Mortality of in-patient medical admissions to a DGH Critical Care Unit (2019)

Type of publication:
Conference abstract

Author(s):
*Sunil Tailor, *Ade Adiamou, *Omu Davies, *Roger Slater

Citation:
State of the Art 2019. Intensive Care Society Conference. Birmingham December 9-12.

Abstract:
Increasing clinical demand and reorganisation of hospital services may result in “stable” medical in-patients being “cohorted” into hospital locations without ready access to critical care services on site. The NEWS tool is recognised to provide warning of deterioration and a trigger for escalation of care [1]. Current EWS tools perform well for predicting death and cardiac arrest within 48 hours, although the impact on in-hospital health outcomes and utilization of resources remains uncertain [2]. In a retrospective case review, we examined the outcome of medical patients who had been hospital in-patients for more than 48 hours, whose condition deteriorated, requiring admission to our critical care unit (Princess Royal Hospital). The aim was to identify “red flag” observations for their deterioration and to measure mortality (overall: hospital + 30-day) in this patient group. During 2016-17 we identified 51 patients, of whom 39 patients were analysed because of a complete data set. We classified 48% (19 patients )as hot: defined as having a NEWS of 5 or more on one or more occasions in the 48-hours prior to ITU admission.
52% (21 patients) were classified as warm; defined as having a NEWS no greater than 4 on one or more occasions in the 48hr prior to ITU admission.
Red flag parameters (individual score of 3) were: Respiratory rate <8 or >25; SpO2 < 91%; temperature < 35C; SBP < 90 or > 220 mmHg; HR < 40 or > 131; AVPU: VPU.
Results:

  • The most common predictive red flag indicator for ITU admission was a raised respiratory rate.
  • 11 of the 39 patients did not score any red flag indicators. The mortality of this group was 33%.
  • The mortality rate of the 39 patients was 66%. The mortality for hot and warm classifications was 71% and 46% respectively.
  • The majority (>80%) of patients were aged 51-80 years .
  • The mean duration of ITU stay was 7.4 days (warm) vs 9.5 days (hot).
  • Over the same time period, ICNARC data demonstrated that 80% of all admissions to the ITU were non-surgical; overall ITU and hospital mortality was 15.7% and 22.5% respectively.

Conclusions

  • Medical inpatients with a persistently high NEWS of 5 or more during 48 hrs prior to ITU admission had a very high 30-day mortality despite ITU care.
  • 11 patients had no red flag indicators in the 48 hours prior to ITU admission despite their subsequent deterioration.
  • There are significant resource implications in managing such patients.
  • Care must be taken in defining stability in respect of medical in-patients in order to avoid later deterioration.

Limitations: Not all patients could be analysed because of incomplete data.

References:

  1. Thompson R. National Early Warning Score (NEWS). Report of a Working Party, Royal College of Physicians,UK, July 2012.
  2. Beth Smith M, Chiovaro J, O’Neil M, et al. Early Warning System Scores for Clinical Deterioration in Hospitalized Patients: A Systemic Review. Ann Am Thorac Soc 2014; 11:1454-1465.

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Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study (2019)

