Acute brain injury due to conditions such as subarachnoid haemorrhage and traumatic brain injury are associated with physical, psychological, cognitive, emotional, and social deficits. Despite reductions in morbidity and mortality, there have been few significant changes in clinical practice. It has been suggested that heterogeneity in outcome assessment in studies has contributed to this limited progress.
Objectives
The objectives of this study were to describe current methods of outcome assessment in aneurysmal subarachnoid haemorrhage and traumatic brain injury studies and to examine the relationship between methods of outcome assessment and reported outcomes.
Methods
We performed a systematic review and meta-analysis of randomised controlled trials and cohort studies enrolling an adult aneurysmal subarachnoid haemorrhage or traumatic brain injury population and reporting at least one functional outcome measure.
Results
We identified 176 studies, including 60 494 participants. The Glasgow Outcome Scale or the Glasgow Outcome Scale Extended was used in 68% (N = 120) of studies and the Modified Rankin Scale in 38% (N = 67) of studies. Outcome assessment was reported at different timepoints, using different methods of application, and often dichotomised using different ranges. Many studies did not report key details on methods of outcome assessment. Outcome assessment using the Modified Rankin Scale was associated with a higher proportion of patients reported as having a favourable outcome 0.62 (95% confidence interval [CI]: 0.58–0.67) than the Glasgow Outcome Scale 0.48 (95% CI: 0.43–0.53) or the Glasgow Outcome Scale Extended 0.42 (95% CI: 0.37–0.48, p < 0.01). In-person assessment was associated with an increased proportion of patients achieving a favourable outcome 0.55 (95% CI: 0.55–0.45) compared to telephone assessment 0.46 (95% CI: 0.40–0.52).
Conclusion
There is significant heterogeneity and incomplete reporting of methods of outcome assessment in critical care studies enrolling aneurysmal subarachnoid haemorrhage and traumatic brain injury patient populations. Our study identified an association between the methods of outcome assessment and reported outcomes. Our study supports initiatives to standardise outcome assessment in neurocritical care research to ensure the quality of outcome data.
Registration
The International Prospective Register of Systematic Reviews (CRD42023072206).
{"title":"Methods of functional outcome assessment in neurocritical care trials: A systematic review and meta-analysis","authors":"Emily Fitzgerald BN, MN , Lachlan Donaldson MBBS, MPhil , Naomi Hammond PhD , Breannan Johnson MBBS , Kwan Yee Leung RN, MN , Rachel McBain MBBS , Gabrielle McDonald MBBS , Kirsten Rowcliff MBBS , Ruan Vlok MBBS , Anthony Delaney PhD","doi":"10.1016/j.aucc.2024.09.009","DOIUrl":"10.1016/j.aucc.2024.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Acute brain injury due to conditions such as subarachnoid haemorrhage and traumatic brain injury are associated with physical, psychological, cognitive, emotional, and social deficits. Despite reductions in morbidity and mortality, there have been few significant changes in clinical practice. It has been suggested that heterogeneity in outcome assessment in studies has contributed to this limited progress.</div></div><div><h3>Objectives</h3><div>The objectives of this study were to describe current methods of outcome assessment in aneurysmal subarachnoid haemorrhage and traumatic brain injury studies and to examine the relationship between methods of outcome assessment and reported outcomes.</div></div><div><h3>Methods</h3><div>We performed a systematic review and meta-analysis of randomised controlled trials and cohort studies enrolling an adult aneurysmal subarachnoid haemorrhage or traumatic brain injury population and reporting at least one functional outcome measure.</div></div><div><h3>Results</h3><div>We identified 176 studies, including 60 494 participants. The Glasgow Outcome Scale or the Glasgow Outcome Scale Extended was used in 68% (N = 120) of studies and the Modified Rankin Scale in 38% (N = 67) of studies. Outcome assessment was reported at different timepoints, using different methods of application, and often dichotomised using different ranges. Many studies did not report key details on methods of outcome assessment. Outcome assessment using the Modified Rankin Scale was associated with a higher proportion of patients reported as having a favourable outcome 0.62 (95% confidence interval [CI]: 0.58–0.67) than the Glasgow Outcome Scale 0.48 (95% CI: 0.43–0.53) or the Glasgow Outcome Scale Extended 0.42 (95% CI: 0.37–0.48, p < 0.01). In-person assessment was associated with an increased proportion of patients achieving a favourable outcome 0.55 (95% CI: 0.55–0.45) compared to telephone assessment 0.46 (95% CI: 0.40–0.52).</div></div><div><h3>Conclusion</h3><div>There is significant heterogeneity and incomplete reporting of methods of outcome assessment in critical care studies enrolling aneurysmal subarachnoid haemorrhage and traumatic brain injury patient populations. Our study identified an association between the methods of outcome assessment and reported outcomes. Our study supports initiatives to standardise outcome assessment in neurocritical care research to ensure the quality of outcome data.</div></div><div><h3>Registration</h3><div>The International Prospective Register of Systematic Reviews (CRD42023072206).</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101124"},"PeriodicalIF":2.6,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Persistent critical illness (PerCI) occurs when the patient's prolonged intensive care unit (ICU) stay results in complications that become the primary drivers of their condition, rather than the initial reason for their admission. Patients with frailty have a higher risk of developing and dying from PerCI. We aimed to investigate the interplay of frailty and PerCI in critically ill patients with COVID-19.
