Journal of the Intensive Care Society最新文献

{"title":"Developing a tool for assessing and communicating the expected difficulty of performing a tracheostomy.","authors":"Jonathon Clymo, Mike Dean, Chris Lambert, Matthew Rollin","doi":"10.1177/17511437241270261","DOIUrl":"10.1177/17511437241270261","url":null,"abstract":"<p><p>There are no guidelines for assessing and communicating the expected difficulty of a tracheostomy, leading to difficulties planning a percutaneous approach in intensive care or referring onwards to surgical teams. A Delphi process was used to develop a tool containing metrics which are relevant for either specialty and can be universally assessed by both. Palpable tracheal rings, prior surgery or radiotherapy to the anterior neck, uncorrectable clotting or platelet dysfunction, ability to extend the neck freely, and overlying vessels visible, palpable or on imaging were all found to be relevant. It is hoped this tool will aid communication between specialties.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437241270261"},"PeriodicalIF":2.1,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649219","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":"An exploration of intensive care unit patents' experiences of the Addenbrooke's Cognitive Examination (ACE-III) as a screening tool for cognitive functioning at different points in recovery from critical illness.","authors":"Rachel Clarke, Aishah Hannan, Homen Chow, Lydia Bowering-Sheehan, Kristy Kerrison, Amelia Bullock, Holly Schofield","doi":"10.1177/17511437241241242","DOIUrl":"https://doi.org/10.1177/17511437241241242","url":null,"abstract":"<p><p>Being critically ill can result in cognitive change. Cognitive functioning should be screened at different points in the care pathway, and it is important to understand patient's experience of this process. A service evaluation examined fifteen in-patients' and eleven outpatients' experiences of completing the Addenbrookes Cognitive Examination-III (ACE-III) using thematic analysis. Four themes emerged: (1) willingness & acceptability (2) strengths and weaknesses (3) factors affecting performance and (4) improving delivery. Generally, patients accepted the ACE-III and valued cognitive screening. Consideration is given to areas for development.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"25 4","pages":"416-418"},"PeriodicalIF":2.1,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629136","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":"Eye tracking during a simulated start of shift safety check: An observational analysis of gaze behavior of critical care nurses.","authors":"Yael van der Geest, Ivan Chau, Pedro David Wendel-Garcia, Philipp K Buehler, Wolf Hautz, Miodrag Filipovic, Daniel A Hofmaenner, Urs Pietsch","doi":"10.1177/17511437241268160","DOIUrl":"https://doi.org/10.1177/17511437241268160","url":null,"abstract":"<p><strong>Background: </strong>The handover and associated shift start checks by nurses of critical care patients are complex and prone to errors. However, which aspects lead to errors remains unknown. Fewer errors might occur in a structured approach. We hypothesized that specific gaze behavior during handover and shift start safety check correlates with error recognition.</p><p><strong>Methods: </strong>In our observational eye tracking study, we analyzed gaze behavior of critical care nurses during handover and shift start safety check in a simulation room with built-in errors. Four areas of interest (AOI) were pre-defined (patient, respirator, prescriptions, monitor). The primary outcome were different gaze metrics (time to first fixation, revisits, first visual intake duration, average visual intake duration, dwell time) on AOIs. Parameters were analyzed by taking all errors in account, and by dividing them into minor and critical.</p><p><strong>Results: </strong>Forty-three participants were included. All participants committed at least a minor error (<i>n</i> = 43, 100%), at least one critical error occurred in 29 participants (67%). Taking all errors into account, longer time to first fixation and more revisits were associated with an increased risk of missing errors (Time to First Fixation: OR 1.099 (95% CI 1.023-1.191, <i>p</i> = 0.0002), Revisits: OR 1.080 (95% CI 1.025-1.143, <i>p</i> = 0.0055)).</p><p><strong>Conclusion: </strong>Error detection during shift start safety check was associated with distinct gaze behavior. Nurses who recognized more errors had a shorter time to first fixation and less revisits. These gaze characteristics might correspond to a more structured approach. Further research is necessary, for example by implementing a checklist, to reduce errors in the future and improve patient safety.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"25 4","pages":"383-390"},"PeriodicalIF":2.1,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629538","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 efficacy, safety and effectiveness of hyperoncotic albumin solutions in patients with sepsis: A systematic review and meta-analysis.","authors":"Jonathan Bannard-Smith, Mohamed Elrakhawy, Gill Norman, Rhiannon Owen, Tim Felton, Paul Dark","doi":"10.1177/17511437241259437","DOIUrl":"10.1177/17511437241259437","url":null,"abstract":"<p><strong>Background: </strong>Intravenous fluid therapy is a ubiquitous intervention for the management of patients with sepsis, however excessive cumulative fluid balance has been shown to result in worse outcomes. Hyperoncotic albumin is presented in low volumes, is an effective resuscitation fluid and may have effects beyond plasma volume expansion alone. This systematic review aimed to assess the efficacy, safety and effectiveness of hyperoncotic albumin solutions in the management of sepsis.