Brief description of media:

Objective: To improve quality of life (QOL) in patients at risk for posteintensive care syndrome (PICS).
Patients and Methods: We conducted a mixed-method, prospective, observational, pre-post interven-tional study in an adult medical and mixed medical/surgical/transplant intensive care unit (ICU) at a tertiary academic hospital. Pre intervention included patients admitted from October 1 through October
31, 2016, and postintervention included patients admitted from January 15 through February 14, 2017. First, a multidisciplinary team of stakeholders identified barriers associated with decreased QOL in patients at risk for PICS. Next, interventions were designed and implemented. The effect of interventions was assessed using a mixed-method analysis. The qualitative analysis used a modified grounded theory approach. The quantitative analysis included assessment of preexisting symptoms and risk factors associated with PICS. The 36-Item Short-Form Health Status Survey (SF-36), which surveys physical and mental composite scores, was used to assess QOL.
Results: Barriers identified were lack of awareness and understanding of PICS. Interventions included educational videos, paper and online education and treatment materials, and online and in-person support groups for education and treatment. After interventions, the qualitative analysis found that patients who
participated in the interventions after hospital discharge showed improved QOL, whereas education during hospitalization alone was not effective. The quantitative analysis did not find improvement in QOL, as defined by SF-36 physical or mental composite scores.
Conclusion: Interventions targeted to patients after hospitalization may offer subjective improvement in QOL for those at risk for PICS.

Brief description of media:

This well-conducted review concluded that early extubation appeared safe and was associated with reduction in length of intensive care unit and hospital stay, without adverse effects on mortality or morbidity, after paediatric heart surgery. However, available studies were poor, varied and not suitable to demonstrate a causal effect. These conclusions are likely to be reliable.

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Hypothesis: Restrictive albumin use guidelines in the surgical intensive care unit (SICU) will not increase mortality and will result in cost savings.

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Objective: To conduct a systematic review and meta analysis of the prevalence, risk factors, and prevention/treatment strategies for post traumatic stress disorder symptoms in critical illness survivors.

Brief description of media:

The Intensive Care Unit (ICU) is situated in the Ulster Hospital in Dundonald, Belfast. The hospital is the major acute hospital for the South Eastern Health and Social Care Trust and delivers a full range of acute services for the population. Staff had noticed that ICU patients and their relatives returning to the follow up clinic were describing concerning issues including nightmares, sleep deprivation, hallucinations and flashbacks. These contributed to them being unable to adjust to being home and leading a regular family life, creating stress for both the patient and their family. To build on the work of the follow up clinic and to further improve the psychological support for patients, staff thought that a possible solution was the introduction of patient diaries.

Brief description of media:

Delirium is an acute deterioration in mental functioning arising over hours or days that is triggered mainly by acute medical illness, surgery, trauma, or drugs. It was previously termed ‘acute confusional state’. Delirium is independently linked with poor outcomes including medical complications, falls, increased length of hospital stay, new institutionalisation, and mortality.It can cause significant patient and carer distress.
The main features of delirium are acute cognitive deficits and altered level of arousal, with up to half of patients also experiencing hallucinations or delusions. Delirium varies in duration, mostly resolving within days, but in some people it can last weeks or months.
Delirium is among the most common of medical emergencies. A UK study found a prevalence of 20% in adult acute general medical patients. The prevalence is higher in particular clinical groups, such as patients in intensive care units (ICU). It affects up to 50% who have hip fracture and up to 75% in intensive care. Several predisposing factors increase the risk of delirium, including older age, dementia, frailty, the presence of multiple comorbidities, male sex, sensory impairments, a history of depression, a history of delirium, and alcohol misuse.
Despite its importance, there are deficiencies in care of people with delirium in Scotland. It is underdiagnosed, and the treatment of patients with established delirium is variable. Preventative measures can reduce the incidence of delirium, yet few clinical units have formal delirium risk-reduction programmes.
Experience gained from quality improvement programmes in Scotland shows that advances can be made. There is potential to improve clinical practice by reducing variation in the standards of assessment and management of people with delirium. This new national guideline on delirium provides a critical focal point for Scotland-wide improvements in delirium care. Because delirium is so common, all healthcare staff having contact with acutely unwell patients need to assume responsibility for detecting and treating it, as well as aiming to reduce the risk of delirium occurring. Those working in the long-term care environment should be able to recognise delirium, reduce risk, and monitor those in their care to resolve delirium.

