scholarly journals Use of matching methods in observational studies with critical patients and renal outcomes. Scoping review

2020 ◽  
Vol 49 (2) ◽  
Author(s):  
Henry Oliveros Rodríguez ◽  
Giancarlo Buitrago ◽  
Paola Castellanos Saavedra
Keyword(s):  
Critically Ill ◽  
Scoping Review ◽  
Observational Studies ◽  
Pharmacological Intervention ◽  
Critically Ill Patient ◽  
Renal Outcomes ◽  
Matching Methods ◽  
Critical Patients ◽  
Clinical Experiments ◽  
Matching Techniques

Introduction: The use of matching techniques in observational studies has been increasing and is not always used appropriately. Clinical experiments are not always feasible in critical patients with renal outcomes, and observational studies are an important alternative. Objective: Through a scoping review, determine the available evidence on the use of matching methods in studies involving critically ill patients and assessing renal outcomes. Methods: Medline, Embase, and Cochrane databases were used to identify articles published between 1992 and 2020 up to week 10, which studied different exposures in the critically ill patient with renal outcomes and used propensity matching methods. Results: Most publications are cohort studies 94 (94. 9 %), five studies (5. 1 %) were cross-sectional. The main pharmacological intervention was the use of antibiotics in seven studies (7. 1%) and the main risk factor studied was renal injury prior to ICU admission in 10 studies (10. 1%). The balance between the baseline characteristics assessed by standardized means, in only 28 studies (28. 2%). Most studies 95 (96 %) used logistic regression to calculate the propensity index. Conclusion: Major inconsistencies were observed in the use of methods and in the reporting of findings. A summary is made of the aspects to be considered in the use of the methods and reporting of the findings with the matching by propensity index.

scholarly journals Checklist para o transporte intra-hospitalar seguro do doente crítico: A scoping review

2020 ◽  
Vol 19 (4) ◽  
pp. 525-572
Author(s):  
Madalena Canellas ◽  
Isabel Palma ◽  
Patrícia Pontífice-Sousa ◽  
Isabel Rabiais
Keyword(s):  
Patient Safety ◽  
Critically Ill ◽  
Scoping Review ◽  
Critically Ill Patients ◽  
Full Text ◽  
Scientific Evidence ◽  
Critically Ill Patient ◽  
Intrahospital Transport ◽  
Preparation Phase ◽  
Critical Patients

