Sepsis care bundles reduce mortality odds 40%

Compliance with sepsis care bundles can significantly reduce death in hospital. However compliance rates are generally low.

This study assessed how the Surviving Sepsis Campaign was implemented in various countries and the impact of implementing these care bundles for people with severe sepsis or septic shock. Data were analysed about 1,794 patients from 62 countries. Compliance with all the three-hour bundle metrics was 19%. Compliance was associated with lower hospital mortality. Compliance with all the six-hour bundle metrics was 36%. This was associated with lower hospital mortality. Overall, patients who received all aspects of the care bundles had a 40% reduction in the odds of dying in hospital with the three-hour bundle and a 36% reduction with the six-hour bundle.

Automated drug dispensing systems in the intensive care unit: a financial analysis

Introducing automated drug dispensing systems on ICUs may have a high return on investment for hospitals.

A hospital in France assessed the economic impact of automated-drug dispensing systems in three surgical intensive care units (ICUs). These systems were implemented in each unit to replace traditional floor stock approaches. Costs before and after implementation were assessed in terms of floor stock inventories, expired drugs and time spent by nurses and pharmacy technicians on medication-related work . After automated systems were introduced, nurses spent less time on medication-related activities, saving an average of 15 hours per 33 beds. However, pharmacy technicians spent more time on stocking activities, with an average of 3.5 extra hours per day across the three ICUs. The cost of drug storage reduced by 44,298 euro and the cost of expired drugs reduced by 14,772 euro per year across the three ICUs. The hospital continued to see savings over a five year period.
Full reference: Chapuis C. et al. Automated drug dispensing systems in the intensive care unit: a financial analysis. Critical Care. 2015. 19 318

Non-invasive monitoring of oxygen delivery in acutely ill patients: new frontiers

Annals of Intensive Care 2015, 5:24

pulse oximeter

Hypovolemia, anemia and hypoxemia may cause critical deterioration in the oxygen delivery (DO2 ). Their early detection followed by a prompt and appropriate intervention is a cornerstone in the care of critically ill patients. And yet, the remedies for these life-threatening conditions, namely fluids, blood and oxygen, have to be carefully titrated as they are all associated with severe side-effects when administered in excess.

New technological developments enable us to monitor the components of DO 2 in a continuous non-invasive manner via the sensor of the traditional pulse oximeter. The ability to better assess oxygenation, hemoglobin levels and fluid responsiveness continuously and simultaneously may be of great help in managing the DO 2 .

The non-invasive nature of this technology may also extend the benefits of advanced monitoring to wider patient populations.

via Annals of Intensive Care | Full text | Non-invasive monitoring of oxygen delivery in acutely ill patients: new frontiers.

I can use intensive-care data to save people’s lives

Intensive care units gather huge amounts of patient data, but much of it just gets thrown away. Give it to me, says Thomas Heldt

data

Interview from New Scientist Magazine issue 3040 published 26 September 2015

You’re trying to start a data revolution in hospitals. Why?
I’m interested in clinical environments such as intensive care units, operating rooms and emergency rooms. These are places where huge amounts of data is gathered from patients at great expense. What surprised me when I entered this field is that this data is collected and displayed on a monitor, but after a holding period of between 48 and maybe 96 hours, it just gets deleted. It never becomes part of the medical record. I see that as a wasted opportunity.

What happens to the data while it is collected and temporarily stored?
Clinical staff might look at the monitors to check the data as it is collected. They might scroll back to see what happened 8, 12 or 24 hours earlier. Occasionally they might want that kind of information if something really bad or unexpected happens, but even then they would probably rely on the medical notes rather than the real-time physiological data that came off the monitors. So usually not much is done with this data after it has been collected and displayed.

Which types of patients are you targeting?
People with brain injuries and very premature babies are two examples. Most babies go on to be just fine but some develop severe brain injuries or serious complications that affect their gut or lungs. A day or so before it happens, you might have no idea there’s anything wrong. It’s only when you see a massive bleed in the head on a scan, or when you send them to the imaging department and you discover that their gut has become necrotic. The aim of my approach is not only to analyse the data coming off the monitors but also to use it to predict and prevent these kinds of injuries and complications.

How do you make sense of the data?
It is coming out of a system that has been studied for over 200 years: our physiology. Physiologists are very good at rooting their understanding in the language of basic mathematics or in engineering principles such as conservation of momentum, flow or energy. Using these kinds of principles one can quantify in a mathematical sense what is going on in patients and build models to describe it. Such models will enable us to warn doctors, “OK, so this is about to happen”. Not only that, we will be able to say: “This is about to happen because of X, Y and Z, and here’s how you could intervene.”

