Acute kidney injury epidemiology, risk factors, and outcomes in critically ill patients 16-25 years of age treated in an adult intensive care unit

This research by Fuhrum et al was published in Annals of Intensive Care in February 2018
Background:  Most studies of acute kidney injury (AKI) have focused on older adults, and little is known about AKI in young adults (16-25 years) that are cared for in an adult intensive care unit (ICU). We analysed data from a large single-center ICU database and defined AKI using the Kidney Disease Improving Global Outcomes criteria. We stratified patients 16-55 years of age into four age groups for comparison and used multivariable logistic regression to identify associations of potential susceptibilities and exposures with AKI and mortality.
Results:  AKI developed in 52.6% (n = 8270) of the entire cohort and in 39.8% of the young adult age group (16-25 years). The AUCs for the age categories were similar at 0.754, 0.769, 0.772, and 0.770 for the 16-25-, 26-35-, 36-45-, and 45-55-year age groups, respectively. For the youngest age group, diabetes (OR 1.89; 95% CI 1.09-3.29), surgical reason for admission (OR 1.79; 95% CI 1.44-2.23), severity of illness (OR 1.02; 95% CI 1.02-1.03), hypotension (OR 1.13; 95% CI 1.04-1.24), and certain medications (vancomycin and calcineurin inhibitors) were all independently associated with AKI. AKI was a significant predictor for longer length of stay, ICU mortality, and mortality after discharge.
Conclusions:  AKI is a common event for young adults admitted to an adult tertiary care center ICU with an associated increased length of stay and risk of mortality. Potentially modifiable risk factors for AKI including medications were identified for all stratified age groups.
The full text of this article is available via the PDF that can be accessed via this link

Association of admission serum levels of vitamin D, calcium, Phosphate, magnesium and parathormone with clinical outcomes in neurosurgical ICU patients

This article by Ardehali et al was published in Scientific Reports in February 2018.
To evaluate the association of admission serum levels of 25(OH)D, parathormone and the related electrolytes with severity of illness and clinical outcomes in neurosurgical critically ill patients, serum levels of 25(OH)D, parathormone, calcium, magnesium, and phosphate, along with APACHE II score were measured for 210 patients upon admission. Mean serum 25(OH)D was 21.1 ± 7.4 ng/mL. 25(OH)D deficiency (less than 20 ng/dL) and elevated serum parathormone level were found in 47.6% and 38% of patients respectively. Hypocalcaemia, hypophosphatemia, hypomagnesaemia and hypermagnesaemia were found in 29.5%, %63.8, 41.9% and 27.6% of patients respectively. The APACHE II score was significantly correlated with serum levels of 25(OH)D, parathormone, calcium, and phosphate. Multivariate regression analysis adjusted by other risk factors showed that among all clinical outcomes, admission hypovitaminosis D was associated with longer duration of ICU stay and a high admission of parathormone was associated with in ICU mortality. We concluded that disorders of admission serum levels of 25(OH)D, parathormone, calcium, magnesium, and phosphate are related to the presence of multiple causal factors such as severity of disease and are not independently associated with clinical outcomes. Most often they are normalize spontaneously with resolution of the disease process.
The full text of this article is available via the PDF that can be accessed via this link

Critical Care Reviews Newsletter 18th February 2018 Issue 323

The 323rd Critical Care Reviews Newsletter, brings you the best critical care research articles from across the medical literature in the last week.  “The highlights are randomiscritcal care reviewsed controlled trials on rehabilitation in the critically ill, contrast nephropathy, & carbapenem-resistant Gram-negative bacteria; guidelines on the organization of ECMO programs, haemodynamic assessment and support in sepsis and septic shock in resource-limited settings, & frailty in patients with acute cardiovascular disease; plus narrative reviews on perioperative stroke, delirium in the cardiac ICU, & traumatic brain injury.”

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Video didactic at the point of care impacts hand hygiene compliance in the neonatal intensive care unit (NICU)