Type of publication:
Journal article

Author(s):
Claireaux H.A.; Antoniou I.; Dean R.; Davies N.; Trecarten S.; Henderson I.; Holmes C.; Wylie J.; Shuttleworth R.H.; Jindal A.; Hughes F.; Gouda P.; McNamee L.; Fleck R.; Hanrahan M.; Karunakaran P.; Chen J.H.; Sykes M.C.; Sethi R.K.; Suresh S.; Patel P.; Patel M.; Varma R.K.; Mushtaq J.; Gundogan B.; Bolton W.; Mohan M.; Khan T.; Burke J.; Morley R.; Favero N.; Adams R.; Thirumal V.; Kennedy E.D.; Ong K.K.; Tan Y.H.; Gabriel J.; Bakhsh A.; Low J.Y.L.; Yener A.; Paraoan V.; Preece R.; Tilston T.W.; Cumber E.; Dean S.; Ross T.; McCance E.; Amin H.; Satterthwaite L.; Clement K.D.; Gratton R.; Mills E.D.; Chiu S.M.; Hung G.; Rafiq N.M.; Hayes J.D.B.; Robertson K.L.; Dynes K.; Huang H.C.; Assadullah S.; Duncumb J.W.; Moon R.D.C.; Poo S.X.; Mehta J.K.; Joshi K.R.; Callan R.; Norris J.M.; Chilvers N.J.; Keevil H.; Jull P.; Mallick S.; Elf D.; Carr L.; Player C.; Barton E.C.; Martin A.L.; Ratu S.G.; Roberts E.J.; Phan P.N.; Dyal A.R.; Rogers J.E.; Henson A.D.; Reid N.B.; Burke D.; Culleton G.; Lynne S.; Mansoor S.; Brennan C.; Blessed R.; Holloway C.; Hill A.; Goldsmith T.; Mackin S.; Kim S.; Woin E.; Brent G.; Coffin J.; Ziff O.; Momoh Z.; Debenham R.; Ahmed M.; Yong C.S.; Wan J.C.; Copley H.C.; Raut P.; Chaudhry F.I.; Nixon G.; Dorman C.; Tan R.; Kanabar S.; Canning N.; Dolaghan M.; Bell N.; McMenamin M.; Chhabra A.; Duke K.; Turner L.; Patel T.; Chew L.S.; Mirza M.; Lunawat S.; Oremule B.; Ward N.; Khan M.; Tan E.T.; Maclennan D.; McGregor R.J.; Chisholm E.G.; Griffin E.J.; Bell L.; Hughes B.A.; Davies J.; Haq H.; Ahmed H.; Ungcharoen N.; Whacha C.; Thethi R.; Markham R.M.; Lee A.H.Y.; Batt E.; Bullock N.P.; Francescon C.T.; Davies J.E.; Shafiq N.M.; Zhao J.; Vivekanantham S.; Barai I.; Allen J.L.Y.; Marshall D.C.; McIntyre C.J.; Wilson H.C.P.; Ashton A.J.; Lek C.; Behar N.; Davis-Hall M.; Seneviratne N.; Esteve L.; Sirakaya M.; Ali S.; Pope S.; Ahn J.S.; Craig-McQuaide A.; Gatfield W.A.; Leong S.; Demetri A.M.; Kerr A.L.; Rees C.; Loveday J.; Liu S.; Wijesekera M.; Maru D.; Attalla M.; Smith N.; Brown D.; Sritharan P.; Shah A.; Charavanamuttu V.; Heppenstall-Harris G.; Ng K.; Raghvani T.; Rajan N.; Hulley K.; Moody N.; Williams M.; Cotton A.; Sharifpour M.; Lwin K.N.; Bright M.; Chitnis A.R.; Abdelhadi M.; Semana A.D.; Morgan F.; Reid R.; Dickson J.; Anderson L.; McMullan R.; Ahern N.; Asmadi A.; Anderson L.B.; Boon Xuan J.L.; Crozier L.; McAleer S.; Lees D.M.; Adebayo A.A.; Das M.; Amphlett A.H.; Al-Robeye A.; Valli A.; Khangura J.; Winarski A.; Ali A.; Woodward H.; Gouldthrope C.; Turner M.; Sasapu K.; Tonkins M.; Wild J.R.L.; Robinson M.; Hardie J.; Heminway R.; Narramore R.; Ramjeeawon N.; Hibberd A.; Winslow F.; Ho W.; Chong B.F.; Lim K.; Ho S.; Crewdson J.A.; Singagireson S.; Kalra N.; Koumpa