Journal of the Intensive Care Society最新文献

{"title":"The fragility index in randomised controlled trials of interventions for aneurysmal subarachnoid haemorrhage: A systematic review.","authors":"Aravind V Ramesh, Henry Np Munby, Matt Thomas","doi":"10.1177/17511437231218199","DOIUrl":"10.1177/17511437231218199","url":null,"abstract":"<p><strong>Background: </strong>Fragility analysis supplements the <i>p</i>-value and risk of bias assessment in the interpretation of results of randomised controlled trials. In this systematic review we determine the fragility index (FI) and fragility quotient (FQ) of randomised trials in aneurysmal subarachnoid haemorrhage.</p><p><strong>Methods: </strong>This is a systematic review registered with PROSPERO (ID: CRD42020173604). Randomised controlled trials in adults with aneurysmal subarachnoid haemorrhage were analysed if they reported a statistically significant primary outcome of mortality, function (e.g. modified Rankin Scale), vasospasm or delayed neurological deterioration.</p><p><strong>Results: </strong>We identified 4825 records with 18 randomised trials selected for analysis. The median fragility index was 2.5 (inter-quartile range 0.25-5) and the median fragility quotient was 0.015 (IQR 0.02-0.039). Five of 20 trial outcomes (25%) had a fragility index of 0. In seven trials (39.0%), the number of participants lost to follow-up was greater than or equal to the fragility index. Only 16.7% of trials are at low risk of bias.</p><p><strong>Conclusion: </strong>Randomised controlled trial evidence supporting management of aneurysmal subarachnoid haemorrhage is weaker than indicated by conventional analysis using <i>p</i>-values alone. Increased use of fragility analysis by clinicians and researchers could improve the translation of evidence to practice.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"25 2","pages":"164-170"},"PeriodicalIF":2.7,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11086711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913364","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":"EPidemiology Of Cardiogenic sHock in Scotland (EPOCHS): A multicentre, prospective observational study of the prevalence, management and outcomes of cardiogenic shock in Scotland","authors":"A. Warren, Philip McCall, Alastair Proudfoot, Stuart Gillon, Ahmad Abu-Arafeh, A. McKnight, Rosemary Mudie, David Armstrong, E. Tzolos, J. Livesey, A. Sinclair, Veronica Baston, Jonathan Dalzell, Deborah Owen, Lucy Fleming, I. Scott, A. Puxty, Matthew M Y Lee, Fiona Walker, Simon Hobson, Euan Campbell, Michael Kinsella, Eilidh McGinnigle, Robert B. Docking, Grant Price, Alex Ramsay, Richard Bauld, Suzanne Herron, Nazir I Lone, Nicholas L Mills, Louise Hartley","doi":"10.1177/17511437231217877","DOIUrl":"https://doi.org/10.1177/17511437231217877","url":null,"abstract":"Despite high rates of cardiovascular disease in Scotland, the prevalence and outcomes of patients with cardiogenic shock are unknown. We undertook a prospective observational cohort study of consecutive patients with cardiogenic shock admitted to the intensive care unit (ICU) or coronary care unit at 13 hospitals in Scotland for a 6-month period. Denominator data from the Scottish Intensive Care Society Audit Group were used to estimate ICU prevalence; data for coronary care units were unavailable. We undertook multivariable logistic regression to identify factors associated with in-hospital mortality. In total, 247 patients with cardiogenic shock were included. After exclusion of coronary care unit admissions, this comprised 3.0% of all ICU admissions during the study period (95% confidence interval [CI] 2.6%–3.5%). Aetiology was acute myocardial infarction (AMI) in 48%. The commonest vasoactive treatment was noradrenaline (56%) followed by adrenaline (46%) and dobutamine (40%). Mechanical circulatory support was used in 30%. Overall in-hospital mortality was 55%. After multivariable logistic regression, age (odds ratio [OR] 1.04, 95% CI 1.02–1.06), admission lactate (OR 1.10, 95% CI 1.05–1.19), Society for Cardiovascular Angiographic Intervention stage D or E at presentation (OR 2.16, 95% CI 1.10–4.29) and use of adrenaline (OR 2.73, 95% CI 1.40–5.40) were associated with mortality. In Scotland the prevalence of cardiogenic shock was 3% of all ICU admissions; more than half died prior to discharge. There was significant variation in treatment approaches, particularly with respect to vasoactive support strategy.","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"280 9","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139152842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The incidence and risk factors of proximal lower extremity deep vein thrombosis without pharmacologic prophylaxis in critically ill surgical Taiwanese patients: A prospective study","authors":"Ting-Lung Lin, Wen-Hao Liu, W. Lai, Ying-Ju Chen, Po-Hsun Chang, I-Ling Chen, Wei-Feng Li, Yueh-Wei Liu, Eric J Ley, Chih-Chi Wang","doi":"10.1177/17511437231214906","DOIUrl":"https://doi.org/10.1177/17511437231214906","url":null,"abstract":"Venous thromboembolism (VTE) in critically ill patients has been well-studied in Western countries. Many studies have developed risk assessments and established pharmacological protocols to prevent deep venous thrombosis (DVT). However, the DVT rate and need for pharmacologic VTE prophylaxis in critically ill Taiwanese patients are limited. This study aimed to prospectively determine the DVT incidence, risk factors, and outcomes in critically ill Taiwanese patients who do not receive pharmacologic VTE