Intensive Care Unit (ICU)

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Research outputs from the Intensive Care Unit (ICU) at the RD&E.


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Now showing 1 - 5 of 22
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    Ten areas for ICU clinicians to be aware of to help retain nurses in the ICU
    (BioMed Central, 2022-10-13) Vincent, J. L.; Boulanger, C.; van Mol, M. M. C.; Hawryluck, L.; Azoulay, E.
    Shortage of nurses on the ICU is not a new phenomenon, but has been exacerbated by the COVID-19 pandemic. The underlying reasons are relatively well-recognized, and include excessive workload, moral distress, and perception of inappropriate care, leading to burnout and increased intent to leave, setting up a vicious circle whereby fewer nurses result in increased pressure and stress on those remaining. Nursing shortages impact patient care and quality-of-work life for all ICU staff and efforts should be made by management, nurse leaders, and ICU clinicians to understand and ameliorate the factors that lead nurses to leave. Here, we highlight 10 broad areas that ICU clinicians should be aware of that may improve quality of work-life and thus potentially help with critical care nurse retention.
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    FUSIC HD. Comprehensive haemodynamic assessment with ultrasound
    (Sage, 2022-08-01) Miller, A.; Peck, M.; Clark, T.; Conway, H.; Olusanya, S.; Fletcher, N.; Coleman, N.; Parulekar, P.; Aron, J.; Kirk-Bayley, J.; Wilkinson, J. N.; Wong, A.; Stephens, J.; Rubino, A.; Attwood, B.; Walden, A.; Breen, A.; Waraich, M.; Nix, C.; Hayward, S.
    FUSIC haemodynamics (HD) - the latest Focused Ultrasound in Intensive Care (FUSIC) module created by the Intensive Care Society (ICS) - describes a complete haemodynamic assessment with ultrasound based on ten key clinical questions: 1. Is stroke volume abnormal? 2. Is stroke volume responsive to fluid, vasopressors or inotropes? 3. Is the aorta abnormal? 4. Is the aortic valve, mitral valve or tricuspid valve severely abnormal? 5. Is there systolic anterior motion of the mitral valve? 6. Is there a regional wall motion abnormality? 7. Are there features of raised left atrial pressure? 8. Are there features of right ventricular impairment or raised pulmonary artery pressure? 9. Are there features of tamponade? 10. Is there venous congestion? FUSIC HD is the first system of its kind to interrogate major cardiac, arterial and venous structures to direct time-critical interventions in acutely unwell patients. This article explains the rationale for this accreditation, outlines the training pathway and summarises the ten clinical questions. Further details are included in an online supplementary appendix.
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    Development of competencies for advanced nursing practice in intensive care units across Europe: A modified e-Delphi study
    (Elsevier, 2022-08-01) Endacott, R.; Scholes, J.; Jones, C.; Boulanger, C.; Egerod, I.; Blot, S.; Iliopoulou, K.; Francois, G.; Latour, J.
    PURPOSE: The aim of this study was to identify and define core competencies for advanced nursing roles in adult intensive care units across Europe. METHODS: Three round electronic Delphi conducted between September 2018 and November 2019, with an expert panel of 184 nurses from 20 countries, supplemented by consensus meetings with 16 participants from 10 countries before each round. RESULTS: In Round 1, participants generated 275 statements across 4 domains (knowledge skills and clinical performance; clinical leadership, teaching and supervision; personal effectiveness; safety and systems management). These were re-worded as competency statements and refined at a consensus meeting resulting in 230 statements in 30 sub-domains. The expert panel rated the 'importance' of each statement in Round 2; further refinement at the consensus meeting and the addition of descriptors for sub-domains resulted in 95 competency statements presented to the panel in Round 3. These were all retained in the final set of competency statements. CONCLUSION: We have used consensus techniques to generate competencies for advanced practice in intensive care nursing that are relevant across European countries and available in eight languages. These have provided the basis for an outline curriculum from which education programmes can be developed within countries.
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    Epidemiology and outcome of pressure injuries in critically ill patients with chronic obstructive pulmonary disease: A propensity score adjusted analysis
    (Elsevier, 2022-03-08) Martin-Loeches, I.; Rose, L.; Afonso, E.; Benbenishty, J.; Blackwood, B.; Boulanger, C.; Calvino-Gunther, S.; Chaboyer, W.; Coyer, F.; Llaurado-Serra, M.; Lin, F.; Rubulotta, F.; Williams, G.; Deschepper, M.; Francois, G.; Labeau, S. O.; Blot, S. I.
