Subjects -> MEDICAL SCIENCES (Total: 8185 journals)
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EMERGENCY AND INTENSIVE CRITICAL CARE (121 journals)                     

Showing 1 - 124 of 124 Journals sorted alphabetically
AACN Advanced Critical Care     Full-text available via subscription   (Followers: 36)
Academic Emergency Medicine     Hybrid Journal   (Followers: 90)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acute and Critical Care     Open Access   (Followers: 9)
Acute Cardiac Care     Hybrid Journal   (Followers: 11)
Acute Medicine     Full-text available via subscription   (Followers: 8)
Advances in Emergency Medicine     Open Access   (Followers: 16)
Advances in Neonatal Care     Hybrid Journal   (Followers: 43)
African Journal of Anaesthesia and Intensive Care     Full-text available via subscription   (Followers: 7)
African Journal of Emergency Medicine     Open Access   (Followers: 7)
AINS - Anasthesiologie - Intensivmedizin - Notfallmedizin - Schmerztherapie     Hybrid Journal   (Followers: 5)
American Journal of Emergency Medicine     Hybrid Journal   (Followers: 54)
Annals of Emergency Medicine     Hybrid Journal   (Followers: 132)
Annals of Intensive Care     Open Access   (Followers: 37)
Annals of the American Thoracic Society     Full-text available via subscription   (Followers: 15)
Archives of Academic Emergency Medicine     Open Access   (Followers: 6)
Archives of Trauma Research     Open Access   (Followers: 4)
ASAIO Journal     Hybrid Journal   (Followers: 2)
Australasian Journal of Paramedicine     Open Access   (Followers: 7)
Australian Critical Care     Full-text available via subscription   (Followers: 21)
Bangladesh Critical Care Journal     Open Access   (Followers: 1)
BMC Emergency Medicine     Open Access   (Followers: 25)
BMJ Quality & Safety     Hybrid Journal   (Followers: 65)
Burns Open     Open Access  
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine     Hybrid Journal   (Followers: 2)
Case Reports in Acute Medicine     Open Access   (Followers: 3)
Case Reports in Critical Care     Open Access   (Followers: 13)
Case Reports in Emergency Medicine     Open Access   (Followers: 19)
Chronic Wound Care Management and Research     Open Access   (Followers: 7)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 32)
Clinical Intensive Care     Hybrid Journal   (Followers: 6)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 3)
Clinical Risk     Hybrid Journal   (Followers: 5)
Crisis: The Journal of Crisis Intervention and Suicide Prevention     Hybrid Journal   (Followers: 15)
Critical Care     Open Access   (Followers: 74)
Critical Care and Resuscitation     Full-text available via subscription   (Followers: 29)
Critical Care Clinics     Full-text available via subscription   (Followers: 34)
Critical Care Explorations     Open Access   (Followers: 3)
Critical Care Medicine     Hybrid Journal   (Followers: 293)
Critical Care Research and Practice     Open Access   (Followers: 13)
Current Emergency and Hospital Medicine Reports     Hybrid Journal   (Followers: 5)
Current Opinion in Critical Care     Hybrid Journal   (Followers: 73)
Disaster and Emergency Medicine Journal     Open Access   (Followers: 12)
Egyptian Journal of Critical Care Medicine     Open Access   (Followers: 2)
EMC - Urgenze     Full-text available via subscription  
Emergency Care Journal     Open Access   (Followers: 7)
Emergency Medicine (Medicina neotložnyh sostoânij)     Open Access  
Emergency Medicine Australasia     Hybrid Journal   (Followers: 17)
Emergency Medicine Clinics of North America     Full-text available via subscription   (Followers: 19)
Emergency Medicine International     Open Access   (Followers: 8)
Emergency Medicine Journal     Hybrid Journal   (Followers: 53)
Emergency Medicine News     Full-text available via subscription   (Followers: 7)
Emergency Nurse     Full-text available via subscription   (Followers: 17)
Enfermería Intensiva (English ed.)     Full-text available via subscription  
European Burn Journal     Open Access   (Followers: 12)
European Journal of Emergency Medicine     Hybrid Journal   (Followers: 23)
Frontiers in Emergency Medicine     Open Access   (Followers: 8)
Global Journal of Transfusion Medicine     Open Access   (Followers: 1)
Hong Kong Journal of Emergency Medicine     Full-text available via subscription   (Followers: 5)
Indian Journal of Burns     Open Access   (Followers: 2)
Injury     Hybrid Journal   (Followers: 20)
Intensive Care Medicine     Hybrid Journal   (Followers: 82)
Intensive Care Medicine Experimental     Open Access   (Followers: 2)
Intensivmedizin up2date     Hybrid Journal   (Followers: 4)
International Journal of Critical Illness and Injury Science     Open Access   (Followers: 1)
International Journal of Emergency Medicine     Open Access   (Followers: 9)
International Journal of Emergency Mental Health and Human Resilience     Open Access   (Followers: 2)
International Paramedic Practice     Full-text available via subscription   (Followers: 14)
Iranian Journal of Emergency Medicine     Open Access  
Irish Journal of Paramedicine     Open Access   (Followers: 2)
Journal Européen des Urgences et de Réanimation     Hybrid Journal   (Followers: 1)
Journal of Acute Care Physical Therapy     Hybrid Journal   (Followers: 4)
Journal of Cardiac Critical Care TSS     Open Access   (Followers: 1)
Journal Of Cardiovascular Emergencies     Open Access  
Journal of Concussion     Open Access  
Journal of Critical Care     Hybrid Journal   (Followers: 48)
Journal of Critical Care Medicine     Open Access   (Followers: 18)
Journal of Education and Teaching in Emergency Medicine     Open Access   (Followers: 1)
Journal of Emergencies, Trauma and Shock     Open Access   (Followers: 13)
Journal of Emergency Medical Services     Full-text available via subscription   (Followers: 12)
Journal of Emergency Medicine     Hybrid Journal   (Followers: 53)
Journal of Emergency Medicine, Trauma and Acute Care     Open Access   (Followers: 25)
Journal of Emergency Practice and Trauma     Open Access   (Followers: 6)
Journal of Intensive Care     Open Access   (Followers: 9)
Journal of Intensive Care Medicine     Hybrid Journal   (Followers: 22)
Journal of Intensive Medicine     Open Access  
Journal of Neuroanaesthesiology and Critical Care     Open Access   (Followers: 3)
Journal of Stroke Medicine     Hybrid Journal  
Journal of the American College of Emergency Physicians Open     Open Access   (Followers: 1)
Journal of the Intensive Care Society     Hybrid Journal   (Followers: 4)
Journal of the Royal Army Medical Corps     Hybrid Journal   (Followers: 6)
Journal of Thrombosis and Haemostasis     Hybrid Journal   (Followers: 81)
Journal of Translational Critical Care Medicine     Open Access   (Followers: 5)
Journal of Trauma and Acute Care Surgery, The     Hybrid Journal   (Followers: 34)
La Presse Médicale Open     Open Access  
Médecine de Catastrophe - Urgences Collectives     Hybrid Journal  
Medicina Intensiva     Open Access   (Followers: 3)
Medicina Intensiva (English Edition)     Hybrid Journal   (Followers: 1)
Mediterranean Journal of Emergency Medicine & Acute Care : MedJEM     Open Access  
Notfall + Rettungsmedizin     Hybrid Journal   (Followers: 3)
OA Critical Care     Open Access   (Followers: 3)
OA Emergency Medicine     Open Access   (Followers: 2)
Open Access Emergency Medicine     Open Access   (Followers: 6)
Open Journal of Emergency Medicine     Open Access   (Followers: 2)
Palliative Care : Research and Treatment     Open Access   (Followers: 19)
Palliative Medicine     Hybrid Journal   (Followers: 54)
Prehospital Emergency Care     Hybrid Journal   (Followers: 19)
Regulatory Toxicology and Pharmacology     Hybrid Journal   (Followers: 41)
Research and Opinion in Anesthesia and Intensive Care     Open Access   (Followers: 3)
Resuscitation     Hybrid Journal   (Followers: 54)
Resuscitation Plus     Open Access   (Followers: 1)
Saudi Critical Care Journal     Open Access   (Followers: 2)
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine     Open Access   (Followers: 11)
Seminars in Thrombosis and Hemostasis     Hybrid Journal   (Followers: 45)
Shock : Injury, Inflammation, and Sepsis : Laboratory and Clinical Approaches     Hybrid Journal   (Followers: 10)
Sklifosovsky Journal Emergency Medical Care     Open Access  
The Journal of Trauma Injury Infection and Critical Care     Full-text available via subscription   (Followers: 24)
Therapeutics and Clinical Risk Management     Open Access   (Followers: 1)
Transplant Research and Risk Management     Open Access  
Trauma Case Reports     Open Access   (Followers: 1)
Trauma Monthly     Open Access   (Followers: 3)
Visual Journal of Emergency Medicine     Full-text available via subscription   (Followers: 1)
Western Journal of Emergency Medicine     Open Access   (Followers: 11)
 AEM Education and Training : A Global Journal of Emergency Care     Open Access   (Followers: 1)

