Journal of the Intensive Care Society最新文献

{"title":"Antibiotic prophylaxis reduced broad-spectrum antibiotics and length of stay in ICU patients with alcohol withdrawal induced refractory delirium tremens.","authors":"Dunia Al-Hashimi, Martin Kåberg, Anders Krifors, Michael Wanecek, Ola Blennow","doi":"10.1177/17511437241298518","DOIUrl":"10.1177/17511437241298518","url":null,"abstract":"<p><strong>Background: </strong>Pneumonia is a well-known complication in patients with severe alcohol withdrawal syndrome (SAWS). Antibiotic prophylaxis in ICU treated SAWS patients may be beneficial but data is lacking. The aims of this study were to investigate the effect of introduction of trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis, on use of broad-spectrum antibiotics and ICU length of stay (LOS) in SAWS patients with refractory delirium tremens (rDT).</p><p><strong>Methods: </strong>Retrospective observational cohort study comparing before (control group) and after the introduction of TMP-SMX prophylaxis in patients admitted to a single center ICU because of alcohol withdrawal induced rDT.</p><p><strong>Results: </strong>A total of 108 patients were included, 53 patients in the control group and 55 patients in the TMP-SMX group. Baseline characteristics did not differ between the groups (89% male, median age 52 years). The use of broad-spectrum antibiotics was significantly lower in the TMP-SMX group than in the control group (11 vs 70%, <i>p</i> < 0.001). The only variable associated with decreased use of broad-spectrum antibiotics in multiple logistic regression analysis was receiving TMP-SMX (0.06, 95% CI 0.02, 0.19, <i>p</i>-value: <0.001). Median LOS was shorter in the TMP-SMX group than in the control group (61 vs 72 h, <i>p</i> = 0.004). In multiple linear regression analysis receiving TMP-SMX SMX was associated with shorter LOS (-22.7, 95% CI: -41.3, -4.1, <i>p</i>-value: 0.02) and having one or more comorbidities with longer LOS (37.4, 95% CI: 10.4, 64.5, <i>p</i>-value: <0.01).</p><p><strong>Conclusion: </strong>Prophylaxis with TMP-SMX in ICU-treated rDT patients was associated with reduced use of broad-spectrum antibiotics and reduced ICU LOS.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437241298518"},"PeriodicalIF":2.1,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11586926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733006","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":"Assessment of hemodynamic parameters by PiCCO and PAC in patients treated with the Impella CP.","authors":"Dominik Schmitt, Andreas Schneider, Björn Lengenfelder, Martin Wagner, Daniel Patschan, Benjamin Sasko, Georg Ertl, Stefan Frantz, Oliver Ritter, Dirk Weismann","doi":"10.1177/17511437241300909","DOIUrl":"10.1177/17511437241300909","url":null,"abstract":"<p><p>In 28 patients supported by an Impella pump (Impella CP, Abiomed Inc.^®, Danvers, MA), hemodynamic measurements by PiCCO (PULSION Medical Systems SE^®, Feldkirchen, Germany) and pulmonary artery catheter (PAC or Swan-Ganz Catheter; Edwards Lifescience^®, Unterschleissheim, Germany) were compared. There was a significant positive correlation of cardiac output (CO; <i>r</i> ² = 0.917, <i>p</i> < 0.001), systemic vascular resistance index (SVRI; <i>r</i> ² = 0.904, <i>p</i> < 0.001), stroke volume index (SI; <i>r</i> ² = 0.909, <i>p</i> < 0.001) and left ventricular work index (LCWI; <i>r</i> ² = 0.689, <i>p</i> < 0.001) in PiCCO and PAC measurements under Impella CP support. We conclude, that in patients with left-ventricular Impella support, hemodynamics may be assessentd by PiCCO or PAC.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"108-111"},"PeriodicalIF":2.1,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11586927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733016","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":"Delivery of evidence-based critical care practices across the United Kingdom: A UK-wide multi-site service evaluation in adult units.","authors":"William R Thomson, Zudin Puthucheary, Panayiotis Stavrinou, Dalia Barghouthy, Shreekant Champanerkar, Douglas Findlay, Sarah Gordon, David McWilliams, Kate Tantam, Helen Woodward, Timothy J Stephens","doi":"10.1177/17511437241293917","DOIUrl":"10.1177/17511437241293917","url":null,"abstract":"<p><strong>Background: </strong>The ICU Liberation Bundle was developed to improve outcomes for patients admitted to critical care. Despite a lack of Bundle adoption in the UK, the individual evidence-based practices (EBPs) within the bundle are defined as standards of care by the UK Intensive Care Society. There are limited data on the delivery of these EBPs.</p><p><strong>Objective: </strong>To evaluate current delivery of the EBPs of the ICU Liberation bundle in a sample of hospitals in the UK National Health Service (NHS) presenting delivery of EBP's between hospitals, their stability of delivery across multiple weeks and in comparison to US hospitals in the original ICU Liberation Bundle study.</p><p><strong>Methods: </strong>Multi-centre service evaluation, using modified definitions of compliance from the ICU Liberation Bundle study. We sampled six representative units from across the UK; data collection totalled 1116 patient days. Data were analysed using descriptive statistics.</p><p><strong>Results: </strong>Across all six units, patients received a median of 42.9% (IQR 40%-60%) of all possible bundle EBPs. Unit bundle proportional compliance (number of components completed/eligible number of components) ranged from 40.0% (IQR 28.6%-50.0%) to 71.4% (IQR 57.1%-80.0%). Units completed spontaneous awakening trials most regularly in 80.1% of eligible patients (149/186). Delirium assessments were the least adhered to EBP with only 32.2% (359/1116) of patients receiving at least two validated delirium assessments per day. Full bundle compliance was lower in the UK cohort in comparison to the original trial (4% vs 8%).