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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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- Research report: Management of dysphagia using pharyngeal electrical
stimulation in the general intensive care population – A service
development-
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Authors: Thomas Williams, Elizabeth Walkden, Karishma Patel, Naomi E Cochrane, Brendan A McGrath, Sarah Wallace
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background:Dysphagia places a substantial burden on the critically ill, affecting 12%–84% of this cohort, and is independently associated with worse outcomes. Pharyngeal electrical stimulation (PES-treatment) is a novel dysphagia therapy with an emerging evidence base. This retrospective observational study describes our dysphagia service and reports the use of PES-treatment as a standard of care in recovering critically ill patients at a single-site tertiary UK hospital.Methods:Patients admitted to Acute or Cardio-Thoracic adult intensive care units between 1st July 2017 and 30th June 2022 were routinely referred to Speech and Language Therapy (SLT) following tracheostomy, or suspected dysphonia/dysphagia. Clinical assessments and direct laryngeal visualisation using Fibreoptic Evaluation of Swallowing (FEES) were performed. Severe dysphagia was defined as Penetration-Aspiration Score of ⩾6 and patients were offered PES-treatment when staffing allowed.Results:Of 289 patients with severe dysphagia, 19 underwent a course of PES-treatment with the remaining patients receiving standard care. PES-treatment patients were significantly less likely to remain nil-by-mouth (11.1% vs 62.5%, Chi2 p
Citation: Journal of the Intensive Care Society
PubDate: 2024-08-20T06:48:20Z
DOI: 10.1177/17511437241270244
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- Intensive care unit contact lens care: Evaluating staff understanding and
promoting patient safety-
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Authors: Harry E Skinner, Anand D Padmakumar
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Citation: Journal of the Intensive Care Society
PubDate: 2024-08-17T06:15:59Z
DOI: 10.1177/17511437241272268
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- Levelling up, with autism in mind
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Authors: Aoife Abbey
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Citation: Journal of the Intensive Care Society
PubDate: 2024-08-17T06:14:40Z
DOI: 10.1177/17511437241270258
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- Developing a tool for assessing and communicating the expected difficulty
of performing a tracheostomy-
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Authors: Jonathon Clymo, Mike Dean, Chris Lambert, Matthew Rollin
Abstract: Journal of the Intensive Care Society, Ahead of Print.
There are no guidelines for assessing and communicating the expected difficulty of a tracheostomy, leading to difficulties planning a percutaneous approach in intensive care or referring onwards to surgical teams. A Delphi process was used to develop a tool containing metrics which are relevant for either specialty and can be universally assessed by both. Palpable tracheal rings, prior surgery or radiotherapy to the anterior neck, uncorrectable clotting or platelet dysfunction, ability to extend the neck freely, and overlying vessels visible, palpable or on imaging were all found to be relevant. It is hoped this tool will aid communication between specialties.
Citation: Journal of the Intensive Care Society
PubDate: 2024-08-07T05:30:56Z
DOI: 10.1177/17511437241270261
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- Contribution of intrapulmonary shunt to the pathogenesis of profound
hypoxaemia in viral infection: a mechanistic discussion with an
illustrative case-
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Authors: Tom Lyne, Luigi Camporota, Hugh Montgomery
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background:The formation of anastomoses between the pulmonary arteries and pulmonary veins, or the pulmonary and the bronchial circulation, is part of normal foetal lung development. They persist in approximately 30% of adults at rest, and open in almost all adults during exertion. Blood flowing through these anastomoses bypasses the alveolar surface and increases in such shunting can thus cause hypoxaemia. This is now known to contribute to the pathogenesis of hypoxaemia in COVID-19 disease. We here provide evidence to support a similar role in influenza A infection.Illustrative case presentation:We describe a case of influenza A infection associated with severe hypoxaemia, poorly responsive to supplemental oxygen and which worsened following the application of continuous positive airway pressure (CPAP), despite the presence of a normal physical examination, chest radiograph and echocardiogram. This combination suggests a significant intrapulmonary (extra-alveolar) shunt as a cause of the severe hypoxaemia. The shunt fraction was estimated to be approximately 57%.Discussion and conclusion:Intrapulmonary vascular shunts can contribute substantially to hypoxaemia in viral infection. Seeking to understand the pathogenesis of observed hypoxaemia can help guide respiratory therapy. Mechanistic research may suggest novel therapeutic targets which could assist in avoiding intubation and mechanical ventilatory support.
Citation: Journal of the Intensive Care Society
PubDate: 2024-08-07T05:29:26Z
DOI: 10.1177/17511437241267745
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- An exploration of intensive care unit patents’ experiences of the
Addenbrooke’s Cognitive Examination (ACE-III) as a screening tool for
cognitive functioning at different points in recovery from critical
illness-
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Authors: Rachel Clarke, Aishah Hannan, Homen Chow, Lydia Bowering-Sheehan, Kristy Kerrison, Amelia Bullock, Holly Schofield
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Being critically ill can result in cognitive change. Cognitive functioning should be screened at different points in the care pathway, and it is important to understand patient’s experience of this process. A service evaluation examined fifteen in-patients’ and eleven outpatients’ experiences of completing the Addenbrookes Cognitive Examination-III (ACE-III) using thematic analysis. Four themes emerged: (1) willingness & acceptability (2) strengths and weaknesses (3) factors affecting performance and (4) improving delivery. Generally, patients accepted the ACE-III and valued cognitive screening. Consideration is given to areas for development.
