Journal of the Intensive Care Society最新文献

{"title":"Spontaneous subarachnoid hemorrhage: A primer for acute care practitioners.","authors":"Heppner Jonathan, Chwalek Michal, Findlay Max, Brindley Peter George","doi":"10.1177/17511437251333269","DOIUrl":"https://doi.org/10.1177/17511437251333269","url":null,"abstract":"<p><p>Subarachnoid hemorrhage (SAH) refers to intracranial bleeding into the cerebrospinal filled space beneath the arachnoid membrane that covers the brain. It is further defined as a spontaneous SAH when not associated with trauma. The commonest single cause is rupture of a saccular (i.e. a small bag-shaped or pouch-shaped) intracranial aneurysm, arising from the larger conducting arteries traveling through the subarachnoid space at the base of the brain. As these are high-pressure and higher-volume arterial hemorrhages, aneurysmal subarachnoid hemorrhages (aSAH) are associated with high early mortality and substantial long-term morbidity. But, as we outline below, prompt and collaborative multidisciplinary care can improve the likelihood and quality of survival. Accordingly, we offer the following primer as a common resource to increase knowledge and collaborative care.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251333269"},"PeriodicalIF":2.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182664","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}

{"title":"A retrospective comparison study of delayed admissions into the critical care unit.","authors":"Simran Aujla, Sanjog Banstola, Shondipon Laha, Craig Marshall","doi":"10.1177/17511437251333268","DOIUrl":"https://doi.org/10.1177/17511437251333268","url":null,"abstract":"<p><p>Little is known about the effect of alternative patient routes prior to ICU admission on clinical outcomes. Therefore, this study compared patients that were admitted directly from the emergency department into the ICU with those admitted from the wards. Patients admitted from the wards had significantly higher SOFA (6 vs 5, <i>p</i> = 0.038) and APACHE scores (19 vs 16, <i>p</i> = 0.007), as well as a greater need for invasive ventilation (45.5% vs 28.6%, <i>p</i> < 0.001). Hence, this hypothesis-generating study suggests that further work is needed to assess if scoring systems are sensitive enough to assess the need for ICU admission.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251333268"},"PeriodicalIF":2.1,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175191","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}

{"title":"Stress ulcer prophylaxis practice in UK critical care units: A comparison of cross-sectional surveys between 2020 and 2024.","authors":"Mark Borthwick, Greg Barton, Emma Boxall, John P Dade, Odran Farrell, Ruth Forrest, Emma Graham-Clarke, David Kean, Helen Leigh, Reena Mehta, Gillian Mulherron, Ruth Roadley-Battin, David Sapsford, Alan Timmins, John Warburton, Richard S Bourne","doi":"10.1177/17511437251338614","DOIUrl":"https://doi.org/10.1177/17511437251338614","url":null,"abstract":"<p><strong>Background: </strong>Critically ill patients are at risk of bleeding from stress ulcers. Comprehensive information regarding United Kingdom stress ulcer prophylaxis (SUP) practices are not available and may change over time. We aimed to describe SUP practices in 2020 and reevaluate the position in 2024.</p><p><strong>Methods: </strong>Critical care pharmacists provided observed SUP practice data for UK adult critical care units via an electronic repository in 2020 and 2024. One response was accepted from each critical care unit at each time point. Data collected included trigger criteria for commencing SUP, primary medication class used, primary SUP cessation criteria, and level of nutritional intake (if part of cessation criteria).</p><p><strong>Results: </strong>There were high response rates of 70.3% (2020) and 66.7% (2024) of registered UK adult critical care units. Few differences in primary SUP trigger criteria between 2020 and 2024 were seen, with small differences in the categories of 'SUP not used' (<i>p</i> = 0.002) and 'Shock' (<i>p</i> = 0.027) driving statistical significance (χ²(7, 454) = 16.76, <i>p</i> = 0.019). There was a significant change in the primary medication class used for SUP (H2 receptor antagonist 49.4% 2020, vs 0.4% 2024, proton pump inhibitor 44.7% 2020 vs 97.8% 2024; χ²(2, 458) = 159.62, <i>p</i> < 0.001). Primary SUP cessation criteria was 'Patient fed' (66.8% 2020, 64.6% 2024), with most describing this threshold as met when the patient receives full enteral feed (72.0% 2020, 78.8% 2024).</p><p><strong>Conclusion: </strong>The UK has moved towards proton pump inhibitors as the primary SUP medication class. SUP is most frequently discontinued on establishment of enteral nutrition.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251338614"},"PeriodicalIF":2.1,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175192","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}

