Journal of the Intensive Care Society最新文献

{"title":"Bedside naso-jejunal placement is more difficult, but successful in patients with COVID-19 in critical care: A retrospective service evaluation of a dietitian-led service.","authors":"Mary E Phillips,&nbsp;Jessica Zekavica,&nbsp;Rajesh Kumar,&nbsp;Rajiv Lahiri,&nbsp;Justin Kirk-Bayley,&nbsp;Amish Patel,&nbsp;Adam E Frampton","doi":"10.1177/17511437231153045","DOIUrl":"https://doi.org/10.1177/17511437231153045","url":null,"abstract":"<p><p>The COVID-19 pandemic presented clinical and logistical challenges in the delivery of adequate nutrition in the critical care setting. The use of neuromuscular-blocking drugs, presence of maxilla-facial oedema, strict infection control procedures, and patients placed in a prone position complicated feeding tube placement. We audited the outcomes of dietitian-led naso-jejunal tube (NJT) insertions using the IRIS^® (Kangaroo, USA) device, before and during the COVID-19 pandemic. NJT placement was successful in 78% of all cases (<i>n</i> = 50), and 87% of COVID-19 cases. Anaesthetic support was only required in COVID-19 patients (53%). NJT placement using IRIS was more difficult but achievable in patients with COVID-19.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 4","pages":"435-437"},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922656/pdf/10.1177_17511437231153045.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239522","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":"Is high sensitivity troponin, taken regardless of a clinical indication, associated with 1 year mortality in critical care patients?","authors":"Jonathan Hinton,&nbsp;Maclyn Augustine,&nbsp;Lavinia Gabara,&nbsp;Mark Mariathas,&nbsp;Rick Allan,&nbsp;Florina Borca,&nbsp;Zoe Nicholas,&nbsp;Neil Gillett,&nbsp;Chun Shing Kwok,&nbsp;Paul Cook,&nbsp;Michael Pw Grocott,&nbsp;Mamas Mamas,&nbsp;Nick Curzen","doi":"10.1177/17511437231160078","DOIUrl":"https://doi.org/10.1177/17511437231160078","url":null,"abstract":"<p><p>The aim of this study was to assess whether high sensitivity troponin (hs-cTnI) is associated with 1 year mortality in critical care (CC). One year mortality data were obtained from NHS Digital for a consecutive cohort of patients admitted to general CC unit (GCCU) and neuroscience CC unit (NCCU) who had hs-cTnI tests performed throughout their CC admission, regardless of whether the test was clinically indicated. Cox proportional hazards were used to estimate the risk of 1-year mortality. A landmark analysis was undertaken to assess whether any relationship at 1 year was driven by mortality within the first 30 days. A total of 1033 consecutive patients were included. At 1 year 254 (24.6%) patients had died. The admission log(10)hs-cTnI concentration in the entire cohort (HR 1.35 (95% CI 1.05-1.75) <i>p</i> = 0.009 with a bootstrap of 1000 samples) was independently associated with 1 year mortality. On landmark analysis the association with 1 year mortality was driven by 30 day mortality. These results indicate that admission hs-cTnI concentration is independently associated with 1 year mortality in CC and this relationship may be driven by differences in mortality at 30 days.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 4","pages":"392-398"},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10572482/pdf/10.1177_17511437231160078.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239605","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":"biomArker-guided Duration of Antibiotic treatment in hospitalised Patients with suspecTed Sepsis (ADAPT-Sepsis): A protocol for a multicentre randomised controlled trial.","authors":"Paul Dark, Gavin D Perkins, Ronan McMullan, Danny McAuley, Anthony C Gordon, Jonathan Clayton, Dipesh Mistry, Keith Young, Scott Regan, Nicola McGowan, Matt Stevenson, Simon Gates, Gordon L Carlson, Tim Walsh, Nazir I Lone, Paul R Mouncey, Mervyn Singer, Peter Wilson, Tim Felton, Kay Marshall, Anower M Hossain, Ranjit Lall","doi":"10.1177/17511437231169193","DOIUrl":"10.1177/17511437231169193","url":null,"abstract":"<p><strong>Aim: </strong>To describe the protocol for a multi-centre randomised controlled trial to determine whether treatment protocols monitoring daily CRP (C-reactive protein) or PCT (procalcitonin) safely allow a reduction in duration of antibiotic therapy in hospitalised adult patients with sepsis.</p><p><strong>Design: </strong>Multicentre three-arm randomised controlled trial.</p><p><strong>Setting: </strong>UK NHS hospitals.</p><p><strong>Target population: </strong>Hospitalised critically ill adults who have been commenced on intravenous antibiotics for sepsis.