Name of Media:

Posttraumatic Stress Disorder in General Intensive Care Unit Survivors: A Systematic Review

Type of Library Material:

Medical Journal

Brief description of media:

The authors reviewed 16,301 citations, 1,908 abstracts and 193 full-text articles containing reference to PICS and selected 15 for detailed review. The review identified ICU acquired weakness, brain dysfunctions and mental health problems as key PICS symptoms.

Name of Media:

ICU Diary: The Gift of Care™

Type of Library Material:

Magazine Article

Brief description of media:

As an ICU nurse you’ve probably encountered the critically ill patient who is experiencing hallucinations, delusions, and confusion. Healthcare providers are learning just how detrimental this state of mind can be to the patient’s recovery process as he or she transitions from the ICU setting. One proposed intervention, the ICU diary, has been used in Europe since the 1980s but is not widely used in the United States. I conducted the first evidence-based practice (EBP) ICU diary pilot project in an acute care setting located in Central Texas.

Name of Media:

ICU Stays Can Result in Long-Lasting Mental Health Problems

Type of Library Material:

Medical Journal

Brief description of media:

Almost 6 million patients a year are admitted to an intensive care unit (ICU) in the United States, according to the Society of Critical Care Medicine (SCCM). The majority of those survive to be discharged. But for many of them, though their initial illness or injury may have been resolved, a new challenge awaits—a cluster of health problems commonly referred to as post-intensive care syndrome (PICS).

Name of Media:

Post-intensive care syndrome: What it is and how to help prevent it

Type of Library Material:

Medical Journal

Brief description of media:

American Nurse Today article notes that at least one-third of ICU patients and families experience PICS and half still need care after 1 year. Discusses the SCCM ABCDEF guidelines for care.

Name of Media:

Laryngeal mask airway versus endotracheal tube for percutaneous dilatational tracheostomy in critically ill adults

Type of Library Material:

Medical Journal

Brief description of media:

Background

Percutaneous dilatational tracheostomy (PDT) is one of the most common bedside surgical procedures performed in critically ill adults, on intensive care units (ICUs), who require long‐term ventilation. PDT is associated with relevant life‐threatening complications: Cuff rupture or accidental extubation may lead to hypoxia, aspiration or loss of airway. Puncture of the oesophagus, or creating a false passage during dilatation or replacement of the tracheostomy tube, can lead to pneumothorax or emphysema. Wound infections may occur which can cause mediastinits, especially after creation of false passage or in early tracheotomized post‐sternotomy patients after cardiac surgery. During the procedure, the patient's airway can be secured with an endotracheal tube (ETT) or a laryngeal mask airway (LMA). This is an updated version of the review first published in 2014.
Objectives

To assess the safety and effectiveness of LMA versus ETT in critically ill adults undergoing PDT on the ICU.
Search methods

We searched the following databases to 9 January 2018: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase. We searched for reports of ongoing trials in the metaRegister of Controlled Trials (mRCT). We handsearched for relevant studies in conference proceedings of five relevant annual congresses. We contacted study authors and experts concerning unpublished data and ongoing trials. We searched for further relevant studies in the reference lists of all included trials and of relevant systematic reviews.
Selection criteria

We included randomized controlled trials (RCTs) that compared use of laryngeal mask airways versus endotracheal tubes in critically ill adults undergoing elective PDT in the ICU, without injuries to or diseases of the face or neck. We imposed no restrictions with regard to language, timing or technique of PDT performed.
Data collection and analysis

Two review authors independently assessed the eligibility and methodological quality of each study and carried out data extraction. Our primary outcomes were all‐cause mortality, procedure‐related mortality and tally of participants with one or more serious adverse events. Where possible, we combined homogeneous studies for meta‐analysis. We used Cochrane's 'Risk of bias' tool and used GRADE to assess the quality of evidence for key outcomes.
Main results

We included nine RCTs in this review involving 517 participants.

Studies had a high or unclear risk of bias. The main reason for this was low methodological quality or missing data, even after study authors were contacted. Study size was generally small, with a minimum of 40, and a maximum of 73 participants.

In one study (40 participants), three deaths in the LMA group and two deaths in the ETT group were reported, although none of the deaths were related to the procedure (very low‐quality evidence).