Method
We conducted a retrospective multicentre cohort study including 103 Australian and New Zealand ICUs over the period of January 2020 to December 2021. We included all adult patients with COVID-19 and documented the Clinical Frailty Scale (frail ≥ 5). PerCI is defined as an ICU length of stay of ≥10 days. We aimed to investigate the hospital mortality with and without PerCI across varying degrees of frailty and examined the potential interaction effect between frailty status and PerCI.
Results
The prevalence of PerCI was similar between patients with and without frailty (25.4% vs. 27.9%; p = 0.44). Hospital mortality was higher in patients with PerCI than in those without (28.8% vs. 9.3%; p < 0.001). Mortality in patients with PerCI also increased with increasing frailty (p < 0.001). Frailty independently predicted hospital mortality. When adjusted for Australia and New Zealand risk of death mortality prediction model and sex, the impact of frailty was no different in patients with and without PerCI (odds ratio = 1.30 [95% confidence interval: 1.14–1.49] vs. (odds ratio = 1.46 [95% confidence interval: 1.29–1.64]). Furthermore, increasing frailty did not influence mortality in patients with PerCI more (or less) than in those without PerCI (pinteraction = 0.82).
Conclusions
The presence of frailty independently predicted hospital mortality in patients with PerCI with COVID-19, but the impact of frailty on mortality was no different in those who developed PerCI from those without PerCI.
{"title":"The interplay between frailty status and persistent critical illness on the outcomes of patients with critical COVID-19: A population-based retrospective cohort study","authors":"William Bonavia MBBS , Ryan Ruiyang Ling MBBS, MS, FRCSEd, MCh, MSc, FCICM, EDIC, PhD , Ravindranath Tiruvoipati FRCSEd FCICM PhD , Mallikarjuna Ponnapa Reddy MBBS FCICM DCH DDU , David Pilcher MBBS MRCP FRACP FCICM , Ashwin Subramaniam MBBS, MMed, FRACP, FCICM, PhD","doi":"10.1016/j.aucc.2024.09.013","DOIUrl":"10.1016/j.aucc.2024.09.013","url":null,"abstract":"<div><h3>Objectives</h3><div>Persistent critical illness (PerCI) occurs when the patient's prolonged intensive care unit (ICU) stay results in complications that become the primary drivers of their condition, rather than the initial reason for their admission. Patients with frailty have a higher risk of developing and dying from PerCI. We aimed to investigate the interplay of frailty and PerCI in critically ill patients with COVID-19.</div></div><div><h3>Method</h3><div>We conducted a retrospective multicentre cohort study including 103 Australian and New Zealand ICUs over the period of January 2020 to December 2021. We included all adult patients with COVID-19 and documented the Clinical Frailty Scale (frail ≥ 5). PerCI is defined as an ICU length of stay of ≥10 days. We aimed to investigate the hospital mortality with and without PerCI across varying degrees of frailty and examined the potential interaction effect between frailty status and PerCI.</div></div><div><h3>Results</h3><div>The prevalence of PerCI was similar between patients with and without frailty (25.4% vs. 27.9%; p = 0.44). Hospital mortality was higher in patients with PerCI than in those without (28.8% vs. 9.3%; p < 0.001). Mortality in patients with PerCI also increased with increasing frailty (p < 0.001). Frailty independently predicted hospital mortality. When adjusted for Australia and New Zealand risk of death mortality prediction model and sex, the impact of frailty was no different in patients with and without PerCI (odds ratio = 1.30 [95% confidence interval: 1.14–1.49] vs. (odds ratio = 1.46 [95% confidence interval: 1.29–1.64]). Furthermore, increasing frailty did not influence mortality in patients with PerCI more (or less) than in those without PerCI (p<sub>interaction</sub> = 0.82).</div></div><div><h3>Conclusions</h3><div>The presence of frailty independently predicted hospital mortality in patients with PerCI with COVID-19, but the impact of frailty on mortality was no different in those who developed PerCI from those without PerCI.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101128"},"PeriodicalIF":2.6,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-02DOI: 10.1016/j.aucc.2024.10.001
Julie E. Potter RN PhD , Lin Perry RN PhD , Rosalind M. Elliott RN PhD , COMFORT Investigators
Background
Offering organ donation is part of routine end-of-life care in critical care. Families describe feeling emotionally overwhelmed, which reduces their ability to understand complex medical information necessary to make informed decisions about organ donation. Late decisional regret is more common among families who decline donation. Thus, it is vital to investigate whether the organ donation decision choices that families make in hospital endure unchanged and what factors affect their perspectives.
