Lung ultrasonic B-lines have high accuracy in diagnosing extravascular lung water (ELW) but have not been systematically subcategorized to differentiate the varied etiologies of ELW. This brief communication describes subcategories of B-lines into "inflammatory" and "transudative" patterns, based on their location, pleural morphology and associated subpleural pathologies. This subcategorization was derived using information from trainees undergoing lung ultrasound training in the Learning Ultrasound in Critical Care program, pathophysiological principles and their corresponding ultrasound correlates. This subcategorization helped trainees differentiate inflammatory pathologies of ELW (e.g. pneumonia, acute respiratory distress syndrome) from transudative (congestive) pathologies (e.g. fluid overload, cardiac failure).
肺部超声 B 线在诊断血管外肺水（ELW）方面具有很高的准确性，但尚未对其进行系统的细分，以区分 ELW 的不同病因。本简讯根据 B 线的位置、胸膜形态和相关胸膜下病变，将其细分为 "炎症性 "和 "渗出性 "两种模式。这一分类是根据在重症监护超声学习项目中接受肺部超声培训的学员提供的信息、病理生理学原理及其相应的超声相关性得出的。这种亚分类有助于受训者区分 ELW 的炎症性病变（如肺炎、急性呼吸窘迫综合征）和渗出性（充血）病变（如体液超负荷、心力衰竭）。
{"title":"Inflammatory and transudative B-line patterns on lung ultrasound: a brief communication.","authors":"Arvind Rajamani, Anwar Hassan, Pranav Arun Bharadwaj, Hemamalini Arvind, Stephen Huang","doi":"10.1177/17511437241259438","DOIUrl":"https://doi.org/10.1177/17511437241259438","url":null,"abstract":"<p><p>Lung ultrasonic B-lines have high accuracy in diagnosing extravascular lung water (ELW) but have not been systematically subcategorized to differentiate the varied etiologies of ELW. This brief communication describes subcategories of B-lines into \"inflammatory\" and \"transudative\" patterns, based on their location, pleural morphology and associated subpleural pathologies. This subcategorization was derived using information from trainees undergoing lung ultrasound training in the <i>Learning Ultrasound in Critical Care</i> program, pathophysiological principles and their corresponding ultrasound correlates. This subcategorization helped trainees differentiate inflammatory pathologies of ELW (e.g. pneumonia, acute respiratory distress syndrome) from transudative (congestive) pathologies (e.g. fluid overload, cardiac failure).</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"25 4","pages":"410-412"},"PeriodicalIF":2.1,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01Epub Date: 2024-02-05DOI: 10.1177/17511437231216675
Kamran Abbasi, Parveen Ali, Virginia Barbour, Thomas Benfield, Kirsten Bibbins-Domingo, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Robert Mash, Peush Sahni, Wadeia Mohammad Sharief, Paul Yonga, Chris Zielinski
{"title":"Time to treat the climate and nature crisis as one indivisible global health emergency.","authors":"Kamran Abbasi, Parveen Ali, Virginia Barbour, Thomas Benfield, Kirsten Bibbins-Domingo, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Robert Mash, Peush Sahni, Wadeia Mohammad Sharief, Paul Yonga, Chris Zielinski","doi":"10.1177/17511437231216675","DOIUrl":"https://doi.org/10.1177/17511437231216675","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"25 1","pages":"13-15"},"PeriodicalIF":2.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01Epub Date: 2023-06-20DOI: 10.1177/17511437231182507
Nicholas David Richards, William Weatherhead, Simon Howell, Mark Bellamy, Ruben Mujica-Mota
Introduction: Mechanical ventilation (MV) is a common and often live-saving intervention on the Intensive Care Unit (ICU). The optimisation of sedation to mechanical ventilation is fundamental, and inappropriate sedation has been associated with worse outcomes. This scoping review has been designed to answer the question 'What is known about the use of ketamine as a continuous infusion to provide sedation in mechanically ventilated adults in the intensive care unit, and what are the gaps in the evidence?'
