Intensive Care Management of Patients with Cirrhosis

This article by Olson was published in the April 2018 issue of Current Treatment Options in Gastroenterology.
Purpose of Review:  Cirrhosis is a major worldwide health problem which results in a high level of morbidity and mortality. Patients with cirrhosis who require intensive care support have high mortality rates of near 50%. The goal of this review is to address the management of common complications of cirrhosis in the ICU.
Recent Findings:  Recent epidemiological studies have shown an increase in hospitalizations due to advanced liver disease with an associated increase in intensive care utilization. Given an increasing burden on the healthcare system, it is imperative that we strive to improve our management cirrhotic patients in the intensive care unit. Large studies evaluating the management of patients in the intensive care setting are lacking. To date, most recommendations are based on extrapolation of data from studies in cirrhosis outside of the ICU or by applying general critical care principles which may or may not be appropriate for the critically ill cirrhotic patient. Future research is required to answer important management questions.
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Daily routine versus on-demand chest radiograph policy and practice in adult ICU patients- clinicians’ perspective.

This paper by Al Shahrani and colleagues was published in BMC Medical imaging in April 2018.
Background:  Chest radiographs are taken daily as a part of routine investigations in Intensive care unit (ICU) patients. They are less effective and unlikely to alter the management of the majority of these patients compared to the radiographs obtained when indicated. According to the American College of Radiology (ACR) Appropriateness criteria, only selective ordering of chest radiographs is recommended, including elderly or high risk patients. The aim of this study was to identify and assess the clinician’s perspective in abandoning the current practice of daily routine chest radiograph and replacing with the on-demand radiograph in Saudi hospitals.
Methods:  This was a cross-sectional study. A valid self-administered questionnaire was distributed to all clinical staff members working in ICUs in the major tertiary hospitals in Saudi Arabia. The study population was primarily the ICU intensivists (physicians), nurses and respiratory therapists (RT). The data collected were statistically processed using SPSS version 20.0; descriptive and inferential analyses were done.
Results:  Out of 730 questionnaires sent, we received only 495 completed questionnaires with a response rate of 67.8%. Majority of them (n = 351) are working at academic hospitals. About half of the respondents (n = 247) are working in an open-format ICUs. Findings showed that the daily routine chest X-ray was performed in almost 96.8% of ICUs patients, which the majority of the clinical staff members (73%) thought that this current daily routine CXR protocol in the ICUs should be replaced with the on-demand CXR policy. Interestingly, the differences in demographic and work-related characteristics had no significant impact on the clinician’s view and supported moving to on-demand CXR policy and practice.
Conclusions:  The daily routine CXR is still a common practice in most of the Saudi hospitals ICUs although enough empirical evidence shows that it can be avoided. We observed that intensivists support the change of the current practice and recommend an on-demand CXR policy likely to be followed in intensive care management.

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

Critical Care Reviews Newsletter 329 1st April 2018

The 329th 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 big news this week is the impending opening of registration for #CCR19, on January 17th and 18th in Titanic, Belfast. It might seem a long way in the future, but our new two-day format will encourage delegates from further afield, so there will be more interest, and relatively fewer tickets to go around.”  “This week’s Topic of the Week is the first of two parts, based on a series of articles from the Journal of Thoracic Disease on ECMO, starting with a paper on oxygenator performance and artificial-native lung interaction in today’s Paper of the Day.”
The full text of newsletter 329 can be found via this link

August Issue of “Intensive Care Medicine” Volume 43 Number 7

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To access Intensive Care Medicine’s latest issue’s contents page follow this link.
Articles published in this issue include “Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial”, “Biomarkers for prediction of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis” and “Relationships between markers of neurologic and endothelial injury during critical illness and long-term cognitive impairment and disability”.
To access the full text of these articles 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.
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.

Latest issue of “Intensive and Critical Care Nursing” Volume 45 April 2018

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Articles printed in this issue include “Sustainability of a nurse-driven early progressive mobility protocol and patient clinical and psychological health outcomes in a neurological intensive care unit”, “Predictors of pressure ulcer risk in adult intensive care patients: A retrospective case-control study” and “The contents of a patient diary and its significance for persons cared for in an ICU: A qualitative study”.

The content page of this issue can be accessed via this link.
To see the full text of any 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 article requests online via this link.
Issues of Intensive and Critical Care Nursing from issue older than one year ago can have their full text accessed via this link.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.

Critical Care Reviews Newsletter 328 25th March 2018

The Critical Care Reviews Newsletter brings you the best critical care research and open access articles from the literature in the last week. The highlights of this edition are “a randomised controlled trial on high-flow oxygen in infants with bronchiolitis, narrative reviews on ventilatory strategies in the brain-injured patient and medical ethics for intensivists; plus debates on conservative oxygenation in the intensive care unit and non-invasive ventilation for acute hypoxaemic respiratory failure / ARDS.”
The full text of newsletter 328 can be found via this link