</p><p><strong>Health technology: </strong>Three protocols for guiding antibiotic discontinuation will be compared: (a) standard care; (b) standard care + daily CRP monitoring; (c) standard care + daily PCT monitoring. Standard care will be based on routine sepsis management and antibiotic stewardship. Measurement of outcomes and costs. Outcomes will be assessed to 28 days. The primary outcomes are total duration of antibiotics and safety outcome of all-cause mortality. Secondary outcomes include: escalation of care/re-admission; infection re-lapse/recurrence; antibiotic dose; length and level of critical care stay and length of hospital stay. Ninety-day all-cause mortality rates will also be collected. An assessment of cost effectiveness will be performed.</p><p><strong>Conclusion: </strong>In the setting of routine NHS care, if this trial finds that a treatment protocol based on monitoring CRP or PCT safely allows a reduction in duration of antibiotic therapy, and is cost effective, then this has the potential to change clinical practice for critically ill patients with sepsis. Moreover, if a biomarker-guided protocol is not found to be effective, then it will be important to avoid its use in sepsis and prevent ineffective technology becoming widely adopted in clinical practice.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 4","pages":"427-434"},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10572477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239523","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 acute aortic dissection in critical care.","authors":"Luke Flower,&nbsp;Joseph E Arrowsmith,&nbsp;Jeremy Bewley,&nbsp;Samantha Cook,&nbsp;Graham Cooper,&nbsp;Jake Flower,&nbsp;Renata Greco,&nbsp;Syed Sadeque,&nbsp;Pradeep R Madhivathanan","doi":"10.1177/17511437231162219","DOIUrl":"10.1177/17511437231162219","url":null,"abstract":"<p><p>Aortic dissections are associated with significant mortality and morbidity, with rapid treatment paramount. They are caused by a tear in the intimal lining of the aorta that extends into the media of the wall. Blood flow through this tear leads to the formation of a false passage bordered by the inner and outer layers of the media. Their diagnosis is challenging, with most deaths caused by aortic dissection diagnosed at post-mortem. Aortic dissections are classified by location and chronicity, with management strategies depending on the nature of the dissection. The Stanford method splits aortic dissections into type A and B, with type A dissections involving the ascending aorta. De Bakey classifies dissections into I, II or III depending on their origin and involvement and degree of extension. The key to diagnosis is early suspicion, appropriate imaging and rapid initiation of treatment. Treatment focuses on initial resuscitation, transfer (if possible and required) to a suitable specialist centre, strict blood pressure and heart rate control and potentially surgical intervention depending on the type and complexity of the dissection. Effective post-operative care is extremely important, with awareness of potential post-operative complications and a multi-disciplinary rehabilitation approach required. In this review article we will discuss the aetiology and classifications of aortic dissection, their diagnosis and treatment principles relevant to critical care. Critical care clinicians play a key part in all these steps, from diagnosis through to post-operative care, and thus a thorough understanding is vital.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 4","pages":"409-418"},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10572474/pdf/10.1177_17511437231162219.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239606","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 prevalence of mental frailty in ICU survivors and informal caregiver strain: A 1-year retrospective study of the Frisian aftercare cohort.","authors":"Lise F E Beumeler,&nbsp;Carina Bethlehem,&nbsp;Thialda T Hoogstins-Vlagsma,&nbsp;Tim van Zutphen,&nbsp;Hanneke Buter,&nbsp;Gerjan J Navis,&nbsp;E Christiaan Boerma","doi":"10.1177/17511437221139547","DOIUrl":"https://doi.org/10.1177/17511437221139547","url":null,"abstract":"<p><strong>Background: </strong>Intensive care unit (ICU) survivors often suffer from long-term mental problems and a reduced health-related quality of life (HRQoL). Symptoms of depression, anxiety, and post-traumatic stress disorder may render patients mentally frail post-ICU, resulting in impaired recovery and an increased informal caregiver burden. The aim of this study was to investigate the prevalence of mental frailty up to 12 months after ICU admission and pinpoint markers for early risk-assessment in clinical practice.</p><p><strong>Methods: </strong>A retrospective cohort study (2012-2018) in which clinical and post-ICU data of long-stay (⩾48 h) ICU-patients was used. Mental frailty was identified as clinically relevant symptoms of depression, anxiety, or post-traumatic distress disorder at 12 months after discharge.</p><p><strong>Results: </strong>The prevalence of mental frailty at 12 months post-ICU among the total group of 239 patients was 38%. Mental frailty was defined as clinically relevant symptoms of depression, anxiety, and/or trauma. To achieve this, previously validated cut off values were used for the HADS (HADS-Anxiety ⩾ 8; HADS-Depression ⩾ 8) and TSQ (⩾6), and CSI (⩾7).