Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Effect of Hydrocortisone Therapy Initiated 7 to 14 Days After Birth on Mortality or Bronchopulmonary Dysplasia Among Very Preterm Infants Receiving Mechanical Ventilation: a Randomized Clinical Trial Author(s): Wes Onland, PhD; Filip Cools, PhD; Andre Kroon, PhD; Karin Rademaker, PhD; Maruschka P. Merkus, PhD; Peter H. Dijk, PhD; Henrica L. van Straaten, PhD; Arjan B. Te Pas, PhD; Thilo Mohns, PhD; Els Bruneel, PhD; Arno F. van Heijst, PhD; Boris W. Kramer, PhD; Anne Debeer, PhD; Inge Zonnenberg, MD; Yoann Marechal, PhD; Henry Blom, PhD; Katleen Plaskie, MD; Martin Offringa, PhD; Anton H. van Kaam, PhD Publisher or Source: JAMA Type of Media: Medical Research Media Originally for: Critical Care Physicians Country of Origin: Netherlands (the) Primary Focus of Media: Pre-Use of PICS Designation COVID-19 Related: No Description: IMPORTANCE Dexamethasone initiated after the first week of life reduces the rate of death or bronchopulmonary dysplasia (BPD) but may cause long-term adverse effects in very preterm infants. Hydrocortisone is increasingly used as an alternative, but evidence supporting its efficacy and safety is lacking. OBJECTIVE To assess the effect of hydrocortisone initiated between 7 and 14 days after birth on death or BPD in very preterm infants. DESIGN, SETTING, AND PARTICIPANTS Double-blind, placebo-controlled randomized trial conducted in 19 neonatal intensive care units in the Netherlands and Belgium from November 15, 2011, to December 23, 2016, among preterm infants with a gestational age of less than 30 weeks and/or birth weight of less than 1250 g who were ventilator dependent between 7 and 14 days of life, with follow-up to hospital discharge ending December 12, 2017. INTERVENTIONS Infants were randomly assigned to receive a 22-day course of systemic hydrocortisone (cumulative dose, 72.5 mg/kg) (n = 182) or placebo (n = 190). MAIN OUTCOMES AND MEASURES The primary outcome was a composite of death or BPD assessed at 36 weeks’ postmenstrual age. Twenty-nine secondary outcomes were analyzed up to hospital discharge, including death and BPD at 36 weeks’ postmenstrual age. RESULTS Among 372 patients randomized (mean gestational age, 26 weeks; 55% male), 371 completed the trial; parents withdrew consent for 1 child treated with hydrocortisone. Death or BPD occurred in 128 of 181 infants (70.7%) randomized to hydrocortisone and in 140 of 190 infants (73.7%) randomized to placebo (adjusted risk difference, −3.6% [95% CI, −12.7% to 5.4%]; adjusted odds ratio, 0.87 [95% CI, 0.54-1.38]; P = .54). Of 29 secondary outcomes, 8 showed significant differences, including death at 36 weeks’ postmenstrual age (15.5% with hydrocortisone vs 23.7% with placebo; risk difference, −8.2% [95% CI, −16.2% to −0.1%]; odds ratio, 0.59 [95% CI, 0.35-0.995]; P = .048). Twenty-one outcomes showed nonsignificant differences, including BPD (55.2% with hydrocortisone vs 50.0% with placebo; risk difference, 5.2% [95% CI, −4.9% to 15.2%]; odds ratio, 1.24 [95% CI, 0.82-1.86]; P = .31). Hyperglycemia requiring insulin therapy was the only adverse effect reported more often in the hydrocortisone group (18.2%) than in the placebo group (7.9%). CONCLUSIONS AND RELEVANCE Among mechanically ventilated very preterm infants, administration of hydrocortisone between 7 and 14 days after birth, compared with placebo, did not improve the composite outcome of death or BPD at 36 weeks’ postmenstrual age. These findings do not support the use of hydrocortisone for this indication. 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: Prophylactic inferior vena cava filter insertion for trauma: intensive care unit versus operating room Author(s): Gonzalez RP, Cohen M, Bosarge P, Ryan J, Rodning C Publisher or Source: University of York Type of Media: Statistical Analysis Media Originally for: Critical Care Physicians, Nurses and/or Other Critical Care Medical Professionals Country of Origin: United Kingdom Primary Focus of Media: Pre-Use of PICS Designation COVID-19 Related: No Description: This is an economic evaluation that meets the criteria for inclusion on NHS EED. 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: Rationale and Study Design of an Early Care, Therapeutic Education, and Psychological Intervention for the Management of Post-intensive Care Syndrome and Chronic Pain After Coronavirus Disease 2019 (PAIN-COVID): Study protocol for a randomized controlled trial Author(s): Antonio Ojeda, Andrea Calvo, Tomas Cuñat, Ricard Mellado Artigas, Oscar Comino-Trinidad, Jorge Aliaga, Marilyn Arias, Maribel Ahuir, Carlos Ferrando, Christian Dürsteler Publisher or Source: Research Square 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: Spain Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: Yes Description: Background: Critically ill patients with COVID-19 disease are an especially susceptible population to develop Post-intensive Care