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Background: The COVID‐19 pandemic stretched Swedish intensive care unit (ICU) resources to an extent never experienced before, but even before the pandemic staffing was difficult and the number of staffed ICU beds was low. Studies have revealed high levels of COVID‐19 ICU staff burn‐out and fatigue, and as similar situations with high demands are likely to occur in the future a better understanding of resources that improve staff resilience is important. Using the job‐demand resource theory as a framework, we explored ICU professionals' views on demands and resources when working in COVID‐19 ICUs with the aim to highlight factors that increased the job resources. Methods: Data were collected via a web survey distributed to COVID‐19 ICU professionals, including both regular and temporary roles, working in 13 COVID‐19 ICU wards in Stockholm and Sörmland counties during the spring 2021. A total of 251 written responses to the question "What would have made work in the COVID‐19 ICU less demanding?" were analyzed using thematic analysis. One year later a member‐checking focus group interview was conducted to validate and further explore staff experiences. Results: The main themes were work strategy, fairness and support, continuity, accessible leadership, introduction/information, and crisis preparedness. The analysis of the focus group conducted confirmed the main results and the extreme demands on ICU staff during the initial stages of the pandemic. Conclusion: To increase staff health and performance in a long‐term crisis our results suggest; maintaining workplace leadership, scheduling work in advance and, when possible, schedule for recovery. [ABSTRACT FROM AUTHOR]

Background: Feeding intolerance is common in critically ill patients and can lead to malnutrition. Prokinetic agents may be used to enhance the uptake of nutrition. However, the evidence on the effectiveness and safety of prokinetic agents is sparse, and there is a lack of data on their use in intensive care units (ICU). Methods: We will conduct an international 14‐day inception cohort study of 1000 acutely admitted adult ICU patients. Data will be collected from ICU admission and daily during ICU stay for up to 90 days. The primary outcome will be the proportion of ICU patients who receive prokinetic agents. Secondary outcomes include mortality, days alive without life support, days alive out of ICU, days alive out of hospital (all within 90 days) and the number of patients with one or more serious adverse events. Results: We will present data on the use of prokinetic agents descriptively and use Cox regressions with death and ICU discharge as competing events to evaluate the association between patient characteristics and the use of prokinetic agents. We will use extended Cox models with time‐varying covariates and linear regression models to assess the associations between the use of prokinetic agents and the secondary outcomes. Conclusion: The outlined international cohort study will provide valuable epidemiological data on the use of prokinetic agents in adult, acutely admitted ICU patients. [ABSTRACT FROM AUTHOR]

Background: This Intensive Care Medicine Rapid Practice Guideline (ICM‐RPG) provides an evidence‐based recommendation to address the question: in adult patients in intensive care units (ICUs), should we use small‐volume or conventional blood collection tubes? Methods: We included 23 panelists in 8 countries and assessed and managed financial and intellectual conflicts of interest. Methodological support was provided by the Guidelines in Intensive Care, Development, and Evaluation (GUIDE) group. We conducted a systematic review, including evidence from observational and randomized studies. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, we evaluated the certainty of evidence and developed recommendations using the Evidence‐to‐Decision framework. Results: We identified 8 studies (1 cluster and 2 patient‐level randomized trials; 5 observational studies) comparing small‐volume to conventional tubes. We had high certainty evidence that small‐volume tubes reduce daily and cumulative blood sampling volume; and moderate certainty evidence that they reduce the risk of transfusion and mean number of red blood cell units transfused, but these estimates were limited by imprecision. We had high certainty that small‐volume tubes have a similar rate of specimens with insufficient quantity. The panel considered that the desirable effects of small‐volume tubes outweigh the undesirable effects, are less wasteful of resources, and are feasible, as demonstrated by successful implementation across multiple countries, although there are upfront implementation costs to validate small‐volume tubes on laboratory instrumentation. Conclusion: This ICM‐RPG panel made a strong recommendation for the use of small‐volume sample collection tubes in adult ICUs based on overall moderate certainty evidence. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion The glycemic response to critical COVID‐19 remains uncertain. We aimed to assess the association between COVID‐19, insulin requirements, glycemic control, and mortality in intensive care unit (ICU) patients.We conducted a retrospective observational study of 350 COVID‐19 patients and 1067 non‐COVID‐19 patients admitted to the ICU. Insulin requirement was defined as the total units of exogenous insulin required to cover one gram of administered carbohydrates (insulin‐to‐carbohydrate ratio, ICR). We used multivariable generalized linear mixed‐model (GLMM) analysis to assess the association of the interaction between COVID‐19 and ICU‐day with daily ICR, adjusted for fixed and time‐dependent covariates. Glycemic control was assessed after stratification on diabetes and COVID‐19. We used multivariable logistic regression analysis to assess the association between ICR and 90‐day mortality.The mean (95% CI) of the mean daily ICR among patients without diabetes was 0.09 (0.08–0.11) U/g and 0.15 (0.11–0.18) U/g in the non‐COVID‐19 group and COVID‐19 group (p = .01), respectively. In diabetes patients, the corresponding ICRs were 0.52 (0.43–0.62) U/g and 0.59 (0.50–0.68) U/g (p = .32). In multivariable GLMM analysis, the interaction between COVID‐19 and ICU‐day was independently associated with ICR (risk estimate 1.22, 95% CI 1.15–1.31, p < .001). COVID‐19 was associated with higher hypoglycemia prevalence irrespective of diabetes status, higher average glucose levels, more pronounced glucose variability, and a lower proportion of glucose values within target range among patients without diabetes. On multivariable logistic regression analysis, the adjusted odds ratio for 90‐day mortality was 1.77 (95% CI 0.94–3.34, p = .076) per one unit increase in mean ICR.In our cohort of ICU patients, COVID‐19 was associated with higher daily insulin requirements per gram of administered carbohydrates, and worse glycemic control. We found no robust association between ICR and increased odds of death at 90 days. [ABSTRACT FROM AUTHOR]

Background: Aneurysmal subarachnoid haemorrhage (aSAH) is a life‐threatening disease with high mortality and morbidity. Patients with aSAH in Sweden are cared for at one of six neuro intensive care units (NICU) or at a general intensive care unit (ICU).This study aimed to describe the incidence, length of stay, time in ventilator and mortality for these patients. Methods: This is a retrospective, descriptive study of patients with aSAH, registered in the Swedish Intensive care Registry between 2017 and 2019. The cohort was divided in sub‐cohorts (NICU and general ICU) and regions. Mortality was analysed with logistic regression. Results: A total of 1520 patients with aSAH from five regions were included in the study. Mean age of the patients were 60.6 years and 58% were female. Mortality within 180 days of admission was 30% (n = 456) of which 17% (n = 258) died during intensive care. A majority of the patients were treated at one hospital and in one ICU (70%, n = 1062). More than half of the patients (59%, n = 897) had their first intensive care admission at a hospital with a NICU. Patients in the North region had the lowest median GCS (10) and the highest SAPS3 score (60) when admitted to NICU. Treatment with invasive mechanical ventilation differed significantly between regions; 91% (n = 80) in the region with highest proportion versus 56% (n = 94) in the region with the lowest proportion, as did mortality; 16% (n = 44) versus 8% (n = 23). No differences between regions were found regarding age, sex and length of stay. Conclusions: Patients with aSAH treated in a NICU or in an ICU in Sweden differs in characteristics. The study further showed some differences between regions which might be reduced if there were national consensus and treatment guidelines implemented. [ABSTRACT FROM AUTHOR]

Background and Aim: Assisted mechanical ventilation may alter the pressure profile in the thorax compared to normal breathing, which can affect the blood flow to and from the heart. Studies suggest that in patients with severe lung disease, airway pressure release ventilation (APRV) may be haemodynamically beneficial compared to other ventilator settings. The primary aim of this study was to investigate if APRV affects cardiac index in intubated intensive care patients without severe lung disease when compared to pressure support ventilation (PSV). The secondary aim comprised potential changes in other haemodynamic and ventilatory parameters. Methods: Twenty patients were enrolled in the intensive care unit (ICU) at Sahlgrenska University Hospital. Eligible patients met the inclusion criteria; 18 years of age or above, intubated and mechanically ventilated, triggering and stable on PSV mode, with indwelling haemodynamic monitoring via a pulse‐induced continuous cardiac output (PiCCO) catheter. The study protocol started with a 30‐min interval on PSV mode, followed by a 30‐min interval on APRV mode, and finally a 30‐min interval back on PSV mode. At the end of each interval, PiCCO outputs, ventilator outputs, arterial and venous blood gas analyses, heart rate and central venous pressure were recorded and compared between modes. Results: There was no significant difference in cardiac index (3.42 vs. 3.39 L/min/m2) between PSV and APRV, but a significant increase in central venous pressure (+1.0 mmHg, p =.027). Furthermore, we found a significant reduction in peak airway pressure (−3.16 cmH2O, p <.01) and an increase in mean airway pressure (+2.1 cmH2O, p <.01). No statistically significant change was found in oxygenation index (partial pressure of O2 [pO2]/fraction of inspired oxygen) nor in other secondary outcomes when comparing PSV and APRV. There was no significant association between global end‐diastolic volume index and cardiac index (R2 = 0.0089) or central venous pressure (R2 = 0.278). All parameters returned to baseline after switching the ventilator mode back to PSV. Conclusion: We could not detect any changes in cardiac index in ICU patients without severe lung disease during APRV compared to PSV mode, despite lower peak airway pressure and increased mean airway pressure. [ABSTRACT FROM AUTHOR]

