NIHR Signal Transfusing blood close to its use-by date does not increase deaths in critically ill adults

Transfusing more recently-collected red blood cells does not improve the chance of survival for critically-ill people who need blood transfusions, compared with blood that has been stored for longer.

This large international study included almost 5,000 critically ill people in intensive care units. Participants were transfused with either the freshest compatible blood available (mean storage 11.8 days) or the oldest compatible stored blood within its use-by date (mean storage time 22.4 days).

From the NIHR Dissemination Centre

Eye Care in the Intensive Care Unit (ICU)

Produced in collaboration with the Intensive Care Society, the Eye Care in Intensive Care Unit guidance provides advice for clinical staff involved in eye care in the ICU. It is primarily intended to help non-ophthalmic ICU staff to:

• protect the eye in vulnerable patients, thus preventing ICU-related eye problems
• identify disease affecting the eye in ITU patients, and specifically those which might need ophthalmic referral
• deliver treatment to the eye when it is prescribed

It concentrates on the common problems of the eye surface but also touches on other less common conditions. As such, it should also be helpful to those ophthalmologists asked for advice about ICU patients.

Join enhanced care improvement collaborative for inpatient acute/community trusts

NHS Improvement is launching an enhanced care improvement collaborative in March 2018 to deliver an improved experience for critically ill or vulnerable patients in hospital. The programme will build on the learning from the pilot programme in 2015/16 and roll out best practice.

A review of breastfeeding training intervention studies that evaluate staff knowledge outcomes in NICU

Journal of Neonatal Nursing : http://dx.doi.org/10.1016/j.jnn.2017.10.002

The NICU environment presents many barriers for mothers to provide breast milk for their infants. In order to succeed, mothers require advice and assistance from healthcare staff, however some staff lack the necessary knowledge and skills to support them. This review evaluates studies of breastfeeding education interventions on staff knowledge outcomes.

UHCW Research: Amber Dunlop

The Regulation of Medical Associate Professions in the UK

This DH consultation seeks views on the regulation of medical associate professions in the UK, including physician associates, physicians’ assistants, surgical care practitioners and advanced critical care practitioners. The closing date for comments is 22 December 2017.

Rehabilitation after critical illness in adults [QS158]

New NICE quality standard covers adults with rehabilitation needs as a result of critical illness that required level 2 or level 3 critical care. It describes high-quality care in priority areas for improvement.

Rehabilitation after critical illness in adults

This new quality standard from NICE covers adults with rehabilitation needs as a result of critical illness that required level 2 or level 3 critical care. It describes high-quality care in priority areas for improvement.

Major trauma in older people: implications for anaesthesia and intensive care medicine

Editorial in Anaesthesia. DOI: 10.1111/anae.14027

The Trauma Audit and Research Network (TARN ) is the independent monitor of trauma care in England and Wales. It produces reports for participating hospitals three times a year, and has also produced national reports on major trauma in children [1, 2]. It is the trauma equivalent of the Intensive Care National Audit and Research Centre (ICNARC) for Intensive Care Medicine. The latest themed report has just been published and is entitled ‘Major trauma in older people’ [3]. This first report on trauma in older people from TARN was written by a multidisciplinary group of healthcare professionals and we were privileged to be the representatives from anaesthesia.

UHCW Research: D. Surendra Kumar

Decisions regarding admission to the ICU and international initiatives to improve the decision-making process

Critical care (London, England) 21.1: 174. (July 4, 2017)

Whether a critically ill patient should or should not be offered life-supporting treatment in the intensive care unit (ICU) is arguably the most important decision that is regularly made on behalf of a patient; deciding not to admit somebody may mean that their death is inevitable. Yet these decisions are often made in the face of uncertain information, time constraints and without the patient being able to participate in discussions. In this context it is perhaps surprising that more research and guidance has not addressed this area of practice.

There are three overarching considerations that must influence the decision not to admit a patient to ICU. Firstly, that an individual patient’s preference may be to decline intensive care treatments. Secondly, that the burden of invasive and distressing treatments on the ICU may outweigh any potential benefit. Thirdly, that the ICU is a labour and resource-intensive endeavour: resources are not available for every patient to be admitted. Intensivists are provided with a limited amount of resources and are, usually implicitly, charged with doing as much good as possible with what is available. This means that at times of high demand or limited resource availability, patients who have less clear-cut potential to benefit from the ICU may not be admitted [1, 2]. Managing resources is an unavoidable part of the intensivist’s job.