Citation: Journal of the Intensive Care Society
PubDate: 2024-08-06T05:07:01Z
DOI: 10.1177/17511437241241242
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- Eye tracking during a simulated start of shift safety check: An
observational analysis of gaze behavior of critical care nurses-
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Authors: Yael van der Geest, Ivan Chau, Pedro David Wendel-Garcia, Philipp K Buehler, Wolf Hautz, Miodrag Filipovic, Daniel A Hofmaenner, Urs Pietsch
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background:The handover and associated shift start checks by nurses of critical care patients are complex and prone to errors. However, which aspects lead to errors remains unknown. Fewer errors might occur in a structured approach. We hypothesized that specific gaze behavior during handover and shift start safety check correlates with error recognition.Methods:In our observational eye tracking study, we analyzed gaze behavior of critical care nurses during handover and shift start safety check in a simulation room with built-in errors. Four areas of interest (AOI) were pre-defined (patient, respirator, prescriptions, monitor). The primary outcome were different gaze metrics (time to first fixation, revisits, first visual intake duration, average visual intake duration, dwell time) on AOIs. Parameters were analyzed by taking all errors in account, and by dividing them into minor and critical.Results:Forty-three participants were included. All participants committed at least a minor error (n = 43, 100%), at least one critical error occurred in 29 participants (67%). Taking all errors into account, longer time to first fixation and more revisits were associated with an increased risk of missing errors (Time to First Fixation: OR 1.099 (95% CI 1.023–1.191, p = 0.0002), Revisits: OR 1.080 (95% CI 1.025–1.143, p = 0.0055)).Conclusion:Error detection during shift start safety check was associated with distinct gaze behavior. Nurses who recognized more errors had a shorter time to first fixation and less revisits. These gaze characteristics might correspond to a more structured approach. Further research is necessary, for example by implementing a checklist, to reduce errors in the future and improve patient safety.
Citation: Journal of the Intensive Care Society
PubDate: 2024-08-02T08:50:38Z
DOI: 10.1177/17511437241268160
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- Book Review: Cases in Paediatric Critical Care Transfer and Retrieval
Medicine by Shelley Riphagen and Sam Foster-
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Authors: Jonny Coppel
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Citation: Journal of the Intensive Care Society
PubDate: 2024-07-27T08:56:17Z
DOI: 10.1177/17511437241264981
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- A survey of United Kingdom intensive care echocardiography provision
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Authors: Waqas Akhtar, Lenster Marshal, Helen Buglass, Thomas Billyard, Charlotte Goedvolk, Reinout Mildner, Hannah Conway, Hatem Soliman Aboumarie, Ashley Miller, Marcus Peck, Antonio Rubino
Abstract: Journal of the Intensive Care Society, Ahead of Print.
This study, conducted under the oversight of National Health Service Blood & Transplant, aimed to evaluate the current feasibility and implementation of both comprehensive and focused donor echocardiography in United Kingdom Intensive Care Units through a nationwide survey. Responses from 95 hospitals across all 4 UK nations showed each ICU had median 4 (IQR 2, 6) personal with 3 (IQR 2, 5) consultants and 1 (IQR 0, 2) registrar trained in focused echocardiography. A comprehensive echocardiogram can be acquired in 48% (n = 46) of hospitals within 6 h during regular working hours. This percentage drops to 11% (n = 10) outside of regular working hours, with 53% (n = 50) indicating this would require more than 24 h. In the case of focused echocardiogram acquisition, 60% (n = 57) of hospitals can obtain it within 6 h during normal working hours. This figure decreases to 20% (n = 19) outside of regular working hours, with 32% (n = 30) indicating that this would require more than 24 h to obtain. Overall, 98% of responding units (n = 93) have point-of-care ultrasound machines (median 2 (IQR 2, 3) machines per ICU) all equipped with echocardiographic capabilities. However, only 52% (n = 49) of respondents indicated have the ability for remote viewing of echocardiogram images.