Background: Digital modalities which enable asynchronous learning, such as audio podcasts and videos demonstrating procedures, may benefit acquisition and retention of knowledge and clinical skills. The main objective of this nationwide cross‐sectional survey study was to evaluate key aspects and factors related to usage of audio podcasts and procedural videos in anaesthesiology and intensive care. Methods: A 20‐item multiple‐choice‐question online survey was created through a consensus process including pilot testing among residents and consultants. Data were collected over a 3‐month period, September–November 2023. Results: The survey was completed by 466 anaesthetists. More than a third reported using procedural videos ≥1 time per week, whereas fewer than one in four participants used audio podcasts at least once per week. Multivariable logistic regression analysis showed that working at a university hospital, male sex, and younger age were independently associated with podcast use ≥1 time per week, with the highest odds ratio (OR) for younger age (<40 years vs. ≥40 years old; OR 5.86 (95% confidence interval 3.55–9.67), p <.001). Younger age was also significantly associated with higher frequency of video use (OR 1.71 (1.13–2.58), p =.011), while working predominantly in intensive care was associated with a lower frequency of video use. Podcasts were often used during commuting (42.3%), household work (30.7%), and exercise (24.9%), indicating a role in multi‐tasking. Approximately half of respondents expressed that audio podcast‐based learning has a moderate to very large positive impact on acquisition of theoretical knowledge, as well as practical skills. A vast majority, 85.2%, reported that procedural videos have a moderate to very large impact on development of clinical skills. Conclusion: Audio podcasts and procedural videos are appreciated tools with potential to supplement more traditional didactic techniques in anaesthesiology and intensive care. Procedural video use is common, with perceived large effects on development of clinical skills. Further data are needed to fully understand learning outcomes, quality of peer‐review processes, and potential sex‐differences. [ABSTRACT FROM AUTHOR]

Background: Postextubation dysphagia (PED) is a common complication to endotracheal intubation in critically ill patients and may lead to pneumonia, prolonged ventilation, longer hospital stays, and increased mortality. Recognizing dysphagia is paramount to preventing adverse events. The aim of this study was to describe PED management by investigating practice in Danish intensive care units (ICUs) focusing on current practice in 2023 (screening, prevention, and treatment), perceived best practice (barriers and facilitators), and when possible, to compare practice in 2017 and 2023. Methods: Self‐reported, cross‐sectional survey of dysphagia practice in Danish ICUs administered from April to May 2023. In addition, data were compared with the 2017 Dysphagia in Intensive Care Evaluation study, when possible. Results: Only half of Danish ICUs reported to have a PED protocol, and less than half routinely screen patients for dysphagia after extubation. Most common screening methods were the oral mechanism examination, water test, and Facio‐oral tract therapy. Nurses and physicians often relied on an overall physical assessment of the patient. Best treatment methods were uniformly agreed to be patient positioning, modification of food and fluids, use of ergonomic utensils, and compensatory maneuvers. Key barriers to dysphagia management were lack of specialized staff, under‐recognition of dysphagia as a health issue, and lack of standardized protocols. Conclusion: Awareness of PED is increasing and identification, prevention, and treatment is slowly improving, but systematic implementation of protocols for dysphagia screening and treatment could enhance dysphagia management in Danish ICUs. [ABSTRACT FROM AUTHOR]

Background: It is unknown whether physicians treating critically ill patients have realistic perceptions of their patients' prognoses. Methods: We sent a survey by email to Finnish anesthesiologists to investigate their ability to estimate the probability of 1‐year survival of intensive care unit (ICU) patients based on data available at the beginning of intensive care. We presented 12 fictional but real‐life‐based patient cases and asked the respondent to estimate the probability of 1‐year survival in each case by choosing one of the alternatives 5%, 10%–90% in 10% intervals and 95%. We compared the physicians' estimates to registry data‐based realistic prognoses of comparable patients treated in the ICU. Based on the difference between the estimate and the realistic prognosis, we categorized the estimates into three groups: (1) difference less than 10 percentage points, (2) difference between 10 and 20 percentage points, and (3) difference over 20 percentage points. Results: We received 210 responses (totally 2520 estimates). Of the respondents, 43 (20.5%) were specialists working mainly in the ICU, 81 (38.6%) were specialists working occasionally in the ICU, 47 (22.4%) were specialists not working in the ICU, and 39 (18.6%) were doctors in training. The difference between the estimate and the realistic prognosis was less than 10 percentage points for 1083 (43.0%) estimates, between 10 and 20 percentage points for 645 (25.6%) estimates, and over 20 percentage points for 792 (31.4%) estimates, out of which 612 (24.3% of all estimates) underestimated and 180 (7.1%) overestimated the likelihood of survival. The median error (the median of the differences between the estimate and the realistic prognosis) for all estimates was −8.8 [interquartile range (IQR), −20.0 to −0.2], which means that the most typical response underestimated the likelihood of survival by 9 percentage points. Based on the 12 estimates, we calculated the median error for each respondent. The median (IQR) of these median errors was −8.6 (−12.6 to −5.0) for specialists working mainly in the ICU, −8.1 (−13.0 to −5.2) for specialists working occasionally in the ICU, −9.7 (−17.7 to −6.3) for specialists not working in the ICU, and −9.1 (−14.5 to −5.1) for doctors in training (p =.29). Conclusion: Finnish anesthesiologists commonly misestimate the long‐term prognoses of ICU patients, more often underestimating than overestimating the likelihood of 1‐year survival. More education about critically ill patients' prognoses and better prediction tools are needed. [ABSTRACT FROM AUTHOR]

Background: Ventilator‐associated lower respiratory tract infections (VA‐LRTI) increase morbidity and mortality in intensive care unit (ICU) patients. Higher incidences of VA‐LRTI have been reported among COVID‐19 patients requiring invasive mechanical ventilation (IMV). The primary objectives of this study were to describe clinical characteristics, incidence, and risk factors comparing patients who developed VA‐LRTI to patients who did not, in a cohort of Swedish ICU patients with acute hypoxemic respiratory failure due to COVID‐19. Secondary objectives were to decipher changes over the three initial pandemic waves, common microbiology and the effect of VA‐LTRI on morbidity and mortality. Methods: We conducted a multicenter, retrospective cohort study of all patients admitted to 10 ICUs in southeast Sweden between March 1, 2020 and May 31, 2021 because of acute hypoxemic respiratory failure due to COVID‐19 and were mechanically ventilated for at least 48 h. The primary outcome was culture verified VA‐LRTI. Patient characteristics, ICU management, clinical course, treatments, microbiological findings, and mortality were registered. Logistic regression analysis was conducted to determine risk factors for first VA‐LRTI. Results: Of a total of 536 included patients, 153 (28.5%) developed VA‐LRTI. Incidence rate of first VA‐LRTI was 20.8 per 1000 days of IMV. Comparing patients with VA‐LRTI to those without, no differences in mortality, age, sex, or number of comorbidities were found. Patients with VA‐LRTI had fewer ventilator‐free days, longer ICU stay, were more frequently ventilated in prone position, received corticosteroids more often and were more frequently on antibiotics at intubation. Regression analysis revealed increased adjusted odds‐ratio (aOR) for first VA‐LRTI in patients treated with corticosteroids (aOR 2.64 [95% confidence interval [CI]] [1.31–5.74]), antibiotics at intubation (aOR 2.01 95% CI [1.14–3.66]), and days of IMV (aOR 1.05 per day of IMV, 95% CI [1.03–1.07]). Few multidrug‐resistant pathogens were identified. Incidence of VA‐LRTI increased from 14.5 per 1000 days of IMV during the first wave to 24.8 per 1000 days of IMV during the subsequent waves. Conclusion: We report a high incidence of culture‐verified VA‐LRTI in a cohort of critically ill COVID‐19 patients from the first three pandemic waves. VA‐LRTI was associated with increased morbidity but not 30‐, 60‐, or 90‐day mortality. Corticosteroid treatment, antibiotics at intubation and time on IMV were associated with increased aOR of first VA‐LRTI. [ABSTRACT FROM AUTHOR]

Background: We aimed to develop a simple scoring table for predicting probability of death within 1‐year after admission to an intensive care unit. We analysed data on emergency admissions from the nationwide Finnish intensive care quality registry. Methods: We included first admissions of adult patients with data available on 1‐year vital status (dead or alive) and all five variables included in a premorbid functional status score, which is the number of activities the person can manage independently of the following five: get out of bed, move indoors, dress, climb stairs and walk 400 m. We analysed data on patient characteristics and admission‐associated factors from 2012 to 2014 to find predictors of 1‐year mortality and to develop a score for predicting probability of death. We tested the performance of this score in data from 2015. We assessed the 1‐year functional status score of survivors with data available. Results: Out of 25,261 patients, 20,628 (81.7%) patients were able to perform all five functional activities independently prior to the intensive care unit admission. At 1‐year post admission, 19,625 (77.7%) patients were alive. 1‐year functional status score was known for 11,011 patients and 8970 (81.5%) patients achieved functional status score 5, managing all five activities independently. The score based on age, sex, preceding functional status, type of intensive care unit admission, severity of acute illness and the most significant diagnoses predicted 1‐year mortality with an area under the receiver operating characteristic curve 0.78 (95% CI, 0.76–0.79). The calibration of our prediction model was good, with calibration intercept −0.01 (−0.07 to 0.05) and calibration slope 0.96 (0.90 to 1.02). Conclusion: Our score based on data available at intensive care unit admission predicted 1‐year mortality with fairly good discrimination. Most survivors achieved good functional recovery. [ABSTRACT FROM AUTHOR]

