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61. Is there a role for inhaled epoprostenol, inhaled nitric oxide or sildenafil to treat secondary pulmonary hypertension and hypoxaemia in ICU patients with acute respiratory distress syndrome?

Is there a role for inhaled epoprostenol, inhaled nitric oxide or sildenafil to treat secondary pulmonary hypertension and hypoxaemia in ICU patients with acute respiratory distress syndrome? Is there a role for inhaled epoprostenol, inhaled nitric oxide or sildenafil to treat secondary pulmonary hypertension and hypoxaemia in ICU patients with acute respiratory distress syndrome? – SPS - Specialist Pharmacy Service – The first stop for professional medicines advice Menu · · Coronavirus (COVID

2020 Specialist Pharmacy Services

62. Elevation of the head during intensive care management in people with severe traumatic brain injury. Full Text available with Trip Pro

Elevation of the head during intensive care management in people with severe traumatic brain injury. Traumatic brain injury (TBI) is a major public health problem and a fundamental cause of morbidity and mortality worldwide. The burden of TBI disproportionately affects low- and middle-income countries. Intracranial hypertension is the most frequent cause of death and disability in brain-injured people. Special interventions in the intensive care unit are required to minimise factors (...) intensive care management in people with severe TBI.We searched the following electronic databases from their inception up to March 2017: Cochrane Injuries' Specialised Register, CENTRAL, MEDLINE, Embase, three other databases and two clinical trials registers. The Cochrane Injuries' Information Specialist ran the searches.We selected all randomised controlled trials (RCTs) involving people with TBI who underwent different HBE or backrest positions. Studies may have had a parallel or cross-over design

2017 Cochrane

63. The hospital-based evaluation of laxative prophylaxis in ICU (HELP-ICU): A pilot cluster-crossover randomized clinical trial. (Abstract)

The hospital-based evaluation of laxative prophylaxis in ICU (HELP-ICU): A pilot cluster-crossover randomized clinical trial. Prophylactic laxative regimens may prevent constipation but may increase diarrhea and subsequent rectal tube insertion. Our aim was to compare three prophylactic laxative regimens on the rate of rectal tube insertion (primary outcome) and major constipation- or diarrhea-associated complications.We conducted a cluster-crossover trial. Three pods in a single ICU were each

2019 Journal of critical care Controlled trial quality: uncertain

64. Challenges and barriers to optimising sedation in intensive care: a qualitative study in eight Scottish intensive care units. Full Text available with Trip Pro

Challenges and barriers to optimising sedation in intensive care: a qualitative study in eight Scottish intensive care units. Various strategies to promote light sedation are highly recommended in recent guidelines, as deep sedation is associated with suboptimum patient outcomes. Yet, the challenges met by clinicians in delivering high-quality analgosedation is rarely addressed. As part of the evaluation of a cluster-randomised quality improvement trial in eight Scottish intensive care units (...) (ICUs), we aimed to understand the challenges to optimising sedation in the Scottish ICU settings prior to the trial. This article reports on the findings.A qualitative exploratory design: We conducted focus groups (FG) with clinicians during the preintervention period. Setting and participants: Eight Scottish ICUs. Nurses, physiotherapists and doctors working in each ICU volunteered to participate. FG were recorded and verbatim transcribed and inserted in NVivo V.10 for analysis. Qualitative

2019 BMJ open

65. Effects of Changes in ICU Bed Supply on ICU Utilization. (Abstract)

Effects of Changes in ICU Bed Supply on ICU Utilization. The availability of intensive care unit (ICU) beds may influence the demand for critical care. Although small studies support a model of supply-induced demand in the ICU, there is a paucity of system-wide data.The objective of this study was to determine the relationship between ICU bed supply and ICU admission in United States hospitals.Retrospective cohort study using all-payer inpatient records from Florida, Massachusetts, New Jersey (...) , New York, and Washington from 2010 to 2012, linked to hospital data from Medicare's Healthcare Cost Reporting Information System.Three patient groups with a low likelihood of benefiting from ICU admission-low severity patients with acute myocardial infarction and pulmonary embolism; and high severity patients with metastatic cancer at the end of life.We compared the risk-adjusted probability of ICU admission at hospitals that increased their ICU bed supply over time to matched hospitals that did

