The impact of extended bed rest on the musculoskeletal system in the critical care environment

Patients with critical illness often have renal dysfunction, either primary or secondary, that can both complicate and prolong their medical management. Therefore, an understanding of normal renal physiology can help recognize the process or processes that caused the renal dysfunction, and determine the most appropriate corrective and supportive care. The kidney has many important roles other than just urine production. The impact of kidney disease is often predictable. The kidney plays a critical role in fluid and electrolyte balance via many specialized transmembrane pathways. The kidney is also involved in the production and modification of two key hormones and one enzyme. Understanding normal renal physiology can help determine clinical management.This chapter summarizes the important aspects of renal physiology relevant to those who work in a critical care environment.

Download Full-text

Telemedicine in critical care

10.1093/med/9780199600830.003.0012 ◽

2016 ◽

Author(s):

Bela Patel ◽

Eric J. Thomas

Keyword(s):

Critical Care ◽

Best Practices ◽

Bloodstream Infections ◽

Ventilator Associated Pneumonia ◽

Care Model ◽

Stress Ulcers ◽

Care Environment ◽

The Past ◽

The Usa ◽

The Impact

The majority of critically-ill patients are admitted to hospitals that do not have physician intensivist coverage, despite strong evidence that clinical outcomes are improved with intensivist staffing. Telemedicine can leverage clinical resources by providing critical care expertise to patients in intensive care units (ICUs) by off-site clinicians using video, audio, and electronic links. In the past 10 years, telemedicine in critical care has seen tremendous growth in the number of ICU patients being supported by this care model across the USA. The impact of ICU telemedicine coverage has been studied rigorously only in a few studies and the outcomes have been mixed and inconsistent. Telemedicine has been shown in some studies to improve adherence to ICU best practices for the prevention of deep venous thrombosis, stress ulcers, ventilator-associated pneumonia, and catheter-related bloodstream infections. Further research in ICU telemedicine is required to understand the variability of outcomes among the telemedicine programmes studied and to effectively implement the technology to consistently improve outcomes and reduce costs in the critical care environment.

Download Full-text

The critical care environment

10.1093/med/9780199696260.003.0002 ◽

2017 ◽

Author(s):

Sheila Adam ◽

Sue Osborne ◽

John Welch

Keyword(s):

Critical Care ◽

Clinical Information ◽

Electronic Patient Records ◽

Care Environment ◽

Team Working ◽

Use Of Technology ◽

Design Structure ◽

Key Factor ◽

The Impact ◽

Location Design

This chapter details the optimal location, design, structure, staffing, and equipment required to support high quality critical care. The chapter covers the impact of the critical care environment on patients, family, and staff themselves. The use of technology, including clinical information systems and electronic patient records, is described. Staffing numbers and roles and the importance of team working and collaboration as a key factor in the effectiveness of the critical care environment are also covered. The impact of cleanliness and infection control features as part of the design. The role that the environment has in mitigating the impact on patients in critical care as well as improving outcomes is described as well as other aspects of safety within critical care.

Download Full-text

Critical Care Nursing

10.1093/med/9780199696260.001.0001 ◽

2017 ◽

Cited By ~ 4

Keyword(s):

Critical Care ◽

Kidney Injury ◽

Multiple Organ ◽

Major Incident ◽

Organ Support ◽

Evidence Based ◽

Care Environment ◽

Organ Systems ◽

General Aspects ◽

The Impact

This textbook encompasses the knowledge, skills, and expertise needed to deliver excellent nursing care to critically ill patients. Emphasis is placed on a holistic and compassionate approach towards humanizing the impact of the environment, organ support, and monitoring, as well as critical illness itself. Chapters cover the general aspects of critical care such as the critical care environment or critical care continuum and specific organ systems and diseases. The structure of the systems chapters reminds the reader of the underlying anatomy and physiology as well as highlighting areas of particular relevance to critical care. The focus on priorities for management builds on the ABCDE assessment and offers insight into key interventions in urgent situations as well as outlining evidence-based practice. The book is ideal for those new to the critical care environment, but will also act as a reminder for more experienced nurses when faced with a new situation or when teaching/mentoring students. The patient and their family remain the centre of all This new edition brings the definitions, pathophysiology, and management of fast-changing and challenging areas such as ARDS, sepsis and multiple organ dysfunction, resuscitation, and acute kidney injury up to date as well as including any evidence-based changes associated with nursing practice in critical care. A new chapter covers major incident planning and management and the role of critical care in pandemic situations.

Download Full-text

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab182 ◽

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.

Download Full-text

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

BMC Nursing ◽

10.1186/s12912-021-00616-0 ◽

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.

Download Full-text

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

BMC Anesthesiology ◽

10.1186/s12871-021-01246-4 ◽

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.

Download Full-text

379 The Critical Care Experience of Irish Surgical Non-Consultant Hospital Doctors, Are We Equipped to Assist During the Covid-19 Outbreak and Beyond?

British Journal of Surgery ◽

10.1093/bjs/znab134.135 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

E Burke ◽

P Balfe

Keyword(s):

Critical Care ◽

Intensive Care ◽

Healthcare Systems ◽

Care Environment ◽

Care Experience ◽

Electronic Survey ◽

Surgical Trainees ◽

Hospital Doctors ◽

Basic Course ◽

Further Development

Abstract Introduction The ongoing COVID-19 pandemic has presented unforeseen threats and stresses to healthcare systems around the world, most notably in the ability to provide critical care. Aim To assess surgical NCHD experience in providing critical care and working in an intensive care environment. Method An electronic survey was distributed amongst surgical trainees and then amongst individual surgical departments. Ten questions were included in the survey assessing the NCHD’s experience with aspects of critical care. Results 39 respondents including 16 specialist registrars, 3 senior registrars, 11 registrars and 9 senior house officers. 18% of respondents had previous experience in anaesthetics or intensive care. 23% self-reported being competent in performing endotracheal intubation. 15% self-reported being competent in the use of CPAP and BiPaP, 5% did not know what these were. 20% self-reported being competent in the use of AIRVO. 15% self-reported being competent in placing central and arterial lines. 15% self-reported being competent in starting and adjusting inotropes/vasopressors. 49% reported completing a CCRISP or BASIC course. 85% felt that a rotation in anaesthesia should be a routine part of surgical training. Conclusions Whilst there is critical care experience amongst the surgical NCHD cohort there remains room for further development.

Download Full-text

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

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1058 ◽

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

Download Full-text