</p><p><strong>Conclusion: </strong>A significant proportion of ICU-survivors can be identified as mentally frail, which is associated with impaired HRQoL at baseline and post-ICU, and high caregiver strain. These findings emphasize the need for integrative aftercare programs for both the patient and their informal caregivers.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 4","pages":"356-363"},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10572478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239608","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 use of neurone specific enolase to prognosticate neurological recovery and long term neurological outcomes in OOHCA patients.","authors":"Caitlyn Maher,&nbsp;Matthew Cadd,&nbsp;Maya Nunn,&nbsp;Jennifer Worthy,&nbsp;Rebecca Gray,&nbsp;Owen Boyd","doi":"10.1177/17511437231160089","DOIUrl":"10.1177/17511437231160089","url":null,"abstract":"<p><strong>Introduction: </strong>Hypoxic-ischaemic brain injury (HIBI), is a common sequalae following out-of-hospital cardiac arrest (OOHCA), it is reported as the cause of death in 68% of patients who survive to ICU admission, while other patients can be left with permanent neurological disability. Prediction of neurological outcome follows a multimodal approach, including use of the biomarker, neurone specific enolase (NSE). There is however no definitive cut-off value for poor neurological outcome, and little research has analysed NSE and long-term outcomes in survivors. We investigated an NSE threshold for poor short-term neurological outcome and the relationship between NSE and poor neurological outcome in survivors.</p><p><strong>Methods: </strong>A retrospective study was conducted of all adult OOHCA patients admitted to the Royal County Sussex Hospital ICU between April 2017 and November 2018. NSE levels, Targeted Temperature Management (TTM), cross-sectional imaging, mortality and GCS on ICU discharge were recorded. Assessment of neurological function after a median of 19 months (range 14-32 months) post ICU discharge was undertaken following ICU discharge and related to NSE.</p><p><strong>Results: </strong>NSE levels were measured in 59 patients; of these 36 (61%) had a poor neurological outcome due to hypoxic ischaemic brain injury. Youden's index and ROC analysis established an NSE cut-off value of 64.5 μg/L, with AUC of 0.901, sensitivity of 77.8% and specificity of 100%. Follow-up of 26 survivors after 19 months did not show a significant relationship between NSE after OOHCA and long-term neurological outcome.</p><p><strong>Conclusion: </strong>Our results show that NSE >64.5 µg/L has a poor short-term neurological outcome with 100% specificity. Whilst limited by a low sample size, NSE in survivors showed no relationship with neurological outcome post OOHCA in the long term.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 4","pages":"386-391"},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10572481/pdf/10.1177_17511437231160089.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239609","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 international survey exploring the adoption and utility of diagnostic lung ultrasound by physiotherapists and respiratory therapists in intensive care.","authors":"Yin Hung Lau,&nbsp;Simon Hayward,&nbsp;George Ntoumenopoulos","doi":"10.1177/17511437221148920","DOIUrl":"10.1177/17511437221148920","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Lung ultrasound (LUS) is an emerging assessment tool for intensive care unit (ICU) therapists (physiotherapists, physical therapists and respiratory therapists) to aid pathology identification, intervention selection, clinical reasoning and as an outcome measure to assess intervention efficacy. However, the extent of LUS adoption and use by ICU therapists internationally has not been described in the literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This survey explored the interest in LUS amongst ICU therapists internationally. In addition, LUS training, use in clinical practice and barriers to implementation were also explored. The survey findings were used to facilitate recommendations for future adoption.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;International ICU therapists were invited to answer a 37 question cross-sectional open e-survey, distributed using the online survey tool REDCap&lt;sup&gt;®&lt;/sup&gt;. The exact sample size of eligible ICU therapists from around the world is unknown, therefore the participant responses received were a representative convenience sample of the international ICU therapist population. Survey links were posted on the relevant web pages and social media forums utilised by various ICU therapist associations and professional organisations worldwide. A snowballing technique was used to encourage survey participants to forward the survey link within their professional networks. The survey was open on REDCap&lt;sup&gt;®&lt;/sup&gt; for an 8-week period between March and May 2021.