Implementation of a structured communication tool improves family satisfaction and expectations in the intensive care unit

This paper by Sviri and colleagues was published in the Journal of Critical Care online during January 2019.
Background:  Intensive care unit (ICU) physicians should provide relatives of critically ill patients with appropriate and clear information, regarding prognosis, treatment options and expectations.
Objectives:  To assess whether a structured communication tool improves satisfaction with care and engenders realistic expectations among relatives of critically ill patients.
Study design:  A controlled, pre-post intervention design was implemented in the General and Medical ICUs in the Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Methods:  Forty relatives of patients who received usual communication from the medical staff (control group) were interviewed. We then implemented a structured communication tool and another forty family members were interviewed (intervention group). The ICU physicians who participated in the family meeting were also interviewed.
Results:  Satisfaction in the intervention group was higher regarding ease of obtaining the information (90% vs 70%, p = .025) and the consistency of information provided (92.5% vs 77.5%, p = .057). There was better correlation between physicians’ and relatives’ expectations in the intervention group regarding hospital survival (Kappa 0.322 vs 0.054, p = .01). Physicians predicted more accurately patients’ actual hospital survival.
Conclusions:  A structured communication tool was associated with improved family satisfaction with communication and expectations regarding hospital survival. Further research is required to evaluate this promising intervention.
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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Early mobilisation in intensive care during renal replacement therapy: A quality improvement project

This article by Ragland and others was published online during January 2019 in “Intensive and Critical Care Nursing”.
Objective:  To improve mobility for patients undergoing renal replacement therapy within intensive care.
Design:  A quality improvement study utilising a step-wise mobility protocol within a before-and-after audit design.
Setting:  Twenty-four bed Trauma/Surgical intensive care unit within a level one trauma and academic centre.
Main outcome:  Improvement of compliance to the mobility plan following introduction of a step-wise mobility protocol.
Results:  A total of fifty-six renal replacement therapy patients were measured on a randomly selected day each week during the nine month before-and-after protocol audit period. Before introducing the protocol, compliance to mobility was 12.5%, compared to 62.5% after the protocol was introduced. There were no identified negative outcomes, such as catheter loss, filter loss or bleeding, associated with mobilising these patients following implementation of the protocol.
Conclusion:  The use of a step-wise mobility protocol was effective and safe strategy to increase mobility in the renal replacement therapy patient population.
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.

Haloperidol for the management of delirium in adult intensive care unit patients: A systematic review and meta-analysis of randomized controlled trials

This article by Zayed et al was published online in the Journal of Critical Care during January 2019.
Purpose:  Delirium commonly presents as a complication in critically ill patients. Our aim is to perform a meta-analysis investigating the role of haloperidol versus placebo in management (treatment and prophylaxis), of delirium in intensive care unit (ICU).
Materials and methods:  Our study is a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing haloperidol versus placebo for treatment and/or prophylaxis of ICU-related delirium.
Results:  Six RCTs representing 2552 patients. There was no significant difference between haloperidol and placebo-treated patients in short-term all-cause mortality (risk ratio [RR] 0.96; 95% confidence interval [CI] 0.81–1.14; P = 0.67), incidence of delirium (RR 0.93; 95% CI 0.65–1.34; P = 0.70), ICU length of stay (Mean difference [MD] 0.00 days; 95% CI -0.82-0.83; P = 0.99), or delirium/coma-free days (MD 0.09; 95% CI -0.05-0.24; P = 0.21). Haloperidol was not associated with increased risk for serious adverse events (RR 0.65; 95% CI 0.23–1.88; P = 0.43), QTc prolongation (RR 0.87; 95% CI 0.63–1.19; P = 0.38), or extrapyramidal symptoms (RR 0.84; 95% CI 0.57–1.23; P = 0.37).
Conclusion:  Among critically ill patients, haloperidol administration compared with placebo does not significantly affect short-term mortality, incidence of delirium, ICU length of stay, or delirium or coma-free days. Additionally, there was no increased risk of adverse events.
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.

