Brief description of media:

Background: Anaemia affects 60-80 % of patients admitted to intensive care units (ICUs). Allogeneic red blood cell (RBC) transfusions remain the mainstay of treatment for anaemia but are associated with risks and are costly. Our objective was to assess the efficacy and safety of iron supplementation by any route, in anaemic patients in adult ICUs.

Methods: Electronic databases (CENTRAL, MEDLINE, EMBASE) were searched through March 2016 for randomized controlled trials (RCT)s comparing iron by any route with placebo/no iron. Primary outcomes were red blood cell transfusions and mean haemoglobin concentration. Secondary outcomes included mortality, infection, ICU and hospital length of stay, mean difference (MD) in iron biomarkers, health-related quality of life and adverse events.

Results: Five RCTs recruiting 665 patients met the inclusion criteria; intravenous iron was tested in four of the RCTs. There was no difference in allogeneic RBC transfusion requirements (relative risk 0.87, 95 % confidence interval (CI) 0.70 to 1.07, p = 0.18, five trials) or mean number of RBC units transfused (MD -0.45, 95 % CI -1.34 to 0.43, p = 0.32, two trials) in patients receiving or not receiving iron. Similarly, there was no difference between groups in haemoglobin at short-term (up to 10 days) (MD -0.25, 95 % CI -0.79 to 0.28, p = 0.35, three trials) or mid-term follow up (last measured time point in hospital or end of trial) (MD 0.21, 95 % CI -0.13 to 0.55, p = 0.23, three trials). There was no difference in secondary outcomes of mortality, in-hospital infection, or length of stay. Risk of bias was generally low although three trials had high risk of attrition bias; only one trial had low risk of bias across all domains.

Conclusion: Iron supplementation does not reduce RBC transfusion requirements in critically ill adults, but there is considerable heterogeneity between trials in study design, nature of interventions, and outcomes. Well-designed trials are needed to investigate the optimal iron dosing regimens and strategies to identify which patients are most likely to benefit from iron, together with patient-focused outcomes.

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The brochure describes the symptoms of people with Delirium, and what the family can do to help.

Brief description of media:

MILAN (Reuters) -Italy reported 502 coronavirus-related deaths on Tuesday against 354 the day before, the health ministry said, while the daily tally of new infections rose to 20,396 from 15,267 the day before.

Brief description of media:

Survivors of critical illness frequently experience a post–intensive care syndrome comprising physical, psychological, and cognitive disabilities. In this randomized clinical trial,Walsh and colleagues developed a rehabilitation strategy that used a dedicated therapist to increase the frequency and intensity of mobilization and exercise therapy, dietetic review and advice, and referral for other therapies using predefined triggers, together with providing greater illness-specific information.

Brief description of media:

NHS Kent and Medway Clinical Commissioning Group (CCG) is working with hospitals, GPs and other professionals providing support and care to people with Long Covid to further develop services.
As an integral part of this process, the CCG would like to hear the views of people experiencing the long-term health effects of a Covid-19 infection.
To capture feedback, the CCG has launched a survey and will be holding virtual patient experience workshops which can be attended on the evening of Thursday 8 April or the morning of Wednesday 28 April.
Dr Neil Banik is the GP leading the development of NHS services to support people with Long Covid in Kent and Medway.

Brief description of media:

Background

Percutaneous dilatational tracheostomy (PDT) is one of the most common bedside surgical procedures performed in critically ill adults, on intensive care units (ICUs), who require long‐term ventilation. PDT is associated with relevant life‐threatening complications: Cuff rupture or accidental extubation may lead to hypoxia, aspiration or loss of airway. Puncture of the oesophagus, or creating a false passage during dilatation or replacement of the tracheostomy tube, can lead to pneumothorax or emphysema. Wound infections may occur which can cause mediastinits, especially after creation of false passage or in early tracheotomized post‐sternotomy patients after cardiac surgery. During the procedure, the patient's airway can be secured with an endotracheal tube (ETT) or a laryngeal mask airway (LMA). This is an updated version of the review first published in 2014.
Objectives

