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Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Comparison of medical admissions to intensive care units in the United States and United Kingdom Author(s): Hannah Wunsch, MD, MSc; Derek C. Angus, MD, MPH; David A. Harrison, PhD; Walter T. Linde-Zwirble; and Kathryn M. Rowan, DPhil Publisher or Source: American Journal of Respiratory and Critical Care Medicine Type of Media: Medical Journal Media Originally for: Critical Care Physicians, General Medical Professionals, Nurses and/or Other Critical Care Medical Professionals Country of Origin: United States Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: No Description: Rationale: The US has seven times as many intensive care unit (ICU) beds per capita as the UK; the effect on care of critically ill patients is unknown. Objective: Compare medical ICU admission in the US and UK. Methods: Retrospective (2002-2004) cohort study of 172,785 admissions (137 US ICUs, Project IMPACT database; 160 UK ICUs, UK Case Mix Programme), with patients followed until initial hospital discharge. Results: UK (vs US) admissions were less likely to be admitted directly from the emergency room (ER), (33.4 vs 58.0%), had longer hospital stays before ICU admission (mean days 2.6±8.2 vs 1.0±3.6), and fewer were ≥85 years (3.2% vs 7.8%). UK patients were more frequently mechanically ventilated within 24h after ICU admission (68.0% vs 27.4%), were sicker (mean Acute Physiology Score 16.7±7.6 vs 10.6±6.8), and had higher primary hospital mortality (38.0% vs 15.9%; adjusted Odds Ratio (OR) 1.73, 95%CI 1.50-1.99). There was no mortality difference for mechanically ventilated patients admitted from the ER (adjusted OR 1.09, 0.89-1.33). Comparisons of hospital mortality were confounded by differences in casemix, hospital length of stay (UK median 10 days (IQR 3-24) vs US 6 (3-11)), and discharge practices: more US patients were discharged to skilled care facilities (29.0% of survivors vs 6.0% in the UK). Conclusions: Lower UK ICU bed availability is associated with fewer direct admissions from the ER, longer hospital stays before ICU admission, and higher severity of illness. Interpretation of between-country hospital outcomes is confounded by differences in casemix, processes of care and discharge practices. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

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Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Spouses of ICU patients may be at increased risk for cardiac events or hospitalization Author(s): Tadahiro Goto, M.D., M.P.H., Ph.D.; Yuki Miyamoto, M.D.; and Hideo Yasunaga, M.D., Ph.D. Publisher or Source: Circulation Journal Type of Media: Newspaper Article Media Originally for: Critical Care Physicians,Former ICU Patients,Former ICU Patients' Family Members, Friends or Caregivers,Nurses and/or Other Critical Care Medical Professionals Country of Origin: United States of America (the) Primary Focus of Media: Post Intensive Care Syndrome for Families (PICS-F) COVID-19 Related: No Description: DALLAS, Oct. 5, 2020 -- Having a spouse in a hospital's intensive care unit (ICU) may make a person more likely to have a heart attack or cardiac-related hospitalization themselves within a few weeks of the ICU admission, according to new research published today in the American Heart Association's flagship journal Circulation. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