Objectives
The objective of this study was to explore family members’ perspectives of their final organ donation decision in hospital, either to consent or to decline donation, at around 90 d later.
Methods
This dual-method study comprised semistructured interviews of family members of donor-eligible patients who experienced care in seven metropolitan teaching hospitals, a tertiary paediatric hospital, and a major regional hospital in New South Wales, Australia. Interviews were audio recorded and transcribed verbatim. Descriptive quantitative analysis and thematic analysis were used.
Findings
Participants overwhelmingly agreed that their organ donation decision remained unchanged at 3 months after the death of their relative (n = 127, 97%). The remainder (n = 3, 2%) were unsure or stated “possibly not” (n = 1, 1%); in these cases, the eligible donor was certified dead via circulatory criteria. Five themes were synthesised in relation to the organ donation decision: Knowledge of the donor-eligible patient's prior wishes, Family members' prior decision to donate their own organs, Solace in the decision, Altruism, and Reality of the process.
Conclusions
The organ donation decision choice remained unchanged for the large majority. Further research is required to ascertain how people can be assisted to understand the organ donation process, particularly in the setting of certification of death by circulatory criteria, and how best to positively influence consent rates.
Clinical trial registry number
Australian and New Zealand Clinical Trial Registration ACTRN12613000815763.
{"title":"Bereaved family members’ perspectives of their organ donation decision at 3 months post death of the donor-eligible patient in critical care: A dual-method study","authors":"Julie E. Potter RN PhD , Lin Perry RN PhD , Rosalind M. Elliott RN PhD , COMFORT Investigators","doi":"10.1016/j.aucc.2024.10.001","DOIUrl":"10.1016/j.aucc.2024.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Offering organ donation is part of routine end-of-life care in critical care. Families describe feeling emotionally overwhelmed, which reduces their ability to understand complex medical information necessary to make informed decisions about organ donation. Late decisional regret is more common among families who decline donation. Thus, it is vital to investigate whether the organ donation decision choices that families make in hospital endure unchanged and what factors affect their perspectives.</div></div><div><h3>Objectives</h3><div>The objective of this study was to explore family members’ perspectives of their final organ donation decision in hospital, either to consent or to decline donation, at around 90 d later.</div></div><div><h3>Methods</h3><div>This dual-method study comprised semistructured interviews of family members of donor-eligible patients who experienced care in seven metropolitan teaching hospitals, a tertiary paediatric hospital, and a major regional hospital in New South Wales, Australia. Interviews were audio recorded and transcribed verbatim. Descriptive quantitative analysis and thematic analysis were used.</div></div><div><h3>Findings</h3><div>Participants overwhelmingly agreed that their organ donation decision remained unchanged at 3 months after the death of their relative (n = 127, 97%). The remainder (n = 3, 2%) were unsure or stated “possibly not” (n = 1, 1%); in these cases, the eligible donor was certified dead via circulatory criteria. Five themes were synthesised in relation to the organ donation decision: Knowledge of the donor-eligible patient's prior wishes, Family members' prior decision to donate their own organs, Solace in the decision, Altruism, and Reality of the process.</div></div><div><h3>Conclusions</h3><div>The organ donation decision choice remained unchanged for the large majority. Further research is required to ascertain how people can be assisted to understand the organ donation process, particularly in the setting of certification of death by circulatory criteria, and how best to positively influence consent rates.</div></div><div><h3>Clinical trial registry number</h3><div>Australian and New Zealand Clinical Trial Registration ACTRN12613000815763.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101132"},"PeriodicalIF":2.6,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Approximately 70% of patients in intensive care units (ICUs) experience untreated pain, often due to severe patient conditions and communication barriers.
Aim: The aim of this study was to implement the Critical-Care Pain Observation Tool (CPOT) to improve pain assessment in patients unable to self-report pain in the ICU.
