scholarly journals Impact of Early Mobility of ABCDEF Bundle on Delirium

2020 ◽  
Author(s):  
Brent Medeiros
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Critical Appraisal ◽  
Advanced Practice ◽  
Inclusion Criteria ◽  
Early Mobility ◽  
Abcdef Bundle ◽  
The Impact

A systematic review was performed utilizing the PRISMA checklist to evaluate the impact of early mobility of the ABCDEF bundle on delirium in critically-ill patients. Critical appraisal of the research utilizing CASP and cross analysis was performed of 5 studies that met inclusion criteria revealing two statistically significant results on the impact of early mobility on delirium. Summary and conclusion as well as recommendations for application within the advanced practice role were included.

scholarly journals The Impact of Pain Assessment on Critically Ill Patients’ Outcomes: A Systematic Review

2015 ◽  
Vol 2015 ◽  
pp. 1-18 ◽  
Author(s):  
Evanthia Georgiou ◽  
Maria Hadjibalassi ◽  
Ekaterini Lambrinou ◽  
Panayiota Andreou ◽  
Elizabeth D. E. Papathanassoglou
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Quality Assessment ◽  
Critically Ill ◽  
Pain Assessment ◽  
Critically Ill Patients ◽  
Methodological Quality ◽  
Assessment Tools ◽  
Current Evidence ◽  
The Impact

In critically ill patients, pain is a major problem. Efficient pain management depends on a systematic, comprehensive assessment of pain. We aimed to review and synthesize current evidence on the impact of a systematic approach to pain assessment on critically ill patients’ outcomes. A systematic review of published studies (CINAHL, PUBMED, SCOPUS, EMBASE, and COCHRANE databases) with predetermined eligibility criteria was undertaken. Methodological quality was assessed by the EPHPP quality assessment tool. A total of 10 eligible studies were identified. Due to big heterogeneity, quantitative synthesis was not feasible. Most studies indicated the frequency, duration of pain assessment, and types of pain assessment tools. Methodological quality assessment yielded “strong” ratings for 5/10 and “weak” ratings for 3/10 studies. Implementation of systematic approaches to pain assessment appears to associate with more frequent documented reports of pain and more efficient decisions for pain management. There was evidence of favorable effects on pain intensity, duration of mechanical ventilation, length of ICU stay, mortality, adverse events, and complications. This systematic review demonstrates a link between systematic pain assessment and outcome in critical illness. However, the current level of evidence is insufficient to draw firm conclusions. More high quality randomized clinical studies are needed.

scholarly journals Prediction models for acute kidney injury in critically ill patients: a protocol for systematic review and critical appraisal

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e046274
Author(s):  
Danqiong Wang ◽  
Weiwen Zhang ◽  
Jian Luo ◽  
Honglong Fang ◽  
Shanshan Jing ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Critical Appraisal ◽  
Prediction Models ◽  
External Validation ◽  
Kidney Injury ◽  
Risk Of Bias

IntroductionAcute kidney injury (AKI) has high morbidity and mortality in intensive care units, which can lead to chronic kidney disease, more costs and longer hospital stay. Early identification of AKI is crucial for clinical intervention. Although various risk prediction models have been developed to identify AKI, the overall predictive performance varies widely across studies. Owing to the different disease scenarios and the small number of externally validated cohorts in different prediction models, the stability and applicability of these models for AKI in critically ill patients are controversial. Moreover, there are no current risk-classification tools that are standardised for prediction of AKI in critically ill patients. The purpose of this systematic review is to map and assess prediction models for AKI in critically ill patients based on a comprehensive literature review.Methods and analysisA systematic review with meta-analysis is designed and will be conducted according to the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS). Three databases including PubMed, Cochrane Library and EMBASE from inception through October 2020 will be searched to identify all studies describing development and/or external validation of original multivariable models for predicting AKI in critically ill patients. Random-effects meta-analyses for external validation studies will be performed to estimate the performance of each model. The restricted maximum likelihood estimation and the Hartung-Knapp-Sidik-Jonkman method under a random-effects model will be applied to estimate the summary C statistic and 95% CI. 95% prediction interval integrating the heterogeneity will also be calculated to pool C-statistics to predict a possible range of C-statistics of future validation studies. Two investigators will extract data independently using the CHARMS checklist. Study quality or risk of bias will be assessed using the Prediction Model Risk of Bias Assessment Tool.Ethics and disseminationEthical approval and patient informed consent are not required because all information will be abstracted from published literatures. We plan to share our results with clinicians and publish them in a general or critical care medicine peer-reviewed journal. We also plan to present our results at critical care international conferences.OSF registration number10.17605/OSF.IO/X25AT.

scholarly journals Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Eleni Papoutsi ◽  
Vassilis G. Giannakoulis ◽  
Eleni Xourgia ◽  
Christina Routsi ◽  
Anastasia Kotanidou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
All Cause Mortality ◽  
Detectable Difference

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

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