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Objectives: Compared with noncardiac critical illness, critically ill postoperative cardiac surgical patients have different underlying pathophysiologies, are exposed to different processes of care, and thus may experience different outcome trajectories. Our objective was to systematically review the outcomes of cardiac surgical patients requiring prolonged intensive care with respect to survival, residential status, functional recovery, and quality of life in both hospital and long-term follow-up.

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Back in December, I was hospitalized for pneumonia-related Covid-19, which I have been recovering from ever since. I am now officially classified as a Covid survivor. With every breath I take, I am reminded of others who are currently battling this menacing disease. My family and I are extremely fortunate that I was able to survive this dreadful illness, and I am incredibly grateful for all of the true heroes, doctors and nurses, as well as true friends who supported and encouraged me to fight on.
While I am mostly functional, in many ways, I continue to operate below the normal capacity level. Several weeks ago, I felt strong enough to go on long walks, but I managed to work in just under a mile before the post-exertional malaise came on: brain fog, fatigue, palpitations, chest pain and shortness of breath. As a formerly energetic and competitive person in both work and personal life, the impact of this disease managed to turn my world around upside down. There is always a high risk of developing post-intensive care syndrome (PICS), a condition that can include an acquired weakness, cognitive or dysfunction and other health related disorders.

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EVERY YEAR, ABOUT 6 million people are admitted to intensive care units with a life-threatening illness. As medical technology advances, more people survive conditions that once would have been fatal. However, about half of these ICU survivors develop some form of cognitive, psychosocial and physical deficits in a condition known as post-intensive care syndrome, or PICS.

Brief description of media:

Every year, about 6 million people are admitted to intensive care units with a life-threatening illness. As medical technology advances, more people survive conditions that once would have been fatal. However, about half of these ICU survivors develop some form of cognitive, psycho-social and physical deficits in a condition known as post-intensive care syndrome, or PICS.

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A steadily increasing number of patients survive their stay in the Intensive Care Unit (ICU), and a significant percentage become chronic cases. Patient post-intensive care syndrome (PICS-P) is a recently described condition that affects an important number of patients (30---50%). It encompasses the physical (mainly respiratory and neuromuscular), cognitive (memory and attention) and psychological sequelae (depression, anxiety, stress and/or post traumatic stress syndrome)
at discharge from the ICU, and which have a negative impact
upon patient quality of life.

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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.
Health technology

Prophylactic course of antibiotics to cirrhotic patients admitted to an intensive care unit (ICU) with gastrointestinal haemorrhage and high risk of infection. Amoxicillin and clavulanic acid 1 g/200 mg three times daily and ciprofloxacin 200 mg twice daily.

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People usually associate post-traumatic stress disorder with those who survive military combat, major catastrophes or assaults. But critically ill patients who survive an intensive care unit stay are at equally high risk for PTSD

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Key Points
The group has considered new evidence on Transmission of COVID-19 in school children and the treatment Remdesivir.
Measurements from NHS Wales and the Data Monitor show that the infection is slowly receding in Wales and people are broadly complying with the social distancing regulations.
There are several potential Vaccines that are considered viable, and Wales is represented on the new UK Vaccines Taskforce.
There is evidence that Wales now has as many different lineages of the virus as England.

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The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Telemetric adjustable pulmonary artery banding for reducing pulmonary hypertension in infants with congenital heart defects, in November 2014.
January 2018: The device linked to this guidance (FloWatch) is no longer available. NICE would consider whether to issue new guidance on Telemetric adjustable pulmonary artery banding for pulmonary hypertension in infants with congenital heart defects should evidence using an appropriately CE marked device become available.
Description
Congenital heart defects with a left-to-right shunt and excessive pulmonary blood flow can result in pulmonary hypertension and congestive heart failure in the neonatal period. The usual treatment is surgical correction of any defect when the infant is big enough. The most common defects needing this type of treatment include functionally univentricular hearts, transposition of the great arteries and atrioventricular or multiple septal defects. The symptoms include fatigue, dyspnoea, tachypnoea and failure to thrive if the lungs are not protected. Infants may develop a condition of irreversible pulmonary hypertension because of hypertrophy of the pulmonary arterioles.
Pulmonary artery banding (PAB) is a palliative procedure that is used as part of staged treatment before definitive surgical correction of congenital heart defects. The aim of PAB is to reduce the diameter of the main pulmonary artery, decreasing blood flow and reducing pulmonary artery pressure. Improvement of systemic pressure, cardiac output and ventricular function can also be expected in patients with a large left-to-right shunt. Risks of the procedure include lowering of systemic oxygen saturation, ventricular hypertrophy, subaortic obstruction, and pulmonary branch and valve distortion. The conventional technique of PAB involves surgical placement of a (not telemetrically adjustable) band around the main pulmonary artery. Different techniques using a variety of materials (such as strips of polytetrafluoroethylene, polydioxanone or nylon) and sutures are used. In non-adjustable PAB methods, reoperation is often needed to adjust the tightness of the band.

