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Acupressure for post-operative nausea and vomiting: A pilot randomised controlled trial
Papers and Poster Abstracts / Australian Critical Care 28 (2015) 37–53
Results: Four RCTs have been conducted in patients with acute lung failure; all of which concluded with no difference in all-cause mortality. One trial reported higher survival in the ECMO group at 6 months post-intervention. Medical and technological advancements around the year 2000 introduced clinical heterogeneity that prevented meta-analyses of the four RCTs. There were no completed RCTs in cardiac failure or cardiac arrest. We found two RCTs recruiting patients with cardiac arrest and two RCTs recruiting patients with acute lung failure. Conclusion(s): ECMO use in patients with acute respiratory failure remains inconclusive. ECMO use in cardiac failure or arrest is a new area with no completed RCTs available. We recommend matching and combining of ongoing RCTs with RCTs conducted after the year 2000. http://dx.doi.org/10.1016/j.aucc.2014.10.030 Acupressure for post-operative nausea and vomiting: A pilot randomised controlled trial T. Wendt 1,∗ , J. Best 1 , M. Edwards 1 , A. Spooner 1 , I. Rapchuk 1 , L. O’Connel 1 , D. McCabe 1 , C. Rickard 2 , J. Fraser 1 , S. Doi 3 , M. Cooke 2 1 Critical Care Research Group, Intensive Care and Anaesthesia, TPCH, Australia 2 Research Centre for Clinical & Community Practice Innovation, Griffith University, Australia 3 School of Population Health, University of Queensland, Australia
Despite optimal pharmacological interventions, post-operative nausea and vomiting (PONV) is prevalent in patients following surgery. Vomiting is ranked the most undesirable outcome experienced by patients post-operatively. Acupressure has been recommended for the prevention of PONV but evidence to date is limited in the cardiac surgical population. This study aims to assess the feasibility and the efficacy of pericardium channel (PC) 6 acupoint stimulation versus placebo on PONV in cardiac surgical patients. This two-group, randomised, controlled, pilot trial was conducted at a tertiary referral intensive care unit in Brisbane. Twenty-nine patients were randomly assigned to receive the acupressure (bead) or placebo (non-bead) wristband. Wristbands were applied to both wrists post-operatively in the ICU and were removed at 36 h. Incidence of PONV, and need for rescue antiemetics were assessed up to 36 h. A Quality of Recovery (QoR) survey was conducted at day four. Thirteen patients were randomised to the acupressure group (8 males), and 16 patients to the placebo group (13 male). The mean Apfel risk score (predictor of PONV 0 = low risk and 4 = high risk) was two in both groups. The mean anaesthesia and cardiopulmonary bypass times were longer in the acupressure group (287.50 min, 102.50 min) than the placebo group (255.71 min, 78.86 min). Although patient reports of nausea were similar between groups (46%, 50%), only 15% of patients vomited in the acupressure group as opposed to 53% in the placebo group. The use of rescue antiemetic therapy did not differ between groups (75%, 73%). The mean QoR score at day four was the same between groups (74.50, 74.31). These interim results indicate that PC 6 acupoint stimulation is associated with less vomiting up to 36 h post cardiac surgery. A larger sample is required to determine the feasibility of conducting a multi-centre study. http://dx.doi.org/10.1016/j.aucc.2014.10.031
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Evaluation of circuit temperature during continuous renal replacement therapy (CRRT) utilising two current standard extracorporeal circuit warming techniques D. Williams 1,∗ , A. Berry 1 , C. Dickson 1 , C. Gordon 2 , T. Cummins 1 , K. Jagger 1 , A. Marshall 1 , M. Taylor 1 1 2
Westmead Hospital, Australia Sydney University, Australia