2019 Medical Care

66. Key mechanisms by which post-ICU activities can improve in-ICU care: results of the international THRIVE collaboratives. Full Text available with Trip Pro

Key mechanisms by which post-ICU activities can improve in-ICU care: results of the international THRIVE collaboratives. To identify the key mechanisms that clinicians perceive improve care in the intensive care unit (ICU), as a result of their involvement in post-ICU programs.Qualitative inquiry via focus groups and interviews with members of the Society of Critical Care Medicine's THRIVE collaborative sites (follow-up clinics and peer support). Framework analysis was used to synthesize (...) and interpret the data.Five key mechanisms were identified as drivers of improvement back into the ICU: (1) identifying otherwise unseen targets for ICU quality improvement or education programs-new ideas for quality improvement were generated and greater attention paid to detail in clinical care. (2) Creating a new role for survivors in the ICU-former patients and family members adopted an advocacy or peer volunteer role. (3) Inviting critical care providers to the post-ICU program to educate, sensitize

2019 Intensive Care Medicine

67. Diarrhoea: interventions, consequences and epidemiology in the intensive care unit (DICE-ICU): a protocol for a prospective multicentre cohort study. Full Text available with Trip Pro

Diarrhoea: interventions, consequences and epidemiology in the intensive care unit (DICE-ICU): a protocol for a prospective multicentre cohort study. Diarrhoea is a frequent concern in the intensive care unit (ICU) and is associated with prolonged mechanical ventilation, increased length of ICU stay, skin breakdown and renal dysfunction. However, its prevalence, aetiology and prognosis in the critically ill have been poorly studied. The primary objectives of this study are to determine (...) associated with diarrhoea (as defined using WHO criteria) and the kappa statistic to measure agreement on diarrhoea rates between the WHO definition and the Bristol Stool Chart and Bliss Stool Classification System.The protocol has been approved by the research ethics board of all participating centres. The diarrhoea interventions, consequences and epidemiology in the intensive care unit (DICE-ICU) study will generate evidence about diarrhoea and its frequency, predisposing factors and consequences

2019 BMJ open

68. Evaluation of Medication Errors at the Transition of Care From an ICU to Non-ICU Location. (Abstract)

Evaluation of Medication Errors at the Transition of Care From an ICU to Non-ICU Location. To determine the point prevalence of medication errors at the time of transition of care from an ICU to non-ICU location and assess error types and risk factors for medication errors during transition of care.This was a multicenter, retrospective, 7-day point prevalence study.Fifty-eight ICUs within 34 institutions in the United States and two in the Netherlands.Nine-hundred eighty-five patients (...) transferred from an ICU to non-ICU location.None.Of 985 patients transferred, 450 (45.7%) had a medication error occur during transition of care. Among patients with a medication error, an average of 1.88 errors per patient (SD, 1.30; range, 1-9) occurred. The most common types of errors were continuation of medication with ICU-only indication (28.4%), untreated condition (19.4%), and pharmacotherapy without indication (11.9%). Seventy-five percent of errors reached the patient but did not cause harm

2019 Critical Care Medicine

69. Pantoprazole prophylaxis in ICU patients with high severity of disease: a post hoc analysis of the placebo-controlled SUP-ICU trial. (Abstract)

Pantoprazole prophylaxis in ICU patients with high severity of disease: a post hoc analysis of the placebo-controlled SUP-ICU trial. In the subgroup of patients with Simplified Acute Physiology Score (SAPS) II > 53 in the Stress Ulcer Prophylaxis in Intensive Care Unit (SUP-ICU) trial, there was interaction (P = 0.049) suggesting increased mortality in patients allocated to pantoprazole as compared with placebo. We aimed to explore this further.The SUP-ICU trial allocated acutely admitted (...) adults at risk of gastrointestinal bleeding to pantoprazole vs placebo. In this post hoc study, we repeated all the preplanned analyses of SUP-ICU in patients with baseline SAPS II > 53.A total of 1140 patients had a complete SAPS II > 53 and were included. At 90 days, 272/579 patients (47%) assigned to pantoprazole had died, as compared with 229/558 patients (41%) assigned to placebo [relative risk 1.13; 95% confidence interval (CI) 1.00-1.29]. This was supported by sensitivity analyses adjusted

