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Journal of the Intensive Care Society
Journal Prestige (SJR): 0.215  Number of Followers: 5  Hybrid journal (It can contain Open Access articles)ISSN (Print) 1751-1437 Published by Sage Publications  [1176 journals]
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- End of life care at home: The role of critical care transfer services
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Authors: Varun Sudunagunta, Neeraj Singh, Pervez Khan, Peter O Beaumont
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background:Most people would rather die at home than in hospital but only 18% of patients do so. Palliative care focuses on the physical, spiritual and psychosocial wellbeing of patients and their families, which should include facilitating transfers home when possible. Patients can have more autonomy over their care and be surrounded by loved ones which can have a significant impact on their quality of life. In this article we describe two cases of home repatriation for palliation. Case 1 describes the transfer of a patient with difficulties and gaps in planning, but with a safe transfer ultimately. Case 2 recounts a more comprehensive planning process emphasising collaboration between teams.Benefits and difficulties of palliative critical care transfers:Facilitating home-based care aligns with patients’ desires for familiar surroundings and emotional support. A secondary benefit is that releasing a bed space allows another patient to receive critical care treatment. Challenges of palliative critical care transfers include needing a highly trained team and thorough planning. Early discussion with the family and community palliative care teams makes this a more feasible option for patients.Conclusion:A multidisciplinary team of hospital and community healthcare professionals working with the patient and their family can facilitate the transfer from intensive care to allow them to die at a place of their choosing. We should aim to fulfil these wishes at the end of life as it can greatly improve the patient’s and their family’s physical and emotional wellbeing during this difficult time.
Citation: Journal of the Intensive Care Society
PubDate: 2023-12-05T06:02:42Z
DOI: 10.1177/17511437231217878
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- Unheard and unseen: The hidden impact of nocebo communication in the
Intensive Care Unit-
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Authors: Kerrianne N Huynh, Sian Rouse-Watson, James Chu, Andrew S Lane, Allan M Cyna
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Citation: Journal of the Intensive Care Society
PubDate: 2023-11-30T05:34:10Z
DOI: 10.1177/17511437231214148
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- Book Review: Point of Care Ultrasound in Critical Care by Luke Flower and
Pradeep Madhivathanan-
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Authors: Peter G Brindley
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Citation: Journal of the Intensive Care Society
PubDate: 2023-11-20T10:50:23Z
DOI: 10.1177/17511437231213527
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- Gastric residual volume monitoring practices in UK intensive care units: A
web-based survey-
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Authors: Bethan Jenkins, Philip C Calder, Luise V Marino
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background and aim:Monitoring of gastric residual volume (GRV) to assess for enteral feeding intolerance is common practice in the intensive care unit (ICU) setting; however, evidence to support the practice is lacking. The aim of this study was: (i) to gain a perspective of current practice in adult ICUs in the UK around enteral feeding and monitoring of GRV, (ii) to characterise the threshold value used for a high GRV in clinical practice, (iii) to describe the impact of GRV monitoring on enteral feeding provision and (iv) to inform future research into the clinical value of GRV measurement in the adult ICU population.Methods:A web-based survey was sent to all UK adult ICUs. The survey consisted of questions pertaining to (i) nutritional assessment and enteral feeding practices, (ii) enteral feeding intolerance and GRV monitoring and (iii) management of raised GRV.Results:Responses were received from 101 units. Ninety-eight percent of units reported routinely measuring GRV, with 86% of ICUs using GRV to define enteral feeding intolerance. Threshold values for a high GRV varied from 200 to 1000 ml with frequency of measurement also differing greatly from 2 to 12 hourly. Initiation of pro-kinetic medication was the most common treatment for a high GRV. Fifty-two percent of respondents stated that volume of GRV would influence their decision to stop enteral feeds a lot or very much. Only 28% of units stated that they had guidelines for the technique for monitoring GRV.Conclusions:Measurement of GRV is the most common method of determining enteral feeding intolerance in adult ICUs in the UK. The practice continues despite evidence of poor validity and reproducibility of this measurement. Further research should be undertaken into the benefit of ongoing GRV measurements in the adult ICU population and alternative markers of enteral feeding intolerance.