Citation: Journal of the Intensive Care Society
PubDate: 2024-07-27T08:54:37Z
DOI: 10.1177/17511437241264978
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- Peripherally administered vasopressors in critically ill adult patients: A
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Authors: Nauman Hussain, Tomas Jovaisa, Zudin Puthucheary, Rupert Pearse, Mandeep K Phull
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background:Peripherally administered vasopressor infusions are used to support critically ill patients. The Intensive Care Society recently published guidelines supporting their use. Preliminary evidence suggests variability in peripheral vasopressor infusion use. We aimed to characterise current practice in the use of peripheral vasopressor infusions in the UK National Health Service and to capture the views of healthcare professionals caring for critically ill adult patients.Method:We conducted an online survey of healthcare professionals from December 2022 to March 2023. Our survey used Google Forms and was shared via email, X (formerly twitter), and mobile phone messaging within the UK. Health Research Authority approval was sought, and ethical approval was not required.Results:We received 227 responses and our survey showed variation in the use of peripherally administered vasopressor infusions in critically ill patients across UK National Health Service hospitals. About 87.7% of healthcare professionals initiated peripheral vasopressor infusions in their clinical role. Peripheral vasopressor use was limited to low dose, short durations of infusions, however, there was variability. Metaraminol was the most used peripheral vasopressor (90.3%). Only 22.5% of healthcare professionals used peripherally administered noradrenaline in practice. Our respondents agreed that equipoise exists.Conclusion:Our survey found variability in the use of peripheral vasopressors and in care delivered to critically ill patients in the UK. Our survey shows there are ongoing concerns regarding safety, dosing ranges and durations of use. Future research is required to explore the optimal role that peripheral vasopressor infusions can play in the care of critically ill patients.
Citation: Journal of the Intensive Care Society
PubDate: 2024-07-26T05:00:17Z
DOI: 10.1177/17511437241259443
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- Inflammatory and transudative B-line patterns on lung ultrasound: a brief
communication-
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Authors: Arvind Rajamani, Anwar Hassan, Pranav Arun Bharadwaj, Hemamalini Arvind, Stephen Huang
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Lung ultrasonic B-lines have high accuracy in diagnosing extravascular lung water (ELW) but have not been systematically subcategorized to differentiate the varied etiologies of ELW. This brief communication describes subcategories of B-lines into “inflammatory” and “transudative” patterns, based on their location, pleural morphology and associated subpleural pathologies. This subcategorization was derived using information from trainees undergoing lung ultrasound training in the Learning Ultrasound in Critical Care program, pathophysiological principles and their corresponding ultrasound correlates. This subcategorization helped trainees differentiate inflammatory pathologies of ELW (e.g. pneumonia, acute respiratory distress syndrome) from transudative (congestive) pathologies (e.g. fluid overload, cardiac failure).
Citation: Journal of the Intensive Care Society
PubDate: 2024-06-20T05:42:46Z
DOI: 10.1177/17511437241259438
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- The efficacy, safety and effectiveness of hyperoncotic albumin solutions
in patients with sepsis: A systematic review and meta-analysis-
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Authors: Jonathan Bannard-Smith, Mohamed Elrakhawy, Gill Norman, Rhiannon Owen, Tim Felton, Paul Dark
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background:Intravenous fluid therapy is a ubiquitous intervention for the management of patients with sepsis, however excessive cumulative fluid balance has been shown to result in worse outcomes. Hyperoncotic albumin is presented in low volumes, is an effective resuscitation fluid and may have effects beyond plasma volume expansion alone. This systematic review aimed to assess the efficacy, safety and effectiveness of hyperoncotic albumin solutions in the management of sepsis.Methods:We searched four databases and two trial registries for controlled clinical trials of hyperoncotic albumin for management of sepsis. Review outcomes were mortality, need for renal replacement therapy, cumulative-fluid balance, and need for organ support. We used methods guided by the Cochrane Handbook for reviews of clinical interventions. Studies were assessed using Cochrane’s Risk of Bias 2 tool. We performed pairwise meta-analysis where possible. Certainty of evidence was assessed using GRADE.Results:We included six trials; four (2772 patients) were meta-analysed. Most studies had moderate or high risk of bias. There was no significant difference in 28-day mortality for septic patients receiving hyperoncotic albumin compared to other intravenous fluids (OR 0.95, [95% CI: 0.8–1.12]); in patients with septic shock (2013 patients) there was a significant reduction (OR 0.82 [95% CI: 0.68–0.98]). There was no significant difference in safety outcomes. Hyperoncotic albumin was associated with variable reduction in early cumulative fluid balance and faster resolution of shock.Conclusions:There is no good-quality evidence to support the use of hyperoncotic albumin in patients with sepsis, but it may reduce short-term mortality in the sub-groups with septic shock. It appears safe in terms of need for renal replacement therapy and is associated with reduced early cumulative fluid balance and faster resolution of shock. Larger, better quality randomised controlled trials in patients with septic shock may enhance the certainty of these findings.Review registration:PROSPERO ref: CRD42021150674
Citation: Journal of the Intensive Care Society
PubDate: 2024-06-20T04:59:47Z
DOI: 10.1177/17511437241259437
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- Retrospective service evaluation of a specialist weaning unit
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Authors: John Finnerty, Sonya E Gill, Emily Alcock, Eleanor Johnson, Emma Flowers, Jemma Price, Andrew Bentley, Tim Felton
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Specialist weaning units (SWUs) aim to liberate patients with complex weaning failure from mechanical ventilation and facilitate their discharge from the ICU. This retrospective service evaluation reports the outcomes of a SWU at Wythenshawe Hospital, Manchester between 2017 and 2019. In total, 75.0% (n = 33/44) of patients survived to hospital discharge. Of these patients, 72.7% (n = 24/33) were self-ventilating. Overall, 1-year survival was 68.2% (n = 30/44), whilst 5-year survival was 52.3% (n = 23/44). Whilst this study is relatively small, these findings are encouraging and further support the case for SWUs.
