Other bulletins in this series include:

Breast Surgery

Thursday, 15 December 2011

The effect of a simulation-based training intervention on the performance of established critical care unit teams

The effect of a simulation-based training intervention on the performance of established critical care unit teams. Critical care medicine, Dec 2011, Vol. 39(12), p. 2605-2611.

Frengley, R.W., et al.

http://journals.lww.com/ccmjournal/Abstract/2011/12000/The_effect_of_a_simulation_based_training.3.aspx

We evaluated the effectiveness of a simulation-based intervention on improving teamwork in multidisciplinary critical care teams managing airway and cardiac crises and compared simulation-based learning and case-based learning on scores for performance.

The factors which influence nurses when weaning patients from mechanical ventilation

The factors which influence nurses when weaning patients from mechanical ventilation: A qualitative study. Intensive & critical care nursing, Oct. 2011, Vol. 27(5), p. 244-252.

Lavelle, C. and Dowling, M.

http://www.intensivecriticalcarenursing.com/article/PIIS0964339711000711/abstract?rss=yes

The aim of the study was to describe the factors that influence critical care nurses when deciding to wean patients from mechanical ventilation. The study adopted a qualitative methodology, using semi-structured interviews and a vignette.

Acute post-traumatic stress in survivors of critical illness who were mechanically ventilated

Acute post-traumatic stress in survivors of critcal illness who were mechanically ventilated: A mixed methods study. Intensive & critical care nursing, Dec. 2011, Vol. 27(6), p. 338-346.

Talisayon, R., et al.

http://www.intensivecriticalcarenursing.com/article/PIIS0964339711000942/abstract?rss=yes

This study investigated the severity of post-traumatic stress (PTS) symptoms, the relationships between PTS symptoms and clinical and demographic characteristics and the subjective experiences of patients who were critically ill and mechanically ventilated in intensive care.

Surviving a critical illness through mutually being there with each other

Surviving a critical illness through mutually being there with each other: A grounded theory study. Intensive & critical care nursing, Dec 2011, Vol. 27(6), p. 317-330.

Chiang, V.C.L.

http://www.intensivecriticalcarenursing.com/article/PIIS0964339711000930/abstract?rss=yes

The objectives of this study were to conduct a theoretical analysis of the critically ill patients’ perceptions of the impact of informal support and care from their main family carer (MFC) during the time of their stay in the hospital (ICU) and thereafter (and vice versa).

Natural history of dental plaque accumulation in mechanically ventilated adults: A descriptive correlational study

National history of dental plaque accumulation in mechanically ventilated adults: A descriptive correlational study. Intensive & critical care nursing, Dec 2011, Vol. 27(6), p. 299-304.

Jones, D.J., et al.

http://www.intensivecriticalcarenursing.com/article/PIIS0964339711000802/abstract?rss=yes

The purpose of this study was to describe the pattern of dental plaque accumulation in mechanically ventilated adults. Accumulation of dental plaque and bacterial colonisation of the oropharynx is associated with a number of systemic diseases including ventilator associated pneumonia.

Vitamin D deficiency as associated with mortality in the medical intensive care unit

Vitamin D deficiency as associated with mortality in the medical intensive care unit. Critical Care, 2011, 15:R292.

Venkatram, S., et al.

http://ccforum.com/content/15/6/R292/abstract

The incidence of vitamin D deficiency in critically ill patients has been reported to range from as low as 17% to 79%. Data regarding the relationship between 25-hydroxyvitamin D levels and outcomes in the medical intensive care unit are sparse. The goal of the study was to evaluate the prevalence of 25-hydroxyvitamin D deficiency in the medical intensive care unit and its relationship with outcomes.

Long-term psychological effects of a no sedation protocol in critically ill patients

Long-term psychological effects of a no sedation protocol in critically ill patients. Critical Care, 2011, R:293.

Stroem, T., et al.

http://ccforum.com/content/15/6/R293/abstract

A protocol of no sedation has been shown to reduce the time patients receive mechanical ventilation and reduce intensive care and total hospital length of stay. The long term psychological effects of this strategy have not yet been described. The purpose of the study was to test whether a strategy of no sedation alters long-term psychological outcome compared with a standard strategy with sedation.

Decisional responsibility for mechanical ventilation and weaning: an international survey

Decisional responsibility for mechanical ventilation and weaning: An international survey. Critical care 2011, 15:R295.

