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The purpose of this website is to provide residents with quick online access to information that will help during your ICU/CCU rotations.

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For people rendered critically ill by coronavirus, the road to recovery will be long and difficult.
Doctors are already weighing up the the aftermath of COVID-19, and how the NHS and social care can help survivors fully rehabilitate.
Even though the UK is more than three months into the health crisis, experts can’t confidently say what the long-lasting impact of Covid will be for some survivors.
Like other people who have been critically ill in intensive care, recovery from the physical and psychological trauma of the virus will be another battle for some patients.
Dougal Atkinson is a consultant in Anaesthesia and Intensive Care Medicine at the Manchester Royal Infirmary (MRI), part of Manchester University NHS Foundation Trust.
For the last three months Dr Atkinson has been working on the frontline of the pandemic caring for Covid patients in the MRI's intensive care unit (ICU).
Dr Atkinson says it can take months for anyone who has been critically ill to recover from the physical and mental strains put on the body while in intensive care.

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Many patients admitted to intensive care units (ICU) for health complications related to the new coronavirus have experienced hospital delirium, a condition that causes hallucinations, confusion and other cognition issues.

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It has long been known that patients with inflammatory bowel disease (IBD) are at higher risk of systemic throm-boembolism than is the general population. In fact, patients with both ulcerative colitis (UC) and Crohn’s disease (CD) have a 3- to 4-fold higher number of throm-boembolic events including pulmonary embolism and a 6-fold higher incidence found at autopsy.1 It has been hypothesized that prothrombotic genetic variants may be more prevalent in IBD patients than in the general population. Bernstein et al identified 492 IBD patients from the Manitoba IBD Research Registry and 412 controls from Manitoba Health’s administrative data-base. Subjects filled out questionnaires and their records were reviewed to determine their demographics, diagnosis, environmental factors, family history, smoking history, IBD phenotype, and extent and location of disease. All participants donated blood for genetic analysis, and most were contacted 2 years after venipuncture to update their history of throm-boembolic events. Subjects’ blood was analyzed for the 4 most common genetic mutations associated with the risk of thrombosis.

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Patients in the surgical intensive care unit (ICU) frequently undergo laboratory and imaging testing. These tests can lead to iatrogenic anemia and radiation exposure. Many of these tests may be unnecessary for the management of a patient’s illness in the surgical ICU, and their ordering may be a reflex rather than in response to a clinical question. Checklists have been used in critical care to identify and address patient care strategies.

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Bronchiolitis obliterans syndrome (BOS) is a form of chronic graft vs. host disease (cGVHD) and a highly morbid pulmonary complication after allogeneic hematopoietic stem cell transplantation (HSCT). We assessed the prevalence and risk factors for BOS and cGVHD in a cohort of HSCT recipients, including those who received reduced intensity conditioning (RIC) HSCT. Between January 1, 2000 and June 30, 2010, all patients who underwent allogeneic HSCT at our institution (n 5 1854) were retrospectively screened for the development of BOS by PFT criteria. We matched the BOS cases with two groups of control patients: (1) patients who had concurrent cGVHD without BOS and (2) those who developed neither cGVHD nor BOS. Comparisons between BOS patients and controls were conducted using t-test or Fisher’s exact tests. Multivariate regression analysis was performed to examine factors associated with BOS diagnosis. All statistical analyses were performed using SAS 9.2. We identified 89 patients (4.8%) meeting diagnostic criteria for BOS at a median time of 491 days (range: 48–2067) after HSCT. Eighty-six (97%) of our BOS cohort had extra-pulmonary cGVHD. In multivariate analysis compared to patients without cGVHD, patients who received busulfan-based conditioning, had unrelated donors, and had female donors were significantly more likely to develop BOS, while ATG administration was associated with a lower risk of BOS. Our novel results suggest that busulfan conditioning, even in RIC transplantation, could be an important risk factor for BOS and cGVHD.
Am. J. Hematol. 89:404–409, 2014. VC 2013 Wiley Periodicals, Inc.

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The purpose of this analysis is to describe the safety of propofol administration in adult ECMO patients. We performed a prospective cohort analysis of patients utilizing ECMO at Brigham and Women’s Hospital between February 2013 and October 2015. Patients were included if they utilized ECMO for at least 48 hours. The major endpoint of the analysis was the median oxygenator lifespan. Oxygenator exchanges were analyzed by the number of patients requiring
an oxygenator exchange and the number of oxygenator exchanges per ECMO day. A priori analysis was performed comparing outcomes between patients who did and did not receive propofol during their ECMO course. During the study, 43 patients were included in the analysis. Sixteen patients utilized propofol during their ECMO course. There were 12 oxygenator exchanges during therapy. Oxygenator exchange occurred on 1.8% of ECMO days. The median oxygenator lifespan was 7 days. Patients who utilized propofol had a significantly longer
oxygenator lifespan (p=0.02). Among patients who received propofol, patients who required oxygenator exchange utilized a significantly lower median daily dose of propofol (p<0.001). The use of propofol appears safe in ECMO with regards to oxygenator viability. Contrary to expected, oxygenator lifespan was significantly longer among patients who received propofol.

