Monitoring and optimising outcomes of survivors of critical illness. Intensive and Critical Care Nursing, 2015, 31: p.1-9
Aitken, L.M. and Marshall, A.P.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(14)00093-7/pdf
Recovery after critical illness can be protracted and challenging. Compromise of physical, psychological, cognitive and social function is experienced by some patients and may persist for a number of years. Measurement of recovery outcomes at regular time points throughout the critical illness and recovery pathway is necessary to identify problems and guide selection of interventions to prevent, minimise or overcome that compromise. Optimisation of factors that enhance recovery, such as sleep, nutrition and memories of intensive care, will also assist with promotion of recovery. Effective assessment of recovery requires integration of assessment of outcomes into routine clinical practice by all members of the interdisciplinary team. There must be agreement of appropriate measures and measurement timeframes alongside relevant education and training to ensure optimal assessment and use of the information gained. Assessment outcomes need to be communicated to interdisciplinary team members across the critical illness and recovery trajectory. Adequate resourcing for both the assessment activities and subsequent care is essential to improve patient outcomes after critical illness.
Thursday, 18 December 2014
The experience of communication difficulties in critically ill patients in and beyond intensive care
The experience of communication difficulties in critically ill patients in and beyond intensive care: findings from a larger phenomenological study. Intensive and Critical Care Nursing, Dec. 2014 [in press].
Tembo, A.C., et al.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(14)00091-3/abstract?rss=yes
Communication difficulties in intensive care units (ICU) with critically ill patients have been well documented for more than three decades. However, there is only a paucity of literature that has explored communication difficulties beyond the ICU environment. This paper discusses the experience of communication difficulties in critically ill patients in ICU and beyond as part of findings from a larger study that explored the lived experiences of critically ill patients in ICU in the context of daily sedation interruption
Tembo, A.C., et al.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(14)00091-3/abstract?rss=yes
Communication difficulties in intensive care units (ICU) with critically ill patients have been well documented for more than three decades. However, there is only a paucity of literature that has explored communication difficulties beyond the ICU environment. This paper discusses the experience of communication difficulties in critically ill patients in ICU and beyond as part of findings from a larger study that explored the lived experiences of critically ill patients in ICU in the context of daily sedation interruption
Feeding the critically ill patient
Feeding the critically ill patient. Critical Care Medicine, Dec. 2014, Vol. 42(12), p.2600-2610.
McClave, S.A., et al.
http://journals.lww.com/ccmjournal/Abstract/2014/12000/Feeding_the_Critically_Ill_Patient.16.aspx
Critically ill patients are usually unable to maintain adequate volitional intake to meet their metabolic demands. As such, provision of nutrition is part of the medical care of these patients. This review provides detail and interpretation of current data on specialized nutrition therapy in critically ill patients, with focus on recently published studies.
McClave, S.A., et al.
http://journals.lww.com/ccmjournal/Abstract/2014/12000/Feeding_the_Critically_Ill_Patient.16.aspx
Critically ill patients are usually unable to maintain adequate volitional intake to meet their metabolic demands. As such, provision of nutrition is part of the medical care of these patients. This review provides detail and interpretation of current data on specialized nutrition therapy in critically ill patients, with focus on recently published studies.
Effectiveness of implementing a wake-up and breathe program on sedation and delirium in the ICU
Effectiveness of implementing a wake-up and breathe program on sedation and delirium in the ICU. Critical Care Medicine, Dec. 2014, Vol. 42(2), p.e791-3795.
Khan, B.A., et al.
http://journals.lww.com/ccmjournal/Abstract/2014/12000/Effectiveness_of_Implementing_a_Wake_Up_and.38.aspx
Mechanically ventilated critically ill patients receive significant amounts of sedatives and analgesics that increase their risk of developing coma and delirium. We evaluated the impact of a “Wake-up and Breathe Protocol” at our local ICU on sedation and delirium.
Khan, B.A., et al.
http://journals.lww.com/ccmjournal/Abstract/2014/12000/Effectiveness_of_Implementing_a_Wake_Up_and.38.aspx
Mechanically ventilated critically ill patients receive significant amounts of sedatives and analgesics that increase their risk of developing coma and delirium. We evaluated the impact of a “Wake-up and Breathe Protocol” at our local ICU on sedation and delirium.
Protein in nutrition support: the newborn hero for the critically ill?
