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  • Heart rate time series characteristics for early detection of infections in critically ill patients

    April 2017 | J Clin Monit Comput.

    A prospective observational study performed at the surgical and medical ICUs of UZ Leuven in Belgium hypothesised that infected ICU patients can be distinguished from non-infected ICU patients based on dynamic features of serum cytokine concentrations and heart rate time series. The authors used simple metrics to quantify these time series to obtain an accurate classification of infected patients. Heart rate measurements were stored in MetaVision. The authors found that heart rate seemed to be a better marker for infection than information captured by cytokine time series when the exact stage of infection is not known. They propose that the predictive value of (expensive) biomarkers should always be weighed against the routinely monitored data, and that these biomarkers have to demonstrate added value.

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  • Effect of goal-directed therapy on outcome after oesophageal surgery: A quality improvement study

    March 2017 | PLoS One

    A Quality Improvement study performed at Academic Medical Center in The Netherlands investigated whether a stroke volume guided goal-directed therapy (GDT) improves the postoperative outcome of patients undergoing oesophageal surgery. The authors initiated a quality improvement program that used GDT as a new standard of care for all patients undergoing oesophagectomy at their institution. Patients’ characteristics, surgical outcome and oncologic results were prospectively collected from the MetaVision Patient Data Management System (PDMS). The authors found that the implementation of GDT during oesophagectomy did not reduce overall morbidity, mortality and hospital length of stay but pneumonia, mediastinal abscesses, the proportion of patients staying more than 48 hours in the ICU and fluid balance were lower in the GDT group. In light of this finding, they suggest that larger (randomised) studies are necessary to reveal possible benefits with a higher reliability, and point out that the economic impact of GDT remains to be determined.

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  • Changes in quality of life after elective surgery: an observational study comparing two measures

    March 2017 | Qual Life Res

    A prospective observational cohort study performed at Barnes Jewish Hospital compared the change in a validated quality of life measure (VR-12) after elective surgery, to a global assessment measure. It also estimated the minimum clinically important difference (MCID) for change in VR-12 quality of life and aimed to describe this change by surgical specialty. Surgical specialty and all other variables were obtained from MetaVision. The results showed the two methods of quality of life assessment to be in poor agreement. The study authors conclude that clinicians should select an instrument based on their goals, using 2.5 points as the MCID for the VR-12. They propose that future studies should confirm the difference in quality of life changes across surgical specialties and explore the reasons for such differences.

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  • The effect of implementing an automated oxygen control on oxygen saturation in preterm infants

    February 2017 | Arch Dis Child Fetal Neonatal Ed.

    A study performed in the NICU at Leiden University Medical Centre compared the effectiveness of an automated fraction of inspired oxygen (FiO2) system with manual titration of FiO2 in maintaining oxygen saturation (SpO2) within the intended target range. This is the first study that examines the impact of having automated FiO2 implemented in routine care for longer periods of time. The characteristics of each infant as well as clinical parameters and ventilator settings (including the FiO2 and SpO2) were sampled every minute and routinely collected in MetaVision. The authors conclude that implementation of automated FiO2 control led to an increased compliance of maintaining SpO2 within the intended target range during oxygen therapy, with the study results showing a significant decrease in hyperoxaemia, although no effect on hypoxaemia. The authors suggest that additional randomised studies be performed to confirm the beneficial effects of such automated oxygen control on the outcome for preterm infants.

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  • Adherence to a nurse-driven feeding protocol in a Pediatric Intensive Care Unit

    February 2017 | JPEN J Parenter Enteral Nutr.

    A prospective cohort audit performed at Alberta Health Services aimed to identify compliance and reasons for noncompliance to a nurse-driven feeding protocol at a tertiary care hospital PICU in Canada, with a secondary aim of determining the mean time (hours) spent without any form of nutrition and to identify reasons for interruptions to nutrition support. To the authors' knowledge, this study is the first to examine reasons for noncompliance to a feeding protocol in the PICU. Data points were collected with a combination of paper charts and MetaVision. The authors found that there was a 95% compliance rate to the protocol and an average of 25.6 hours spent without nutrition per patient, and that the most prevalent reason for noncompliance was an avoidable delay in restarting feeds before/after procedures or after surgery. They conclude that, "A nurse-driven feeding protocol may reduce time spent without nutrition. Future research is required to examine the relationship between adherence to feeding protocols and clinical outcomes."

