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Critical Care Reviews Newsletter 470 13th December 2020

The Critical Care Reviews Newsletter contains “the best critical care research and open access articles from across the medical literature over the past week.”
The highlights of this week’s edition are randomised controlled trials comparing a lower with higher PEEP in patients without ARDS and baricitinib plus remdesivir for hospitalized adults with COVID-19; systematic reviews and meta analyses on corticosteroid treatment for early ARDS and acute respiratory failure and ARDS; and the remarkable GenOMICC study, investigating genetic mechanisms of critical illness in COVID-19.
The full text of the newsletter is available to all via this link.

Effect of non-sedation on physical function in survivors of critical illness – A substudy of the NONSEDA randomized trial

This article by Nedeergard and colleagues was first published in the Journal of Critical Care in December 2020.
Purpose:  Critical illness impairs physical function. The NONSEDA trial was a multicenter randomized trial, assessing non-sedation versus sedation during mechanical ventilation. The aim of this sub-study was to assess the effect of non-sedation on physical function.
Methods:  All patients from one NONSEDA trial site were included. At ICU discharge and three months thereafter, survivors were assessed for physical function.
Results:  205 patients were included, 118 survived to follow-up, 116 participated (98%). Primary outcome: Three months after ICU-discharge, health-related quality of life (SF-36, physical component score) was similar (non-sedated 38.3 vs sedated 36.6, mean difference 1.7, 95% CI -1.7 to 5.1), as was function in activities of daily living (Barthel Index, non-sedated 19.5 vs sedated 18, median difference 1.5, 95% CI -0.2 to 3.2). Secondary outcomes: Non-sedated patients had a better Barthel Index at ICU-discharge (median 9 vs 4, median difference 5, 95% CI 2.5 to 7.5). At three months post-ICU discharge, the two groups did not differ regarding handgrip strength, walking distance, muscle size or biomechanical data.
Conclusion:  Non-sedation did not lead to improved quality of life regarding physical function or better function in activities of everyday living. Non-sedated patients had a better physical recovery at ICU discharge.
The full text of this article is available to subscribers via this link to the journal’s homepage.  The full text of articles from issues older than sixty days is available via this link to an archive of issues of Journal of Critical Care.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.  Please speak to the library staff for more details.

Family participation in physiotherapy-related tasks of critically ill patients: A mixed methods systematic review

This systematic review by Van delft and others first appeared in The Journal of Critical Care in December 2020.
Purpose:  Providing an overview of studies on family participation in physiotherapy-related tasks of critically ill patients, addressing two research questions (RQ): 1) What are the perceptions of patients, relatives, and staff about family participation in physiotherapy-related tasks? and 2) What are the effects of interventions of family participation in physiotherapy-related tasks?
Material and methods:  Qualitative, quantitative and mixed-methods articles were identified using PubMed, Embase and CINAHL. Studies reporting on family participation in physiotherapy-related tasks of adult critically ill patients were included. A convergent segregated approach for mixed-methods reviews was used.
Results:  Eighteen articles were included; 13 for RQ1, and 5 for RQ2. The included studies were quantitative, qualitative and mixed-method, including between 8 and 452 participants. The descriptive studies exhibit a general appreciation for involvement of relatives in physiotherapy-related tasks, although most of the studies reported on family involvement in general care and incorporated diverse physiotherapy-related tasks. One study explored the effectiveness of family participation on a rehabilitation outcome and showed that the percentage of patients mobilizing three times a day increased.
Conclusion:  Positive attitudes were observed among patients, their relatives and staff towards family participation in physiotherapy-related tasks of critically ill patients. However, limited research has been done into the effect of interventions containing family participation in physiotherapy-related tasks.
The full text of this article is available to subscribers via this link to the journal’s homepage.  The full text of articles from issues older than sixty days is available via this link to an archive of issues of Journal of Critical Care.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.  Please speak to the library staff for more details.

