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101. Validation and implementation of group electronic hand hygiene monitoring across twenty-four critical care units

Author

Leis, Jerome A., Obaidallah, Maryam, Williams, Victoria, Muller, Matthew P, Powis, Jeff E., Johnstone, Jennie, Hota, Susy, Katz, Kevin, Payne, Michael, Castellani, Lucas, Downing, Mark, Mertz, Dominik, Ricciuto, Daniel R., Kiss, Alex, and Cuthbertson, Brian H.

Abstract

AbstractObjectives:An accurate estimate of the average number of hand hygiene opportunities per patient hour (HHO rate) is required to implement group electronic hand hygiene monitoring systems (GEHHMSs). We sought to identify predictors of HHOs to validate and implement a GEHHMS across a network of critical care units.Design:Multicenter, observational study (10 hospitals) followed by quality improvement intervention involving 24 critical care units across 12 hospitals in Ontario, Canada.Methods:Critical care patient beds were randomized to receive 1 hour of continuous direct observation to determine the HHO rate. A Poisson regression model determined unit-level predictors of HHOs. Estimates of average HHO rates across different types of critical care units were derived and used to implement and evaluate use of GEHHMS.Results:During 2,812 hours of observation, we identified 25,417 HHOs. There was significant variability in HHO rate across critical care units. Time of day, day of the week, unit acuity, patient acuity, patient population and use of transmission-based precautions were significantly associated with HHO rate. Using unit-specific estimates of average HHO rate, aggregate HH adherence was 30.0% (1,084,329 of 3,614,908) at baseline with GEHHMS and improved to 38.5% (740,660 of 1,921,656) within 2 months of continuous feedback to units (P< .0001).Conclusions:Unit-specific estimates based on known predictors of HHO rate enabled broad implementation of GEHHMS. Further longitudinal quality improvement efforts using this system are required to assess the impact of GEHHMS on both HH adherence and clinical outcomes within critically ill patient populations.

Published
2022
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103. Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study

Author

Wijeysundera, Duminda N., primary, Beattie, W. Scott, additional, Hillis, Graham S., additional, Abbott, Tom E.F., additional, Shulman, Mark A., additional, Ackland, Gareth L., additional, Mazer, C. David, additional, Myles, Paul S., additional, Pearse, Rupert M., additional, Cuthbertson, Brian H., additional, Myles, P.S., additional, Shulman, M.A., additional, Wallace, S., additional, Farrington, C., additional, Thompson, B., additional, Ellis, M., additional, Borg, B., additional, Kerridge, R.K., additional, Douglas, J., additional, Brannan, J., additional, Pretto, J., additional, Godsall, M.G., additional, Beauchamp, N., additional, Allen, S., additional, Kennedy, A., additional, Wright, E., additional, Malherbe, J., additional, Ismail, H., additional, Riedel, B., additional, Melville, A., additional, Sivakumar, H., additional, Murmane, A., additional, Kenchington, K., additional, Kirabiyik, Y., additional, Gurunathan, U., additional, Stonell, C., additional, Brunello, K., additional, Steele, K., additional, Tronstad, O., additional, Masel, P., additional, Dent, A., additional, Smith, E., additional, Bodger, A., additional, Abolfathi, M., additional, Sivalingam, P., additional, Hall, A., additional, Painter, T.W., additional, Macklin, S., additional, Elliott, A., additional, Carrera, A.M., additional, Terblanche, N.C.S., additional, Pitt, S., additional, Samuels, J., additional, Wilde, C., additional, Leslie, K., additional, MacCormick, A., additional, Bramley, D., additional, Southcott, A.M., additional, Grant, J., additional, Taylor, H., additional, Bates, S., additional, Towns, M., additional, Tippett, A., additional, Marshall, F., additional, Mazer, C.D., additional, Kunasingam, J., additional, Yagnik, A., additional, Crescini, C., additional, Yagnik, S., additional, McCartney, C.J.L., additional, Choi, S., additional, Somascanthan, P., additional, Flores, K., additional, Wijeysundera, D.N., additional, Beattie, W.S., additional, Karkouti, K., additional, Clarke, H.A., additional, Jerath, A., additional, McCluskey, S.A., additional, Wasowicz, M., additional, Granton, J.T., additional, Day, L., additional, Pazmino-Canizares, J., additional, Oh, P., additional, Belliard, R., additional, Lee, L., additional, Dobson, K., additional, Chan, V., additional, Brull, R., additional, Ami, N., additional, Stanbrook, M., additional, Hagen, K., additional, Campbell, D., additional, Short, T., additional, Van Der Westhuizen, J., additional, Higgie, K., additional, Lindsay, H., additional, Jang, R., additional, Wong, C., additional, Mcallister, D., additional, Ali, M., additional, Kumar, J., additional, Waymouth, E., additional, Kim, C., additional, Dimech, J., additional, Lorimer, M., additional, Tai, J., additional, Miller, R., additional, Sara, R., additional, Collingwood, A., additional, Olliff, S., additional, Gabriel, S., additional, Houston, H., additional, Dalley, P., additional, Hurford, S., additional, Hunt, A., additional, Andrews, L., additional, Navarra, L., additional, Jason-Smith, A., additional, Thompson, H., additional, McMillan, N., additional, Back, G., additional, Croal, B.L., additional, Lum, M., additional, Martin, D., additional, James, S., additional, Filipe, H., additional, Pinto, M., additional, Kynaston, S., additional, Pearse, R.M., additional, Abbott, T.E.F., additional, Phull, M., additional, Beilstein, C., additional, Bodger, P., additional, Everingham, K., additional, Hu, Y., additional, Niebrzegowska, E., additional, Corriea, C., additional, Creary, T., additional, Januszewska, M., additional, Ahmad, T., additional, Whalley, J., additional, Haslop, R., additional, McNeil, J., additional, Brown, A., additional, MacDonald, N., additional, Pakats, M., additional, Greaves, K., additional, Jhanji, S., additional, Raobaikady, R., additional, Black, E., additional, Rooms, M., additional, Lawrence, H., additional, Koutra, M., additional, Pirie, K., additional, Gertsman, M., additional, Jack, S., additional, Celinski, M., additional, Levett, D., additional, Edwards, M., additional, Salmon, K., additional, Bolger, C., additional, Loughney, L., additional, Seaward, L., additional, Collins, H., additional, Tyrell, B., additional, Tantony, N., additional, Golder, K., additional, Ackland, G.L., additional, Stephens, R.C.M., additional, Gallego-Paredes, L., additional, Reyes, A., additional, Gutierrez del Arroyo, A., additional, Raj, A., additional, Lifford, R., additional, Cuthbertson, B.H., additional, Torres, E., additional, Ambosta, A., additional, Melo, M., additional, Mamdani, M., additional, Thorpe, K.E., additional, Grocott, M.P.W., additional, Hillis, G., additional, and Wijeysundera, H.C., additional