Rose, L., et al.

http://ccforum.com/content/15/6/R295/abstract

Optimal management of mechanical ventilation and weaning requires dynamic and collaborative decision making to minimize complications and avoid delays in the transition to extubation. In the absence of collaboration, ventilation decision making may be fragmented, inconsistent, and delayed Our objective was to describe the professional group with responsibility for key ventilation and weaning decisions and examine organizational characteristics associated with nurse involvement.

Monday, 31 October 2011

Gender-related outcome difference is related to course of sepsis on mixed ICUs

Gender-related outcome difference is related to course of sepsis on mixed ICUs: a prospective, observational clinical study. Critical Care 2011, 15:R151

Nachtigall, I. et al.

Impact of gender on severe infections is in highly controversial discussion with natural survival advantage of females described in animal studies but contradictory to those described human data. This study aims to describe the impact of gender on outcome in mixed intensive care units (ICUs) with a special focus on sepsis.

Impact of quetiapine on resolution of individual delirium symptoms in critically ill patients with delirium

Impact of quetiapine on resolution of individual delirium symptoms in critically ill patients with delirium: a post-hoc analysis of a double-blind, randomized, placebo-controlled study. Critical Care 2011, 15:R215

Devlin, JW., et al.

http://ccforum.com/content/15/5/R215

The outcome of patients with delirium has been linked to the particular delirium symptoms identified with ICDSC evaluation. However, no ICU delirium prevention or treatment strategy published to date reports the impact of interventions on time to resolution of individual delirium symptoms. We hypothesized that the pattern of delirium symptom resolution would differ between patients receiving quetiapine vs. placebo. In this post-hoc analysis, we compared the delirium symptoms evaluated by the ICDSC within our previous randomized study in terms of the time to first resolution and the duration of each delirium symptom.

Outcome effectiveness of the severe sepsis resuscitation bundle with addition of lactate clearance as a bundle item

Outcome effectiveness of the severe sepsis resuscitation bundle with addition of lactate clearance as a bundle item: a multi-national evaluation. Critical Care 2011, 15:R229.

Nguyen, HB., et al.

Implementation of the Surviving Sepsis Campaign (SSC) guidelines has been associated with improved outcome in patients with severe sepsis. Resolution of lactate elevations or lactate clearance has also been shown to be associated with outcome. The purpose of this study was to examine the compliance and effectiveness of the SSC resuscitation bundle with the addition of lactate clearance.

Plasma from septic shock patients induces loss of muscle protein

Plasma from septic shock patients induces loss of muscle protein. Critical Care 2011, 15:R233.

van Hees, HWH, et al.

http://ccforum.com/content/15/5/R233/abstract

ICU-acquired muscle weakness commonly occurs in patients with septic shock and is associated with poor outcome. Although atrophy is known to be involved, it is unclear whether ligands in plasma from these patients are responsible for initiating degradation of muscle proteins. The aim of the present study was to investigate if plasma from septic shock patients induces skeletal muscle atrophy and to examine the time course of plasma-induced muscle atrophy during ICU stay.

Early natural killer cell counts in blood predict mortality in severe sepsis

Early natural killer cell counts in blood predict mortality in severe sepsis. Critical Care 2011, 15:R243

Andaluz-Ojeda, D., et al.

http://ccforum.com/content/15/5/R243/abstract

Host immunity should play a principal role in determining both outcome and recovery of sepsis originated by a microbial infection. Quantification of the levels of key elements of the immune response could have a prognostic value in this disease.

Monday, 15 August 2011

NICE guidelines: Delirium

Delirium: diagnosis, prevention and management. NICE clinical guideline 103, 2010.

http://www.nice.org.uk/nicemedia/live/13060/49909/49909.pdf


Early versus late parenteral nutrition in critically ill adults

Early versus late parenteral nutrition in critically ill adults. N Engl J Med Aug 2011; 365:506-517.

Casaer, MP, et al.

http://www.nejm.org/doi/full/10.1056/NEJMoa1102662

Controversy exists about the timing of the initiation of parenteral nutrition in critically ill adults in whom caloric targets cannot be met by enteral nutrition alone.

Thursday, 28 July 2011

The evaluation and management of delirium among older persons

The evaluation and management of delirium among older persons. Med Clin North Am. 2011 May;95(3):555-77.

Flaherty, JH.

http://www.ncbi.nlm.nih.gov/pubmed/21549878?dopt=Abstract

This article reviews the pathophysiology, prevalence, incidence, and consequences of delirium, focusing on the evaluation of delirium, the published models of care for prevention in patients at risk of delirium, and management of patients for whom delirium is not preventable.