2019 Intensive Care Medicine Controlled trial quality: predicted high

70. Improving decision making in acute healthcare through implementation of an intensive care unit (ICU) intervention in Australia: a multimethod study. Full Text available with Trip Pro

Improving decision making in acute healthcare through implementation of an intensive care unit (ICU) intervention in Australia: a multimethod study. To evaluate the implementation of an intensive care unit (ICU) intervention designed to establish rules for making ICU decisions about postsurgery beds.Preintervention/postintervention case study using a multimethod approach, involving two phases of staff interviews, process mapping and collection of administrative data.ICU in a 700-bed regional (...) tertiary care hospital in Australia.31 interview participants. Phases 1 and 2 participants drawn from three groups of staff: bedside nursing staff in the ICU, ICU specialist doctors and senior management staff involved in oversight of ICU operations. Phase 2 included an additional participant group: staff from surgery and emergency departments.Implementation of an ICU escalation plan and introduction of a multidisciplinary morning meeting to determine ICU bed status in accordance

2019 BMJ open

71. Outcomes of an electronic medical record (EMR)-driven intensive care unit (ICU)-antimicrobial stewardship (AMS) ward round: Assessing the "Five Moments of Antimicrobial Prescribing". (Abstract)

Outcomes of an electronic medical record (EMR)-driven intensive care unit (ICU)-antimicrobial stewardship (AMS) ward round: Assessing the "Five Moments of Antimicrobial Prescribing". The primary objective of this study was to examine the impact of an electronic medical record (EMR)-driven intensive care unit (ICU) antimicrobial stewardship (AMS) service on clinician compliance with face-to-face AMS recommendations. AMS recommendations were defined by an internally developed "5 Moments (...) of Antimicrobial Prescribing" metric: (1) escalation, (2) de-escalation, (3) discontinuation, (4) switch, and (5) optimization. The secondary objectives included measuring the impact of this service on (1) antibiotic appropriateness, and (2) use of high-priority target antimicrobials.A prospective review was undertaken of the implementation and compliance with a new ICU-AMS service that utilized EMR data coupled with face-to-face recommendations. Additional patient data were collected when an AMS

2019 Infection control and hospital epidemiology

72. A National VA Palliative Care Quality Improvement Project for Improving Intensive Care Unit Family Meetings (ICU-FMs). (Abstract)

A National VA Palliative Care Quality Improvement Project for Improving Intensive Care Unit Family Meetings (ICU-FMs). We sought to increase intensive care unit-family meeting (ICU-FM) documentation in the electronic health record in Veterans Affairs (VA) hospitals.Primary outcomes were proportion of VA decedents with ICU-FM and Bereaved Family Survey-Performance Measure (BFS-PM) scores of "excellent."Quality improvement (QI) project, clinical champion, and ICU-FM templates were implemented (...) in nine participating VA facilities. ICU-FMs and BFS-PM were determined in decedents between 2011 and 2018.ICU-FM increased from 3% to 28% in participating vs. 5% to 6% in nonparticipating facilities over time. Participating facilities were five-fold more likely to have ICU-FMs among ICU decedents (OR = 5.69, [4.45-7.28]). Facility-wide excellent BFS-PM scores increased by 19% in participating vs. nonparticipating facilities at the end of the observation period (OR = 1.19, [1.10-1.30

2019 Journal of Pain and Symptom Management

73. Using the National Early Warning Score (NEWS/NEWS 2) in different Intensive Care Units (ICUs) to predict the discharge location of patients. Full Text available with Trip Pro