prophylaxis. We conducted a prospective study in a surgical intensive care unit (SICU) of a tertiary academic medical center in Taiwan. Adult patients admitted to SICU from March 2021 to June 2022 received proximal lower extremities DVT surveillance with venous duplex ultrasound. No patient received pharmacologic VTE prophylaxis. The outcomes were the incidence and risk factors of DVT. Among 501 enrolled SICU patients, 21 patients (4.2%) were diagnosed with proximal lower extremities DVT. In a multivariate regression analysis, hypoalbuminemia (odd ratio (OR) = 6.061, 95% confidence interval (CI): 1.067–34.421), femoral central venous catheter (OR = 4.515, 95% CI: 1.547–13.174), ICU stays more than 10 days (OR = 4.017, 95% CI: 1.270–12.707), and swollen leg (OR = 3.427, 95% CI: 1.075–10.930) were independent risk factors for DVT. In addition, patients with proximal lower extremities DVT have more extended ventilator days ( p = 0.045) and ICU stays ( p = 0.044). Our findings indicate critically ill Taiwanese patients have a higher incidence of DVT than results from prior retrospective studies in the Asian population. Physicians who care for this population should consider the specific risk factors for DVT and prescribe pharmacologic prophylaxis in high-risk groups.","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"37 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139152019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurological outcome following out of hospital cardiac arrest: Evaluation of performance of existing risk prediction models in a UK cohort","authors":"John A Livesey, Nazir Lone, Emily Black, Richard Broome, Alastair Syme, S. Keating, Laura Elliott, Cara McCahill, Gavin Simpson, Helen Grant, Fiona Auld, S. Garrioch, Alasdair Hay, T. H. Craven","doi":"10.1177/17511437231214146","DOIUrl":"https://doi.org/10.1177/17511437231214146","url":null,"abstract":"Out of hospital cardiac arrest (OHCA) is a common problem. Rates of survival are low and a proportion of survivors are left with an unfavourable neurological outcome. Four models have been developed to predict risk of unfavourable outcome at the time of critical care admission – the Cardiac Arrest Hospital Prognosis (CAHP), MIRACLE2, Out of Hospital Cardiac Arrest (OHCA), and Targeted Temperature Management (TTM) models. This evaluation evaluates the performance of these four models in a United Kingdom population and provides comparison to performance of the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score. A retrospective evaluation of the performance of the models was conducted over a 43-month period in 414 adult, non-pregnant patients presenting consecutively following non-traumatic OHCA to the five units in our regional critical care network. Scores were generated for each model for where patients had complete data (CAHP = 347, MIRACLE2 = 375, OHCA = 356, TTM = 385). Cerebral Performance Category (CPC) outcome was calculated for each patient at last documented follow up and an unfavourable outcome defined as CPC ⩾ 3. Performance for discrimination of unfavourable outcome was tested by generating receiver operating characteristic (ROC) curves for each model and comparing the area under the curve (AUC). Best performance for discrimination of unfavourable outcome was demonstrated by the high risk group of the CAHP score with an AUC of 0.87 [95% CI 0.83–0.91], specificity of 97.1% [95% CI 93.8–100] and positive predictive value (PPV) of 96.3% [95% CI 92.2–100]. The high risk group of the MIRACLE2 model, which is significantly easier to calculate, had an AUC of 0.81 [95% CI 0.76–0.86], specificity of 92.3% [95% CI 87.2–97.4] and PPV of 95.2% [95% CI 91.9–98.4]. The CAHP, MIRACLE2, OHCA and TTM scores all perform comparably in a UK population to the original development and validation cohorts. All four scores outperform APACHE-II in a population of patients resuscitated from OHCA. CAHP and TTM perform best but are more complex to calculate than MIRACLE2, which displays inferior performance.","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"35 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138948158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"End of life care at home: The role of critical care transfer services","authors":"Varun Sudunagunta, Neeraj Singh, Pervez Khan, Peter O Beaumont","doi":"10.1177/17511437231217878","DOIUrl":"https://doi.org/10.1177/17511437231217878","url":null,"abstract":"Most people would rather die at home than in hospital but only 18% of patients do so. Palliative care focuses on the physical, spiritual and psychosocial wellbeing of patients and their families, which should include facilitating transfers home when possible. Patients can have more autonomy over their care and be surrounded by loved ones which can have a significant impact on their quality of life. In this article we describe two cases of home repatriation for palliation. Case 1 describes the transfer of a patient with difficulties and gaps in planning, but with a safe transfer ultimately. Case 2 recounts a more comprehensive planning process emphasising collaboration between teams. Facilitating home-based care aligns with patients’ desires for familiar surroundings and emotional support. A secondary benefit is that releasing a bed space allows another patient to receive critical care treatment. Challenges of palliative critical care transfers include needing a highly trained team and thorough planning. Early discussion with the family and community palliative care teams makes this a more feasible option for patients. A multidisciplinary team