Latest issue of “Intensive and Critical Care Nursing” Volume 40 June 2017

The current issue conticcnlogoent page can be accessed via this link.

Included in this issue are articles on “Overcoming nursing barriers to intensive care unit early mobilisation: A quality improvement project”, “A qualitative study of nurse observations of symptoms in infants at end-of-life in the neonatal intensive care unit” and “A family intervention to reduce delirium in hospitalised ICU patients: A feasibility randomised controlled trial.”

To see the full text of any of these articles direct from the journal’s homepage requires a personal subscription.  Individual articles can be ordered via the Rotherham NHS Foundation Trust Library and Knowledge Service.  Registered members of the library can make article requests online via this link.

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.

Latest Issue of “Intensive Care Medicine” Volume 43 Number 5

intensive-care-medicine

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

Articles included in this issue are a review of “Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future” and “Monitoring dynamic arterial elastance as a means of decreasing the duration of norepinephrine treatment in vasoplegic syndrome following cardiac surgery: a prospective, randomized trial”

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.

Latest issue of Critical Care Reviews Newsletter 278 9th April 2017

The Critical Care Reviews Newsletter provides the best critical care research and open access articles from across the medical literature.  Included in the 278 issue are details of a randomised trial on “Effect of neuromuscular stimulation and individualized rehabilitation on muscle strength in Intensive Care Unit survivors”, a systematic review on “Impregnated central venous catheters in children” and an observational study on the “Effect of fresh frozen plasma on critically ill patients”.

The full newsletter can be accessed via this link.

An Official American Thoracic Society Systematic Review: The Effect of Night time Intensivist Staffing on Mortality and Length of Stay among Intensive Care Unit Patients

This systematic review by Kerlin et al was published in the American Journal of Respiratory and Critical Care Medicine in 2017.  The fullajrccm-2016-194-issue-6-cover
text of the article is available to subscribers to this journal via this link
.  The Library and Knowledge Service can obtain the full text of the article for registered members by requesting it via the library website document request form.

Background:  Studies of night time intensivist staffing have yielded mixed results.

Goals:  To review the association of night time intensivist staffing with outcomes of intensive care unit (ICU) patients.

Methods:  We searched five databases (2000–2016) for studies comparing in-hospital night time intensivist staffing with other night time staffing models in adult ICUs and reporting mortality or length of stay. We abstracted data on staffing models, outcomes, and study characteristics and assessed study quality, using standardized tools. Meta-analyses used random effects models.

Results:  Eighteen studies met inclusion criteria: one randomized controlled trial and 17 observational studies. Overall methodologic quality was high. Studies included academic hospitals (n = 10), community hospitals (n = 2), or both (n = 6). Baseline clinician staffing included residents (n = 9), fellows (n = 4), and nurse practitioners or physician assistants (n = 2). Studies included both general and specialty ICUs and were geographically diverse. Meta-analysis (one randomized controlled trial; three nonrandomized studies with exposure limited to night time intensivist staffing with adjusted estimates of effect) demonstrated no association with mortality (odds ratio, 0.99; 95% confidence interval, 0.75–1.29). Secondary analyses including studies without risk adjustment, with a composite exposure of organizational factors, stratified by intensity of daytime staffing and by ICU type, yielded similar results. Minimal or no differences were observed in ICU and hospital length of stay and several other secondary outcomes.

Conclusions:  Notwithstanding limitations of the predominantly observational evidence, our systematic review and meta-analysis suggests night time intensivist staffing is not associated with reduced ICU patient mortality. Other outcomes and alternative staffing models should be evaluated to further guide staffing decisions.

Fluid overload is an independent risk factor for acute kidney injury in critically Ill patients: results of a cohort study

This cohort study by Salahuddin et al was published in BMC Nephrology in early 2017.  The full text of the article can be retrieved via this link.

Background:  Acute Kidney injury (AKI) is common and increases mortality in the intensive care unit (ICU). We carried out this study to explore whether fluid overload is an independent risk factor for AKI.

Methods:  Single-center prospective, observational study. Consecutively admitted, ICU patients were followed for development of AKI. Intravenous fluid volumes, daily fluid balances were measured, hourly urine volumes, daily creatinine levels were recorded.