Background: There are few studies on the differences in end‐of‐life decisions making in critically ill patients with and without coronavirus disease 2019 (COVID‐19). This study aimed to investigate the independent factors that predicted the decision to withdraw or withhold life‐sustaining treatments (LST) in critically ill patients and if these decisions were based on different variables for critically ill patients with COVID‐19 compared to those for critically ill patients with other diagnoses in a Swedish intensive care unit. Methods: This observational pilot study was performed at Sahlgrenska University Hospital, Gothenburg, Sweden. Patients ≥65 years were included from 1 March 2020 to 30 April 2021. The association between a decision to limit LST and a priori selected variables including sex, age, Simplified Acute Physiology Score 3 (SAPS 3), Clinical Frailty Scale ≥4, Charlson Comorbidity Index, Body Mass Index, living at home, invasive and non‐invasive mechanical ventilation was assessed using a univariate and multivariable logistic regression model and presented as odds ratio with corresponding 95% confidence intervals. Results: There were 394 patients included in this study, 131 in the non‐COVID‐19 group and 263 in the COVID‐19 group. For the non‐COVID‐19 cohort, the univariate analysis demonstrated that age and SAPS 3 were significantly associated with the decision to withdraw or withhold life‐sustaining treatments, and this association remained in the multivariable analysis, with odds ratios of 1.10 (1.03–1.19) p =.009 and 1.06 (1.03–1.10) p <.001, respectively. For the COVID‐19 cohort, the univariate analysis indicated that age, SAPS 3, and Charlson comorbidity index were significantly associated with the decision to withdraw or withhold life‐sustaining treatments. However, in multivariable analysis, only the Charlson comorbidity index remained independently associated with the decision to withdraw or withhold life‐sustaining treatments, with an odds ratio of 1.26 (1.07–1.49), p =.006. Conclusion: Decisions to withdraw or withhold life‐sustaining treatments were based on other variables for the critically ill COVID‐19 cohort compared to those for the critically ill non‐COVID‐19 cohort. Further studies are warranted to forge a common path for ethical end‐of‐life decision‐making in critically ill patients. [ABSTRACT FROM AUTHOR]

Background: Fluid overload is associated with increased mortality in intensive care unit (ICU) patients. The GODIF trial aims to assess the benefits and harms of fluid removal with furosemide versus placebo in stable adult patients with moderate to severe fluid overload in the ICU. This article describes the detailed statistical analysis plan for the primary results of the second version of the GODIF trial. Methods: The GODIF trial is an international, multi‐centre, randomised, stratified, blinded, parallel‐group, pragmatic clinical trial, allocating 1000 adult ICU patients with moderate to severe fluid overload 1:1 to furosemide versus placebo. The primary outcome is days alive and out of hospital within 90 days post‐randomisation. With a power of 90% and an alpha level of 5%, we may reject or detect an improvement of 8%. The primary analyses of all outcomes will be performed in the intention‐to‐treat population. For the primary outcome, the Kryger Jensen and Lange method will be used to compare the two treatment groups adjusted for stratification variables supplemented with sensitivity analyses in the per‐protocol population and with further adjustments for prognostic variables. Secondary outcomes will be analysed with multiple linear regressions, logistic regressions or the Kryger Jensen and Lange method as suitable with adjustment for stratification variables. Conclusion: The GODIF trial data will increase the certainty about the effects of fluid removal using furosemide in adult ICU patients with fluid overload. Trial Registrations: EudraCT identifier: 2019‐004292‐40 and ClinicalTrials.org: NCT04180397. [ABSTRACT FROM AUTHOR]

Background: Randomised clinical trials in critical care are prone to inconclusiveness due, in part, to undue optimism about effect sizes and suboptimal accounting for heterogeneous treatment effects. Although causal evidence from rich real‐world critical care can help overcome these challenges by informing predictive enrichment, no overview exists. Methods: We conducted a scoping review, systematically searching 10 general and speciality journals for reports published on or after 1 January 2018, of randomised clinical trials enrolling adult critically ill patients. We collected trial metadata on 22 variables including recruitment period, intervention type and early stopping (including reasons) as well as data on the use of causal evidence from secondary data for planned predictive enrichment. Results: We screened 9020 records and included 316 unique RCTs with a total of 268,563 randomised participants. One hundred seventy‐three (55%) trials tested drug interventions, 101 (32%) management strategies and 42 (13%) devices. The median duration of enrolment was 2.2 (IQR: 1.3–3.4) years, and 83% of trials randomised less than 1000 participants. Thirty‐six trials (11%) were restricted to COVID‐19 patients. Of the 55 (17%) trials that stopped early, 23 (42%) used predefined rules; futility, slow enrolment and safety concerns were the commonest stopping reasons. None of the included RCTs had used causal evidence from secondary data for planned predictive enrichment. Conclusion: Work is needed to harness the rich multiverse of critical care data and establish its utility in critical care RCTs. Such work will likely need to leverage methodology from interventional and analytical epidemiology as well as data science. [ABSTRACT FROM AUTHOR]

Purpose: The objective was to conduct a systematic review of mortality and factors independently associated with mortality of older patients admitted to an intensive care unit (ICU) for COVID‐19. Materials and Methods: Data sources were MEDLINE, EMBASE, the Cochrane Library, and references of included studies. Two reviewers independently selected studies evaluating mortality of older patients (≥ 70 years) admitted to an ICU for COVID‐19. They extracted general characteristics, mortality rate, and factors independently associated with mortality. The methodological quality of each study was evaluated by using the Critical Appraisal Skills Programme checklist. Results: We selected 36 studies (11,989 patients). Many of the studies were conducted in Europe (42%) and many were retrospective (61%) and multicenter (61%). ICU mortality ranged from 8% to 90%, 1‐month mortality from 33% to 90% and 3‐month mortality, reported in five studies, from 46% to 60%. Frailty, assessed by the Clinical Frailty Score (CFS), was significantly associated with 1‐month and 3‐month mortality respectively in two studies (hazard ratio [HR]: 3.2 [2.56–4.13] and HR: 2.83 [95% CI: 1.96–4.08]). Conclusion: In this systematic review of older patients admitted to an ICU with COVID‐19, we documented high heterogeneity of mortality rates. [ABSTRACT FROM AUTHOR]

Background: European guidelines recommend targeted temperature management (TTM) in post‐cardiac arrest care. A large multicentre clinical trial, however, showed no difference in mortality and neurological outcome when comparing hypothermia to normothermia with early treatment of fever. The study results were valid given a strict protocol for the assessment of prognosis using defined neurological examinations. With the current range of recommended TTM temperatures, and applicable neurological examinations, procedures may differ between hospitals and the variation of clinical practice in Sweden is not known. Aim: The aim of this study was to investigate current practice in post‐resuscitation care after cardiac arrest as to temperature targets and assessment of neurological prognosis in Swedish intensive care units (ICUs). Methods: A structured survey was conducted by telephone or e‐mail in all Levels 2 and 3 (= 53) Swedish ICUs during the spring of 2022 with a secondary survey in April 2023. Results: Five units were not providing post‐cardiac arrest care and were excluded. The response rate was 43/48 (90%) of the eligible units. Among the responding ICUs, normothermia (36–37.7°C) was applied in all centres (2023). There was a detailed routine for the assessment of neurological prognosis in 38/43 (88%) ICUs. Neurological assessment was applied 72–96 h after return of spontaneous circulation in 32/38 (84%) units. Electroencephalogram and computed tomography and/or magnetic resonance imaging were the most common technical methods available. Conclusion: Swedish ICUs use normothermia including early treatment of fever in post‐resuscitation care after cardiac arrest and almost all apply a detailed routine for the assessment of neurological prognosis. However, available methods for prognostic evaluation varies between hospitals. [ABSTRACT FROM AUTHOR]

Background: Mortality due to acute hypoxemic respiratory failure (AHRF) in patients with coronavirus disease‐19 (COVID‐19) differs across units, regions, and countries. These variations may be attributed to several factors, including comorbidities, acute physiological derangement, disease severity, treatment, ethnicity, healthcare system strain, and socioeconomic status. This study aimed to explore the features of patient characteristics, clinical management, and staffing that may be related to mortality among three intensive care units (ICUs) within the same hospital system in South Sweden. Methods: We retrospectively analyzed ICU patients with COVID‐19 and AHRF in Region Jönköping County, Sweden. The primary outcome was the 90‐day mortality rate. We used univariate and multivariable logistic regression analyses to investigate the relationship of predictors with outcomes. Results: Between March 15, 2020, and May 31, 2021, 331 patients with AHRF and COVID‐19 were admitted to the three ICUs. There were differences in disease severity, treatments, process‐related factors, and socioeconomic factors between the units. These factors were related to 90‐day mortality. After multivariable adjustment, age, severity of acute respiratory distress syndrome, and the number of nurses per ICU‐bed independently predicted 90‐day mortality. Conclusion: Age, disease severity, and nurse staffing, but not treatment or socioeconomic status, were independently associated with 90‐day mortality among critically ill patients with AHRF due to COVID‐19. We also identified variations in care related processes, which may be a modifiable risk factor and warrants future investigation. [ABSTRACT FROM AUTHOR]

Background: Supplemental oxygen therapy is central to the treatment of acute hypoxaemic respiratory failure, a condition which remains a major driver for morbidity and mortality in intensive care. Despite several large randomised clinical trials comparing a higher versus a lower oxygenation target for these patients, significant differences in study design impede analysis of aggregate data and final clinical recommendations. Methods: This paper presents the protocol for conducting an individual patient data meta‐analysis where full individual patient data according to the intention‐to‐treat principle will be pooled from the HOT‐ICU and HOT‐COVID trials in a one‐step procedure. The two trials are near‐identical in design. We plan to use a hierarchical general linear mixed model that accounts for data clustering at a trial and site level. The primary outcome will be 90‐day all‐cause mortality while the secondary outcome will be days alive without life‐support at 90 days. Further, we outline 14 clinically relevant predefined subgroups which we will analyse for heterogeneity in the intervention effects and interactions, and we present a plan for assessing the credibility of the subgroup analyses. Conclusion: The presented individual patient data meta‐analysis will synthesise individual level patient data from two of the largest randomised clinical trials on targeted oxygen therapy in intensive care. The results will provide a re‐analysis of the intervention effects on the pooled intention‐to‐treat populations and facilitate subgroup analyses with an increased power to detect clinically important effect modifications. [ABSTRACT FROM AUTHOR]

