Medicine (Baltimore). 2022 Jan 21;101(3):e28494. doi: 10.1097/MD.0000000000028494.

ABSTRACT

BACKGROUND: Exercise tolerance and lung function can be improved by pulmonary rehabilitation. As a result, it may lower thoracic surgery intensive care unit (ICU) patients' postoperative problems and death. Enhanced recovery after surgery has advanced significantly in the perioperative care of thoracic surgery ICU patients in recent years, and it now plays an essential role in improving ICU patients' postoperative prognosis. Appropriate tailored rehabilitation nursing intervention is required to promote the postoperative recovery of respiratory function in thoracic surgery ICU patients. This study aims to look at the influence of tailored rehabilitation nurse intervention on postoperative respiratory function recovery in thoracic surgery ICU patients.

METHODS: To find relevant papers, a comprehensive search of electronic databases will be conducted, including three English databases (PubMed, EMBASE, and the Cochrane Library) and two Chinese databases (Chinese National Knowledge Infrastructure and WanFang). Only research that has been published in either English or Chinese will be considered. The retrieval period will run from November 2021 to November 2021. We will look at randomized controlled trials (RCTs) studies that looked at the effect of a customized rehabilitation nursing intervention on the recovery of respiratory function in thoracic surgery ICU patients after surgery. Two writers will review the literature, retrieve study data, and assess the included studies' quality. Any disagreements will be settled via consensus. RevMan 5.3 will be used to do the meta-analysis.

RESULTS: This research will offer high-quality data on the influence of customized rehabilitation nurse intervention on postoperative respiratory function recovery in thoracic surgery ICU patients.

CONCLUSION: This study will look at whether a targeted rehabilitation nurse intervention might help thoracic surgery ICU patients recover their respiratory function more quickly after surgery.

ETHICS AND DISSEMINATION: There will be no need for ethical approval.

REGISTRATION NUMBER: December 12, 2021.osf.io/9rdu2/ (https://osf.io/9rdu2/).

PMID:35060500 | PMC:PMC8772675 | DOI:10.1097/MD.0000000000028494

Nurs Crit Care. 2022 Jan 5. doi: 10.1111/nicc.12734. Online ahead of print.

ABSTRACT

BACKGROUND: Nurses in intensive care units (ICUs) experience more stressful workplace conditions, making them more vulnerable to high levels of depression compared with those working in other healthcare settings.

OBJECTIVES: This meta-analysis aimed to estimate the pooled prevalence of depression in ICU nurses.

METHODS: A systematic search was conducted in Medline, EMBASE, CINHO, and Web of Science databases. Studies that reported depression among ICU nurses measured by a validated tool were synthesized using a random-effects model. Differences in prevalence of depression by study-level characteristics were estimated using sub-group analysis. Heterogeneity was investigated using standard Chi-squared tests and the I² statistic.

RESULTS: Data were extracted from 19 cross-sectional studies (2003-2020) from 11 countries involving 7196 ICU nurses. The overall pooled prevalence of depression or depressive symptoms among ICU nurses was 24.99% (95% CI, 17.9%-32.7%) with high between-study heterogeneity (χ² = 812, τ² = 0.03, I² = 98%, P < .01).

CONCLUSION: Depression appears to be common among ICU nurses. Considering its negative impact on the quality of life of staff, patient care, and the overall critical care work environment, effective interventions should be designed and implemented to improve psychological health in this population.

RELEVANCE TO CLINICAL PRACTICE: Findings of this review indicate that regular screening for depressive symptoms might be helpful, and access to professional help and supportive care should be provided if necessary.

PMID:34989060 | DOI:10.1111/nicc.12734

J Clin Nurs. 2021 Dec 8. doi: 10.1111/jocn.16157. Online ahead of print.

ABSTRACT

AIMS AND OBJECTIVES: To identify the most accurate postoperative delirium screening tools for detecting postoperative delirium among patients who underwent general anaesthesia surgery in general wards.

BACKGROUND: The lack of detection of postoperative delirium can negatively affect the patient's condition, along with their postoperative treatment and rehabilitation, and it can prolong their hospitalisation, persists cognitive dysfunction and increases mortality. Screening for postoperative delirium in hospitalised patients as nursing assessment is routine clinical practice for early detection.

DESIGN: A systematic review and meta-analysis.

METHODS: MEDLINE, Embase, CINAHL, KoreaMed and Cochrane electronic databases were searched using the key words delirium, postoperative, assessment or screening, and adult for articles published up to April 2020, with no limit on the year of publishing. Only prospective cohort studies reporting sensitivity and specificity values were included. We followed the recommendations of the Cochrane Handbook of Diagnostic Test Accuracy Reviews and the PRISMA checklist. The Quality Assessment of the Diagnostic Accuracy Studies-2 tool was used for data extraction and quality assessment, while a bivariate random-effects meta-analysis model was used for pooling and comparing diagnostic accuracy and providing a summary of evidence.

RESULTS: Six delirium assessment tools were evaluated from nine papers including 3088 patients. Due to the limited number of papers, the meta-analysis included the Confusion Assessment Method (CAM) and its variants, Delirium Detection Score (DDS) and Nurses' Delirium Screening Checklist (NuDESC). Overall, NuDESC demonstrated higher sensitivity than CAM or DDS, while all showed high specificity (0.90 or greater).

CONCLUSION: This review suggested that NuDESC can be employed as an accurate screening tool with high specificity for assessing postoperative delirium during routine checkups. However, it is necessary to consider suitable cut-off values, which is the reference point, in accordance with the clinical setting and the patients' condition.

RELEVANCE TO CLINICAL PRACTICE: NuDESC reported the best evidence of diagnostic accuracy, and we recommend clinical nurses to employ this easy-to-use and validated tool for daily screening of postoperative delirium in general wards to facilitate its early detection and the accurate estimation of its prevalence.

PMID:34881476 | DOI:10.1111/jocn.16157

Int J Environ Res Public Health. 2021 Oct 21;18(21):11049. doi: 10.3390/ijerph182111049.

ABSTRACT

Intensive care unit discharge is an important transition that impacts a patient's wellbeing. Nurses can play an essential role in this scenario, potentiating patient empowerment. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (the PRISMA Statement. Embase), PubMed/MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), CUIDEN Plus, and LILACS databases; these were evaluated in May 2021. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence. Quality of the studies included was assessed using the Cochrane risk-of-bias tool. Of the 274 articles initially identified, eight randomized controlled trials that reported on nursing interventions had mainly focused on patients' ICU discharge preparation through information and education. The creation of ICU nurse-led teams and nurses' involvement in critical care multidisciplinary teams also aimed to support patients during ICU discharge. This systematic review provides an update on the clinical practice aimed at improving the patient experience during ICU discharge. The main nursing interventions were based on information and education, as well as the development of new nursing roles. Understanding transitional needs and patient empowerment are key to making the transition easier.

PMID:34769569 | PMC:PMC8582948 | DOI:10.3390/ijerph182111049

Aust Crit Care. 2021 Nov 8:S1036-7314(21)00137-5. doi: 10.1016/j.aucc.2021.08.010. Online ahead of print.

ABSTRACT

BACKGROUND: Oral care is a fundamental nurse-led intervention in the critical care setting that provides patient comfort and prevents adverse outcomes in critically ill patients. To date, there has been minimal focus on nurse-focused interventions to improve adherence to oral care regimens in the adult intensive care unit setting.

OBJECTIVES: The objectives of this study were to (i) identify types and characteristics of interventions to improve oral care adherence amongst critical care nurses and intervention core components, (ii) evaluate the effectiveness of interventions to improve adherence of oral care regimens, and (iii) identify the types of outcome measures used to assess oral care regimen adherence.

DESIGN: This is a systematic review in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

DATA SOURCES: Key bibliographic databases and platforms, including Scopus, Cochrane, MEDLINE, CINAHL, Embase, PsycINFO, ProQuest, and Web of Science, were searched for studies published before July 2020. The Joanna Briggs Institute's quality appraisal tool was used to assess risk of bias in included studies.

RESULTS: A total of 21 original research studies were identified, of which 18 studies used multifaceted interventions. In accordance with the Joanna Briggs Institute's quality appraisal tools, four of the 20 quasi-experimental studies were rated as high quality. The one randomised control trial was of moderate quality. Outcome measures included oral care adherence behaviours, oral care knowledge, self-reported adherence, and documentation. Improved effectiveness in oral care adherence was reported in 20 studies.

CONCLUSIONS: Review findings confirm interventions to change behaviours improve oral care adherence. The most effective interventional approach could not be determined owing to heterogeneity in intervention design and outcome measures. Oral care in the intensive care unit is a vital, nurse-led activity that reduces the risk of hospital-acquired infection. It is recommended that future research adopt implementation science methods to ensure stakeholder engagement and feasibility.

SYSTEMATIC REVIEW REGISTRATION NUMBER: This review was submitted and subsequently registered on PROSPERO, the International Perspective Register of Systematic Reviews PROSPERO 2019 CRD42019123142.

PMID:34764003 | DOI:10.1016/j.aucc.2021.08.010

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Aug;33(8):927-932. doi: 10.3760/cma.j.cn121430-20210412-00536.

ABSTRACT

OBJECTIVE: To summarize the best evidence for extubation management of adult patients with mechanical ventilation in the intensive care unit (ICU), which will provide practical guidelines for medical staffs.

METHODS: BMJ best clinical practice, UpToDate clinical consultants, Guidelines International Network (GIN), National Guideline Clearinghouse (NGC), National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), Registered Nurses' Association of Ontario (RNAO), Medlive guide, Cochrane Library, JBI evidence-based Health Care Center Database, Web of Science, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ebsco, SinoMed, CNKI, Wanfang Database, etc., were systematically searched. Clinical guidelines, systematic reviews, expert consensus, and randomized controlled trial (RCT) studies were searched from the above database unit August 31st, 2020. Literature quality was evaluated using Appraisal of Guidelines for Research and Evaluation II (AGREE II), JBI quality evaluation tools, and Cochrane risk bias assessment. Two researchers evaluated the quality of the included literature respectively, and then the best evidence of endotracheal intubation and extubation management in ICU adult patients with mechanical ventilation was extracted and summarized.

RESULTS: A total of 12 articles were collected, including 2 guidelines, 5 systematic reviews, 2 expert consensus, and 3 RCTs. This paper summarizes 17 best evidences on extubation management of adult patients with mechanical ventilation in ICU, including accurate pre-extubation assessment, personnel and equipment, medication, posture, oxygen therapy, airway management, and post-extubation monitoring.

CONCLUSIONS: Medical staff should choose the best evidence that meets the requirements of the clinical settings and standardize the management of patients after extubation to reduce the incidence of complications and re-intubation rate to ensure the safety of patients, which will be very important for the management of ICU adult patients with mechanical ventilation after extubation.

PMID:34590558 | DOI:10.3760/cma.j.cn121430-20210412-00536

Aust Crit Care. 2021 Aug 2:S1036-7314(21)00094-1. doi: 10.1016/j.aucc.2021.05.012. Online ahead of print.

ABSTRACT

BACKGROUND: Medication errors in adult intensive care units (ICUs) are both frequent and harmful. For nurses, these errors may be multifactorial and multidisciplinary, extending from prescription stage to monitoring of patient response to medication. Therefore, diverse interventions have been developed to optimise the medication process to prevent such errors.

OBJECTIVES: The objective of this systematic review was to identify research investigating interventions that may be effective in reducing the rate of nurses' medication errors in adult ICUs.

METHODS: A systematic search was undertaken of three databases: Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, and EMCARE using a combination of key terms related to "medication errors", "nurses", "interventions", and "intensive care units". The search was limited to studies published in English between 2009 and 2019. Independent screening, quality appraisal, and data extraction were undertaken by two reviewers.

RESULTS: A total of 464 records were identified from database searches. Eleven studies met inclusion criteria: ten were quasi-experimental designs and one was a randomised controlled trial. Studies examined six types of interventions: prefilled syringes, barcode-assisted medication administration, an automated dispensing system, nursing education programs, a protocolised program logic form, and a preventive interventions program with protocols and pharmacist-supported supervision and monitoring. Findings revealed that a prefilled syringe, nurses' education programs, and the protocolised program logic form were most effective in reducing medication errors. For the barcode-assisted medication administration, automated dispensing systems, and a preventive interventions program with protocols and pharmacist-supported supervision and monitoring, results showed wide variability in effectiveness.

CONCLUSION: This review found that the evidence for effective interventions to reduce nurses' medication errors in adult ICUs is limited, due largely to inconsistencies in research design and methods. Therefore, further studies such as randomised controlled trials focusing on a single intervention are required to provide robust evidence of the effectiveness of interventions.

PMID:34353726 | DOI:10.1016/j.aucc.2021.05.012

Nurs Crit Care. 2021 Jul 29. doi: 10.1111/nicc.12687. Online ahead of print.

ABSTRACT

BACKGROUND: Enteral immunomodulatory nutrition is recommended as an adjuvant therapy for patients in intensive care units (ICU), but its effectiveness is incompletely understood.

AIM: The aim of this review was to examine the effect of a commonly used immunomodulatory formula-omega-3 fatty acids, γ-linolenic acid, and antioxidants-on clinical outcomes and mortality risk in critically ill patients.

DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs).

METHOD: PubMed, Scopus, and Institute for Scientific Information (ISI) Web of Knowledge databases were searched until 18 February 2021. RCTs that used the immunomodulatory formula in the ICU were included.

RESULTS: Ten RCTs (1166 participants) were included in the meta-analysis. The immunomodulatory formula reduced the duration of ICU stay weighted mean difference [(WMD): -2.97 days; 95%CI: -5.59, -0.35)], mechanical ventilation (WMD = -2.20 days, 95%CI: -4.29, -0.10), sequential organ failure assessment and multiple organ dysfunction scores (Hedge's g: -0.42 U/L; 95% CI: -0.74, -0.11), decreased 8-day overall mortality risk (RR = 0.74, 95% CI: 0.58, 0.91), and extended the ICU-free days (WMD: 4.06 days, 95% CI: 0.02, 8.09). The improvement in respiratory function and reduction in mortality risk was more in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Furthermore, the reduction in mechanical ventilation and mortality risk was more evident in older (>60 years) vs young adults.

CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Taken together, the immunomodulatory formula may enhance clinical practice for critical care nurses, such that the prevalence and/or susceptibility to secondary conditions commonly encountered in the ICU (ie, ALI and ARDS) could be attenuated, ultimately allowing critical care nurses to focus their care on the primary reason for which a patient is in the ICU. The study protocol was registered in PROSPERO.

PMID:34323346 | DOI:10.1111/nicc.12687

Nurs Crit Care. 2021 Jul 14. doi: 10.1111/nicc.12679. Online ahead of print.

ABSTRACT

BACKGROUND: Nurse turnover is considered a major cause of nurse shortage, representing problems for health care systems in terms of both quality and cost of care for patients, and intention to leave is the strongest practical predictor variable of actual turnover.

AIMS AND OBJECTIVES: This systematic review and meta-analysis aims at exploring the global prevalence of turnover intention in intensive care nurses.

DESIGN: This was a systematic literature review.

METHODS: A systematic review of empirical quantitative studies on turnover intention in nurses of intensive care units (ICUs), published in English till March 2021, was conducted. The databases PubMed, Embase, ISI Web of Knowledge, and CINAHL were searched. Eligible studies were observational or descriptive studies that reported the prevalence of turnover intention among nurses in all types of ICUs. The quality of studies was assessed using a modified Newcastle-Ottawa Scale. A random effect meta-analysis was conducted to estimate the pooled prevalence of turnover intention among ICU nurses.

RESULTS: We identified 18 cross-sectional studies investigating a total of 23 140 intensive care nurses from 23 countries. The intention to leave rate was ranged from 3.0% to 75.0%. The pooled prevalence of turnover intention was 27.7% (95% confidence interval: 21.6%-34.3%).

CONCLUSIONS: This meta-analysis showed that more than 27% of the intensive care nurses had the intention to leave worldwide. In the current context of nursing shortage, efforts should be made to improve conditions for this important group of care providers.

RELEVANCE TO CLINICAL PRACTICE: The prevalence of turnover intention is relatively high among intensive care nurses. Nurse managers should take this intention seriously, as the intention to leave may lead to an actual decision to leave the profession.

PMID:34261191 | DOI:10.1111/nicc.12679

Intensive Crit Care Nurs. 2021 Oct;66:103092. doi: 10.1016/j.iccn.2021.103092. Epub 2021 Jun 17.

ABSTRACT

OBJECTIVE: To evaluate the effectiveness of interventions to mitigate the harmful effects of moral distress experienced by nursing and medical clinicians working in the intensive care setting.

DESIGN: Eligible studies were identified from searches of PubMed, EBSCO (Academic Search Complete, CINAHL and Medline) and Scopus. Included studies were published prior to 20 August 2020.

RESULTS: Twelve studies were included in this review comprising three randomised controlled trials, seven quasi-randomised trials and two observational studies. Nine studies reported interventions targeting only nurses while three included both nurses and doctors. The types of interventions identified included: moral empowerment programs, end-of-life educational programs, reflective exercises through individual narrative writing or group reflective debriefing, multidisciplinary case debriefing meetings integrated into clinical practice and moral resiliency training. Due to the overall low methodological quality and high risk of bias, no single intervention may be considered efficacious in managing moral distress.

CONCLUSIONS: There is weak evidence that some currently available interventions reduce the moral distress experienced by intensive care health care providers. Larger randomised trials involving all intensive healthcare clinicians are required to evaluate multifaceted interventions.

PMID:34147334 | DOI:10.1016/j.iccn.2021.103092

Aust Crit Care. 2022 May;35(3):309-320. doi: 10.1016/j.aucc.2021.04.010. Epub 2021 Jun 10.

ABSTRACT

OBJECTIVE: The aim of the study was to assess the effectiveness of intensive care unit (ICU)-initiated transitional care interventions for patients and families on elements of post-intensive care syndrome (PICS) and/or PICS-family (PICS--F).

REVIEW METHOD USED: This is a systematic review and meta-analysis SOURCES: The authors searched in biomedical bibliographic databases including PubMed, Embase (OVID), CINAHL Plus (EBSCO), Web of Science, and the Cochrane Library and included studies written in English conducted up to October 8, 2020.

REVIEW METHODS: We included (non)randomised controlled trials focussing on ICU-initiated transitional care interventions for patients and families. Two authors conducted selection, quality assessment, and data extraction and synthesis independently. Outcomes were described using the three elements of PICS, which were categorised into (i) physical impairments (pulmonary, neuromuscular, and physical function), (ii) cognitive impairments (executive function, memory, attention, visuo-spatial and mental processing speed), and (iii) psychological health (anxiety, depression, acute stress disorder, post-traumatic stress disorder, and depression).

RESULTS: From the initially identified 5052 articles, five studies were included (i.e., two randomised controlled trials and three nonrandomised controlled trials) with varied transitional care interventions. Quality among the studies differs from moderate to high risk of bias. Evidence from the studies shows no significant differences in favour of transitional care interventions on physical or psychological aspects of PICS-(F). One study with a nurse-led structured follow-up program showed a significant difference in physical function at 3 months.

CONCLUSIONS: Our review revealed that there is a paucity of research about the effectiveness of transitional care interventions for ICU patients with PICS. All, except one of the identified studies, failed to show a significant effect on the elements of PICS. However, these results should be interpreted with caution owing to variety and scarcity of data.

PROSPERO REGISTRATION: CRD42020136589 (available via https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020136589).

PMID:34120805 | DOI:10.1016/j.aucc.2021.04.010

J Adv Nurs. 2021 Nov;77(11):4321-4331. doi: 10.1111/jan.14914. Epub 2021 Jun 7.

ABSTRACT

AIMS: To evaluate the effect of earplugs and eye masks on the sleep quality of patients in intensive care unit (ICU).

DESIGN: Systematic review and meta-analysis.

DATA SOURCES: Randomized controlled trial studies conducted before May 5, 2020 were searched for in Embase, MEDLINE, Cochrane Library, CINAHL and Index to Taiwan Periodical Literature System databases.

REVIEW METHODS: Analyses in this study were according to the PRISMA statement. The heterogeneity of the data was investigated through sub-group analysis while a meta-analysis was performed using the Review Manager 5.3 software.

RESULTS: A total of 797 patients from 13 studies were included in this study. Without considering alone or combined use of earplugs and eye masks, the meta-analysis supported that there was a significant effect on self-reported sleep quality. The overall standardized mean difference of the effect size was 1.44 (95% confidence interval [CI]: [0.80, 2.09]). Sub-group analysis indicated that the use of earplugs alone had no significant effect on sleep quality (effect size: 0.07, 95% [CI]: [-0.50, 0.64]). The use of eye masks alone had a significant effect on sleep quality (effect size: 1.56, 95% [CI]: [1.08, 2.05]). The use of both earplugs and eye masks proved to have the largest effect size on sleep quality (effect size: 2.08, 95% [CI]: [0.95, 3.21]).

CONCLUSION: The combined use of earplugs and eye masks or the standalone use of eye masks is a non-invasive, economical and effective way to promote sleep quality in adult ICU patients.

IMPACT: Clinical nurses could use this meta-analysis as it recommends that nurses provide adult ICU patients with either one or both earplugs and eye masks to improve the patients' sleep quality.

STUDY REGISTRATION: The review protocol was registered a priori and published online in the PROSPERO database of systematic reviews (www.crd.York.ac.uk/Prospero with the registration number # CRD42021221185).

PMID:34096647 | DOI:10.1111/jan.14914

BMC Health Serv Res. 2021 May 12;21(1):456. doi: 10.1186/s12913-021-06387-3.

ABSTRACT

BACKGROUND: The separation of parents and their prematurely born children during care in a neonatal intensive care unit (NICU) can have far-reaching consequences for the well-being of the parents and also of the children. The aim of this study is to evaluate the use of webcams on NICUs and to conduct a systematic assessment of their possible effects on parents and clinical staff. In addition, it aims at determining the need for webcams in German NICUs and to identify possible barriers and moderators. The development and evaluation of practical guidance for the use of webcams will enable the comprehensive education of clinical staff and parents and, as a result, is intended to mitigate any potential undesirable consequences.

METHODS: The study will be based on a mixed methods approach including all groups concerned in the care. Qualitative data will be collected in interviews and focus groups and evaluated using content analysis. The collection of quantitative data will be based on written questionnaires and will aim to assess the status quo as regards the use of webcams on German NICUs and the effects on parents, physicians, and nursing staff. These effects will be assessed in a randomised cross-over design. Four NICUs will be involved in the study and, in total, the parents of 730 premature babies will be invited to take part in the study. The effects on the nursing staff, such as additional workload and interruptions in workflows, will be evaluated on the basis of observation data.

DISCUSSION: This study will be the largest multicentre study known to us that systematically evaluates the use of webcams in neonatal intensive care units. The effects of the implementation of webcams on both parents and care providers will be considered. The results provide evidence to decide whether to promote the use of webcams on NICUs or not and what to consider when implementing them.

TRIAL REGISTRATION: The trial has been registered at the German Clinical Trial Register (DRKS). Number of registration: DRKS00017755 , date of registration: 25.09.2019.

PMID:33980220 | PMC:PMC8117291 | DOI:10.1186/s12913-021-06387-3

Crit Care Med. 2021 Jul 1;49(7):e707-e718. doi: 10.1097/CCM.0000000000005019.

ABSTRACT

OBJECTIVES: This study aims to summarize the current qualitative evidence on patients' experiences of reading the ICU diaries.