Protein in nutrition support: the newborn hero for the critically ill? Critical Care 2014, 18: 592
Oshima, T., et al.
http://ccforum.com/content/18/6/592
Oshima, T., et al.
http://ccforum.com/content/18/6/592
In their current review, Weijs and colleagues highlight the importance of protein and amino acid provision for improving clinical outcome in critically ill patients. The interdependence between energy and protein is highlighted. They call for urgent research to develop new methods to evaluate protein and amino acid requirements, accurately and conveniently, in order to optimize nutrition support for critically ill patients. Appropriate nutrition delivery for critically ill patients remains a highly debated issue. Energy, a critical factor for life, was until now the superstar of nutrition support. It now faces a rival or, more correctly, a partner in function, namely protein. This is a chance to take a close look at protein, the new hero in the field of critical care nutrition, and the struggles it encounters in becoming the true superstar.
Prehospital treatment of sepsis
Prehospital treatment of sepsis: What really makes the "golden hour" golden? Critical Care 2014, 18: 697
Sterling, S.A., et al.
http://ccforum.com/content/18/6/697
The early recognition of severe sepsis is important; however, early identification of severe sepsis can be challenging, especially in the prehospital setting. As previous research has shown, advanced notification of time-sensitive disease states by prehospital personnel can improve outcomes and time to initiation of treatments. Prehospital personnel can potentially impact outcomes in sepsis through early identification and treatment implementations, improving processes of care and transition of care. Further research is needed for a full evaluation of prehospital treatment effects of identification of sepsis and treatment by prehospital personnel and the impact on outcomes.
Sterling, S.A., et al.
http://ccforum.com/content/18/6/697
The early recognition of severe sepsis is important; however, early identification of severe sepsis can be challenging, especially in the prehospital setting. As previous research has shown, advanced notification of time-sensitive disease states by prehospital personnel can improve outcomes and time to initiation of treatments. Prehospital personnel can potentially impact outcomes in sepsis through early identification and treatment implementations, improving processes of care and transition of care. Further research is needed for a full evaluation of prehospital treatment effects of identification of sepsis and treatment by prehospital personnel and the impact on outcomes.
Timing of norepinephrine in septic patients
Timing of norepinephrine in septic patients: Not too little too late. Critical Care 2014, 18: 691
Rachoin, JS and Dellinger, R.P.
http://ccforum.com/content/18/6/691
After years and years of consensus expert opinion as to mean arterial pressure (MAP) target and vasopressor choice in septic shock management, literature is now emerging that supports the MAP target of 65 mm Hg and norepinephrine as the vasopressor choice. However, the literature remains sparse as to the timing of vasopressors relative to fluid resuscitation and how MAP support is balanced between the choices of vasopressor versus fluid resuscitation. Bai and colleagues report data that reveal an association between earlier vasopressor initiation in septic shock and better outcome. Whether this is a linkage to better care, is related to improved early tissue perfusion, or relates to sparing of fluids to reach the MAP target is not yet known.
Rachoin, JS and Dellinger, R.P.
http://ccforum.com/content/18/6/691
After years and years of consensus expert opinion as to mean arterial pressure (MAP) target and vasopressor choice in septic shock management, literature is now emerging that supports the MAP target of 65 mm Hg and norepinephrine as the vasopressor choice. However, the literature remains sparse as to the timing of vasopressors relative to fluid resuscitation and how MAP support is balanced between the choices of vasopressor versus fluid resuscitation. Bai and colleagues report data that reveal an association between earlier vasopressor initiation in septic shock and better outcome. Whether this is a linkage to better care, is related to improved early tissue perfusion, or relates to sparing of fluids to reach the MAP target is not yet known.
Effect of a fever control protocol-based strategy on ventilator-associated pneumonia in severely brain-injured patients
Effect of a fever control protocol-based strategy on ventilator-associated severely brain-injured patients. Critical Care 2014, 18: 689
Launey, Y., et al.
http://ccforum.com/content/pdf/s13054-014-0689-4.pdf
Fever is associated with a poor outcome in severely brain-injured patients, and its control is
one of the therapies used in this condition. But, fever suppression may promote infection, and
severely brain-injured patients are frequently exposed to infectious diseases, particularly
ventilator-associated pneumonia (VAP). Therefore, we designed a study to explore the role of
a fever control protocol in VAP development during neuro-intensive care.
Launey, Y., et al.
http://ccforum.com/content/pdf/s13054-014-0689-4.pdf
Fever is associated with a poor outcome in severely brain-injured patients, and its control is
one of the therapies used in this condition. But, fever suppression may promote infection, and
severely brain-injured patients are frequently exposed to infectious diseases, particularly
ventilator-associated pneumonia (VAP). Therefore, we designed a study to explore the role of
a fever control protocol in VAP development during neuro-intensive care.