Computer protocol facilitates evidence-based care of sepsis in the surgical intenstive care unit

Computer protocol facilitates evidence-based care of sepsis in the surgical ICU. Journal of Trauma. 2011 May;70(5):1153-66; discussion 1166-7.

McKinley, BA, et al.

http://www.ncbi.nlm.nih.gov/pubmed/21610430?dopt=Abstract


Care of sepsis has been the focus of intense research and guideline development for more than two decades. With ongoing success of computer protocol (CP) technology and with publication of Surviving Sepsis Campaign (SSC) guidelines, we undertook protocol development for management of sepsis of surgical intensive care unit patients in mid-2006.

Treatment of cancer pain

Treatment of cancer pain. The Lancet, Volume 377, Issue 9784, Pages 2236 - 2247, 25 June 2011.

Portenoy, RK.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60236-5/abstract?rss=yes

doi:10.1016/S0140-6736(11)60236-5

In patients with active cancer, the management of chronic pain is an essential element in a comprehensive strategy for palliative care. This strategy emphasises multidimensional assessment and the coordinated use of treatments that together mitigate suffering and provide support to the patient and family.

Treatment of chronic non-cancer pain

Treatment of chronic non-cancer pain. The Lancet, Volume 377, Issue 9784, Pages 2226 - 2235, 25 June 2011.

Turk, DC, et al.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60402-9/abstract?rss=yes

doi:10.1016/S0140-6736(11)60402-9

Chronic pain is a pervasive problem that affects the patient, their significant others, and society in many ways. The past decade has seen advances in our understanding of the mechanisms underlying pain and in the availability of technically advanced diagnostic procedures; however, the most notable therapeutic changes have not been the development of novel evidenced-based methods, but rather changing trends in applications and practices within the available clinical armamentarium.

Treatment of acute postoperative pain

Treatment of acute postoperative pain. The Lancet, Volume 377, Issue 9784, Pages 2215 - 2225, 25 June 2011.

Wu, CL and Raja, SN.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60245-6/abstract?rss=yes

doi:10.1016/S0140-6736(11)60245-6

Although postoperative pain remains incompletely controlled in some settings, increased understanding of its mechanisms and the development of several therapeutic approaches have substantially improved pain control in past years.

Managing pain effectively

Managing pain effectively. The Lancet, Volume 377, Issue 9784, Page 2151, 25 June 2011

Editorial.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60942-2/fulltext?rss=yes

Over the past decade, our understanding of the underlying pathophysiological process of pain and its management has advanced, leading to new analgesic drugs and techniques, and offering new avenues to alleviate suffering. In The Lancet today, we publish a clinical Series focusing on treatments for postoperative, chronic non-cancer, and chronic cancer pain to give an overview of these developments.

Anticipating and managing postoperative delirium and cognitive decline in adults

Anticipating and managing postoperative delirium and cognitive decline in adults. BMJ 2011; 343:d4331.

Sanders, RD, et al.

http://www.bmj.com/content/343/bmj.d4331.full?ath_user=nhsckeeling004&ath_ttok=%3CTjEjzaNeydLCjsXQ1g%3E

The brain is vulnerable during the perioperative period in people of all ages. Neurobehavioural disturbances are common complications of perioperative care, manifesting in three distinct forms: emergence delirium, postoperative delirium, and postoperative cognitive decline. Delirium is defined by the presence of disturbed consciousness (reduced clarity of awareness of the environment with reduced ability to focus, sustain, or shift attention) and a change in cognition (such as memory deficit, disorientation, or language disturbance) or the development of a perceptual disturbance that is not better accounted for by a pre-existing, established, or evolving dementia. Emergence delirium occurs on emergence from anaesthesia and sedation, with no lucid interval, and lasts approximately 30 minutes. Postoperative delirium lasts hours or longer, with or without lucid intervals. Postoperative cognitive decline refers to a more subtle cognitive impairment noted on neuropsychological tests that typically assess attention and memory.

Tuesday, 19 July 2011

Commissioners must do more to prioritise care for people at the end of life

Commissioners must do more to prioritise care for people at the end of life. BMJ 2011; 343:d4567. [news item]

Stoker, P.

http://www.bmj.com/content/343/bmj.d4567.full

Healthcare commissioners should prioritise the care of patients who are nearing the end of life to avoid “unnecessary emergency hospital admissions,” says a new report.