DATA SOURCES: We searched the online databases PubMed, Ovid, EMBASE, and EBSCO host from inception to July 2020.

STUDY SELECTION: All studies that presented any qualitative findings regarding patients' experiences of reading an ICU diary were included.

DATA EXTRACTION: Study design, location, publication year, data collection method, and mode, all qualitative themes identified and reported, and participant quotations, when appropriate. We also extracted data regarding the diary structure, when available. A thematic synthesis approach was used to analyze and synthesize qualitative data.

DATA SYNTHESIS: Seventeen studies were analyzed. Most patients reported positive experiences with the ICU diary, such as understanding what they survived during critical illness, better understanding the process of recovery, gaining coherence of nightmares and delusional memories, realizing the importance of the presence of family and loved ones during ICU stay, and humanizing healthcare professionals that helped them survive critical illness. Patients also reported which components of the diary were important for their recovery, such as the presence of photographs and reading the diary with a healthcare professional, allowing the improvement of the concept of the ICU diary.

CONCLUSION: This qualitative synthesis shows that patients recommend having an ICU diary, enlightening benefits such as better coping with the slow recovery from critical illness, strengthening family ties, and humanizing the ICU staff. It also identifies characteristics of the diary valued by the patients, in order to standardize the ICU diary according to their perspectives, and allowing future comparability between randomized controlled trials.

PMID:33861546 | DOI:10.1097/CCM.0000000000005019

Can J Anaesth. 2021 Aug;68(8):1214-1230. doi: 10.1007/s12630-021-01962-y. Epub 2021 Mar 11.

ABSTRACT

PURPOSE: We systematically reviewed existing critical care electroencephalography (EEG) educational programs for non-neurologists, with the primary goal of reporting the content covered, methods of instruction, overall duration, and participant experience. Our secondary goals were to assess the impact of EEG programs on participants' core knowledge, and the agreement between non-experts and experts for seizure identification.

SOURCE: Major databases were searched from inception to 30 August 2020. Randomized controlled trials, cohort studies, and descriptive studies were all considered if they reported an EEG curriculum for non-neurologists in a critical care setting. Data were presented thematically for the qualitative primary outcome and a meta-analysis using a random effects model was performed for the quantitative secondary outcomes.

PRINCIPAL FINDINGS: Twenty-nine studies were included after reviewing 7,486 citations. Twenty-two studies were single centre, 17 were from North America, and 16 were published after 2016. Most EEG studies were targeted to critical care nurses (17 studies), focused on processed forms of EEG with amplitude-integrated EEG being the most common (15 studies), and were shorter than one day in duration (24 studies). In pre-post studies, EEG programs significantly improved participants' knowledge of tested material (standardized mean change, 1.79; 95% confidence interval [CI], 0.86 to 2.73). Agreement for seizure identification between non-experts and experts was moderate (Cohen's kappa = 0.44; 95% CI, 0.27 to 0.60).

CONCLUSIONS: It is feasible to teach basic EEG to participants in critical care settings from different clinical backgrounds, including physicians and nurses. Brief training programs can enable bedside providers to recognize high-yield abnormalities such as non-convulsive seizures.

PMID:33709264 | PMC:PMC7952081 | DOI:10.1007/s12630-021-01962-y

Int J Gen Med. 2020 Dec 8;13:1445-1452. doi: 10.2147/IJGM.S276878. eCollection 2020.

ABSTRACT

BACKGROUND: Agitation and anxiety occur frequently in ICU and affect about 30-80% of patients in ICU present with delirium worldwide, and it is associated with adverse clinical outcomes. This review aimed to systematically review articles and finally draw an evidence-based guideline for an area with limited resources.

METHODS: The review was reported based on preferred reporting items for systemic and meta-analysis (PRISMA) protocol. We searched literature from PubMed, Google Scholar, and Medline database using keywords like the level of sedation, sedation score, pain assessment in ICU, and sedative drugs in ICU from an article published in English. After extraction with a patient population and exclusion, five randomized clinical trials, four systemic reviews and meta-analysis, four observation cohort study, and two practical guidelines were used for the review.

CONCLUSION: In addition to high validity and reliability, RASS has the advantage of easiness to remember for nurses making it a preferred sedation assessment tool in an adult ICU setting. Light sedation with daily interruption was recommended with an aim of an awake and alert patient ready for the weaning trial. Propofol was preferred when sedation is for a short duration and when intermittent awakening is required. Ketamine is the preferred induction for asthmatic hypotensive and patient requiring prolonged continuous sedation. With a similar time for sedation, diazepam shows a shorter time for intubation compared to midazolam. Besides diazepam has shown a cheaper cost of sedation than midazolam. This makes it a drug of preference in a low resource setting.

PMID:33335417 | PMC:PMC7737551 | DOI:10.2147/IJGM.S276878

Invest Educ Enferm. 2020 Oct;38(3):e12. doi: 10.17533/udea.iee.v38n3e12.

ABSTRACT

OBJECTIVES: To determine the relationship between ethical climate and burnout in nurses working in Intensive Care Units (ICUs).

METHODS: This cross-sectional and multi-center study was conducted among 212 nurses working in adult ICUs of six hospitals affiliated to Shiraz University of Medical Sciences, Iran in 2019. The participants were selected using systematic random sampling technique. Data was collected using valid instruments of Olson's Hospital Ethical Climate Survey (HECS) and Maslach Burnout Inventory (MBI).

RESULTS: Ethical climate was favorable (3.5±0.6). The intensity (32.2±12.4) and frequency (25.5±12.4) of burnout were high. Ethical climate had significant and inverse relationships with frequency of burnout (r =-0.23, p=0.001) and with intensity of burnout (r=-0.186, p=0.007). Ethical climate explained 5.9% of burnout. Statistically significant relationships were also found between these factors: age with ethical climate (p=0.001), work shifts with burnout (p=0.02), and gender and with intensity frequency of burnout in ICU nurses (p=0.038). The results of Spearman correlation coefficient showed significant and inverse relationships between ethical climate and job burnout (r=-0.243, p < 0.001).

CONCLUSIONS: Nurses in ICUs perceived that ethical climate was favorable however, burnout was high. Therefore, burnout can be affected by many factors and it is necessary to support ICU nurses since they undertake difficult and complicated task. It is recommended to assess factors that increase burnout and adopt specific measures and approaches to relieve nursing burnout.

PMID:33306902 | PMC:PMC7885543 | DOI:10.17533/udea.iee.v38n3e12

Crit Care Res Pract. 2020 Sep 27;2020:5167623. doi: 10.1155/2020/5167623. eCollection 2020.

ABSTRACT

BACKGROUND: Providing an organ for donation is a major problem worldwide and nurses play an important role in facilitating the process of organ donation. This study is aimed at investigating the knowledge, attitude, and performance of nurses working in the ICU, CCU, and emergency wards regarding organ donation.

METHODS: In this descriptive-analytical study, 185 nurses working in ICU, CCU, and emergency wards were studied through systematic random sampling. The data collection was done by a self-administered questionnaire.

RESULTS: The mean knowledge of nurses was 8.9 ± 1.4 out of 10. There was a significant relationship between knowledge of nurses regarding donation and religion and having organ donation card (P < 0.001). The mean attitude of nurses was 7.8 ± 2.2 out of 8. The variables, including "having a donation card and marriage," were associated with attitude of nurses toward organ donation. The mean performance of nurses was 0.4 ± 0.7 out of 3. There was a significant relationship between performance of nurses and having a donation card (P < 0.001). Knowledge was the strongest predictor of nurses' performance (P < 0.01).

CONCLUSION: The studied nurses showed sufficient knowledge and favorable attitude toward organ donation; however, they had poor performance. It is suggested to hold training courses to improve performance of nurses. The revision of the nursing students' curriculum as future nurses should also be considered.

PMID:33062327 | PMC:PMC7537714 | DOI:10.1155/2020/5167623

Aust Crit Care. 2021 May;34(3):278-286. doi: 10.1016/j.aucc.2020.07.013. Epub 2020 Oct 11.

ABSTRACT

OBJECTIVES: The objective of the study was to compare nurse-led sedation protocols with physician-led usual care in intensive care units (ICUs) in treating mechanically ventilated adult patients.

REVIEW METHOD USED: This is a systematic review and meta-analysis.

DATA SOURCES: PubMed, Cochrane Library, EMBASE, CINAHL, China National Knowledge Infrastructure, and China Wanfang databases were interrogated for articles published before May 2020.

REVIEW METHOD: As per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, eight randomised controlled trials (RCTs) and six preintervention and postintervention studies published in English and Chinese met the inclusion criteria for the meta-analysis. Two reviewers independently extracted data into a tabular format using predefined data fields. Disagreements were resolved by consensus. The quality of the included RCTs and preintervention and postintervention studies was assessed using the Cochrane Quality Assessment Tool and Risk Of Bias In Non-randomised Studies of Interventions assessment tool.

RESULTS: Eight RCTs were of intermediate methodological quality, and six preintervention and postintervention studies exhibited a low to moderate risk of bias. Compared with usual care, nurse-led sedation protocols resulted in significantly decreased durations of mechanical ventilation (days) (standardised mean difference = -1.765; 95% confidence interval [CI] = -2.461, -1.068); P < 0.001; I² = 97.7%); decreased length of ICU stay (days) (standardised mean difference = -1.463; 95% CI = -2.181, -0.745; P < 0.001; I² = 97.3%); reduced ICU mortality (relative risk [RR] = 0.854; 95% CI = 0.747, 0.983; P = 0.027), I² = 0%); and decreased incidence of ventilator-associated pneumonia (RR = 0.438; 95% CI = 0.292, 0.657; P < 0.001; I² = 41.4%), delirium (RR = 0.522; 95% CI = 0.338, 0.807; P = 0.003; I² = 26.6%), and extubation failure (RR = 0.498; 95% CI = 0.266, 0.932; P = 0.029; I² = 45.1%).

CONCLUSIONS: Although pre-post intervention study design cannot establish causality, the present findings raise the considerable possibility that a sedation protocol can be safely implemented by nurses to reduce mortality in ICUs and sedation-related adverse events in patients on mechanical ventilation compared with physician-led usual care.

PMID:33054987 | DOI:10.1016/j.aucc.2020.07.013

Crit Care Med. 2020 Sep;48(9):e835-e840. doi: 10.1097/CCM.0000000000004450.

ABSTRACT

OBJECTIVES: Data show that family members of ICU patients may have high levels of anxiety, depression, posttraumatic stress disorders, and/or complicated grief. This was previously referred to as post-intensive care syndrome-family. We systematically review randomized controlled trials for post-intensive care syndrome-family.

DATA SOURCES: Systematic research in databases (Pubmed, EMBASE, PsycINFO, CINHAL for articles published between January 2000 and October 2019).

STUDY SELECTION: Interventions in randomized controlled trials for post-intensive care syndrome-family in relatives of adult ICU patients.

DATA EXTRACTION: Review, quality assessment, and risk assessment for bias of eligible publications were performed along recommended guidelines for each investigation. Quality assessment graded studies into "strong" (n = 5), "moderate" (n = 4), and "weak" (n = 2).

DATA SYNTHESIS: Out of 2,399 publications, 11 investigations were found eligible (3,183 relatives of ICU patients). Studies addressed interventions during ICU stay (n = 6), during the post-ICU period (n = 4), or both (n = 1). Two studies included relatives of dying/deceased patients. One study implemented end-of-life conferences and showed reduced prevalence of posttraumatic stress disorder (45% vs 69%; p = 0.01), anxiety (45% vs 67%; p = 0.02), and depression (29% vs 56%; p = 0.003). Family conferences with a physician and proactive participation of a nurse reduced anxiety-scores (p = 0.01) without reducing anxiety prevalence (33.3% vs 52.3%; p = 0.08). Other studies failed to improve symptoms or reduce prevalence of post-intensive care syndrome-family. Interestingly, condolence letters may even increase prevalence of posttraumatic stress disorder (52.4% vs 37.1%; p = 0.03). Meetings without the presence of ICU physicians were shown to increase Impact of Event Scale-Revised scores (25.9 vs 21.3; p = 0.0495).

CONCLUSIONS: Only few data are available on interventions for post-intensive care syndrome-family. It appears that proactive communication and provision of information seems pivotal for post-intensive care syndrome-family treatment. Interestingly, some interventions may even worsen post-intensive care syndrome-family. In the light of the relevance of post-intensive care syndrome-family in daily ICU care, more high-quality data seems urgently needed.

PMID:32590386 | DOI:10.1097/CCM.0000000000004450

Nurs Crit Care. 2020 Mar;25(2):84-92. doi: 10.1111/nicc.12489. Epub 2019 Dec 15.

ABSTRACT

BACKGROUND: The level of occupational stress of nurses working in intensive and critical care units is high. Although many studies have assessed the effectiveness of stress management interventions among intensive and critical care nurses, the methodological quality of these studies remains unclear.

PURPOSE: The purpose of this review was to summarize and appraise the methodological quality of primary studies on interventions for management of occupational stress among intensive and critical care nurses.

METHODS: This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted to identify primary studies that assessed the effectiveness of interventions in managing occupational stress among intensive and critical care nurses using multiple databases from January 2009 to June 2019.

RESULTS: Twelve studies published between 2011 and 2019 were eligible for inclusion. These included studies were classified as being of good or fair quality. The consensus across the included studies was that, compared with control condition, cognitive-behavioural skills training and mindfulness-based intervention were more effective in reducing occupational stress among intensive and critical care unit nurses.

CONCLUSION: Further research should focus on methodologically strong studies by blinding the outcome assessors, using Randomized Controlled Trial (RCT) design with an active control group, using standardized assessment tools, and reporting enough details about the stress management intervention-related adverse events.

RELEVANCE TO CLINICAL PRACTICE: This review demonstrates the need for high methodological quality studies to rigorously evaluate the effectiveness of stress management interventions before it can be recommended for use in clinical practice to reduce stress in intensive and critical care unit nurses. In addition, attention should be given to developing research protocols that place more emphasis on interventions aimed at the organization level to address the growing problem of occupational stress among intensive and critical care nurses.

PMID:31840391 | DOI:10.1111/nicc.12489

BMC Pediatr. 2019 Nov 4;19(1):402. doi: 10.1186/s12887-019-1794-y.

ABSTRACT

BACKGROUND: Previous studies showed that parents of very preterm infants expressed feelings of incompetence and experienced high levels of stress upon the discharge of their infants. We conducted a systematic review of seven studies and observed potential benefits for parental outcomes when using discharge interventions that adopted guided participation (GP). More evidence is needed on the effective doses of discharge interventions underpinned by the principles of GP.

AIM: To investigate the feasibility and preliminarily estimate the effects on parental competence and stress outcomes of a newly developed, nurse-led, GP discharge program for mothers of very preterm infants.

METHODS: A two-arm randomized controlled trial was conducted in a neonatal intensive care unit (NICU). Mothers of infants with gestational ages of ≤32 weeks who had no congenital malformations and did not need to undergo major surgeries were recruited. All mothers were the primary caregivers to their infants. The intervention group received a nurse-led GP discharge intervention (three structured 30- to 60-min GP sessions and one follow-up phone call). The control group received usual care. The parental outcomes were measured using the Parenting Sense of Competence Scale (C-PSOC) and Perceived Stress Scale (C-PSS) at baseline (T0), on the day of discharge (T1), after the follow-up phone call (within 72 h after discharge) (T2), and 1 month after discharge (T3). The outcomes were analyzed using generalized estimating equations based on intention-to-treat principles.

RESULTS: Thirty infant-mother dyads were recruited. Greater improvements in the C-PSOC score were observed in the intervention group than in the control group at T1 and T2, although these differences were statistically insignificant. The intervention group exhibited greater improvements than the control group in the C-PSS scores at T1, T2, and T3, although these differences were also not statistically significant.

CONCLUSIONS: The findings suggest that a GP discharge intervention could improve parenting competence and stress among mothers with very preterm infants. The absence of adverse events suggests that the GP discharge intervention could be feasibly implemented in NICU settings. This feasibility study was not powered to determine the effectiveness of the intervention but is anticipated to lay the foundation for a future full-scale study.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03668912. Date of registration: 13 September 2018 (retrospectively registered).

PMID:31684903 | PMC:PMC6827218 | DOI:10.1186/s12887-019-1794-y

JBI Database System Rev Implement Rep. 2019 Nov;17(11):2248-2264. doi: 10.11124/JBISRIR-2017-004025.

ABSTRACT

OBJECTIVE: The objective of this scoping review was to explore existing literature on protocols initiated by nurses for a spontaneous breathing trial in adult intensive care unit (ICU) patients in order to examine and conceptually map the evidence, and identify gaps in the literature.

INTRODUCTION: Nurses are vital in the care of the critically ill mechanically ventilated patient. By involving the nurse in the weaning process through implementing the final stage of the weaning process, the spontaneous breathing trial, patients may liberate from mechanical ventilation more readily, thereby reducing the cost of care and number of complications associated with prolonged ventilation.

INCLUSION CRITERIA: This review considered experimental and quasi-experimental study designs, analytical observational studies, case-control studies, analytical cross-sectional studies, descriptive observational studies, qualitative studies, and text and opinion papers. Adult ICU patients, aged 18 and over who were mechanically ventilated and candidates for weaning to spontaneous breathing trials, were included in the review. Adult ICUs included but were not limited to burn ICUs, cardiovascular ICUs, medical ICUs, neurological ICUs, surgical ICUs and trauma ICUs in all geographic locations. This scoping review considered studies that examined the use of nurse-initiated protocols for a spontaneous breathing trial.

METHODS: The Joanna Briggs Institute scoping review methodology was used. Key information sources searched were Cochrane Database of Systematic Reviews, PubMed, PROSPERO, DARE, CINAHL, Embase, Scopus, Academic Search Premier, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, MedNar, ProQuest Dissertations and Theses, Papers First and societal websites with information relevant to the scoping review. Only studies published in English were included, and no date limits were applied. The data extraction tool was developed by the authors to examine information retrieved from the studies.

RESULTS: Four studies, with 430 participants, were included in this review. One study was a non-randomized controlled trial, two were randomized controlled studies, and one was a text and opinion paper. The four studies included in the review identified both eligibility criteria for spontaneous breathing trial initiation, detailed elements of a spontaneous breathing trial, and criteria for success. Three of the four studies reported outcomes with the use of protocols for spontaneous breathing trials initiated by nurses.

CONCLUSIONS: All included studies support the utilization of protocols and allowing the nurse to initiate the protocol, however variations in the eligibility criteria, details of the spontaneous breathing trial and success criteria create ambiguity in practice.

PMID:31584485 | DOI:10.11124/JBISRIR-2017-004025

Crit Care Med. 2019 Oct;47(10):1442-1449. doi: 10.1097/CCM.0000000000003925.

ABSTRACT

OBJECTIVES: To provide a concise review of the literature and data pertaining to the use of nurse practitioners and physician assistants, collectively called advanced practice providers, in ICU and acute care settings.

DATA SOURCES: Detailed search strategy using the databases PubMed, Ovid MEDLINE, and the Cumulative Index of Nursing and Allied Health Literature for the time period from January 2008 to December 2018.

STUDY SELECTION: Studies addressing nurse practitioner, physician assistant, or advanced practice provider care in the ICU or acute care setting.

DATA EXTRACTION: Relevant studies were reviewed, and the following aspects of each study were identified, abstracted, and analyzed: study population, study design, study aims, methods, results, and relevant implications for critical care practice.

DATA SYNTHESIS: Five systematic reviews, four literature reviews, and 44 individual studies were identified, reviewed, and critiqued. Of the research studies, the majority were retrospective with others being observational, quasi-experimental, or quality improvement, along with two randomized control trials. Overall, the studies assessed a variety of effects of advanced practice provider care, including on length of stay, mortality, and quality-related metrics, with a majority demonstrating similar or improved patient care outcomes.

CONCLUSIONS: Over the past 10 years, the number of studies assessing the impact of advanced practice providers in acute and critical care settings continue to increase. Collectively, these studies identify the value of advanced practice providers in patient care management, continuity of care, improved quality and safety metrics, patient and staff satisfaction, and on new areas of focus including enhanced educational experience of residents and fellows.

PMID:31414993 | PMC:PMC6750122 | DOI:10.1097/CCM.0000000000003925

Cochrane Database Syst Rev. 2018 Nov 12;11(11):CD009771. doi: 10.1002/14651858.CD009771.pub3.

ABSTRACT

BACKGROUND: The sedation needs of critically ill patients have been recognized as a core component of critical care that is vital to assist recovery and ensure humane treatment. Evidence suggests that sedation requirements are not always optimally managed. Suboptimal sedation, both under- and over-sedation, have been linked to short-term (e.g. length of stay) and long-term (e.g. psychological recovery) outcomes. Strategies to improve sedation assessment and management have been proposed. This review was originally published in 2015 and updated in 2018.

OBJECTIVES: To assess the effects of protocol-directed sedation management compared to usual care on the duration of mechanical ventilation, intensive care unit (ICU) and hospital mortality and other patient outcomes in mechanically ventilated ICU adults and children.

SEARCH METHODS: We used the standard search strategy of the Cochrane Anaesthesia, Critical and Emergency Care Group (ACE). We searched the Cochrane Central Register of Controlled trials (CENTRAL) (December 2017), MEDLINE (OvidSP) (2013 to December 2017), Embase (OvidSP) (2013 to December 2017), CINAHL (BIREME host) (2013 to December 2017), LILACS (2013 to December 2017), trial registries and reference lists of articles. (The original search was run in November 2013).

SELECTION CRITERIA: We included randomized controlled trials (RCTs) and quasi-randomized controlled trials conducted in ICUs comparing management with and without protocol-directed sedation in intensive care adults and children.

DATA COLLECTION AND ANALYSIS: Two authors screened the titles and abstracts and then full-text reports identified from our electronic search. We assessed seven domains of potential risk of bias for the included studies. We examined clinical, methodological and statistical heterogeneity and used the random-effects model for meta-analysis where we considered it appropriate. We calculated the mean difference (MD) for duration of mechanical ventilation and risk ratio (RR) for mortality across studies, with 95% confidence intervals (CIs).

MAIN RESULTS: We included four studies with a total of 3323 participants (864 adults and 2459 paediatrics) in this update. Three studies were single-centre, patient-level RCTs and one study was a multicentre cluster-RCT. The settings were in metropolitan centres and included general, mixed medical-surgical, medical only and a range of paediatric units. All four included studies compared the use of protocol-directed sedation, specifically protocols delivered by nurses, with usual care. We rated the risk of selection bias due to random sequence generation low for two studies and unclear for two studies. The risk of bias was highly variable across the domains and studies, with the risk of selection and performance bias generally rated high and the risk of detection and attrition bias generally rated low.When comparing protocol-directed sedation with usual care, there was no clear evidence of difference in duration of mechanical ventilation in hours for the entire duration of the first ICU stay for each patient (MD -28.15 hours, 95% CI -69.15 to 12.84; I² = 85%; 4 studies; adjusted sample 2210 participants; low-quality evidence). There was no clear evidence of difference in ICU mortality (RR 0.77, 95% CI 0.39 to 1.50; I² = 67%; 2 studies; 513 participants; low-quality evidence), or hospital mortality (RR 0.90, 95% CI 0.72 to 1.13; I² = 10%; 3 studies; adjusted sample 2088 participants; low-quality evidence). There was no clear evidence of difference in ICU length of stay (MD -1.70 days, 95% CI-3.71 to 0.31; I² = 82%; 4 studies; adjusted sample of 2123 participants; low-quality of evidence), however there was evidence of a significant reduction in hospital length of stay (MD -3.09 days, 95% CI -5.08 to -1.10; I² = 2%; 3 studies; adjusted sample of 1922 participants; moderate-quality evidence). There was no clear evidence of difference in the incidence of self-extubation (RR 0.88, 95% CI 0.55 to 1.42; I² = 0%; 2 studies; adjusted sample of 1687 participants; high-quality evidence), or incidence of tracheostomy (RR 0.67, 95% CI 0.35 to 1.30; I² = 66%; 3 studies; adjusted sample of 2008 participants; low-quality evidence). Only one study examined incidence of reintubation, therefore we could not pool data; there was no clear evidence of difference (RR 0.65, 95% CI 0.35 to 1.24; 1 study; 321 participants; low-quality evidence).

