221 results found
Nguyen RT, Thippeswamy G, Ravishankar S, et al., 2015, Impact Of Arterial Oxygen Levels On Cerebral Oxygen Delivery And Return Of Spontaneous Circulation In Cardiac Arrest, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
D'Lima DM, Moore J, Bottle A, et al., 2015, Developing effective feedback on quality of anaesthetic care: what are its most valuable characteristics from a clinical perspective?, JOURNAL OF HEALTH SERVICES RESEARCH & POLICY, Vol: 20, Pages: 26-34, ISSN: 1355-8196
Petrie J, Easton S, Naik V, et al., 2015, Hospital costs of out-of-hospital cardiac arrest patients treated in intensive care; a single centre evaluation using the national tariff-based system, BMJ Open, Vol: 5, ISSN: 2044-6055
Parnia S, Yang J, Inigo-Santiago L, et al., 2014, Cerebral Oximetry is a Predictor of Return of Spontaneous Circulation in Cardiac Arrest, Scientific Sessions of the American-Heart-Association and American-Stroke-Association / Resuscitation Science Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: 2124-2124, ISSN: 0009-7322
Corner EJ, Brett SJ, 2014, Early identification of patients at risk of long-term critical illness-associated physical disability: is it possible?, Critical Care, Vol: 18, ISSN: 1466-609X
Banerjee T, Taylor N, Brett SJ, et al., 2014, The use of a modified delphi technique to create a list of ‘top ten tips’ for communication with patients and relatives in intensive care, Journal of the Intensive Care Society, Vol: 15, Pages: 314-319, ISSN: 1751-1437
© The Intensive Care Society 2014. There are many barriers to good communication in intensive care. The authors used a Delphi technique to develop a set of ‘top tips’ for good communication between doctors, patients and families in this environment. They worked with members of the Patients and Relatives Committee of the Intensive Care Society and ICUsteps, who have had experience of being patients or of having a relative who had been a patient receiving intensive care.
Reay H, Arulkumaran N, Brett SJ, 2014, Priorities for future intensive care research in the UK: Results of a james lind alliance priority setting partnership, Journal of the Intensive Care Society, Vol: 15, Pages: 288-296, ISSN: 1751-1437
© The Intensive Care Society 2014. This James Lind Alliance (JLA) Priority Setting Partnership aimed to identify and prioritise unanswered questions about adult intensive care that are important to people who have been critically ill, their families, and the health professionals who care for them. Consensus techniques (modified Delphi and Nominal Group) were used to generate suggestions using online and postal surveys. Following verification and iterative editorial review, research topics were constructed from these suggestions. These topics were presented in a second online and postal survey for rating. A Nominal Group of 21 clinicians, patients and family representatives subsequently met to rank the most important research topics and produce a prioritised list. The project was coordinated by a representative Steering Group and independently overseen by the JLA. The initial survey and review of the literature generated over 1,300 suggestions. Preliminary editing and verification permitted us to encapsulate these suggestions within 151 research topics. Iterative review by members of the Steering Group produced 37 topic statements, subsequently rated by participants. Using the mode to determine importance, 19 topics were presented to the group from which a ‘top three’ intensive care research priorities were identified and a further nine topics were prioritised. By applying and adapting the JLA methodology to focus on an area of care rather than to a single disease, we have provided a means to ensure that patients, their families and professionals materially contribute to the prioritisation of intensive care research in the UK.