Transportar a un paciente crítico conlleva una serie de riesgos que pueden poner en peligro su seguridad. Conocer los riesgos asociados con el transporte intrahospitalario es esencial para mejorar su seguridad. Elegimos estudiar la lista de verificación de transporte intrahospitalario, ya que la literatura los describe como una forma práctica y simple de aumentar la seguridad.Objetivo: Mapear la envidencia científica existente sobre los aspectos del check list o lista de verificación garantizando la seguridad del paciente crítico en el transporte intrahospitalario. Material y método: Se realizó un scoping review através de la metodologia The Joanna Briggs Institute, utilizando los motores de búsqueda EBSCOhost y B-on. La investigación fue realizada en portugués, inglés y español. Fueron seleccionados artículos con texto libre, sin límite de tiempo. Los criterios incluídos: el paciente crítico adulto/anciano, transporte intrahospitalario, la lista de verificación y la seguridad del paciente.Resultados: Se incluyeron 7 artículos. La mayoría de los aspectos de la lista de verificación se enfoca en la preparación del transporte, el aspecto que más se menciona es la monitorización del paciente. La parte después del transporte, aspectos de la lista de verificación solo es mencionada en 3 de los 7 artículos.Conclusión: Todos los estudios constatan aspectos que pueden incluírse en una lista de verificación y que mejoran la seguridad de los pacientes críticos en el transporte intrahospitalario. No hay unanimidad en cuanto a qué aspectos incluir en la lista de verificación. Transporting critically ill patients is has a set of risks that may jeopardize their safety. Knowing the risks associated with intrahospitalar transport of critically ill patients is essential to improving patient safety. For the sake of improving patient safety, was chosen to approach it as an intrahospitalar transport checklist, as the literature describes it as a practical and simple way to increase safety.Objective: Map available scientific evidence regarding aspects of a checklist that ensure the safety of critically ill patients in intrahospitalar transport.Material and Method: A scoping review was performed following the methodology proposed by The Joanna Briggs Institute in databases using the EBSCOhost and B-on search engines. Conducted research in Portuguese, English, and Spanish. Selected free full text articles, with no time limit. Inclusion criteria: adult/elderly critically ill patient, intrahospital transport, a checklist and patient safety.Results: Included 7 articles for analysis. Most verification requests that ensure the safety of critical patients on intrahospitalar transport concern the transport preparation phase, in which patient is monitored was the most mentioned aspect. From the post-transportation phase, checklist aspects are only available in 3 of 7 articles Conclusion: All studies address aspects that improve the safety of critically ill patients in intrahospitalar transport and are likely to be included in the checklist. There is no unanimity as to which aspects to include in the checklist. O transporte do doente crítico acarreta um conjunto de riscos para a sua segurança. Conhecer os riscos associados ao transporte intra-hospitalar do doente crítico é essencial para melhorar a segurança do mesmo. Optou-se por abordar a checklist de transporte intra-hospitalar, uma vez que a literatura a descreve como uma forma prática e simples de aumentar a segurança.Objetivo: Mapear a evidência científica disponível referente aos aspetos de uma checklist que garantem a segurança do doente crítico no transporte intra-hospitalar.Material e Método: Realizou-se uma scoping review recorrendo à metodologia do The Joanna Briggs Institute, nas bases de dados utilizando os motores de busca EBSCOhost e B-on. Realizada pesquisa em Português, Inglês e Espanhol. Selecionados artigos free full text, sem limite temporal. Critérios de inclusão: o doente crítico adulto/idoso, o transporte intra-hospitalar, a checklist e a segurança do doente.Resultados: Foram incluídos 7 artigos. A maioria dos aspetos da checklist que garantem a segurança do doente crítico no transporte intra-hospitalar, dizem respeito à fase da preparação do transporte, na qual o aspeto mais mencionado é a monitorização do doente. Da fase posterior ao transporte, aspetos da checklist apenas são mencionados em 3 dos 7 artigos.Conclusão: Todos os estudos abordam aspetos que são passíveis de incluir em checklist e melhoram a segurança do doente. Não existe unanimidade quanto aos aspetos a incluir na checklist do transporte intra-hospitalar.

scholarly journals The Epistemology of Swarming in Patient Care: An Innovative Approach to Admitting Patients into Intensive Care Units

2021 ◽  
pp. 41-43
Author(s):  
Aretha D Miller ◽  
Cheryl Stephenson
Keyword(s):  
Patient Care ◽  
Critically Ill ◽  
Systematic Approach ◽  
Critically Ill Patient ◽  
Healthcare Team ◽  
Admission Process ◽  
Limits Of Knowledge ◽  
History Of ◽  
Critical Patients ◽  
To Receive

Epistemology is the branch of philosophy that addresses cognitive sciences, the history of science and cultural studies. It investigates the origin, methods, nature and limits of knowledge and seeks to determine what we know and how we know it. It is also used to determine truth or falsehoods as we strive to acquire knowledge. This review examined the epistemology of Swarming in patient care, following the SQUIRE guidelines. No best practices exist on how to SWARM patients, yet this process is performed by frontline nurses daily. Four examples of Swarming were examined and a systematic approach on how to SWARM critically ill patients in the admission process into ICUs was recommended. Tasks needed once the patient arrives into the ICU suite are for the primary RN to receive bedside report from the healthcare team and log into the Electronic Health Record to start the admission note. A checklist was introduced to streamline tasks with the goal to reduce the number of chores to be performed by the primary RN, thus freeing up time for assessments of the critically ill patient. This work strives to improve efficiency in the workflow of the ICU admission process, by improving communication amongst the team via practice and a consistent approach to admitting critical patients.