AUTHORS' CONCLUSIONS: There is currently limited evidence from RCTs evaluating the effectiveness of protocol-directed sedation on patient outcomes. The four included RCTs reported conflicting results and heterogeneity limited the interpretation of results for the primary outcomes of duration of mechanical ventilation and mortality. Further studies, taking into account differing contextual characteristics, are necessary to inform future practice. Methodological strategies to reduce the risk of bias need to be considered in future studies.

PMID:30480753 | PMC:PMC6516800 | DOI:10.1002/14651858.CD009771.pub3

Cochrane Database Syst Rev. 2018 Nov 2;11(11):CD012701. doi: 10.1002/14651858.CD012701.pub2.

ABSTRACT

BACKGROUND: The intensive care unit (ICU) stay has been linked with a number of physical and psychological sequelae, known collectively as post-intensive care syndrome (PICS). Specific ICU follow-up services are relatively recent developments in health systems, and may have the potential to address PICS through targeting unmet health needs arising from the experience of the ICU stay. There is currently no single accepted model of follow-up service and current aftercare programmes encompass a variety of interventions and materials. There is uncertain evidence about whether follow-up services effectively address PICS, and this review assesses this.

OBJECTIVES: Our main objective was to assess the effectiveness of follow-up services for ICU survivors that aim to identify and address unmet health needs related to the ICU period. We aimed to assess effectiveness in relation to health-related quality of life (HRQoL), mortality, depression and anxiety, post-traumatic stress disorder (PTSD), physical function, cognitive function, ability to return to work or education and adverse effects.Our secondary objectives were to examine different models of follow-up services. We aimed to explore: the effectiveness of service organisation (physician- versus nurse-led, face-to-face versus remote, timing of follow-up service); differences related to country (high-income versus low- and middle-income countries); and effect of delirium, which can subsequently affect cognitive function, and the effect of follow-up services may differ for these participants.

SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and CINAHL on 7 November 2017. We searched clinical trials registers for ongoing studies, and conducted backward and forward citation searching of relevant articles.

SELECTION CRITERIA: We included randomised and non-randomised studies with adult participants, who had been discharged from hospital following an ICU stay. We included studies that compared an ICU follow-up service using a structured programme and co-ordinated by a healthcare professional versus no follow-up service or standard care.

DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion, extracted data, assessed risk of bias, and synthesised findings. We used the GRADE approach to assess the certainty of the evidence.

MAIN RESULTS: We included five studies (four randomised studies; one non-randomised study), for a total of 1707 participants who were ICU survivors with a range of illness severities and conditions. Follow-up services were led by nurses in four studies or a multidisciplinary team in one study. They included face-to-face consultations at home or in a clinic, or telephone consultations or both. Each study included at least one consultation (weekly, monthly, or six-monthly), and two studies had up to eight consultations. Although the design of follow-up service consultations differed in each study, we noted that each service included assessment of participants' needs with referrals to specialist support if required.It was not feasible to blind healthcare professionals or participants to the intervention and we did not know whether this may have introduced performance bias. We noted baseline differences (two studies), and services included additional resources (two studies), which may have influenced results, and one non-randomised study had high risk of selection bias.We did not combine data from randomised studies with data from one non-randomised study. Follow-up services for improving long-term outcomes in ICU survivors may make little or no difference to HRQoL at 12 months (standardised mean difference (SMD) -0.0, 95% confidence interval (CI) -0.1 to 0.1; 1 study; 286 participants; low-certainty evidence). We found moderate-certainty evidence from five studies that they probably also make little or no difference to all-cause mortality up to 12 months after ICU discharge (RR 0.96, 95% CI 0.76 to 1.22; 4 studies; 1289 participants; and in one non-randomised study 79/259 deaths in the intervention group, and 46/151 in the control group) and low-certainty evidence from four studies that they may make little or no difference to PTSD (SMD -0.05, 95% CI -0.19 to 0.10, 703 participants, 3 studies; and one non-randomised study reported less chance of PTSD when a follow-up service was used).It is uncertain whether using a follow-up service reduces depression and anxiety (3 studies; 843 participants), physical function (4 studies; 1297 participants), cognitive function (4 studies; 1297 participants), or increases the ability to return to work or education (1 study; 386 participants), because the certainty of this evidence is very low. No studies measured adverse effects.We could not assess our secondary objectives because we found insufficient studies to justify subgroup analysis.

AUTHORS' CONCLUSIONS: We found insufficient evidence, from a limited number of studies, to determine whether ICU follow-up services are effective in identifying and addressing the unmet health needs of ICU survivors. We found five ongoing studies which are not included in this review; these ongoing studies may increase our certainty in the effect in future updates. Because of limited data, we were unable to explore whether one design of follow-up service is preferable to another, or whether a service is more effective for some people than others, and we anticipate that future studies may also vary in design. We propose that future studies are designed with robust methods (for example randomised studies are preferable) and consider only one variable (the follow-up service) compared to standard care; this would increase confidence that the effect is due to the follow-up service rather than concomitant therapies.

PMID:30388297 | PMC:PMC6517170 | DOI:10.1002/14651858.CD012701.pub2

Nurs Crit Care. 2019 Jan;24(1):40-46. doi: 10.1111/nicc.12391. Epub 2018 Oct 15.

ABSTRACT

BACKGROUND: Previous systematic reviews have assessed the effect of critical care outreach services, but none have focused solely on nurse-led services.

AIM: To perform a systematic review examining the impact of nurse-led critical care outreach services on inpatient mortality rates as the primary outcome. Secondary outcomes include arrest call rates and patient length of stay.

METHODS: A comprehensive search of several electronic databases was carried out, including the Cumulative Index to Nursing and Allied Health Literature and Medline. Non-catalogued literature was searched, and contact was made by e-mail with expert authors. All studies were in the English language, and although heterogeneous in design, only quantitative data were extracted for analysis. All included studies were assessed for quality using recognized quality appraisal tools. Meta-analysis was not possible because of heterogeneity.

RESULTS: Ten studies involving almost 72 000 participants were identified. The reduction in mortality rates with nurse-led critical care outreach services was reported to be 80%, but the statistical significance was low - four studies showed reductions ranging from 0·1% to 0·22%. Greater statistical significance was reported in arrest call rates, with two studies claiming decreased rates of 58·7% and 29·6%. Two studies reported a decrease in patient length of stay - the findings of a third study were equivocal. Half of the included studies scored poorly in terms of quality and validity, and all were single-centre studies, thereby limiting generalisability.

CONCLUSION: Nurse-led critical care outreach services demonstrate benefits in terms of patient care and reduction in adverse events. Higher-quality research, including multicentre randomized controlled trials, with meta-analysis is recommended.

RELEVANCE TO CLINICAL PRACTICE: Nurse-led critical care outreach services have the potential to improve patient outcomes. Uniformity of team composition and nomenclature would benefit data collection and reporting.

PMID:30324642 | DOI:10.1111/nicc.12391

J Pediatr Nurs. 2018 Sep-Oct;42:e52-e57. doi: 10.1016/j.pedn.2018.05.002. Epub 2018 May 18.

ABSTRACT

PROBLEM: Daily bathing of the preterm infant in the Neonatal Intensive Care Unit (NICU) is a process that is usually done routinely, but it can cause many adverse effects on the stability of the infant. Highlights include decreased body temperature and increased stress, which can cause alterations in its proper growth and development.

ELIGIBILITY CRITERIA: We included both descriptive studies and analytical studies that evaluated the effects of bathing on the physiological state of the preterm infants admitted to NICU. The limit on the time of publication was not established and the languages included were Spanish and English.

RESULTS: Ten articles (438 patients) met the inclusion criteria, of which one was a quasi-experimental trial, five randomized clinical trials, one cohort study and three followed a descriptive design. A comparison has been made according to the type of bath: sponge bath, bathtub and Swaddle bath, showing that the Swaddle bath was less related to temperature changes and stress levels. It was also shown that the frequency of bathing can be reduced every 96 h without increasing the risk of infection. Finally, it has been observed that the nurse's behavior is also closely related to the stress suffered by the premature infant.

CONCLUSIONS: This paper reveals the importance of correctly bathing premature infants as hospital admission, re-entry and morbidity and mortality may be reduced.

IMPLICATIONS: Swaddle bath has been shown to be the best method for bathing preterm infants in the Neonatal intensive Care Unit.

PMID:29779763 | DOI:10.1016/j.pedn.2018.05.002

Cochrane Database Syst Rev. 2018 May 10;5(5):CD012455. doi: 10.1002/14651858.CD012455.pub2.

ABSTRACT

BACKGROUND: Patients in the intensive care unit (ICU) experience sleep deprivation caused by environmental disruption, such as high noise levels and 24-hour lighting, as well as increased patient care activities and invasive monitoring as part of their care. Sleep deprivation affects physical and psychological health, and patients perceive the quality of their sleep to be poor whilst in the ICU. Artificial lighting during night-time hours in the ICU may contribute to reduced production of melatonin in critically ill patients. Melatonin is known to have a direct effect on the circadian rhythm, and it appears to reset a natural rhythm, thus promoting sleep.

OBJECTIVES: To assess whether the quantity and quality of sleep may be improved by administration of melatonin to adults in the intensive care unit. To assess whether melatonin given for sleep promotion improves both physical and psychological patient outcomes.

SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 8), MEDLINE (1946 to September 2017), Embase (1974 to September 2017), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1937 to September 2017), and PsycINFO (1806 to September 2017). We searched clinical trials registers for ongoing studies, and conducted backward and forward citation searching of relevant articles.

SELECTION CRITERIA: We included randomized and quasi-randomized controlled trials with adult participants (over the age of 16) admitted to the ICU with any diagnoses given melatonin versus a comparator to promote overnight sleep. We included participants who were mechanically ventilated and those who were not mechanically ventilated. We planned to include studies that compared the use of melatonin, given at an appropriate clinical dose with the intention of promoting night-time sleep, against no agent; or against another agent administered specifically to promote sleep.

DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion, extracted data, assessed risk of bias, and synthesized findings. We assessed the quality of evidence with GRADE.

MAIN RESULTS: We included four studies with 151 randomized participants. Two studies included participants who were mechanically ventilated, one study included a mix of ventilated and non-ventilated participants and in one study participants were being weaned from mechanical ventilation. Three studies reported admission diagnoses, which varied: these included sepsis, pneumonia and cardiac or cardiorespiratory arrest. All studies compared melatonin against no agent; three were placebo-controlled trials; and one compared melatonin with usual care. All studies administered melatonin in the evening.All studies reported adequate methods for randomization and placebo-controlled trials were blinded at the participant and personnel level. We noted high risk of attrition bias in one study and were unclear about potential bias introduced in two studies with differences between participants at baseline.It was not appropriate to combine data owing to differences in measurement tools, or methods used to report data.The effects of melatonin on subjectively rated quantity and quality of sleep are uncertain (very low certainty evidence). Three studies (139 participants) reported quantity and quality of sleep as measured through reports of participants or family members or by personnel assessments. Study authors in one study reported no difference in sleep efficiency index scores between groups for participant assessment (using Richards-Campbell Sleep Questionnaire) and nurse assessment. Two studies reported no difference in duration of sleep observed by nurses.The effects of melatonin on objectively measured quantity and quality of sleep are uncertain (very low certainty evidence). Two studies (37 participants) reported quantity and quality of sleep as measured by polysomnography (PSG), actigraphy, bispectral index (BIS) or electroencephalogram (EEG). Study authors in one study reported no difference in sleep efficiency index scores between groups using BIS and actigraphy. These authors also reported longer sleep in participants given melatonin which was not statistically significant, and improved sleep (described as "better sleep") in participants given melatonin from analysis of area under the curve (AUC) of BIS data. One study used PSG but authors were unable to report data because of a large loss of participant data.One study (82 participants) reported no evidence of a difference in anxiety scores (very low certainty evidence). Two studies (94 participants) reported data for mortality: one study reported that overall one-third of participants died; and one study reported no evidence of difference between groups in hospital mortality (very low certainty). One study (82 participants) reported no evidence of a difference in length of ICU stay (very low certainty evidence). Effects of melatonin on adverse events were reported in two studies (107 participants), and are uncertain (very low certainty evidence): one study reported headache in one participant given melatonin, and one study reported excessive sleepiness in one participant given melatonin and two events in the control group (skin reaction in one participant, and excessive sleepiness in another participant).The certainty of the evidence for each outcome was limited by sparse data with few participants. We noted study limitations in some studies due to high attrition and differences between groups in baseline data; and doses of melatonin varied between studies. Methods used to measure data were not consistent for outcomes, and use of some measurement tools may not be effective for use on the ICU patient. All studies included participants in the ICU but we noted differences in ICU protocols, and one included study used a non-standard sedation protocol with participants which introduced indirectness to the evidence.

AUTHORS' CONCLUSIONS: We found insufficient evidence to determine whether administration of melatonin would improve the quality and quantity of sleep in ICU patients. We identified sparse data, and noted differences in study methodology, in ICU sedation protocols, and in methods used to measure and report sleep. We identified five ongoing studies from database and clinical trial register searches. Inclusion of data from these studies in future review updates would provide more certainty for the review outcomes.

PMID:29746721 | PMC:PMC6353085 | DOI:10.1002/14651858.CD012455.pub2

Comput Inform Nurs. 2018 Aug;36(8):383-392. doi: 10.1097/CIN.0000000000000444.

ABSTRACT

This study used social network analysis to identify the main research topics and trends in nursing-related communication in intensive care units. Keywords from January 1967 to June 2016 were extracted from PubMed using Medical Subject Headings terms. Social network analysis was performed using Gephi software. Research publications and newly emerging topics in nursing-related communication in intensive care units were classified into five chronological phases. After the weighting was adjusted, the top five keyword searches were "conflict," "length of stay," "nursing continuing education," "family," and "nurses." During the most recent phase, research topics included "critical care nursing," "patient handoff," and "quality improvement." The keywords of the top three groups among the 10 groups identified were related to "neonatal nursing and practice guideline," "infant or pediatric and terminal care," and "family, aged, and nurse-patient relations," respectively. This study can promote a systematic understanding of communication in intensive care units by identifying topic networks. Future studies are needed to conduct large prospective cohort studies and randomized controlled trials to verify the effects of patient-centered communication in intensive care units on patient outcomes, such as length of hospital stay and mortality.

PMID:29742551 | DOI:10.1097/CIN.0000000000000444

Intensive Crit Care Nurs. 2018 Aug;47:30-38. doi: 10.1016/j.iccn.2018.04.003. Epub 2018 Apr 20.

ABSTRACT

OBJECTIVES: To investigate processes for delivering early mobility interventions in adult intensive care unit patients used in research and quality improvement studies and the role of nurses in early mobility interventions.

METHODS: A systematic review was conducted. Electronic databases PubMED, CINAHL, PEDro, and Cochrane were searched for studies published from 2000 to June 2017 that implemented an early mobility intervention in adult intensive care units. Included studies involved progression to ambulation as a component of the intervention, included the role of the nurse in preparing for or delivering the intervention, and reported at least one patient or organisational outcome measure. The System Engineering Initiative for Patient Safety (SEIPS) model, a framework for understanding structure, processes, and healthcare outcomes, was used to evaluate studies.

RESULTS: 25 studies were included in the final review. Studies consisted of randomised control trials, prospective, retrospective, or mixed designs. A range of processes to support the delivery of early mobility were found. These processes include forming interdisciplinary teams, increasing mobility staff, mobility protocols, interdisciplinary education, champions, communication, and feedback.

CONCLUSION: Variation exists in the process of delivering early mobility in the intensive care unit. In particular, further rigorous studies are needed to better understand the role of nurses in implementing early mobility to maintain a patient's functional status.

PMID:29681432 | DOI:10.1016/j.iccn.2018.04.003

Am J Respir Crit Care Med. 2017 Feb 1;195(3):383-393. doi: 10.1164/rccm.201611-2250ST.

ABSTRACT

BACKGROUND: Studies of nighttime intensivist staffing have yielded mixed results.

GOALS: To review the association of nighttime intensivist staffing with outcomes of intensive care unit (ICU) patients.

METHODS: We searched five databases (2000-2016) for studies comparing in-hospital nighttime intensivist staffing with other nighttime staffing models in adult ICUs and reporting mortality or length of stay. We abstracted data on staffing models, outcomes, and study characteristics and assessed study quality, using standardized tools. Meta-analyses used random effects models.

RESULTS: Eighteen studies met inclusion criteria: one randomized controlled trial and 17 observational studies. Overall methodologic quality was high. Studies included academic hospitals (n = 10), community hospitals (n = 2), or both (n = 6). Baseline clinician staffing included residents (n = 9), fellows (n = 4), and nurse practitioners or physician assistants (n = 2). Studies included both general and specialty ICUs and were geographically diverse. Meta-analysis (one randomized controlled trial; three nonrandomized studies with exposure limited to nighttime intensivist staffing with adjusted estimates of effect) demonstrated no association with mortality (odds ratio, 0.99; 95% confidence interval, 0.75-1.29). Secondary analyses including studies without risk adjustment, with a composite exposure of organizational factors, stratified by intensity of daytime staffing and by ICU type, yielded similar results. Minimal or no differences were observed in ICU and hospital length of stay and several other secondary outcomes.

CONCLUSIONS: Notwithstanding limitations of the predominantly observational evidence, our systematic review and meta-analysis suggests nighttime intensivist staffing is not associated with reduced ICU patient mortality. Other outcomes and alternative staffing models should be evaluated to further guide staffing decisions.

PMID:28145766 | DOI:10.1164/rccm.201611-2250ST

J Pediatr Nurs. 2017 May-Jun;34:5-9. doi: 10.1016/j.pedn.2016.12.004. Epub 2016 Dec 9.

ABSTRACT

Missed nursing care is an emerging measure of front-line nursing care effectiveness in neonatal intensive care units (NICUs). Given Magnet® hospitals' reputations for nursing care quality, missed care comparisons with non-Magnet® hospitals may yield insights about how Magnet® designation influences patient outcomes. The purpose of this secondary analysis was to evaluate the relationship between hospital Magnet® designation and 1) the occurrence of nurse-reported missed care and 2) reasons for missed nursing care between NICU nurses employed in Magnet® and non-Magnet® hospitals. A random sample of certified neonatal intensive care unit nurses was invited to participate in a cross-sectional survey in 2012; data were analyzed from nurses who provided direct patient care (n=230). Logistic regression was used to model relationships between Magnet® designation and reports of the occurrence of and reasons for missed care while controlling for nurse and shift characteristics. There was no relationship between Magnet® designation and missed care occurrence for 34 of 35 types of care. Nurses in Magnet® hospitals were significantly less likely to report tensions and communication breakdowns with other staff, lack of familiarity with policies/procedures, and lack of back-up support from team members as reasons for missed care. Missed nursing care in NICUs occurs regardless of hospital Magnet® recognition. However, nurses' reasons for missed care systematically differ in Magnet® and non-Magnet® hospitals and these differences merit further exploration.

PMID:27955957 | DOI:10.1016/j.pedn.2016.12.004

Crit Care. 2016 Apr 20;20(Suppl 2):94. doi: 10.1186/s13054-016-1208-6.

ABSTRACT

P001 - Sepsis impairs the capillary response within hypoxic capillaries and decreases erythrocyte oxygen-dependent ATP efflux

R. M. Bateman, M. D. Sharpe, J. E. Jagger, C. G. Ellis

P002 - Lower serum immunoglobulin G2 level does not predispose to severe flu.

J. Solé-Violán, M. López-Rodríguez, E. Herrera-Ramos, J. Ruíz-Hernández, L. Borderías, J. Horcajada, N. González-Quevedo, O. Rajas, M. Briones, F. Rodríguez de Castro, C. Rodríguez Gallego

P003 - Brain protective effects of intravenous immunoglobulin through inhibition of complement activation and apoptosis in a rat model of sepsis

F. Esen, G. Orhun, P. Ergin Ozcan, E. Senturk, C. Ugur Yilmaz, N. Orhan, N. Arican, M. Kaya, M. Kucukerden, M. Giris, U. Akcan, S. Bilgic Gazioglu, E. Tuzun

P004 - Adenosine a1 receptor dysfunction is associated with leukopenia: A possible mechanism for sepsis-induced leukopenia

R. Riff, O. Naamani, A. Douvdevani

P005 - Analysis of neutrophil by hyper spectral imaging - A preliminary report

R. Takegawa, H. Yoshida, T. Hirose, N. Yamamoto, H. Hagiya, M. Ojima, Y. Akeda, O. Tasaki, K. Tomono, T. Shimazu

P006 - Chemiluminescent intensity assessed by eaa predicts the incidence of postoperative infectious complications following gastrointestinal surgery

S. Ono, T. Kubo, S. Suda, T. Ueno, T. Ikeda

P007 - Serial change of c1 inhibitor in patients with sepsis – A prospective observational study

T. Hirose, H. Ogura, H. Takahashi, M. Ojima, J. Kang, Y. Nakamura, T. Kojima, T. Shimazu

P008 - Comparison of bacteremia and sepsis on sepsis related biomarkers

T. Ikeda, S. Suda, Y. Izutani, T. Ueno, S. Ono

P009 - The changes of procalcitonin levels in critical patients with abdominal septic shock during blood purification

T. Taniguchi, M. O

P010 - Validation of a new sensitive point of care device for rapid measurement of procalcitonin

C. Dinter, J. Lotz, B. Eilers, C. Wissmann, R. Lott

P011 - Infection biomarkers in primary care patients with acute respiratory tract infections – Comparison of procalcitonin and C-reactive protein

M. M. Meili, P. S. Schuetz

P012 - Do we need a lower procalcitonin cut off?

