2017 ESISM Hot Topics in Vienna: Critical Care Reviews Newsletter

A supplemental Critical Care Reviews Newsletter covers five major research studies presented and published at this conference.  These include the TRANSFUSE trial comparing transfusion of the freshest available blood with standard issue red cells.  The ART trial investigates alveolar recruitment in ARDS.  BREATHE evaluates the role of extubation to non-invasive ventilation in patients failing spontaneous breathing trials.
More details of the trials and about the conference can be found in the full text of the supplementary edition of the newsletter.

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Outcomes of Patient- and Family-Centered Care Interventions in the ICU: A Systematic Review and Meta-Analysis

This paper was published in Critical Care Medicine October 2017 by Goldfarb et al.
Objective:  To determine whether patient- and family-centered care interventions in the ICU improve outcomes.
Data Sources:  We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library databases from inception until December 1, 2016.
Study Selection:  We included articles involving patient- and family-centered care interventions and quantitative, patient- and family-important outcomes in adult ICUs.
Data Extraction:  We extracted the author, year of publication, study design, population, setting, primary domain investigated, intervention, and outcomes.
Data Synthesis:  There were 46 studies (35 observational pre/post, 11 randomized) included in the analysis. Seventy-eight percent of studies (n = 36) reported one or more positive outcome measures, whereas 22% of studies (n = 10) reported no significant changes in outcome measures. Random-effects meta-analysis of the highest quality randomized studies showed no significant difference in mortality (n = 5 studies; odds ratio = 1.07; 95% CI, 0.95-1.21; p = 0.27; I = 0%), but there was a mean decrease in ICU length of stay by 1.21 days (n = 3 studies; 95% CI, -2.25 to -0.16; p = 0.02; I = 26%). Improvements in ICU costs, family satisfaction, patient experience, medical goal achievement, and patient and family mental health outcomes were also observed with intervention; however, reported outcomes were heterogeneous precluding formal meta-analysis.
Conclusions:  Patient- and family-centered care-focused interventions resulted in decreased ICU length of stay but not mortality. A wide range of interventions were also associated with improvements in many patient- and family-important outcomes. Additional high-quality interventional studies are needed to further evaluate the effectiveness of patient- and family-centered care in the intensive care setting.
The full text of this article will usually be only available via the internet to those who have a personal subscription though 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.

Regional anesthesia and analgesia after surgery in ICU

This article by Capdevila et al was published in the October 2017 issue of Current Opinion in Critical Care.

Purpose of Review:  The aim is to demonstrate that ICU physicians should play a pivotal role in developing regional anesthesia techniques that are underused in critically ill patients despite the proven facts in perioperative and long-term pain, organ dysfunction, and postsurgery patient health-related quality of life improvement.

Recent Findings:  Regional anesthesia and/or analgesia strategies in ICU reduce the surgical and trauma-stress response in surgical patients as well as complications incidence. Recent studies suggested that surgical/trauma ICU patients receive opioid-hypnotics continuous infusions to prevent pain and agitation that could increase the risk of posttraumatic stress disorder and chronic neuropathic pain symptoms, and chronic opioid use. Regional anesthesia use decrease the use of intravenous opioids and the ectopic activity of injured small fibers limiting those phenomena. In Cochrane reviews and prospective randomized trials in major surgery patients, regional anesthesia accelerates the return of the gastrointestinal transit and rehabilitation, decreases postoperative pain and opioids use, reduces ICU/hospital stay, improves pulmonary outcomes, including long period of mechanical ventilation and early extubation, reduces overall adverse cardiac events, and reduces ICU admissions when compared with general anesthesia and intravenous opiates alone. The reduction of long-term mortality has been reported in major vascular or orthopedic surgeries.

Summary:  Promoting regional anesthesia/analgesia in ICU surgical/trauma patients could undoubtedly limit the risk of complications, ICU/hospital stay, and improve patient’s outcome. The use of regional anesthesia permits a high doses opioid use limitation which is mandatory and should be considered as feasible and well tolerated in ICU.

