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    Concurrent nutrition and physical rehabilitation interventions for patients with critical illness
    (Ovid Technologies (Wolters Kluwer Health), 2024-12-16)
    GONZALEZ SEGUEL, FELIPE ANDRES  
    ;
    Kirby P. Mayer
    ;
    Renee D. Stapleton
    The effects of either physical rehabilitation or nutrition on outcomes in patients with critical illness are variable and remain unclear. The potential for the combination of exercise and nutritional delivered concurrently to provide benefit is provocative, but data are only emerging. Herein, we provide a summary of evidence from 2023 and 2024 on combined physical rehabilitation and nutrition during and following critical illness. Recent findings While latest trials on physical rehabilitation alone reported conflicting findings, recent nutrition trials found no difference between higher and lower protein delivery and even suggested harm in patients with acute kidney injury. In 2023 and 2024, we identified four studies (one randomized controlled trial) combining physical rehabilitation and nutrition (mainly protein supplementation) within the ICU setting. Overall, these suggested benefits, including reduction of muscle size loss, ICU acquired weakness, delirium, and improved mobility levels, although these benefits did not extend to mortality and hospital length of stay. No recent trials combining physical rehabilitation and nutrition for patients after ICU were identified.</jats:p>
    Scopus© Citations 6  1
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    Six-month post-intensive care outcomes during high and low bed occupancy due to the COVID-19 pandemic: A multicenter prospective cohort study
    (2023)
    CASTRO AVILA, ANA CRISTINA  
    ;
    Catalina Merino-Osorio
    ;
    GONZALEZ SEGUEL, FELIPE ANDRES  
    ;
    CAMUS MOLINA, AGUSTIN  
    ;
    Felipe Muñoz-Muñoz
    <jats:sec id="sec001"> <jats:title>Introduction</jats:title> <jats:p>The COVID-19 pandemic can be seen as a natural experiment to test how bed occupancy affects post-intensive care unit (ICU) patient’s functional outcomes. To compare by bed occupancy the frequency of mental, physical, and cognitive impairments in patients admitted to ICU during the COVID-19 pandemic.</jats:p> </jats:sec> <jats:sec id="sec002"> <jats:title>Methods</jats:title> <jats:p>Prospective cohort of adults mechanically ventilated &gt;48 hours in 19 ICUs from seven Chilean public and private hospitals. Ninety percent of nationwide beds occupied was the cut-off for low versus high bed occupancy. At ICU discharge, 3- and 6-month follow-up, we assessed disability using the World Health Organization Disability Assessment Schedule 2.0. Quality of life, mental, physical, and cognitive outcomes were also evaluated following the core outcome set for acute respiratory failure.</jats:p> </jats:sec> <jats:sec id="sec003"> <jats:title>Results</jats:title> <jats:p>We enrolled 252 participants, 103 (41%) during low and 149 (59%) during high bed occupancy. Patients treated during high occupancy were younger (P<jats:sub>50</jats:sub> [P<jats:sub>25</jats:sub>-P<jats:sub>75</jats:sub>]: 55 [44–63] vs 61 [51–71]; p&lt;0.001), more likely to be admitted due to COVID-19 (126 [85%] vs 65 [63%]; p&lt;0.001), and have higher education qualification (94 [63%] vs 48 [47%]; p = 0.03). No differences were found in the frequency of at least one mental, physical or cognitive impairment by bed occupancy at ICU discharge (low vs high: 93% vs 91%; p = 0.6), 3-month (74% vs 63%; p = 0.2) and 6-month (57% vs 57%; p = 0.9) follow-up.</jats:p> </jats:sec> <jats:sec id="sec004"> <jats:title>Conclusions</jats:title> <jats:p>There were no differences in post-ICU outcomes between high and low bed occupancy. Most patients (&gt;90%) had at least one mental, physical or cognitive impairment at ICU discharge, which remained high at 6-month follow-up (57%).</jats:p> </jats:sec> <jats:sec id="sec005"> <jats:title>Clinical trial registration</jats:title> <jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT04979897" xlink:type="simple">NCT04979897</jats:ext-link> (clinicaltrials.gov).</jats:p> </jats:sec>
      3Scopus© Citations 3
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      16Scopus© Citations 1
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    Scopus© Citations 221  1
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    Assessment of redundancy, methodological and reporting quality, and potential discrepancies of results of systematic reviews of early mobilisation of critically ill adults: a meta-research protocol
    (2023)
    Ruvistay Gutierrez-Arias
    ;
    Dawid Pieper
    ;
    Peter Nydahl
    ;
    Felipe González-Seguel
    ;
    Yorschua Jalil
