gray B, Vandergrift J, Landon B, Reschovsky J, Lipner R. Ann Intern Med. 2018. June 11, 2018. [Epub ahead of print] (6-12-18)

Impact of Primary Care Intensive Management on High-Risk Veterans' Costs and Utilization: A Randomized Quality Improvement Trial. Yoon J, Chang E, Rubenstein LV, Park A, Zulman DM, Stockdale S, Ong MK, Atkins D, Schectman G, Asch SM. Ann Intern Med. 2018 Jun 5. [Epub ahead of print] (6-7-18)

Effect of Increased Inpatient Attending Physician Supervision on Medical Errors, Patient Safety, and Resident Education: A Randomized Clinical Trial. Finn KM, Metlay JP, Chang Y, Nagarur A, Yang S, Landrigan CP, Iyasere C.JAMA Intern Med. 2018 Jun 4 [Epub ahead of print]. (6-6-18)

Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer. Sparano JA, Gray RJ, Makower DF, et al. N Engl J Med. 2018; June 3. (6-4-18)

Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients with Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. Driver BE, Prekker ME, Klein LR, Reardon RF, Miner JR, Fagerstrom ET, Cleghorn MR, McGill JW, Cole JB. JAMA. 2018 May 16. (6-1-18)

Association of Pharmaceutical Industry Marketing of Opioid Products to Physicians With Subsequent Opioid Prescribing. Hadland SE, Cerdá M, Li Y, Krieger MS, Marshall BDL. JAMA Int Med 2018; May 14. [Epub ahead of print] (5-14-18)

Low-Dose CT for the Diagnosis of Pneumonia in Elderly Patients: A Prospective, Interventional Cohort Study. Prendki V, Scheffler M, Huttner B, et al. Eur Respir J. 2018 Apr 12. pii: 1702375. [Epub ahead of print] (5-4-18)

Nivolumab plus Ipilimumab in Lung Cancer with a High Tumor Mutational Burden. Hellmann MD, Ciuleanu TE, Pluzanski A, et al. N Engl J Med. 2018 Apr 16 [Epub ahead of print] (4-17-18)

Four-gene Pan-African Blood Signature Predicts Progression to Tuberculosis. Suliman S, Thompson E, Sutherland J, et al. Am J Respir Crit Care Med. 2018 Apr 6. [Epub ahead of print] (4-10-18)

A Time-Motion Study of Primary Care Physicians' Work in the Electronic Health Record Era. Young RA, Burge SK, Kumar KA, Wilson JM, Ortiz DF. Fam Med. 2018 Feb;50(2):91-9. (3-28-18)

Impact of Temporary Methotrexate Discontinuation for 2 Weeks on Immunogenicity of Seasonal Influenza Vaccination in Patients with Rheumatoid Arthritis: A Randomised Clinical Trial. Park JK, Lee YJ, Shin K, Ha YJ, et al.  Ann Rheum Dis. 2018 Mar 23. pii: annrheumdis-2018-213222. (3-27-18)

Quantifying Population-Level Health Benefits and Harms of E-Cigarette Use in the United States. Soneji SS, Sung HY, Primack BA, Pierce JP, Sargent JD. PLoS One. 2018 Mar 14;13(3):e0193328. (3-15-18)

Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: The SPACE randomized clinical trial. Krebs EE, Gravely A, Nugent S, et al. JAMA. 2018 Mar 6;319(9):872-82. (3-6-18)

Adolescent Exposure to Toxic Volatile Organic Chemicals from E-Cigarettes. Rubinstein ML, Delucchi K, Benowitz NL, et al. Pediatrics. 2018;141(4):e20173557. (3/5/18)

Electronic Cigarette Use and Progression from Experimentation to Established Smoking. Chaffee BW, Watkins SL, Glantz SA. Pediatrics. 2018;141(4):e20173594. (3/5/18)

Association of Cigarette, Cigar, and Pipe Use With Mortality Risk in the US Population. Christensen CH, Rostron B, Cosgrove C, et al. Association of Cigarette, Cigar, and Pipe Use With Mortality Risk in the US Population. JAMA Intern Med. 2018 Feb 19. [Epub ahead of print] (2-22-18)

Cleaning at Home and at Work in Relation to Lung Function Decline and Airway Obstruction. Svanes Ø, Bertelsen RJ, Lygre SH, et al.  Am J Respir Crit Care Med. 2018 Feb 16. [Epub ahead of print] (2-20-18)

Long-term Use of Inhaled Corticosteroids in COPD and the Risk of Fracture. Gonzalez AV, Coulombe J, Ernst P, Suissa S. Chest. 2018;153(2):321-8. (2-15-18)