Method
A stepped-wedge trial was conducted in six adult ICUs in Saudi Arabia between February and June 2022. The sequential transition of ICU clusters occurred in February 2022, from control to intervention, until all ICUs were exposed to the intervention. The primary outcome was the number of pain assessments, whereas the secondary outcomes were reassessments. Other outcomes were length of stay, mechanical ventilation duration, and administered doses of sedatives and analgesic agents. Statistical analyses were performed using the Statistical Analysis Software v9.4.
Results
A total of 725 patients unable to self-report pain were included; 65% (n = 469) were male with an average age of 55 years. Implementing CPOT showed a significant increase in the number of pain assessments (rate ratio: 1.77, 95% confidence interval: 1.45, 2.16, p < 0.001) and reassessments (rate ratio: 13.99, 95% confidence interval: 8.14, 24.02, p < 0.001) between intervention and control conditions. There was no significant effect on the ICU length of stay, mechanical ventilation duration, and the amount of sedation (midazolam, propofol, and ketamine) and analgesia (fentanyl) administered.
Conclusion
The study indicates that the implementation of the CPOT increased the frequency of pain assessment and reassessment. However, the impact on patient outcomes remains inconclusive. Further investigations focussing on CPOT as the primary pain scale are necessary to determine its holistic impact on patient outcomes over the long term.
Trial registration
NCT05488834.
Clinical trial registration number
This study was registered with the U.S. National Library of Medicine (ClinicalTrial.gov, NCT05488834).
{"title":"Impact of implementing the critical-care pain observation tool in the adult intensive care unit: A nonrandomised stepped-wedge trial","authors":"Majid A. Alotni RN, MN , Jenny Sim RN, PhD MACN , Ginger Chu RN, PhD , Michelle Guilhermino RN, PhD , Daniel Barker PhD , Stuart Szwec MPhys PhD , Ritin Fernandez RN, PhD","doi":"10.1016/j.aucc.2024.09.014","DOIUrl":"10.1016/j.aucc.2024.09.014","url":null,"abstract":"<div><h3>Background</h3><div>Approximately 70% of patients in intensive care units (ICUs) experience untreated pain, often due to severe patient conditions and communication barriers.</div><div>Aim: The aim of this study was to implement the Critical-Care Pain Observation Tool (CPOT) to improve pain assessment in patients unable to self-report pain in the ICU.</div></div><div><h3>Method</h3><div>A stepped-wedge trial was conducted in six adult ICUs in Saudi Arabia between February and June 2022. The sequential transition of ICU clusters occurred in February 2022, from control to intervention, until all ICUs were exposed to the intervention. The primary outcome was the number of pain assessments, whereas the secondary outcomes were reassessments. Other outcomes were length of stay, mechanical ventilation duration, and administered doses of sedatives and analgesic agents. Statistical analyses were performed using the Statistical Analysis Software v9.4.</div></div><div><h3>Results</h3><div>A total of 725 patients unable to self-report pain were included; 65% (n = 469) were male with an average age of 55 years. Implementing CPOT showed a significant increase in the number of pain assessments (rate ratio: 1.77, 95% confidence interval: 1.45, 2.16, p < 0.001) and reassessments (rate ratio: 13.99, 95% confidence interval: 8.14, 24.02, p < 0.001) between intervention and control conditions. There was no significant effect on the ICU length of stay, mechanical ventilation duration, and the amount of sedation (midazolam, propofol, and ketamine) and analgesia (fentanyl) administered.</div></div><div><h3>Conclusion</h3><div>The study indicates that the implementation of the CPOT increased the frequency of pain assessment and reassessment. However, the impact on patient outcomes remains inconclusive. Further investigations focussing on CPOT as the primary pain scale are necessary to determine its holistic impact on patient outcomes over the long term.</div></div><div><h3>Trial registration</h3><div>NCT05488834.</div></div><div><h3>Clinical trial registration number</h3><div>This study was registered with the U.S. National Library of Medicine (<span><span>ClinicalTrial.gov</span><svg><path></path></svg></span>, NCT05488834).</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101129"},"PeriodicalIF":2.6,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prone positioning is commonly applied to improve gas exchange in mechanically ventilated patients with coronavirus disease 2019 (COVID-19)–related acute respiratory distress syndrome (ARDS). Whilst prone positioning is effective, specific complications may arise. We aimed to assess the prevalence of specific complications related to prone positioning in patients mechanically ventilated for COVID-19-related ARDS.
Design
Multicentre, retrospective observational study.
Methods
Multi-centre observational study of mechanically ventilated patients with COVID-19-related ARDS admitted to intensive care units in Melbourne, Australia, from August to November 2021. Data on baseline characteristics, prone positioning, complications, and patient outcomes were collected.