To assess the safety and effectiveness of LMA versus ETT in critically ill adults undergoing PDT on the ICU.
Search methods

We searched the following databases to 9 January 2018: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase. We searched for reports of ongoing trials in the metaRegister of Controlled Trials (mRCT). We handsearched for relevant studies in conference proceedings of five relevant annual congresses. We contacted study authors and experts concerning unpublished data and ongoing trials. We searched for further relevant studies in the reference lists of all included trials and of relevant systematic reviews.
Selection criteria

We included randomized controlled trials (RCTs) that compared use of laryngeal mask airways versus endotracheal tubes in critically ill adults undergoing elective PDT in the ICU, without injuries to or diseases of the face or neck. We imposed no restrictions with regard to language, timing or technique of PDT performed.
Data collection and analysis

Two review authors independently assessed the eligibility and methodological quality of each study and carried out data extraction. Our primary outcomes were all‐cause mortality, procedure‐related mortality and tally of participants with one or more serious adverse events. Where possible, we combined homogeneous studies for meta‐analysis. We used Cochrane's 'Risk of bias' tool and used GRADE to assess the quality of evidence for key outcomes.
Main results

We included nine RCTs in this review involving 517 participants.

Studies had a high or unclear risk of bias. The main reason for this was low methodological quality or missing data, even after study authors were contacted. Study size was generally small, with a minimum of 40, and a maximum of 73 participants.

In one study (40 participants), three deaths in the LMA group and two deaths in the ETT group were reported, although none of the deaths were related to the procedure (very low‐quality evidence).

Five studies (281 participants) reported on procedure‐related deaths, stating that no procedure‐related death occurred at all (very low‐quality evidence).

It is uncertain whether there is a difference in the number of people experiencing one or more serious adverse event(s) between LMA and ETT (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.41 to 1.80; 467 participants, 8 studies, very low‐quality evidence).

The duration of the procedure may be shorter in the LMA group (mean difference (MD) ‐1.46 minutes, 95% CI ‐1.92 to ‐1.01 minutes; 6 studies, 324 participants, low‐quality evidence).

However failure of procedure, as allocated by randomization, requiring conversion to any other procedure, may be higher in the LMA group (RR 2.82, 95% CI 1.22 to 6.52; 8 studies, 439 participants, low‐quality evidence).

We did not find any clear evidence of a difference between ETT and LMA groups for all other outcomes. Only one study provided follow‐up data for late complications related to the intervention, showing no clear evidence of benefit for any treatment group.
Authors' conclusions

Evidence on the safety of LMA for PDT is too limited to allow conclusions to be drawn on either its efficacy or safety compared with ETT. Although the LMA procedure may shorten the period during which the airway is insecure, it may also lead to higher conversion rates. Also, late complications have not been investigated sufficiently. These results are primarily based on single‐centre trials with small sample sizes, and therefore the level of evidence remains low. Studies with low risk of bias focusing on late complications and relevant patient‐related outcomes are necessary for definitive conclusions on safety issues related to this procedure. The dependency of the successful placement of a LMA on the type of LMA used should also be further assessed.

There are two studies awaiting classification that may alter the conclusions once assessed.

Brief description of media:

The twinkle in his eyes, the delight in his smile, the joyous way he moved his disease-withered frame. They all proclaimed a single, resounding message: Grateful to be alive!

“As my care team and my family tell me, ‘You were born again. You have to learn to live again,’” said Vicente Perez Castro. “I went through a very difficult time.”

Hell and back is more like it.

Perez, a 57-year-old cook from Long Beach, California, could barely breathe when he was admitted on June 5 to Los Angeles County’s Harbor-UCLA Medical Center. He tested positive for covid-19 and spent three months in the intensive care unit, almost all of it hooked up to a ventilator with a tube down his throat. A different tube conducted nutrients into his stomach.

