Critical Care Reviews Newsletter 380 24th March 2019

The 380th Critical Care Reviews Newsletter, delivers the best critical care research and open access articles from the medical literature in the last week.
The highlights of this week’s edition are randomised controlled trials on coronary angiography after cardiac arrest without ST-segment elevation, non-invasive ventilation versus high-flow nasal cannula oxygen therapy with apnoeic oxygenation for pre-oxygenation before intubation of patients with acute hypoxaemic respiratory failure, & early goal-directed haemodynamic optimization of cerebral oxygenation in comatose survivors after cardiac arrest; a guideline on acute lower gastrointestinal bleeding; and narrative reviews on gut integrity in critical illness; clinical pharmacology of antibiotics, & successful digestive tract decontamination.
The topic of the week is on p-values based on papers from the American Statistician.
The full text of the newsletter is available via this link.

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Utility of pleural effusion drainage in the ICU: An updated systematic review and META-analysis

This research by Vetrugno and colleagues was published online in the “Journal of Critical Care” in March 2019.
Purpose:  The effects on the respiratory or hemodynamic function of drainage of pleural effusion on critically ill patients are not completely understood. First outcome was to evaluate the PiO2/FiO2 (P/F) ratio before and after pleural drainage. Secondary outcomes: evaluation of A-a gradient, End-Expiratory lung volume (EELV), heart rate (HR), mean arterial pressure (mAP), left ventricular end-diastolic volume (LVEDV), stroke volume (SV), cardiac output (CO), ejection fraction (EF), and E/A waves ratio (E/A). A tertiary outcome: evaluation of pneumothorax and hemothorax complications.
Materials and methods:  Searches were performed on MEDLINE, EMBASE, COCHRANE LIBRARY, SCOPUS and WEB OF SCIENCE databases from inception to June 2018 (PROSPERO CRD42018105794).
Results:  We included 31 studies (2265 patients). Pleural drainage improved the P/F ratio (SMD: −0.668; CI: -0.947–0.389; p < .001), EELV (SMD: -0.615; CI: -1.102–0.219; p = .013), but not A-a gradient (SMD: 0.218; CI: -0.273-0.710; p = .384). HR, mAP, LVEDV, SV, CO, E/A and EF were not affected. The risks of pneumothorax (proportion: 0.008; CI: 0.002–0.014; p = .138) and hemothorax (proportion: 0.006; CI: 0.001–0.011; p = .962) were negligible.
Conclusions:  Pleural effusion drainage improves oxygenation of critically ill patients. It is a safe procedure. Further studies are needed to assess the hemodynamic effects of pleural drainage.
The full text of this article is available to subscribers via this link to the journal’s homepage.  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.

Critical Care Reviews Newsletter 379 18th March 2019

The 379th Critical Care Reviews Newsletter provides you with the best critical care research and open access articles from across the medical literature over the past seven days.
This includes randomised controlled trials including “A Fully Magnetically Levitated Left Ventricular Assist Device”, systematic reviews such as “Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: infection and sepsis” and observational studies for example “Postoperative critical care and high acuity care provision in the United Kingdom, Australia and New Zealand”.  It also includes guidelines such as “Patient Blood Management. Recommendations From the 2018 Frankfurt Consensus Conference.
The full text of the newsletter is available via this link.

The impact of errors on healthcare professionals in the critical care setting

This research by Kaur and colleagues was published online in the Journal of Critical Care in March 2019.
Purpose:  Medical errors occur at high rates in intensive care units (ICUs) and have great consequences. The impact of errors on healthcare professionals is rarely discussed. We hypothesized that issues regarding blame and guilt following errors in the ICU exist and may be dependent on type of practitioner, level of experience, and error type.
Materials and methods:  An online survey was conducted of members of a large critical care medical society addressing three clinical scenarios of procedural, diagnostic and treatment errors.
Results:  Nine hundred one practitioners responded. In all scenarios, negative feeling after medical errors occurred in all practitioners regardless of experience or field. Surgeons and anesthesiologists showed higher negative responses after procedural errors while internal medicine and emergency medicine practitioners had higher negative responses after diagnostic errors. Survey respondents identified multiple ways to address these adverse feelings, including debriefing with the medical team (68%), talking with colleagues (68%) and discussing with patients and families (36%).
Conclusions:  In critical care, blame and guilt after medical errors are common and affect all providers. Critical care practitioners have identified methods which may help mitigate adverse feeling after medical errors, including debriefing and talking with colleagues. Hospitals may benefit from developing these types of strategies after medical errors.