Citation: Journal of the Intensive Care Society
PubDate: 2023-11-20T10:46:53Z
DOI: 10.1177/17511437231210483
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- The 2023 intensive care society cauldron: Five ways to tackle
sustainability-
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Authors: Richard Kirkdale, Rasmus Knudsen, Emily Yeung, Catherine Anderson, Nina Hjelde, Peter George Brindley
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Citation: Journal of the Intensive Care Society
PubDate: 2023-11-16T08:18:55Z
DOI: 10.1177/17511437231212072
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- Book Review: One Medicine: How Understanding Animals Can Save Your Life by
Matt Morgan-
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Authors: Peter G Brindley
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Citation: Journal of the Intensive Care Society
PubDate: 2023-10-30T04:26:07Z
DOI: 10.1177/17511437231206120
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- Dying to be better: Outlining the growing benefits of palliative care
training in intensive care medicine-
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Authors: Stuart Edwardson, Sophia Henderson, Conal Corr, Clair Clark, Monika Beatty
Abstract: Journal of the Intensive Care Society, Ahead of Print.
A core part of an intensivist’s work involves navigating the challenges of End of Life Care. While rates of survival from critical illness have gradually improved, 15%–20% of our patients die during their hospital admission, and a further 20% die within a year. 80% of our patients lack capacity to express their wishes with regard to treatment escalation planning. The critical care unit can be an excellent place to provide a good death, however the very nature of critical illness provides some obstacles to this. Prognostic uncertainty, time-pressured critical decision making, and lack of meaningful contact with a patient and their loved ones are but a few. In this article, we compare the ethos of critical care and palliative care medicine and explore how training in both of these specialities could be brought closer together and more formalised such that the intensivists of the future are more strongly equipped with the skills to shape a critical care unit to overcome these challenges and provide the best care to these patients, many of whom may be in the final phase of their life.
Citation: Journal of the Intensive Care Society
PubDate: 2023-10-25T11:04:59Z
DOI: 10.1177/17511437231207478
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- Prophylactic platelet transfusions in critical care: How low can you
go'-
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Authors: Akshay Shah, Simon J Stanworth, James C Doidge, Peter J Watkinson
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Citation: Journal of the Intensive Care Society
PubDate: 2023-10-25T09:32:04Z
DOI: 10.1177/17511437231206013
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- Dynamic dosing for continuous renal replacement therapy: Service
evaluation of the safety and effectiveness of titrating dose to
biochemistry-
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Authors: Jack C Eldridge, Aroon Bhardwaj Shah, Susana Lucena-Amaro, Christopher J Kirwan, John R Prowle, Yize I Wan
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Introduction:Continuous renal replacement therapy (CRRT) dose is usually fixed and primarily weight-based. Whilst this is safe, theoretically, underdosing or overdosing may occur in those requiring acute versus maintenance CRRT respectively. We have developed a dynamic dosing protocol for CRRT which individualises and updates dosing according to biochemistry. Here we describe the protocol and compare it to a fixed dose protocol to evaluate its safety and effectiveness.Methods:We conducted a service evaluation of this novel protocol using data from consecutive non-COVID-19 admissions receiving CRRT within Barts Health NHS trust, United Kingdom (UK). Fifty admissions using the dynamic protocol were compared to historically collected data from 108 admissions who used the fixed protocol. Acute and maintenance CRRT subgroups were analysed.Results:For the dynamic protocol 49 patients were treated with 135 CRRT circuits. One patient had two admissions. Protocol compliance (compared in one ICU) was 76% (dynamic) vs 61% (fixed) (p
Citation: Journal of the Intensive Care Society
PubDate: 2023-09-29T09:33:14Z
DOI: 10.1177/17511437231202898
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- Major incident preparedness in a post pandemic world: A survey of
anaesthetists-
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Authors: James Brooks, Sarah Marsden, Stuart Andrew Edwardson
Abstract: Journal of the Intensive Care Society, Ahead of Print.
