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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 Simple leg raise test may help in assessing patients’ fluid needs in intensive care
This review of 23 trials found a simple leg raise test helped predict whether patients were responsive to extra intravenous fluids in intensive care. Passive leg raising—using a hospital bed to tilt a patient’s straight legs up to a 45 degree angle—increases the amount of blood returning to their heart, similar to the effect of giving them an extra 250 to 350mls of fluid. The immediate but temporary increase in heart blood flow from leg raising helped identify those most likel...
NIHR Signal Earplugs may reduce risk of confusion in patients while in intensive care
Earplugs appear effective at reducing the risk of patients in intensive care units (ICU) developing delirium, a state of confusion in people who are unwell. The effect was seen whether the earplugs were used alone or with other sleep aids like eye masks or soothing music. Earplugs also reduced the duration of confusion by around two days. Patient compliance was high at 86.9%. Cost and cost-effectiveness were not measured, but earplugs are relatively inexpensive. Around 1 in 5 hospitalised peopl...
NIHR Signal Interventions that help and harm patients in the critical care unit
This systematic review and expert consensus process found 15 non-surgical interventions affecting adult mortality in critical care. Seven interventions, such as the use of tranexamic acid after severe blood loss, reduced deaths. Eight interventions, such as improving oxygen supply by using a drug, dobutamine, increased them. 2015 UK guidelines only partly reflect these findings. They may need amending to more explicitly identify interventions considered beneficial and harmful in critical care. T...
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