</p><p><strong>Methods: </strong>We searched four databases and two trial registries for controlled clinical trials of hyperoncotic albumin for management of sepsis. Review outcomes were mortality, need for renal replacement therapy, cumulative-fluid balance, and need for organ support. We used methods guided by the Cochrane Handbook for reviews of clinical interventions. Studies were assessed using Cochrane's Risk of Bias 2 tool. We performed pairwise meta-analysis where possible. Certainty of evidence was assessed using GRADE.</p><p><strong>Results: </strong>We included six trials; four (2772 patients) were meta-analysed. Most studies had moderate or high risk of bias. There was no significant difference in 28-day mortality for septic patients receiving hyperoncotic albumin compared to other intravenous fluids (OR 0.95, [95% CI: 0.8-1.12]); in patients with septic shock (2013 patients) there was a significant reduction (OR 0.82 [95% CI: 0.68-0.98]). There was no significant difference in safety outcomes. Hyperoncotic albumin was associated with variable reduction in early cumulative fluid balance and faster resolution of shock.</p><p><strong>Conclusions: </strong>There is no good-quality evidence to support the use of hyperoncotic albumin in patients with sepsis, but it may reduce short-term mortality in the sub-groups with septic shock. It appears safe in terms of need for renal replacement therapy and is associated with reduced early cumulative fluid balance and faster resolution of shock. Larger, better quality randomised controlled trials in patients with septic shock may enhance the certainty of these findings.</p><p><strong>Review registration: </strong>PROSPERO ref: CRD42021150674.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"25 3","pages":"308-318"},"PeriodicalIF":2.1,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120838","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":"Inflammatory and transudative B-line patterns on lung ultrasound: a brief communication.","authors":"Arvind Rajamani, Anwar Hassan, Pranav Arun Bharadwaj, Hemamalini Arvind, Stephen Huang","doi":"10.1177/17511437241259438","DOIUrl":"https://doi.org/10.1177/17511437241259438","url":null,"abstract":"<p><p>Lung ultrasonic B-lines have high accuracy in diagnosing extravascular lung water (ELW) but have not been systematically subcategorized to differentiate the varied etiologies of ELW. This brief communication describes subcategories of B-lines into \"inflammatory\" and \"transudative\" patterns, based on their location, pleural morphology and associated subpleural pathologies. This subcategorization was derived using information from trainees undergoing lung ultrasound training in the <i>Learning Ultrasound in Critical Care</i> program, pathophysiological principles and their corresponding ultrasound correlates. This subcategorization helped trainees differentiate inflammatory pathologies of ELW (e.g. pneumonia, acute respiratory distress syndrome) from transudative (congestive) pathologies (e.g. fluid overload, cardiac failure).</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"25 4","pages":"410-412"},"PeriodicalIF":2.1,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629554","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":"Time to treat the climate and nature crisis as one indivisible global health emergency.","authors":"Kamran Abbasi, Parveen Ali, Virginia Barbour, Thomas Benfield, Kirsten Bibbins-Domingo, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Robert Mash, Peush Sahni, Wadeia Mohammad Sharief, Paul Yonga, Chris Zielinski","doi":"10.1177/17511437231216675","DOIUrl":"https://doi.org/10.1177/17511437231216675","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"25 1","pages":"13-15"},"PeriodicalIF":2.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355932","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":"Continuous infusion ketamine for sedation of mechanically ventilated adults in the intensive care unit: A scoping review.","authors":"Nicholas David Richards, William Weatherhead, Simon Howell, Mark Bellamy, Ruben Mujica-Mota","doi":"10.1177/17511437231182507","DOIUrl":"10.1177/17511437231182507","url":null,"abstract":"<p><strong>Introduction: </strong>Mechanical ventilation (MV) is a common and often live-saving intervention on the Intensive Care Unit (ICU). The optimisation of sedation to mechanical ventilation is fundamental, and inappropriate sedation has been associated with worse outcomes. This scoping review has been designed to answer the question '<i>What is known about the use of ketamine as a continuous infusion to provide sedation in mechanically ventilated adults in the intensive care unit, and what are the gaps in the evidence?'</i></p><p><strong>Methods: </strong>The protocol was designed using the PRISMA-ScR checklist and the JBI manual for evidence synthesis. Data were extracted and reviewed by a minimum of two reviewers.</p><p><strong>Results: </strong>Searches of electronic databases (PubMed, OVID, Scopus, Web of Science) produced 726 results; 45 citations were identified for further eligibility assessment, an additional five studies were identified through keyword searches, and 12 through searching reference lists. Of these 62 studies, 27 studies were included in the final review: 6 case reports/case series, 11 retrospective cohort/observational studies, 1 prospective cohort study, 9 prospective randomised studies.</p><p><strong>Conclusion: </strong>We found a lack of high-quality well-designed studies investigating the use of continuous ketamine sedation on ICU. The available data suggests this intervention is safe and well tolerated, however this is of very low certainty given the poor quality of evidence.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"1 1","pages":"59-77"},"PeriodicalIF":2.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41869914","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 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}