— jeremy faust (@jeremyfaust) June 24, 2016
Filed under: FOAMEd, SMACCDUB Tagged: reuben-strayer
A tropical fish keeper comes in with uveitis. He’s 27 and has no past medical history and doesn’t take any medications. He had been well recently – other than coming off his bike while mountain biking in the outback. He’s particularly annoyed about that, as the multiple abrasions include a recently done tattoo on his right arm – which is now swollen and inflammed. You immediately hear the hoof-beats of zebras and think…?
This post is a collation of references and resource material from my second presentation in the inaugural Caboolture Redcliffe ICU Sepsis Workshop for nurses. The objective of this session was to work through critical appraisal of 5 prominent critical care trials with particular significance to our practice context. The completely unambiguous overtone of this session was to practice critical appraisal and engage with the literature that informs the medical decisions in our ICU.
Following a brief introduction and overview of the constructs of evidence based practice and grading of evidence, I lead the group through a structured critical appraisal of the SPLIT Trial (Young et al 2015). We used the Critical Appraisal Skills Programme (CASP) Randomised Contol Trial (RCT) Appraisal Tool to dissect the study. Following this, the participants were broken into four small groups and each given a prominent sepsis trial to appraise and feedback to the whole group in 30 minutes time.
The trials were purposely selected for discussion as they all hold specific relevance to practice in our ICU. These trials also share one commonality – they were all ‘negative’ or no difference trials. One key aspect discussed was the importance of no difference trials. During the group feedback particular focus was drawn to identifying the Population, Intervention, Comparison and Outcome (PICO), whether the study was believable (internal validity and biological plausibility), and whether it should change practice or confirmed our current practice.
About 20 minutes into the appraisal activity the groups were provided with the Bottom Line review for their relevant study to aid in synthesising final feedback and as an example of an excellent critical appraisal. The Bottom Line is an excellent critical appraisal and literature resource for Intensive Care. Founded by members of the Wessex Intensive Care Society and now with international authorship, this is one of my absolute go-to resources to help filter and process the swathe of ICU trials.
|HEAT Trial – Acetaminophen for Fever in Critically Ill Patients with Suspected Infection (Young et al 2015)||Bottom Line on HEAT – Steve Mathieu|
|ARISE Trial – Goal-Directed Resuscitation for Patients with Early Septic Shock (Delaney et al 2014)||Bottom Line on ARISE – Steve Mathieu|
|CORTICUS Trial – Hydrocortisone Therapy for Patients with Septic Shock (Sprung et al 2008)||Bottom Line on CORTICUS – Duncan Chambler|
|BLISS Trial – Beta-Lactam Infusion in Severe Sepsis (BLISS): a prospective, two-centre, open-labelled randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis (Abdul-Aziz et al 2016)||Bottom Line on BLISS – Adrian Wong|
|SPLIT Trial – Effect of a Buffered Crystalloid Solution vs Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit (Young et al 2015)||Bottom Line on SPLIT – Adrian Wong|
Anthony Crocco from Sketchy EBM – How to read (most) research papers