Syndrome (PICS) due to acute respiratory distress syndrome (ARDS). Patients can suffer acute severe pain and may have long-term deterioration in mental, cognitive, and functional health after discharge. However, few controlled trials are evaluating interventions for the prevention and treatment of PICS. The study hypothesis is that a specific care program based on early therapeutic education and a psychological intervention improves the quality of life of patients at risk of developing PICS and chronic pain after COVID-19 disease. The primary objective is to determine if the program is superior to standard-of-care on health-related life quality at six months after hospital discharge. The secondary objectives are to determine if the intervention is superior to standard care, evaluating the health-related life quality, the incidence of chronic pain and the degree of functional limitation, the incidence of anxiety, depression, and post-traumatic stress syndrome at 3 and 6 months after hospital discharge. Methods: The PAINCOVID trial is a unicentric randomized, controlled, patient blinded superiority trial with two parallel groups. The primary endpoint is the health-related quality of life at six months after hospital discharge, and randomization will be performed with a 1:1 allocation. This paper details the methodology and statistical analysis plan of the trial and was submitted before outcome data were available. Discussion: This the first randomized clinical trial assessing the effectiveness of an early care therapeutic education, and psychological intervention for the management of PICS and Chronic Pain after COVID-19. The intervention will serve as a sample of the need to implement early care programs on early stages, having an incalculable impact given the current scenario of the pandemic. Trial registration: This study is being in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board Comité Ético de Investigación Clínica del Hospital Clinic de Barcelona (approval number: HCB/2020/0549) and was registered on May 9, 2020 at clinicaltrials.gov (NCT04394169). 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: The Space GlucoseControl system for managing blood‑glucose in critically ill patients in intensive care Author(s): Birmingham and Brunel Consortium Publisher or Source: National Institute for Health and Care Excellence - NICE Type of Media: Medical Professional Education 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: NICE has developed a Medtech Innovation Briefing (MIB) on the Space GlucoseControl system for managing blood-glucose in critically ill patients in intensive care. The Space GlucoseControl system is intended to be used for controlling blood-glucose levels of critically ill patients in intensive care and could be used in place of manual protocols for planning the measurement of blood-glucose levels. The system includes nutrition infusion pumps, an insulin pump, and an algorithm to calculate insulin dosing and blood-glucose measurement intervals. Medtech Innovation Briefings provide a description of the medical technology, including its likely place in therapy, the costs of using the technology and a critical review of the strengths and weaknesses of the relevant published evidence. Their purpose is to provide objective information on device and diagnostic technologies to aid local decision-making by clinicians, managers and procurement professionals. By making this information available, NICE helps to avoid the need for NHS organisations to produce similar information for local use. Medtech Innovation Briefings are not NICE guidance. They differ in format, contain no judgement on the value of the technology and do not constitute a guidance recommendation. MIBs are commissioned by NHS England and produced in support of the NHS 5 Year Forward View, specifically as one of a number of steps which will accelerate innovation in new treatments and diagnostics. 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: Effect of a Recombinant Human Soluble Thrombomodulin on Mortality in Patients With Sepsis-Associated Coagulopathy: the SCARLET Randomized Clinical Trial Author(s): Jean-Louis Vincent, MD, PhD; Bruno Francois, MD; Igor Zabolotskikh, MD, PhD; Mradul Kumar Daga, MD; Jean-Baptiste Lascarrou, MD;Mikhail Y. Kirov, MD; Ville Pettilä, MD; Xavier Wittebole, MD; Ferhat Meziani, MD, PhD; Emmanuelle Mercier, MD; Suzana M. Lobo, MD, PhD;Philip S. Barie, MD, MBA; Mark Crowther, MD; Charles T. Esmon, PhD; Jawed Fareed, PhD; Satoshi Gando, MD, PhD; Kenneth J. Gorelick, MD, PhD;Marcel Levi, MD, PhD; Jean-Paul Mira, MD, PhD; Steven M. Opal, MD; Joseph Parrillo, MD, PhD; James A. Russell, MD; Hidehiko Saito, MD, PhD;Kazuhisa Tsuruta, PhD; Takumi Sakai; David Fineberg, M Publisher or Source: JAMA Type of Media: Medical Research Media Originally for: Critical Care Physicians,Nurses and/or Other Critical Care Medical Professionals Country of Origin: Belgium