Top 10 publications of Intensive Care Medicine journal 2020

COVID-19 pandemic provoked an increasing interest in recent advances in diagnosis and treatment of critical care patients. Among the main problems are the lack of evidence-based guidelines and a growing number of patients with multiple organ dysfunction syndrome. Therefore, indications for the use of previously uncommon intensive care approaches are expanding. These reasons, along with a large pool of non-systematic literature, dictate the need in the narrative review of top 10 recent publications which provide a snapshot of the most relevant research in critical care. These papers overview evidence-based information on the control of acute kidney injury, ventilator-associated pneumonia and sepsis in critically ill patients including those with COVID-19, principles of proper haemodynamic and ventilatory support, timely cessation of antimicrobial therapy, efficient prevention of gastrointestinal bleeding, and the use of the prone position in patients with acute respiratory distress syndrome.

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Critical Care Clinicians’ Knowledge of Evidence-Based Guidelines for Preventing Ventilator-Associated Pneumonia

American Journal of Critical Care ◽

10.4037/ajcc2009131 ◽

2010 ◽

Vol 19 (3) ◽

pp. 272-276 ◽

Cited By ~ 21

Author(s):

Mohamad F. El-Khatib ◽

Salah Zeineldine ◽

Chakib Ayoub ◽

Ahmad Husari ◽

Pierre K. Bou-Khalil

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Evidence Based ◽

Ventilator Associated Pneumonia ◽

Care Providers ◽

Care Experience ◽

Respiratory Therapists ◽

Evidence Based Guidelines

Background Ventilator-associated pneumonia is the most common hospital-acquired infection among patients receiving mechanical ventilation in an intensive care unit. Different initiatives for the prevention of ventilator-associated pneumonia have been developed and recommended.Objective To evaluate knowledge of critical care providers (physicians, nurses, and respiratory therapists in the intensive care unit) about evidence-based guidelines for preventing ventilator-associated pneumonia.Methods Ten physicians, 41 nurses, and 18 respiratory therapists working in the intensive care unit of a major tertiary care university hospital center completed an anonymous questionnaire on 9 nonpharmacological guidelines for prevention of ventilator-associated pneumonia.Results The mean (SD) total scores of physicians, nurses, and respiratory therapists were 80.2% (11.4%), 78.1% (10.6%), and 80.5% (6%), respectively, with no significant differences between them. Furthermore, within each category of health care professionals, the scores of professionals with less than 5 years of intensive care experience did not differ significantly from the scores of professionals with more than 5 years of intensive care experience.Conclusions A health care delivery model that includes physicians, nurses, and respiratory therapists in the intensive care unit can result in an adequate level of knowledge on evidence-based nonpharmacological guidelines for the prevention of ventilator-associated pneumonia.

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Measuring Height in Recumbent Critical Care Patients

American Journal of Critical Care ◽

10.4037/ajcc2015761 ◽

2015 ◽

Vol 24 (1) ◽

pp. 41-47 ◽

Cited By ~ 9

Author(s):

Diane M. Dennis ◽

Emily E. Hunt ◽

Charley A. Budgeon

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Gold Standard ◽

Ventilatory Support ◽

Whole Body ◽

Standing Height ◽

Preadmission Clinic ◽

Practice Methods ◽

Critical Care Patients

Background Estimates of the height of patients in the intensive care unit are required to adhere to clinical guidelines for drug dosages, ventilatory support, and nutrition. The gold standard of standing height cannot be used because these patients are often unconscious and recumbent. The ability of physiotherapists or dietitians to measure height in unconscious, recumbent patients has not been evaluated. Objectives To compare the accuracy of physicians, physiotherapists, and dietitians in estimating the height of recumbent critical care patients by using existing practice methods. Methods A total of 35 patients were recruited from the cardiothoracic preadmission clinic, where standing height is routinely measured by a physiotherapist. After surgery, in the intensive care unit, 1 physician, 2 physiotherapists, and 2 dietitians measured each recumbent patient’s height. Three methods were used: observation, whole-body measurement, and height estimated by using length of the forearm and the British Association for Parenteral and Enteral Nutrition normative chart. Difference from standing height was measured from zero and was compared across professions and methods, with zero indicating no difference. Results Overall, 17 physicians, 4 dietitians, and 9 physiotherapists consented to measure patients. After adjustments for method, measurements by physiotherapists did not differ significantly from the gold standard (P = .59), whereas those of physicians (P = .02) and dietitians (P < .001) did. Conclusions Physiotherapists’ measurements of supine height of recumbent critical care patients, obtained by using a nonrigid measuring tape, are more accurate than measurements obtained by physicians and dietitians.

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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.

