Provision of trauma teams in Scotland: a national survey

<b>Background and Aims:</b> Trauma is still the leading cause of mortality in the first four decades of life. Despite multiple reports on how trauma care could be improved in the UK, treatment has been shown to be inconsistent and of poor quality. Trauma teams have been shown to have a positive effect on outcome. We aimed to determine the prevalence of trauma teams in Scotland. <b>Methods:</b> We performed a telephone survey of 24 hospitals with Emergency Departments and spoke to the senior clinician regarding provision of trauma teams. <b>Results:</b> 5 (21%) of the hospitals questioned had trauma teams. The most common reasons for not having one were: no problem with current system 8 (44%) and inability to include senior enough staff on the team 6 (24%). <b>Conclusions:</b> There are few trauma teams in Scottish acute hospitals. There was little enthusiasm for introducing them for a variety of reasons. Local evidence of benefit is likely needed before their adoption becomes widespread

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

No abstract available

A randomised, controlled, double blind, non-inferiority trial of ultrasound-guided fascia iliaca block vs. spinal morphine for analgesia after primary hip arthroplasty

We performed a single centre, double blind, randomised, controlled, non-inferiority study comparing ultrasound-guided fascia iliaca block with spinal morphine for the primary outcome of 24-h postoperative morphine consumption in patients undergoing primary total hip arthroplasty under spinal anaesthesia with levobupivacaine. One hundred and eight patients were randomly allocated to receive either ultrasound-guided fascia iliaca block with 2 mg.kg−1 levobupivacaine (fascia iliaca group) or spinal morphine 100 μg plus a sham ultrasound-guided fascia iliaca block using saline (spinal morphine group). The pre-defined non-inferiority margin was a median difference between the groups of 10 mg in cumulative intravenous morphine use in the first 24 h postoperatively. Patients in the fascia iliaca group received 25 mg more intravenous morphine than patients in the spinal morphine group (95% CI 9.0–30.5 mg, p < 0.001). Ultrasound-guided fascia iliaca block was significantly worse than spinal morphine in the provision of analgesia in the first 24 h after total hip arthroplasty. No increase in side-effects was noted in the spinal morphine group but the study was not powered to investigate all secondary outcomes

Characteristics and outcome of patients with newly diagnosed advanced or metastatic lung cancer admitted to intensive care units (ICUs)

BACKGROUND: Although patients with advanced or metastatic lung cancer have poor prognosis, admission to the ICU for management of life-threatening complications has increased over the years. Patients with newly diagnosed lung cancer appear as good candidates for ICU admission, but more robust information to assist decisions is lacking. The aim of our study was to evaluate the prognosis of newly diagnosed unresectable lung cancer patients. METHODS: A retrospective multicentric study analyzed the outcome of patients admitted to the ICU with a newly diagnosed lung cancer (diagnosis within the month) between 2010 and 2013. RESULTS: Out of the 100 patients, 30 had small cell lung cancer (SCLC) and 70 had non-small cell lung cancer. (Thirty patients had already been treated with oncologic treatments.) Mechanical ventilation (MV) was performed for 81 patients. Seventeen patients received emergency chemotherapy during their ICU stay. ICU, hospital, 3- and 6-month mortality were, respectively, 47, 60, 67 and 71%. Hospital mortality was 60% when invasive MV was used alone, 71% when MV and vasopressors were needed and 83% when MV, vasopressors and hemodialysis were required. In multivariate analysis, hospital mortality was associated with metastatic disease (OR 4.22 [1.4-12.4]; p = 0.008), need for invasive MV (OR 4.20 [1.11-16.2]; p = 0.030), while chemotherapy in ICU was associated with survival (OR 0.23, [0.07-0.81]; p = 0.020). CONCLUSION: This study shows that ICU management can be appropriate for selected newly diagnosed patients with advanced lung cancer, and chemotherapy might improve outcome for patients with SCLC admitted for cancer-related complications. Nevertheless, tumors' characteristics, numbers and types of organ dysfunction should be taken into account in the decisional process before admitting these patients in ICU.Peer reviewe

Long‐term mortality of patients admitted to an intensive care unit with seizures: a population‐based study

No abstract available

Short- and long-term outcomes of intensive care patients with acute kidney disease

