Varshan Karunakaran, Keri Harding, Alexander Sarnowski, Edward Walter
{"title":"Trace elements: Clinical perspectives in the critically ill.","authors":"Varshan Karunakaran, Keri Harding, Alexander Sarnowski, Edward Walter","doi":"10.1177/17511437241305269","DOIUrl":"10.1177/17511437241305269","url":null,"abstract":"<p><p>Trace elements are required in minute quantities in the diet but play a vital role in a wide variety of functions, such as co-factors in antioxidant reactions and normal immune function to DNA and protein synthesis and skeletal and tissue remodelling and repair. Critically ill patients are at risk of trace element deficiency or excess, due to changes in intake, absorption, metabolism or excretion. Deficiency or excess can lead to a wide range of cellular and organ dysfunction that may be seen in patients with an acute or critical illness, including cardiomyopathy, impaired glucose tolerance and reduced oxygen delivery. In addition, various diseases, such as systemic inflammation and renal and intestinal failure, and intensive care treatments, such as parenteral nutrition, renal replacement therapy and diuretics, can increase the likelihood of deficient or excessive amounts of micronutrient levels. This narrative review discusses sources and normal physiology of trace element handling and how this may be impaired in critically ill patients. It then discusses various conditions seen in critically ill patients that may be caused or exacerbated by abnormal trace element status and the current evidence around whether supplementation is of benefit in particular critical illnesses.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437241305269"},"PeriodicalIF":2.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sampath Weerakkody, Jemima Unwin Teji, Edward Barrett, Margarita Kousteni, Lorna Flores-Villa, Emma Jenkins, Hugh Montgomery
{"title":"Improved intensive care lighting and staff wellbeing: A pilot feasibility service evaluation.","authors":"Sampath Weerakkody, Jemima Unwin Teji, Edward Barrett, Margarita Kousteni, Lorna Flores-Villa, Emma Jenkins, Hugh Montgomery","doi":"10.1177/17511437251315570","DOIUrl":"10.1177/17511437251315570","url":null,"abstract":"<p><strong>Background: </strong>The lighting environment in intensive care units (ICUs) is markedly different from natural light, potentially disrupting patients' circadian rhythms and impacting staff wellbeing. New lighting technologies may mitigate these effects.</p><p><strong>Methods: </strong>A mixed methods service evaluation was conducted in a London ICU using Dyson Lightcycle™ luminaires (DLs) to evaluate staff wellbeing. Wellbeing assessments and user perceptions of the built environment were conducted using validated questionnaires before, during, and after DL deployment. Existing ambient light usage was measured using HOBO devices installed on the ceiling. Additionally, data on DL usage (including spectral data) were collected continuously using Raspberry Pi™ sensors.</p><p><strong>Results: </strong>DL usage was high (>70% per 24 h), primarily as supplementary lighting. Users found DLs easy to control and beneficial for clinical and administrative tasks. Participants assigned a 12.5% higher satisfaction score rated from 0 to 8 of lighting overall during deployment compared to pre-deployment (6.06 ± 0.29 and 5.06 ± 0.60, respectively; <i>p</i> = 0.20). Control variables for the built environment (noise, temperature and air quality) remained unchanged. Staff reported improvements in mood (38%, <i>p</i> < 0.001), fatigue (17.7%, <i>p</i> < 0.001), and sleep quality (21.2%, <i>p</i> = 0.01) during DL use.</p><p><strong>Discussion: </strong>In the first pilot feasibility service evaluation of its kind, the relationship between ICU lighting quality and staff wellbeing was investigated using DLs. We show that it is feasible to equip an ICU with a novel mode of lighting to evaluate both illuminance and user-centred outcomes. The study suggests a positive association between DL use and staff wellbeing, with notable improvements in mood, fatigue and sleep quality. The nature of the emitted light may enhance the space rather than simply illuminate, thus further adding to a feeling of wellbeing. These findings support data from studies which report effects of light brightness and colour on mood. Additionally, there appears to be a signal towards benefit to the user when additional lighting is provided, compared to the current overhead fluorescent luminaires prevalent in most ICUs. In this service evaluation these benefits were demonstrated in ICU staff operating the device. However, it is conceivable that effects such as improved mood and reduced sleep disturbance may have patient benefits too.