Using the National Early Warning Score (NEWS/NEWS 2) in different Intensive Care Units (ICUs) to predict the discharge location of patients. The National Early Warning Score (NEWS/NEWS 2) has been adopted across the National Health Service (NHS) in the U.K. as a method of escalating care for deteriorating patients. Intensive Care Unit (ICU) resources are limited and in high demand, with patient discharge a focal point for managing resources effectively. There are currently no universally (...) the receiver operating characteristic (AUROC) curve and a large vital signs database (n=2,723,055) collected from 28,523 critical care admissions.The NEWS AUROC (95% CI) at 24h following admission: all patients 0.727 (0.709-0.745); Coronary Care Unit (CCU) 0.829 (0.821-0.837); Cardiac Surgery Recovery Unit (CSRU) 0.844 (0.838-0.850); Medical Intensive Care Unit (MICU) 0.778 (0.767-0.791); Surgical Intensive Care Unit (SICU) 0.775 (0.762-0.788); Trauma Surgical Intensive Care Unit (TSICU) 0.765 (0.751-0.773

2019 BMC Public Health

74. Describing vancomycin serum levels in pediatric intensive care unit (ICU) patients: are expected goals being met. Full Text available with Trip Pro

Describing vancomycin serum levels in pediatric intensive care unit (ICU) patients: are expected goals being met. In the pediatric population, infections by methicillin-resistant Staphylococcus aureus (MRSA) are associated with significant morbidity and hospital costs. Vancomycin is a glycopeptide antibiotic, widely used for the treatment of serious infections by Gram-positive microorganisms, especially MRSA. It is recommended to keep the serum level of vancomycin between 10 and 20 mg/L (...) , that correlates with AUC/MIC > 400 in adults. This pharmacodynamic target is extrapolated to pediatric patients despite the lack of similar evidence. However, recent studies suggest that serum levels between 7 and 10 mg/L are predictive of reaching the pharmacodynamic target in this population. In spite of widespread use, ideal information about dosage for the pediatric population remains limited.A retrospective study was conducted in patients admitted to the Pediatric Intensive Care Unit during the period

2019 BMC Pediatrics

75. One-year trial of 12-hour shifts in a non-intensive care unit and an intensive care unit in a public hospital: a qualitative study of 24 nurses' experiences. Full Text available with Trip Pro

One-year trial of 12-hour shifts in a non-intensive care unit and an intensive care unit in a public hospital: a qualitative study of 24 nurses' experiences. The aim of this study was to provide recommendations to hospital owners and employee unions about developing efficient, sustainable and safe work-hour agreements. Employees at two clinics of a hospital, one a non-intensive care and the other a newborn intensive care unit (ICU), trialled 12-hour shifts on weekends for 1 year.We (...) systematically recorded the experiences of 24 nurses' working 12-hour shifts, 16 in the medical unit and 8 in the ICU for 1 year. All were interviewed before, during and at the end of the trial period. The interview material was recorded, transcribed to text and coded systematically.The experiences of working 12-hour shifts differed considerably between participants, especially those in the ICU. Their individual experiences differed in terms of health consequences, effects on their family, appreciation

2019 BMJ open

76. Promoting Family Engagement in the ICU: Experience From a National Collaborative of 63 ICUs. (Abstract)

Promoting Family Engagement in the ICU: Experience From a National Collaborative of 63 ICUs. As part of an improvement program targeting ICU, a national collaborative was launched to help hospitals implement patient- and family-centered care engagement initiatives.Ten-month quality improvement collaborative.Guided by a national patient and family advisory group, participating teams implemented an individual project including open visitation; integrating families on rounds; establishing (...) a patient and family advisory committee; using patient and family diaries, among others.Sixty-three adult and PICU teams from both academic and community hospitals in 34 states participated.Monthly team calls, quarterly webinars, newsletters, an online eCommunity, and team reporting assignments were used to facilitate project implementation.The Family Satisfaction with Care in the ICU 24 was used to assess family satisfaction. Clinician perceptions were assessed with the Institute for Patient

