Journal of the Intensive Care Society最新文献

{"title":"Reduction in transfer of micro-organisms between patients and staff using short-sleeved gowns and hand/arm hygiene in intensive care during the COVID-19 pandemic: A simulation-based randomised trial.","authors":"Laura Vincent,&nbsp;Mudathir Ibrahim,&nbsp;Joanne Kitchin,&nbsp;Claire Pickering,&nbsp;Jennie Wilson,&nbsp;Enrico Sorrentino,&nbsp;Claudia Salvagno,&nbsp;Laurie Earl,&nbsp;Louise Ma,&nbsp;Kathryn Simpson,&nbsp;Rose Baker,&nbsp;Peter McCulloch","doi":"10.1177/17511437221116472","DOIUrl":"https://doi.org/10.1177/17511437221116472","url":null,"abstract":"<p><strong>Background: </strong>Current personal protective equipment (PPE) practices in UK intensive care units involve \"sessional\" use of long-sleeved gowns, risking nosocomial infection transmitted via gown sleeves. Data from the first wave of the COVID19 pandemic demonstrated that these changes in infection prevention and control protocols were associated with an increase in healthcare associated bloodstream infections. We therefore explored the use of a protocol using short-sleeved gowns with hand and arm hygiene to reduce this risk.</p><p><strong>Methods: </strong>ICU staff were trained in wearing short-sleeved gowns and using a specific hand and arm washing technique between patients (experimental protocol). They then underwent simulation training, performing COVID-19 intubation and proning tasks using either experimental protocol or the standard (long-sleeved) control protocol. Fluorescent powder was used to simulate microbial contamination, detected using photographs under ultraviolet light. Teams were randomised to use control or experimental PPE first. During the simulation, staff were questioned on their feelings about personal safety, comfort and patient safety.</p><p><strong>Results: </strong>Sixty-eight staff and 17 proning volunteers were studied. Experimental PPE completely prevented staff contamination during COVID-19 intubation, whereas this occurred in 30/67 staff wearing control PPE (<i>p</i> = .003, McNemar). Proning volunteers were contaminated by staff in 15/17 control sessions and in 1/17 with experimental PPE (<i>p</i> = .023 McNemar). Staff comfort was superior with experimental PPE (<i>p</i>< .001, Wilcoxon). Their personal safety perception was initially higher with control PPE, but changed towards neutrality during sessions (<i>p</i> < .001 start, 0.068 end). Their impressions of patient safety were initially similar (<i>p</i> = .87), but finished strongly in favour of experimental PPE (<i>p</i> < .001).</p><p><strong>Conclusions: </strong>Short-sleeved gowns with hand and forearm cleansing appear superior to sessional long-sleeved gowns in preventing cross-contamination between staff and patients.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 3","pages":"265-276"},"PeriodicalIF":2.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515327/pdf/10.1177_17511437221116472.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41158502","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":"Predictors of health-related quality of life in patients undergoing extracorporeal membrane oxygenation for acute severe respiratory failure.","authors":"Ahmed Mham Mostafa,&nbsp;Christopher J Tuttle,&nbsp;Mikel A Mckie,&nbsp;Jo-Anne Fowles,&nbsp;Jasvir Parmar,&nbsp;Alain Vuylsteke","doi":"10.1177/17511437221111639","DOIUrl":"https://doi.org/10.1177/17511437221111639","url":null,"abstract":"<p><strong>Background: </strong>Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a form of life support used in severe respiratory failure. While the short-term complications of VV-ECMO are well described, impacts on health-related quality of life (HRQOL) are less well characterised. This study aims to assess the HRQOL of patients who underwent VV-ECMO for acute severe respiratory failure and explore predictors of poor HRQOL.</p><p><strong>Methods: </strong>We performed a retrospective, observational study of a large cohort of adults who underwent VV-ECMO for acute severe respiratory failure in a single tertiary centre (June 2013-March 2019). Patients surviving critical care discharge were invited to a six-month clinic, where they completed an EQ-5D-5L questionnaire assessing HRQOL. Multivariate analysis was performed to assess prognostic factors for HRQOL.