scholarly journals TP10.1.9End Colostomy Formation: Change in Practice during the Covid-19 Pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
E Z Farrow ◽  
T A Cook
Keyword(s):  
Critical Care ◽  
Recovery Period ◽  
Surgical Practice ◽  
Stoma Formation ◽  
Change In Practice ◽  
End Colostomy ◽  
The Impact ◽  
Early Phases

Abstract Aim Intercollegiate guidance favoured the increased stoma formation during the early phases of the Covid-19 pandemic due to uncertainty around the availability of critical care beds and peri-operative impact of SARS-CoV-2. This study assessed the impact the Covid-19 pandemic and changing guidance had on end colostomy formation. Methods Data were reviewed from a prospectively collected database on the number of end colostomies formed over a 10-month period from 1st March to 31st December 2020. Comparison was made with the same period in 2019. Details were confirmed using clinical letters. Results There was an overall 11.5% increase in the number of end colostomies formed in the in the same 10-month period in 2020 compared with 2019 (87 vs 78). The increase in end colostomy formation was most marked in the 3-month period of March to May, with 36.8% more end colostomies formed in 2020 than in 2019 (26 vs 19). The number of end colostomies formed in the remaining 7-month period of June to December was similar in the two years (61 vs 59). Conclusions There was a change in surgical practice in favour of stoma formation, which peaked in the period of March to May 2020. This coincided with a time of maximum uncertainty surrounding the Covid-19 pandemic and changing intercollegiate guidance. The change in practice has implications for patients longer term and may impact on the service in the post-Covid recovery period with patients requesting reversal procedures.

scholarly journals EP.WE.205Impact of the Covid-19 Pandemic on Loop Ileostomy Formation

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
E Z Farrow ◽  
T A Cook
Keyword(s):  
Primary Anastomosis ◽  
Loop Ileostomy ◽  
Median Number ◽  
Subsequent Reduction ◽  
Emergency Case ◽  
Defunctioning Stoma ◽  
Stoma Formation ◽  
Colorectal Cancer Patients ◽  
The Impact ◽  
Early Phases

Abstract Aim Uncertainty during the early phases of the Covid-19 pandemic regarding availability of critical care beds and peri-operative impact of SARS-CoV-2 led to changing intercollegiate guidance in favour of increased stoma formation. This study assessed the impact the Covid-19 pandemic had on loop ileostomy formation. Methods Data were reviewed from a prospectively collected database on the number of loop ileostomies formed over a 10-month period from 1st March to 31st December 2020. Comparison was made with the same period in 2019. Details were confirmed using clinical letters. Results 114 loop ileostomies were formed in the 20-month period. There was a 10.0% reduction in loop ileostomy formation in 2020 compared with 2019. The median number of loop ileostomies formed per month over the two 10-month periods was 6. This peaked at 11 in April 2020 coinciding with the first wave of Covid-19, falling in subsequent months. All 11 of these loop ileostomies were formed in colorectal cancer patients undergoing anterior resection, after appropriate counselling. Conclusions There was a reduction in the number of ileostomies formed in 2020 compared with 2019 reflecting the impact of the Covid-19 pandemic on both elective and emergency case load and presentations. These results show reactive change in surgical practice corresponding to guidance at a time of maximum uncertainty. Primary anastomosis still occurred but with an increased likelihood of a defunctioning stoma to minimise the consequences of an anastomotic leak. A subsequent reduction in stoma formation in the following months indicates that practice rapidly returned to normal.

THE EFFECT OF A NEW POLICY FOR INWARD TRANSFER OF PATIENTS DIAGNOSED WITH CEREBRAL VENOUS THROMBOSIS (CVT) ACROSS GREATER MANCHESTER TO THE TERTIARY NEUROSCIENCES CENTRE

2015 ◽  
Vol 86 (11) ◽  
pp. e4.102-e4
Author(s):  
Timothy Lavin ◽  
Jason McMinn ◽  
Martin Punter ◽  
Mark Kellett
Keyword(s):  
Critical Care ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Waiting Times ◽  
Large Change ◽  
Number Of Patients ◽  
Change In Practice ◽  
Bed Days ◽  
The Impact

