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Authors' objectives

To determine the most effective sedation agent used in adult patients with respiratory failure who require mechanical ventilation in the intensive care unit (ICU).

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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
This article compared an analgesia-based sedation regimen with remifentanil and propofol versus a conventional regimen with midazolam and fentanyl in patients requiring postoperative mechanical ventilation in the intensive care unit (ICU) following cardiac surgery. Remifentanil was administered at 6 to 12 microg/kg per hour, or up to a maximum of 60 microg/kg per hour. Propofol supplementation, where required, was given at 0.3 to 1.0 mg/kg per hour, or up to a maximum of 4 mg/kg per hour. The conventional midazolam/fentanyl regimen comprised an initial dose of fentanyl of 1 to 2 microg/kg, followed by a dose of 1 to 2 microg/kg per hour (or up to a maximum of 7 microg/kg per hour) plus an initial dose of 0.03 to 0.2 mg/kg midazolam.

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Background

Ventilator‐associated pneumonia (VAP) is associated with increased mortality, prolonged length of hospital stay and increased healthcare costs in critically ill patients. Guidelines recommend a semi‐recumbent position (30º to 45º) for preventing VAP among patients requiring mechanical ventilation. However, due to methodological limitations in existing systematic reviews, uncertainty remains regarding the benefits and harms of the semi‐recumbent position for preventing VAP.
Objectives

To assess the effectiveness and safety of semi‐recumbent positioning versus supine positioning to prevent ventilator‐associated pneumonia (VAP) in adults requiring mechanical ventilation.

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Post-intensive care syndrome (PICS) is a physical, cognitive, and mental impairment observed in intensive care unit (ICU) survivors. Although this is an emerging problem in the ICU, how sepsis induces the characteristic symptoms of PICS remains unclear. To develop a model of PICS, we induced sepsis in male C57/B6 mice via sublethal cecum slurry injection and subsequently treated them using ICU-like interventions. At 1–2 weeks post-sepsis induction, we simultaneously evaluated the abilities of the surviving mice using the following behavioral tests: (1) a grip strength test (GST) and a treadmill test for physical assessment, (2) a novel object recognition test (NORT) for cognitive assessment, and (3) an open field test (OFT) and a marble burying test (MBT) for mental assessment. The surviving mice showed a range of deficits, including muscle weakness with significantly decreased grip strength in the GST; decreased total mileage during the treadmill test; anxiety and decreased activity, with significantly decreased time in the central area, and increased duration of immobility in the OFT; and an increased number of buried marbles in the MBT. Given these physical and mental impairments in the surviving mice, our model has the potential to elucidate mechanistic insights and to discover therapeutic targets and new interventions for PICS.

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Sepsis, severe sepsis and septic shock are used to describe the systemic inflammatory response of patients to infection, as a continuum of progressive and life threatening severity.  Sepsis is the clinical syndrome defined by the presence of both infection and a systemic inflammatory response. The aim of this guideline is to facilitate the early recognition and appropriate treatment of sepsis in Ireland in order to maximise survival opportunity and minimise the burden of chronic sequelae. The Guideline Development Group recommends the Surviving Sepsis Campaign Guidelines and the Sepsis 6 bundle as the guide to the management of sepsis in Ireland.

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Evidence-based recommendations  on the SepsiTest assay for rapidly identifying bloodstream bacteria and fungi.

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The TaperGuardEvac oral tracheal tube is intended for airway management in critically ill patients needing mechanical ventilation. Two randomised controlled trials comparing the use of TaperGuardEvac with conventional tubes found no statistically significant differences between the groups in the incidence of ventilator-associated pneumonia, time to onset of ventilator-associated pneumonia, or length of intensive care unit stay. Using TaperGuardEvac costs £111.07 (for a box of 10single-use tubes), plus a variety of accessories.

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Background and objectives: Impaired physical functioning is common and long lasting after an intensive care unit (ICU) admission. The 6-minute walk test (6MWT) is a validated and widely used test of functional capacity. This systematic review synthesizes existing data in order to: (1) evaluate 6-minute walk distance (6MWD) in meters over longitudinal follow-up after critical illness, (2) compare 6MWD between acute respiratory distress syndrome (ARDS) versus non-ARDS survivors, and (3) evaluate patient- and ICU-related factors associated with 6MWD.

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Post-traumatic stress disorder (PTSD) is a type of anxiety disorder that the NHS says is caused by “very stressful, frightening or distressing events”, and new research suggests Covid-19 patients admitted to hospital can suffer from it, particularly if they require a ventilator.
The research, published in the journal BJPsych Open from the Royal College of Psychiatrists, looked at 13,049 survivors in the UK who had suspected or confirmed Covid-19.

Brief description of media:

Post-traumatic stress disorder (PTSD) is a type of anxiety disorder that the NHS says is caused by “very stressful, frightening or distressing events”, and new research suggests Covid-19 patients admitted to hospital can suffer from it, particularly if they require a ventilator.

The research, published in the journal BJPsych Open from the Royal College of Psychiatrists, looked at 13,049 survivors in the UK who had suspected or confirmed Covid-19.

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Joy Ezekiel-Gibson and Michael Clark both caught COVID-19 last March during the horrible first wave, when tests were hard to get, when only medical workers wore masks — if they could find them — and when doctors were figuring out on the fly how to treat a brand-new, deadly disease.
Ezekiel-Gibson, 47, of Atco, Camden County, survived 17 days on a ventilator, then needed a second hospitalization for pneumonia and blood clots. Clark, a 32-year-old runner from Philadelphia, fought the virus at home despite serious symptoms. He was afraid to go to the emergency department.

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For most people—about 80%, according to the World Health Organization—COVID-19 won't result in serious illness. But that still means 1 in 5 people who contract the infection will end up with a more severe form of the disease, and will need hospitalization. In the most severe cases—typically in those with underlying conditions like high blood pressure, heart and lung problems, or diabetes—COVID-19 patients may be admitted to a hospital's intensive care unit (ICU), where they can benefit from respiratory support through a ventilator.

According to multiple studies, the majority of patients admitted to the ICU and require ventilation do not survive. Data from the Intensive Care National Audit and Research Center in London shows that, of outcome data available for 690 ICU patients, 346 (or 50.1%) patients died, while 344 (49.9%) were discharged alive. Similar findings were shown in an Italian study published in JAMA: Of 1,581 patients with available ICU disposition data at the end of the study, 920 patients were still in the ICU—but of the remaining 661 patients, 405 (61.3%) died while 256 (38.7%) were discharged.

Of course, being discharged from the ICU is the best-case scenario—but sometimes, even after coming off of respiratory support, hospitalized patients can experience another issue: ICU delirium.