</p><p><strong>Discussion: </strong>We identified substantial variation in the delivery of seven evidence-based practices that are considered standards of care in the UK. Variation existed between hospitals and within each hospital over time. These data begin to describe the current state of EBP adherence in a selection of critical care units.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437241293917"},"PeriodicalIF":2.1,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11585010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711187","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":"In vivo assessment of a modification of a domiciliary ventilator which reduces oxygen consumption in mechanically ventilated patients.","authors":"Timothy O Jenkins, Thomas M Sutton, Peter Griffen, Yoseph Mebrate, Michael I Polkey","doi":"10.1177/17511437241296685","DOIUrl":"10.1177/17511437241296685","url":null,"abstract":"<p><p>There are instances where hospitals may experience a relative shortage of oxygen, for example, future pandemics, natural disasters or wartime. We developed a modification to a domiciliary ventilator that captures oxygen normally vented during expiration into the atmosphere, delivering it to the patient. The modification significantly increases PaO₂ in mechanically ventilated patients at their baseline FiO₂ and baseline FiO₂ +1, +2 and +3 L/min compared to no modification. The modification reduces walled oxygen consumption by median (IQR) -1.0 (-1.25 to -1.00) L/min whilst maintaining PaO₂. This modification may be a valuable in circumstances where there is a relative shortage of oxygen.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"112-114"},"PeriodicalIF":2.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628830","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":"Management of adult mechanically ventilated patients: A UK-wide survey.","authors":"James Ward, Isis Terrington, Katie Preston, Alexander Smith, Thomas Roe, Jonathan Barnes, Emma Allen, Sandra Lima, Rebecca Cusack, Michael P W Grocott, Ahilanandan Dushianthan","doi":"10.1177/17511437241292190","DOIUrl":"10.1177/17511437241292190","url":null,"abstract":"<p><strong>Background: </strong>Mechanical ventilation is a common and often lifesaving intervention that is utilised in intensive care. However, the practices can vary between centres. Through this national survey we aim to gain more information about different strategies adopted across the UK.</p><p><strong>Methods: </strong>All adult intensive care units in the UK were approached to participate. The questionnaire was developed with an electronic survey engine and conducted between 09/11/2023 and 01/04/2024 (Survey Monkey^®). The survey included questions on ventilator modes, settings, protocols/pathways, rescue strategies, immediate post-extubation period and follow-up.</p><p><strong>Results: </strong>There were 196 responses from 104 hospitals. The most widely adopted start-up ventilation mode was pressure-regulated volume-controlled mode. For acute hypoxaemic respiratory failure (AHRF), most of respondents reported full (39.8%) or partial compliance (58.1%) with the ARDSnet protocol, with PEEP settings being the commonest deviation. Prone positioning (99.0%), followed by recruitment manoeuvres (91.3%) were commonly used rescue measures during AHRF. APRV (55.7%), inhaled (51.3%) and systemic pulmonary vasodilators (44.1%) were also commonly used. Conservative oxygen targets (SaO₂ of 88%-92%) were commonly adopted (70.6%). As a care bundle, intermittent ETT cuff pressure monitoring was more common (65.5%) than continuous cuff pressure monitoring (20.0%). Propofol and alfentanil were the most common initial sedative and analgesia (99.5% and 56.9%) respectively. Routine volatile anaesthetic use was rare.</p><p><strong>Conclusions: </strong>Our survey has shown significant variation of practice in common but crucial elements of management of patients receiving mechanical ventilation. We hope the results in our survey highlight potential future areas of research.</p><p><strong>Collaborators: </strong>South-coast Peri-operative Audit and Research Collaborative (SPARC)Severn Trainee Anaesthetic and Critical Care Research group (STAR)Collaborative research in Anaesthesia in the Northeast (CRANE).</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437241292190"},"PeriodicalIF":2.1,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628832","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":"Small volume fluid resuscitation and supplementation with 20% albumin versus buffered crystalloids in adults with septic shock: A protocol for a randomised feasibility trial.","authors":"Jonathan Bannard-Smith, Rinaldo Bellomo, Tim W Felton, Daniel F McAuley, Gareth B Kitchen, Catherine Fullwood, Alexander Thompson, Paul M Dark","doi":"10.1177/17511437241292194","DOIUrl":"https://doi.org/10.1177/17511437241292194","url":null,"abstract":"<p><strong>Background: </strong>Fluid therapy is universally administered in the management of patients with sepsis, however excessive cumulative fluid balance has been shown to result in worse outcomes. Hyperoncotic albumin results in both lower fluid volumes and early cumulative fluid balance, and may reduce short-term mortality in patients with septic shock.