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CRD summary

This review concluded that critical care transition programmes appeared to reduce the risk of intensive care unit readmission, for patients discharged to a general hospital ward. This conclusion reflects the evidence and seems reliable; the limitations of the evidence justify the authors' recommendations for research.
Authors' objectives

To compare the impact of programmes for the transition from critical care, versus standard care, on the risks of readmission to the intensive care unit (ICU) or death in adults.

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This guide is for:
• People who have survived a frightening medical experience, such as being admitted to critical care (intensive care).
• People who have been hospitalized with severe medical problems related to COVID-19.
• Their family and friends.
• Mental health and medical professionals who want to understand more about how to help.
If you have had any of the experiences described in this guide, you might find some of the examples ‘triggering’ or upsetting. Remember that there is nothing in this guide which can harm you, and that learning about what has happened (and is still happening) to you can help your recovery. We suggest that you read it slowly in sections, and that if you find it too overwhelming to approach it with the help of a health professional.

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As a result of the current global health crisis, many more people than usual are having serious medical experiences. These include admissions to hospital with breathing difficulties, or transfers to critical care (intensive care) units. A significant proportion of these people will go on to develop symptoms of post-traumatic stress disorder (PTSD).

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This powerpoint briefly introduced the website named criticalcarerecovery.com.

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More than a decade ago, Meredith Mealer embarked on research that has only increased in relevance with the passing years.

The study focused on the prevalence of post-traumatic stress disorder (PTSD) among survivors of acute respiratory distress syndrome, a devastating lung disorder. Mealer, PhD, RN, was then a research coordinator, working on the study with Marc Moss, MD, a pulmonary/critical care physician leading the effort. As Mealer paged through the symptoms patients and families reported – nightmares, high stress, emotional numbing, anxiety attacks – some struck her close to home. Prior to shifting her focus to clinical research, Mealer had been an intensive care unit nurse.

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hese extubation guidelines comprise three algorithms on what to do in the following situations:

basic extubation

low-risk extubation

'at risk' extubation

Their common features are planning, preparation and recovery.

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These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. They have been informed by advances in the understanding of crisis management and emphasise the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimising trauma from airway interventions.

It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. 

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Background: Researchers have seldom included bereaved parents in studies of participants’ views of
randomised controlled trials (RCTs); hence our understanding of the impact of trials is based on skewed
and incomplete samples. Little is known about parental experiences of the death of a child subsequent to
their enrollment in a trial or of provision made for this experience by clinicians and trial teams. The
Bereavement and RAndomised ControlLEd Trials (BRACELET) study was funded to consider bereavement in
the context of paediatric intensive care (PIC) and neonatal intensive care (NIC) trials.

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Decontamination strategies to remove potentially harmful bacteria from the mouth, throat and gut of critically ill patients don’t reduce the risk of intensive care unit-acquired bloodstream infections or deaths from bacteria that were resistant to antibiotics. The study was carried out in 13 intensive care units across Europe, including the UK, with moderate to high levels of antibiotic resistance (extended resistance in more than 5% of all bloodstream infections). This fills an important gap in the evidence as most previous studies have been in units with lower levels of resistant organisms.

Infections with multi-drug resistant gram-negative bacteria are a frequent problem for ventilated patients on intensive care wards. In this trial of 8,665 patients, the use of chlorhexidine mouthwash, selective digestive tract decontamination, or selective mouth and throat decontamination were compared to standard care, involving daily body washings with chlorhexidine and a hand hygiene improvement programme.

The decontamination strategies were not associated with a significant difference in multi-drug resistant bloodstream infections, suggesting that they should not be used in the UK as a strategy to reduce antibiotic resistance in hospitals with similar extended resistance rates.

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Patient and family* engagement in the ICU is an active partnership between health professionals and patients and families working at every level of the healthcare system to improve health and the quality, safety, and delivery of healthcare. Arenas for such engagement include but are not limited to participation in direct care, communication of patient values and goals, and transformation of care processes to promote and protect individual respect and dignity. PFE comprises five core concepts: Collaboration, Respect and Dignity, Activation and Participation, Information Sharing, and Decision Making

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This guide is to help family and friend of the ICU patients to identified if the patients had delirium and how to help them.

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Delirium is a common syndrome experienced by patients with COVID-19 while being treated in the ICU, according to a session at the 2020 ASHP Midyear Clinical Meeting and Exhibition.