Effects of discontinuing or continuing ongoing statin therapy in severe sepsis and septic shock

Effects of discontinuing or continuing ongoing statin therapy in severe sepsis and septic shock: a retrospective cohort study. Critical care, vol. 15(4), July 2011.

Dessap, AM, et al.

http://ccforum.com/content/15/4/R171

Recent publications suggest potential benefits from statins as a preventive or adjuvant therapy in sepsis. Whether ongoing statin therapy should be continued or discontinued in patients admitted in the intensive care unit (ICU) for sepsis is open to question.

Management and outcome of mechanically ventilated neurologic patients

Management and outcome of mechanically ventilated neurologic patients. Critical care medicine, vol. 39(6), June 2011, p.1482-1492.

Pelosi, P., et al.

http://journals.lww.com/ccmjournal/Abstract/2011/06000/Management_and_outcome_of_mechanically_ventilated.36.aspx

To describe and compare characteristics, ventilatory practices, and associated outcomes among mechanically ventilated patients with different types of brain injury and between neurologic and nonneurologic patients.

Important questions asked by family members of intensive care unit patients

Important questions asked by family members of intensive care unit patients. Critical care medicine, vol. 39(6), June 2011, p. 1365-1371.

Peigne, V., et al.

http://journals.lww.com/ccmjournal/Abstract/2011/06000/Important_questions_asked_by_family_members_of.19.aspx


Relatives often lack important information about intensive care unit patients. High-quality information is crucial to help relatives overcome the often considerable situational stress and to acquire the ability to participate in the decision-making process, most notably regarding the appropriate level of care. We aimed to develop a list of questions important for relatives of patients in the intensive care unit.

Wednesday, 6 July 2011

Are we sedating more than just the brain?

Are we sedating more than just the brain? Critical Care 2011 15:163

Brummel, NE and Girard TD.


Heavy sedation in the ICU is associated with coma, delirium, and prolonged stays, but links between sedatives and non-brain organ failure have rarely been described. In a post-hoc analysis, Strom et al. explored associations between sedation and acute kidney injury among ICU patients randomized to one of two sedation strategies. The "no sedation" protocol was associated with less kidney injury, but methodologic limitations preclude firm conclusions regarding mechanisms underlying this association. This hypothesis-generating study warns that sedation may harm organs other than the brain during critical illness, a possibility that warrants careful study in the future.

Fever in septic ICU patients: friend or foe?

Fever in septic ICU patients: friend or foe? Critical Care 2011 15:222

Launey Y., et al.

In recent years, fever control in critically ill patients by medications and/or external cooling has gained widespread use, notably in patients suffering from neurological injuries. Nevertheless, such a strategy in septic patients is not supported by relevant data. Indeed, in response to sepsis, experimental and clinical studies argue that fever plays a key role in increasing the clearance of microorganisms, the immune response and the heat shock response. Moreover, fever is a cornerstone diagnostic sign in clinical practice, which aids in early and appropriate therapy, and allows physicians to follow the infection course. After discussing the physiological aspects of fever production, this review aims to delineate the advantages and drawbacks of fever in septic patients.

Gender related outcome difference is related to course of sepsis on mixed ICUs

Gender related outcome difference is related to course of sepsis on mixed ICUs: a prospective, observational clinical study. Critical Care 2011, 15:R151

Natchtigall I., et al.

http://ccforum.com/content/15/3/R151

Impact of gender on severe infections is in highly controversial discussion with natural survival advantage of females described in animal studies but contradictory to human data. This study aims to describe impact of gender on outcome in mixed intensive care units (ICU) with a special focus on sepsis. Conclusions: There were no differences in patients' outcome related to gender aspects on mainly surgical ICUs. However, for patients suffering from sepsis there is an increase of mortality related to the female sex.

Wednesday, 15 June 2011

How did you sleep in the ICU?

How did you sleep in the ICU? Critical Care 2011, 15:408

Franck L., et al.

http://ccforum.com/content/15/2/408

Sleep is important for healing and survival of critical illness, as far as quantitative and qualitative sleep deprivation can have negative consequences on a physiologic function, particularly the immune mechanism, as well as psychological well-being. We explored the memorization of sleep disturbances during an ICU stay and then evaluated the quality of sleep reported by patients after critical care.

Is cytomegalovirus reactivation increasing the mortality of patients with severe sepsis?

Is cytomegalovirus reactivation increasing the mortality of patients with severe sepsis? Critical Care 2011 15:138

Kalil AC and Florescu DF.