           

Similar Journals
Journal Cover
Journal of the Intensive Care Society
Journal Prestige (SJR): 0.215
Number of Followers: 4  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1751-1437
Published by Sage Publications Homepage  [1174 journals]
  • Abstracts

    • Free pre-print version: Loading...

      Pages: 1 - 210
      Abstract: Journal of the Intensive Care Society, Volume 23, Issue 1_suppl, Page 1-210, August 2022.

      Citation: Journal of the Intensive Care Society
      PubDate: 2022-08-03T07:19:19Z
      DOI: 10.1177/17511437221095122
      Issue No: Vol. 23, No. 1_suppl (2022)
       
  • Erratum

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      Abstract: Journal of the Intensive Care Society, Ahead of Print.

      Citation: Journal of the Intensive Care Society
      PubDate: 2022-09-26T09:52:36Z
      DOI: 10.1177/17511437221125306
       
  • Is your study acronym someone else’s intellectual property'

    • Free pre-print version: Loading...

      Authors: Alicia AC Waite, Heather Rogers, Sandra Winskill, Ingeborg D Welters
      Abstract: Journal of the Intensive Care Society, Ahead of Print.

      Citation: Journal of the Intensive Care Society
      PubDate: 2022-09-01T10:45:09Z
      DOI: 10.1177/17511437221121713
       
  • The association between mean platelet volume and poor outcome in patients
           with COVID-19: Systematic review, meta-analysis, and meta-regression

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      Authors: Ahmad Fariz Malvi Zamzam Zein, Catur Setiya Sulistiyana, Wilson Matthew Raffaelo, Raymond Pranata
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      Introduction:This study aims to assess the association between mean platelet volume (MPV) and poor outcome in patients with COVID-19.Methods:We performed a comprehensive literature search using the PubMed, Embase and Scopus databases with keywords “2019-nCoV” OR “SARS-CoV-2” OR “COVID-19” AND “mean platelet volume” OR “MPV” on 8 July 2021. The primary outcome was composite poor outcome, defined as severe COVID-19 or mortality. The pooled effect estimate was reported as mean differences in terms of MPV between the group with and without outcome.Results:There were 17 studies which consist of 4549 patients with COVID-19 were included in this study. The incidence of poor outcome was 25% (20%–30%). Mean MPV was found to be higher in the poor outcome group in compare to no poor outcome group (10.3 ± 1.9 fL vs 9.9 ± 1.7 fL). The mean MPV difference between both group was 0.47 fL [95% CI 0.27, 0.67], p < 0.001; I2: 62.91%, p < 0.001). In the sub-group analysis, patients with severe COVID-19 had higher MPV (mean difference 0.54 fL [95% CI 0.28, 0.80], p < 0.001; I2: 54.84%, p = 0.014). Furthermore, MPV was also higher in the mortality group (mean difference 0.54 fL [95% CI 0.29, 0.80], p = 0.020; I2: 71.11%, p = 0.004). Meta-regression analysis showed that the association between MPV and poor outcome was not affected by age (p = 0.789), gender (p = 0.167), platelets (p = 0.056), white blood cells (p = 0.639), and lymphocytes (p = 0.733).Conclusion:This meta-analysis indicated that increased MPV was associated with severity and mortality in patients with COVID-19. Further research is needed to determine the optimum cut-off point.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-08-26T09:32:19Z
      DOI: 10.1177/17511437221121234
       
  • Corrigendum to airway management during in-hospital cardiac arrest in
           adults: UK national survey and interview study with anaesthetic and
           intensive care trainees. Journal of Intensive Care Society.
           22(3):192--197. DOI: 10.1177/1751143720949458

    • Free pre-print version: Loading...

      Abstract: Journal of the Intensive Care Society, Ahead of Print.

      Citation: Journal of the Intensive Care Society
      PubDate: 2022-08-20T12:15:58Z
      DOI: 10.1177/17511437221118614
       
  • Reduction in transfer of micro-organisms between patients and staff using
           short-sleeved gowns and hand/arm hygiene in intensive care during the
           COVID-19 pandemic: A simulation-based randomised trial

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      Authors: Laura Vincent, Mudathir Ibrahim, Joanne Kitchin, Claire Pickering, Jennie Wilson, Enrico Sorrentino, Claudia Salvagno, Laurie Earl, Louise Ma, Kathryn Simpson, Rose Baker, Peter McCulloch
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      BackgroundCurrent personal protective equipment (PPE) practices in UK intensive care units involve “sessional” use of long-sleeved gowns, risking nosocomial infection transmitted via gown sleeves. Data from the first wave of the COVID19 pandemic demonstrated that these changes in infection prevention and control protocols were associated with an increase in healthcare associated bloodstream infections. We therefore explored the use of a protocol using short-sleeved gowns with hand and arm hygiene to reduce this risk.MethodsICU staff were trained in wearing short-sleeved gowns and using a specific hand and arm washing technique between patients (experimental protocol). They then underwent simulation training, performing COVID-19 intubation and proning tasks using either experimental protocol or the standard (long-sleeved) control protocol. Fluorescent powder was used to simulate microbial contamination, detected using photographs under ultraviolet light. Teams were randomised to use control or experimental PPE first. During the simulation, staff were questioned on their feelings about personal safety, comfort and patient safety.ResultsSixty-eight staff and 17 proning volunteers were studied. Experimental PPE completely prevented staff contamination during COVID-19 intubation, whereas this occurred in 30/67 staff wearing control PPE (p = .003, McNemar). Proning volunteers were contaminated by staff in 15/17 control sessions and in 1/17 with experimental PPE (p = .023 McNemar). Staff comfort was superior with experimental PPE (p< .001, Wilcoxon). Their personal safety perception was initially higher with control PPE, but changed towards neutrality during sessions (p < .001 start, 0.068 end). Their impressions of patient safety were initially similar (p = .87), but finished strongly in favour of experimental PPE (p < .001).ConclusionsShort-sleeved gowns with hand and forearm cleansing appear superior to sessional long-sleeved gowns in preventing cross-contamination between staff and patients.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-08-16T08:47:26Z
      DOI: 10.1177/17511437221116472
       
  • A thematic analysis of staff perspectives on the impact of a mental health
           nurse (RMN) in a critical care unit

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      Authors: Charlotte Hill, Sarah Sims, Magdalena ap Robert, Sarah Collier
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      BackgroundRecent guidelines in the UK have shaped Critical Care Units (CCUs) to bring the mental health needs of patients, and staff wellbeing to the forefront of service provision. A health board based in NHS Wales has trialled the secondment of a Mental Health Nurse (RMN) within a CCU to help service provision adhere to such guidelines.MethodsCritical care staff were invited to attend focus groups to share their experiences of how the RMN influenced service provision.ResultsThematic analysis identified five main themes; including ‘smoother care pathways’, ‘a holistic approach to care’, ‘co-production’, ‘knowledge and confidence’ and ‘staff wellbeing’. Each of these themes reflected how the RMN had both direct and indirect benefits on patient and staff wellbeing.ConclusionThis qualitative exploration suggests that staff perceived value in the role of the RMN for both staff and patient outcomes, although further measures were considered necessary to improve staff-wellbeing within a critical care environment. This service evaluation supports recommendations for commissioning a RMN permanently in a CCU.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-08-10T12:36:39Z
      DOI: 10.1177/17511437221116474
       
  • Letter of response to: “Echocardiographic assessment and critical care
           management of peri-partum women with unexpected left ventricular
           failure”

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      Authors: Bhaskar Narayan
      Abstract: Journal of the Intensive Care Society, Ahead of Print.