F.; Jhala H.; Soon W.C.; Karia M.; Rasiah M.G.; Xylas D.; Gilbert H.; Sundar-Singh M.; Wills J.; Akhtar S.; Patel S.; Hu L.; Brathwaite-Shirley C.; Nayee H.; Amin O.; Rangan T.; Turner E.J.H.; McCrann C.; Shepherd R.; Patel N.; Prest-Smith J.; Auyoung E.; Murtaza A.; Coates A.; Prys-Jones O.; King M.; Gaffney S.; Dewdney C.J.; Nehikhare I.; Lavery J.; Bassett J.; Davies K.; Ahmad K.; Collins A.; Acres M.; Egerton C.; Cheng K.; Chen X.; Chan N.; Sheldon A.; Khan S.; Empey J.; Ingram E.; Malik A.; Johnstone M.; Goodier R.; Shah J.P.; Giles J.E.; Sanders J.A.; McLure S.W.; Pal S.; Rangedara A.; Baker A.N.; Asbjoernsen C.A.; Girling C.; Gray L.; Gauntlett L.; Joyner C.; Qureshi S.; Mogan Y.P.; Ng J.C.K.; Kumar A.N.; Park J.H.; Tan D.; Choo K.P.; Raman K.P.; Buakuma P.; Xiao C.; Govinden S.; Thompson O.D.; Charalambos M.A.; Brown E.; Karsan R.B.; Dogra T.; Bullman L.M.; Dawson P.M.; Frank A.L.; Abid H.; Tung L.; Qureshi U.; Tahmina A.; Matthews B.W.; Harris R.T.; O’Connor A.; Mazan K.; Iqbal S.; Stanger S.A.; Thompson J.D.; Sullivan J.A.L.; Uppal E.; MacAskill A.; Bamgbose F.A.; Neophytou C.; Carroll A.F.; Rookes C.W.; Datta U.; Dhutia A.J.; Rashid S.; Ahmed N.; Lo T.; Bhanderi S.; Blore C.D.; Ahmed S.; Shaheen H.; Abburu S.; Majid S.; Abbas Z.; Talukdar S.S.; Burney L.J.; Patel J.B.; Al-Obaedi O.; Roberts A.W.; Mahboob S.; Singh B.; Sheth S.; Karia P.; Prabhudesai A.; Kow K.; Koysombat K.; Wang S.; Morrison P.; Maheswaran Y.; Keane P.; Copley P.C.; Brewster O.; Xu G.X.; Harries P.; Wall C.; AlMousawi A.; Bonsu S.; Cunha P.; Ward T.; Paul J.; Nadanakumaran K.; Tayeh S.; Holyoak H.; Remedios J.; Theodoropoulou K.; Luhishi A.; Jacob L.; Long F.; Atayi A.; Sarwar S.; Parker O.; Harvey J.; Ross H.; Rampal R.; Thomas G.; Vanmali P.; McGowan C.; Stein J.; Robertson V.; Carthew L.; Teng V.; Fong J.; Street A.N.; Thakker C.E.; O’Reilly D.; Bravo M.; Pizzolato A.; Khokhar H.A.; Ryan M.; Cheskes L.; Carr R.; Salih A.E.; Bassiony S.; Yuen R.; Chrastek D.; Rosen O’Sullivan H.; Amajuoyi A.; Wang A.; Sitta O.; Wye J.; Qamar M.A.; Major C.; Kaushal A.; Morgan C.; Petrarca M.; Allot R.; Verma K.; Dutt S.; Chilima C.P.; Peroos S.; Kosasih S.R.; Chin H.; Ashken L.; Pearse R.J.; O’Loughlin R.A.; Menon A.; Singh K.; Norton J.; Sagar R.; Jathanna N.; Rothwell L.; Watson N.; Harding F.; Dube P.; Khalid H.; Punjabi N.; Sagmeister M.; Gill P.; Shahid S.; Hudson-Phillips S.; George D.; Ashwood J.; Lewis T.; Dhar M.; Sangal P.; Rhema I.A.; Kotecha D.; Afzal Z.; Syeed J.A.; Prakash E.; Jalota P.; Herron J.; Kimani L.; Delport A.; Shukla A.; Agarwal V.; Parthiban S.; Thakur H.; Cymes W.; Rinkoff S.; Turnbull J.A.; Hayat M.; Darr S.; Khan U.; Lim J.; Higgins A.; Lakshmipathy G.; Forte B.; Canning E.; Jaitley A.; Lamont J.; Toner E.; Ghaffar A.; McDowell M.; Salmon D.; O’Carroll