{"title":"Improving physical function with physiotherapy assistants following intensive care unit admission (EMPRESS): A randomised controlled feasibility study.","authors":"Rebecca J Cusack, Andrew Bates, Hannah Golding, Kay Mitchell, Linda Denehy, Nicholas Hart, Ahilanandan Dushianthan, Gordon Sturmey, Iain Davey, Zoe van Willigen, Sarah Elliott, Laura Ortiz-RuizDeGordoa, Jessica Cooper, Barbara Philips, Jenny Rains, Sally Pitts, Nigel Beauchamp, Isabel Reading, Mike Grocott","doi":"10.1177/17511437251328899","DOIUrl":"10.1177/17511437251328899","url":null,"abstract":"<p><strong>Introduction: </strong>Early rehabilitation of critically ill patients is challenging due to limited staff resources. This study assessed the feasibility of delivering a randomised controlled trial of physiotherapy assistants delivering early protocolised rehabilitation plus usual care compared with usual care.</p><p><strong>Methods: </strong>We conducted a randomised feasibility study in three U.K. mixed medical/surgical intensive care units. Eligible patients were intubated and ventilated <72 h, expected to be ventilated for a further 48 h, and functionally independent before ICU admission. Patients were randomised to protocolised early rehabilitation plus usual care or usual care. Feasibility outcomes were (i) recruitment of one to two patients/per month/site; (ii) >75% of patients commencing the intervention within 72 h of ventilation with >70% interventions delivered; and (iii) blinded outcome measures recorded at three-time points in >80% of patients.</p><p><strong>Results: </strong>The study delivery was compromised by the COVID-19 pandemic: 46 patients were enrolled, of which 22 were allocated to intervention. Feasibility outcomes: (i) recruitment of 0.9 patients/month/site, (ii) 90% of patients commenced interventions within 72 h of ventilation, with 166/264 (63%) of study interventions delivered: median total 22.5 min (IQR 15-35) of therapy per day in the usual care group and 45 min (IQR 25-70) in the intervention group, and (iii) the outcome assessments were performed at three-time points for 64% of survivors, 63% of which were blinded.</p><p><strong>Conclusion: </strong>While delivery of protocolised rehabilitation by physiotherapy assistants is feasible, the design of a future RCT needs to consider strategies to improve recruitment and complete blinded outcome assessments.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251328899"},"PeriodicalIF":2.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095338","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}

{"title":"The association between socioeconomic status and outcomes in critical illness: A national cohort study of emergency admissions to critical care units in Scotland 2010-2021.","authors":"Ryan D McHenry, Christopher Ej Moultrie, Alasdair R Corfield, Nazir I Lone, Daniel F Mackay, Jill P Pell","doi":"10.1177/17511437251338608","DOIUrl":"10.1177/17511437251338608","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic inequalities in chronic disease management and outcomes are well-established. Their association with critical illness management and outcomes is less clear. This study aimed to investigate the association between socioeconomic status and outcomes following emergency admission for critical illness.</p><p><strong>Methods: </strong>Three Scotland-wide health databases were linked: the Scottish Intensive Care Society Audit Group database (critical care units); the Scottish Morbidity Record 01 (hospital admissions) and death certificates. A retrospective cohort study was conducted on adults (⩾16 years) admitted as an emergency to critical care units between 25th October 2010 and 25th October 2021 inclusive. Cox proportional hazards models were used to investigate the association between area-based socioeconomic status (Scottish Index of Mortality (SIMD) decile) and all-cause mortality, adjusting for potential confounders: age, sex, comorbidities, illness severity, and diagnostic group. Secondary outcomes included unit and hospital lengths of stay, and emergency hospital readmissions.</p><p><strong>Results: </strong>Overall, 50,914 patients were included in the cohort. Those in the least deprived decile were less likely to die (_adjHR 0.85, 95% CI 0.79-0.92), had 19% longer critical care unit stays (95% CI 13-26) and a 12% longer hospital stays (95% CI 7%-18%). Over the subsequent year, the least deprived had significantly fewer emergency hospital re-admissions (_adjIRR 0.73; 95% CI 0.67-0.81).</p><p><strong>Discussion: </strong>People living in the most deprived communities have worse outcomes following emergency admission to critical care; particularly in the longer term and reinforcing the need to address socioeconomic inequalities in healthcare access and outcomes.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251338608"},"PeriodicalIF":2.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095340","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}

