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Effects of Esmolol in Patients With
Caring for the critically ill patient
Sympathetic activation with tachycardia is common in septic shock. To investigate whether
β-adrenergic blockade might be beneficial, Morelli and colleagues randomly assigned 154
patients with septic shock and a heart rate of 95/min or greater to receive either a continuous
infusion of the short-acting β-blocker esmolol (titrated to maintain heart rate between
80/min-94/min) or standard treatment. The authors report that target heart rates were achieved in
all esmolol-treated patients without an increase in adverse outcomes. In an Editorial, Pinsky
discusses the use of β-blockers in severe sepsis.
Statin Therapy, Mortality in
Observational data suggest that statins may improve outcomes among patients with various
infections. In a multicenter randomized trial with a planned enrollment of 1002 patients, Papazian
and colleagues investigated the effect of simvastatin compared with placebo on 28-day mortality
among patients with suspected ventilator-associated pneumonia. A planned interim analysis was
conducted after enrollment of 300 patients. The study was stopped for futility when the interim
analysis revealed that compared with placebo, adjunctive simvastatin therapy did not improve 28-day
survival of adults with suspected ventilator-associated pneumonia.
Risk-Reduction Counseling and
Sexually Transmitted Infections
Routine human immunodeficiency virus (HIV) infection screening is generally recommended for
patients aged 13 to 64 years, with no requirement for prevention counseling as part of screening. In
a randomized trial that enrolled 5012 patients undergoing rapid HIV testing at 9 sexually
transmitted disease clinics, Metsch and colleagues assessed the effect of brief patient-centered
risk-reduction counseling vs HIV test information alone on subsequent acquisition of sexually
transmitted infections (STIs). The authors report that 6-month acquisition rates of STIs were
similar in the 2 groups. In an Editorial, Haukoos and Thrun discuss how eliminating HIV
risk-prevention counseling can improve HIV screening rates.
Influenza Vaccine and Cardiovascular
Recent influenzalike infection is associated with fatal and nonfatal atherothrombotic events.
Udell and colleagues analyzed data from 6 randomized clinical trials (6735 patients; mean age, 67
years) to assess whether influenza vaccination is associated with prevention of cardiovascular
events. Among the authors’ findings was that influenza vaccine was associated with a lower
risk of adverse cardiovascular events—with the greatest treatment effect among the
highest-risk patients with more active coronary disease. In an Editorial, Neuzil discusses benefits
of increasing the influenza vaccine coverage rate.
Author Video Interview
Clinical Review & Education
Diagnosis and Treatment of
Conjunctivitis is estimated to affect 6 million people annually in the United States. In a
systematic literature review, Azari and Barney identified 86 articles that provided evidence-based
information relating to the diagnosis and treatment of conjunctivitis—particularly in primary
care settings. Among the authors’ findings is that supportive care is appropriate for most
cases of viral conjunctivitis and uncomplicated cases of bacterial conjunctivitis. Topical
antibiotics are recommended for contact lens wearers and patients with suspected chlamydial and
gonococcal conjunctivitis. Antihistamines and mast cell stabilizers may alleviate symptoms of
Continuing Medical Education
Persistent Red, Crusted Plaque After
a Puncture Wound
A patient has an irregular, red plaque on his back, which has been present since he sustained a
puncture wound at the site 4 years ago. He was initially diagnosed with eczema and treated with
topical hydrocortisone cream without improvement. On examination, the plaque is elevated and covered
in waxy white crusts. What would you do next?
Highlights. JAMA. 2013;310(16):1643–1645. doi:10.1001/jama.2013.5377
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