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Critical Care Reviews Newsletter 17th September 2017 Issue 301

critcal care reviewsWelcome to the 301st Critical Care Reviews Newsletter, which bringing you the best critical care research from across the medical literature over the past seven days. The highlights of this week are randomised controlled trials on checklists for endotracheal intubation of critically ill adults, nebulized vs intravenous amikacin for hospital and ventilator-acquired pneumonia and transfusions in burns; a new European / Latin American guideline on the management of hospital-acquired pneumonia and ventilator-associated pneumonia; plus reviews on heart-lung interactions, ARDS and critical illness-associated diaphragm weakness.

The full newsletter can be accessed via this link.

Serial Daily Organ Failure Assessment Beyond ICU Day 5 Does Not Independently Add Precision to ICU Risk-of-Death Prediction.

This research was published by Holder et al in the September 2017 issue of Critical Care Medicine.

Objectives:  To identify circumstances in which repeated measures of organ failure would improve mortality prediction in ICU patients.

Design:  Retrospective cohort study, with external validation in a deidentified ICU database.

Setting:  Eleven ICUs in three university hospitals within an academic healthcare system in 2014.

Patient:  Adults (18 yr old or older) who satisfied the following criteria: 1) two of four systemic inflammatory response syndrome criteria plus an ordered blood culture, all within 24 hours of hospital admission; and 2) ICU admission for at least 2 calendar days, within 72 hours of emergency department presentation.

Intervention:  None

Measurement and Main Results:  Data were collected until death, ICU discharge, or the seventh ICU day, whichever came first. The highest Sequential Organ Failure Assessment score from the ICU admission day (ICU day 1) was included in a multivariable model controlling for other covariates. The worst Sequential Organ Failure Assessment scores from the first 7 days after ICU admission were incrementally added and retained if they obtained statistical significance (p < 0.05). The cohort was divided into seven subcohorts to facilitate statistical comparison using the integrated discriminatory index. Of the 1,290 derivation cohort patients, 83 patients (6.4%) died in the ICU, compared with 949 of the 8,441 patients (11.2%) in the validation cohort. Incremental addition of Sequential Organ Failure Assessment data up to ICU day 5 improved the integrated discriminatory index in the validation cohort. Adding ICU day 6 or 7 Sequential Organ Failure Assessment data did not further improve model performance.

Conclusions:  Serial organ failure data improve prediction of ICU mortality, but a point exists after which further data no longer improve ICU mortality prediction of early sepsis.

The full text of this article will usually be only available via the internet to those who have a personal subscription though some articles may be available freely without a password.  Library members can order individual articles via the Rotherham NHS Foundation Trust Library and Knowledge Service using the article requests online via this link.

Nursing Care Disparities in Neonatal Intensive Care Units.

This article was published in the September 2017 issue of Health Services Research by Lake et al.

Objectives:  To describe the variation across neonatal intensive care units (NICUs) in missed nursing care in disproportionately black and non-black-serving hospitals. To analyze the nursing factors associated with missing nursing care.

Data sources:  Survey of random samples of licensed nurses in four large U.S. states.

Study design:  This was a retrospective, secondary analysis of 1,037 staff nurses in 134 NICUs classified into three groups based on their percent of infants of black race. Measures included the average patient load, individual nurses’ patient loads, professional nursing characteristics, nurse work environment, and nursing care missed on the last shift.

Data collection:  Survey data from a Multi-State Nursing Care and Patient Safety Study were analyzed (39 percent response rate).

Principal Findings:  The patient-to-nurse ratio was significantly higher in high-black hospitals. Nurses in high-black NICUs missed nearly 50 percent more nursing care than in low-black NICUs. Lower nurse staffing (an additional patient per nurse) significantly increased the odds of missed care, while better practice environments decreased the odds.

Conclusions:  Nurses in high-black NICUs face inadequate staffing. They are more likely to miss required nursing care. Improving staffing and workloads may improve the quality of care for the infants born in high-black hospitals.

The full text of this article will usually be only available via the internet to those who have a personal subscription though some articles may be available freely without a password.  Library members can order individual articles via the Rotherham NHS Foundation Trust Library and Knowledge Service using the article requests online via this link.

Could the use of bedside lung ultrasound reduce the number of chest x-rays in the intensive care unit?

This research was published by Brogi et al in Cardiovascular Ultrasound’s September issue

Background:  Lung ultrasound can be used as an alternative to chest radiography (CXR) for the diagnosis and follow-up of various lung diseases in the intensive care unit (ICU). Our aim was to evaluate the influence that introducing a routine daily use of lung ultrasound in critically ill patients may have on the number of CXRs and as a consequence, on medical costs and radiation exposure.