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Three hundred twenty ICU therapists from 30 countries responded with most respondents coming from either the United Kingdom (&lt;i&gt;n&lt;/i&gt; = 94) or Australia (&lt;i&gt;n&lt;/i&gt; = 87). Eighty-nine of the ICU therapist respondents (30%) reported being users of LUS, however, 40 of those 89 respondents reported having no formal accreditation. The top clinical indications to perform a LUS scan were changes on chest radiograph, altered findings on auscultation and a low partial pressure of arterial oxygen/fraction of inspired oxygen ratio. The 71% of LUS users reported that their ICU does not have a local policy in place to guide ICU therapists' use of LUS. Most LUS users (82%) only document their LUS findings in the patient's medical notes and (73%) only store the LUS clips on the ICU's ultrasound machine. The 85% of respondents perceive LUS becoming an increasing part of their objective assessment in the future and 96% report that they have other ICU therapist colleagues interested in adopting LUS. Main reasons why respondents believe that ICU therapists are not adopting LUS in their ICU are a difficulty in access to appropriate training, mentorship, and a lack of local governance policy guiding their use of LUS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;To the authors' knowledge this is the first study to explore the international adoption and utility of LUS by ICU therapists. LUS is a growing technique with widespread interest","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 4","pages":"364-371"},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10572484/pdf/10.1177_17511437221148920.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239520","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 nurses' experiences of caring for isolated COVID-positive patients during first wave of COVID-19.","authors":"Allan Køster,&nbsp;Anthony Vincent Fernandez,&nbsp;Christian Sylvest Meyhoff,&nbsp;Lars Peter Kloster Andersen","doi":"10.1177/17511437231160073","DOIUrl":"10.1177/17511437231160073","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 has fundamentally changed all fields of health care. Intensive care nurses have been at the forefront of the pandemic facing the massive impact of the disease, both professionally and personally. This study investigated nurses' experiences of caring for isolated COVID-19 positive patients in the intensive care department during the first wave of the COVID-19 pandemic. The study investigated how isolation affected the nurses themselves, how they related with their patients, and how isolation affected patient care in general.</p><p><strong>Methods: </strong>The study was performed at a 20-bed university hospital intensive care department in Copenhagen, Denmark. COVID-19 positive patients were isolated or cohort isolated. A dedicated nurse cared for each isolated patient and wore full personal protective equipment. The study is based on in-depth phenomenological interviews with intensive care nurses conducted in summer 2020. The interviews were structured according to the principles of \"Phenomenologically Grounded Qualitative Research.\" The data included observations from within the isolated patient rooms.</p><p><strong>Findings: </strong>Six intensive care nurses participated in the study. The analysis documented following themes consistently reported by all nurses: (1) a general sense of uncanniness, (2) intense feelings of confinement and co-isolation, and (3) heightened senses of bodily objectification, including how nurses' experienced their patients and also themselves.</p><p><strong>Conclusion: </strong>This is the first Scandinavian phenomenological study to focus on mapping the experiences of intensive care nurses during the extreme circumstances of the first wave of the COVID-19 pandemic. Further studies may explore long-term effects, such as psychiatric morbidity or psychological functioning in these individuals.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 4","pages":"379-385"},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10111162/pdf/10.1177_17511437231160073.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239527","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":"Clinical course and outcomes of cancer patients admitted in medical ICU with sepsis.","authors":"Anisha Beniwal,&nbsp;Omender Singh,&nbsp;Deven Juneja,&nbsp;Hemant Kumar Beniwal,&nbsp;Sahil Kataria,&nbsp;Madhura Bhide,&nbsp;Devraj Yadav","doi":"10.1177/17511437221136831","DOIUrl":"https://doi.org/10.1177/17511437221136831","url":null,"abstract":"<p><strong>Background and aims: </strong>Sepsis is not only a leading cause of intensive care unit (ICU) admission but also one of the variables which affect outcomes of cancer patients. We aimed to assess the clinical characteristics, clinical course, mortality and risk factors associated with 30-day mortality in medical oncology patients admitted in a multi-disciplinary medical ICU.