“Intensive Care Medicine” Volume 44 Number 9 September 2018

“Intensive Care Medicine” is a publication for the communication and exchange of current work and ideas in intensive care medicine.  To access the latest issue’s contents page follow this link.
intensive-care-medicineArticles in this edition include “Factors associated with health-related quality of life 6 years after ICU discharge in a Finnish paediatric population: a cohort study” and “Prevalence and outcome of heparin-induced thrombocytopenia diagnosed under veno-arterial extracorporeal membrane oxygenation: a retrospective nationwide study”.
To access the full text of these articles via the journal’s homepage you require a personal subscription to the journal.  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 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.

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High-flow nasal cannula oxygen therapy alone or with non-invasive ventilation during the weaning period after extubation in ICU: the prospective randomised controlled HIGH-WEAN protocol

This article by Thille and colleagues as part of the REVA research network was published in BMJ Open in September 2018.
Introduction:  Recent practice guidelines suggest applying non-invasive ventilation (NIV) to prevent postextubation respiratory failure in patients at high risk of extubation failure in intensive care unit (ICU). However, such prophylactic NIV has been only a conditional recommendation given the low certainty of evidence. Likewise, high-flow nasal cannula (HFNC) oxygen therapy has been shown to reduce reintubation rates as compared with standard oxygen and to be as efficient as NIV in patients at high risk. Whereas HFNC may be considered as an optimal therapy during the postextubation period, HFNC associated with NIV could be an additional means of preventing postextubation respiratory failure. We are hypothesising that treatment associating NIV with HFNC between NIV sessions may be more effective than HFNC alone and may reduce the reintubation rate in patients at high risk.
Methods and Analysis:  This study is an investigator-initiated, multicentre randomised controlled trial comparing HFNC alone or with NIV sessions during the postextubation period in patients at high risk of extubation failure in the ICU. Six hundred patients will be randomised with a 1:1 ratio in two groups according to the strategy of oxygenation after extubation. The primary outcome is the reintubation rate within the 7 days following planned extubation. Secondary outcomes include the number of patients who meet the criteria for moderate/severe respiratory failure, ICU length of stay and mortality up to day 90.
Ethics and Dissemination: The study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.
The full text of this article is freely available via this link.

Critical Care Reviews Newsletter 353 16th September 2018

Welcome to the 353rd Critical Care Reviews Newsletter that brings you the best critical care research and open access articles in the medical literature during the last week.
“The highlights of this week’s edition are a randomised controlled trial comparing piperacillin-tazobactacritcal care reviewsm with meropenem in patients with E coli or Klebsiella pneumoniae bacteraemia and ceftriaxone resistance; systematic reviews and meta analyses on critically ill patients with tuberculosis & benzodiazepine use and neuropsychiatric outcomes in the ICU; plus observational studies on post-anaesthesia pulmonary complications after use of muscle relaxants & haemodynamic effects of an open lung strategy analyzed with echocardiography. There are also narrative reviews on understanding myocardial infarction & ARDS; commentaries on antibiotics for sepsis & aligning patient and physician incentives; and editorials on avoiding the term “fluid overload” & computerized protocols to replace physicians for managing mechanical ventilation; as well as correspondence on the EOLIA trial (being discussed at the Critical Care Reviews Meeting 2019).”

The full text of the newsletter can be accessed via this link.

Identifying determinants of noise in a medical intensive care unit

This article by Crawford and others was published in the September 2018 issue of the Journal of Occupational and Environmental Hygiene.
Continuous and intermittent exposure to noise elevates stress, increases blood pressure, and disrupts sleep among patients in hospital intensive care units. The purpose of this study was to determine the effectiveness of a behavior-based intervention to reduce noise and to identify determinants of noise in a medical intensive care unit.  Staff were trained for six weeks to reduce noise during their activities in an effort to keep noise levels below 55 dBA during the day and below 50 dBA at night. One-min noise levels were logged continuously in patient rooms eight weeks before and after the intervention. Noise levels were compared by room position, occupancy status, and time of day. Noise levels from flagged days (>60 dBA for >10 hrs) were correlated with activity logs. The intervention was ineffective with noise frequently exceeding project goals during the day and night. Noise levels were higher in rooms with the oldest heating, ventilation, and air-conditioning system, even when patient rooms were unoccupied. Of the flagged days, the odds of noise over 60 dBA occurring was 5.3 higher when high-flow respiratory support devices were in use compared to times with low-flow devices in use (OR= 5.3, 95% CI = 5.0 – 5.5). General sources, like the heating, ventilation, and air-conditioning system, contribute to high baseline noise and high-volume (>10 L/min) respiratory-support devices generate additional high noise (>60 dBA) in Intensive Care Unit patient rooms. This work suggests that engineering controls (e.g., ventilation changes or equipment shielding) may be more effective in reducing noise in hospital intensive care units than behavior modification alone.
To access the full text of these articles via the journal’s homepage you require a personal subscription to the journal. Library members can order individual articles via the Rotherham NHS Foundation Trust Library and Knowledge Service using the article requests online via this link.