The COVID-19 pandemic profoundly changed anaesthetic and critical care departments across the UK and fulfilled the definition of a major incident for an extended period of time. It is regularly highlighted that individual and organisational readiness for major incident is inconsistent, as is support in the aftermath. Post-pandemic rates of anxiety and PTSD in healthcare staff have significantly increased, but we still have no embedded method of helping to prevent it. Clinical debriefing is an emerging tool with proven improved psychological outcomes for staff following an adverse event. We surveyed 354 anaesthetists of a range of grades and experiences prior to attending a webinar centred on major incident organisation, human factors and clinical debrief. While 73.8% knew where to access their hospital’s major incident plan, only 16.8% had been trained in any form of clinical debrief. Only 29% had ever received any formal training in major incident management. It seems that the occurrence of major incidents is no longer a ‘once in a career’ event. The inconsistencies in training and preparedness shown in our survey highlight opportunities for our workforce to be more agile and subsequently better supported for the future.
Citation: Journal of the Intensive Care Society
PubDate: 2023-09-26T08:33:37Z
DOI: 10.1177/17511437231202962
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- A multi-national survey to identify health professionals’ opinions for
the appropriate frequency of urine output monitoring in post-operative
patients-
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Authors: Hannah Baggot, Martin Whyte, Lui Forni, Luke Hodgson, Christina Koulouglioti
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Urine output is an important clinical measurement and oliguria may highlight the development of acute kidney injury (AKI) earlier than serum creatinine (sCr). Despite the importance of urine output monitoring, there are no definitive guidelines or recommendations for best practice. A survey was sent to healthcare professionals with a specialist interest in AKI to gather opinions of what constitutes a good standard of urine output monitoring and by corollary missed care, post- major surgery. Data was gathered from 221 respondents. Results will inform audit and improvement projects in post-operative nursing care.
Citation: Journal of the Intensive Care Society
PubDate: 2023-09-20T12:14:43Z
DOI: 10.1177/17511437231199900
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- Nebuliser therapy in critical care: The past, present and future
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Authors: Andrew Arnott, Malcolm Watson, Malcolm Sim
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Nebulisers are devices that reduce a body of liquid into a fine aerosol suitable for inhalation. Utilising the efficiency of pulmonary drug absorption, they offer a safe and powerful modality for local and systemic drug delivery in the treatment of critical illness. In comparison to conventional jet (JN) and ultrasonic nebulisers (USN), the advent of vibrating mesh nebulisers (VMN) has significantly improved the therapeutic potential of modern devices. This review article aims to summarise the history and evolution of nebulisers from first inception through to the modern vibrating mesh technology. It provides an overview on the basic science of nebulisation and pulmonary drug delivery, and the current use of nebulised therapies in critical care.
Citation: Journal of the Intensive Care Society
PubDate: 2023-09-20T07:22:57Z
DOI: 10.1177/17511437231199899
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- Guidance to inform research recruitment processes for studies involving
critically ill patients-
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Authors: Kerry Woolfall, Katie Paddock, Megan Watkins, Anna Kearney, Katie Neville, Lucy Frith, Ingeborg Welters, Carrol Gamble, John Trinder, Natalie Pattison, Catherine White, Stephen Brett, Steve Dilworth, Mike Ross, Paul Mouncey, Kathy Rowan, Angus Dawson, Clive Collet, Tim Walsh, Bridget Young
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Clinical research in intensive care units (ICUs) is essential for improving treatments for critically ill patients. However, invitations to participate in clinical research in this situation pose numerous challenges. Studies are frequently initiated within a narrow time window when patients are often unconscious and unable to consent. Consultations or consent discussions must therefore be held with consultees or representatives, usually the patient’s relatives. Conversations about research participation in this setting may be difficult, as relatives are often overwhelmed and may feel uneasy about making decisions on behalf of their relatives. In some circumstances, legislation allows doctors to act as consultees or representatives to enrol patients in research. However, there is little good quality evidence on UK stakeholders’ perspectives to inform how recruitment is carried out in ICU studies. The Perspectives Study collected evidence on the views of over 1400 stakeholders, including patients, relatives and healthcare practitioners, many of whom had first-hand experience of ICU treatment and research. This evidence was used to inform good practice guidance on recruitment of critically ill patients to research. Established social science methods and empirical ethics were employed to reflect the interests of stakeholders and justify recommendations. This guidance aims to bridge the gap between the legal frameworks and the realities of ICU studies and to ensure that research recruitment processes reflect the views of patients and families. Researchers and an expert Advisory Group brought different perspectives to interpreting the evidence to develop the guidance. In this article we present guidance for future ICU studies.
