Critical Care Patients Research Articles

Nursing intervention in acute or critically ill patients with thirst: an integrated review

Aim: Analyze the existing nursing interventions and their effectiveness in managing thirst and promoting the person’s comfort. Background: Thirst is a symptom often experienced by people hospitalized in an acute and/or critical situation, but it is still frequently under-evaluated and under-treated in clinical practice, one of the main reasons being the difficulty in assessing thirst when it comes to people with an altered state of consciousness. Methods: To analyze the existing nursing interventions in managing thirst and promoting the person’s comfort, an integrative review was elaborated through electronic databases MEDLINE, CINAHL, PubMed, and other sources from March 2023 to August 2023. The review protocol is registered (PROSPERO CRD42023413584) and this review integrates a Project in a Higher School of Nursing. Results: After assessing eligibility, 16 final documents were obtained for data extraction and analysis. The results obtained show that several effective strategies were identified to thirst relief, such as drinking cold liquids, ingestion of carbohydrate drinks when fasting is really necessary, the use of ice, performing oral hygiene, applying lip moisturizer, using mentholated substances, controlling the ambient temperature, use of salivary stimulants and artificial saliva. Conclusions: This is a sensitive area of nursing care. Thus, a more significant investment in the scope of nursing research and the development of innovative technology that can improve nursing interventions for the management and thirst relief, would be beneficial to improve the quality of the nursing care provided for hospitalized patients in critical care.

Prokinetic effect of erythromycin in the management of gastroparesis in critically ill patients-our experience and literature review.

Gastroparesis is a disorder characterized by impaired gastric emptying and the accumulation of food in the intestines without any clear mechanical cause. Gastroparesis in critical care patients is a prevalent issue in the intensive care unit. The disruption of normal gastrointestinal motility in critically ill patients is linked to a significant risk of intolerance to enteral feeding, colonization of the gastrointestinal tract with pathogenic bacterial strains, increased permeability of the intestinal wall, translocation of the intestinal microbiota, leading to progressive malnutrition, and potential development of bacterial infection. The literature was reviewed to assess the benefits and risks associated with the use of this medication. The aim of the study was to treat the symptoms of gastroparesis and stimulate gastrointestinal motility. Consequently, the aim was to reduce the amount of backed-up food content in the stomach, accelerate gastrointestinal motility, and return to intestinal feeding. Gastroparesis is a frequent issue among patients in the intensive care unit. Critical illness can lead to gastrointestinal motility disorders, causing slowed gastric emptying. This increases the risk of problems such as intolerance to enteral feeding, regurgitation, and aspiration of gastrointestinal contents into the respiratory tract, as well as colonization of the gastrointestinal tract by pathogens. Over time, impaired intestinal absorption can result in malnutrition, necessitating the initiation of parenteral nutrition. After analysis of the literature and published scientific reports, as well as considering their own research, it is evident that erythromycin, as a prokinetic drug, effectively enhances gastrointestinal motility. This contributes to stimulating gastric emptying in critically ill patients with gastroparesis who are hospitalized in an intensive care unit. The use of erythromycin in combination with metoclopramide and/or itopride hydrochloride allows for a synergistic effect, leading to the quickest possible return to enteral feeding.

WP5.13 - National Emergency Laparotomy (NELA) critical care admissions: A cohort study