Five studies (281 participants) reported on procedure‐related deaths, stating that no procedure‐related death occurred at all (very low‐quality evidence).

It is uncertain whether there is a difference in the number of people experiencing one or more serious adverse event(s) between LMA and ETT (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.41 to 1.80; 467 participants, 8 studies, very low‐quality evidence).

The duration of the procedure may be shorter in the LMA group (mean difference (MD) ‐1.46 minutes, 95% CI ‐1.92 to ‐1.01 minutes; 6 studies, 324 participants, low‐quality evidence).

However failure of procedure, as allocated by randomization, requiring conversion to any other procedure, may be higher in the LMA group (RR 2.82, 95% CI 1.22 to 6.52; 8 studies, 439 participants, low‐quality evidence).

We did not find any clear evidence of a difference between ETT and LMA groups for all other outcomes. Only one study provided follow‐up data for late complications related to the intervention, showing no clear evidence of benefit for any treatment group.
Authors' conclusions

Evidence on the safety of LMA for PDT is too limited to allow conclusions to be drawn on either its efficacy or safety compared with ETT. Although the LMA procedure may shorten the period during which the airway is insecure, it may also lead to higher conversion rates. Also, late complications have not been investigated sufficiently. These results are primarily based on single‐centre trials with small sample sizes, and therefore the level of evidence remains low. Studies with low risk of bias focusing on late complications and relevant patient‐related outcomes are necessary for definitive conclusions on safety issues related to this procedure. The dependency of the successful placement of a LMA on the type of LMA used should also be further assessed.

There are two studies awaiting classification that may alter the conclusions once assessed.

Name of Media:

Economic evaluation of chlorhexidine-impregnated sponges for preventing catheter-related infections in critically ill adults in the Dressing Study

Type of Library Material:

Medical Professional Education

Brief description of media:

The study examined the cost-effectiveness of chlorhexidine gluconate-impregnated sponges (CHIGIS) for arterial and central venous catheters for prevention of catheter-related infections in critically ill adults using data from a recent clinical trial. The authors concluded that the CHGIS strategy reduced the rate of MCRI and saved costs from the perspective of an intensive care unit. The analysis was appropriately carried out using a micro-costing approach alongside a randomised controlled trial. The authors’ conclusions appear robust.

Name of Media:

Negative B natriuretic peptide testing confirms low risk stratification for patients with a definite pulmonary embolus

Type of Library Material:

Medical Professional Education

Brief description of media:

Three Part Question
In [patients with definite pulmonary embolus] can a [low/negative BNP/NT-proBNP result] predict [low risk of death / adverse outcome?]
Clinical Scenario
A patient presents with a few days history of pleuritic chest pain. All clinical findings and investigations are normal except for a raised d-dimer. A high probability V/Q scan confirms the diagnosis of pulmonary embolism. The patient is very keen to be discharged. You are aware that right ventricular strain is associated with a poor outcome in pulmonary embolism and you also know that B natriuretic peptides are raised in the presence of ventricular strain. You wonder if a low B natriuretic peptide level could be used to confirm the absence of ventricular stain and low risk of death or serious complications, therefore suggesting suitability for outpatient management.
Search Strategy
Cochrane Database of Systematic Reviews, EMBASE and Ovid Medline through Ovid interface, January 2015.

[bnp.mp. OR brain natriuretic peptide.mp. OR natriuretic peptide.mp. OR NT-proBNP.mp. OR proBNP.mp.] AND [pulmonary embolism.mp. OR pe.mp. OR thromboembolic disease.mp. OR lung embolism.mp.] LIMIT to english language and human (Limit not valid in CDSR)

Name of Media:

Early (< 8 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants

Type of Library Material:

Medical Journal

Brief description of media:

Review objective: To determine the relative benefits and harms of treatment with drugs that suppress inflammation, called corticosteroids, given to babies born too early during the first week after birth to prevent lung injury, known as bronchopulmonary dysplasia (sometimes also called chronic lung disease).