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Critically ill patients need advanced support to remain alive and prevent serious
complications. However, patients may experience either pleasant or unpleasant memories during their stay in ICU. Unpleasant experiences can affect patients or lead to later negative consequences. Critical care nurses have a pivotal role in identifying traumatic experiences in order to improve care. This study aims to explore the intensive care experiences among ICU survivors. This study was conducted in the general wards of three selected hospitals in Malaysia. One hundred and forty-two(142) participants agreed to take part in this study and to answer the Intensive Care Experience Questionnaire (ICEQ) which included additional questions that covered four domains: awareness of surroundings, frightening experiences, recall of experiences, and satisfaction with care. There sults of the study were as follows: Half of the samples reported a high awareness of their surroundings. The less aware group reported not being aware of people, place and time. About70% (67.6%)of the samples reported high levels of frightening experiences.Pain experienced by the participants came from medical procedures or by the disease process. Only 17.6% of the samples reported being able to recall precisely what happened in the ICU.Participants recalled seeing scary things but having enough sleep in the ICU.The results showed that43.0% reported being highly satisfied with their care, and claimed that the staff waskind and delivered the best care to patients.This result indicates that critically ill patients, especially in the ICU,need strong support physically and psychologically in order to minimize unpleasant experiences and, later, negative consequences by providing a conducive environment and care with sympathetic concern.

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Flolan (iFLO) and Veletri (iVEL) are 2 inhaled epoprostenol formulations. There is no published literature comparing these formulations in critically ill patients with refractory hypoxemia.
Objective: To compare efficacy, safety, and cost outcomes in patients who received either iFLO or iVEL for hypoxic respiratory failure. Methods: This was a retrospective, single-center analysis of adult, mechanically ventilated patients receiving iFLO or iVEL for improvement in oxygenation. The primary end point was the change in the PaO2/FiO2 ratio after 1 hour of pulmonary vasodilator therapy.
Secondary end points assessed were intensive care unit (ICU) length of stay (LOS), hospital LOS, duration of study therapy, duration of mechanical ventilation, mortality, incidence of adverse events, and cost.
Results: A total of 104 patients were included (iFLO = 52; iVEL = 52). More iFLO patients had acute respiratory distress syndrome compared with the iVEL group (61.5 vs 34.6%; P = 0.01). There was no difference in the change in the PaO/FiO ratio after 1 hour of therapy (33.04
± 36.9 vs 31.47 ± 19.92; P = 0.54) in the iFLO and iVEL groups, respectively. Patients who received iVEL had a shorter duration of mechanical ventilation (P < 0.001) and ICU LOS (P < 0.001) but not hospital LOS (P = 0.86) and duration of therapy (P = 0.36). No adverse events were attributed to pulmonary vasodilator therapy, and there was no difference in cost.
Conclusions: We found no difference between iFLO and iVEL when comparing the change in the PaO/FiO ratio, safety, and cost in hypoxic, critically ill patients. There were differences in secondary outcomes, likely a result of differences in underlying indication for inhaled epoprostenol.

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Clinical practice guidelines are published and promoted, often by professional societies, because they provide a current and transparently analyzed review of relevant research and are written with the aim to guide clinical practice. The 2018 Pain, Agitation/sedation, Delirium, Immobility (rehabilitation/mobilization), and Sleep (disruption) (PADIS) guidelines first 1) builds on this mission by updating the 2013 PAD guidelines ; 2) by adding two inextricably related clinical care topics (immobility and sleep); 3) by including patients as collaborators and coauthors; and 4) by inviting panelists from high-income countries as an early step toward incorporating more diverse practices and expertise from the global critical care
community.

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ICUs have historically focused on survival as the single most important outcome of critical illness. Recent research has shown that most patient who survive their ICU stay develop a combination of cognitive impairment; emotional problems, including depression, anxiety, and posttraumatic stress disorder; physical weakness; and significant social and financial hardships. Together, this constellation of symptoms has been termed post-intensive care syndrome (PICS). The physical, psychological, and financial burden of caring for patients with PICS has common and predictable effects, including anxiety and depression, on family members of ICU survivors. These effects have been termed PICS-F, for the PICS effect on families.

As understanding has improved of the impact that PICS and PICS-F have on quality of life, critical care providers have started to open specialized clinics to provide and coordinate care for ICU survivors and their families. These clinics are composed of an interdisciplinary team of professionals, including critical care and mental health physicians, nurses, physical and occupational therapists, and social workers. Their ultimate goal is to improve patients’ quality of life, ease caregiver burden on families, and work to restore patients to their prior level of functioning.

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Background. Patients may suffer extreme psychological reactions in intensive care units (ICU), and post-traumatic stress disorder (PTSD) after leaving hospital. Previous systematic reviews of studies up to 2007 found that the true prevalence of and consistent risk factors for PTSD after ICU were not established, due to methodological shortcomings of studies. Therefore we aimed to conduct a systematic review of observational studies of post-ICU PTSD from 2008-2012, and to compare them to 1997-2007 studies, with regard to quality, prevalence estimates and risk factors.
Methods. We used a pre-specified protocol, and systematic, explicit methods to identify, select and critically appraise studies. Studies in general ICU settings with mixed-diagnosis patients (N.>30) were included. Risk of bias was assessed, with lower-risk studies given greater weight. No quantitative synthesis was possible due to heterogeneity, therefore ranges of estimates and frequencies of risk factors were examined.
Results. The review included 26 papers, 13 from 1997-2007 and 13 from 2008-2012. There were more high quality studies in the latter period. The range of prevalence estimates from high-quality studies was similar; 8% to 27% (1997-2007) and 9% to 27% (2008-2012). Clinical risk factors consistently identified over the two periods were use of benzodiazepines, duration of sedation and mechanical ventilation. Psychological risk factors include stress and fear experienced acutely in ICU, and frightening memories of the admission.
Conclusion. The quality and number of post-ICU PTSD studies has increased over time, and we can be more confident in the accumulated findings. Evidence from both periods suggests that up to 27% of ICU survivors suffer from PTSD. There is also increasing evidence that use of benzodiazepines and duration of sedation, along with fear, stress and delirium in the ICU are likely risk factors for subsequent PTSD. (Minerva Anestesiol 2013;79:944-63)