Abstract Aims NELA is committed to enhancing quality of peri-operative care of patients undergoing emergency laparotomy. NELA emphasizes importance of identifying high risk patients, who are associated with significant morbidity & mortality. Critical care allows close monitoring, organ (basic/advanced) support. Aim of study is to review the NELA critical care patients. Methods Cohort study of NELA patients that received post-operative ITU care (direct/indirect admission) at single centre. Descriptive demography, and outcomes were evaluated. NELA parsimonious risk & CCMDS ITU scores used. NELA patient that did not require ITU care were controls. Results NELA critical care (n = 400) NELA non critical care (n = 466) Mann Whitney U (p value) Deaths (n) - (n) Age(yrs) 71.8 64.0 < 0.0001 Sex(M:F) 173 : 227 220 : 246 NS ASA 3 2 < 0.0001 BMI(kg/m2) 26.3 25.0 NS Lap(n) 67 168 Open(n) 333 293 Op time(mins) 131.0 109.4 < 0.0001 LOS(days) 18 9.5 < 0.0001 Deaths 30 day 50 25 60 day 66 37 90 day 73 40 Lactate(mmol/L) 2.4 1.8 <0.01 WCC(x109/L) 13.0 11.8 <0.05 CRP(mg/L) 90.1 56.6 <0.0001 Physiological-score 25.6 19.8 <0.0001 Operative-severity-score 17.9 15.9 <0.0001 Prepossum-score 21.6 7.5 <0.0001 PPmortality-score 11.9 4.9 <0.0001 PPmorbidity-score 77.3 55.7 <0.0001 Survival Rate (%) 1styear 75.4 86.2 5thyear 53.8 70.8 Logrank 10thyear 41.1 58.7 p<0.0001 Conclusion NELA critical care patients had poorer survival rates in our study. Theatre return or indirect critical care transfers can adversely affect survival. These patients were older, frail, multiple co-morbid status. NELA parsimonious mortality risk score >5% should encourage consultant level supervision, mortality risk score >10% should encourage direct critical care involvement.

Therapeutics involved in managing initial and recurrent Clostridium difficile infection: An updated literature review.

Clostridium difficile infection (CDI) has been increasing due to the effect of recurrent hospitalizations. The use of antibiotics has been shown to alter the gut microbiome and lead to CDIs. The treatment is limited to three major antibiotics; however, the incidence of recurrent CDIs has been increasing and drug resistance is a major concern. This aspect is a growing concern in modern medicine especially in the elderly population, critical care patients, and immunocompromised individuals who are at high risk of developing CDIs. Clostridium difficile can lead to various complications including septic shock and fulminant colitis that could prove to be lethal in these patients. Newer modalities of treatment have been developed including bezlotoxumab, a monoclonal antibody and fecal microbiota transplant. There have been studies showing asymptomatic carriers and drug resistance posing a major threat to the healthcare system. Newer treatment options are being studied to treat and prevent CDIs. This review will provide an insight into the current treatment modalities, prevention and newer modalities of treatment and challenges faced in the treatment of CDIs.

Incidence of post-extubation dysphagia among critical care patients undergoing orotracheal intubation: a systematic review and meta-analysis

BackgroundPost-extubation dysphagia (PED) emerges as a frequent complication following endotracheal intubation within the intensive care unit (ICU). PED has been strongly linked to adverse outcomes, including aspiration, pneumonia, malnutrition, heightened mortality rates, and prolonged hospitalization, resulting in escalated healthcare expenditures. Nevertheless, the reported incidence of PED varies substantially across the existing body of literature. Therefore, the principal objective of this review was to provide a comprehensive estimate of PED incidence in ICU patients undergoing orotracheal intubation.MethodsWe searched Embase, PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science, Technology Journal Database (VIP), and SinoMed databases from inception to August 2023. Two reviewers independently screened studies and extracted data. Subsequently, a random-effects model was employed for meta-statistical analysis utilizing the “meta prop” command within Stata SE version 15.0 to ascertain the incidence of PED. In addition, we performed subgroup analyses and meta-regression to elucidate potential sources of heterogeneity among the included studies.ResultsOf 4144 studies, 30 studies were included in this review. The overall pooled incidence of PED was 36% (95% confidence interval [CI] 29–44%). Subgroup analyses unveiled that the pooled incidence of PED, stratified by assessment time (≤ 3 h, 4–6 h, ≤ 24 h, and ≤ 48 h), was as follows: 31.0% (95% CI 8.0–59.0%), 28% (95% CI 22.0–35.0%), 41% (95% CI 33.0–49.0%), and 49.0% (95% CI 34.0–63.0%), respectively. When sample size was 100 < N ≤ 300, the PED incidence was more close to the overall PED incidence. Meta-regression analysis highlighted that sample size, assessment time and mean intubation time constituted the source of heterogeneity among the included studies.ConclusionThe incidence of PED was high among ICU patients who underwent orotracheal intubation. ICU professionals should raise awareness about PED. In the meantime, it is important to develop guidelines or consensus on the most appropriate PED assessment time and assessment tools to accurately assess the incidence of PED.Graphical abstract

Development and validation of a nomogram to predict the risk of vancomycin-related acute kidney injury in critical care patients.