</p><p><strong>Conclusion: </strong>Local lighting systems like DLs show promise in enhancing ICU staff wellbeing. Their impact on patient outcomes and the potential for broader implementation deserve further investigation in appropriately designed and powered larger-scale trials.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251315570"},"PeriodicalIF":2.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caitlin Lythgoe, David Oliver Hamilton, Brian W Johnston, Sandra Ortega-Martorell, Ivan Olier, Ingeborg Welters
{"title":"The use of machine learning based models to predict the severity of community acquired pneumonia in hospitalised patients: A systematic review.","authors":"Caitlin Lythgoe, David Oliver Hamilton, Brian W Johnston, Sandra Ortega-Martorell, Ivan Olier, Ingeborg Welters","doi":"10.1177/17511437251315319","DOIUrl":"10.1177/17511437251315319","url":null,"abstract":"<p><strong>Background: </strong>Community acquired pneumonia (CAP) is a common cause of hospital admission. CAP carries significant risk of adverse outcomes including organ dysfunction, intensive care unit (ICU) admission and death. Earlier admission to ICU for those with severe CAP is associated with better outcomes. Traditional prediction models are used in clinical practice to predict the severity of CAP. However, accuracy of predicting severity may be improved by using machine learning (ML) based models with added advantages of automation and speed. This systematic review evaluates the evidence base of ML-prediction tools in predicting CAP severity.</p><p><strong>Methods: </strong>MEDLINE, EMBASE and PubMed were systematically searched for studies that used ML-based models to predict mortality and/or ICU admission in CAP patients, where a performance metric was reported.</p><p><strong>Results: </strong>11 papers including a total of 351,365 CAP patients were included. All papers predicted severity and four predicted ICU admission. Most papers applied multiple ML algorithms to datasets and derived area under the receiver operator characteristic curve (AUROC) of 0.98 at best performance and 0.57 at worst, with a mixed performance against traditional prediction tools.</p><p><strong>Conclusion: </strong>Although ML models showed good performance at predicting CAP severity, the variables selected for inclusion in each model varied significantly which limited comparisons between models and there was a lack of reproducible data, limiting validity. Future research should focus on validating ML predication models in multiple cohorts to derive robust, reproducible performance measures, and to demonstrate a benefit in terms of patient outcomes and resource use.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251315319"},"PeriodicalIF":2.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mark Brown, Fayez Elsawy, Benjamin Allison, Brendan McGrath
{"title":"Antiplatelet and anticoagulation use and risk of bleeding from percutaneous dilatational tracheostomy insertion: Systematic review and meta-analysis.","authors":"Mark Brown, Fayez Elsawy, Benjamin Allison, Brendan McGrath","doi":"10.1177/17511437251314298","DOIUrl":"10.1177/17511437251314298","url":null,"abstract":"<p><strong>Introduction: </strong>Antiplatelet and anticoagulation therapies are frequently required in acutely unwell patients and confer an increased propensity for procedural bleeding. During percutaneous tracheostomy insertion, the decision to stop these therapies is left to clinical decision-makers. This meta-analysis summarises the risk of bleeding associated with antiplatelet and anticoagulation therapy during percutaneous tracheostomy insertion.