BackgroundFrom June 2014, Greater Manchester, Lancashire and Cumbria neurology network implemented regional guidelines on management of CVT. Central to this was an agreement to transfer where appropriate all radiologically confirmed CVT to the regional neurosciences unit within 24 hr. Given this change in practice we assessed the impact on our service in Greater Manchester Neurosciences Centre.ResultsBetween June 2014 and November 2014, 14 patients were admitted; compared to 6 in 2012 and 6 in 2013.The wait for urgent beds did not vary compared to equivalent period in 2012 and 2013; median wait 1d. The wait for non-urgent beds increased slightly between 2013 and 2014 from 15.9d to 16.7d. Both were worse compared to 2012 (9.8d), likely reflecting overall pressure on acute services.There was no increase in the average LOS for the acute neurology wards. Average LOS was 15.3d between June and Nov 2014 compared to 22.3d in the equivalent period in 2013.ConclusionDespite a large change in practice for management of CVT there was a small increase in number of patients and no significant effect on admission waiting times, average LOS or critical care bed days was noted.

scholarly journals Evaluation of Clinical Outcomes after Introduction of a Dedicated Infectious Diseases- Critical Care Medicine Service in Critical Care Units

2021 ◽  
Author(s):  
Polina Trachuk ◽  
Vagish Hemmige ◽  
Ruth Eisenberg ◽  
Kelsie Cowman ◽  
Victor Chen ◽  
...  
Keyword(s):  
Critical Care ◽  
Infectious Diseases ◽  
Clinical Outcomes ◽  
Broad Spectrum ◽  
Critical Care Medicine ◽  
Care Hospital ◽  
Intervention Period ◽  
Broad Spectrum Antibiotics ◽  
Antibiotic Utilization ◽  
The Impact

Abstract Objective Infection is a leading cause of admission to intensive care units (ICU), with critically ill patients often receiving empiric broad-spectrum antibiotics. Nevertheless, a dedicated infectious diseases (ID) consultation and stewardship team is not routinely established. An ID-Critical Care Medicine (ID-CCM) pilot program was designed at a 400-bed tertiary care hospital in which an ID attending was assigned to participate in daily rounds with the ICU team, as well as provide ID consultation on select patients. We sought to evaluate the impact of this dedicated ID program on antibiotic utilization and clinical outcomes in patients admitted to the ICU. Method In this single site retrospective study, we analyzed antibiotic utilization and clinical outcomes in patients admitted to an ICU during post-intervention period from January 1, 2017 to December 31, 2017 and compared it to antibiotic utilization in the same ICUs during the pre-intervention period from January 1, 2015 to December 31, 2015. Results Our data showed a statistically significant reduction in usage of most frequently prescribed antibiotics including vancomycin, piperacillin-tazobactam and cefepime during the intervention period. When compared to pre-intervention period there was no difference in-hospital mortality, hospital length of stay and re-admission. Conclusion With this multidisciplinary intervention, we saw a decrease in the use of the most frequently prescribed broad-spectrum antibiotics without a negative impact on clinical outcomes. Our study shows that the implementation of an ID-CCM service is a feasible way to promote antibiotic stewardship in the ICU and can be used as a strategy to reduce unnecessary patient exposure to broad-spectrum agents.

scholarly journals Frequency of repositioning for preventing pressure ulcers in patients hospitalized in ICU: protocol of a cluster randomized controlled trial

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Olga L. Cortés ◽  
Mauricio Herrera-Galindo ◽  
Juan Carlos Villar ◽  
Yudi A. Rojas ◽  
María del Pilar Paipa ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Critical Care ◽  
Pressure Ulcers ◽  
Controlled Trial ◽  
Cluster Randomized Controlled Trial ◽  
Control Group ◽  
Randomized Controlled ◽  
Link Type ◽  
Cluster Randomized ◽  
The Impact

