Critical Care Reviews Newsletter Issue 306 22nd October 2017

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 highlightcritcal care reviewss 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?.”

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Structured nurse-led follow-up for patients after discharge from the intensive care unit: prospective quasi-experimental study

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.

Critical Care Cycling Study (CYCLIST) trial protocol: a randomised controlled trial of usual care plus additional in-bed cycling sessions versus usual care in the critically ill

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 feasicube-1002897_960_720ble, 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.

Critical Care Reviews Newsletter Issue 307 29th October 2017

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 a pilot randomised controlled trial investigating brain oxygen optimization in severe traumatic brain injury; meta analyses on PEEP, recruitment manoeuvers and high frequency oscillation for ARDS; an observational study suggesting harm for men receiving blood transfusion from previously pregnant female donors; a guideline from the neurocritical care society on targeted temperature management; as well as narrative reviews on traumatic brain injury, acute right ventricular dysfunction in ICU and sepsis in alcohol-related liver disease.”
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A “Neurological Emergency Trolley” reduces turnaround time for high-risk medications in a general intensive care unit

This article by Aizenberg et al was published in the October 2017 edition of Intensive and Critical Care Nursing.

Objectives:  To reduce medication turnaround times during neurological emergencies, a multidisciplinary team developed a neurological emergency crash trolley in our intensive care unit. This trolley includes phenytoin, hypertonic saline and mannitol, as well as other equipment. The aim of this study was to assess whether the cart reduced turnaround times for these medications.

Research Methodology / Design:  In this retrospective cohort study, medication delivery times for two year epochs before and after its implementation were compared. Eligible patients were identified from our intensive care unit screening log. Adults who required emergent use of phenytoin, hypertonic saline or mannitol while in the intensive care unit were included. Groups were compared with nonparametric analyses.

Setting:  33-bed general medical-surgical intensive care unit in an academic teaching hospital.

Main Outcome Measures:  Time to medication administration.

Results:  In the pre-intervention group, there were 43 patients with 66 events. In the post-intervention group, there were 45 patients with 80 events. The median medication turnaround time was significantly reduced after implementation of the neurological emergency trolley (25 vs. 10minutes, p=0.003). There was no statistically significant difference in intensive care or 30-day survival between the two cohorts.

Conclusion:  The implementation of a novel neurological emergency crash trolley in our intensive care unit reduced medication turnaround times.

The full text of this article will usually be only available via the internet to those who have a personal subscription though 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.

Impact of prior ICU experience on ICU patient family members’ psychological distress: A descriptive study

This article by Lewis and Taylor was published in “Intensive and Critical Care Nursing” October 2017.

Objective:  To determine if current levels of anxiety, depression and acute stress disorder symptoms differ significantly among family members of intensive-care-unit patients depending upon previous intensive-care experience.

Research Design:  This study used a prospective, descriptive study design.

Setting:  Family members (N=127) from patients admitted within a 72-hour timeframe to the medical, surgical, cardiac and neurological intensive care units were recruited from waiting rooms at a medium-sized community hospital in the Southeastern United States.

Main outcome measures:  Participants completed the Hospital Anxiety and Depression Scale, the Impact of Events Scale-Revised, the Acute Stress Disorder Scale and a demographic questionnaire.

Results:  A multivariate analysis revealed that family members of intensive-care-unit patients with a prior intensive-care experience within the past two years (n=56) were significantly more likely to report anxiety, depression and acute stress symptoms, Λ=0.92, F [4122]=2.70, p=0.034, partial η2=0.08, observed power=0.74.

Conclusion:  Results of this study show that family members’ psychological distress is higher with previous familial or personal intensive-care experience. Nurses need to assess for psychological distress in ICU family members and identify those who could benefit from additional support services provided in collaboration with multidisciplinary support professionals.

The full text of this article will usually be only available via the internet to those who have a personal subscription though 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.

Critical Care Reviews Newsletter Issue 305 15th October 2017

The 305th 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 higcritcal care reviewshlights of this week’s newsletter are randomised controlled trials on tapered-cuff tracheal tubes for the prevention of micro-aspiration and red cell transfusion triggers in cardiac surgery.  There is also the protocol of the COAST trial, comparing high flow versus oxygen versus control in African children with severe pneumonia.  Narrative reviews include ones on brain monitoring in adult and paediatric ECMO patients, cardiogenic shock, intraoperative mechanical ventilation and interhospital transfer of critically ill patients.  There are editorials on fixed minimum volume sepsis resuscitation (pro & con) and when antibiotic treatment fails.

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