</p><p><strong>Method: </strong>We conducted a systematic review and meta-analysis of studies which reported intraoperative bleeding during percutaneous tracheostomy while on single antiplatelet therapy (SAPT) or dual antiplatelet therapy (DAPT), as well as therapeutic anticoagulation (TAC). Groups were compared against those with prophylactic or no anticoagulation. Studies were pooled using random effects via the inverse variance method.</p><p><strong>Results: </strong>Four databases found 22 eligible studies, of which 14 studies presented data for meta-analysis representing 3,485 percutaneous tracheostomy insertion procedures. These included six studies that reported intraoperative bleeding outcome SAPT, six for DAPT and five for TAC. Overall, methodological quality was poor. No significant association was found for SAPT (Odds ratio 1.58; 95% confidence interval 0.72-4.41); <i>P</i> = 0.25; <i>I</i> <sup>2</sup> = 81%) and TAC (OR 1.79; 95% CI 0.58-5.56; <i>P</i> = 0.35; I<sup>2</sup> = 35%). The DAPT group was associated with increased bleeding with an OR of 2.05 (95% CI 1.18-3.56; <i>P</i> = 0.01; <i>I</i> <sup>2</sup> = 0%).</p><p><strong>Conclusion: </strong>Our study supports temporarily withholding DAPT or TAC (if clinically feasible) to minimize bleeding risks associated with percutaneous dilatational tracheostomy.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251314298"},"PeriodicalIF":2.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lorna M Cowan, Imad Adamestam, John A Masterson, Monika Beatty, James P Boardman, Louis Chislett, Pamela Johnston, Judith Joss, Heather Lawrence, Kerry Litchfield, Nicholas Plummer, Stella Rhode, Timothy S Walsh, Arlene Wise, Rachael Wood, Christopher J Weir, Nazir I Lone
{"title":"Predicting risk of maternal critical care admission in Scotland: Development of a risk prediction model.","authors":"Lorna M Cowan, Imad Adamestam, John A Masterson, Monika Beatty, James P Boardman, Louis Chislett, Pamela Johnston, Judith Joss, Heather Lawrence, Kerry Litchfield, Nicholas Plummer, Stella Rhode, Timothy S Walsh, Arlene Wise, Rachael Wood, Christopher J Weir, Nazir I Lone","doi":"10.1177/17511437251313700","DOIUrl":"10.1177/17511437251313700","url":null,"abstract":"<p><strong>Background: </strong>Identifying women at highest or lowest risk of perinatal intensive care unit (ICU) admission may enable clinicians to risk stratify women antenatally so that enhanced care or elective admission to ICU may be considered or excluded in birthing plans. We aimed to develop a statistical model to predict the risk of maternal ICU admission.</p><p><strong>Methods: </strong>We studied 762,918 pregnancies between 2005 and 2018. Predictive models were constructed using multivariable logistic regression. The primary outcome was ICU admission. Additional analyses were performed to allow inclusion of delivery-related factors. Predictors were selected following expert consultation and reviewing literature, resulting in 13 variables being included in the primary analysis: demographics, prior health status, obstetric history and pregnancy-related factors. A complete case analysis was performed. <i>K</i>-fold cross validation was used to mitigate against overfitting.</p><p><strong>Results: </strong>Complete data were available for 578,310 pregnancies, of whom 1087 were admitted to ICU (0.19%). Model performance was fair (area under the ROC curve = 0.66). A comparatively high cut-point of ⩾0.6% for ICU admission risk resulted in a negative predictive value (NPV) of 99.8% (specificity 97.8%) but positive predictive value (PPV) of 0.8% (sensitivity 9.1%). Models including delivery-related factors demonstrated superior discriminative performance.</p><p><strong>Conclusions: </strong>Our model for maternal ICU admission has an acceptable discriminative performance. The low frequency of ICU admission and resulting low PPV indicates that the model would be unlikely to be useful as a 'rule-in' test for pre-emptive consideration of ICU admission. Its potential for improving efficiency in screening as a 'rule-out' test remains uncertain.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251313700"},"PeriodicalIF":2.1,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Margot Kelly-Hedrick, Sunny Liu, Jordan Hatfield, Alexandria L Soto, Alyssa M Bartlett, Helen J Heo, Ellen O'Callaghan, Evangeline Arulraja, Samantha Kaplan, Tetsu Ohnuma, Vijay Krishnamoorthy, Katherine Colton, Jordan Komisarow