Critically ill patients who are immunocompetent before intensive care unit (ICU) admission may also become more prone to develop active CMV infection if they have prolonged hospitalizations, high disease severity, and severe sepsis. The development of active CMV disease has been associated with a significant higher risk of death in several previous studies. This Critical Care edition brings a new study by Heininger et al in which they found that patients with severe sepsis who developed active CMV infection had a significantly longer ICU and hospital stays, prolonged mechanical ventilation, but no changes in mortality compared to patients without CMV infection.

Prolonged mechanical ventilation in critically ill patients

Prolonged mechanical ventilation in critically ill patients: epidemiology, outcomes and modelling the potential cost consequences of establishing a regional weaning unit.

Lone NI and Walsh TS.

http://ccforum.com/content/15/2/R102

The number of patients requiring prolonged mechanical ventilation (PMV) is likely to increase. Transferring patients to specialised weaning units may improve outcomes and reduce costs. The aim of this study was to establish the incidence and outcomes of PMV in a UK administrative health care region without a dedicated weaning unit, and model the potential impact of establishing a dedicated weaning unit.

An evidence-based recommendation on bed head elevation for mechanically ventilated patients

An evidence-based recommendation on bed head elevation for mechanically ventilated patients. Critical Care 2011, 15:R111

Niƫl-Weise BS, et al.

A semi-upright position in ventilated patients is recommended to prevent ventilator-associated pneumonia (VAP) and is one of the components in the Ventilator Bundle of the Institute for Health Care Improvement. This recommendation, however, is not an evidence-based one. Methods: A systematic review on the benefits and disadvantages of semi-upright position in ventilated patients was done according to PRISMA guidelines. Then a European expert panel developed a recommendation based on the results of the systematic review and considerations beyond the scientific evidence in a three-round electronic Delphi procedure. Results: Three trials (337 patients) were included in the review. The results showed that it was uncertain whether a 45 degrees bed head elevation was effective or harmful with regard to the occurrence of clinically suspected ventilator-associated pneumonia (VAP), microbiologically confirmed VAP, decubitus and mortality, and that it was unknown whether 45 degrees elevation for 24 hours a day increased the risk for thromboembolism or hemodynamic instability. A group of 22 experts recommended elevating the head of the bed of mechanically ventilated patients to a 20 to 45 degrees position and preferably in a [greater than or equal to] 30 degrees position as long as it does not pose risks or conflicts with other nursing tasks, medical interventions or patients' wishes

Sedation and renal impairment in critically ill patients

Sedation and renal impairment in critically ill patients: a post-hoc analysis of a randomized trial. Critical Care 2011, 15:R119

Strom T, Johansen RR, Prahl JR and Toft P.

http://ccforum.com/content/15/3/R119

Not sedating critically ill patients reduces the time patients receive mechanical ventilation, decreases the time in the intensive care department and reduces the total hospital length of stay. We hypothesized that no sedation improves hemodynamic stability, decreases the need for vasoactive drugs, diminishes the need for extra fluids and lowers the risk of acute kidney injury.

Care bundles: implementing evidence or common sense?

Care bundles: implementing evidence or common sense? Critical Care 2011 15:159

Camporota, L and Brett S.

Care bundles aim to improve standard of care and patient outcome by promoting the consistent implementation of a group of effective interventions. However, a variety of barriers prevent their full application in clinical practice. Here, we discuss some of the benefits and limitations of care bundles in the delivery of safer and more effective and consistent health care.

Are we sedating more than just the brain?

Are we sedating more than just the brain? Critical Care 2011 15:163

Brummel NE and Girard TD.

Heavy sedation in the ICU is associated with coma, delirium, and prolonged stays, but links between sedatives and non-brain organ failure have rarely been described. In a post-hoc analysis, Strom et al. explored associations between sedation and acute kidney injury among ICU patients randomized to one of two sedation strategies. The "no sedation" protocol was associated with less kidney injury, but methodologic limitations preclude firm conclusions regarding mechanisms underlying this association. This hypothesis-generating study warns that sedation may harm organs other than the brain during critical illness, a possibility that warrants careful study in the future.

Fever in septic ICU patients: friend or foe?

Fever in septic ICU patients: friend or foe? Critical Care 2011 15:222

Launey Y, Nesseler, N, Malledant Y and Seguin P.