Citation: Journal of the Intensive Care Society
PubDate: 2024-06-06T05:19:43Z
DOI: 10.1177/17511437241257117
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- Autism in ICU
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Authors: Rosaleen Baruah
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Autism is a lifelong neurodevelopmental condition. Autistic people face challenges as patients in the intensive care unit (ICU) and as providers of healthcare in the ICU. This article describes the experience of autistic people using a neurodiversity-affirming approach. Using the ‘Autistic SPACE’ framework, the needs of autistic people are described in terms of sensory needs, need for predictability, need for autistic acceptance, communication differences and how to approach them, and the benefits of a person-centred empathy-based approach to autistic people. The approach to autistic patients is described in terms of reasonable adjustments within a framework of positive risk taking. For supervisors and managers of autistic healthcare professionals, autism-friendly adjustments to training and working practice, with rationales, are suggested.
Citation: Journal of the Intensive Care Society
PubDate: 2024-04-23T05:45:17Z
DOI: 10.1177/17511437241249847
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- Intensive care unit admission criteria: a scoping review
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Authors: James Soares, Catherine Leung, Victoria Campbell, Anton Van Der Vegt, James Malycha, Christopher Andersen
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background:Effectively identifying deteriorated patients is vital to the development and validation of automated systems designed to predict clinical deterioration. Existing outcome measures used for this purpose have significant limitations. Published criteria for admission to high acuity inpatient areas may represent markers of patient deterioration and could inform the development of alternate outcome measures.Objectives:In this scoping review, we aimed to characterise published criteria for admission of adult inpatients to high acuity inpatient areas including intensive care units. A secondary aim was to identify variables that are extractable from electronic health records (EHRs).Data sources:Electronic databases PubMed and ProQuest EBook Central were searched to identify papers published from 1999 to date of search. We included publications which described prescriptive criteria for admission of adult inpatients to a clinical area with a higher level of care than a general hospital ward.Charting methods:Data was extracted from each publication using a standardised data-charting form. Admission criteria characteristics were summarised and cross-tabulated for each criterion by population group.Results:Five domains were identified: diagnosis-based criteria, clinical parameter criteria, organ-support criteria, organ-monitoring criteria and patient baseline criteria. Six clinical parameter-based criteria and five needs-based criteria were frequently proposed and represent variables extractable from EHRs. Thresholds for objective clinical parameter criteria varied across publications, and by disease subgroup, and universal cut-offs for criteria could not be elucidated.Conclusions:This study identified multiple criteria which may represent markers of deterioration. Many of the criteria are extractable from the EHR, making them potential candidates for future automated systems. Variability in admission criteria and associated thresholds across the literature suggests clinical deterioration is a heterogeneous phenomenon which may resist being defined as a single entity via a consensus-driven process.
Citation: Journal of the Intensive Care Society
PubDate: 2024-04-16T04:19:06Z
DOI: 10.1177/17511437241246901
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- Evaluating the clinical and cost-effectiveness of a conservative approach
to oxygen therapy for invasively ventilated adults in intensive care:
Protocol for the UK-ROX trial-
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Authors: Daniel S Martin, Tasnin Shahid, Doug W Gould, Alvin Richards-Belle, James C Doidge, Julie Camsooksai, Walton N Charles, Miriam Davey, Amelia Francis Johnson, Roger M Garrett, Michael PW Grocott, Joanne Jones, Lamprini Lampro, Lorna Miller, B Ronan O’Driscoll, Anthony J Rostron, Zia Sadique, Tamas Szakmany, Paul J Young, Kathryn M Rowan, David A Harrison, Paul R Mouncey
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background:In the United Kingdom, around 184,000 adults are admitted to an intensive care unit (ICU) each year with over 30% receiving mechanical ventilation. Oxygen is the commonest therapeutic intervention provided to these patients but it is unclear how much oxygen should be administered for the best clinical outcomes.Methods:The UK-ROX trial will evaluate the clinical and cost-effectiveness of conservative oxygen therapy (the minimum oxygen concentration required to maintain an oxygen saturation of 90% ± 2%) versus usual oxygen therapy in critically ill adults receiving supplemental oxygen when invasively mechanically ventilated in ICUs in England, Wales and Northern Ireland. The trial will recruit 16,500 patients from approximately 100 UK adult ICUs. Using a deferred consent model, enrolled participants will be randomly allocated (1:1) to conservative or usual oxygen therapy until ICU discharge or 90 days after randomisation.Objectives:The primary clinical outcome is all cause mortality at 90 days following randomisation.Discussion:The UK-ROX trial has received ethical approval from the South Central – Oxford C Research Ethics Committee (Reference: 20/SC/0423) and the Confidentiality Advisory Group (Reference: 22/CAG/0154). The trial commenced in May 2021 and, at the time of publication, 95 sites had opened to recruitment.