Published
2020
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104. microRNA signatures of perioperative myocardial injury after elective non-cardiac surgery: prospective observational cohort study

Author

May, Shaun M., primary, Abbott, Tom E.F., additional, Del Arroyo, Ana Gutierrez, additional, Reyes, Anna, additional, Martir, Gladys, additional, Stephens, Robert C.M., additional, Brealey, David, additional, Cuthbertson, Brian H., additional, Wijeysundera, Duminda N., additional, Pearse, Rupert M., additional, and Ackland, Gareth L., additional

Published
2020
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106. The harm of high-frequency oscillatory ventilation (HFOV) in ARDS is not related to a high baseline risk of acute cor pulmonale or short-term changes in hemodynamics

Author

Angriman, Federico, primary, Ferreyro, Bruno L., additional, Donaldson, Lachlan, additional, Cuthbertson, Brian H., additional, Ferguson, Niall D., additional, Bollen, Casper W., additional, Bachman, Thomas E., additional, Lamontagne, François, additional, and Adhikari, Neill K. J., additional

Published
2019
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109. Determinants of Depressive Symptoms at 1 Year Following ICU Discharge in Survivors of ≥ 7 Days of Mechanical Ventilation

Author

Hamilton, Mika, primary, Tomlinson, George, additional, Chu, Leslie, additional, Robles, Priscila, additional, Matte, Andrea, additional, Burns, Stacey, additional, Thomas, Claire, additional, Lamontagne, Francois, additional, Adhikari, Neill K.J., additional, Ferguson, Niall, additional, Friedrich, Jan O., additional, Rudkowski, Jill C., additional, Skrobik, Yoanna, additional, Meggison, Hilary, additional, Cameron, Jill, additional, Herridge, Margaret, additional, Herridge, Margaret S., additional, Chu, Leslie M., additional, Chan, Linda, additional, Mehta, Sangeeta, additional, Levasseur, Melanie, additional, Ferguson, Niall D., additional, Flannery, John, additional, Bayley, Mark, additional, Batt, Jane, additional, Santos, Claudia dos, additional, Abbey, Susan E., additional, Tan, Adrienne, additional, Lo, Vincent, additional, Mathur, Sunita, additional, Parotto, Matteo, additional, Morris, Denise, additional, Flockhart, Linda, additional, Fan, Eddy, additional, Lee, Christie M., additional, Wilcox, M. Elizabeth, additional, Ayas, Najib, additional, Choong, Karen, additional, Fowler, Robert, additional, Scales, Damon C., additional, Sinuff, Tasnim, additional, Cuthbertson, Brian H., additional, Rose, Louise, additional, Cypel, Marcelo, additional, Singer, Lianne, additional, Chaparro, Cecelia, additional, Chow, Chung-Wai, additional, Keshavjee, Shaf, additional, Brochard, Laurent, additional, Hebert, Paul, additional, Slutsky, Arthur S., additional, Marshall, John C., additional, Cook, Deborah, additional, and Cameron, Jill I., additional

Published
2019
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114. Association of six-minute walk test distance with postoperative complications in non-cardiac surgery: a secondary analysis of a multicentre prospective cohort study.

Author

Ramos, Ryan J., Ladha, Karim S., Cuthbertson, Brian H., Shulman, Mark A., Myles, Paul S., and Wijeysundera, Duminda N.

Abstract

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2021
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117. Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study

Author

Wijeysundera, Duminda N, primary, Pearse, Rupert M, additional, Shulman, Mark A, additional, Abbott, Tom E F, additional, Torres, Elizabeth, additional, Ambosta, Althea, additional, Croal, Bernard L, additional, Granton, John T, additional, Thorpe, Kevin E, additional, Grocott, Michael P W, additional, Farrington, Catherine, additional, Myles, Paul S, additional, Cuthbertson, Brian H, additional, Wallace, Sophie, additional, Thompson, Bruce, additional, Ellis, Mathew, additional, Borg, Brigette, additional, Kerridge, Ross