The creation of meaning – Intensive care nurses’ experiences of conducting nurse-led follow-up on intensive care units

This article by Flinterud was published on line in “Intensive and Critical Care Nursing” during May 2019.
Objective:  To explore and describe the experiences of Norwegian intensive care unit nurses providing nurse-led follow-up to patients and their families.
Design and methods:  The study had a qualitative design with a phenomenological approach. Three focus-group interviews were conducted with nurses on three intensive care units. Giorgi’s phenomenological method guided the analysis.
Findings:  The creation of meaning emerged as a general structure describing intensive care nurses’ experiences of nurse-led follow-up. When caring for critically ill patients, nurses described becoming emotionally moved, which motivated them to perform nurse-led follow-up procedures, such as writing in patient diaries. A general wish to give context to the patients’ time spent in intensive care emerged. When conducting nurse-led follow-up, the nurses made personal contributions, which could be emotionally challenging for them. Overall, nurse-led follow-up was found to increase nurses’ insight into and motivation for their own practice.
Conclusion:  The performance of nurse-led follow-up appears to be grounded in care for and engagement in individual patients and families. The nurses studied wanted to help patients and families to be able to handle their experiences during an intensive care stay. In addition, nurse-led follow-up gave meaning to the intensive care nurses’ own practice.
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 389 27th May 2019

The 389th 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.
The highlights of this week’s edition are randomised controlled trials on the effect of targeting mean arterial pressure during cardiopulmonary bypass by monitoring cerebral autoregulation on postsurgical delirium among older patients & nasal high-flow therapy for newborn infants in special care nurseries; systematic reviews and meta analyses on sodium bicarbonate therapy for critically ill patients with metabolic acidosis & melatonin and melatonin receptor agonists to improve sleep and delirium in the ICU; and observational studies on survival prediction in ICUs based on aggregation of long-term disease history and acute physiology & assessment of anti–factor Xa levels of patients undergoing colorectal surgery given once-daily enoxaparin prophylaxis. There are also guidelines on acute respiratory distress syndrome & classification of cardiogenic shock; narrative reviews on traumatic spinal cord injury & sepsis-associated disseminated intravascular coagulation as well as two series on heart failure, one on improving critical care for Americans with critical illness and another on space medicine. There are also editorials on the pilot SUPERNOVA RCT and awake videolaryngoscope – guided intubation; and commentaries on artificial intelligence in health care & the dangers of the digital age.
The full text of the newsletter can be accessed via this link.

Critical Care Reviews Newsletter ATS Supplement 20th May 2019

This supplemental newsletter contains links to the important trials presented and simultaneously published at the annual ATS conference in Dallas that will be discussed at #CCR20 in January.  These are the:

ROSE Trial:
The National Heart, Lung, and Blood Institute PETAL Clinical Trials Network. Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome (ROSE trial). N Engl J Med 2019;epublished May 19th

SPICE III Trial
Shehabi. Early Sedation with Dexmedetomidine in Critically Ill Patients (SPICE III trial). N Engl J Med 2019;epublished May 19th

SCARLET Trial
Vincent. Effect of a Recombinant Human Soluble Thrombomodulin on Mortality in Patients With Sepsis-Associated Coagulopathy. The SCARLET Randomized Clinical Trial. JAMA 2019;epublished May 19th
van der Poll. Recombinant Human Soluble Thrombomodulin in Patients With Sepsis-Associated Coagulopathy. Another Negative Sepsis Trial? JAMA 2019;epublished May 19th

Sepsis Phenotypes
Seymour. Derivation, Validation, and Potential Treatment Implications of Novel Clinical Phenotypes for Sepsis. JAMA 2019;epublished May 19th
Knaus. New Phenotypes for Sepsis. The Promise and Problem of Applying Machine Learning and Artificial Intelligence in Clinical Research. JAMA 2019;epublished May 19th

Critical Care Reviews Newsletter 388 20th May 2019

The 388th 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.
The highlights of this week’s edition are a randomised controlled trial on hypothermia in addition to decompressive hemicraniectomy in treatment of malignant middle cerebral artery stroke; systematic reviews and meta analyses on vasoactive medications in septic shock & prophylactic antibiotic use following cardiac arrest; and an observational study reporting an economic evaluation of the TRANSFUSE trial. There are also guidelines on drug-induced liver injury & long-term mechanical circulatory support; narrative reviews on hemoadsorption during ECMO & acute liver failure; and editorials on oxygen therapy & significance testing in clinical trials; as well as correspondence on whether ECMO should be used in cardiogenic shock & if APRV really prevents lung collapse.
The full text of the newsletter is available via this link.

The incidence, characteristics, outcomes and associations of small short-term point-of-care creatinine increases in critically ill patients

This article by Toh and colleagues was published online in the Journal of Critical Care during May 2019.
Purpose:  We assessed the incidence, characteristics, outcomes, and associations of small, short-term point-of-care creatinine increases in critically ill patients.
Methods:  We prospectively identified the first episode of small (>1 μmol/L/h) short-term (3–4 h) point-of-care creatinine increase between two sequential arterial blood gas measurements. We followed patients for the subsequent development of Kidney Disease: Improving Global Outcomes (KDIGO) defined acute kidney injury (AKI) in the intensive care unit (ICU).
Results:  Of 387 patients, 279 (72.1%) developed an episode of small short-term point-of-care creatinine increase and 212 (54.8%) developed AKI. Such episodes occurred at a median of 5 (IQR 2–10) hours after ICU admission, while AKI occurred at a median of 15 (IQR 9–28) hours after admission. Patients with such episodes were more likely to be mechanically ventilated on admission (83.9 vs. 44.4%; p < .001) and had higher hospital mortality (10.9 vs. 3.7%, p = .03). Creatinine increase episodes had a sensitivity of 86% (95% CI 78–95) and specificity of 31% (95% CI 26–36) for subsequent AKI stages 2 and 3 in 24 h.
Conclusions:  Small, short-term point-of-care creatinine increase episodes are common. They are associated with illness severity, occur early, precede AKI by 10 h and are sensitive rather than specific markers of AKI.
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 387 13th May 2019