In this issue Nicolas Chin-Yee and colleagues shine more light on the interaction of these three issues by studying the impact of admission to the ICU for older patients.

UHCW Research: Bassford, Christopher

Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care Unit

Among adults with suspected infection admitted to an ICU, an increase in SOFA score of 2 or more had greater prognostic accuracy for in-hospital mortality than SIRS criteria or the qSOFA score. These findings suggest that SIRS criteria and qSOFA may have limited utility for predicting mortality in an ICU setting.

JAMA. 2017 Jan 17;317(3):290-300. doi: 10.1001/jama.2016.20328.

Should real resuscitationists use airway checklists?

New from BestBETs:

In [critically ill patients requiring endotracheal intubation] does [the use of a preprocedural checklist] reduce [the incidence of adverse events].

Current evidence suggests there may be a potential reduction in adverse events with the use of preprocedural checklists, during intubation of the critically ill patient outside a theatre environment. However, this evidence is level 3 at best and should be considered hypothesis generating. Further evidence is required before airway checklists can be considered a standard of care.

Toolkit To Improve Safety for Mechanically Ventilated Patients

The Toolkit To Improve Safety for Mechanically Ventilated Patients helps hospitals make care safer for mechanically ventilated patients in intensive care units (ICUs). These patients require the assistance of a ventilator to breathe. ICU staff can use the toolkit to apply the proven principles and methods of AHRQ’s Comprehensive Unit-based Safety Program (CUSP) to reduce complications for patients on ventilators. Such complications include ventilator-associated pneumonia, which affects as many as 20 percent of patients who are on a ventilator for more than 48 hours.

Delivery Plan for the critically ill to 2020

NHS Wales has published a delivery plan for the critically ill which aims to deliver the highest standard of care to the critically ill.

Paediatric Intensive Care Surge Standard Operating Procedure

NHS England has published updated guidance for managing seasonal pressures in paediatric intensive care.

The Paediatric Intensive Care Surge Standard Operating Procedure sets out instructions for managing unplanned peaks in demand for critical care beds, across the country’s 29 paediatric intensive care units (PICUs).

Low-dose sedative reduces sudden confusion after major surgery in older adults

Giving a low-dose sedative to older adults in intensive care after surgery reduces sudden confusion, also known as delirium, without increasing the risk of adverse effects.

From the NIHR Dissemination Centre

Bedside tracheostomy may be at least as good as traditional surgical techniques

Bedside tracheostomy procedures in intensive care units were at least as good as surgical tracheostomies, usually done in theatre.

From the NIHR Dissemination Centre

How nurses support families of intensive care patients towards the end of life

Families of people dying in intensive care need to receive personalised communication and ongoing support, and be involved in the dying process.

Reviewers identified three main ways, or themes, in which families are supported. First, information and good communication, such as the focus on careful use of language, was seen commonly. Second, by careful management of treatment withdrawal itself, for example by clarifying the gradual change expected when medically focussed life-sustaining treatments are withdrawn and family centred end-of-life care begins. Lastly they described a common focus on making the nursing contribution more visible, such as using techniques to build lasting memories for families.

From the NIHR Dissemination Centre

PICANet Annual Report 2016

The PICANet (Paediatric Intensive Care Audit Network) Audit aims to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales.   This report summaries its audit for the period January 2013-December 2015.

Syringe Labelling in Critical Care Areas Review 2014 (updated November 2016)

Since the new standard for syringe labelling was introduced in May 2003, a number of changes needed to be made. These changes are to bring the standard in line with the change from British Approved Names (BANs) to recommended International Non-Propriety Names (rINNs) , and also to bring the standard in line with the Australian/New Zealand Standard3 and ISO Standard which have superseded it.

NHS England accelerates national reviews of vital specialist services for children

NHS England has formally announced more details of its accelerated national reviews of both paediatric critical care, and specialised surgery for children.