      Citation: Journal of the Intensive Care Society
      PubDate: 2022-07-20T06:53:19Z
      DOI: 10.1177/17511437221116471
       
  • Benefits and options for voice restoration in mechanically ventilated
           intensive care unit patients with a tracheostomy

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      Authors: Sarah Wallace, Sue McGowan, Anna-Liisa Sutt
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      Communication difficulties and their effects on patients who are mechanically ventilated are commonly reported and well described. The possibility of restoring speech for patients has obvious benefits, not only for meeting patient’s immediate needs, but for helping them to re-engage in relationships and participate meaningfully in their recovery and rehabilitation. This opinion piece by a group of United Kingdom (UK) based Speech and Language Therapy experts working in critical care describes the various ways by which a patient’s own voice can be restored. Common barriers to using different techniques and potential solutions are explored. We therefore hope that this will encourage intensive care unit (ICU) multi-disciplinary teams to advocate and facilitate early verbal communication in these patients.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-07-11T06:53:04Z
      DOI: 10.1177/17511437221113162
       
  • Team Immediate Meet tool to help intensive care staff: Staff perception of
           an updated version and preliminary feedback following implementation

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      Authors: Matthew Edmondson, Layla Guscoth, Julie Highfield, Fiona E Kelly
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      Intensive Care Unit staff deal with potentially traumatic cases throughout their careers. We designed and implemented a ‘Team Immediate Meet’ (TIM) tool, a communication aid designed to facilitate a two-minute ‘hot debrief’ after a critical event, provide the team with information about the normal reaction to such an event and signpost staff to strategies to help support their colleagues (and themselves). We describe our TIM tool awareness campaign, quality improvement project and subsequent feedback from staff who reported that the tool would be useful for navigating the aftermath of potentially traumatic events and could be transferable to other ICUs.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-07-05T06:51:16Z
      DOI: 10.1177/17511437221113239
       
  • Predictors of health-related quality of life in patients undergoing
           extracorporeal membrane oxygenation for acute severe respiratory failure

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      Authors: Ahmed MHAM Mostafa, Christopher J Tuttle, Mikel A Mckie, Jo-Anne Fowles, Jasvir Parmar, Alain Vuylsteke
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      BackgroundVeno-venous extracorporeal membrane oxygenation (VV-ECMO) is a form of life support used in severe respiratory failure. While the short-term complications of VV-ECMO are well described, impacts on health-related quality of life (HRQOL) are less well characterised. This study aims to assess the HRQOL of patients who underwent VV-ECMO for acute severe respiratory failure and explore predictors of poor HRQOL.MethodsWe performed a retrospective, observational study of a large cohort of adults who underwent VV-ECMO for acute severe respiratory failure in a single tertiary centre (June 2013–March 2019). Patients surviving critical care discharge were invited to a six-month clinic, where they completed an EQ-5D-5L questionnaire assessing HRQOL. Multivariate analysis was performed to assess prognostic factors for HRQOL.ResultsAmong the 245 consecutive patients included in this study (median age 45 years), 187 (76.3%) survived until ECMO decannulation and 172 (70.2%) until hospital discharge. Of those, 98 (57.3%) attended a follow-up clinic at a mean (±SD) of 204 (±45) days post-discharge. Patients reported problems with pain/discomfort (56%), usual daily activities (53%), anxiety/depression (49%), mobility (46%), and personal care (21%). Multivariate analysis identified limb ischaemia (−0.266, 95% C.I. [−0.116; −0.415], p = 0.0005), renal replacement therapy (−0.149, [−0.046; −0.252], p = 0.0044), and having received more than four platelet units (−0.157, [−0.031; −0.283], p = 0.0146) as predictors of poor HRQOL.ConclusionWe report that survivors of VV-ECMO have reduced HRQOL in multiple domains at 6 months, with pain reported most frequently. Patients who had limb ischaemia, renal replacement therapy or were transfused more than four units of platelets are particularly at risk of poor HRQOL and may benefit from added support measures.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-06-30T03:24:14Z
      DOI: 10.1177/17511437221111639
       
  • An Intensive Care Unit peer support group: Participants’ views on
           format, content and the impact on recovery journeys

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      Authors: Rachel Clarke, Homen Chow, Kristy Kerrison
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      BackgroundPeer support groups reduce psychological morbidity and increase social support for Intensive Care Unit (ICU) survivors. Group formats differ and research, although emerging, is limited. This study explores a continuously running ICU Expert by Experience group, which has a dual role of support and service-user consultative, from attendees’ perspectives.MethodsA thematic analysis was conducted on interviews with current and past members of an ICU Expert by Experience group. 11 participants took part in online and telephone interviews. Three provided written responses. Final themes were created following a process of data validation with participants.ResultsFour main themes emerged: (1) Support in the difficult recovery journey (2) Relationships and shared experiences (3) Value of professional facilitation (4) Practical considerations.ConclusionPatients highlighted the help gained from the group as an integral part of their recovery journey. Results also identified practical implications for those considering setting up similar support groups.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-06-20T07:30:32Z
      DOI: 10.1177/17511437221108905
       
  • 1-year outcomes of patients admitted to critical care with treatment
           limitations: A dual-centre observational study

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      Authors: Masseh Yakubi, Annie Devlin, Richard Venn, Luke Hodgson
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      Intensivists are increasingly involved in the care of frail patients as our population ages. Careful person-orientated, individualised decision-making, weighing benefits and harms of critical care are required in such situations. Few studies have reported outcomes of patients with treatment limitations. This dual-centre observational study reports outcomes of 3781 patients (2018-20). At least one treatment limitation was set at admission in 13% (n = 486). Of this group 55% survived to hospital discharge, of whom 69% were discharged home; 39% remained alive at 1 year. These findings provide objective data to support clinicians, patients and relatives in shared decision-making. Future multi-centre work could explore how best to identify those most likely to benefit from critical care
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-06-16T08:14:22Z
      DOI: 10.1177/17511437221108900
       
  • Building a Covid-19 secure intensive care unit: A human-centred design
           approach

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      Authors: Jody Ede, David Garry, Graham Barker, Owen Gustafson, Elizabeth King, Hannah Routley, Christopher Biggs, Cherry Lumley, Lyn Bennett, Stephanie Payne, Andrew Ellis, Clinton Green, Nathan Smith, Laura Vincent, Matthew Holdaway, Peter Watkinson
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      BackgroundThe Covid-19 pandemic has highlighted weaknesses in the National Health Service critical care provision including both capacity and infrastructure. Traditionally, healthcare workspaces have failed to fully incorporate Human-Centred Design principles resulting in environments that negatively affect the efficacy of task completion, patient safety and staff wellbeing. In the summer of 2020, we received funds for the urgent construction of a Covid-19 secure critical care facility. The aim of this project was to design a pandemic resilient facility centred around both staff and patient requirements and safety, within the available footprint.MethodsWe developed a simulation exercise, underpinned by Human-Centred Design principles, to evaluate intensive care designs through Build Mapping, Tasks Analysis and Qualitative data. Build Mapping involved taping out sections of the design and mocking up with equipment. Task Analysis and qualitative data were collected following task completion.Results56 participants completed the build simulation exercise generating 141 design suggestions (69 task related, 56 patient and relative related, 16 staff related). Suggestions translated to 18 multilevel design improvements; five significant structural changes (Macro level) including wall moves and lift size change. Minor improvements were made at a Meso and Micro design level. Critical care design drivers identified included functional drivers (visibility, Covid-19 secure environment, workflow, and task efficiency) and behavioural drivers (learning and development, light, humanising intensive care and design consistency).ConclusionSuccess of clinical tasks, infection control, patient safety and staff/patient wellbeing are highly dependent on clinical environments. Primarily, we have improved clinical design by focusing on user requirements. Secondly, we developed a replicable approach to exploring healthcare build plans revealing significant design changes, that may have only been identified once built.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-06-15T10:42:07Z
      DOI: 10.1177/17511437221092685
       