Prevention of Ventilator-Associated Pneumonia: The Multimodal Approach of the Spanish ICU “Pneumonia Zero” Program.  Álvarez-Lerma F, Palomar-Martínez M, Sánchez-García M, et al. Crit Care Med 2018;46:181-8. (2-8-18) 

Progressive Massive Fibrosis in Coal Miners From 3 Clinics in Virginia. Blackley DJ, Reynolds LE, Short C, Carson R, Storey,E, Halldin,CN, Laney AS. JAMA 2018;319(5):50-1. (2-6-18)

Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. Hackshaw A,  Morris JK, Boniface S, Tang JL, Milenković D. BMJ. 2018;360:j5855. (1-27-18)

Comparison of observed harms and expected mortality benefit for persons in the veterans health affairs lung cancer screening demonstration project. Caverly TJ, Fagerlin A, Wiener RS, Slatore CG, Tanner NT, Yun S, Hayward R. JAMA Intern Med. 2018 Jan 22. [Epub ahead of print] (1-22-18)

Risk of thromboembolism in cisplatin versus carboplatin-treated patients with lung cancer. Kim ES, Baran AM, Mondo EL, et al. PLoS One. 2017 Dec 11;12(12):e0189410. (1-8-18)

Association of cardiovascular risk with inhaled long-acting bronchodilators in patients with chronic obstructive pulmonary disease: A nested case-control study. Wang MT, Liou JT, Lin CW, Tsai CL, Wang YH, Hsu YJ, Lai JH. JAMA Intern Med. 2018 Jan 2. [Epub ahead of print] (1-5-18)

Previously selected articles that were thought important but had received little attention were summarized under our “News” section. However, the work of publication (review, DOAJ, doi, social media, etc.) has become too arduous to do justice to these publications. Therefore, we are beginning a new section titled “News from Other Journals” where selected articles are briefly summarized. Important articles that are published in journals commonly read by pulmonologists, intensivists or sleep physicians will not necessarily be reviewed but articles that are in general medicine journals or lower impact journals that might be of interest to the practicing physician are selected. As always, there will be links to the article via CrossRef and/or PubMed.

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Tuesday
Mar262019

Whole-Genome Sequencing of Pharmacogenetic Drug Response in Racially Diverse Children with Asthma

Mak ACY, White MJ, Eckalbar WL, et al. Am J Respir Crit Care Med. 2018 Jun 15;197(12):1552-64. [CrossRef] [PubMed]

Albuterol, a bronchodilator medication, is the first-line therapy for asthma worldwide. However, there are significant racial/ethnic differences in albuterol drug response. The authors performed whole-genome sequencing pharmacogenetics study from 1,441 children with asthma to identify genetic association with bronchodilator response (BDR). They identified population-specific and shared genetic variants associated with BDR, including genome-wide significant (P < 3.53 × 10−7) and suggestive (P < 7.06 × 10−6) loci near genes previously associated with lung capacity (DNAH5), immunity (NFKB1 and PLCB1), and β-adrenergic signaling (ADAMTS3 and COX18). Functional analyses of the BDR-associated SNP in NFKB1 revealed potential regulatory function in bronchial smooth muscle cells. The SNP is also an expression quantitative trait locus for a neighboring gene, SLC39A8. This study demonstrates that a set of genetic mutations found mostly in children of African-American or Puerto Rican descent may make them less likely to respond to albuterol. This research suggests that a genetic test could be developed to help identify patients who are resistant to albuterol and could benefit from alternative treatments.

Thursday
Mar072019

Patient Safety Outcomes under Flexible and Standard Resident Duty-Hour Rules and Sleep and Alertness in a Duty-Hour Flexibility Trial in Internal Medicine

Silber JH, Bellini LM, Shea JA, et al. N Engl J Med 2019; 380:905-14. [CrossRef]

Basner M, Asch DA, Shea JA, et al. N Engl J Med 2019; 380:915-23. [CrossRef] [PubMed]

In 2003 the American Council on Graduate Medical Education (ACGME) limited resident work-hour limits. In 2011 the ACGME enacted even more stringent requirements. However, waivers were granted allowing some flexibility in shift length, as well as time off between shifts; caps on weekly hours worked, total days off, and the frequency of overnight call were maintained. Some argued that there was a paucity of evidence to support these changes and some new risks, such as those associated with increased handoffs of care or inadequate educational exposure. The Arizona Thoracic Society was amongst those who urged the ACGME to conduct randomized trials. In today’s edition of the New England Journal the results of two of these trials are reported.