</p><p><strong>Results: </strong>Among the 245 consecutive patients included in this study (median age 45 years), 187 (76.3%) survived until ECMO decannulation and 172 (70.2%) until hospital discharge. Of those, 98 (57.3%) attended a follow-up clinic at a mean (±SD) of 204 (±45) days post-discharge. Patients reported problems with pain/discomfort (56%), usual daily activities (53%), anxiety/depression (49%), mobility (46%), and personal care (21%). Multivariate analysis identified limb ischaemia (-0.266, 95% C.I. [-0.116; -0.415], <i>p</i> = 0.0005), renal replacement therapy (-0.149, [-0.046; -0.252], <i>p</i> = 0.0044), and having received more than four platelet units (-0.157, [-0.031; -0.283], <i>p</i> = 0.0146) as predictors of poor HRQOL.</p><p><strong>Conclusion: </strong>We report that survivors of VV-ECMO have reduced HRQOL in multiple domains at 6 months, with pain reported most frequently. Patients who had limb ischaemia, renal replacement therapy or were transfused more than four units of platelets are particularly at risk of poor HRQOL and may benefit from added support measures.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 3","pages":"283-291"},"PeriodicalIF":2.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1f/e2/10.1177_17511437221111639.PMC10515334.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41145612","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":"Risk factors associated with post-intensive care syndrome in family members (PICS-F): A prospective observational study.","authors":"Carolina Tintim Lobato,&nbsp;João Camões,&nbsp;Daniela Carvalho,&nbsp;Cláudia Vales,&nbsp;Cláudia Camila Dias,&nbsp;Ernestina Gomes,&nbsp;Rui Araújo","doi":"10.1177/17511437221108904","DOIUrl":"https://doi.org/10.1177/17511437221108904","url":null,"abstract":"<p><strong>Background: </strong>The family members of intensive care unit (ICU) patients play a crucial role in modern ICUs. These individuals are predisposed to the development of post-intensive care syndrome in family members (PICS-F), a syndrome experienced by family members of ICU patients in response to critical illness and characterised by new or worsening psychological symptoms. This study sought to evaluate the levels of anxiety and depression exhibited by the family members of patients hospitalised in the ICU. It also aimed to identify the risk factors associated with the experience of PICS-F, which should assist with its prevention in the future.</p><p><strong>Methods: </strong>The study sample comprised 164 ICU patients and their family members. Sociodemographic data were gathered at the time of ICU admission and 3 months after discharge, and the family members were screened for emotional distress using the Hospital Anxiety and Depression Scale (HADS). Comparison tests were used to test for an association between family/patient characteristics and a positive HADS score. In addition, a multivariable logistic regression model was constructed to identify the independent factors associated with a positive HADS score.</p><p><strong>Results: </strong>Emotional distress was identified in 24% of the family members 3 months after their relatives had been discharged from the ICU. A number of personal traits were found to be associated with emotional distress in the family members, namely unemployment (<i>p</i> = .008), smoking/drinking habits (<i>p</i> = .036) and personal history of psychopathology (<i>p</i> = .045). In the multiple logistic regression analyses, only unemployment was found to be an independent factor associated with both anxiety and depression in the family members (OR = 2.74, CI 95%: 1.09-6.93). No association was found between the patients' characteristics and emotional distress in the family members.</p><p><strong>Conclusions: </strong>The findings of this study indicate an association between emotional distress in the family members of ICU patients and their personal traits, thereby building on the prior literature by suggesting that patient characteristics are less pertinent to the experience of PICS-F. Unemployment may represent a meaningful risk factor for emotional distress in family members (a potential marker of PICS-F), given its relationship with family members' positive HADS scores post-ICU discharge. These findings should influence preventative strategies concerning PICS-F by illustrating the need to assess family characteristics and demographics early in a patient's ICU stay and, consequently, allowing for the early identification of at-risk individuals and the prompt implementation of adequate support services.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 3","pages":"247-257"},"PeriodicalIF":2.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515326/pdf/10.1177_17511437221108904.