O.; Khan A.; Kelly M.E.; Clesham K.; Palmer C.; Lyons R.; Bell A.; Chin R.; Waldron R.M.; Trimble A.; Cox S.E.; Ashfaq U.; Campbell J.; Holliday R.B.S.; McCabe G.; Morris F.; Priestland R.; Vernon O.K.; Ledsam A.; Vaughan R.; Lim D.; Bakewell Z.R.; Hughes R.K.; Koshy R.M.; Jackson H.R.; Narayan P.; Cardwell A.E.; Jubainville C.L.; Arif T.; Elliott L.E.; Gupta V.; Bhaskaran G.; Odeleye A.; Ahmed F.; Shah R.; Pickard J.; Suleman Y.N.; North A.S.; McClymont L.F.; Hussain N.; Ibrahim I.; Ng G.S.; Wong V.; Lim A.E.; Harris L.N.; Tharmachandirar T.; Mittapalli D.; Patel V.; Lakhani M.; Bazeer H.Z.; Narwani V.; Sandhu K.K.; Wingfield L.R.; Gentry S.; Adjei H.; Bhatti M.; Braganza L.; Barnes J.; Mistry S.; Chillarge G.; Stokes S.; Cleere J.; Wadanamby S.; Bucko A.M.; Meek J.; Boxall N.; Heywood E.G.; Wiltshire J.J.; Toh C.; Ward A.E.; Shurovi B.N.; Horth D.; Patel B.Y.; Ali B.; Spencer T.; Axelson T.; Kretzmer L.; Chhina C.; Anandarajah C.; Fautz T.; Horst C.; Thevathasan A.A.; Ng J.Q.; Hirst F.; Brewer C.F.; Logan A.E.; Lockey J.W.; Forrest P.R.; Keelty N.; Wood A.D.; Springford L.R.; Avery P.; Schulz T.M.; Bemand T.P.; Howells L.; Collier H.; Khajuria A.; Tharakan R.G.; Parsons S.; Buchan A.M.; McGalliard R.J.; Mason J.D.; Cundy O.J.; Li N.; Redgrave N.A.; Watson R.P.; Pezas T.P.; Dennis Y.F.; Segall E.; Hameed M.; Lynch A.S.; Chamberlain M.; Peck F.S.; Neo Y.N.; Russell G.; Elseedawy M.; Lee S.; Foster N.L.; Soo Y.H.; Puan L.; Dennis R.; Goradia H.; Qureshi A.; Osman S.; Reeves T.; Dinsmore L.; Marsden M.; Lu Q.; Pitts-Tucker T.; Dunn C.E.; Walford R.A.; Heathcote E.; Martin R.; Pericleous A.; Brzyska K.; Reid K.G.; Williams M.R.; Wetherall N.; McAleer E.; Thomas D.; Kiff R.; Milne S.; Holmes M.J.V.; Bartlett J.; Lucas de Carvalho J.; Bloomfield T.; Tongo F.; Bremner R.H.; Yong N.; Atraszkiewicz B.A.; Mehdi A.; Tahir M.; Sherliker G.X.J.; Tear A.K.; Pandey A.; Broyd A.; Omer H.M.; Raphael M.; Chaudhry W.W.; Shahidi S.; Jawad A.S.; Gill C.K.; Fisher I.H.; Adeleja I.; Clark I.J.; Aidoo-Micah G.E.; Stather P.W.; Salam G.J.; Glover T.E.; Deas G.; Sim N.K.; Obute R.D.; Wynell-Mayow W.M.; Sait M.S.; Mitha N.; de Bernier G.L.; Siddiqui M.; Shaunak R.; Wali A.; Cuthbert G.; Bhudia R.; Webb E.; Shah S.; Ansari N.; Perera M.; Kelly N.; McAllister R.; Stanley G.H.; Keane C.P.; Shatkar V.; MaxwellArmstrong C.; Henderson L.A.; Maple N.; Manson R.; Adams R.D.; Semple E.; Mills M.; Daoub A.; Marsh A.; Ramnarine A.; Hartley J.; Malaj M.; Jewell P.D.; Whatling E.A.; Hitchen N.; Chen M.; Goh B.; Fern J.; Rogers S.; Derbyshire L.; Robertson D.T.; Abuhussein N.; Deekonda P.; Abid A.; Harrison P.L.M.; Aildasani L.; Turley H.; Sherif M.A.; Pandey G.; Filby J.J.; Johnston A.; Burke E.; Mohamud M.; Gohil K.; Tsui A.Y.; Singh R.; Lim S.J.; O’Sullivan K.; McKelvey L.L.; O’Neill