Evaluation of Sleep Architecture Using 24-hour Polysomnography in Patients Recovering from Critical Illness in an Intensive Care Unit and High Dependency Unit: A Longitudinal, Prospective, and Observational Study

Abstract Background and objective The sleep architecture of critically ill patients being treated in Intensive Care Units (ICU) and High Dependency Units (HDU) is frequently unsettled and inadequate both qualitatively and quantitatively. The study aimed to investigate and elucidate factors influencing sleep architecture and quality in ICU and HDU in a limited resource setting with financial constraints, lacking human resources and technology for routine monitoring of noise, light and sleep promotion strategies in ICU. Methods The study was longitudinal, prospective, hospital-based, analytic, and observational. Insomnia Severity Index (ISI) and the Epworth Sleepiness Scale (ESS) pre hospitalisation scores were recorded. Patients underwent 24-hour polysomnography (PSG) with the simultaneous monitoring of noise and light in their environments. Patients stabilised in ICU were transferred to HDU, where the 24-hour PSG with the simultaneous monitoring of noise and light in their environments was repeated. Following PSG, the Richards-Campbell Sleep Questionnaire (RCSQ) was employed to rate patients’ sleep in both the ICU and HDU. Results Of 46 screened patients, 26 patients were treated in the ICU and then transferred to the HDU. The mean (SD) of the study population’s mean (SD) age was 35.96 (11.6) years with a predominantly male population (53.2% (n=14)). The mean (SD) of the ISI and ESS scores were 6.88 (2.58) and 4.92 (1.99), respectively. The comparative analysis of PSG data recording from the ICU and HDU showed a statistically significant reduction in N1, N2 and an increase in N3 stages of sleep (p<0.05). Mean (SD) of RCSQ in the ICU and the HDU were 54.65 (7.70) and 60.19 (10.85) (p-value = 0.04) respectively. The disease severity (APACHE II) has a weak correlation with the arousal index but failed to reach statistical significance (coeff= 0.347, p= 0.083). Conclusion Sleep in ICU is disturbed and persisting during the recovery period in critically ill. However, during recovery, sleep architecture shows signs of restoration.

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A Descriptive Study of Length of Stay at an Intensive Care Unit

International Journal of Research Foundation of Hospital and Health Care Administration ◽

10.5005/jp-journals-10035-1033 ◽

2015 ◽

Vol 3 (1) ◽

pp. 29-32

Author(s):

Kasturi Shukla ◽

Priyadarshini Chandrashekhar ◽

Nirmal Kumar ◽

Pradnya K Devade

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Descriptive Study ◽

P Value ◽

Chi Square ◽

High Dependency ◽

Chi Square Test ◽

The Mean ◽

Student’S T

ABSTRACT Background and aims As intensive care units (ICUs) are very resource intensive, length of stay (LOS) is of prime importance. This study was done to analyze the LOS in different ICUs and analyze it against a set benchmark. Materials and methods This retrospective study was conducted from April to June 2013 on patients admitted during January to March 2013 in the neurosurgery ICU (NICU), medical ICU (MICU), high dependency unit (HDU) and isolation ICU of a large multispecialty hospital in Pune (India). As per the quality manual of the hospital, benchmark LOS was considered as 3.08 days for ICU. Mean and median LOS was analyzed through Student's t and Chi-square test; proportion of short (<2 days) and long stay (>4 days) patients was also computed. Results Out of 835 patients admitted to the NICU, MICU, HDU and Isolation ICU, the overall mean LOS was 3.37 ± 5.54 days which was statistically significant at a p-value <0.001 (t = 17.58, 95% CI 3-3.75). The overall mean LOS was higher than the benchmarked 3.08 days but still within the optimal range of 2 to 4 days. Mean LOS was statistically significant when tested for department-wise variations with a Chi-value of 173.56 (p-value < 0.001, LR = 113.75). Highest mean LOS was observed for isolation ICU and lowest for MICU. 360 (43.1%) were short stay, 141(16.8%) were long stay and remaining were optimal stay patients. Conclusion The mean LOS for the ICUs varied significantly across the type of ICUs which needs to be continuously monitored. Mean LOS variation across ICU type indicates need for separate benchmarks. How to cite this article Shukla K, Chandrashekhar P, Kumar N, Devade PK. A Descriptive Study of Length of Stay at an Intensive Care Unit. Int J Res Foundation Hosp Healthc Adm 2015;3(1):29-32.

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Pediatric Multi-Organ Dysfunction Syndrome: Analysis by an Untargeted “Shotgun” Lipidomic Approach Reveals Low-Abundance Plasma Phospholipids and Dynamic Recovery over 8-Day Period, a Single-Center Observational Study

Nutrients ◽

10.3390/nu13030774 ◽

2021 ◽

Vol 13 (3) ◽

pp. 774

Author(s):

Mara L. Leimanis-Laurens ◽

Karen Ferguson ◽

Emily Wolfrum ◽

Brian Boville ◽

Dominic Sanfilippo ◽

...

