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This review compared standard parenteral nutrition (PN) with standard enteral nutrition (EN) in critically ill patients. Reduced mortality was associated with PN but only in comparison with delayed EN. More infectious complications were noted with PN, although their clinical importance was unclear. The conclusions appear reliable, but the authors highlighted the need for higher quality studies to confirm their findings.

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Introduction
Engaging patients and family members as partners in research increases the relevance of study results and enhances patient-centered care; how to best engage patients and families in research is unknown.
Methods
We tested a novel research approach that engages and trains patients and family members as researchers to see if we could understand and describe the experiences of patients admitted to the intensive care unit (ICU) and their families. Former patients and family members conducted focus groups and interviews with patients (n = 11) and families of surviving (n = 14) and deceased (n = 7) patients from 13 ICUs in Alberta Canada, and analyzed data using conventional content analysis. Separate blinded qualitative researchers conducted an independent analysis.
Results
Participants described three phases in the patient/family “ICU journey”; admission to ICU, daily care in ICU, and post-ICU experience. Admission to ICU was characterized by family shock and disorientation with families needing the presence and support of a provider. Participants described five important elements of daily care: honoring the patient’s voice, the need to know, decision-making, medical care, and culture in ICU. The post-ICU experience was characterized by the challenges of the transition from ICU to a hospital ward and long-term effects of critical illness. These “ICU journey” experiences were described as integral to appropriate interactions with the care team and comfort and trust in the ICU, which were perceived as essential for a community of caring. Participants provided suggestions for improvement: 1) provide a dedicated family navigator, 2) increase provider awareness of the fragility of family trust, 3) improve provider communication skills, 4) improve the transition from ICU to hospital ward, and 5) inform patients about the long-term effects of critical illness. Analyses by independent qualitative researchers identified similar themes.
Conclusions
Patient and family member-led research is feasible and can identify opportunities for improving care.

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For years it has been known that many patients who survive critical illness do not return to their original state of health, resulting in long-term consequences of critical illness. Weakness acquired in the intensive care unit (ICU) is a physical consequence occurring in 25% to 80% of patients who receive mechanical ventilation for more than 4 days and in 50% to 75% of patients with sepsis. Nearly all patients affected with ICU-acquired weakness have symptoms that persist years later. Issues with cognitive function occur in 30% to 80% of ICU survivors and include memory, planning, problem-solving, visual-spatial, and processing problems. Cognitive consequences may improve during the months after discharge. However, 25% of patients with adult respiratory distress syndrome (ARDS) have long-term persistent cognitive impairment 6 years after discharge. In several studies,1-3 survivors of severe sepsis who were more than 65 years of age still had cognitive impairment 8 years after hospital discharge. Anxiety, depression, and sleep disturbances can last from months to years. Survivors also experience post traumatic stress disorder (PTSD) long-term, with an incidence between 10% and 50% and persisting for up to 8 years. Follow-up studies longer than 8 years have not been reported, and for some survivors, these consequences of critical illness may not resolve.

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The Patient Communicator app by the Society of Critical Care Medicine is designed to improve communication among patients, families, and caregivers. The app can help ease the stress of a hospital stay.

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This guide is for:
• People who have survived a frightening medical experience, such as being admitted to
critical care (intensive care).
• People who have been hospitalized with severe medical problems related to COVID-19.
• Their family and friends.
• Mental health and medical professionals who want to understand more about how to help.
If you have had any of the experiences described in this guide, you might find some of the examples ‘triggering’ or upsetting. Remember that there is nothing in this guide which can harm you, and that learning about what has happened (and is still happening) to you can help your recovery. We suggest that you read it slowly in sections, and that if you find it too overwhelming to approach it with the help of a health professional.

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The guide gives information about: How you might feel after spending time in intensive care. Psychoeducation about PTSD. Things about intensive care that can contribute to the development of PTSD. Information about delirium. Psychological approaches to treating PTSD. Signposting to evidence-based treatment. Information for mental health professionals working with patients who have PTSD following admission to intensive care.

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This Facilitator’s Guide contains an overview of each video, strategies to create an environment in which the learners are allowed to reflect openly and recognize
good and poor communication, a template for showing the video, suggestions for facilitating debriefing discussions, and additional questions to facilitate conversation on specific elements addressed in each video.

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Background:Because critical illness survivors frequently experience several long-term psychological impairments altering quality of life after ICU, there is a trend towards increasing follow-up care, mainly via ICU follow-up clinics.Despite these and other initiatives, understanding of patient’s post-ICU needs to help them cope with their problems and subsequently improve quality of life is largely lacking. Our aim was therefore to assess the needs,expectations and wishes in ICU survivors to receive information with the purpose to help them better grasp ICU treatment. In addition, we assessed the perceived burden of psychological trauma after ICU treatment and the health-related quality of life (HRQoL) up to 2.5 years after ICU discharge.
Methods:In a multicentre, retrospective cross-sectional cohort study, the needs and preferred intervention methods were assessed using a self-composed inventory in adult mechanically ventilated ICU survivors (n= 43). Additionally, the Impact of Event Scale Revised, the Beck Depression Inventory, the EuroQol-5D-5L, and the Short-Form 12 were used to assess psychological burden and HRQoL.
Results:A substantial proportion of all ICU survivors (59%, 95% CI 44% to 74%) suffered from psychological impairments after ICU treatment. Seventy-five percent of these patients expressed a wish to receive information,but only 36% desired to receive this information using a commonly used information brochure. In contrast, 71% of these patients had a wish to receive information using a video film/VR. Furthermore, only 33% of these patients was satisfied with the information provided by their treating hospital. Patients with psychological PICS reported aworse HRQoL as compared to a normative Dutch sample (P< 0.001) and as compared to patients without psychological PICS (P< 0.01).
Conclusions:In a Dutch cohort of critical illness survivors, a substantial part of ICU survivors suffer from psychological impairments, such as PTSD and depression, which was associated with a worse HRQoL. These patients are in need of information, have no desire using an information brochure, but are willing to receive information using a video film/virtual reality module. These results support the exploration of such an intervention.

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Throughout the coronavirus pandemic, public attention has mainly focused on the number of people who become severely ill and die from COVID-19. But what's become clear in recent months is the large and growing group of people who continue to deal with prolonged symptoms long after their original illness.
In a recent study posted on the preprint server medRxiv, analysis of an international survey of more than 3,700 respondents with COVID-19 found that over two-thirds were still experiencing numerous symptoms at 6 months, with significant impacts on patients' lives and livelihoods. Respondents with symptoms for more than 6 months said they are experiencing an average of nearly 14 symptoms across multiple organ systems.

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Critical care units’ nurses should seek to develop collaborative relationships with patients’ family members based
on their needs and help them to cope with their distress. Te objective of this study was to fnd out the perception of nurses on
needs of family members of patients admitted to critical care units.

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The authors concluded that elective percutaneous dilatational tracheostomy is associated with significantly fewer wound infections than surgical tracheostomy in critically ill adults, and may also reduce bleeding and mortality (compared with surgical tracheostomy performed in the operating theatre). The quality of the primary studies was limited and outcome definitions differed widely. However, the review was well-conducted and these conclusions appear reliable.

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The purpose of this Framework for Practice is to assist decision-making relating to perinatal care and preterm delivery at 26 weeks and 6 days of gestation or less in the United Kingdom.
This framework was developed in collaboration with Bliss, BMFMS, MBRRACE-UK, the NNA, RCOG, RCPCH and Sands.