S.; Roberts H.F.; Brown F.S.; Cao Y.; Buckle R.T.; Liew Y.; Sii S.; Ventre C.M.; Graham C.J.; Filipescu T.; Yousif A.; Dawar R.; Wright A.; Peters M.; Varley R.; Owczarek S.; Hartley S.; Khattak M.; Iqbal A.; Ali M.; Durrani B.; Narang Y.; Bethell G.S.; Horne L.; Pinto R.; Nicholls K.; Kisyov I.; Torrance H.D.; English W.; Lakhani S.M.; Ashraf S.F.; Venn M.; Elangovan V.; Kazmi Z.; Brecher J.; Sukumar S.; Mastan A.; Mortimer A.; Parker J.; Boyle J.; Elkawafi M.; *Beckett J.; *Mohite A.; *Narain A.; *Mazumdar E.; *Sreh A.; *Hague A.; *Weinberg D.; *Fletcher L.; *Steel M.; Shufflebotham H.; Masood M.; Sinha Y.; Jenvey C.; Kitt H.; Slade R.; Craig A.R.; Deall C.; Reakes T.; Chervenkoff J.; Strange E.; O’Bryan M.; Murkin C.; Joshi D.; Bergara T.; Naqib S.; Wylam D.; Scotcher S.E.; Hewitt C.M.; Stoddart M.T.; Kerai A.; Trist A.J.; Cole S.J.; Knight C.L.; Stevens S.; Cooper G.E.; Ingham R.; Dobson J.; O’Kane A.; Moradzadeh J.; Duffy A.; Henderson C.; Ashraf S.; McLaughin C.; Hoskins T.C.; Reehal R.S.; Bookless L.R.; McLean R.C.; Stone E.J.; Wright E.V.; Abdikadir H.R.; Roberts C.; Spence O.; Srikantharajah M.; Ruiz E.M.; Matthews J.H.; Gardner E.; Hester E.; Naran P.; Simpson R.; Minhas M.; Cornish E.; Semnani S.A.; Rojoa D.; Radotra A.; Eraifej J.; Eparh K.; Smith D.N.E.; Mistry B.D.; Hickling S.L.; Din W.; Liu C.; Mithrakumar P.; Mirdavoudi V.; Rashid M.; Mcgenity C.; Hussain O.; Kadicheeni M.; Gardner H.; Anim-Addo N.; Pearce J.; Aslanyan A.; Ntala C.; Sorah T.; Parkin J.; Alizadeh M.; White A.; Edozie F.; Johnston J.; Kahar A.; Navayogaarajah V.; Patel B.; Carter D.; Khonsari P.; Burgess A.; Kong C.; Ponweera A.; Cody A.; Tan Y.; Ng A.Y.L.; Croall A.; Allan C.; Ng S.; Raghuvir V.; Telfer R.; Greenhalgh A.D.; McKerr C.N.; Edison M.A.; Patel B.A.; Dear K.; Hardy M.R.; Williams P.; Hassan S.; Sajjad U.; O’Neill E.M.; Lopes S.; Healy L.; Jamal N.; Tan S.; Lazenby D.; Husnoo S.B.; Beecroft S.; Sarvanandan T.; Weston C.; Bassam N.; Rabinthiran S.; Hayat U.; Ng L.; Varma D.; Sukkari M.; Mian A.; Omar A.; Kim J.W.; Sellathurai J.; Mahmood J.; O’Connell C.; Bose R.; Heneghan H.; Lalor P.; Matheson J.; Doherty C.; Cullen C.; Cooper D.; Angelov S.; Drislane C.; Smith A.C.D.; Kreibich A.; Palkhi E.; Durr A.; Lotfallah A.; Gold D.; Mckean E.; Dhanji A.; Anilkumar A.; Thacoor A.; Siddiqui Z.H.; Lim S.; Piquet A.; Anderson S.M.; McCormack D.R.; Gulati J.; Ibrahim A.; Murray S.E.; Walsh S.L.; McGrath A.; Ziprin P.; Chua E.Y.; Lou C.N.; Bloomer J.; Paine H.R.; Osei-Kuffour D.; White C.J.; Szczap A.; Gokani S.; Patel K.; Malys M.K.; Reed A.; Torlot G.E.; Cumber E.M.; Charania A.; Ahmad S.; Varma N.; Cheema H.; Austreng L.; Petra H.; Chaudhary M.; Zegeye M.I.; Cheung F.; Coffey D.; Heer R.S.; Singh S.; Seager E.; Cumming S.; Suresh R.S.; Verma S.; Ptacek I.B.; Gwozdz