Methods: The protocol was designed using the PRISMA-ScR checklist and the JBI manual for evidence synthesis. Data were extracted and reviewed by a minimum of two reviewers.
Results: Searches of electronic databases (PubMed, OVID, Scopus, Web of Science) produced 726 results; 45 citations were identified for further eligibility assessment, an additional five studies were identified through keyword searches, and 12 through searching reference lists. Of these 62 studies, 27 studies were included in the final review: 6 case reports/case series, 11 retrospective cohort/observational studies, 1 prospective cohort study, 9 prospective randomised studies.
Conclusion: We found a lack of high-quality well-designed studies investigating the use of continuous ketamine sedation on ICU. The available data suggests this intervention is safe and well tolerated, however this is of very low certainty given the poor quality of evidence.
机械通气(MV)是重症监护病房(ICU)常见的救命干预手段。优化镇静对机械通气是基本的，不适当的镇静与较差的结果相关。本综述旨在回答以下问题:“对于重症监护病房中使用氯胺酮作为持续输注以提供镇静作用，我们知道些什么?证据中的空白是什么?”该方案使用PRISMA-ScR检查表和JBI证据合成手册进行设计。数据由至少两名审稿人提取和审查。对电子数据库(PubMed, OVID, Scopus, Web of Science)的搜索产生了726个结果;通过关键词检索确定了另外5项研究，通过参考文献列表检索确定了12项研究。在这62项研究中，有27项研究被纳入最终综述:6项病例报告/病例系列，11项回顾性队列/观察性研究，1项前瞻性队列研究，9项前瞻性随机研究。我们发现缺乏高质量的精心设计的研究来调查在ICU中使用持续氯胺酮镇静的情况。现有数据表明，这种干预是安全且耐受性良好的，然而，由于证据质量较差，这是非常低的确定性。
{"title":"Continuous infusion ketamine for sedation of mechanically ventilated adults in the intensive care unit: A scoping review.","authors":"Nicholas David Richards, William Weatherhead, Simon Howell, Mark Bellamy, Ruben Mujica-Mota","doi":"10.1177/17511437231182507","DOIUrl":"10.1177/17511437231182507","url":null,"abstract":"<p><strong>Introduction: </strong>Mechanical ventilation (MV) is a common and often live-saving intervention on the Intensive Care Unit (ICU). The optimisation of sedation to mechanical ventilation is fundamental, and inappropriate sedation has been associated with worse outcomes. This scoping review has been designed to answer the question '<i>What is known about the use of ketamine as a continuous infusion to provide sedation in mechanically ventilated adults in the intensive care unit, and what are the gaps in the evidence?'</i></p><p><strong>Methods: </strong>The protocol was designed using the PRISMA-ScR checklist and the JBI manual for evidence synthesis. Data were extracted and reviewed by a minimum of two reviewers.</p><p><strong>Results: </strong>Searches of electronic databases (PubMed, OVID, Scopus, Web of Science) produced 726 results; 45 citations were identified for further eligibility assessment, an additional five studies were identified through keyword searches, and 12 through searching reference lists. Of these 62 studies, 27 studies were included in the final review: 6 case reports/case series, 11 retrospective cohort/observational studies, 1 prospective cohort study, 9 prospective randomised studies.</p><p><strong>Conclusion: </strong>We found a lack of high-quality well-designed studies investigating the use of continuous ketamine sedation on ICU. The available data suggests this intervention is safe and well tolerated, however this is of very low certainty given the poor quality of evidence.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"1 1","pages":"59-77"},"PeriodicalIF":2.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41869914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-28eCollection Date: 2024-05-01DOI: 10.1177/17511437231218199
Aravind V Ramesh, Henry Np Munby, Matt Thomas
Background: Fragility analysis supplements the p-value and risk of bias assessment in the interpretation of results of randomised controlled trials. In this systematic review we determine the fragility index (FI) and fragility quotient (FQ) of randomised trials in aneurysmal subarachnoid haemorrhage.
