scholarly journals Adding the Capacity for an Intensive Care Unit Dedicated to COVID 19, Preserving the Operational Capability of a French Golden Hour Offset Surgical Team in Sahel

2020 ◽  
Author(s):  
Henri de Lesquen ◽  
Marie Bergez ◽  
Antoine Vuong ◽  
Alexandre Boufime-Jonqheere ◽  
Nicolas de l’Escalopier
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Large Scale ◽  
Damage Control ◽  
Surgical Care ◽  
Damage Control Surgery ◽  
Surgical Team ◽  
Golden Hour ◽  
Surgical Teams

Abstract Introduction In April 2020, the military medical planning needs to be recalibrated to support the COVID-19 crisis during a large-scale combat operation carried out by the French army in Sahel. Material and Methods Since 2019, proper positioning of Forward Surgical Teams (FSTs) has been imperative in peer-to-near-peer conflict and led to the development of a far-forward surgical asset: The Golden Hour Offset Surgical Team (GHOST). Dedicated to damage control surgery close to combat, GHOST made the FST aero-mobile again, with a light logistical footprint and a fast setting. On 19 and 25 March 2020, Niger and Mali confirmed their first COVID-19 cases, respectively. The pandemic was ongoing in Sahel, where 5,100 French soldiers were deployed in the Barkhane Operation. Results For the first time, the FST had to provide, continuously, both COVID critical care and surgical support to the ongoing operation in Liptako. Its deployment on a Main Operating Base had to be rethought on Niamey, to face the COVID crisis and support ongoing operations. This far-forward surgical asset, embedded with a doctrinal Role-1, sat up a 4-bed COVID intensive care unit while maintaining a casualty surgical care capacity. A COVID training package has been developed to prepare the FST for this innovative employment. This far-forward surgical asset was designed to support a COVID-19 intensive care unit before evacuation, preserving forward surgical capability for battalion combat teams. Conclusion Far-forward surgical assets like GHOST have demonstrated their mobility and effectiveness in a casualty care system and could be adapted as critical care facilities to respond to the COVID crisis in wartime.

Practice Patterns and Opinions on Current Clinical Practice Guidelines Regarding the Management of Delirium in the Intensive Care Unit

2016 ◽  
Vol 30 (2) ◽  
pp. 162-171 ◽  
Author(s):  
Yoonsun Mo ◽  
Anthony E. Zimmermann ◽  
Michael C. Thomas
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Large Scale ◽  
Online Survey ◽  
Early Mobilization ◽  
Screening Tools ◽  
Delirium Management ◽  
New Guidelines ◽  
Pharmacologic Agents

Objective: The aim of this study was to determine current delirium practices in the intensive care unit (ICU) setting and evaluate awareness and adoption of the 2013 Pain, Agitation, and Delirium (PAD) guidelines with emphasis on delirium management. Design, Setting, and Participants: A large-scale, multidisciplinary, online survey was administered to physician, pharmacist, nurse, and mid-level practitioner members of the Society of Critical Care Medicine (SCCM) between September 2014 and October 2014. A total of 635 respondents completed the survey. Measurements and Main Results: Nonpharmacologic interventions such as early mobilization were used in most ICUs (83%) for prevention of delirium. A majority of respondents (97%) reported using pharmacologic agents to treat hyperactive delirium. Ninety percent of the respondents answered that they were aware of the 2013 PAD guidelines, and 75% of respondents felt that their delirium practices have been changed as a result of the new guidelines. In addition, logistic regression analysis of this study showed that respondents who use delirium screening tools were twice more likely to be fully aware of key components of the updated guidelines (odds ratio [OR] = 2.07, 95% confidence interval [CI] = 1.20-3.60). Conclusions: Most critical care practitioners are fully aware and knowledgeable of key recommendations in the new guidelines and have changed their delirium practices accordingly.

scholarly journals In This Issue

2021 ◽  
Vol 23 (2) ◽  
pp. 123-123
Author(s):  
Rinaldo Bellomo ◽  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Natural Language Processing ◽  
Language Processing ◽  
Large Scale ◽  
Health Staff ◽  
Behavioural Disturbance ◽  
Binary State ◽  
The Difference

What is delirium? How do we diagnose it? What is the difference between delirium and behavioural disturbance? Is delirium a useful clinical construct? Is behavioural disturbance a more useful clinical construct for intensivists? Can we do large-scale epidemiological assessment of behavioural disturbance given that it is not a binary state and that it cannot be diagnosed by numbers? These are fundamental questions in the practice of modern intensive care medicine given that such “states” appear to affect one-third or more of patients admitted to the intensive care unit (ICU). In this issue of Critical Care and Resuscitation, we present the first attempt to address this concept using the technique of natural language processing and applying it to electronic ICU notes by nurses, doctors and allied health staff. The findings may surprise you, fascinate you, and make you think about these concepts from a different perspective, as summarised in a thoughtful editorial by Professor Reade.

