A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical Care

2018 ◽  
pp. 235-240
Author(s):  
Joseph R. Guenzer ◽  
Andrew Vardanian
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Controlled Clinical Trial ◽  
Large Trial ◽  
Transfusion Threshold ◽  
Transfusion Requirements ◽  
Red Cell Transfusion ◽  
Study Intervention ◽  
The Impact

This chapter provides a summary of the landmark study known as the TRICC trial. Is a restrictive strategy of red-cell transfusion equivalent to a liberal transfusion strategy in critically ill patients? Starting with that question, the chapter describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism, and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. Although this first large trial to examine the impact of transfusion thresholds on mortality in critically ill patients was underpowered, the trend toward decreased mortality in the restrictive group suggests that it is unlikely that the lower transfusion threshold subjects patients to increased harm. However, care must be taken in generalizing these results to cardiac surgery patients or to actively bleeding patients based on this study alone.

Impact of Hospitalized Nutritional Formula on Anthropometric, Clinical and Biochemical Indices among Egyptian Adult Cardio-Thoracic Critically Ill Patients: A Single Institutional Study

2021 ◽  
Vol 7 (1) ◽  
pp. 01-11
Author(s):  
Khalil NS
Keyword(s):  
Critically Ill ◽  
Clinical Data ◽  
Critically Ill Patients ◽  
Skin Color ◽  
Admission Time ◽  
Chest Disease ◽  
Disease Hospital ◽  
Biochemical Indices ◽  
The Impact

Background: Malnutrition is a common consequence notably in patients admitted to the intensive care unit. Aim of the study: was to assess the Impact of hospitalized nutritional formula on anthropometric, clinical and biochemical indices among Egyptian adult cardio-thoracic Critically Ill Patients on admission and discharge days. Methods: Totally, A convenient sample of 100 cardiothoracic patients was evaluated from admission to discharge in ICUs at Damietta Chest Disease Hospital in Egypt. The patients' anthropometric measurements, clinical data and biochemical indices were assessed As well, hospital diet prescription and intake was also evaluated. Results: High significant statistical difference patients' clinical data on admission and after one week such as body built (X2 = 52.6; p = 0.0), skin color (X2= 12.9; p = 0.02), skin turgor (X2= 13.19; p = 0.0), and occurrence of bed sore (X2= 27.7; p = 0.0). On the other hand, no significant statistical differences were found in the patients' weight and body mass index on admission and discharge (one week). Moreover, significant statistical differences were found in patients biochemical indices such as albumin (t= 3.03; p=0.003) and lymphocyte counts (3.74; p=0.000). So, the 88 % of patients showed decreased albumin after one week when compared to admission time. While, 10 % of patients showed increased lymphocytic count after one week of admission when compared to admission time. Conclusion and Recommendations: Clinical assessment, anthropometric, and biochemical indices are essential for evaluation, follow-up and management of cardiothoracic critically ill patients

A Protocol of No Sedation for Critically Ill Patients Receiving Mechanical Ventilation

2018 ◽  
pp. 33-38
Author(s):  
Ulrich Schmidt ◽  
Zeb McMillan
Keyword(s):  
Mechanical Ventilation ◽  
Randomized Trial ◽  
Critically Ill ◽  
Study Design ◽  
Critically Ill Patients ◽  
Clinical Case ◽  
Daily Interruption ◽  
Study Intervention ◽  
Landmark Study

This chapter provides a summary of the landmark study known as a protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomized trial. Can duration of mechanical ventilation be reduced with a protocol of no sedation versus daily interruption of sedation? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. Understanding that not all patients receiving mechanical ventilation require sedation is an important first step to determining the best regimen.

Daily Interruption of Sedative Infusions in Critically Ill Patients Undergoing Mechanical Ventilation

2018 ◽  
pp. 15-20
Author(s):  
David Stahl
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Controlled Trial ◽  
Mechanically Ventilated ◽  
Daily Interruption ◽  
Relevant Context ◽  
Study Intervention ◽  
Daily Sedation Interruption

This chapter provides a summary of a landmark study in critical care medicine. Does the daily interruption of continuous sedative infusions in critically ill patients receiving mechanical ventilation decrease the duration of mechanical ventilation and the duration of stay in the intensive care unit (ICU)? This chapter describes the study designed to answer that question including funding, study location, patient population, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant context and studies, discusses implications, and concludes with a relevant clinical case. This was the first randomized-controlled trial to demonstrate that daily sedation interruption for mechanically ventilated medical ICU patients is safe and may reduce the duration of mechanical ventilation and length of stay in the ICU.

