The literature suggests that informed consent documents (ICDs) are not well understood by research participants. The patient decision aid model may suggest improvements for the informed consent process, particularly in the critical care setting (ICU) because of patient capacity issues. Our goal was to evaluate the extent to which existing ICDs used in ICU research adhere to standards and recommendations for high quality informed consent. Eighteen items from recommendations specific to ICU trials were added to a previously developed ICD evaluation tool. A sample of ICU trials was identified from clinicaltrials.gov database and the investigators contacted for their trial ICD. Conformity to the recommendations was variable. Some information are found routinely in consent documents for critical care research and some are not. Efforts should aim to establish tools for measuring decision quality in the ICU with the goal of facilitating and helping patients and surrogates work through trial participation decisions.

Patients admitted to intensive care unit (ICU) are known to develop significant impairments in physical function. Patients with critical illness suffer up to 30% reductions in muscle size within the first ten days of admission to the ICU. Muscle strength testing, Medical Research Council-sum score, is current gold-standard to diagnosis ICU-acquired weakness and predicts risk of mortality and long-term physical function. Muscle power different from muscle strength in that it accounts for velocity of movement, is potentially a better independent predictor of function that has not been studied in this population. In addition, we hypothesize that muscle size and quality measured through ultrasound imaging has better applicability and prediction that strength testing. Therefore, we prospectively collected data surrounding these muscle parameters in patients admitted to the medicine ICU at University of Kentucky. Primary outcomes included physical function, muscle power with a novel assessment tool for the critically ill population, muscle strength, and muscle size and quality assess through ultrasound imaging. 36 patients admitted to ICU and 18 aged-matched controlled were enrolled. Patients had significantly lower scores on muscle power assessment at ICU discharge (33.6 ±19.0 W; t= 4.01, p < 0.001) and at hospital discharge (40.9 ±16.5 W; t= 4.81, p < 0.001) in comparison to controls (59.3± 14.7 W). Patients with better scores on muscle power assessment had significantly better scores on physical function measures (Six-minute walk test; rs = 0.548, p = 0.0001). Muscle size (cross-sectional area of rectus femoris muscle) and muscle power were strongly correlated (rs = 0.66, p < 0.0001). These data suggest that patients with critical illness have significantly reduced muscle power which directly related to deficits in physical function.

<p>Uvod: Učestalost akutne renalne insuficijencije, odnosno akutnog bubrežnog o&scaron;tećenja u jedinicama intenzivnog lečenja se kreće od 36 do 66 %. Akutno bubrežno o&scaron;tećenje povi&scaron;ava smrtnost, trajanje hospitalizacije i ukupne tro&scaron;kove lečenja. Ranije prepoznavanje prediktivnih faktora za nastanak akutnog bubrežnog o&scaron;tećenja može da ima značajan uticaj na pravovremeno započinjanje terapijskih mera i smanjivanje mortaliteta kod kritično obolelih. Cilj istraživanja: Utvrditi incidencu akutnog bubrežnog o&scaron;tećenja na Odeljenju reanimacije Urgentnog centra Kliničkog centra Vojvodine tokom 2011.godine, učestalost sepse kao etiolo&scaron;kog faktora i značajne prediktivne faktore za nastanak akutnog bubrežnog o&scaron;tećenja koji se javljaju u toku prvih 24 časa lečenja na odeljenju intenzivnog lečenja. Metodologija: Retrospektivno-prospektivna opservaciona studija uključila je uzorak od 251 ispitanika koji su se lečili na dva odeljenja intenzivnog lečenja u Kliničkom centru Vojvodine tokom 2010, 2011, i prvih 6 meseci 2012.godine. Iz medicinske dokumentacije (istorije bolesti, dnevne terapijske liste i liste vitalnih i laboratorijskih parametara) za svakog ispitanika je verifikovano prisutvo ili odsustvo potencijalnog prediktivnog faktora. Zatim je zabeležena pojava akutnog bubrežnog o&scaron;tećenja prema RIFLE kriterijumima. Statistička analiza je izvr&scaron;ena pomoću statističkog paketa IBM SPSS 20 Statistics. Podaci su predstavljeni tabelarno i grafički, a statistička značajnost određivana je na nivou p&lt; 0,05. Prikupljeni podaci su obrađeni standardnim statističkim testovima. Za izvođenje modela predviđanja primenjena je multivarijatna logistička regresija. Određene su granične tačke na osnovu ROC analize za dobijene značajne prediktore iz multivarijacione logističke regresije i izračunati su pridruženi