of hospital and community healthcare professionals working with the patient and their family can facilitate the transfer from intensive care to allow them to die at a place of their choosing. We should aim to fulfil these wishes at the end of life as it can greatly improve the patient’s and their family’s physical and emotional wellbeing during this difficult time.","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"37 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138602700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unheard and unseen: The hidden impact of nocebo communication in the Intensive Care Unit","authors":"Kerrianne N Huynh, Sian Rouse-Watson, James Chu, Andrew S Lane, A. M. Cyna","doi":"10.1177/17511437231214148","DOIUrl":"https://doi.org/10.1177/17511437231214148","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"15 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139215120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Book Review: Point of Care Ultrasound in Critical Care by Luke Flower and Pradeep Madhivathanan","authors":"Peter G Brindley","doi":"10.1177/17511437231213527","DOIUrl":"https://doi.org/10.1177/17511437231213527","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"135 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139259723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric residual volume monitoring practices in UK intensive care units: A web-based survey","authors":"B. Jenkins, Philip C Calder, Luise V Marino","doi":"10.1177/17511437231210483","DOIUrl":"https://doi.org/10.1177/17511437231210483","url":null,"abstract":"Monitoring of gastric residual volume (GRV) to assess for enteral feeding intolerance is common practice in the intensive care unit (ICU) setting; however, evidence to support the practice is lacking. The aim of this study was: (i) to gain a perspective of current practice in adult ICUs in the UK around enteral feeding and monitoring of GRV, (ii) to characterise the threshold value used for a high GRV in clinical practice, (iii) to describe the impact of GRV monitoring on enteral feeding provision and (iv) to inform future research into the clinical value of GRV measurement in the adult ICU population. A web-based survey was sent to all UK adult ICUs. The survey consisted of questions pertaining to (i) nutritional assessment and enteral feeding practices, (ii) enteral feeding intolerance and GRV monitoring and (iii) management of raised GRV. Responses were received from 101 units. Ninety-eight percent of units reported routinely measuring GRV, with 86% of ICUs using GRV to define enteral feeding intolerance. Threshold values for a high GRV varied from 200 to 1000 ml with frequency of measurement also differing greatly from 2 to 12 hourly. Initiation of pro-kinetic medication was the most common treatment for a high GRV. Fifty-two percent of respondents stated that volume of GRV would influence their decision to stop enteral feeds a lot or very much. Only 28% of units stated that they had guidelines for the technique for monitoring GRV. Measurement of GRV is the most common method of determining enteral feeding intolerance in adult ICUs in the UK. The practice continues despite evidence of poor validity and reproducibility of this measurement. Further research should be undertaken into the benefit of ongoing GRV measurements in the adult ICU population and alternative markers of enteral feeding intolerance.","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"291 10","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139257162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 2023 intensive care society cauldron: Five ways to tackle sustainability","authors":"Richard Kirkdale, Rasmus Knudsen, Emily Yeung, Catherine Anderson, Nina Hjelde, Peter G Brindley","doi":"10.1177/17511437231212072","DOIUrl":"https://doi.org/10.1177/17511437231212072","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"29 6","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139268844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing key performance indicators for adult critical care transfer services: Scoping review and Delphi technique.","authors":"Nick Haslam,&nbsp;Aurelien Giouse,&nbsp;Jonathon Dean,&nbsp;Mamoun Abu-Habsa,&nbsp;Simon J Finney","doi":"10.1177/17511437231153049","DOIUrl":"10.1177/17511437231153049","url":null,"abstract":"<p><p>In 2021 NHS England commissioned regional Adult Critical Care Transfer Services. These services will replace a historically predominant ad hoc approach to adult critical care transfers nationally. It is anticipated that these new formal services will provide a system of robust regional & national governance previously acknowledged to be deficient. As part of this process, it is important that an agreed set of transfer service quality indicators are developed to drive equitable improvement in patient care. We used a Delphi technique to develop a set of key performance indicators through consensus for a recently established London critical care transfer service. We believe this may be the first-time key performance indicators have been developed for adult critical care transfer services using a consensus method. We hope services will consider tracking similar measures to enable benchmarking and drive improvements in patient care.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 4","pages":"438-441"},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10572479/pdf/10.1177_17511437231153049.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239525","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}