K, additional, Douglas, Jeanene, additional, Brannan, John, additional, Pretto, Jeff, additional, Godsall, Guy, additional, Beauchamp, Nicola, additional, Allen, Sandra, additional, Kennedy, Ann, additional, Wright, Ewan, additional, Malherbe, Johan, additional, Ismail, Hilmy, additional, Riedel, Bernhard, additional, Melville, Andrew, additional, Sivakumar, Harry, additional, Murmane, Andrew, additional, Kenchington, Kay, additional, Kirabiyik, Yesim, additional, Gurunathan, Usha, additional, Stonell, Chris, additional, Brunello, Kate, additional, Steele, Katherine, additional, Tronstad, Oystein, additional, Masel, Philip, additional, Dent, Annette, additional, Smith, Emma, additional, Bodger, Alanna, additional, Abolfathi, Miriam, additional, Sivalingam, Pal, additional, Hall, Adrian, additional, Painter, Thomas W, additional, Macklin, Simon, additional, Elliott, Adrian, additional, Carrera, Anna Maria, additional, Terblanche, Nico CS, additional, Pitt, Simon, additional, Samuel, Joanne, additional, Wilde, Chris, additional, Leslie, Kate, additional, MacCormick, Andrew, additional, Bramley, David, additional, Southcott, Anne Marie, additional, Grant, John, additional, Taylor, Hugh, additional, Bates, Samantha, additional, Towns, Miriam, additional, Tippett, Anna, additional, Marshall, Fiona, additional, Mazer, C David, additional, Kunasingam, Janarthanee, additional, Yagnik, Anmol, additional, Crescini, Charmagne, additional, Yagnik, Sanjay, additional, McCartney, Colin JL, additional, Somascanthan, Priya, additional, Choi, Stephen, additional, Flores, Kathrina, additional, Au, Shelly, additional, Beattie, W Scott, additional, Karkouti, Keyvan, additional, Clarke, Hance A, additional, Jerath, Angela, additional, McCluskey, Stuart A, additional, Wasowicz, Marcin, additional, Day, Lauren, additional, Pazmino-Canizares, Janneth, additional, Oh, Paul, additional, Belliard, Rene, additional, Lee, Leanna, additional, Dobson, Karen, additional, Chan, Vincent, additional, Brull, Richard, additional, Ami, Noam, additional, Stanbrook, Matthew, additional, Hagen, Katherine, additional, Campbell, Douglas, additional, Short, Timothy, additional, Van Der Westhuizen, Joreline, additional, Higgie, Kushlin, additional, Lindsay, Helen, additional, Jang, Ryan, additional, Wong, Chris, additional, McAllister, Davina, additional, Ali, Marlynn, additional, Kumar, Jonathan, additional, Waymouth, Ellen, additional, Kim, Chang Joon, additional, Dimech, Julian, additional, Lorimer, Michael, additional, Tai, Joyce, additional, Miller, Reuben, additional, Sara, Rachel, additional, Collingwood, Andrew, additional, Olliff, Sue, additional, Gabriel, Sharon, additional, Houston, Helen, additional, Dalley, Paul, additional, Hurford, Sally, additional, Hunt, Anna, additional, Andrews, Lynn, additional, Navarra, Leanlove, additional, Jason-Smith, Adelaide, additional, Thompson, Helen, additional, McMillan, Natalie, additional, Back, Geraldine, additional, Lum, Mark, additional, Martin, Daniel, additional, James, Sarah, additional, Filipe, Helder, additional, Pinto, Manuel, additional, Kynaston, Stephen, additional, Phull, Mandeep, additional, Beilstein, Christian, additional, Bodger, Pheobe, additional, Everingham, Kirsty, additional, Hu, Ying, additional, Niebrzegowska, Edyta, additional, Corriea, Carmen, additional, Creary, Thais, additional, Januszewska, Marta, additional, Ahmad, Tahania, additional, Whalley, Jan, additional, Haslop, Richard, additional, McNeil, Jane, additional, Brown, Alistair, additional, MacDonald, Neil, additional, Pakats, Mari Liis, additional, Greaves, Kathryn, additional, Jhanji, Shaman, additional, Raobaikady, Ravishanar, additional, Black, Ethel, additional, Rooms, Martin, additional, Lawrence, Helen, additional, Koutra, Maria, additional, Pirie, Katrina, additional, Gertsman, Michelle, additional, Jack, Sandy, additional, Celinski, Michael, additional, Levett, Denny, additional, Edwards, Mark, additional, Salmon, Karen, additional, Bolger, Clare, additional, Loughney, Lisa, additional, Seaward, Leanne, additional, Collins, Hannah, additional, Tyrell, Bryony, additional, Tantony, Natasha, additional, Golder, Kim, additional, Ackland, Gareth L, additional, Stephens, RCM, additional, Gallego-Paredes, Laura, additional, Reyes, Anna, additional, Gutierrez del Arroyo, Ana, additional, Raj, Ashok, additional, Lifford, Rhiannon, additional, Melo, Magda, additional, Mamdani, Muhammad, additional, Hillis, Graham, additional, and Wijeysundera, Harindra C, additional

