Friday, April 19, 2024 at 17:15 BE

HIBN, GIP, AAQC

2024 ICM - A randomised controlled trial of a nurse facilitator to promote communication for family members of CI pxs (Kentish‑Barnes) [RCT].pdf

ICU LOS = ICU length of stay, MV = mechanical ventilation, H+_MM = hospital mortality, ITW = interviews, Hospital Anxiety and Depression Scale = HADS

1. Y, J, C ➖ T ➕ N ➕ t ➖ PICO:
2. 2024, ICM, FR ➖ RCT ➕ 385 pxs ➕ 2020-2023 ➖ PICO:
   - P: ICU pxs families
   - I: nurse facilitators communication & support
   - C: standard communication by ICU clinicians
   - O: pOC = family symptoms of depression ➕ sOC = HADS-anxiety, event scale-6, QUAL-E
3. Importance:
   - Psychological burden = anxiety, depression & post traumatic stress
   - Communication = skills, goals of care, confidence & biliefs
   - Family satisfaction = influenced by hospital culture
   - Previous interventions (px navigation, discharge planning, care coordination) = ↘️ re-hospitalizations
4. Methods:
   - Co-designed with J. Randall Curtis
   - 5 university H+
   - Table 1 explored: MV same % in I + C ➕ ICU LOS = same % in I + C
   - IN pxs: adults + expected LOS ≥2d + chronic life-timing illness (SS >2y + SOFA H+_MM >15%), FR speaking, visiting relatives, informed OR deferred consent
   - IN families: adults + FR speaking + legal surrogates + w_informed consent
5. Procedures:
   - 2-day training session for training facilitators by EXTERNAL CONSULTANTS (EC)
   - EC w_expertise in clinical communication skills, use of attachment theory, and mediation.
6. The facilitators’ role = help families prepare for ITW w_docto, considering:
   - what information did they want to share
   - what questions did they want to ask
   - what difficulties were they experiencing
   - what were their specific needs
   - once these were identified, the facilitator would strive to help families express these questions/difficulties/needs.
7. The control:
   - open visitation policies
   - multidisciplinary D3 meeting to review (DX, TTO, PROG)
   - Meetings when deemed necessary - The possibility to meet with a psychologist ± a social worker.

8. Results: - pOC ➩ HADS at 6m - sOC ➩ anxiety, PTS, goal-concordant care, QOL9. Limitations: … to continue…

Friday, May 10, 2024 at 17h15 at BE

HIBN, AAQC

2024 ICM - Systemic inflammation and delirium during critical illness (brummel) [R].pdf

Glossary: oDYS = dysfunction; CI = cognitive impairment

1. 2024, ICM, USA ➖ prospective cohort ➕ 991 (5 centers)➕ 3y (Jan 2007 - Dec 2010) ➖ PICO:
   - P: BRAIN-ICU + MIND-ICU. 🫁 failure + SHOCK (>18y)
   - I: samples (CRP, IFN-∂, IL-1ß, MMP-9, TNF-alfa, TNFR1, prot C) + mental status (RASS, CAM-ICU) ➩ association delirium ⌄ coma
   - C: normal mental status (next day)
   - O: “association”
2. Importance + background:
   - Delirium affects 1/2 pxs w_Critical Illness.
   - Duration predicts: ↗️ MM + in survivors “CI + daily activity disability”
   - Acute inflammation + ↓ endogenous anticoagulant activity = oDYS
3. Justification:
   - Small sample size previous studies
   - Limited number of markers
   - Inconsistent associations
4. Methods
   - IN. ✔︎
   - EX. Acute oDYS for>72 h ➕ a recent ICU stay>5 d ➕ s_preexisting CI ➕ inability to communicate in English.
   - Taken from PARENT STUDIES
5. Results. The following day: - Delirium = ↑ concentrations of IL-6 (OR 1.8), IL-8 (1.3), IL-10 (1.5), TNF-α (1.2), and TNFR1 (1.3) and lower concentrations of protein C (0.7)

   - Coma = ↑ concentrations of CRP (1.4), IFN-γ (1.3), IL-6 (2.3 ), IL-8 (1.8), and IL-10 (1.5) and lower concentrations of protein C (0.6) - IL-1β, IL-12, MMP-9 ➩ NOT associated w_mental status.

Friday, Nov 29, 2024 at 18h30 at BO - 23h30 at BE

RCH, RICH, HIBN, AAQC

2024 NCC - Quetiapine Versus Haloperidol in the mm of Hyperactive Delirium (zakhary) [RCT].pdf

⏳ TIME MANAGEMENT.
01:02:41

Round: 2 22:12:52 Wrap-up

Round: 1 40:28:71 Article 1

Codified by AAQC

Glossary: w_MV = with mechanical ventilation; ICU MM = ICU mortality; in_H MM ‎ = in hospital mortality; in_H stay = in hospital stay; nf_MV = need for mechanical ventilation; 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ brief scope = year (Y), journal (J), country (C) ➖ type of study (T) ➕ number of patients/sample (N) ➕ time (t) ➖ population (P), intervention (I), comparison (C), outcome (O).