Critical Care Considerations for Damage Control in a Trauma Patient

2021 ◽  
Vol 32 (1) ◽  
pp. 64-75
Author(s):  
Shannon Gaasch
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cause Of Death ◽  
Damage Control ◽  
Operative Procedure ◽  
Fixed Ratio ◽  
Damage Control Surgery ◽  
Fluid Restriction ◽  
Damage Control Resuscitation ◽  
Lethal Triad

Traumatic injury remains the leading cause of death among individuals younger than age 45 years. Hemorrhage is the primary preventable cause of death in trauma patients. Management of hemorrhage focuses on rapidly controlling bleeding and addressing the lethal triad of hypothermia, acidosis, and coagulopathy. The principles of damage control surgery are rapid control of hemorrhage, temporary control of contamination, resuscitation in the intensive care unit to restore normal physiology, and a planned, delayed definitive operative procedure. Damage control resuscitation focuses on 3 key components: fluid restriction, permissive hypotension, and fixed-ratio transfusion. Rapid recognition and control of hemorrhage and implementation of resuscitation strategies to control damage have significantly improved mortality and morbidity rates. In addition to describing the basic principles of damage control surgery and damage control resuscitation, this article explains specific management considerations for and potential complications in patients undergoing damage control interventions in an intensive care unit.

scholarly journals Damage control in the intensive care unit: what should the intensive care physician know and do?

2021 ◽  
Vol 52 (2) ◽  
pp. e4174810
Author(s):  
Monica Vargas ◽  
Alberto Garcia ◽  
Yaset Caicedo ◽  
Michael Parra ◽  
Carlos Alberto Ordoñez
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Severe Trauma ◽  
Massive Hemorrhage ◽  
Care Physician ◽  
Trauma Patients ◽  
Physiological Alterations ◽  
Definitive Repair

When trauma patients are admitted into the intensive care unit after undergoing damage control surgery, they generally present some degree of bleeding, hypoperfusion, and injuries that require definitive repair. Trauma patients admitted into the intensive care unit after undergoing damage control surgery can present injuries that require a definite repair, which can cause bleeding and hypoperfusion. The intensive care team must evaluate the severity and systemic repercussions in the patient. This will allow them to establish the need for resuscitation, anticipate potential complications, and adjust the treatment to minimize trauma-associated morbidity and mortality. This article aims to describe the alterations present in patients with severe trauma who undergo damage control surgery and considerations in their therapeutic approach. The intensivist must detect the different physiological alterations presented in trauma patients undergoing damage control surgery, mainly caused by massive hemorrhage. Monitor and support strategies are defined by the evaluation of bleeding and shock severity and resuscitation phase in ICU admission. The correction of hypothermia, acidosis, and coagulopathy is fundamental in the management of severe trauma patients.

scholarly journals Experience of the MALA Bag in the Open Abdomen Management in an Obstetrical Intensive Care Unit

2013 ◽  
Vol 26 (6) ◽  
pp. 699
Author(s):  
María de Jesús Angeles Vásquez ◽  
Luis Emilio Reyes Mendoza ◽  
Ricardo Mauricio Malagón Reyes ◽  
Hugo Mendieta Zerón
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Open Abdomen ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Abdominal Sepsis ◽  
History Of ◽  
The Mean ◽  
Surgical Option ◽  
Previous Cesarean