Methods: This is a systematic review registered with PROSPERO (ID: CRD42020173604). Randomised controlled trials in adults with aneurysmal subarachnoid haemorrhage were analysed if they reported a statistically significant primary outcome of mortality, function (e.g. modified Rankin Scale), vasospasm or delayed neurological deterioration.
Results: We identified 4825 records with 18 randomised trials selected for analysis. The median fragility index was 2.5 (inter-quartile range 0.25-5) and the median fragility quotient was 0.015 (IQR 0.02-0.039). Five of 20 trial outcomes (25%) had a fragility index of 0. In seven trials (39.0%), the number of participants lost to follow-up was greater than or equal to the fragility index. Only 16.7% of trials are at low risk of bias.
Conclusion: Randomised controlled trial evidence supporting management of aneurysmal subarachnoid haemorrhage is weaker than indicated by conventional analysis using p-values alone. Increased use of fragility analysis by clinicians and researchers could improve the translation of evidence to practice.
{"title":"The fragility index in randomised controlled trials of interventions for aneurysmal subarachnoid haemorrhage: A systematic review.","authors":"Aravind V Ramesh, Henry Np Munby, Matt Thomas","doi":"10.1177/17511437231218199","DOIUrl":"10.1177/17511437231218199","url":null,"abstract":"<p><strong>Background: </strong>Fragility analysis supplements the <i>p</i>-value and risk of bias assessment in the interpretation of results of randomised controlled trials. In this systematic review we determine the fragility index (FI) and fragility quotient (FQ) of randomised trials in aneurysmal subarachnoid haemorrhage.</p><p><strong>Methods: </strong>This is a systematic review registered with PROSPERO (ID: CRD42020173604). Randomised controlled trials in adults with aneurysmal subarachnoid haemorrhage were analysed if they reported a statistically significant primary outcome of mortality, function (e.g. modified Rankin Scale), vasospasm or delayed neurological deterioration.</p><p><strong>Results: </strong>We identified 4825 records with 18 randomised trials selected for analysis. The median fragility index was 2.5 (inter-quartile range 0.25-5) and the median fragility quotient was 0.015 (IQR 0.02-0.039). Five of 20 trial outcomes (25%) had a fragility index of 0. In seven trials (39.0%), the number of participants lost to follow-up was greater than or equal to the fragility index. Only 16.7% of trials are at low risk of bias.</p><p><strong>Conclusion: </strong>Randomised controlled trial evidence supporting management of aneurysmal subarachnoid haemorrhage is weaker than indicated by conventional analysis using <i>p</i>-values alone. Increased use of fragility analysis by clinicians and researchers could improve the translation of evidence to practice.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"25 2","pages":"164-170"},"PeriodicalIF":2.7,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11086711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-28DOI: 10.1177/17511437231217877
A. Warren, Philip McCall, Alastair Proudfoot, Stuart Gillon, Ahmad Abu-Arafeh, A. McKnight, Rosemary Mudie, David Armstrong, E. Tzolos, J. Livesey, A. Sinclair, Veronica Baston, Jonathan Dalzell, Deborah Owen, Lucy Fleming, I. Scott, A. Puxty, Matthew M Y Lee, Fiona Walker, Simon Hobson, Euan Campbell, Michael Kinsella, Eilidh McGinnigle, Robert B. Docking, Grant Price, Alex Ramsay, Richard Bauld, Suzanne Herron, Nazir I Lone, Nicholas L Mills, Louise Hartley
Despite high rates of cardiovascular disease in Scotland, the prevalence and outcomes of patients with cardiogenic shock are unknown. We undertook a prospective observational cohort study of consecutive patients with cardiogenic shock admitted to the intensive care unit (ICU) or coronary care unit at 13 hospitals in Scotland for a 6-month period. Denominator data from the Scottish Intensive Care Society Audit Group were used to estimate ICU prevalence; data for coronary care units were unavailable. We undertook multivariable logistic regression to identify factors associated with in-hospital mortality. In total, 247 patients with cardiogenic shock were included. After exclusion of coronary care unit admissions, this comprised 3.0% of all ICU admissions during the study period (95% confidence interval [CI] 2.6%–3.5%). Aetiology was acute myocardial infarction (AMI) in 48%. The commonest vasoactive treatment was noradrenaline (56%) followed by adrenaline (46%) and dobutamine (40%). Mechanical circulatory support was used in 30%. Overall in-hospital mortality was 55%. After multivariable logistic regression, age (odds ratio [OR] 1.04, 95% CI 1.02–1.06), admission lactate (OR 1.10, 95% CI 1.05–1.19), Society for Cardiovascular Angiographic Intervention stage D or E at presentation (OR 2.16, 95% CI 1.10–4.29) and use of adrenaline (OR 2.73, 95% CI 1.40–5.40) were associated with mortality. In Scotland the prevalence of cardiogenic shock was 3% of all ICU admissions; more than half died prior to discharge. There was significant variation in treatment approaches, particularly with respect to vasoactive support strategy.