Primary Focus of Media: Pre-Use of PICS Designation COVID-19 Related: No Description: Importance: Previous research suggested that soluble human recombinant thrombomodulin may reduce mortality among patients with sepsis-associated coagulopathy. Objective: To determine the effect of human recombinant thrombomodulin vs placebo on 28-day all-cause mortality among patients with sepsis-associated coagulopathy. Design, Setting, and Participants: The SCARLET trial was a randomized, double-blind, placebo-controlled, multinational, multicenter phase 3 study conducted in intensive care units at 159 sites in 26 countries. All adult patients admitted to one of the participating intensive care units between October 2012 and March 2018 with sepsis-associated coagulopathy and concomitant cardiovascular and/or respiratory failure, defined as an international normalized ratio greater than 1.40 without other known etiology and a platelet count in the range of 30 to 150 × 109/L or a greater than 30% decrease in platelet count within 24 hours, were considered for inclusion. The final date of follow-up was February 28, 2019. Interventions: Patients with sepsis-associated coagulopathy were randomized and treated with an intravenous bolus or a 15-minute infusion of thrombomodulin (0.06 mg/kg/d [maximum, 6 mg/d]; n = 395) or matching placebo (n = 405) once daily for 6 days. Main Outcome and Measures: The primary end point was 28-day all-cause mortality. Results: Among 816 randomized patients, 800 (mean age, 60.7 years; 437 [54.6%] men) completed the study and were included in the full analysis set. In these patients, the 28-day all-cause mortality rate was not statistically significantly different between the thrombomodulin group and the placebo group (106 of 395 patients [26.8%] vs 119 of 405 patients [29.4%], respectively; P =.32). The absolute risk difference was 2.55% (95% CI, -3.68% to 8.77%). The incidence of serious major bleeding adverse events (defined as any intracranial hemorrhage; life-threatening bleeding; or bleeding event classified as serious by the investigator, with administration of at least 1440 mL [typically 6 units] of packed red blood cells over 2 consecutive days) was 23 of 396 patients (5.8%) in the thrombomodulin group and 16 of 404 (4.0%) in the placebo group. Conclusions and Relevance: Among patients with sepsis-associated coagulopathy, administration of a human recombinant thrombomodulin, compared with placebo, did not significantly reduce 28-day all-cause mortality. 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: A scoping review of use of wearable devices to evaluate outcomes in survivors of critical illness Author(s): Gluck, S., Chapple, L. S., Chapman, M. J., Iwashyna, T. J., & Deane, A. M. Publisher or Source: Critical Care and Resuscitation Type of Media: Medical Journal Media Originally for: Critical Care Physicians Country of Origin: Australia Primary Focus of Media: Pre-Use of PICS Designation COVID-19 Related: No Description: Objective: Wearable devices using new technology may be a cost-effective method to assess functional outcomes in survivors of critical illness. Our primary objective was to review the extent to which wearable devices such as smartphones, pedometers, accelerometers and global positioning systems have been used to evaluate outcomes in survivors of an intensive care unit admission. Design: We included studies of patients surviving an ICU admission and which measured outcomes using wearable devices. We performed a scoping review of studies found by searching the CINAHL, Embase, MEDLINE and PubMed databases. Results: The seven studies we identified were published in or after 2012 and were predominantly descriptive (n = 6) with one randomised controlled trial. All studies described outcomes in cohorts of relatively few participants (range, 11-51 participants). Duration to follow-up was mostly short, at a median time of 3 months after ICU discharge (range, in-hospital to 27 years). All studies used accelerometers to monitor patient movement: physical activity (n = 5), sleep quality (n = 1), and infant movement (n = 1). The accelerometers were bi-axial (n = 3), uni-axial (n = 2) combined uni-axial (n = 1) and tri-axial (n = 1). Common outcomes evaluated were the number of participants walking for < 30 min/day, mean daily step count and walking speed. Conclusions: Wearable devices have infrequently been used to measure physical activity in survivors of critical illness and all identified studies were published recently, which suggests that the use of wearable devices for research may be increasing. To date, only accelerometry has been reported, and the wide variation in methodologies used and the outcomes measured limits synthesis of these data. 