Introduction: Current indications for open abdomen management are damage control surgery, severe intra-abdominal sepsis, abdominal compartment syndrome, abdominal wall closure under tension and mass loss of the abdominal wall.Objective: To describe the experience in open abdomen management using the MALA (mayor absorción de líquido abdominal [greater absorption of abdominal liquid]) bag at the Maternal-Perinatal Hospital Mónica Pretelini Saénz, Health Institute of the State of Mexico.Material and Methods: This was a bidirectional, descriptive and observational study. All patients with the diagnosis of open abdomen managed with the MALA bag admitted to the Obstetric Intensive Care Unit from February 2009 to June 2012 were included.Results: From 25 cases identified in the period of the study, seven were eliminated for incomplete files, remaining 18 cases for the analysis. The mean age was 31.5 years. 78% of the patients were multigravidas, 50% of them with a history of 2 or more deliveries, 83% had a previous cesarean section and 78% were hysterectomized. Evisceration was present in one patient. The main indication for surgical management was damage control. One patient died and a second was transferred to another institution, the rest were discharged by clinical improvement. 12 patients (67%) spent less than 14 days in the Obstetric Intensive Care Unit, only one patient required morethan 30 days in the unit. Discussion: Halve the women who required this surgical alternative, were above 30 years of age. Stressing is the fact that from the 18 admitted patients, 14 (78%) had undergone obstetric hysterectomy, with the etiology of uterine atony in most cases. Damage control surgery seems to be the most elective surgical option to use MALA bag followed by ACS and abdominal sepsis.Conclusion: The MALA bag can offer an economic and effective surgical option for the open abdomen management as well as adrainage technique.

scholarly journals Indications for the Appropriate Use of Damage Control Surgery and Damage Control Interventions in Civilian Trauma Patients

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Derek Jason Roberts ◽  
Juan Duchesne ◽  
Megan L. Brenner ◽  
Bruno Pereira ◽  
Bryan A. Cotton ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Healthcare Resource Utilization ◽  
Trauma Patients ◽  
Appropriate Use ◽  
Initial Surgery ◽  
Civilian Trauma ◽  
Planned Reoperation

In patients undergoing emergent operation for trauma, surgeons must decide whether to perform a definitive or damage control (DC) procedure. DC surgery (abbreviated initial surgery followed by planned reoperation after a period of resuscitation in the intensive care unit) has been suggested to most benefit patients more likely to succumb from the “vicious cycle” of hypothermia, acidosis, and coagulopathy and/or postoperative abdominal compartment syndrome (ACS) than the failure to complete organ repairs. However, there currently exists no unbiased evidence to support that DC surgery benefits injured patients. Further, the procedure is associated with substantial morbidity, long lengths of intensive care unit and hospital stay, increased healthcare resource utilization, and possibly a reduced quality of life among survivors. Therefore, it is important to ensure that DC laparotomy is only utilized in situations where the expected procedural benefits are expected to outweigh the expected procedural harms. In this manuscript, we review the comparative effectiveness and safety of DC surgery when used for different procedural indications. We also review recent studies suggesting variation in use of DC surgery between trauma centers and the potential harms associated with overuse of the procedure. We also review published consensus indications for the appropriate use of DC surgery and specific abdominal, pelvic, and vascular DC interventions in civilian trauma patients. We conclude by providing recommendations as to how the above list of published appropriateness indications may be used to guide medical and surgical education, quality improvement, and surgical practice.

scholarly journals A Timely Call to Arms: COVID-19, the Circadian Clock, and Critical Care

2021 ◽  
Vol 36 (1) ◽  
pp. 55-70
Author(s):  
Jeffrey Haspel ◽  
Minjee Kim ◽  
Phyllis Zee ◽  
Tanja Schwarzmeier ◽  
Sara Montagnese ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Human Physiology ◽  
Critical Care ◽  
Intensive Care ◽  
Severe Acute Respiratory Syndrome ◽  
Circadian Clock ◽  
Clinical Course ◽  
Disease Expression ◽  
Severe Manifestation ◽  
Novel Coronavirus

We currently find ourselves in the midst of a global coronavirus disease 2019 (COVID-19) pandemic, caused by the highly infectious novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we discuss aspects of SARS-CoV-2 biology and pathology and how these might interact with the circadian clock of the host. We further focus on the severe manifestation of the illness, leading to hospitalization in an intensive care unit. The most common severe complications of COVID-19 relate to clock-regulated human physiology. We speculate on how the pandemic might be used to gain insights on the circadian clock but, more importantly, on how knowledge of the circadian clock might be used to mitigate the disease expression and the clinical course of COVID-19.

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