Critical Care Reviews Newsletter 468 29th November 2020

The Critical Care Reviews Newsletter contains “the best critical care research and open access articles from across the medical literature over the past seven days.”
The highlights of this week’s edition are randomised controlled trials on convalescent plasma in covid-19 severe pneumonia, laryngeal mask airway in neonatal resuscitation & nebulized magnesium in children with refractory acute asthma; systematic reviews and meta analyses on elevated troponins in patients hospitalised with coronavirus disease 2019 & glycoprotein IIb/IIIa inhibitors for cardiogenic shock complicating acute myocardial infarction; and observational studies on the effect of non-sedation on physical function in survivors of critical illness, cardiopulmonary resuscitation in COVID-19 patients experiencing in-hospital cardiac arrest & the association of frailty with morbidity and mortality in emergency general surgery by procedural risk level.
The full text of the newsletter is available to all via this link.

Intensive Care Medicine Volume 46 Issue 12 December 2020

To view the content page of this special issue on mechanical ventilation follow this link.
To read the full text of any of these articles via the journal’s homepage requires a personal subscription to “Intensive Care Medicine” though some are available open access.  Individual articles can be ordered from the Rotherham NHS Foundation Trust Library and Knowledge Service. Registered members of the library can make article requests online via this link.
The full text of articles from issues older than one year ago is available via this link to an archive of issues of Intensive Care Medicine.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.  Please speak to the library staff for more details.

Critical Care Reviews Newsletter 467 22nd November 2020

The Critical Care Reviews Newsletter, brings you the best critical care research and open access articles from across the medical literature over the past seven days.  It includes randomised controlled trials such as “Tranexamic acid in patients with intracerebral haemorrhage (STOP-AUST): a multicentre, randomised, placebo-controlled, phase 2 trial”, secondary research such as Fluid Overload and Mortality in Adult Critical Care Patients—A Systematic Review and Meta-Analysis of Observational Studies and observational including Improved Oxygenation After Prone Positioning May Be a Predictor of Survival in Patients With Acute Respiratory Distress Syndrome.
The full text of the newsletter is available to all via this link.

ICU acquired hypernatremia treated by enteral free water – A retrospective cohort study

This article by de Vos and colleagues was first published in the Journal of Critical Care in November 2020.
Purpose:  ICU acquired hypernatremia (IAH) is associated with increased morbidity and mortality, however treatment remains controversial. This study aims to determine the effect of enteral free water suppletion in patients with IAH.
Materials and methods: Retrospective single center study in a tertiary ICU. Inclusion criteria: patients with IAH and treatment with enteral free water. Exclusion criteria: patients with renal replacement therapy, diabetic ketoacidosis or hyperosmolar hyperglycaemic state. Primary outcome: change in plasma sodium (in mmol/L) after 5 days treatment. Responders were defined as patients with a decrease in sodium level of 5 mmol/L or more.
Results:  In total 382 consecutive patients were included. The median sodium level at the start of water therapy was 149 mmol/l (IQR 147–150). The median volume of enteral water was 4423 ml (IQR 3349–5379 ml) after 5 days and mean sodium decrease was 1.87 mmol/l (SD 4.84). There was no significant correlation between the volume of enteral water and sodium decrease (r2 = 0.01).
Conclusions:  Treatment with enteral free water did not result in a clinically relevant decrease in serum sodium level in patients with IAH. In addition, the volume of enteral free water and the use of diuretics was unrelated with sodium change over 5 days.
The full text of this article is available to subscribers via this link to the journal’s homepage.  The full text of articles from issues older than sixty days is available via this link to an archive of issues of Journal of Critical Care.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.  Please speak to the library staff for more details.

Decreased serial scores of severe organ failure assessments are associated with survival in mechanically ventilated patients; the prospective Maastricht Intensive Care COVID cohort