Citation: Journal of the Intensive Care Society
PubDate: 2023-09-08T09:44:16Z
DOI: 10.1177/17511437231197293
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- The effect of conservative oxygen therapy on mortality in adult critically
ill patients: A systematic review and meta-analysis of randomised
controlled trials-
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Authors: Daniel S Martin, Helen T Mckenna, Kathryn M Rowan, Doug W Gould, Paul R Mouncey, Michael PW Grocott, David A Harrison
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background: Oxygen is the commonest intervention provided to critically ill patients requiring mechanical ventilation. Despite this, it is unclear how much oxygen should be administered to patients in order to promote the best clinical outcomes and it has been suggested that a strategy of conservative oxygen therapy (COT) may be advantageous. We therefore sought to answer the question of whether COT versus usual or liberal oxygen therapy was beneficial to adult patients receiving mechanical ventilation on an intensive care unit (ICU) by performing a systematic review and meta-analysis.Methods:Studies were included if they were randomised controlled trials comparing COT to liberal or usual oxygen therapy strategies in acutely ill adults (aged ⩾18 years) admitted to an ICU, and reported an outcome of interest. Studies were excluded if they were limited to a specific single disease diagnosis. The review was registered on PROSPERO (CRD42022308436). Risk of bias was assessed using a modified Cochrane Risk of Bias assessment tool. Effect estimates were pooled using a random effects model with the between study variance estimated using restricted maximum likelihood and standard errors calculated using the method of Hartung-Knapp/Sidik-Jonkman. Between study heterogeneity was quantified using the I2 statistic. The certainty in the body of evidence was assessed using GRADE criteria.Results:Nine eligible studies with 5727 participants fulfilled all eligibility criteria. Trials varied in their definitions of COT and liberal or usual oxygen therapy. The pooled estimate of risk ratio for 90 day mortality for COT versus comparator was 0.99 (95% confidence interval 0.88–1.12, 95% prediction interval 0.82–1.21). There was low heterogeneity among studies (I2 = 22.4%). The finding that mortality was similar for patients managed with COT or usual/liberal oxygen therapy was graded as moderate certainty.Conclusions:In critically ill adults admitted to an ICU, COT is neither beneficial nor harmful when compared to usual or liberal oxygen therapy. Trials to date have been inconsistent in defining both COT and liberal or usual oxygen therapy, which may have had an impact on the results of this meta-analysis. Future research should focus on unifying definitions and outcome measures.
Citation: Journal of the Intensive Care Society
PubDate: 2023-08-23T12:12:48Z
DOI: 10.1177/17511437231192385
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- Standards for research in NHS Wales critical care units: A modified Delphi
study-
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Authors: Paul Twose, Ceri Lynch, Richard Pugh, Tamas Szakmany
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Introduction:The importance of research and development in all aspects of healthcare is well acknowledged. Within critical care, national guidelines provide a limited number of standards and series of recommendations on Research and Development (R&D) activity. The aim of this study was to create a broader set of standards in support of R&D activity in critical care departments.Methods:A modified Delphi study was undertaken across NHS Wales critical care units. Proposed standards were developed by a group of experts, which across three rounds, majority agreement was sought. Additional standards were added based on participant’s responses.Results:This study identified 49 standards for R&D activity within critical care units in NHS Wales. All these standards reached majority agreement, as determined by>70% of multi-disciplinary participants determine each standard as essential.Conclusions:The results of this study will be utilised within Wales to inform wider service specification with regard workforce requirements, responsibilities, reporting and collaboration.
Citation: Journal of the Intensive Care Society
PubDate: 2023-07-29T09:33:30Z
DOI: 10.1177/17511437231189438
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- Malnutrition incidence in individuals with body-mass index>25 kg/m2 on
admission to intensive care-
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Authors: Kate McCully, Alice Extance
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Precise and timely nutrition support is essential for good outcomes in a critical care setting. Individuals with body mass index (BMI) in the overweight or obese category are often assumed to be well nourished, and are therefore at risk of being overlooked for nutrition support. This single centre clinical audit evaluated the incidence of malnutrition on admission of patients with BMI > 25. Results suggested that 70%–80% of individuals in this category can be considered either malnourished or at risk of malnutrition. This demonstrates the need for urgent, personalised nutritional care for critically ill patients regardless of body size.
