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  • Unsuspected serotonin toxicity in the ICU

    December 2016 | Annals of Intensive Care

    An observational prospective cohort study performed at VU University Medical Center in Amsterdam set out to determine whether delirious patients admitted to the ICU and MCU show characteristics that possibly match serotonergic toxicity, in order to gain more clarity on whether or not serotonergic toxicity should be considered as one of the contributing factors in delirious patients. The authors found that a significant proportion of ICU patients who have been diagnosed with delirium might in fact be classified as suffering from serotonin toxicity and showed that awareness of potential serotonin toxicity is low among physicians in their tertiary university ICU. Given the lack of existing studies, the authors point out the necessity for further studies about the incidence and prevalence of serotonin toxicity in ICU patients and the effect of possible early therapeutic interventions. Demographic characteristics for the study, such as age, gender, and severity of illness expressed in Acute Physiology and Chronic Health Evaluation (APACHE) II and IV score, were collected in MetaVision.

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  • Skeletal muscle quality as assessed by CT-derived skeletal muscle density is associated with 6-month mortality in mechanically ventilated critically ill patients

    December 2016 | Critical Care

    A retrospective study at VU University Medical Center Amsterdam investigated whether computed tomography (CT)-derived low skeletal muscle quality at ICU admission is independently associated with 6-month mortality and other clinical outcomes, the first study to investigate the relation between CT-derived markers for muscle quality and outcome in ventilated critically ill patients. Patient data such as age, sex, weight, height, admission diagnosis, APACHE II score, length of ventilation, ICU length of stay and hospital length of stay, discharge destination, and ICU and hospital mortality was obtained from MetaVision. The authors conclude that "Low skeletal muscle quality at ICU admission, as assessed by skeletal muscle density on CT scans, is associated with higher 6-month mortality in mechanically ventilated patients, independent of muscle quantity, APACHE II score, and BMI. Low muscle quality was also associated with longer hospital length of stay in survivors. Therefore, muscle quality appears to be as important for outcome as muscle quantity. Future intervention studies, including nutrition and early exercise, should not only focus on preventing further deterioration of muscle quantity, but also of muscle quality."

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  • New surgical scoring system to predict postoperative mortality

    December 2016 | Journal of Anesthesia

    A study performed at Tokyo Women’s Medical University attempted to develop a new scoring system that would enable a comprehensive assessment of preoperative and intraoperative patient statuses instantly following entry of data into an electronic anaesthesia chart, accurately and automatically predicting postoperative mortality. The usefulness of this new scoring system, the SASA, was compared with that of the surgical Apgar score (sAs) and American Society of Anesthesiologists physical status classification (ASA-PS), which are the components of the new system. The study, which included 32,555 patients who underwent surgery under general or regional anaesthesia from 2008 to 2012, used MetaVision to extract factors presumably associated with surgical outcomes, such as patient characteristics and ASA-PS, and the three intraoperative indexes used to calculate the sAs. The authors found that  while the sAs and ASA-PS were shown to be extremely useful for predicting mortality within 30 days of surgery,  an even higher predictive ability was demonstrated by the SASA, which combines these scoring systems, and conclude, "We expect that the SASA will be widely used as a new easy scoring system for predicting prognosis, allowing a comprehensive assessment of perioperative patient status and automatic calculation of scores at the end of entering data into electronic anesthesia charts."

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  • Readmission of ICU patients: A quality indicator?

    December 2016 | Journal of Critical Care

    A retrospective cohort study conducted at OLVG hospital aimed to verify previously identified potential determinants for readmission of ICU patients to assess which modifiable factors can make readmission rate a quality indicator. This is the largest single centre cohort of ICU patients to date, with 19,750 patients at risk for readmission included over a 14-year period. Demographic and clinical characteristics were extracted from MetaVision. The authors found that since readmission rate is associated with factors that are mainly patient dependent and cannot be modified, such as age, severity of disease, type of admission, infection, and immunodeficiency, readmission rate does not meet the criteria to be used as a useful quality indicator.

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  • Implementation of a transfusion bundle reduces inappropriate red blood cell transfusions in intensive care – a before and after study

    December 2016 | Transfus Med.

    A study performed at Academic Medical Center in the Netherlands investigated the effect of the application of a transfusion bundle on transfusion practice, hypothesising that the implementation of the transfusion bundle would lead to a reduction of inappropriate red blood cell transfusions. The authors quantified the true effect of the transfusion bundle by assessing, per transfusion, whether the decision to transfuse was based on a lower pre-transfusion haemoglobin level than the patients’ individual preset haemoglobin threshold.  Data about appropriate transfusions were collected at baseline (4 months), during the implementation period (4 months) and during the post-implementation period (4 months) using MetaVision. The authors found that using the transfusion bundle helps to improve compliance with transfusion guidelines in daily practice and suggest that future research should focus on implementing a transfusion bundle for other types of blood products, such as fresh frozen plasma or platelets, and on the cost effectiveness of implementing the transfusion bundle.