Transfusion Requirements in Critical Care (TRICC)

2018 ◽  
pp. 114-118
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cardiac Ischemia ◽  
Red Cell ◽  
Transfusion Threshold ◽  
Chronic Anemia ◽  
Transfusion Requirements

This case focuses on red cell transfusions in critically ill patients by asking the question: When should patients in the intensive care unit (ICU) with anemia receive red cell transfusions? For most critically ill patients, waiting to transfuse red cells until the hemoglobin (Hgb) drops below 7 g/dL is at least as effective as, and likely preferable to, transfusing at an Hgb less than 10 g/dL. These findings may not apply to patients with chronic anemia, who were excluded from the trial. The results also may not apply to patients with active cardiac ischemia, who were poorly represented in the trial and had nonsignificantly worse outcomes with a transfusion threshold of 7.

Red Cell Transfusion in Critically Ill Patients

2017 ◽  
Author(s):  
Michael E. Hochman
Keyword(s):  
Intensive Care Unit ◽  
Critically Ill ◽  
Clinical Case ◽  
Critically Ill Patient ◽  
Red Cell ◽  
Surgical Critical Care ◽  
Red Cell Transfusion ◽  
Study Intervention ◽  
Landmark Study

This chapter provides a summary of the landmark study in surgical critical care known as the TRICC trial. When should patients in the intensive care unit (ICU) with anemia receive red cell transfusions? Starting with that question, it describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case about a red cell transfusion for a critically ill patient.

scholarly journals Protocol for a randomised trial of an interprofessional team-delivered intervention to support surrogate decision-makers in ICUs

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e033521
Author(s):  
Taylor Lincoln ◽  
Anne-Marie Shields ◽  
Praewpannarai Buddadhumaruk ◽  
Chung-Chou H Chang ◽  
Francis Pike ◽  
...  
Keyword(s):  
Family Support ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Maslach Burnout Inventory ◽  
Skills Training ◽  
Icu Stay ◽  
Surrogate Decision ◽  
The Impact

IntroductionAlthough shortcomings in clinician–family communication and decision making for incapacitated, critically ill patients are common, there are few rigorously tested interventions to improve outcomes. In this manuscript, we present our methodology for the Pairing Re-engineered Intensive Care Unit Teams with Nurse-Driven Emotional support and Relationship Building (PARTNER 2) trial, and discuss design challenges and their resolution.Methods and analysisThis is a pragmatic, stepped-wedge, cluster randomised controlled trial comparing the PARTNER 2 intervention to usual care among 690 incapacitated, critically ill patients and their surrogates in five ICUs in Pennsylvania. Eligible subjects will include critically ill patients at high risk of death and/or severe long-term functional impairment, their main surrogate decision-maker and their clinicians. The PARTNER intervention is delivered by the interprofessional ICU team and overseen by 4–6 nurses from each ICU. It involves: (1) advanced communication skills training for nurses to deliver support to surrogates throughout the ICU stay; (2) deploying a structured family support pathway; (3) enacting strategies to foster collaboration between ICU and palliative care services and (4) providing intensive implementation support to each ICU to incorporate the family support pathway into clinicians’ workflow. The primary outcome is surrogates’ ratings of the quality of communication during the ICU stay as assessed by telephone at 6-month follow-up. Prespecified secondary outcomes include surrogates’ scores on the Hospital Anxiety and Depression Scale, the Impact of Event Scale, the modified Patient Perception of Patient Centredness scale, the Decision Regret Scale, nurses’ scores on the Maslach Burnout Inventory, and length of stay during and costs of the index hospitalisation.We also discuss key methodological challenges, including determining the optimal level of randomisation, using existing staff to deploy the intervention and maximising long-term follow-up of participants.Ethics and disseminationWe obtained ethics approval through the University of Pittsburgh, Human Research Protection Office. The findings will be published in peer-reviewed journals.Trial registration numberNCT02445937

