Journal of the Intensive Care Society最新文献

{"title":"Research report: Management of dysphagia using pharyngeal electrical stimulation in the general intensive care population - A service development.","authors":"Thomas Williams, Elizabeth Walkden, Karishma Patel, Naomi E Cochrane, Brendan A McGrath, Sarah Wallace","doi":"10.1177/17511437241270244","DOIUrl":"https://doi.org/10.1177/17511437241270244","url":null,"abstract":"<p><strong>Background: </strong>Dysphagia places a substantial burden on the critically ill, affecting 12%-84% of this cohort, and is independently associated with worse outcomes. Pharyngeal electrical stimulation (PES-treatment) is a novel dysphagia therapy with an emerging evidence base. This retrospective observational study describes our dysphagia service and reports the use of PES-treatment as a standard of care in recovering critically ill patients at a single-site tertiary UK hospital.</p><p><strong>Methods: </strong>Patients admitted to Acute or Cardio-Thoracic adult intensive care units between 1st July 2017 and 30th June 2022 were routinely referred to Speech and Language Therapy (SLT) following tracheostomy, or suspected dysphonia/dysphagia. Clinical assessments and direct laryngeal visualisation using Fibreoptic Evaluation of Swallowing (FEES) were performed. Severe dysphagia was defined as Penetration-Aspiration Score of ⩾6 and patients were offered PES-treatment when staffing allowed.</p><p><strong>Results: </strong>Of 289 patients with severe dysphagia, 19 underwent a course of PES-treatment with the remaining patients receiving standard care. PES-treatment patients were significantly less likely to remain nil-by-mouth (11.1% vs 62.5%, Chi² <i>p</i> < 0.001) or to have an enteral feeding tube in situ at discharge from critical care (27.8% vs 62.5%, <i>p</i> = 0.006) than those receiving standard dysphagia care. Both groups demonstrated an improvement in Penetration-Aspiration Score at repeat FEES: PES-treatment mean difference -2.0 (<i>p</i> = 0.003); non-PES-treatment -1.68 (<i>p</i> < 0.001); (61% PES-treatment improved vs 40% non-PES-treatment, <i>p</i> = 0.09).</p><p><strong>Conclusion: </strong>Our observations suggest that PES may be effective in the general critical care population. PES may offer new treatment options for patients and healthcare staff managing severe dysphagia and its significant consequences.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"25 4","pages":"374-382"},"PeriodicalIF":2.1,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629787","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":"Levelling up, with autism in mind.","authors":"Aoife Abbey","doi":"10.1177/17511437241270258","DOIUrl":"10.1177/17511437241270258","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"25 3","pages":"253-254"},"PeriodicalIF":2.1,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120837","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 unit contact lens care: Evaluating staff understanding and promoting patient safety.","authors":"Harry E Skinner, Anand D Padmakumar","doi":"10.1177/17511437241272268","DOIUrl":"https://doi.org/10.1177/17511437241272268","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"25 4","pages":"440-441"},"PeriodicalIF":2.1,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629715","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":"Contribution of intrapulmonary shunt to the pathogenesis of profound hypoxaemia in viral infection: a mechanistic discussion with an illustrative case.","authors":"Tom Lyne, Luigi Camporota, Hugh Montgomery","doi":"10.1177/17511437241267745","DOIUrl":"https://doi.org/10.1177/17511437241267745","url":null,"abstract":"<p><strong>Background: </strong>The formation of anastomoses between the pulmonary arteries and pulmonary veins, or the pulmonary and the bronchial circulation, is part of normal foetal lung development. They persist in approximately 30% of adults at rest, and open in almost all adults during exertion. Blood flowing through these anastomoses bypasses the alveolar surface and increases in such shunting can thus cause hypoxaemia. This is now known to contribute to the pathogenesis of hypoxaemia in COVID-19 disease. We here provide evidence to support a similar role in influenza A infection.</p><p><strong>Illustrative case presentation: </strong>We describe a case of influenza A infection associated with severe hypoxaemia, poorly responsive to supplemental oxygen and which worsened following the application of continuous positive airway pressure (CPAP), despite the presence of a normal physical examination, chest radiograph and echocardiogram. This combination suggests a significant intrapulmonary (extra-alveolar) shunt as a cause of the severe hypoxaemia. The shunt fraction was estimated to be approximately 57%.</p><p><strong>Discussion and conclusion: </strong>Intrapulmonary vascular shunts can contribute substantially to hypoxaemia in viral infection. Seeking to understand the pathogenesis of observed hypoxaemia can help guide respiratory therapy. Mechanistic research may suggest novel therapeutic targets which could assist in avoiding intubation and mechanical ventilatory support.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"25 4","pages":"427-431"},"PeriodicalIF":2.1,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629156","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":"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":"105-107"},"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}