  • Risk factors associated with post-intensive care syndrome in family
           members (PICS-F): A prospective observational study

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      Authors: Carolina Tintim Lobato, João Camões, Daniela Carvalho, Cláudia Vales, Cláudia Camila Dias, Ernestina Gomes, Rui Araújo
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      BackgroundThe family members of intensive care unit (ICU) patients play a crucial role in modern ICUs. These individuals are predisposed to the development of post-intensive care syndrome in family members (PICS-F), a syndrome experienced by family members of ICU patients in response to critical illness and characterised by new or worsening psychological symptoms. This study sought to evaluate the levels of anxiety and depression exhibited by the family members of patients hospitalised in the ICU. It also aimed to identify the risk factors associated with the experience of PICS-F, which should assist with its prevention in the future.MethodsThe study sample comprised 164 ICU patients and their family members. Sociodemographic data were gathered at the time of ICU admission and 3 months after discharge, and the family members were screened for emotional distress using the Hospital Anxiety and Depression Scale (HADS). Comparison tests were used to test for an association between family/patient characteristics and a positive HADS score. In addition, a multivariable logistic regression model was constructed to identify the independent factors associated with a positive HADS score.ResultsEmotional distress was identified in 24% of the family members 3 months after their relatives had been discharged from the ICU. A number of personal traits were found to be associated with emotional distress in the family members, namely unemployment (p = .008), smoking/drinking habits (p = .036) and personal history of psychopathology (p = .045). In the multiple logistic regression analyses, only unemployment was found to be an independent factor associated with both anxiety and depression in the family members (OR = 2.74, CI 95%: 1.09–6.93). No association was found between the patients’ characteristics and emotional distress in the family members.ConclusionsThe findings of this study indicate an association between emotional distress in the family members of ICU patients and their personal traits, thereby building on the prior literature by suggesting that patient characteristics are less pertinent to the experience of PICS-F. Unemployment may represent a meaningful risk factor for emotional distress in family members (a potential marker of PICS-F), given its relationship with family members’ positive HADS scores post-ICU discharge. These findings should influence preventative strategies concerning PICS-F by illustrating the need to assess family characteristics and demographics early in a patient’s ICU stay and, consequently, allowing for the early identification of at-risk individuals and the prompt implementation of adequate support services.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-06-15T07:30:21Z
      DOI: 10.1177/17511437221108904
       
  • Investigating the impact of brief training in decision-making on treatment
           escalation to intensive care using objective structured clinical
           examination-style scenarios

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      Authors: Hisham M Riad, Adam J Boulton, Anne-Marie Slowther, Christopher Bassford
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      BackgroundThe decision to admit patients to the intensive care unit (ICU) is complex. Structuring the decision-making process may be beneficial to patients and decision-makers alike. The aim of this study was to investigate the feasibility and impact of a brief training intervention on ICU treatment escalation decisions using the Warwick model- a structured decision-making framework for treatment escalation decisions.MethodsTreatment escalation decisions were assessed using Objective Structured Clinical Examination-style scenarios. Participants were ICU and anaesthetic registrars with experience of making ICU admission decisions. Participants completed one scenario, followed by training with the decision-making framework and subsequently a second scenario. Decision-making data was collected using checklists, note entries and post-scenario questionnaires.ResultsTwelve participants were enrolled. Brief decision-making training was successfully delivered during the normal ICU working day. Following training participants demonstrated greater evidence of balancing the burdens and benefits of treatment escalation. On visual analogue scales of 0–10, participants felt better trained to make treatment escalation decisions (4.9 vs 6.8, p = 0.017) and felt their decision-making was more structured (4.7 vs 8.1, p = 0.017).Overall, participants provided positive feedback and reported feeling more prepared for the task of making treatment escalation decisions.ConclusionOur findings suggest that a brief training intervention is a feasible way to improve the decision-making process by improving decision-making structure, reasoning and documentation. Training was implemented successfully, acceptable to participants and participants were able to apply their learning. Further studies of regional and national cohorts are needed to determine if training benefit is sustained and generalisable.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-06-02T04:08:03Z
      DOI: 10.1177/17511437221105979
       
  • Critical care drowning admissions in Southwest England 2009–2020, a
           retrospective study

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      Authors: Adam B Brayne, William Jones, Adrienne Lee, Catherine Chatfield-Ball, Duncan Kaye, Matthew Ball, Gorki Sacher, Patrick Morgan
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      AimIn the United Kingdom (UK), 600 deaths per annum are attributable to drowning. Despite this there is scarce critical care data on drowning patients globally. We describe drowning cases admitted to critical care units with a focus on functional outcomes.Materials and MethodsMedical records for critical care admissions following a drowning event were retrospectively reviewed across six hospitals in Southwest England for cases presenting in the period between 2009 and 2020. Data was collected according to the Utstein international consensus guidelines on drowning.ResultsForty-nine patients were included, 36 males and 13 females, including seven children. Median submersion duration was 2.5 min 20 cases were in cardiac arrest when rescued. At discharge 22 patients had preserved functional status, 10 patients had a reduced functional status. 17 patients died in hospital.ConclusionAdmission to critical care following drowning is uncommon and associated with high rates of mortality and poor functional outcomes. We find that 31% of those who survived a drowning event subsequently required an increased level of assistance with their activities of daily living.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-06-01T09:42:18Z
      DOI: 10.1177/17511437221105774
       
  • Albumin versus balanced crystalloid for resuscitation in the treatment of
           sepsis: A protocol for a randomised controlled feasibility study,
           “ABC-Sepsis”

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      Authors: John Cafferkey, Andrew Ferguson, Julia Grahamslaw, Katherine Oatey, John Norrie, Nazir Lone, Timothy Walsh, Daniel Horner, Andy Appelboam, Peter Hall, Richard Skipworth, Derek Bell, Kevin Rooney, Manu Shankar-Hari, Alasdair Corfield, Alasdair Gray
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      BackgroundPatients presenting with suspected sepsis to secondary care often require fluid resuscitation to correct hypovolaemia and/or septic shock. Existing evidence signals, but does not demonstrate, a benefit for regimes including albumin over balanced crystalloid alone. However, interventions may be started too late, missing a critical resuscitation window.MethodsABC Sepsis is a currently recruiting randomised controlled feasibility trial comparing 5% human albumin solution (HAS) with balanced crystalloid for fluid resuscitation in patients with suspected sepsis. This multicentre trial is recruiting adult patients within 12 hours of presentation to secondary care with suspected community acquired sepsis, with a National Early Warning Score ≥5, who require intravenous fluid resuscitation. Participants are randomised to 5% HAS or balanced crystalloid as the sole resuscitation fluid for the first 6 hours.ObjectivesPrimary objectives are feasibility of recruitment to the study and 30-day mortality between groups. Secondary objectives include in-hospital and 90-day mortality, adherence to trial protocol, quality of life measurement and secondary care costs.DiscussionThis trial aims to determine the feasibility of conducting a trial to address the current uncertainty around optimal fluid resuscitation of patients with suspected sepsis. Understanding the feasibility of delivering a definitive study will be dependent on how the study team are able to negotiate clinician choice, Emergency Department pressures and participant acceptability, as well as whether any clinical signal of benefit is detected.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-05-31T04:36:51Z
      DOI: 10.1177/17511437221103692
       