Background: Acute kidney disease (AKD) is a proposed definition for acute kidney injury (AKI) lasting 7 days or longer. Little has been reported regarding characteristics of patients with AKD and their short- and long-term outcomes. We describe the epidemiology and risk factors for AKD and outcomes following AKD. Methods: This retrospective observational cohort study identified patients aged 16 or older admitted to the Glasgow Royal Infirmary and Queen Elizabeth University Hospital intensive care units (ICUs) in Scotland between 1st July 2015 and 30th June 2018. Baseline serum creatinine and subsequent values were used to identify patients with de-novo kidney injury (DNKI). Patients with recovery prior to day 7 were classified as AKI; recovery at day 7 or beyond was classified as AKD. Outcomes were in-hospital and long-term mortality, and proportion of major adverse kidney events (MAKEs). Multivariable logistic regression was used to identify risk factors for AKD. A Cox proportional hazards model was used to identify factors associated with long-term outcomes. Findings: Of the 5,334 patients admitted to ICU who were assessed for DNKI, 1,620 (30·4%) suffered DNKI and of these, 403 (24·9%) met AKD criteria; 984 (60·7%) were male and the median age was 60·0 (IQR=48·0–72·0). Male sex, sepsis and lower baseline estimated glomerular filtration rate (eGFR) were associated with development of AKD. In-ICU (16·1%vs6·2%) and in-hospital (26·1%vs11·6%) mortality rates were significantly higher in AKD patients than AKI patients. Long-term survival was not different for AKD patients (HR=1·16; p-value=0·261) but AKD was associated with subsequent MAKEs (OR=1·25). Interpretation: One in four ICU patients with DNKI met AKD criteria. These patients had an increased risk of short-term mortality and long-term MAKEs. Whilst the trend for long-term survival was lower, this was not significantly different from shorter-term AKI patients. Patients with AKD during their ICU stay should be identified to initiate interventions to reduce risk of future MAKEs. Funding: No funding was associated with this study

CO<inf>2</inf> absorption using diethanolamine-water solutions in a rotating spiral contactor

Results for mass transfer in a rotating spiral device are presented here for absorption of carbon dioxide from nitrogen carrier gas using mixtures of diethanolamine (DEA) and water. The ability of the device to examine the full range of flow rate ratio for the two phases while controlling the relative thicknesses of the phase layers is applied to surveying absorption performance over a wide range of DEA concentration at 312 K and 1.8 bara. Comparisons are made for a fixed 86 μm liquid layer thickness, which is shown to fix also the fraction of the liquid accessible by diffusion, while maintaining 90% removal of CO2 from a gas stream of 10% (mole) CO2 in nitrogen. The increasing liquid viscosity with DEA fraction is countered by reducing the liquid flow rate to maintain constant liquid layer thickness and diffusion depth. The allowed gas throughput, while meeting 90% removal, increases with DEA concentration until the increasing viscosity gives sufficient reduction in liquid flow rate to offset the increasing CO2 capacity of the liquid. The maximum gas flow rate has a broad peak centred at a DEA mole fraction of about 0.072 (31% by mass). Utilisation of the amine is increased as DEA concentration increases, apparently as a result of the longer residence time, suggesting an effect of chemical time scales on the order of seconds. For a fixed concentration, full utilisation of the amine is achieved by decreasing the liquid flow rate, which reduces layer thickness and increases diffusion time. The work highlights the use of the rotating spiral for rapid and accurate testing to determine optimum liquid composition of absorbent formulations

Use of protracted CPAP as a supportive treatment for COVID-19 pneumonitis and associated outcomes: a national cohort study

Background: Continuous positive airway pressure (CPAP) has been increasingly deployed to manage patients with COVID-19 and hypoxemic respiratory failure, often for protracted periods. However, concerns about protracted CPAP have been raised. This study aims to examine the use of CPAP for patients with COVID-19 and the outcomes after protracted use. Methods: This is a national cohort study of all adults admitted to Scottish critical care units with COVID-19 from 01/03/20 to 25/12/21 that received CPAP. Protracted CPAP was defined as ≥ 5 continuous days of CPAP. Outcomes included CPAP failure rate (institution of invasive mechanical ventilation (IMV) or death), mortality, and outcomes following institution of IMV. Multivariable logistic regression was performed to assess the impact of protracted CPAP on mortality after IMV. Results: 1961 patients with COVID-19 received CPAP for COVID pneumonitis with 733 patients (37.4%) receiving protracted CPAP. CPAP failure occurred in 891 (45.4%): 544 patients (27.7%) received IMV and 347 patients (17.7%) died in critical care without IMV. Hospital mortality rate was 41.3% for the population. For patients that subsequently commenced IMV, hospital mortality was 58.7% for the standard duration CPAP group and 73.9% for the protracted duration CPAP group (p=0.003), however, there was no statistical difference in hospital mortality after adjustment for confounders (OR 1.4, (95% CI 0.84, 2.33, p=0.195). Conclusions: Protracted CPAP was used frequently for managing patients with COVID-19. Whilst it was not associated with worse outcomes for those patients who subsequently required IMV, this may be due to residual confounding and differences in processes of care