bodovi koji bi činili skoring sistem za utvrđivanje rizika od nastanka akutnog bubrežnog o&scaron;tećenja. Rezultati: Incidenca akutnog bubrežnog o&scaron;tećenja na Odeljenju reanimacije Urgentnog centra Kliničkog centra Vojvodine u Novom Sadu kod bolesnika koji su hospitalizovani najkraće 48 časova u toku 2011.godine je 32 %. Rezna tačka (cut off value) zapremine provocirane diureze jedan čas nakon intravenskog davanja bolusa furosemida od 0,165 ml/kg telesne mase/čas/po miligramu datog furosemida ima najvi&scaron;u senzitivnost (82,3 %) i specifičnost (67,5 %) u diferenciranju bolesnika koji će razviti ABO. Konačni model predloženog skoring sistema sa ulogom predikcije nastanka ABO nakon 24 časa lečenja bolesnika na odeljenju intenzivnog lečenja sadrži sledeće varijable: starost vi&scaron;u od 53 godine, vrednost APACHE skora vi&scaron;u od 16, prosečnu diurezu prvih 6 časova hospitalizacije nižu od 0,875 ml/kg/h, primenu vazopresora, kalijemiju vi&scaron;u od 4,5 mmol/l i koncentraciju laktata iznad 2 mmol/l. Zaključak: Incidenca akutnog bubrežnog o&scaron;tećenja na Odeljenju reanimacije Urgentnog centra Kliničkog centra Vojvodine je slična literaturnim podacima. Bolesnici koji su stariji, imaju vi&scaron;e vrednosti APACHE II skora, nižu prosečnu zapreminu diureze u toku prvih 6 časova po prijemu, koji primaju vazopresorne medikamente, imaju vi&scaron;u koncentraciju kalijuma i vi&scaron;e koncentracije laktata u toku prvih 24 časa lečenja imaju veću &scaron;ansu da razviju akutno bubrežno o&scaron;tećenje.</p> / <p>Introduction: The incidence of acute renal insufficiency (acute kidney injury) in intensive care unit is between 36 and 66 %. Acute kidney injury is responsible for higher mortality, longer hospitalization and higher costs. Earlier recognition of acute kidney injury predictive factors could have important impact on right timing of therapeutic measures and lower mortality in critically ill patients. Aims: investigate the incidence of acute kidney injury during 2011. in patients who are hospitalized at Department of reanimation of Emergency centre, Clinical centre of Vojvodina, incidence of acute kidney injury caused by sepsis in the same period and detect acute kidney injury occurrence predicitive factors Methodology: This retrospective-prospective observational study investigated 251 critically ill patients-study subjects who were treated at two intensive care departments in Clinical centre of Vojvodina during 2010, 2011 and first six months of 2012. Potential predictive factors were identified out of medical records (patient history, daily therapeutic lists, vital parameters and laboratory values lists); the occurrence of acute kidney injury was noted according to RIFLE criteria. IBM SPSS version 20 was used for statistical analysis, standard statystical test were applied. The results were presented in tables and graphs, statystical significance was set at p value of less than 0,05. Multivariate logistic regression model was used for potential predictive factors. Statystically important factors were identified and their best sensitivity and specificity cut-off values were found using ROC curve analysis.; These cut-off values were used for creating a scoring system that determines the risk for acute kidney injury occurrence. Results: The incidence of acute kidney injury at Department of reanimation, Clinical centre of Vojvodina in patients who were hospitalized at least 48 hours was 32 % during 2011. The cut off value of provoked hourly urine output during first hour after furosemide intravenous bolus of 0.165 ml/kg body weight/h/miligram of administered furosemide has the highest sensitivity (82.3 %) and specifity (67.5 %) in differentiation of patients who would develop acute kidney injury and those who would not. The final suggested model of scoring system with the role of acute kidney injury prediction after 24 hours of treatment contains the next variables: age higher than 53 years, APACHE II score higher than 16, avarage hourly urine output during first 6 hours after ICU admission less than 0,875 ml/kg BW/h, vasopressor medication administration, blood potassium concentration higher than 4,5 mmol/l, lactates higher than 2 mmol/l after 24 hours of treatment. Conclusion: The incidence of acute kidney injury at Department of reanimation of Emergency centre, Clinical centre of Vojvodina is similar to world literature references. Critically ill patients who are more likely to develop acute kidney injury are older, have higher APACHE II score values, lower avarage urine output in the first 6 hours after ICU admission, are administered vasopressor medication, have higher blood potassium and lactate concentration in the first 24 hours of their treatment.</p>