In recent years, fever control in critically ill patients by medications and/or external cooling has gained widespread use, notably in patients suffering from neurological injuries. Nevertheless, such a strategy in septic patients is not supported by relevant data. Indeed, in response to sepsis, experimental and clinical studies argue that fever plays a key role in increasing the clearance of microorganisms, the immune response and the heat shock response. Moreover, fever is a cornerstone diagnostic sign in clinical practice, which aids in early and appropriate therapy, and allows physicians to follow the infection course. After discussing the physiological aspects of fever production, this review aims to delineate the advantages and drawbacks of fever in septic patients.

Totem and taboo: fluids in sepsis

Totem and taboo: fluids in sepsis. Critical Care 2011 15:164

Hilton, AK and Bellomo, R.

The need for early, rapid, and substantial fluid resuscitation in septic patients has long been an article of faith in the intensive care community, a tribal totem that is taboo to question. The results of a recent multicenter trial in septic children in Africa, published in The New England Journal of Medicine, powerfully challenge the fluid paradigm. The salient aspects of the trial need to be understood and reflected upon. In this commentary, we discuss the background to and findings of the trial and explain why they will likely trigger a re-evaluation of our thinking about fluids in sepsis, a re-evaluation that is already happening in the treatment of acute respiratory distress syndrome and acute kidney injury and in postoperative care.

Thursday, 10 March 2011

Utile or futile: Biomarkers in the ICU

Utile or futile: Biomarkers in the ICU. Critical Care 2011, 15:131

Balmelli, C., et al.

http://ccforum.com/content/15/2/131

Biomarkers complement other clinical information by proving quantitative information regarding a pathophysiological mechanism that can be used for the early diagnosis of a specific disease, to monitor and guide treatment, and to predict the risk of death or other adverse events.

Arterial hyperoxia and in-hospital mortality after resuscitation from cardiac arrest

Arterial hyperoxia and in-hospital mortality after resuscitation from cardiac arrest. Critical Care 2011, 15:R90.

Bellomo, R., et al.

http://ccforum.com/content/15/2/R90

Hyperoxia has been recently reported as an independent risk factor for mortality in patients resuscitated from cardiac arrest. We examined the independent relationship between hyperoxia and outcome in such patients.

Activagted protein C in septic shock: a propensity-matched analysis

Activated protein C in septic shock: a propensity-matched analysis. Critical Care 2011, 15:R89

Sadaka, F., et al.

http://ccforum.com/content/15/2/R89

The use of human recombinant activated protein C (rhAPC) for the treatment of severe sepsis remains controversial despite multiple reported trials. The efficacy of rhAPC remains a matter of dispute. We hypothesized that patients with septic shock who were treated with rhAPC had an improved in-hospital mortality compared to patients with septic shock with similar acuity who did not receive rhAPC.

Tuesday, 8 March 2011

Quality of life after intensive care: A systematic review of the literature

Quality of life after intensive care: A systematic review of the literature. Critical Care Medicine, Vol 38(12), December 2010,p. 2386-2400.

Oeyen, S.G., et al.

http://journals.lww.com/ccmjournal/Abstract/2010/12000/Quality_of_life_after_intensive_care__A_systematic.18.aspx

Quality of life differed on diagnostic category but, overall, critically ill patients had a lower quality of life than an age- and gender-matched population. A minority of studies met the predefined methodologic quality criteria. Results concerning the influence of the patients' characteristics and illnesses on long-term quality of life were conflicting.

Delirium duration and mortality in lightly sedated, mechanicaly ventilated intensive care patients

Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients. Critical Care Medicine, Vol 38(12), December 2010, p. 2311-2318.

Shehabi, Y., et al.

http://journals.lww.com/ccmjournal/Abstract/2010/12000/Delirium_duration_and_mortality_in_lightly.7.aspx

To determine the relationship between the number of delirium days experienced by intensive care patients and mortality, ventilation time, and intensive care unit stay.

Septic shock: a multidisciplinary response team and weekly feedback to clinicians improve the process of care and mortality

Septic shock: A multidisciplinary response team and weekly feedback to clinicians improve the process of care and mortality. Critical Care Medicine, Vol 39(2),
February 2011, p. 252-258.

Schramm, G.E., et al.

http://journals.lww.com/ccmjournal/Abstract/2011/02000/Septic_shock__A_multidisciplinary_response_team.2.aspx

To evaluate the impact of weekly feedback to clinicians and the activation of a sepsis response team on the process of care and hospital mortality in patients with severe sepsis or septic shock.