Background: Corticosteroids can reduce lung inflammation in newborn babies with bronchopulmonary dysplasia but may produce major adverse effects. Bronchopulmonary dysplasia is a major problem for newborn babies in neonatal intensive care units. Persistent inflammation of the lungs is the most likely cause. Corticosteroid drugs have been used to prevent or treat bronchopulmonary dysplasia through their strong anti‐inflammatory effects.

Study characteristics: We reviewed all clinical trials in preterm babies in which corticosteroids had been given as a medication during the first week after birth, and from which data on the rate of bronchopulmonary dysplasia later in the newborn period were available.

Key results: This review of trials revealed that the benefits of giving systemic corticosteroids to infants starting up to seven days after birth may not outweigh the known adverse effects. However, a particular corticosteroid called hydrocortisone shows promise in improving short‐term outcomes without adversely affecting long‐term neurodevelopment. Beneficial effects of systemic corticosteroids overall included shorter time on the ventilator and less bronchopulmonary dysplasia, but adverse effects included higher blood pressure, bleeding from the stomach or bowel, perforation of the bowel, excessive glucose in the bloodstream, and increased risk of cerebral palsy at follow‐up, particularly in those treated with dexamethasone ‐ another type of corticosteroid. Early use of corticosteroids, especially dexamethasone, to treat or prevent bronchopulmonary dysplasia should be curtailed until additional research has been performed.

Quality of evidence: Overall, the quality of evidence supporting our conclusions was high.

Name of Media:

Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic

Type of Library Material:

Medical Journal

Brief description of media:

Background: Before the COVID-19 pandemic, coronaviruses caused two noteworthy outbreaks: severe acute respiratory syndrome (SARS), starting in 2002, and Middle East respiratory syndrome (MERS), starting in 2012. We aimed to assess the psychiatric and neuropsychiatric presentations of SARS, MERS, and COVID-19.

Methods: In this systematic review and meta-analysis, MEDLINE, Embase, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature databases (from their inception until March 18, 2020), and medRxiv, bioRxiv, and PsyArXiv (between Jan 1, 2020, and April 10, 2020) were searched by two independent researchers for all English-language studies or preprints reporting data on the psychiatric and neuropsychiatric presentations of individuals with suspected or laboratory-confirmed coronavirus infection (SARS coronavirus, MERS coronavirus, or SARS coronavirus 2). We excluded studies limited to neurological complications without specified neuropsychiatric presentations and those investigating the indirect effects of coronavirus infections on the mental health of people who are not infected, such as those mediated through physical distancing measures such as self-isolation or quarantine. Outcomes were psychiatric signs or symptoms; symptom severity; diagnoses based on ICD-10, DSM-IV, or the Chinese Classification of Mental Disorders (third edition) or psychometric scales; quality of life; and employment. Both the systematic review and the meta-analysis stratified outcomes across illness stages (acute vs post-illness) for SARS and MERS. We used a random-effects model for the meta-analysis, and the meta-analytical effect size was prevalence for relevant outcomes, I2 statistics, and assessment of study quality.