Results
We assessed 553 prone episodes in 220 patients across seven sites (mean ± standard deviation age: 54 ± 13 years, 61% male). Overall, 58% (127/220) of patients experienced at least one prone-positioning-related complication. Pressure injury was the most prevalent (n = 92/220, 42%) complication reported. Factors associated with increased risk of pressure injury were male sex (adjusted odds ratio = 1.15, 95% confidence interval: [1.02–1.31]) and the total number of prone episodes (adjusted odds ratio = 1.11, 95% confidence interval: [1.07–1.15]). Device dislodgement was the next most common complication, occurring in 28 of 220 (13%) patients. There were no nerve or retinal injuries reported.
Conclusions
Pressure injuries and line dislodgement were the most prevalent complications associated with prone positioning of patients mechanically ventilated for COVID-19. The risk of pressure injuries was associated with male sex and the number of prone positioning episodes.
{"title":"Complications associated with prone positioning in mechanically ventilated COVID-19 patients: A multicentre, retrospective observational study","authors":"Thomas C. Rollinson PT, BPhysio(Hons) , Luke A. McDonald PT, BHlthSci, MPhysioPrac , Joleen Rose PT, BSci(Hons), BPhysio(Hons) , Glenn Eastwood RN, PhD , Rahul Costa-Pinto MBBS, MPH, FCICM , Lucy Modra MBBS(Hons), MPH, FACEM, FCICM , Maeda Akinori MD , Zoe Bacolas PT, BBiomedSc, BSc(Hons), DPT , James Anstey MBBS, FRACP, FCICM , Samantha Bates RN, BN , Scott Bradley BAppSc Physio, PhD, PT , Jodi Dumbrell BN, BNutDietet/BHlthSc, MPH , Craig French MBBS, FCICM , Angaj Ghosh MBBS, FACEM, FCICM , Kimberley Haines PT, PhD, BHSc , Tim Haydon MBBS, FRACP, FANZCA, MCCU, MBioeth , Carol L. Hodgson BAppSc Physio, PhD, PACP, PT , Jennifer Holmes RN, BN, PostGradDipAdvNurs , Nina Leggett PT, DPT, BBiomed , Forbes McGain FCICM, FANZCA, PhD , Rinaldo Bellomo MD, PhD, MBBS","doi":"10.1016/j.aucc.2024.09.002","DOIUrl":"10.1016/j.aucc.2024.09.002","url":null,"abstract":"<div><h3>Background and aims</h3><div>Prone positioning is commonly applied to improve gas exchange in mechanically ventilated patients with coronavirus disease 2019 (COVID-19)–related acute respiratory distress syndrome (ARDS). Whilst prone positioning is effective, specific complications may arise. We aimed to assess the prevalence of specific complications related to prone positioning in patients mechanically ventilated for COVID-19-related ARDS.</div></div><div><h3>Design</h3><div>Multicentre, retrospective observational study.</div></div><div><h3>Methods</h3><div>Multi-centre observational study of mechanically ventilated patients with COVID-19-related ARDS admitted to intensive care units in Melbourne, Australia, from August to November 2021. Data on baseline characteristics, prone positioning, complications, and patient outcomes were collected.</div></div><div><h3>Results</h3><div>We assessed 553 prone episodes in 220 patients across seven sites (mean ± standard deviation age: 54 ± 13 years, 61% male). Overall, 58% (127/220) of patients experienced at least one prone-positioning-related complication. Pressure injury was the most prevalent (n = 92/220, 42%) complication reported. Factors associated with increased risk of pressure injury were male sex (adjusted odds ratio = 1.15, 95% confidence interval: [1.02–1.31]) and the total number of prone episodes (adjusted odds ratio = 1.11, 95% confidence interval: [1.07–1.15]). Device dislodgement was the next most common complication, occurring in 28 of 220 (13%) patients. There were no nerve or retinal injuries reported.</div></div><div><h3>Conclusions</h3><div>Pressure injuries and line dislodgement were the most prevalent complications associated with prone positioning of patients mechanically ventilated for COVID-19. The risk of pressure injuries was associated with male sex and the number of prone positioning episodes.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101117"},"PeriodicalIF":2.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The objective of this research was to evaluate the extent of harm for critically ill patients, family members, and healthcare professionals associated with writing and reading intensive care unit (ICU) diaries.
Review method used
A systematic literature review and a synthesis of qualitative data were performed. The protocol of this study has been registered in the International prospective register of systematic reviews (CRD42022376393).
Data sources
Databases were PubMed, Cochrane Library, CINAHL, PsychNet, and Livivo.
