Good clinical practice for the use of vasopressor and inotropic drugs in critically ill patients: state-of-the-art and expert consensus

Critically ill patients in the intensive care unit (ICU) have a high risk of developing malnutrition, and this is associated with poorer clinical outcomes. In clinical practice, nutrition, including enteral nutrition (EN), is often not prioritized. Resulting from this, risks and safety issues for patients and healthcare professionals can emerge. The aim of this literature review, inspired by the Rapid Review Guidebook by Dobbins, 2017, was to identify risks and safety issues for patient safety in the management of EN in critically ill patients in the ICU. Three databases were used to identify studies between 2009 and 2020. We assessed 3495 studies for eligibility and included 62 in our narrative synthesis. Several risks and problems were identified: No use of clinical assessment or screening nutrition assessment, inadequate tube management, missing energy target, missing a nutritionist, bad hygiene and handling, wrong time management and speed, nutritional interruptions, wrong body position, gastrointestinal complication and infections, missing or not using guidelines, understaffing, and lack of education. Raising awareness of these risks is a central aspect in patient safety in ICU. Clinical experts can use a checklist with 12 identified top risks and the recommendations drawn up to carry out their own risk analysis in clinical practice.

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Music therapy in critical care: indications and guidelines for intervention

Critical Care Nurse ◽

10.4037/ccn1999.19.3.35 ◽

1999 ◽

Vol 19 (3) ◽

pp. 35-41 ◽

Cited By ~ 37

Author(s):

L Chlan ◽

MF Tracy

Keyword(s):

Critical Care ◽

Clinical Practice ◽

Music Therapy ◽

Stress Management ◽

Critically Ill ◽

Critically Ill Patients ◽

Anxiety Reduction ◽

Music Listening ◽

Sense Of Control ◽

Music Selection

Music therapy is an effective intervention for critically ill patients for such purposes as anxiety reduction and stress management. The therapy is readily accepted by patients and is an intervention patients thoroughly enjoy. The MAIT is one resource that nurses caring for critically ill patients can use to implement music therapy in clinical practice. Patients can be given the opportunity to select a musical tape they prefer and to negotiate with the nurse for uninterrupted music-listening periods. Allowing patients control over music selection and providing uninterrupted time for music listening gives the patients an enhanced sense of control in an environment that often controls them.

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Serum Albumin Levels: Who Needs Them?

Annals of Pharmacotherapy ◽

10.1177/1060028020959348 ◽

2020 ◽

pp. 106002802095934 ◽

Cited By ~ 1

Author(s):

Brian L. Erstad

Keyword(s):

Clinical Practice ◽

Serum Albumin ◽

Critically Ill ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Critically Ill Patients ◽

Severity Of Illness ◽

Current Clinical Practice ◽

Albumin Administration ◽

Nutritional Monitoring

Objectives The purpose of this critical narrative review is to discuss common indications for ordering serum albumin levels in adult critically ill patients, evaluate the literature supporting these indications, and provide recommendations for the appropriate ordering of serum albumin levels. Data Sources PubMed (1966 to August 2020), Cochrane Library, and current clinical practice guidelines were used, and bibliographies of retrieved articles were searched for additional articles. Study Selection and Data Extraction Current clinical practice guidelines were the preferred source of recommendations regarding serum albumin levels for guiding albumin administration and for nutritional monitoring. When current comprehensive reviews were available, they served as a baseline information with supplementation by subsequent studies. Data Synthesis Serum albumin is a general marker of severity of illness, and hypoalbuminemia is associated with poor patient outcome, but albumin is an acute phase protein, so levels vacillate in critically ill patients in conjunction with illness fluctuations. The most common reasons for ordering serum albumin levels in intensive care unit (ICU) settings are to guide albumin administration, to estimate free phenytoin or calcium levels, for nutritional monitoring, and for severity-of-illness assessment. Relevance to Patient Care and Clinical Practice Because hypoalbuminemia is common in the ICU setting, inappropriate ordering of serum albumin levels may lead to unnecessary albumin administration or excessive macronutrient administration in nutritional regimens, leading to possible adverse effects and added costs. Conclusions With the exception of the need to order serum albumin levels as a component of selected severity-of-illness scoring systems, there is little evidence or justification for routinely ordering levels in critically ill patients.

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Blood tranfusion in critically ill patients: state of the art

Clinics ◽

10.1590/s1807-59322007000400019 ◽

2007 ◽

Vol 62 (4) ◽

pp. 507-524 ◽

Cited By ~ 16

Author(s):

Ludhmila Abrahão Hajjar ◽

Jose Otávio Costa Auler Junior ◽

Luciana Santos ◽

Filomena Galas

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

State Of The Art

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Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care expert consensus statement on the use of lung ultrasound in critically ill patients with coronavirus disease 2019 (ITACO)

Journal of Anesthesia, Analgesia and Critical Care ◽

10.1186/s44158-021-00015-6 ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Luigi Vetrugno ◽

Francesco Mojoli ◽

Andrea Cortegiani ◽

Elena Giovanna Bignami ◽

Mariachiara Ippolito ◽

...

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Working Group ◽

Lung Ultrasound ◽

Invasive Mechanical Ventilation ◽

Italian Society ◽

Expert Consensus ◽

Consensus Statements

Abstract Background To produce statements based on the available evidence and an expert consensus (as members of the Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care, SIAARTI) on the use of lung ultrasound for the management of patients with COVID-19 admitted to the intensive care unit. Methods A modified Delphi method was applied by a panel of anesthesiologists and intensive care physicians expert in the use of lung ultrasound in COVID-19 intensive critically ill patients to reach a consensus on ten clinical questions concerning the role of lung ultrasound in the following: COVID-19 diagnosis and monitoring (with and without invasive mechanical ventilation), positive end expiratory pressure titration, the use of prone position, the early diagnosis of pneumothorax- or ventilator-associated pneumonia, the process of weaning from invasive mechanical ventilation, and the need for radiologic chest imaging. Results A total of 20 statements were produced by the panel. Agreement was reached on 18 out of 20 statements (scoring 7–9; “appropriate”) in the first round of voting, while 2 statements required a second round for agreement to be reached. At the end of the two Delphi rounds, the median score for the 20 statements was 8.5 [IQR 8.9], and the agreement percentage was 100%. Conclusion The Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care produced 20 consensus statements on the use of lung ultrasound in COVID-19 patients admitted to the ICU. This expert consensus strongly suggests integrating lung ultrasound findings in the clinical management of critically ill COVID-19 patients.

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