Findings: 1963 studies and 87 preprints were identified by the systematic search, of which 65 peer-reviewed studies and seven preprints met inclusion criteria. The number of coronavirus cases of the included studies was 3559, ranging from 1 to 997, and the mean age of participants in studies ranged from 12·2 years (SD 4·1) to 68·0 years (single case report). Studies were from China, Hong Kong, South Korea, Canada, Saudi Arabia, France, Japan, Singapore, the UK, and the USA. Follow-up time for the post-illness studies varied between 60 days and 12 years. The systematic review revealed that during the acute illness, common symptoms among patients admitted to hospital for SARS or MERS included confusion (36 [27·9%; 95% CI 20·5-36·0] of 129 patients), depressed mood (42 [32·6%; 24·7-40·9] of 129), anxiety (46 [35·7%; 27·6-44·2] of 129), impaired memory (44 [34·1%; 26·2-42·5] of 129), and insomnia (54 [41·9%; 22·5-50·5] of 129). Steroid-induced mania and psychosis were reported in 13 (0·7%) of 1744 patients with SARS in the acute stage in one study. In the post-illness stage, depressed mood (35 [10·5%; 95% CI 7·5-14·1] of 332 patients), insomnia (34 [12·1%; 8·6-16·3] of 280), anxiety (21 [12·3%; 7·7-17·7] of 171), irritability (28 [12·8%; 8·7-17·6] of 218), memory impairment (44 [18·9%; 14·1-24·2] of 233), fatigue (61 [19·3%; 15·1-23·9] of 316), and in one study traumatic memories (55 [30·4%; 23·9-37·3] of 181) and sleep disorder (14 [100·0%; 88·0-100·0] of 14) were frequently reported. The meta-analysis indicated that in the post-illness stage the point prevalence of post-traumatic stress disorder was 32·2% (95% CI 23·7-42·0; 121 of 402 cases from four studies), that of depression was 14·9% (12·1-18·2; 77 of 517 cases from five studies), and that of anxiety disorders was 14·8% (11·1-19·4; 42 of 284 cases from three studies). 446 (76·9%; 95% CI 68·1-84·6) of 580 patients from six studies had returned to work at a mean follow-up time of 35·3 months (SD 40·1). When data for patients with COVID-19 were examined (including preprint data), there was evidence for delirium (confusion in 26 [65%] of 40 intensive care unit patients and agitation in 40 [69%] of 58 intensive care unit patients in one study, and altered consciousness in 17 [21%] of 82 patients who subsequently died in another study). At discharge, 15 (33%) of 45 patients with COVID-19 who were assessed had a dysexecutive syndrome in one study. At the time of writing, there were two reports of hypoxic encephalopathy and one report of encephalitis. 68 (94%) of the 72 studies were of either low or medium quality.

Interpretation: If infection with SARS-CoV-2 follows a similar course to that with SARS-CoV or MERS-CoV, most patients should recover without experiencing mental illness. SARS-CoV-2 might cause delirium in a significant proportion of patients in the acute stage. Clinicians should be aware of the possibility of depression, anxiety, fatigue, post-traumatic stress disorder, and rarer neuropsychiatric syndromes in the longer term.

Name of Media:

Cost-effectiveness of immunoglobulin M-enriched immunoglobulin (Pentaglobin) in the treatment of severe sepsis and septic shock

Type of Library Material:

Medical Professional Education

Brief description of media:

Record Status

This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
Health technology

The use of a specific polyclonal intravenous immune globulin preparation (Pentaglobin) for adult patients treated for severe sepsis and septic shock.

Name of Media:

Adult CHD level 2 standards

Type of Library Material:

Medical Professional Education

Brief description of media:

This document is part of a suite of documents setting out adult and paediatric standards and service specifications for congenital heart disease services in England.

Name of Media:

Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review

Type of Library Material:

Medical Journal

Brief description of media:

Introduction

Although many terminally ill people are admitted to an intensive care unit (ICU) at the end of life, their care is often inadequate because of poor communication by physicians and lack of patient- and family-centred care. The aim of this systematic literature review was to describe physician-related barriers to adequate communication within the team and with patients and families, as well as barriers to patient- and family-centred decision-making, towards the end of life in the ICU. We base our discussion and evaluation on the quality indicators for end-of-life care in the ICU developed by the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup.
Method

Four electronic databases (MEDLINE, Embase, CINAHL and PsycINFO) were searched, using controlled vocabulary and free text words, for potentially relevant records published between 2003 and 2013 in English or Dutch. Studies were included if the authors reported on physician-related and physician-reported barriers to adequate communication and decision-making. Barriers were categorized as being related to physicians’ knowledge, physicians’ attitudes or physicians’ practice. Study quality was assessed using design-specific tools. Evidence for barriers was graded according to the quantity and quality of studies in which the barriers were reported.
Results

Of 2,191 potentially relevant records, 36 studies were withheld for data synthesis. We determined 90 barriers, of which 46 were related to physicians’ attitudes, 24 to physicians’ knowledge and 20 to physicians’ practice. Stronger evidence was found for physicians’ lack of communication training and skills, their attitudes towards death in the ICU, their focus on clinical parameters and their lack of confidence in their own judgment of their patient’s true condition.
Conclusions

We conclude that many physician-related barriers hinder adequate communication and shared decision-making in ICUs. Better physician education and palliative care guidelines are needed to enhance knowledge, attitudes and practice regarding end-of-life care. Patient-, family- and health care system–related barriers need to be examined.