Venous Thromboembolism Prophylaxis: A Narrative Review With a Focus on the High-Risk Critically Ill Patient

2018 ◽  
Vol 34 (11-12) ◽  
pp. 877-888 ◽  
Author(s):  
Tyler C. Lewis ◽  
Jennifer Cortes ◽  
Diana Altshuler ◽  
John Papadopoulos
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Observational Studies ◽  
Health Concern ◽  
Fixed Dose ◽  
Critically Ill Patient ◽  
Increased Risk

Venous thromboembolism (VTE) is a major health concern associated with significant morbidity and mortality. Critically ill patients are at an increased risk of VTE compared to general medical patients due to unique risk factors: prolonged immobilization, invasive lines and devices, certain medications, and acquired thrombophilia. Furthermore, VTE in the critically ill is associated with increased duration of mechanical ventilation, increased length of intensive care unit and hospital stay, and a trend toward increased mortality. Clinical practice guidelines therefore recommend VTE prophylaxis with either subcutaneous heparin or low-molecular-weight heparin for all critically ill patients without contraindication. Yet, many patients will develop VTE despite appropriate pharmacologic prophylaxis, which has led to interest in risk-stratifying critically ill patients for more aggressive prophylaxis strategies. Recent research identified patients at highest risk of failure of thromboprophylaxis and provided insight into the pathophysiologic mechanisms. Obesity and the receipt of vasopressors are 2 risk factors consistently identified in observational studies; further clinical data support decreased absorption of anticoagulant administered via the subcutaneous route as the likely mechanism behind thromboprophylaxis failure in these patient populations. Several studies have investigated novel thromboprophylaxis strategies to circumvent pharmacokinetic limitations in patients who are obese or on vasopressors: increased fixed-dose, weight-based subcutaneous, or continuous intravenous infusion of a prophylactic dose of anticoagulant has shown promise in limited studies; however, the results have yet to demonstrate superiority compared to current standard-of-care. This review discusses observational studies identifying patients at risk of thromboprophylaxis failure and critiques clinical studies evaluating novel thromboprophylaxis strategies in high-risk, critically ill patients with a focus on their limitations. Future studies are currently being conducted that will provide further guidance into the appropriate use of individualized thromboprophylaxis.

scholarly journals Estrategias de optimización de uso de betalactámicos

2019 ◽  
Vol 11 (9) ◽  
pp. 3
Author(s):  
Luisa Maria Charco Roca ◽  
José María Jiménez Vizuete ◽  
Antonio Ayelo Navarro
Keyword(s):  
Critically Ill ◽  
Early Treatment ◽  
Plasma Concentrations ◽  
Critically Ill Patient ◽  
Beta Lactams ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Pharmacodynamic Profile ◽  
Multiresistant Bacteria ◽  
Abstract Optimization ◽  
Critical Patients

Se han propuesto varias estrategias de mejora con la finalidad de optimizar el uso de antibióticos en los pacientes críticos. Entre ellas destacan la de-escalada, el ciclado, el tratamiento anticipado o el uso de parámetros farmacocinéticos/farmacodinámicos para ajustar la dosificación. Las alteraciones fisiopatológicas que ocurren en el paciente crítico condicionan la farmacocinética y la farmacodinamia de los antibióticos, especialmente de los betalactámicos. Por ello,  la predicción del resultado antimicrobiano basado en sus concentraciones plasmáticas, puede ser muy difícil de establecer en el lugar de acción, debido a dichas alteraciones, pudiendo tener esto consecuencias clínicamente relevantes. Se puede mejorar el perfil farmacodinámico de los betalactámicos, mediante una exposición más prolongada con dosis más frecuentes o con infusiones continuas o extendidas, especialmente para tratar bacterias multirresistentes. ABSTRACT OPTIMIZATION STRATEGIES FOR THE USE OF BETA -LACTAMS. The importance of the pathophysiological peculiarities in the critically ill patient. There are several  strategies aimed at improving the use of antibiotics in critical patients. These strategies include de-escalation, cycling, early treatment or the use of pharmacokinetic / pharmacodynamic parameters to adjust the dosage. The pathophysiological changes that occur in the critical patient can condition the pharmacokinetics and pharmacodynamics paramethers of antibiotics, especially in beta-lactams. Therefore, anticipating the antimicrobial result based on their plasma concentrations in the place of action can be very difficult to establish, which, in turn, may have clinically relevant consequences. The pharmacodynamic profile of beta-lactams can be improved, through longer exposure with more frequent doses or with continuous or extended infusions, especially to treat multiresistant bacteria.