 

Intensive Care Society State-of-the-Art Meeting 10-12th December 2018

State of the Art (SOA) this year is in central London, at the QEII Centre. The three-day programme has ninety of the very best speakers, over thirty concurrent sessions, opening and closing plenary’s.  This year also have the SOAp Box with relaxed mini-talks in the Exhibition Hall, Cauldron, PechaKucha, E-posters, and a Learning Suite, including immersive simulation, echo and POCUS live demonstrations. There are also five different opportunities to present your work to peers.
More details including registration are available via this link.

Sepsis incidence and mortality are underestimated in Australian intensive care unit administrative data

This research by Heldens and colleagues was published in the Medical Journal of Australia in September 2018.
Objectives:  To compare estimates of the incidence and mortality of sepsis and septic shock among patients in Australian intensive care units (ICUs) according to clinical diagnoses or binational intensive care database (ANZICS CORE) methodology.
Design, Setting, Participants:  Prospective inception cohort study (3-month inception period, 1 October – 31 December 2016, with 60-day follow-up); daily screening of all patients in a tertiary hospital 60-bed multidisciplinary ICU.
Main Outcomes:  Diagnoses of sepsis and septic shock according to clinical criteria and database criteria; in-hospital mortality (censored at 60 days).
Results:  Of 864 patients admitted to the ICU, 146 (16.9%) were diagnosed with sepsis by clinical criteria and 98 (11%) according to the database definition (P < 0.001); the sensitivity of the database criteria for sepsis was 52%, the specificity 97%. Forty-nine patients (5.7%) were diagnosed with septic shock by clinical criteria and 83 patients (9.6%) with the database definition (P < 0.001); the sensitivity of the database criteria for septic shock was 65%, the specificity 94%. In-hospital mortality of patients diagnosed with sepsis was greater in the clinical diagnosis group (39/146, 27%) than in the database group (17/98, 17%; P = 0.12); for septic shock, mortality was significantly higher in the clinical diagnosis group (13/83, 16%) than in the database group (18/49, 37%; P = 0.006).
Conclusions:  When compared with the reference standard – prospective clinical diagnosis – ANZICS CORE database criteria significantly underestimate the incidence of sepsis and overestimate the incidence of septic shock, and also result in lower estimated hospital mortality rates for each condition.
The full text of this article is freely available via this link.

Red blood cell distribution width predicts long-term outcomes in sepsis patients admitted to the intensive care unit

This research by Han and colleagues was published in Clinica chimica acta; international journal of clinical chemistry September 2018 issue.
Background:  Although some underpowered studies have proven that increased red blood cell distribution width (RDW) may be associated with short-term prognosis of sepsis, the long-term prognostic value of RDW remains largely unknown.
Methods:  This retrospective observational study was based on the Medical Information Mart for Intensive Care III (MIMIC III), a large critical care database. Baseline RDW and conventional disease severity scores were extracted along with data on 4-year mortality, of adult patients with severe sepsis upon first admission to the intensive care unit (ICU). The prognostic value of RDW was analysed with Kapan-Meier cure, Cox model, receiver operating characteristic (ROC) curve analysis, net reclassification index (NRI) and integrated discriminatory index (IDI).
Results:  A total of 4264 subjects were included. The area under ROC curve of RDW for predicting 4-year mortality was 0.64 (95% CI: 0.63-0.66). In multivariable Cox model, increased RDW was independently associated with all-cause mortality, irrespective of anemia. With conventional severity scores as reference, RDW had continuous NRI comprised between 0.18 and 0.20, and IDI comprised between 0.30 and 0.40.
Conclusions:  RDW values significantly predicts long-term all-cause mortality in critically ill patients with severe sepsis beyond conventional severity scores.
To access the full text of these articles via the journal’s homepage you require a personal subscription to the journal. Library members can order individual articles via the Rotherham NHS Foundation Trust Library and Knowledge Service using the article requests online via this link.