Published
2018
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119. Heart rate recovery and morbidity after noncardiac surgery: Planned secondary analysis of two prospective, multi-centre, blinded observational studies.

Author

Ackland, Gareth L., Abbott, Tom E. F., Minto, Gary, Clark, Martin, Owen, Thomas, Prabhu, Pradeep, May, Shaun M., Reynolds, Joseph A., Cuthbertson, Brian H., Wijesundera, Duminda, Pearse, Rupert M., and null, null

Subjects
HEART beat, SECONDARY analysis, SURGICAL clinics, CLINICAL trial registries, DISEASES, EXERCISE tests
Abstract

Background: Impaired cardiac vagal function, quantified preoperatively as slower heart rate recovery (HRR) after exercise, is independently associated with perioperative myocardial injury. Parasympathetic (vagal) dysfunction may also promote (extra-cardiac) multi-organ dysfunction, although perioperative data are lacking. Assuming that cardiac vagal activity, and therefore heart rate recovery response, is a marker of brainstem parasympathetic dysfunction, we hypothesized that impaired HRR would be associated with a higher incidence of morbidity after noncardiac surgery. Methods: In two prospective, blinded, observational cohort studies, we established the definition of impaired vagal function in terms of the HRR threshold that is associated with perioperative myocardial injury (HRR ≤ 12 beats min-1 (bpm), 60 seconds after cessation of cardiopulmonary exercise testing. The primary outcome of this secondary analysis was all-cause morbidity three and five days after surgery, defined using the Post-Operative Morbidity Survey. Secondary outcomes of this analysis were type of morbidity and time to become morbidity-free. Logistic regression and Cox regression tested for the association between HRR and morbidity. Results are presented as odds/hazard ratios [OR or HR; (95% confidence intervals). Results: 882/1941 (45.4%) patients had HRR≤12bpm. All-cause morbidity within 5 days of surgery was more common in 585/822 (71.2%) patients with HRR≤12bpm, compared to 718/1119 (64.2%) patients with HRR>12bpm (OR:1.38 (1.14–1.67); p = 0.001). HRR≤12bpm was associated with more frequent episodes of pulmonary (OR:1.31 (1.05–1.62);p = 0.02)), infective (OR:1.38 (1.10–1.72); p = 0.006), renal (OR:1.91 (1.30–2.79); p = 0.02)), cardiovascular (OR:1.39 (1.15–1.69); p<0.001)), neurological (OR:1.73 (1.11–2.70); p = 0.02)) and pain morbidity (OR:1.38 (1.14–1.68); p = 0.001) within 5 days of surgery. Conclusions: Multi-organ dysfunction is more common in surgical patients with cardiac vagal dysfunction, defined as HRR ≤ 12 bpm after preoperative cardiopulmonary exercise testing. Clinical trial registry: . [ABSTRACT FROM AUTHOR]