Dysnatremia after congenital heart disease (CHD) surgery is common. European guidelines on intraoperative fluid therapy in children recommend isotonic solutions to avoid hyponatremia, but prolonged cardiopulmonary bypass and administration of high sodium‐containing solutions (i.e., blood products and sodium bicarbonate) are associated with postoperative hypernatremia. The aim of the study was to describe fluid composition prior to and during the development of postoperative dysnatremia. A retrospective observational, single‐center study including infants undergoing CHD surgery. Demographics and clinical characteristics were registered. Highest and lowest plasma sodium values were recorded and associations with perioperative fluid administration, blood products, crystalloids, and colloids were explored in relation to three perioperative periods. Postoperative dysnatremia occurred in nearly 50% of infants within 48 h after surgery. Hypernatremia was mainly associated with administration of blood products (median [IQR]: 50.5 [28.4–95.5] vs. 34.5 [18.5–61.1] mL/kg; p = 0.001), and lower free water load (1.6 [1.1–2.2] mL/kg/h; p = 0.01). Hyponatremia was associated with a higher free water load (2.3 [1.7–3.3] vs. 1.8 [1.4–2.5] mL/kg/h; p = 0.001) and positive fluid balance. On postoperative day 1, hyponatremia was associated with higher volumes of free water (2.0 [1.5–2.8] vs. 1.3 [1.1–1.8] mL/kg/h; p < 0.001) and human albumin, despite a larger diuresis and more negative daily fluid balance. Postoperative hyponatremia occurred in 30% of infants despite restrictive volumes of hypotonic maintenance fluid, whereas hypernatremia was mainly associated with blood product transfusion. Individualized fluid therapy, with continuous reassessment to reduce the occurrence of postoperative dysnatremia is mandatory in pediatric cardiac surgery. Prospective studies to evaluate fluid therapy in pediatric cardiac surgery patients are warranted. [ABSTRACT FROM AUTHOR]

Background: Salt and water accumulation leading to fluid overload is associated with increased mortality in intensive care unit (ICU) patients, but diuretics' effects on patient outcomes are uncertain. In this first version of the GODIF trial, we aimed to assess the effects of goal‐directed fluid removal with furosemide versus placebo in adult ICU patients with fluid overload. Methods: We conducted a multicentre, randomised, stratified, parallel‐group, blinded, placebo‐controlled trial in clinically stable, adult ICU patients with at least 5% fluid overload. Participants were randomised to furosemide versus placebo infusion aiming at achieving neutral cumulative fluid balance as soon as possible. The primary outcome was the number of days alive and out of the hospital at 90 days. Results: The trial was terminated after the enrolment of 41 of 1000 participants because clinicians had difficulties using cumulative fluid balance as the only estimate of fluid status (32% of participants had their initially registered cumulative fluid balance adjusted and 29% experienced one or more protocol violations). The baseline cumulative fluid balance was 6956 ml in the furosemide group and 6036 ml in the placebo group; on day three, the cumulative fluid balances were 1927 ml and 5139 ml. The median number of days alive and out of hospital at day 90 was 50 days in the furosemide group versus 45 days in the placebo group (mean difference 1 day, 95% CI ‐19 to 21, p‐value.94). Conclusions: The use of cumulative fluid balance as the only estimate of fluid status appeared too difficult to use in clinical practice. We were unable to provide precise estimates for any outcomes as only 4.1% of the planned sample size was randomised. [ABSTRACT FROM AUTHOR]

Background: Early mobilisation of mechanically ventilated patients during their stay at an intensive care unit (ICU) can improve physical recovery. Yet, an objective and specified description of physical activities while in the ICU is lacking. Therefore, our aim was to describe the objectively assessed type, quantity, and daily variation of physical activity among mechanically ventilated patients while in the ICU. Method: In an observational study in two mixed medical/surgical ICUs, we measured body posture in 39 patients on mechanical ventilation using a thigh‐ and chest‐worn accelerometer while in the ICU. The accelerometer describes time spent lying, sitting, moving, in‐bed cycling, standing and walking. Descriptive analysis of physical activity and daily variation was done using STATA. Results: We found that mechanically ventilated patients spend 20/24 h lying in bed, 3 h sitting and only 1 h standing, moving, walking or bicycling while in the ICU. Intervals of non‐lying time appeared from 9.00 to 12.00 and again from 18.00 to 21.30, with peaks at the hours of 9.00 and 18.00. Conclusion: ICU patients on mechanical ventilation were primarily sedentary. Physical activity of mechanically ventilated patients seems to be related to nurse‐ and/or physiotherapy‐initiated activities. There is a need to create an awareness of improving clinical routines, towards active mobilisation throughout the day, for this vulnerable patient population during their stay in the ICU. [ABSTRACT FROM AUTHOR]

Background: Hyperglycaemia is common in patients with acute brain injury admitted to an intensive care unit (ICU). Many studies have found associations between development of hyperglycaemia and increased mortality in hospitalised patients. However, the optimal target for blood glucose control is unknown. We want to conduct a systematic review with meta‐analysis and trial sequential analysis to explore the beneficial and harmful effects of restrictive versus liberal glucose control on patient outcomes in adults with severe acute brain injury. Methods: We will systematically search medical databases including CENTRAL, Embase, MEDLINE and trial registries. We will search the following websites for ongoing or unpublished trials: http://www.controlled-trials.com/, http://www.clinicaltrials.gov/, www.eudraCT.com, http://centerwatch.com/, The Cochrane Library's CENTRAL, PubMed, EMBASE, Science Citation Index Expanded and CINAHL. Two authors will independently review and select trials and extract data. We will include randomised trials comparing levels of glucose control in our analyses and observational studies will be included to address potential harms. The primary outcomes are defined as all‐cause mortality, functional outcome and health‐related quality of life. Secondary outcomes include serious adverse events including hypoglycaemia, length of ICU stay and duration of mechanical ventilation, and explorative outcomes including intracranial pressure and infection. Trial Sequential Analysis will be used to investigate the risk of type I error due to repetitive testing and to further explore imprecision. Quality of trials will be evaluated using the Cochrane Risk of Bias tool, and quality of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Discussion: The results of the systematic review will be disseminated through peer‐reviewed publication. With the review, we hope to inform future randomised clinical trials and improve clinical practice. [ABSTRACT FROM AUTHOR]

Background: Post-resuscitation care of comatose survivors from cardiac arrest includes target temperature management (TTM) to mitigate cerebral reperfusion injury. High-quality TTM requires protocols enhancing good precision. This study explored how the quality of TTM may have evolved with increasing experience from clinical trial protocols and standard operating procedures. We hypothesized that there would be a positive effect over time, detectable between trial periods and between trial periods and later everyday practice.Methods: Three TTM quality parameters were defined: time to target, temperature variability, and fever incidence. Data from 181 patients treated during three different time periods in a tertiary center were analyzed; 45 from Period 1 (local trial cohort 2011-2013) targeting 33°C or 36°C; 76 from Period 2 (local trial cohort 2018-2020) targeting 33 or <37.5°C; 60 from Period 3 (current standard operating procedure 2020-2021) targeting 36°C. Groups of similar target temperatures from different time periods were compared using ordinary group statistics.Results: TTM quality in all three parameters increased between trial periods. There were no differences in TTM quality as to temperature variability or fever incidence between the <37.5°C Period 2 and the 36°C Period 3 groups. A 33°C target temperature was associated with lower fever incidence than 36°C and <37.5°C target regimes.Conclusion: The observed increase in TTM quality in this single-center study may be a result of increased competence through learning and training in different strict TTM protocols. If so, the results of this study further support the protocolization of post-cardiac arrest intensive care. [ABSTRACT FROM AUTHOR]

Background: Fluid overload is a risk factor for mortality in intensive care unit (ICU) patients. Administration of loop diuretics is the predominant treatment of fluid overload, but evidence for its benefit is very uncertain when assessed in a systematic review of randomised clinical trials. The GODIF trial will assess the benefits and harms of goal directed fluid removal with furosemide versus placebo in ICU patients with fluid overload.Methods: An investigator-initiated, international, randomised, stratified, blinded, parallel-group trial allocating 1000 adult ICU patients with fluid overload to infusion of furosemide versus placebo. The goal is to achieve a neutral fluid balance. The primary outcome is days alive and out of hospital 90 days after randomisation. Secondary outcomes are all-cause mortality at day 90 and 1-year after randomisation; days alive at day 90 without life support; number of participants with one or more serious adverse events or reactions; health-related quality of life and cognitive function at 1-year follow-up. A sample size of 1000 participants is required to detect an improvement of 8% in days alive and out of hospital 90 days after randomisation with a power of 90% and a risk of type 1 error of 5%. The conclusion of the trial will be based on the point estimate and 95% confidence interval; dichotomisation will not be used.Clinicaltrials: gov identifier: NCT04180397.Perspective: The GODIF trial will provide important evidence of possible benefits and harms of fluid removal with furosemide in adult ICU patients with fluid overload. [ABSTRACT FROM AUTHOR]