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BACKGROUND: The drainage, irrigation and fibrinolytic therapy (DRIFT) trial, conducted in 2003-6, showed a reduced rate of death or severe disability at 2 years in the DRIFT compared with the standard treatment group, among preterm infants with intraventricular haemorrhage (IVH) and post-haemorrhagic ventricular dilatation.OBJECTIVES: To compare cognitive function, visual and sensorimotor ability, emotional well-being, use of specialist health/rehabilitative and educational services, neuroimaging, and economic costs and benefits at school age.DESIGN: Ten-year follow-up of a randomised controlled trial.SETTING: Neonatal intensive care units (Bristol, Katowice, Glasgow and Bergen).PARTICIPANTS: Fifty-two of the original 77 infants randomised.INTERVENTIONS: DRIFT or standard therapy (cerebrospinal fluid tapping).MAIN OUTCOME MEASURES: Primary - cognitive disability. Secondary - vision; sensorimotor disability; emotional/behavioural function; education; neurosurgical sequelae on magnetic resonance imaging; preference-based measures of health-related quality of life; costs of neonatal treatment and of subsequent health care in childhood; health and social care costs and impact on family at age 10 years; and a decision analysis model to estimate the cost-effectiveness of DRIFT compared with standard treatment up to the age of 18 years.RESULTS: By 10 years of age, 12 children had died and 13 were either lost to follow-up or had declined to participate. A total of 52 children were assessed at 10 years of age (DRIFT, n?=?28; standard treatment, n?=?24). Imbalances in gender and birthweight favoured the standard treatment group. The unadjusted mean cognitive quotient (CQ) score was 69.3 points [standard deviation (SD) 30.1 points] in the DRIFT group compared with 53.7 points (SD 35.7 points) in the standard treatment group, a difference of 15.7 points, 95% confidence interval (CI) -2.9 to 34.2 points; p?=?0.096. After adjusting for the prespecified covariates (gender, birthweight and grade of IVH), this evidence strengthened: children who received DRIFT had a CQ advantage of 23.5 points (p?=?0.009). The binary outcome, alive without severe cognitive disability, gave strong evidence that DRIFT improved cognition [unadjusted odds ratio (OR) 3.6 (95% CI 1.2 to 11.0; p?=?0.026) and adjusted OR 10.0 (95% CI 2.1 to 46.7; p?=?0.004)]; the number needed to treat was three. No significant differences were found in any secondary outcomes. There was weak evidence that DRIFT reduced special school attendance (adjusted OR 0.27, 95% CI 0.07 to 1.05; p?=?0.059). The neonatal stay (unadjusted mean difference £6556, 95% CI -£11,161 to £24,273) and subsequent hospital care (£3413, 95% CI -£12,408 to £19,234) costs were higher in the DRIFT arm, but the wide CIs included zero. The decision analysis model indicated that DRIFT has the potential to be cost-effective at 18 years of age. The incremental cost-effectiveness ratio (£15,621 per quality-adjusted life-year) was below the National Institute for Health and Care Excellence threshold. The cost-effectiveness results were sensitive to adjustment for birthweight and gender.LIMITATIONS: The main limitations are the sample size of the trial and that important characteristics were unbalanced at baseline and at the 10-year follow-up. Although the analyses conducted here were prespecified in the analysis plan, they had not been prespecified in the original trial registration.CONCLUSIONS: DRIFT improves cognitive function when taking into account birthweight, grade of IVH and gender. DRIFT is probably effective and, given the reduction in the need for special education, has the potential to be cost-effective as well. A future UK multicentre trial is required to assess efficacy and safety of DRIFT when delivered across multiple sites.TRIAL REGISTRATION: Current Controlled Trials ISRCTN80286058.FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 4. See the NIHR Journals Library website for further project information. The DRIFT trial and 2-year follow-up was funded by Cerebra and the James and Grace Anderson Trust.

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Mechanical circulatory support (MSC) has made tremendous progress in the past 15 years as thousands of patients worldwide have undergone implantation of long-term MSC devices (MCSDs). Currently, management of patients with MCSDs has been guided by individual clinicians and centre-specific protocols. Short-term success with MCS therapy largely depends on patient selection, surgical technique, and post-operative management. Long-term success depends on physician and patient engagement in care of their device and personal health.

These International Society for Heart and Lung Transplantation guidelines address the following areas:


patient selection for permanent pump implantation

mechanisms that are important for patient optimisation prior to device implantation

intraoperative considerations and immediate post-operative care in the intensive care unit (ICU) setting

inpatient management during the post-operative phase, once the patient is out of the ICU through discharge, and during re-admission to the hospital

long-term outpatient care of  the MCS patient using a multidisciplinary approach

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This article demonstrates the principles of treatment on Respiratory Complications in Poliomyelitis patients through several real cases that patients had been improved by measures usually carried out by the anesthetist during his daily work in the operating room.