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Greenhalgh T, Engebretsen E. Pragmatism and crisis: A response to three commentaries. Soc Sci Med 2024; 348:116782. [PMID: 38538379 DOI: 10.1016/j.socscimed.2024.116782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/11/2024] [Indexed: 04/29/2024]
Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
| | - Eivind Engebretsen
- Centre for Sustainable Healthcare Education, Faculty of Medicine, University of Oslo, Norway
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Bracegirdle L, Stubbs M, Rahman R, Jackson AIR, Burton-Papp HC, Chambers R, Gupta S, Grocott MPW, Dushianthan A. Organisation and delivery of a dedicated multidisciplinary prone ventilation team in the intensive care unit: Strategies and lessons from COVID-19. PLoS One 2023; 18:e0296379. [PMID: 38153940 PMCID: PMC10754430 DOI: 10.1371/journal.pone.0296379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND COVID-19 placed immense strain on healthcare systems, necessitating innovative responses to the surge of critically ill patients, particularly those requiring mechanical ventilation. In this report, we detail the establishment of a dedicated critical care prone positioning team at University Hospital Southampton in response to escalating demand for prone positioning during the initial wave of the pandemic. METHODS The formation of a prone positioning team involved meticulous planning and collaboration across disciplines to ensure safe and efficient manoeuvrers. A comprehensive training strategy, aligned with national guidelines, was implemented for approximately 550 staff members from a diverse background. We surveyed team members to gain insight to the lived experience. RESULTS A total of 78 full-time team members were recruited and successfully executed over 1200 manoeuvres over an eight-week period. Our survey suggests the majority felt valued and expressed pride and willingness to participate again should the need arise. CONCLUSION The rapid establishment and deployment of a dedicated prone positioning team may have contributed to both patient care and staff well-being. We provide insight and lessons that may be of value for future respiratory pandemics. Future work should explore objective clinical outcomes and long-term sustainability of such services.
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Affiliation(s)
- Luke Bracegirdle
- Shackleton Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Faculty of Medicine, University of Southampton, University Hospital Southampton, Southampton, United Kingdom
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Matthew Stubbs
- Shackleton Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Rezaur Rahman
- Shackleton Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Alexander I. R. Jackson
- Shackleton Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Faculty of Medicine, University of Southampton, University Hospital Southampton, Southampton, United Kingdom
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Helmi C. Burton-Papp
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Robert Chambers
- Shackleton Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Sanjay Gupta
- Shackleton Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Michael P. W. Grocott
- Shackleton Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Faculty of Medicine, University of Southampton, University Hospital Southampton, Southampton, United Kingdom
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Ahilanandan Dushianthan
- Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Faculty of Medicine, University of Southampton, University Hospital Southampton, Southampton, United Kingdom
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Watson A, Beecham R, Grocott MPW, Saeed K, Dushianthan A. Severe Parainfluenza Viral Infection-A Retrospective Study of Adult Intensive Care Patients. J Clin Med 2023; 12:7106. [PMID: 38002717 PMCID: PMC10672094 DOI: 10.3390/jcm12227106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
There is little known about parainfluenza virus (PIV) infection in adult intensive care unit (ICU) patients. Here, we aim to describe the characteristics, clinical course and outcomes of PIV infection in adults requiring intensive care. In this retrospective study of consecutive patients admitted to our ICU with confirmed PIV infection over a 7-year period, we report the patient characteristics, laboratory tests and prognostic scores on ICU admission. The main outcomes reported are 30-day mortality and organ support required. We included 50 patients (52% male, mean age 67.6 years). The mean PaO2/FiO2 and neutrophil/lymphocyte ratios on ICU admission were 198 ± 82 mmHg and 15.7 ± 12.5. Overall, 98% of patients required respiratory support and 24% required cardiovascular support. The median length of ICU stay was 5.9 days (IQR 3.7-9.1) with a 30-day mortality of 40%. In conclusion, PIV infection in adult ICU patients is associated with significant mortality and morbidity. There were significant differences between patients who presented with primary hypoxemic respiratory failure and hypercapnic respiratory failure.
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Affiliation(s)
- Adam Watson
- General Intensive Care Unit, Southampton General Hospital, Southampton SO16 6YD, UK; (A.W.); (R.B.); (K.S.); (A.D.)
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Ryan Beecham
- General Intensive Care Unit, Southampton General Hospital, Southampton SO16 6YD, UK; (A.W.); (R.B.); (K.S.); (A.D.)
| | - Michael P. W. Grocott
- General Intensive Care Unit, Southampton General Hospital, Southampton SO16 6YD, UK; (A.W.); (R.B.); (K.S.); (A.D.)
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Kordo Saeed
- General Intensive Care Unit, Southampton General Hospital, Southampton SO16 6YD, UK; (A.W.); (R.B.); (K.S.); (A.D.)
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Department of Microbiology, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Ahilanandan Dushianthan
- General Intensive Care Unit, Southampton General Hospital, Southampton SO16 6YD, UK; (A.W.); (R.B.); (K.S.); (A.D.)