H. Hawa, M. Sharshir, M. Aburageila, N. Salahuddin

P013 - The predictive role of C-reactive protein and procalcitonin biomarkers in central nervous system infections with extensively drug resistant bacteria

V. Chantziara, S. Georgiou, A. Tsimogianni, P. Alexandropoulos, A. Vassi, F. Lagiou, M. Valta, G. Micha, E. Chinou, G. Michaloudis

P014 - Changes in endotoxin activity assay and procalcitonin levels after direct hemoperfusion with polymyxin-b immobilized fiber

A. Kodaira, T. Ikeda, S. Ono, T. Ueno, S. Suda, Y. Izutani, H. Imaizumi

P015 - Diagnostic usefullness of combination biomarkers on ICU admission

M. V. De la Torre-Prados, A. Garcia-De la Torre, A. Enguix-Armada, A. Puerto-Morlan, V. Perez-Valero, A. Garcia-Alcantara

P016 - Platelet function analysis utilising the PFA-100 does not predict infection, bacteraemia, sepsis or outcome in critically ill patients

N. Bolton, J. Dudziak, S. Bonney, A. Tridente, P. Nee

P017 - Extracellular histone H3 levels are inversely correlated with antithrombin levels and platelet counts and are associated with mortality in sepsis patients

G. Nicolaes, M. Wiewel, M. Schultz, K. Wildhagen, J. Horn, R. Schrijver, T. Van der Poll, C. Reutelingsperger

P018 - Il-8: is this a more reliable biomarker for sepsis severity than CRP, Procalcitonin, E-selectin, IL-6 and TNF-[alpha]

S. Pillai, G. Davies, G. Mills, R. Aubrey, K. Morris, P. Williams, P. Evans

P019 - Relation between adrenomedullin and short-term outcome in ICU patients: Results from the frog ICU study

E. G. Gayat, J. Struck, A. Cariou, N. Deye, B. Guidet, S. Jabert, J. Launay, M. Legrand, M. Léone, M. Resche-Rigon, E. Vicaut, A. Vieillard-Baron, A. Mebazaa

P020 - Impact of disease severity assessment on performance of heparin-binding protein for the prediction of septic shock

R. Arnold, M. Capan, A. Linder, P. Akesson

P021 - Kinetics and prognostic value of presepsin (sCD14) in septic patients. A pilot study

M. Popescu, D. Tomescu

P022 - Comparison of CD64 levels performed by the facs and accellix systems

C. L. Sprung, R. Calderon Morales, G. Munteanu, E. Orenbuch-Harroch, P. Levin, H. Kasdan, A. Reiter, T. Volker, Y. Himmel, Y. Cohen, J. Meissonnier

P023 - Diagnosing sepsis in 5 minutes: Nanofluidic technology study with pancreatic-stone protein (PSP/ reg)

L. Girard, F. Rebeaud

P024 - How nanotechnology-based approaches could contribute to sepsis prevention, diagnosis and treatment

I. Herrmann

P025 - Il7r transcriptional expression analysis during septic shock

B. Delwarde, E. Peronnet, E. Cerrato, F. Venet, A. Lepape, T. Rimmelé, G. Monneret, J. Textoris

P026 - Disbalance of microbial metabolites of aromatic acids affects the severity in critically ill patients

N. Beloborodova, V. Moroz, A. Osipov, A. Bedova, Y. Sarshor, A. Pautova, A. Sergeev, E. Chernevskaya

P027 - Copeptin predicts 10-year all-cause mortality in community patients

J. Odermatt, R. Bolliger, L. Hersberger, M. Ottiger, M. Christ-Crain, B. Mueller, P. Schuetz

P028 - Identification of differential proteomic response in septic patients secondary to community and hospital acquired pneumonia

N. K. Sharma, A. K. Tashima, M. K. Brunialti, F. R. Machado, M. Assuncao, O. Rigato, R. Salomao

P029 - Monocyte HLA-DR expression in community-acquired bacteremic sepsis - dynamics associated to aetiology and prediction of secondary sepsis

S. C. Cajander, G. Rasmussen, E. Tina, B. Söderquist, J. Källman, K. Strålin

P030 - Soluble B- and T-lymphocyte attenuator: A possible prognostic marker in sepsis

A. L. Lange, J. S. Sundén-Cullberg, A. M. Magnuson, O. H. Hultgren

P031 - Fractal dimension: A new biomarker for quantifying clot microstructure in patients across the sepsis spectrum

G. Davies, S. Pillai, G. Mills, R. Aubrey, K. Morris, P. Williams, P. Evans

P032 - Comparison between the new biomarker for coagulation, clot microstructure (Df) with rotational thromboelastometry (ROTEM) in patients across the sepsis spectrum

S. Pillai, G. Davies, G. Mills, R. Aubrey, K. Morris, P. Williams, P. Evans

P033 - Changes in fibrinolysis across the sepsis spectrum: The use of rotational thromboelastometry (ROTEM) lysis index (LI60) and D-Dimer concentration

S. Pillai, G. Davies, G. Mills, R. Aubrey, K. Morris, P. Williams, P. Evans

P034 - The intensive care infection score – a promising marker for the prediction of infection and its severity.

P. Van der Geest, M. Mohseni, J. Linssen, R. De Jonge, S. Duran, J. Groeneveld

P035 - Challenges in the clinical diagnosis of sepsis

R. Miller III, B. K. Lopansri, L. C. McHugh, A. Seldon, J. P. Burke

P036 - Does zero heat flux thermometry more accurately identify sepsis on intensive care?

J. Johnston, R. Reece-Anthony, A. Bond, A. Molokhia

P037 - Advancing quality (AQ) sepsis programme: Improving early identification & treatment of sepsis in North West England.

C. Mcgrath, E. Nsutebu

P038 - Prehospital transport of acute septic patients

P. Bank Pedersen, D. Pilsgaard Henriksen, S. Mikkelsen, A. Touborg Lassen

P039 - Vasodilatory plant extracts gel as an alternative treatment for fever in critically ill patients

R. Tincu, C. Cobilinschi, D. Tomescu, Z. Ghiorghiu, R. Macovei

P040 - Host response and outcome of hypothermic sepsis

M. A. Wiewel, M. B. Harmon, L. A. Van Vught, B. P. Scicluna, A. J. Hoogendijk, J. Horn, A. H. Zwinderman, O. L. Cremer, M. J. Bonten, M. J. Schultz, T. Van der Poll, N. P. Juffermans, W. J. Wiersinga

P041 - Septic shock alert over SIRS criteria has an impact on outcome but needs to be revised

G. Eren, Y Tekdos, M. Dogan, O. Acicbe, E. Kaya, O. Hergunsel

P042 - Association between previous prescription of βblockers and mortality rate among septic patients: A retrospective observational study

S. Alsolamy, G. Ghamdi, L. Alswaidan, S. Alharbi, F. Alenezi, Y. Arabi

P043 - Recognition and treatment of sepsis on labour ward– teaching & information resources can improve knowledge

J. Heaton, A. Boyce, L. Nolan, J. Johnston, A. Dukoff-Gordon, A. Dean, A. Molokhia

P044 - Culture negative sepsis in the ICU – what is unique to this patient population?

T. Mann Ben Yehudah

P045 - Organ dysfunction in severe sepsis patients identified in administrative data in Germany, 2007-2013

C. Fleischmann, D. Thomas-Rueddel, C. Haas, U. Dennler, K. Reinhart

P046 - A comparison of residents’ knowledge regarding; the Surviving Sepsis Campaign 2012 guideline

O. Suntornlohanakul, B. Khwannimit

P047 - Effectiveness of a septic shock bundle to improve outcomes in the ICU

F. Breckenridge, A. Puxty

P048 - Dose of norepinephrine in the first 24 hours as a parameter evaluating the effectiveness of treatment in patients with severe sepsis and septic shock

P. Szturz, P. Folwarzcny, J. Svancara, R. Kula, P. Sevcik

P049 - Norepinephrine or vasopressin + norepinephrine in septic shock. A retrospective series of 39 patients

L. Caneva, A. Casazza, E. Bellazzi, S. Marra, L. Pagani, M. Vetere, R. Vanzino, D. Ciprandi, R. Preda, R. Boschi, L. Carnevale

P050 - Methylene blue effectiveness as contributory treatment in patients with septic shock

V. Lopez, M. Aguilar Arzapalo, L. Barradas, A. Escalante, J. Gongora, M. Cetina

P051 - Coagulation disorders in patients with severe sepsis and DIC evaluated with thromboelastometry.

B Adamik, D Jakubczyk, A Kübler

P052 - Frequency and outcome of early sepsis-associated coagulopathy

A. Radford, T. Lee, J. Singer, J. Boyd, D. Fineberg, M. Williams, J. Russell

P053 - Assessment of coagulopathy in cancer patients with severe sepsis or septic shock. A case-control pilot study

E. Scarlatescu, D. Tomescu, G. Droc, S. Arama

P054 - Thromboelastometry in critically ill patients with disseminated intravascular coagulation

M. Müller, M. Straat, S. S. Zeerleder, N. P. Juffermans

P055 - Cessation of a preexisting chronic antiplatelet therapy is associated with increased mortality rates in severe sepsis and septic shock

C. F. Fuchs, C. S. Scheer, S. W. Wauschkuhn, M. V. Vollmer, K. M. Meissner, S. K. Kuhn, K. H. Hahnenkamp, S. R. Rehberg, M. G. Gründling

P056 - Neutrophil Extracellular Traps (NETs) production under hypoxic condition

N. Yamamoto, M. Ojima, S. Hamaguchi, T. Hirose, Y. Akeda, R. Takegawa, O. Tasaki, T. Shimazu, K. Tomono

P057 - Impact of ultraviolet air sterilizer in intensive care unit room, and clinical outcomes of patients

E. Gómez-Sánchez, M. Heredia-Rodríguez, E. Álvarez-Fuente, M. Lorenzo-López, E. Gómez-Pesquera, M. Aragón-Camino, P. Liu-Zhu, A. Sánchez-López, A. Hernández-Lozano, M. T. Peláez-Jareño, E. Tamayo

P058 - Focus of infection in severe sepsis - comparison of administrative data and prospective cohorts from Germany

D. O. Thomas-Rüddel, C. Fleischmann, C. Haas, U. Dennler, K. Reinhart

P059 - “Zero CLABSI” – can we get there? Obstacles on the 4 year journey and our strategies to overcome them – experience from an Indian ICU

V. Adora, A. Kar, A. Chakraborty, S. Roy, A. Bandyopadhyay, M. Das

P060 - Novel molecular techniques to identify central venous catheter (CVC) associated blood stream infections (BSIs)

T. Mann Ben Yehudah, G. Ben Yehudah, M. Salim, N. Kumar, L. Arabi, T. Burger, P. Lephart, E. Toth-martin

P061 - Zero clabsi” – can we get there? Obstacles on the 4 year journey and our strategies to overcome them – experience from an Indian ICU

R. Rao, A. Kar, A. Chakraborty

P062 - Prevention of central line-associated bloodstream infections in intensive care units: An international online survey

C. Valencia, N. Hammami, S. Blot, J. L. Vincent, M. L. Lambert

P063 - 30 days antimicrobial efficacy of non-leaching central venous catheters

J. Brunke, T. Riemann, I. Roschke

P064 - Efficacy of noble metal alloy-coated catheter in prevention of bacteriuria

R. Tincu, C. Cobilinschi, D. Tomescu, Z. Ghiorghiu, R. Macovei

P065 - Predicting bacteremic urinary tract infection in community setting: A prospective observational study

S. Nimitvilai, K. Jintanapramote, S. Jarupongprapa

P066 - Eight-year analysis of acinetobacter spp. monobacteremia in surgical and medical intensive care units at university hospital in Lithuania

D. Adukauskiene, D. Valanciene

P067 - Group A and group B streptococcal infections in intensive care unit – our experience in a tertiary centre

G. Bose, V. Lostarakos, B. Carr

P068 - Improved detection of spontaneous bacterial peritonitis by uritop + tm strip test and inoculation of blood culture bottles with ascitic fluid

S. Khedher, A. Maaoui, A. Ezzamouri, M. Salem

P069 - Increased risk of cellulitis in patients with congestive heart failure: a population based cohort study

J. Chen

P070 - Outcomes of severe cellulitis and necrotizing fasciitis in the critically ill

D. R. Cranendonk, L. A. Van Vught, M. A. Wiewel, O. L. Cremer, J. Horn, M. J. Bonten, M. J. Schultz, T. Van der Poll, W. J. Wiersinga

P071 - Botulism outbreak associated with people who inject drugs (PWIDs) in Scotland.

M. Day, G. Penrice, K. Roy, P. Robertson, G. Godbole, B. Jones, M. Booth, L. Donaldson

P072 - Surveillance of ESBL-producing enterobacteriaceae fecal carriers in the ICU

Y. Kawano, H. Ishikura

P073 - Prevalence of ESBL and carbapenemase producing uropathogens in a newly opened hospital in south India

S. Sreevidya, N. Brahmananda Reddy, P. Muraray Govind, R. Pratheema, J. Devachandran

Apollo Speciality Hospital - OMR, Chennai, India

P074 - Prevalence, risk factors and outcomes of methicillin-resistant staphylococcus aureus nasal colonization in critically ill patients

H. Al-Dorzi, M. Almutairi, B. Alhamadi, A. Crizaldo Toledo, R. Khan, B. Al Raiy, Y. Arabi

P075 - Multidrug-resistant Acinetobacter baumannii infection in intensive care unit patients in a hospital with building construction: Is there an association?

H. Talaie

P076 - Multidrug-resistant organisms in a Dutch ICU

J. A. Van Oers, A. Harts, E. Nieuwkoop, P. Vos

P077 - Epidemiology and risk factors of ICU acquired infections caused by multidrug-resistant gram negative bacilli

Y. Boussarsar, F. Boutouta, S. Kamoun, I. Mezghani, S. Koubaji, A. Ben Souissi, A. Riahi, M. S. Mebazaa

P078 - Improving outcomes of severe infections by multidrug-resistant pathogens with polyclonal IgM-enriched immunoglobulins

E. Giamarellos-Bourboulis, N. Tziolos, C. Routsi, C. Katsenos, I. Tsangaris, I. Pneumatikos, G. Vlachogiannis, V. Theodorou, A. Prekates, E. Antypa, V. Koulouras, N. Kapravelos, C. Gogos, E. Antoniadou, K. Mandragos, A. Armaganidis

P079 - Must change the medical practice in ICU?

A. R. Robles Caballero, B. Civantos, J. C. Figueira, J. López

P080 - Mediterranean spotted fever in an infectious diseases intensive care unit

A. Silva-Pinto, F. Ceia, A. Sarmento, L. Santos

P081 - Clinical features and outcomes of patients with Middle East respiratory syndrome requiring admission to a saudi intensive care unit: A retrospective analysis of 31 cases

G. Almekhlafi, Y. Sakr

P082 - The ICU response to a hospital outbreak of Middle East respiratory syndrome coronavirus infection

H. Al-Dorzi, R. Khan, S. Baharoon, A. Aldawood, A. Matroud, J. Alchin, S. Al Johani, H. Balkhy, Y. Arabi

P083 - Middle East respiratory syndrome: Surveillance data analysis

S. Alsolamy, S. Y. Yousif, B. O. Alotabi, A. S. Alsaawi

P085 - Use of Taqman array card molecular diagnostics in severe pneumonia: A case series

J. Ang, MD Curran, D. Enoch, V. Navapurkar, A. Conway Morris

P086 - ‘BUNS’: An investigation protocol improves the ICU management of pneumonia

R. Sharvill, J. Astin

P087 - Pneumonia in patients following secondary peritonitis: epidemiological features and impact on mortality

M. Heredia-Rodríguez, E. Gómez-Sánchez, M. T. Peláez-Jareño, E. Gómez-Pesquera, M. Lorenzo-López, P. Liu-Zhu, M. Aragón-Camino, A. Hernández-Lozano, A. Sánchez-López, E. Álvarez-Fuente, E. Tamayo

P088 - The use of the “CURB-65 score” by emergency room clinicians in a large teaching hospital

J. Patel, C. Kruger

P089 - Incidence of community acquired pneumonia with viral infection in mechanically ventilated patients in the medical intensive care unit

J. O’Neal, H. Rhodes, J. Jancik

P090 - The SAATELLITE Study: Prevention of S aureus Nosocomial Pneumonia (NP) with MEDI4893, a Human Monoclonal Antibody (mAb) Against S aureus

B. François, P. F. Laterre, P. Eggimann, A. Torres, M. Sánchez, P. F. Dequin, G. L. Bassi, J. Chastre, H. S. Jafri

P091 - Risk factors and microbiological profile for nosocomial infections in trauma patients

M. Ben Romdhane, Z. Douira, S. Kamoun, M. Bousselmi, A. Ben Souissi, Y. Boussarsar, A. Riahi, M.S. Mebazaa

P092 - Correlation between percentages of ventilated patients developed vap and use of antimicrobial agents in ICU patients.

A. Vakalos, V. Avramidis

P093 - A comparison of two ventilator associated pneumonia surveillance techniques

T. H. Craven, G. Wojcik, K. Kefala, J. McCoubrey, J. Reilly, R. Paterson, D. Inverarity, I. Laurenson, T. S. Walsh

P094 - Lung ultrasound before and after fiberbronchoscopy - modifications may improve ventilator-associated pneumonia diagnosis

S. Mongodi, B. Bouhemad, A. Orlando, A. Stella, G. Via, G. Iotti, A. Braschi, F. Mojoli

P095 - Comparing the accuracy of predictors of mortality in ventilator-associated pneumonia

M. Haliloglu, B. Bilgili, U. Kasapoglu, I. Sayan, M. Süzer Aslan, A. Yalcın, I. Cinel

P096 - Impact of pRBCs transfusion on percentage of ventilated patients developed VAP in ICU patients

A. Vakalos, V. Avramidis

P097 - The impact of a series of interventions on the rate of ventilator associated pneumonia in a large teaching hospital

H. E. Ellis, K. Bauchmuller, D. Miller, A Temple

P098 - The EVADE study: Prevention of Nosocomial Pneumonia (NP) caused by P aeruginosa with MEDI3902, a Novel Bispecific Monoclonal Antibody, against P aeruginosa virulence factors

J. Chastre, B. François, A. Torres, C. E. Luyt, M. Sánchez, M. Singer, H. S. Jafri

P099 - Short-term inhaled colistin adjunctive therapy for ventilator-associated pneumonia

Y. Nassar, M. S. Ayad

P100 - Effect of aerosolised colistin on weaning from mechanical ventilation

A. Trifi, S. Abdellatif, F. Daly, R. Nasri, S. Ben Lakhal

P101 - Septic shock is an independent risk factor for colistin-induced severe acute kidney injury: a retrospective cohort study

B. Bilgili, M. Haliloglu, F. Gul, I. Cinel

P102 - Nosocomial pneumonia - emphasis on inhaled tobramycin

A. Kuzovlev, A. Shabanov, S. Polovnikov, V. Moroz

P103 - In vitro evaluation of amikacin inhale and commercial nebulizers in a mechanical ventilator

N. Kadrichu, T. Dang, K. Corkery, P. Challoner

P104 - The effects of nebulized amikacin/fosfomycin and systemic meropenem on severe amikacin-resistant meropenem-susceptible P.aeruginosa pneumonia

G. Li Bassi, E. Aguilera, C. Chiurazzi, C. Travierso, A. Motos, L. Fernandez, R. Amaro, T. Senussi, F. Idone, J. Bobi, M. Rigol, A. Torres

P105 - Optimization of gentamicin peak concentrations in critically ill patients

C. J. Hodiamont, N. P. Juffermans, J. M. Janssen, C. S. Bouman, R. A. Mathôt, M. D. De Jong, R. M. Van Hest

P106 - Systematic review of cefepime induced neurotoxicity

L. Payne, G. L. Fraser

P107 - Unasyn® causes QT prolongation during treatment of intensive care patients

B. Tudor, M. Lahner, G. Roth, C. Krenn

P108 - Comparative study between teicoplanin and vancomycin in methicillin-resistant staphylococcus aureus (mrsa) infectious of toxicological intensive care unit (ticu) patients – Tehran, Iran

H. Talaie

P109 - Phage therapy against antimicrobial resistance, design of the first clinical study phagoburn

P. Jault, J. Gabard, T. Leclerc, S. Jennes, Y. Que, A. Rousseau, F. Ravat

P110 - Antibiotic dosing errors in critically ill patients with severe sepsis or septic shock

H. Al-Dorzi, A. Eissa, S. Al-Harbi, T. Aldabbagh, R. Khan, Y. Arabi

P111 - Does empiric antifungal therapy improve survival in septic critically ill patients? (immunocompromised excluded)

A. Trifi, S. Abdellatif, F. Daly, R. Nasri, S. Ben Lakhal

P112 - Neurocysticercosis-Qatar experience

F. Paramba, N. Purayil, V. Naushad, O. Mohammad, V. Negi, P. Chandra

P113 - Early indicators in acute haemorrhagic shock

A. Kleinsasser

P114 - Filtering of red blood cells reduces the inflammatory response of pulmonary cells in an in vitro model of mechanical ventilation

M. R. Witrz, J. F. Buchner-Doeven, A. M. Tuip-de Boer, J. C. Goslings, N. P. Juffermans

P115 - Microparticles from red blood cell transfusion induce a pro-coagulant and pro-inflammatory endothelial cell response

M. Van Hezel, M. Straat, A Boing, R Van Bruggen, N Juffermans

P116 - The contribution of cytokines on thrombosis development during hospitalization in ICU

D. Markopoulou, K. Venetsanou, V. Kaldis, D. Koutete, D. Chroni, I. Alamanos

P117 - Prophylactic enoxaparin dosing and adjustment through anti-xa monitoring in an inpatient burn unit

L. Koch, J. Jancik, H. Rhodes, E. Walter

P118 - Determination of optimal cut-off values of haemoglobin, platelet count and fibrinogen at 24 hours after injury associated with mortality in trauma patients

K. Maekawa, M. Hayakawa, S. Kushimoto, A. Shiraishi, H. Kato, J. Sasaki, H. Ogura, T. Matauoka, T. Uejima, N. Morimura, H. Ishikura, A. Hagiwara, M. Takeda

P119 - Trauma-induced coagulopathy - prothrombin complex concentrate vs fresh frozen plasma

O. Tarabrin, S. Shcherbakow, D. Gavrychenko, G. Mazurenko, V. Ivanova, O. Chystikov

P120 - First study to prove the superiority of prothrombin complex concentrates on mortality rate over fresh frozen plasma in patients with acute bleeding

C. Plourde, J. Lessard, J. Chauny, R. Daoust

P121 - Prothrombin complex concentrate vs fresh frozen plasma in obstetric massive bleeding

S. Shcherbakow, O. Tarabrin, D. Gavrychenko, G. Mazurenko, O. Chystikov

P122 - Impact of FFP transfusion on VAP in ICU patients

A. Vakalos, V. Avramidis

P123 - Preoperative platelet function test and the thrombin generation assay are predictive for blood loss after cardiac surgery

L. Kropman, L. In het Panhuis, J. Konings, D. Huskens, E. Schurgers, M. Roest, B. De Laat, M. Lance

P124 - Rotational thromboelastometry versus standard coagulation tests before surgical interventions

M. Durila, P. Lukas, M. Astraverkhava, J. Jonas

P125 - Correction of impaired clot quality and stability by fibrinogen and activated prothrombin complex concentrate in a model of severe thrombocytopenia

I. Budnik, B. Shenkman

P126 - Assessment of point-of-care prothrombin time analyzer as a monitor after cardiopulmonary bypass

H. Hayami, Y. Koide, T. Goto

P127 - Disseminated intravascular coagulation (dic) is underdiagnosed in critically ill patients: do we need d-dimer measurements?

