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NIHR Signal Early, intense rehabilitation helps recovery after serious traumatic head injury
Early, intensive rehabilitation aids recovery and improves outcomes for people with moderate to severe traumatic brain injury. A review of 11 studies found that starting rehabilitation early, while people were still in intensive care, or offering more intensive treatments helped patients with brain injury regain function compared with usual care. Early rehabilitation often included multisensory stimulation while the patient was still in a coma. The intensive multidisciplinary programmes mostly ...
NIHR Signal Balanced electrolyte solutions give marginal benefit over saline for very ill patients
About 14% of critically ill patients receiving electrolyte-balanced crystalloids either developed kidney failure, needed kidney-replacement therapy or died compared with 15% receiving normal saline. This small but statistically significant benefit was only apparent when combining outcomes; there was no difference between fluids for the three individual outcomes analysed separately. A solution of 0.9% sodium chloride (normal saline) is the most commonly used intravenous (IV) fluid, but it can ca...
NIHR Signal Plastic wraps or bags keep pre-term infants warm immediately after birth
Cheap and simple plastic wrapping used in the first 10 minutes after birth helps pre-term and low birth weight infants avoid hypothermia. Infants treated in this way are likely to be warmer when admitted to neonatal intensive care than those treated according to standard care. Pre-term infants are most likely to benefit. Routine infant care usually involves ensuring the delivery room is warm, drying the infant immediately after birth, wrapping the infant in pre-warmed dry blankets and pre-warmi...
NIHR Signal Statins are of no benefit in acute respiratory distress syndrome
Giving statins to patients with acute respiratory distress syndrome made no difference to the number of days they spent on a ventilator. It also had no effect on mortality or the length of time spent in intensive care or in hospital compared with placebo. In acute respiratory distress syndrome, the lungs become severely inflamed, fill with fluid (pulmonary oedema) and can no longer function. The person needs mechanical ventilation and is at high risk of multiple organ failure and mortality. Thi...
NIHR Signal Intravenous antibiotics, administered over 3 hours, are linked to lower death rates in sepsis
The risk of death in adults with sepsis was 30% lower when each dose of antibiotic was given intravenously over three hours compared to a bolus or less than 60 minutes. This systematic review included adults on intensive care units with a range of ages, severity of sepsis and other symptoms. A variety of antibiotics of the anti-pseudomonal beta-lactam class were used in the trials. These included carbapenems, penicillins and cephalosporins. In the UK, current guidance for intravenous use of th...
NIHR Signal Transfusing blood close to its use-by date does not increase deaths in critically ill adults
Transfusing more recently-collected red blood cells does not improve the chance of survival for critically-ill people who need blood transfusions, compared with blood that has been stored for longer. This large international study included almost 5,000 critically ill people in intensive care units. Participants were transfused with either the freshest compatible blood available (mean storage 11.8 days) or the oldest compatible stored blood within its use-by date (mean storage time 22.4 days). ...
NIHR Signal Blood test could shorten antibiotic treatment in newborns with suspected sepsis
Measuring procalcitonin levels in newborns with suspected sepsis in the first days of life reduced antibiotic duration by 10 hours compared with standard care. There was no increase in the risk of re-infection or death. Systemic infection can be rapidly life-threatening in newborn babies, so those with risk factors are often treated pre-emptively with intravenous antibiotics. If sepsis is not confirmed by blood culture the decision whether to discontinue antibiotics needs to be made, but result...
NIHR Signal Checklists are no substitute for experience in spotting patients who are deteriorating
Experience was found to count in recognising and acting on patient deterioration. National guidelines recommend the use of “track and trigger” systems to monitor seriously ill patients for the signs of deterioration. Following their identification, prompt referral to critical care teams is suggested, for example, but this does not always happen reliably. This realist review explored the organisational factors within UK hospitals that influence how and why these alert systems work in ...
NIHR Signal A focus on treating fever does not improve survival in sepsis
Specifically treating fever in adults with sepsis did not reduce the number of people dying within 28 days. It also had no effect on the frequency of hospital-acquired infections, reversing septic shock, lowering heart rate or improving breathing. Sepsis is a rare complication of an infection. Among the 123,000 people a year in England who develop sepsis around 30% will die from it, so improving our understanding of how to treat sepsis is clearly important. Early treatment of sepsis is importan...
NIHR Signal Very strict blood sugar control in critically ill children provides no benefit
Strict control of blood sugar levels for critically ill children in ICU with high blood sugar did not increase the number of days they spent outside of ICU in the first month. The trial was stopped early as more infections and very low glucose levels were recorded in the strict control group. This trial found that using insulin to control blood sugar to within 4.4 to 6.1 mmol/L, rather than 8.3 to 10mmol/L, in critically ill children made no difference to the number of days they spent in the i...
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