Bright environmental light improves the sleepiness of night shift ICU nurses

This article by Griepentrog and others was published in Critical Care in November 2018.
Background:  Shift work can disturb circadian homeostasis and result in fatigue, excessive sleepiness, and reduced quality of life. Lighttherapy has been shown to impart positive effects in night shift workers. Wesought to determine whether or not prolonged exposure to bright light during anight shift reduces sleepiness and enhances psychomotor performance among ICUnurses.

Methods:  This is a single-center randomized, crossover clinical trial at a surgical trauma ICU. ICU nurses working a night shift were exposed to a 10-h period of high illuminance (1500-2000 lx) white light compared to standard ambient fluorescent lighting of the hospital. They then completed the Stanford Sleepiness Scale and the Psychomotor Vigilance Test. The primary and secondary endpoints were analyzed using the paired t test. A p value <0.05 was considered significant.

Results:  A total of 43 matched pairs completed both lighting exposures and were analyzed. When exposed to high illuminance lighting subjects experienced reduced sleepiness scores on the Stanford Sleepiness Scale than when exposed to standard hospital lighting: mean (sem) 2.6 (0.2) vs. 3.0 (0.2), p = 0.03. However, they committed more psychomotor errors: 2.3 (0.2) vs. 1.7 (0.2), p = 0.03.

Conclusions:  A bright lighting environment for ICU nurses working the night shift reduces sleepiness but increases the number of psychomotor errors.

The full text of this article is freely available via this link.

Critical Care Reviews Newsletter 364 3rd December 2018

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 APRV in paediatric ARDS; a systematic review and meta analysis on non-pharmacological interventions in reducing the incidence and duration of delirium; and an observational study looking at the mortality changes associated with mandated public reporting for sepsis in New York. There are also multiple guidelines, including a series from the American Society of Hematology on venothromboembolism; as well as narrative reviews on decompressive craniectomy in traumatic brain injury & what’s new in heart failure therapy 2018; editorials on guiding ventilation with transpulmonary pressure & chloride; and commentaries on hemoadsorption with CytoSorb & management of victims contaminated with radionuclides after a “dirty bomb” attack.”

The full text of the newsletter is available via this link.

Critical Care Reviews Newsletter 370 13th January 2019

The 370^th Critical Care Reviews Newsletter highlights the best critical care research articles from the medical literature in the last week.  “The highlights of this week’s edition are randomised controlled trials comparing enteral and intravenous sedation of critically ill patients & conservative fluid management after sepsis resuscitation, and systematic reviews and meta analyses on ECMO for ARDS & haloperidol for delirium. There are also guidelines on neuroanesthetic emergencies & peri-operative care of people with dementia; narrative reviews on the endothelial glycocalyx & weaning failure of cardiovascular origin; editorials on artificial intelligence in the ICU & a biomarker-based stratification tool for pediatric ARDS; and a commentary on managing renal transplant recipients.”  The newsletter also provides details of how to watch presentations from the Critical Care Reviews Meeting 2019 being held in Belfast. The full text of the newsletter is available via this link.

Constipation, diarrhea, and prophylactic laxative bowel regimens in the critically ill: A systematic review and meta-analysis

This article by Hay and colleague was published online in the Journal of Critical Care during January 2019.
Introduction:  Prophylactic laxative bowel regimens may prevent constipation in enterally-fed critically ill patients. However, their use may also increase diarrhea. We performed a systematic review to: 1. Explore the epidemiology of constipation and/or diarrhea in critically ill patients; and 2. Appraise trials evaluating prophylactic laxative bowel regimens.
Methods:  We searched MEDLINE, Embase, and CINAHL for publications that reported constipation or diarrhea in critically ill adult patients and/or prophylactic laxative bowel regimens.
Results:  The proportion of critically ill patients experiencing constipation was reported between 20% and 83% and the proportion experiencing diarrhea was reported between 3.3% and 78%. Six studies of prophylactic laxative bowel regimens were identified but only 3 randomised controlled trials were identified, and these were subjected to meta-analysis. Compared with placebo, a prophylactic laxative bowel regimen increased the risk of diarrhea (RR 1.58, 95% CI 1.22 to 2.04) but did not reduce the risk of constipation (RR 0.39, 95% CI 0.14 to 1.05), and did not affect the duration of mechanical ventilation, duration of ICU admission, or mortality.
Conclusions:  Constipation and diarrhea occur frequently in the critically ill but data evaluating prophylactic laxative bowel regimens in such patients are sparse and do not support their use.
The full text of articles from issues older than sixty days is available via this link to an archive of issues of Journal of Critical Care.  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.