Background: Characteristics and care of intensive care unit (ICU) patients with COVID‐19 may have changed during the pandemic, but longitudinal data assessing this are limited. We compared patients with COVID‐19 admitted to Danish ICUs in the first wave with those admitted later. Methods: Among all Danish ICU patients with COVID‐19, we compared demographics, chronic comorbidities, use of organ support, length of stay and vital status of those admitted 10 March to 19 May 2020 (first wave) versus 20 May 2020 to 30 June 2021. We analysed risk factors for death by adjusted logistic regression analysis. Results: Among all hospitalised patients with COVID‐19, a lower proportion was admitted to ICU after the first wave (13% vs. 8%). Among all 1374 ICU patients with COVID‐19, 326 were admitted during the first wave. There were no major differences in patient's characteristics or mortality between the two periods, but use of invasive mechanical ventilation (81% vs. 58% of patients), renal replacement therapy (26% vs. 13%) and ECMO (8% vs. 3%) and median length of stay in ICU (13 vs. 10 days) and in hospital (20 vs. 17 days) were all significantly lower after the first wave. Risk factors for death were higher age, larger burden of comorbidities (heart failure, pulmonary disease and kidney disease) and active cancer, but not admission during or after the first wave. Conclusions: After the first wave of COVID‐19 in Denmark, a lower proportion of hospitalised patients with COVID‐19 were admitted to ICU. Among ICU patients, use of organ support was lower and length of stay was reduced, but mortality rates remained at a relatively high level. [ABSTRACT FROM AUTHOR]

Background: ICU admission due to COVID‐19 may result in cognitive and physical impairment. We investigated the long‐term cognitive and physical status of Danish ICU patients with COVID‐19. Methods: We included all patients with COVID‐19 admitted to Danish ICUs between March 10 and May 19, 2020. Patients were the contacted prospectively at 6 and 12 months for follow‐up. Our primary outcomes were cognitive function and frailty at 6 and 12 months after ICU admission, estimated by the Mini Montreal Cognitive Assessment, and the Clinical Frailty Scale. Secondary outcomes were 6‐ and 12‐month mortality, health‐related quality of life (HRQoL) assessed by EQ‐5D‐5L, functional status (Barthel activities of daily living and Lawton–Brody instrumental activities of daily living), and fatigue (Fatigue Assessment Scale). The study had no information on pre‐ICU admission status for the participants. Results: A total of 326 patients were included. The 6‐ and 12‐month mortality was 37% and 38%, respectively. Among the 204 six‐month survivors, 105 (51%) participated in the 6‐month follow‐up; among the 202 twelve‐month survivors, 95 (47%) participated in the 12‐month follow‐up. At 6 months, cognitive scores indicated impairment for 26% (95% confidence interval [CI], 11.4–12.4) and at 12 months for 17% (95% CI, 12.0–12.8) of participants. Frailty was indicated in 20% (95% CI, 3.4–3.9) at 6 months, and for 18% (95% CI, 3.3–3.8) at 12 months. Fatigue was reported by 52% at 6 months, and by 47% at 12 months. For HRQoL, moderate, severe, or extreme health problems were reported by 28% at 6 months, and by 25% at 12 months. Conclusion: Long‐term cognitive, functional impairment was found in up to one in four of patients surviving intensive care for COVID‐19. Fatigue was present in nearly half the survivors at both 6 and 12 months. However, pre‐ICU admission status of the patients was unknown. [ABSTRACT FROM AUTHOR]

Background: Tracheostomies are commonly utilized in ICU patients due to prolonged mechanical ventilation, upper airway obstruction, or surgery in the face/neck region. However, practices regarding the timing of placement and utilization vary. This study provides a nationwide overview of tracheostomy utilization and outcomes in the ICU over a 14‐year period. Methods: A retrospective study including all patients that received a tracheostomy during their ICU stay in Iceland between 2007 and 2020. Data were retrieved from hospital records on admission cause, comorbidities, indication for tracheostomy insertion, duration of mechanical ventilation before and after tracheostomy placement, extubation attempts, complications, length of ICU and hospital stay and survival. Descriptive statistics were provided, and survival analysis was performed using Cox regression. Results: A total of 336 patients (median age 64 years, 33% females) received a tracheostomy during the study period. The most common indication for tracheostomy insertion was respiratory failure, followed by neurological disorders. The median duration of mechanical ventilation prior to tracheostomy insertion was 9 days and at least one extubation had been attempted in 35% of the cases. Percutaneous tracheostomies were 32%. The overall rate of complications was 25% and the most common short‐term complication was bleeding (5%). In‐hospital mortality was 33%. The one‐ and five‐year survival rate was 60% and 44%, respectively. Conclusions: We describe a whole‐nation practice of tracheostomies. A notable finding is the relatively low rate of extubation attempts prior to tracheostomy insertion. Future work should focus on standardization of assessing the need for tracheostomy and the role of extubation attempts prior to tracheostomy placement. [ABSTRACT FROM AUTHOR]

Background: Melatonin is widely employed as a hypnotic in various patient groups. In intensive care patients, melatonin seems to be increasingly used due to potential clinical effects and a favourable safety profile. Objectives: We aimed to investigate the extend of usage and clinical practice of melatonin therapy in intensive care departments in Denmark. Design: Data from regional hospital pharmacies and the Danish Intensive Care Database were used to estimate defined daily dose and defined daily dose per 1000 ICU admission days. Also, related expenses in the period 2015–2019. Finally, a questionnaire describing the clinical practice of melatonin therapy was provided to all Danish intensive care departments. Principal Observations: The usage of melatonin in intensive care departments in Denmark increased from 21,300 DDD (200.0 DDD per 1000 ICU admission days) in 2015 to 52,170 DDD (560.7 DDD per 1000 ICU admission days) in 2019. A total of 32 ICU departments participated in the study (97% of all Danish ICU departments). All included ICU departments employed melatonin as a hypnotic. Nineteen percent of included departments administered melatonin to all admitted patients, whereas 25% of departments rarely administered melatonin. Magistral melatonin 3‐mg tablets was the most employed drug dose/formulation. Increased doses of melatonin were administered in selected patients. Melatonin was considered safe by prescribing clinicians. Conclusions: Melatonin is widely and increasingly used in Danish intensive care departments. The more than doubled usage of melatonin in the study period advocates for further studies employing validated outcomes of sleep and other patient‐relevant outcomes. Editorial Comment: This study documents that melatonin is frequently used as a hypnotic in Danish intensive care units during recent years despite a shortage of reliable evidence to support a recommendation to treat with melatonin in this context. These results support a need for conducting clinical trials to determine whether or not there is a beneficial effect of melatonin treatment in critically ill patients. [ABSTRACT FROM AUTHOR]

Purpose: Chronic critical illness after trauma injury has not been fully evaluated, and there is little evidence in this regard. We aim to describe the prevalence and risk factors of chronic critical illness (CCI) in trauma patients admitted to the intensive care unit. Material and Methods: Retrospective observational multicenter study (Spanish Registry of Trauma in ICU (RETRAUCI)). Period March 2015 to December 2019. Trauma patients admitted to the ICU, who survived the first 48 h, were included. Chronic critical illness (CCI) was considered as the need for mechanical ventilation for a period greater than 14 days and/or placement of a tracheostomy. The main outcomes measures were prevalence and risk factors of CCI after trauma. Results: 1290/9213 (14%) patients developed CCI. These patients were older (51.2 ± 19.4 vs 49 ± 18.9); p <.01) and predominantly male (79.9%). They presented a higher proportion of infectious complications (81.3% vs 12.7%; p <.01) and multiple organ dysfunction syndrome (MODS) (27.02% vs 5.19%; p <.01). CCI patients required longer stays in the ICU and had higher ICU and overall in‐hospital mortality. Age, injury severity score, head injury, infectious complications, and development of MODS were independent predictors of CCI. Conclusion: CCI in trauma is a prevalent entity in our series. Early identification could facilitate specific interventions to change the trajectory of this process. [ABSTRACT FROM AUTHOR]

Background and purpose: Little is currently known about the cost‐effectiveness of intensive care of acute ischemic stroke (AIS). We evaluated 1‐year costs and outcome for patients with AIS treated in the intensive care unit (ICU). Materials and methods: A single‐center retrospective study of patients admitted to an academic ICU with AIS between 2003 and 2013. True healthcare expenditure was obtained up to 1 year after admission and adjusted to consumer price index of 2019. Patient outcome was 12‐month functional outcome and mortality. We used multivariate logistic regression analysis to identify independent predictors of favorable outcomes and linear regression analysis to assess factors associated with costs. We calculated the effective cost per survivor (ECPS) and effective cost per favorable outcome (ECPFO). Results: The study population comprised 154 patients. Reasons for ICU admission were: decreased consciousness level (47%) and need for respiratory support (40%). There were 68 (44%) 1 year survivors, of which 27 (18%) had a favorable outcome. High age (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.91–0.98) and high hospital admission National Institutes of Health Stroke Scale score (OR 0.92, 95% CI 0.87–0.97) were independent predictors of poor outcomes. Increased age had a cost ratio of 0.98 (95% CI 0.97–0.99) per added year. The ECPS and ECPFO were 115,628€ and 291,210€, respectively. Conclusions: Treatment of AIS in the ICU is resource‐intense, and in an era predating mechanical thrombectomy the outcome is often poor, suggesting a need for further research into cost‐efficacy of ICU care for AIS patients. [ABSTRACT FROM AUTHOR]