Incidence, risk factors and outcomes of new-onset atrial fibrillation in patients with sepsis
Incidence, risk factors and outcomes of new-onset atrial fibrillation in patients with sepsis: a systematic review. Critical Care 2014, 18: 688
Kuipers, S., et al.
http://ccforum.com/content/pdf/s13054-014-0688-5.pdf
Critically ill patients with sepsis are prone to develop cardiac dysrhythmias, most commonly
atrial fibrillation (AF). Systemic inflammation, circulating stress hormones, autonomic
dysfunction, and volume shifts are all possible triggers for AF in this setting. We conducted a
systematic review to describe the incidence, risk factors and outcomes of new-onset AF in
patients with sepsis.
Kuipers, S., et al.
http://ccforum.com/content/pdf/s13054-014-0688-5.pdf
Critically ill patients with sepsis are prone to develop cardiac dysrhythmias, most commonly
atrial fibrillation (AF). Systemic inflammation, circulating stress hormones, autonomic
dysfunction, and volume shifts are all possible triggers for AF in this setting. We conducted a
systematic review to describe the incidence, risk factors and outcomes of new-onset AF in
patients with sepsis.
Association between vitamin D deficiency and mortality in critically ill adult patients
Association between vitamin D deficiency and mortality in critically ill adult patients: a meta-analysis of cohort studies. Critical Care 2014, 18: 684
Sun, TW, et al.
http://ccforum.com/content/pdf/s13054-014-0684-9.pdf
Vitamin D deficiency is common in critically ill patients, and was reported to be associated with adverse outcomes. However, the effect of vitamin D deficiency on mortality in critically ill patients remains unclear.
Sun, TW, et al.
http://ccforum.com/content/pdf/s13054-014-0684-9.pdf
Vitamin D deficiency is common in critically ill patients, and was reported to be associated with adverse outcomes. However, the effect of vitamin D deficiency on mortality in critically ill patients remains unclear.
A practical approach to goal-directed echocardiography in the critical care setting
A practical approach to goal-directed echocardiography in the critical care setting. Critical Care 2014, 18: 681
Walley, P.E., et al.
http://ccforum.com/content/18/6/681
Urgent cardiac ultrasound examination in the critical care setting is clinically useful. Application of goal-directed echocardiography in this setting is quite distinct from typical exploratory diagnostic comprehensive echocardiography, because the urgent critical care setting mandates a goal-directed approach. Goal-directed echocardiography most frequently aims to rapidly identify and differentiate the cause(s) of hemodynamic instability and/or the cause(s) of acute respiratory failure. Accordingly, this paper highlights 1) indications, 2) an easily memorized differential diagnostic framework for goal-directed echocardiography, 3) clinical questions that must be asked and answered, 4) practical issues to allow optimal image capture, 5) primary echocardiographic views, 6) key issues addressed in each view, and 7) interpretation of findings within the differential diagnostic framework.
Walley, P.E., et al.
http://ccforum.com/content/18/6/681
Urgent cardiac ultrasound examination in the critical care setting is clinically useful. Application of goal-directed echocardiography in this setting is quite distinct from typical exploratory diagnostic comprehensive echocardiography, because the urgent critical care setting mandates a goal-directed approach. Goal-directed echocardiography most frequently aims to rapidly identify and differentiate the cause(s) of hemodynamic instability and/or the cause(s) of acute respiratory failure. Accordingly, this paper highlights 1) indications, 2) an easily memorized differential diagnostic framework for goal-directed echocardiography, 3) clinical questions that must be asked and answered, 4) practical issues to allow optimal image capture, 5) primary echocardiographic views, 6) key issues addressed in each view, and 7) interpretation of findings within the differential diagnostic framework.
The early antibiotic therapy in septic patients
The early antibiotic therapy in septic patients - milestone or sticking point? Critical Care 2014, 18: 671
Bernhard, M., et al.
http://ccforum.com/content/18/6/671
Sepsis is one of the oldest and most elusive syndromes in medicine. Every effort should be made to treat these patients with the best available evidence. As a milestone, empiric antimicrobial therapy is essential in order to reduce morbidity and mortality of septic patients. As a sticking point, the use of broad-spectrum antimicrobial agents may be associated with induction of resistance among common pathogens.