    <jats:sec><jats:title>Introduction</jats:title><jats:p>Several systematic reviews (SRs) have been conducted to determine the effectiveness of early mobilisation in critically ill adults with heterogeneous methodology and results. Redundancy in conducting SRs, unclear justification when leading new SRs or updating, and discordant results of SRs on the same research question may generate research waste that makes it difficult for clinicians to keep up to date with the best available evidence. This meta-research aims to assess the redundancy, methodological and reporting quality, and potential reasons for discordance in the results reported by SRs conducted to determine the effectiveness of early mobilisation in critically ill adult patients.</jats:p></jats:sec><jats:sec><jats:title>Methods and analysis</jats:title><jats:p>A meta-research of early mobilisation SRs in critically ill adult patients will be conducted. A search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos and other search resources will be conducted. Two independent reviewers will perform study selection, data extraction and quality appraisal. Discrepancies will be resolved by consensus or a third reviewer. The redundancy of SRs will be assessed by the degree of overlap of primary studies. In addition, the justification for conducting new SRs will be evaluated with the ‘Evidence-Based Research’ framework. The methodological quality of the SRs will be assessed with the A MeaSurement Tool to Assess systematic Reviews 2 tool, and the quality of the reports through compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. To assess the potential reasons for discordance in the results of the SRs considering divergence in results and their interpretation.</jats:p></jats:sec><jats:sec><jats:title>Ethics and dissemination</jats:title><jats:p>As meta-research, this study does not involve the participation of people whose rights may be violated. However, this overview will be developed rigorously and systematically to achieve valid and reliable results. The findings of this meta-research study will be presented at conferences and published in a peer-reviewed journal related to rehabilitation, critical care or research methodology.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p>osf.io/kxwq9.</jats:p></jats:sec>
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    Revista Chilena de Pediatría/Andes Pediatrica en el nuevo milenio. Análisis bibliométrico.
    (2021)
    Luisa Schonhaut B.
    ;
    Ilan Oppenheimer S.
    ;
    Catalina Del Río G.
    ;
    Vicente Pizarro F.
    ;
    Italo Costa-Roldan
    <jats:p>Andes Pediatrica/Revista Chilena de Pediatría (AP/RCHP), mantiene un perfil de documentos que abarca todos los formatos de la publicación científica, desde Artículos Originales (AO) hasta Cartas al Editor. Para una adecuada planificación editorial se requiere un análisis bibliométrico de largo plazo. Objetivo: Describir el perfil de AO publicados en AP/RCHP en las últimas 2 décadas. Metodología: Desde una lista de vocabulario controlado se estandarizaron los descriptores temáticos y metodológicos de los documentos del 2000 al 2020. Se analizó nacionalidad, género y profesión de los autores, tipología documental y diseño de los AO. Se analizó los descriptores citados en Google Schoolar y los más visitados en el sitio web de la revista en los últimos años. Resultados: Se publicaron 1.738 manuscritos, 580 (33,4%) AO, con un incremento de 59 a 129 AO entre el primer y último trienio. El promedio de autores fue superior para los AO (4,7) que para los no originales (3,0); el año 2020 hubo 9 colaboraciones multicéntricas de distintos países. Los AO de autores extranjeros incrementaron de 3,3 a 28,7%, la autoría en primera posición de profesionales no médicos aumentó de 15 a 31%, hubo predominio de primer autor femenino (relación 1,4/1). De los AO 9,1% eran experimentales, 3,3% cualitativos y el resto cuantitativos observacionales. Los descriptores más publicados fueron Nutrición, Infectología, Neonatología y Broncopulmonar, mientras que los más citados fueron Nutrición, Neonatología y Salud Oral, sin tendencia entre los más visitados. El 44% de los artículos más citados y el 35% de los más visitados fueron AO. Conclusiones: Destaca un importante incremento de AO publicados, con baja frecuencia de diseños experimentales. Hubo participación de autores de distintas nacionalidades y profesiones. Los AO contribuyeron a un tercio de las visitas y casi la mitad de las citas, sin demostrarse correlación entre los descriptores más publicados y los más citados.</jats:p>
    Scopus© Citations 3  2
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    Scopus© Citations 2  1
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    Support and follow-up needs of patients discharged from intensive care after severe COVID-19: a mixed-methods study of the views of UK general practitioners and intensive care staff during the pandemic’s first wave
    (2021)
    CASTRO AVILA, ANA CRISTINA  
    ;
    Laura Jefferson
    ;
    Veronica Dale
    ;
    Karen Bloor
    <jats:sec><jats:title>Objectives</jats:title><jats:p>To identify follow-up services planned for patients with COVID-19 discharged from intensive care unit (ICU) and to explore the views of ICU staff and general practitioners (GPs) regarding these patients’ future needs and care coordination.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>This is a sequential mixed-methods study using online surveys and semistructured interviews. Interview data were inductively coded and thematically analysed. Survey data were descriptively analysed.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>GP surgeries and acute National Health Service Trusts in the UK.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>GPs and clinicians leading care for patients discharged from ICU.