Vancomycin-associated acute kidney injury (AKI) leads to underestimated morbidity in the intensive care unit (ICU). It is significantly important to predict its occurrence in advance. However, risk factors and nomograms to predict this AKI are limited. This was a retrospective analysis of two databases. A total of 1,959 patients diagnosed with AKI and treated with vancomycin were enrolled from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. According to the 7:3 ratio, the training set (n = 1,372) and the internal validation set (n = 587) were randomly allocated. The external validation set included 211 patients from the eICU Collaborative Research Database (eICU). Next, to screen potential variables, the least absolute shrinkage and selection operator (LASSO) regression was utilized. Subsequently, the nomogram was developed by the variables of the selected results in the multivariable logistic regression. Finally, discrimination, calibration, and clinical utility were evaluated to validate the nomogram. The constructed nomogram showed fine discrimination in the training set (area under the receiver operator characteristic curve [AUC] = 0.791; 95% confidence interval [CI]: 0.758-0.823), internal validation set (AUC = 0.793; 95% CI: 0.742-0.844), and external validation set (AUC = 0.755; 95% CI: 0.663-0.847). Moreover, it also well demonstrated calibration and clinical utility. The significant improvement (P < 0.001) in net reclassification improvement (NRI) and integrated differentiation improvement (IDI) confirmed that the predictive model outperformed others. This established nomogram indicated promising performance in determining individual AKI risk of vancomycin-treated critical care patients, which will be beneficial in making clinical decisions.

Analysis of metabolic alterations as 30 days intensive care mortality predictors for patients undergoing continuous renal replacement therapy

BackgroundAcute kidney injury patients on continuous renal replacement therapy are subjected to alterations in metabolism, which in turn are associated with worse clinical outcome and mortality. The aim of this study is to determine which metabolism indicators can be used as independent predictors of 30 days intensive care unit (ICU) mortality. MethodsThis was a prospective observational study on critical care patients on renal replacement therapy. Integrated approach of metabolism evaluation was used, combining the energy expenditure measured by indirect calorimetry, bioelectrical impedance provided fat free mass index (FFMI), amino acid and glucose concentrations. ICU mortality was defined as all cause 30 days mortality. Regression analysis was conducted to determine the conventional and metabolism associated predictors of mortality. ResultsThe study was conducted between the 2021 March and 2022 October. 60 high mortality risk patients (APACHE II of 22.98±7.87, 97% on vasopressors, 100% on mechanical ventilation) were included during the period of the study. The rate of 30 days ICU mortality was 50% (n=30). Differences across survivors and non-survivors in metabolic predictors were noted in energy expenditure (kcal/kg/day) (19.79 ±5.55 vs 10.04 ±3.97 p=0.013), amino acid concentrations (mmol/L) (2.40 ±1.06 vs 1.87 ±0.90 p=0.040) and glucose concentrations (mmol/L) (7.89 ±1.90 vs 10.04 ±3.97 p=0.010). No differences were noted in FFMI (23.38 ±4.25 vs 21.95 ±3.08 p=0.158). In the final linear regression analysis model, lower energy expenditure (exp(B)= 0.852 CI95%: 0.741-0.979 p=0.024) and higher glucose (exp(B)=1.360 CI95%: 1.013-1.824 p=0.041) remained as independent predictors of the higher mortality. ConclusionThe results of the study imply strong association between the metabolic alterations and ICU outcome. Our findings suggest that lower systemic amino acid concentration, lower energy expenditure and higher systemic glucose concentration are predictive of 30 days ICU mortality.

Effect of different single and combined antihypertensive drug regimens on the mortality of critical care patients.

