Brief description of media:

The review assessed whether fast-track treatments for adults at low risk of complications after coronary artery bypass surgery reduce the length of stay in hospital. The authors concluded that a protocol for early tracheal extubation appears essential. The authors did not provide sufficient information about the included studies to justify their conclusions.

Brief description of media:

At the beginning of the Covid-19 pandemic, when we knew ­precious little about the virus, the standard message was most people recover from mild ­infections in two weeks and serious ones in three.

This is clearly not true. NHS England has estimated nearly half of hospital patients need ongoing support.

Their symptoms vary so much over a huge range of intensity and duration that many people feel they’re not being believed and are not getting the support they need.

Brief description of media:

A Dundee ICU doctor hopes more can be done for those leaving intensive care after Covid-19 helped “shine a light” on the trauma suffered.

Brief description of media:

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.

Brief description of media:

Review objective: To determine the relative benefits and harms of treatment with drugs that suppress inflammation, called corticosteroids, given to babies born too early during the first week after birth to prevent lung injury, known as bronchopulmonary dysplasia (sometimes also called chronic lung disease).

Background: Corticosteroids can reduce lung inflammation in newborn babies with bronchopulmonary dysplasia but may produce major adverse effects. Bronchopulmonary dysplasia is a major problem for newborn babies in neonatal intensive care units. Persistent inflammation of the lungs is the most likely cause. Corticosteroid drugs have been used to prevent or treat bronchopulmonary dysplasia through their strong anti‐inflammatory effects.

Study characteristics: We reviewed all clinical trials in preterm babies in which corticosteroids had been given as a medication during the first week after birth, and from which data on the rate of bronchopulmonary dysplasia later in the newborn period were available.

Key results: This review of trials revealed that the benefits of giving systemic corticosteroids to infants starting up to seven days after birth may not outweigh the known adverse effects. However, a particular corticosteroid called hydrocortisone shows promise in improving short‐term outcomes without adversely affecting long‐term neurodevelopment. Beneficial effects of systemic corticosteroids overall included shorter time on the ventilator and less bronchopulmonary dysplasia, but adverse effects included higher blood pressure, bleeding from the stomach or bowel, perforation of the bowel, excessive glucose in the bloodstream, and increased risk of cerebral palsy at follow‐up, particularly in those treated with dexamethasone ‐ another type of corticosteroid. Early use of corticosteroids, especially dexamethasone, to treat or prevent bronchopulmonary dysplasia should be curtailed until additional research has been performed.

Quality of evidence: Overall, the quality of evidence supporting our conclusions was high.

Brief description of media:

This review concluded that early enteral nutrition reduced mortality and pneumonia in critically ill patients, but further research was needed to confirm the findings and their generalisability. Given the poor quality of the evidence, the authors' cautious conclusion for further research appears reasonable.

Brief description of media:

Record Status

This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
CRD summary

This study examined the clinical and economic impact of a mobility protocol, based on physical therapy, versus the usual care, for patients with acute respiratory failure in an intensive care unit. The authors concluded that the protocol led to an earlier start of physical therapy and a shorter hospital stay, without compromising the quality of care or increasing the hospital costs. The clinical analysis was satisfactory, but the economic information was limited. The authors’ conclusions appear to be appropriate.

Brief description of media:

New or worsened disabilities in functional, cognitive, or mental health following an intensive care unit (ICU) stay are referred to as post intensive care syndrome (PICS). PICS has not been described in older adults receiving home care. Our aim was to examine the relationship between length of ICU stay and PICS among older adults receiving home care. We expected that patients in the ICU for 3 days or longer would demonstrate significantly more disability in all three domains on follow-up than those not in the ICU. A secondary aim was to identify patient characteristics increasing the odds of disability.

Brief description of media:

Survivors of critical illness often experience new or worsening impairments of physical, cognitive, and/or mental health, referred to as Post-Intensive Care Syndrome (PICS). Such impairments can be long-lasting and negatively affect survivors’ quality of life. Early rehabilitation in the intensive care unit (ICU), while patients remain on life-support therapy, may reduce the complications associated with PICS. This article addresses evidence-based rehabilitation interventions to reduce the physical and mental health impairments associated with PICS. Implementation of effective early rehabilitation interventions targeting physical impairment requires consideration of five factors: barriers, benefits, feasibility, safety, and resources. Mental health impairments may be addressed by use of the following interventions: use of ICU diaries, early in-ICU psychological interventions, and post-ICU coping skills training. In both cases, a multidisciplinary team-based approach is paramount to successful incorporation of early rehabilitation into routine practice in the ICU.