Citation: Journal of the Intensive Care Society
PubDate: 2023-07-17T12:32:18Z
DOI: 10.1177/17511437231185726
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- Learning to clap: A post-COVID19 recovery story
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Authors: Peter Julian, Mark ZY Tan
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Citation: Journal of the Intensive Care Society
PubDate: 2023-07-13T10:37:10Z
DOI: 10.1177/17511437231186691
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- The carbon footprint of Bubble-PAPR™: A novel item of personal
protective equipment-
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Authors: Annie Pinder, Li Fang, Rosie Hillson, Ingeborg Steinbach, Brendan McGrath, Cliff Shelton
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background:Personal protective equipment has important environmental impacts, assessing these impacts is therefore an important element of personal protective equipment design. We applied carbon footprinting methodology to Bubble-PAPR™, a novel, part-reusable and part-recyclable powered air-purifying respirator, designed at our institution. Current guidance states that disposable respirator masks can be worn for 1-h in the United Kingdom, whilst the Bubble-PAPR™ allows prolonged use.Methods:Following a detailed use-case analysis, the carbon footprint of each component was estimated using a bottom-up (attributional) cradle-to-grave process-based analysis. Modelling considered the use of virgin or closed loop recycled polyvinyl chloride for the disposable hood element, and disposal via infectious or recycling waste streams to estimate a per-use carbon footprint.Results:The per-use carbon footprint with manufacture from virgin polyvinyl chloride and disposal via incineration is 0.805 kgCO2e. With nine cycles of closed loop recycling and manufacture of the polyvinyl chloride hood (10 uses), the carbon footprint falls to an average of 0.570 kgCO2e per use.Conclusion:Carbon footprinting may contribute to the value proposition of this novel technology. We estimate that a single Bubble-PAPR™ use has a higher carbon footprint than disposable respirator mask-based PPE. However, this is mitigated in circumstances when multiple disposable mask changes are required (e.g. prolonged use) and use may be justifiable when user comfort, visualisation and communication with patients and colleagues are essential.
Citation: Journal of the Intensive Care Society
PubDate: 2023-07-11T10:00:13Z
DOI: 10.1177/17511437231173349
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- The use of neurone specific enolase to prognosticate neurological recovery
and long term neurological outcomes in OOHCA patients-
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Authors: Caitlyn Maher, Matthew Cadd, Maya Nunn, Jennifer Worthy, Rebecca Gray, Owen Boyd
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Introduction: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.Methods: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.Results: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.Conclusion: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.
Citation: Journal of the Intensive Care Society
PubDate: 2023-06-29T08:54:47Z
DOI: 10.1177/17511437231160089
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- Phase I pilot safety and feasibility of a novel restraint device for
critically ill patients requiring mechanical ventilation-
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Authors: Biren B Kamdar, Janelle M Fine, Marie T Pavini, Sara S Ardren, Stephanie Burns, Jason HT Bates, Ryan S McGinnis, Vinciya Pandian, Benjamin H Lin, Dale M Needham, Renee D Stapleton
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background:Mechanically ventilated Intensive Care Unit (ICU) patients often require wrist restraints, contributing to immobility and agitation, over-sedation, and delirium. The Exersides® Refraint® (Healthy Design, LLC), a novel restraint alternative, may be safe and facilitate greater mobility than traditional restraints.Objective:This National Institutes of Health Small Business Technology Transfer (STTR) Program Grant-funded single-site Phase I feasibility study evaluated Exersides® safety and feasibility in anticipation of a multi-site Phase II randomized controlled trial (RCT).Methods:In two academic ICUs, mechanically ventilated adults ⩾25 years old who were non-comatose, required restraints and had an expected stay of ⩾2 days were enrolled to wear Exersides® and traditional wrist restraints for 4 h on day 1, in a randomized order, and in the reverse order on day 2. Main outcomes were Exersides® safety (i.e., patient/clinician lacerations/injuries), feasibility (i.e., ⩾90% of required data collected), and patient/family/clinician feedback.Results:Eight patients were enrolled; one no longer required restraints at initiation, yielding seven subjects (median [interquartile range (IQR)] age 65 [55, 70] years, 86% men). All seven wore Exersides®, averaging (SD) 2.5 (1.0) hours per session, with no safety events reported. Across restraint time periods, 92% and 100% of Richmond Agitation-Sedation Scale (RASS) and wrist actigraphy data, respectively, were collected. Feedback was positive (more movement and comfortable than traditional restraints) and constructive (bulky, intimidating to apply).Conclusions:This pilot study provided key safety and feasibility data for a Phase II RCT evaluating Exersides® versus traditional wrist restraints. Feedback motivated minor device modifications before RCT initiation.