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 435 consecutive cancer patients admitted in medical ICU over a 28 months period. Patients were divided into two groups based on the presence of sepsis at the time of ICU admission. Data regarding baseline patient characteristics, clinical and laboratory data, need for organ support and 30-day mortality were collected. Sepsis patients were further classified as 30-day survivors and non-survivors and risk factors for mortality in these patients were determined.</p><p><strong>Results: </strong>Overall 30-day mortality was 57.8%. It was significantly higher in sepsis group patients (73.9%) as compared to non-sepsis patients (46.6%) (<i>p</i> < 0.001). Most common reason for ICU admission in non-sepsis group was respiratory distress (51.4%) followed by altered sensorium (28.4%). Presence of metastasis [odds ratio, OR: 3.89 (95% confidence interval, CI: 1.536-9.901)], high lactate [OR: 1.374 (95% CI: 1.024-1.843)] and need of invasive mechanical ventilator (IMV) support [OR: 7.634 (95% CI: 2.519-23.256)] or vasopressor support [OR: 3.268 (95% CI: 1.179-9.090)] were directly associated with 30-day mortality.</p><p><strong>Conclusion: </strong>Critically ill cancer patients admitted with sepsis had high mortality. Presence of metastasis, high lactate and need of IMV or vasopressor support was associated with worse prognosis in cancer patients admitted with sepsis in ICU.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 4","pages":"351-355"},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10572483/pdf/10.1177_17511437221136831.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239524","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":"Focused transoesophageal TOE (fTOE): A new accreditation pathway.","authors":"Antonio Rubino,&nbsp;Marcus Peck,&nbsp;Ashley Miller,&nbsp;Thomas Edmiston,&nbsp;Andrew A Klein,&nbsp;Robert Orme,&nbsp;Vinoth Sankar,&nbsp;Nick Fletcher,&nbsp;Niall O'Keeffe,&nbsp;Henry Skinner","doi":"10.1177/17511437231173350","DOIUrl":"10.1177/17511437231173350","url":null,"abstract":"<p><p>The concept of a focused ultrasound study to identify sources of haemodynamic instability has revolutionized patient care. Point-of-care ultrasound (POCUS) using transthoracic scanning protocols, such as FUSIC Heart, has empowered non-cardiologists to rapidly identify and treat the major causes of haemodynamic instability. There are, however, circumstances when a transoesphageal, rather than transthoracic approach, may be preferrable. Due to the close anatomical proximity between the oesophagus, stomach and heart, a transoesphageal echocardiogram (TOE) can potentially overcome many of the limitations encountered in patients with poor transthoracic ultrasound windows. These are typically patients with severe obesity, chest wall injuries, inability to lie in the left lateral decubitus position and those receiving high levels of positive airway pressure. In 2022, to provide all acute care practitioners with the opportunity to acquire competency in focused TOE, the Intensive Care Society (ICS) and Association of Anaesthetists (AA) launched a new accreditation pathway, known as Focused Transoesophageal Echo (fTOE). The aim of fTOE is to provide the practitioner with the necessary information to identify the aetiology of haemodynamic instability. Focused TOE can be taught in a shorter period of time than comprehensive and teaching programmes are achievable with support from cardiothoracic anaesthetists, intensivists and cardiologists. Registration for fTOE accreditation requires registration via the ICS website. Learning material include theoretical modules, clinical cases and multiple-choice questions. Fifty fTOE examinations are required for the logbook, and these must cover a range of pathology, including ventricular dysfunction, pericardial effusion, tamponade, pleural effusion and low preload. The final practical assessment may be undertaken when the supervisors deem the candidate's knowledge and skills consistent with that required for independent practice. After the practitioner has been accredited in fTOE, they must maintain knowledge and competence through relevant continuing medical education. Accreditation in fTOE represents a joint venture between the ICS and AA and is endorsed by Association of Cardiothoracic Anaesthesia and Critical care (ACTACC). The process is led by TOE experts, and represents a valuable expansion in the armamentarium of acute care practitioners to assess haemodynamically unstable patients.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 4","pages":"419-426"},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10572472/pdf/10.1177_17511437231173350.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239526","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}