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41147471","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":"1-year outcomes of patients admitted to critical care with treatment limitations: A dual-centre observational study.","authors":"Masseh Yakubi,&nbsp;Annie Devlin,&nbsp;Richard Venn,&nbsp;Luke Hodgson","doi":"10.1177/17511437221108900","DOIUrl":"https://doi.org/10.1177/17511437221108900","url":null,"abstract":"<p><p>Intensivists are increasingly involved in the care of frail patients as our population ages. Careful person-orientated, individualised decision-making, weighing benefits and harms of critical care are required in such situations. Few studies have reported outcomes of patients with treatment limitations. This dual-centre observational study reports outcomes of 3781 patients (2018-20). At least one treatment limitation was set at admission in 13% (<i>n</i> = 486). Of this group 55% survived to hospital discharge, of whom 69% were discharged home; 39% remained alive at 1 year. These findings provide objective data to support clinicians, patients and relatives in shared decision-making. Future multi-centre work could explore how best to identify those most likely to benefit from critical care.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 3","pages":"338-340"},"PeriodicalIF":2.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515323/pdf/10.1177_17511437221108900.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41152890","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":"Erratum.","authors":"","doi":"10.1177/17511437221125306","DOIUrl":"https://doi.org/10.1177/17511437221125306","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1177/17511437221105777.].</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 3","pages":"341"},"PeriodicalIF":2.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515332/pdf/10.1177_17511437221125306.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41166569","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 care of transgender patients in critical care: A call to action.","authors":"Luke Flower, Alice Humphreys, Stuart Edwardson","doi":"10.1177/17511437221147476","DOIUrl":"10.1177/17511437221147476","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 3","pages":"245-246"},"PeriodicalIF":2.1,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515335/pdf/10.1177_17511437221147476.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41162697","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":"A thematic analysis of staff perspectives on the impact of a mental health nurse (RMN) in a critical care unit.","authors":"Charlotte Hill,&nbsp;Sarah Sims,&nbsp;Magdalena Ap Robert,&nbsp;Sarah Collier","doi":"10.1177/17511437221116474","DOIUrl":"https://doi.org/10.1177/17511437221116474","url":null,"abstract":"<p><strong>Background: </strong>Recent guidelines in the UK have shaped Critical Care Units (CCUs) to bring the mental health needs of patients, and staff wellbeing to the forefront of service provision. A health board based in NHS Wales has trialled the secondment of a Mental Health Nurse (RMN) within a CCU to help service provision adhere to such guidelines.</p><p><strong>Methods: </strong>Critical care staff were invited to attend focus groups to share their experiences of how the RMN influenced service provision.</p><p><strong>Results: </strong>Thematic analysis identified five main themes; including 'smoother care pathways', 'a holistic approach to care', 'co-production', 'knowledge and confidence' and 'staff wellbeing'. Each of these themes reflected how the RMN had both direct and indirect benefits on patient and staff wellbeing.</p><p><strong>Conclusion: </strong>This qualitative exploration suggests that staff perceived value in the role of the RMN for both staff and patient outcomes, although further measures were considered necessary to improve staff-wellbeing within a critical care environment. This service evaluation supports recommendations for commissioning a RMN permanently in a CCU.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 3","pages":"292-298"},"PeriodicalIF":2.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515331/pdf/10.1177_17511437221116474.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41172125","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":"Silicone adhesive multilayer foam dressings for preventing facial pressure injuries in COVID-19 patients in prone position.","authors":"Pia Otto,&nbsp;Tobias Großkreutz,&nbsp;Stefan Köberich","doi":"10.1177/17511437221079122","DOIUrl":"https://doi.org/10.1177/17511437221079122","url":null,"abstract":"<p><p>The development of facial pressure injury (PI) during prone position is frequently described. During the COVID-19 pandemic, the number of patients with facial PIs increased. This quality improvement project describes the effectiveness of using silicone adhesive multilayer foams for preventing facial PIs in COVID-19 patients in need of prone position therapy. After introduction of foam dressing on chin and forehead to the standard protocol procedures for PI prevention, the decrease in number of patients developing facial PIs was statistically significant. Based on these results, the use of silicone adhesive multilayer foam will be implemented as a standard procedure for facial PIs prevention.