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  • Staphylococcus aureus carriage at admission predicts early-onset pneumonia after burn trauma

    November 2016 | Eur J Clin Microbiol Infect Dis.

    A retrospective analysis Centre Hospitalier Universitaire Vaudois (CHUV) aimed to analyse the epidemiology, characteristics, and risk factors associated with Staphylococcus aureus early-onset pneumonia (EOP) to identify predictive factors that could be used to target it with early preemptive treatment, such as that using focused antibiotics or specific monoclonal antibodies. Data for all burn patients requiring more than four hours of mechanical ventilation who were admitted between January 2001 and October 2012 were extracted using MetaVision. The authors identified S. aureus carriage as an independent and strong predictor of EOP. They suggest that since rapid point of care testing for S. aureus is readily available, all patients should be tested at admission for burn trauma and early preemptive treatment should be considered for all positive patients, and note that further studies are needed to evaluate this new strategy.

     

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  • A first evaluation of OMNI, a new device for continuous renal replacement therapy

    November 2016 | Blood Purif.

    A prospective observational study at Centre Hospitalier Universitaire Vaudois (CHUV) evaluated OMNI®, a new device for continuous renal replacement therapy (CRRT), by testing it in real-life conditions for the first time. The authors also assessed user (nurses) satisfaction and aimed to provide direct feedback to the manufacturer regarding issues raised and user interface improvement suggestions. Ten critically ill patients received CRRT in CVVH-heparin and CVVHD-citrate modes using OMNI. The authors collected therapy data and metabolic parameters using MetaVision, and evaluated user’s satisfaction with a survey. The authors found that, "RRT could be provided using Omni in a safe and efficient way in both CVVH-heparin and CVVHD-RCA modes in 10 critically ill patients. Alarms-related downtime was minimal and renal dose delivery high. Users provided positive feedback for therapy setup, management and design."

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  • Improving manual oxygen titration in preterm infants by training

    November 2016 | Eur J Pediatr.

    A study performed at Leiden University Medical Center (LUMC) in the Netherlands studied oxygen saturation (SpO2) targeting before and after training and guideline implementation of manual oxygen titration by comparing two cohorts of preterm infants <30 weeks of gestation needing respiratory support and oxygen therapy. Respiratory support was given by a mechanical ventilator connected to the MetaVision patient data management system (PDMS), which supplied basic patient characteristics as well as clinical parameters every minute. The authors found that training guideline implementation in manual oxygen titration improved SpO2 targeting in preterm infants, with more time spent within the target range and less frequent hyperoxaemia. The durations of hypoxaemia and hyperoxaemia during ABCs (apnoea, bradycardia, cyanosis) were shorter. They conclude that, "This initiative in quality improvement had a positive effect, and if the observed reduction in the risk for hypoxaemia and hyperoxaemia could be maintained through repetitive training, it would be likely to improve the outcome of preterm infants."

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  • The effect of positive end-expiratory pressure on intracranial pressure and cerebral hemodynamics

    November 2016 | Neurocrit Care

    A study performed at Beth Israel Deaconess Medical Center evaluated the effect of positive end-expiratory pressure (PEEP) on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in a large population of patients with acute brain injury and varying categories of acute lung injury, defined by PaO2/FiO2. The authors hypothesised that PEEP could be applied safely to patients with severe brain injury without causing intracranial hypertension or dangerous reductions in CPP. The authors conclude that " the application of PEEP for patients with varying degrees of acute lung injury and concomitant severe, acute brain injury does not appear to have a clinically significant effect on ICP or CPP. However, our findings should be applied with caution as further prospective studies are needed to assess the safety and clinical outcomes of applying a lung protective ventilation strategy to patients with both lung and brain injuries In this study, the largest analysis of the relationship between PEEP and ICP, MetaVision was used to identify eligible patients and collect ventilation, physiologic, laboratory, medication, and demographic data.

     

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  • Impact of early nutritional intake on preterm brain: a magnetic resonance imaging study

    November 2016 | J Pediatr.

    A study at University Hospital of Lausanne (CHUV) in Switzerland investigated the association between morphologic brain development, assessed by cerebral magnetic resonance imaging(MRI) at term equivalent age (TEA), and macronutrient and energy intakes during the first 2 weeks after birth. MetaVision provided an exact record of enteral and parenteral intakes. The authors found that higher energy and lipid intake during the first 2 weeks after birth was associated with a lower incidence of brain lesions and dysmaturation at term equivalent age in preterm neonates and conclude that "Optimizing nutritional intake may be an effective and feasible way to improve preterm brain development and to potentially alleviate the effect of early stressors such as inflammation and infection. The impact on long term neurodevelopmental outcome must be confirmed, especially in more vulnerable populations. Finally, larger interventional trials are needed to further investigate and develop effective neuroprotective nutritional strategies."

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