Academic research

A study performed at Beth Israel Deaconess Medical Center evaluated the effect of positive end-expiratory pressure (PEEP) on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in a large population of patients with acute brain injury and varying categories of acute lung injury, defined by PaO2/FiO2. The authors hypothesised that PEEP could be applied safely to patients with severe brain injury without causing intracranial hypertension or dangerous reductions in CPP. The authors conclude that “the application of PEEP for patients with varying degrees of acute lung injury and concomitant severe, acute brain injury does not appear to have a clinically significant effect on ICP or CPP. However, our findings should be applied with caution as further prospective studies are needed to assess the safety and clinical outcomes of applying a lung protective ventilation strategy to patients with both lung and brain injuries.” In this study, the largest analysis of the relationship between PEEP and ICP, MetaVision was used to identify eligible patients and collect ventilation, physiologic, laboratory, medication, and demographic data.

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A study performed at Leiden University Medical Center (LUMC) in the Netherlands studied oxygen saturation (SpO2) targeting before and after training and guideline implementation of manual oxygen titration by comparing two cohorts of preterm infants <30 weeks of gestation needing respiratory support and oxygen therapy. Respiratory support was given by a mechanical ventilator connected to the MetaVision patient data management system (PDMS), which supplied basic patient characteristics as well as clinical parameters every minute. The authors found that training guideline implementation in manual oxygen titration improved SpO2 targeting in preterm infants, with more time spent within the target range and less frequent hyperoxaemia. The durations of hypoxaemia and hyperoxaemia during ABCs (apnoea, bradycardia, cyanosis) were shorter. They conclude that, “This initiative in quality improvement had a positive effect, and if the observed reduction in the risk for hypoxaemia and hyperoxaemia could be maintained through repetitive training, it would be likely to improve the outcome of preterm infants.”

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A prospective observational study at Centre Hospitalier Universitaire Vaudois (CHUV) evaluated OMNI®, a new device for continuous renal replacement therapy (CRRT), by testing it in real-life conditions for the first time. The authors also assessed user (nurses) satisfaction and aimed to provide direct feedback to the manufacturer regarding issues raised and user interface improvement suggestions. Ten critically ill patients received CRRT in CVVH-heparin and CVVHD-citrate modes using OMNI. The authors collected therapy data and metabolic parameters using MetaVision, and evaluated user’s satisfaction with a survey. The authors found that, “RRT could be provided using Omni in a safe and efficient way in both CVVH-heparin and CVVHD-RCA modes in 10 critically ill patients. Alarms-related downtime was minimal and renal dose delivery high. Users provided positive feedback for therapy setup, management and design.”

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A retrospective analysis Centre Hospitalier Universitaire Vaudois (CHUV) aimed to analyse the epidemiology, characteristics, and risk factors associated with Staphylococcus aureus early-onset pneumonia (EOP) to identify predictive factors that could be used to target it with early preemptive treatment, such as that using focused antibiotics or specific monoclonal antibodies. Data for all burn patients requiring more than four hours of mechanical ventilation who were admitted between January 2001 and October 2012 were extracted using MetaVision. The authors identified S. aureus carriage as an independent and strong predictor of EOP. They suggest that since rapid point of care testing for S. aureus is readily available, all patients should be tested at admission for burn trauma and early preemptive treatment should be considered for all positive patients, and note that further studies are needed to evaluate this new strategy.

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An observational cohort study of three large tertiary care ICUs in the Netherlands evaluated previously used and newly constructed metrics of arterial hyperoxia and systematically assessed their association with clinical outcomes in different subgroups in the ICU. Arterial blood gas analyses and concurrent ventilator settings were extracted from MetaVision. The authors found that metrics of central tendency for severe arterial hyperoxia, as well as exposure time for mild and severe arterial hyperoxia, were associated with unfavorable outcomes of ICU patients both within and beyond the first day of admission. Their results suggest that the relationship was consistent for large patient groups and that previously used approaches may not have completely captured the actual exposure effects. The authors conclude that “we should limit the PaO2 levels of critically ill patients within a safe range, as we do with other physiologic variables. Analytical metrics of arterial hyperoxia should be judiciously considered when interpreting and comparing study results and future studies are needed to validate our findings in a randomized fashion design.”

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A retrospective study was performed at St Andrew’s Centre for Burns and Plastic Surgery to determine whether the development of major trauma systems have improved the management of patients with major burns by reviewing all major burns in adults and children received at a regional burns centre in the UK over a four-year period before and after the implementation of the regional trauma systems and major trauma centres (MTC). The International Burn Injury Database (IBID) and MetaVision were used for data collection. The authors found that there was no significant difference in survival when comparing referrals from all hospitals pre and post establishment of the major trauma network and suggest that further research is needed to ascertain whether burns patients benefit from prolonged transfer times to a MTC compared to those seen at their local hospitals prior to transfer to a regional burns unit for further specialist care.

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A systematic review and a meta-analysis of evidence of the impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, LOS, and mortality in ICUs was performed. The authors found that the transition from paper-based ordering to commercial CPOE systems in ICUs was found to be associated with an 85% reduction in medication prescribing error rates. Studies based on MetaVision were included in this review. The authors conclude that, “While limited, the current evidence base suggests that the implementation of commercial CPOE systems can significantly decrease the frequency of medication prescribing error rates, as well as reducing the risk of mortality in ICUs. Future studies that aim to examine medication errors and patient outcomes should ensure they have sufficient sample sizes that are powered to identify the true effect of CPOE implementation. There is also a critical need to understand the nature of errors arising post-CPOE and how the addition of advanced CDSSs can be used to provide even greater benefit to delivering safe and effective patient care.”

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A study performed at Johns Hopkins Hospital evaluated the effect of red blood cell average storage duration on perioperative infectious complications and overall morbidity in patients undergoing radical cystectomy (RC), a high- risk patient population, using clinically relevant definitions of older blood. We hypothesise perioperative blood transfusion with blood stored for longer average duration are associated with higher rates of perioperative infection and morbidity in patients undergoing RC. Patients who underwent RC for bladder cancer at Johns Hopkins Hospital between January 2010 and December 2014 were analysed using data from MetaVision, among other systems. The authors found that although blood is stored up to 42 days, storage of 28 days or more may expose RC patients to increased perioperative infections and overall morbidity compared with storage of less than 28 days. They suggest that prospective cohort studies are performed in cystectomy and other high-risk surgical oncology patients to better determine the effect of blood storage duration.

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The Joint Commission (United States) established fall prevention as one of its national patient safety goals in 2015. A prospective cohort study at Barnes Jewish Hospital performed a study with two objectives:  to characterise postoperative falls, including their rate, timing, associated injuries, and risk factors, and to determine whether preoperative falls independently predicted postoperative falls (primary outcome), functional dependence, quality of life, complications and readmission. The authors conclude that “postoperative falls are common both during and after hospitalization, and preoperative falls are a main indicator for these events. Preoperative falls also predict functional dependence and in-hospital complications better than commonly-used measures. Therefore, a history of preoperative falls is a valuable and pragmatic tool, and should become part of routine preoperative assessment.” Their findings also suggest that perioperative fall interventions should be geared towards patients of all ages. Demographic and confounder variables, including those from the preoperative assessment visit, were obtained from MetaVision.

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