1. Y, J, C ➖ T ➕ N ➕ t ➖ PICO: ➩ 2024, NCC, EGYPT ➖ RCT ➕ 100/344 ➕ 4m ➖ PICO:
   - P: adults in ICU w_MV
   - I: quetiapina
   - C: haloperidol
   - O:
       * primary ➩ DRS-R-98 w_↓ ≥50% and ↓ to ≤12
       * Secondary (6)➩ ICU MM + in_H MM + in_H stay + nf_MV + ICU stay + sleeping hours
2. Traditional use for DELIRIUM = haloperidol – new evidence towards atypical antipsychotics (quetiapine and risperidone)
3. RESULTS:
   - Response in 92%
   - sOC = NO DIFF
   - INT ↓ ICU stay + ↑ sleeping hours per night ….

4. Written informed consent was obtained from the patient’s legal guardian in a private room beside the ICU following approval by the research ethics committee, the Department of Critical Care Medicine of the Faculty of Medicine at Alexandria University, and after thorough explanation of the benefits and risks of the study interventions. This study’s protocol was registered on ClinicalTrials.gov (identifier: NCT05690698).

Friday, Nov 22, 2024 at 18h30 at BO - 23h30 at BE

RCH, RICH, ABFL, HIBN, AAQC

2024 EJHF - Applicability of heart failure clinical practice GL in low+middle-income countries (Zieroth) [R]

Codified by MAAT

Glossary: CH = Switzerland; HF = heart failure; GL = guidelines; TMA = Translational Medicine Academy; HIC = high-income country; LMIC = low-middle income countries; OC = outcome; pxs = patients; 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ brief scope = year (Y), journal (J), country (C) ➖ type of study (T) ➕ number of patients/sample (N) ➕ time (t) ➖ population (P), intervention (I), comparison (C), outcome (O).

1. Bsss ➩ 2024, EJHF, CH ➖ int, internet-based survey ➕ >2.5k clinicians ➕ Oct - Nov 2023 ➖PICO:
   - P: clinicians HIC and LMIC
   - I: survey (email)
   - C: NA
   - O: applicability view of HF GL
2. METHODS
   - 1 original, 4 reminders (emails)
   - TMA database ➩ non-profit medical education organization in Basel, CH. ➩ OBJ = enhance Px care + ↑ OC ➩ develop + disseminate research & education programs (conferences, website, webinars)
   - Variables: demographics, experience, views of HF GL
   - QuestionPro® ➩ for dissemination + data accumulation
   - All multiple choice - one not analyzed (nature of responses)
3. STATS
   - Fisher exact + chi-square➩ categorical
   - Unpaired t-test ➩ continuous
   - HIC 🆚 other counties compared
   - Continuous ➩ mean (SE)
   - Categorical ➩ number (%)
4. RESULTS
   - LMIC regarded HF GL to be ↓ applicable 🆚 HIC (p = 0.0002).
   - From all, >75% = somewhat or mostly true (mostly applicable to HIC)
   - Those from LMIC (not HIC) ➩ the greatest implementation obstacle was that the guidelines were for HIC (51.3% vs. 43.1%; p = 0.0387).
   - A significantly higher proportion ➩ resources were the problem

5. QUOTE: “While it is not the intention that they be directed for clinicians and patients solely in the higher socio-economic environments, by the nature of the data and experts’ experience, and with appropriate attention to newer pharmaceuticals, devices, and interventions, the result is that they are perceived in that manner.”

6. RESULTS.
  - ↓ d_ATBs
      * PCT 🆚 SOC ➩ ✔
      * CRP 🆚 SOC ➩ ✖ (no difference)
  - MM28
      * PCT 🆚 SOC ➩ ✖ (noninferior)
7. RATIONALE.

  - Suspected sepsis = a_OD ↔ suspected INF

  - We did not mandate a definition for acute organ dysfunction.

⏳ TIME MANAGEMENT.
01:02:41

Round: 6 02:27:50 Comments
Round: 5 13:37:72 Comments
Round: 4 49:15:51 Evidence
Round: 3 19:40:68 Scope
Round: 2 01:46:38 ART selection
Round: 1 04:57:22 Past JC

Friday, Dec 13, 2024 at 18h30 at BO - 23h30 at BE

RICH, OQC, JCAU, HIBN, GMC, DFM, AHO, AAQC

2024 JAMA - ADAPT, Biomarker-Guided Antibiotic Duration for Hospitalized Patients w_suspected S (dark) [RCT].pdf

Codified by 

Glossary: 🫁 = lungs; ARDS = acute respiratory distress syndrome; SS = Survival; ii = investigator initiated; mc = multicentric; int_ = international; SOC = standard of care; ICU LOS = ICU length of stay; H+ LOS ‎ = Hospital length of stay; MV = mechanical ventilation; MM = mortality; MM28 = mortality at 28 days; MM90 = mortality at 90 days; ATB = antibiotics; d_ = duration; TTO = treatment; RES = resistance; bioM = biomarkers; SSC = surviving sepsis campaign; ENG = England; SCO = Scotland; p = primary; s = secondary; toci = tocilizumab; sari= sarilumab; RANDOM = randomization; INTERV = interventions; SX = surgery; ⛔ = stop;