</jats:p></jats:sec><jats:sec><jats:title>Primary and secondary outcomes</jats:title><jats:p>Usual follow-up practice after ICU discharge, changes in follow-up during the pandemic, and GP awareness of follow-up and support needs of patients discharged from ICU.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We obtained 170 survey responses and conducted 23 interviews. Over 60% of GPs were unaware of the follow-up services generally provided by their local hospitals and whether or not these were functioning during the pandemic. Eighty per cent of ICUs reported some form of follow-up services, with 25% of these suspending provision during the peak of the pandemic and over half modifying their provision (usually to provide the service remotely). Common themes relating to barriers to provision of follow-up were funding complexities, remit and expertise, and communication between ICU and community services. Discharge documentation was described as poor and lacking key information. Both groups mentioned difficulties accessing services in the community and lack of clarity about who was responsible for referrals and follow-up.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The pandemic has highlighted long-standing issues of continuity of care and complex funding streams for post-ICU follow-up care. The large cohort of ICU patients admitted due to COVID-19 highlights the need for improved follow-up services and communication between specialists and GPs, not only for patients with COVID-19, but for all those discharged from ICU.</jats:p></jats:sec>
      1Scopus© Citations 26  1
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    INTEnsive care bundle with blood pressure reduction in acute cerebral hemorrhage trial (INTERACT3): study protocol for a pragmatic stepped-wedge cluster-randomized controlled trial
    (2021)
    Lili Song
    ;
    Xin Hu
    ;
    Lu Ma
    ;
    Xiaoying Chen
    ;
    Menglu Ouyang
    <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Early intensive blood pressure (BP) lowering remains the most promising treatment for acute intracerebral hemorrhage (ICH), despite discordant results between clinical trials and potential variation in the treatment effects by approach to control BP. As the third in a series of clinical trials on this topic, the INTEnsive care bundle with blood pressure Reduction in Acute Cerebral hemorrhage Trial (INTERACT3) aims to determine the effectiveness of a goal-directed care bundle protocol of early physiological control (intensive BP lowering, glycemic control, and pyrexia treatment) and reversal of anticoagulation, in acute ICH.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>INTERACT3 is a pragmatic, international, multicenter, stepped-wedge (4 phases/3 steps), cluster-randomized controlled trial to determine the effectiveness of a multifaceted care package in adult (age ≥ 18 years) patients (target 8360) with acute ICH (&lt; 6 h of onset) recruited from 110 hospitals (average of 19 consecutive patients per phase) in low- and middle-income countries. After a control phase, each hospital implements the intervention (intensive BP lowering, target systolic &lt; 140 mmHg; glucose control, target 6.1–7.8 mmol/L and 7.8–10.0 mmol/L in those without and with diabetes mellitus, respectively; anti-pyrexia treatment to target body temperature ≤ 37.5 °C; and reversal of anticoagulation, target international normalized ratio &lt; 1.5 within 1 h). Information will be obtained on demographic and baseline clinical characteristics, in-hospital management, and 7-day outcomes. Central trained blinded assessors will conduct telephone interviews to assess physical function and health-related quality of life at 6 months. The primary outcome is the modified Rankin scale (mRS) at 6 months analyzed using ordinal logistic regression. The sample size of 8360 subjects provides 90% power (<jats:italic>α</jats:italic> = 0.05) to detect a 5.6% absolute improvement (shift) in the primary outcome of the intervention versus control standard care, with various assumptions.</jats:p> </jats:sec><jats:sec> <jats:title>Discussion</jats:title> <jats:p>As the largest clinical trial in acute ICH, INTERACT3 is on schedule to provide an assessment of the effectiveness of a widely applicable goal-directed care bundle for a serious condition in which a clearly proven treatment has yet to be established.</jats:p> </jats:sec><jats:sec> <jats:title>Trial registration</jats:title> <jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://clinicaltrials.gov">ClinicalTrials.gov</jats:ext-link> NCT03209258. Registered on 1 July 2017. Chinese Trial Registry ChiCTR-IOC-17011787. Registered on 28 June 2017</jats:p> </jats:sec>
    Scopus© Citations 15  1
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    Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis
    (2023)
    Emily R Smith
    ;
    Erin Oakley
    ;
    Gargi Wable Grandner
    ;
    Kacey Ferguson
    ;
    Fouzia Farooq
    <jats:sec><jats:title>Introduction</jats:title><jats:p>Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.</jats:p><jats:p>Pregnant women with SARS-CoV-2 infection—as compared with uninfected pregnant women—were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).</jats:p><jats:p>Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>This analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol.</jats:p></jats:sec>
      7Scopus© Citations 143