Critical Care Reviews Newsletter 401 18th August 2019

The 401st Critical Care Reviews Newsletter, provides the best critical care research and open access articles from across the medical literature over the past seven days.  Articles contained in the issue include; ORI monitoring allows a reduction of time with hyperoxia in critically ill patients: the randomized control ORI2 study, Timing of continuous renal replacement therapy in patients with septic AKI: A systematic review and meta-analysis and The Treatment Intensity of Anticoagulant Therapy for Patients With Sepsis-Induced Disseminated Intravascular Coagulation and Outcomes: A Multicenter Cohort Study.
The full text of the newsletter is available via this link.

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Non-opioid analgesics as adjuvants to opioid for pain management in adult patients in the ICU: A systematic review and meta-analysis

This research by Zhao and colleagues was published online in the Journal of Critical Care during August 2018.
Purpose:  To identify the impact of non-opioid analgesics as adjuvants to opioid on opioid consumption and its side effects, as well as the analgesic effectiveness in adult patients in the ICU.
Methods:  Only randomized clinical trials using non-opioid analgesics for analgesia in the ICU were included. Pooled analyses with 95% CI were determined.
Results:  Twelve studies (mainly surgical and Guillain-Barre syndrome patients) were included. Non-opioid analgesics as adjuvants to opioid were associated with a significant reduction in the consumption of opioids when compared with opioid use alone at Day 1 (MD -15.40; 95% CI -22.41 to −8.39; P< .001) and Day 2 (MD -22.93; 95% CI -27.70 to −18.16; P< .001). Non-opioid analgesics as adjuvants to opioid were associated with a significantly lower incidence of nausea and vomiting when compared with opioid use alone (RR 0.46; 95% CI 0.30 to 0.68; P< .001). Non-opioid analgesics as adjuvants to opioid significantly decreased the pain score at Day 1 (MD -0.68; 95% CI -1.28 to −0.08; P = .03) and Day 2 (MD -1.36; 95% CI -2.47 to −0.24; P = .02).
Conclusions:  Non-opioid analgesics as adjuvants to opioid reduced the consumption and the side effects of opioids in adult surgical and Guillain-Barre syndrome patients in the ICU.
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.

Prospective validation and refinement of the APPROACH cardiovascular surgical intensive care unit readmission score

This research by Verma et al was published online in the Journal of Critical Care during August 2019.
Purpose:  The APPROACH cardiovascular surgical intensive care unit (CVICU) readmission score has excellent discrimination and calibration for CVICU readmission after discharge to a surgical ward; however, it has not been prospectively validated.
Material and methods:  In a prospective consecutive cohort of 805 patients ≥18 years admitted to the CVICU after coronary artery bypass and/or valvular surgery, the APPROACH CVICU readmission score was calculated at the time of discharge to a surgical ward. The study compared observed versus predicted CVICU readmission and the model discrimination was evaluated using AUC c-index. The incremental prognostic utility of 6 pre-specified prospectively collected respiratory (re-intubation, tracheostomy, oxygen at discharge) and hemodynamic variables (heart rate, systolic blood pressure, inotropes at discharge) were tested using net reclassification index (NRI) and integrated discrimination improvement (IDI).
Results:  A total of 37 (4.6%) patients were readmitted to the CVICU. The median CVICU length of stay (9.0 vs 2.0 days, p < .001) and all-cause in-hospital mortality (8.1% vs 0.4%, p < .001) was higher among readmitted patients. The model had good discrimination (c-index = 0.748). Systolic blood pressure at discharge yielded the largest improvement in model discrimination (c-index = 0.782; Hosmer-Lemshow p = .749).
Conclusions:  In a prospective validation cohort, the APPROACH CVICU readmission risk score had good discrimination and could be operationalized in future research and clinical practice.
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.