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: 1 In 10 People Experience Long Covid For 3 Months Or More Author(s): Tom Hale Publisher or Source: IFLScience Type of Media: Newspaper Article Media Originally for: General Public Country of Origin: United Kingdom of Great Britain and Northern Ireland (the) Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: Yes Description: Around one in five people have lingering side-effects of Covid-19 up to five weeks after initially falling sick, according to a big new analysis in the UK. Furthermore, around one in 10 people with Covid-19 appear to experience nagging symptoms for 12 weeks or longer. 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: The state of bereavement support in adult intensive care Author(s): Efstathiou, N., Walker, W., Metcalfe, A., & Vanderspank-Wright, B. Publisher or Source: University of Birmingham Type of Media: Medical Research Media Originally for: Critical Care Physicians 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: Purpose: Despite advances in medical science, patient death and family bereavement are commonly encountered in adult intensive care units (ICUs). This is the first review to investigate the state of ICU bereavement support globally, and the availability and effectiveness of bereavement support interventions. Methods: A systematic review and narrative synthesis. Medline, CINAHL Plus, PsycINFO, Web of Science, EMBASE were searched and inclusion/exclusion criteria were applied. Included studies were appraised using relevant appraisal tools. Results: Fourteen papers formed the review; five of which were international surveys reporting variable bereavement practices and levels of support. A lack of training and resources were identified barriers. Nine papers reported the effectiveness of primarily discrete bereavement support interventions including: a personal memento, a handwritten condolence letter, a post-death meeting; storytelling, research participation, use of an ICU diary. One study evaluated a bereavement follow-up program. Generally, all identified interventions were well accepted by bereaved families. Conclusions: The reviewed evidence was weak, and findings were contextually bound. As such, it is difficult to make recommendations for the most acceptable and effective bereavement support intervention(s). Bereavement support in ICU needs further exploration and clinicians must be adequately trained and supported for the delivery of evidence-informed, culturally competent care. Keywords: Bereavement; Intensive care units; Narrative synthesis; Systematic review. 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: Incidence Estimation in Post-ICU Populations: Challenges and Possible Solutions When Using Claims Data Author(s): Brandl, M., Apfelbacher, C., Weiß, A., Brandstetter, S., Baumeister, S.E. Publisher or Source: Gesundheitswesen Type of Media: Medical Journal Media Originally for: General Medical Professionals Country of Origin: Germany Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: No Description: New or worsening cognitive, physical and/or mental health impairments after acute care for critical illness are referred to as “post-intensive care syndrome” (PICS). Little is known about the incidence of its components, since it is challenging to recruit patients after intensive care unit (ICU) treatment for observational studies. Claims data are particularly suited to achieve incidence estimates in difficult-to-recruit groups. However, some limitations remain when using claims data for empirical research on the outcome of ICU treatment. The objective of this article is to describe three challenges and possible solutions for the estimation of the incidence of PICS based on claims data. 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: Survival, Hospitalization Charges and Follow-up Results in Critically Ill Patients Author(s): David J. Cullen, M.D., Linda C. Ferrara, R.N., Burton A. Briggs, M.D., Peter F. Walker, M.D., and John Gilbert, Ph.D. Publisher or Source: The New England Journal of 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: Pre-Use of PICS Designation COVID-19 Related: No Description: In 226 consecutive critically ill primarily postoperative patients, we determined survival and quality of life, hospitalizaron charges, and consumption of blood and blood products. The patients were physiologically unstable and required intensive physician and nursing care. By one month, 123 patients had died (54 percent), 70 were still hospitalized, and 31 were home; only one of 103 survivors had fully recovered. By 12 months, 164 patients (73 per cent) had died, 10 were still hospitalized, and 51were home. Twenty-seven of 64 survivors had fully recovered. Hospitalization charges averaged $14,304 per patient. The total charge for blood and blood fractions was $617,710—21 per cent of the total hospitalization charge; $ 515, 71 (83 per cent) of the blood charge went to 164 nonsurvivors, whereas $101,939 (17 per cent) went to the 62 survivors. These data document the use of increasingly limited resources in the management of critically ill