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NIHR Signal ICU admission decision support tool showed promise but was rarely used
A decision support tool developed to help doctors determine whether patients should be admitted to intensive care showed promise in facilitating patient-clinician communication, but was not often used by doctors, with fewer than 30% using the forms. Intensive care can deliver lifesaving treatment. It can be invasive and distressing with no guarantee of success. At present, there is little to guide doctors in the decision-making process, and this NIHR-funded study sought to help doctors by devel...
NIHR Signal Age of stored blood used for transfusions in critically ill children doesn’t affect outcomes
Using more recently-collected red blood cells for transfusions does not reduce organ dysfunction, infection or risk of death in critically ill children, compared with blood that has been stored for longer. This large, international trial included more than 1,500 children in paediatric intensive care units. The study provides robust evidence to support the continued practice of using the oldest compatible red blood cells within their use-by date. This is done to minimise the amount of donated b...
NIHR Signal Tranexamic acid is safe to use following mild-to-moderate traumatic brain injury and reduces deaths
In people with mild-to-moderate traumatic brain injury, tranexamic acid (a drug which reduces bleeding) given within three hours of injury reduces the risk of death by 22%. This effect is seen in a subgroup of those who are less severely affected. This NIHR-funded multi-centre international trial randomised 12,737 adults with intracranial bleeding to receive either tranexamic acid or a placebo. Overall, there was no difference in risk of death within 28 days between the two groups. However, whe...
NIHR Signal A nurse-led intervention did not reduce post-traumatic stress disorder symptoms in critical care patients
For adults in critical care, a complex psychological intervention delivered by nurses did not reduce the severity of post-traumatic stress disorder (PTSD) symptoms at six months, compared with usual care. The intervention included creating a therapeutic environment, three stress support sessions, and a relaxation/recovery programme. A cost-effectiveness evaluation showed great uncertainty over whether the programme was value for money. The intervention was developed using the limited evidence t...
NIHR Signal Diagnosis of delirium in hospitals can be improved by the 4 A’s test
A new shorter test for delirium appears helpful in assessing older people in hospital who may have the condition. A normal score on the 4 A’s test effectively rules out delirium while an abnormal score is reasonably useful for detecting the condition. People detected by the test would still need a full assessment to confirm the diagnosis. Delirium is common in older people who have been hospitalised, but it can go undiagnosed. To help combat this, the 4 A’s test was developed as an ...
NIHR Signal Antimicrobial central venous catheters do not reduce infections in pre-term babies
Central venous catheters (CVCs) impregnated with antimicrobial agents are no better than standard CVCs for avoiding bloodstream infection in pre-term babies. This NIHR-funded trial compared peripherally inserted CVCs that had been impregnated with a combination of the antifungal miconazole and the broad-spectrum antibiotic rifampicin, against standard non-antimicrobial-impregnated CVCs for preterm babies in intensive care. Rates of bloodstream infections were similar in both groups, and no diff...
NIHR Signal Training for clinical competence and resilience reduced job strain among intensive care nurses in France
A five-day educational course showed potential to reduce work-based stress and burnout among nurses working in intensive care units in France. The study conducted in multiple adult intensive care units aimed to identify the effects of an intensive, continuing medical education program on occupational stress. The course focussed on nursing theory, role-play and debriefing sessions. Six months after attending the programme, intensive care unit nurses showed reduced levels of job strain compared t...
NIHR Signal Decontamination of the mouth or digestive tract was not linked to reductions in drug-resistant bloodstream infections in the intensive care unit
Decontamination strategies to remove potentially harmful bacteria from the mouth, throat and gut of critically ill patients don’t reduce the risk of intensive care unit-acquired bloodstream infections or deaths from bacteria that were resistant to antibiotics. The study was carried out in 13 intensive care units across Europe, including the UK, with moderate to high levels of antibiotic resistance (extended resistance in more than 5% of all bloodstream infections). This fills an important ...
NIHR Signal Early cooling provides no benefit following traumatic brain injury
Deliberate cooling (prophylactic hypothermia) in the early management of traumatic brain injury does not improve neurological outcomes at six months. Inducing hypothermia may also increase the risk of pneumonia. Hypothermia (33-35oC) is sometimes induced to try and limit brain damage in people with severe head injuries. However, evidence for its safety and effectiveness has been mixed. A 2015 trial (Eurotherm 3235) found that therapeutic hypothermia, for adults with raised intracranial pressur...
NIHR Signal Premature babies have fewer complications if a lower platelet count is accepted
Fewer premature babies die or have major bleeding if platelet transfusions are withheld until platelet numbers drop to a lower level. At 28 days, death or new major bleeding occurred in 19% of neonates transfused when they had less than 25,000/mm3 platelets compared to 26% of neonates transfused when they had less than 50,000/mm3 platelets. This trial included 660 premature babies with low platelet counts. The results suggest that in the absence of actual bleeding, platelet transfusions may be...
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