Right ventricular dysfunction in patients with COVID-19 pneumonitis whose lungs are mechanically ventilated: a multicentre prospective cohort study

Cardiovascular complications due to COVID-19, such as right ventricular dysfunction, are common. The combination of acute respiratory distress syndrome, invasive mechanical ventilation, thromboembolic disease and direct myocardial injury creates conditions where right ventricular dysfunction is likely to occur. We undertook a prospective, multicentre cohort study in 10 Scottish intensive care units of patients with COVID-19 pneumonitis whose lungs were mechanically ventilated. Right ventricular dysfunction was defined as the presence of severe right ventricular dilation and interventricular septal flattening. To explore the role of myocardial injury, high-sensitivity troponin and N-terminal pro B-type natriuretic peptide plasma levels were measured in all patients. We recruited 121 patients and 118 (98%) underwent imaging. It was possible to determine the primary outcome in 112 (91%). Severe right ventricular dilation was present in 31 (28%), with interventricular septal flattening present in nine (8%). Right ventricular dysfunction (the combination of these two parameters) was present in seven (6%, 95%CI 3–13%). Thirty-day mortality was 86% in those with right ventricular dysfunction as compared with 45% in those without (p = 0.051). Patients with right ventricular dysfunction were more likely to have: pulmonary thromboembolism (p &lt; 0.001); higher plateau airway pressure (p = 0.048); lower dynamic compliance (p = 0.031); higher plasma N-terminal pro B-type natriuretic peptide levels (p = 0.006); and raised plasma troponin levels (p = 0.048). Our results demonstrate a prevalence of right ventricular dysfunction of 6%, which was associated with increased mortality (86%). Associations were also observed between right ventricular dysfunction and aetiological domains of: acute respiratory distress syndrome; ventilation; thromboembolic disease; and direct myocardial injury, implying a complex multifactorial pathophysiology

EPidemiology Of Cardiogenic sHock in Scotland (EPOCHS):a multicentre, prospective observational study of the prevalence, management and outcomes of cardiogenic shock in Scotland

BackgroundDespite high rates of cardiovascular disease in Scotland, the prevalence and outcomes of patients with cardiogenic shock are unknown.MethodsWe undertook a prospective observational cohort study of consecutive patients with cardiogenic shock admitted to the intensive care unit (ICU) or coronary care unit at 13 hospitals in Scotland for a six-month period. Denominator data from the Scottish Intensive Care Society Audit Group were used to estimate ICU prevalence; data for coronary care units were unavailable. We undertook multivariable logistic regression to identify factors associated with in-hospital mortality.ResultsIn total, 247 patients with cardiogenic shock were included. After exclusion of coronary care unit admissions, this comprised 3.0% of all ICU admissions during the study period (95% confidence interval [CI] 2.6 to 3.5%). Aetiology was acute myocardial infarction (AMI) in 48%. The commonest vasoactive treatment was noradrenaline (56%) followed by adrenaline (46%) and dobutamine (40%). Mechanical circulatory support was used in 30%. Overall in-hospital mortality was 55%. After multivariable logistic regression, age (odds ratio [OR] 1.04, 95% CI 1.02 to 1.06), admission lactate (OR 1.10, 95% CI 1.05 to 1.19), Society for Cardiovascular Angiographic Intervention stage D or E at presentation (OR 2.16, 95% CI 1.10 to 4.29), and use of adrenaline (OR 2.73, 95% CI 1.40 to 5.40) were associated with mortality.ConclusionsIn Scotland the prevalence of cardiogenic shock was 3% of all ICU admissions; more than half died prior to discharge. There was significant variation in treatment approaches, particularly with respect to vasoactive support strategy. <br/