Critical Care Reviews Newsletter 374 16th February 2019

The 374th Critical Care Reviews Newsletter highlights the best critical care research articles from the medical literature during the previous seven days.
“The highlights of this week’s edition are randomised controlled trials on EEG-guided anesthetic administration on postoperative delirium among older adults undergoing major surgery & high-flow nasal cannula versus oxygen face mask for environmental bacterial contamination in critically ill pneumonia patients; systematic reviews and meta analyses on assessing intubation difficulty and intravenous IgM-enriched immunoglobulin (pentaglobin) in sepsis or septic shock; observational studies on andexanet alfa for bleeding associated with factor Xa inhibitors & synergy between norepinephrine and terlipressin during septic shock”.
The full text of the newsletter is available via this link.

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Acute respiratory distress syndrome in leptospirosis

This research by Vandroux and colleagues was published online in the Journal of Critical during February 2019.
Purpose: Acute Respiratory Distress Syndrome is a major complication of leptospirosis, leading to the majority of fatalities.
Methods:  Retrospective, descriptive and single-centre cohort study. The primary outcome was the Standardized Mortality Ratio (SMR) for ARDS in leptospirosis based on the quartiles of the SAPS2 score in the reference population of 1683 patients hospitalized for ARDS. The second outcomes were to determine the risk factors of mortality of ARDS in leptospirosis and to describe the cases requiring Extracorporeal Membrane Oxygenation (ECMO).
Results:  Of 172 leptospirosis patients from January 2004 to October 2017, 39 (23%) presented a moderate or severe ARDS with a mortality rate of 23% (9 cases). Among patients with ARDS, the SMR with regards to Simplified Acute Physiology Score II was 0.49 (CI95%: 0.21; 0.96). Risk factors associated with mortality found by bivariate analysis were Severity Acute Physiology Score II (p = 0.01), Sequential Organ Failure Assessment (p = 0.01), base excess (p = 0.002), kaliemia (p = 0.004), bilirubinemia (p = 0.01) and level of aspartate aminotransferase (p = 0.01). Eight patients underwent ECMO for refractory ARDS and six survived.
Conclusions:  Leptospirosis can induce serious but transient ARDS with a better prognosis than that of other causes of ARDS. Several patients have been successfully treated with ECMO.
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 373 9th February 2019

The 373rd Critical Care Reviews Newsletter highlights the best critical care research articles from the medical literature in the last week.

“The highlights of this week’s edition are randomised controlled trials on the early use of norepinephrine in septic shock resuscitation & the impact of scribes on emergency medicine doctors’ productivity and patient throughput; systematic reviews and meta analyses on stress ulcer prophylaxis & the diagnostic accuracy of a point-of-care ultrasound protocol for shock etiology; and observational studies on the use of vasopressors in septic shock & diagnostic accuracy of clinical examination for estimating cardiac output in critically ill patients.”
The full text of the newsletter is available via this link.


Intensive Care Medicine Volume 45 Number 2 February 2019

To view Intensive Care Medicine’s November issue’s contents page follow this link.
Articles published in this issue include: “Stress ulcer prophylaxis with proton pump inhibitors or histamin-2 receptor antagonists in adult intensive care patients: a systematic review with meta-analysis and trial sequential analysis”, “A multicentre controlled pre–post trial of an implementation science intervention to improve venous thromboembolism prophylaxis in critically ill patients” and “Tailored multicomponent program for discomfort reduction in critically ill patients may decrease post-traumatic stress disorder in general ICU survivors at 1 year”.
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.