A.M.; Yang T.; Khetarpal A.A.; Shumon S.; Fung T.M.P.; Leung W.; Kwang P.; Chew L.; Loke W.; Curran A.; Chan C.; McGarrigle C.; Mohan K.; Cullen S.; Wong E.; Toale C.; Collins D.; Keane N.; Traynor B.P.; Shanahan D.; Yan A.; Jafree D.J.; Topham C.; Mitrasinovic S.; Omara S.; Bingham G.; Lykoudis P.M.; Miranda B.H.; Whitehurst K.; Kumaran G.; Devabalan Y.; Aziz H.; Shoa M.; Dindyal S.; Yates J.A.; Bernstein I.; Rattan G.; Coulson R.; Stezaker S.; Isaac A.; Salem M.; McBride A.; McFarlane H.; Yow L.; MacDonald J.; Bartlett R.D.; Turaga S.; White U.; Liew W.; Yim N.; Ang A.; Simpson A.; McAuley D.; Craig E.; Murphy L.; Shepherd P.; Kee J.Y.; Abdulmajid A.; Chung A.; Warwick H.L.; Livesey A.; Holton P.; Theodoreson M.D.; Jenkin S.L.; Turner J.; Entwisle J.H.; Marchal S.T.; O’Connor S.; Blege H.K.; Aithie J.M.; Sabine L.M.; Stewart G.E.; Jackson S.; Kishore A.; Lankage C.M.; Acquaah F.; Joyce H.L.; McKevitt K.L.; Coffey C.J.; Fawaz A.S.; Dolbec K.S.; O’Sullivan D.A.; Geraghty J.M.; Lim E.; Bolton L.; FitzPatrick D.; Robinson C.; Ramtoola T.; Collinson S.; Grundy L.; McEnhill P.M.; Harbhajan Singh G.S.; Loughran D.; Golding D.M.; Keeling R.E.; Williams R.P.; Whitham R.D.J.; Yoganathan S.; Nachiappan R.; Egan R.J.; Owasil R.; Kwan M.L.; He A.; Goh R.W.; Bhome R.; Wilson H.; Teoh P.J.; Raji K.; Jayakody N.; Matthams J.; Chong J.; Luk C.Y.; Greig R.J.; Trail M.; Charalambous G.; Rocke A.S.; Gardiner N.; Bulley F.; Warren N.; Brennan E.; Fergurson P.; Wilson R.; Whittingham H.; Brown E.J.; Khanijau R.; Gandhi K.; Morris S.; Boulton A.J.; Chandan N.; Barthorpe A.E.; Maamari R.; Sandhu S.; McCann M.; Higgs L.; Balian V.; Reeder C.; Diaper C.; Sale T.; Ali H.; Archer C.H.; Clarke A.K.; Heskin J.; Hurst P.C.; Farmer J.D.; O’Flynn L.D.; Doan L.; Shuker B.A.; Stott G.D.; Vithanage N.A.; Hoban K.A.; Nesargikar P.N.; Kennedy H.R.; Grossart C.M.; Tan E.S.M.; Roy C.S.D.; Sim P.; Leslie K.E.; Sim D.; Abul M.H.; Cody N.; Tay A.Y.; Woon E.; Sng S.; Mah J.; Robson J.; Shakweh E.; Wing V.C.; Mills H.; Li M.M.; Barrow T.R.; Balaji S.; Jordan H.E.M.; Phillips C.; Naveed H.; Hirani S.; Tai A.; Ratnakumaran R.; Sahathevan A.; Shafi A.M.A.; Seedat M.; Weaver R.; Batho A.; Punj R.; Selvachandran H.; Bhatt N.; Botchey S.; Khonat Z.; Brennan K.; Morrison C.J.; Devlin E.; Linton A.; Galloway E.; McGarvie S.; Ramsay N.; McRobbie H.D.; Whewell H.; Dean W.; Nelaj S.; Eragat M.; Mishra A.; Kane T.; Zuhair M.; Wells M.; Wilkinson D.; Woodcock N.; Sun E.; Aziz N.; Ghaffar M.K.A.; McLean K.A.; Glasbey J.C.; Borakati A.; Brooks T.M.; Chang H.M.; Choi S.M.; Goodson R.; Nielsen M.; Pronin S.; Salloum N.L.; Sewart E.; Vanniasegaram D.; Drake T.M.; Gillies M.A.; Harrison E.M.; Chapman S.J.; Khatri C.; Kong C.Y.; Bath M.F.; Kelly M.; Mitchell H.; Fitzgerald J.E.; Bhangu A.; Nepogodiev D