尽管苏格兰的心血管疾病发病率很高，但心源性休克患者的发病率和预后却不为人知。我们对苏格兰 13 家医院重症监护室（ICU）或冠心病监护室连续收治的心源性休克患者进行了为期 6 个月的前瞻性队列观察研究。我们使用苏格兰重症监护协会审计小组提供的分母数据来估算重症监护病房的发病率；冠心病监护病房的数据不详。我们进行了多变量逻辑回归，以确定与院内死亡率相关的因素。总共纳入了 247 名心源性休克患者。在排除冠心病监护病房收治的患者后，这些患者占研究期间所有入住 ICU 患者的 3.0%（95% 置信区间 [CI]：2.6%-3.5%）。48%的病因是急性心肌梗死（AMI）。最常见的血管活性疗法是去甲肾上腺素（56%），其次是肾上腺素（46%）和多巴酚丁胺（40%）。30%的患者使用了机械循环支持。院内总死亡率为 55%。经过多变量逻辑回归，年龄（几率比 [OR] 1.04，95% CI 1.02-1.06）、入院乳酸（OR 1.10，95% CI 1.05-1.19）、发病时心血管造影介入学会 D 或 E 期（OR 2.16，95% CI 1.10-4.29）和肾上腺素的使用（OR 2.73，95% CI 1.40-5.40）与死亡率有关。在苏格兰，心源性休克的发病率占所有入住重症监护室患者的 3%；一半以上的患者在出院前死亡。治疗方法存在很大差异，尤其是在血管活性支持策略方面。
{"title":"EPidemiology Of Cardiogenic sHock in Scotland (EPOCHS): A multicentre, prospective observational study of the prevalence, management and outcomes of cardiogenic shock in Scotland","authors":"A. Warren, Philip McCall, Alastair Proudfoot, Stuart Gillon, Ahmad Abu-Arafeh, A. McKnight, Rosemary Mudie, David Armstrong, E. Tzolos, J. Livesey, A. Sinclair, Veronica Baston, Jonathan Dalzell, Deborah Owen, Lucy Fleming, I. Scott, A. Puxty, Matthew M Y Lee, Fiona Walker, Simon Hobson, Euan Campbell, Michael Kinsella, Eilidh McGinnigle, Robert B. Docking, Grant Price, Alex Ramsay, Richard Bauld, Suzanne Herron, Nazir I Lone, Nicholas L Mills, Louise Hartley","doi":"10.1177/17511437231217877","DOIUrl":"https://doi.org/10.1177/17511437231217877","url":null,"abstract":"Despite high rates of cardiovascular disease in Scotland, the prevalence and outcomes of patients with cardiogenic shock are unknown. We undertook a prospective observational cohort study of consecutive patients with cardiogenic shock admitted to the intensive care unit (ICU) or coronary care unit at 13 hospitals in Scotland for a 6-month period. Denominator data from the Scottish Intensive Care Society Audit Group were used to estimate ICU prevalence; data for coronary care units were unavailable. We undertook multivariable logistic regression to identify factors associated with in-hospital mortality. In total, 247 patients with cardiogenic shock were included. After exclusion of coronary care unit admissions, this comprised 3.0% of all ICU admissions during the study period (95% confidence interval [CI] 2.6%–3.5%). Aetiology was acute myocardial infarction (AMI) in 48%. The commonest vasoactive treatment was noradrenaline (56%) followed by adrenaline (46%) and dobutamine (40%). Mechanical circulatory support was used in 30%. Overall in-hospital mortality was 55%. After multivariable logistic regression, age (odds ratio [OR] 1.04, 95% CI 1.02–1.06), admission lactate (OR 1.10, 95% CI 