Plasmapheresis in the Management of Severe Hypertriglyceridemia

2013 ◽  
Vol 33 (4) ◽  
pp. 18-23 ◽  
Author(s):  
Gilbert Seda ◽  
Jill M. Meyer ◽  
Dennis E. Amundson ◽  
Massoud Daheshia
Keyword(s):  
Diabetic Ketoacidosis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Serum Levels ◽  
Critical Care Nursing ◽  
Laboratory Studies ◽  
Severe Hypertriglyceridemia ◽  
Medical Intensive Care ◽  
The Impact

Plasmapheresis can benefit a variety of critically ill patients. A woman with diabetic ketoacidosis and severe hypertriglyceridemia was treated with plasmapheresis when conventional treatments did not markedly reduce her triglyceridemia. The patient was admitted to a medical intensive care unit because of diabetic ketoacidosis with severe lipemia. The lipemia-associated interference in laboratory studies made treatment of electrolyte abnormalities extremely difficult. The hypertriglyceridemia was initially treated with insulin, antilipidemic medications, and heparin, but the levels of triglycerides remained elevated, delaying results of needed laboratory studies for hours. After plasmapheresis, the serum level of triglycerides decreased by 77% in less than 24 hours. Severe lipemia interferes with photometric laboratory studies, yielding an underestimation of serum levels of electrolytes. Plasmapheresis is safe, rapid, and effective for emergent management of severe hypertriglyceridemia in critically ill patients. The impact of the procedure on critical care nursing is growing as nurses become involved in the treatment and follow-up care of patients who have plasmapheresis.

Follow-up blood cultures in Gram-negative bacilli bacteremia: are they needed for critically ill patients?

2020 ◽  
Vol 86 (5) ◽  
Author(s):  
Martina Spaziante ◽  
Alessandra Oliva ◽  
Giancarlo Ceccarelli ◽  
Francesco Alessandri ◽  
Francesco Pugliese ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Cultures ◽  
Gram Negative

scholarly journals Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients

2021 ◽  
pp. 1-11
Author(s):  
Wendy G. Lichtenthal ◽  
Martin Viola ◽  
Madeline Rogers ◽  
Kailey E. Roberts ◽  
Lindsay Lief ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Experiential Avoidance ◽  
Decision Makers ◽  
Post Intervention ◽  
Prolonged Grief ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Peritraumatic Distress

Abstract Objective The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes. Method Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments. Results Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30). Significance of results Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.

scholarly journals Outcomes of non-COVID-19 critically ill patients during the COVID-19 pandemic

2021 ◽  
Author(s):  
Răzvan Bologheanu ◽  
Mathias Maleczek ◽  
Daniel Laxar ◽  
Oliver Kimberger
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Specialty ◽  
Routine Care ◽  
Treatment Pathways ◽  
Icu Length Of Stay ◽  
Matched Study ◽  
The Impact

Summary Background Coronavirus disease 2019 (COVID-19) disrupts routine care and alters treatment pathways in every medical specialty, including intensive care medicine, which has been at the core of the pandemic response. The impact of the pandemic is inevitably not limited to patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their outcomes; however, the impact of COVID-19 on intensive care has not yet been analyzed. Methods The objective of this propensity score-matched study was to compare the clinical outcomes of non-COVID-19 critically ill patients with the outcomes of prepandemic patients. Critically ill, non-COVID-19 patients admitted to the intensive care unit (ICU) during the first wave of the pandemic were matched with patients admitted in the previous year. Mortality, length of stay, and rate of readmission were compared between the two groups after matching. Results A total of 211 critically ill SARS-CoV‑2 negative patients admitted between 13 March 2020 and 16 May 2020 were matched to 211 controls, selected from a matching pool of 1421 eligible patients admitted to the ICU in 2019. After matching, the outcomes were not significantly different between the two groups: ICU mortality was 5.2% in 2019 and 8.5% in 2020, p = 0.248, while intrahospital mortality was 10.9% in 2019 and 14.2% in 2020, p = 0.378. The median ICU length of stay was similar in 2019: 4 days (IQR 2–6) compared to 2020: 4 days (IQR 2–7), p = 0.196. The rate of ICU readmission was 15.6% in 2019 and 10.9% in 2020, p = 0.344. Conclusion In this retrospective single center study, mortality, ICU length of stay, and rate of ICU readmission did not differ significantly between patients admitted to the ICU during the implementation of hospital-wide COVID-19 contingency planning and patients admitted to the ICU before the pandemic.

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