Published
2019
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120. The RECOVER Program: Disability Risk Groups and 1-Year Outcome after 7 or More Days of Mechanical Ventilation

Author

Herridge, Margaret S., primary, Chu, Leslie M., additional, Matte, Andrea, additional, Tomlinson, George, additional, Chan, Linda, additional, Thomas, Claire, additional, Friedrich, Jan O., additional, Mehta, Sangeeta, additional, Lamontagne, Francois, additional, Levasseur, Melanie, additional, Ferguson, Niall D., additional, Adhikari, Neill K. J., additional, Rudkowski, Jill C., additional, Meggison, Hilary, additional, Skrobik, Yoanna, additional, Flannery, John, additional, Bayley, Mark, additional, Batt, Jane, additional, Santos, Claudia dos, additional, Abbey, Susan E., additional, Tan, Adrienne, additional, Lo, Vincent, additional, Mathur, Sunita, additional, Parotto, Matteo, additional, Morris, Denise, additional, Flockhart, Linda, additional, Fan, Eddy, additional, Lee, Christie M., additional, Wilcox, M. Elizabeth, additional, Ayas, Najib, additional, Choong, Karen, additional, Fowler, Robert, additional, Scales, Damon C., additional, Sinuff, Tasnim, additional, Cuthbertson, Brian H., additional, Rose, Louise, additional, Robles, Priscila, additional, Burns, Stacey, additional, Cypel, Marcelo, additional, Singer, Lianne, additional, Chaparro, Cecelia, additional, Chow, Chung-Wai, additional, Keshavjee, Shaf, additional, Brochard, Laurent, additional, Hebert, Paul, additional, Slutsky, Arthur S., additional, Marshall, John C., additional, Cook, Deborah, additional, and Cameron, Jill I., additional

Published
2016
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125. Reference value models for predicting preoperative six-minute walk test in patients scheduled for abdominal and pelvic cancer surgery

Author

Makker, Preet GS, Koh, Cherry, Solomon, Michael J, Ansari, Nabila, Pillinger, Neil, Denehy, Linda, Riedel, Bernhard, Edbrooke, Lara, Crowe, Jess, Wijeysundera, Duminda N, Cuthbertson, Brian H, and Steffens, Daniel

Abstract

Preoperative assessment of functional capacity with the six-minute walk test (6MWT) allows for estimation of surgical risk and targeted triage to prehabilitation services. Patient with abdominal and pelvic cancers have worse preoperative function compared with the general population. However, six-minute walk distance (6MWD) reference values from cancer patients are unknown, which limits the interpretation of 6MWT in this population. This study aimed to establish an explanatory reference value model for preoperative 6MWD in patients with abdominal or pelvic cancers undergoing elective surgery. Adult patients undergoing surgery for abdominal or pelvic cancers at major international hospitals were included. The 6MWT was assessed before surgery using a standardised protocol. Anthropometric data including age, sex, height, weight and body mass index (BMI) were collected and included in multiple linear regression analysis to model preoperative 6MWD. A total of 742 patients were included. Age, height and BMI were correlated with 6MWD. Six regression models were estimated, including two from the entire cohort, two from the subset of males and two from the subset of females. A sex-neutral model was the most representative, explaining 15% of the variance in 6MWD (6MWD = 761.00–3.00 * Age (years) –2.86 * BMI (kg/m2) – 48.09 * Sex (M1, F2)). The explored regression models, using anthropometric variables, poorly explained the variance between measured and modelled 6MWD, which suggests that these models have no clinical utility in the cancer population. Consideration of additional, non-anthropometric variables may improve regression modelling of preoperative 6MWD in patients in abdominal and pelvic cancers.