Background: The glycemic response to critical COVID-19 remains uncertain. We aimed to assess the association between COVID-19, insulin requirements, glycemic control, and mortality in intensive care unit (ICU) patients., Methods: We conducted a retrospective observational study of 350 COVID-19 patients and 1067 non-COVID-19 patients admitted to the ICU. Insulin requirement was defined as the total units of exogenous insulin required to cover one gram of administered carbohydrates (insulin-to-carbohydrate ratio, ICR). We used multivariable generalized linear mixed-model (GLMM) analysis to assess the association of the interaction between COVID-19 and ICU-day with daily ICR, adjusted for fixed and time-dependent covariates. Glycemic control was assessed after stratification on diabetes and COVID-19. We used multivariable logistic regression analysis to assess the association between ICR and 90-day mortality., Results: The mean (95% CI) of the mean daily ICR among patients without diabetes was 0.09 (0.08-0.11) U/g and 0.15 (0.11-0.18) U/g in the non-COVID-19 group and COVID-19 group (p = .01), respectively. In diabetes patients, the corresponding ICRs were 0.52 (0.43-0.62) U/g and 0.59 (0.50-0.68) U/g (p = .32). In multivariable GLMM analysis, the interaction between COVID-19 and ICU-day was independently associated with ICR (risk estimate 1.22, 95% CI 1.15-1.31, p < .001). COVID-19 was associated with higher hypoglycemia prevalence irrespective of diabetes status, higher average glucose levels, more pronounced glucose variability, and a lower proportion of glucose values within target range among patients without diabetes. On multivariable logistic regression analysis, the adjusted odds ratio for 90-day mortality was 1.77 (95% CI 0.94-3.34, p = .076) per one unit increase in mean ICR., Conclusion: In our cohort of ICU patients, COVID-19 was associated with higher daily insulin requirements per gram of administered carbohydrates, and worse glycemic control. We found no robust association between ICR and increased odds of death at 90 days., (© 2024 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

Background: Spontaneous breathing is desirable in most ventilated patients. We therefore studied the influence of isoflurane versus propofol sedation on early spontaneous breathing in ventilated surgical intensive care patients and evaluated potential mediation by opioids and arterial carbon dioxide during the first 20 h of study sedation. Methods: We included a single‐center subgroup of 66 patients, who participated in a large multi‐center trial assessing efficacy and safety of isoflurane sedation, with 33 patients each randomized to isoflurane or propofol sedation. Both sedatives were titrated to a sedation depth of −4 to −1 on the Richmond Agitation Sedation Scale. The primary outcome was the fraction of time during which patients breathed spontaneously. Results: Baseline characteristics of isoflurane and propofol‐sedated patients were well balanced. There were no substantive differences in management or treatment aside from sedation, and isoflurane and propofol provided nearly identical sedation depths. The mean fraction of time spent spontaneously breathing was 82% [95% CI: 69, 90] in patients sedated with isoflurane compared to 35% [95% CI: 22, 51] in those assigned to propofol: median difference: 61% [95% CI: 14, 89], p <.001. After adjustments for sufentanil dose and arterial carbon dioxide partial pressure, patients sedated with isoflurane were twice as likely to breathe spontaneously than those sedated with propofol: adjusted risk ratio: 2.2 [95%CI: 1.4, 3.3], p <.001. Conclusions: Isoflurane compared to propofol sedation promotes early spontaneous breathing in deeply sedated ventilated intensive care patients. The benefit appears to be a direct effect isoflurane rather than being mediated by opioids or arterial carbon dioxide. [ABSTRACT FROM AUTHOR]

Background: Dysnatremia after surgery for congenital heart disease (CHD) is well known and has been associated with prolonged pediatric intensive care unit length of stay (PICU‐LOS). Fluctuations in plasma sodium levels occur perioperatively. The primary aim of the study was to evaluate the occurrence of dysnatremia during the first 48 h after surgery and whether it was associated with PICU‐LOS. The secondary aim was to evaluate if the degree of sodium fluctuations was associated with PICU‐LOS. Methods: A retrospective observational, single‐center study including infants undergoing surgery for CHD. The highest and lowest plasma sodium value was registered for the prespecified time periods. PICU‐LOS was analyzed in relation to the occurrence of dysnatremia and the degree of plasma sodium fluctuations. The occurrence of dysnatremia was evaluated in relation to surgical procedure and fluid administration. Results: Two hundred and thirty infants who underwent 249 surgical procedures were included. Dysnatremia developed in more than 60% within 48 h after surgery. Infants with normonatremia had a 40%–50% shorter PICU‐LOS among children in RACHS‐1 category 3–6, compared with infants developing either hypo‐ or hyper‐/hyponatremia within 48 h after surgery (p =.006). Infants who had a decline of plasma sodium >11 mmol/L had almost double the PICU‐LOS compared to those with a decline of <8 mmol/L. Conclusion: Dysnatremias were common after surgery for CHD and associated with prolonged PICU‐LOS. The degree of decline in plasma sodium was significantly associated with PICU‐LOS. Fluid administration both in terms of volume and components (blood products and crystalloids) as well as diuresis were related to the occurrence of dysnatremias. [ABSTRACT FROM AUTHOR]

Background: The cohort of critically ill patients transported between Intensive Care Units (ICUs) in Norway has not been studied previously. The aim of this study was to describe the characteristics of patients and transports for different types of interhospital transfers and explore whether there were differences in morbidity and mortality between the different transfer categories and the general Norwegian ICU population. Methods: All transports of critically ill adult patients transferred between two geographically different Intensive Care Units during a one‐year period were registered. Patient and transport data were obtained from The Norwegian Intensive Care Registry, The Norwegian Cause of Death Registry, the hospital Electronic Patient Journal, the Air Ambulance Journal System, and the Emergency Medical Communication Centre database. Results: 821 transports of 788 surgical and medical patients were enrolled. Simplified Acute Physiology Scores (SAPSII) were 43, 36 and 38 for urgent secondary transport, non‐urgent secondary transport and return transfers, respectively. These were comparable to nationwide SAPSII scores that were 40 for university hospitals and 34 for local hospitals during the same time period. The return transfers had a median SOFA‐score of 4.7 and 53% were mechanically ventilated. Only 33% of return transfers were performed by established teams. Conclusion: Intensive care patients transferred between ICUs are as critically ill as the rest of the ICU population, with a similar morbidity and mortality. The return transfers of ICU‐patients appear under‐triaged compared to secondary transports in terms of allocated resources. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 acute respiratory distress syndrome (COVID‐19 ARDS) is a disease that often requires invasive ventilation. Little is known about COVID‐19 ARDS sequelae. We assessed the mid‐term lung status of COVID‐19 survivors and investigated factors associated with pulmonary sequelae. Methods: All adult COVID‐19 patients admitted to the intensive care unit from 25th February to 27th April 2020 were included. Lung function was evaluated through chest CT scan and pulmonary function tests (PFT). Logistic regression was used to identify predictors of persisting lung alterations. Results: Forty‐nine patients (75%) completed lung assessment. Chest CT scan was performed after a median (interquartile range) time of 97 (89–105) days, whilst PFT after 142 (133–160) days. The median age was 58 (52–65) years and most patients were male (90%). The median duration of mechanical ventilation was 11 (6–16) days. Median tidal volume/ideal body weight (TV/IBW) was 6.8 (5.71–7.67) ml/Kg. 59% and 63% of patients showed radiological and functional lung sequelae, respectively. The diffusion capacity of carbon monoxide (DLCO) was reduced by 59%, with a median per cent of predicted DLCO of 72.1 (57.9–93.9) %. Mean TV/IBW during invasive ventilation emerged as an independent predictor of persistent CT scan abnormalities, whilst the duration of mechanical ventilation was an independent predictor of both CT and PFT abnormalities. The extension of lung involvement at hospital admission (evaluated through Radiographic Assessment of Lung Edema, RALE score) independently predicted the risk of persistent alterations in PFTs. Conclusions: Both the extent of lung parenchymal involvement and mechanical ventilation protocols predict morphological and functional lung abnormalities months after COVID‐19. [ABSTRACT FROM AUTHOR]

Background: The prediction of in‐hospital mortality for ICU patients with COVID‐19 is fundamental to treatment and resource allocation. The main purpose was to develop an easily implemented score for such prediction. Methods: This was an observational, multicenter, development, and validation study on a national critical care dataset of COVID‐19 patients. A systematic literature review was performed to determine variables possibly important for COVID‐19 mortality prediction. Using a logistic multivariable model with a LASSO penalty, we developed the Rapid Evaluation of Coronavirus Illness Severity (RECOILS) score and compared its performance against published scores. Results: Our development (validation) cohort consisted of 1480 (937) adult patients from 14 (11) Dutch ICUs admitted between March 2020 and April 2021. Median age was 65 (65) years, 31% (26%) died in hospital, 74% (72%) were males, average length of ICU stay was 7.83 (10.25) days and average length of hospital stay was 15.90 (19.92) days. Age, platelets, PaO2/FiO2 ratio, pH, blood urea nitrogen, temperature, PaCO2, Glasgow Coma Scale (GCS) score measured within +/−24 h of ICU admission were used to develop the score. The AUROC of RECOILS score was 0.75 (CI 0.71–0.78) which was higher than that of any previously reported predictive scores (0.68 [CI 0.64–0.71], 0.61 [CI 0.58–0.66], 0.67 [CI 0.63–0.70], 0.70 [CI 0.67–0.74] for ISARIC 4C Mortality Score, SOFA, SAPS‐III, and age, respectively). Conclusions: Using a large dataset from multiple Dutch ICUs, we developed a predictive score for mortality of COVID‐19 patients admitted to ICU, which outperformed other predictive scores reported so far. [ABSTRACT FROM AUTHOR]