To investigate the effect of different single and combined pre-admission antihypertensive drug regimens on the prognosis of critically ill patients. We performed a retrospective cohort study using data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. All initial ICU admission records of patients with hypertension and previous antihypertensive exposure before ICU admission were included. Our primary outcome was 90-day mortality. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to balance the distribution of baseline characteristics. Logistic regression analysis and subgroup analysis were performed to determine the independent effect of different single and combined antihypertensive drug regimens on 90-day mortality. A total of 13,142 patients were included in the final analysis. The 90-day mortality rate in the combined groups is lower than that in the single therapy group (10.94% vs 11.12%), but no statistical significance was found in the original cohort (p = 0.742). After adjustment for potential confounders, the significantly decreased 90-day mortality rate was found in the combined groups (10.78% vs 12.65%, p = 0.004 in PSM; 10.34% vs 11.90%, p = 0.007). Patients who were exposed to either ACEIs or ARBs had a better prognosis than those not exposed (7.19% vs 17.08%, p < 0.001 in single antihypertensive groups; 8.14% vs18.91%, p < 0.001 in combined antihypertensive groups). The results keep robustness in the PSM and IPTW cohorts. In the logistic regression model analysis, combined therapy was associated with a 12%-20% reduced risk of 90-day death after adjusting potential confounders (OR 0.80-0.88, all p < 0.05), while exposure to ACEIs or ARBs was associated with the decreased risk of 90-day death by 52%-62% (OR 0.38-0.48, all p < 0.001) and 40%-62% (OR 0.38-0.60, all p < 0.001) in the single and combined therapy groups, respectively. The results were still robust to subgroup analysis. Pre-admission combined antihypertensive therapy is associated with a significantly lower risk of death than exposure to single antihypertensives in critically ill patients. Meanwhile, either ACEIs or ARBs seem to be the optimal candidates for both single and combined therapy. Further high-quality trials are needed to confirm our findings.

Multifaceted approach to successful management of pediatric acute liver failure: High-volume plasma exchange as a pivotal intervention

Abstract: Pediatric acute liver failure (pALF) poses a formidable clinical challenge characterized by rapid hepatocyte necrosis and pro-inflammatory events. The urgency of pALF necessitates advanced therapeutic modalities, prompting the exploration of high-volume plasma exchange (HVPE) as a sophisticated intervention. This case report delves into the intricate management of a 16-year-old female with hyperacute liver failure secondary to hepatitis A, highlighting the critical need for nuanced and multidisciplinary approaches. The case unfolds through a detailed description of symptoms, clinical decision-making, and the therapeutic journey. The management includes a calculated deferral of liver transplantation in favor of HVPE, with a focus on the rationale for choosing HVPE over continuous renal replacement therapy. Technical aspects of the procedure, such as blood volume calculations and procedural details, are meticulously outlined. Laboratory investigations track the patient’s progress, showcasing the profound impact of HVPE on clinical and laboratory recovery. The patient’s response to HVPE is evident in the comprehensive clinical and laboratory recovery observed after the intervention. The resolution of encephalopathy, successful extubation, and eventual discharge highlight the positive outcomes achieved through the judicious application of HVPE. However, the procedure is not without challenges, as the emergence of hypertension during the second and third cycles and a lone episode of seizure require swift and careful management. The management of pALF demands a sophisticated and multidimensional approach, especially when liver transplantation is not immediately feasible. This case report underscores the nuanced decision-making involved in selecting extracorporeal therapies, with a focus on the successful application of HVPE. HVPE, as recommended by the American Society for Apheresis, emerges as a promising intervention in the context of pALF, offering a viable option when liver transplantation is deferred due to advanced encephalopathy. The favorable outcomes and considerations of cost-effectiveness and procedural simplicity further accentuate the potential of HVPE as a cornerstone in the critical care of pediatric patients with acute liver failure.

Public Availability of Data Management and Analysis Scripts of Studies Conducted on Open-Access Intensive Care Databases.

Intensive care units (ICUs) provide care for critical patients at high risk of morbidity and mortality, and require continuous monitoring of clinical, biological and, imaging parameters. Collaborative ventures have enabled the emergence of large open access databases for the secondary use of Electronic Health Records (EHRs). The objective of this work was to evaluate the availability of scripts and datasets in publications based on ICU open-access databases. We included 910 original articles based on four ICU open-access databases (Amsterdam University Medical Centers Database, eICU Collaborative Research Database, High time resolution ICU dataset, and Medical Information Mart for Intensive Care). The majority of the studies did not provide their data management scripts (n=839, 92.9%), neither the analysis script (n=843, 93.4%) in the article. Attempts to contact the 845 corresponding authors in question resulted in 89.11% (n=753) of our e-mail requests going unanswered over a two-month period. We received 51 automated messages (55.43%) indicating that emails have not been delivered, while 6 messages (6.52%) redirected to alternative email addresses. Only 20 corresponding authors (18.18%) answered, finally providing the requested materials. Despite scientific journals recommendations to share materials, our study unveils the absence of crucial components for the replication of studies by other research teams.

