Latest Issue of “Intensive and Critical Care Nursing” Volume 34 June 2016

The content page of the most recent issue of this journal can be accessed via this link

Articles in this issue include “Early recognition of delirium in trauma patients”, “Ticcnlogohe experiences of nurses implementing the Modified Early Warning Score and a 24 hour on call Mobile Intensive Care: An exploratory study” and “Task management Skills and their deficiencies during care delivery in simulated medical emergency situation: a classification”.

A personal subscription to the journal is needed to access the full text of any articles direct from the journal’s website.  However, articles can be ordered via the Rotherham NHS Foundation Trust Library and Knowledge Service.  This can be done either in person or via this link if you are a registered member of the library.

Effect of Noninvasive Ventilation on Tracheal Reintubation Among Patients With Hypoxemic Respiratory Failure Following Abdominal Surgery: A Randomized Clinical Trial

This article was published in JAMA 5th April 2016 v315 n13 p1345-53 by the NIVAS Study Group is described below.  This issue of JAMA is available in the Healthcare Library on D Level of Rotherham Hospital.

It has not been established whether non-invasive ventilation (NIV) reduces the need for invasive mechanical ventilation in patients who develop hypoxemic acute respiratory failure after abdominal surgery. This research evaluated whether non-invasive ventilation improves outcomes among patients developing hypoxemic acute respiratory failure after abdominal surgery.

Multi-centre, randomized, parallel-group clinical trial conducted between May 2013 and September 2014 in 20 French intensive care units among 293 patients who had undergone abdominal surgery and developed hypoxemic respiratory failure.  Patients were randomly assigned to receive standard oxygen therapy (up to 15 L/min to maintain SpO2 of 94% or higher) (n = 145) or NIV delivered via facial mask (inspiratory pressure support level, 5-15 cm H2O; positive end-expiratory pressure, 5-10 cm H2O; fraction of inspired oxygen titrated to maintain SpO2 ≥94%) (n = 148).

The primary outcome was tracheal reintubation for any cause within 7 days of randomization. Secondary outcomes were gas exchange, invasive ventilation-free days at day 30, health care-associated infections, and 90-day mortality. Among the 293 patients included in the intention-to-treat analysis, reintubation occurred in 33.1% in the NIV group and in 45.5% in the standard oxygen therapy group.  Noninvasive ventilation was associated with significantly more invasive ventilation-free days compared with standard oxygen therapy (25.4 vs 23.2 days), while fewer patients developed health care-associated infections (31.4% vs 49.2%).  At 90 days, 14.9% in the NIV group and 21.5% in the standard oxygen therapy group had died. There were no significant differences in gas exchange.

Among patients with hypoxemic respiratory failure following abdominal surgery, use of NIV compared with standard oxygen therapy reduced the risk of tracheal reintubation within 7 days. These findings support use of NIV in this setting.

Effect of Postextubation High-Flow Nasal Cannula vs Conventional Oxygen Therapy on Reintubation in Low-Risk Patients: A Randomized Clinical Trial

This research by Hernandez and colleagues was published in JAMA on 5th April 2016.  The abstract is described below and a physical copy of the issue is available in the Health Care library on Level D of the hospital.

Studies of mechanically ventilated critically ill patients that combine populations that are at high and low risk for reintubation suggest that conditioned high-flow nasal cannula oxygen therapy after extubation improves oxygenation compared with conventional oxygen therapy. However, conclusive data about reintubation are lacking.

This multi-centre randomized clinical trial was conducted between September 2012 and October 2014 in 7 intensive care units (ICUs) in Spain. Participants were 527 adult critical patients at low risk for reintubation who fulfilled criteria for planned extubation.  Patients were randomized to undergo either high-flow or conventional oxygen therapy for 24 hours after extubation.

The primary outcome was reintubation within 72 hours, compared with the Cochran-Mantel-Haenszel χ2 test. Secondary outcomes included postextubation respiratory failure, respiratory infection, sepsis and multiorgan failure, ICU and hospital length of stay and mortality, adverse events, and time to reintubation.  Of the 527 patients randomised 264 received high-flow therapy and 263 conventional oxygen therapy.

Reintubation within 72 hours was less common in the high-flow group (4.9% vs 12.2%) in the conventional group.  Postextubation respiratory failure was less common in the high-flow group (8.3% vs 14.4%).  Time to reintubation was not significantly different between groups 19 hours in the high-flow group vs 15 hours in the conventional group. No adverse effects were reported.

Among extubated patients at low risk for reintubation, the use of high-flow nasal cannula oxygen compared with conventional oxygen therapy reduced the risk of reintubation within 72 hours.

Latest issue of “Journal of Critical Care” Volume 33 June 2016

The content page of the most recent issue of this journal can be accessed via this link

The theme of the issue is acute respiratory distress syndrome (ARDS) including a discussion on the definition of ARDS and an article on the imaging of ARDS.  Reviejournal of critical carew
articles include “Venovenous extracorporeal membrane oxygenation for acute respiratory failure” and “Recovery and outcomes after the ARDS in patients and their family caregivers”.

A personal subscription to the journal is required to access the full text of these articles direct from this website.  However, articles can be ordered via the Rotherham NHS Foundation Trust Library and Knowledge Service.  This can be done either in person or via this link if you are a registered member of the library.

Current issue of “Intensive Care Medicine” Volume 42 Issue 5 May 2016

The content page of the most recent issue of this journal can be accessed via this link

The theme of the issue is acute respiratory distress syndrome (ARDS) including a discussion on the definition of ARDS and an article on the
imaging of ARDS.  Review articles include “Venovenous extracorporeal membrane oxygenation for acute respiratory failure” and “Recovery and outcomes after the ARDS in patients and their family caregivers”.

A personal subscription to the journal is required to access the full text of these articles direct from this website.  However, articles can be ordered via the Rotherham NHS Foundation Trust Library and Knowledge Service.  This can be done either in person or via this link if you are a registered member of the library.

Latest Issue of “Journal of Intensive Care Medicine” May 2016 Volume 42 Issue 4

The content page of the most recent issue of this journal can be accessed via this link

The titles of articles included in the issue include “Effect of Compliance With a Nurse-Led Intensive Care Unit Checklist on Clinical Outcomes in Mechanically and Non-mechanically Ventilated Patients” and “Exploration of Withdrawal of Life-Sustaining Therapy in Canadian Intensive Care Units”.

To access the full text of these articles direct from the journal’s homepage requires a personal subscription.  Individual articles can be ordered via the Rotherham NHS Foundation Trust Library and Knowledge Service.  Registered members of the library can make requests online via this link.

Patients at high risk for psychiatric symptoms after a stay in the intensive care unit

Johns Hopkins Medicine. ScienceDaily. Published online: 20 April 2106

Results of a multi-institutional national study of nearly 700 people who survived life-threatening illness with a stay in an intensive care unit (ICU) suggest that a substantial majority of them are at high risk for persistent depression, anxiety and post-traumatic stress disorder — especially if they are female, young and unemployed.

The study, led by Johns Hopkins University researchers, found that two-thirds of study participants who survived a condition called acute respiratory distress syndrome (ARDS) and spent time in the ICU self-reported symptoms of at least one of these psychiatric disorders, and one-third of those patients with at least one psychiatric symptom said they experienced all three at the same time.

Contrary to the common risk factors associated with post-ARDS physical impairments and mortality, such as severity of illness and length of ICU stay, this study demonstrated that none of these risk factors had positive association with psychiatric symptoms.

Read the full commentary here