Brief description of media:

This NICE Pathway covers diagnosis and management of bacterial meningitis and meningococcal septicaemia in children and young people (under 16 years) in primary and secondary care.
Meningococcal disease is the leading infectious cause of death in early childhood. It most commonly presents as bacterial meningitis (15% of cases of N meningitidis) or septicaemia (25% of cases), or as a combination of the two presentations (60% of cases).
The epidemiology of bacterial meningitis in the UK has changed dramatically in the past two decades following the introduction of vaccines to control H influenzae type b, serogroup C meningococcus and pneumococcal disease.
The control of meningococcal disease is therefore a priority for clinical management (as well as public health surveillance and control).
Bacterial meningitis and meningococcal septicaemia are managed in different ways, therefore it is important that healthcare professionals are able to recognise them and manage them accordingly.

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Due to advances in critical care medicine, more patients survive their critical illness. However, intensive care unit (ICU) survivors often experience long-term physical, cognitive and mental problems, summarised as post-intensive care syndrome (PICS), impacting their health-related quality of life (HRQoL). In what frequency PICS occurs, and to what extent this influences ICU survivors’ HRQoL, is mostly unknown. The aims of this study are therefore to study the: (1) 5-year patient outcomes, (2) predictors for PICS, (3) ratio between HRQoL of ICU survivors and healthcare-related costs, and (4) care and support needs.

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After long-term hospitalization or ICU treatment, COVID-
19 patients are severe functionally impaired. They experience not only physical weakness but may also suffer from problems on the pulmonary, physical, psychosocial and cognitive domain. These domains interact, and the impact on participation varies between patients. Therefore, aftercare should be customized to the patient individual needs. In this article, we present a patient-centred model to tailor treatment in the view of the Dutch healthcare system. This model can be helpful to determine the appropriate treatment for each patient at the
right time in the right setting.

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Five key mechanisms were identified as drivers of improvement back into the ICU: (1) identifying otherwise unseen targets for ICU quality improvement or education programs—new ideas for quality improvement were generated and greater attention paid to detail in clinical care. (2) Creating a new role for survivors in the ICU—former patients and family members adopted an advocacy or peer volunteer role. (3) Inviting critical care providers to the post-ICU program to educate, sensitize, and motivate them—clinician peers and trainees were invited to attend as a helpful learning strategy to gain insights into post-ICU care requirements. (4) Changing clinician’s own understanding of patient experience—there appeared to be a direct individual benefit from working in post-ICU programs. (5) Improving morale and meaningfulness of ICU work—this was achieved by closing the feedback loop to ICU clinicians regarding patient and family outcomes.

Brief description of media:

In this multicenter cohort study, one or more PICS problems were present in the
majority of survivors, but co-occurring problems were present in only 1 out of 4. Education was protective from PICS and frailty predictive of the development of PICS. Future studies are needed to understand better the heterogeneous subtypes of PICS and to identify modifiable risk factors.

Brief description of media:

Purpose: Closed endotracheal suctioning (CES) may impact ventilator-associated pneumonia (VAP) risk by reducing environmental contamination. In developing countries where resource limitations constrain the provision of optimal bed space for critically ill patients, CES assumes greater importance.

Brief description of media:

This evidence note, together with evidence note 52 (TAVI for severe symptomatic aortic stenosis in adults at high surgical risk), updates evidence note 38 published in August 20111. It summarises the clinical and cost-effectiveness evidence
from published secondary sources, randomised controlled trials (RCTs) and economic evaluations comparing TAVI with medical management in adults with severe symptomatic AS who are not eligible for surgery. Additional data from the
UK and other European TAVI registries are also included.

Brief description of media:

Purpose: Shortening the duration of antibiotic therapy (ABT) is a key measure in antimicrobial stewardship. The optimal duration of ABT for treatment of postoperative intra-abdominal infections (PIAI) in critically ill patients is unknown.
Methods: A multicentre prospective randomised trial conducted in 21 French intensive care units (ICU) between May 2011 and February 2015 compared the efficacy and safety of 8-day versus 15-day antibiotic therapy in critically ill patients with PIAI. Among 410 eligible patients (adequate source control and ABT on day 0), 249 patients were randomly assigned on day 8 to either stop ABT immediately (n = 126) or to continue ABT until day 15 (n = 123). The primary endpoint was the number of antibiotic-free days between randomization (day 8) and day 28. Secondary outcomes were death, ICU and hospital length of stay, emergence of multi drug-resistant (MDR) bacteria and re operation rate, with 45-day follow-up.
Results: Patients treated for 8 days had a higher median number of antibiotic-free days than those treated for 15 days (15 [6–20] vs 12 [6–13] days, respectively; P < 0.0001) (Wilcoxon rank difference 4.99 days [95% CI 2.99–6.00; P < 0.0001). Equivalence was established in terms of 45-day mortality (rate difference 0.038, 95% CI − 0.013 to 0.061). Treatments did not differ in terms of ICU and hospital length of stay, emergence of MDR bacteria or re-operation rate, while subsequent drainage between day 8 and day 45 were observed following short-course ABT (P= 0.041).
Conclusion: Short-course antibiotic therapy in critically ill ICU patients with PIAI reduces antibiotic exposure. Continuation of treatment until day 15 is not associated with any clinical benefit.

Brief description of media:

The case for adopting the E-vita open plus for treating complex aneurysms and dissections of the thoracic aorta, in a carefully selected group of people, is supported by the evidence.
Using the E-vita open plus could remove the need for a second procedure and the associated risk of serious complications, and it should therefore be considered for people:who would otherwise need a 2-stage repair procedure because their aortic disease extends into or beyond the distal part of their aortic arch (into the proximal descending aorta),but who would not need additional intervention (such as stent grafting) in the descending aorta.
The E-vita open plus is estimated to generate cost savings compared with current 2-stage repair from about 2years after the procedure. The estimated cost saving per patient at 5years after the procedure is around £13,334 when compared with 2-stage repair involving open insertion of a vascular graft,£10,225 when compared with 2-stage repair involving endovascular stent grafting and £12,536 when compared with open surgical debranching followed by endoluminal stent grafting. At 10years after the procedure, the estimated cost savings range from around £22,704 to £29,210 across the 3 comparators.

Brief description of media:

The service deals with the management of children with serious tracheal disease in childhood. It is primarily concerned with the treatment of long segment congenital tracheal stenosis (and its associated [60%] lesions), severe tracheo bronchomalacia and a variety of other, rarer pathologies. Management involves assessment of airway disease by bronchoscopy, bronchography, optical coherence tomography, echocardiography, 3-D imaging by computed tomography (CT) and magnetic resonance imaging (MRI). Treatment may involve surgery, for example slide tracheoplasty for tracheal stenosis, or stenting for malacia. Follow up is both by shared care with referring institutions but by annual review at Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH) with anatomic, physiologic and quality of life assessment

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How to register for the intensive care quality improvement programme (ICCQIP), a national intensive care unit infection surveillance programme in England.

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The COVID-19 pandemic has led to unprecedented expansion of and challenge to our critical care services. Undoubtedly, this will require significant planning and re-structuring of dietetic services to ensure that we are able to provide a safe and effective service during this time.This document has been developed by members from the Critical Care Dietitians Specialist Group (CCSG) of the British Dietetic Association taking into account current recommendations for planning and local experiences to date. In the absence of evidence-based guidance in this area, we have drawn upon the experiences and knowledge obtained from those already working with critically ill patients with COVID-19, including our international colleagues.