Brief description of media:

Aim: To describe a randomized controlled trial protocol designed to evaluate the effectiveness of mobile health based Preterm Home Care Program (mHealthPHCP) known as "NeoRaksha" mobile health application in improving parent-infant-interaction, growth and development of preterms.

Brief description of media:

Background and purpose: Aspiration of secretions containing bacterial pathogens into the lower respiratory tract is the main cause of ventilator-associated pneumonia. Endotracheal tubes with subglottic secretion drainage can potentially reduce this and, therefore, the incidence of ventilator-associated pneumonia. New evidence on subglottic secretion drainage as a preventive measure for ventilator-associated pneumonia has been recently published and to consider the evidence in totality, we conducted an updated systematic review and meta-analysis.

Brief description of media:

This publication discusses the utility of chest radiographs and chest ultrasound (US) in the intensive care unit (ICU)setting. The intentions for routine daily portable chest radiographs—patient monitoring; documenting the course of disease for which radiographs are obtained after specific procedures or following insertion of tubes and lines, suchas endotracheal, nasogastric (orogastric), and chest tubes; placement of pulmonary artery and central venouscatheters (CVCs); and chest tube removal—are addressed.

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Open abdominal management with negative-pressure wound therapy (NPWT) is increasingly used for critically ill trauma and surgery patients. We sought to determine the comparative efficacy and safety of NPWT versus alternate temporary abdominal closure (TAC) techniques in critically ill adults with open abdominal wounds.

Brief description of media:

Background Early physical rehabilitation in the intensive care unit (ICU) has been shown to improve short-term clinical outcomes but long-term benefit has not been proven and the optimum intensity of rehabilitation is not known.

Methods We conducted a randomised, parallel-group, allocation-concealed, assessor-blinded, controlled trial in patients who had received at least 48 hours of invasive or non-invasive ventilation. Participants were randomised in a 1:1 ratio, stratified by admitting ICU, admission type and level of independence. The intervention group had a target of 90 min physical rehabilitation per day, the control group a target of 30 min per day (both Monday to Friday). The primary outcome was the Physical Component Summary (PCS) measure of SF-36 at 6 months.

Results We recruited 308 participants over 34 months: 150 assigned to the intervention and 158 to the control group. The intervention group received a median (IQR) of 161 (67–273) min of physical rehabilitation on ICU compared with 86 (31–139) min in the control group. At 6 months, 62 participants in the intervention group and 54 participants in the control group contributed primary outcome data. In the intervention group, 43 had died, 11 had withdrawn and 34 were lost to follow-up, while in the control group, 56 had died, 5 had withdrawn and 43 were lost to follow-up. There was no difference in the primary outcome at 6 months, mean (SD) PCS 37 (12.2) in the intervention group and 37 (11.3) in the control group.

Conclusions In this study, ICU-based physical rehabilitation did not appear to improve physical outcomes at 6 months compared with standard physical rehabilitation.

Brief description of media:

A significant proportion of people in England and Wales would wish to donate their organs after death for the purpose of transplantation. This guideline recognises the complexities that arise owing to the majority of potential organ donors lacking the capacity to be directly involved in decision making at the time of their death. This guideline seeks to promote the identification and fulfilment of these wishes through:
• more effective and expedient identification and referral of potential organ donors
• a more informed, considered and timely approach to consent for donation that is based primarily on identifying the wishes of the individual whenever known and however recorded.