Abstract Background Despite being considered preventable, ulcers due to pressure affect between 30 and 50% of patients at high and very high risk and susceptibility, especially those hospitalized under critical care. Despite a lack of evidence over the efficacy in prevention against ulcers due to pressure, hourly repositioning in critical care as an intervention is used with more or less frequency to alleviate pressure on patients’ tissues. This brings up the objective of our study, which is to evaluate the efficacy in prevention of ulcers due to pressure acquired during hospitalization, specifically regarding two frequency levels of repositioning or manual posture switching in adults hospitalized in different intensive care units in different Colombian hospitals. Methods A nurse-applied cluster randomized controlled trial of parallel groups (two branches), in which 22 eligible ICUs (each consisting of 150 patients), will be randomized to a high-frequency level repositioning intervention or to a conventional care (control group). Patients will be followed until their exit from each cluster. The primary result of this study is originated by regarding pressure ulcers using clusters (number of first ulcers per patient, at the early stage of progression, first one acquired after admission for 1000 days). The secondary results include evaluating the risk index on the patients’ level (Hazard ratio, 95% IC) and a description of repositioning complications. Two interim analyses will be performed through the course of this study. A statistical difference between the groups < 0.05 in the main outcome, the progression of ulcers due to pressure (best or worst outcome in the experimental group), will determine whether the study should be put to a halt/determine the termination of the study. Conclusion This study is innovative in its use of clusters to advance knowledge of the impact of repositioning as a prevention strategy against the appearance of ulcers caused by pressure in critical care patients. The resulting recommendations of this study can be used for future clinical practice guidelines in prevention and safety for patients at risk. Trial registration PENFUP phase-2 was Registered in Clinicaltrials.gov (NCT04604665) in October 2020.

scholarly journals Systematic review and bibliometric analysis of African anesthesia and critical care medicine research part II: a scientometric analysis of the 116 most cited articles

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ulrick Sidney Kanmounye ◽  
Joel Noutakdie Tochie ◽  
Aimé Mbonda ◽  
Cynthia Kévine Wafo ◽  
Leonid Daya ◽  
...  
Keyword(s):  
Critical Care ◽  
South African ◽  
Web Of Science ◽  
Descriptive Analysis ◽  
World Journal ◽  
Critical Care Medicine ◽  
Scientometric Analysis ◽  
Medicine Research ◽  
Qualitative Descriptive ◽  
The Impact

Abstract Background Scientometrics is used to assess the impact of research in several health fields, including Anesthesia and Critical Care Medicine. The purpose of this study was to identify contributors to highly-cited African Anesthesia and Critical Care Medicine research. Methods The authors searched Web of Science from inception to May 4, 2020, for articles on and about Anesthesia and Critical Care Medicine in Africa with ≥2 citations. Quantitative (H-index) and qualitative (descriptive analysis of yearly publications and interpretation of document, co-authorship, author country, and keyword) bibliometric analyses were done. Results The search strategy returned 116 articles with a median of 5 (IQR: 3–12) citations on Web of Science. Articles were published in Anesthesia and Analgesia (18, 15.5%), World Journal of Surgery (13, 11.2%), and South African Medical Journal (8, 6.9%). Most (74, 63.8%) articles were published on or after 2013. Seven authors had more than 1 article in the top 116 articles: Epiu I (3, 2.6%), Elobu AE (2, 1.7%), Fenton PM (2, 1.7%), Kibwana S (2, 1.7%), Rukewe A (2, 1.7%), Sama HD (2, 1.7%), and Zoumenou E (2, 1.7%). The bibliometric coupling analysis of documents highlighted 10 clusters, with the most significant nodes being Biccard BM, 2018; Baker T, 2013; Llewellyn RL, 2009; Nigussie S, 2014; and Aziato L, 2015. Dubowitz G (5) and Ozgediz D (4) had the highest H-indices among the authors referenced by the most-cited African Anesthesia and Critical Care Medicine articles. The U.S.A., England, and Uganda had the strongest collaboration links among the articles, and most articles focused on perioperative care. Conclusion This study highlighted trends in top-cited African articles and African and non-African academic institutions’ contributions to these articles.

scholarly journals The impact of topical lidocaine and timing of LMA removal on the incidence of airway events during the recovery period in children: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ruiqiang Sun ◽  
Xiaoyun Bao ◽  
Xuesong Gao ◽  
Tong Li ◽  
Quan Wang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Recovery Period ◽  
Awake State ◽  
Randomized Controlled ◽  
Laryngeal Spasm ◽  
Topical Lidocaine ◽  
Lubricant Application ◽  
Pacu Stay ◽  
The Impact