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Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Antibiotics for exacerbations of chronic obstructive pulmonary disease Author(s): Vollenweider DJ, Frei A, Steurer‐Stey CA, Garcia‐Aymerich J, Puhan MA Publisher or Source: Cochrane Database of Systematic Reviews Type of Media: Medical Research Media Originally for: Critical Care Physicians Country of Origin: Switzerland Primary Focus of Media: Pre-Use of PICS Designation COVID-19 Related: No Description: Background Many patients with an exacerbation of chronic obstructive pulmonary disease (COPD) are treated with antibiotics. However, the value of antibiotics remains uncertain, as systematic reviews and clinical trials have shown conflicting results. Objectives To assess effects of antibiotics on treatment failure as observed between seven days and one month after treatment initiation (primary outcome) for management of acute COPD exacerbations, as well as their effects on other patient‐important outcomes (mortality, adverse events, length of hospital stay, time to next exacerbation). Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library, MEDLINE, Embase, and other electronically available databases up to 26 September 2018. Selection criteria We sought to find randomised controlled trials (RCTs) including people with acute COPD exacerbations comparing antibiotic therapy and placebo and providing follow‐up of at least seven days. Data collection and analysis Two review authors independently screened references and extracted data from trial reports. We kept the three groups of outpatients, inpatients, and patients admitted to the intensive care unit (ICU) separate for benefit outcomes and mortality because we considered them to be clinically too different to be summarised as a single group. We considered outpatients to have a mild to moderate exacerbation, inpatients to have a severe exacerbation, and ICU patients to have a very severe exacerbation. When authors of primary studies did not report outcomes or study details, we contacted them to request missing data. We calculated pooled risk ratios (RRs) for treatment failure, Peto odds ratios (ORs) for rare events (mortality and adverse events), and mean differences (MDs) for continuous outcomes using random‐effects models. We used GRADE to assess the quality of the evidence. The primary outcome was treatment failure as observed between seven days and one month after treatment initiation. Main results We included 19 trials with 2663 participants (11 with outpatients, seven with inpatients, and one with ICU patients). For outpatients (with mild to moderate exacerbations), evidence of low quality suggests that currently available antibiotics statistically significantly reduced the risk for treatment failure between seven days and one month after treatment initiation (RR 0.72, 95% confidence interval (CI) 0.56 to 0.94; I² = 31%; in absolute terms, reduction in treatment failures from 295 to 212 per 1000 treated participants, 95% CI 165 to 277). Studies providing older antibiotics not in use anymore yielded an RR of 0.69 (95% CI 0.53 to 0.90; I² = 31%). Evidence of low quality from one trial in outpatients suggested no effects of antibiotics on mortality (Peto OR 1.27, 95% CI 0.49 to 3.30). One trial reported no effects of antibiotics on re‐exacerbations between two and six weeks after treatment initiation. Only one trial (N = 35) reported health‐related quality of life but did not show a statistically significant difference between treatment and control groups. Evidence of moderate quality does not show that currently used antibiotics statistically significantly reduced the risk of treatment failure among inpatients with severe exacerbations (i.e. for inpatients excluding ICU patients) (RR 0.65, 95% CI 0.38 to 1.12; I² = 50%), but trial results remain uncertain. In turn, the effect was statistically significant when trials included older antibiotics no longer in clinical use (RR 0.76, 95% CI 0.58 to 1.00; I² = 39%). Evidence of moderate quality from two trials including inpatients shows no beneficial effects of antibiotics on mortality (Peto OR 2.48, 95% CI 0.94 to 6.55). Length of hospital stay (in days) was similar in antibiotic and placebo groups. The only trial with 93 patients admitted to the ICU showed a large and statistically significant effect on treatment failure (RR 0.19, 95% CI 0.08 to 0.45; moderate‐quality evidence; in absolute terms, reduction in treatment failures from 565 to 107 per 1000 treated participants, 95% CI 45 to 254). Results of this trial show a statistically significant effect on mortality (Peto OR 0.21, 95% CI 0.06 to 0.72; moderate‐quality evidence) and on length of hospital stay (MD ‐9.60 days, 95% CI ‐12.84 to ‐6.36; low‐quality evidence). Evidence of moderate quality gathered from trials conducted in all settings shows no statistically significant effect on overall incidence of adverse events (Peto OR 1.20, 95% CI 0.89 to 1.63; moderate‐quality evidence) nor on diarrhoea (Peto OR 1.68, 95% CI 0.92 to 3.07; moderate‐quality evidence). Authors' conclusions Researchers have found that antibiotics have some effect on inpatients and outpatients, but these effects are small, and they are inconsistent for some outcomes (treatment failure) and absent for other outcomes (mortality, length of hospital stay). Analyses show a strong beneficial effect of antibiotics among ICU patients. Few data are available on the effects of antibiotics on health‐related quality of life or on other patient‐reported symptoms, and data show no statistically significant increase in the risk of adverse events with antibiotics compared to placebo. These inconsistent effects call for research into clinical signs and biomarkers that can help identify patients who would benefit from antibiotics, while sparing antibiotics for patients who are unlikely to experience benefit and for whom downsides of antibiotics (side effects, costs, and multi‐resistance) should be avoided. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

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Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Interventions to improve professional adherence to guidelines for prevention of device-related infections Author(s): Gerd Flodgren, Lucieni O Conterno, Alain Mayhew, Omar Omar, Cresio Romeu Pereira,Sasha Shepperd Publisher or Source: Cochrane Database of Systematic Reviews Type of Media: Medical Journal Media Originally for: Critical Care Physicians,Nurses and/or Other Critical Care Medical Professionals Country of Origin: United Kingdom of Great Britain and Northern Ireland (the) Primary Focus of Media: Pre-Use of PICS Designation COVID-19 Related: No Description: Healthcare‐associated infections (HAIs) are a major threat to patient safety, and are associated with mortality rates varying from 5% to 35%. Important risk factors associated with HAIs are the use of invasive medical devices (e.g. central lines, urinary catheters and mechanical ventilators) that breach the body's normal defence mechanisms, and poor staff adherence to infection prevention practices during insertion and care for the devices when in place. We identified 13 studies: one cluster randomised controlled trial (CRCT) and 12 interrupted time series (ITS) studies, involving 40 hospitals, 51 intensive care units (ICUs), 27 wards and more than 1406 healthcare professionals and 3504 patients, which assessed the impact of different interventions to reduce the occurrence of device‐related infections for inclusion in this review. We judged all studies to be at moderate to high risk of bias. The effect sizes were small with the largest median effect for studies addressing central line associated blood stream infections (CLABSIs) occurring immediately after the implementation of an intervention to improve adherence to guidelines, in the majority of studies this change was not sustained over longer follow‐up times. The median effect for studies aiming to reduce ventilator‐associated pneumonia (VAP) was somewhat greater and was sustained up to 12 months follow‐up. The results of six studies that reported adherence/non‐adherence with infection control recommendations showed very varying adherence scores ranging from 14% to 98%. The low to very low quality of the evidence of the studies included in this review provides insufficient evidence to determine with certainty which interventions are most effective in changing professional behaviour and in what contexts. However, interventions that may be worth further study are educational interventions consisting of more than one active element and that are repeatedly administered over time, and interventions employing dedicated personnel, who are focused on a certain aspect of care that is supported by evidence e.g. dentists/dental auxiliaries providing oral care. If healthcare organisations and policy makers wish to improve professional adherence to guidelines for the prevention of device‐related infections, funding of well designed studies to generate high quality evidence is needed to guide policy. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Dynamics of Critical Care Conference 2019 Author(s): Canadian Association of Critical Care Nurses Publisher or Source: Canadian Association of Critical Care Nurses (CACCN) Type of Media: Brochure Media Originally for: Nurses and/or Other Critical Care Medical Professionals Country of Origin: Canada Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: No Description: Dynamics is the annual national convention and product exhibition of the Canadian Association of Critical Care Nurses (CACCN). Diverse programming allows participants to choose from a broad selection of evidence-based topics that are geared to enhancing clinical practice, leadership, education, and research. With paediatric and adult critical care opportunities provided, participants design educational agendas to meet their own unique needs. Dynamics brings colleagues together from coast to coast, to share ideas and experiences. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.