R. Iqbal, Y. Alhamdi, N. Venugopal, S. Abrams, C. Downey, C. H. Toh, I. D. Welters

P128 - Validity of the age-adjusted d-dimer cutoff in patients with COPD

B. Bombay, J. M. Chauny, R. D. Daoust, J. L. Lessard, M. M. Marquis, J. P. Paquet

P129 - A scoping review of strategies for prevention and management of bleeding following paediatric cardiopulmonary bypass surgery

K. Siemens, D. Sangaran, B. J. Hunt, A. Durward, A. Nyman, I. A. Murdoch, S. M. Tibby

P130 - Nadir hemoglobulin during cardiopulmonary bypass: impact on postoperative morbidity and mortality

F. Ampatzidou, D. Moisidou, E. Dalampini, M. Nastou, E. Vasilarou, V. Kalaizi, H. Chatzikostenoglou, G. Drossos

P131 - Red blood cell transfusion do not influence the prognostic value of RDW in critically ill patients

S. Spadaro, A. Fogagnolo, T. Fiore, A. Schiavi, V. Fontana, F. Taccone, C. Volta

P132 - Reasons for admission in the paediatric intensive care unit and the need for blood and blood products transfusions

E. Chochliourou, E. Volakli, A. Violaki, E. Samkinidou, G. Evlavis, V. Panagiotidou, M. Sdougka

P133 - The implementation of a massive haemorrhage protocol (mhp) for the management of major trauma: a ten year, single-centre study

R. Mothukuri, C. Battle, K. Guy, G. Mills, P. Evans

P134 - An integrated major haemorrhage protocol for pre-hospital and retrieval medical teams

J. Wijesuriya, S. Keogh

P135 - The impact of transfusion thresholds on mortality and cardiovascular events in patients with cardiovascular disease (non-cardiac surgery): a systematic review and meta-analysis

A. Docherty, R. O’Donnell, S. Brunskill, M. Trivella, C. Doree, L. Holst, M. Parker, M. Gregersen, J. Almeida, T. Walsh, S. Stanworth

P136 - The relationship between poor pre-operative immune status and outcome from cardiac surgery is specific to the peri-operative antigenic threat

S. Moravcova, J. Mansell, A. Rogers, R. A. Smith, C. Hamilton-Davies

P137 - Impact of simple clinical practice guidelines for reducing post-operative atrial fibrillation after cardiac surgery.

A. Omar, M. Allam, O. Bilala, A. Kindawi, H. Ewila

P138 - Dexamethasone administration during cardiopulmonary bypass has no beneficial effects on elective postoperative cardiac surgery patients

F. Ampatzidou, D. Moisidou, M. Nastou, E. Dalampini, A. Malamas, E. Vasilarou, G. Drossos

P139 - Intra-aortic balloon counterpulsation in patients undergoing cardiac surgery (IABCS): preliminary results

G. Ferreira, J. Caldas, J. Fukushima, E. A. Osawa, E. Arita, L. Camara, S. Zeferino, J. Jardim, F. Gaioto, L. Dallan, F. B. Jatene, R. Kalil Filho, .F Galas, L. A. Hajjar

P140 - Effects of low-dose atrial natriuretic peptide infusion on cardiac surgery-associated acute kidney injury

C. Mitaka, T. Ohnuma, T. Murayama, F. Kunimoto, M. Nagashima, T. Takei, M. Tomita

P141 - Acute kidney injury influence on high sensitive troponin measurements after cardiac surgery

A. Omar, K. Mahmoud, S. Hanoura, S. Sudarsanan, P. Sivadasan, H. Othamn, Y. Shouman, R. Singh, A. Al Khulaifi

P142 - Complex evaluation of endothelial dysfunction markers for prognosis of outcomes in patients undergoing cardiac surgery

I. Mandel, S. Mikheev, I. Suhodolo, V. Kiselev, Y. Svirko, Y. Podoksenov

P143 - New-onset atrial fibrillation in intensive care: incidence, management and outcome

S. A. Jenkins, R. Griffin

P144 - One single spot measurement of the sublingual microcirculation during acute pulmonary hypertension in a pig model of shock

M. S. Tovar Doncel, A. Lima, C. Aldecoa, C. Ince

P145 - Assessment of levosimendan as a therapeutic option to recruit the microcirculation in cardiogenic shock – initial experience in cardiac ICU

A. Taha, A. Shafie, M. Mostafa, N. Syed, H. Hon

P146 - Terlipressin vs. norepinephrine in the Potential Multiorgan Donor(PMD)

F. Righetti, E. Colombaroli, G. Castellano

P147 - Echocardiography in the potential heart donor exposed to substitution hormonotherapy

F. Righetti, E. Colombaroli

P148 - Machine learning can reduce rate of monitor alarms

M. Hravnak, L. C. Chen, A. D. Dubrawski, G. C. Clermont, M. R. Pinsky

P149 - Peripherally inserted central catheters placed in the ICU

S. Gonzalez, D. Macias, J. Acosta, P. Jimenez, A. Loza, A. Lesmes, F. Lucena, C. Leon

P150 - Recordings of abnormal central venous pressure waveform morphology during an episode of pulmonary hypertension in a porcine shock model

M. S. Tovar Doncel, C. Ince, C. Aldecoa, A. Lima

P151 - Ultrasound guided central venous access technique among French intensivists

M. Bastide, J. Richecoeur, E. Frenoy, C. Lemaire, B. Sauneuf, F. Tamion, S. Nseir, D. Du Cheyron, H. Dupont, J. Maizel

P152 - Predictive ability of the Pv-aCO2 gap in patients with shock

M. Shaban, R. Kolko, N. Salahuddin, M. Sharshir, M. AbuRageila, A. AlHussain

P153 - Comparison of echocardiography and pulmonary artery catheter measurements of hemodynamic parameters in critical ill patients

P. Mercado, J. Maizel, L. Kontar, D. Titeca, F. Brazier, A. Riviere, M. Joris, T. Soupison, B. De Cagny, M. Slama

P154 - The volume clamp method for noninvasive cardiac output measurement in postoperative cardiothoracic surgery patients: a comparison with intermittent pulmonary artery thermodilution

J. Wagner, A. Körner, M. Kubik, S. Kluge, D. Reuter, B. Saugel

P155 - Hemodynamic monitoring in patients with septic shock (SS) – CPCCO (continuous pulse contour cardiac output) vs. TEE (transesophageal echocardiography)

E. Colombaroli, F. Righetti, G. Castellano

P156 - Cardiac output measurement with transthoracic echocardiography in critically ill patients: a pragmatic clinical study

T. Tran, D. De Bels, A. Cudia, M. Strachinaru, P. Ghottignies, J. Devriendt, C. Pierrakos

P157 - Left ventricular outflow tract velocity time integral correlates with stroke volume index in mechanically ventilated patients

Ó. Martínez González, R. Blancas, J. Luján, D. Ballesteros, C. Martínez Díaz, A. Núñez, C. Martín Parra, B. López Matamala, M. Alonso Fernández, M. Chana

P158 - Transpulmonary thermodilution (TPTD) derived from femoral vs. jugular central venous catheter: validation of a previously published correction formula and a proprietary correction formula for global end-diastolic volume index (GEDVI)

W. Huber, M. Eckmann, F. Elkmann, A. Gruber, I. Klein, R. M. Schmid, T. Lahmer

P160 - Dynamic arterial elastance calculated with lidcoplus monitor does not predict changes in arterial pressure after a fluid challenge in postsurgical patients

D. Bastoni, H. Aya, L. Toscani, L. Pigozzi, A. Rhodes, M. Cecconi

P159 - Venous return driving pressure and resistance in acute blood volume changes

P. W. Moller, S. Sondergaard, S. M. Jakob, J. Takala, D. Berger

P160 - Dynamic arterial elastance calculated with lidcoplus monitor does not predict changes in arterial pressure after a fluid challenge in postsurgical patients

D. Bastoni, H. Aya, L. Toscani, L. Pigozzi, A. Rhodes, M. Cecconi

P161 - Analysis of duration of post-operative goal-directed therapy protocol

C. Ostrowska, H. Aya, A. Abbas, J. Mellinghoff, C. Ryan, D. Dawson, A. Rhodes, M. Cecconi

P162 - Hemodynamic optimization – back to square one?

M. Cronhjort, O. Wall, E. Nyberg, R. Zeng, C. Svensen, J. Mårtensson, E. Joelsson-Alm

P163 - Effectiveness of fluid thoracic content measurement by bioimpedance guiding intravascular volume optimization in patients with septic shock

M. Aguilar Arzapalo, L. Barradas, V. Lopez, M. Cetina

P164 - A systematic review on the role of internal jugular vein ultrasound measurements in assessment of volume status in critical shock patients

N. Parenti, C. Palazzi, L. A. Amidei, F. B. Borrelli, S. C. Campanale, F. T. Tagliazucchi, G. S. Sedoni, D. L. Lucchesi, E. C. Carella, A. L Luciani

P165 - Importance of recognizing dehydration in medical Intensive Care Unit

M. Mackovic, N. Maric, M. Bakula

P166 - Effect of volume for a fluid challenge in septic patients

H. Aya, A. Rhodes, R. M. Grounds, N. Fletcher, M. Cecconi

P167 - Fluid bolus practices in a large Australian intensive care unit

B. Avard, P. Zhang

P168 - Liberal late fluid management is associated with longer ventilation duration and worst outcome in severe trauma patients: a retrospective cohort of 294 patients

M. Mezidi, J. Charbit, M. Ould-Chikh, P. Deras, C. Maury, O. Martinez, X. Capdevila

P169 - Association of fluids and outcomes in emergency department patients hospitalized with community-acquired pneumonia

P. Hou, W. Z. Linde-Zwirble, I. D. Douglas, N. S. Shapiro

P170 - Association of positive fluid balance with poor outcome in medicosurgical ICU patients

A. Ben Souissi, I. Mezghani, Y. Ben Aicha, S. Kamoun, B. Laribi, B. Jeribi, A. Riahi, M. S. Mebazaa

P171 - Impact of fluid balance to organ dysfunction in critically ill patients

C. Pereira, R. Marinho, R. Antunes, A. Marinho

P172 - Volume bolus in ICU patients: do we need to balance our crystalloids?

M. Crivits, M. Raes, J. Decruyenaere, E. Hoste

P173 - The use of 6 % HES solution do not reduce total fluid requirement in the therapy of patients with burn shock

V. Bagin, V. Rudnov, A. Savitsky, M. Astafyeva, I. Korobko, V. Vein

P174 - Electron microscopic assessment of acute kidney injury in septic sheep resuscitated with crystalloids or different colloids

T. Kampmeier , P. Arnemann, M. Hessler, A. Wald, K. Bockbreder, A. Morelli, H. Van Aken, S. Rehberg, C. Ertmer

P175 - Alterations of conjunctival microcirculation in a sheep model of haemorrhagic shock and resuscitation with 0.9 % saline or balanced tetrastarch

P. Arnemann, M. Hessler, T. Kampmeier, S. Rehberg, H. Van Aken, C. Ince, C. Ertmer

P176 - A single centre nested pilot study investigating the effect of using 0.9 % saline or Plasma-Lyte 148 ® as crystalloid fluid therapy on gastrointestinal feeding intolerance in mechanically ventilated patients receiving nasogastric enteral nutrition

S. Reddy, M. Bailey, R. Beasley, R. Bellomo, D. Mackle, A. Psirides, P. Young

P177 - A single centre nested pilot study investigating the effect on post-operative bleeding of using 0.9 % saline or Plasma-Lyte® 148 as crystalloid fluid therapy in adults in ICU after heart surgery

S. Reddy, M. Bailey, R. Beasley, R. Bellomo, D. Mackle, P. Young

P178 - Extreme hypernatremia and sepsis in a patient with Huntington’s dementia: a conundrum in fluid management

H. Venkatesh, S. Ramachandran, A. Basu, H. Nair

P179 - Diagnosis and management of severe hypernatraemia in the critical care setting

S. Egan, J. Bates

P180 - Correlation between arterial blood gas and electrolyte disturbances during hospitalization and outcome in critically ill patients

S. Oliveira, N. R. Rangel Neto, F. Q. Reis

P181 - Missing the “I” in MUDPILES – a rare cause of high anion gap metabolic acidosis (HAGMA)

C. P. Lee, X. L. Lin, C. Choong , K. M. Eu, W. Y. Sim , K. S. Tee, J. Pau , J. Abisheganaden

P182 - Plasma NGAL and urinary output: potential parameters for early initiation of renal replacement therapy

K. Maas, H. De Geus

P183 - Renal replacement therapy for critically ill patients: an intermittent continuity

E. Lafuente, R. Marinho, J. Moura, R. Antunes, A. Marinho

P184 - A survey of practices related to renal replacement therapy in critically ill patients in the north of England.

T. E. Doris, D. Monkhouse, T. Shipley, S. Kardasz, I Gonzalez

P185 - High initiation creatinine associated with lower 28-day mortality in critically ill patients necessitating continuous renal replacement therapy

S. Stads, A. J. Groeneveld

P186 - The impact of Karnofsky performance scale on outcomes in acute kidney injury patients receiving renal replacement therapy on the intensive care unit

I. Elsayed, N. Ward, A. Tridente, A. Raithatha

P187 - Severe hypophosphatemia during citrate-anticoagulated CRRT

A. Steuber, C. Pelletier, S. Schroeder, E. Michael, T. Slowinski, D. Kindgen-Milles

P188 - Citrate regional anticoagulation for post dilution continuous renal replacement therapy

S. Ghabina

P189 - Citrate 18 mmol/l improves anticoagulation during RRT with adsorbing filters

F. Turani, A. Belli, S. Busatti, G. Barettin, F. Candidi, F. Gargano, R. Barchetta, M. Falco

P190 - Calcium gluconate instead of calcium chloride in citrate-anticoagulated CVVHD

O. Demirkiran, M. Kosuk, S. Bozbay

P191 - Enhanced clearance of interleukin-6 with continuous veno-venous haemodialysis (CVVHD) using Ultraflux EMiC2 vs. Ultraflux AV1000S

V. Weber, J. Hartmann, S. Harm, I. Linsberger, T. Eichhorn, G. Valicek, G. Miestinger, C. Hoermann

P192 - Removal of bilirubin with a new adsorbent system: in vitro kinetics

S. Faenza, D. Ricci, E. Mancini, C. Gemelli, A. Cuoghi, S. Magnani, M. Atti

P193 - Case series of patients with severe sepsis and septic shock treated with a new extracorporeal sorbent

T. Laddomada, A. Doronzio, B. Balicco

P194 - In vitro adsorption of a broad spectrum of inflammatory mediators with CytoSorb® hemoadsorbent polymer beads

M. C. Gruda, P. O’Sullivan, V. P. Dan, T. Guliashvili, A. Scheirer, T. D. Golobish, V. J. Capponi, P. P. Chan

P195 - Observations in early vs. late use of cytosorb therapy in critically ill patients

K. Kogelmann, M. Drüner, D. Jarczak

P196 - Oxiris membrane decreases endotoxin during rrt in septic patients with basal EAA > 0,6

F. Turani, A. B. Belli, S. M. Martni, V. C. Cotticelli, F. Mounajergi, R. Barchetta

P197 - An observational prospective study on the onset of augmented renal clearance: the first report

S. Morimoto, H. Ishikura

P198 - An ultrasound- guided algorithm for the management of oliguria in severe sepsis

I. Hussain, N. Salahuddin, A. Nadeem, K. Ghorab, K. Maghrabi

P199 - Ultrasound in acute kidney injury (aki). First findings of farius, an education-programme in structural ultrasonography

S. K. Kloesel, C. Goldfuss, A. Stieglitz, A. S. Stieglitz, L. Krstevska, G. Albuszies

P200 - Effectiveness of renal angina index score predicting acute kidney injury on critically ill patients

M. Aguilar Arzapalo, L. Barradas, V. Lopez, A. Escalante, G. Jimmy, M. Cetina

P201 - Time length below blood pressure thresholds and progression of acute kidney injury in critically ill patients with or without sepsis: a retrospective, exploratory cohort study

J. Izawa, T. Iwami, S. Uchino, M. Takinami, T. Kitamura, T. Kawamura

P202 - Anaemia does not affect renal recovery in acute kidney injury

J. G. Powell-Tuck, S. Crichton, M. Raimundo, L. Camporota, D. Wyncoll, M. Ostermann

P203 - Estimated glomerular filtration rate based on serum creatinine: actual practice in Dutch ICU’s

A. Hana, H. R. De Geus

P204 - Comparison of estimated glomerular filtration rate calculated by mdrd, ckd-epi-serum-creatinine and ckd-epi-cystatin-c in adult critically ill patients

H. R. De Geus, A. Hana

P205 - Early diagnosis of septic acute kidney injury in medical critical care patients with a urine cell cycle arrest marker: insulin like growth factor binding protein-7 (IGFBP-7)

M. Aydogdu, N. Boyaci, S. Yuksel, G. Gursel, A. B. Cayci Sivri

P206 - Urinary neutrophil gelatinase-associated lipocalin as early biomarker of severe acute kidney injury in intensive care

J. Meza-Márquez, J. Nava-López, R. Carrillo-Esper

P207 - Shrunken pore syndrome is associated with a sharp rise in mortality in patients undergoing elective coronary artery bypass grafting

A. Dardashti, A. Grubb

P208 - The biomarker nephrocheck™ can discriminate the septic shock patients with an akin 1 or 2 acute renal failure who will not progress toward the akin 3 level

J. Maizel, M. Wetzstein, D. Titeca, L. Kontar, F. Brazier, B. De Cagny, A. Riviere, T. Soupison, M. Joris, M. Slama

P209 - A worldwide multicentre evaluation of acute kidney injury in septic and non-septic critically ill patients: the intensive care over nations (icon) audit

E. Peters, H. Njimi, P. Pickkers, J. L. Vincent

P210 - Does enhanced recovery after surgery reduce the incidence of acute kidney injury in those undergoing major gynae-oncological surgery?

M. Waraich , J. Doyle, T. Samuels, L. Forni

P211 - Identification of risk factors for the development of acute kidney injury after lower limb arthroplasty

N. Desai, R. Baumber, P. Gunning, A. Sell

P212 - Incidences and associations of acute kidney injury after major trauma

S. Lin, H. Torrence, M. O’Dwyer, C. Kirwan, J. Prowle

P213 - Acute kidney injury of major trauma patients

T Kim

P214 - Trajectory of serum creatinine after major surgery and the diagnosis of acute kidney injury

M. E. O’Connor, R. W. Hewson, C. J. Kirwan, R. M. Pearse, J. Prowle

P215 - Epidemiology of acute kidney injury after cardiac surgery. A single center retrospective study

S. Hanoura , A. Omar, H. Othamn, S. Sudarsanan , M. Allam, M. Maksoud, R. Singh, A. Al Khulaifi

P216 - Post-operative acute kidney injury after major non-cardiac surgery and its association with death in the following year

M. E. O’Connor, R. W. Hewson, C. J. Kirwan, R. M. Pearse, J. Prowle

P217 - Factors affecting acute renal failure in intensive care unit and effect of these factors on mortality

O. Uzundere, D. Memis , M. Ýnal, A. , N. Turan

P218 - Results of the live kidney transplantations according to national data of turkish organ and tissue information system

M. A. Aydin, H. Basar, I. Sencan, A. Kapuagasi, M. Ozturk, Z. Uzundurukan, D. Gokmen, A. Ozcan, C. Kaymak

P219 - Anaesthesia procedure and intensive therapy in patients with neck phlegmon

V. A. Artemenko, A. Budnyuk

P220 - Nasal high flow oygen for acute respiratory failure: a systematic review

R. Pugh , S. Bhandari

P221 - Setting optimal flow rate during high flow nasal cannula support: preliminary results

T. Mauri, C. Turrini, T. Langer, P. Taccone, C. A. Volta, C. Marenghi, L. Gattinoni, A. Pesenti

P222 - Dose to dose consistency across two different gas flow rates using cystic fibrosis and normal adult breathing profiles during nasal high flow oxygen therapy

L. Sweeney, A . O’ Sullivan, P. Kelly, E. Mukeria, R. MacLoughlin

P223 - Final results of an evaluation of airway medix closed suction system compared to a standard closed suction system

M. Pfeffer, J. T. Thomas, G. B. Bregman, G. K. Karp, E. K. Kishinevsky, D. S. Stavi, N. A. Adi

P224 - Different cuff materials and different leak tests - one size does not fit all

T. Poropat, R. Knafelj

P225 - Observational study on the value of the cuff-leak test and the onset of upper airway obstruction after extubation

E. Llopart, M. Batlle, C. De Haro, J. Mesquida, A. Artigas

P226 - A device for emergency transtracheal lung ventilation

D. Pavlovic, L. Lewerentz, A. Spassov, R. Schneider

P227 - Long-term outcome and health-related quality of life in patients discharged from the intensive care unit with a tracheostomy and with or without prolonged mechanical ventilation

S. De Smet, S. De Raedt, E. Derom, P Depuydt, S. Oeyen, D. Benoit, J. Decruyenaere

P228 - Ultrasound-guided percutaneous dilational tracheostomy versus bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients (trachus): a randomized clinical trial

A. Gobatto, B. Bese, P. Tierno, L. Melro, P. Mendes, F. Cadamuro, M. Park, L. M. Malbouisson

P229 - Is it safe to discharge patients with tracheostomy from the ICU to the ward?

B. C. Civanto, J. L. Lopez, A. Robles, J. Figueira, S. Yus, A. Garcia

P230 - The application of tracheostomy in children in ICU

A. Oglinda, G. Ciobanu, C. Oglinda, L. Schirca, T. Sertinean, V. Lupu

P231 - The impact of passive humidifiers on aerosol drug delivery during mechanical ventilation

P. Kelly, A. O’Sullivan, L. Sweeney, R. MacLoughlin

P232 - Evaluation of vibrating mesh and jet nebuliser performance at two different attachment setups in line with a humidifier nebuliser system

A. O’Sullivan, P. Kelly, L. Sweeney, E. Mukeria, M. Wolny , R. MacLoughlin

P233 - Psv-niv versus cpap in the treatment of acute cardiogenic pulmonary edema

A. Pagano, F. Numis, G. Vison, L. Saldamarco, T. Russo, G. Porta, F. Paladino

P234 - Noninvasive ventilation in patients with haematologic malignancy: a retrospective review

C. Bell, J. Liu, J. Debacker, C. Lee, E. Tamberg, V. Campbell, S. Mehta

P235 - Use of non-invasive ventilation in infectious diseases besides classical indications

A. Silva-Pinto, A. Sarmento, L. Santos

P236 - The impact of fragility on noninvasive mechanical ventilation application and results in the ICU

Ý. Kara, F. Yýldýrým, A. Zerman, Z. Güllü, N. Boyacý, B. Basarýk Aydogan, Ü. Gaygýsýz, K. Gönderen, G. Arýk, M. Turkoglu, M. Aydogdu, G. Aygencel, Z. Ülger, G. Gursel

P237 - Effects of metabolic alkalosis on noninvasive ventilation success and ICU outcome in patients with hypercapnic respiratory failure

N. Boyacý, Z. Isýkdogan, Ö. Özdedeoglu, Z. Güllü, M. Badoglu, U. Gaygýsýz, M. Aydogdu, G. Gursel

P238 - Asynchrony index and breathing patterns of acute exacerbation copd patients assisted with noninvasive pressure support ventilation and neurally adjusted ventilatory assist

N. Kongpolprom, C. Sittipunt

P239 - High frequency jet ventilation for severe acute hypoxemia

A. Eden, Y. Kokhanovsky, S. Bursztein – De Myttenaere, R. Pizov

P240 - HFOV revisited: a 7 year retrospective analysis of patients receiving HFOV who met oscillate trial entry criteria

L. Neilans, N. MacIntyre

P241 - Implementation of a goal-directed mechanical ventilation order set driven by respiratory therapists can improve compliance with best practices for mechanical ventilation

M. Radosevich, B. Wanta, V. Weber, T. Meyer, N. Smischney, D. Brown, D. Diedrich

P242 - A reduction in tidal volumes for ventilated patients on ICU calculated from IBW. can it minimise mortality in comparison to traditional strategies?