The full text of this article will usually be only available via the internet to those who have a personal subscription though 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 Association of Age With Short-Term and Long-Term Mortality in Adults Admitted to the Intensive Care Unit

This article was published Journal of intensive care medicine October 2017 by Seethala et al
Background:  Based on the current literature, it is unclear whether advanced age itself leads to higher mortality in critically ill patients or whether it is due to the greater number of comorbidities in the elderly patients. We hypothesized that increasing age would increase the odds of short-term and long-term mortality after adjusting for baseline comorbidities in intensive care unit (ICU) patients.
Methods:  We performed a retrospective cohort study of 57 160 adults admitted to any ICU over 5 years at 2 academic tertiary care centers. Patients were divided into age-groups, 18 to 39, 40 to 59, 60 to 79, and ≥80. The primary outcomes were 30-day and 365-day mortality. Results were analyzed with multivariate logistic regression adjusting for demographics and the Elixhauser-van Walraven Comorbidity Index.
Results:  The adjusted 30-day mortality odds ratios (ORs) were 1.39 (95% confidence interval [CI]: 1.21-1.60), 2.00 (95% CI: 1.75-2.28), and 3.33 (95% CI: 2.90-3.82) for age-groups 40 to 59, 60 to 79, and ≥80, respectively, using the age-group 18 to 39 as the reference. The adjusted 365-day mortality ORs were 1.46 (95% CI: 1.32-1.61), 2.10 (95% CI: 1.91-2.31), and 2.96 (95% CI: 2.67-3.27).
Conclusions:  In critically ill patients, increasing age is associated with higher odds of short-term and long-term death after correcting for existing comorbidities.
The full text of this article will usually be only available via the internet to those who have a personal subscription though 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.

Management of Hemostatic Disorders in Patients With Advanced Liver Disease Admitted to an Intensive Care Unit

This article from the October issue of Transfusion Medicine Reviews was written by Lisman and Bernal
Patients with liver diseases frequently acquire complex changes in their hemostatic system. Traditionally, bleeding complications in patients with liver disease were ascribed to these hemostatic changes, and liver diseases were considered as an acquired bleeding disorder. Nowadays, it is increasingly acknowledged that patients with liver diseases are in “hemostatic rebalance” due to a commensurate decline in pro- and anticoagulant drivers. Indeed, both thrombosis and bleeding may complicate liver disease. Such complications may be particularly worrisome in critically ill patients with liver disease. This review will outline knowns and unknowns in prediction, prevention, and treatment of bleeding and thrombosis in patients with liver disease admitted to an intensive care unit.
The full text of this article is available via the following link.  If you are having any problems please contact the Library and Knowledge Service.

Patient Blood Management in the Intensive Care Unit

Shander and colleagues published this article in Transfusion Medicine Reviews October issue.
Patient Blood Management underscores a fundamental shift from a product-centered approach to a patient-centric approach through timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss in an effort to improve patient outcome. In this concept, allogeneic blood transfusion is not viewed as the treatment of default for anemic patients, but one among many treatment modalities that should be weighed based on its merits-potentials risks and benefits-for the individual patient in the context of other alternatives. Patient blood management provides a multidisciplinary framework for patient-centered decision making with strategies focusing on the management of anemia, optimization of coagulation and hemostasis, and utilization of blood conservation modalities. Among the critically ill patients, Patient Blood Management can be particularly effective given the extremely high prevalence of anemia, variable and unjustified transfusion practices, high frequency of coagulation disorders, and avoidable sources of blood loss such as unnecessary diagnostic blood draws. Proper management of anemia-prevention, screening/monitoring, diagnostic workup, and treatment including hematinic agents-is the key to effective implementation of patient blood management. Blood transfusions should be used in accordance of current guidelines, which are supportive of more restrictive transfusion strategies in most critically ill patients. Emerging studies report on the success of Patient Blood Management programs in reducing transfusion utilization, reducing the burden of anemia in patients, and improving patient outcomes including shortened length of hospital stays, less frequency of complications and lower risk of mortality.

The full text of this article is available via the following link.  If you are having any problems please contact the Library and Knowledge Service.

October 2017 Issue of “Intensive Care Medicine” Volume 43 Number 10

intensive-care-medicine

To view Intensive Care Medicine’s latest issue’s contents page follow this link.

Included in this issue are a review article on “Antimicrobial resistance in the next 30 years, humankind, bugs and drugs: a visionary approach” and original articles on the “Trends in short term and one year mortality in very elderly intensive care patients in the Netherlands: a retrospective study from 2008 to 2014” and “A multi center prospective cohort study of patient transfers from the intensive care unit to the hospital ward”.

To read the full text of these articles from the journal’s homepage requires a personal subscription to “Intensive Care Medicine”.  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.