Introduction: The incidence of hypothermia during CRRT has been reported to be as high as 55%. The two established CRRT circuit warming methods for continuous veno venous haemodiafiltration (CVVHDF) in adults utilising the Prismaflex® system are warming of the patient’s blood or warming the dialysate fluid. There is no documented evidence that either method is more effective in reducing patient hypothermia. In some intensive care units, the choice of warming method is dependent upon the individual nurse’s preference. Objectives: To establish the optimal extracorporeal circuit warming technique to minimise hypothermia in adult patients receiving CVVHDF via the Prismflex® system. Methods: This prospective block randomisation study was conducted in the general and cardiothoracic ICUs of a tertiary referral hospital. Using the PrismathermII® warming device, the study compared warming either the patient’s blood or warming dialysate fluid. All patients prescribed CRRT were screened for inclusion in the study. Patients who had undergone more than two treatments were exposed to both warming methods, according to the randomisation regimen. Monotherm® skin thermometers were attached to the exterior of both the blood access and return lines of the CRRT circuit and both temperatures were recorded second hourly for the duration of circuit life. Results: Data from a total of 123 CVVHDF circuits was analysed. The mean temperature loss between the circuit access and return lines was 0.76 ◦ C when blood was warmed and 0.92 ◦ C when dialysate was warmed. This difference between the two was not statistically significant. Conclusion(s): In relation to CRRT circuit temperature loss, there is still no evidence that either of the currently available circuit warming methods is better in CVVHDF on the Prismaflex® system. http://dx.doi.org/10.1016/j.aucc.2014.10.032 Impact of a transport checklist on adverse events during intra-hospital transport of critically ill patients A. Ash ∗ , C. Whitehead, B. Hughes, D. Williams, V. Nayyar Intensive Care Unit, Westmead Hospital, Australia Introduction: Intra-hospital transport of critically ill patients is challenging due to unanticipated complications, which can adversely affect patient safety. These can be contributed by organisational, equipment, patient and human factors. Objectives: We designed a transport checklist and determined its effect on adverse events during intra-hospital transport. Methods: A prospective, single-centre study was conducted from 1/7/2013 to 31/12/2103 in a 23 bed, mixed medical/surgical ICU. A transport checklist was introduced at three months for ICU patients proceeding for a diagnostic imaging procedure. Data were obtained before and after introduction of this checklist and focussed on physiological derangements and adverse events during
Results: Four RCTs have been conducted in patients with acute lung failure; all of which concluded with no difference in all-cause mortality. One trial reported higher survival in the ECMO group at 6 months post-intervention. Medical and technological advancements around the year 2000 introduced clinical heterogeneity that prevented meta-analyses of the four RCTs. There were no completed RCTs in cardiac failure or cardiac arrest. We found two RCTs recruiting patients with cardiac arrest and two RCTs recruiting patients with acute lung failure. Conclusion(s): ECMO use in patients with acute respiratory failure remains inconclusive. ECMO use in cardiac failure or arrest is a new area with no completed RCTs available. We recommend matching and combining of ongoing RCTs with RCTs conducted after the year 2000. http://dx.doi.org/10.1016/j.aucc.2014.10.030 Acupressure for post-operative nausea and vomiting: A pilot randomised controlled trial T. Wendt 1,∗ , J. Best 1 , M. Edwards 1 , A. Spooner 1 , I. Rapchuk 1 , L. O’Connel 1 , D. McCabe 1 , C. Rickard 2 , J. Fraser 1 , S. Doi 3 , M. Cooke 2 1 Critical Care Research Group, Intensive Care and Anaesthesia, TPCH, Australia 2 Research Centre for Clinical & Community Practice Innovation, Griffith University, Australia 3 School of Population Health, University of Queensland, Australia
Despite optimal pharmacological interventions, post-operative nausea and vomiting (PONV) is prevalent in patients following surgery. Vomiting is ranked the most undesirable outcome experienced by patients post-operatively. Acupressure has been recommended for the prevention of PONV but evidence to date is limited in the cardiac surgical population. This study aims to assess the feasibility and the efficacy of pericardium channel (PC) 6 acupoint stimulation versus placebo on PONV in cardiac surgical patients. This two-group, randomised, controlled, pilot trial was conducted at a tertiary referral intensive care unit in Brisbane. Twenty-nine patients were randomly assigned to receive the acupressure (bead) or placebo (non-bead) wristband. Wristbands were applied to both wrists post-operatively in the ICU and were removed at 36 h. Incidence of PONV, and need for rescue antiemetics were assessed up to 36 h. A Quality of Recovery (QoR) survey was conducted at day four. Thirteen patients were randomised to the acupressure group (8 males), and 16 patients to the placebo group (13 male). The mean Apfel risk score (predictor of PONV 0 = low risk and 4 = high risk) was two in both groups. The mean anaesthesia and cardiopulmonary bypass times were longer in the acupressure group (287.50 min, 102.50 min) than the placebo group (255.71 min, 78.86 min). Although patient reports of nausea were similar between groups (46%, 50%), only 15% of patients vomited in the acupressure group as opposed to 53% in the placebo group. The use of rescue antiemetic therapy did not differ between groups (75%, 73%). The mean QoR score at day four was the same between groups (74.50, 74.31). These interim results indicate that PC 6 acupoint stimulation is associated with less vomiting up to 36 h post cardiac surgery. A larger sample is required to determine the feasibility of conducting a multi-centre study. http://dx.doi.org/10.1016/j.aucc.2014.10.031
49
Evaluation of circuit temperature during continuous renal replacement therapy (CRRT) utilising two current standard extracorporeal circuit warming techniques D. Williams 1,∗ , A. Berry 1 , C. Dickson 1 , C. Gordon 2 , T. Cummins 1 , K. Jagger 1 , A. Marshall 1 , M. Taylor 1 1 2
Westmead Hospital, Australia Sydney University, Australia
Introduction: The incidence of hypothermia during CRRT has been reported to be as high as 55%. The two established CRRT circuit warming methods for continuous veno venous haemodiafiltration (CVVHDF) in adults utilising the Prismaflex® system are warming of the patient’s blood or warming the dialysate fluid. There is no documented evidence that either method is more effective in reducing patient hypothermia. In some intensive care units, the choice of warming method is dependent upon the individual nurse’s preference. Objectives: To establish the optimal extracorporeal circuit warming technique to minimise hypothermia in adult patients receiving CVVHDF via the Prismflex® system. Methods: This prospective block randomisation study was conducted in the general and cardiothoracic ICUs of a tertiary referral hospital. Using the PrismathermII® warming device, the study compared warming either the patient’s blood or warming dialysate fluid. All patients prescribed CRRT were screened for inclusion in the study. Patients who had undergone more than two treatments were exposed to both warming methods, according to the randomisation regimen. Monotherm® skin thermometers were attached to the exterior of both the blood access and return lines of the CRRT circuit and both temperatures were recorded second hourly for the duration of circuit life. Results: Data from a total of 123 CVVHDF circuits was analysed. The mean temperature loss between the circuit access and return lines was 0.76 ◦ C when blood was warmed and 0.92 ◦ C when dialysate was warmed. This difference between the two was not statistically significant. Conclusion(s): In relation to CRRT circuit temperature loss, there is still no evidence that either of the currently available circuit warming methods is better in CVVHDF on the Prismaflex® system. http://dx.doi.org/10.1016/j.aucc.2014.10.032 Impact of a transport checklist on adverse events during intra-hospital transport of critically ill patients A. Ash ∗ , C. Whitehead, B. Hughes, D. Williams, V. Nayyar Intensive Care Unit, Westmead Hospital, Australia Introduction: Intra-hospital transport of critically ill patients is challenging due to unanticipated complications, which can adversely affect patient safety. These can be contributed by organisational, equipment, patient and human factors. Objectives: We designed a transport checklist and determined its effect on adverse events during intra-hospital transport. Methods: A prospective, single-centre study was conducted from 1/7/2013 to 31/12/2103 in a 23 bed, mixed medical/surgical ICU. A transport checklist was introduced at three months for ICU patients proceeding for a diagnostic imaging procedure. Data were obtained before and after introduction of this checklist and focussed on physiological derangements and adverse events during