{"title":"Management of traumatic brain injury and acute respiratory distress syndrome-What evidence exists? A scoping review.","authors":"Margot Kelly-Hedrick, Sunny Liu, Jordan Hatfield, Alexandria L Soto, Alyssa M Bartlett, Helen J Heo, Ellen O'Callaghan, Evangeline Arulraja, Samantha Kaplan, Tetsu Ohnuma, Vijay Krishnamoorthy, Katherine Colton, Jordan Komisarow","doi":"10.1177/17511437241311398","DOIUrl":"10.1177/17511437241311398","url":null,"abstract":"<p><strong>Introduction: </strong>Up to 20% of patients with traumatic brain injury (TBI) develop acute respiratory distress syndrome (ARDS), which is associated with increased odds of mortality. Guideline-based treatment for ARDS includes \"lung protective\" ventilation strategies, some of which are in opposition to \"brain protective\" strategies used for ventilation with patients with TBI. We conducted a scoping review of ventilation management strategies with clinical outcomes among patients with TBI and ARDS.</p><p><strong>Methods: </strong>We searched three databases (MEDLINE, Embase, Web of Science) using a systematic search strategy. We included any studies of patients with TBI and ARDS with ventilation strategies including PEEP, oxygenation, prone positioning, recruitment maneuvers, pulmonary vasodilators (e.g., nitric oxide), high frequency oscillatory ventilation (HFOV), and extracorporeal membrane oxygenation (ECMO). All clinical outcomes were included. Extracted data included details about sample (age, gender), study design, inclusion/exclusion criteria, intervention details, and outcomes.</p><p><strong>Results: </strong>The search returned 10,514 articles, 35 of which met final inclusion criteria. Interventions studied included ECMO (<i>n</i> = 13 articles), HFOV (<i>n</i> = 4), PEEP interventions (<i>n</i> = 3), prone positioning (<i>n</i> = 3), vasodilators (<i>n</i> = 4), and other lung recruitment maneuvers (<i>n</i> = 9). No randomized controlled trials were identified; studies were mostly case reports (<i>n</i> = 18/35, 51%) and series (<i>n</i> = 7/35, 20%), with some cohort studies (<i>n</i> = 5/35, 14%) and non-randomized experimental trials (<i>n</i> = 5/35, 14%), all at single institutions. Outcomes included physiologic changes (e.g., change in cerebrodynamics or hemodynamics with intervention) and clinical outcomes such as mortality, complications, or neurologic recovery. Five studies (14%) included pediatric patients.</p><p><strong>Discussion: </strong>In this scoping review of ventilatory strategies for patients with concurrent TBI and ARDS, we found variation in heterogeneity of study design, interventions, and outcomes. Studies were mostly case report/series and observational studies, seriously limiting our ability to draw conclusions about effectiveness of interventions. Targeted areas of further research are discussed.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437241311398"},"PeriodicalIF":2.1,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alicia Ac Waite, Mary Gemma Cherry, Stephen L Brown, Karen Williams, Andrew J Boyle, Brian W Johnston, Christina Jones, Peter Fisher, Ingeborg D Welters
{"title":"Psychological impact of an intensive care admission for COVID-19 on patients in the United Kingdom.","authors":"Alicia Ac Waite, Mary Gemma Cherry, Stephen L Brown, Karen Williams, Andrew J Boyle, Brian W Johnston, Christina Jones, Peter Fisher, Ingeborg D Welters","doi":"10.1177/17511437241312113","DOIUrl":"10.1177/17511437241312113","url":null,"abstract":"<p><strong>Background: </strong>The psychological impact of surviving an admission to an intensive care unit (ICU) with COVID-19 is uncertain. The objective of the study was to assess the prevalence of anxiety, depression and post-traumatic stress disorder (PTSD) symptoms in ICU survivors treated for COVID-19 infection, and identify risk factors for psychological distress.</p><p><strong>Methods: </strong>This observational study was conducted at 52 ICUs in the United Kingdom. Participants, treated for COVID-19 infection during an ICU admission of ⩾24 h, were recruited post-ICU discharge. Self-report questionnaires were completed at 3, 6 and/or 12 months. Symptoms of anxiety and depression were identified using the Hospital Anxiety and Depression Scale. PTSD was assessed using the Impact of Events Scale-6. Demographic, clinical, physical and psychosocial factors were considered as putative predictors of psychological distress.