Bernhard, M., et al.
http://ccforum.com/content/18/6/671
Sepsis is one of the oldest and most elusive syndromes in medicine. Every effort should be made to treat these patients with the best available evidence. As a milestone, empiric antimicrobial therapy is essential in order to reduce morbidity and mortality of septic patients. As a sticking point, the use of broad-spectrum antimicrobial agents may be associated with induction of resistance among common pathogens.
Sleep continuity
Sleep continuity: a new metric to quantify disrupted hypnograms in non-sedated intensive care unit patients. Critical Care 2014, 18: 628
Drouot, X., et al.
http://ccforum.com/content/pdf/s13054-014-0628-4.pdf
Sleep in intensive care unit (ICU) patients is severely altered. In a large proportion of critically ill patients, conventional sleep electroencephalogram (EEG) patterns are replaced by atypical sleep. On the other hand, some non-sedated patients can display usual sleep EEG patterns. In the latter, sleep is highly fragmented and disrupted and conventional rules may not be optimal. We sought to determine whether sleep continuity could be a useful metric to quantify the amount of sleep with recuperative function in critically ill patients with usual sleep EEG features.
Drouot, X., et al.
http://ccforum.com/content/pdf/s13054-014-0628-4.pdf
Sleep in intensive care unit (ICU) patients is severely altered. In a large proportion of critically ill patients, conventional sleep electroencephalogram (EEG) patterns are replaced by atypical sleep. On the other hand, some non-sedated patients can display usual sleep EEG patterns. In the latter, sleep is highly fragmented and disrupted and conventional rules may not be optimal. We sought to determine whether sleep continuity could be a useful metric to quantify the amount of sleep with recuperative function in critically ill patients with usual sleep EEG features.
Intravenous immunoglobulin for severe sepsis and septic shock
Intravenous immunoglobulin for severe sepsis and septic shock: clinical effectiveness, cost effectiveness and value of a further randomised controlled trial. Critical Care 2014, 18: 649
Soares, M.O., et al.
http://ccforum.com/content/pdf/s13054-014-0649-z.pdf
Prior to investing in a large, multicentre randomised controlled trial (RCT), the National Institute for Health Research in the UK called for an evaluation of the feasibility and value for money of undertaking a trial on intravenous immunoglobulin (IVIG) as an adjuvant therapy for severe sepsis/septic shock.MethodsIn response to this call, this paper assessed the clinical and cost-effectiveness of IVIG (using a decision model), and evaluated the value of conducting an RCT (using expected value of information (EVI) analysis).
Soares, M.O., et al.
http://ccforum.com/content/pdf/s13054-014-0649-z.pdf
Prior to investing in a large, multicentre randomised controlled trial (RCT), the National Institute for Health Research in the UK called for an evaluation of the feasibility and value for money of undertaking a trial on intravenous immunoglobulin (IVIG) as an adjuvant therapy for severe sepsis/septic shock.MethodsIn response to this call, this paper assessed the clinical and cost-effectiveness of IVIG (using a decision model), and evaluated the value of conducting an RCT (using expected value of information (EVI) analysis).
Sedation assessment in a mobile intensive care unit
Sedation assessment in a mobile intensive care unit: a prospective pilot-study on the relation of clinical sedation scales and the bispectral index. Critical Care 2014, 18: 615
Prottengeier, J., et al.
http://ccforum.com/content/18/6/615
The critically-ill undergoing inter-hospital transfers commonly receive sedatives in continuation of their therapeutic regime or to facilitate a safe transfer shielded from external stressors. While sedation assessment is well established in critical care in general, there is only little data available relating to the special conditions during patient transport and their effect on patient sedation levels. The aim of this prospective study was to investigate the feasibility and relationship of clinical sedation assessment (Richmond Agitation-Sedation Scale (RASS)) and objective physiological monitoring (bispectral index (BIS)) during patient transfers in our Mobile-ICU.
Prottengeier, J., et al.
http://ccforum.com/content/18/6/615
The critically-ill undergoing inter-hospital transfers commonly receive sedatives in continuation of their therapeutic regime or to facilitate a safe transfer shielded from external stressors. While sedation assessment is well established in critical care in general, there is only little data available relating to the special conditions during patient transport and their effect on patient sedation levels. The aim of this prospective study was to investigate the feasibility and relationship of clinical sedation assessment (Richmond Agitation-Sedation Scale (RASS)) and objective physiological monitoring (bispectral index (BIS)) during patient transfers in our Mobile-ICU.
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