1.05–1.19), Society for Cardiovascular Angiographic Intervention stage D or E at presentation (OR 2.16, 95% CI 1.10–4.29) and use of adrenaline (OR 2.73, 95% CI 1.40–5.40) were associated with mortality. In Scotland the prevalence of cardiogenic shock was 3% of all ICU admissions; more than half died prior to discharge. There was significant variation in treatment approaches, particularly with respect to vasoactive support strategy.","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"280 9","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139152842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-28DOI: 10.1177/17511437231214906
Ting-Lung Lin, Wen-Hao Liu, W. Lai, Ying-Ju Chen, Po-Hsun Chang, I-Ling Chen, Wei-Feng Li, Yueh-Wei Liu, Eric J Ley, Chih-Chi Wang
Venous thromboembolism (VTE) in critically ill patients has been well-studied in Western countries. Many studies have developed risk assessments and established pharmacological protocols to prevent deep venous thrombosis (DVT). However, the DVT rate and need for pharmacologic VTE prophylaxis in critically ill Taiwanese patients are limited. This study aimed to prospectively determine the DVT incidence, risk factors, and outcomes in critically ill Taiwanese patients who do not receive pharmacologic VTE prophylaxis. We conducted a prospective study in a surgical intensive care unit (SICU) of a tertiary academic medical center in Taiwan. Adult patients admitted to SICU from March 2021 to June 2022 received proximal lower extremities DVT surveillance with venous duplex ultrasound. No patient received pharmacologic VTE prophylaxis. The outcomes were the incidence and risk factors of DVT. Among 501 enrolled SICU patients, 21 patients (4.2%) were diagnosed with proximal lower extremities DVT. In a multivariate regression analysis, hypoalbuminemia (odd ratio (OR) = 6.061, 95% confidence interval (CI): 1.067–34.421), femoral central venous catheter (OR = 4.515, 95% CI: 1.547–13.174), ICU stays more than 10 days (OR = 4.017, 95% CI: 1.270–12.707), and swollen leg (OR = 3.427, 95% CI: 1.075–10.930) were independent risk factors for DVT. In addition, patients with proximal lower extremities DVT have more extended ventilator days ( p = 0.045) and ICU stays ( p = 0.044). Our findings indicate critically ill Taiwanese patients have a higher incidence of DVT than results from prior retrospective studies in the Asian population. Physicians who care for this population should consider the specific risk factors for DVT and prescribe pharmacologic prophylaxis in high-risk groups.
