BackgroundThe collection of blood cultures is an extremely important method in the management of patients with suspected infection. Microbiology laboratories should monitor blood culture collection.MethodsOver an 8-month period we developed a prospective, observational study in an adult Intensive Care Unit (ICU). We correlated the mass contained in the blood vials with blood culture positivity and we also verified the relationship between the mass of blood and blood volume collected for the diagnosis of bloodstream infection (BSI), as well as we explored factors predicting positive blood cultures.ResultsWe evaluated 345 patients with sepsis, severe sepsis or septic shock for whom blood culture bottles were collected for the diagnosis of BSI. Of the 55 patients with BSI, 40.0 % had peripheral blood culture collection only. BSIs were classified as nosocomial in 34.5 %. In the multivariate model, the blood culture mass (in grams) remained a significant predictor of positivity, with an odds ratio 1.01 (i.e., for each additional 1 mL of blood collected there was a 1 % increase in positivity; 95 % CI 1.01–1.02, p = 0.001; Nagelkerke R Square [R2] = 0.192). For blood volume collected, the adjusted odds ratio was estimated at 1.02 (95 % CI: 1.01–1.03, p < 0.001; R2 = 0.199). For each set of collected blood cultures beyond one set, the adjusted odds ratio was estimated to be 1.27 (95 % CI: 1.14–1.41, p < 0.001; R2 = 0.221).ConclusionsOur study was a quality improvement project that showed that microbiology laboratories can use the weight of blood culture bottles to determine if appropriate volume has been collected to improve the diagnosis of BSI.
Introduction
Daily multidisciplinary rounds (DMRs) consist of systematic
patient-centred discussions aiming to establish joint therapeutic goals
for the next 24 hours of intensive care unit (ICU) care. The aim of the
present study protocol is to evaluate whether an intervention consisting
of guided DMRs, supported by a remote specialist and audit/feedback on
care performance will reduce ICU length of stay compared with a control
group.
Methods and analysis
A multicentre, controlled, cluster-randomised superiority trial
including 30 ICUs in Brazil (15 intervention and 15 control), from
August 2019 to June 2021. In a parallel assignment, ICUs are randomised
to a complex-intervention composed by daily rounds carried out through
Tele-ICU by a remote ICU physician; development of local quality
indicators dashboards coupled with monthly meetings with local
leadership; and dissemination of evidence-based clinical protocols
versus usual care. Primary outcome is ICU length of stay. Secondary
outcomes include classification of the unit according to the profiles
defined by the standardised resource use and the standardised mortality
rate, hospital mortality, incidence of healthcare-associated infections,
ventilator-free days at 28 days, patient-days receiving oral or enteral
feeding, patient-days under light sedation or alert and calm, rate of
patients under normoxaemia. All adult patients admitted after the
beginning of the study in each participant ICU will be enrolled.
Inclusion criteria (clusters): public Brazilian ICUs with a minimum of 8
ICU beds interested/committed to participating in the study. Exclusion
criteria (clusters): units with fully established DMRs by an
intensivist, specialised or step-down units.
Ethics and dissemination
The study protocol was approved by the institutional review board
(IRB) of the coordinator centre, and by IRBs of each enrolled
hospital/ICU. Statistical analysis protocol is being prepared for
submission before the end of patient’s enrolment. Results will be
disseminated through conferences, peer-reviewed journals and to each
participating unit.
Trial registration number
NCT03920501; Pre-results.
Objective:
The TELE-critical Care verSus usual Care On ICU PErformance (TELESCOPE) trial aims to assess whether a complex telemedicine intervention in intensive care units, which focuses on daily multidisciplinary rounds performed by remote intensivists, will reduce intensive care unit length of stay compared to usual care.
Methods:
The TELESCOPE trial is a national, multicenter, controlled, open label, cluster randomized trial. The study tests the effectiveness of daily multidisciplinary rounds conducted by an intensivist through telemedicine in Brazilian intensive care units. The protocol was approved by the local Research Ethics Committee of the coordinating study center and by the local Research Ethics Committee from each of the 30 intensive care units, following Brazilian legislation. The trial is registered with ClinicalTrials. gov (NCT03920501). The primary outcome is intensive care unit length of stay, which will be analyzed accounting for the baseline period and cluster structure of the data and adjusted by prespecified covariates. Secondary exploratory outcomes included intensive care unit performance classification, in-hospital mortality, incidence of nosocomial infections, ventilator-free days at 28 days, rate of patients receiving oral or enteral feeding, rate of patients under light sedation or alert and calm, and rate of patients under normoxemia.
Conclusion:
According to the trial’s best practice, we report our statistical analysis prior to locking the database and beginning analyses. We anticipate that this reporting practice will prevent analysis bias and improve the interpretation of the reported results.
ClinicalTrials.gov registration:
NCT03920501
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