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Background: Clinical benefits of recruitment maneuver in ARDS patients are controversial. A number of previous studies showed possible benefits; a large recent study reported that recruitment maneuver and PEEP titration may even be harmful. This meta-analysis was designed to compare the clinical utility of recruitment maneuver with low tidal volume ventilation in adult patients with ARDS.

Methods: Randomized controlled trials comparing recruitment maneuver and lung protective ventilation strategy with lung protective strategy ventilation protocol alone in adult patients with ARDS has been included in this meta-analysis. PubMed and Cochrane Central Register of Controlled Trials were searched from inception to 10 November 2017 to identify potentially eligible trials. Pooled risk ratio (RR) and standardized mean difference (SMD) were calculated for binary and continuous variables respectively.

Results: Data of 2480 patients from 7 randomized controlled trials have been included in this meta-analysis and systemic review. Reported mortality at the longest available follow-up [RR (95% CI) 0.93 (0.80, 1.08); p = 0.33], ICU mortality [RR (95% CI) 0.91 (0.76, 1.10); p = 0.33] and in-hospital mortality [RR (95% CI) 0.95 (0.83, 1.08); p = 0.45] were similar between recruitment maneuver group and standard lung protective ventilation group. Duration of hospital stay [SMD (95% CI) 0.00 (- 0.09, 0.10); p = 0.92] and duration of ICU stays [SMD (95% CI) 0.05 (- 0.09, 0.19); p = 0.49] were also similar between recruitment maneuver group and standard lung protective ventilation group. Risk of barotrauma was also similar.

Conclusion: Use of recruitment maneuver along with co-interventions such as PEEP titration does not provide any benefit in terms of mortality, length of ICU, and hospital stay in ARDS patients.

Keywords: ARDS; Open lung; PEEP titration; Recruitment maneuver.

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Reduced use of resources by early tracheostomy in ventilator-dependent patients with blunt trauma. Surgery 1998; 124(4): 763-766StatusThis 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.CRD summaryIndexing statusSubject indexing assigned by NLMIndex termsAdult; Female; Health Resources /economics /utilization; Hospital Charges; Humans; Intensive Care Units /economics /utilization; Length of Stay; Male; Middle Aged; Respiration, Artificial /adverse effects /economics; Retrospective Studies; Time Factors; Tracheostomy /adverse effects /economics; Wounds, Nonpenetrating /therapy

Brief description of media:

Reduced use of resources by early tracheostomy in ventilator-dependent patients with blunt trauma. Surgery 1998; 124(4): 763-766StatusThis 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.CRD summaryIndexing statusSubject indexing assigned by NLMIndex termsAdult; Female; Health Resources /economics /utilization; Hospital Charges; Humans; Intensive Care Units /economics /utilization; Length of Stay; Male; Middle Aged; Respiration, Artificial /adverse effects /economics; Retrospective Studies; Time Factors; Tracheostomy /adverse effects /economics; Wounds, Nonpenetrating /therapy

Brief description of media:

Introduction Acute kidney injury (AKI) is a well-recognised complication of critical illness which is of crucial importance for morbidity, mortality and health resource utilisation. Renal replacement therapy (RRT) inevitably entails an escalation of treatment complexity and increases costs for those patients with severe AKI. However, it is still not clear whether regional citrate anticoagulation or systemic heparin anticoagulation for continuous RRT (CRRT) is most appropriate. We hypothesise that, in contrast to systemic heparin anticoagulation, regional citrate anticoagulation for CRRT prolongs filter life span and improves overall survival in a 90-day follow-up period (coprimary endpoints).

Methods and analysis We will conduct a prospective, randomised, multicentre, clinical trial including up to 1450 critically ill patients with AKI requiring CRRT. We suggest to investigate the effect of regional citrate anticoagulation for CRRT as compared with systemic heparin anticoagulation. The two coprimary outcomes are filter life span and overall survival in a 90-day follow-up period. Secondary outcomes are length of stay in the intensive care unit; length of hospitalisation; duration of CRRT; recovery of renal function at days 28, 60, 90 and 1 year; requirement for RRT after days 28, 60, 90 and 1 year; 28 days, 60 days, 90 days and 1-year all-cause mortality; major adverse kidney events at days 28, 60, 90 and 1 year; bleeding complications; transfusion requirements; infection rate and costs of RRT. Additionally, in an add-on study involving several of the participating centres, blood samples from recruited patients will be collected at different time points to analyse whether the anticoagulation strategy has an impact on immune response as evidenced by leucocyte recruitment and function.
Ethics and dissemination The RICH trial has been approved by the Federal Institute for Drugs and Medical Devices, the leading Ethics Committee of the University of Münster and the corresponding Ethics Committee at each participating site.

