The 290th issue of the Critical Care Reviews Newsletter includes the “best critical care research and open access articles from across the medical literature over the past seven days”. The “Topic of the Week” is critical care in resource limited settings including a paper on Intensive Care Unit Capacity in Low Income Counties
To view Intensive Care Medicine’s latest issue’s contents page follow this link.
Articles contained in this issue include “Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries”, “Appropriate endpoints for evaluation of new antibiotic therapies for severe infections: a perspective from COMBACTE’s STAT-Net” and “The role of infection models and PK/PD modelling for optimising care of critically ill patients with severe infections.”
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.
The 289th issue of the Critical Care Reviews Newsletter includes the “best critical care research and open access articles from across the medical literature over the past seven days”.
Research linked to from this issue include “Efficacy and safety of ridinilazole compared with vancomycin for the treatment of Clostridium difficile infection: a phase 2, randomised, double-blind, active-controlled, non-inferiority study” from Lancet Infectious Diseases, “The practice of tracheostomy decannulation—a systematic review” from the Journal of Intensive Care and “Wengenmayer. Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR) from Critical Care.
Patients in the intensive care unit with an imbalanced microbiome are at increased risk for complications and longer ICU stays, according to findings presented at Clinical Nutrition Week 2017 | Anesthesiology News
Image shows bacterial microbiome mapping – a bioartistic experiment.
Paul Wischmeyer, MD, professor of anesthesiology and surgery and director of perioperative research at Duke Clinical Research Institute, in Durham, N.C., who also is part of the ICU Microbiome Project, told meeting attendees that ICU patients experience significant microbiome perturbations and added complications, including acute respiratory distress syndrome (ARDS).
“ICU patients have massive loss of health-promoting bacteria and higher levels of pathogenic species, compared with healthy patients,” Dr. Wischmeyer said. “It is astonishing how rapidly pathogenic bacteria flourish and how this shift to dysbiosis appears to affect a variety of outcomes.”
Dr. Wischmeyer and his colleagues have been examining fecal and oral microbiome samples from 115 ICU patients treated at four hospitals and comparing them with samples from healthy people participating in the American Gut project. In previous research, they found decreases in populations of Bacteroides and Firmicutes, as well as the healthy bacterium, Faecalibacterium prausnitzii, which produces short-chain fatty acids that help preserve normal gut barrier function (mSphere 2016;1. pii:e00199-16). Meanwhile, they discovered increases in the relative abundance of Proteobacteria, a phylum of gram-negative bacteria linked to infections in ICU and hospitalized patients.
ICU patients also tended to lose overall fecal microbiota diversity, with some patients having only one organism compose 95% of their fecal bacteria after a short time in the ICU, he explained.
Despite the potential benefits central venous lines can have for patients, there is a high risk of bloodstream infection associated with these catheters | Intensive and Critical Care Nursing
Aim: Identify and critique the best available evidence regarding interventions to prevent central venous line associated bloodstream infections in adult intensive care unit patients other than anti-microbial catheters.
Methods: A systematic review of studies published from January 2007 to February 2016 was undertaken. A systematic search of seven databases was carried out: MEDLINE; CINAHL Plus; EMBASE; PubMed; Cochrane Library; Scopus and Google Scholar. Studies were critically appraised by three independent reviewers prior to inclusion.
Results: Nineteen studies were included. A range of interventions were found to be used for the prevention or reduction of central venous line associated bloodstream infections. These interventions included dressings, closed infusion systems, aseptic skin preparation, central venous line bundles, quality improvement initiatives, education, an extra staff in the Intensive Care Unit and the participation in the ‘On the CUSP: Stop Blood Stream Infections’ national programme.
Conclusions: Central venous line associated bloodstream infections can be reduced by a range of interventions including closed infusion systems, aseptic technique during insertion and management of the central venous line, early removal of central venous lines and appropriate site selection.
Full reference: Velasquez Reyes, D.C. et al. (2017) Prevention of central venous line associated bloodstream infections in adult intensive care units: A systematic review. Intensive and Critical Care Nursing. Published online: 26 June 2017
Sepsis and septic shock are medical emergencies that require immediate action | Anesthesiology News
Early resuscitation should begin with early antibiotics and fluids, as well as the identification of the source of infection, according to new guidelines that were released at the Society of Critical Care Medicine’s (SCCM) 2017 Critical Care Congress.
In addition, the new guidelines say a health care provider who is trained and skilled in the management of sepsis should reassess the patient frequently at the bedside. “It is not the initial assessment, but the frequent reassessment that will make a difference,” said Andrew Rhodes, MD, FRCP, FRCA, FFICM, the co-chair of the guidelines committee.
Read the full news story here
The aim of this study was to understand whether critical care nurses’ critical thinking disposition affects their clinical decision-making skills | Intensive and Critical Care Nursing
Background: A critical thinker may not necessarily be a good decision-maker, but critical care nurses are expected to utilise outstanding critical thinking skills in making complex clinical judgements. Studies have shown that critical care nurses’ decisions focus mainly on doing rather than reflecting. To date, the link between critical care nurses’ critical thinking and decision-making has not been examined closely in Malaysia.
Conclusion: While this small-scale study has shown a relationship exists between critical care nurses’ critical thinking disposition and clinical decision-making in one hospital, further investigation using the same measurement tools is needed into this relationship in diverse clinical contexts and with greater numbers of participants. Critical care nurses’ perceived high level of critical thinking and decision-making also needs further investigation.
Full reference: Ludin, S.L. (2017) Does good critical thinking equal effective decision-making among critical care nurses? A cross-sectional survey. Intensive and Critical Care Nursing. Published online: 26 June 2017