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In this review, we seek to highlight how critical illness and critical care affect longer-term outcomes, to underline the contribution of ICU delirium to cognitive dysfunction several months after ICU discharge, to give new insights into ICU acquired weakness, to emphasize the importance of value-based healthcare, and to delineate the elements of family-centered care. This consensus of 29 also provides a perspective and a research agenda about post-ICU recovery., SCOPUS: re.j, info:eu-repo/semantics/published

Outcomes research plays a key role in defining the effects of medical care in critical care. Last year Critical Care published a number of papers that evaluated patient-centered and policy-relevant outcomes. We present this review article focusing on key reported outcomes associated with severe community-acquired pneumonia, mortality associated with decisions regarding triage to the ICU, and both short-term and long-term mortality associated with ICU admissions. We further analyze the literature, assessing outcomes such as quality of life and the psychological burden associated with critical care. We also reviewed processes of care, and studies looking at cost analysis of treatment associated with critical care.

Recent research suggests that the oral cavity may provide an early opportunity to monitor the innate immune system; an oral rinse assay was found to be a reliable predictor of bone marrow engraftment and neutrophil recovery in patients undergoing bone marrow transplantation [1]. Multiorgan failure may be mediated by neutrophil extravasation and aggregation [2] in highly inflammatory states, such as cardiopulmonary bypass (CPB). The objective of this novel pilot study was to determine whether the kinetics of oral neutrophil recovery post-CPB surgery reflect systemic immune activation.

Background Advances in resuscitation science have dramatically improved survival rates following cardiac arrest. However, about 60% of adults that regain spontaneous circulation die before leaving the hospital. Recently it has been shown that inducing hypothermia in cardiac arrest survivors immediately following their arrival in hospital can dramatically improve both overall survival and neurological outcomes. Despite the strong evidence for its efficacy and the apparent simplicity of this intervention, recent surveys show that therapeutic hypothermia is delivered inconsistently, incompletely, and often with delay. Methods and design This study will evaluate a multi-faceted knowledge translation strategy designed to increase the utilization rate of induced hypothermia in survivors of cardiac arrest across a network of 37 hospitals in Southwestern Ontario, Canada. The study is designed as a stepped wedge randomized trial lasting two years. Individual hospitals will be randomly assigned to four different wedges that will receive the active knowledge translation strategy according to a sequential rollout over a number of time periods. By the end of the study, all hospitals will have received the intervention. The primary aim is to measure the effectiveness of a multifaceted knowledge translation plan involving education, reminders, and audit-feedback for improving the use of induced hypothermia in survivors of cardiac arrest presenting to the emergency department. The primary outcome is the proportion of eligible OHCA patients that are cooled to a body temperature of 32 to 34°C within six hours of arrival in the hospital. Secondary outcomes will include process of care measures and clinical outcomes. Discussion Inducing hypothermia in cardiac arrest survivors immediately following their arrival to hospital has been shown to dramatically improve both overall survival and neurological outcomes. However, this lifesaving treatment is frequently not applied in practice. If this trial is positive, our results will have broad implications by showing that a knowledge translation strategy shared across a collaborative network of hospitals can increase the number of patients that receive this lifesaving intervention in a timely manner. Trial Registration ClinicalTrials.gov Trial Identifier: NCT00683683