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Nutrition in the intensive care unit

The Southwest Respiratory and Critical Care Chronicles ◽

10.12746/swrccc.v3i10.195 ◽

2015 ◽

Vol 3 (10) ◽

pp. 10 ◽

Cited By ~ 1

Author(s):

Chase C. Hansen ◽

Sharmila Dissanaike

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Medical School ◽

Enteral Feeding ◽

Surgical Patients ◽

Evidence Based ◽

Timing Of Initiation ◽

Evidence Based Guidelines

Nutrition has evolved into an integral part of modern critical care for both medical and surgical patients. Multiple international societies now issue evidence-based guidelines to help clinician optimize their patients’ Nutrition. However, adherence to these guidelines throughout the country is poor, and education in nutrition is still lagging in medical school. The authors also highlight four key areas where evidence-based recommendations exist – timing of initiation of enteral feeding, calculating and meeting total daily requirements, use of gastric residual volumes to guide delivery, and interuption of feeding for procedures – but are currently often not followed. Reasons for this lack of adherence are explored, and potential solutions discussed.

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PIN156 Knowledge of Intensive Care Nurses about the Evidence-Based Guidelines of Preventing Centralvenous Catheter Related Infection

Value in Health ◽

10.1016/j.jval.2020.08.997 ◽

2020 ◽

Vol 23 ◽

pp. S569-S570

Author(s):

V. Pacsai ◽

B. Szabó ◽

E. Kalamár-Birinyi ◽

L. Horváth ◽

I. Boncz ◽

...

Keyword(s):

Intensive Care ◽

Evidence Based ◽

Catheter Related Infection ◽

Intensive Care Nurses ◽

Evidence Based Guidelines

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Sedation and delirium

Challenging Concepts in Critical Care ◽

10.1093/med/9780198814924.003.0010 ◽

2019 ◽

pp. 145-160

Author(s):

Nim Pathmanathan ◽

Paul Nixon

Keyword(s):

Critical Care ◽

Intensive Care ◽

Case History ◽

Critical Care Unit ◽

Daily Practice ◽

Care Staff ◽

Evidence Based ◽

Standard Textbook ◽

Learning Points

This chapter is centred on a case study of sedation and delirium. This topic is one of the key challenging areas in critical care medicine and one that all intensive care staff will encounter. The chapter is based on a detailed case history, ensuring clinical relevance, together with relevant images, making this easily relatable to daily practice in the critical care unit. The chapter is punctuated by evidence-based, up-to-date learning points, which highlight key information for the reader. Throughout the chapter, a topic expert provides contextual advice and commentary, adding practical expertise to the standard textbook approach and reinforcing key messages.

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Decisions Made By Critical Care Nurses During Mechanical Ventilation and Weaning in an Australian Intensive Care Unit

American Journal of Critical Care ◽

10.4037/ajcc2007.16.5.434 ◽

2007 ◽

Vol 16 (5) ◽

pp. 434-443 ◽

Cited By ~ 21

Author(s):

Louise Rose ◽

Sioban Nelson ◽

Linda Johnston ◽

Jeffrey J. Presneill

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Critical Care ◽

Intensive Care ◽

Interdisciplinary Collaboration ◽

Multiple Organ ◽

Critical Care Nurses ◽

Royal Melbourne Hospital ◽

Adult Intensive Care Unit ◽

Fraction Of Inspired Oxygen

Background Responsibilities of critical care nurses for management of mechanical ventilation may differ among countries. Organizational interventions, including weaning protocols, may have a variable impact in settings that differ in nursing autonomy and interdisciplinary collaboration. Objective To characterize the role of Australian critical care nurses in the management of mechanical ventilation. Methods A 3-month, prospective cohort study was performed. All clinical decisions related to mechanical ventilation in a 24-bed, combined medical-surgical adult intensive care unit at the Royal Melbourne Hospital, a university-affiliated teaching hospital in Melbourne, Victoria, Australia, were determined. Results Of 474 patients admitted during the 81-day study period, 319 (67%) received mechanical ventilation. Death occurred in 12.5% (40/319) of patients. Median durations of mechanical ventilation and intensive care stay were 0.9 and 1.9 days, respectively. A total of 3986 ventilation and weaning decisions (defined as any adjustment to ventilator settings, including mode change; rate or pressure support adjustment; and titration of tidal volume, positive end-expiratory pressure, or fraction of inspired oxygen) were made. Of these, 2538 decisions (64%) were made by nurses alone, 693 (17%) by medical staff, and 755 (19%) by nurses and staff in collaboration. Decisions made exclusively by nurses were less common for patients with predominantly respiratory disease or multiple organ dysfunction than for other patients. Conclusions In this unit, critical care nurses have high levels of responsibility for, and autonomy in, the management of mechanical ventilation and weaning. Revalidation of protocols for ventilation practices in other clinical contexts may be needed.