Citation: Journal of the Intensive Care Society
PubDate: 2023-06-23T09:16:49Z
DOI: 10.1177/17511437231182503
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- Continuous infusion ketamine for sedation of mechanically ventilated
adults in the intensive care unit: A scoping review-
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Authors: Nicholas David Richards, William Weatherhead, Simon Howell, Mark Bellamy, Ruben Mujica-Mota
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Introduction:Mechanical ventilation (MV) is a common and often live-saving intervention on the Intensive Care Unit (ICU). The optimisation of sedation to mechanical ventilation is fundamental, and inappropriate sedation has been associated with worse outcomes. This scoping review has been designed to answer the question ‘What is known about the use of ketamine as a continuous infusion to provide sedation in mechanically ventilated adults in the intensive care unit, and what are the gaps in the evidence'’Methods:The protocol was designed using the PRISMA-ScR checklist and the JBI manual for evidence synthesis. Data were extracted and reviewed by a minimum of two reviewers.Results:Searches of electronic databases (PubMed, OVID, Scopus, Web of Science) produced 726 results; 45 citations were identified for further eligibility assessment, an additional five studies were identified through keyword searches, and 12 through searching reference lists. Of these 62 studies, 27 studies were included in the final review: 6 case reports/case series, 11 retrospective cohort/observational studies, 1 prospective cohort study, 9 prospective randomised studies.Conclusion:We found a lack of high-quality well-designed studies investigating the use of continuous ketamine sedation on ICU. The available data suggests this intervention is safe and well tolerated, however this is of very low certainty given the poor quality of evidence.
Citation: Journal of the Intensive Care Society
PubDate: 2023-06-20T12:09:32Z
DOI: 10.1177/17511437231182507
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- Creating a smart classroom in intensive care using assisted reality
technology-
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Authors: Charlotte Willis, Jessica Dawe, Christopher Leng
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background:Medical students receive relatively little exposure to intensive care medicine throughout their undergraduate training. The COVID-19 pandemic further hindered students’ exposure with the entrance to intensive care units (ICU) limited. To address the problem, this study explored the use of assisted reality technology to create a smart classroom in intensive care.Methods:Six intensive care teaching sessions were live streamed to groups of medical students (n = 33) using wearable assisted reality glasses, and the results were pooled for analysis. Feedback from students and educators was collected using the evaluation of technology-enhanced learning materials (ETELM).Results:The response rate for the ETELM-learner and ETELM-educator perceptions was 100%. Students strongly agreed that the session was well organised, relevant and that the navigation of technology-based components was logical and efficient. Students strongly disagreed that their learning was negatively affected by technology issues. Educators reported some difficulties with balancing teaching delivery alongside the clinical demands of the ICU and some minor technological issues.Discussion:There is potential for smart classrooms to revolutionise intensive care education. The use of smart classrooms on intensive care using assisted reality technology was well received by students and educators. The main limitations included the cost of the technology and risk of technology issues. There is a significant role for smart classrooms to continue in the post-pandemic period as they provide an open and safe platform for students to explore intensive care medicine and ask questions that they may feel less able to raise in the busy clinical environment.
Citation: Journal of the Intensive Care Society
PubDate: 2023-06-06T05:21:01Z
DOI: 10.1177/17511437231178207
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- Focused transoesophageal TOE (fTOE): A new accreditation pathway
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Authors: Antonio Rubino, Marcus Peck, Ashley Miller, Thomas Edmiston, Andrew A Klein, Robert Orme, Vinoth Sankar, Nick Fletcher, Niall O’Keeffe, Henry Skinner
Abstract: Journal of the Intensive Care Society, Ahead of Print.