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Paediatric Critical Care (PCC) services look after children and young people whose conditions are life-threatening and need constant close monitoring and support from equipment and medication to restore and/or maintain normal body functions. The definitions of the full range of Paediatric Critical Care is provided below.
This specification specifically covers care provided in Level 3 Paediatric Critical Care (PCC) units previously known as PICUs, (Paediatric Intensive Care Units) which are usually located in tertiary centres or specialist hospitals which provide all 3 levels of PCC. However PCC level 3 units will care for patients across the whole range of PCC levels 1 – 3.
PCC level 3 units provide ca re for children requiring intensive care and monitoring, including medically unstable patients requiring intubation or ventilation, single or multi-organ support, and continuous or intensive medical or nursing supervision. PCC level 3 units also provides routine planned post-operative care for surgical procedures, or during some planned medical admissions.

Brief description of media:

Review question

We aimed to investigate whether liberal fluid therapy can lead to more beneficial or harmful effects compared to conservative fluid therapy for adults and children with severe sepsis or septic shock. We mainly evaluated the different effects of these two interventions on risk of death and occurrence of adverse events.

Background

Sepsis and septic shock are complications of infection. Patients in the intensive care unit (ICU) are more likely than others to be affected by this condition. Once affected, patients experience organ dysfunction, which in some cases may lead to death. Fluid therapy is often used as an important intervention for initial treatment of sepsis in adults and children.

Results

We searched the electronic databases on 16 January 2018. We identified no adult trials that met our inclusion criteria. We included three trials involving 3402 children. We identified three 'ongoing' trials that have not yet been published. Pooled results from two trials (involving 3288 children) show that liberal fluid therapy may increase risk of in‐hospital death by 38%, and risk of death at four‐week follow‐up by 39%. This means that for every 34 children receiving fluid therapy, one more in‐hospital death will occur in the liberal fluid therapy group than in the conservative fluid therapy group. Similarly, at four‐week follow‐up, one more death will occur in the liberal fluid therapy group than in the conservative fluid therapy group for every 29 children receiving fluid therapy. One small study reported inconclusive results on risk of in‐hospital death. We are uncertain whether there is a difference in adverse events (i.e. hepatomegaly, need for ventilation, allergic reaction, and neurological sequelae) between patients receiving liberal versus conservative fluid therapy.

One trial (involving 101 children) reported that conservative fluid therapy can shorten ICU stay and the duration of ventilation. However, we have very little confidence in this finding owing to the small sample size. We found no studies investigating adults with sepsis or septic shock.

Conclusion

Low‐ to high‐quality evidence shows that liberal fluid therapy may increase the death rate for children with sepsis or septic shock. Except for this finding, we are uncertain about the effects of liberal versus conservative fluid therapy on the risk of adverse events. We are also uncertain about the effects of these two interventions for adults with sepsis or septic shock due to lack of data. Future trials focusing on adult sepsis or septic shock in other settings, with a wider range of pathogens, are expected. Once published and assessed, the three 'ongoing' studies identified may alter the conclusions of this review.

Brief description of media:

This information booklet is largely aimed at assisting the patient in
recovery following a period of critical illness. However, from
experience, it is evident that the relatives need to read this first.
During the first few days after leaving the ICU, the patient may be
unable to concentrate, understand and apply the information to
themselves. By reading this booklet the relatives will hopefully gain
an understanding of what the patient is going through and this helps
them to be actively involved in the patient's recovery and
rehabilitation.

Brief description of media:

This information booklet is largely aimed at assisting the patient in recovery following a period of critical illness. However, from experience, it is evident that the relatives need to read this first. During the first few days after leaving the ICU, the patient may be unable to concentrate, understand and apply the information to
themselves. By reading this booklet the relatives will hopefully gain an understanding of what the patient is going through and this helps them to be actively involved in the patient's recovery and rehabilitation. The RaCI team are available to support both the patient and the relatives throughout the rehabilitation process - the contact number for the team is on the cover and page 2 of this booklet.

Brief description of media:

Many are struggling to overcome a range of troubling residual symptoms of the coronavirus, and some problems may persist for months, years or even the rest of their lives. Patients who are returning home after being hospitalised for severe respiratory failure from the virus are confronting physical, neurological, cognitive and emotional issues.