Background Fatigue often occurs as long-term complication in chronically critically ill (CCI) patients after prolonged intensive care treatment. The Multidimensional Fatigue Inventory (MFI-20) has been established as valid instrument to measure fatigue in a wide range of medical illnesses. Regarding the measurement of fatigue in CCI patients, the psychometric properties of the MFI-20 have not been investigated so far. Thus, the present study examines reliability and validity of the MFI-20 in CCI patients. Methods A convenience sample of n = 195 patients with Critical Illness Polyneuropathy (CIP) or Myopathy (CIM) were recruited via personal contact within four weeks (t1) following the transfer from acute care ICU to post-acute ICU at a large rehabilitation hospital. N = 113 (median age 61.1 yrs., 72.6% men) patients were again contacted via telephone three (t2) and six (t3) months following the transfer to post-acute ICU. The MFI-20, the Euro-Quality of Life (EQ-5D-3 L) and the Structured Clinical Interview for the Diagnostic and Statistical Manual of mental disorders DSM-IV (SCID-I) were applied within this prospective cohort study. Results The internal consistency Cronbach’s α was adequate for the MFI-total and all but the subscale Reduced Motivation (RM) (range: .50–.91). Item-to-total correlations (range: .22–.80) indicated item redundancy for the subscale RM. Confirmatory Factor analyses (CFAs) revealed poor model fit for the original 5-factor model of the MFI-20 (t2/t3, Confirmatory Fit Index, CFI = .783/ .834; Tucker-Lewis Index, TLI = .751/ .809; Root Mean Square Error of Approximation, RMSEA = .112/ .103). Among the alternative models (1-, 2-, 3-factor models), the data best fit to a 3-factor solution summarizing the highly correlated factors General −/ Physical Fatigue/ Reduced Activity (GF/ PF/ RA) (t2/ t3, CFI = .878/ .896, TLI = .846/ .869, RMSEA = .089/ .085, 90% Confidence Interval .073–.104/ .066–.104). The MFI-total score significantly correlated with the health-related quality of life (range: −.65-(−).66) and the diagnosis of major depression (range: .27–.37). Conclusions In the present sample of CCI patients, a reliable and valid factor structure of the MFI-20 could not be ascertained. Especially the subscale RM should be revised. Since the factors GF, PF and RA cannot be separated from each other and the unclear factorial structure in the present sample of CCI patients, the MFI-20 is not recommended for use in this context.

BACKGROUND: Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical illness (CCI). Close family members are confronted with the life-threatening condition of the CCI patients and are prone to develop posttraumatic stress disorder affecting their health-related quality of life (HRQL). Main aim of the present study was to investigate patient- and family-related risk factors for posttraumatic stress and decreased HRQL in family members of CCI patients. METHODS: In a cross-sectional design nested within a prospective longitudinal cohort study, posttraumatic stress symptoms and quality of life were assessed in family members of CCI patients (n = 83, aged between 18 and 72 years) up to 6 months after transfer from ICU at acute care hospital to post-acute rehabilitation. Patients admitted a large rehabilitation hospital for ventilator weaning. The Posttraumatic Stress Scale-10 and the Euro-Quality of life-5D-3L were applied in both patients and their family members via telephone interview. RESULTS: A significant proportion of CCI patients and their family members (14.5 and 15.7 %, respectively) showed clinically relevant scores of posttraumatic stress. Both CCI patients and family members reported poorer HRQL than a normative sample. Factors independently associated with posttraumatic stress in family members were the time following ICU discharge (β = .256, 95 % confidence interval .053-.470) and the patients\' diagnosis of PTSD (β = .264, 95 % confidence interval .045-.453). Perceived satisfaction with the relationship turned out to be a protective factor for posttraumatic stress in family members of CCI patients (β = -.231, 95 % confidence interval -.423 to -.015). Regarding HRQL in family members, patients\' acute posttraumatic stress at ICU (β = -.290, 95 % confidence interval -.360 to -.088) and their own posttraumatic stress 3 to 6 months post-transfer (β = -.622, 95 % confidence interval -.640 to -.358) turned out to be significant predictors. CONCLUSIONS: Posttraumatic stress and HRQL should be routinely assessed in family members of CCI patients at regular intervals starting early at ICU. Preventive family-centered interventions are needed to improve posttraumatic stress and HRQL in both patients and their family members.