    BACKGROUND: Pressure injuries are a frequent complication in intensive care unit (ICU) patients, especially in those with comorbid conditions such as chronic obstructive pulmonary disease (COPD). Yet no epidemiological data on pressure injuries in critically ill COPD patients are available. OBJECTIVE: To assess the prevalence of ICU-acquired pressure injuries in critically ill COPD patients and to investigate associations between COPD status, presence of ICU-acquired pressure injury, and mortality. STUDY DESIGN AND METHODS: This is a secondary analysis of prospectively collected data from DecubICUs, a multinational one-day point-prevalence study of pressure injuries in adult ICU patients. We generated a propensity score summarizing risk for COPD and ICU-acquired pressure injury. The propensity score was used as matching criterion (1:1-ratio) to assess the proportion of ICU-acquired pressure injury attributable to COPD. The propensity score was then used in regression modeling assessing the association of COPD with risk of ICU-acquired pressure injury, and examining variables associated with mortality (Cox proportional-hazard regression). RESULTS: Of the 13,254 patients recruited to DecubICUs, 1663 (12.5%) had documented COPD. ICU-acquired pressure injury prevalence was higher in COPD patients: 22.1% (95% confidence interval [CI] 20.2 to 24.2) vs. 15.3% (95% CI 14.7 to 16.0). COPD was independently associated with developing ICU-acquired pressure injury (odds ratio 1.40, 95% CI 1.23 to 1.61); the proportion attributable to COPD was 6.4% (95% CI 5.2 to 7.6). Compared with non-COPD patients without pressure injury, mortality was no different among patients without COPD but with pressure injury (hazard ratio [HR] 1.07, 95% CI 0.97 to 1.17) or COPD patients without pressure injury (HR 1.13, 95% CI 1.00 to 1.27). Mortality was higher among COPD patients with pressure injury (HR 1.35, 95% CI 1.15 to 1.58). CONCLUSION AND IMPLICATIONS: Critically ill COPD patients have a statistically significant higher risk of pressure injury. Moreover, those that develop pressure injury are at higher risk of mortality. As such, pressure injury may serve as a surrogate for poor prognostic status to help clinicians identify patients at high risk of death. Also, delivery of interventions to prevent pressure injury are paramount in critically ill COPD patients. Further studies should determine if early intervention in critically ill COPD patients can modify development of pressure injury and improve prognosis.
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    Trends in 28-Day Mortality of Critical Care Patients With Coronavirus Disease 2019 in the United Kingdom: A National Cohort Study, March 2020 to January 2021
    (Wolters Kluwer, 2021-11-01) Dennis, J. M.; McGovern, A. P.; Thomas, N. J.; Wilde, H.; Vollmer, S. J.; Mateen, B. A.
    OBJECTIVES: To determine whether the previously described trend of improving mortality in people with coronavirus disease 2019 in critical care during the first wave was maintained, plateaued, or reversed during the second wave in United Kingdom, when B117 became the dominant strain. DESIGN: National retrospective cohort study. SETTING: All English hospital trusts (i.e., groups of hospitals functioning as single operational units), reporting critical care admissions (high dependency unit and ICU) to the Coronavirus Disease 2019 Hospitalization in England Surveillance System. PATIENTS: A total of 49,862 (34,336 high dependency unit and 15,526 ICU) patients admitted between March 1, 2020, and January 31, 2021 (inclusive). INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: The primary outcome was inhospital 28-day mortality by calendar month of admission, from March 2020 to January 2021. Unadjusted mortality was estimated, and Cox proportional hazard models were used to estimate adjusted mortality, controlling for age, sex, ethnicity, major comorbidities, social deprivation, geographic location, and operational strain (using bed occupancy as a proxy). Mortality fell to trough levels in June 2020 (ICU: 22.5% [95% CI, 18.2-27.4], high dependency unit: 8.0% [95% CI, 6.4-9.6]) but then subsequently increased up to January 2021: (ICU: 30.6% [95% CI, 29.0-32.2] and high dependency unit, 16.2% [95% CI, 15.3-17.1]). Comparing patients admitted during June-September 2020 with those admitted during December 2020-January 2021, the adjusted mortality was 59% (CI range, 39-82) higher in high dependency unit and 88% (CI range, 62-118) higher in ICU for the later period. This increased mortality was seen in all subgroups including those under 65. CONCLUSIONS: There was a marked deterioration in outcomes for patients admitted to critical care at the peak of the second wave of coronavirus disease 2019 in United Kingdom (December 2020-January 2021), compared with the post-first-wave period (June 2020-September 2020). The deterioration was independent of recorded patient characteristics and occupancy levels. Further research is required to determine to what extent this deterioration reflects the impact of the B117 variant of concern.