Abstract Background The timing of laryngeal mask airway (LMA) removal remains undefined. This study aimed to assess the optimal timing for LMA removal and whether topical anesthesia with lidocaine could reduce airway adverse events. Methods This randomized controlled trial assessed one-to-six-year-old children with ASA I-II scheduled for squint correction surgery under general anesthesia. The children were randomized into the LA (lidocaine cream smeared to the cuff of the LMA before insertion, with mask removal in the awake state), LD (lidocaine application and LMA removal under deep anesthesia), NLA (hydrosoluble lubricant application and LMA removal in the awake state) and NLD (hydrosoluble lubricant application and LMA removal in deep anesthesia) groups. The primary endpoint was a composite of irritating cough, laryngeal spasm, SpO2 < 96%, and glossocoma in the recovery period in the PACU. The secondary endpoints included the incidence of pharyngalgia and hoarseness within 24 h after the operation, duration of PACU stay, and incidence of agitation in the recovery period. The assessor was unblinded. Results Each group included 98 children. The overall incidence of adverse airway events was significantly lower in the LA group (9.4%) compared with the LD (23.7%), NLA (32.6%), and NLD (28.7%) groups (P=0.001). Cough and laryngeal spasm rates were significantly higher in the NLA group (20.0 and 9.5%, respectively) than the LA (5.2 and 0%, respectively), LD (4.1 and 1.0%, respectively), and NLD (9.6 and 2.1%, respectively) groups (P=0.001). Glossocoma incidence was significantly lower in the LA and NLA groups (0%) than in the LD (19.6%) and NLD (20.2%) groups (P< 0.001). At 24 h post-operation, pharyngalgia incidence was significantly higher in the NLA group (15.8%) than the LA (3.1%), LD (1.0%), and NLD (3.2%) groups (P< 0.001). Conclusions LMA removal in the awake state after topical lidocaine anesthesia reduces the incidence of postoperative airway events. Trial registration ChiCTR, ChiCTR-IPR-17012347. Registered August 12, 2017.

scholarly journals The Impact of Changing to an Algorithm-Based Clostridioides difficile Test on the Decision to Treat Clostridioides difficile

2020 ◽  
Vol 41 (S1) ◽  
pp. s407-s407
Author(s):  
Lana Dbeibo ◽  
Joy Williams ◽  
Josh Sadowski ◽  
William Fadel ◽  
Vera Winn ◽  
...  
Keyword(s):  
Critical Care ◽  
Toxic Megacolon ◽  
Adverse Outcomes ◽  
Clinical Criteria ◽  
Testing Method ◽  
Clostridioides Difficile ◽  
Critical Care Admission ◽  
The Impact ◽  
Test Result ◽  
Pcr Test

Background: Polymerase chain reaction (PCR) testing for the diagnosis of Clostridioides difficile infection (CDI) detects the presence of the organism; a positive result therefore cannot differentiate between colonization and the pathogenic presence of the bacterium. This may result in overdiagnosis, overtreatment, and risking disruption of microbial flora, which may perpetuate the CDI cycle. Algorithm-based testing offers an advantage over PCR testing as it detects toxin, which allows differentiation between colonization and infection. Although previous studies have demonstrated the clinical utility of this testing algorithm in differentiating infection from colonization, it is unknown whether the test changes CDI treatment decisions. Our facility switched from PCR to an algorithm-based testing method for CDI in June 2018. Objective: In this study, we evaluated whether clinicians’ decisions to treat patients are impacted by a test result that implies colonization (GDH+/Tox−/PCR+ test), and we examined the impact of this decision on patient outcomes. Methods: This is a retrospective cohort study of inpatients with a positive C. diff test between June 2017 and June 2019. The primary outcome was the proportion of patients treated for CDI. We compared this outcome in 3 groups of patients: those with a positive PCR test (June 2017–June 2018), those who had a GDH+/Tox−/PCR+ or a GDH+/Tox+ test result (June 2018–June 2019). Secondary outcomes included toxic megacolon, critical care admission, and mortality in patients with GDH+/Tox−/PCR+ who were treated versus those who were untreated. Results: Of patients with a positive PCR test, 86% were treated with CDI-specific antibiotics, whereas 70.4% with GDH+/Tox+ and 29.25% with GDH+/Tox−/PCR+ result were treated (P < .0001). Mortality was not different between patients with GDH+/Tox−/PCR+ who were treated versus those who were untreated (2.7% vs 3.4%; P = .12), neither was critical care admission within 2 or 7 days of test result (2% vs 1.4%; P = .15) and (4.1% vs 5.4%, P = .39), respectively. There were no cases of toxic megacolon during the study period. Conclusions: The change to an algorithm-based C. difficile testing method had a significant impact on the clinicians’ decisions to treat patients with a positive test, as most patients with a GDH+/Tox−/PCR+ result did not receive treatment. These patients did not suffer more adverse outcomes compared to those who were treated, which has implications for testing practices. It remains to be explored whether clinicians are using clinical criteria to decide whether or not to treat patients with a positive algorithm-based test, as opposed to the more reflexive treatment of patients with a positive PCR test.Funding: NoneDisclosures: None

A Systematic Review of Anticoagulation Strategies for Patients With Atrial Fibrillation in Critical Care.