Impact of nursing interventions on the prevention of ocular surface disorders in critical care patients: A systematic review.

Intensive care unit (ICU) patients are at an increased risk of ocular surface injuries because of various factors such as reduced tear production and impaired protective mechanisms. Despite the significance of ocular care in ICU settings, there is a lack of consensus on effective interventions, leading to inadequate prevention of ocular surface disease (OSD). This systematic review aimed to assess the effectiveness of nursing eye care in preventing OSD in ICU patients. Secondary objectives included identifying primary risk factors for ocular injuries and examining the most effective preventive methods. A systematic review following PRISMA guidelines was conducted, encompassing a literature search, article selection, quality assessment and data synthesis. Studies meeting inclusion criteria were observational studies and clinical trials, focusing on adults admitted to ICUs under sedation and receiving mechanical ventilation. Of 3545 initially identified articles, 12 studies met inclusion criteria. These studies involved a total of 1853 participants. Various interventions were assessed, including saline rinsing, lubricating drops, gel lubricants, occlusion with polyethylene dressing, passive blinking and eyelid closure with tape. Moist chamber occlusion every 6 h combined with gel lubrication emerged as the most effective method in preventing OSD. Gel lubrication along with moist chamber occlusion proved to be the most effective strategy in preventing ocular injuries in ICU patients. Conversely, the routine use of physiological saline was associated with increased severity of corneal lesions. Properly defined protocols and well-trained nursing teams are crucial for reducing ocular injuries in ICU settings. The findings underscore the importance of implementing evidence-based eye care protocols in ICUs, emphasizing the use of gel lubrication and ocular surface protection to mitigate the risk of OSD. This highlights the need for comprehensive training programmes for ICU nursing staff to ensure optimal ocular care delivery.

The role of lipid emulsions containing omega-3 fatty acids for medical and surgical critical care patients

In critical illness the regulation of inflammation and oxidative stress can improve patient outcomes, and thus omega-3 polyunsaturated fatty acids (PUFAs) have been used as part of parenteral nutrition (PN) owing to their potential anti-inflammatory effects. The international lipids in PN Summit, encompassed discussions and the production of consensus guidelines concerning PN intravenous lipid emulsion (ILE) use in critical care. The Lipid Summit participants agreed that the inclusion of fish oil in ILEs is associated with meaningful clinical benefits without signals of harm, based on a strong biological rationale and current clinical evidence. Decisions concerning ILE choice should be made based on current evidence, thus addressing clinical requirements for guidance, particularly as further definitive evidence seems unlikely to occur. In addition, a future of individualized ICU care is envisioned, yielding better clinical outcomes. This approach will require the greater use of intelligent study designs incorporating the use of biomarkers of omega-3 derivatives, inflammatory-resolving processes, and/or muscle protein breakdown.

Critical care innovations: navigating pain relief in intensive care: the role of regional anesthesia.

The purpose of this article is to provide an update of regional anesthesia and its applications in the critical care patient population. Regional anesthesia including blocks of the abdomen and thorax, head and neck, as well as upper and lower extremities can be used to alleviate pain and assist in managing life-threatening conditions such as cerebral vasospasm and ventricular storm in the ICU population. There have been many advances in these techniques including ultrasound-guidance with innovative approaches that allow for more superficial procedures that are safer for critically ill patients. Regional anesthesia can decrease hospital length of stay (LOS), prevent ICU admission, shorten ICU LOS, and increase ventilator free days and may have mortality benefits. Pain management in the ICU is an important and sometimes challenging aspect of patient care. Regional anesthetic techniques have more indications and are safe, versatile tools that should be incorporated into care of critically ill patients.

