Latest issue of “Intensive and Critical Care Nursing” Volume 40 June 2017

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Titles of articles published in this issue include “Working together: a critical care nurses experiences of temporary staffing within Swedish health care: a qualitative study”, “burnout and job satisfaction of intensive care personnel and the relationship with personality and religious traits: an observational multi centre cross sectional study” and “Effect of nocturnal sound reduction on the incidence of delirium in intensive care unit patients: an interrupted time series analysis”

The content page of this issue can be accessed via this link.

To see the full text of any of these articles direct from the journal’s homepage requires a personal subscription.  Individual articles can be ordered via the Rotherham NHS Foundation Trust Library and Knowledge Service.  Registered members of the library can make article requests online via this link.

Issues of Intensive and Critical Care Nursing from issue older than one year ago can have their full text accessed via this link.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.

Early, Goal-Directed Therapy for Septic Shock – A Patient-Level Meta-Analysis.

This paper by the PRISM investigators led by Kathryn Rowan was published in the New England Journal of Medicine in June 2017 Volume 376 number 23.  The full text of the article is available to subscribers to this journal via this link.  The Library and Knowledge Service can obtain the full text of the article for registered members by requesting it via the library website document request form.

BACKGROUND:  After a single-center trial and observational studies suggesting that early, goal-directed therapy (EGDT) reduced mortality from septic shock, three multicenter trials (ProCESS, ARISE, and ProMISe) showed no benefit. This meta-analysis of individual patient data from the three recent trials was designed prospectively to improve statistical power and explore heterogeneity of treatment effect of EGDT.

METHODS:  We harmonized entry criteria, intervention protocols, outcomes, resource-use measures, and data collection across the trials and specified all analyses before unblinding. After completion of the trials, we pooled data, excluding the protocol-based standard-therapy group from the ProCESS trial, and resolved residual differences. The primary outcome was 90-day mortality. Secondary outcomes included 1-year survival, organ support, and hospitalization costs. We tested for treatment-by-subgroup interactions for 16 patient characteristics and 6 care-delivery characteristics.

RESULTS:  We studied 3723 patients at 138 hospitals in seven countries. Mortality at 90 days was similar for EGDT (462 of 1852 patients [24.9%]) and usual care (475 of 1871 patients [25.4%]); the adjusted odds ratio was 0.97 (95% confidence interval, 0.82 to 1.14; P=0.68). EGDT was associated with greater mean (±SD) use of intensive care (5.3±7.1 vs. 4.9±7.0 days, P=0.04) and cardiovascular support (1.9±3.7 vs. 1.6±2.9 days, P=0.01) than was usual care; other outcomes did not differ significantly, although average costs were higher with EGDT. Subgroup analyses showed no benefit from EGDT for patients with worse shock (higher serum lactate level, combined hypotension and hyperlactatemia, or higher predicted risk of death) or for hospitals with a lower propensity to use vasopressors or fluids during usual resuscitation.

CONCLUSIONS:  In this meta-analysis of individual patient data, EGDT did not result in better outcomes than usual care and was associated with higher hospitalization costs across a broad range of patient and hospital characteristics.

Meeting the needs of critical care patients after discharge home

With improved survival rates in critical care, increasing focus is being placed on survivorship and how best to support patients in returning to their former activity | Nursing in Critical Care

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Objectives: To describe former critical care patients’ perspectives on the support needed to optimize recovery.

Findings: Four themes of support were described: effective management of transfer anxiety, tailored information provision, timely access to services and a supportive social network.

Conclusion: Survivors of critical care should be equipped with information about their critical care stay, ongoing health issues and recovery and should be provided with holistic care at home. Critical care follow up was an effective way of meeting many of these needs, but this needs to be flexible to be useful to attendees. Peer support groups (face-to-face and online) provided information, reassurance, a social network and an avenue for those who had longer-lasting problems than current services provide for.

Relevance to clinical practice: Whilst there are commonalities in the problems faced by critical care survivors, recovery is highly individualized, and current support services do not have sufficient flexibility to cater for this. This study shows that many survivors experience after-effects of critical care that outlast the support they are given. These longer-term survivors are often excluded from research studies because of fears of recall bias, resulting in poor understanding of their experiences.

Full reference: Allum, L. et al. (2017) Meeting the needs of critical care patients after discharge home: a qualitative exploratory study of patient perspectives. Nursing in Critical Care. Version of Record online: 22 Jun 2017

Most recent issue of Critical Care Reviews Newsletter 288 18th June 2017

The 288th issue of the Critical Care Reviews Newsletter includes the latest research from across the medical literature during the last week.  Highlights of this latest issue include the REVIVE RCT investigating an exercise programme post discharge home after critical illness, a paediatric trail examining the FAST scan in trauma and an RCT on icatibant for ACE inhibitor induced upper airway angioedema.

The full text of the newsletter can be accessed via this link.

Latest Issue of “Intensive Care Medicine” Volume 43 Number 6

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To view Intensive Care  Medicine’s latest issue’s contents page follow this link.

This issue includes a systematic review on “Quality indicators of continuous renal replacement therapy (CRRT) care in critically ill patients”, “LICRA pragmatic controlled clinical trial on effects of restricting perioperative use of intravenous chloride on kidney injury in patients undergoing cardiac surgery” and a review on “Current state of the art for renal replacement therapy in critically ill patients with acute kidney injury”.

To read the full text of these articles from the journal’s homepage a personal subscription to “Intensive Care Medicine” is required.  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.

Intensive Care Society State of the Art Meeting: December 2017 Liverpool

This conference will be held at the Arena and Convention Centre Liverpool on 4th to 6th December 2017.  The format has been redesigned to be more interactive and provide plenty of chance to ask questions, exchange views and network.  Content highlights will include “peri-op medicine and ICU: the interface”, “all new all day trauma track” and “Is there a place for standalone HDUs?”.  A full programme and booking details will be available soon.  For more details see the meetings’ website via this link.

Latest issue of Critical Care Reviews Newsletter 287 11th June 2017

The 287th issue of the Critical Care Reviews Newsletter includes the latest research from across the medical literature from the previous week.  Highlights include “the pilot TOP-UP and SPIRIT randomised controlled trials, a worrying study on data fabrication in anaesthetic and general medical journals, a guideline on acute kidney injury reviews on fluid responsiveness, clinical examination in circulatory shock, continuous renal replacement therapy forty year anniversary and an interesting discussion on the management of septic shock”.
The full text of the newsletter can be accessed via this link.