  • Acute kidney injury following induction of chemotherapy: Diagnosis and
           management in critical care

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      Authors: Robert Chapman, Sita Shah, Alberto D’Angelo
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      A 48-year-old gentleman who had recently commenced chemotherapy for diffuse B-cell lymphoma was admitted to hospital with nausea and generalised weakness. He developed abdominal pain and oliguric acute kidney injury with multiple electrolyte derangements and was transferred to the intensive care unit (ICU). His condition deteriorated, requiring endotracheal intubation and renal replacement therapy (RRT). Tumour lysis syndrome (TLS) is a common and life-threatening complication of chemotherapy and represents an oncological emergency. TLS affects multiple organ systems and is best managed in the ICU with closer monitoring of fluid balance, serum electrolytes, cardiorespiratory and renal function. TLS patients may go on to require mechanical ventilation and RRT. TLS patients require input from a large multidisciplinary team of clinicians and allied health professionals.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-05-30T04:31:06Z
      DOI: 10.1177/17511437221106441
       
  • Intensive care clincians’ information acquisition during the first wave
           of the Covid 19 pandemic

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      Authors: Isabella Sawyer, Jeni Harden, Rosaleen Baruah
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      IntroductionThe global pandemic caused by novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has led to an unprecedented demand on critical care resources. The United Kingdom experienced its ‘first wave’ of Coronavirus–19 (Covid-19) disease in Spring 2020. Critical care units had to make major changes to their working practices in a short space of time and faced multiple challenges in doing so, including the challenge of caring for patients in multiple organ failure secondary to Covid-19 infection in the absence of an established evidence base of best practice. We undertook a qualitative investigation of the personal and professional challenges faced by critical care consultants in one Scottish health board in acquiring and evaluating information to guide clinical decision making during the first wave of the SARS-CoV-2 pandemic.MethodsCritical care consultants in NHS Lothian working in critical care from March to May 2020 were eligible to participate in the study. Participants were invited to take part in a one-to-one semi structured interview conducted using Microsoft Teams videoconferencing software. Reflexive thematic analysis was used as the method for data analysis using qualitative research methodology informed by a subtle realist position.ResultsAnalysis of the interview data generated the following themes: The Knowledge Gap; Trust in Information; and Implications for Practice. Illustrative quotes are presented in the text and thematic tables.DiscussionThis study explored the experiences of critical care consultant physicians in acquiring and evaluating information to guide clinical decision making during the first wave of the SARS CoV2 pandemic. This study revealed that clinicians were profoundly affected by the pandemic and the ways in which it changed how they could access information to guide clinical decision making. The paucity of reliable information on SARS-CoV-2 posed a significant threat to the clinical confidence of participants. Two strategies were adopted to ease mounting pressures – an organised approach to data collection and the establishment of a local community of collaborative decision-making. These findings contribute to the wider literature by describing health care professionals’ experiences in unprecedented times and could inform recommendations for future clinical practice. This could include governance around responsible information sharing in professional instant messaging groups, and medical journal guidelines on suspension of usual peer review and other quality assurance processes during pandemics.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-05-28T04:52:12Z
      DOI: 10.1177/17511437221105777
       
  • Nasointestinal tube placement: Techniques that increase success

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      Authors: Stephen J Taylor, Kaylee Sayer, Paul White
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      BackgroundDelayed gastric emptying (DGE) is a major cause of undernutrition that can be overcome using nasointestinal (NI) feeding, but tube placement often fails. We analyse which techniques enable successful NI tube placement.MethodsEfficacy of tube technique was determined at each of six anatomical points: Nose, nasopharynx-oesophagus, stomach-upper and -lower, duodenum part-1 and intestine.ResultsIn 913 first NI tube placements, significant associations with tube advancement were found in the pharynx (head tilt, jaw thrust, laryngoscopy), stomach_upper (air insufflation, 10 cm or 20–30 cm flexible tube tip ± reverse Seldinger manoeuvre), stomach_lower (air insufflation, possibly flexible tip and wire stiffener) and duodenum part-1 and beyond part-2 (flexible tip and combinations of micro-advance, slack removal, wire stiffener or prokinetic drugs).ConclusionThis is the first study to show what techniques are associated with tube advancement and the alimentary tract level they are specific to.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-05-27T03:46:04Z
      DOI: 10.1177/17511437221095336
       
  • Investigating the impact of physical activity interventions on delirium
           outcomes in intensive care unit patients: A systematic review and
           meta-analysis

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      Authors: Annika Jarman, Keeleigh Chapman, Sarah Vollam, Robyn Stiger, Mark Williams, Owen Gustafson
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      BackgroundTo investigate the impact of physical activity interventions, including early mobilisation, on delirium outcomes in critically ill patients.MethodsElectronic database literature searches were conducted, and studies were selected based on pre-specified eligibility criteria. Cochrane Risk of Bias-2 and Risk Of Bias In Non-randomised Studies-of Interventions quality assessment tools were utilised. Grading of Recommendations, Assessment, Development and Evaluations was used to assess levels of evidence for delirium outcomes. The study was prospectively registered on PROSPERO (CRD42020210872).ResultsTwelve studies were included; ten randomised controlled trials one observational case-matched study and one before-after quality improvement study. Only five of the included randomised controlled trial studies were judged to be at low risk of bias, with all others, including both non-randomised controlled trials deemed to be at high or moderate risk. The pooled relative risk for incidence was 0.85 (0.62–1.17) which was not statistically significant in favour of physical activity interventions. Narrative synthesis for effect on duration of delirium found favour towards physical activity interventions reducing delirium duration with median differences ranging from 0 to 2 days in three comparative studies. Studies comparing varying intervention intensities showed positive outcomes in favour of greater intensity. Overall levels of evidence were low quality.ConclusionsCurrently there is insufficient evidence to recommend physical activity as a stand-alone intervention to reduce delirium in Intensive Care Units. Physical activity intervention intensity may impact on delirium outcomes, but a lack of high-quality studies limits the current evidence base.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-05-26T04:00:35Z
      DOI: 10.1177/17511437221103689
       
  • Perceived barriers to mobility in the intensive care units of Singapore:
           The Patient Mobilisation Attitudes and Beliefs Survey for the intensive
           care units

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      Authors: Meredith T. Yeung, Nicholas K. Tan, Gideon Z. Lee, Yuemian Gao, Chun Ju Tan, Clement C Yan
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      PurposeProlonged bed rest and immobility in the intensive care units (ICU) increase the risk of ICU-acquired weakness (ICUAW) and other complications. Mobilisation has been shown to improve patient outcomes but may be limited by the perceived barriers of healthcare professionals to mobilisation. The Patient Mobilisation Attitudes and Beliefs Survey for the ICU (PMABS-ICU) was adapted to assess perceived barriers to mobility in the Singapore context (PMABS-ICU-SG).MethodsThe 26-item PMABS-ICU-SG was disseminated to doctors, nurses, physiotherapists, and respiratory therapists working in ICU of various hospitals across Singapore. Overall and subscale (knowledge, attitude, and behaviour) scores were obtained and compared with the clinical roles, years of work experience, and type of ICU of the survey respondents.ResultsA total of 86 responses were received. Of these, 37.2% (32/86) were physiotherapists, 27.9% (24/86) were respiratory therapists, 24.4% (21/86) were nurses and 10.5% (9/86) were doctors. Physiotherapists had significantly lower mean barrier scores in overall and all subscales compared to nurses (p < 0.001), respiratory therapists (p < 0.001), and doctors (p = 0.001). A poor correlation (r = 0.079, p < 0.05) was found between years of experience and the overall barrier score. There was no statistically significant difference in the overall barriers score between types of ICU (χ2(2) = 4.720, p = 0.317).ConclusionIn Singapore, physiotherapists had significantly lower perceived barriers to mobilisation compared to the other three professions. Years of experience and type of ICU had no significance in relation to barriers to mobilisation.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-05-13T09:26:42Z
      DOI: 10.1177/17511437221099791
       