2021 ◽  
Author(s):  
Alexandra Jayne Nelson ◽  
Brian W Johnston ◽  
Alicia Achiaa Charlotte Waite ◽  
Gedeon Lemma ◽  
Ingeborg Dorothea Welters
Keyword(s):  
Atrial Fibrillation ◽  
Critical Care ◽  
Critically Ill ◽  
Major Bleeding ◽  
Critically Ill Patients ◽  
Thromboembolic Events ◽  
Bleeding Events ◽  
Major Bleeding Events ◽  
The Impact ◽  
Anticoagulated Patients

Background. Atrial fibrillation (AF) is the most common cardiac arrhythmia in critically ill patients. There is a paucity of data assessing the impact of anticoagulation strategies on clinical outcomes for general critical care patients with AF. Our aim was to assess the existing literature to evaluate the effectiveness of anticoagulation strategies used in critical care for AF. Methodology. A systematic literature search was conducted using MEDLINE, EMBASE, CENTRAL and PubMed databases. Studies reporting anticoagulation strategies for AF in adults admitted to a general critical care setting were assessed for inclusion. Results. Four studies were selected for data extraction. A total of 44087 patients were identified with AF, of which 17.8-49.4% received anticoagulation. The reported incidence of thromboembolic events was 0-1.4% for anticoagulated patients, and 0-1.3% in non-anticoagulated patients. Major bleeding events were reported in three studies and occurred in 7.2-8.6% of the anticoagulated patients and up to 7.1% of the non-anticoagulated patients. Conclusions. There was an increased incidence of major bleeding events in anticoagulated patients with AF in critical care compared to non-anticoagulated patients. There was no significant difference in the incidence of reported thromboembolic events within studies, between patients who did and did not receive anticoagulation. However, the outcomes reported within studies were not standardised, therefore, the generalisability of our results to the general critical care population remains unclear. Further data is required to facilitate an evidence-based assessment of the risks and benefits of anticoagulation for critically ill patients with AF.

A Case–Control Study Evaluating the Impact of Dedicated Palliative Care Training on Critical Care Interventions at the end of Life

2021 ◽  
pp. 082585972110374
Author(s):  
Jee Y. You ◽  
Lie D. Ligasaputri ◽  
Adarsh Katamreddy ◽  
Kiran Para ◽  
Elizabeth Kavanagh ◽  
...  
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
High Risk ◽  
End Of Life ◽  
Poor Prognosis ◽  
Medical Interventions ◽  
Risk Of Death ◽  
Before And After ◽  
The Difference ◽  
The Impact

Many patients admitted to intensive care units (ICUs) are at high risk of dying. We hypothesize that focused training sessions for ICU providers by palliative care (PC) certified experts will decrease aggressive medical interventions at the end of life. We designed and implemented a 6-session PC training program in communication skills and goals of care (GOC) meetings for ICU teams, including house staff, critical care fellows, and attendings. We then reviewed charts of ICU patients treated before and after the intervention. Forty-nine of 177 (28%) and 63 of 173 (38%) patients were identified to be at high risk of death in the pre- and postintervention periods, respectively, and were included based on the study criteria. Inpatient mortality (45% vs 33%; P = .24) and need for mechanical ventilation (59% vs 44%, P = .13) were slightly higher in the preintervention population, but the difference was not statistically significant. The proportion of patients in whom the decision not to initiate renal replacement therapy was made because of poor prognosis was significantly higher in the postintervention population (14% vs 67%, P = .05). There was a nonstatistically significant trend toward earlier GOC discussions (median time from ICU admission to GOC 4 vs 3 days) and fewer critical care interventions such as tracheostomies (17% vs 4%, P = .19). Our study demonstrates that directed PC training of ICU teams has a potential to reduce end of life critical care interventions in patients with a poor prognosis.

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