Brief description of media:

Introduction We examined the effectiveness of early rehabilitation for the prevention of postintensive care syndrome (PICS), characterised by an impaired physical, cognitive or mental health status, among survivors of critical illness.

Methods We performed a systematic literature search of several databases (Medline, Embase and Cochrane Central Register of Controlled Trials) and a manual search to identify randomised controlled trials (RCTs) comparing the effectiveness of early rehabilitation versus no early rehabilitation or standard care for the prevention of PICS. The primary outcomes were short-term physical-related, cognitive-related and mental health-related outcomes assessed during hospitalisation. The secondary outcomes were the standardised, long-term health-related quality of life scores (EuroQol 5 Dimension (EQ5D) and the Medical Outcomes Study 36-Item Short Form Health Survey Physical Function Scale (SF-36 PF)). We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate the quality of evidence (QoE).

Results Six RCTs selected from 5105 screened abstracts were included. Early rehabilitation significantly improved short-term physical-related outcomes, as indicated by an increased Medical Research Council scale score (standardised mean difference (SMD): 0.38, 95% CI 0.10 to 0.66, p=0.009) (QoE: low) and a decreased incidence of intensive care unit-acquired weakness (OR 0.42, 95% CI 0.22 to 0.82, p=0.01, QoE: low), compared with standard care or no early rehabilitation. However, the two groups did not differ in terms of cognitive-related delirium-free days (SMD: −0.02, 95% CI −0.23 to 0.20, QoE: low) and the mental health-related Hospital Anxiety and Depression Scale score (OR: 0.79, 95% CI 0.29 to 2.12, QoE: low). Early rehabilitation did not improve the long-term outcomes of PICS as characterised by EQ5D and SF-36 PF.

Conclusions Early rehabilitation improved only short-term physical-related outcomes in patients with critical illness. Additional large RCTs are needed.

Brief description of media:

Background
Long‐term mechanical ventilation is the most common situation for which tracheostomy is indicated for patients in intensive care units (ICUs). 'Early' and 'late' tracheostomies are two categories of the timing of tracheostomy. Evidence on the advantages attributed to early versus late tracheostomy is somewhat conflicting but includes shorter hospital stays and lower mortality rates.
Objectives
To evaluate the effectiveness and safety of early (≤ 10 days after tracheal intubation) versus late tracheostomy (> 10 days after tracheal intubation) in critically ill adults predicted to be on prolonged mechanical ventilation with different clinical conditions.
Search methods
This is an update of a review last published in 2012 (Issue 3, The Cochrane Library) with previous searches run in December 2010. In this version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 8); MEDLINE (via PubMed) (1966 to August 2013); EMBASE (via Ovid) (1974 to August 2013); LILACS (1986 to August 2013); PEDro (Physiotherapy Evidence Database) at www.pedro.fhs.usyd.edu.au (1999 to August 2013) and CINAHL (1982 to August 2013). We reran the search in October 2014 and will deal with any studies of interest when we update the review.
Selection criteria
We included all randomized and quasi‐randomized controlled trials (RCTs or QRCTs) comparing early tracheostomy (two to 10 days after intubation) against late tracheostomy (> 10 days after intubation) for critically ill adult patients expected to be on prolonged mechanical ventilation.
Data collection and analysis
Two review authors extracted data and conducted a quality assessment. Meta‐analyses with random‐effects models were conducted for mortality, time spent on mechanical ventilation and time spent in the ICU.
Main results
We included eight RCTs (N = 1977 participants). At the longest follow‐up time available in these studies, evidence of moderate quality from seven RCTs (n = 1903) showed lower mortality rates in the early as compared with the late tracheostomy group (risk ratio (RR) 0.83, 95% confidence interval (CI) 0.70 to 0.98; P value 0.03; number needed to treat for an additional beneficial outcome (NNTB) ≅ 11). Divergent results were reported on the time spent on mechanical ventilation and no differences were noted for pneumonia, but the probability of discharge from the ICU was higher at day 28 in the early tracheostomy group (RR 1.29, 95% CI 1.08 to 1.55; P value 0.006; NNTB ≅ 8).
Authors' conclusions
The whole findings of this systematic review are no more than suggestive of the superiority of early over late tracheostomy because no information of high quality is available for specific subgroups with particular characteristics.

Brief description of media:

The study examined the cost-effectiveness of chlorhexidine gluconate-impregnated sponges (CHIGIS) for arterial and central venous catheters for prevention of catheter-related infections in critically ill adults using data from a recent clinical trial. The authors concluded that the CHGIS strategy reduced the rate of MCRI and saved costs from the perspective of an intensive care unit. The analysis was appropriately carried out using a micro-costing approach alongside a randomised controlled trial. The authors’ conclusions appear robust.