Effect of Jet Nebulization on Noninvasive Positive-Pressure Ventilation Administered with Noninvasive or Intensive Care Unit Ventilators: A Bench Study

This article by Xu and colleagues was published in the December 2018 issue of Respiration international review of thoracic diseases.
Background:  Most of the patients on non invasive positive pressure ventilation require aerosol inhalation therapy to moisturize the airways or deliver drugs in acute settings. However, the effect of jet nebulization on non invasive positive pressure ventilation (NPPV) has not been determined.
Objectives:  This study was designed to investigate the impact of jet nebulization on NPPV applied in ventilators.
Methods:  Aerosol therapy during NPPV was conducted in a simulated lung. The jet nebulizer was connected at both the distal and proximal end of the exhalation valve for the noninvasive ventilators, while it was placed both in front of the Y tube proximal to the patient and at 15 cm distance from the Y-tube inspiratory limb distal to the patient for the intensive care unit (ICU) ventilators. Driving flow was set at 4 and 8 L/min, respectively.
Results:  TPmin (time from the beginning of the lung simulator’s inspiratory effort to the lowest value of airway pressure needed to trigger the ventilator), Ttrig (time to trigger), and Ptrig (the magnitude of airway pressure drop needed to trigger) were not significantly altered by jet nebulization in the non-invasive ventilators, while they were significantly increased in the ICU ventilators. The greater the driving flow, the stronger the impact on TPmin, Ttrig, and Ptrig. The actual tidal volume and control performance were not significantly affected by jet nebulization in either non-invasive or ICU ventilators. The tidal volume monitored was significantly increased at 8 L/min driving flow. The greater the driving flow, the stronger the impact on the tidal volume monitored.
Conclusion:  The effect of jet nebulization on NPPV was different when compared to invasive ventilation. Jet nebulization only affected the tidal volume monitored in the non-invasive ventilator. Jet nebulization also affected the triggering performance and tidal volume monitored in the ICU ventilator.
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.

Critical Care Reviews Newsletter 366 17th December 2018

The 366^th Critical Care Reviews Newsletter, provides 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 French guidelines on tracheotomy in the intensive care unit & targeted temperature management in the ICU, & a Brazilian guideline on management of acute kidney injury in patients with cirrhosis; narrative reviews on complications of decompressive craniectomy, left ventricular assist devices & multidrug resistant bacteria in critically ill patients”

The full text of the newsletter is available via this link.

Critical Care Reviews Newsletter 365 10th December 2018

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.  
This issue includes interventional studies such as “Inhaled Tranexamic Acid for Hemoptysis Treatment. A Randomized Controlled Trial”, secondary research including “Terlipressin for the treatment of acute variceal bleeding: A systematic review and meta-analysis of randomized controlled trials” and observational studies such as “Persistence of Central Venous Oxygen Desaturation During Early Sepsis Is Associated With Higher Mortality. A Retrospective Analysis of the ALBIOS Trial.”
The full text of the newsletter is available via this link.

Intensive Care Medicine Volume 44 Number 11 November 2018

To view Intensive Care Medicine’s November issue’s contents page follow this link.
Articles published in this issue include: “A multi centre randomized pilot trial on the effectiveness of different levels of cooling in comatose survivors of out-of-hospital cardiac arrest: the FROST-I trial”, “Early PREdiction of sepsis using leukocyte surface bio-markers: the ExPRES-sepsis cohort study” and “Concordance of longitudinal strain and MRI in a case of myocardial contusion in a patient with normal conventional 2D echocardiography”.
To read the full text of any of these articles via the journal’s homepage requires a personal subscription to “Intensive Care Medicine” though some are available open access.  Individual articles can be ordered from the Rotherham NHS Foundation Trust Library and Knowledge Service.  Registered members of the library can make 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.

Intensive Care Society State-of-the-Art Meeting 10-12th December 2018

State of the Art (SOA) this year is in central London, at the QEII Centre. The three-day programme has ninety of the very best speakers, over thirty concurrent sessions, opening and closing plenary’s.  This year also have the SOAp Box with relaxed mini-talks in the Exhibition Hall, Cauldron, PechaKucha, E-posters, and a Learning Suite, including immersive simulation, echo and POCUS live demonstrations. There are also five different opportunities to present your work to peers.
More details including registration are available via this link.

Body temperature measurement methods and targets in Australian and New Zealand intensive care units.

This research by Cutuli and colleagues was published in the “Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine” in September 2018.
Objective:  In Australian and New Zealand (ANZ) intensive care units (ICUs), the preferred measurement methods and targets for temperature remain uncertain, but are crucial for future interventional studies. We aimed to investigate the reported use of temperature measurement methods and targets in ANZ ICUs.
Design, setting and participants:  Structured online questionnaire delivered via the email list of the Australian and New Zealand Intensive Care Society Clinical Trials Group.
Main outcomes measures:  Measurements methods and targets for temperature in ANZ ICUs.
Results:  Of 209 respondents, 130 were nurses (62.2%) and 79 were doctors (37.8%). Only 21.5% of the respondents reported having a unit protocol for measuring body temperature. However, invasive temperature measurement methods were preferred by doctors (69.8% v 55.3%) and non-invasive methods by nurses (29.9% v 44.2%). Moreover, among non-invasive methods, tympanic measurement was preferred by doctors (66.0% v 26.9%) and axillary by nurses (11.7% v 51.9%). Both professions reported a wide range of temperature thresholds that they believed required cooling interventions, but 16.7% of doctors and 42.4% of nurses reported that, in patients with cardiac arrest, they would actively cool patients only if the temperature was ≥ 38°C.
Conclusion:  In ANZ ICUs, preferred temperature measurement methods and targets are typically not governed by protocol, vary greatly and differ between doctors and nurses. Targeted temperature management after cardiac arrest is not fully established. Future studies of the comparative accuracy of non-invasive temperature measurements methods and practice in patients with cardiac arrest appear important.
To access the full text of this article via the journal’s homepage you require a personal subscription to the journal.  Library members can order individual articles via the Rotherham NHS Foundation Trust Library and Knowledge Service using the article requests online via this link.