This article by Moore and colleagues appeared in the June 2018 issue of Intensive Care Medicine Experimental.
Background: A dysregulated stress response has been implicated in the pathogenesis of critical illness. Sedative agents utilised in the critically unwell patient may impact upon the stress response with a downstream negative effect on multiple organ systems. This study was designed to assess the feasibility of investigating components of the stress response as a sub-study of the current SPICE-III study (NCT01728558).
Methods: This pilot observational cohort study was conducted in a single intensive care unit in Queensland, Australia. Enrolled patients were over 18 years who had been commenced on mechanical ventilation requiring sedation for less than 12h but expected to remain ventilated for > 24h. Blood samples were taken at 12h intervals over a 5-day period commencing at the time of enrolment, and subsequently tested for various markers of key efferent limbs of the stress axis.
Results: The 12 patients recruited closely mirrored the population within the pilot study used to design SPICE-III. Eighty-nine percent (107/120) of all planned blood samples were obtained and drawn within 0h (0-0.3) of the planned sampling time point. Time from eligibility to enrolment was a median (IQR) 1.4h (0.36-9.19), and time from eligibility to the first blood sample was 4.79h (2.0-10.61). Physiological, hormonal, metabolic and cardiac biomarkers were consistent with an elevated stress response at baseline which mostly normalised over the 5-day study period. Plasma noradrenaline levels correlated with the dose of norepinephrine used.
Conclusions: A larger sub-study of the SPICE-III study is feasible. The study has demonstrated a predictable trend of variation of the components of the blood panel during the evolution of critical illness and supports multiple sampling time points for the follow-up study.
The full text of the article is available via the link to “Download PDF” on this page.
The 341st issue of the Critical Care Reviews Newsletter, brings you the best critical care research and open access articles from across the medical literature in the last week. This includes experimental research such as “Early fibrinogen concentrate therapy for major haemorrhage in trauma (E-FIT 1): results from a UK multi-centre, randomised, double blind, placebo-controlled pilot trial”’, observational studies including “Long-term Risk of Seizures among Cardiac Arrest Survivors” and secondary research for instance “Revascularization strategies in cardiogenic shock complicating acute myocardial infarction: A systematic review and meta-analysis.”
The full text of newsletter 341 can be found via this link
This piece of experimental research by White and colleagues was published in the June 21st issue of the New England Journal of Medicine.
Background: Surrogate decision makers for incapacitated, critically ill patients often struggle with decisions related to goals of care. Such decisions cause psychological distress in surrogates and may lead to treatment that does not align with patients’ preferences.
Methods: We conducted a stepped-wedge, cluster-randomized trial involving patients with a high risk of death and their surrogates in five intensive care units (ICUs) to compare a multi-component family-support intervention delivered by the inter-professional ICU team with usual care. The primary outcome was the surrogates’ mean score on the Hospital Anxiety and Depression Scale (HADS) at 6 months (scores range from 0 to 42, with higher scores indicating worse symptoms). Pre-specified secondary outcomes were the surrogates’ mean scores on the Impact of Event Scale (IES; scores range from 0 to 88, with higher scores indicating worse symptoms), the Quality of Communication (QOC) scale (scores range from 0 to 100, with higher scores indicating better clinician-family communication), and a modified Patient Perception of Patient Centeredness (PPPC) scale (scores range from 1 to 4, with lower scores indicating more patient- and family-centered care), as well as the mean length of ICU stay.
Results: A total of 1420 patients were enrolled in the trial. There was no significant difference between the intervention group and the control group in the surrogates’ mean HADS score at 6 months (11.7 and 12.0, respectively; beta coefficient, -0.34; 95% confidence interval [CI], -1.67 to 0.99; P=0.61) or mean IES score (21.2 and 20.3; beta coefficient, 0.90; 95% CI, -1.66 to 3.47; P=0.49). The surrogates’ mean QOC score was better in the intervention group than in the control group (69.1 vs. 62.7; beta coefficient, 6.39; 95% CI, 2.57 to 10.20; P=0.001), as was the mean modified PPPC score (1.7 vs. 1.8; beta coefficient, -0.15; 95% CI, -0.26 to -0.04; P=0.006). The mean length of stay in the ICU was shorter in the intervention group than in the control group (6.7 days vs. 7.4 days; incidence rate ratio, 0.90; 95% CI, 0.81 to 1.00; P=0.045), a finding mediated by the shortened mean length of stay in the ICU among patients who died (4.4 days vs. 6.8 days; incidence rate ratio, 0.64; 95% CI, 0.52 to 0.78; P<0.001).