{"title":"Doppler echocardiography: The noninvasive method for accurately estimating stroke volume in ischaemic cardiogenic shock.","authors":"Hazem Lashin, Olusegun Olusanya, Andrew Smith, Sanjeev Bhattacharyya","doi":"10.1177/17511437251338609","DOIUrl":"https://doi.org/10.1177/17511437251338609","url":null,"abstract":"<p><p>Accurate stroke volume (SV) assessment is crucial in ischaemic cardiogenic shock. While pulmonary artery catheterisation remains the gold standard, its invasive nature necessitates reliable noninvasive alternatives. However, the literature on echocardiographic SV accuracy is inconsistent. This study evaluated commonly used echocardiographic techniques-Doppler-derived and Simpson's method-against invasive thermodilution in 39 patients. SV by Doppler showed strong correlation (<i>r</i> = 0.91, <i>p</i> < 0.0001) and minimal bias, whereas the Simpson's method exhibited weaker correlation and more significant underestimation. These findings suggest Doppler echocardiography as the more accurate noninvasive tool for SV estimation, addressing prior discrepancies and enhancing haemodynamic management in critical care.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251338609"},"PeriodicalIF":2.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014381","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}

{"title":"Guidance for: The acute management of status epilepticus in adult patients.","authors":"Randeep Mullhi, Thomas Hayton, Alex Midgley-Hunt, Michael Trimble, Umair Javaid Chaudhary, Shanika Samarasekera, James France, Tonny Veenith","doi":"10.1177/17511437251321338","DOIUrl":"https://doi.org/10.1177/17511437251321338","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"26 2","pages":"249-262"},"PeriodicalIF":2.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020333","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}

{"title":"Lawrence Wilson - Obituary.","authors":"Simon Ridler","doi":"10.1177/17511437251340661","DOIUrl":"https://doi.org/10.1177/17511437251340661","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251340661"},"PeriodicalIF":2.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003333","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}

{"title":"Intensive care medicine: Is this the time to unify our professional organisations?","authors":"Waqas Akhtar, Sekina Bakare","doi":"10.1177/17511437251336914","DOIUrl":"https://doi.org/10.1177/17511437251336914","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251336914"},"PeriodicalIF":2.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12018350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014625","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}

{"title":"High Flow Nasal Oxygen (HFNO), swallowing and dysphagia in adults: A narrative review with implications for ICU clinical practice and future research.","authors":"Anna-Liisa Sutt, Sarah Wallace","doi":"10.1177/17511437251333272","DOIUrl":"https://doi.org/10.1177/17511437251333272","url":null,"abstract":"<p><p>The use of high flow nasal oxygen (HFNO) in clinical practice is increasing with robust evidence of its respiratory benefits. Swallowing is known to be heavily coordinated with breathing, in addition to sharing a physical pathway in the upper airway. Applying HFNO via these spaces may also have an impact on the swallowing process. Yet, there is a lack of literature regarding the effect of HFNO on swallowing and on dysphagia. This narrative review aims to summarise the existing literature, draw conclusions on important clinical questions where possible and set the scene for future research. A database search was conducted on 24/01/2024 across CINAHL, Medline and Embase. Due to paucity of literature, studies with adult participants within and outside of ICU were included, and references cross-checked. Conference abstracts were also included. The search was repeated on 5/6/2024. Twelve articles were included in direct data comparison, in addition to studies examining the biomedical effect of HFNO that is, the impact of HFNO on the physiology of the oropharynx and swallow function. The authors conclude that whilst studies are limited in numbers and some results controversial, indications are that HFNO may demand adaptations to swallowing and some patients may not have this capability to adapt. HFNO should not be a barrier to a swallow assessment, irrespective of flow rate and the decision to assess should be based on overall patient presentation, as with any other population. Instrumental swallowing assessment is recommended to confirm any detrimental or beneficial impact of HFNO on swallow function. Robust research and guidelines are needed.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437251333272"},"PeriodicalIF":2.1,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12000000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020331","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}