Academic research

A study performed at Academic Medical Center in the Netherlands investigated the effect of the application of a transfusion bundle on transfusion practice, hypothesising that the implementation of the transfusion bundle would lead to a reduction of inappropriate red blood cell transfusions. The authors quantified the true effect of the transfusion bundle by assessing, per transfusion, whether the decision to transfuse was based on a lower pre-transfusion haemoglobin level than the patients’ individual preset haemoglobin threshold.  Data about appropriate transfusions were collected at baseline (4 months), during the implementation period (4 months) and during the post-implementation period (4 months) using MetaVision. The authors found that using the transfusion bundle helps to improve compliance with transfusion guidelines in daily practice and suggest that future research should focus on implementing a transfusion bundle for other types of blood products, such as fresh frozen plasma or platelets, and on the cost effectiveness of implementing the transfusion bundle.

Read Abstract

A retrospective cohort study conducted at OLVG hospital aimed to verify previously identified potential determinants for readmission of ICU patients to assess which modifiable factors can make readmission rate a quality indicator. This is the largest single centre cohort of ICU patients to date, with 19,750 patients at risk for readmission included over a 14-year period. Demographic and clinical characteristics were extracted from MetaVision. The authors found that since readmission rate is associated with factors that are mainly patient dependent and cannot be modified, such as age, severity of disease, type of admission, infection, and immunodeficiency, readmission rate does not meet the criteria to be used as a useful quality indicator.

Read Abstract

A study performed at Tokyo Women’s Medical University attempted to develop a new scoring system that would enable a comprehensive assessment of preoperative and intraoperative patient statuses instantly following entry of data into an electronic anaesthesia chart, accurately and automatically predicting postoperative mortality. The usefulness of this new scoring system, the SASA, was compared with that of the surgical Apgar score (sAs) and American Society of Anesthesiologists physical status classification (ASA-PS), which are the components of the new system. The study, which included 32,555 patients who underwent surgery under general or regional anaesthesia from 2008 to 2012, used MetaVision to extract factors presumably associated with surgical outcomes, such as patient characteristics and ASA-PS, and the three intraoperative indexes used to calculate the sAs. The authors found that  while the sAs and ASA-PS were shown to be extremely useful for predicting mortality within 30 days of surgery,  an even higher predictive ability was demonstrated by the SASA, which combines these scoring systems, and conclude, “We expect that the SASA will be widely used as a new easy scoring system for predicting prognosis, allowing a comprehensive assessment of perioperative patient status and automatic calculation of scores at the end of entering data into electronic anesthesia charts.”

Read Abstract

A retrospective study at VU University Medical Center Amsterdam investigated whether computed tomography (CT)-derived low skeletal muscle quality at ICU admission is independently associated with 6-month mortality and other clinical outcomes, the first study to investigate the relation between CT-derived markers for muscle quality and outcome in ventilated critically ill patients. Patient data such as age, sex, weight, height, admission diagnosis, APACHE II score, length of ventilation, ICU length of stay and hospital length of stay, discharge destination, and ICU and hospital mortality was obtained from MetaVision. The authors conclude that “Low skeletal muscle quality at ICU admission, as assessed by skeletal muscle density on CT scans, is associated with higher 6-month mortality in mechanically ventilated patients, independent of muscle quantity, APACHE II score, and BMI. Low muscle quality was also associated with longer hospital length of stay in survivors. Therefore, muscle quality appears to be as important for outcome as muscle quantity. Future intervention studies, including nutrition and early exercise, should not only focus on preventing further deterioration of muscle quantity, but also of muscle quality.”

Read Abstract

An observational prospective cohort study performed at VU University Medical Center in Amsterdam set out to determine whether delirious patients admitted to the ICU and MCU show characteristics that possibly match serotonergic toxicity, in order to gain more clarity on whether or not serotonergic toxicity should be considered as one of the contributing factors in delirious patients. The authors found that a significant proportion of ICU patients who have been diagnosed with delirium might in fact be classified as suffering from serotonin toxicity and showed that awareness of potential serotonin toxicity is low among physicians in their tertiary university ICU. Given the lack of existing studies, the authors point out the necessity for further studies about the incidence and prevalence of serotonin toxicity in ICU patients and the effect of possible early therapeutic interventions. Demographic characteristics for the study, such as age, gender, and severity of illness expressed in Acute Physiology and Chronic Health Evaluation (APACHE) II and IV score, were collected in MetaVision.