</p><p><strong>Results: </strong>1620 patients provided consent and 1258 (77.7%) responded to at least one questionnaire, with responses at 3 months (<i>N</i> = 426), 6 months (<i>N</i> = 656) and 12 months (<i>N</i> = 1050) following ICU admission. The following prevalence rates were found at 3, 6 and 12 months, respectively: anxiety in 28.8% (95% CI 24.6-33.1), 30.4% (95% CI 27.0-33.8) and 29.3% (95% CI 26.5-32.1); depression in 25.1% (21.0-29.3), 25.9% (22.7-29.3) and 24.0% (21.5-26.6); and PTSD in 43.5% (38.8-48.2), 44.3% (40.6-48.0) and 43.2% (40.2-46.1) of patients. Risk factors for psychological distress included a previous mental health diagnosis, unemployment or being on sick leave, and a history of asthma or COPD.</p><p><strong>Conclusion: </strong>Clinically significant symptoms of anxiety, depression and PTSD were common and persisted up to 12 months post-ICU discharge.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437241312113"},"PeriodicalIF":2.1,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elsa Joyce, Suzanne Guerin, Lindi Synman, Melanie Ryberg
{"title":"Exploring perspectives of supporting the process of dying, death and bereavement among critical care staff: A multidisciplinary, qualitative approach.","authors":"Elsa Joyce, Suzanne Guerin, Lindi Synman, Melanie Ryberg","doi":"10.1177/17511437241308672","DOIUrl":"https://doi.org/10.1177/17511437241308672","url":null,"abstract":"<p><strong>Background: </strong>Dying and death in critical care settings can have particularly negative implications for the bereavement experience of family members, family interaction and the wellbeing of critical care staff. This study explored critical care staff perspectives of dying, death and bereavement in this context, and their role related to patients and their families, adopting a multidisciplinary perspective.</p><p><strong>Method: </strong>This study employed a descriptive exploratory qualitative design, using reflexive thematic analysis to interpret the data. Semi-structured interviews were conducted with 15 critical care staff from hospitals in the Republic of Ireland. Most participants were female (<i>n</i> = 11), with four male participants. Professional disciplines included nursing, dietetics, physiotherapy, anaesthesiology and medicine.</p><p><strong>Results: </strong>Key findings included supporting a 'nice death' for patients and their families, the challenges critical care staff experience, the need for better supports in critical care, and the need for change in current bereavement support provision given the diversity evident in the modern Irish population.</p><p><strong>Conclusion: </strong>This study suggests that the unique challenges faced by staff and families throughout the dying process may benefit from the development of additional psychological, educational, and infrastructural supports. Inconsistencies in supports across critical care units in Ireland were also identified. Future research should complement the current study and examine family members' experience of the dying process in critical care and their perspectives on supports provided.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437241308672"},"PeriodicalIF":2.1,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brenda O'Neill, Mark A Linden, Pam Ramsay, Alia Darweish Medniuk, Joanne Outtrim, Judy King, Bronagh Blackwood
{"title":"Patient activation and support needs in patients after ICU discharge: A UK survey of critical illness survivors.","authors":"Brenda O'Neill, Mark A Linden, Pam Ramsay, Alia Darweish Medniuk, Joanne Outtrim, Judy King, Bronagh Blackwood","doi":"10.1177/17511437241305266","DOIUrl":"https://doi.org/10.1177/17511437241305266","url":null,"abstract":"<p><strong>Background: </strong>Understanding the degree to which patients are actively involved, confident and capable of engaging with self-management and rehabilitation could be an initial step in guiding individualised supportive strategies for people after critical illness.