  • Therapy professionals in critical care: A UK wide workforce survey

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      Authors: Paul Twose, Ella Terblanche, Una Jones, James Bruce, Penelope Firshman, Julie Highfield, Gemma Jones, Judith Merriweather, Vicky Newey, Helen Newman, Claire Rock, Sarah Wallace
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      IntroductionNational guidelines suggest recommended staffing levels for therapies. The aim of this study was to capture information on existing staffing levels, roles and responsibilities and service structures.MethodsAn observational study using online surveys distributed to 245 critical care units across the United Kingdom (UK). Surveys consisted of a generic and five profession specific surveys.ResultsEight hundred sixty-two responses were received from 197 critical care units across the UK. Of those that responded, over 96% of units had input from dietetics, physiotherapy and SLT. Whereas only 59.1% and 48.1% had an OT or psychology service respectively. Units with ring fenced services had improved therapist to patient ratios.DiscussionThere is significant variation in access to therapists for patients admitted to critical care in the UK, with many services not having services for core therapies such as psychology and OT. Where services do exist, they fall below the recommended guidance.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-05-09T02:15:08Z
      DOI: 10.1177/17511437221100332
       
  • The impact of frailty on death, discharge destination and modelling
           accuracy in patients receiving organ support on the intensive care unit

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      Authors: Andy Georgiou, Nicholas Turner, Alfredo Serrano Ruiz, Harry Wadman, Emma Saunsbury, Stephen Laver, Rob Maybin
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      BackgroundThis study aims to identify any effect of frailty in altering the risk of death or poor outcome already associated with receipt of organ support on ICU. It also aims to assess the performance of mortality prediction models in frail patients.MethodsAll admissions to a single ICU over 1-year were prospectively allocated a Clinical Frailty Score (CFS). Logistic regression analysis was used to investigate the effect of frailty on death or poor outcome (death/discharge to a medical facility). Logistic regression analysis, area under the Receiver Operator Curve (AUROC) and Brier scores were used to investigate the ability of two mortality prediction models, ICNARC and APACHE II, to predict mortality in frail patients.ResultsOf 849 patients, 700 (82%) patients were not frail, and 149 (18%) were frail. Frailty was associated with a stepwise increase in the odds of death or poor outcome (OR for each point rise of CFS = 1.23 ([1.03–1.47]; p = .024) and 1.32 ([1.17–1.48]; p =
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-05-05T12:53:15Z
      DOI: 10.1177/17511437221096287
       
  • Driving resumption after critical illness:A survey and framework analysis
           of patient experience and process

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      Authors: Joel Meyer, Natalie Pattison, Chloe Apps, Melanie Gager, Carl Waldmann
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      Background: Adverse sequelae are common in survivors of critical illness. Physical, psychological and cognitive impairments can affect quality of life for years after the original insult. Driving is an advanced task reliant on complex physical and cognitive functioning. Driving represents a positive recovery milestone. Little is currently known about the driving habits of critical care survivors. The aim of this study was to explore the driving practices of individuals after critical illness.Methods: A purpose-designed questionnaire was distributed to driving licence holders attending critical care recovery clinic. Results: A response rate of 90% was achieved. 43 respondents declared their intention to resume driving. Two respondents had surrendered their licence on medical grounds. 68% had resumed driving by 3 months, 77% by 6 months, and 84% by 1 year. The median interval (range) between critical care discharge and resumption of driving was 8 weeks (1–52 weeks). Psychological, physical and cognitive barriers were cited by respondents as barriers to driving resumption. Eight themes regarding driving resumption were identified from the framework analysis under three core domains and included: psychological/cognitive impact on ability to drive (Emotional readiness and anxiety; Confidence; Intrinsic motivation; Concentration), physical ability to drive (Weakness and fatigue; Physical recovery), and supportive care and information needs to resume driving (Information/advice; Timescales).Conclusion: This study demonstrates that resumption of driving following critical illness is substantially delayed. Qualitative analysis identified potentially modifiable barriers to driving resumption.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-05-03T01:36:03Z
      DOI: 10.1177/17511437221099118
       
  • Coercion in intensive care, an insufficiently explored issue—a scoping
           review of qualitative narratives of patient’s experiences

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      Authors: Susanne Joebges, Corine Mouton-Dorey, Bara Ricou, Nikola Biller-Andorno
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      PurposeThe use of coercion, in a clinical context as imposing a measure against a patient’s opposition or declared will, can occur in various forms in intensive care units (ICU). One prime example of a formal coercive measure in the ICU is the use of restraints, which are applied for patients’ own safety. Through a database search, we sought to evaluate patient experiences related to coercive measures.ResultsFor this scoping review, clinical databases were searched for qualitative studies. A total of nine were identified that fulfilled the inclusion and the CASP criteria. Common themes emerging from the studies on patient experiences included communication issues, delirium, and emotional reactions. Statements from patients revealed feelings of compromised autonomy and dignity that came with a loss of control. Physical restraints were only one concrete manifestation of formal coercion as perceived by patients in the ICU setting.ConclusionThere are few qualitative studies focusing on patient experiences of formal coercive measures in the ICU. In addition to the experience of restricted physical movement, the perception of loss of control, loss of dignity, and loss of autonomy suggests that restraining measures are just one element in a setting that may be perceived as informal coercion.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-04-19T02:14:34Z
      DOI: 10.1177/17511437221091051
       
  • Re: Thromboelastography demonstrates progressive hypercoagulability in
           COVID-19 patients admitted to ICU with respiratory failure

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      Authors: James Hilton, Tobias Katz, Edward Walter
      Abstract: Journal of the Intensive Care Society, Ahead of Print.

      Citation: Journal of the Intensive Care Society
      PubDate: 2022-04-15T05:26:29Z
      DOI: 10.1177/17511437221081623
       
  • Critical illness-related cardiac arrest: Protocol for an investigation of
           the incidence and outcome of cardiac arrest within intensive care units in
           the United Kingdom

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      Authors: Robert Darnell, Christopher Newell, Julia Edwards, Emma Gendall, David Harrison, Stefan Sprinckmoller, Paul Mouncey, Doug Gould, Matt Thomas
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      Critical illness-related cardiac arrest (CIRCA) as a distinct entity is not well described epidemiologically. There is currently a knowledge gap regarding how many occur in the UK or the impact on patient outcome. The CIRCA study is a prospective multi-centre observational cohort study of patients in the United Kingdom experiencing a cardiac arrest while in a Critical Care Unit embedded in the Case Mix Programme and National Cardiac Arrest Audit. The duration of data collection is 12 months, with surviving patients and family members receiving questionnaire follow-up at 90 days, 180 days and 12 months. This paper describes the protocol for the CIRCA study which received favourable ethical opinion from South Central – Berkshire Research Ethics Committee and approval from the Health Research Authority. Study registration is on clinicaltrials.gov (NCT04219384).
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-03-14T05:01:32Z
      DOI: 10.1177/17511437211055899
       
  • Critical illness related cardiac arrest: Protocol for an investigation of
           the incidence and outcome of cardiac arrest within intensive care units in
           the United Kingdom

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      Authors: Robert Darnell, Christopher Newell, Julia Edwards, Emma Gendall, David Harrison, Stefan Sprinckmoller, Paul Mouncey, Doug Gould, Matt Thomas
      Abstract: Journal of the Intensive Care Society, Ahead of Print.