{"title":"The incidence and risk factors of proximal lower extremity deep vein thrombosis without pharmacologic prophylaxis in critically ill surgical Taiwanese patients: A prospective study","authors":"Ting-Lung Lin, Wen-Hao Liu, W. Lai, Ying-Ju Chen, Po-Hsun Chang, I-Ling Chen, Wei-Feng Li, Yueh-Wei Liu, Eric J Ley, Chih-Chi Wang","doi":"10.1177/17511437231214906","DOIUrl":"https://doi.org/10.1177/17511437231214906","url":null,"abstract":"Venous thromboembolism (VTE) in critically ill patients has been well-studied in Western countries. Many studies have developed risk assessments and established pharmacological protocols to prevent deep venous thrombosis (DVT). However, the DVT rate and need for pharmacologic VTE prophylaxis in critically ill Taiwanese patients are limited. This study aimed to prospectively determine the DVT incidence, risk factors, and outcomes in critically ill Taiwanese patients who do not receive pharmacologic VTE prophylaxis. We conducted a prospective study in a surgical intensive care unit (SICU) of a tertiary academic medical center in Taiwan. Adult patients admitted to SICU from March 2021 to June 2022 received proximal lower extremities DVT surveillance with venous duplex ultrasound. No patient received pharmacologic VTE prophylaxis. The outcomes were the incidence and risk factors of DVT. Among 501 enrolled SICU patients, 21 patients (4.2%) were diagnosed with proximal lower extremities DVT. In a multivariate regression analysis, hypoalbuminemia (odd ratio (OR) = 6.061, 95% confidence interval (CI): 1.067–34.421), femoral central venous catheter (OR = 4.515, 95% CI: 1.547–13.174), ICU stays more than 10 days (OR = 4.017, 95% CI: 1.270–12.707), and swollen leg (OR = 3.427, 95% CI: 1.075–10.930) were independent risk factors for DVT. In addition, patients with proximal lower extremities DVT have more extended ventilator days ( p = 0.045) and ICU stays ( p = 0.044). Our findings indicate critically ill Taiwanese patients have a higher incidence of DVT than results from prior retrospective studies in the Asian population. Physicians who care for this population should consider the specific risk factors for DVT and prescribe pharmacologic prophylaxis in high-risk groups.","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"37 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139152019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-21DOI: 10.1177/17511437231214146
John A Livesey, Nazir Lone, Emily Black, Richard Broome, Alastair Syme, S. Keating, Laura Elliott, Cara McCahill, Gavin Simpson, Helen Grant, Fiona Auld, S. Garrioch, Alasdair Hay, T. H. Craven
Out of hospital cardiac arrest (OHCA) is a common problem. Rates of survival are low and a proportion of survivors are left with an unfavourable neurological outcome. Four models have been developed to predict risk of unfavourable outcome at the time of critical care admission – the Cardiac Arrest Hospital Prognosis (CAHP), MIRACLE2, Out of Hospital Cardiac Arrest (OHCA), and Targeted Temperature Management (TTM) models. This evaluation evaluates the performance of these four models in a United Kingdom population and provides comparison to performance of the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score. A retrospective evaluation of the performance of the models was conducted over a 43-month period in 414 adult, non-pregnant patients presenting consecutively following non-traumatic OHCA to the five units in our regional critical care network. Scores were generated for each model for where patients had complete data (CAHP = 347, MIRACLE2 = 375, OHCA = 356, TTM = 385). Cerebral Performance Category (CPC) outcome was calculated for each patient at last documented follow up and an unfavourable outcome defined as CPC ⩾ 3. Performance for discrimination of unfavourable outcome was tested by generating receiver operating characteristic (ROC) curves for each model and comparing the area under the curve (AUC). Best performance for discrimination of unfavourable outcome was demonstrated by the high risk group of the CAHP score with an AUC of 0.87 [95% CI 0.83–0.91], specificity of 97.1% [95% CI 93.8–100] and positive predictive value (PPV) of 96.3% [95% CI 92.2–100]. The high risk group of the MIRACLE2 model, which is significantly easier to calculate, had an AUC of 0.81 [95% CI 0.76–0.86], specificity of 92.3% [95% CI 87.2–97.4] and PPV of 95.2% [95% CI 91.9–98.4]. The CAHP, MIRACLE2, OHCA and TTM scores all perform comparably in a UK population to the original development and validation cohorts. All four scores outperform APACHE-II in a population of patients resuscitated from OHCA. CAHP and TTM perform best but are more complex to calculate than MIRACLE2, which displays inferior performance.