Review methods
The search included qualitative and mixed-methods studies related to harm with an ICU diary. Deductive content analysis was used to create abstractions of quotations. Study quality was assessed with the Critical Appraisal Skills Programme.
Results
Of 12 827 titles, 27 studies with 476 participants were included. Events involving the patients, family members, and healthcare professionals occurred but did not result in harm. A total of 68 quotations from patients, family members, and healthcare professionals were extracted. Those patients, their families, and healthcare professionals who mentioned intense emotions regarding diaries experienced writing and reading diaries as an emotional journey (patients), a help with tears (families), or a question of emotional distance (healthcare professionals).
Conclusions
Writing and reading ICU diaries can be associated with intense emotions, which are natural reactions when coping with a stressful situation. No study reported harm. Based on uncertain qualitative evidence, the benefits of writing and reading ICU diaries as coping strategies outweigh the potential harm. More research is needed.
Registration of review
The International prospective register of systematic reviews CRD42022376393.
{"title":"Intensive care unit diaries—harmful or harmless: A systematic literature review and qualitative data synthesis","authors":"Matthias Thomas Exl RN, MScN , Lea Lotzer RN, BScN , Teresa Deffner PhD , Marie-Madlen Jeitziner RN, PhD , Peter Nydahl RN, PhD","doi":"10.1016/j.aucc.2024.09.006","DOIUrl":"10.1016/j.aucc.2024.09.006","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this research was to evaluate the extent of harm for critically ill patients, family members, and healthcare professionals associated with writing and reading intensive care unit (ICU) diaries.</div></div><div><h3>Review method used</h3><div>A systematic literature review and a synthesis of qualitative data were performed. The protocol of this study has been registered in the International prospective register of systematic reviews (CRD42022376393).</div></div><div><h3>Data sources</h3><div>Databases were PubMed, Cochrane Library, CINAHL, PsychNet, and Livivo.</div></div><div><h3>Review methods</h3><div>The search included qualitative and mixed-methods studies related to harm with an ICU diary. Deductive content analysis was used to create abstractions of quotations. Study quality was assessed with the Critical Appraisal Skills Programme.</div></div><div><h3>Results</h3><div>Of 12 827 titles, 27 studies with 476 participants were included. Events involving the patients, family members, and healthcare professionals occurred but did not result in harm. A total of 68 quotations from patients, family members, and healthcare professionals were extracted. Those patients, their families, and healthcare professionals who mentioned intense emotions regarding diaries experienced writing and reading diaries as an emotional journey (patients), a help with tears (families), or a question of emotional distance (healthcare professionals).</div></div><div><h3>Conclusions</h3><div>Writing and reading ICU diaries can be associated with intense emotions, which are natural reactions when coping with a stressful situation. No study reported harm. Based on uncertain qualitative evidence, the benefits of writing and reading ICU diaries as coping strategies outweigh the potential harm. More research is needed.</div></div><div><h3>Registration of review</h3><div>The International prospective register of systematic reviews CRD42022376393.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101121"},"PeriodicalIF":2.6,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.aucc.2024.09.007
Hinpetch Daungsupawong PhD, Viroj Wiwanitkit MD
{"title":"Comment on dose-response relationship between awake prone-positioning duration and PaO2/FiO2 changes and risk of disease aggravation in patients with severe COVID-19","authors":"Hinpetch Daungsupawong PhD, Viroj Wiwanitkit MD","doi":"10.1016/j.aucc.2024.09.007","DOIUrl":"10.1016/j.aucc.2024.09.007","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101122"},"PeriodicalIF":2.6,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.aucc.2024.09.001
Kym Wittholz MDietS , Kate Fetterplace BNutDiet, PhD , Lee-anne Chapple MNutDiet, PhD , Emma J. Ridley BNutriDietet, PhD , Mark Finnis MBBS, MBiostat , Jeffrey Presneill MBBS, MBiostat, PhD , Marianne Chapman MBBS, PhD , Sandra Peake MBBS, PhD , Rinaldo Bellomo MBBS, PhD , Amalia Karahalios HBSc, PhD , Adam M. Deane MBBS, PhD
Background
Critically ill patients with a traumatic brain injury (TBI) may require prolonged intensive care unit (ICU) admission and hence receive greater exposure to hospital enteral nutrition. It is unknown if augmented energy delivery with enteral nutrition during ICU admission impacts quality of life in survivors or gastrointestinal tolerance during nutrition delivery in the ICU.
Objectives
The objective of this study was to compare health-related quality of life, using the EuroQol five-dimensions five-level visual analogue scale at 6 months, in survivors who presented with a TBI and received augmented energy (1.5 kcal/ml) to those who received routine energy (1.0 kcal/ml). Secondary objectives were to explore differences in total energy and protein delivery, gastrointestinal tolerance, and mortality between groups.
