Rescue stem cell allograft in intensive care unit patients during septic shock with multi-organ failure

This research by Lepretre and colleagues was first published online in the Journal of Critical Care during July 2019.
Purpose:  We describe what we believe to be the first two cases of patients who received an allograft in intensive care unit (ICU) despite severe septic shock with multi-organ failure (MOF).
Results:  One patient had aggressive large B-cell lymphoma. After allograft, the patient initially improved after withdrawing norepinephrine and renal replacement therapy but he subsequently died thirty-two days later because of a new relapse of the disease. The second patient had acute myeloid leukemia type 1 with a need for an allograft after a first complete remission. She was discharged from ICU at D23 after allograft and still alive 7 months later with complete remission. For the two patients, allograft conditioning was performed before admission to our ICU. These two cases highlight one major problem in such situations which is to find the best time to perform the allograft, particularly in ventilated patients with septic shock and MOF. We performed the allograft when we thought that the risk-benefit ratio was in favor of restoring immunity.
Conclusion:  Allograft should be considered as a rescue therapy in ICU for patients with aplasia, during septic shock with multi-organ failure, however close multidisciplinary discussion is required between intensivists and onco-hematologists.
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.

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Intensive Care Medicine Volume 45 Number 7 July 2019

To view Intensive Care Medicine’s July issue’s contents page follow this link.
This issue includes original articles such as “Brain ultrasonography: methodology, basic and advanced principles and clinical applications. A narrative review”, “Complications in internal jugular vs subclavian ultrasound-guided central venous catheterization: a comparative randomized trial” and “Molecular targeted therapy-related life-threatening toxicity in patients with malignancies. A systematic review of published cases”.
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.

Moral distress in intensive care unit personnel is not consistently associated with adverse medication events and other adverse events

This article by Dodek and others was published in the Journal of Critical Care online in July 2019.
Purpose:  To examine the association between moral distress in ICU personnel, and medication errors and adverse events, and other adverse events.
Materials and methods:  In 13 ICUs, we measured moral distress once in all ICU staff, and incidence of five explicity-defined adverse safety events over 2 years. In 10 of the ICUs, pharmacists tabulated medication errors and adverse events during 1 day in the 2-year period. Average moral distress scores for each professional group were correlated with each safety measure.
Results:  In the pharmacy study, there were almost no significant correlations between moral distress and measures of medication safety. However, higher moral distress in nurses was associated with more interceptions of near misses per administration error (r = 0.68, p = 0.04), and higher moral distress in physicians was associated with more incorrect measurements for medication monitoring per recommended action for monitoring (r = 0.68, p = 0.03). For the other adverse events, the only significant association was a positive association between moral distress in physicians and bleeding while on anticoagulants (OR: 1.1; 95% CI: 1.0–1.3).
Conclusion:  Moral distress in ICU personnel is generally not associated with medication errors or adverse events, or other adverse events, but it may be associated with both hyper-vigilance and distraction.
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 394 8th July 2019

Welcome to the 394th Critical Care Reviews Newsletter lists 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 a randomised controlled trial comparing the effects of restrictive and liberal red blood cell transfusion on AKI; a systematic review and meta analysis on dopamine in critically ill patients with cardiac dysfunction; and observational studies on detection of brain activation in unresponsive patients with acute brain injury & high-sensitivity troponin in suspected myocardial infarction.
Full text of the 394th newsletter is available via this link.

A national survey of approaches to manage the ICU patient with opioid use disorder

This paper by Reicheld and colleagues was published online at the end of June 2019 in the Journal of Critical Care.
Purpose:  Opioid associated admissions to the Intensive Care Unit (ICU) are increasing, but how institutions manage the care of these patients is unknown. We studied the availability of protocols and guidelines in Intensive Care Units (ICUs) for the management of the critically ill patient with opioid use disorder.
Materials and methods:  A survey was sent to a random sampling of ICU clinicians at acute care hospitals in the United States.
Results:  Of the 300 hospitals contacted, 118 agreed to participate and 58 submitted surveys (49%, 58/118 response rate). While a majority of ICUs has a guideline to titrate sedative analgesics, only 7% reported a guideline that addresses the sedation needs of patients with opioid use disorder. Only one respondent identified a guideline for the continuation of medication-assisted treatment such as methadone. Most respondents did not have, or were unaware of, a guideline to manage opioid withdrawal or to prevent over-reversal with naloxone. Outpatient resources were offered to patients by 36% of institutions, while even fewer reported the use of a dedicated addiction care team.
Conclusions:  Few institutional guidelines exist to provide clinicians with the tools necessary to prevent harm and promote recovery for this growing and vulnerable ICU population.
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.

Time of admission to intensive care unit, strained capacity, and mortality: A retrospective cohort study

This research by Cardoso and colleagues was published online in June 2019 in the Journal of Critical Care.
Purpose:  We sought to study the association between afterhours ICU admission and ICU mortality considering measures of strained ICU capacity.
Materials and methods:  Retrospective analysis of 4141 admissions to 2 ICUs in Lisbon, Portugal (06/2016–06/2018). Primary exposure was ICU admission on 20:00 h–07:59 h. Primary outcome was ICU mortality. Measures of strained ICU capacity were: bed occupancy rate ≥ 90% and cluster of ICU admissions 2 h before or following index admission.
Results:  There were 1581 (38.2%) afterhours ICU admissions. Median APACHE II score (19 vs. 20) was similar between patients admitted afterhours and others (P = .27). Patients admitted afterhours had higher crude ICU mortality (15.4% vs. 21.9%; P < .001), but similar adjusted ICU mortality (aOR [95%CI] = 1.15 [0.97–1.38]; P = .12). While bed occupancy rate ≥ 90% was more frequent in patients admitted afterhours (23.1% vs. 29.1%) or deceased in ICU (23.6% vs. 33.7%), cluster of ICU admissions was more frequent in patients admitted during daytime hours (75.2% vs. 58.9%) or that survived the ICU stay (70.1% vs. 63.9%; P ≤ .001 for all). These measures of strained ICU capacity were not associated with adjusted ICU mortality (P ≥ .10 for both).
Conclusions:  Afterhours ICU admission and measures of strained ICU capacity were associated with crude but not adjusted ICU mortality.
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.