June 2018 Issue of “Intensive Care Medicine” Volume 44 Number 6

intensive-care-medicine“Intensive Care Medicine” is a publication for the communication and exchange of current work and ideas in intensive care medicine.  To access the latest issue’s contents page follow this link. 
Articles in this edition include “Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients”, “A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill” and “The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients”
To access the full text of these articles via the journal’s homepage you require a personal subscription to the journal.  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.
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.

Advertisements

Intensive care doctors’ preferences for arterial oxygen tension levels in mechanically ventilated patients

This article by Schjorring and others was published in Acta Anaesthesioligica Scandinavica in June 2018.
Background:  Oxygen is liberally administered in intensive care units (ICUs). Nevertheless, ICU doctors’ preferences for supplementing oxygen are inadequately described. The aim was to identify ICU doctors’ preferences for arterial oxygenation levels in mechanically ventilated adult ICU patients.
Methods:  In April to August 2016, an online multiple-choice 17-part-questionnaire was distributed to 1080 ICU doctors in seven Northern European countries. Repeated reminder e-mails were sent. The study ended in October 2016.
Results:  The response rate was 63%. When evaluating oxygenation 52% of respondents rated arterial oxygen tension (PaO2 ) the most important parameter; 24% a combination of PaO2 and arterial oxygen saturation (SaO2 ); and 23% preferred SaO2 . Increasing, decreasing or not changing a default fraction of inspired oxygen of 0.50 showed preferences for a PaO2 around 8 kPa in patients with chronic obstructive pulmonary disease, a PaO2 around 10 kPa in patients with healthy lungs, acute respiratory distress syndrome or sepsis, and a PaO2 around 12 kPa in patients with cardiac or cerebral ischaemia. Eighty per cent would accept a PaO2 of 8 kPa or lower and 77% would accept a PaO2 of 12 kPa or higher in a clinical trial of oxygenation targets.
Conclusion:  Intensive care unit doctors preferred PaO2 to SaO2 in monitoring oxygen treatment when peripheral oxygen saturation was not included in the question. The identification of PaO2 as the preferred target and the thorough clarification of preferences are important when ascertaining optimal oxygenation targets. In particular when designing future clinical trials of higher vs lower oxygenation targets in ICU patients.
To access the full text of these articles via the journal’s homepage you require a personal subscription to the journal.  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.

Interruptions During Senior Nurse Handover in the Intensive Care Unit: A Quality Improvement Study

This article by Spooner and colleagues was published in June 2018 issue of the Journal of Nursing Care Quality.
Background:  Interruptions during handover may compromise continuity of care and patient safety.
Local Problem:  Interruptions occur frequently during handovers in the intensive care unit.
Methods:  A quality improvement study was undertaken to improve nursing team leader handover processes. The frequency, source, and reason interruptions occurred were recorded before and after a handover intervention.
Interventions:  The intervention involved relocating handover from the desk to bedside and using a printed version of an evidence-based electronic minimum data set. These strategies were supported by education, champions, reminders, and audit and feedback.
Results:  Forty handovers were audio taped before, and 49 were observed 3 months following the intervention. Sixty-four interruptions occurred before and 52 after the intervention, but this difference was not statistically significant. Team leaders were frequently interrupted by nurses discussing personal or work-specific matters before and after the intervention.
Conclusions:  Further work is required to reduce interruptions that do not benefit patient care.
The full text of this article is available via this link to the journal’s homepage if you have a personal subscription to the journal.  Library members can order individual articles via the Rotherham NHS Foundation Trust Library and Knowledge Service using the article requests online via this link.

Allostasis and sedation practices in intensive care evaluation: an observational pilot study.

This article by Moore and colleagues appeared in the June 2018 issue of Intensive Care Medicine Experimental.
Background:  A dysregulated stress response has been implicated in the pathogenesis of critical illness. Sedative agents utilised in the critically unwell patient may impact upon the stress response with a downstream negative effect on multiple organ systems. This study was designed to assess the feasibility of investigating components of the stress response as a sub-study of the current SPICE-III study (NCT01728558).
Methods:  This pilot observational cohort study was conducted in a single intensive care unit in Queensland, Australia. Enrolled patients were over 18 years who had been commenced on mechanical ventilation requiring sedation for less than 12h but expected to remain ventilated for > 24h. Blood samples were taken at 12h intervals over a 5-day period commencing at the time of enrolment, and subsequently tested for various markers of key efferent limbs of the stress axis.
Results:  The 12 patients recruited closely mirrored the population within the pilot study used to design SPICE-III. Eighty-nine percent (107/120) of all planned blood samples were obtained and drawn within 0h (0-0.3) of the planned sampling time point. Time from eligibility to enrolment was a median (IQR) 1.4h (0.36-9.19), and time from eligibility to the first blood sample was 4.79h (2.0-10.61). Physiological, hormonal, metabolic and cardiac biomarkers were consistent with an elevated stress response at baseline which mostly normalised over the 5-day study period. Plasma noradrenaline levels correlated with the dose of norepinephrine used.
Conclusions:  A larger sub-study of the SPICE-III study is feasible. The study has demonstrated a predictable trend of variation of the components of the blood panel during the evolution of critical illness and supports multiple sampling time points for the follow-up study.
The full text of the article is available via the link to “Download PDF” on this page.

