Physical outcome measure for critical care patients following intensive care discharge

Introduction: The aim of this study was to evaluate the most suitable physical outcome measures to be used with critical care patients following discharge. ICU survivors experience physical problems such as reduced exercise capacity and intensive care acquired weakness. NICE guideline ‘Rehabilitation after critical illness’ (1) recommends the use of outcome measures however does not provide any specific guidance. A recent Cochrane review noted wide variability in measures used following ICU discharge (2). Methods: Discharged ICU patients attended a five week multidisciplinary programme. Patients’ physical function was assessed during the programme, at 6 months and 12 months post discharge. Three outcome measures were included in the initial two cohorts. The Six Minute Walk Test (6MWT) and the Incremental Shuttle Walk test (ISWT) were chosen as they have been used within the critical care follow up setting (2). The Chester Step Test (CST) is widely thought to be a good indicator of ability to return to work (one of the programmes primary aims). Ethics approval was waived as the programme was part of a quality improvement initiative. Results: Data was collected for the initial patients attending the programme (n = 13), median age was 52 (IQR = 38-72), median ICU LOS was 19 days (IQR = 4-91), median APACHE II was 23 (IQR = 19-41) and 11 were men. One patient was so physically debilitated that the CST or ISWT could not be completed however a score was achieved using the 6MWT. Another patient almost failed to achieve level 1 of the ISWT. Subsequent patients for this project (total n = 47) have all therefore been tested using the 6MWT. Good inter-rater and intrarater reliability and validity have been reported for the 6MWT (3). Conclusions: Exercise capacity measurement is not achievable for some patients with either the ISWT or the CST due to the severity of their physical debilitation. Anxiety, post-traumatic stress disorder and depression are common psychological problems post discharge (4), therefore using a test with a bleep is not appropriate. Therefore, the 6MWT is the most appropriate physical outcome measure to be used with critical care patients post discharge

Organ failure, outcomes and deprivation status among critically ill cirrhosis patients — a one-year cohort study

No abstract available

Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Our main objective is to assess the effectiveness of follow-up services for ICU survivors that aim to identify and address unmet health needs related to the ICU period. We aim to assess the effectiveness in relation to health-related quality of life, mortality, depression and anxiety, post-traumatic stress disorder, physical function, cognitive function, ability to return to work or education and adverse events. Our secondary objectives are, in general, to examine both the various ways that follow-up services are provided and any major influencing factors. Specifically, we aim to explore: the effectiveness of service organisation (physician versus nurse led, face to face versus remote, timing of follow-up service); possible differences in services related to country (developed versus developing country); and whether participants had delirium within the ICU setting

Safety of extubating mechanically ventilated patients on vasoactive infusions: a retrospective cohort study

No abstract available

Superfluid toroidal currents in atomic condensates

The dynamics of toroidal condensates in the presence of condensate flow and dipole perturbation have been investigated. The Bogoliubov spectrum of condensate is calculated for an oblate torus using a discrete-variable representation and a spectral method to high accuracy. The transition from spheroidal to toroidal geometry of the trap displaces the energy levels into narrow bands. The lowest-order acoustic modes are quantized with the dispersion relation $\omega \sim |m| \omega_s$ with $m=0,\pm 1,\pm 2, ...$. A condensate with toroidal current $\kappa$ splits the $|m|$ co-rotating and counter-rotating pair by the amount: $\Delta E \approx 2 |m|\hbar^2 \kappa < r^{-2}>$. Radial dipole excitations are the lowest energy dissipation modes. For highly occupied condensates the nonlinearity creates an asymmetric mix of dipole circulation and nonlinear shifts in the spectrum of excitations so that the center of mass circulates around the axis of symmetry of the trap. We outline an experimental method to study these excitations.Comment: 8 pages, 8 figure

Gyroscopic motion of superfluid trapped atomic condensates

The gyroscopic motion of a trapped Bose gas containing a vortex is studied. We model the system as a classical top, as a superposition of coherent hydrodynamic states, by solution of the Bogoliubov equations, and by integration of the time-dependent Gross-Pitaevskii equation. The frequency spectrum of Bogoliubov excitations, including quantum frequency shifts, is calculated and the quantal precession frequency is found to be consistent with experimental results, though a small discrepancy exists. The superfluid precession is found to be well described by the classical and hydrodynamic models. However the frequency shifts and helical oscillations associated with vortex bending and twisting require a quantal treatment. In gyroscopic precession, the vortex excitation modes $m=\pm 1$ are the dominant features giving a vortex kink or bend, while the $m=+2$ is found to be the dominant Kelvin wave associated with vortex twisting.Comment: 18 pages, 7 figures, 1 tabl

Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors

Background: The intensive care unit (ICU) stay has been linked with a number of physical and psychological sequelae, known collectively as post‐intensive care syndrome (PICS). Specific ICU follow‐up services are relatively recent developments in health systems, and may have the potential to address PICS through targeting unmet health needs arising from the experience of the ICU stay. There is currently no single accepted model of follow‐up service and current aftercare programmes encompass a variety of interventions and materials. There is uncertain evidence about whether follow‐up services effectively address PICS, and this review assesses this. Objectives: Our main objective was to assess the effectiveness of follow‐up services for ICU survivors that aim to identify and address unmet health needs related to the ICU period. We aimed to assess effectiveness in relation to health‐related quality of life (HRQoL), mortality, depression and anxiety, post‐traumatic stress disorder (PTSD), physical function, cognitive function, ability to return to work or education and adverse effects. Our secondary objectives were to examine different models of follow‐up services. We aimed to explore: the effectiveness of service organisation (physician‐ versus nurse‐led, face‐to‐face versus remote, timing of follow‐up service); differences related to country (high‐income versus low‐ and middle‐income countries); and effect of delirium, which can subsequently affect cognitive function, and the effect of follow‐up services may differ for these participants. Search methods: We searched CENTRAL, MEDLINE, Embase and CINAHL on 7 November 2017. We searched clinical trials registers for ongoing studies, and conducted backward and forward citation searching of relevant articles. Selection criteria: We included randomised and non‐randomised studies with adult participants, who had been discharged from hospital following an ICU stay. We included studies that compared an ICU follow‐up service using a structured programme and co‐ordinated by a healthcare professional versus no follow‐up service or standard care. Data collection and analysis: Two review authors independently assessed studies for inclusion, extracted data, assessed risk of bias, and synthesised findings. We used the GRADE approach to assess the certainty of the evidence. Main results: We included five studies (four randomised studies; one non‐randomised study), for a total of 1707 participants who were ICU survivors with a range of illness severities and conditions. Follow‐up services were led by nurses in four studies or a multidisciplinary team in one study. They included face‐to‐face consultations at home or in a clinic, or telephone consultations or both. Each study included at least one consultation (weekly, monthly, or six‐monthly), and two studies had up to eight consultations. Although the design of follow‐up service consultations differed in each study, we noted that each service included assessment of participants' needs with referrals to specialist support if required. It was not feasible to blind healthcare professionals or participants to the intervention and we did not know whether this may have introduced performance bias. We noted baseline differences (two studies), and services included additional resources (two studies), which may have influenced results, and one non‐randomised study had high risk of selection bias. We did not combine data from randomised studies with data from one non‐randomised study. Follow‐up services for improving long‐term outcomes in ICU survivors may make little or no difference to HRQoL at 12 months (standardised mean difference (SMD) ‐0.0, 95% confidence interval (CI) ‐0.1 to 0.1; 1 study; 286 participants; low‐certainty evidence). We found moderate‐certainty evidence from five studies that they probably also make little or no difference to all‐cause mortality up to 12 months after ICU discharge (RR 0.96, 95% CI 0.76 to 1.22; 4 studies; 1289 participants; and in one non‐randomised study 79/259 deaths in the intervention group, and 46/151 in the control group) and low‐certainty evidence from four studies that they may make little or no difference to PTSD (SMD ‐0.05, 95% CI ‐0.19 to 0.10, 703 participants, 3 studies; and one non‐randomised study reported less chance of PTSD when a follow‐up service was used). It is uncertain whether using a follow‐up service reduces depression and anxiety (3 studies; 843 participants), physical function (4 studies; 1297 participants), cognitive function (4 studies; 1297 participants), or increases the ability to return to work or education (1 study; 386 participants), because the certainty of this evidence is very low. No studies measured adverse effects. We could not assess our secondary objectives because we found insufficient studies to justify subgroup analysis. Authors' conclusions: We found insufficient evidence, from a limited number of studies, to determine whether ICU follow‐up services are effective in identifying and addressing the unmet health needs of ICU survivors. We found five ongoing studies which are not included in this review; these ongoing studies may increase our certainty in the effect in future updates. Because of limited data, we were unable to explore whether one design of follow‐up service is preferable to another, or whether a service is more effective for some people than others, and we anticipate that future studies may also vary in design. We propose that future studies are designed with robust methods (for example randomised studies are preferable) and consider only one variable (the follow‐up service) compared to standard care; this would increase confidence that the effect is due to the follow‐up service rather than concomitant therapies