The 313th 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 issue are two RCTs in out-of-hospital cardiac arrest, investigating inhaled xenon and prehospital cooling respectively, meta analyses on stress ulcer prophylaxis, polymyxin B-immobilized hemoperfusion insepsis, and lung and diaphragmatic ultrasound to predict weaning outcome; plus observational studies on prone positioning in ARDS and hypoxemic respiratory failure in immunocompromised patients. There are also guidelines on bleeding in patients on oral anticoagulants and emergency airway management; and excellent narrative reviews on high-frequency oscillatory ventilation in ARDS , high-flow nasal oxygen and renal replacement therapy for acute brain injury.”
To access Intensive Care Medicine’s latest issue’s contents page follow this link.
Articles in this issue include “Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC)”, “Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study)” and “The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years)”.
To access the full text of these articles from the journal’s homepage requires a personal subscription to the journal. 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.
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.
The 312nd 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 the latest issue are “The highlights of this week’s issue are randomised controlled trials investigating prehospital antibiotics for sepsis & reducing discomfort in critically ill patients; narrative reviews on blood pressure management in acute intracerebral hemorrhage, non-invasive cardiac output monitoring, managing persistent hypoxemia & ventilator-associated pneumonia; as well as commentaries on 10 false beliefs in adult critical care nephrology, medical preprints and five ways to fix statistics.”
Critical Care Reviews Newsletter brings you the best critical care research and open access articles from across the medical literature in the last week.
“The highlights of this week’s edition are randomised controlled trials on therapeutic hypothermia for newborns with hypoxic-ischemic encephalopathy, neuromuscular blockade in patients during targeted temperature management after resuscitation from cardiac arrest and the safety of the mechanical chest compression devices AutoPulse and LUCAS in cardiac arrest; observational studies on prehospital blood product transfusion for combat casualties in Afghanistan and the UK cost-utility analysis and secondary analyses of the ABLE trial; narrative reviews on extracorporeal life support in preoperative and postoperative heart transplant management and Clostridium difficile infection in the ICU ; plus editorials on thrombosis and bleeding and apparent research misconduct; as well as commentaries on fever control, individualized perfusion targets in post-cardiac arrest hypoxic ischemic brain injury and is this critically ill patient elderly or too old?.”
This article by Jonasdottir et al was published in the Journal of Advanced Nursing during October 2017.
Aims: To describe a structured three-month nurse-led follow-up of patients after discharge from intensive care and measure its effects on health status.
Background: Patients requiring intensive care stay frequently have lengthy and incomplete recovery suggesting need for additional support. The effects of intensive care nurse-led follow-up have not been sufficiently elucidated.
Design: A prospective, quasi-experimental study of patients who received structured nurse-led follow-up from intensive care nurses after discharge from intensive care until three months afterwards. The control group received usual care.
Methods: Of 574 patients assessed for eligibility, from November 2012 – May 2015, 168 were assigned to the experimental group (N=73) and the control group (N=75). Primary outcome was health status, measured with eight scales of Short Form-36v2, before the intensive care admission and at four time points until twelve months after intensive care. A mixed effect model tested differences between the groups over time. Criteria for Reporting Development and Evaluation of Complex Interventions 2 guideline, guided the reporting of the intervention.
Results: The structured nurse-led follow-up did not improve patients’ health status compared with usual care (mixed effect model, p = 0.078 – 0.937).
Conclusion: The structured nurse-led follow-up did not reveal an effect on the intensive care patients studied. Further examination of intensive care nurse-led follow-up is needed, taking into account the heterogeneity of the patient population, variations in length of ward stay, patients’ health care needs during the first week at home after discharge from general ward and health status before intensive care admission. This article is protected by copyright. All rights reserved.
The physical copy of available Journal of Advanced Nursing is available in the Healthcare Library on Level D of Rotherham Hospital. The full text of the article can be accessed by personal subscribers using this link.
This article by Prechter et al was published in Critical Care in October 2017. The full text of the article can be accessed via this link.
Over the last years, there was an increase in the number and severity of Clostridium difficile infections (CDI) in all medical settings, including the intensive care unit (ICU). The current prevalence of CDI among ICU patients is estimated at 0.4-4% and has severe impact on morbidity and mortality. An estimated 10-20% of patients are colonized with C. difficile without showing signs of infection and spores can be found throughout ICUs. It is not yet possible to predict whether and when colonization will become infection. Figuratively speaking, our patients are sleeping with the enemy and we do not know when this enemy awakens. Most patients developing CDI in the ICU show a mild to moderate disease course. Nevertheless, difficult-to-treat severe and complicated cases also occur. Treatment failure is particularly frequent in ICU patients due to comorbidities and the necessity of continued antibiotic treatment. This review will give an overview of current diagnostic, therapeutic, and prophylactic challenges and options with a special focus on the ICU patient. First, we focus on diagnosis and prognosis of disease severity. This includes inconsistencies in the definition of disease severity as well as diagnostic problems. Proceeding from there, we discuss that while at first glance the choice of first-line treatment for CDI in the ICU is a simple matter guided by international guidelines, there are a number of specific problems and inconsistencies. We cover treatment in severe CDI, the problem of early recognition of treatment failure, and possible concepts of intensifying treatment. In conclusion, we mention methods for CDI prevention in the ICU.
This article by Nickels and colleagues was published in BMJ Open during October 2017. The full text of the article is available via this link.
Introduction: In-bed cycling with patients with critical illness has been shown to be safe and feasible, and improves physical function outcomes at hospital discharge. The effects of early in-bed cycling on reducing the rate of skeletal muscle atrophy, and associations with physical and cognitive function are unknown.
Methods and Analysis: A single-centre randomised controlled trial in a mixed medical-surgical intensive care unit (ICU) will be conducted. Adult patients (n=68) who are expected to be
mechanically ventilated for more than 48 hours and remain in ICU for a further 48 hours from recruitment will be randomly allocated into either (1) a usual care group or (2) a group that receives usual care and additional in-bed cycling sessions. The primary outcome is change in rectus femoris cross-sectional area at day 10 in comparison to baseline measured by blinded assessors. Secondary outcome measures include muscle strength, incidence of ICU-acquired weakness, handgrip strength, time to achieve functional milestones (sitting out of bed, walking), Functional Status Score in ICU, ICU Mobility Scale, 6 min walk test 1 week post-ICU discharge, incidence of delirium and quality of life (EuroQol Five Dimensions questionnaire Five Levels scale). Quality of life assessments will be conducted post-ICU admission at day 10, 3 and 6 months after acute hospital discharge. Participants in the intervention group will complete an acceptability of intervention questionnaire.
Ethics and Dissemination: Appropriate ethical approval from Metro South Health Human Research Ethics Committee has been attained. Results will be published in peer-reviewed publications and presented at scientific conferences to assist planning of future multicentre randomised controlled trials (if indicated) that will test in-bed cycling as an intervention to improve the physical, cognitive and health-related quality of life outcomes of patients with critical illness.