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Background: Longitudinal analyses of large, detailed adult critical care datasets provide insights into practice trends and generate useful outcome and process benchmarks., Methods: Data representing 991,571 consecutive critical care visits to 160 US adult ICUs from 2009 to 2013 from the eICU Research Institute clinical practice database were used to quantitate patient characteristics, APACHE IV-based acuity predictions, treatments, and outcomes. Analyses for changes over time were performed for patient characteristics, entry and discharge locations, primary admission diagnosis, treatments, adherence to consensus ICU best practices, length of stay (LOS), and inpatient mortality., Results: We detected significant trends for increasing age, BMI, and risk of mortality, higher frequency of admission from an ED and stepdown unit, and more frequent hospital discharge to substance abuse centers and skilled nursing facilities. Significantly more patients were admitted for sepsis, emphysema, coma, congestive heart failure, diabetic ketoacidosis, and fewer were admitted for asthma, unspecified chest pain, coronary artery bypass graft, and stroke care. The frequency of noninvasive mechanical ventilation and adherence to critical care best practices significantly increased, whereas the duration of renal replacement therapies, frequency of transfusions, antimicrobial use, critical care complications, LOS, and inpatient mortality decreased., Conclusions: Analyses of patients, practices, and outcomes from a large geographically dispersed sample of adult ICUs revealed trends of increasing age and acuity, higher rates of adherence to best practice, use of noninvasive mechanical ventilation, and decreased use of antimicrobials, transfusions, and duration of renal replacement therapies. Acuity-adjusted LOS and in hospital mortality decreased., (Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Background: Nationwide benchmarks representing current critical care practice for the range of ICUs are lacking. This information may highlight opportunities for care improvement and allows comparison of ICU practice data., Methods: Data representing 243,553 adult admissions from 271 ICUs and 188 US nonfederal hospitals during 2008 were analyzed using the eICU Research Institute clinical practice database. Participating ICUs and hospitals varied widely regarding bed number, community size, academic status, geographic location, and organizational structure., Results: More than one-half of these critically ill adults were < 65 years old, and most patients returned to their homes after hospital discharge. Most patients were admitted from an ED, had a medical admission diagnosis, and received antimicrobial therapy. Intensive treatment was common, including 27% who received mechanical ventilation, 7.5% who were supported with noninvasive ventilation, 24.3% who were treated with vasoactive infusions, > 20% who received a blood product, and 4.4% who agreed to a care limitation order during their ICU stay. Forty percent of cases had a < 10% mortality risk and did not have an intensive treatment documented., Conclusions: Admission to an ICU in 2008 involved active treatments that often included life support and counseling for those near the end of life and was associated with favorable outcomes for most patients.

Intravenous haloperidol is recommended as the drug of choice to treat delirium in ICU patients. Movement disorders and other adverse events commonly occur with oral haloperidol use but are rarely seen with IV haloperidol use, and withdrawal symptoms have not been reported with short-term ICU use. We describe self-limited dyskinesia during withdrawal of high-dose continuous IV haloperidol therapy in five ICU patients.