Conclusions: Among critically ill patients and their surrogates, a family-support intervention delivered by the inter-professional ICU team did not significantly affect the surrogates’ burden of psychological symptoms, but the surrogates’ ratings of the quality of communication and the patient- and family-centeredness of care were better and the length of stay in the ICU was shorter with the intervention than with usual care.
The printed copy of the New England Journal of Medicine is available in the Health Care Library on D Level of Rotherham Hospital.
Critical Care Reviews Newsletter, brings you 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 the BICAR-ICU randomised controlled trial, investigating sodium bicarbonate for metabolic acidaemia; observational studies on subphenotypes in septic shock & late mortality after acute hypoxic respiratory failure; guidelines on cancer patients requiring intensive care support & intermediate care units; narrative reviews on perioperative myocardial injury and the contribution of hypotension, vasoactive agents in shock & ventilation during extracorporeal support. There are also contrasting editorials on whether trials that report a neutral or negative treatment effect improve the care of critically ill patients – Yes & No; thrombocytopenia in the ICU & sepsis: who will shoot first? pharma or diagnostics; as well as commentaries on severe pulmonary embolism, type 2 myocardial infarction & acute kidney injury.”
The full text of newsletter 340 can be found via this link
Articles published in this issue include “Zika virus: Report from the task force on tropical diseases by the world Federation of Societies of intensive and critical care medicine”, Oxygen management in mechanically ventilated patients: A multicenter prospective observational study” and “Does the clinical frailty score improve the accuracy of the SOFA score in predicting hospital mortality in elderly critically ill patients? A prospective observational study”
The content page of this issue can be accessed via this link. A personal subscription to the journal is required to access the full text of these articles direct from this website. If you are a member of the Rotherham NHS Foundation Trust Library and Knowledge Service the full text of the article can be ordered for you via this link or in person in the library.
The current issue content page can be accessed via this link.
Articles published in this issue include “Use of the CAM-ICU during daily sedation stops in mechanically ventilated patients as assessed and experienced by intensive care nurses – A mixed-methods study”, “A systematic review evaluating the role of nurses and processes for delivering early mobility interventions in the intensive care unit” and “The professional and personal debriefing needs of ward based nurses after involvement in a cardiac arrest: An explorative qualitative pilot study”.
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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.
This article by Parikh and colleagues was published in the June 2018 issue of Vaccine.
The epidemiology of invasive meningococcal disease (IMD) is constantly changing as new strains are introduced into a population and older strains are removed through vaccination, population immunity or natural trends. Consequently, the clinical disease associated with circulating strains may also change over time. In England, IMD incidence has declined from 1.8/100,000 in 2010/2011 to 1.1/100,000 in 2013/2014, with a small increase in 2014/2015 to 1.3/100,000. Between 01 January 2011 and 30 June 2015, MenB was responsible for 73.0% (n = 2489) of 3411 laboratory-confirmed IMD cases, followed by MenW (n = 371, 10.9%), MenY (n = 373, 10.9%) and MenC (n = 129, 3.8%); other capsular groups were rare (n = 49, 1.4%). Detailed questionnaires were completed for all 3411 laboratory-confirmed cases. Clinical presentation varied by capsular group and age. Atypical presentations were uncommon (244/3411; 7.2%), increasing from 1.2% (41/3411) in children to 3.5% (120/3411) in older adults. Known IMD risk factors were rare (18/3411; 0.5%) and included complement deficiency (n = 11), asplenia (n = 6) or both (n = 1). Nearly a third of cases required intensive care (1069/3411; 31.3%), with rates highest in adults. The 28-day CFR was 6.9% (n = 237), with the lowest rates in 0-14 year-olds (85/1885, 4.5%) and highest among 85+ year-olds (30/94, 31.9%). These observations provide a useful baseline for the current burden of IMD in a European country with enhanced national surveillance.
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