Read Abstract

Papworth Hospital undertook a retrospective chart review and tested the hypothesis that tidal volume is a predictor of mortality in cardiothoracic (medical and surgical) critical care patients receiving invasive mechanical ventilation (MV). Additional aims were to 1)  identify the commonly used ventilatory modes and parameters in our cardiothoracic ICU (postoperative and nonsurgical patients), 2)  identify whether certain components of lung protective ventilation care bundles are followed by our institution’s cardiac intensivists at the onset of MV, 3) help develop a ventilatory guideline within our cardiac ICU and cardiac recovery unit and integrate a ventilator bundle in checklist format in the MetaVision clinical information system and 4) organise teaching sessions on lung protective strategies for all ICU medical, nursing, and allied health professionals. Predictor variables in the first 24 hours extracted from MetaVision included sequential organ failure assessment (SOFA) score at the onset of MV, ventilator mode, types of surgery (cardiac/thoracic, transplant, and nonsurgical) and more. The authors found that when controlling for covariates, Vt and other ventilator variables did not independently predict mortality in our model, despite best evidence suggesting that they should. The Berlin Definition of ARDS severity categorises patients on their degree of hypoxemia (mild, moderate, and severe based on PaO2:FiO2 ratio) which should predict mortality, but the authors did not sample equally from each of these groups and conclude, “As a result, our study was not adequately powered to detect a difference in mortality between these groups and therefore our results are not definitive. Further study of this sample would add the required power or use subgroup analyses to determine all factors contributing to death.”

Read Abstract

A retrospective study at Leiden University Medical Center aimed to determine the occurrence and duration of hypothermia in infants < 32 weeks gestational age at birth during the first three hours after arrival at their neonatal intensive care unit (NICU) and to identify risk factors. During admission, skin temperature was continuously measured by a skin temperature probe and recorded every minute in MetaVision. The authors found that gestational age at birth and hypothermia at admission were independent risk factors for the occurrence of hypothermia in the first hours during admission and conclude that because hypothermia increases the risks in morbidity and mortality, caregivers should take all precautions to prevent hypothermia, not only in the delivery room, but also in the first hours after admission.

Read Abstract

A single-center, historical cohort study at Massachusetts General Hospital sought to calculate the incidence of prolonged emergence (i.e., >15 min) for patients under the care of clinical anaesthesia (CA) residents and to identify factors from resident training, medical history, anaesthetic use, and anaesthesia staffing, which affect emergence. Data extracted from MetaVision was analysed in order to understand the effect of anaesthesia resident training duration on patient emergence time. The authors conclude that, “…the incidence of prolonged emergence from general anesthesia decreased linearly over time during the CA-1 residency year residency. Furthermore, the frequency of prolonged emergence differed among individual residents. Finally, in addition to operative time and anesthetic choice, non-obvious patient factors such as ASA PS III or greater and male gender are associated with prolonged emergence time. Thus, this frequency may be a useful index of 1st-year anesthesia resident progress pending further validity-type evidence.”

Read Abstract

A study at University Hospital of Lausanne (CHUV) in Switzerland investigated the association between morphologic brain development, assessed by cerebral magnetic resonance imaging(MRI) at term equivalent age (TEA), and macronutrient and energy intakes during the first 2 weeks after birth. MetaVision provided an exact record of enteral and parenteral intakes. The authors found that higher energy and lipid intake during the first 2 weeks after birth was associated with a lower incidence of brain lesions and dysmaturation at term equivalent age in preterm neonates and conclude that “Optimizing nutritional intake may be an effective and feasible way to improve preterm brain development and to potentially alleviate the effect of early stressors such as inflammation and infection. The impact on long term neurodevelopmental outcome must be confirmed, especially in more vulnerable populations. Finally, larger interventional trials are needed to further investigate and develop effective neuroprotective nutritional strategies.”

Read Abstract