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Covid-19 has raised public awareness about critical illness, but there has been less focus on establishing the services and infrastructure required to support patients in their recovery after hospital discharge. The burden experienced by patients who survive critical illness is well documented. The symptoms are collectively known as post-intensive care syndrome and can include long term physical impairments such as muscle weakness, weight loss, breathlessness ; cognitive impairment such as problems with memory, attention, and executive function ; and psychological symptoms such as depression or anxiety. Those recovering from covid 19 are also more likely have additional respiratory sequelae. Furthermore, deficits in quality of life can persist for up to 12 years after critical illness with many people unable to return to work. Families of patients can also be deeply affected by their experience.

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This document sets out the BSRM’s recommendations for rehabilitation services for adults aged 16 years and over in the wake of the Covid-19 pandemic - in particular, the role of specialist rehabilitation to support patients with more complex rehabilitation needs.

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High-pitched alarms beep sporadically. A ventilator wheezes. You have an IV line stuck in your arm, a breathing tube down your throat, and a catheter in your urethra. As a patient in a hospital intensive care unit, chances are good that you feel helpless, scared, and confused. Odds are also good, new research shows, that the ordeal could trigger mild to severe depression.

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Define Post‐Intensive Care Syndrome (PICS),
associated risk factors, and long term
consequences
Recognize available resources to address PICS
through education, therapy, and support groups
Integrate knowledge into practice to guide at risk
patients/families towards available resources

Brief description of media:

Millions of patients are admitted to intensive care units (ICUs) each year, one third of whom need a machine to help them breathe (ventilator). These critically ill patients may develop health problems related to their illness, injury, ventilator or other treatments. Such problems cannot be totally prevented and can continue after the patient leaves the hospital. Delirium, acute respiratory distress syndrome, and sepsis increase the chances of these problems occurring. They, too, may not always be prevented.

If you are an ICU patient or family member, this guide helps you understand the health problems known as post-intensive care syndrome, or PICS, so you know what to look for when you return home. It also includes tips on how to minimize PICS. Many people develop PICS, and help is available. You will have the best chance of recovery if you explain your health problems to your primary care doctor, who can refer you to the specialists you need.

Brief description of media:

The Intensive Care Unit (ICU) of a hospital is where very sick patients are treated, and are are sometimes put on a ventilator, or breathing machine, to survive. The illness or injury, and even the treatments you received in the hospital while in the ICU, can often cause health problems that exist long after you have returned home. Recognize the signs and seek help as soon as you can so you can make a more complete recovery. Ask your medical provider if you need guidance finding specialized professionals who can help

Brief description of media:

This article stresses four main questions about PICS: What is post intensive care syndrome (PICS), Who gets post-intensive care syndrome (PICS), What are the symptoms of post-intensive care syndrome (PICS), and What causes post-intensive care syndrome (PICS).

Brief description of media:

Advances in critical care medicine have led to improved outcomes; as a result, most patients will survive their critical illness episode. However, many survivors do not return to their pre critical illness functional levels. Rather, survivors of critical illness often experience impairments in cognition, mental health, and physical health that endure. Research over the past 2 decades has increased our knowledge and awareness of these morbidities after critical illness. Post–intensive care syndrome (PICS), a term coined in 2012 to raise awareness of these impairments, is common after critical illness. Specifically, 34% of patients who experience shock and/or require invasive mechanical ventilation experience cognitive impairment at 12 months at a level consistent with moderate traumatic brain injury.
Symptoms of anxiety, depression, and/or posttraumatic stress disorder (PTSD) afflict approximately 25% of survivors of critical illness, and 27% of survivors are physically impaired at 1 year after critical illness. Together, 56% of survivors experience a new, enduring impairment in 1 or more of these domains, and 21% experience 2 or more impairments at 1 year.
Similarly, findings from a small telephone-based study that used patient report of problems found that 54% of patients developed impairments and 56% of patients had 2 or more impairments after critical illness. Related to the 3 domains that define PICS—impairments in cognition, mental health, and physical health survivors experience a myriad of challenges and functional impairments, including pulmonary dysfunction, particularly among survivors of acute respiratory distress syndrome (ARDS); chronic pain; sexual dysfunction; and functional disability related to contractures.These impairments contribute to the reduced health-related quality of life that has been observed among survivors of critical illness as well as the inability to return to full-time employment.