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 3","pages":"332-334"},"PeriodicalIF":2.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8886309/pdf/10.1177_17511437221079122.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41132718","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 association between mean platelet volume and poor outcome in patients with COVID-19: Systematic review, meta-analysis, and meta-regression.","authors":"Ahmad Fariz Malvi Zamzam Zein,&nbsp;Catur Setiya Sulistiyana,&nbsp;Wilson Matthew Raffaelo,&nbsp;Raymond Pranata","doi":"10.1177/17511437221121234","DOIUrl":"10.1177/17511437221121234","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to assess the association between mean platelet volume (MPV) and poor outcome in patients with COVID-19.</p><p><strong>Methods: </strong>We performed a comprehensive literature search using the PubMed, Embase and Scopus databases with keywords \"2019-nCoV\" OR \"SARS-CoV-2\" OR \"COVID-19\" AND \"mean platelet volume\" OR \"MPV\" on 8 July 2021. The primary outcome was composite poor outcome, defined as severe COVID-19 or mortality. The pooled effect estimate was reported as mean differences in terms of MPV between the group with and without outcome.</p><p><strong>Results: </strong>There were 17 studies which consist of 4549 patients with COVID-19 were included in this study. The incidence of poor outcome was 25% (20%-30%). Mean MPV was found to be higher in the poor outcome group in compare to no poor outcome group (10.3 ± 1.9 fL vs 9.9 ± 1.7 fL). The mean MPV difference between both group was 0.47 fL [95% CI 0.27, 0.67], <i>p</i> < 0.001; <i>I</i>²: 62.91%, <i>p</i> < 0.001). In the sub-group analysis, patients with severe COVID-19 had higher MPV (mean difference 0.54 fL [95% CI 0.28, 0.80], <i>p</i> < 0.001; <i>I</i>²: 54.84%, <i>p</i> = 0.014). Furthermore, MPV was also higher in the mortality group (mean difference 0.54 fL [95% CI 0.29, 0.80], <i>p</i> = 0.020; <i>I</i>²: 71.11%, <i>p</i> = 0.004). Meta-regression analysis showed that the association between MPV and poor outcome was not affected by age (<i>p</i> = 0.789), gender (<i>p</i> = 0.167), platelets (<i>p</i> = 0.056), white blood cells (<i>p</i> = 0.639), and lymphocytes (<i>p</i> = 0.733).</p><p><strong>Conclusion: </strong>This meta-analysis indicated that increased MPV was associated with severity and mortality in patients with COVID-19. Further research is needed to determine the optimum cut-off point.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 3","pages":"299-308"},"PeriodicalIF":2.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515336/pdf/10.1177_17511437221121234.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41172813","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":"A comparative study into the effects of venous and arterial blood on clot microstructure in critically unwell patients. Assessment of the diagnostic potential of a biomarker of haemostasis.","authors":"Suresh Pillai,&nbsp;Vanessa Evans,&nbsp;Gareth Davies,&nbsp;Matthew J Lawrence,&nbsp;Janet Whitley,&nbsp;Ceri E Battle,&nbsp;Phylip R Williams,&nbsp;Keith Morris,&nbsp;Phillip A Evans","doi":"10.1177/17511437211060154","DOIUrl":"https://doi.org/10.1177/17511437211060154","url":null,"abstract":"<p><p>Blood for coagulation analysis can be sampled from the arterial or venous system in intensive care units (ICU). The determination of clot microstructure and strength by fractal analysis (d_<i>f</i>) gives valuable information in a range of vascular haemostatic disease and sepsis. We aimed to determine if d_<i>f</i> could be measured equally and comparatively in arterial or venous blood, and 45 critically ill patients in an ICU were recruited. d_<i>f</i> was found to be readily measured in arterial blood with results comparable to those in venous blood and that add value of d_<i>f</i> as a potential marker of haemostasis in these patients.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"224-226"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227903/pdf/10.1177_17511437211060154.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10297483","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}