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
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Dailly S, Boatswain E, Brooks J, Campbell G, Dallow K, Dushianthan A, Glover S, Griffiths M, Gupta S, Austin J, Chambers R, Jeremiah S, Morris C, Mahobia N, Poxon M, Rickman A, Jaques H, Yam T, Saeed K. Aspergillus in COVID-19 intensive care unit; what is lurking above your head? J Infect Prev 2022; 23:278-284. [PMID: 36277859 PMCID: PMC9475376 DOI: 10.1177/17571774221127548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 09/04/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Through routine respiratory samples surveillance among COVID-19 patients in
the intensive care, three patients with aspergillus were identified in a
newly opened general intensive care unit during the second wave of the
pandemic. Methodology As no previous cases of aspergillus had occurred since the unit had opened.
An urgent multidisciplinary outbreak meeting was held. The possible sources
of aspergillus infection were explored. The multidisciplinary approach
enabled stakeholders from different skills to discuss possible sources and
management strategies. Environmental precipitants like air handling units
were considered and the overall clinical practice was reviewed. Settle
plates were placed around the unit to identify the source. Reports of recent
water leaks were also investigated. Results Growth of aspergillus on a settle plate was identified the potential source
above a nurse’s station. This was the site of a historic water leak from the
ceiling above, that resolved promptly and was not investigated further.
Subsequent investigation above the ceiling tiles found pooling of water and
mould due to a slow water leak from a pipe. Conclusion Water leaks in patient areas should be promptly notified to infection
prevention. Detailed investigation to ascertain the actual cause of the leak
and ensure any remedial work could be carried out swiftly. Outbreak meetings
that include diverse people with various expertises (clinical and
non-clinical) can enable prompt identification and resolution of
contaminated areas to minimise risk to patients and staff. During
challenging pandemic periods hospitals must not lose focus on other clusters
and outbreaks occurring simultaneously.
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Affiliation(s)
- Sue Dailly
- Infection Prevention and Control, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Erin Boatswain
- Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Julie Brooks
- Infection Prevention and Control, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Glen Campbell
- Estates, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Katy Dallow
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ahilanandan Dushianthan
- Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Glover
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Melanie Griffiths
- Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sanjay Gupta
- Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - James Austin
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Robert Chambers
- Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Jeremiah
- Infection Prevention and Control, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Charlotte Morris
- Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nitin Mahobia
- Infection Prevention and Control, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Martyn Poxon
- Estates, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alison Rickman
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Helen Jaques
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tatshing Yam
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kordo Saeed
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Dushianthan A, Griffiths M, Hall F, Nolan K, Richardson D, Skinner B, Matthews L, Charles D, Elsheikh R, Pignatari R, Rahman R, Theivendrampillai S, Egglestone R, Stokes A, Danibenvenutti G, Stewart M, Celinski M, Cusack R, Gupta S, Saeed K. Caring for COVID-19 patients through a pandemic in the intensive care setting: A narrative review. WIREs Mech Dis 2022; 14:e1577. [PMID: 35835688 PMCID: PMC9350295 DOI: 10.1002/wsbm.1577] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/20/2022] [Accepted: 06/23/2022] [Indexed: 12/21/2022]
Abstract
Since the declaration of the novel SARS-CoV-2 virus pandemic, health systems/ health-care-workers globally have been overwhelmed by a vast number of COVID-19 related hospitalizations and intensive care unit (ICU) admissions. During the early stages of the pandemic, the lack of formalized evidence-based guidelines in all aspects of patient management was a significant challenge. Coupled with a lack of effective pharmacotherapies resulted in unsatisfactory outcomes in ICU patients. The anticipated increment in ICU surge capacity was staggering, with almost every ICU worldwide being advised to increase their capacity to allow adequate care provision in response to multiple waves of the pandemic. This increase in surge capacity required advanced planning and reassessments at every stage, taking advantage of experienced gained in combination with emerging evidence. In University Hospital Southampton General Intensive Care Unit (GICU), despite the initial lack of national and international guidance, we enhanced our ICU capacity and developed local guidance on all aspects of care to address the rapid demand from the increasing COVID-19 admissions. The main element of this success was a multidisciplinary team approach intertwined with equipment and infrastructural reorganization. This narrative review provides an insight into the approach adopted by our center to manage patients with COVID-19 critical illness, exploring the initial planning process, including contingency preparations to accommodate (360% capacity increment) and adaptation of our management pathways as more evidence emerged throughout the pandemic to provide the most appropriate levels of care to our patients. We hope our experience will benefit other intensive care units worldwide. This article is categorized under: Infectious Diseases > Genetics/Genomics/Epigenetics.
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Affiliation(s)
- Ahilanadan Dushianthan
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Melanie Griffiths
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Fiona Hall
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kathleen Nolan
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Dominic Richardson
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Benjamin Skinner
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lewis Matthews
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David Charles
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Razaz Elsheikh
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Renato Pignatari
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rezaur Rahman
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Rebecca Egglestone
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Aaron Stokes
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Giovani Danibenvenutti
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Michael Stewart
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Michael Celinski
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rebecca Cusack
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sanjay Gupta
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kordo Saeed
- Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Infection, Microbiology Laboratory, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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