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1.
ERJ Open Res ; 10(2)2024 Mar.
Article in English | MEDLINE | ID: mdl-38651090

ABSTRACT

Early career members of Assembly 2 (Respiratory Intensive Care) attended the 2023 European Respiratory Society International Congress in Milan, Italy. The conference covered acute and chronic respiratory failure. Sessions of interest to our assembly members and to those interested in respiratory critical care are summarised in this article and include the latest updates in respiratory intensive care, in particular acute respiratory distress syndrome and mechanical ventilation.

2.
J Hosp Infect ; 2024 Apr 23.
Article in English | MEDLINE | ID: mdl-38663517

ABSTRACT

Nosocomial infection has significant consequences in healthcare, at the individual level driving increased morbidity and mortality, but also at the organisational level due to increased costs. Hospital acquired pneumonia(HAP) is the most common nosocomial infection and is associated with high excess mortality, frequent use of broad spectrum anti-microbials and increased length of stay. In this review we explore the preventative strategies that have been examined in non-ventilator acquired hospital associated pneumonia (NVHAP). We discuss management of aspiration risk, interventions for oral hygiene, the role of mobilisation and physiotherapy, modification of environmental factors, and vaccination. Many of these interventions are low risk, acceptable to patients and have good cost-benefit ratios. However, the evidence base for prevention of NVHAP is weak. We identify lack of a unified research definition, under-recruitment to studies, and variation in intervention and outcome measures as limitations in the existing literature. Given the core risk factors for acquisition of NVHAP are increasing there is an urgent need for research to address the prevention of NVHAP. In this review we call for a unified definition, identification of a core outcome set for studies in NVHAP and suggest future directions for research in NVHAP. Improving care for people with NVHAP will reduce morbidity, mortality, and healthcare costs significantly.

4.
Clin Med (Lond) ; 22(1): 63-70, 2022 01.
Article in English | MEDLINE | ID: mdl-35078796

ABSTRACT

BACKGROUND: Severity scores in pneumonia and sepsis are being applied to SARS-CoV-2 infection. We aimed to assess whether these severity scores are accurate predictors of early adverse outcomes in COVID-19. METHODS: We conducted a multicentre observational study of hospitalised SARS-CoV-2 infection. We assessed risk scores (CURB65, qSOFA, Lac-CURB65, MuLBSTA and NEWS2) in relation to admission to intensive care or death within 7 days of admission, defined as early severe adverse events (ESAE). The 4C Mortality Score was also assessed in a sub-cohort of patients. FINDINGS: In 2,387 participants, the overall mortality was 18%. In all scores examined, increasing score was associated with increased risk of ESAE. Area under the curve (AUC) to predict ESAE for CURB65, qSOFA, Lac-CURB65, MuLBSTA and NEWS2 were 0.61, 0.62, 0.59, 0.59 and 0.68, respectively. AUC to predict ESAE was 0.60 with ISARIC 4C Mortality Score. CONCLUSION: None of the scores examined accurately predicted ESAE in SARS-CoV-2 infection. Non-validated scores should not be used to inform clinical decision making in COVID-19.


Subject(s)
COVID-19 , Pneumonia , Hospital Mortality , Humans , Pneumonia/diagnosis , Pneumonia/epidemiology , Prognosis , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index
5.
ERJ Open Res ; 5(1)2019 Feb.
Article in English | MEDLINE | ID: mdl-30847349

ABSTRACT

The respiratory intensive care Assembly of the European Respiratory Society is proud to present a summary of several important sessions held at the International Congress in Paris in 2018. For the highly esteemed reader who may have missed the Congress, a concise review was written on three topics: the state-of-the-art session on respiratory critical care, hot topics in weaning and the best abstracts in noninvasive ventilation.

6.
BMJ Open Qual ; 7(1): e000238, 2018.
Article in English | MEDLINE | ID: mdl-29610773

ABSTRACT

Steroid-induced hyperglycaemia (SIH) is a common adverse effect in patients both with and without diabetes. This project aimed to improve the screening and diagnosis of SIH by improving the knowledge of healthcare professionals who contribute to the management of SIH in hospitalised patients. Monitoring and diagnosis of SIH were measured in areas of high steroid use in our hospital from May 2016 to January 2017. Several interventions were implemented to improve knowledge and screening for SIH including a staff education programme for nurses, healthcare assistants and doctors. The Trust guidelines for SIH management were updated based on feedback from staff. The changes to the guideline included shortening the document from 14 to 4 pages, incorporating a flowchart summarising the management of SIH and publishing the guideline on the Trust intranet. A questionnaire based on the recommendations of the Joint British Diabetes Societies for SIH was used to assess the change in knowledge pre-intervention and post-intervention. Results showed an increase in junior doctors' knowledge of this topic. Although there was an initial improvement in screening for SIH, this returned to near baseline by the end of the study. This study highlights that screening for SIH can be improved by increasing the knowledge of healthcare staff. However, there is a need for ongoing interventions to sustain this change.

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