A . Fuller, P. McLindon, K. Sim

P243 - Predictive value of lung aeration scoring using lung ultrasound in weaning failure

M. Shoaeir, K. Noeam, A. Mahrous, R. Matsa, A. Ali

P244 - Conventional versus automated weaning from mechanical ventilation using SmartCare™

C. Dridi, S. Koubaji, S. Kamoun, F. Haddad, A. Ben Souissi, B. Laribi, A. Riahi, M. S. Mebazaa

P245 - Ultrasonographic evaluation protocol for weaning from mechanichal ventilation

A. Pérez-Calatayud, R. Carrillo-Esper, A. Zepeda-Mendoza, M. Diaz-Carrillo, E. Arch-Tirado

P246 - Diaphragm ultrasonography: a method for weaning patients from mechanical ventilation

S. Carbognin, L. Pelacani, F. Zannoni, A. Agnoli, G. Gagliardi

P247 - Dorsal diaphragmatic excursion tracks transpulmonary pressure in ventilated ARDS patients: a potential non-invasive indicator of lung recruitment?

R. Cho, A. Adams , S. Lunos, S. Ambur, R. Shapiro, M. Prekker

P248 - Pulse oximetry in the icu patient: is the perfusion index of any value?

M. Thijssen, L. Janssen, N. Foudraine

P249 - Ventilation is a better assessment of respiratory status than EtCO2

C. J. Voscopoulos, J. Freeman

P250 - Evaluation of the relationship between non-invasive minute ventilation and end-tidal CO2 in patients undergoing general vs spinal anesthesia

C. J. Voscopoulos, J. Freeman, E. George

P251 - Respiratory volume monitoring provides early warning of respiratory depression and can be used to reduce false alarms in non-intubated patients

C. J. Voscopoulos, D. Eversole, J. Freeman, E. George

P252 - P/i index: a predictive edi-derived weaning index during nava

S. Muttini, R. Bigi, G. Villani, N. Patroniti

P253 - Adequacy of ventilation in patients receiving opioids in the post anesthesia care unit: minute ventilation versus respiratory rate

G. Williams, C. J. Voscopoulos, J. Freeman, E. George

P254 - Comparison of regional and global expiratory time constants measured by electrical impedance tomography (EIT)

A. Waldmann, S. Böhm, W. Windisch, S. Strassmann, C. Karagiannidis

P255 - Electrical impedance tomography: robustness of a new pixel wise regional expiratory time constant calculation

A. Waldmann, S. Böhm, W. Windisch, S. Strassmann, C. Karagiannidis

P256 - Validation of regional and global expiratory time constant measurement by electrical impedance tomography in ards and obstructive pulmonary diseases

C. K. Karagiannidis, A. W. Waldmann, S. B. Böhm, S. Strassmann, W. W. Windisch

P257 - Transpulmonary pressure in a model with elastic recoiling lung and expanding chest wall

P. Persson, S. Lundin, O. Stenqvist

P258 - Lactate in pleural and abdominal effusion

G. Porta, F. Numis, C. S. Serra, A. P. Pagano, M. M. Masarone, L. R. Rinaldi, A. A. Amelia, M. F. Fascione, L. A. Adinolfi, E. R. Ruggiero

P259 - Outcome of patients admitted to the intensive care with pulmonary fibrosis

F. Asota, K. O’Rourke, S. Ranjan, P. Morgan

P260 - Sedation and analgesia practice in extra-corporeal membrane oxygenation (ECMO)-treated patients with acute respiratory distress syndrome (ARDS): a retrospective study

J. W. DeBacker, E. Tamberg, L. O’Neill, L. Munshi, L. Burry, E. Fan, S. Mehta

P261 - Characteristics and outcomes of patients deemed not eligible when referred for veno-venous extracorporeal membrane oxygenation (vv-ECMO)

S. Poo, K. Mahendran, J. Fowles, C. Gerrard, A. Vuylsteke

P262 - The SAVE SMR for veno-arterial ECMO

R. Loveridge, C. Chaddock, S. Patel, V. Kakar, C. Willars, T. Hurst, C. Park, T. Best, A. Vercueil, G. Auzinger

P263 - A simplified score to predict early (48 h) mortality in patients being considered for VA-ECMO

A. Borgman, A. G. Proudfoot, E. Grins, K. E. Emiley, J. Schuitema, S. J. Fitch, G. Marco, J. Sturgill, M. G. Dickinson, M. Strueber, A. Khaghani, P. Wilton, S. M. Jovinge

P264 - Lung function six months post extra corporeal membrane oxygenation (ECMO) for severe acute respiratory failure in adult survivors

C. Sampson, S. Harris-Fox

P265 - Bicarbonate dialysis removes carbon dioxide in hypoventilated rodents.

M. E. Cove, L. H. Vu, A. Sen, W. J. Federspiel, J. A. Kellum

P266 - Procalcitonin as predictor of primary graft dysfunction and mortality in post-lung transplantation

C. Mazo Torre, J. Riera, S. Ramirez, B. Borgatta, L. Lagunes, J. Rello

P267 - New molecular biomarkers of acute respiratory distress syndrome in abdominal sepsis

A. K. Kuzovlev, V. Moroz, A. Goloubev, S. Polovnikov, S. Nenchuk

P268 - Tight junction’s proteins claudin -5 and regulation by tnf in experimental murine lung injury model of ali/ards

V. Karavana, C. Glynos, A. Asimakos, K. Pappas, C. Vrettou, M. Magkou, E. Ischaki, G. Stathopoulos, S. Zakynthinos

P269 - Cell counts in endobronchial aspirate to assess airway inflammation in ARDS patients: a pilot study

S. Spadaro, I. Kozhevnikova, F. Dalla Corte, S. Grasso, P. Casolari, G. Caramori, C. Volta

P270 - Epidemiological and clinical profile of patients with acute respiratory distress syndrome in the surgical intensive care unit surgical, hospital JRA, Antananarivo

T. Andrianjafiarinoa, T. Randriamandrato, T. Rajaonera

P271 - Effect of high PEEP after recruitment maneuver on right ventricular function in ARDS. Is it good for the lung and for the heart?

S. El-Dash, ELV Costa, MR Tucci, F Leleu, L Kontar, B. De Cagny, F. Brazier, D. Titeca, G. Bacari-Risal, J. Maizel, M. Amato, M. Slama

P272 - Effect of recruitment maneuver on left ventricular systolic strain

P. Mercado, J. Maizel, L. Kontar, D. Titeca, F. Brazier, A. Riviere, M. Joris, T. Soupison, B. De Cagny, S. El Dash, M. Slama

P273 - Inhaled nitric oxide – is switching supplier cost effective?

Remmington, A. Fischer, S. Squire, M. Boichat

P274 - Epidemiological study of severe acute pancreatitis in Japan, comparison of the etiology and the patient outcomes on 1159 patients.

H. Honzawa, H. Yasuda, T. Adati, S. Suzaki, M. Horibe, M. Sasaki, M. Sanui

P275 - Extracorporeal liver support therapy. Experience in an intensive care unit

R. Marinho, J. Daniel, H. Miranda, A. Marinho

P276 - Accuracy of mortality prediction models in acute versus acute-on-chronic liver failure in the intensive care setting

K. Milinis, M. Cooper, G. R. Williams, E. McCarron, S. Simants, I. Patanwala, I. Welters

P277 - Risk of coronary artery disease in patients with chronic liver disease: a population based cohort study

Y. Su

P278 - 20 years of liver transplantation in Santiago de Compostela (Spain). Experience review

J. Fernández Villanueva, R. Fernández Garda, A. López Lago, E. Rodríguez Ruíz, R. Hernández Vaquero, S. Tomé Martínez de Rituerto, E. Varo Pérez

P279 - Diarrhea is a risk factor for liver injury and may lead to intestinal failure associated liver disease in critical illness

N. Lefel, F. Schaap, D. Bergmans, S. Olde Damink, M. Van de Poll

P280 - Bowel care on the intensive care unit: constipation guideline compliance and complications

K. Tizard, C. Lister, L. Poole

P281 - Malnutrition assessed by phase angle determines outcomes in low risk cardiac surgery patients

D. Ringaitiene, D. Gineityte, V. Vicka, I. Norkiene, J. Sipylaite

P282 - Preoperative fasting times in an irish hospital

A. O’Loughlin, V. Maraj, J. Dowling

P283 - Costs and final outcome of early x delayed feeding in a private Brazil ICU

M. B. Velasco, D. M. Dalcomune, E. B. Dias, S. L. Fernandes

P284 - Can ventilator derived energy expenditure measurements replace indirect calorimetry?

T. Oshima, S. Graf, C. Heidegger, L. Genton, V. Karsegard, Y. Dupertuis, C. Pichard

P285 - Revisiting the refeeding syndrome: results of a systematic review

N. Friedli, Z. Stanga, B. Mueller, P. Schuetz

P286 - Compliance with the new protocol for parenteral nutrition in our ICU

L. Vandersteen, B. Stessel, S. Evers, A. Van Assche, L. Jamaer, J. Dubois

P287 - Nutrition may be another treatment in the intensive care unit where less is more?

R. Marinho, H. Castro, J. Moura, J. Valente, P. Martins, P. Casteloes, C. Magalhaes, S. Cabral, M. Santos, B. Oliveira, A. Salgueiro, A. Marinho

P288 - Should we provide more protein to critically ill patients?

R. Marinho, M. Santos, E. Lafuente, H. Castro, S. Cabral, J. Moura, P. Martins, B. Oliveira, A. Salgueiro, S. Duarte, S. Castro, M. Melo, P. Casteloes, A. Marinho

P289 Protein provision in an adult intensive care unit

S. Gray

P290 - Prevalence and clinical outcomes of vitamin d deficiency in the medical critically ill patients in Songklanagarind hospital

K. Maipang, R. Bhurayanontachai

P291 - Vitamin d deficiency strongly predicts adverse medical outcome across different medical inpatient populations: results from a prospective study

L. G. Grädel, P. Schütz

P292 - Omega-3 fatty acids in patients undergoing cardiac surgery: a systematic review and meta-analysis

P. Langlois, W. Manzanares

P293 - Can 5-hydroxytriptophan prevent post-traumatic stress disorder in critically ill patients?

R. Tincu, C. Cobilinschi, D. Tomescu, Z. Ghiorghiu, R. Macovei

P294 - Parenteral selenium in the critically ill: an updated systematic review and meta-analysis

W. Manzanares, P. Langlois, M. Lemieux, G. Elke, F. Bloos, K. Reinhart, D. Heyland

P295 - Probiotics in the critically ill: an updated systematic review and meta-analysis

P. Langlois, M. Lemieux, I. Aramendi, D. Heyland, W. Manzanares

P296 - Diabetes with hyperglycemic crisis episodes may be associated with higher risk of pancreatic cancer: a population-based cohort study

Y. Su

P297 - Incidence of hypoglycemia in an intensive care unit depending on insulin protocol

R. Marinho, N. Babo, A. Marinho

P298 - Severity of the diseases is two-dimensionally correlated to blood glucose, including blood glucose variability, especially in moderately to severely ill patients with glucose intolerance.

M. Hoshino, Y. Haraguchi, S. Kajiwara, T. Mitsuhashi, T. Tsubata, M. Aida

P299 - A study of glycemic control by subcutaneous glargine injection transition from continuous regular insulin infusion in critically ill patients

T. Rattanapraphat, R. Bhurayanontachai, C. Kongkamol, B. Khwannimit

P300 - Glycemic control in Portuguese intensive care unit

R. Marinho, M. Santos, H. Castro, E. Lafuente, A. Salgueiro, S. Cabral, P. Martins, J. Moura, B. Oliveira, M. Melo, B. Xavier, J. Valente, C. Magalhaes, P. Casteloes, A. Marinho

P301 - Impact of hyperglycemia duration on the day of operation on short-term outcome of cardiac surgery patients

D. Moisidou, F. Ampatzidou, C. Koutsogiannidis, M. Moschopoulou, G. Drossos

P302 - Lactate levels in diabetic ketoacidosis patients at ICU admissions

G. Taskin, M. Çakir, AK Güler, A. Taskin, N. Öcal, S. Özer, L. Yamanel

P303 - Intensive care implications of merging heart attack centre units in London

J. M. Wong, C. Fitton, S. Anwar, S. Stacey

P304 - Special characteristics of in-hospital cardiac arrests

M. Aggou, B. Fyntanidou, S. Patsatzakis, E. Oloktsidou, K. Lolakos, E. Papapostolou, V. Grosomanidis

P305 - Clinical evaluation of ICU-admitted patients who were resuscitated in the general medicine ward

S. Suda , T. Ikeda, S. Ono, T. Ueno, Y. Izutani

P306 - Serious game evaluation of a one-hour training basic life support session for secondary school students: new tools for future bystanders

S. Gaudry, V. Desailly, P. Pasquier, PB Brun, AT Tesnieres, JD Ricard, D. Dreyfuss, A. Mignon

P307 - Public and clinical staff perceptions and knowledge of CPR compared to local and national data

J. C White, A. Molokhia, A. Dean, A. Stilwell, G. Friedlaender

P308 Dispatcher-assisted telephone cardiopulmonary resuscitation using a French-language compression-ventilation pediatric protocol

M. Peters, S. Stipulante, A. Delfosse, AF Donneau, A. Ghuysen

P309 Dantrolene versus amiodarone for resuscitation – an experimental study

C. Feldmann, D. Freitag, W. Dersch, M. Irqsusi, D. Eschbach, T. Steinfeldt, H. Wulf, T. Wiesmann

P310 Long term survival and functional neurological outcome in comatose survivors undergoing therapeutic hypothermia

N. Kongpolprom, J. Cholkraisuwat

P311 Impact of kidney disease on mortality and neurological outcome in out-of-hospital cardiac arrest: a prospective observational study

S. Beitland , E. Nakstad, H. Stær-Jensen , T. Drægni , G. Andersen , D. Jacobsen , C. Brunborg, B. Waldum-Grevbo , K. Sunde

P312 ICU dependency of patients admitted after primary percutaneous coronary intervention (PPCI) following out of the hospital cardiac arrest

K. Hoyland, D. Pandit

P313 Prognostic indicators and outcome prediction model for patients with return of spontaneous circulation from cardiopulmonary arrest: comprehensive registry of in-hospital intensive care on OHCA survival (critical) study in Osaka, Japan

K. Hayakawa

P314 Cerebral oxygen saturation during resuscitation in a porcine model of cardiac arrest

E. Oloktsidou, K. Kotzampassi, B. Fyntanidou, S. Patsatzakis, L. Loukipoudi, E. Doumaki, V. Grosomanidis

P315 Presumption of cardiopulmonary resuscitation for sustaining cerebral oxidation using regional cerebral saturation of oxygen: observational cohort study (press study)

H. Yasuda

P316 EEG reactivity in patients after cardiac arrest: a close look at stimuli

MM Admiraal, M. Van Assen, MJ Van Putten, M. Tjepkema-Cloostermans, AF Van Rootselaar, J. Horn

P317 Prognostic value of neuron-specific enolase after cardiac arrest

F. Ragusa, A. Marudi , S. Baroni, A. Gaspari, E. Bertellini

P318 Correlation between electroencephalographic findings and serum neuron specific enolase with outcome of post cardiac arrest patients

A. Taha, T. Abdullah, S. Abdel Monem

P319 Introduction of a targeted temperature management strategy following cardiac arrest in a district general hospital intensive care unit.

S. Alcorn, S. McNeill, S. Russell

P320 The evolution of cerebral oxygen saturation in post-cardiac arrest patients treated with therapeutic hypothermia

W. Eertmans, C. Genbrugge, I. Meex, J. Dens, F. Jans, C. De Deyne

P321 Prognostic factors and neurological outcomes of therapeutic hypothermia in comatose survivors from cardiac arrest: 8-year single center experience

J. Cholkraisuwat, N. Kongpolprom

P322 Adherence to targeted temperature management after out of hospital cardiac arrest

B. Avard, R. Burns

P323 Implementation of a therapeutic hypothermia protocol for comatose survivors of out-of-hospital cardiac arrest.

A. Patarchi, T. Spina

P324 Factors associated with ventilator weaning after targeted temperature management for cardiac arrest patients in japan

H. Tanaka, N. Otani, S. Ode, S. Ishimatsu

P325 Differential activation of c-fos in paraventricular nuclei of the hypothalamus and thalamus of the rat following myocardial infarction

J. Cho, J. B. Moon, C. W. Park, T. G. Ohk, M. C. Shin, M. H. Won

P326 Monitoring of cTroponin I in patients with acute ischemic stroke - predictor of inhospital mortality

S. Dakova, Z. Ramsheva, K. Ramshev

P327 Hyperthermic preconditioning severely accelerates neuronal damage in the gerbil ischemic hippocampal dentate gyrus via decreasing sods expressions

J. Cho, J. B. Moon, C. W. Park, T. G. Ohk, M. C. Shin

P328 Failure in neuroprotection of remote limb ischemic post conditioning in the hippocampus of a gerbil model of transient cerebral ischemia

J. Cho, J. B. Moon, C. W. Park, T. G. Ohk, M. C. Shin

P329 Brain death and admission diagnosis in neurologic intensive care unit, a correlation?

A Marudi, S Baroni, A Gaspari, E Bertellini

P330 Brain magnetic resonance imaging findings in patients with septic shock

G. Orhun, E. Senturk, P. E. Ozcan, S. Sencer, C. Ulusoy, E. Tuzun, F . Esen

P331 Benefits of L-carnitine in valproic acid induced encephalopathy

R. Tincu, C. Cobilinschi, D. Tomescu, Z. Ghiorghiu, R. Macovei

P332Automatic analysis of EEG reactivity in comatose patients

M. Van Assen, M. M. Admiraal, M. J. Van Putten, M. Tjepkema-Cloostermans, A. F. Van Rootselaar, J. Horn

P333 Usefulness of common ICU severity scoring systems in predicting outcome after spontaneous intracerebral hemorrhage

M. Fallenius, M. B. Skrifvars, M. Reinikainen, S. Bendel, R. Raj

P334 Evalution of patients with suspected subarachnoid haemorrhage and negative ct imaging

M. Abu-Habsa, C. Hymers, A. Borowska, H. Sivadhas, S. Sahiba, S. Perkins

P335 Timing of endovascular and surgical treatment for aneurysmal subarachnoid haemorrhage: early but not so fast.

J. Rubio, J. A. Rubio, R. Sierra

P336 Red blood cell transfusion in aneurysmal subarachnoid hemorrhage – the Sahara cohort study

S. English, M. Chasse, A. Turgeon, F. Lauzier, D. Griesdale, A. Garland, D. Fergusson, R. Zarychanski, A. Tinmouth, C. Van Walraven, K. Montroy, J. Ziegler, R. Dupont Chouinard, R. Carignan, A. Dhaliwal, C. Lum, J. Sinclair, G. Pagliarello, L. McIntyre

P337 - Aneurysmal subarachnoid hemorrhage and anemia: a canadian multi-centre retrospective cohort study

S. English, M. Chasse, A. Turgeon, F. Lauzier, D. Griesdale, A. Garland, D. Fergusson, R. Zarychanski, A. Tinmouth, C. Van Walraven, K. Montroy, J. Ziegler, R. Dupont Chouinard, R. Carignan, A. Dhaliwal, C. Lum, J. Sinclair, G. Pagliarello, L. McIntyre

P338 - Does the neutrophil-to-lymphocyte (NLR) ratio predict symptomatic vasospasm or delayed cerebral ischemia (DCI) after aneurysmal subarachnoid haemorrhage (SAH)?

T. Groza, N. Moreau, D. Castanares-Zapatero, P. Hantson

P339 - ICU-acquired infections in aneurysmal subarachnoid hemorrhage patients: impact on ICU and hospital length of stay

M. Carbonara , F. Ortolano, T. Zoerle, S. Magnoni, S. Pifferi, V. Conte, N. Stocchetti

P340 - Cerebral metabolic effects of normobaric hyperoxia during the acute phase of aneurysmal subarachnoid hemorrhage

L. Carteron, T. Suys, C. Patet, H. Quintard, M. Oddo

P341 - Postoperative care for elective craniotomy: where is best done?

J. A. Rubio, J. Rubio, R. Sierra

P342 - 5-year follow-up of patients after transplantation of organs from donors from neurocritical care

V. Spatenkova, E. Pokorna, P. Suchomel

P343 - Evaluation of levetiracetam pharmacokinetics after severe traumatic brain injury in neurocritical care patients at a level one trauma center

N. Ebert, J. Jancik, H. Rhodes

P344 - Model based time series cluster analysis to determine unique patient states in traumatic brain injury

T. Bylinski, C. Hawthorne, M. Shaw, I. Piper, J. Kinsella

P345 - Brain compartment monitoring capabilities from ICP to BI (bioimpedance) during HS (hypertonic saline) administration. State of art simulation outcome depending on brain swelling type

A. K. Kink , I. R. Rätsep

P346 - Transfusion of red blood cells in patients with traumatic brain injury admitted to Canadian trauma health centers: a multicenter cohort study

A. Boutin, L. Moore, M. Chasse, R. Zarychanski, F. Lauzier, S. English, L. McIntyre, J. Lacroix, D. Griesdale, P. Lessard-Bonaventure, A. F. Turgeon

P347 - Hemoglobin thresholds and red blood cell transfusions in adult patients with moderate or severe traumatic brain injury: a retrospective cohort study

A. Boutin, L. Moore, R. Green, P. Lessard-Bonaventure, M. Erdogan, M. Butler, F. Lauzier, M. Chasse, S. English, L. McIntyre, R. Zarychanski, J. Lacroix, D. Griesdale, P. Desjardins, D. A. Fergusson, A. F. Turgeon

P348 - Characteristics of patients with gunshot wounds to the head - an observational Brazilian study

B. Goncalves, B. Vidal, C. Valdez, A. C. Rodrigues, L. Miguez, G. Moralez

P349 - Base excess as predictor for ICU admission and the injury severity in blunt trauma patients

T. Hong

P350 - Enhancement of usual emergency department care with proadrenomedullin to improve outcome prediction - Results from the multi-national, prospective, observational TRIAGE study

A. Kutz, P. Hausfater, D. Amin, T. Struja, S. Haubitz, A. Huber, B. Mueller, P. Schuetz

P351 - Developing an innovative emergency medicine point-of-care simulation programme

T. Brown, J. Collinson, C. Pritchett, T. Slade

P352 - The InSim program: an in situ simulation program for junior trainees in intensive care

M. Le Guen, S. Hellings, R. Ramsaran

P353 - Impact of excessive and inappropriate troponin testing in the emergency setting how good are we

A. Alsheikhly

P354 - The development of time tracking monitor at emergency department

T. Abe

P355 - Role of focussed echocardiography in emergency assessment of syncope

L. Kanapeckaite, M. Abu-Habsa, R. Bahl

P356 - Insertion of an open-ended 14-gauge catheter through the chest wall causes a significant pneumothorax in a self-ventilating swine model

M. Q Russell, K. J. Real, M. Abu-Habsa , R. M. Lyon, N. P. Oveland

P357 - Ez-io® intraosseous access teaching in the workplace using a mobile ‘tea trolley’ training method

J. Penketh, M. Mcdonald, F. Kelly

P358 - Black widow envenomation in Saudi Arabia: a prospective observational case series

M. Alfafi, S. Alsolamy, W. Almutairi, B. Alotaibi

P359 - Mechanical ventilation in patients with overdose not yet intubated on icu admission

A. E. Van den Berg, Y. Schriel, L. Dawson, I. A. Meynaar

P360 - Central nervous system depressants poisoning and ventilator associated pneumonia: an underrated risk factor in toxicological intensive care unit

H. Talaie

P361 - Acute barium intoxication treated with hemodiafiltration

D. Silva, S. Fernandes, J. Gouveia, J. Santos Silva

P362 - Major trauma presenting to the emergency department. the spectrum of cycling injuries in Ireland

J. Foley, A. Kaskovagheorgescu, D. Evoy, J. Cronin, J. Ryan

P363 - Burns from French military operations: a 14-year retrospective observational analysis.