The full text of this article is available to subscribers via this link to the journal’s homepage 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.

ICU nurses feel unprepared to care for patients with mental illness: A survey of nurses’ attitudes, knowledge, and skills

This article by Weare and colleagues was published online in “Intensive and Critical Care Nursing” during March 2019.
Objectives:  To examine the knowledge, skills, and attitudes of a cohort of Australian nurses towards caring for patients with mental illness in the intensive care unit.
Research design:  A questionnaire was developed and distributed via internal email to all nurses working in the study intensive care unit. Responses were anonymous.
Setting: A metropolitan intensive care unit located in Melbourne, Australia.
Main outcome measures: Intensive care nurses completed a 76-question self-administered questionnaire.
Results:  Forty intensive care nurses completed the survey, a response rate of 35.7% (n = 40/112). Respondents were predominantly female (82.5%) and held a post-graduate qualification (62.5%).
ICU nurses felt that they needed further training and education to care for patients with mental illness in the intensive care unit. While respondents were empathetic to this patient group, negative stereotypes and stigma were reported by some participants. The pressures of the environment were perceived barriers to delivering optimal person-centred care for patients with mental illness.
Conclusion:  This sample of nurses felt they require education and support in order to care for patients with mental illness in the intensive care unit. Further education may also help to reduce negative perceptions of this patient group.
Subscribers to Intensive and Critical Care Nursing can access the full text of the article via this link.  The full text of articles from issues older than sixty days is available via this link to an archive of issues of Intensive and Critical Care Nursing.  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.

Relationship of symptoms associated with ICU-survivorship: An integrative literature review

This research by Proffitt and Menzies was published online during March 2019 in “Intensive and Critical Care Nursing”.
Background:  The number of adults who survive a critical illness involving admission to an intensive care unit is increasing. These survivors have an increased risk of developing impairments in cognition, physical function and psychological health.
Objective:  This integrative literature review examined the literature for studies exploring the relationships among two or more of the variables of interest, i.e. cognitive, physical, and psychological symptoms (depressive, anxiety, or posttraumatic stress) in intensive care unit survivors post-hospital discharge.
Methods:  A literature search was conducted using PubMed, CINHAL and PsycINFO databases.
Findings:  While all 13 studies included in the review explored some aspect of a relationship among the variables of interest, none explored associations among all three variables. Five studies explored physical function and psychological symptoms, four studies explored cognitive impairment and psychological symptoms and five studies explored the association among different psychological symptoms. Inconsistencies were found in the study designs, follow-up time frames, patient populations and measures used.
Conclusions:  Further research using well-designed methodologies and standardized instruments is warranted. Gaining a better understanding of the relationships among these impairments has the potential to contribute to the development of screening guidelines, preventative strategies, and treatments.
Subscribers to Intensive and Critical Care Nursing can access the full text of the article via this link.  The full text of articles from issues older than sixty days is available via this link to an archive of issues of Intensive and Critical Care Nursing.  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.

Critical Care Reviews Newsletter 378 11th March 2019

The 378th Critical Care Reviews Newsletter, highlights 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 randomised controlled trials on chlorhexidine bathing & temperature thresholds in critically ill children with fever and infection; systematic reviews and meta analyses on chlorhexidine-related mortality, extracorporeal-CPR & hypertonic saline in sepsis; and observational studies on rapidly improving ARDS, accuracy of critical care transesophageal echocardiograph & Impella support for acute myocardial infarction complicated by cardiogenic shock.
There are also guidelines on stress ulcer prophylaxis & pulmonary arterial hypertension; narrative reviews on cerebral vasospasm and delayed cerebral ischemiahigh-sensitive troponin assay interpretation in critical care & ultrasound-guided vascular access; editorials on mechanical power in VILI & intensive care management of transplanted lung patients; and commentaries on myotrauma in mechanically ventilated patients & a report about Plan S’s potential effects on journals.
The full text of the newsletter is available via this link.