Eye tracking during a simulated start of shift safety check: An observational analysis of gaze behavior of critical care nurses.

The handover and associated shift start checks by nurses of critical care patients are complex and prone to errors. However, which aspects lead to errors remains unknown. Fewer errors might occur in a structured approach. We hypothesized that specific gaze behavior during handover and shift start safety check correlates with error recognition. In our observational eye tracking study, we analyzed gaze behavior of critical care nurses during handover and shift start safety check in a simulation room with built-in errors. Four areas of interest (AOI) were pre-defined (patient, respirator, prescriptions, monitor). The primary outcome were different gaze metrics (time to first fixation, revisits, first visual intake duration, average visual intake duration, dwell time) on AOIs. Parameters were analyzed by taking all errors in account, and by dividing them into minor and critical. Forty-three participants were included. All participants committed at least a minor error (n = 43, 100%), at least one critical error occurred in 29 participants (67%). Taking all errors into account, longer time to first fixation and more revisits were associated with an increased risk of missing errors (Time to First Fixation: OR 1.099 (95% CI 1.023-1.191, p = 0.0002), Revisits: OR 1.080 (95% CI 1.025-1.143, p = 0.0055)). Error detection during shift start safety check was associated with distinct gaze behavior. Nurses who recognized more errors had a shorter time to first fixation and less revisits. These gaze characteristics might correspond to a more structured approach. Further research is necessary, for example by implementing a checklist, to reduce errors in the future and improve patient safety.

Evaluation of score-based tertiary triage policies during the COVID-19 pandemic: simulation study with real-world intensive care data.

The explicit prohibition of discontinuing intensive care unit (ICU) treatment that has already begun by the newly established German Triage Act in favor of new patients with better prognoses (tertiary triage) under crisis conditions may prevent saving as many patients as possible and therefore may violate the international well-accepted premise of undertaking the "best for the most" patients. During the COVID-19 pandemic, authorities set up lockdown measures and infection-prevention strategies to avoid an overburdened health-care system. In cases of situational overload of ICU resources, when transporting options are exhausted, the question of atertiary triage of patients arises. We provide data-driven analyses of score- and non-score-based tertiary triage policies using simulation and real-world electronic health record data in aCOVID-19 setting. Ten different triage policies, for example, based on the Simplified Acute Physiology Score (SAPSII), are compared based on the resulting mortality in the ICU and inferential statistics. Our study shows that score-based tertiary triage policies outperform non-score-based tertiary triage policies including compliance with the German Triage Act. Based on our simulation model, aSAPSII score-based tertiary triage policy reduces mortality in the ICU by up to 18percentage points. The longer the queue of critical care patients waiting for ICU treatment and the larger the maximum number of patients subject to tertiary triage, the greater the effect on the reduction of mortality in the ICU. ASAPSII score-based tertiary triage policy was superior in our simulation model. Random allocation or "first come, first served" policies yield the lowest survival rates, as will adherence to the new German Triage Act. An interdisciplinary discussion including an ethical and legal perspective is important for the social interpretation of our data-driven results.

Epicardial adipose tissue defined by initial polytrauma CT of mechanically ventilated trauma patients: retrospective single-center cohort study to predict short-term outcomes.

Epicardial adipose tissue (EAT) detected by computed tomography (CT) is associated with morbidity and mortality in patients with COVID-19 and other critical care patient cohorts, whereas their prognostic relevance in trauma patients remains unclear. The present study explored associations with four potential short-term outcomes in trauma patients. All consecutive trauma patients requiring emergency tracheal intubation and mechanical ventilation before initial whole-body CT imaging at a level-1 trauma center over a 12-year period (2008-2019) were reanalyzed for this study. EAT was measured semiquantitatively in initial CT and analyzed regarding associations with 24-hour and 30-day mortality using Cox proportional hazard models. In survivors, associations of EAT with intensive care unit length of stay (ICU LOS) and mechanical ventilation duration were analyzed using linear regression analyses. Four hundred fifty-five patients (74.7% male) with a median age of 49 years, and a median injury severity score (ISS) of 26 points were analyzed. In univariable analysis, EAT index was significantly associated with 24-hour and 30-day mortality (p = 0.007, and p = 0.013, respectively). After adjustment for significant predictors age, body mass index, and ISS, no significant associations were confirmed (p = 0.622, and p = 0.903, respectively). In a subanalysis of 353 survivors, EAT index was significantly associated with ICU LOS and mechanical ventilation duration in univariable analyses (p = 0.031, and p = 0.014, respectively), but not in multivariable analyses (p = 0.81 and p = 0.46, respectively). EAT index was associated with short-term outcomes in severely injured trauma patients, which not remained significant in multivariable analysis, suggesting that its prognostic capability is limited.