Critical Care Reviews Newsletter 341 24th June 2018

critcal care reviewsThe 341st issue of the Critical Care Reviews Newsletter, brings you the best critical care research and open access articles from across the medical literature in the last week.  This includes experimental research such as “Early fibrinogen concentrate therapy for major haemorrhage in trauma (E-FIT 1): results from a UK multi-centre, randomised, double blind, placebo-controlled pilot trial”’, observational studies including “Long-term Risk of Seizures among Cardiac Arrest Survivors” and secondary research for instance “Revascularization strategies in cardiogenic shock complicating acute myocardial infarction: A systematic review and meta-analysis.”
The full text of newsletter 341 can be found via this link

A Randomized Trial of a Family-Support Intervention in Intensive Care Units

This piece of experimental research by White and colleagues was published in the June 21st issue of the New England Journal of Medicine.
Background:  Surrogate decision makers for incapacitated, critically ill patients often struggle with decisions related to goals of care. Such decisions cause psychological distress in surrogates and may lead to treatment that does not align with patients’ preferences.
Methods:  We conducted a stepped-wedge, cluster-randomized trial involving patients with a high risk of death and their surrogates in five intensive care units (ICUs) to compare a multi-component family-support intervention delivered by the inter-professional ICU team with usual care. The primary outcome was the surrogates’ mean score on the Hospital Anxiety and Depression Scale (HADS) at 6 months (scores range from 0 to 42, with higher scores indicating worse symptoms). Pre-specified secondary outcomes were the surrogates’ mean scores on the Impact of Event Scale (IES; scores range from 0 to 88, with higher scores indicating worse symptoms), the Quality of Communication (QOC) scale (scores range from 0 to 100, with higher scores indicating better clinician-family communication), and a modified Patient Perception of Patient Centeredness (PPPC) scale (scores range from 1 to 4, with lower scores indicating more patient- and family-centered care), as well as the mean length of ICU stay.
Results:  A total of 1420 patients were enrolled in the trial. There was no significant difference between the intervention group and the control group in the surrogates’ mean HADS score at 6 months (11.7 and 12.0, respectively; beta coefficient, -0.34; 95% confidence interval [CI], -1.67 to 0.99; P=0.61) or mean IES score (21.2 and 20.3; beta coefficient, 0.90; 95% CI, -1.66 to 3.47; P=0.49). The surrogates’ mean QOC score was better in the intervention group than in the control group (69.1 vs. 62.7; beta coefficient, 6.39; 95% CI, 2.57 to 10.20; P=0.001), as was the mean modified PPPC score (1.7 vs. 1.8; beta coefficient, -0.15; 95% CI, -0.26 to -0.04; P=0.006). The mean length of stay in the ICU was shorter in the intervention group than in the control group (6.7 days vs. 7.4 days; incidence rate ratio, 0.90; 95% CI, 0.81 to 1.00; P=0.045), a finding mediated by the shortened mean length of stay in the ICU among patients who died (4.4 days vs. 6.8 days; incidence rate ratio, 0.64; 95% CI, 0.52 to 0.78; P<0.001).
Conclusions:  Among critically ill patients and their surrogates, a family-support intervention delivered by the inter-professional ICU team did not significantly affect the surrogates’ burden of psychological symptoms, but the surrogates’ ratings of the quality of communication and the patient- and family-centeredness of care were better and the length of stay in the ICU was shorter with the intervention than with usual care.
The printed copy of the New England Journal of Medicine is available in the Health Care Library on D Level of Rotherham Hospital.

Critical Care Reviews Newsletter 340 27th May 2018

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.  The highlights of this week’s edition are the BICAR-ICU randomised controlled trial, investigating sodium bicarbonate for metabolic acidaemia; observational studies on subphenotypes in septic shock & late mortality after acute hypoxic respiratory failure; guidelines on cancer patients requiring intensive care support & intermediate care units; narrative reviews on perioperative myocardial injury and the contribution of hypotension, vasoactive agents in shock & ventilation during extracorporeal support. There are also contrasting editorials on whether trials that report a neutral or negative treatment effect improve the care of critically ill patients – Yes & No; thrombocytopenia in the ICU & sepsis: who will shoot first? pharma or diagnostics; as well as commentaries on severe pulmonary embolism, type 2 myocardial infarction & acute kidney injury.”
The full text of newsletter 340 can be found via this link