This paper was published in Journal of Healthcare Risk Management February 2018 by Hoang et al.
Objective:  To increase the hand-washing (HW) duration of staff and visitors in the NICU to a minimum of 20 seconds as recommended by the CDC.
Methods:  Intervention included video didactic triggered by motion sensor to play above wash basin. Video enacted Centers for Disease Control and Prevention (CDC) HW technique in real time and displayed timer of 20 seconds. HW was reviewed from surveillance video. Swabs of hands plated and observed for qualitative growth (QG) of bacterial colonies.
Results:  In visitors, the mean HW duration at baseline was 16.3 seconds and increased to 23.4 seconds at the 2-week interval (p = .003) and 22.9 seconds at the 9-month interval (p < .0005). In staff, the mean HW duration at baseline was 18.4 seconds and increased to 29.0 seconds at 2-week interval (p = .001) and 25.7 seconds at the 9-month interval (p < .0005). In visitors, HW compliance at baseline was 33% and increased to 52% at the 2-week interval (p = .076) and 69% at the 9-month interval (p = .001). In staff, HW compliance at baseline was 42% and increased to 64% at the 2-week interval (p = .025) and 72% at the 9-month interval (p = .001). Increasing HW was significantly associated with linear decrease in bacterial QG.
Conclusions:  The intervention significantly increased mean HW time, compliance with a 20-econd wash time and decreased bacterial QG of hands and these results were sustained over a 9-month period.
Library members can order the full text of individual articles such as this one via the Rotherham NHS Foundation Trust Library and Knowledge Service using the article requests online via this link.

Outcomes for haematological cancer patients admitted to an intensive care unit in a university hospital

This article by Alp and colleagues was published in Australian critical care: official journal of the Confederation of Australian Critical Care Nurses; February 2018.
Background:  Haematological cancer (HC) patients are increasingly requiring intensive care (ICUs). The aim of this study was to investigate the outcome of HC patients in our ICU and evaluate 5 days-full support as a breakpoint for patients’ re-assessment for support.
Methods:  Retrospective study enrolling 112 consecutive HC adults, requiring ICU in January-December 2015. Patients’ data were collected from medical records and Infection Control Committee surveillance reports. Logistic regression analysis was performed to identify independent risk factors for ICU mortality.
Results:  Sixty-one were neutropenic, and 99 (88%) had infection at ICU admission. Acute myeloid leukaemia was diagnosed in 43%. Thirty-five (31%) were hematopoietic stem cell transplant recipients. Only 17 (15%) were in remission. Eighty-nine underwent mechanical ventilation on admission. Fifty-three patients acquired ICU-infection (35 bacteremia) being gram negative bacteria (Klebsiella pneumoniae and non-fermenters) the top pathogens. However, ICU-acquired infection had no impact on mortality. The overall ICU and 1-year survival rate was 27% (30 patients) and 7% (8 patients), respectively. Moreover, only 2/62 patients survived with APACHE II score ≥25. The median time for death was 4 days. APACHE II score ≥25 [OR:35.20], septic shock [OR:8.71] and respiratory failure on admission [OR:10.55] were independent risk factors for mortality in multivariate analysis. APACHE II score ≥25 was a strong indicator for poor outcome (ROC under curve 0.889).
Conclusions:  APACHE II score ≥25 and septic shock were criteria of ICU futility. Our findings support the full support of patients for 5 days and the need to implement a therapeutic limitations protocol.
Library members can order the full text of individual articles such as this one via the Rotherham NHS Foundation Trust Library and Knowledge Service using the article requests online via this link.

Privacy at end of life in ICU: a review of the literature

This article was published in Journal of Clinical Nursing February 2018 by Timmins et al.
Background:  While the provision of ICU care is vital, the nature and effect of the potential lack of privacy during death and dying in ICUs has not been extensively explored.
Aim:  This paper aims to explore the issues surrounding privacy during death in ICU.
Design:  A literature search using CINAHL and Pubmed revealed articles related to privacy, death and dying in ICU.
Method:  Key words used in the search were ‘ICU’, ‘Privacy’, ‘Death’ and ‘Dying’. A combination of these terms using Boolean operators ‘or’ or ‘and’ revealed a total of 23 citations. Six papers were ultimately deemed suitable for inclusion in the review and were subjected to code analysis with Atlas.ti v8 QDA software.
Findings:  The analysis of the studies revealed eight themes, and this paper presents the three key themes that were found to be recurring and strongly interconnected to the experience of privacy and death in ICU: ‘Privacy in ICU’, ‘ICU environment’ and ‘End-of-Life Care’.
Conclusions:  Research has shown that patient and family privacy during the ICU hospitalisation and the provision of the circumstances that lead to an environment of privacy during and after death remains a significant challenge for ICU nurses. Family members have little or no privacy in shared room and cramped waiting rooms, while they wish to be better informed and involved in end-of-life decisions. Hence, death and dying for many patients takes place in open and/or shared spaces which is problematic in terms of both the level of privacy and respect that death ought to afford.
Relevance to clinical practice:  It is best if end-of-life care in the ICU is planned and coordinated, where possible. Nurses need to become more self-reflective and aware in relation to end-of-life situations in ICU in order to develop privacy practices that are responsive to family and patient needs. This article is protected by copyright. All rights reserved.
Library members can order the full text of individual articles such as this one via the Rotherham NHS Foundation Trust Library and Knowledge Service using the article requests online via this link.

Autophagy: should it play a role in ICU management?

This review article by Rosenthal and colleagues was published in “Current Opinion in Critical Care” February issue.
The purpose of this review is to discuss the role of autophagy in the critically ill patient population. As the understanding of autophagy continues to expand and evolve, there are certain controversies surrounding whether intensivist should allow the benefit of autophagy to supersede gold standard of insulin therapy or early nutritional support. This review is relevant as the current literature seems to support under-feeding patients, and perhaps the reason these studies were positive could be prescribed to the mechanisms of autophagy. It is well understood that autophagy is a physiologic response to stress and starvation, and that the inducible form could help patients with end-organ dysfunction return to homeostasis. In conclusion, the jury is still out as to how autophagy will play into clinical practice as we review several gold standard therapies for the critically ill.
Library members can order the full text of individual articles such as this one via the Rotherham NHS Foundation Trust Library and Knowledge Service using the article requests online via this link.

A qualitative study of factors that influence active family involvement with patient care in the ICU: Survey of critical care nurses

This article by Hetland et al was published in the February 2018 issue of “Intensive and critical care nursing”.
Objective:  Family caregiver involvement may improve patient and family outcomes in the intensive care unit. This study describes critical care nurses’ approaches to involving family caregivers in direct patient care.
Research Methodology and Design:  This is a qualitative content analysis of text captured through an electronic survey.
Setting:  A convenience sample of 374 critical care nurses in the United States who were subscribers to one of the American Association of Critical Care Nurses social media sites or electronic newsletters.
Main Outcome Measure:  Critical care nurses’ responses to five open-ended questions about their approaches to family involvement in direct patient care.
Findings:  Nurse, patient and family caregiver factors intersected in the context of the professional practice environment and the available resources for family care. Two main themes were identified: “Involving family caregivers in patient care in the intensive care unit requires careful assessment” and “There are barriers and facilitators to caregiver involvement in patient care in the intensive care unit.”
Conclusion:  Patient care demands, the professional practice environment and a lack of resources for families hindered nursing family caregiver involvement. Greater attention to these barriers as they relate to family caregiver involvement and clinical outcomes should be a priority in future research.
The full text of this article is available via the PDF that can be accessed via this link

The ability of intensive care unit physicians to estimate long-term prognosis in survivors of critical illness

This research by Soliman et al was published in the February issue of Journal of Critical Care.
Purpose:  To assess the reliability of physicians’ prognoses for intensive care unit (ICU) survivors with respect to long-term survival and health related quality of life (HRQoL).
Methods:  We performed an observational cohort-study in a single mixed tertiary ICU in The Netherlands. ICU survivors with a length of stay >48h were included. At ICU discharge, one-year prognosis was estimated by physicians using the four-option Sabadell score to record their expectations. The outcome of interest was poor outcome, which was defined as dying within one-year follow-up, or surviving with an EuroQoL5D-3L index <0.4.
Results:  Among 1399 ICU survivors, 1068 (76%) subjects were expected to have a good outcome; 243 (18%) a poor long-term prognosis; 43 (3%) a poor short-term prognosis, and 45 (3%) to die in hospital (i.e. Sabadell score levels). Poor outcome was observed in 38%, 55%, 86%, and 100% of these groups respectively (concomitant c-index: 0.61). The expected prognosis did not match observed outcome in 365 (36%) patients. This was almost exclusively (99%) due to overoptimism. Physician experience did not affect results.
Conclusions:  Prognoses estimated by physicians incorrectly predicted long-term survival and HRQoL in one-third of ICU survivors. Moreover, inaccurate prognoses were generally the result of overoptimistic expectations of outcome.
The full text of the article is available via this link

Critical Care Reviews Newsletter 11th February 2018 Issue 322

The 322nd Critical Care Reviews Newsletter provides the best critical care research from across the medical literature over the past seven days.  New publcritcal care reviewsications highlighted  in this issue include “a guideline on assessment of sublingual microcirculation, narrative reviews on paediatric traumatic brain injury, anaphylaxis, cerebral venous thrombosis and integration of bedside ultrasound into the ICU; editorials on nutritional management during non-invasive ventilation and maternal sepsis; commentaries on acute-on-chronic liver failure and cardiac output monitoring; plus correspondence on the long overdue banning of hydroxyethyl starch solutions.”




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