Ten-year trends in intensive care admissions for respiratory infections in the elderly

This article by Laporte and colleagues was published in Annals of Intensive Care August issue.
Background:  The consequences of the ageing population concerning ICU hospitalisation need to be adequately described. We believe that this discussion should be disease specific. A focus on respiratory infections is of particular interest, because it is strongly associated with old age. Our objective was to assess trends in demographics over a decade among elderly patients admitted to the ICU for acute respiratory infections.
Methods:  A cross-sectional study was performed between 2006 and 2015 based on hospital discharge databases in one French region (2.5 million inhabitants). Patients with acute respiratory infection were selected according to the specific ICD-10 diagnosis codes recorded, including acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and community-acquired pneumonia (CAP). We also identified comorbid conditions based on any significant ICD-10 secondary diagnoses adapted from the Charlson and Elixhauser indexes.
Results:  A total of 98,381 hospital stays for acute respiratory infection were identified among the 3,856,785 stays over the 10-year period. The number of patients 75 y/o and younger increased 1.6-fold from 2006 to 2015, whereas the numbers of patients aged 85-89 and ≥ 90 y/o increased by 2.5- and 2.1-fold, respectively. Both CAP and AECOPD hospitalisations significantly increased for all age groups over the decade. ICU hospitalisations for respiratory infection increased 2.7-fold from 2006 to 2015 (p = 0.0002). The greatest increases in the use of ICU resources were for the 85-89 and ≥ 90 y/o groups, which corresponded to increases of 3.3- and 5.8-fold. Indeed, the proportion of patients hospitalized for respiratory infection in ICU that were elderly clearly grew during the decade: 11.3% were ≥ 85 y/o in 2006 versus 16.4% in 2015 (p < 0.0001). This increase in ICU hospitalisation rate of ageing patients was not associated with significant changes in the level of care or ICU mortality except for patients ≥ 90 y/o (for whom ICU mortality dropped from 40.9 to 22.3%, p = 0.03).
Conclusion:  We observed a substantial increase in acute respiratory infection diagnoses associated with hospitalisation between 2006 and 2015, with a growing demand for critical care services. Both the absolute number and the percentage of elderly patient ICU admissions increased over the last decade, with the greatest increases being observed for patients 85 years and older.
The full text of this article is freely available via this link.

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Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials

The secondary research was published in the journal Critical Care in August 2018 by Wirz and others.
Background:  The clinical utility of serum procalcitonin levels in guiding antibiotic treatment decisions in patients with sepsis remains unclear. This patient-level meta-analysis based on 11 randomized trials investigates the impact of procalcitonin-guided antibiotic therapy on mortality in intensive care unit (ICU) patients with infection, both overall and stratified according to sepsis definition, severity, and type of infection.
Methods:  For this meta-analysis focusing on procalcitonin-guided antibiotic management in critically ill patients with sepsis of any type, in February 2018 we updated the database of a previous individual patient data meta-analysis which was limited to patients with respiratory infections only. We used individual patient data from 11 trials that randomly assigned patients to receive antibiotics based on procalcitonin levels (the “procalcitonin-guided” group) or the current standard of care (the “controls”). The primary endpoint was mortality within 30 days. Secondary endpoints were duration of antibiotic treatment and length of stay.
Results:  Mortality in the 2252 procalcitonin-guided patients was significantly lower compared with the 2230 control group patients (21.1% vs 23.7%; adjusted odds ratio 0.89, 95% confidence interval (CI) 0.8 to 0.99; p = 0.03). These effects on mortality persisted in a subgroup of patients meeting the sepsis 3 definition and based on the severity of sepsis (assessed on the basis of the Sequential Organ Failure Assessment (SOFA) score, occurrence of septic shock or renal failure, and need for vasopressor or ventilatory support) and on the type of infection (respiratory, urinary tract, abdominal, skin, or central nervous system), with interaction for each analysis being > 0.05. Procalcitonin guidance also facilitated earlier discontinuation of antibiotics, with a reduction in treatment duration (9.3 vs 10.4 days; adjusted coefficient -1.19 days, 95% CI -1.73 to -0.66; p < 0.001).
Conclusion:  Procalcitonin-guided antibiotic treatment in ICU patients with infection and sepsis patients results in improved survival and lower antibiotic treatment duration.
The full text of this article is freely available via this link.

Interprofessional Collaborative Practice in the Medical Intensive Care Unit: a Survey of Caregivers’ Perspectives.