M. Huck, C. Hoffmann, J. Renner, P. Laitselart, N. Donat, A. Cirodde, J. V. Schaal, Y. Masson, A. Nau, T. Leclerc

P364 - A comparison of mortality scores in burns patients on the intensive care unit.

O. Howarth, K. Davenport, P. Jeanrenaud, S. Raftery

P365 - Clasification of pain and its treatment and an intensive care rehabiliation clinic

P. MacTavish, H. Devine, J. McPeake, M. Daniel, J. Kinsella, T. Quasim

P366 - Pain management adequacy in critical care areas ,the process and the barriers perceived by critical care nurses

S. Alrabiee, A. Alrashid , S. Alsolamy

P367 - Pain assessment in critically ill adult patients: validation of the Turkish version of the critical-care pain observation tool

O. Gundogan, C. Bor, E. Akýn Korhan, K. Demirag , M. Uyar

P368 - An audit of pain and sedation assessments in the intensive care unit: recommendations for clinical practice

F. Frame, C. Ashton, L. Bergstrom Niska

P369 - Impact of pharmaceutical care on treatment of pain and agitation in medical intensive care unit

P. Dilokpattanamongkol, T. Suansanae, C. Suthisisang, S. Morakul, C. Karnjanarachata, V. Tangsujaritvijit

P370 - Agitation in trauma ICU, prevention and outcome

S. Mahmood, H. Al Thani, A. Almenyar

P371 Correlation between percentages of ventilated patients developed vap and use of sedative agents in icu patients.

A. Vakalos , V. Avramidis

P372 - Improving recording of sedation events in the Emergency Department: The implementation of the SIVA International Taskforce adverse event reporting tool for procedural sedation

R. Sharvill, J. Penketh

P373 - Impact of sedative drug use on the length of mechanical ventilation

S. E. Morton, Y. S. Chiew, C. Pretty, J. G. Chase, G. M. Shaw

P374 - Co-administration of nitric oxide and sevoflurane using anaconda

R. Knafelj, P. Kordis

P375 - A retrospective study of the use of Dexmedetomidine in an oncological critical care setting

S. Patel, V. Grover

P376 - Dexmedetomidine and posttraumatic stress disorder incidence in alcohol withdrawal icu patients

I. Kuchyn, K. Bielka

P377 - Hemodynamic effects of dexmedetomidine in a porcine model of septic shock

Z. Aidoni, V. Grosomanidis, K. Kotzampassi, G. Stavrou, B. Fyntanidou, S. Patsatzakis, C. Skourtis

P378 - Ketamine for analgosedation in severe hypoxic respiratory failure

S. D. Lee, K. Williams, I. D. Weltes

P379 - Madness from the moon? lunar cycle and the incidence of delirium on the intensive care unit

S. Berhane, C. Arrowsmith, C. Peters, S. Robert

P380 - Impaired dynamic cerebral autoregulation after coronary artery bypass grafting and association with postoperative delirium

J. Caldas, R. B. Panerai, T. G. Robinson, L. Camara, G. Ferreira, E. Borg-Seng-Shu, M. De Lima Oliveira, N. C. Mian, L. Santos, R. Nogueira, S. P. Zeferino, M. Jacobsen Teixeira, F. Galas, L. A. Hajjar

P381 - Risk factors predicting prolonged intensive care unit length of stay after major elective surgery.

P. Killeen, M. McPhail, W. Bernal, J. Maggs, J. Wendon, T. Hughes

P382 - Systemic inflammatory response syndrome criteria and hospital mortality prediction in a brazilian cohort of critically ill patients

L. U. Taniguchi, E. M. Siqueira, J. M. Vieira Jr, L. C. Azevedo

P383 - Evaluating the efficacy of a risk predictor panel in identifying patients at elevated risk of morbidity following emergency admission

A. N. Ahmad, M. Abu-Habsa, R. Bahl, E. Helme, S. Hadfield, R. Loveridge

P384 - A retrospective comparison of outcomes for elective surgical patients admitted post-operatively to the critical care unit or general ward

J. Shak, C. Senver, R. Howard-Griffin

P385 - Effect of obesity on mortality in surgical critically ill patients.

P. Wacharasint, P. Fuengfoo, N. Sukcharoen, R. Rangsin

P386 - The national early warning score (news) reliably improves adverse clinical outcome prediction in community-acquired pneumonia - results from a 6 year follow-up

D. Sbiti-Rohr, P. Schuetz

P387 - Clinical usefulness of the charlson¡¯s weighted index of comorbidities _as prognostic factor in patients with prolonged acute mechanical ventilation

H. Na, S. Song, S. Lee, E. Jeong, K. Lee

P388 - Comparison of mortality prediction scoring systems in patients with cirrhosis admitted to general intensive care unit

M. Cooper, K. Milinis, G. Williams, E. McCarron, S. Simants, I. Patanwala, I. D. Welters

P389 - Impact of admission source and time of admission on outcome of pediatric intensive care patients: retrospective 15 years study

E. Zoumpelouli, EA Volakli, V. Chrysohoidou, S. Georgiou, K. Charisopoulou, E. Kotzapanagiotou, V. Panagiotidou, K. Manavidou, Z. Stathi, M. Sdougka

P390 - Heart rate variability and outcomes prediction in critical illness

N. Salahuddin, B. AlGhamdi, Q. Marashly, K. Zaza, M. Sharshir, M. Khurshid, Z. Ali, M. Malgapo, M. Jamil, A. Shafquat, M. Shoukri, M. Hijazi

P391 - The incidence and outcome of hyperlactatemia in the post anaesthesia care unit

T. Abe, S. Uchino, M. Takinami

P392 - Correlation between arterial blood gas disturbances and arterial lactate levels during hospitalization and outcome in critically septic patients

N. R. Rangel Neto, S. Oliveira, F. Q. Reis, F. A. Rocha

P393 - External validation of saps 3 and mpm iii scores in 48,816 patients from 72 brazilian icus

G. Moralez, K. Ebecken, L. S. Rabello, M. F. Lima, R. Hatum, F. V. De Marco, A. Alves, J. E. Pinto, M. Godoy, P. E. Brasil, F. A. Bozza, J. I. Salluh, M. Soares

P394 - The frailty penalty: pre-admission functional status confounds mortality prediction models in critically ill patients

J. Krinsley, G. Kang

P395 - ‘sooner rather than later”: how delayed discharge from critical care leads to increased out of hours discharges and subsequent increase in in-hospital mortality.

J. Perry, H. Hines

P396 - Identifying poor outcome patient groups in a resource-constrained critical care unit

K. M. Wilkinson, C. Tordoff, B. Sloan, M. C. Bellamy

P397 - Effects of icu weekend admission and discharge on mortality.

E. Moreira, F. Verga, M. Barbato, G. Burghi

P398 - Organizational factors, outcomes and resource use in 9,946 cancer patients admitted to 70 ICUs

M Soares, U. V. Silva, L. C. Azevedo, A. P. Torelly, J. M. Kahn, D. C. Angus, M. F. Knibel, P. E. Brasil, F. A. Bozza, J. I. Salluh

P399 - Evaluation of oncological critically ill patients, severity score and outcome compared to not oncological in a particular hospital cti.

M. B. Velasco, D. M. Dalcomune

P400 - Outcomes of patients admitted to a large uk critical care department with palliative oncological diagnoses

R. Marshall, T. Gilpin, A. Tridente, A. Raithatha

P401 - Predictors of mortality in febrile neutropenic patients with haematological malignancies admitted to an intensive care unit of a cancer center

D. Mota, B. Loureiro, J. Dias, O. Afonso, F. Coelho, A. Martins, F. Faria

P402 - Patients with hematologic malignancies requiring invasive mechanical ventilation: characteristics and predictors of mortality

H. Al-Dorzi, H. Al Orainni , F. AlEid, H. Tlaygeh, A. Itani, A. Hejazi, Y. Arabi

P403 - Patient-important outcomes in randomized controlled trials in critically ill patients: a systematic review

S. Gaudry, J. Messika, J. D. Ricard, S. Guillo, B. Pasquet, E. Dubief, D. Dreyfuss, F. Tubach

P404 - Alopecia in survivors of critical illness: a qualitative study

C . Battle, K. James, P. Temblett

P405 - The impact of mental health on icu admission

L. Davies, C. Battle, C. Lynch

P406 - Cognitive impairment 5 years after ICU discharge

S. Pereira, S. Cavaco, J. Fernandes, I. Moreira, E. Almeida, F. Seabra Pereira, M. Malheiro, F. Cardoso, I. Aragão, T. Cardoso

P407 - Apache ii versus apache iv for octagenerians in medical icu

M. Fister, R. Knafelj

P408 - Outcomes of octagenarians in an indian icu

P. Muraray Govind, N. Brahmananda Reddy, R. Pratheema, E. D. Arul, J. Devachandran

P409 - Mortality and outcomes in elderly patients 80 years of age or older admitted to the icu

M. B. Velasco , D. M. Dalcomune

P410 - Octagenerians in medical icu - adding days to life or life to days?

R. Knafelj, M. Fister

P411 - The very elderly admitted to intensive care unit: outcomes and economic evaluation

N. Chin-Yee, G. D’Egidio, K. Thavorn, D. Heyland, K. Kyeremanteng

P412 - The very elderly in intensive care: relationship between acuity of illness and long-term mortality

A. G. Murchison, K. Swalwell, J. Mandeville, D. Stott

P413 - Acquired weakness in an oncological intensive care unit

I. Guerreiro

P414 - Musculoskeletal problems in intensive care unit (ICU) patients post-discharge

H. Devine, P. MacTavish, J. McPeake, T. Quasim, J. Kinsella, M. Daniel

P415 - Premorbid obesity, but not nutrition, prevents critical illness-induced muscle wasting and weakness

C. Goossens M. B. Marques, S. Derde, S. Vander Perre, T. Dufour, S. E. Thiessen, F. Güiza, T. Janssens, G. Hermans, I. Vanhorebeek, K. De Bock, G. Van den Berghe, L. Langouche

P416 - Physical outcome measures for critical care patients following intensive care unit (icu) discharge

H. Devine, P. MacTavish, T. Quasim, J. Kinsella, M. Daniel, J. McPeake

P417 - Improving active mobilisation in a general intensive care unit

B. Miles , S. Madden, H. Devine

P418 - Mobilization in patients on vasoactive drugs use – a pilot study.

M. Weiler, P. Marques, C. Rodrigues, M. Boeira, K. Brenner, C. Leães, A. Machado, R. Townsend, J. Andrade

P419 - Pharmacy intervention at an intensive care rehabilitation clinic

P. MacTavish, J. McPeake, H. Devine, J. Kinsella, M. Daniel, R. Kishore, C. Fenlon, T. Quasim

P420 - Interactive gaming is feasible and potentially increases icu patients’ motivation to be engaged in rehabilitation programs

T. Fiks, A. Ruijter, M. Te Raa, P. Spronk

P421 - Simulation-based design of a robust stopping rule to ensure patient safety

Y. S. Chiew, P. Docherty, J. Dickson, E. Moltchanova, C. Scarrot, C. Pretty, G. M. Shaw, J. G. Chase

P422 - Are daily blood tests on the intensive care unit necessary?

T. Hall, W. C. Ngu, J. M. Jack, P. Morgan

P423 - Measuring urine output in ward patients: is it helpful?

B. Avard, A. Pavli, X. Gee

P424 - The incidence of pressure ulcers in an adult mixed intensive care unit in turkey

C . Bor, E. Akin Korhan, K. Demirag, M. Uyar

P425 - Intensivist/patient ratios in closed ICUs in Alexandria, Egypt; an overview

M. Shirazy, A. Fayed

P426 - Eicu (electronic intensive care unit): impact on ALOS (average length of stay) in a developing country like India

S. Gupta, A. Kaushal, S. Dewan, A. Varma

P427 - Predicting deterioration in general ward using early deterioration indicator

E. Ghosh, L. Yang, L. Eshelman, B. Lord, E. Carlson

P428 - High impact enhanced critical care outreach - the imobile service: making a difference

E. Helme, R. Broderick, S. Hadfield, R. Loveridge

P429 - Impact of bed availability and cognitive load on intensive care unit (ICU) bed allocation: a vignette-based trial

J. Ramos, D. Forte

P430 - Characteristics of critically ill patients admitted through the emergency department

F. Yang, P. Hou

P431 - Admission to critical care: the quantification of functional reserve

J. Dudziak, J. Feeney, K. Wilkinson, K. Bauchmuller, K. Shuker, M. Faulds, A. Raithatha, D. Bryden, L. England, N. Bolton, A. Tridente

P432 - Admission to critical care: the importance of frailty

K. Bauchmuller, K Shuker, A Tridente, M Faulds, A Matheson, J. Gaynor, D Bryden, S South Yorkshire Hospitals Research Collaboration

P433 - Development of an instrument to aid triage decisions for intensive care unit admission

J. Ramos, B. Peroni, R. Daglius-Dias, L. Miranda, C. Cohen, C. Carvalho, I . Velasco, D. Forte

P434 - Using selective serotonin re-uptake inhibitors and serotonin-norepinephrine re-uptake inhibitors in critical care: a systematic review of the evidence for benefit or harm

J. M. Kelly, A. Neill, G. Rubenfeld, N. Masson, A. Min

P435 - Measuring adaptive coping of hospitalized patients with a severe medical condition:the sickness insight in coping questionnaire (sicq)

E. Boezeman, J. Hofhuis , A. Hovingh, R. De Vries, P. Spronk

P436 - Results of a national survey regarding intensive care medicine training

G. Cabral-Campello, I. Aragão, T. Cardoso

P437 - Work engagement among healthcare professionals in the intensive care unit

M. Van Mol, M. Nijkamp, E . Kompanje

P438 - Empowering the intensive care practitioners. is it a burnout ameliorating intervention?

P. Ostrowski, A. Omar

P439 - Icu patients suffer from circadian rhythm desynchronisation

K. Kiss , B. Köves, V. Csernus, Z. Molnár

P440 - Noise reduction in the ICU: feasible ?

Y. Hoydonckx, S. Vanwing, B. Stessel, A. Van Assche, L. Jamaer, J. Dubois

P441 - Accidental removal of invasive devices in the critical patient into the bed-washing. does the presence of professional nurse modify his incidence?

V. Medo, R. Galvez, J. P. Miranda

P442 - Deprivation of liberty safeguards (dols): audit of compliance in a of a 16-bed specialist cancer critical care unit.

C. Stone, T. Wigmore

P443 - Use of a modified cristal score to predict futility of critical care in the elderly

Y. Arunan, A. Wheeler, K. Bauchmuller, D. Bryden

P444 - Improvement of Referral Rate to Palliative Care for Patients with Poor Prognosis in Neurosurgical Intensive Care Unit

Y. Wong, C. Poi, C. Gu

P445 - Factors associated with limitation of life supporting care (lsc) in a medico-surgical intermediate care unit, and outcome of patients with lsc limitation: a monocentric, six-month study.

P. Molmy, N. Van Grunderbeeck, O. Nigeon, M. Lemyze, D. Thevenin, J. Mallat

P446 - Palliative care consultation and intensive care unit admission request: a cohort study

J. Ramos, M. Correa, R. T. Carvalho, D. Forte

P447 - Nursing and medicine together in postsurgical intensive care unit: situations of prognostic conflict at the end of life. our critical care nurses suffer with our medical activism?

A. Fernandez, C. McBride

P448 - End of life who may decide

E. Koonthalloor, C. Walsh

P449 - Correctly diagnosing death

A. Webber, M. Ashe, K. Smith, P. Jeanrenaud

P450 - Skin procurement performed by intensive care physicians: yes, we can.

A. Marudi , S. Baroni, F. Ragusa, E. Bertellini

P451 - Death analysis in pediatric intensive care patients

E. A. Volakli , E. Chochliourou, M. Dimitriadou, A. Violaki, P. Mantzafleri, E. Samkinidou, O. Vrani, A. Arbouti, T. Varsami, M. Sdougka

P452 - The potential impact of euthanasia on organ donation: analysis of data from belgium

J. A. Bollen, T. C. Van Smaalen, W. C. De Jongh, M. M. Ten Hoopen, D. Ysebaert, L. W. Van Heurn, W. N. Van Mook

P453 - Communication within an intensive care setting

K. Sim, A. Fuller

P454 - Development and implementation of a longitudinal communication curriculum for critical care medicine fellows

A. Roze des Ordons, P. Couillard, C. Doig

P455 - Staff-family conflict in a multi-ethnic intensive care unit

R. V. Van Keer, R. D. Deschepper, A. F. Francke, L. H. Huyghens, J. B. Bilsen

P456 - Does the source of admission to critical care affect family satisfaction?

B. Nyamaizi, C. Dalrymple, A. Molokhia, A. Dobru

P457 - A simple alternative to the family satisfaction survey (fs-icu)

E. Marrinan, A. Ankuli, A. Molokhia

P458 - A study to explore the experiences of patient and family volunteers in a critical care environment: a phenomenological analysis

J. McPeake, R. Struthers, R. Crawford , H. Devine , P. Mactavish , T. Quasim

P459 - Prevalence and risk factors of anxiety and depression in relatives of burn patients.

P. Morelli, M. Degiovanangelo, F. Lemos, V. MArtinez, F. Verga, J. Cabrera, G. Burghi

P460 - Guidance of visiting children at an adult intensive care unit (icu)

A. Rutten , S. Van Ieperen, S. De Geer, M. Van Vugt, E. Der Kinderen

P461 - Visiting policies in Italian pediatric ICUs: an update

A. Giannini, G Miccinesi, T Marchesi, E Prandi

PMID:27885969 | PMC:PMC5493079 | DOI:10.1186/s13054-016-1208-6

JBI Libr Syst Rev. 2012;10(46):2944-2997. doi: 10.11124/jbisrir-2012-25.

ABSTRACT

BACKGROUND: The use of propofol as a sedative in various outpatient settings is controversial. At the heart of this controversy is the use of propofol by non-anesthesia trained healthcare providers.

OBJECTIVE: To synthesize the best available evidence on the administration of propofol for sedation by anesthesia and non-anesthesia providers in spontaneous breathing patients in non-critical care settings.

INCLUSION CRITERIA: This review considered non-anesthesia trained and anesthesia trained healthcare providers administering propofol as the agent for sedation in patients of all ages who were not mechanically ventilated and were undergoing procedures for gastrointestinal endoscopy, cardiac catheterization, and procedural sedation for emergency room and radiology procedures.This review included studies where propofol was the sole sedative agent used by non-anesthesia trained, and formally trained anesthesia healthcare providers.This review considered as outcomes procedure time, return to baseline functioning, postoperative recovery time, mean amount of propofol administered, patient satisfaction, incidence of adverse hemodynamic and respiratory events, unplanned admission to hospital, and death.This review considered randomized controlled trials, cohort studies, case-control studies, and case series/report studies.

SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies in English language beginning with the commercial use of propofol in 1989 through 2011. Search was performed across: CINAHL, MEDLINE, Nursing@Ovid, EMBASE, Elsevier Science Direct, Mednar, and Proquest.

METHODOLOGICAL QUALITY: Studies were critically appraised by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute.

DATA COLLECTION: Data was extracted using the standardized data extraction tool from the Joanna Briggs Institute.

DATA SYNTHESIS: Due to the heterogeneous nature of the interventions and outcome measurements, a meta-analysis was not possible; results are presented in a narrative summary.

RESULTS: 9 studies were included in the review: 1 randomized controlled trial, 2 cohort studies, and 6 descriptive studies. In seven of the studies, non-anesthesia providers administered propofol, while two studies had anesthesia providers providing propofol sedation. Five studies reported procedure time. None of the studies reported a return to baseline functioning. Four studies reported postoperative recovery time. One study reported mean propofol dosage according to the two phases of the study, while another study in addition to reporting total and mean propofol dosages, differentiated propofol dosage according to ASA classification. Six of the studies reported average or mean propofol dosage, with one study also reporting the propofol induction dosage. Reporting of adverse hemodynamic and respiratory events varied in the studies. None of the studies reported unplanned admission to the hospital or death.

CONCLUSIONS: The evidence suggests that anesthesia healthcare providers have the experience and training to safely administer propofol in non-critical care settings involving procedures in non-mechanically ventilated patients. The evidence also suggests that non-anesthesia trained healthcare providers can safely administer propofol sedation in low-risk patients who are not mechanically ventilated if they have received specialized training in the use of propofol sedation, are experienced in its administration, and follow a defined dosage protocol.

IMPLICATIONS FOR PRACTICE: The administration of propofol sedation by anesthesia providers can be safely administered in patients of all risk categories and depth of sedation.The administration of propofol sedation by non-anesthesia providers can be safely administered to low risk patients for moderate sedation providing the non-anesthesia provider is specially trained and experienced in the administration of propofol sedation while using a defined dosage protocol.

IMPLICATIONS FOR RESEARCH: Randomized controlled trials are needed to examine the propofol sedation by non-anesthesia healthcare providers in spontaneous breathing patients in non-critical care settings. The type of training required for safe administration of propofol in the outpatient settings should be explored.

PMID:27820497 | DOI:10.11124/jbisrir-2012-25

Minerva Anestesiol. 2017 Feb;83(2):145-154. doi: 10.23736/S0375-9393.16.11103-4. Epub 2016 Sep 20.

ABSTRACT

BACKGROUND: International guidelines recommend systematic assessment of pain, agitation/sedation and delirium with validated scales for all ICU patients. However, these evaluations are often not done. We have created an e-learning training platform for the continuous medical education, and assessed its efficacy in increasing the use of validated tools by all medical and nursing staff of the participating ICUs during their daily practice.

METHODS: Multicenter, randomized, before and after study. The eight participating centers were randomized in two groups, and received training at different times. The use of validated tools (Verbal Numeric Rating or Behavioral Pain Scale for pain; Richmond Agitation-Sedation Scale for agitation; Confusion Assessment Method for the ICU for delirium) was evaluated from clinical data recorded in medical charts during a week, with follow-up up to six months after the training. All the operators were invited to complete a questionnaire, at baseline and after the training.

RESULTS: Among the 374 nurses and physicians involved, 140 (37.4%) completed at least one of the three courses. The assessment of pain (38.1 vs. 92.9%, P<0.01) and delirium (0 vs. 78.6%, P<0.01) using validated tools significantly increased after training. Observation in the follow-up showed further improvement in delirium monitoring, with no signs of extinction for pain and sedation/agitation measurements.

CONCLUSIONS: This e-learning program shows encouraging effectiveness, and the increase in the use of validated tools for neurological monitoring in critically ill patients lasts over time.

