Improving care for intensive care survivors and their families requires collaboration between practitioners and researchers in both the inpatient and outpatient settings. Strategies were developed to address the major themes arising from the conference to improve outcomes for survivors and families.

A program of universal surveillance, contact precautions, hand hygiene, and institutional culture change was associated with a decrease in health care-associated transmissions of and infections with MRSA in a large health care system.

Background Hyperglycemia during critical illness is common and associated with increased mortality. Intensive insulin therapy has improved outcomes in some, but not all, intervention trials. It is currently unclear whether the benefits of treatment differ among specific patient populations. Objective To determine the association between hyperglycemia and risk-adjusted mortality in critically ill patients and in separate groups stratified by admission diagnosis. Secondarily, determine if mortality risk from hyperglycemia varies with ICU type, length of stay, or diagnosed diabetes. Design Retrospective cohort study Setting 173 U.S. medical, surgical, and cardiac ICUs Patients 259,040 admissions from 10/2002–9/2005; unadjusted mortality, 11.2% Measurements A two-level logistic regression model determined the relationship between glycemia and mortality. Age, diagnosis, co-morbidities and laboratory variables were used to calculate a predicted mortality, which was then analyzed with mean glucose to determine the association of hyperglycemia with hospital mortality. Results Hyperglycemia was associated with increased mortality independent of illness severity. When compared to normoglycemic individuals (70–110 mg/dl), adjusted odds of mortality (odds ratio, [95% CI]) for mean glucose 111–145, 146–199, 200–300, > 300 mg/dl was, 1.31(1.26–1.36), 1.82(1.74–1.90), 2.13(2.03–2.25), and 2.85(2.58–3.14) respectively. Moreover, the adjusted odds of mortality related to hyperglycemia varied with admission diagnosis, demonstrating a clear association in some (acute myocardial infarction, arrhythmia, unstable angina, pulmonary embolism) and little or no association in others. Hyperglycemia was associated with increased mortality independent of ICU type, length of stay and diabetes. Conclusions The association between hyperglycemia and mortality implicates hyperglycemia as a potentially harmful and correctable abnormality in critically ill patients. The finding that hyperglycemia-related risk varied with admission diagnosis suggests differences in the interaction between specific medical conditions and injury from hyperglycemia. The design and interpretation of future trials should consider the primary disease states of patients and the balance of medical conditions in the ICU studied.

: Admission diagnosis and severity of illness influence frequency and severity of acute kidney injury. Small elevations in creatinine in the intensive care unit are associated with increased risk-adjusted mortality across all intensive care unit settings, whereas renal recovery was associated with a protective effect. Strategies to prevent even mild acute kidney injury or promote renal recovery may improve survival.

We identified barriers that might explain some of the variability in the use of CRs. Although these barriers may be difficult to overcome, some strategies may increase user acceptance and therefore the effectiveness of the CRs. These include explicitly assigning responsibility for each CR to nurses or providers, improving visibility of positive results from CRs in the electronic medical record, creating a feedback mechanism about CR use, and limiting the overall number of CRs.