Comparison of the sepsis-2 and sepsis-3 definitions in severely injured trauma patients

This research by Eriksson et al was published online in the Journal of Critical Care during August 2019.
Purpose:  To evaluate the performance of the new SOFA-based sepsis definition in trauma patients.
Materials and methods:  A single-centre, retrospective, observational study. Primary outcome was 30-day mortality including a censoring analysis for early deaths. The primary outcome was evaluated with logistic regression, receiver operating characteristics (ROC) curves and Kaplan-Meier survival analyses.
Results:  722 severely injured patients were included between 2007 and 2016. 315 patients fulfilled the sepsis-2 criteria and 148 fulfilled the sepsis-3 criteria during the first ten days in the ICU. The odds ratios for 30-day mortality were 0.7 (CI 0.4–1.2) for sepsis-2 and 1.5 (CI 0.8–2.6) for sepsis-3. When censoring patients dying at day 1, sepsis-3 became associated with 30-day mortality whereas sepsis-2 did not. This finding was persistent and enhanced through continuing day-by-day censoring of early deaths. The same pattern was seen for the ROC curves analyses, censoring of early deaths resulted in significant discriminatory properties for sepsis-3 but not for sepsis-2.
Conclusions:  The sepsis-3 definition identifies much fewer patients and is more strongly associated with adverse outcomes than the sepsis-2 definition. The sepsis-3 definition seems to be useful in the post trauma setting.
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.

A pilot study evaluating a simple cardiac dysfunction score to predict complications and survival among critically-ill patients with traumatic brain injury

This research by Gibbons and others was published online in the Journal of Critical Care during August 2019.
Purpose:  To describe the frequency of cardiovascular complications and cardiac dysfunction in critically-ill patients with moderate-severe traumatic brain injury (msTBI) and cardiac factors associated with in-hospital survival.
Methods:  Retrospective analysis of a prospective cohort study at a single Level-1 trauma center with a dedicated neuro-trauma intensive care unit (ICU). Adult patients admitted to the ICU with msTBI were consecutively enrolled in the prospective OPTIMISM study between November 2009 and January 2017. Cardiac dysfunction was measured using a combination of EKG parameters, echocardiography abnormalities, and peak serum troponin-I levels during the index hospitalization. These items were combined into a cardiac dysfunction index (CDI), ranging from 0 to 3 points and modeled in a Cox regression analysis.
Results:  A total of 326 patients with msTBI were included. For every one-point increase in the CDI, the multivariable adjusted risk of dying during the patient’s acute hospitalization more than doubled (adjusted HR 2.41; 95% CI 1.29–4.53).
Conclusion:  Cardiac dysfunction was common in patients with msTBI and independently associated with more severe brain injury and a reduction in hospital survival in this population. Further research is needed to validate the CDI and create more precise scoring tools.
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.

The impact of real-time chest compression feedback increases with application of the 2015 guidelines

This research by Davis and colleagues was published online in the Journal of Critical Care during August 2019.
Background:  Cardiac arrest survival depends upon chest compression quality. Real-time audiovisual feedback may improve compression guideline adherence, particularly with the more specific 2015 guidelines.
Methods:  Subjects included healthcare providers from multiple U.S. hospitals. Compression rate and depth were recorded using standard manikins and real-time audiovisual feedback defibrillators (ZOLL R Series). Subjects were enrolled before (n = 756) and after (n = 995) release of the 2015 guidelines, which define narrower compression targets. Subjects performed 2 min of continuous compressions before and after activation of feedback. The percentage of compressions meeting appropriate rate/depth targets was determined before and after release of the 2015 guidelines.
Results:  An increase in compression guideline adherence was observed with use of feedback before [68.7% to 96.3%, p < .001] and after [16.6% to 94.1%, p < .001] release of the 2015 guidelines. The proportion of subjects requiring feedback to achieve adherence was higher for the 2015 guidelines [28.6% vs. 78.5%, OR 9.12, 95% CI 7.33–11.35,p < .001].
Conclusions:  The use of real-time audiovisual feedback increases adherence to chest compression guidelines, particularly with application of the narrower 2015 guidelines targets for compression depth and rate.
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 8 August 2019

Articles published in this issue include: “Intensive care unit length of stay is reduced by protocolized family support intervention: a systematic review and meta-analysis”, Continual hemodynamic monitoring with a single-use transesophageal echocardiography probe in critically ill patients with shock: a randomized controlled clinical trial and Functional outcomes in adult patients with herpes simplex encephalitis admitted to the ICU: a multicenter cohort study
The full contents list of Intensive Care Medicine August 2019 issue are available via this link.
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.