Long term effects of mechanical ventilation on lung function in critical care patients: Systematic review

Long term effects of mechanical ventilation on lung function in critical care patients: Systematic review

"Mind the Gap"-Differences between Documentation and Reality on Intensive Care Units: A Quantitative Observational Study.

Digitalization in medicine is steadily increasing. Complex treatments, scarce personnel resources and a high level of documentation are a constant burden on healthcare systems. The balancing between correct manual documentation in the digital records and limited staff resources is rarely successful. The aim of this study is to evaluate the adherence between documentation and lack of documentation in the treatment of critical care patients. For the evaluation, data from the hospital information system (HIS) of several intensive care units (ICU) were examined in conjunction with data collected from a checklist. All boluses of sedatives, analgesics and catecholamines were documented paper based across all shifts and all weekdays and compared with corresponding digital data from the HIS (2019-2022) of previous years. 939 complete digital patient records revealed a massive under-documentation of the medication administration compared to that applied according to the checklist. Only 12% of all administered catecholamines, 11% of α2-agonists, 33% of propofol, 92% of midazolam and 46% of opioids were found in the digital recordings. In comparison, the effect was more pronounced on weekdays compared to weekends. In addition, the highest documentation gap was found in the comparison of early shifts. Comparing neurosurgical vs. internal vs. anesthesiologic ICUs there was a highly significant difference between anesthesiologic ICUs compared with other disciplines (p < 0.0001). Our data shows that there is a remarkable documentation gap and incongruence in the area of applied boli. Automated documentation by connecting syringe pumps that enter data directly into the HIS can not only reduce the workload, but also lead to comprehensive and legally required documentation of all administered medication.

Propofol administration for induction is associated with peri-intubation instability in trauma critical care unit patients

IntroductionPeri-intubation hypotension is associated with increased hospital length of stay and morbidity. Propofol is associated with alterations in hemodynamics. We hypothesize that using propofol for induction leads to peri-intubation hypotension in trauma critical care patients. MethodsPatients that underwent unplanned intubation in the trauma intensive care unit (TICU) were prospectively enrolled. Peri-intubation vitals and medications were recorded to assess hypotension within 10 ​min of intubation. Patients were divided into propofol (PROP) or other medication (OTR) groups. ResultsData was complete for 69 patients; 31 PROP and 38 OTR. In OTR there was an 8.8-point (−21.1, 3.6) SBP decrease (p ​= ​0.159) and in PROP there was a 30.8-point (−45.6, −16.0) SBP decrease (p ​= ​0.0002) with significant increases in heart rate (HR) and shock index (SI) (HR p ​= ​0.001, SI p ​< ​0.0001). ConclusionIn patients without hypotension prior to intubation, we observed a statistically significant drop in the patients’ SBP with use of propofol. In trauma critical care unit patients, we recommend considering an induction medication for unplanned intubation other than propofol.

USE OF CEREBRAL OXIMETRY IN ANEMIC PATIENT

Anemia increases the duration of hospital stay, costs, mortality, and morbidity. It is a serious health problem commonly seen in both perioperative and critical care patients. The primary purpose of blood is to transport oxygen to cells for the realization of energy-producing aerobic metabolism. Near-Infrared Spectroscopy (NIRS) technique is a non-invasive monitoring method that assesses average regional tissue oxygenation. The cerebral oximeter was placed bilaterally on the frontal cortex and measured near the transcutaneous membrane. It is believed that NIRS monitoring will be an effective key in resolving the dilemma of anemia and transfusion in patients by detecting tissue oxygenation disorders. Clinical studies are required for this. In this article, the connection between NIRS and anemia will be discussed.