Citation:
British Journal of Anaesthesia; Jan 2019; vol. 122 (no. 1); p. 42-50

Abstract:
Background: Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. Method(s): This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. Result(s): Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. Conclusion(s): After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

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Predicting and measuring fluid responsiveness with echocardiography (2016)

Type of publication:
Journal article

Author(s):
*Miller, Ashley, Mandeville, Justin

Citation:
Echo research and practice, June 2016, vol. 3, no. 2, p. G1

Abstract:
Echocardiography is ideally suited to guide fluid resuscitation in critically ill patients. It can be used to assess fluid responsiveness by looking at the left ventricle, aortic outflow, inferior vena cava and right ventricle. Static measurements and dynamic variables based on heart-lung interactions all combine to predict and measure fluid responsiveness and assess response to intravenous fluid resuscitation. Thorough knowledge of these variables, the physiology behind them and the pitfalls in their use allows the echocardiographer to confidently assess these patients and in combination with clinical judgement manage them appropriately.

Link to full text: http://www.echorespract.com/content/3/2/G1.abstract

Complications of airway management and how to avoid them (2014)

Type of publication:
Journal article

Author(s):
*Chandra P., Frerk C.

Citation:
Trends in Anaesthesia and Critical Care, December 2014, vol./is. 4/6(195-199)

Abstract:
Major complications of airway management are rare, but complications causing minor patient harm are common. Our aim should be to manage our patients airways without causing any injury. Complications arise from technique failure, direct and indirect trauma and as a consequence of cardiovascular instability associated with our airway management techniques. Avoiding complications depends on planning (choosing the lowest risk procedure & having a well thought through strategy), providing optimal conditions, using the best available equipment and using the optimum technique for all practical procedures. This review provides an overview of the technical and non-technical aspects of airway management to help minimise the incidence of complications.

Link to more details or full-text: