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.”

 

 

 

The full newsletter can be accessed via this link.

Comparative Antimicrobial Efficacy of Two Hand Sanitizers in Intensive Care Units Common Areas: A Randomized, Controlled Trial

The paper written by Deshpande et al was published in “Infection control and hospital epidemiology” January 2018.
Objective:  Contaminated hands of healthcare workers (HCWs) are an important source of transmission of healthcare-associated infections. Alcohol-based hand sanitizers, while effective, do not provide sustained antimicrobial activity. The objective of this study was to compare the immediate and persistent activity of 2 hand hygiene products (ethanol [61% w/v] plus chlorhexidine gluconate [CHG; 1.0% solution] and ethanol only [70% v/v]) when used in an intensive care unit (ICU).
Design:  Prospective, randomized, double-blinded, crossover study
Setting: Three ICUs at a large teaching hospital
Participants: In total, 51 HCWs involved in direct patient care were enrolled in and completed the study.
Methods:   All HCWs were randomized 1:1 to either product. Hand prints were obtained immediately after the product was applied and again after spending 4-7 minutes in the ICU common areas prior to entering a patient room or leaving the area. The numbers of aerobic colony-forming units (CFU) were compared for the 2 groups after log transformation. Each participant tested the alternative product after a 3-day washout period.
Results:  On bare hands, use of ethanol plus CHG was associated with significantly lower recovery of aerobic CFU, both immediately after use (0.27 ± 0.05 and 0.88 ± 0.08 log10 CFU; P = .035) and after spending time in ICU common areas (1.81 ± 0.07 and 2.17 ± 0.05 log10 CFU; P<.0001). Both the antiseptics were well tolerated by HCWs.
Conclusions:  In comparison to the ethanol-only product, the ethanol plus CHG sanitizer was associated with significantly lower aerobic bacterial counts on hands of HCWs, both immediately after use and after spending time in ICU common areas.
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.

Transfers from intensive care unit to hospital ward: a multicentre textual analysis of physician progress notes

11708-2This research was published in the January issue of Critical Care by Brown et al.
Background:  Little is known about documentation during transitions of patient care between clinical specialties. Therefore, we examined the focus, structure and purpose of physician progress notes for patients transferred from the intensive care unit (ICU) to hospital ward to identify opportunities to improve communication breaks.
Methods:  This was a prospective cohort study in ten Canadian hospitals. We analysed physician progress notes for consenting adult patients transferred from a medical-surgical ICU to hospital ward. The number, length, legibility and content of notes was counted and compared across care settings using mixed-effects linear regression models accounting for clustering within hospitals. Qualitative content analyses were conducted on a stratified random sample of 32 patients.
Results:  A total of 447 patient medical records that included 7052 progress notes (mean 2.1 notes/patient/day 95% CI 1.9-2.3) were analysed. Notes written by the ICU team were significantly longer than notes written by the ward team (mean lines of text 21 vs. 15, p < 0.001). There was a discrepancy between documentation of patient issues in the last ICU and first ward notes; mean agreement of patient issues was 42% [95% CI 31-53%]. Qualitative analyses identified eight themes related to focus (central point – e.g., problem list), structure (organization, – e.g., note-taking style), and purpose (intention – e.g., documentation of patient course) of the notes that varied across clinical specialties and physician seniority.
Conclusions:  Important gaps and variations in written documentation during transitions of patient care between ICU and hospital ward physicians are common, and include discrepancies in documentation of patient information.
The full text of the article is available via this link

Impact of Obesity on Outcomes in a Multiethnic Cohort of Medical Intensive Care Unit Patients

Purpose:  To examine the association of obesity with in-hospital mortality and complications during critical illness.
Methods:  We performed a retrospective analysis of a multiethnic cohort of 699 patients admitted to medical intensive care unit between January 2010 and May 2011 at Mount Sinai St. Luke’s and Mount Sinai West Hospitals, tertiary care centers in New York City. Multivariate logistic regression analysis was used to evaluate the association between obesity (body mass index [BMI] ≥ 30] and in-hospital mortality. Subgroup analysis was performed in elderly patients (age ≥65 years).
Results:  Compared to normal BMI, obese patients had lower in-hospital mortality (24.4% vs 17.6%, P = .04). On multivariate analysis, obesity was independently associated with lower in-hospital mortality (odds ratio [OR]: 0.49, 95% confidence interval [CI]: 0.27-0.89, P = .018). There was no significant difference in rates of mechanical ventilation, reintubation, and vasopressor requirement across BMI categories. In subgroup analysis, elderly obese patients did not display lower in-hospital mortality (adjusted OR: 0.85, 95% CI: 0.40-1.82, P = .68).
Conclusions:  Our study supports the hypothesis that obesity is associated with decreased mortality during critical illness. However, this finding was not observed among elderly obese patients. Further studies should explore the interaction between age, obesity, and outcomes in critical illness.
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.

Permissive or Trophic Enteral Nutrition and Full Enteral Nutrition Had Similar Effects on Clinical Outcomes in Intensive Care: A Systematic Review of Randomized Clinical Trials

This article by Silva et al was published in Nutrition in Clinical Practice in January 2018.
The aim of this study was to systematically review the effect of permissive underfeeding/trophic feeding on the clinical outcomes of critically ill patients. A systematic review of randomized clinical trials to evaluate the mortality, length of stay, and mechanical ventilation duration in patients randomized to either hypocaloric or full-energy enteral nutrition was performed. Data sources included PubMed and Scopus and the reference lists of the articles retrieved. Two independent reviewers participated in all phases of this systematic review as proposed by the Cochrane Handbook, and the review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 7 randomized clinical trials that included a total of 1,717 patients were reviewed. Intensive care unit length of stay and mechanical ventilation duration were not statistically different between the intervention and control groups in all randomized clinical trials, and mortality rate was also not different between the groups. In conclusion, hypocaloric enteral nutrition had no significantly different effects on morbidity and mortality in critically ill patients when compared with full-energy nutrition. It is still necessary to determine the safety of this intervention in this group of patients, the optimal amount of energy provided, and the duration of this therapy.
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.