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS ➩ 2024, JAMA, ENG + SCO ➖ ii_mc_int_RCT ➕ >2.5k (41 ICUs) ➕ 2018-2024 (lockdown 2020)➖ P I C O:
   - P: adults, > ♂, suspected sepsis
   - I: CRP + PCT
   - C: standard
   - O: p ➩ duration ATB + MM28 ➖ s ➩ LOS H+ …ICU + MM90
3. EVIDENCE.
  - Timely + appropriate ATB ➩↗️ OC
  - Optimal d_ATB ➩ uncertain ➖ decisions guided to stop ATB by clinical progress + bioM   

     (CRP and PCT) [ICM 2015, Albrich et al - Pros and cons of bioM 🆚 clinical decisions…].
  - Optimized d_ATB ➩ a. ↓ overTTO, b. ⛔ unwanted effects, c. Preserves ATB effectiveness

     by ↓ RES.
  - PCT use shows safe ↓ of ATB d_ [CC 2018, Wirz et al - PCT-guided ATB on clinical OC] ▶

     clinical trial evidence judged as “low quality” [Evans et al, ICM 2021 - SSC]
  - No consensus guidance for CRP [Evans et al, ICM 2021 - SSC]
4. METHODS.
  - IN ➠ 24h window bioM baseline
  - EX ➠ required prolonged ATB (ie,>21days) ➖ severely immunocompromised (not due to

    sepsis, neutrophils <500) ➖ expected to receive IL-6 receptor ⊖ (toci, sari) d_acute phase

   ➖S TTOs likely to ⛔ within_24h (futility) ➖ declined consent + previousl enrolled
  - RANDOM ➠ assignation (1:1:1) ➖ stratification (severity, recruitment site, rec_SX) ➖

    allocation (web-based) 

  - INTERV ➠ Blood (random to ATB ⛔, taken daily, )➖ standardized written advice (REF 10      & 11 for cuts-offs of PCT, CRP)➖ follow-up (when blood sampling ⛔) ➖ IF ATB       

    reintroduced within 28d, NO need to resume/restart blood sampling ➖ IF discharged with

    ATB for home, the study ⛔

Friday, Dec 06, 2024 at 18h30 at BO - 23h30 at BE

RICH, OQC, GMC, DFM, AHO, HIBN, AAQC

2024 BMJ - Oxygen extraction guided transfusion strategy in CIpxs study protocol for RCT (Fogagnolo) [RCT].pdf

Codified by HIBN

Glossary: RBCT = red blood cell transfusion; HH = hemorrhage; ACS = acute coronary syndrome; wo_ = without; EX = exclusion; IN = inclusion; pxs = patients; MM90 = mortality at 90 days; ↗ = improve; ↘ = worsen; ↑ = increase; 💨 = perfusion; 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ brief scope = year (Y), journal (J), country (C) ➖ type of study (T) ➕ number of patients/sample (N) ➕ time (t) ➖ population (P), intervention (I), comparison (C), outcome (O).

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ PICO: ➩ 2024, BMJ, IT + BE ➖ ol_mc(3)_int(2)_RCT ➕ >324 (162 Per arm) ➕ X ➖ PICO:
   - P: CI pxs + non-HH
   - I: RBCT (Hb ≤9 + O2ER≥30%)
   - C: RBCT (ESICM GL)
   - O: MM + AKI
2. RBCT thresholds
   - ACS <9
   - 🫀 surgery OR major vascular <7.5
   - Malignancy <7 (ok <9)
   - Elderly (>80yo) <7 (<9)
3. Troponin I will be measured at inclusion + 24h later
4. O2ER will be validated as a physiological indicator to guide RBCT
5. IN
   - Labs mentioned
   - Arterial line + central venous line
6. EX
   - <18yo + pregnancy
   - Bleeding
   - Malignancy
   - Sick cell disease
   - Coagulation disorders
   - AKI S1 or CKD G3a (GFR <60)
7.

8. Transfusing with <O2ER was associated with ↑ mortality ➩ SOOOO, RBCT might be deleterious when the cells use O2 adequately

9. O2ER showed good performance to identify the correct timing ➩ implications in MM90. Fogagnolo (CC 2020)

10. O2ER based RCCT may ↓ inc_AKI (↗ DO2 + organ 💨)

⏳ TIME MANAGEMENT.
01:02:41

Round: 5 00:01:73 Final words

Round: 4 16:04:42 Wrap-up

Round: 3 01:27:41 ART

Round: 2 07:08:47 ART selection

Round: 1 04:18:24 Past JC