The first report used Medicare claims data to assess patient outcomes. Mortality, readmissions and payments did not differ in programs with flexible hours worked standard hours. The second study found that sleep duration also did not differ in flexible programs as compared with standard programs, with interns in both groups averaging approximately 7 hours of sleep per night. Essentially, interns made up for lost sleep on extended shifts by sleeping more during time off.

A thoughtful editorial by Rosenbaum and Lamas summarizes the data and points out that there may be some downsides to the resident hour restrictions including increased handoffs of care or inadequate educational exposure.

Monday
Feb252019

Factors Associated with High-Quality Guidelines for the Pharmacologic Management of Chronic Diseases in Primary Care: A Systematic Review

Molino CGRC, Leite-Santos NC, Gabriel FC, et al. JAMA Intern Med. 2019 Feb 18. [Epub ahead of print] [CrossRef] [PubMed]

The authors assessed 421 clinical practice guidelines (CPGs) in primary care using the validated Appraisal of Guidelines for Research and Evaluation Instrument, version II (AGREE-II) tool. A multiple logistic regression was performed to identify factors associated with quality of CPGs. Of the CPGs reviewed only 23.5% (99) were classified as high quality. Factors associated with high-quality CPGs included having more than 20 authors (odds ratio, 9.08; 95%CI, 3.35-24.62), development at governmental institutions (odds ratio, 10.38; 95%CI, 2.72-39.60), and reporting funding (odds ratio, 10.34; 95%CI, 4.77-22.39). Year of publication, region, guideline version, and scope were not associated with quality among included CPGs. An accompanying editorial discusses the implications of the study and argues that only high quality guidelines should be implemented. The study agrees with previous publications examining the quality of non-primary care guidelines including the Infectious Disease Society of America and American Thoracic Society by Lee et al. in 2011 and several publications in the SWJPCC examining ICU guidelines.

Thursday
Feb212019

Effect of Titrating Positive End-Expiratory Pressure (PEEP) With an Esophageal Pressure-Guided Strategy vs an Empirical High PEEP-Fio2 Strategy on Death and Days Free from Mechanical Ventilation Among Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial

Beitler JR, Sarge T, Banner-Goodspeed VM, et al. JAMA. 2019 Feb 18. [Epub ahead of print] [CrossRef] [PubMed]

Shortly after ARDS was described the beneficial effects of PEEP on oxygenation were discovered. However, PEEP can have deleterious effects.  Despite many proposed measures and methods, how to adjust the pressure to the “optimal” level has remained elusive. This multicenter study sought to determine whether PEEP titration guided by esophageal pressure (PES), an estimate of pleural pressure, was more effective than empirical high PEEP-fraction of inspired oxygen (Fio2) in moderate to severe ARDS. Two hundred mechanically ventilated patients aged 16 years and older with moderate to severe ARDS (Pao2:Fio2 ≤200 mm Hg) were randomized to PES-guided PEEP (n = 102) or empirical high PEEP-Fio2 (n = 98). All participants received low tidal volumes. PES-guided PEEP, compared with empirical high PEEP-Fio2, resulted in no significant difference in death and days free from mechanical ventilation. The authors conclude that these findings do not support PES-guided PEEP titration in ARDS. A thoughtful editorial accompanies the manuscript in the same issue of JAMA.

Tuesday
Feb192019

Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals

Rhee C, Jones TM, Hamad Y, et al. JAMA Netw Open. 2019 Feb 1;2(2):e187571. [CrossRef] [PubMed]

Sepsis affects nearly 270,000 Americans each year and has a mortality risk of 30% to 60%. Nearly one in three patients who die in the hospital have sepsis, according to the Centers for Disease Control and Prevention and has been targeted as a preventable hospital-acquired infection by the Centers for Medicare and Medicaid Services. However, the extent to which sepsis is preventable, is unknown.

The authors conduced a retrospective cohort study of 568 randomly selected adults admitted to 6 US academic and community hospitals who died in the hospital or were discharged to hospice and not readmitted. The preventability of each sepsis-associated death was rated on a 6-point Likert scale.

Sepsis was present in 300 of the 568 subjects and was the immediate cause of death in 198 cases. The next most common immediate causes of death were progressive cancer (92) and heart failure (39). Suboptimal care, most commonly delays in antibiotics, was identified in 68 of 300 sepsis-associated deaths. However, only 11 sepsis-associated deaths (3.7%) were judged definitely or moderately likely preventable; another 25 sepsis-associated deaths (8.3%) were considered possibly preventable.

The authors conclude that in this cohort from 6 US hospitals, sepsis was the most common immediate cause of death. However, most underlying causes of death were related to severe chronic comorbidities and most sepsis-associated deaths were unlikely to be preventable through better hospital-based care.