</p><p><strong>Methods: </strong>In this single centre, open label, feasibility trial; patients with early septic shock will be randomly allocated either 20% albumin for resuscitation and daily supplementation, versus buffered crystalloids alone for all fluid therapy. The intervention period will last 7 days, with follow up points at ICU and hospital discharge, and 90 days after randomisation.</p><p><strong>Objectives: </strong>Primary outcome measures including recruitment rate, intervention adherence, data completeness and safety will constitute objective evidence of feasibility, according to pre-specified thresholds. Secondary outcomes will include mortality and healthcare utilisation at 90 days, alongside other physiological and patient centred outcomes to inform the design of a future effectiveness trial.</p><p><strong>Conclusion: </strong>This study will rigorously test the feasibility of conducting a future trial to test both the clinical and cost-effectiveness of hyperoncotic albumin in patients with early septic shock.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"25 4","pages":"419-426"},"PeriodicalIF":2.1,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629854","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":"Should viscoelastic testing be a standard point-of-care test on all intensive care units?","authors":"Neha Natasha Passi, Thomas Parker","doi":"10.1177/17511437241290154","DOIUrl":"https://doi.org/10.1177/17511437241290154","url":null,"abstract":"<p><p>Viscoelastic tests (VETs) have transformed assessment of haemostasis and transfusion practices in trauma, cardiac and liver transplantation centres. Impaired haemostasis is a common problem on the general intensive care unit (ICU), but routine use of VETs is rare. We have accordingly reviewed the evidence to determine whether there is evidence to support the use of VETs as a standard point of care test on all ICUs in assessing and managing patients. The benefits of using VETs in the management of major haemorrhage, namely faster identification of a coagulopathy, in particular early detection of fibrinolysis, and reduced transfusion requirements for blood products have been seen in the general ICU. Validation of treatments algorithms is now required to standardise practice. There is also emerging evidence to support the use of VETs to guide urgent treatment decisions in patients with a coagulopathy or in patients taking anti-coagulants or anti-platelet therapies. We recommend that departments independently review the feasibility of setting up a viscoelastic point of care service which considers the applicability to their patient cohort, the financial cost and the personnel required.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"25 4","pages":"432-439"},"PeriodicalIF":2.1,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629789","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 role of the United Kingdom national poisons information service (NPIS) in the diagnosis of death according to neurological criteria in poisoned and non-poisoned patients.","authors":"Jeanie Worthington, Leon Cohen, Ian Thomas, Laurence Gray, Euan Sandilands, Emma Moyns","doi":"10.1177/17511437241289000","DOIUrl":"10.1177/17511437241289000","url":null,"abstract":"<p><p>The diagnosis of death by neurological criteria (DNC) requires the exclusion of any clinical effect attributable to xenobiotics. We undertook a retrospective analysis of enquiries to the National Poisons Information Service (NPIS) relating to DNC over a 10-year period. Enquiries were categorised as toxicological, where exposure to a non-therapeutically administered xenobiotic was implicated in the clinical presentation and non-toxicological where exposure to the xenobiotic was not the primary cause of the clinical state. The frequency of enquiry to the NPIS regarding xenobiotics and DNC demonstrates that it remains a valuable source of expert advice.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437241289000"},"PeriodicalIF":2.1,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628898","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":"Citation for honorary membership of the Intensive Care Society.","authors":"Jeremy Bewley, Stephen T Webb, Steve Mathieu","doi":"10.1177/17511437241281476","DOIUrl":"https://doi.org/10.1177/17511437241281476","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"25 4","pages":"369-370"},"PeriodicalIF":2.1,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629215","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":"Discharge from the intensive care unit: Straight home or go to ward? A comparison of their admission and discharge characteristics.","authors":"Hayaka Amada, Patrick Jerred, Joanna Thomas, Peter Adam Turton","doi":"10.1177/17511437241281171","DOIUrl":"https://doi.org/10.1177/17511437241281171","url":null,"abstract":"<p><p>More patients are discharged directly to home (DDH) after intensive care admission. This single-centre study compared admission characteristics, length of stay and discharge outcomes of DDH patients after mechanical ventilation, compared to patients discharged to wards (DW). Of 161 eligible patients, 32.9% were DDH and 68.1% were DW. DDH patients were significantly younger with lower APACHE II scores. They were ventilated for a shorter length of time, and overall length of stay was 7 days shorter. Physical function scores (CPAx) were significantly higher in DDH. There were no differences in re-admission or 90-day mortality. In certain patients, discharge direct to home may be a safe option.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"25 4","pages":"413-415"},"PeriodicalIF":2.1,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629160","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}