Background: Critical illness is often followed by mental and physical impairments. We aimed to assess the health‐related quality of life (HRQoL), symptoms of anxiety and depression, and physical function in critically ill patients after discharge from the intensive care unit. Methods: For this prospective cohort study we included all available adult patients admitted to the ICU for >24 h during a 12‐month period. Home visits took place at 3 and 12 months after discharge from the hospital and included Short‐Form Health Survey (SF‐36), Hospital Anxiety and Depression Scale, and Chelsea Critical Care Assessment Too (CPAx). Results: We visited 79 patients at 3 and 53 at 12 months. In patients with data from both visits the mental components SF‐36 scores (median (IQR)) were 55 (43–63) at 3, and 58.5 (49.5–64) at 12 months; physical component SF‐36 scores were 35 (28–45) at 3, and 36 (28–42) at 12 months. SF‐36 subdomains of mental health, social functioning, and role emotional were close to normal. Vitality, bodily pain, general health, physical functioning, and role physical were severely affected. Incidences of anxiety and depression symptoms were 16%/8% at 3 and 13%/8% at 12 months) and physical function (CPAx) was 47 at both time points). Conclusion: We found no change in HRQoL, anxiety, and depression, or physical function from 3 months to 1 year. Physical health‐related quality of life was impaired at both time points. Subdomain scores for physical health‐related quality of life were affected more than mental domains at both time points. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has put an exceptional strain on intensive care units worldwide. During the first year, the survival of patients with acute hypoxaemic respiratory failure appears to have improved. We aimed to describe the mortality rates, management characteristics and two pandemic waves during the first year at three non‐academic rural intensive care units in Sweden. Methods: We retrospectively analysed all cases of COVID‐19 admitted to intensive care units in Region Jönköping County during 1 year. The primary endpoint was 30‐day mortality. Results: Between 14th March 2020 and 13th March 2021, 264 patients were admitted to undergo intensive care with confirmed SARS‐CoV‐2 infection. The 30‐day mortality rate after the initial intensive care admission was 12.9%, and this rate remained unchanged during both pandemic waves. However, we found several distinct differences between the two pandemic waves, including an increase in the use of high‐flow nasal oxygen but a decrease in invasive mechanical ventilation use, biochemical markers of inflammation, continuous renal replacement therapy and length of stay in the intensive care unit. Conclusion: Our study showed that critically ill patients with COVID‐19 in Sweden have a low 30‐day mortality rate which compares well with results published from academic centres and national cohorts throughout Scandinavia. During the second pandemic wave, the proportion of patients receiving invasive mechanical ventilation and continuous renal replacement therapy was lower than that in the first wave. This could be the result of increased knowledge and improved therapeutic options. [ABSTRACT FROM AUTHOR]

The purpose of this commentary is to help facilitating and improving communication in the ICU with patients and/or families when conducting end-of-life (EOL) conferences or advanced care planning (ACP). Only two papers have provided specific advice for improving communication in the ICU1-2 , hence we present a list of 22 hints and advice to help increase patient and family satisfaction and to help prevent that disproportionate care is provided to patients who will not benefit or who does not want it. [ABSTRACT FROM AUTHOR]

Background: Rocking chair therapy has been explored in patients with dementia to promote the feeling of relaxation, but not in Intensive Care Unit (ICU) patients with delirium. Aim: The aim is to investigate the effect of a chair with or without rocking motion on the duration of delirium and intensity of agitation in critically ill patients admitted to the ICU. Design: This is an investigator‐initiated pragmatic, multicentre, parallel‐grouped, centrally randomised, stratified, data analyst‐blinded trial. Method: We will include patients for 1:1 web‐based randomisation, stratified by site in patients 18 y or older with a positive delirium score identified by a validated tool. We will exclude patients mainly due to mobilisation restrictions, body weight exceeding 130 kg, inability to provide consent, and presence of multiresistant bacteria or viral droplet infections. The intervention group will receive a minimum of 20 min of rocking therapy daily. The control group will be transferred to the same type of chair but without rocking therapy daily. A power calculation with a risk reduction of 20%, a power of 80% with an alpha cut‐off on 5% and further 20% inclusion gives 76 patients in intervention and control group reaching a total of n = 152 inclusion in the trial. Conclusion: The RockingICU trial will provide important new knowledge and raise research questions regarding nonpharmacological interventions to alleviate delirium in ICU patients. [ABSTRACT FROM AUTHOR]

Background: COVID‐19 disease can lead to severe functional impairments after discharge. We assessed the quality of life of invasively ventilated COVID‐19 ARDS survivors. Methods: We carried out a prospective follow‐up study of the patients admitted to the Intensive Care Units (ICUs) of a teaching hospital. Patients affected by COVID‐19 ARDS who required invasive ventilation and were successfully discharged home were assessed through the telephone administration of validated tests. We explored survival, functional outcomes, return to work, quality of life, cognitive and psychological sequelae. The main variables of interest were the following: demographics, severity scores, laboratory values, comorbidities, schooling, working status, treatments received during ICU stay, complications, and psychological, cognitive, functional outcomes. Results: Out of 116 consecutive invasively ventilated patients, overall survival was 65/116 (56%) with no death occurring after hospital discharge. Forty‐two patients were already discharged home with a median follow‐up time of 61 (51‐71) days after ICU discharge and 39 of them accepted to be interviewed. Only one patient (1/39) experienced cognitive decline. The vast majority of patients reported no difficulty in walking (32/35:82%), self‐care (33/39:85%), and usual activities (30/39:78%). All patients were either malnourished (15/39:38%) or at risk for malnutrition (24/39:62%). Exertional dyspnea was present in 20/39 (51%) patients. 19/39 (49%) reported alterations in senses of smell and/or taste either before or after hospitalization. Conclusions: Invasively ventilated COVID‐19 ARDS survivors have an overall good recovery at a 2‐months follow‐up which is better than what was previously reported in non‐COVID‐19 ARDS patients. [ABSTRACT FROM AUTHOR]

Background: Follow‐up for heterogeneous intensive care patients presents challenges for rehabilitation interventions and outcome measurements. The aim was to describe and explore characteristics and determinants for visiting/not visiting a nurse‐led clinic (NLC) at different time‐points, and to describe physical and mental health (HRQoL) over time. Methods: Patients with a length of stay (LOS) of ≥72 hours, discharged from a general intensive care unit 2004‐2014, who participated in a 6‐month follow‐up programme offering visits to NLC at 2 and 6 months were included. The register study includes information regarding patients' participation in NLC, clinical and demographic data from the Patient Administrative System within Intensive care, and data on 2‐, 6‐ and 12‐month HRQoL by using SF‐36 from the Swedish Intensive Care Registry. Results: Of 656 patients, 57% visited the NLC on some occasion. These patients were younger (P =.000), had lower Simplified Acute Physiology scores (P =.001) and higher SF‐36 physical health domain scores at 2 months (P <.05) compared to those not visiting at all. Visitors at 2 months only were younger, had shorter LOS and higher physical and mental domain scores than patients visiting at 6 months only. Patients visiting the NLC scored significantly higher in all domains from 2 to 12 months, whereas non‐visiting‐patients' did this in four out of eight domains during the same time frame. Conclusion: Individual patient's characteristics and current health conditions seem to influence visits to NLC or not. The findings may contribute to the development of existing routines to match the diversity of patients' needs and life situations. [ABSTRACT FROM AUTHOR]

Introduction: Critically ill Covid-19 pneumonia patients are likely to develop the sequence of acute pulmonary hypertension, right ventricular (RV) strain, and eventually RV failure due to known pathophysiology (endothelial inflammation plus thrombo-embolism) that promotes increased pulmonary vascular resistance and pulmonary artery pressure. This study aimed to investigate the occurrence of acute pulmonary hypertension (aPH) as per established trans-thoracic echocardiography (TTE) criteria in Covid-19 patients receiving intensive care and to explore whether short-term outcomes are affected by the presence of aPH.Methods: Medical records were reviewed for patients treated in the intensive care units at a tertiary university hospital over a month. The presence of aPH on the TTE was noted, and plasma NTproBNP and troponin were measured as markers of cardiac failure and myocardial injury, respectively. Follow-up data were collected 21 d after the performance of TTE.Results: In total, 26 of 67 patients (39%) had an assessed systolic pulmonary artery pressure of > 35 mmHg (group aPH), meeting the TTE definition of aPH. NTproBNP levels (median [range]: 1430 [102-30 300] vs. 470 [45-29 600] ng L-1 ; P = .0007), troponin T levels (63 [22-352] vs. 15 [5-407] ng L-1 ; P = .0002), and the 21-d mortality rate (46% vs. 7%; P < .001) were substantially higher in patients with aPH compared to patients not meeting aPH criteria.Conclusion: TTE-defined acute pulmonary hypertension was frequently observed in severely ill Covid-19 patients. Furthermore, aPH was linked to biomarker-defined myocardial injury and cardiac failure, as well as an almost sevenfold increase in 21-d mortality. [ABSTRACT FROM AUTHOR]

Background: In previous studies of predictors of gastrointestinal (GI) bleeding in the intensive care unit (ICU), most patients received pharmacological stress ulcer prophylaxis (SUP). We aimed to assess associations between potential predictors of clinically important GI bleeding (CIB) and overt GI bleeding in adult ICU patients, while considering the effect and potential interaction with use of SUP.Methods: We included 3291 acutely admitted adult ICU patients with risk factors for GI bleeding randomized to SUP (pantoprazole) or placebo in the SUP-ICU trial. We used logistic regression models adjusted for allocation to SUP to estimate associations between 23 potential predictors and CIB (primary outcome) and overt GI bleeding (secondary outcome). Furthermore, we assessed associations between potential predictors and both outcomes in each allocation group and assessed potential interaction with allocation to SUP.Results: Increasing SAPS II and SOFA scores, use of circulatory support and renal replacement therapy were associated with increased risk of CIB and overt GI bleeding; chronic lung disease was associated with increased risk of overt GI bleeding. Results for the remaining potential predictors were compatible with both no difference or increased and decreased risks. We found no strong evidence for any interaction between treatment allocation and any potential predictors.Conclusion: In adult ICU patients at risk of GI bleeding, severity of illness, use of circulatory support and renal replacement therapy were associated with higher odds of CIB, with no strong evidence of interaction with SUP. [ABSTRACT FROM AUTHOR]

