Articles: critical-care.
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Randomized Controlled Trial Multicenter Study
Minimising haemodynamic lability during changeover of syringes infusing norepinephrine in adult critical care patients: a multicentre randomised controlled trial.
Arterial pressure lability is common during the process of replacing syringes used for norepinephrine infusions in critically ill patients. It is unclear if there is an optimal approach to minimise arterial pressure instability during this procedures. We investigated whether 'double pumping' changeover (DPC) or automated changeover (AC) reduced blood pressure lability in critically ill adults compared with quick syringe changeover (QC). ⋯ NCT02304939.
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Multicenter Study Observational Study
Outcomes after Tracheostomy in COVID-19 Patients.
To determine the outcomes of patients undergoing tracheostomy for COVID-19 and of healthcare workers performing these procedures. ⋯ Alterations to tracheostomy practices and processes were successfully instituted. Following these steps, tracheostomy in COVID-19 intubated patients seems safe for both patients and healthcare workers performing the procedure.
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Acta Anaesthesiol Scand · Sep 2020
Multicenter Study Observational StudySepsis is underreported in Swedish intensive care units: a retrospective observational multicentre study.
Sepsis is a common indication for admission to the intensive care unit (ICU). Since definitions vary across studies, comparisons of prevalence and outcomes have been challenging. We aimed to compare sepsis according to ICU discharge codes with sepsis according to Sepsis-3 criteria and to investigate the epidemiology of sepsis in the ICU. We hypothesized that sepsis using discharge codes is underreported. ⋯ This large Swedish multicentre study showed that 28% of adult ICU patients fulfilled the Sepsis-3 criteria, but only one third of them had sepsis according to ICU discharge codes. We could confirm our hypothesis, that sepsis is severely underreported in Swedish ICUs, and we conclude that discharge codes should not be used for quality control or research purposes.
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Acta Anaesthesiol Scand · Sep 2020
Randomized Controlled Trial Multicenter StudyEffect of non-sedation on posttraumatic stress and psychological health in survivors of critical illness.
Critical illness can cause post-traumatic stress and impaired mental health. The NONSEDA trial was a Scandinavian multicenter RCT, assessing non-sedation versus sedation with a daily wake-up call during mechanical ventilation in critically ill adults. The aim of this substudy was to assess the effect of non-sedation on post-traumatic stress and mental health. ⋯ Levels of PTSD, anxiety and depression and quality of life regarding mental health were similar between the non-sedated and sedated group.
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J. Cardiothorac. Vasc. Anesth. · Sep 2020
Multicenter StudyOutcomes of Venoarterial Extracorporeal Membrane Oxygenation Patients Requiring Multiple Episodes of Support.
This study describes the largest North American single-institution experience with adult patients requiring multiple extracorporeal membrane oxygenation (ECMO) runs in the same admission and aims to describe outcomes of survival and complication rates in this patient population. ⋯ Fourteen of 326 patients in the authors' VA ECMO database required additional ECMO therapy after decannulation; this represents at least 1 to 2 cases per year at higher-volume centers. Despite the small number of patients in this retrospective review, it seems that certain patients are reasonable candidates for additional ECMO therapy should their cardiopulmonary function again decline. The findings of renal replacement therapy and infection being more common during a second ECMO run are logical, but larger cohorts (ideally multicenter or from within the Extracorporeal Life Support Organization registry) are required to validate these preliminary findings.