Fallowfield JL, Delves SK, Hill NE, et al., 2014, Energy expenditure, nutritional status, body composition and physical fitness of Royal Marines during a 6-month operational deployment in Afghanistan, British Journal of Nutrition, Vol: 112, Pages: 821-829, ISSN: 1475-2662
Understanding the nutritional demands on serving military personnel is critical to inform training schedules and dietary provision. Troopsdeployed to Afghanistan face austere living and working environments. Observations from the military and those reported in the Britishand US media indicated possible physical degradation of personnel deployed to Afghanistan. Therefore, the present study aimed to investigatethe changes in body composition and nutritional status of military personnel deployed to Afghanistan and how these were related tophysical fitness. In a cohort of British Royal Marines (n 249) deployed to Afghanistan for 6 months, body size and body composition wereestimated from body mass, height, girth and skinfold measurements. Energy intake (EI) was estimated from food diaries and energy expendituremeasured using the doubly labelled water method in a representative subgroup. Strength and aerobic fitness were assessed. Themean body mass of volunteers decreased over the first half of the deployment (24·6 (SD 3·7) %), predominately reflecting fat loss.Body mass partially recovered (mean þ2·2 (SD 2·9) %) between the mid- and post-deployment periods (P,0·05). Daily EI (mean10 590 (SD 3339) kJ) was significantly lower than the estimated daily energy expenditure (mean 15 167 (SD 1883) kJ) measured in a subgroupof volunteers. However, despite the body mass loss, aerobic fitness and strength were well maintained. Nutritional provision for Britishmilitary personnel in Afghanistan appeared sufficient to maintain physical capability and micronutrient status, but providing appropriatenutrition in harsh operational environments must remain a priority
Patel A, Laffan MA, Waheed U, et al., 2014, Randomised trials of human albumin for adults with sepsis: systematic review and meta-analysis with trial sequential analysis of all-cause mortality, British Medical Journal, Vol: 349, ISSN: 0959-8138
Objective To assess the efficacy and safety of pooled human albumin solutions as part of fluid volume expansion and resuscitation (with or without improvement of baseline hypoalbuminaemia) in critically unwell adults with sepsis of any severity.Design Systematic review and meta-analysis of randomised clinical trials, with trial sequential analysis, subgroup, and meta-regression analyses.Data sources PubMed, PubMed Central, Web of Science (includes Medline, Conference Proceedings Citation Index, Data Citation Index, Chinese Science Citation Database, CAB abstracts, Derwent Innovations Index), OvidSP (includes Embase, Ovid Medline, HMIC, PsycINFO, Maternity and Infant Care, Transport Database), Cochrane Library, clinicaltrials.gov, controlled-trials.com, online material, relevant conference proceedings, hand searching of reference lists, and contact with authors as necessary.Eligibility criteria Prospective randomised clinical trials of adults with sepsis of any severity (with or without baseline hypoalbuminaemia) in critical or intensive care who received pooled human albumin solutions as part of fluid volume expansion and resuscitation (with or without improvement of hypoalbuminaemia) compared with those who received control fluids (crystalloid or colloid), were included if all-cause mortality outcome data were available. No restriction of language, date, publication status, or primary study endpoint was applied.Data extraction Two reviewers independently assessed articles for inclusion, extracted data to assess risk of bias, trial methods, patients, interventions, comparisons, and outcome. The relative risk of all-cause mortality was calculated using a random effects model accounting for clinical heterogeneity.Primary outcome measure All-cause mortality at final follow-up.Results Eighteen articles reporting on 16 primary clinical trials that included 4190 adults in critical or intensive care with sepsis, severe sepsis, or septic shock. A median of 70.0 g daily of p
Fitzgerald M, Millar J, Blackwood B, et al., 2014, Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review., Crit Care, Vol: 18
Acute respiratory distress syndrome (ARDS) continues to have significant mortality and morbidity. The only intervention proven to reduce mortality is the use of lung-protective mechanical ventilation strategies, although such a strategy may lead to problematic hypercapnia. Extracorporeal carbon dioxide removal (ECCO₂R) devices allow uncoupling of ventilation from oxygenation, thereby removing carbon dioxide and facilitating lower tidal volume ventilation. We performed a systematic review to assess efficacy, complication rates, and utility of ECCO₂R devices. We included randomised controlled trials (RCTs), case-control studies and case series with 10 or more patients. We searched MEDLINE, Embase, LILACS (Literatura Latino Americana em Ciências da Saúde), and ISI Web of Science, in addition to grey literature and clinical trials registries. Data were independently extracted by two reviewers against predefined criteria and agreement was reached by consensus. Outcomes of interest