Published
2024
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126. Predicting the occurrence of major adverse cardiac events within 30 days of a vascular surgery: an empirical comparison of the minimum p value method and ROC curve approach using individual patient data meta-analysis

Author

Vanniyasingam, Thuva, primary, Rodseth, Reitze N., additional, Lurati Buse, Giovanna A., additional, Bolliger, Daniel, additional, Burkhart, Christoph S., additional, Cuthbertson, Brian H., additional, Gibson, Simon C., additional, Mahla, Elisabeth, additional, Leibowitz, David W., additional, Biccard, Bruce M., additional, and Thabane, Lehana, additional

Published
2016
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128. Measurement of Exercise Tolerance before Surgery (METS) study: a protocol for an international multicentre prospective cohort study of cardiopulmonary exercise testing prior to major non-cardiac surgery

Author

Wijeysundera, Duminda N, primary, Pearse, Rupert M, additional, Shulman, Mark A, additional, Abbott, Tom E F, additional, Torres, Elizabeth, additional, Croal, Bernard L, additional, Granton, John T, additional, Thorpe, Kevin E, additional, Grocott, Michael P W, additional, Farrington, Catherine, additional, Myles, Paul S, additional, and Cuthbertson, Brian H, additional

Published
2016
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131. Team working in intensive care:current evidence and future endeavors

Author

Richardson, Joanne, West, Michael A., and Cuthbertson, Brian H.

Subjects
education
Abstract

Purpose of review: It has recently been argued that the future of intensive care medicine will rely on high quality management and teamwork. Therefore, this review takes an organizational psychology perspective to examine the most recent research on the relationship between teamwork, care processes, and patient outcomes in intensive care. Recent findings: Interdisciplinary communication within a team is crucial for the development of negotiated shared treatment goals and short-team patient outcomes. Interventions for maximizing team communication have received substantial interest in recent literature. Intensive care coordination is not a linear process, and intensive care teams often fail to discuss how to implement goals, trigger and align activities, or reflect on their performance. Despite a move toward interdisciplinary team working, clinical decision-making is still problematic and continues to be perceived as a top-down and authoritative process. The topic of team leadership in intensive care is underexplored and requires further research. Summary: Based on findings from the most recent research evidence in medicine and management, four principles are identified for improving the effectiveness of team working in intensive care: engender professional efficacy, create stable teams and leaders, develop trust and participative safety, and enable frequent team reflexivity.

Published
2010

135. Reply to Andrade and Pallin

Author

UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (SLuc) Service de soins intensifs, Cuthbertson, Brian H., Chevret, Sylvie, Vincent, Jean Louis, Garfield, Mark, Freivogel, Klaus, Laterre, Pierre-François, Sprung, Charles L., UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (SLuc) Service de soins intensifs, Cuthbertson, Brian H., Chevret, Sylvie, Vincent, Jean Louis, Garfield, Mark, Freivogel, Klaus, Laterre, Pierre-François, and Sprung, Charles L.

Abstract

This reply refers to the comments available at: doi: 10.1007/s00134-010-1878-5 and 10.1007/s00134-010-1880-y.

Published
2010

136. Team Working in Intensive Care: : Current Evidence and Future Endeavors

Author

Richardson, Joanne, West, Michael, Cuthbertson, Brian H., Richardson, Joanne, West, Michael, and Cuthbertson, Brian H.

Abstract

Purpose of review: It has recently been argued that the future of intensive care medicine will rely on high quality management and teamwork. Therefore, this review takes an organizational psychology perspective to examine the most recent research on the relationship between teamwork, care processes, and patient outcomes in intensive care. Recent findings: Interdisciplinary communication within a team is crucial for the development of negotiated shared treatment goals and short-team patient outcomes. Interventions for maximizing team communication have received substantial interest in recent literature. Intensive care coordination is not a linear process, and intensive care teams often fail to discuss how to implement goals, trigger and align activities, or reflect on their performance. Despite a move toward interdisciplinary team working, clinical decision-making is still problematic and continues to be perceived as a top-down and authoritative process. The topic of team leadership in intensive care is underexplored and requires further research. Summary: Based on findings from the most recent research evidence in medicine and management, four principles are identified for improving the effectiveness of team working in intensive care: engender professional efficacy, create stable teams and leaders, develop trust and participative safety, and enable frequent team reflexivity.