2019 Critical Care Medicine

77. Near-simultaneous intensive care unit (ICU) admissions and all-cause mortality: a cohort study. (Abstract)

Near-simultaneous intensive care unit (ICU) admissions and all-cause mortality: a cohort study. Prior studies have reported the adverse effects of strain on patient outcomes. There is a paucity of literature about a type of strain that may be caused by near-simultaneous intensive care unit (ICU) admissions. We hypothesized that when multiple admissions arrive nearly at the same time, the ICU teams are excessively strained, and this leads to unfavorable patient outcomes.This is a retrospective (...) cohort study of consecutive adult patients admitted to an academic medical ICU of a tertiary referral center over five consecutive years. Primary outcomes were the all-cause hospital and ICU mortality.We enrolled 13,234 consecutive ICU admissions during the study period. One-fourth of the admissions had an elapsed time since the last admission (ETLA) of < 55 min. Near-simultaneous admissions (NSA) had on average, a higher unadjusted odds ratio (OR) of ICU death of 1.16 (95% CI 1-1.35, P = 0.05

2019 Intensive Care Medicine

78. External validation of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU). (Abstract)

External validation of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU). The Simplified Mortality Score for the Intensive Care Unit (SMS-ICU) is a clinical prediction model, which estimates the risk of 90-day mortality in acutely ill adult ICU patients using 7 readily available variables. We aimed to externally validate the SMS-ICU and compare its discrimination with existing prediction models used with 90-day mortality as the outcome.We externally validated the SMS-ICU (...) using data from 3282 patients included in the Stress Ulcer Prophylaxis in the Intensive Care Unit trial, which randomised acutely ill adult ICU patients with risk factors for gastrointestinal bleeding to prophylactic pantoprazole or placebo in 33 ICUs in Europe. We assessed discrimination, calibration and overall performance of the SMS-ICU and compared discrimination with the commonly used and more complex SAPS II and SOFA scores.Mortality at day 90 was 30.7%. The discrimination (area under

2019 Acta Anaesthesiologica Scandinavica Controlled trial quality: uncertain

79. Pantoprazole in ICU patients at risk for gastrointestinal bleeding-1-year mortality in the SUP-ICU trial. (Abstract)

Pantoprazole in ICU patients at risk for gastrointestinal bleeding-1-year mortality in the SUP-ICU trial. The long-term effects of stress ulcer prophylaxis with pantoprazole are unknown in ICU patients. We report 1-year mortality outcome in the Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU) trial.In the SUP-ICU trial, acutely admitted adult ICU patients at risk of gastrointestinal bleeding were randomised to intravenous pantoprazole 40 mg vs placebo (saline) once daily during (...) their ICU stay. We assessed mortality at 1 year and did sensitivity analyses according to the trial protocol and statistical analysis plan.A total of 3261 of the 3291 patients with available data (99.1%) were followed up at 1 year after randomisation; 1635 were allocated to pantoprazole and 1626 to placebo. At 1 year after randomisation, 610 of 1635 patients (37.3%) had died in the pantoprazole group as compared with 601 of 1626 (37.0%) in the placebo group (relative risk, 1.01; 95% confidence interval

2019 Acta Anaesthesiologica Scandinavica Controlled trial quality: predicted high

80. Long-term follow-up for Psychological stRess in Intensive CarE (PRICE) survivors: study protocol for a multicentre, prospective observational cohort study in Australian intensive care units. Full Text available with Trip Pro

Long-term follow-up for Psychological stRess in Intensive CarE (PRICE) survivors: study protocol for a multicentre, prospective observational cohort study in Australian intensive care units. There are little published data on the long-term psychological outcomes in intensive care unit (ICU) survivors and their family members in Australian ICUs. In addition, there is scant literature evaluating the effects of psychological morbidity in intensive care survivors on their family members. The aims (...) at 3 and 12 months follow-up using validated and published screening tools. The primary objective is to compare the prevalence of affective symptoms in intubated and non-intubated survivors of intensive care and their families and its effects on HRQoL. The secondary objective is to explore dyadic relations of psychological outcomes in patients and their family members.The study has been approved by the relevant human research ethics committees (HREC) of Australian Capital Territory (ACT) Health

2019 BMJ open

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