Citation: Journal of the Intensive Care Society
PubDate: 2024-04-12T04:59:06Z
DOI: 10.1177/17511437241239880
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- “It saved me”: A thematic analysis of experiences of psychological
therapy following critical illness and intensive care-
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Authors: Rachel Clarke, Victoria Weare, Homen Chow, Lydia Bowering-Sheehan, Clark Hitchcock
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background:ICU-survivors are likely to struggle with psychological wellbeing. Providing post-ICU therapeutic interventions is a relatively novel field and little is known about patients’ experiences.Methods:Thematic analysis was used to analyze semi-structured interviews with 20 ICU-survivors who had accessed psychological therapy following discharge from an ICU in the Southwest of Britain. Descriptive statistics were used to summarize data to provide service related contextual information.Results:Five themes emerged from the data: the impact of critical illness, value of therapy, accessing therapy, process of therapy and role of psychologist. Psychological therapy is viewed as an important part of recovery. Critical illness is a complex experience. Therapy supported sense-making, acceptance and moving forwards. Although therapy could be initially difficult, there were lasting positive effects. There were different challenges to and facilitators of accessing therapy and offering ongoing support provided reassurance. A safe therapeutic relationship and an ICU-specific service was important.Conclusion:Psychological therapy, alongside other rehabilitation interventions, can facilitate recovery. Considerations for local and wider service development are discussed.
Citation: Journal of the Intensive Care Society
PubDate: 2024-03-26T10:06:44Z
DOI: 10.1177/17511437241241243
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- Decompressive craniectomy: A primer for acute care practitioners
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Authors: Peter George Brindley, Mark Sanderson, Dustin Anderson, Cian O’Kelly
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Decompressive craniectomy (DC) involves surgical removal of the skull that overlies swollen, imperiled, brain. This is done to combat intracranial hypertension and mitigate a vicious cycle of secondary brain injury. If, instead, this pathophysiology goes uninterrupted, it can mean brain herniation and brain stem death. As such, DC can save lives when all else fails. Regardless, it is no panacea and can also “ruin deaths,” and leave patients profoundly disabled. DC is not a new procedure; however, this therapy is increasingly noteworthy due to advances in neurocritical care, alongside ethical concerns. We cover the physiological rationale, the surgical basics, the trial data, and focus on secondary decompression (for refractory intracranial pressure (ICP)) rather than primary decompression (i.e. during evacuation of an intracranial mass). Given that DC should not be undertaken indiscriminately, we conclude by introducing ways in which to discuss DC with families and colleagues. Our goal is to provide a primer and common resource for the multidisciplinary team. We aim to increase not only knowledge but wisdom, prudence, collegiality, and family-focused care.
Citation: Journal of the Intensive Care Society
PubDate: 2024-03-25T04:30:15Z
DOI: 10.1177/17511437241237760
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- Outcomes of percutaneous versus surgical tracheostomy in an Australian
Quaternary Intensive Care Unit: An entropy-balanced retrospective study-
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Authors: Nilesh Anand Devanand, Venkatesan Thiruvenkatarajan, Wai-Man Liu, Isuru Sirisinghe, Stefan Court-Kowalski, Lee Pryor, Anne Gatley, Sandeep Sethi, Krishnaswamy Sundararajan
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background:Studies comparing percutaneous tracheostomy (PT) and surgical tracheostomy (ST) complications in the critically ill patient population with high acuity, complexity, and severity of illness are sparse. This study evaluated the outcomes of elective PT versus ST in such patients managed at a quaternary referral center.Aims:The primary aim was to detect a difference in hospital mortality between the two techniques. The secondary aims were to compare Intensive Care Unit (ICU) mortality, complications (including stoma site, tracheostomy-related, and decannulation complications), ICU and hospital length of stay, and time to decannulation.Methods:This was a single-center retrospective observational study of ICU admission from August 2018 to August 2021. Patients were included if an elective tracheostomy was performed during their ICU admission. Patients with a pre-existing tracheostomy and those who underwent an obligatory tracheostomy requirement (e.g. total laryngectomy) were excluded. Cohorts were matched using Hainmueller’s entropy balancing. Binary data were evaluated using logistic regression and continuous data with ordinary least squares regression.Results:349 patients with a tracheostomy were managed in the ICU during the observation period. They were predominantly males (75% in PT; 67% in ST), with a mean age in the PT and ST group of (47; SD = 18) and (55; SD = 16), respectively. After exclusion, 135 patients remained, with 63 in the PT group and 72 in the ST group. Patients receiving ST were significantly older with a higher Body Mass Index (BMI) than the PT group. There were no significant differences in gender, Acute Physiological And Chronic Health Evaluation (APACHE) III, and the Australian and New Zealand Risk Of Death (ANZROD) between the two groups. There was no difference in hospital mortality between groups (OR 0.91, CI 0.26–3.18, p = 0.88). There were also no differences in ICU mortality, ICU and hospital length of stay, and time to decannulation. PT was associated with a greater likelihood of complications (OR 4.19; 95% CI 1.73–10.13; p
Citation: Journal of the Intensive Care Society
PubDate: 2024-03-19T03:49:33Z
DOI: 10.1177/17511437241238877
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- Understanding aggression displayed by patients and families towards
intensive care staff: A systematic review-
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Authors: Varadaraj Sridharan, Kelvin CY Leung, Carmelle Peisah