Published
2010

137. N-terminal pro-B-type natriuretic peptide levels and early outcome after cardiac surgery: a prospective cohort study

Author

Cuthbertson, Brian H, Croal, Bernard L, Rae, Daniela, Gibson, Patrick, McNeilly, Jane, Jeffrey, Robert, Smith, W Cairns, Prescott, Gordon, Buchan, Keith, El-Shafei, Hussein, Gibson, George A, Hillis, Graham, Cuthbertson, Brian H, Croal, Bernard L, Rae, Daniela, Gibson, Patrick, McNeilly, Jane, Jeffrey, Robert, Smith, W Cairns, Prescott, Gordon, Buchan, Keith, El-Shafei, Hussein, Gibson, George A, and Hillis, Graham

Abstract

Background N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a powerful predictor of cardiovascular outcome in many circumstances. There are, however, limited data regarding the utility of NT-proBNP or BNP levels in patients undergoing cardiac surgery. The current study assesses the ability of NT-proBNP to predict early outcome in this setting. Methods One thousand and ten patients undergoing non-emergent cardiac surgery were recruited prospectively. Baseline clinical details were obtained and the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Parsonnet score were calculated. Preoperative NT-proBNP levels were measured using the Roche Elecsys assay. The primary endpoint was 30 day mortality. Results Median NT-proBNP levels were 624 ng litre−1 among patients who died within 30 days of surgery (n=29), compared with 279 ng litre−1 in survivors [odds ratio (OR) 1.03 per 250 ng litre−1, 95% confidence interval 1.01–1.05, P=0.001). NT-proBNP levels remained predictors of 30 day mortality in models including either the additive EuroSCORE (OR 1.03 per 250 ng litre−1, P=0.01), the logistic EuroSCORE (OR 1.03 per 250 ng litre−1, P=0.004), or the Parsonnet score (OR 1.02 per 250 ng litre−1, P=0.04). Levels of NT-proBNP were also predictors of prolonged (>1 day) stay in the intensive care unit (OR 1.03 per 250 ng litre−1, P<0.001) and of a hospital stay >1 week (OR 1.07 per 250 ng litre−1, P<0.001). They remained predictive of these outcomes in regression models that included either the EuroSCORE or the Parsonnet score and in a model that included all study variables. Conclusions NT-proBNP levels predict early outcome after cardiac surgery. Their prognostic utility is modest—but is independent of traditional indicators and conventional risk prediction scores.

Published
2009

138. Educational interventions for preventing vascular catheter bloodstream infections in critical care: evidence map, systematic review and economic evaluation

Author

Frampton, Geoff K, primary, Harris, Petra, additional, Cooper, Keith, additional, Cooper, Tracey, additional, Cleland, Jennifer, additional, Jones, Jeremy, additional, Shepherd, Jonathan, additional, Clegg, Andrew, additional, Graves, Nicholas, additional, Welch, Karen, additional, and Cuthbertson, Brian H, additional

Published
2014
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140. Hydrocortisone therapy for patients with septic shock.

Author

UCL - MD/MINT - Département de médecine interne, UCL - (SLuc) Service de soins intensifs, Sprung, Charles L, Annane, Djillali, Keh, Didier, Moreno, Rui, Singer, Mervyn, Freivogel, Klaus, Weiss, Yoram G, Benbenishty, Julie, Kalenka, Armin, Forst, Helmuth, Laterre, Pierre-François, Reinhart, Konrad, Cuthbertson, Brian H, Payen, Didier, Briegel, Josef, CORTICUS Study Group, UCL - MD/MINT - Département de médecine interne, UCL - (SLuc) Service de soins intensifs, Sprung, Charles L, Annane, Djillali, Keh, Didier, Moreno, Rui, Singer, Mervyn, Freivogel, Klaus, Weiss, Yoram G, Benbenishty, Julie, Kalenka, Armin, Forst, Helmuth, Laterre, Pierre-François, Reinhart, Konrad, Cuthbertson, Brian H, Payen, Didier, Briegel, Josef, and CORTICUS Study Group