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Acute kidney injury in pediatric patients: experience of a single center during an 11-year period

Medicina ◽

10.3390/medicina46080073 ◽

2010 ◽

Vol 46 (8) ◽

pp. 511 ◽

Cited By ~ 11

Author(s):

Birutė Pundzienė ◽

Diana Dobilienė ◽

Šarūnas Rudaitis

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Kidney Injury ◽

Pediatric Intensive Care ◽

Multiple Organ ◽

Multiple Organ Dysfunction ◽

Second Period

The aim of our study was to determine the causes of acute kidney injury (AKI) in children, to compare outcomes between two periods – 1998–2003 and 2004-2008 – and to evaluate the influence of new methods of renal replacement therapy on mortality. Material and methods. A retrospective analysis of medical record data of all children treated for AKI at the Clinic of Children Diseases, Hospital of Kaunas University of Medicine, during the period of 1998–2008 was made. Both periods were compared regarding various variables. Results. Of the 179 children with AKI, 75 (41.9%) were treated during 1998–2003 and 104 (58.1%) during 2004–2008. Primary glomerular disease and sepsis were the leading causes of AKI in both the periods. AKI without involvement of other organs was diagnosed for 106 (59.2%) children: for 42 (56.0%) children in the first period and 64 (61.5%) in the second. A total of 124 (69.3%) children were treated in a pediatric intensive care unit. Multiple organ dysfunction syndrome with AKI was diagnosed for 33 (44%) patients in the first period and for 40 (38.5%) in the second. A significant decrease in mortality among patients with multiple organ dysfunction syndrome during the second period was observed (78.8% vs. 37.5%). Conclusions. More than half of patients had secondary acute kidney injury of nonrenal origin. More than two-thirds (69.3%) of patients with AKI were treated in the pediatric intensive care unit. Multiple organ dysfunction syndrome was diagnosed for 40.8% of children with AKI. Renal replacement therapy was indicated for one-third of patients with AKI. A 2.5-fold decrease in mortality was observed in the second period as compared to the first one.

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Enteral Nutrition in the Prevention and Treatment of Pressure Ulcers in Adult Critical Care Patients

Critical Care Nurse ◽

10.4037/ccn2014950 ◽

2014 ◽

Vol 34 (6) ◽

pp. 15-27 ◽

Cited By ~ 7

Author(s):

Jill Cox ◽

Louisa Rasmussen

Keyword(s):

Wound Healing ◽

Critical Care ◽

Nutritional Status ◽

Pressure Ulcers ◽

Burden Of Illness ◽

Evidence Based ◽

Adequate Nutrition ◽

Nutritional Guidelines ◽

Registered Dietician ◽

Critical Care Patients

Prevention and healing of pressure ulcers in critically ill patients can be especially challenging because of the patients’ burden of illness and degree of physiological compromise. Providing adequate nutrition may help halt the development or worsening of pressure ulcers. Optimization of nutrition can be considered an essential ingredient in prevention and healing of pressure ulcers. Understanding malnutrition in critical care patients, the effect of nutrition on wound healing, and the application of evidence-based nutritional guidelines are important aspects for patients at high risk for pressure ulcers. Appropriate screenings for nutritional status and risk for pressure ulcers, early collaboration with a registered dietician, and administration of appropriate feeding formulations and micronutrient and macronutrient supplementation to promote wound healing are practical solutions to improve the nutritional status of critical care patients. Use of nutritional management and enteral feeding protocols may provide vital elements to augment nutrition and ultimately result in improved clinical outcomes.

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The Impact of Changes to an Electronic Admission Order Set on Prescribing and Clinical Outcomes in the Intensive Care Unit

Applied Clinical Informatics ◽

10.1055/s-0040-1702215 ◽

2020 ◽

Vol 11 (01) ◽

pp. 182-189

Author(s):

Ellen T. Muniga ◽

Todd A. Walroth ◽

Natalie C. Washburn

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Clinical Outcomes ◽

Prescribing Patterns ◽

Number Of Patients ◽

Order Sets ◽

Critical Care Admission ◽

The Impact ◽

Order Set

Abstract Background Implementation of disease-specific order sets has improved compliance with standards of care for a variety of diseases. Evidence of the impact admission order sets can have on care is limited. Objective The main purpose of this article is to evaluate the impact of changes made to an electronic critical care admission order set on provider prescribing patterns and clinical outcomes. Methods A retrospective, observational before-and-after exploratory study was performed on adult patients admitted to the medical intensive care unit using the Inpatient Critical Care Admission Order Set. The primary outcome measure was the percentage change in the number of orders for scheduled acetaminophen, a histamine-2 receptor antagonist (H2RA), and lactated ringers at admission before implementation of the revised order set compared with after implementation. Secondary outcomes assessed clinical impact of changes made to the order set. Results The addition of a different dosing strategy for a medication already available on the order set (scheduled acetaminophen vs. as needed acetaminophen) had no impact on physician prescribing (0 vs. 0%, p = 1.000). The addition of a new medication class (an H2RA) to the order set significantly increased the number of patients prescribed an H2RA for stress ulcer prophylaxis (0 vs. 20%, p < 0.001). Rearranging the list of maintenance intravenous fluids to make lactated ringers the first fluid option in place of normal saline significantly decreased the number of orders for lactated ringers (17 vs. 4%, p = 0.005). The order set changes had no significant impact on clinical outcomes such as incidence of transaminitis, gastrointestinal bleed, and acute kidney injury. Conclusion Making changes to an admission order set can impact provider prescribing patterns. The type of change made to the order set, in addition to the specific medication changed, may have an effect on how influential the changes are on prescribing patterns.

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