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Objectives:The objective of this systematic review was to synthesise literature pertaining to patient and family violence (PFV) directed at Intensive Care Unit (ICU) staff.Design:Study design was a systematic review. The data was not amenable to meta-analysis.Data Sources and Review Methods:Electronic searches of databases were conducted to identify studies between 1 January 2000 and 6 March 2023, limited to literature in English only. Published empirical peer-reviewed literature of any design (qualitative or quantitative) were included. Studies which only described workplace violence outside of ICU, systematic reviews, commentaries, editorials, letters, non-English literature and grey literature were excluded. All studies were appraised for quality and risk of bias using validated tools.Results:Eighteen studies were identified: 13 quantitative; 2 qualitative and 3 mixed methodology. Themes included: (i) what is abuse and what do I do about it' (ii) who is at risk' (iii) it is common, but how common' (iv) workplace factors; (v) impact on patient care; (vi) effect on staff; (vii)the importance of the institutional response; and (viii) current or suggested solutions.Conclusions:This systematic review demonstrated that PFV in the ICU is neither well-understood nor well-managed due to multiple factors including non-standardised definition of abuse, normalisation, inadequate organisational support and general lack of education of staff and public. This will guide in future research and policy decision making.
Citation: Journal of the Intensive Care Society
PubDate: 2024-03-16T10:48:30Z
DOI: 10.1177/17511437241231707
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- The barriers to and facilitators of implementing early mobilisation for
patients with delirium on intensive care units: A systematic review-
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Authors: Jacqueline Bennion, Christopher Manning, Stephanie K Mansell, Roger Garrett, Daniel Martin
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background:Early mobilisation of critically ill patients remains variable across practice. This study set out to determine barriers to and facilitators of early mobilisation for patients diagnosed with delirium in the intensive care unit (ICU).Methods:A mixed-methods descriptive systematic review. Electronic databases (AMED, BNI, CINAHL Plus, Cochrane Library, Medline and EMBASE) were searched for publications up to 22nd December 2021. Independent reviewers screened studies and extracted data using Covidence Systematic Review Management software. Data were summarised according to frequency (n/%) of barriers and facilitators. Thematic analysis of qualitative studies was carried out in order to address the secondary aim. Quantitative studies were assessed using the GRADE quality assessment tool. Qualitative studies were analysed according to the GRADE-CERQual quality assessment tool. This study was prospectively registered on PROSPERO (CRD 42021227655).Results:Ten studies met the inclusion criteria. Quantitative findings demonstrated the presence of delirium was the most common reported barrier to early mobilisation. The most common facilitator was ICU staff experience of positive outcomes as a result of early mobilisation interventions. Thematic analysis identified six main themes that may describe potential meanings behind these findings: (1) knowledge, (2) personal preferences, (3) perceived burden of delirium, (4) perceived complexity, (5) decision-making and (6) culture.Conclusion:These findings highlight the reported need to further understand the impact and value of early mobilisation as a non-pharmacological intervention for patients diagnosed with delirium in ICU. Evaluation of early mobilisation interventions involving key stakeholders may address these concerns and provide effective implementation strategies.
Citation: Journal of the Intensive Care Society
PubDate: 2024-03-07T05:53:11Z
DOI: 10.1177/17511437231216610
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- Association between critical care admission and chronic medication
discontinuation post-hospital discharge: A retrospective cohort study-
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Authors: Charvi Kanodia, Richard S Bourne, Elizabeth T Mansi, Nazir I Lone
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background: Discontinuation of important chronic medication after hospitalisation is common. This study aimed to investigate the association between critical care (vs non-critical care) admission and discontinuation of chronic medications post-hospital discharge, along with factors associated with discontinuation among critical care survivors. Methods: This was a retrospective cohort study in Lothian, Scotland of adults who were admitted to hospital between 01/01/2012 and 31/12/2019 and survived to hospital discharge. Medication classes investigated were statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs), beta-blockers, oral anticoagulants, and thyroid hormones. The risk of medication discontinuation for each class was estimated by odds ratios (OR), with 95% confidence intervals (95%CI), using multivariable logistic regression adjusted for patient demographics, main clinical condition, and index comorbidity. A secondary analysis assessed factors associated with discontinuation in critical care survivors. Results: There were 22,340 critical care and 367,185 non-critical care survivors included. Critical care admission had the highest association with ACEi/ARBs discontinuation (adjusted OR 2.41, 95%CI: 2.26–2.58), followed by oral anticoagulants (adjusted OR 1.33, 95%CI: 1.15–1.53), and beta blockers (adjusted OR 1.18, 95%CI: 1.07–1.29). There was no significant association with thyroid hormones or statin discontinuation. Among critical care survivors, hospital length of stay of 14 days or more was associated with increased discontinuation across all medication classes. Conclusion: Critical care admission was associated with discontinuation of three out of five medication classes studied (ACEi/ARBs, beta-blockers, and oral anticoagulants). Further research is needed to understand the reason for increased medication discontinuation in critical care survivors and how these risks can be mitigated to improve patient outcomes.