Are we on the cusp of a transformation in how hospitals deal with this data?
I think we are. For example, Boston Children’s Hospital now captures all of the data from every bedside monitor routinely. We recently had the luxury of rolling back up to 48 hours into the intensive care data, and we did see trends. We saw how patients could deteriorate very, very slowly – something that you probably wouldn’t be able to pick up over the course of a single nursing shift. When we presented this to clinicians it was a revelation to them.

By Jessica Griggs via I can use intensive-care data to save people’s lives | New Scientist.

Risk factors for delirium after on-pump cardiac surgery: a systematic review

Critical Care 2015, 19:346

Introduction
As evidence-based effective treatment protocols for delirium after cardiac surgery are lacking, efforts should be made to identify risk factors for preventive interventions. Moreover, knowledge of these risk factors could increase validity of etiological studies in which adjustments need to be made for confounding variables. This review aims to systematically identify risk factors for delirium after cardiac surgery and to grade the evidence supporting these associations.

Method
A prior registered systematic review was performed using EMBASE, CINAHL, MEDLINE and Cochrane from 1990 till January 2015 (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007371). All studies evaluating patients for delirium after cardiac surgery with cardiopulmonary bypass (CPB) using either randomization or multivariable data analyses were included. Data was extracted and quality was scored in duplicate. Heterogeneity impaired pooling of the data; instead a semi-quantitative approach was used in which the strength of the evidence was graded based on the number of investigations, the quality of studies, and the consistency of the association reported across studies.

Results
In total 1462 unique references were screened and 34 were included in this review, of which 16 (47 %) were graded as high quality. A strong level of evidence for an association with the occurrence of postoperative delirium was found for age, previous psychiatric conditions, cerebrovascular disease, pre-existent cognitive impairment, type of surgery, peri-operative blood product transfusion, administration of risperidone, postoperative atrial fibrillation and mechanical ventilation time. Postoperative oxygen saturation and renal insufficiency were supported by a moderate level of evidence, and there is no evidence that gender, education, CPB duration, pre-existent cardiac disease or heart failure are risk factors.

Conclusion
Of many potential risk factors for delirium after cardiac surgery, for only 11 there is a strong or moderate level of evidence. These risk factors should be taken in consideration when designing future delirium prevention strategies trials or when controlling for confounding in future etiological studies.

via Critical Care | Full text | Risk factors for delirium after on-pump cardiac surgery: a systematic review.

Study: Critical care nurses find balancing work satisfaction, stress challenging

By Nurse.com: October 1 2015

critical care nurse

Critical care nurses face a challenge in balancing the satisfaction of providing quality care to patients and their families with fatigue and stresses on their own quality of life. According to an article in the August issue of Critical Care Nurse, understanding the demographic and organizational factors related to nurses’ professional quality of life can help educators and healthcare leaders develop effective work environment interventions.

In “Compassion Satisfaction and Compassion Fatigue Among Critical Care Nurses,” lead author Tara Sacco, MS, RN, CCRN, AGCNS-BC, ACCNS-AG, and her team describe the demographic, unit and organizational factors that may contribute to nurses’ professional quality of life. The article also discusses the prevalence of satisfaction and fatigue in adult, pediatric and neonatal critical care nurses.
Critical care nurses at a western New York academic medical center were surveyed using a demographic questionnaire and the Professional Quality of Life Scale to measure levels of compassion fatigue and compassion satisfaction, according to the article. A total of 221 nurses from nine units responded to the cross-sectional survey, which examined levels of compassion satisfaction, burnout and secondary traumatic stress.

Carry on reading the full article via Study: Critical care nurses find balancing work satisfaction, stress challenging.

Breakthrough in cardiac arrest: reports from the 4th Paris International Conference

Annals of Intensive Care 2015, 5:22

Abstract

Jean-Luc Diehl The French Intensive Care Society organized on 5th and 6th June 2014 its 4th “Paris International Conference in Intensive Care”, whose principle is to bring together the best international experts on a hot topic in critical care medicine. The 2014 theme was “Breakthrough in cardiac arrest”, with many high-quality updates on epidemiology, public health data, pre-hospital and in-ICU cares. The present review includes short summaries of the major presentations, classified into six main chapters:

  • Epidemiology of CA
  • Pre-hospital management
  • Post-resuscitation management: targeted temperature management
  • Post-resuscitation management: optimizing organ perfusion and metabolic parameters
  • Neurological assessment of brain damages
  • Public healthcare

via Annals of Intensive Care | Full text | Breakthrough in cardiac arrest: reports from the 4th Paris International Conference.