included mortality, intensive care and hospital lengths of stay, respiratory parameters and complications. The review included 14 studies with 495 patients (two RCTs and 12 observational studies). Arteriovenous ECCO₂R was used in seven studies, and venovenous ECCO₂R in seven studies. Available evidence suggests no mortality benefit to ECCO₂R, although post hoc analysis of data from the most recent RCT showed an improvement in ventilator-free days in more severe ARDS. Organ failure-free days or ICU stay have not been shown to decrease with ECCOvR. Carbon dioxide removal was widely demonstrated as feasible, facilitating the use of lower tidal volume ventilation. Complication rates varied greatly across the included studies, representing technological advances. There was a general paucity of high-quality data and significant variation in both practice and technology used among studies, which confounded analysis. ECCO₂R is a rapidly evolving technology and is an efficacious treatment t
Roberts JA, Stove V, De Waele JJ, et al., 2014, Variability in protein binding of teicoplanin and achievement of therapeutic drug monitoring targets in critically ill patients: lessons from the DALI Study., Int J Antimicrob Agents, Vol: 43, Pages: 423-430
The aims of this study were to describe the variability in protein binding of teicoplanin in critically ill patients as well as the number of patients achieving therapeutic target concentrations. This report is part of the multinational pharmacokinetic DALI Study. Patients were sampled on a single day, with blood samples taken both at the midpoint and the end of the dosing interval. Total and unbound teicoplanin concentrations were assayed using validated chromatographic methods. The lower therapeutic range of teicoplanin was defined as total trough concentrations from 10 to 20 mg/L and the higher range as 10-30 mg/L. Thirteen critically ill patients were available for analysis. The following are the median (interquartile range) total and free concentrations (mg/L): midpoint, total 13.6 (11.2-26.0) and free 1.5 (0.7-2.5); trough, total 11.9 (10.2-22.7) and free 1.8 (0.6-2.6). The percentage free teicoplanin for the mid-dose and trough time points was 6.9% (4.5-15.6%) and 8.2% (5.5-16.4%), respectively. The correlation between total and free antibiotic concentrations was moderate for both the midpoint (ρ = 0.79, P = 0.0021) and trough (ρ = 0.63, P = 0.027). Only 42% and 58% of patients were in the lower and higher therapeutic ranges, respectively. In conclusion, use of standard dosing for teicoplanin leads to inappropriate concentrations in a high proportion of critically ill patients. Variability in teicoplanin protein binding is very high, placing significant doubt on the validity of total concentrations for therapeutic drug monitoring in critically ill patients.
Roberts JA, Paul SK, Akova M, et al., 2014, DALI: Defining Antibiotic Levels in Intensive Care Unit Patients: Are Current beta-Lactam Antibiotic Doses Sufficient for Critically Ill Patients?, CLINICAL INFECTIOUS DISEASES, Vol: 58, Pages: 1072-1083, ISSN: 1058-4838
Brett S, Hatch R, 2014, Characterising early recovery in survivors of cardiac arrest, RESUSCITATION, Vol: 85, Pages: 454-455, ISSN: 0300-9572
Patel A, Brett SJ, 2014, Identifying Future Risk From Routine Tests?, Critical Care Medicine, Vol: 42, Pages: 999-1000, ISSN: 0090-3493
Corner EJ, Soni N, Handy JM, et al., 2014, Construct validity of the Chelsea critical care physical assessment tool: an observational study of recovery from critical illness, CRITICAL CARE, Vol: 18, ISSN: 1466-609X
Gordon AC, Mason AJ, Perkins GD, et al., 2014, The interaction of vasopressin and corticosteroids in septic shock: A pilot randomized controlled trial, Critical Care Medicine, Vol: 42, Pages: 1325-1333, ISSN: 0090-3493
OBJECTIVES: Vasopressin and corticosteroids are both commonly used adjunctive therapies in septic shock. Retrospective analyses have suggested that there may be an interaction between these drugs, with higher circulating vasopressin levels and improved outcomes in patients treated with both vasopressin and corticosteroids. We aimed to test for an interaction between vasopressin and corticosteroids in septic shock. DESIGN: Prospective open-label randomized controlled pilot trial. SETTING: Four adult ICUs in London teaching hospitals. PATIENTS: Sixty-one adult patients who had septic shock. INTERVENTIONS: Initial vasopressin IV infusion titrated up to 0.06 U/min and then IV hydrocortisone (50 mg 6 hourly) or placebo. Plasma vasopressin levels were measured at 6-12 and 24-36 hours after hydrocortisone/placebo administration. MEASUREMENTS AND MAIN RESULTS: Thirty-one patients were allocated to vasopressin + hydrocortisone and 30 patients to vasopressin + placebo. The hydrocortisone group required a shorter duration of vasopressin therapy (3.1 d; 95% CI, 1.1-5.1; shorter in hydrocortisone group) and required a lower total dose of vasopressin (ratio, 0.47; 95% CI, 0.32-0.71) compared with the placebo group. Plasma vasopressin levels were not higher in the hydrocortisone group compared with the placebo group (64 pmol/L difference at 6- to 12-hour time point; 95% CI, -32 to 160 pmol/L). Early vasopressin use was well tolerated with only one serious adverse event possibly related to study drug administration reported. There were no differences in mortality rates (23% 28-day mortality in both groups) or organ failure assessments between the two treatment groups. CONCLUSIONS: Hydrocortisone spared vasopressin requirements, reduced duration, and reduced dose, when used together in the treatment of septic shock, but it did not alter plasma vasopressin levels. Further trials are needed to assess the clinical effectiveness of vasopressin as the initial vasopressor therapy with or