Methods
Secondary analysis of participants admitted with a TBI in the Augmented versus Routine Approach to Giving Energy Trial (TARGET) randomised controlled trial. Data are represented as n (%) or median (interquartile range).
Results
Of the 3957 patients in TARGET, 231 (5.8%) were admitted after a TBI (augmented = 124; routine = 107). Patients within TARGET who were admitted with a TBI were relatively young (42 [27, 61] years) and received TARGET enteral nutrition for an extended period (9 [5, 15] days). At 6 months, EuroQol five-dimensions five-level quality-of-life scores were available for 166 TBI survivors (72% of TBI cohort randomised, augmented = 97, routine = 69). There was no evidence of a difference in quality of life (augmented = 70 [52, 90]; routine = 70 [55, 85]; median difference augmented vs routine = 0 [95% confidence interval: -5, 10]). TBI participants assigned to augmented energy received more energy with a similar protein than the routine group. Gastrointestinal tolerance was similar between groups.
Conclusion
While patients admitted after a TBI received enteral nutrition for an extended period, an increased exposure to augmented energy did not affect survivors’ quality-of-life scores.
{"title":"Six-month outcomes after traumatic brain injury in the Augmented versus Routine Approach to Giving Energy multicentre, double-blind, randomised controlled Trial (TARGET)","authors":"Kym Wittholz MDietS , Kate Fetterplace BNutDiet, PhD , Lee-anne Chapple MNutDiet, PhD , Emma J. Ridley BNutriDietet, PhD , Mark Finnis MBBS, MBiostat , Jeffrey Presneill MBBS, MBiostat, PhD , Marianne Chapman MBBS, PhD , Sandra Peake MBBS, PhD , Rinaldo Bellomo MBBS, PhD , Amalia Karahalios HBSc, PhD , Adam M. Deane MBBS, PhD","doi":"10.1016/j.aucc.2024.09.001","DOIUrl":"10.1016/j.aucc.2024.09.001","url":null,"abstract":"<div><h3>Background</h3><div>Critically ill patients with a traumatic brain injury (TBI) may require prolonged intensive care unit (ICU) admission and hence receive greater exposure to hospital enteral nutrition. It is unknown if augmented energy delivery with enteral nutrition during ICU admission impacts quality of life in survivors or gastrointestinal tolerance during nutrition delivery in the ICU.</div></div><div><h3>Objectives</h3><div>The objective of this study was to compare health-related quality of life, using the EuroQol five-dimensions five-level visual analogue scale at 6 months, in survivors who presented with a TBI and received augmented energy (1.5 kcal/ml) to those who received routine energy (1.0 kcal/ml). Secondary objectives were to explore differences in total energy and protein delivery, gastrointestinal tolerance, and mortality between groups.</div></div><div><h3>Methods</h3><div>Secondary analysis of participants admitted with a TBI in the Augmented versus Routine Approach to Giving Energy Trial (TARGET) randomised controlled trial. Data are represented as n (%) or median (interquartile range).</div></div><div><h3>Results</h3><div>Of the 3957 patients in TARGET, 231 (5.8%) were admitted after a TBI (augmented = 124; routine = 107). Patients within TARGET who were admitted with a TBI were relatively young (42 [27, 61] years) and received TARGET enteral nutrition for an extended period (9 [5, 15] days). At 6 months, EuroQol five-dimensions five-level quality-of-life scores were available for 166 TBI survivors (72% of TBI cohort randomised, augmented = 97, routine = 69). There was no evidence of a difference in quality of life (augmented = 70 [52, 90]; routine = 70 [55, 85]; median difference augmented vs routine = 0 [95% confidence interval: -5, 10]). TBI participants assigned to augmented energy received more energy with a similar protein than the routine group. Gastrointestinal tolerance was similar between groups.</div></div><div><h3>Conclusion</h3><div>While patients admitted after a TBI received enteral nutrition for an extended period, an increased exposure to augmented energy did not affect survivors’ quality-of-life scores.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101116"},"PeriodicalIF":2.6,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.aucc.2024.09.005
Mahsa Tebyanian, Ali Darvishpoor Kakhki, Sepehr Feizi
Background: As the population ages, the number of older patient admitted to intensive care units (ICUs) will increase. This age group is at higher risk for developing eye problems because of higher prevalence of dry eye among older people. Inconsistency of early studies' results and less attention to eye care guidelines for older patients in the ICU pose severe consequences such as dry eye and corneal ulcer.