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  • Prevention of hypoxemia during apnoea testing: A comparison of oxygen insufflation and continuous positive airway pressure

    February 2017 | Neurocrit Care.

    A multicenter, population-based cohort study of consecutive apnoea tests was performed in urban centers in the province of Alberta in order to compare the conventional oxygen (O2) insufflation catheter method with use of a resuscitation bag with continuous positive airway pressure (CPAP) valve. The MetaVision clinical information system, which is used in ICUs across the province of Alberta, was used to identify consecutive apnoea tests that were performed in Calgary since introduction of the clinical information system in 2012-2013, and in Edmonton since mid-2014. The results showed that apnoea testing can be safely performed with both methods assessed in the study, including the O2 catheter technique recommended in major guideline documents. In contrast with some previous research, this study could not confirm the superiority of apnoea testing using a CPAP valve. The authors come to the following conclusions: "We believe that clinicians should perform regular arterial blood gases (ABGs) at fixed intervals of 3–5 min in order to avoid severe respiratory acidosis, and terminate the apnoea test as soon as accepted criteria for brain death are met to help avoid significant hemodynamic complications. If the O2 catheter method is used, limiting flow rate to no more than 6–8 L/min may minimise the risk of pneumothorax and avoid any carbon dioxide (CO2) elimination that could conceivably slow the rise of arterial partial pressure of carbon dioxide (PCO2) in some patients."

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  • Thrombotic and infectious morbidity are associated with transfusion in posterior spine fusion

    February 2017| HSS Journal

    A study performed at Johns Hopkins Hospital aimed to characterise the relationship between blood transfusion and different types of morbidity after posterior spine fusion by retrospectively analysing electronic medical records. The purpose of the study was to determine both if perioperative red blood cell (RBC) transfusion is associated with postoperative morbidity (including non-infectious complications) and if a dose-response relationship exists between transfusion and the likelihood of developing these complications. MetaVision was one of the systems that provided the necessary data for the study. To the authors' knowledge, this is the first study to investigate non-infectious outcomes after spine fusion, and the relationship between transfusion and these complications. The data demonstrates risk-adjusted and transfusion dose-related increases in perioperative morbidity, with thrombotic and infectious events being the most common. The authors conclude that their findings offer new insights into the risk-benefit balance between anaemia, transfusion, and outcomes, and may help inform clinical decision-making, stating "By identifying transfusion as a risk factor for thrombosis and infections, our results may serve to heighten clinician awareness to optimise prevention, diagnosis, and treatment of these complications and thereby improve outcomes after spinal fusion."

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  • Investigation of the usability of computerised critical care information systems in Germany

    January 2017 | J Intensive Care Med

    A study investigated and compared usability across eight different computerised critical care information systems (CCIS) currently used in Germany. German intensive care unit (ICU) nurses and physicians completed a specialised, previously validated, web-based questionnaire which assessed CCIS usability based on three rating models: an overall rating of the systems, a model rating technical usability, and a model rating task-specific usability. This is the first study to compare how clinical users rate the usability of CCIS currently in clinical use and to perform an in-depth analysis of the underlying conditions determining high/low CCIS usability. MetaVision was one of the three systems that received the highest marks in overall ratings as well as in ratings of technical usability (i.e., the ease-of-use or user-friendliness of the system), and task-specific usability (i.e., the utility of the system or functions/features that a program offers to support specific clinical tasks). The authors conclude that, "Regardless of the program used, our results show that the overall rating of a CCIS is more dependent on the program’s ease-of-use than the actual scope of the features that a program has to offer. Furthermore, for most systems, the general scope of the functions offered is rated better than how well the functions are realized. This suggests that the time has come for manufacturers to shift some of their effort away from the development of new features and focus increasingly on improving the user-friendliness and quality of existing features."

     

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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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