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.
Citation: Journal of the Intensive Care Society
PubDate: 2023-06-05T12:45:23Z
DOI: 10.1177/17511437231173350
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- biomArker-guided Duration of Antibiotic treatment in hospitalised Patients
with suspecTed Sepsis (ADAPT-Sepsis): A protocol for a multicentre
randomised controlled trial-
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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
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Aim: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.Design:Multicentre three-arm randomised controlled trial.Setting:UK NHS hospitals.Target population:Hospitalised critically ill adults who have been commenced on intravenous antibiotics for sepsis.Health technology: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.Conclusion: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.
Citation: Journal of the Intensive Care Society
PubDate: 2023-04-26T05:45:36Z
DOI: 10.1177/17511437231169193
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- Intensive care nurses’ experiences of caring for isolated COVID-positive
patients during first wave of COVID-19-
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Authors: Allan Køster, Anthony Vincent Fernandez, Christian Sylvest Meyhoff, Lars Peter Kloster Andersen
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background: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.Methods: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.Findings: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.Conclusion: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.
Citation: Journal of the Intensive Care Society
PubDate: 2023-04-18T07:26:09Z
DOI: 10.1177/17511437231160073
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- Preparing internal medicine trainees for their intensive care rotations:
What are we doing across the UK'-
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Authors: Amy Fox
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Internal medicine trainees (IMTs) comprise a significant portion of rotational junior doctors in intensive care units (ICUs) in the UK. Provision of formal training for this role is highly variable, delivered by only 67% of units responding to our UK-wide survey. Topics most often covered in formal training include renal medicine, airway management, pharmacology, ventilators, vascular access and assessing the critically unwell patient. The results of the survey have been used to design a follow-up national survey of IMTs to elicit their perceived training needs when undertaking their intensive care medicine rotation.
Citation: Journal of the Intensive Care Society
PubDate: 2023-04-13T06:07:09Z
DOI: 10.1177/17511437231163694
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- Is high sensitivity troponin, taken regardless of a clinical indication,
associated with 1 year mortality in critical care patients'-
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Authors: Jonathan Hinton, Maclyn Augustine, Lavinia Gabara, Mark Mariathas, Rick Allan, Florina Borca, Zoe Nicholas, Neil Gillett, Chun Shing Kwok, Paul Cook, Michael PW Grocott, Mamas Mamas, Nick Curzen
Abstract: Journal of the Intensive Care Society, Ahead of Print.
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) p = 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.
Citation: Journal of the Intensive Care Society
PubDate: 2023-03-30T01:37:49Z
DOI: 10.1177/17511437231160078
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- Management of acute aortic dissection in critical care
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Authors: Luke Flower, Joseph E Arrowsmith, Jeremy Bewley, Samantha Cook, Graham Cooper, Jake Flower, Renata Greco, Syed Sadeque, Pradeep R Madhivathanan
Abstract: Journal of the Intensive Care Society, Ahead of Print.
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.
Citation: Journal of the Intensive Care Society
PubDate: 2023-03-29T12:04:59Z
DOI: 10.1177/17511437231162219
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- Developing key performance indicators for adult critical care transfer
services: Scoping review and Delphi technique-
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Authors: Nick Haslam, Aurelien Giouse, Jonathon Dean, Mamoun Abu-Habsa, Simon J Finney
Abstract: Journal of the Intensive Care Society, Ahead of Print.
In 2021 NHS England commissioned regional Adult Critical Care Transfer Services. These services will replace a historically predominant ad hoc approach to adult critical care transfers nationally. It is anticipated that these new formal services will provide a system of robust regional & national governance previously acknowledged to be deficient. As part of this process, it is important that an agreed set of transfer service quality indicators are developed to drive equitable improvement in patient care. We used a Delphi technique to develop a set of key performance indicators through consensus for a recently established London critical care transfer service. We believe this may be the first-time key performance indicators have been developed for adult critical care transfer services using a consensus method. We hope services will consider tracking similar measures to enable benchmarking and drive improvements in patient care.