BACKGROUND: Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical illness (CCI). Close family members are confronted with the life-threatening condition of the CCI patients and are prone to develop posttraumatic stress disorder affecting their health-related quality of life (HRQL). Main aim of the present study was to investigate patient- and family-related risk factors for posttraumatic stress and decreased HRQL in family members of CCI patients. METHODS: In a cross-sectional design nested within a prospective longitudinal cohort study, posttraumatic stress symptoms and quality of life were assessed in family members of CCI patients (n = 83, aged between 18 and 72 years) up to 6 months after transfer from ICU at acute care hospital to post-acute rehabilitation. Patients admitted a large rehabilitation hospital for ventilator weaning. The Posttraumatic Stress Scale-10 and the Euro-Quality of life-5D-3L were applied in both patients and their family members via telephone interview. RESULTS: A significant proportion of CCI patients and their family members (14.5 and 15.7 %, respectively) showed clinically relevant scores of posttraumatic stress. Both CCI patients and family members reported poorer HRQL than a normative sample. Factors independently associated with posttraumatic stress in family members were the time following ICU discharge (β = .256, 95 % confidence interval .053-.470) and the patients\' diagnosis of PTSD (β = .264, 95 % confidence interval .045-.453). Perceived satisfaction with the relationship turned out to be a protective factor for posttraumatic stress in family members of CCI patients (β = -.231, 95 % confidence interval -.423 to -.015). Regarding HRQL in family members, patients\' acute posttraumatic stress at ICU (β = -.290, 95 % confidence interval -.360 to -.088) and their own posttraumatic stress 3 to 6 months post-transfer (β = -.622, 95 % confidence interval -.640 to -.358) turned out to be significant predictors. CONCLUSIONS: Posttraumatic stress and HRQL should be routinely assessed in family members of CCI patients at regular intervals starting early at ICU. Preventive family-centered interventions are needed to improve posttraumatic stress and HRQL in both patients and their family members.

Background Fatigue often occurs as long-term complication in chronically critically ill (CCI) patients after prolonged intensive care treatment. The Multidimensional Fatigue Inventory (MFI-20) has been established as valid instrument to measure fatigue in a wide range of medical illnesses. Regarding the measurement of fatigue in CCI patients, the psychometric properties of the MFI-20 have not been investigated so far. Thus, the present study examines reliability and validity of the MFI-20 in CCI patients. Methods A convenience sample of n = 195 patients with Critical Illness Polyneuropathy (CIP) or Myopathy (CIM) were recruited via personal contact within four weeks (t1) following the transfer from acute care ICU to post-acute ICU at a large rehabilitation hospital. N = 113 (median age 61.1 yrs., 72.6% men) patients were again contacted via telephone three (t2) and six (t3) months following the transfer to post-acute ICU. The MFI-20, the Euro-Quality of Life (EQ-5D-3 L) and the Structured Clinical Interview for the Diagnostic and Statistical Manual of mental disorders DSM-IV (SCID-I) were applied within this prospective cohort study. Results The internal consistency Cronbach’s α was adequate for the MFI-total and all but the subscale Reduced Motivation (RM) (range: .50–.91). Item-to-total correlations (range: .22–.80) indicated item redundancy for the subscale RM. Confirmatory Factor analyses (CFAs) revealed poor model fit for the original 5-factor model of the MFI-20 (t2/t3, Confirmatory Fit Index, CFI = .783/ .834; Tucker-Lewis Index, TLI = .751/ .809; Root Mean Square Error of Approximation, RMSEA = .112/ .103). Among the alternative models (1-, 2-, 3-factor models), the data best fit to a 3-factor solution summarizing the highly correlated factors General −/ Physical Fatigue/ Reduced Activity (GF/ PF/ RA) (t2/ t3, CFI = .878/ .896, TLI = .846/ .869, RMSEA = .089/ .085, 90% Confidence Interval .073–.104/ .066–.104). The MFI-total score significantly correlated with the health-related quality of life (range: −.65-(−).66) and the diagnosis of major depression (range: .27–.37). Conclusions In the present sample of CCI patients, a reliable and valid factor structure of the MFI-20 could not be ascertained. Especially the subscale RM should be revised. Since the factors GF, PF and RA cannot be separated from each other and the unclear factorial structure in the present sample of CCI patients, the MFI-20 is not recommended for use in this context.