Objective: The objective of this study was to investigate the effectiveness of artificial tear gel, polyethylene cover, and conventional eye care methods for preventing dry eye and corneal ulcer in older patients admitted to an ICU.
Methods: In this three-arm randomised clinical trial, 99 older ICU patients with Glasgow Coma Scale scores measuring <7 were randomly assigned to one of three treatment groups: (i) participants who received artificial tear gel in one eye and polyethylene cover on the other; (ii) these interventions were applied in the opposite eyes; and (iii) participants who received conventional eye care including antiallergic adhesive to closed eyelids. Development of dry eye and corneal ulcer was assessed based on Schirmer's and the fluorescein tests for 5 days. Repeated measures analysis of variance was used to detect differences between groups.
Results: The mean age of the participants was 70.91 (±9.47). No statistically significant difference was observed between the groups regarding baseline demographic and disease characteristics. While there was a nonsignificant difference between artificial tear gel and polyethylene cover in reducing dry eye and corneal ulcer, each of these methods could reduce dry eye and corneal ulcer significantly (P < 0.001) compared with conventional eye care.
Conclusions: The results revealed that artificial tear gel eye care and polyethylene cover methods were more effective in prevention of dry eye and corneal ulcer than antiallergic adhesive eye care. Nurses can choose an appropriate care method based on clinical conditions, costs, and care burden in older ICU patients.
Registration: Iranian Clinical Trial Registry (IRCT20200711048079N1). The first recruitment was conducted in October 2021.
{"title":"Comparison of different eye care methods to prevent dry eye and corneal ulcer in older critically ill patients: A three-arm randomised clinical trial.","authors":"Mahsa Tebyanian, Ali Darvishpoor Kakhki, Sepehr Feizi","doi":"10.1016/j.aucc.2024.09.005","DOIUrl":"10.1016/j.aucc.2024.09.005","url":null,"abstract":"<p><strong>Background: </strong>As the population ages, the number of older patient admitted to intensive care units (ICUs) will increase. This age group is at higher risk for developing eye problems because of higher prevalence of dry eye among older people. Inconsistency of early studies' results and less attention to eye care guidelines for older patients in the ICU pose severe consequences such as dry eye and corneal ulcer.</p><p><strong>Objective: </strong>The objective of this study was to investigate the effectiveness of artificial tear gel, polyethylene cover, and conventional eye care methods for preventing dry eye and corneal ulcer in older patients admitted to an ICU.</p><p><strong>Methods: </strong>In this three-arm randomised clinical trial, 99 older ICU patients with Glasgow Coma Scale scores measuring <7 were randomly assigned to one of three treatment groups: (i) participants who received artificial tear gel in one eye and polyethylene cover on the other; (ii) these interventions were applied in the opposite eyes; and (iii) participants who received conventional eye care including antiallergic adhesive to closed eyelids. Development of dry eye and corneal ulcer was assessed based on Schirmer's and the fluorescein tests for 5 days. Repeated measures analysis of variance was used to detect differences between groups.</p><p><strong>Results: </strong>The mean age of the participants was 70.91 (±9.47). No statistically significant difference was observed between the groups regarding baseline demographic and disease characteristics. While there was a nonsignificant difference between artificial tear gel and polyethylene cover in reducing dry eye and corneal ulcer, each of these methods could reduce dry eye and corneal ulcer significantly (P < 0.001) compared with conventional eye care.</p><p><strong>Conclusions: </strong>The results revealed that artificial tear gel eye care and polyethylene cover methods were more effective in prevention of dry eye and corneal ulcer than antiallergic adhesive eye care. Nurses can choose an appropriate care method based on clinical conditions, costs, and care burden in older ICU patients.</p><p><strong>Registration: </strong>Iranian Clinical Trial Registry (IRCT20200711048079N1). The first recruitment was conducted in October 2021.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-08DOI: 10.1016/j.aucc.2024.05.002
Daksh Tyagi, Sheryn Tan, Joshua G. Kovoor, Brandon Stretton, Minh-Son To, Rudy Goh, Christopher D. Ovenden, Yiran Tan, James Malycha, Aashray K. Gupta, Stephen Bacchi
{"title":"In-hospital mortality is associated with observation-chart modifications","authors":"Daksh Tyagi, Sheryn Tan, Joshua G. Kovoor, Brandon Stretton, Minh-Son To, Rudy Goh, Christopher D. Ovenden, Yiran Tan, James Malycha, Aashray K. Gupta, Stephen Bacchi","doi":"10.1016/j.aucc.2024.05.002","DOIUrl":"10.1016/j.aucc.2024.05.002","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"37 6","pages":"Pages 837-838"},"PeriodicalIF":2.6,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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