The 387th Critical Care Reviews Newsletter, brings you the best critical care research and open access articles from across the medical literature during the last week.
The highlights of this week’s edition are randomised controlled trials on trans-nasal evaporative intra-arrest cooling in out-of-hospital cardiac arrest & thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke; systematic reviews and meta analyses on vasopressin in septic shock & RCTs in the perioperative and critical care setting demonstrating increasing mortality; and an observational study on the effect of age of transfused red blood cells on neurologic outcome following traumatic brain injury. There are also guidelines on antibiotic therapy in acute pancreatitis & both ECMO & nutrition; narrative reviews on intensive care unit–acquired weakness & enteral tolerance; editorials on why are bleeding trauma patients still dying & clustering algorithms in critical care research to unravel patient heterogeneity; and commentaries on what’s new in electrical impedance tomography & more evidence for 24-7 intensivist cardiac surgical intensive care unit coverage
The full text of the newsletter is available via this link.

Do health care professionals worry about delirium? Relatives’ experience of delirium in the intensive care unit: A qualitative interview study

This research by Bohart and colleagues was published online in “Intensive and Critical Care Nursing” during May 2019.
Objectives:  In intensive care units, there is a high incidence of delirium, which relates to the risk of complications. Engagement of relatives is an acknowledged part of handling delirium, but knowledge of relatives’ perspectives is lacking.
Aim:  To explore relatives’ experiences of delirium in the critically ill patient admitted to an intensive care unit.Research design:  A qualitative design with a phenomenological approach. Semi-structured interviews with eleven relatives of critically ill patients who had delirium during admission to the intensive care unit.Setting:  An intensive care unit in Denmark.
Findings:  Three categories emerged: ‘Delirium is not the main concern’, ‘Communication with health-care professionals is crucial’, and ‘Delirium impacts on relatives’. Relatives had a lack of knowledge of delirium. Symptoms of delirium were thought of as a natural consequence of critical illness and seemed to be a secondary problem. Health-care professionals did not talk about delirium and information was requested. Delirium and the manifestation of it was experienced in different ways and brought different ways of coping.
Conclusion:  Findings give a new insight into relatives’ experience of delirium in the intensive care unit. Relatives need more information to better understand delirium. Future research must investigate the potential in helping relatives to cope with delirium, to the benefit of both patient and relatives.
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 386 6th May 2019

The 386th 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 observational studies on re-appraisal of ventilator-free days, emulating a novel clinical trial using existing observational data & the effect of carbapenem resistance on outcomes of bloodstream infection caused by Enterobacteriaceae in low-income and middle-income countries. There is also a guideline on perioperative care in cardiac surgery; narrative reviews on cardiogenic shock complicating acute myocardial infarction & multiple organ support therapy; commentaries on using instrumental variables to address bias from unobserved confounders & how to feed a patient with acute kidney injury; as well as correspondence on hydrocortisone, ascorbic acid, and thiamine (HAT) therapy & a simple technique of non-endoscopic insertion of a post-pyloric feeding tube.”
The full text of the newsletter is available via this link.

Epidemiology and outcomes of source control procedures in critically ill patients with intra-abdominal infection

This research by de Groep and colleagues was published online in the Journal of Critical Care during May 2019.
Purpose:  To describe the characteristics and procedural outcomes of source control interventions among Intensive Care Unit (ICU) patients with severe intra-abdominal-infection (IAI).
Material and methods:  We identified consecutive patients with suspected IAI in whom a source control intervention had been performed in two tertiary ICUs in the Netherlands, and performed retrospective in-depth case reviews to evaluate procedure type, diagnostic yield, and adequacy of source control after 14 days.
Results:  A total of 785 procedures were observed among 353 patients, with initial interventions involving 266 (75%) surgical versus 87 (25%) percutaneous approaches. Surgical index procedures typically involved IAI of (presumed) gastrointestinal origin (72%), whereas percutaneous index procedures were mostly performed for infections of the biliary tract/pancreas (50%) or peritoneal cavity (33%). Overall, 178 (50%) patients required multiple interventions (median 3 (IQR 2–4)). In a subgroup of 236 patients having their first procedure upon ICU admission, effective source control was ultimately achieved for 159 (67%) subjects. Persistence of organ failure was associated with inadequacy of source control at day 14, whereas trends in inflammatory markers were non-predictive.
Conclusions:  Approximately half of ICU patients with IAI require more than one intervention, yet successful source control is eventually achieved in a majority of cases.
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.

Intensive Care Medicine Volume 45 Number 5 May 2019

To view Intensive Care Medicine’s May issue’s contents page follow this link.
This issue includes original articles such as “Cardiovascular clusters in septic shock combining clinical and echocardiographic parameters: a post hoc analysis”, “Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry” and “
Pantoprazole prophylaxis in ICU patients with high severity of disease: a post hoc analysis of the placebo-controlled SUP-ICU trial”.
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.