</p><p><strong>Aims: </strong>To assess the levels of active involvement with self management among ICU survivors using the Patient Activation Measure (PAM), explore associations between patient characteristics and PAM results, and investigate its relationship with patients' support needs at key transition points during the recovery process.</p><p><strong>Methods: </strong>Eligible participants received both the PAM and Support Needs After Critical care (SNAC) questionnaires by post. The return of the completed questionnaires was considered as consent to participate. Ethical approval was obtained (17/NI/0236). Descriptive statistics were used to summarise the data and Pearson's coefficient for correlations between variables.</p><p><strong>Findings: </strong>There were 200 completed PAM and SNAC questionnaires. PAM scores showed that levels of active involvement with self management fell into level 1 (<i>n</i> = 64; disengaged and overwhelmed, low confidence to self manage) and 2 (<i>n</i> = 70; still struggling), with considerably less participants achieving scores in level 3 (<i>n</i> = 51; taking action) and 4 (<i>n</i> = 15; pushing further). Lower patient activation levels were associated with higher support needs (r = -0.16, p = 0.02).</p><p><strong>Conclusion: </strong>We found that patient activation levels are low implying low knowledge, skills and confidence to self-manage after critical illness, and also that patients have support needs at various timepoints during recovery. Future research should focus on a longitudinal study to track changes in activation and support needs in the same patients over time and identify effective strategies to optimise recovery after critical illness.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437241305266"},"PeriodicalIF":2.1,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jonathan Stewart, Ellen Pauley, Danielle Wilson, Judy Bradley, Nigel Hart, Danny McAuley
{"title":"Factors to consider when designing post-hospital interventions to support critical illness recovery: Systematic review and qualitative evidence synthesis.","authors":"Jonathan Stewart, Ellen Pauley, Danielle Wilson, Judy Bradley, Nigel Hart, Danny McAuley","doi":"10.1177/17511437241308674","DOIUrl":"https://doi.org/10.1177/17511437241308674","url":null,"abstract":"<p><strong>Background: </strong>Survivors of intensive care unit (ICU) admission experience significant deficits in health-related quality of life due to long-term physical, psychological, and cognitive sequelae of critical illness, which may persist for many years. There has been a proliferation of post-hospital interventions in recent years which aim to support ICU-survivors, however there is currently limited evidence to inform optimal approach. We therefore aimed to synthesise factors which impacted the implementation of these interventions from the perspective of healthcare providers, patients, and their carers, and to compare different intervention designs.</p><p><strong>Methods: </strong>We conducted a systematic review and synthesis of qualitative evidence using four databases (MEDLINE, EMBASE, CINAHL and Web of Science) which were searched from inception to May 2024. The extraction and synthesis of factors which impacted intervention implementation was informed by the domains of the Consolidated Framework for Implementation Research (CFIR) and Template for Intervention Description and Replication (TIDieR) checklist.</p><p><strong>Results: </strong>Thirty-seven studies were included, reporting on a range of interventions including follow-up clinics and rehabilitation programmes. We identified some overarching principles and specific intervention component and design factors which may support in the design of future strategies to improve outcomes for ICU survivors. For each intervention characteristic, various patient, staff, and setting factors were found to impact implementation. Considering how the intervention will rely on and integrate with existing outpatient and community resources is likely to be important.</p><p><strong>Conclusion: </strong>This review provides a framework to future research examining the optimal approach to supporting ICU survivor recovery following hospital discharge.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437241308674"},"PeriodicalIF":2.1,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}