The timing of tracheostomy in critically ill patient

ORL ro ◽  
2017 ◽  
Vol 2 (35) ◽  
pp. 20
Author(s):  
Liliana Mirea ◽  
Raluca Ungureanu ◽  
Daniel Mirea ◽  
Mirela Țigliș ◽  
Ioana Cristina Grințescu ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patient

scholarly journals Impact of Renal Replacement Therapy on Mortality in Critically Ill Patients—The Nephrologist’s View within an Interdisciplinary Intensive Care Team

2021 ◽  
Vol 10 (15) ◽  
pp. 3379
Author(s):  
Matthias Klingele ◽  
Lea Baerens
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Impact ◽  
Kidney Injury ◽  
Care Team ◽  
Critically Ill Patient ◽  
Late Start

Acute kidney injury (AKI) is a common complication in critically ill patients with an incidence of up to 50% in intensive care patients. The mortality of patients with AKI requiring dialysis in the intensive care unit is up to 50%, especially in the context of sepsis. Different approaches have been undertaken to reduce this high mortality by changing modalities and techniques of renal replacement therapy: an early versus a late start of dialysis, high versus low dialysate flows, intermittent versus continuous dialysis, anticoagulation with citrate or heparin, the use of adsorber or special filters in case of sepsis. Although in smaller studies some of these approaches seemed to have a positive impact on the reduction of mortality, in larger studies these effects could not been reproduced. This raises the question of whether there exists any impact of renal replacement therapy on mortality in critically ill patients—beyond an undeniable impact on uremia, hyperkalemia and/or hypervolemia. Indeed, this is one of the essential challenges of a nephrologist within an interdisciplinary intensive care team: according to the individual situation of a critically ill patient the main indication of dialysis has to be identified and all parameters of dialysis have to be individually chosen with respect to the patient’s situation and targeting the main dialysis indication. Such an interdisciplinary and individual approach would probably be able to reduce mortality in critically ill patients with dialysis requiring AKI.

scholarly journals UK consultants’ experiences of the decision-making process around referral to intensive care: an interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044752
Author(s):  
Kaja Heidenreich ◽  
Anne-Marie Slowther ◽  
Frances Griffiths ◽  
Anders Bremer ◽  
Mia Svantesson
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Moral Responsibility ◽  
Critically Ill ◽  
Interpersonal Relationships ◽  
Qualitative Interviews ◽  
Working Environment ◽  
Critically Ill Patient ◽  
Decision Making Process ◽  
Moral Duties

ObjectiveThe decision whether to initiate intensive care for the critically ill patient involves ethical questions regarding what is good and right for the patient. It is not clear how referring doctors negotiate these issues in practice. The aim of this study was to describe and understand consultants’ experiences of the decision-making process around referral to intensive care.DesignQualitative interviews were analysed according to a phenomenological hermeneutical method.Setting and participantsConsultant doctors (n=27) from departments regularly referring patients to intensive care in six UK hospitals.ResultsIn the precarious and uncertain situation of critical illness, trust in the decision-making process is needed and can be enhanced through the way in which the process unfolds. When there are no obvious right or wrong answers as to what ought to be done, how the decision is made and how the process unfolds is morally important. Through acknowledging the burdensome doubts in the process, contributing to an emerging, joint understanding of the patient’s situation, and responding to mutual moral duties of the doctors involved, trust in the decision-making process can be enhanced and a shared moral responsibility between the stake holding doctors can be assumed.ConclusionThe findings highlight the importance of trust in the decision-making process and how the relationships between the stakeholding doctors are crucial to support their moral responsibility for the patient. Poor interpersonal relationships can damage trust and negatively impact decisions made on behalf of a critically ill patient. For this reason, active attempts must be made to foster good relationships between doctors. This is not only important to create a positive working environment, but a mechanism to improve patient outcomes.

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