      Citation: Journal of the Intensive Care Society
      PubDate: 2022-03-04T02:57:31Z
      DOI: 10.1177/17511437221086890
       
  • Head and neck positioning for out-of-theatre intubation during the
           COVID-19 pandemic

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      Authors: Alexander Malin, James Cassidy
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      The COVID-19 pandemic has brought with it a large number of challenges for healthcare professionals including intubation safety in out-of-theatre environments. An important aspect of this topic is the optimisation of a patient’s head and neck position prior to laryngoscopy which can be challenging when a pillow cannot be located. As a result, the authors compared how well the sniffing position (35o neck flexion and 15o head extension) could be reached using pillows or other novel head supports. The resulting data demonstrated that a 1-litre pressure bag and two 1-litre saline bags achieved the most accurate position.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-02-28T09:13:22Z
      DOI: 10.1177/17511437221079121
       
  • Silicone adhesive multilayer foam dressings for preventing facial pressure
           injuries in COVID-19 patients in prone position

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      Authors: Pia Otto, Tobias Großkreutz, Stefan Köberich
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      The development of facial pressure injury (PI) during prone position is frequently described. During the COVID-19 pandemic, the number of patients with facial PIs increased. This quality improvement project describes the effectiveness of using silicone adhesive multilayer foams for preventing facial PIs in COVID-19 patients in need of prone position therapy. After introduction of foam dressing on chin and forehead to the standard protocol procedures for PI prevention, the decrease in number of patients developing facial PIs was statistically significant. Based on these results, the use of silicone adhesive multilayer foam will be implemented as a standard procedure for facial PIs prevention.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-02-28T01:51:02Z
      DOI: 10.1177/17511437221079122
       
  • The clinical frailty scale – does it predict outcome of the very-old
           in UK ICUs'

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      Authors: Dagan O Lonsdale, Liting Tong, Helen Farrah, Sarah Farnell-Ward, Chris Ryan, Ximena Watson, Maurizio Cecconi, Hans Flaatten, Jesper Fjølner, Christian Jung, Bertrand Guidet, Dylan de Lange, Wojciech Szczeklik, Johanna M Muessig, Susannah K Leaver
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      IntroductionThe age of patients admitted into critical care in the UK is increasing. Clinical decisions for very-old patients, usually defined as over 80, can be challenging. Clinicians are frequently asked to predict outcomes as part of discussions around the pros and cons of an intensive care unit (ICU) admission. Measures of overall health in old age, such as the clinical frailty scale (CFS), are increasingly used to help guide these discussions. We aimed to understand the characteristics of the very-old critically unwell population in the UK and the associations between frailty and outcome of an ICU admission in our healthcare system (National Health Service, NHS).MethodsBaseline characteristics, ICU interventions and outcomes (ICU- and 30-day mortality) were recorded for sequential admissions of very old patients to UK ICUs as part of the European VIP 1 and 2 studies. Patient characteristics, interventions and outcome measures were compared by frailty group using standard statistical tests. Multivariable logistic regression modelling was undertaken to test association between baseline characteristics, admission type and outcome.Results1858 participants were enrolled from 95 ICUs in the UK. The median age was 83. The median CFS was 4 (IQR 3–5). 30-day survival was significantly lower in the frail group (CFS> 4, 58%) compared to vulnerable (CFS = 4, 65%) and fit (CFS < 4 68%, p = .004). Sequential organ failure assessment (SOFA) score, reason for admission and CFS were all independently associated with increased 30-day mortality (p < .01).ConclusionIn the UK, frailty is associated with an increase in mortality at 30-days following an ICU admission. At moderate frailty (CFS 5–6), three out of every five patients admitted survived to 30-days. This is a similar mortality to septic shock.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-02-09T12:31:15Z
      DOI: 10.1177/17511437211050789
       
  • ‘Ticked off’' Can a new outcomes-based postgraduate curriculum
           utilising programmatic assessment reduce assessment burden in Intensive
           Care Medicine'

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      Authors: Christopher Smith, Mumtaz Patel
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      ContextIncreasing dissatisfaction with existing methods of assessment in the workplace alongside a national drive towards outcomes-based postgraduate curricula led to a recent overhaul of the way Intensive Care Medicine (ICM) trainees are assessed in the United Kingdom. Programmatic assessment methodology was utilised; the existing ‘tick-box’ approach using workplace-based assessment to demonstrate competencies was de-emphasised and the expertise of trainers used to assess capability relating to fewer, high-level outcomes related to distinct areas of specialist practice.MethodsA thematic analysis was undertaken investigating attitudes from 125 key stakeholders, including trainees and trainers, towards the new assessment strategy in relation to impact on assessment burden and acceptability.ResultsThis qualitative study suggests increased satisfaction with the transition to an outcomes-based model with capability judged by educational supervisors. However, reflecting frustration relating to current assessment in the workplace, participants felt assessment burden has been significantly reduced. The approach taken was felt to be an improved method for assessing professional practice; there was enthusiasm for this change. However, this research highlights trainee and trainer anxiety regarding how to ‘pass’ these expert judgement decisions of capability in the real world. Additionally, concerns relating to the impact on subgroups of trainees due to the potential influence of implicit biases on the resultant fewer but ‘higher stakes’ interrogative judgements became apparent.ConclusionThe move further towards a constructivist paradigm in workplace assessment in ICM reduces assessment burden yet can provoke anxiety amongst trainees and trainers requiring considered implementation. Furthermore, the perception of potential for bias in global judgements of performance requires further exploration.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-02-07T11:22:46Z
      DOI: 10.1177/17511437211061642
       
  • WireSafeTM – A pilot study of a novel safety engineered device designed
           to prevent guidewire retention and reduce sharps injuries during central
           venous catheter insertion

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      Authors: Vikesh Patel, Faiz M Chemban, Sohel Samad, Thomas Swan, James Gooch, Jonathan Dean, Darcy Pearson, Robin Heij, Peter J Young, Maryanne ZA Mariyaselvam
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      BackgroundGuidewire retention and sharps injury during central venous catheter insertion are errors that cause patient and healthcare professional harm. The WireSafeTM is a novel procedure safety pack engineered to prevent guidewire retention and sharps injury during central venous catheter insertion. This is a pilot study aimed to determine its acceptability, usability and safety during clinical practice.MethodsAn observational time and motion study was conducted comparing central venous catheter insertion and sharps disposal practice using standard versus WireSafeTM techniques. One-year following implementation, a structured survey was conducted to determine clinician opinion and experiences of using the WireSafeTM.Results15 procedures were observed using standard practice and 16 using the WireSafeTM technique. The WireSafeTM technique decreased the time taken from removal of the guidewire to disposal of sharps (standard 11.4 ± 5.6 min vs WireSafeTM 8.7 ± 1.4 min, p = 0.035), as well as total procedure time (standard 16 ± 7 min vs WireSafeTM 14.2 ± 2 min, p = 0.17), although this latter trend did not reach significance. Clinicians frequently practiced unsafe behaviour during sharps disposal in the standard group (53%), but when using the WireSafeTM technique, 100% exhibited safe practice by transferring sharps to the bin inside the sealed WireSafeTM box. One-year following implementation, 20 clinicians participated in the structured survey. Clinicians across three different departments used the WireSafeTM in varying clinical situations and reported that its use for central line insertion was either easier (10/20) or no different (10/20) compared to standard practice. All clinicians (20/20) felt that the WireSafeTM reduced the risk of guidewire retention and all stated that they approved of the WireSafeTM technique, and supported its use for convenience and safety benefits.ConclusionUtilising the WireSafeTM for central line insertion facilitated earlier and safer sharps disposal, and the device was well supported by clinicians for its convenience and safety benefits.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-02-02T10:00:31Z
      DOI: 10.1177/17511437211069318
       
  • Dosage and clinical outcomes of medical emergency team and conventional
           referral mediated unplanned intensive care admissions