This article was published in Journal of General Internal Medicine in August 2018 by Chen and colleagues.
Background:  Research on caregivers, defined as designated family members or support persons, in the medical intensive care unit (MICU) has primarily focused on their emotional needs and experiences, thus leaving a gap in knowledge related to their perceptions of team dynamics.
Objective:  To examine caregivers’ perceptions of team interactions and competencies for interprofessional collaborative practice (IPCP) and overall satisfaction with the MICU team.
Methods:  The Support Person Jefferson Teamwork Observation Guide (JTOG)™ was administered to a convenience sample of caregivers in the MICU at a large urban academic medical center between May 2016 and December 2016.
Results:  One hundred sixty-one JTOG surveys were completed. Caregivers agreed on the importance of healthcare professionals working together as a team to provide patient care (3.97 out of 4.0 on Likert response scale where 1 is “Not at all important” and 4 is ‘Extremely important”) and were satisfied with the MICU team (3.74 out of 4.0), positively evaluating the four core competencies for IPCP (3.55 for values/ethics, 3.58 for interprofessional communication, 3.61 for roles/responsibilities, and 3.64 for teams/teamwork) and the patient/family-centeredness sub-competency (3.58 out of 4.0). There was a strong positive correlation between caregivers’ Global JTOG scores and overall satisfaction with the MICU team (r = 0.596, p < 0.01). Caregivers’ comments about factors that affected their experience focused on aspects of interprofessional communication and patient/family-centeredness.
Conclusion:  Findings underscore the importance of interprofessional communication and providing patient/family-centered care. Assessing caregivers’ perceptions of IPCP can provide a critical lens into team functioning and, thus, be used to identify teams’ strengths as well as opportunities for improvement.
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Critical Care Reviews Newsletter 348 12th August 2018

The 348th Critical Care Reviews Newsletter, brings you the best critical care research and open access articles from across the medical literature during the last week.  “The highlights of this week’s edition are randomised controlled trials on terlipressin versus noradrenaline for AKI in acute-on-chronic liver failure, restricted fluid bolus volume in early paediatric septic shock & early CPAP in acute respiratory failure in children with impacritcal care reviewsired immunity; systematic reviews and meta analyses on complications and failures of central vascular access devices & laryngeal injury and upper airway symptoms after intubation during critical care; and guidelines and position statements on steroid therapy for sepsis, disorders of consciousness & spinal motion restriction in trauma.”

The full text of the newsletter can be accessed via this link.

August Issue of “Intensive Care Medicine” Volume 44 Number 8

To access Intensive Care Medicine’s latest issue’s contents page follow this link.
intensive-care-medicineArticles published in this issue include “Assessing predictive accuracy for outcomes of ventilator-associated events in an international cohort: the EUVAE study”, “Health-related outcomes of critically ill patients with and without sepsis” and “Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: a systematic review and meta-analysis”.
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.

Critical Care Reviews Newsletter 347 5th August 2018

Welcome to the 347th Critical Care Reviews Newsletter, bringing 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 a randomised controlled trial on high cut off versus standard hemofiltration; a systematic review and meta-analysis on extracorporeal cardiopulmonary resuscitation for cardiac arrest; and a fascinating observational study on changes in temperature management of cardiac arrest patients following publication of the TTM trial. There are also guidelines on the use of viscoelastic haemostatic assays in the management of major bleeding & paediatric tracheostomy emergencies; narrative reviews on glycemic control & mechanisms of sepsis; editorials on out-of-hours discharge from intensive care & liberal or restricted fluid resuscitation in critical illness; as well as commentaries.”
The full text of the newsletter can be accessed via this link.

Measuring patient respect in the intensive care unit: Validation of the ICU-RESPECT instrument

This research by Geller and colleagues was published in the Journal of Critical Care in August 2018.
Purpose:  To validate a brief index of patient and family experiences of respect in the intensive care unit.
Material and Methods:  A survey including the 10-item ICU-RESPECT scale was administered to patients and family members in one ICU at a large west coast academic medical center. Confirmatory psychometric analyses were conducted.
Results:  Based on 142 completed surveys, factor analysis confirmed a unidimensional scale with an alpha of 0.90, an Eigen value of 4.9, and factor loadings from 0.50 to 0.86. The mean total score was 7.59 (SD = 3.06) out of a maximum of 10. Among the 106 surveys that included demographics, overall scores did not differ by type of respondent (patient or family) or by gender. There were modest differences in overall scores by patient race. Two individual items differed by type of respondent.
Conclusions:  The ICU-RESPECT index demonstrates reliability and concurrent validity in a different ICU setting from the one where the index was developed. Future research should assess the scale’s predictive validity, and factors associated with variation in scores. As hospitals address patient experience more broadly in response to national metrics, the index could identify particular behaviors or ICUs that would benefit from interventions to enhance respectful treatment.
To access the full text of this article 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.