ICU Pharmacists e-Group
UKCPA-Critical Care
Hosted by www.ukcpa.org
Critical Care Journal Club Bulletin
August 2013
“A Systematic Review of Evidence-Informed Practices for Patient Care Rounds in
the ICU.”
*
Lane, Daniel et al.
Review
Crit Care Med (41) 8: 2015-2029
Bottom line: A review of 43 articles looking at facilitators and barriers to patient
care rounds in ICU. Pharmacist presence on care rounds has been shown to:
reduce adverse drug events and interactions, save money, improve overall patient
care through interventions, and reduce patient mortality. Ideally, rounds should be
conducted by a multi-disciplinary team with defined roles, following a standardised
structure including a best-practice checklist and a goal-oriented approach. Barriers
to patient care rounds included long round times and interruptions.
No stars = Paper highlighted for general interest (read only if of particular interest or relevance to you)
One star = Highlighted paper of particular note with relevance to most ICU pharmacists (should be read)
Two stars = Ground breaking or keynote paper of direct relevance to all (essential reading for all ICU pharmacists)
Collated By Patricia Ging
Contributions
“Atypical Sleep in Ventilated Patients: Empirical Electroencephalography Findings and the
Path Toward Revised ICU Sleep Scoring Criteria.”
Watson, Paula L et al.
Crit Care Med (41) 8: 1958-1967
“Early Goal-Directed Sedation Versus Standard Sedation in Mechanically Ventilated Critically
Ill Patients: A Pilot Study.”
Shehabi, Yahya et al.
Crit Care Med (41) 8: 1983-1991
“Evaluating Pain, Sedation, and Delirium in the Neurologically Critically Ill-Feasibility and
Reliability of Standardized Tools: A Multi-Institutional Study.”
Yu, Amy et al.
Crit Care Med (41) 8: 2002-2007
“A Systematic Review of Evidence-Informed Practices for Patient Care Rounds in the ICU.” *
Lane, Daniel et al.
Review
Crit Care Med (41) 8: 2015-2029
Bottom line: A review of 43 articles looking at facilitators and barriers to patient care rounds in
ICU. Pharmacist presence on care rounds has been shown to: reduce adverse drug events and
interactions, save money, improve overall patient care through interventions, and reduce
patient mortality. Ideally, rounds should be conducted by a multi-disciplinary team with
defined roles, following a standardised structure including a best-practice checklist and a goaloriented approach. Barriers to patient care rounds included long round times and
interruptions.
Contributed by Louise Carr, Newcastle Upon Tyne Hospitals NHS Trust,
27/08/2013
“Regional anaesthesia and patients with abnormalities of coagulation:The Association of
Anaesthetists of Great Britain & Ireland, The Obstetric Anaesthetists’ Association, and Regional
Anaesthesia UK.
Harrop-Griffiths W et al
Anaesthesia 2013, 68, pp966-972
Multi-party recommendations regarding the risks of regional anaesthesia (including spinals and
epidurals) in patients with abnormal coagulation, including that caused by drugs eg heparin,
aspirin, rivaroxaban. Comprehensive and authoritative information.
Residual anaesthesia drugs – silent threat, visual solutions
Oglesby KJ, Cook TM, Jordan L
Anaesthesia 2013, 68, pp981-2
Letter following up on a previous report of harm caused by drugs left in a cannula subsequently
being flushed into the system. Highlights that the incidence is probably higher than recognised,
and illustrates some local solutions to the problem.
Contributed by: Alan Timmins, Queen Margaret Hospital
21/08/13
British Journal of Anaesthesia –backlog!
Impact of the World Health Organization’s Surgical Safety Checklist on safety culture in the
operating theatre: a controlled intervention study
Hauget et al.. BJA (2013) 110 (5) 807-815
Shows that active implementation of this checklist in Norwegian hospital improves theatre
staffs safety awareness.
Characteristics of pain in hospitalised medical patients, surgical patients and outpatients
attending a pain management centre
Rockett et al.. BJA (2013) 110(6): 1017-1023.
Survey of a snapshot of inpatients (38) on one day. Sample small and unmatched but
interesting concept and discussion. Medical and surgical inpatients have the same pain severity
and frequency of pain in this study.
June contains a special issue on anaesthetic neurotoxicity and neuroplasticity.
Is postoperative cognitive dysfunction (POCD) a risk factor for dementia? A cohort follow-up
study.
BJA (2013) 110 (suppl 1)192-197.
Despite an extensive follow up of 11 years there was no statistical increase in dementia. All
minor or major cardiac surgery patients with local or general anaesthesia included. Supports
POCD being largely reversible.
July 2013(A pain focused edition)
Managing pain: recent advances and new challenges. [Editorial Colvin, LA et Rowbotham, J.]
BJA (2013) 111 (1): 1-3 Also III