Ramsay P, Salisbury LG, Merriweather JL, et al., 2014, A rehabilitation intervention to promote physical recovery following intensive care: a detailed description of construct development, rationale and content together with proposed taxonomy to capture processes in a randomised controlled trial, TRIALS, Vol: 15, ISSN: 1745-6215
Dunning JW, Merson L, Rohde GGU, et al., 2014, Open source clinical science for emerging infections, The Lancet Infectious Diseases, Vol: 14, Pages: 8-9, ISSN: 1473-3099
Gordon AC, Mason AJ, Perkins GD, et al., 2014, Protocol for a randomised controlled trial of VAsopressin versus Noradrenaline as Initial therapy in Septic sHock (VANISH), BMJ Open, Vol: 4
Introduction Vasopressin is an alternative vasopressor in the management of septic shock. It spares catecholamine use but whether it improves outcome remains uncertain. Current evidence suggests that it may be most effective if used early and possibly in conjunction with corticosteroids. This trial will compare vasopressin to noradrenaline as initial vasopressor in the management of adult septic shock and investigate whether there is an interaction of vasopressin with corticosteroids.Methods and analysis This is a multicentre, factorial (2×2), randomised, double-blind, placebo-controlled trial. 412 patients will be recruited from multiple UK intensive care units and randomised to receive vasopressin (0–0.06 U/min) or noradrenaline (0–12 µg/min) as a continuous intravenous infusion as initial vasopressor therapy. If maximum infusion rates of this first study drug are reached, the patient will be treated with either hydrocortisone (initially 50 mg intravenous bolus six-hourly) or placebo, before additional open-label catecholamine vasopressors are prescribed. The primary outcome of the trial will be the difference in renal failure-free days between treatment groups. Secondary outcomes include need for renal replacement therapy, survival rates, other organ failures and resource utilisation.Ethics and dissemination The trial protocol and information sheets have received a favourable opinion from the Oxford A Research Ethics Committee (12/SC/0014). There is an independent Data Monitoring and Ethics Committee and independent membership of the Trial Steering Committee including patient and public involvement. The trial results will be published in peer-reviewed journals and presented at national and international scientific meetings.Trial registration number: ISRCTN 20769191 and EudraCT 2011-005363-24.
Parnia S, Santiago LI, Ahn A, et al., 2013, The Utility of Cerebral Oximetry (rSO2%) During In-Hospital Cardiac Arrest as a Marker for the Prediction of Return of Spontaneous Circulation (ROSC), Scientific Sessions and Resuscitation Science Symposium of the American-Heart-Association, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
Patel A, Brett SJ, 2013, Gelatin solutions for critically unwell septic adults., Br J Hosp Med (Lond), Vol: 74, ISSN: 1750-8460
Semple MG, Myles PR, Nicholson KG, et al., 2013, An Evaluation of Community Assessment Tools (CATs) in Predicting Use of Clinical Interventions and Severe Outcomes during the A(H1N1)pdm09 Pandemic, PLOS ONE, Vol: 8, ISSN: 1932-6203
Patel A, Stasiowska M, Waheed U, et al., 2013, Poor analgesic efficacy of epidural analgesia in critical care patients post-pancreaticoduodenectomy, Pancreas, Vol: 43, Pages: 373-379, ISSN: 0885-3177
ObjectivesTo investigate the analgesic efficacy of functional and prematurely aborted epidurals post- pancreaticoduodenectomy in critical care, as this is unknown.MethodsProspectively collected data from elective pancreaticoduodenectomy recipients admitted to the critical care unit over 44 months. Epidural (0.1% bupivacaine and 2 μg.ml-1 fentanyl) analgesic efficacy was assessed with a ranked categorical verbal pain score (primary end- point). If no epidural was placed, intravenous (IV) fentanyl patient-controlled analgesia (PCA) was used.Results86 pancreaticoduodenectomy patients had a mean age of 66.5 years, 61.6% were men, 73 received an epidural, and 13 an IV PCA. Epidural abortion rate was 42.5%, associated with a higher 24-hour (p = 0.02) but not 48-hour pain score. Overall, fewer patients reported any pain (p = 0.010; number needed to harm (NNH) 3.2, 95% confidence interval (CI) 1.7-3.2) or severe pain (p = 0.006; NNH 2.9, 95% CI 2.1-4.7) with functional epidurals. Pain (sensitivity 93.8%) and severe pain (specificity 87.8%) were predictive of epidural abortion. Most post- epidural analgesia was IV PCA (p = 0.097) after both functional and aborted epidurals.ConclusionsPremature epidural abortion rate was high, and associated with analgesic morbidity. Pain score was predictive of epidural abortion. Thus preference towards epidural analgesia cannot be supported.
