Brief description of media:

This review concluded that intensive insulin therapy did not reduce mortality or improve health outcomes in hospitalised patients, but that it was associated with increased risk of severe hypoglycaemia. The authors' conclusions reflected the evidence presented, but in view of the potential for language bias and the clinical variation between trials, the conclusions should be viewed with caution.

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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.

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Of all his years, 2020 was exceptionally challenging for Vietnam veteran Matthew Thomas. After the 75-year-old Aurora resident tested positive for Covid-19 in mid-May, doctors had to intubate him for 33 days so he didn’t go into respiratory failure. While Thomas survived, his 33-year-old son, diagnosed with Covid-19 shortly before his father was hospitalized, passed away.

Thomas also faced widespread effects from Covid-19, stemming from the time spent intubated and in intensive care. “The byproduct of the disease is that my muscles went to sleep,” says Thomas, who says his muscles became so weak that he could not use his arms and legs.

“I couldn’t do anything. I couldn’t even stand up,” he says.

Brief description of media:

1. Identify symptoms and risk factors for post-intensive care syndrome-families (PICS-F).
2. Describe techniques for pre venting PICS-F.
3. Discuss management of PICS-F

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Preventing, assessing, and treating trauma suffered by families of a hospitalized loved one.

Brief description of media:

Aim
To describe published literature on the needs and experiences of family members of adults admitted to intensive care and interventions to improve family satisfaction and psychological well‐being and health.
Design
Scoping review.
Methods
Several selective databases were searched. English‐language articles were retrieved, and data extracted on study design, sample size, sample characteristics and outcomes measured.
Results
From 469 references, 43 studies were identified for inclusion. Four key themes were identified: (a) Different perspectives on meeting family needs; (b) Family satisfaction with care in intensive care; (c) Factors having an impact on family health and well‐being and their capacity to cope; and (d) Psychosocial interventions. Unmet informational and assurance needs have an impact on family satisfaction and mental health. Structured written and oral information shows some effect in improving satisfaction and reducing psychological burden. Future research might include family in the design of interventions, provide details of the implementation process and have clearly identified outcomes.

Brief description of media:

This slides present information regarding the updated Guidelines for family centered care in 4 sections:
First, the guideline development process focusing on changes and novel approaches taken. Next, the recommendations, sorted not in the order you would find them in the manuscript, but instead by which recommendations are retained from the 2007 Guidelines, and then new recommendations. Tools that were simultaneously developed by a combined team of guidelines writing members and members of a task force from the SCCM Patient/Education Committee,
Finally topics for future research in family centered care: What we know we do not know.

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Today we welcome Giora Netzer M.D., M.S.C.E., Associate Professor of Medicine here at the University of Maryland Medical Center. Dr. Netzer was trained at the great bastion of intensive care medicine, the University of Pennsylvania, where he also earned a master’s degree in clinical epidemiology. Since joining the University of Maryland Pulmonary and Critical Care Medicine department he has proven to be one the greatest minds the ICU has to offer, earning him the title: Wiki-Netzer. His passion for knowledge led to his appointment as the Director of Clinical Research and has yielded a tremendous breadth of publications. Today he focuses on his true passion: how to assist family members care for their loved ones both in the ICU and in the post-ICU setting. Trust me, this is a topic that is often overlooked and one that can truly mean life or death for your patients! You cannot miss it!!

Brief description of media:

Bedside rounds have evolved concurrently with hospitalist medicine and patient-centered care. Family-centered rounds are the foundation of effective communication in the in-patient pediatric setting. Participant perspectives (family members, patients, nurses, faculty, and trainees) on family-centered rounds differ and goals may not always align. Further, the practical components of how rounds are conducted varies and have continued opportunities for improvement. This article summarizes the most recent experience with rounds in an attempt to identify unified and effective strategies moving forward.

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At least one in ten patients experience ongoing symptoms three months after Covid-19 infection – with the most commonly reported problem being fatigue, a wide-ranging review has found.

In its second review of the evidence, a team at the National Institutes for Health Research (NIHR) said that figure may well increase and long Covid was affecting people’s ability to work as well as their finances and relationships.

In a survey of more than 3,000 patients done to support the NIHR review, a third said they had not been able to access all the healthcare they felt they needed.

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You didn’t die. You battled COVID-19 in intensive care for more than a week. You were on a ventilator but pulled through. Now you are disabled.

This will happen to a significant number of people who discharge home after fighting COVID-19. It is typical of the course that post-intensive care syndrome (PICS) takes by creating or worsening physical impairment as well as causing cognitive and psychological impairment among patients who have been critically ill.

Neuromuscular weakness is the most common form of physical impairment that individuals acquired during a stay in the ICU, with more than 25% having poor mobility, recurrent falls, or quadri or tetra paresis.

Physical symptoms often resolve within 12 months after discharge from an acute care setting. However, research shows that ICU-acquired weakness can last as long as 24 months.

Brief description of media:

To describe the duration of fever, fever management, and outcomes among intensive care patients with fever and known or suspected infection. Prospective observational trial in three tertiary intensive care units over 6 weeks in 2010. Adult patients were screened for eligibility and inclusion if they had a fever of ≥38.0°C and known or suspected infection being treated with antimicrobials; those with neurological injury or elective surgery within 72 hours were excluded. Mean and peak daily temperatures were recorded and the use of antipyretics and other cooling measures were recorded over the first 7 days. Mortality, ICU-free survival, ventilator-free survival and renal replacement therapy-free survival were determined at Day 28. 51/565 patients (9.0%) were included. The mean daily peak temperature and the proportion of patients with a documented temperature of ≥38.0°C decreased over the first 3 days after first documented fever. Thereafter, the proportion of patients who had daily peak temperatures ≥38.0°C remained about 20%. Paracetamol was administered to 58%-70% of patients per day. Physical cooling was used at least once for 12% of patients. Mean ICU-free survival to Day 28 in eligible patients was 16.0 (SD, 9.2) days. The mortality rate of eligible patients was more than double that of ineligible patients (8/51 [16%] v 36/514 [7%]; P = 0.05). We have described the typical time course of fever in an easily identified cohort of patients with known or suspected infection and have determined that these patients have significant morbidity and mortality. This information is vital to the design of interventional studies for the treatment of fever in ICU.