Pain research: what we have learned and where we are going. F. Cervera.
I: Mentions the interaction of the nervous system with the immune system, exploration of the
placebo effect and capitalising on the neuroplasticity of the nervous system in tackling pain.
III: A muse on pain from the President of the International Association for the Study of Pain. A
reminder of our collective responsibility to take pain seriously and the inadequacy of our
methods to measure the effectiveness of analgesia, particularly in chronic pain.
Contributed by: Niamh McGarry
The Royal Hospitals, Belfast 19/08/13
"Role of Dexmedetomidine for the Prevention and Treatment of Delirium in Intensive Care
Unit Patients"
Yoonsun Mo and Anthony E Zimmermann Ann Pharmacother aph.1R708; published ahead of
print May 21, 2013, doi:10.1345/aph.1R708
OBJECTIVE: To review recent clinical studies regarding the role of dexmedetomidine for
prevention and treatment of delirium in intensive care unit (ICU) patients.
DATA SOURCES: MEDLINE and PubMed searches (1988-Feburary 2013) were conducted, using
the key words delirium, dexmedetomidine, Precedex, agitation, α-2 agonists, critical care, and
intensive care. References from relevant articles were reviewed for additional information.
DATA SYNTHESIS: Dexmedetomidine is a highly selective α-2 receptor agonist that provides
sedation, anxiolysis, and modest analgesia with minimal respiratory depression. Its mechanism
of action is unique compared with that of traditional sedatives because it does not act on γaminobutyric acid receptors. In addition, dexmedetomidine lacks anticholinergic activity and
promotes a natural sleep pattern. These pharmacologic characteristics may explain the
possible anti delirium effects of dexmedetomidine. Eight clinical trials, including 5 double-blind
randomized trials, were reviewed to evaluate the impact of dexmede to midine on ICU
delirium.
CONCLUSIONS: Currently available evidence suggests that dexmedetomidine is a promising
agent, not only for prevention but also for treatment of ICU-associated delirium. However,
larger, well-designed trials are warranted to define the role of dexmedetomidine in preventing
and treating delirium in the ICU.
Contributed by: Chris Jay Hutt Valley Hospital, NZ
18/08/13
Critical Care — An All-Encompassing Specialty
Finfer S, Vincent JL, M.D.,
N Engl J Med 2013 369;7 669-70
Critical care is a young specialty that is generally considered to have developed from the
successful use of invasive ventilation during the 1952 polio epidemic in Copenhagen. In his
report
of the response to that epidemic, Ibsen described much more than the use of invasive
ventilation;
he also described collaborative, multidisciplinary care that can serve as a model for critical care
services to this day. Article on the history of critical care to mark a new series of articles for the
next 5 weeks
Severe Sepsis and Septic Shock
Derek C. Angus, M.D., M.P.H., and Tom van der Poll, M.D., Ph.D.
N Engl J Med 2013;369:840-51.
First in a critical care series, there will also be an evolving case study on the website with voting
etc.
This article covers the EBM in sepsis with plenty of pretty illustrations, useful for teaching.
Abusive Prescribing of Controlled Substances — A Pharmacy View
Betses M, Brennan T, M.D., M.P.H
August 21, 2013DOI: 10.1056/NEJMp1308222
Overprescription of opioids is now a leading cause of overdose and death particularly in the
USA. Pharmacists have a duty to avoid contributing to this, which is obviously difficult when an
unknown patient presents a valid prescription. This article details how the CVS pharmacy chain
identified “pill mill” overprescribers of opioids from national prescription data. Following
attempts to clarify the reasons for the unusual patterns of prescribing , identified prescribers’
prescriptions are not dispensed by the chain.
Contributed by: Patricia Ging Mater Misericordiae University Hospital
21/08/13
Internet resources
Commentary
Another step in improving the diagnosis of disseminated intravascular
coagulation in sepsis
Levi M
Critical Care 2013, 17:448 (23 August 2013)
[Abstract] [Full text] [PDF]
Commentary
AT1 receptor-associated protein and septic shock-induced vascular
hyporeactivity: another 'magic bullet' in the pipe?
Kimmoun A, Levy B
Critical Care 2013, 17:447 (23 August 2013)
[Abstract] [Full text] [PDF]
Research
Hyperoxemia and long-term outcome after traumatic brain injury
Raj R, Bendel S, Reinikainen M, Kivisaari R, Siironen J, Lång M, Skrifvars M
Critical Care 2013, 17:R177 (19 August 2013)
[Abstract] [Provisional PDF] [PubMed]
Letter
The angiogenic factors and their soluble receptors in sepsis: friend, foe, or
both?
Zhang R, Liu Y, Qu H, Tang Y
Critical Care 2013, 17:446 (22 August 2013)
[Abstract] [Full text] [PDF]