Citation: Journal of the Intensive Care Society
PubDate: 2023-02-13T05:25:53Z
DOI: 10.1177/17511437231153049
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- 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-
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Authors: Mary E Phillips, Jessica Zekavica, Rajesh Kumar, Rajiv Lahiri, Justin Kirk-Bayley, Amish Patel, Adam E Frampton
Abstract: Journal of the Intensive Care Society, Ahead of Print.
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 (n = 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.
Citation: Journal of the Intensive Care Society
PubDate: 2023-02-11T09:10:21Z
DOI: 10.1177/17511437231153045
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- Assessment of neuropsychiatric manifestations in a cohort of intensive
care unit survivors: A proof of concept study-
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Authors: Steen K Fagerberg, Mary Kruse, Tilde Skovkær Withen Olesen, Heidi Andersen, Kirsten Klostergaard, Peter Derek Christian Leutscher
Abstract: Journal of the Intensive Care Society, Ahead of Print.
The aim of this study was to assess the feasibility and outcome of a neuropsychiatric evaluation protocol intended for adult intensive care unit survivors in a Danish regional hospital, in which a follow-up consultation was conducted 2 months after hospital discharge. Twenty-three participants were able to finalize the neuropsychiatric evaluation, and 20 (87%) among those were detected with neuropsychiatric manifestations, including cognitive impairment (n = 17; 74%) and fatigue (n = 17, 74%). This study finds a high prevalence of neuropsychiatric manifestations and fatigue, and evaluates a follow-up protocol for the ICU patient population.
Citation: Journal of the Intensive Care Society
PubDate: 2023-02-07T09:08:01Z
DOI: 10.1177/17511437231151527
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- A simple mortality prediction model for sepsis patients in intensive care
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Authors: Hazem Koozi, Adina Lidestam, Maria Lengquist, Patrik Johnsson, Attila Frigyesi
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background:Sepsis is common in the intensive care unit (ICU). Two of the ICU’s most widely used mortality prediction models are the Simplified Acute Physiology Score 3 (SAPS-3) and the Sequential Organ Failure Assessment (SOFA) score. We aimed to assess the mortality prediction performance of SAPS-3 and SOFA upon ICU admission for sepsis and find a simpler mortality prediction model for these patients to be used in clinical practice and when conducting studies.Methods:A retrospective study of adult patients fulfilling the Sepsis-3 criteria admitted to four general ICUs was performed. A simple prognostic model was created using backward stepwise multivariate logistic regression. The area under the curve (AUC) of SAPS-3, SOFA and the simple model was assessed.Results:One thousand nine hundred eighty four admissions were included. A simple six-parameter model consisting of age, immunosuppression, Glasgow Coma Scale, body temperature, C-reactive protein and bilirubin had an AUC of 0.72 (95% confidence interval (CI) 0.69–0.75) for 30-day mortality, which was non-inferior to SAPS-3 (AUC 0.75, 95% CI 0.72–0.77) (p = 0.071). SOFA had an AUC of 0.67 (95% CI 0.64–0.70) and was inferior to SAPS-3 (p
Citation: Journal of the Intensive Care Society
PubDate: 2023-02-02T07:02:50Z
DOI: 10.1177/17511437221149572
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- An international survey exploring the adoption and utility of diagnostic
lung ultrasound by physiotherapists and respiratory therapists in
intensive care-
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Authors: Yin Hung Lau, Simon Hayward, George Ntoumenopoulos
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Introduction: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.Objectives: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.Methods:International ICU therapists were invited to answer a 37 question cross-sectional open e-survey, distributed using the online survey tool REDCap®. 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® for an 8-week period between March and May 2021.Results:Three hundred twenty ICU therapists from 30 countries responded with most respondents coming from either the United Kingdom (n = 94) or Australia (n = 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.Conclusions: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 from ICU therapists internationally with a desire to adopt LUS into their assessments and upskill their practice. ICU therapists’ use of LUS could allow more targetted and appropriate treatment for patients on ICU. Barriers to LUS adoption could be mitigated by having access to quality training programmes and mentorship. Development of profession specific guidance and policies within local infrastructure should facilitate growth and ensure robust quality assurance and governance processes.
Citation: Journal of the Intensive Care Society
PubDate: 2023-02-02T07:01:30Z
DOI: 10.1177/17511437221148920
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