Abstract

BACKGROUND: Hydrocortisone is widely used in patients with septic shock even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appropriately after the administration of corticotropin. METHODS: In this multicenter, randomized, double-blind, placebo-controlled trial, we assigned 251 patients to receive 50 mg of intravenous hydrocortisone and 248 patients to receive placebo every 6 hours for 5 days; the dose was then tapered during a 6-day period. At 28 days, the primary outcome was death among patients who did not have a response to a corticotropin test. RESULTS: Of the 499 patients in the study, 233 (46.7%) did not have a response to corticotropin (125 in the hydrocortisone group and 108 in the placebo group). At 28 days, there was no significant difference in mortality between patients in the two study groups who did not have a response to corticotropin (39.2% in the hydrocortisone group and 36.1% in the placebo group, P=0.69) or between those who had a response to corticotropin (28.8% in the hydrocortisone group and 28.7% in the placebo group, P=1.00). At 28 days, 86 of 251 patients in the hydrocortisone group (34.3%) and 78 of 248 patients in the placebo group (31.5%) had died (P=0.51). In the hydrocortisone group, shock was reversed more quickly than in the placebo group. However, there were more episodes of superinfection, including new sepsis and septic shock. CONCLUSIONS: Hydrocortisone did not improve survival or reversal of shock in patients with septic shock, either overall or in patients who did not have a response to corticotropin, although hydrocortisone hastened reversal of shock in patients in whom shock was reversed. (ClinicalTrials.gov number, NCT00147004.)

Published
2008

143. PREDICTING THE OCCURRENCE OF MAJOR ADVERSE CARDIAC EVENTS WITHIN 30 DAYS AFTER A PATIENT'S VASCULAR SURGERY: AN INDIVIDUAL PATIENT-DATA META-ANALYSIS

Author

Vanniyasingam, Thuvaraha, primary, Thabane, Lehana, additional, Rodseth, Reitze, additional, Buse, Giovana A. Lurati, additional, Bolliger, Daniel, additional, Daniel, Christoph S., additional, Cuthbertson, Brian H., additional, Gibson, Simon C., additional, Mahla, Elisabeth, additional, Leibowitz, David W., additional, and Biccard, Bruce, additional

Published
2013
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145. Communication and Culture in the Surgical Intensive Care Unit.

Author

Conn, Lesley Gotlib, Haas, Barbara, Cuthbertson, Brian H., Amaral, Andre C., Coburn, Natalie, and Nathens, Avery B.

Subjects
SURGERY & psychology, ATTITUDE (Psychology), COMMUNICATION, CRITICAL care medicine, INTENSIVE care units, MEDICAL quality control, MEDICAL personnel, PATIENTS, QUALITY assurance, ETHNOLOGY research, PHYSICIANS' attitudes
Abstract

This ethnography explores communication around critically ill surgical patients in three surgical intensive care units (ICUs) in Canada. A boundary framework is used to articulate how surgeons’, intensivists’, and nurses’ communication practices shape and are shaped by their respective disciplinary perspectives and experiences. Through 50 hours of observations and 43 interviews, these health care providers are found to engage in seven communication behaviors that either mitigate or magnify three contested symbolic boundaries: expertise, patient ownership, and decisional authority. Where these boundaries are successfully mitigated, experiences of collaborative, high-quality patient care are produced; by contrast, boundary magnification produces conflict and perceptions of unsafe patient care. Findings reveal that high quality and safe patient care are produced through complex social and cultural interactions among surgeons, intensivists, and nurses that are also expressions of knowledge and power. This enhances our understanding of why current quality improvement efforts targeting communication may be ineffective. [ABSTRACT FROM AUTHOR]

Published
2016
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147. Clinical stakeholders’ opinions on the use of selective decontamination of the digestive tract in critically ill patients in intensive care units: an international Delphi study

Author

Cuthbertson, Brian H, primary, Campbell, Marion K, additional, MacLennan, Graeme, additional, Duncan, Eilidh M, additional, Marshall, Andrea P, additional, Wells, Elisabeth C, additional, Prior, Maria E, additional, Todd, Laura, additional, Rose, Louise, additional, Seppelt, Ian M, additional, Bellingan, Geoff, additional, and Francis, Jill J, additional

Published
2013
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149. A cross-country comparison of intensive care physicians’ beliefs about their transfusion behaviour: A qualitative study using the theoretical domains framework

Author

Islam, Rafat, primary, Tinmouth, Alan T, additional, Francis, Jill J, additional, Brehaut, Jamie C, additional, Born, Jennifer, additional, Stockton, Charlotte, additional, Stanworth, Simon J, additional, Eccles, Martin P, additional, Cuthbertson, Brian H, additional, Hyde, Chris, additional, and Grimshaw, Jeremy M, additional

Published
2012
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