Corticosteroid therapy for patients in septic shock: some progress in a difficult decision

Corticosteroid therapy for patients in septic shock: Some progress in a difficult decision. Critical Care Medicine Vol 39(3), March 2011, p. 571-574

Sprung, C.L., et al.

http://journals.lww.com/ccmjournal/Abstract/2011/03000/Corticosteroid_therapy_for_patients_in_septic.20.aspx

Reversible adrenal insufficiency has been frequently diagnosed in critically ill patients with sepsis who have either low basal cortisol levels or low cortisol responses to adrenocorticotrophic hormone (ACTH) stimulation. It is generally accepted that a phenomenon called “endotoxin tolerance” contributes to immunosuppression during sepsis. The present study was to investigate whether endotoxin tolerance occurs in the adrenal gland, leading to hyporesponsiveness of adrenal gland during sepsis.

Effect of transcutaneous electrical muscle stimulation on muscle volume in patients with septic shock

Effect of transcutaneous electrical muscle stimulation on muscle volume in patients with septic shock. Critical Care Medicine Vol 39(3), March 2011, p.456-461

Poulsen, J.B., et al.

http://journals.lww.com/ccmjournal/Abstract/2011/03000/Effect_of_transcutaneous_electrical_muscle.5.aspx

Intensive care unit admission is associated with muscle wasting and impaired physical function. We investigated the effect of early transcutaneous electrical muscle stimulation on quadriceps muscle volume in patients with septic shock.

How did you sleep in the ICU?

How did you sleep in the ICU? Critical Care 2011, 15:408.

Franck, L., et al.

http://ccforum.com/content/15/2/408

Patient sleep is extremely disturbed in the intensive care unit. We explored the memorization of sleep disturbances during a phone interview of 60 patients using the Basic Nordic Sleep Questionnaire. Half of them reminded sleep deprivation and one third of them had a decreased long term quality of sleep. Protocols to improve sleep quality are necessary

Inspiratory muscle strength training improves weanting outcome in failure to wean patients: a randomized trial

Inspiratory muscle strength training improves weaning outcome in failure to
wean patients: a randomized trial. Critical Care 2011, Vol 15(2):R84

Martin, A.D., et al.

http://ccforum.com/content/15/2/R84

Most patients are readily liberated from mechanical ventilation (MV) support, however, 10% - 15% of patients experience failure to wean (FTW). FTW patients account for approximately 40% of all MV days and have significantly worse clinical outcomes. MV induced inspiratory muscle weakness has been implicated as a contributor to FTW and recent work has documented inspiratory muscle weakness in humans supported with MV.

Thursday, 3 March 2011

Delirium in the ICU: time to probe the hard questions

Delirium in the ICU: time to probe the hard questions. Critical Care 2011 15:118

Stevens, R.D., et al.

Prevalent in critically ill patients, delirium remains poorly understood and difficult to treat. In a cross-sectional study conducted in 12 countries, delirium was identified in close to one third of patients and was independently associated with increased mortality. While such epidemiological accounts represent an important cornerstone for research, scientific efforts are needed to elucidate the causes of delirium and the mechanisms underlying its association with poor outcomes.

Sizing the lung of mechanically ventilated patients

Sizing the lung of mechanically ventilated patients. Critical Care 2011, 15:R60

Mattingley, J.S., et al

http://ccforum.com/content/15/1/R60

This small observational study was motivated by our belief that scaling the tidal volume in mechanically ventilated patients to the size of the injured lung is safer and more "physiologic" than scaling it to predicted body weight, i.e. its size before it was injured. We defined Total Lung Capacity (TLC) as the thoracic gas volume at an airway pressure of 40 cm H2O and tested if TLC could be inferred from the volume of gas that enters the lungs during a brief "recruitment" maneuver.

Blood purification for sepsis

Blood purification for sepsis. Critical Care 2011 15:205.

Kellum, J.

Sepsis is the primary cause of death in the intensive care unit. Extracorporeal blood purification therapies have been proposed for patients with sepsis in order to improve outcomes since these therapies can alter the host inflammatory response by non-selective removal of inflammatory mediators and/or bacterial products. Recent technological progress has increased the number of techniques available for blood purification and their performance.In this overview, we report on the latest advances in blood purification for sepsis, how they relate to current concepts of disease, and we review the current evidence for high-volume hemofiltration, cascade hemofiltration, hemoadsorption, coupled plasma filtration adsorption, high-adsorption hemofiltration and high cut-off hemofiltration/hemodialysis. Promising results have been reported with all these blood purification therapies showing that they are well tolerated, effective in clearing inflammatory mediators and/or bacterial toxins from the plasma and efficacious for improvement various physiologic outcomes (e.g. hemodynamics, oxygenation). However, numerous questions remain unanswered including the timing, duration and frequency of these therapies in the clinical setting. Large multicenter trials evaluating the ability of these therapies to improve clinical outcomes (i.e. mortality or organ failure), rather than surrogate markers such as plasma mediator clearance or transient improvement in physiologic variables, are required to define the precise role of blood purification in the management of sepsis.