PMID:27647465 | DOI:10.23736/S0375-9393.16.11103-4

Hu Li Za Zhi. 2016 Jun;63(3):94-104. doi: 10.6224/JN.63.3.94.

ABSTRACT

BACKGROUND: Prolonged of use mechanical ventilators results in respiratory muscle atrophy and difficulties in weaning, which increase mortality rates and psychlogical distress. While pulmonary rehabilitation has been shown to improve respiratory muscle strength, the effects of this intervention in critical-care patients who use mechanical ventilation remain uncertain.

PURPOSE: The present paper uses a systematic review of the literature to evaluate the effects of pulmonary rehabilitation on the rate of ventilator weaning and on the physical performance of ventilator patients receiving critical care.

METHODS: A systematic review was used. Searches were conducted in databases including: Cochrane Library, Embase, MEDLINE, PubMed and Airit Library. Keywords that were used included: "mechanical ventilation", "pulmonary rehabilitation", "exercise", "weaning", and "activities of daily living". The search focused on articles that were published prior to February 2015. Based on inclusion and exclusion criteria, 7 articles addressing relevant randomized controlled trials were extracted.

RESULTS: All of the 7 studies supported that pulmonary rehabilitation interventions improve mechanical ventilation weaning and functional independence activities. Several studies were limited by small sample size and differences in the types of rehabilitations used. Thus, the generalizability of the findings of this review is limited. and further research is required to verify the effects of pulmonary rehabilitation.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results of this systematic review support that pulmonary rehabilitation interventions improved the weaning rate, activities of functional independence, and maximal inspiratory pressure (MIP) in critical patients who had used mechanical ventilators for over 48 hours. Under hemodynamic-stablized and pressure-support mode, inspiratory muscle training is suggested as useful for patients with limited ability to participate in rehabilitation programs.

PMID:27250963 | DOI:10.6224/JN.63.3.94

J Adv Nurs. 2016 Feb;72(2):261-72. doi: 10.1111/jan.12843. Epub 2015 Nov 6.

ABSTRACT

AIMS: Assess the effects of protocol-directed sedation management on the duration of mechanical ventilation and other relevant patient outcomes in mechanically ventilated intensive care unit patients.

BACKGROUND: Sedation is a core component of critical care. Sub-optimal sedation management incorporates both under- and over-sedation and has been linked to poorer patient outcomes.

DESIGN: Cochrane systematic review of randomized controlled trials.

DATA SOURCES: Cochrane Central Register of Controlled trials, MEDLINE, EMBASE, CINAHL, Database of Abstracts of Reviews of Effects, LILACS, Current Controlled Trials and US National Institutes of Health Clinical Research Studies (1990-November 2013) and reference lists of articles were used.

REVIEW METHODS: Randomized controlled trials conducted in intensive care units comparing management with and without protocol-directed sedation were included. Two authors screened titles, abstracts and full-text reports. Potential risk of bias was assessed. Clinical, methodological and statistical heterogeneity were examined and the random-effects model used for meta-analysis where appropriate. Mean difference for duration of mechanical ventilation and risk ratio for mortality, with 95% confidence intervals, were calculated.

RESULTS: Two eligible studies with 633 participants comparing protocol-directed sedation delivered by nurses vs. usual care were identified. There was no evidence of differences in duration of mechanical ventilation or hospital mortality. There was statistically significant heterogeneity between studies for duration of mechanical ventilation.

CONCLUSIONS: There is insufficient evidence to evaluate the effectiveness of protocol-directed sedation as results from the two randomized controlled trials were conflicting.

PMID:26541275 | DOI:10.1111/jan.12843

Nurse Educ Today. 2015 Oct;35(10):e8-12. doi: 10.1016/j.nedt.2015.07.025. Epub 2015 Aug 1.

ABSTRACT

OBJECTIVE: The aim of this study was to examine the use of high fidelity patient simulation (HFPS) in paediatric intensive care nursing education through the use of a systematic literature review.

METHOD: A systematic search was undertaken in the electronic databases CINAHL (via EBSCOhost), Medline and Pubmed, ClinicalKey, Science Direct and OVID. Electronic searches were supplemented by hand searches of journals, individual article reference lists and the World Wide Web. Main outcome measures were learner outcomes. The search was limited to papers published in English between 2000 and 2015.

RESULTS: Eight papers satisfied the inclusion criteria of the review. Studies included in the review ranged from moderate to low on the quality assessment scale. HFPS training was associated with improved short-term learner outcomes of various measures, however this should be considered with the small number of studies examining this topic and the scarcity of high quality randomised studies.

CONCLUSIONS: The evidence of improved learner outcomes following HFPS training in paediatric intensive care (PICU) nursing education should be considered together with the quality and methodological limitations of existing research. There was no evidence of negative effects. The direction of research suggests that HFPS is a useful tool in the education of PICU nurses.

PMID:26260524 | DOI:10.1016/j.nedt.2015.07.025

Pediatr Crit Care Med. 2015 Jun;16(5):461-7. doi: 10.1097/PCC.0000000000000352.

ABSTRACT

OBJECTIVE: To determine the accuracy and reliability of electroencephalographic seizure detection by critical care providers using color density spectral array electroencephalography.

DESIGN: Tutorial and questionnaire.

SUBJECTS: Critical care providers (attending physicians, fellow trainees, and nurses).

INTERVENTIONS: A standardized powerpoint color density spectral array tutorial followed by classification of 200 color density spectral array images as displaying seizures or not displaying seizures.

MEASUREMENTS AND MAIN RESULTS: Using conventional electroencephalography recordings obtained from patients who underwent electroencephalography monitoring after cardiac arrest, we created 100 color density spectral array images, 30% of which displayed seizures. The gold standard for seizure category was electroencephalographer determination from the full montage conventional electroencephalography. Participants did not have access to the conventional electroencephalography tracings. After completing a standardized color density spectral array tutorial, images were presented to participants in duplicate and in random order. Twenty critical care physicians (12 attendings and eight fellows) and 19 critical care nurses classified the color density spectral array images as having any seizure(s) or no seizures. The 39 critical care providers had a color density spectral array seizure detection sensitivity of 70% (95% CI, 67-73%), specificity of 68% (95% CI, 67-70%), positive predictive value of 46%, and negative predictive value of 86%. The sensitivity of color density spectral array detection of status epilepticus was 72% (95% CI, 69-74%).

CONCLUSION: Determining which post-cardiac arrest patients experience electrographic seizures by critical care providers is feasible after a brief training. There is moderate sensitivity for seizure and status epilepticus detection and a high negative predictive value.

PMID:25651050 | PMC:PMC4456208 | DOI:10.1097/PCC.0000000000000352

Cochrane Database Syst Rev. 2015 Jan 7;1:CD009771. doi: 10.1002/14651858.CD009771.pub2.

ABSTRACT

BACKGROUND: The sedation needs of critically ill patients have been recognized as a core component of critical care and meeting these is vital to assist recovery and ensure humane treatment. There is growing evidence to suggest that sedation requirements are not always optimally managed. Sub-optimal sedation incorporates both under- and over-sedation and has been linked to both short-term (e.g. length of stay) and long-term (e.g. psychological recovery) outcomes. Various strategies have been proposed to improve sedation management and address aspects of assessment as well as delivery of sedation.

OBJECTIVES: To assess the effects of protocol-directed sedation management on the duration of mechanical ventilation and other relevant patient outcomes in mechanically ventilated intensive care unit (ICU) patients. We looked at various outcomes and examined the role of bias in order to examine the level of evidence for this intervention.

SEARCH METHODS: We searched the Cochrane Central Register of Controlled trials (CENTRAL) (2013; Issue 11), MEDLINE (OvidSP) (1990 to November 2013), EMBASE (OvidSP) (1990 to November 2013), CINAHL (BIREME host) (1990 to November 2013), Database of Abstracts of Reviews of Effects (DARE) (1990 to November 2013), LILACS (1990 to November 2013), Current Controlled Trials and US National Institutes of Health Clinical Research Studies (1990 to November 2013), and reference lists of articles. We re-ran the search in October 2014. We will deal with any studies of interest when we update the review.

SELECTION CRITERIA: We included randomized controlled trials (RCTs) conducted in adult ICUs comparing management with and without protocol-directed sedation.

DATA COLLECTION AND ANALYSIS: Two authors screened the titles and abstracts and then the full-text reports identified from our electronic search. We assessed seven domains of potential risk of bias for the included studies. We examined the clinical, methodological and statistical heterogeneity and used the random-effects model for meta-analysis where we considered it appropriate. We calculated the mean difference (MD) for duration of mechanical ventilation and risk ratio (RR) for mortality across studies, with 95% confidence intervals (CI).

MAIN RESULTS: We identified two eligible studies with 633 participants. Both included studies compared the use of protocol-directed sedation, specifically protocols delivered by nurses, with usual care. We rated the risk of selection bias due to random sequence generation low for one study and unclear for one study. The risk of selection bias related to allocation concealment was low for both studies. We also assessed detection and attrition bias as low for both studies while we considered performance bias high due to the inability to blind participants and clinicians in both studies. Risk due to other sources of bias, such as potential for contamination between groups and reporting bias, was considered unclear. There was no clear evidence of differences in duration of mechanical ventilation (MD -5.74 hours, 95% CI -62.01 to 50.53, low quality evidence), ICU length of stay (MD -0.62 days, 95% CI -2.97 to 1.73) and hospital length of stay (MD -3.78 days, 95% CI -8.54 to 0.97) between people being managed with protocol-directed sedation versus usual care. Similarly, there was no clear evidence of difference in hospital mortality between the two groups (RR 0.96, 95% CI 0.71 to 1.31, low quality evidence). ICU mortality was only reported in one study preventing pooling of data. There was no clear evidence of difference in the incidence of tracheostomy (RR 0.77, 95% CI 0.31 to 1.89). The studies reported few adverse event outcomes; one study reported self extubation while the other study reported re-intubation; given this difference in outcomes, pooling of data was not possible. There was significant heterogeneity between studies for duration of mechanical ventilation (I(2) = 86%, P value = 0.008), ICU length of stay (I(2) = 82%, P value = 0.02) and incidence of tracheostomy (I(2) = 76%, P value = 0.04), with one study finding a reduction in duration of mechanical ventilation and incidence of tracheostomy and the other study finding no difference.

AUTHORS' CONCLUSIONS: There is currently insufficient evidence to evaluate the effectiveness of protocol-directed sedation. Results from the two RCTs were conflicting, resulting in the quality of the body of evidence as a whole being assessed as low. Further studies, taking into account contextual and clinician characteristics in different ICU environments, are necessary to inform future practice. Methodological strategies to reduce the risk of bias need to be considered in future studies.

PMID:25562750 | DOI:10.1002/14651858.CD009771.pub2

Br J Nurs. 2014 Jul 24-Aug 13;23(14):800-4. doi: 10.12968/bjon.2014.23.14.800.

ABSTRACT

Significant psychological impacts, including post-traumatic stress disorder (PTSD), have been associated with patients under sedation in intensive care units (ICUs). However, it remains unknown if and how sedation is related to post-ICU psychological outcomes. This literature review explores the relationships between sedation, the depth of sedation and psychological disorders. A review of existing literature was undertaken systematically with key terms and included peer-reviewed primary research and randomised controlled trials (RCTs). To ensure subject relevance pre-2006, non-English and paediatric-based research was excluded. Findings highlighted that reduced sedation levels did not significantly reduce the outcome of PTSD, yet reduced ICU length of stay and length of mechanical ventilation (MV) were both associated with lighter sedation. Further research is recommended into more specific factual and delusional memories post ICU in relation to the level of sedation and to psychological distress.

PMID:25062316 | DOI:10.12968/bjon.2014.23.14.800

Ann Surg. 2014 Apr;259(4):630-41. doi: 10.1097/SLA.0000000000000371.

ABSTRACT

OBJECTIVE: To perform a systematic review of interventions used to reduce adverse events in surgery.

BACKGROUND: Many interventions, which aim to improve patient safety in surgery, have been introduced to hospitals. Little is known about which methods provide a measurable decrease in morbidity and mortality.

METHODS: MEDLINE, EMBASE, and Cochrane databases were searched from inception to Week 19, 2012, for systematic reviews, randomized controlled trials (RCTs), and cross-sectional and cohort studies, which reported an intervention aimed toward reducing the incidence of adverse events in surgical patients. The quality of observational studies was measured using the Newcastle-Ottawa Scale. RCTs were assessed using the Cochrane Collaboration's tool for assessing risk of bias.

RESULTS: Ninety-one studies met inclusion criteria, 26 relating to structural interventions, 66 described modifying process factors. Only 17 (of 42 medium to high quality studies) reported an intervention that produced a significant decrease in morbidity and mortality. Structural interventions were: improving nurse to patient ratios (P = 0.008) and Intensive Care Unit (ITU) physician involvement in postoperative care (P < 0.05). Subspecialization in surgery reduced technical complications (P < 0.01). Effective process interventions were submission of outcome data to national audit (P < 0.05), use of safety checklists (P < 0.05), and adherence to a care pathway (P < 0.05). Certain safety technology significantly reduced harm (P = 0.02), and team training had a positive effect on patient outcome (P = 0.001).

CONCLUSIONS: Only a small cohort of medium- to high-quality interventions effectively reduce surgical harm and are feasible to implement. It is important that future research remains focused on demonstrating a measurable reduction in adverse events from patient safety initiatives.

PMID:24368639 | DOI:10.1097/SLA.0000000000000371

J Crit Care. 2013 Dec;28(6):918-22. doi: 10.1016/j.jcrc.2013.06.019. Epub 2013 Sep 4.

ABSTRACT

BACKGROUND: Inappropriate diagnosis and treatment of pain, agitation, and delirium (PAD) in intensive care settings results in poor patient outcomes. We designed and used a protocol for systematic assessment and management of PAD by the nurses to improve clinical intensive care unit (ICU) outcomes.

MATERIALS AND METHODS: A total of 201 patients admitted to 2 mixed medical-surgical ICUs were randomly allocated to protocol and control groups. A multidisciplinary team approved the protocol. Pain was assessed by Numerical Rating Scale and Behavioural Pain Scale, agitation by Richmond Agitation Sedation Scale, and delirium by Confusion Assessment Method in ICU. The Persian version of the scales was prepared and tested for validity, reliability, and feasibility in a preliminary study. The patients in the protocol group were managed pharmacologically according to the protocol, whereas those in the control group were managed according to the ICU routine.

RESULTS: The median (interquartile range) for the duration of mechanical ventilation in the protocol and control groups was 19 (9.3-67.8) and 40 (0-217) hours, respectively (P = .038). The median (interquartile range) length of ICU stay was 97 (54.5-189) hours in the protocol group vs 170 (80-408) hours in the control group (P < .001). The mortality rate in the protocol group was significantly reduced from 23.8% to 12.5% (P = .046).

CONCLUSION: The current randomized trial provided evidence for a substantial reduction in the duration of need to ventilatory support, length of ICU stay, and mortality rates in ICU-admitted patients through protocol-directed management of PAD.

PMID:24011845 | DOI:10.1016/j.jcrc.2013.06.019

Chest. 2013 Nov;144(5):1469-1480. doi: 10.1378/chest.13-0779.

ABSTRACT

BACKGROUND: ICU admissions are ever increasing across the United States. Following critical illness, physical functioning (PF) may be impaired for up to 5 years. We performed a systematic review of randomized controlled trials evaluating the efficacy of interventions targeting PF among ICU survivors. The objective of this study was to identify effective interventions that improve long-term PF in ICU survivors.

METHODS: MEDLINE, Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Physiotherapy Evidence-Based Database (PEDro) were searched between 1990 and 2012. Two reviewers independently evaluated studies for eligibility, critically appraised the included studies, and extracted data into standardized evidence tables.

RESULTS: Fourteen studies met the inclusion criteria. Interventions included exercise/physical therapy (PT), parenteral nutrition, nurse-led follow-up, spontaneous awakening trials, absence of sedation during mechanical ventilation, and early tracheotomy. Nine studies failed to demonstrate efficacy on PF of the ICU survivors. However, early physical exercise and PT-based interventions had a positive effect on long-term PF.

CONCLUSIONS: The only effective intervention to improve long-term PF in critically ill patients is exercise/PT; its benefit may be greater if started earlier. Further research in this area comparing different interventions and timing is needed.

PMID:23949645 | PMC:PMC3817929 | DOI:10.1378/chest.13-0779

J Microbiol Immunol Infect. 2013 Dec;46(6):456-62. doi: 10.1016/j.jmii.2012.07.013. Epub 2012 Oct 8.

ABSTRACT

BACKGROUND: Fungemia in preterm infants is associated with high mortality and morbidity. This study reports an outbreak of unusual fungemia in a tertiary neonatal intensive care unit (NICU).

METHODS: Ten Candida pelliculosa bloodstream isolates were identified from six infants hospitalized in the NICU from February to March 2009. Environmental study was performed, and genetic relatedness among the 10 clinical isolates of C pelliculosa and six control C pelliculosa strains was characterized by randomly amplified polymorphic DNA assay. In vitro susceptibility of isolates to six antifungal agents was analyzed by broth microdilution method. Amphotericin B was given to infected infants and prophylactic fluconazole was prescribed to the other noninfected extremely low birth weight infants during the outbreak.

RESULTS: Thrombocytopenia (platelet counts <100×10(9)/L) was the early laboratory finding in four infants. One of six patients died, making overall mortality 17%. Fluconazole, voriconazole, amphotericin B, and micafungin provided good antifungal activity. Cultures from the environment and hands of caregivers were all negative. Molecular studies indicated the outbreak as caused by a single strain. The outbreak was controlled by strict hand washing, cohort infected patients, confined physicians and nurses to take care of patients, prophylactic fluconazole to uninfected neonates, and proper management of human milk.

CONCLUSION: The study demonstrated the clinical importance of emerged non-albicans Candida species in NICU. For unusual pathogen isolated from immunocompromised hosts, more attention should be paid to monitor the possibility of an outbreak.

PMID:23050985 | DOI:10.1016/j.jmii.2012.07.013

Minerva Anestesiol. 2012 Mar;78(3):369-80.

ABSTRACT

Analgesics and sedatives are commonly prescribed in the ICU environment for patient comfort, however, recent studies have shown that these medications can themselves lead to adverse patient outcomes. Interventions that facilitate a total dose reduction in analgesic and sedative medications e.g. the use of nurse controlled protocol guided sedation, the combination of spontaneous awakening and breathing trials, and the use of short acting medications, are associated with improved outcomes such as decreased time of mechanical ventilation and ICU length of stay. This purpose of this review is to provide an overview of the pharmacology of commonly prescribed analgesics and sedatives, and to discuss the evidence regarding best prescribing practices of these medications, to facilitate early liberation from mechanical ventilation and to promote animation in critically ill patients.

PMID:22240616

Implement Sci. 2011 Oct 24;6:119. doi: 10.1186/1748-5908-6-119.

ABSTRACT

BACKGROUND: Feedback is potentially effective in improving the quality of care. However, merely sending reports is no guarantee that performance data are used as input for systematic quality improvement (QI). Therefore, we developed a multifaceted intervention tailored to prospectively analyzed barriers to using indicators: the Information Feedback on Quality Indicators (InFoQI) program. This program aims to promote the use of performance indicator data as input for local systematic QI. We will conduct a study to assess the impact of the InFoQI program on patient outcome and organizational process measures of care, and to gain insight into barriers and success factors that affected the program's impact. The study will be executed in the context of intensive care. This paper presents the study's protocol.

METHODS/DESIGN: We will conduct a cluster randomized controlled trial with intensive care units (ICUs) in the Netherlands. We will include ICUs that submit indicator data to the Dutch National Intensive Care Evaluation (NICE) quality registry and that agree to allocate at least one intensivist and one ICU nurse for implementation of the intervention. Eligible ICUs (clusters) will be randomized to receive basic NICE registry feedback (control arm) or to participate in the InFoQI program (intervention arm). The InFoQI program consists of comprehensive feedback, establishing a local, multidisciplinary QI team, and educational outreach visits. The primary outcome measures will be length of ICU stay and the proportion of shifts with a bed occupancy rate above 80%. We will also conduct a process evaluation involving ICUs in the intervention arm to investigate their actual exposure to and experiences with the InFoQI program.

DISCUSSION: The results of this study will inform those involved in providing ICU care on the feasibility of a tailored multifaceted performance feedback intervention and its ability to accelerate systematic and local quality improvement. Although our study will be conducted within the domain of intensive care, we believe our conclusions will be generalizable to other settings that have a quality registry including an indicator set available.

TRIAL REGISTRATION: Current Controlled Trials ISRCTN50542146.

PMID:22024188 | PMC:PMC3217909 | DOI:10.1186/1748-5908-6-119

Nurs Crit Care. 2010 May-Jun;15(3):118-28. doi: 10.1111/j.1478-5153.2009.00383.x.

ABSTRACT

AIMS AND OBJECTIVES: To critically review evidence on the effects of psychological support during intensive care unit (ICU) treatment on adult ICU patients' psychological and physiological outcomes. Evidence from intervention studies on imagery and relaxation has been included, as well.

BACKGROUND: Stress and negative emotions may have both immediate, as well as long-term effects on ICU patients' psychological and physical well-being, and they are linked to delayed physical recovery. DESIGN, METHODS: A narrative critical review methodology was employed. Databases searched included Medline, CINAHL, PubMed, PsychInfo and the Cochrane Library. Experimental, quasi-experimental or pretest-posttest peer-reviewed intervention studies published since 1970 were included.

RESULTS: Fourteen studies: seven on nurse led relaxation, three on guided imagery, one on nurse-patient interaction, two on physician-patient interaction and one correlational study on perceived social support were included. The results suggest significant improvements in patients' outcomes: improved vital signs, decrease in pain ratings, anxiety, rate of complications and length of stay, and improved sleep and patient satisfaction. Eight studies employed randomized experimental, four quasi-experimental and two descriptive correlational designs. Two studies explored effects on patients' sleep, and two on procedure-related pain.

CONCLUSIONS: The literature is limited in exploring the effects of nurse-patient interactions. The amount and quality of psychosocial support in the ICU, as well as imagery and relaxation techniques, are linked to short-term and long-term patients' outcomes.

RELEVANCE TO CLINICAL PRACTICE: ICU nurses need to engage in psychological support in a systematic way, and to acknowledge the high priority of support interventions.

PMID:20500650 | DOI:10.1111/j.1478-5153.2009.00383.x

Nurs Crit Care. 2010 Jan-Feb;15(1):20-5. doi: 10.1111/j.1478-5153.2009.00377.x.

ABSTRACT

AIM: The purpose of this article is to analyse the research papers published in Nursing in Critical Care (n = 168) over the past 15 years to examine trends in methodology, theoretical contribution and authorship.

BACKGROUND: Research is a contested term and the paper starts with defining the criteria by which papers were selected for the review.

METHODS: The approach undertaken was a documentary review based on an adaptation of Schatzman's dimensional analysis. Papers were loaded into a matrix then categorized and grouped to determine trends and frequency.

CONCLUSION: Research papers published in the journal reflect a wide range of interests and broad spread of research methods. Qualitative and quantitative data are used by authors but to distinguish papers into these two categories would be over simplistic. Systematic reviews along with randomized control trials and studies using a quasi-experimental design are the least frequently occurring approaches in the published papers, although they are growing in number in recent years. All the papers make explicit the implications for clinical practice and as such contribute to the growing body of knowledge to inform critical care nursing practice.

PMID:20070811 | DOI:10.1111/j.1478-5153.2009.00377.x