Patel A, Laffan MA, Dazzi F, et al., 2013, Mesenchymal stromal stem cell therapy for septic shock, UK Critical Care Research Forum
Patel A, Waheed U, Brett SJ, 2013, Harm associated with 6 % tetrastarch 130 kDa [hydroxyethyl starch (HES) 130/0.4 and 130/0.42] is robust to sensitivity analysis by excluding Dolecek et al., Intensive Care Medicine, ISSN: 0342-4642
Myles P, Nguyen-Van-Tam JS, Semple MG, et al., 2013, Differences between asthmatics and nonasthmatics hospitalised with influenza A infection, EUROPEAN RESPIRATORY JOURNAL, Vol: 41, Pages: 824-831, ISSN: 0903-1936
Patel A, Brett SJ, 2013, Is 6% tetrastarch 130 kDa (hydroxyethyl starch130/0.4 or 130/0.42) suitable for severe sepsis?, British Journal of Hospital Medicine, Vol: 74, ISSN: 1750-8460
Patel A, Waheed U, Brett SJ, 2013, Randomised trials of 6 % tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis, Intensive Care Medicine, Vol: 39, Pages: 811-822, ISSN: 0342-4642
PurposeTo assess the impact of 6 % tetrastarch [hydroxyethyl starch (HES) 130/0.4 and 130/0.42] in severe sepsis patients. The primary outcome measure was 90-day mortality.MethodsA structured literature search was undertaken to identify prospective randomised controlled trials (RCTs) in adult patients with severe sepsis receiving 6 % tetrastarch (of potato or waxy maize origin) as part of fluid resuscitation in comparison with other non-HES fluids after randomisation in the critical care setting. A systematic review and meta-analysis were performed.ResultsSix RCTs were included (n = 3,033): three from 2012 (n = 2,913) had low risk of bias. Median tetrastarch exposure was 37.4 ml/kg (range 30–43 ml/kg). Ninety-day mortality was associated with tetrastarch exposure [relative risk (RR) 1.13; 95 % confidence interval (CI) 1.02–1.25; p = 0.02] compared with crystalloid. The number needed to harm (NNH) was 28.8 (95 % CI 14.6–942.5). Publication bias and statistical heterogeneity (I 2 = 0 %) were not present. Tetrastarch exposure was also associated with renal replacement therapy (p = 0.01; NNH 15.7) and allogeneic transfusion support (p = 0.001; NNH 9.9). No difference between groups was observed for 28-day mortality, for comparison with colloid as control, or for waxy maize-derived tetrastarch, but power was lacking. Overall mortality was associated with tetrastarch exposure (RR 1.13; 95 % CI 1.02–1.25; p = 0.02).ConclusionsIn our analysis, 6 % tetrastarch as part of initial fluid resuscitation for severe sepsis was associated with harm and, as alternatives exist, in our view should be avoided.
Brett S, Reay H, 2013, The James lind alliance intensive care research priority setting partnership: Why another research prioritisation exercise?!, Journal of the Intensive Care Society, Vol: 14, ISSN: 1751-1437
Griffiths J, Hatch RA, Bishop J, et al., 2013, An exploration of social and economic outcome and associated health-related quality of life after critical illness in general intensive care unit survivors: a 12-month follow-up study, CRITICAL CARE, Vol: 17, ISSN: 1466-609X
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