Citation: Journal of the Intensive Care Society
PubDate: 2024-03-01T10:52:36Z
DOI: 10.1177/17511437241230260
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- Swallowing during provision of helmet ventilation: Review and provisional
multidisciplinary guidance-
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Authors: José Vergara, Michael J Brenner, Stacey A Skoretz, Vinciya Pandian, Amy Freeman-Sanderson, Alessandra Dorça, Debra Suiter, Martin B Brodsky
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Use of noninvasive ventilation provided by a helmet increased globally during and after the COVID-19 pandemic. This approach may reduce need for intubation and its associated clinical complications in critically ill patients. Use of helmet interface minimizes virus aerosolization while enabling verbal communication, oral feeding and coughing/expectoration of secretions during its administration. Although improved oral hydration is a recognized benefit of helmet NIV, relatively little is known about the safety and efficiency of swallowing during helmet NIV. Risk of aspiration is a key consideration given the fragile pulmonary status of critically ill patients requiring respiratory support, and therefore the decision to initiate oral intake is best made based on multidisciplinary input. We reviewed the current published evidence on NIV and its effects on upper airway physiology and swallowing function. We then presented a case example demonstrating preservation of swallowing performance with helmet NIV. Last, we offer provisional multidisciplinary guidance for clinical practice, and provide directions for future research.
Citation: Journal of the Intensive Care Society
PubDate: 2024-03-01T04:51:38Z
DOI: 10.1177/17511437241231704
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- Are routine chest radiographs still indicated after central line
insertion' A scoping review-
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Authors: P. G. Brindley, J. Deschamps, L. Milovanovic, B. M. Buchanan
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Introduction:Central venous catheters are increasingly inserted using point-of-care ultrasound (POCUS) guidance. Following insertion, it is still common to request a confirmatory chest radiograph for subclavian and internal jugular lines, at least outside of the operating theater. This scoping review addresses: (i) the justification for routine post-insertion radiographs, (ii) whether it would better to use post-insertion POCUS instead, and (iii) the perceived barriers to change.Methods:We searched the electronic databases, Ovid MEDLINE (1946-) and Ovid EMBASE (1974-), using the MESH terms (“Echography” OR “Ultrasonography” OR “Ultrasound”) AND “Central Venous Catheter” up until February 2023. We also searched clinical practice guidelines, and targeted literature, including cited and citing articles. We included adults (⩾18 years) and English and French language publications. We included randomized control trials, prospective and retrospective cohort studies, systematic reviews, and surveys.Results:Four thousand seventy-one articles were screened, 117 full-text articles accessed, and 41 retained. Thirteen examined cardiac/vascular methods; 5 examined isolated contrast-enhanced ultrasonography; 7 examined isolated rapid atrial swirl sign; and 13 examined combined/integrated methods. In addition, three systematic reviews/meta-analyses and one survey addressed barriers to POCUS adoption.Discussion:We believe that the literature supports retiring the routine post-central line chest radiograph. This is not only because POCUS has made line insertion safer, but because POCUS performs at least as well, and is associated with less radiation, lower cost, time savings, and greater accuracy. There has been less written about perceived barriers to change, but the literature shows that these concerns- which include upfront costs, time-to-train, medicolegal concerns and habit- can be challenged and hence overcome.
Citation: Journal of the Intensive Care Society
PubDate: 2024-02-20T03:37:44Z
DOI: 10.1177/17511437241227739
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- When is directed deceased donation justified' Practical, ethical, and
legal issues-
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Authors: David Shaw, Dale Gardiner, Rutger Ploeg, Anne Floden, Jessie Cooper, Alicia Pérez-Blanco, Tineke Wind, Lydia Dijkhuizen, Nichon Jansen, Bernadette Haase-Kromwijk
Abstract: Journal of the Intensive Care Society, Ahead of Print.
This paper explores whether directed deceased organ donation should be permitted, and if so under which conditions. While organ donation and allocation systems must be fair and transparent, might it be “one thought too many” to prevent directed donation within families' We proceed by providing a description of the medical and legal context, followed by identification of the main ethical issues involved in directed donation, and then explore these through a series of hypothetical cases similar to those encountered in practice. Ultimately, we set certain conditions under which directed deceased donation may be ethically acceptable. We restrict our discussion to the allocation of organs to recipients already on the waiting list.