Complications of Non-invasive Ventilation Techniques
British Journal of Anaesthesia, August 28, 2013

Mechanisms of ARDS in Children and Adults
Pediatric Critical Care Medicine, August 26, 2013

Impact of Parental Presence and Holding in the NICU
Journal of Perinatology : Official Journal of the California Perinatal Association, August 23, 2013

Recurrence Risk Following Acute Venous Thromboembolism
Current Opinion in Pulmonary Medicine, August 23, 2013

Therapies for Pulmonary Arterial Hypertension in Children
Pediatric Pharmacotherapy, August 22, 2013

Procalcitonin-Guided Algorithm for Patients With Sepsis
BMC Infectious Diseases, August 21, 2013

Early Sedation vs Standard in Ventilated Patients
Critical Care Medicine, August 21, 2013

Central Line-Associated Bloodstream Infection in Children
The Pediatric Infectious Disease Journal, August 19, 2013

Predictors of Severe H1N1 Infection in Children
British Medical Journal, August 16, 2013

Dexmedetomidine Use in the ICU
Critical Care, August 15, 2013

Inappropriate Medication Prescriptions in Elderly Adults
Journal of the American Geriatrics Society, August 14, 2013

Evaluation and Treatment of Pain in Critically Ill Adults
Seminars in Respiratory and Critical Care Medicine, August 12, 2013
List of Contributors
Contributor
Nicola Rudall
Nicola.Rudall@nuth.nhs.uk
Louise Potts
Louise.Potts3@nuth.nhs.uk
Newcastle Upon Tyne Hospitals NHS
Foundation Trust
Matt Elliott
Royal Derby Hospital
matthew.elliott1@nhs.net
Gillian Mulherron
Newcastle Upon Tyne Hospitals NHS
Foundation Trust
Gillian.Mulherron@nuth.nhs.uk
Olivia Moswela
Radcliffe Infirmary
olivia.moswela@orh.nhs.uk
Patricia Ging
Mater Misericordiae University Hospital
Dublin
pging@mmuh.ie
Journal
Critical Care
Medicine
Contributor
Annie Egan
Nelson Hospital, NZ
annie_egan2000@hotmail.com
Journal
Critical Care
Intensive Care
Medicine
Niamh Mc Garry
The Royal Hospitals, Belfast
niamh.mcgarry@belfasttrust.hscni.net
Clare Crowley
Oxford Radcliffe Hospitals
clare.crowley@orh.nhs.uk
British Journal of
Anaesthesia
John Dade
St. James's University Hospital
john.dade@leedsth.nhs.uk
Thorax
Andreas Fischer
A.Fischer@rbht.nhs.uk
Snehal Shah
S.Shah6@rbht.nhs.uk
Royal Brompton & Harefield NHS Trust
Alan Timmins
Queen Margaret Hospital
alan.timmins@nhs.net
Jennifer de Val
Guy's & St Thomas' NHS Foundation
Trust
Jennifer.deVal@gstt.nhs.uk
Chris Jay
Hutt Valley Hospital, NZ
chris.jay@huttvalleydhb.org.nz
Chest
Fraser Hanks
King's College Hospital NHSFT
fraser.hanks@nhs.net
Anaesthesia and
Intensive Care
medicine
American Journal of
Respiratory and
Critical Care (First
Fortnight)
American Journal of
Respiratory and
Critical Care (Second
Fortnight) and
Neurosciences
journals
New England Journal
of Medicine
Mark Borthwick
Oxford Radcliffe Hospitals
mark.borthwick@orh.nhs.uk
Anja Richter
Whittington Health
anja.richter@nhs.net
Circulation
Internet Resources
Emma Graham-Clarke
Sandwell and West Birmingham Hospitals
NHS Trust
emma.graham-clarke@nhs.net
Jane Sheldon
Stockport
Jane.Sheldon@stockport.nhs.uk
Sanchia Pickering
Sanchia.Pickering@cmft.nhs.uk
Tony Dunne
CMFT, Manchester
(List last updated 31 January 2013)
JAMA (weekly)
Alternating months
Lancet (Weekly)
Quality and Safety
in Healthcare
Anaesthesia
Anaesthesia and
Analgesia
The Annals of
Pharmacotherapy
(EGC+ Key articles
from clinical nutrition
and e-SPEN)
BMJ (Weekly)
This bulletin would not be possible without the valuable help of volunteer contributors. If there is a journal, article or resource
that you would like to contribute a précis for, or just make the newsgroup aware of, then please e-mail emma.grahamclarke@nhs.net
Next Bulletin scheduled to go out on: Friday 27thth September 2013 and will be collated by: Niamh McGarry
(niamh.mcgarry@belfasttrust.hscni.net )