Background: Critical illness is associated with severely impaired health‐related quality of life (HRQoL) for years following discharge. The NONSEDA trial was a multicenter randomized trial on non‐sedation versus sedation with a daily wake‐up trial in critically ill, mechanically ventilated patients in Scandinavia. The aim of this sub‐study was to assess the effect of non‐sedation on HRQoL and degree of independence in activities in daily living (ADL) 3 months post‐ICU. Methods: All survivors were asked to complete the Medical Outcomes Study Short‐Form 36 questionnaire (SF‐36) and the Barthel Index 3 months post‐ICU. To limit missing data, reminders were sent. If unsuccessful, telephone interviews could be used. Outcomes were the level of HRQoL and ADL‐function in each group. All outcomes were assessed blinded. Results: Of the 700 patients included 412 survived to follow‐up. A total of 344 survivors participated (82%). Baseline data were equal between the two groups. Mean SF‐36 scores for the non‐sedated vs sedated patients were as follows: Physical Function 45 vs 40, P =.69, Bodily Pain: 61 vs 52, P =.81, General Health: 50 vs 50, P =.84, Vitality: 42 vs 44, P =.85, Social Function: 75 vs 63, P =.85, Role Emotional: 58 vs 50, P =.82, Mental Health: 70 vs 70, P =.89, Role Physical: 25 vs 28, P =.32, Physical Component Score: 38 vs 37, P =.81, Mental Component Score: 48 vs 46, P =.94, Barthel Index: 20 vs 20, P =.74. Conclusion: Randomization to non‐sedation neither improved nor impaired health‐related quality of life or degree of independence in activities in daily living 3 months post‐ICU discharge. [ABSTRACT FROM AUTHOR]

Background: The clinical impact of chronic substance abuse of alcohol and drugs—referred to as substance use disorders (SUD)—is often overlooked in the intensive care (ICU) setting. The aims of the present study were to identify patients with SUD—regardless of cause of admission—in a mixed Norwegian ICU‐population, and to compare patients with and without SUD with regard to clinical characteristics and mortality. Methods: Cross‐sectional prospective study of a mixed medical and surgical ICU‐population aged ≥18 years in Oslo, Norway. Data were collected consecutively, using a questionnaire including the AUDIT‐C test, medical records and toxicology results. Patients classified with SUD were divided into the subgroups alcohol use disorders (AUD) and drug use disorders (DUD). Results: Overall, 222 (26%) of the 861 patients included were classified with SUD; 137 (16%) with AUD and 85 (10%) with DUD. 130/222 (59%) of the SUD‐patients had substance abuse‐related cause of ICU‐admission. Compared to non‐SUD patients, DUD‐patients were younger (median age 42 vs 65 years) and had lower SAPS II scores (41 vs 46), while AUD‐patients had higher SOFA scores (8.0 vs 7.3). Overall, age‐adjusted logistic regression analysis showed similar hospital mortality for SUD‐patients and non‐SUD patients, but AUD was associated with increased mortality among medical patients and in patients with sepsis (OR 1.7 (95% CI 1.0‐2.8), and OR 2.6 (95% CI 1.1‐6.2)). Conclusion: One in four ICU‐patients had SUD regardless of cause of admission. Alcohol use disorder was associated with increased mortality in medical patients and in patients with sepsis. [ABSTRACT FROM AUTHOR]

Keywords: cardiac arrest; intensive care; mild therapeutic hypothermia EN cardiac arrest intensive care mild therapeutic hypothermia 427 429 3 03/22/22 20220401 NES 220401 The publication of two landmark studies in 2002 on the use of mild therapeutic hypothermia (MTH) in unconscious cardiac arrest patients at risk of hypoxic brain injury had a major influence on the management of these patients in the intensive care unit (ICU).1,2 Although only 300 patients were included in these two trials, hypothermia targeting post-resuscitation temperature to 33°C became standard practice and was quickly adopted widely.3 One likely explanation may also have been its protective effect with good neurological outcomes after prolonged resuscitation, which most clinicians will have seen in patients after accidental hypothermia.4-6 Experimental evidence also appeared to support hypothermia during and after hypoxia,7 and retrospective and observational studies showed very impressive improvements in outcomes with the use of therapeutic hypothermia in cardiac arrest patients treated in the ICU in Scandinavian settings.8,9 Guidelines on post-cardiac arrest care were updated and recommended MTH in unconscious patients after out-of-hospital cardiac arrest.10 Nonetheless, some questioned whether the evidence was strong enough for MTH in patients after cardiac arrest,11 and further studies followed. In summer 2022, the TTM2 study was published.15 In this, the largest study conducted on MTH to date, 1850 patients were randomised to either MTH targeting 33°C or avoidance of fever - defined as temperatures higher than 37.8°C. [Extracted from the article]

Background: Acute kidney injury (AKI) is a syndrome of reduced glomerular filtration rate and/or reduced urine flow associated with mortality in corona virus disease 2019 (COVID‐19). AKI is often associated with renal tissue damage, which may lead to chronic kidney disease. Biomarkers of tissue damage may identify patients of particular risk. Methods: In a prospective observational study of 57 patients admitted to intensive care, AKI incidence and characteristics was evaluated according to KDIGO criteria and related to days after admission. Urinary albumin, Neutrophil Gelatinase‐Associated Lipocalin (NGAL), Kidney Injury Molecule 1 (KIM‐1) and Plasma Tissue Inhibitor of MetalloProteinase 2 (TIMP‐2) were analysed in 52 patients at admission. The majority (n = 51, 89%) of patients developed AKI, and 27 (47%) patients had predominantly oliguric AKI where oliguria was more severe than plasma Creatinine increase. Severe oliguria within first 2 days after admission was common (n = 37, 65%), whereas stage 2 and 3 AKI due to Creatinine occurred later than day 2 in 67% (12/18) of cases. Renal replacement therapy was started in 9 (16%) patients, and 30‐day mortality was 28%. Urinary biomarkers were increased in a majority of patients, but did not robustly predict KDIGO stage. Most patients had microalbuminuria, and severe albuminuria (albumin Creatinine ratio > 30 mg/mmol) was found in n = 9 (17%) patients. Conclusions: A majority of patients with COVID‐19 admitted to the ICU develop AKI. The functional deficit is often low urinary volume, and initial levels of biomarkers are generally increased without clear relation to final AKI stage. [ABSTRACT FROM AUTHOR]

Background: The management of COVID‐19 ARDS is debated. Although current evidence does not suggest an atypical acute respiratory distress syndrome (ARDS), the physiological response to prone positioning is not fully understood and it is unclear which patients benefit. We aimed to determine whether proning increases oxygenation and to evaluate responders. Methods: This case series from a single, tertiary university hospital includes all mechanically ventilated patients with COVID‐19 and proning between 17 March 2020 and 19 May 2020. The primary measure was change in PaO2:FiO2. Results: Forty‐four patients, 32 males/12 females, were treated with proning for a total of 138 sessions, with median (range) two (1‐8) sessions. Median (IQR) time for the five sessions was 14 (12‐17) hours. In the first session, median (IQR) PaO2:FiO2 increased from 104 (86‐122) to 161 (127‐207) mm Hg (P <.001). 36/44 patients (82%) improved in PaO2:FiO2, with a significant increase in PaO2:FiO2 in the first three sessions. Median (IQR) FiO2 decreased from 0.7 (0.6‐0.8) to 0.5 (0.35‐0.6) (<0.001). A significant decrease occurred in the first three sessions. PaO2, tidal volumes, PEEP, mean arterial pressure (MAP), and norepinephrine infusion did not differ. Primarily, patients with PaO2:FiO2 approximately < 120 mm Hg before treatment responded to proning. Age, sex, BMI, or SAPS 3 did not predict success in increasing PaO2:FiO2. Conclusion: Proning increased PaO2:FiO2, primarily in patients with PaO2:FiO2 approximately < 120 mm Hg, with a consistency over three sessions. No characteristic was associated with non‐responding, why proning may be considered in most patients. Further study is required to evaluate mortality. [ABSTRACT FROM AUTHOR]

Background: Thrombocytopenia is frequent in intensive care unit (ICU) patients and may be associated with adverse outcomes. We aimed to assess the incidence, risk factors, and outcomes associated with thrombocytopenia in adult ICU patients.Methods: We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We included study reports on adult ICU patients with thrombocytopenia and assessed patient-important outcomes, including mortality and health-related quality-of-life.Results: We included a total of 70 studies comprising a total of 215 098 patients; 57 were cohort studies. The incidence of thrombocytopenia varied from 8 to 56 per 100 admissions (very low quality of evidence). We identified several risk factors including age, sepsis, and higher disease severity (low quality of evidence). Thrombocytopenia was associated with bleeding, use of life support, length of stay in the ICU, and increased mortality (low/very low quality of evidence). Data on platelet transfusion before invasive procedures and transfusion thresholds were limited. No studies assessed the benefits and harms of thromboprophylaxis in ICU patients with thrombocytopenia.Conclusions: Thrombocytopenia is common and associated with increased morbidity and mortality in adult ICU patients. Several risk factors for thrombocytopenia exists, but the evidence-base on management strategies, including transfusion thresholds and thromboprophylaxis in ICU patients is very limited. [ABSTRACT FROM AUTHOR]