院外心脏骤停（OHCA）是一个常见问题。存活率很低，一部分幸存者的神经系统状况不佳。目前已开发出四种模型来预测重症监护入院时出现不良预后的风险，即心脏骤停医院预后（CAHP）、MIRACLE2、院外心脏骤停（OHCA）和目标体温管理（TTM）模型。该评估对这四种模型在英国人群中的表现进行了评估，并与急性生理学和慢性健康评估 II (APACHE-II) 评分的表现进行了比较。在为期 43 个月的时间里，我们对 414 名在非创伤性 OHCA 后连续到我们地区重症监护网络的五个单位就诊的成年非孕妇患者的模型性能进行了回顾性评估。为每个模型生成了患者完整数据的分数（CAHP = 347、MIRACLE2 = 375、OHCA = 356、TTM = 385）。在最后一次有记录的随访中计算每位患者的脑功能分类（CPC）结果，CPC ⩾3定义为不利结果。通过为每个模型生成接收者操作特征曲线（ROC）并比较曲线下面积（AUC），测试了判别不利结果的性能。CAHP 评分的高风险组在判别不利结果方面表现最佳，其 AUC 为 0.87 [95% CI 0.83-0.91]，特异性为 97.1% [95% CI 93.8-100]，阳性预测值 (PPV) 为 96.3% [95% CI 92.2-100]。MIRACLE2 模型的高风险组明显更容易计算，其 AUC 为 0.81 [95% CI 0.76-0.86]，特异性为 92.3% [95% CI 87.2-97.4]，PPV 为 95.2% [95% CI 91.9-98.4]。CAHP、MIRACLE2、OHCA 和 TTM 评分在英国人群中的表现均与原始开发和验证队列相当。在 OHCA 复苏患者群体中，所有四个评分均优于 APACHE-II。CAHP 和 TTM 表现最好，但计算起来比 MIRACLE2 复杂，后者表现较差。
{"title":"Neurological outcome following out of hospital cardiac arrest: Evaluation of performance of existing risk prediction models in a UK cohort","authors":"John A Livesey, Nazir Lone, Emily Black, Richard Broome, Alastair Syme, S. Keating, Laura Elliott, Cara McCahill, Gavin Simpson, Helen Grant, Fiona Auld, S. Garrioch, Alasdair Hay, T. H. Craven","doi":"10.1177/17511437231214146","DOIUrl":"https://doi.org/10.1177/17511437231214146","url":null,"abstract":"Out of hospital cardiac arrest (OHCA) is a common problem. Rates of survival are low and a proportion of survivors are left with an unfavourable neurological outcome. Four models have been developed to predict risk of unfavourable outcome at the time of critical care admission – the Cardiac Arrest Hospital Prognosis (CAHP), MIRACLE2, Out of Hospital Cardiac Arrest (OHCA), and Targeted Temperature Management (TTM) models. This evaluation evaluates the performance of these four models in a United Kingdom population and provides comparison to performance of the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score. A retrospective evaluation of the performance of the models was conducted over a 43-month period in 414 adult, non-pregnant patients presenting consecutively following non-traumatic OHCA to the five units in our regional critical care network. Scores were generated for each model for where patients had complete data (CAHP = 347, MIRACLE2 = 375, OHCA = 356, TTM = 385). Cerebral Performance Category (CPC) outcome was calculated for each patient at last documented follow up and an unfavourable outcome defined as CPC ⩾ 3. Performance for discrimination of unfavourable outcome was tested by generating receiver operating characteristic (ROC) curves for each model and comparing the area under the curve (AUC). Best performance for discrimination of unfavourable outcome was demonstrated by the high risk group of the CAHP score with an AUC of 0.87 [95% CI 0.83–0.91], specificity of 97.1% [95% CI 93.8–100] and positive predictive value (PPV) of 96.3% [95% CI 92.2–100]. The high risk group of the MIRACLE2 model, which is significantly easier to calculate, had an AUC of 0.81 [95% CI 0.76–0.86], specificity of 92.3% [95% CI 87.2–97.4] and PPV of 95.2% [95% CI 91.9–98.4]. The CAHP, MIRACLE2, OHCA and TTM scores all perform comparably in a UK population to the original development and validation cohorts. All four scores outperform APACHE-II in a population of patients resuscitated from OHCA. CAHP and TTM perform best but are more complex to calculate than MIRACLE2, which displays inferior performance.","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"35 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138948158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-04DOI: 10.1177/17511437231217878
Varun Sudunagunta, Neeraj Singh, Pervez Khan, Peter O Beaumont