Citation: Journal of the Intensive Care Society
PubDate: 2024-02-14T06:49:41Z
DOI: 10.1177/17511437241231705
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- Improving eye care in an intensive care unit
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Authors: Mertcan Sevgi, Emma Monachello, Mark Yates, David Lockington, Richard Cowan
Abstract: Journal of the Intensive Care Society, Ahead of Print.
In Intensive Care Units (ICUs), patients are at risk of developing ocular complications, especially exposure keratopathy. Plan, Do, Study, Act for PDSA cycle. Despite national guidelines, implementation remains challenging. Using the PDSA cycle, we devised an eye care protocol integrated into the electronic patient record system, complemented by a poster summary of guidelines. An initial audit showed 2% adherence to eye exposure guidelines; post-intervention, adherence rose to 76%. A 9-month analysis revealed 16% of patients experienced eye exposure in ICU. This initiative emphasises the new protocol’s efficacy and the role of education in its adoption, advocating a more standardised approach to eye care in ICUs.
Citation: Journal of the Intensive Care Society
PubDate: 2024-01-28T07:30:10Z
DOI: 10.1177/17511437241228587
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- Exploring the recovery journey of COVID-19 critical care survivors during
the first year after hospital discharge-
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Authors: Lena Wodecka, Christina Koulouglioti, Ana-Carolina Gonçalves, Adele Hill, Luke Hodgson
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Objectives:To explore the longitudinal recovery of patients admitted to critical care following COVID-19 over the year following hospital discharge. To understand the important aspects of the patients’ recovery process and key elements of their caregivers’ experiences during this time.Design:A longitudinal qualitative study using semi-structured interviews.Setting:Two acute hospitals in South East England and follow-up in the community.Participants:Six COVID-19 critical care survivors from the first wave of the pandemic (March–May 2020) and five relatives were interviewed 3 months after hospital discharge. The same six survivors and one relative were interviewed again at 1 year. Interviews were transcribed verbatim, anonymised and a reflexive thematic analysis was conducted.Results:Three themes were developed: (1) ‘The cycle of guilt, fear and stigma’; (2) ‘Facing the uncertainties of recovery’ and (3) ‘Coping with lingering symptoms – the new norm’. The first theme highlights survivors’ reluctance to share their experiences associated with contracting the disease. The second theme, explores challenges faced by the survivors and their relatives in navigating the recovery process, given the unknown nature of the illness. The final theme illustrates the mechanisms survivors develop to come to terms with the remnants of their illness and critical care stay.Conclusions:The longitudinal nature of the study highlighted the persisting symptoms of long COVID-19, their impact on survivors and coping methods amidst the ongoing pandemic. Further research into the experiences of those affected in the first and subsequent waves of the COVID-19 pandemic, is desirable to help guide the formulation of the optimally supported recovery pathways.
Citation: Journal of the Intensive Care Society
PubDate: 2024-01-23T12:54:27Z
DOI: 10.1177/17511437241227738
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- Psychotropic prescribing after hospital discharge in survivors of critical
illness, a retrospective cohort study (2012–2019)-
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Authors: Elizabeth T Mansi, Christopher T Rentsch, Richard S Bourne, Bruce Guthrie, Nazir I Lone
Abstract: Journal of the Intensive Care Society, Ahead of Print.
Background:Many people survive critical illness with the burden of new or worsened mental health issues and sleep disturbances. We examined the frequency of psychotropic prescribing after critical illness, comparing critical care to non-critical care hospitalised survivors, and whether this varied in important subgroups.Methods:This retrospective cohort study included 23,340 critical care and 367,185 non-critical care hospitalised adults from 2012 through 2019 in Lothian, Scotland, who survived to discharge.Results:One-third of critical care survivors (32%; 7527/23,340) received a psychotropic prescription within 90 days after hospital discharge (25% antidepressants; 14% anxiolytics/hypnotics; 4% antipsychotics/mania medicines). In contrast, 15% (54,589/367,185) of non-critical care survivors received a psychotropic prescription (12% antidepressants; 5% anxiolytics/hypnotics; 2% antipsychotics/mania medicines). Among patients without psychotropic prescriptions within 180 days prior to hospitalisation, after hospital discharge, the critical care group had a higher incidence of psychotropic prescription (10.3%; 1610/15,609) compared with the non-critical care group (3.2%; 9743/307,429); unadjusted hazard ratio (HR) 3.39, 95% CI: 3.22–3.57. After adjustment for potential confounders, the risk remained elevated (adjusted HR 2.03, 95% CI: 1.91–2.16), persisted later in follow-up (90–365 days; adjusted HR 1.38, 95% CI: 1.30–1.46), and was more pronounced in those without recorded comorbidities (adjusted HR 3.49, 95% CI: 3.22–3.78).Conclusions:Critical care survivors have a higher risk of receiving psychotropic prescriptions than hospitalised patients, with a significant proportion receiving benzodiazepines and other hypnotics. Future research should focus on the requirement for and safety of psychotropic medicines in survivors of critical illness, to help guide policy for clinical practice.
Citation: Journal of the Intensive Care Society
PubDate: 2024-01-19T08:56:09Z
DOI: 10.1177/17511437231223470
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