Klingensmith, N.J. & Coopersmith, C.M. Critical Care. Published online: 19 December 2016
Approximately 40 trillion bacteria reside inside the human intestine, meaning there are at least as many cells of microbial origin as human origin. While it was once believed that bacteria and humans simply co-existed in the same space, a wide body of evidence now suggests that host–microbial communication is more complex than ever imagined and the microbiome plays a critical role in maintaining host homeostasis. The microbiome is also altered in multiple disease states, including heart disease , cancer, and Clostridium difficile infection, with changes detectable in microbial composition, number, diversity, and virulence compared to healthy controls. While the majority of studies linking the microbiome to disease are associative, there is increasing evidence that the microbiome plays a crucial role in mediating the pathophysiology of multiple acute and chronic illnesses.
This quality standard covers the general principles of blood transfusion in adults, young people and children over 1 year old. It describes high-quality care in priority areas for improvement. It does not cover specific conditions that blood transfusion is used for. This quality standard is reviewed each year and updated if needed.
The four quality statements included in the latest review:
Statement 1 People with iron-deficiency anaemia who are having surgery are offered iron supplementation before and after surgery.
Statement 2 Adults who are having surgery and expected to have moderate blood loss are offered tranexamic acid.
Statement 3 People are clinically reassessed and have their haemoglobin levels checked after each unit of red blood cells they receive, unless they are bleeding or are on a chronic transfusion programme.
Statement 4 People who may need or who have had a transfusion are given verbal and written information about blood transfusion.
This issue includes a special feature on “What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine” together with a range of articles on sepsis, pulmonary and outcomes.
To access the full text of these articles from the journal’s website you require your own subscription. However, the full text of any articles can be ordered via the Rotherham NHS Foundation Trust Library and Knowledge Service. You can do this in person or if you are a registered member of the library you can use this link to a journal article request form.
Families of people dying in intensive care need to receive personalised communication and ongoing support, and be involved in the dying process | NIHR
Researchers gathered evidence on how nurses care for patients and their families in intensive care when life-sustaining treatment is withdrawn. The included studies explored the care of the family before, during and after the process. Most of the studies in this small, mixed methods review were qualitative.
Reviewers identified three main ways, or themes, in which families are supported. First, information and good communication, such as the focus on careful use of language, was seen commonly. Second, by careful management of treatment withdrawal itself, for example by clarifying the gradual change expected when medically focussed life-sustaining treatments are withdrawn and family centred end-of-life care begins. Lastly they described a common focus on making the nursing contribution more visible, such as using techniques to build lasting memories for families.
Checklist-style guidelines decreased unnecessary blood culture collection by nearly half in study
Investigators say that safely reducing the frequency of blood draws in hospitalized children with fevers has historically not been a hospital priority despite the stress, pain and high rate of false positives associated with the procedure.
The researchers found that fostering cross-departmental collaboration and offering guidelines to clinicians helped reduce the number of unnecessary blood draws on some of the smallest and most vulnerable patients at the Johns Hopkins Children’s Center. Clinicians were able to accomplish an immediate reduction in unnecessary blood draws using the newly designed checklist protocols, and they were able to sustain the reduction over time.
Crompton, E et al. Critical Care Medicine. Published online: December 9 2016
Objective: Therapeutic hypothermia has been used to attenuate the effects of traumatic brain injuries. However, the required degree of hypothermia, length of its use, and its timing are uncertain. We undertook a comprehensive meta-analysis to quantify benefits of hypothermia therapy for traumatic brain injuries in adults and children by analyzing mortality rates, neurologic outcomes, and adverse effects.
Conclusions: Therapeutic hypothermia is likely a beneficial treatment following traumatic brain injuries in adults but cannot be recommended in children.