Methods:  Data were collected by conducting a retrospective evaluation of the medical records of adult patients who needed thoracic imaging and were admitted to our academic polyvalent ICU. We compared the number of CXRs and relative costs before and after the introduction of lung ultrasound in our ICU.

Results:  A total of 4134 medical records were collected from January 2010 to December 2014. We divided our population into two groups, before (Group A, 1869 patients) and after (Group B, 2265 patients) the introduction of a routine use of LUS in July 2012. Group A performed a higher number of CXRs compared to Group B (1810 vs 961, P = 0.012), at an average of 0.97 vs 0.42 exams per patient. The estimated reduction of costs between Groups A and B obtained after the introduction of LUS, was 57%. No statistically significant difference between the outcome parameters of the two groups was observed.

Conclusions:  Lung ultrasound was effective in reducing the number of CXRs and relative medical costs and radiation exposure in ICU, without affecting patient outcome.

 

The full text of this article is available via the following link.  If you are having any problems please contact the Library and Knowledge Service.

The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review.

This article was published in the September issue of Human Resources for Health and written by Woo and colleagues.

Background:  The prevalence of chronic illness and multimorbidity rises with population aging, thereby increasing the acuity of care. Consequently, the demand for emergency and critical care services has increased. However, the forecasted requirements for physicians have shown a continued shortage. Among efforts underway to search for innovations to strengthen the workforce, there is a heightened interest to have nurses in advanced practice participate in patient care at a great extent. Therefore, it is of interest to evaluate the impact of increasing the autonomy of nurses assuming advanced practice roles in emergency and critical care settings on patient outcomes.

Objectives:  The objectives of this study are to present, critically appraise, and synthesize the best available evidence on the impact of advanced practice nursing on quality of care, clinical outcomes, patient satisfaction, and cost in emergency and critical care settings.

Methods:  A comprehensive and systematic search of nine electronic databases and a hand-search of two key journals from 2006 to 2016 were conducted to identify studies evaluating the impact of advanced practice nursing in the emergency and critical care settings. Two authors were involved selecting the studies based on the inclusion criteria. Out of the original search yield of 12,061 studies, 15 studies were chosen for appraisal of methodological quality by two independent authors and subsequently included for analysis. Data was extracted using standardized tools.

Results:  Narrative synthesis was undertaken to summarize and report the findings. This review demonstrates that the involvement of nurses in advanced practice in emergency and critical care improves the length of stay, time to consultation/treatment, mortality, patient satisfaction, and cost savings.

Conclusions:  Capitalizing on nurses in advanced practice to increase patients’ access to emergency and critical care is appealing. This review suggests that the implementation of advanced practice nursing roles in the emergency and critical care settings improves patient outcomes. The transformation of healthcare delivery through effective utilization of the workforce may alleviate the impending rise in demand for health services. Nevertheless, it is necessary to first prepare a receptive context to effect sustainable change.

The full text of this article is available via the following link.  If you are having any problems please contact the Library and Knowledge Service.

Evaluating the past to improve the future – A qualitative study of ICU patients’ experiences.

This article was published in “Intensive and Critical Care Nursing” by Olsen et al in September 2017

Background:  The recovery period for patients who have been in an intensive care units often prolonged and suboptimal. Anxiety, depression and post-traumatic stress disorder are common psychological problems. Intensive care staff offer various types of intensive aftercare. Intensive care follow-up aftercare services are not standard clinical practice in Norway.

Objectives:  The overall aim of this study is to investigate how adult patients experience the intensive care stay their recovery period, and the usefulness of an information pamphlet.

Method:  A qualitative, exploratory research with semi-structured interviews of 29 survivors after discharge from intensive care and three months after discharge from the hospital.

Results:  Two main themes emerged: “Being on an unreal, strange journey” and “Balancing between who I was and who I am” Patients’ recollection of their intensive care stay differed greatly. Continuity of care and the nurse’s ability to see and value individual differences was highlighted. The information pamphlet helped intensive care survivors understand that what they went through was normal.

Conclusions:  Continuity of care and an individual approach is crucial to meet patients’ uniqueness and different coping mechanisms. Intensive care survivors and their families must be included when information material and rehabilitation programs are designed and evaluated.

 

The full text of this article will usually be only available via the internet to those who have a personal subscription though some articles may be available freely without a password.  Library members can order individual articles via the Rotherham NHS Foundation Trust Library and Knowledge Service using the article requests online via this link.

Critical Care Reviews Newsletter 300 10th September 2017

The CCRN brings “you 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 a randomised controlled trial comparing a coping skills training program with an education program for survivors of critical illness, a guideline on safe medication use in the ICU, plus narrative reviews on cerebral oximetry, paediatric burn resuscitation and randomized, controlled trials in health insurance systems.”  The full newsletter can be accessed via this link.