Interventions for the management and prevention of sarcopenia in the critically ill: A systematic review

This article by Tretheway and others was published online in the Journal of Critical Care during January 2019.
Purpose:  In the critically ill, sarcopenia is associated with a variety of adverse outcomes however there is no consensus regarding its management. This study aimed to systematically review the evidence for interventions for the management and prevention of sarcopenia in critically ill patients.
Materials and Methods:  Bibliographic databases were searched according to pre-specified criteria (PROSPERO-CRD42018086271). Randomised controlled trials (RCTs) investigating interventions to preserve muscle mass and/or function in critically ill patients were included. Two independent authors selected the articles and assessed bias using the Cochrane Risk of Bias Tool.
Results:  Twenty-two eligible RCTs were identified comprising 2792 patients. Three main groups of interventions were implemented in these trials: neuromuscular electrical stimulation (NMES), exercise-based and nutritional. Both the interventions and outcomes measured varied significantly between studies. NMES was most frequently studied as an intervention to preserve muscle mass whilst exercise-based treatments were evaluated as interventions to preserve muscle function. There was significant variation in the efficacy of the interventions on sarcopenia markers and secondary outcomes.
Conclusions:  NMES and exercise-based interventions may preserve muscle mass and function in patients with critical illness. There is a lack of consistency seen in the effects of these interventions. Further, large, high quality RCTs are required.
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.

Association of septic shock definitions and standardized mortality ratio in a contemporary cohort of critically ill patients

This research by Kashyap and colleagues was first published on line in the “Journal of Critical Care” during January 2019.
Purpose:  The newly proposed septic shock definition has provoked a substantial controversy in the emergency and critical care communities. We aim to compare new (SEPSIS-III) versus old (SEPSIS-II) definitions for septic shock in a contemporary cohort of critically ill patients.
Material and methods:  Retrospective cohort of consecutive patients, age ≥ 18 years admitted to intensive care units at the Mayo Clinic between January 2009 and October 2015. We compared patients who met old, new, both, or neither definition of sepsis shock. SMR were calculated using APACHE IV predicted mortality.
Results:  The initial cohort consisted of 16,720 patients who had suspicion of infection, 7463 required vasopressor support. The median (IQR) age was 65(54–75) years and 4167(55.8%) were male. Compared to patients with old definition, the patients with new definition had higher APACHE III score (median IQR); (73 (57–92) vs. 70 (56–89), p < .01); SOFA score; (6 (4–10) vs. 6 (4–9), p < .01), were older (70 (59–79) vs. 64 (54–74) years, p = .03). They also had higher hospital mortality, N (%) 71, (19.7%) vs. 40 (12.6%), p < .01) and a higher SMR (0.66 vs. 0.45, p < .01).
Conclusions:  Compared to SEPSIS-II, SEPSIS-III definition of septic shock identifies patients further along disease trajectory with higher likelihood of poor outcome.
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 369 6th January 2019

The 369th Critical Care Reviews Newsletter highlights the best critical care research from the medical literature in the last week.  Content of this issue includes; “Systematic Review of Intrathecal Nicardipine for the Treatment of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage”, “Post–pathogen interactions and prognosis of critically ill immunocompetent patients with pneumococcal pneumonia: the nationwide prospective observational” and “Guiding intensive care physicians’ communication and behavior towards bereaved relatives: study protocol for a cluster randomized controlled trial (COSMIC-EOL)”.
Details of the Critical Care Reviews Meeting 2019 to be held in Belfast in January are also listed on the newsletter or via this link.
The full text of the newsletter is available via this link.

A mixed methods exploration of intensive care unit nurses’ perception of handling oxygen therapy to critically ill patients

This article was published on line in “Intensive and Critical Nursing” in January 2019 by Bunkenborg and Bundgaard.
Objectives:  Nurses handle supplementary oxygen to intensive care unit patients as part of their daily practise. To secure patients of optimal and safe care, knowledge of nurses’ perception of this practise, including influencing factors for adjusting oxygenation levels is essential. This study aimed to explore intensive care nurses’ perception of handling oxygenation and of factors that govern and influence this practise.
Research methodology/design:  A mixed methods approach was applied comprising six focus group interviews, conducted in February/March 2017, leading to construction of a questionnaire distributed to 535 ICU nurses in September 2017. Following a process of content analysis, the findings were discussed against Gittell’s framework for relational coordination.
Setting:  Intensive care units in rural, urban and university hospital settings.
Main outcome:  A deeper understanding of nurses’ perception of handling oxygenation to patients in the intensive care unit.
Findings and results:  Findings are presented through the categories Treatment Guidance, Nursing Practise, Knowledge and Competences and Inter-professional Collaboration.
Conclusion:  Nurses’ practise of handling supplementary oxygen therapy to the intensive care patient is influenced by day-by-day physician prescribed upper and lower limits for pO2 and pCO2, by nurses’ understanding of the individual clinical patient situation and by knowledge of pros and cons in relation to oxygen therapy including observational and clinical assessment expertise. Establishing working environments in the intensive care unit setting based on mutual inter- and intra-professional respect may contribute to enhance safe and high quality patient care.
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.