Immunity, inflammation and sepsis: new insights and persistent questions

Immunity, inflammation and sepsis: new insights and persistent questions.
Critical Care 2011 15:124

Frazier, W.J.

Sepsis is now understood to affect a variety of changes in the host, chief among them being alterations in immune system function. Proper immune function involves a competent proinflammatory response to stimuli as well as a regulated counteracting force to restore homeostasis and prevent systemic inflammation and organ dysfunction. Broad-spectrum suppression of the inflammatory response has not been shown to be beneficial to patients suffering from septic disease. In fact, sepsis-related immune suppression has become increasingly recognized as an important contributor to late morbidity and mortality in the critically ill. Giamarellos-Bourboulis and colleagues detail the impaired ability of septic patients to produce proinflammatory cytokines upon ex-vivo stimulation, and introduce altered caspase-1activity as potentially contributory to this process. Proper understanding of the cellular and molecular events resulting in immune suppression following sepsis are important in the identification of new strategies for treatment and the ideal timing of therapy.

Thursday, 27 January 2011

Paradoxical ventilator associated pneumonia incidences

Paradoxical ventilator associated pneumonia incidences among selective digestive decontamination studies versus other studies of mechanically ventilated patients: benchmarking the evidence base. Critical Care 2011, 15:R7.

Hurley, J.C.

Selective digestive decontamination (SDD) appears to have a more compelling evidence base than non-antimicrobial methods for the prevention of ventilator associated pneumonia (VAP). However, the striking variability in ventilator associated pneumonia-incidence proportion (VAP-IP) among the SDD studies remains unexplained and a postulated contextual effect remains untested for.

Anxiety and depression symptoms in critically ill patients

Early intra-intensive care unit psychological intervention promotes recovery from post traumatic stess disorders, anxiety and depression symptoms in critically patients. Critical Care 2011, 15:R41.

Peris, A., et al.

http://ccforum.com/content/pdf/cc10003.pdf

Critically ill patients who required intensive care unit (ICU) treatment may experience psychological distress, with increasing development of psychological disorders and related morbidity. Our aim was to determine whether intra-ICU clinical psychologist interventions decrease the prevalence of anxiety, depression and post traumatic stress disorder after 12 months from ICU discharge.

Tuesday, 4 January 2011

Glycemic control in the ICU

Glycemic control in the ICU. N Engl J Med 2010; 363:2540-2546

Kavanagh, BP and McCowen, KC.

http://www.nejm.org/doi/full/10.1056/NEJMcp1001115

A 42-year-old man is admitted to the intensive care unit (ICU) with an acute exacerbation of asthma associated with community-acquired pneumonia. He is treated with cefotaxime and azithromycin, nebulized albuterol, and intravenous hydrocortisone. He has no known history of diabetes mellitus. Shortly after admission, his arterial glucose concentration is 105 mg per deciliter (5.8 mmol per liter), and on the next day, it has increased to 195 mg per deciliter (10.8 mmol per liter). His glycated hemoglobin level is 5.3%. Should this elevated glucose level be treated?

Diagnosing delirium

Diagnosing delirium. JAMA. 2010;304(19):2125.

Radtke, FM, et al.

http://jama.ama-assn.org/content/304/19/2125.1.full

Dr Wong and colleagues​ provided a systematic review that included discussion of easy-to-use bedside instruments to detect delirium; such tools are paramount in early diagnosis and treatment. However, there are 2 important additional aspects that we would like to address.

(See previous post)

Does this patient have delirium?

Does this patient have delirium? JAMA. 2010;304(7):779-786.

Wong, CL, et al.

http://jama.ama-assn.org/content/304/7/779.abstract?ijkey=&keytype2=tf_ipsecsha

Delirium occurs in many hospitalized older patients and has serious consequences including increased risk for death and admission to long-term care. Despite its importance, health care clinicians often fail to recognize delirium. Simple bedside instruments may lead to improved identification.