patients. The medical profession must make difficult decisions to allocate these resources effectively. (N Engl J Med 269:982-987,1976) 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: Strategies to Optimize ICU Liberation (A to F) Bundle Performance in Critically Ill Adults With Coronavirus Disease 2019 Author(s): John W. Devlin, PharmD, MCCM; Hollis R. O’Neal Jr, MD, MS; Christopher Thomas , MD; Mary Ann Barnes Daly, MS, RN, CCRN; Joanna L. Stollings, PharmD, FCCM; David R. Janz, MD, MS; E. Wesley Ely, MD, MS, FCCM; John C. Lin, MD Publisher or Source: Critical Care Explorations Type of Media: Medical Journal Media Originally for: Critical Care Physicians,Nurses and/or Other Critical Care Medical Professionals Country of Origin: United States of America (the) Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: Yes Description: Objectives: The severe acute respiratory syndrome coronavirus 2 pandemic has stretched ICU resources in an unprecedented fashion and outstripped personal protective equipment supplies. The combination of a novel disease, resource limitations, and risks to medical personnel health have created new barriers to implementing the ICU Liberation (“A” for Assessment, Prevention, and Manage pain; “B” for Both Spontaneous Awakening Trials and Spontaneous Breathing Trials; “C” for Choice of Analgesia and Sedation; “D” for Delirium Assess, Prevent, and Manage; “E” for Early Mobility and Exercise; and “F” for Family Engagement and Empowerment [ABCDEF]) Bundle, a proven ICU care approach that reduces delirium, shortens mechanical ventilation duration, prevents post-ICU syndrome, and reduces healthcare costs. This narrative review acknowledges barriers and offers strategies to optimize Bundle performance in coronavirus disease 2019 patients requiring mechanical ventilation. Data Sources, Study Selection, and Data Extraction: The most relevant literature, media reports, and author experiences were assessed for inclusion in this narrative review including PubMed, national newspapers, and critical care/pharmacology textbooks. Data Synthesis: Uncertainty regarding coronavirus disease 2019 clinical course, shifts in attitude, and changes in routine behavior have hindered Bundle use. A domino effect results from: 1) changes to critical care hierarchy, priorities, and ICU team composition; 2) significant personal protective equipment shortages cause; 3) reduced/restricted physical bedside presence favoring; 4) increased depth of sedation and use of neuromuscular blockade; 5) which exacerbate drug shortages; and 6) which require prolonged use of limited ventilator resources. Other identified barriers include manageable knowledge deficits among non-ICU clinicians unfamiliar with the Bundle or among PICU specialists deploying pediatric-based Bundle approaches who are unfamiliar with adult medicine. Both groups have been enlisted to augment the adult ICU work force to meet demand. Strategies were identified to facilitate Bundle performance to liberate patients from the ICU. Conclusions: We acknowledge current challenges that interfere with comprehensive management of critically ill patients during the coronavirus disease 2019 pandemic. Rapid response to new circumstances precisely requires established safety mechanisms and protocols like the ABCDEF Bundle to increase ICU and ventilator capacity and help survivors maximize recovery from coronavirus disease 2019 as early as possible. Key Words: ABCDEF bundle; agitation; ARDS; coronavirus disease 2019; delirium; intensive care 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: Cognitive therapy for traumatic stress disorder following critical illness and intensive care unit admission Author(s): Murray, H., Grey, N., Wild, J., Warnock-Parkes, E., Kerr, A., Clark, D. M., & Ehlers, A. Publisher or Source: The Cognitive Behavior Therapist Type of Media: Magazine Article, Medical Journal Media Originally for: General Medical Professionals Country of Origin: United Kingdom Primary Focus of Media: Post Traumatic Stress Disorder (PTSD) COVID-19 Related: No Description: Around a quarter of patients treated in intensive care units (ICUs) will develop symptoms of post-traumatic stress disorder (PTSD). Given the dramatic increase in ICU admissions during the COVID-19 pandemic, clinicians are likely to see a rise in post-ICU PTSD cases in the coming months. Post-ICU PTSD can present various challenges to clinicians, and no clinical guidelines have been published for delivering trauma-focused cognitive behavioural therapy with this population. In this article, we describe how to use cognitive therapy for PTSD (CT-PTSD), a first line treatment for PTSD recommended by the National Institute for Health and Care Excellence. Using clinical case examples, we outline the key techniques involved in CT-PTSD, and describe their application to treating patients with PTSD following ICU. 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.