Results:  Three hundred thirty nine patients were included; AKI developed in 141 (41.6%) patients; RISK in 27 (8%) patients; INJURY in 25 (7%); FAILURE in 89 (26%) by the RIFLE criteria. Fluid balance was significantly higher in patients with AKI; 1755 ± 2189 v/s 924 ± 1846 ml, p < 0.001 on ICU day 1. On multivariate regression analysis, a net fluid balance in first 24 h of ICU admission, OR 1.02 (95% CI 1.01,1.03 p = 0.003), percentage of fluid accumulation adjusted for body weight OR1.009 (95% CI 1.001,1.017, p = 0.02), fluid balance in first 24 h of ICU admission with serum creatinine adjusted for fluid balance, OR 1.024 (95% CI 1.012,1,035, p = 0.005), Age, OR 1.02 95% CI 1.01,1.03, p < 0.001, CHF, OR 3.1 (95% CI 1.16,8.32, p = 0.023), vasopressor requirement on ICU day one, OR 1.9 (95% CI 1.13,3.19, p = 0.014) and Colistin OR 2.3 (95% CI 1.3, 4.02, p < 0.001) were significant predictors of AKI. There was no significant association between fluid type; Chloride-liberal, Chloride-restrictive, and AKI.

Conclusions:  Fluid overload is an independent risk factor for AKI.

The role of total cell-free DNA in predicting outcomes among trauma patients in the intensive care unit: a systematic review

This systematic review by Gogenur et al was published in the journal Critical Care in early 2017.  The full text of the article is fully available via this link

Background:  Cell-free DNA has been proposed as a means of predicting complications among severely injured patients. The purpose of this systematic review was to assess whether cell-free DNA was useful as a prognostic biomarker for outcomes in trauma patients in the intensive care unit.

Methods:  We searched Pubmed, Embase, Scopus and the Cochrane Central Register for Controlled Trials and reference lists of relevant articles for studies that assessed the prognostic value of cell-free DNA detection in trauma patients in the intensive care unit. Outcomes of interest included survival, posttraumatic complications and severity of trauma. Due to considerable heterogeneity between the included studies, a checklist was formed to assess quality of cell-free DNA measurement.

Results:  A total of 14 observational studies, including 904 patients, were eligible for analysis. Ten studies were designed as prospective cohort studies; three studies included selected patients from a cohort while one study was of a retrospective design. We found a significant correlation between higher values of cell-free DNA and higher mortality. This significant correlation was evident as early as on intensive care unit admission. Likewise, cell-free DNA predicted the severity of trauma and posttraumatic complications in a majority of patients.

Conclusion:  The amount of cell-free DNA can function as a prognostic tool for mortality and to a lesser extent severity of trauma and posttraumatic complications. Standardizing cell-free DNA measurement is paramount to ensure further research in cell-free DNA as a prognostic tool.

A randomized placebo-controlled phase II study of a Pseudomonas vaccine in ventilated ICU patients

This research by Rello et al was published in early 2017 in the journal “Critical Care”.  The full text of the article is available via this link.

Background:  Currently, no vaccine against Pseudomonas is available. IC43 is a new, recombinant, protein (OprF/I)-based vaccine against the opportunistic pathogen, Pseudomonas aeruginosa, a major cause of serious hospital-acquired infections. IC43 has proven immunogenicity and tolerability in healthy volunteers, patients with burns, and patients with chronic lung diseases. In order to assess the immunogenicity and safety of IC43 in patients who are most at risk of acquiring Pseudomonas infections, it was evaluated in mechanically ventilated ICU patients.

Methods:  We conducted a randomized, placebo-controlled, partially blinded study in mechanically ventilated ICU patients. The immunogenicity of IC43 at day 14 was determined as the primary endpoint, and safety, efficacy against P. aeruginosa infections, and all-cause mortality were evaluated as secondary endpoints. Vaccinations (100 μg or 200 μg IC43 with adjuvant, or 100 μg IC43 without adjuvant, or placebo) were given twice in a 7-day interval and patients were followed up for 90 days.

Results  Higher OprF/I IgG antibody titers were seen at day 14 for all IC43 groups versus placebo (P < 0.0001). Seroconversion (≥4-fold increase in OprF/I IgG titer from days 0 to 14) was highest with 100 μg IC43 without adjuvant (80.6%). There were no significant differences in P. aeruginosa infection rates, with a low rate of invasive infections (pneumonia or bacteremia) in the IC43 groups (11.2-14.0%). Serious adverse events (SAEs) considered possibly related to therapy were reported by 2 patients (1.9%) in the group of 100 µg IC43 with adjuvant. Both SAEs resolved and no deaths were related to study treatment. Local tolerability symptoms were mild and rare (<5% of patients), a low rate of treatment-related treatment-emergent adverse events (3.1–10.6%) was observed in the IC43 groups.

Conclusion:  This phase II study has shown that IC43 vaccination of ventilated ICU patients produced a significant immunogenic effect. P. aeruginosa infection rates did not differ significantly between groups. In the absence of any difference in immune response following administration of 100 μg IC43 without adjuvant compared with 200 μg IC43 with adjuvant, the 100 μg dose without adjuvant was considered for further testing of its possible benefit of improved outcomes. There were no safety or mortality concerns.