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      Authors: Rajkumar Satyavolu, Mohammad Ishaq Ruknuddeen, Natalie Soar, Suzanne Melissa Edwards
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      Background: Unplanned intensive care unit (ICU) admission occurs via activation of medical emergency team (MET) and conventional ICU referral (CIR), i.e., ICU consultation. We aimed to compare the dosage, association with unplanned ICU admissions and hospital mortality between MET and CIR systems.Methods: We performed a retrospective, single centre observational study on unplanned ICU admissions from hospital wards between July 2017 and June 2018. We evaluated the dosage (expressed per 1000 admissions) and association of CIR and MET system with unplanned ICU admission using Chi-square test. The relationship (unadjusted and adjusted to Australia and New Zealand risk of death (ANZROD) and lead time) between unplanned ICU admission pathway (MET vs CIR) and hospital mortality was tested by binary logistic regression analysis [Odds ratio (OR) with 95% confidence interval (CI)].Results: Out of 38,628 patients hospitalised, 679 had unplanned ICU admission (2%) with an ICU admission rate of 18 per 1000 ward admissions. There were 2153 MET and 453 CIR activations, producing a dosage of 56 and 12 per 1000 admissions, respectively. Higher unplanned ICU admission was significantly associated with CIR compared to MET activation (324/453 (71.5%) vs 355/2153 (16.5%) p < 0.001). On binary logistic regression, MET system was significantly associated with higher hospital mortality on unadjusted analysis (OR 1.65 (95% CI: 1.09–2.48) p = 0.02) but not after adjustment with ANZROD and lead time (OR 1.15 (95% CI: 0.71–1.86), p = 0.58).Conclusions: Compared to CIR, MET system had higher dosage but lower frequency of unplanned ICU admissions and lacked independent association with hospital mortality.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-02-02T07:15:47Z
      DOI: 10.1177/17511437211060157
       
  • A critical care follow-up service evaluation: Acquired peripheral nerve
           injury after admission with COVID-19 respiratory disease

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      Authors: Ellen C Barton, Gearoid Crosbie, Sophie Hobson, Janis Harvey, Ahmad Abu-Arafeh, John A Livesey, Elizabeth Wilson
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      Anticipated sequelae of critical care admission for COVID-19 disease remain unclear. Our Edinburgh-based critical care follow-up service identified patterns with nerve injury in 13 of 35 patients who attended following a critical care admission between 15/03/2020 and 25/12/2020. This included 7 cases of meralgia parasthetica, 1 brachial plexopathy, 2 common peroneal neuropathies and 3 ulnar neuropathies. All cases of upper limb neuropathy and foot drop occurred in patients in whom prone positioning was used, with meralgia parasthetica occurring additionally in patients who remained supine.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-01-31T04:04:24Z
      DOI: 10.1177/17511437221075291
       
  • Rethinking ‘Westernised’ medical ethics in end-of-life care

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      Authors: Emma Jackson, Mike Charlesworth
      Abstract: Journal of the Intensive Care Society, Ahead of Print.

      Citation: Journal of the Intensive Care Society
      PubDate: 2022-01-29T05:48:58Z
      DOI: 10.1177/17511437221075288
       
  • The utility of bandemia in prognostication and prediction of mortality in
           sepsis

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      Authors: Nivedita Prasanna, Benjamin DelPrete, Geoffrey Ho, David Yamane, Amira Elshikh, Amir Rashed, Andrew Sparks, Danielle Davison, Katrina Hawkins
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      Background: Bandemia, defined as a band count>10%, is indicative of underlying infection and is increasingly being used for early detection of sepsis. While an absolute band level has been linked to worse outcomes, its trend has not been extensively studied as a prognostic marker. In this study, we assessed patients admitted to the ICU with sepsis or septic shock and evaluated the correlation between bandemia trends and clinical trajectory among these patients.Methods: This study was a retrospective chart review. Band counts, serum lactate levels, and SOFA scores at 0 and 72 h after admission to the ICU were collected. Patients were risk stratified into groups depending on their SOFA trends, and corresponding band trends and serum lactate levels were compared.Results: 134 patients were included for analysis. There was a statistically significant decrease in bandemia trends for patients with a reduction in SOFA scores [median (IQR)−4.5 (−11, 0); p < 0.0001], and a statistically significant increase in bandemia trends for patients with worsening SOFA scores [median (IQR) 4 (0, 8); p = 0.0007].Conclusion: Early trends of serum band levels in patients with sepsis or septic shock may help to predict a clinical trajectory and overall prognosis. More investigation is warranted as to whether incorporating bandemia trends, when used in conjunction with other known markers such as lactate levels, may help to guide bedside clinical decisions such as risk stratification, tailored therapies, and ultimately improve outcomes.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-01-28T02:39:58Z
      DOI: 10.1177/17511437211069307
       
  • Continuous renal replacement therapy in patients receiving extracorporeal
           membrane oxygenation therapy

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      Authors: Meera Raja, Ricardo Leal, James Doyle
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      Methods of continuous renal replacement therapy (CRRT) in extracorporeal membrane oxygenation (ECMO) patients include dedicated central venous cannula (CVC) (vCRRT), in-series with filter connected to ECMO circuit (eCRRT) or in-line with haemodiafilter incorporated within ECMO circuit. We assessed the efficacy and safety of eCRRT versus vCRRT in 20 ECMO-CRRT patients. Average filter lifespan was 42 vs 28 hours and filter runs completing 72hours were 40% vs 13.8% (eCRRT vs vCRRT, respectively). One incidence of ECMO circuit air embolus occurred (vCRRT). eCRRT achieved adequate filtration and increased filter lifespan, and has become our default for ECMO-CRRT if a pre-existing dialysis CVC is not present.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-01-10T07:56:20Z
      DOI: 10.1177/17511437211067088
       
  • Withdrawing antibiotics in the terminally ill ICU patient: Should it be a
           road less travelled'

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      Authors: Christoffel J Opperman
      Abstract: Journal of the Intensive Care Society, Ahead of Print.

      Citation: Journal of the Intensive Care Society
      PubDate: 2022-01-10T07:50:30Z
      DOI: 10.1177/17511437211060146
       
  • CORONA (COre ultRasOund of covid in iNtensive care and Acute medicine)
           study: National service evaluation of lung and heart ultrasound in
           intensive care patients with suspected or proven COVID-19

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      Authors: Prashant Parulekar, James Powys-Lybbe, Thomas Knight, Nicholas Smallwood, Daniel Lasserson, Gavin Rudge, Ashley Miller, Marcus Peck, Jonathon Aron
      Abstract: Journal of the Intensive Care Society, Ahead of Print.
      BackgroundCombined Lung Ultrasound (LUS) and Focused UltraSound for Intensive Care heart (FUSIC Heart - formerly Focused Intensive Care Echocardiography, FICE) can aid diagnosis, risk stratification and management in COVID-19. However, data on its application and results are limited to small studies in varying countries and hospitals. This United Kingdom (UK) national service evaluation study assessed how combined LUS and FUSIC Heart were used in COVID-19 Intensive Care Unit (ICU) patients during the first wave of the pandemic.MethodTwelve trusts across the UK registered for this prospective study. LUS and FUSIC Heart data were obtained, using a standardised data set including scoring of abnormalities, between 1st February 2020 to 30th July 2020. The scans were performed by intensivists with FUSIC Lung and Heart competency as a minimum standard. Data was anonymised locally prior to transfer to a central database.Results372 studies were performed on 265 patients. There was a small but significant relationship between LUS score>8 and 30-day mortality (OR 1.8). Progression of score was associated with an increase in 30-day mortality (OR 1.2). 30-day mortality was increased in patients with right ventricular (RV) dysfunction (49.4% vs 29.2%). Severity of LUS score correlated with RV dysfunction (p < 0.05). Change in management occurred in 65% of patients following a combined scan.ConclusionsIn COVID-19 patients, there is an association between lung ultrasound score severity, RV dysfunction and mortality identifiable by combined LUS and FUSIC Heart. The use of 12-point LUS scanning resulted in similar risk score to 6-point imaging in the majority of cases. Our findings suggest that serial combined LUS and FUSIC Heart on COVID-19 ICU patients may aid in clinical decision making and prognostication.
      Citation: Journal of the Intensive Care Society
      PubDate: 2022-01-10T07:34:17Z
      DOI: 10.1177/17511437211065611
       
 
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