This article by Bels and others was first published in the Journal of Critical Care in November 2020.
Background:  The majority of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are admitted to the Intensive Care Unit (ICU) for mechanical ventilation. The role of multi-organ failure during ICU admission as driver for outcome remains to be investigated yet.
Design and setting:  Prospective cohort of mechanically ventilated critically ill with SARS-CoV-2 infection.
Participants and methods:  94 participants of the MaastrICCht cohort (21% women) had a median length of stay of 16 days (maximum of 77). After division into survivors (n = 59) and non-survivors (n = 35), we analysed 1555 serial SOFA scores using linear mixed-effects models.
Results:  Survivors improved one SOFA score point more per 5 days (95% CI: 4–8) than non-survivors. Adjustment for age, sex, and chronic lung, renal and liver disease, body-mass index, diabetes mellitus, cardiovascular risk factors, and Acute Physiology and Chronic Health Evaluation II score did not change this result. This association was stronger for women than men (P-interaction = 0.043).
Conclusions:  The decrease in SOFA score associated with survival suggests multi-organ failure involvement during mechanical ventilation in patients with SARS-CoV-2. Surviving women appeared to improve faster than surviving men. Serial SOFA scores may unravel an unfavourable trajectory and guide decisions in mechanically ventilated patients with SARS-CoV-2.
The full text of this article is available to subscribers via this link to the journal’s homepage.  The full text of articles from issues older than sixty days is available via this link to an archive of issues of Journal of Critical Care.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.  Please speak to the library staff for more details.

Development of a machine learning algorithm to predict intubation among hospitalized patients with COVID-19

This article by Arvind and others first appeared in the Journal of Critical Care in November 2020.
Purpose:  The purpose of this study is to develop a machine learning algorithm to predict future intubation among patients diagnosed or suspected with COVID-19.
Materials and methods:  This is a retrospective cohort study of patients diagnosed or under investigation for COVID-19. A machine learning algorithm was trained to predict future presence of intubation based on prior vitals, laboratory, and demographic data. Model performance was compared to ROX index, a validated prognostic tool for prediction of mechanical ventilation.
Results: 4087 patients admitted to five hospitals between February 2020 and April 2020 were included. 11.03% of patients were intubated. The machine learning model outperformed the ROX-index, demonstrating an area under the receiver characteristic curve (AUC) of 0.84 and 0.64, and area under the precision-recall curve (AUPRC) of 0.30 and 0.13, respectively. In the Kaplan-Meier analysis, patients alerted by the model were more likely to require intubation during their admission (p < 0.0001).
Conclusion:  In patients diagnosed or under investigation for COVID-19, machine learning can be used to predict future risk of intubation based on clinical data which are routinely collected and available in clinical setting. Such an approach may facilitate identification of high-risk patients to assist in clinical care.
The full text of this article is available to subscribers via this link to the journal’s homepage.  The full text of articles from issues older than sixty days is available via this link to an archive of issues of Journal of Critical Care.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.  Please speak to the library staff for more details.

Impact of therapeutic hypothermia on bleeding events in adult patients treated with extracorporeal life support peri-cardiac arrest

This article by Mecklenburg and colleagues was first published in Journal of Critical Care during November 2020.
Purpose:  Whether therapeutic hypothermia (TH) adds to the risk of bleeding in patients on extracorporeal life support (ECLS) peri-cardiac arrest remains unknown.
Material and methods:  Single center retrospective study on patients receiving veno-arterial ECLS peri-cardiac arrest ± TH at 32–34 C (January 2009–December 2015). Primary outcome: major bleeding (including intracerebral hemorrhage, ICH) < 72h of cardiac arrest. Logistic regression and marginal structural models were used to analyze associations with major bleeding.
Results:  Of 66 patients receiving ECLS, 36 were treated with TH. Major bleeding occurred in 14 patients (39%) treated with ECLS+TH and in 17 patients (57%) with ECLS alone. ICH was reported in 3 (8%) and one patient (3%), respectively. There was no difference in mortality, but lung injury occurred more often in ECLS+TH. A platelet count <60 × 109/L but not TH was associated with major bleeding (including ICH). The estimated causal risk ratio of TH on the occurrence of major bleeding (including ICH) at 72 h post cardiac arrest was 0.95 (95%CI 0.62–1.45).
Conclusions:  Bleeding complications were common in our study. However, TH (32–34 C) was not associated with an increased risk of major bleeding in patients on ECLS peri-cardiac arrest.
The full text of this article is available to subscribers via this link to the journal’s homepage.  The full text of articles from issues older than sixty days is available via this link to an archive of issues of Journal of Critical Care.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.  Please speak to the library staff for more details.