Most people would rather die at home than in hospital but only 18% of patients do so. Palliative care focuses on the physical, spiritual and psychosocial wellbeing of patients and their families, which should include facilitating transfers home when possible. Patients can have more autonomy over their care and be surrounded by loved ones which can have a significant impact on their quality of life. In this article we describe two cases of home repatriation for palliation. Case 1 describes the transfer of a patient with difficulties and gaps in planning, but with a safe transfer ultimately. Case 2 recounts a more comprehensive planning process emphasising collaboration between teams. Facilitating home-based care aligns with patients’ desires for familiar surroundings and emotional support. A secondary benefit is that releasing a bed space allows another patient to receive critical care treatment. Challenges of palliative critical care transfers include needing a highly trained team and thorough planning. Early discussion with the family and community palliative care teams makes this a more feasible option for patients. A multidisciplinary team of hospital and community healthcare professionals working with the patient and their family can facilitate the transfer from intensive care to allow them to die at a place of their choosing. We should aim to fulfil these wishes at the end of life as it can greatly improve the patient’s and their family’s physical and emotional wellbeing during this difficult time.
{"title":"End of life care at home: The role of critical care transfer services","authors":"Varun Sudunagunta, Neeraj Singh, Pervez Khan, Peter O Beaumont","doi":"10.1177/17511437231217878","DOIUrl":"https://doi.org/10.1177/17511437231217878","url":null,"abstract":"Most people would rather die at home than in hospital but only 18% of patients do so. Palliative care focuses on the physical, spiritual and psychosocial wellbeing of patients and their families, which should include facilitating transfers home when possible. Patients can have more autonomy over their care and be surrounded by loved ones which can have a significant impact on their quality of life. In this article we describe two cases of home repatriation for palliation. Case 1 describes the transfer of a patient with difficulties and gaps in planning, but with a safe transfer ultimately. Case 2 recounts a more comprehensive planning process emphasising collaboration between teams. Facilitating home-based care aligns with patients’ desires for familiar surroundings and emotional support. A secondary benefit is that releasing a bed space allows another patient to receive critical care treatment. Challenges of palliative critical care transfers include needing a highly trained team and thorough planning. Early discussion with the family and community palliative care teams makes this a more feasible option for patients. A multidisciplinary team of hospital and community healthcare professionals working with the patient and their family can facilitate the transfer from intensive care to allow them to die at a place of their choosing. We should aim to fulfil these wishes at the end of life as it can greatly improve the patient’s and their family’s physical and emotional wellbeing during this difficult time.","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"37 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138602700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-29DOI: 10.1177/17511437231214148
Kerrianne N Huynh, Sian Rouse-Watson, James Chu, Andrew S Lane, A. M. Cyna
{"title":"Unheard and unseen: The hidden impact of nocebo communication in the Intensive Care Unit","authors":"Kerrianne N Huynh, Sian Rouse-Watson, James Chu, Andrew S Lane, A. M. Cyna","doi":"10.1177/17511437231214148","DOIUrl":"https://doi.org/10.1177/17511437231214148","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"15 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139215120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-20DOI: 10.1177/17511437231213527
Peter G Brindley
{"title":"Book Review: Point of Care Ultrasound in Critical Care by Luke Flower and Pradeep Madhivathanan","authors":"Peter G Brindley","doi":"10.1177/17511437231213527","DOIUrl":"https://doi.org/10.1177/17511437231213527","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"135 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139259723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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