ICU readmission of patients with cancer: Incidence, risk factors and mortality

This research by AbuSara and colleagues was published online in the Journal of Critical Care in February 2019.
Purpose:  Few studies evaluated ICU readmission in cancer patients. This study aimed to describe the incidence and risk factors for ICU readmission in cancer patients and the association with mortality.
Materials and methods:  The study was a retrospective cohort at a comprehensive cancer center, which included cancer patients who were discharged after their initial ICU admission over a 5-year period.  The characteristics and outcomes of patients who required ICU readmission within 30 days of discharge were compared to those who did not require readmission during the study period. Multivariate analyses were performed to identify factors associated with readmission and to evaluate the association between readmission and mortality.
Results:  Among 1582 patients discharged from the ICU, 313(19.8%) were readmitted after a median of 6 days. The most common readmission diagnoses were respiratory failure and sepsis.  Mechanical ventilation (OR 5.80; 95% CI 4.29–7.84) and thrombocytopenia (OR 1.66; 95% CI 1.16–2.38), on the first ICU admission were associated with readmission. Readmission was associated with a higher risk of 28-day and 90-day mortality, (OR 3.02; CI 2.3–4.00) and (OR 3.47; 95% CI 2.69–4.49), respectively.
Conclusions:  ICU readmission was associated with increased mortality. Mechanical ventilation and thrombocytopenia at the first admission were associated with ICU readmission.
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.

Caring for non-sedated mechanically ventilated patients in ICU: A qualitative study comparing perspectives of expert and competent nurses

This article by Mortensen and colleagues was published on line in February 2019 in the Journal of Intensive and Critical Care Nursing.
Background:  Sedation practice has evolved from deep to lighter or no sedation in mechanically ventilated patients in the intensive care unit (ICU). The care of conscious intubated patients constitutes a change in the nurse-patient interaction.
Objective:  We aimed to compare the perspectives of expert and competent nurses regarding their interaction with non-sedated mechanically ventilated ICU patients.
Method:  The study had a qualitative comparative design applying semi-structured dyadic interviews. We interviewed five pairs of expert and competent ICU nurses with respectively >8 and 2–3 years of ICU experience and performed qualitative content analysis to explore the two perspectives.
Findings:  We identified four main categories illustrating complexities of nurse-patient interaction: Managing frustration, Attempting dialogue, Negotiating reality and Alleviating discomfort. Expert nurses expressed more frustration and ambivalence towards light sedation than competent nurses, who took awake patients for granted. All nurses experienced communication issues, demanding patients, and inability to provide adequate patient comfort.
Conclusion:  Our study added to the knowledge of nurse-patient interaction by describing issues of frustration, ambivalence and insecurity in a contemporary context of minimal sedation. Expert nurses were mere concerned by awake patients than competent nurses. Lighter sedation in ICU requires better staffing and improved communication tools.
Subscribers to Intensive and Critical Care Nursing can access the full text of the article via this link.  The full text of articles from issues older than sixty days is available via this link to an archive of issues of Intensive and Critical Care Nursing.  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.

Serum albumin as a risk factor for death in patients with prolonged sepsis: An observational study

This paper by Takegawa and colleagues was published on line in February 2019 in the Journal of Critical Care.
Purpose:  The aim of this study was to evaluate an association between nutritional biomarkers and prognosis in septic patients.
Methods:  We retrospectively searched the association between nutritional biomarkers including serum albumin (Alb), total protein (TP), total cholesterol (T-chol), and cholinesterase (ChE), and prognosis for septic patients treated in the ICU for >7 days. We used time-dependent Cox proportional hazard regression analysis to resolve the difference of the statistical weight of each day’s data for all 14 consecutive days among individual sepsis patients. The covariates were based on the minimum moving values determined from 1 day, 3 days, 7 days, and 14 days of serial data. The values of these covariates and ICU survival were considered as outcomes.
Results:  We included 136 septic patients. The decreases in the values of Alb, TP, T-chol, and ChE were significantly associated with the risk of death in the septic patients (p < .05). Especially, the daily changes of Alb were significantly associated with mortality during the ICU stay (p < .05).
Conclusions:  We found that the changes in serial data of the nutritional markers of Alb, TP, T-chol, and ChE reflected the higher risk of death in patients with prolonged sepsis.
The full text of this article is available to subscribers via this link to the journal’s homepageThe 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.