Keyword(s):

Mass Spectrometry ◽

Intensive Care ◽

Critically Ill ◽

Organ Dysfunction ◽

Lipid Profiles ◽

Critically Ill Children ◽

P Value ◽

Time Points ◽

Logistic Organ Dysfunction ◽

Multi Organ Dysfunction Syndrome

Lipids are molecules involved in metabolism and inflammation. This study investigates the plasma lipidome for markers of severity and nutritional status in critically ill children. Children with multi-organ dysfunction syndrome (MODS) (n = 24) are analyzed at three time-points and cross-referenced to sedation controls (n = 4) for a total of N = 28. Eight of the patients with MODS, needed veno-arterial extracorporeal membrane oxygenation (VA ECMO) support to survive. Blood plasma lipid profiles are quantified by nano-electrospray (nESI), direct infusion high resolution/accurate mass spectrometry (MS), and tandem mass spectrometry (MS/MS), and compared to nutritional profiles and pediatric logistic organ dysfunction (PELOD) scores. Our results show that PELOD scores were not significantly different between MODS and ECMO cases across time-points (p = 0.66). Lipid profiling provides stratification between sedation controls and all MODS patients for total lysophosphatidylserine (lysoPS) (p-value = 0.004), total phosphatidylserine (PS) (p-value = 0.015), and total ether-linked phosphatidylethanolamine (ether-PE) (p-value = 0.03) after adjusting for sex and age. Nutrition intake over time did not correlate with changes in lipid profiles, as measured by caloric and protein intake. Lipid measurement in the intensive care environment shows dynamic changes over an 8-day pediatric intensive care unit (PICU) course, suggesting novel metabolic indicators for defining critically ill children.

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1412. The utility of respiratory viral panel testing for nosocomial fever in the neonatal intensive care unit

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1594 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S713-S713

Author(s):

Carlo Fopiano Palacios ◽

Eric Lemmon ◽

James Campbell

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Linear Regression ◽

Length Of Stay ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

P Value ◽

Fisher Exact Test ◽

The Mean ◽

Pcr Test

Abstract Background Patients in the neonatal intensive care unit (NICU) often develop fevers during their inpatient stay. Many neonates are empirically started on antibiotics due to their fragile clinical status. We sought to evaluate whether the respiratory viral panel (RVP) PCR test is associated with use of antibiotics in patients who develop a fever in the NICU. Methods We conducted a retrospective chart review on patients admitted to the Level 4 NICU of the University of Maryland Medical Center from November 2015 to June 2018. We included all neonates who developed a fever 48 hours into their admission. We collected demographic information and data on length of stay, fever work-up and diagnostics (including labs, cultures, RVP), and antibiotic use. Descriptive statistics, Fisher exact test, linear regression, and Welch’s ANOVA were performed. Results Among 347 fever episodes, the mean age of neonates was 72.8 ± 21.6 days, and 45.2% were female. Out of 30 total RVP samples analyzed, 2 were positive (6.7%). The most common causes of fever were post-procedural (5.7%), pneumonia (4.8%), urinary tract infection (3.5%), meningitis (2.6%), bacteremia (2.3%), or due to a viral infection (2.0%). Antibiotics were started in 208 patients (60%), while 61 neonates (17.6%) were already on antibiotics. The mean length of antibiotics was 7.5 ± 0.5 days. Neonates were more likely to get started on antibiotics if they had a negative RVP compared to those without a negative RVP (89% vs. 11%, p-value < 0.0001). Patients with a positive RVP had a decreased length of stay compared to those without a positive RVP (30.3 ± 8.7 vs. 96.8 ± 71.3, p-value 0.01). On multivariate linear regression, a positive RVP was not associated with length of stay. Conclusion Neonates with a negative respiratory viral PCR test were more likely to be started on antibiotics for fevers. Respiratory viral PCR testing can be used as a tool to promote antibiotic stewardship in the NICU. Disclosures All Authors: No reported disclosures

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Abstract 15293: Noninvasive Echocardiographic Cardiac Power Output Predicts Mortality in Cardiac Intensive Care Unit Patients

Circulation ◽

10.1161/circ.142.suppl_3.15293 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Barry Burstein ◽

Vidhu Anand ◽

Bradley Ternus ◽

Meir Tabi ◽

Nandan S Anavekar ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Critically Ill ◽

Power Output ◽

Critically Ill Patients ◽

Cardiac Intensive Care Unit ◽

Cardiac Power ◽

The Mean ◽

Cardiac Intensive Care

Introduction: A low cardiac power output (CPO), measured invasively, identifies critically ill patients at increased risk of mortality. CPO can also be measured non-invasively with transthoracic echocardiography (TTE), although prognostic data in critically ill patients is not available. Hypothesis: Reduced CPO measured by TTE is associated with increased hospital mortality in cardiac intensive care unit (CICU) patients. Methods: Using a database of CICU patients admitted between 2007 and 2018, we identified patients with TTE within one day (before or after) of CICU admission who had data necessary for calculation of CPO. Multivariable logistic regression determined the relationship between CPO and adjusted hospital mortality. Results: We included 5,585 patients with a mean age of 68.3±14.8 years, including 36.7% females. Admission diagnoses included acute coronary syndrome (ACS) in 57%, heart failure (HF) in 50%, cardiac arrest (CA) in 12%, and cardiogenic shock (CS) in 13%. The mean left ventricular ejection fraction (LVEF) was 47±16%, and the mean CPO was 1.0±0.4 W. CPO was inversely associated with the risk of hospital mortality (Figure A), including among patients with ACS, HF, and CS (Figure B). On multivariable analysis, lower CPO was associated with higher hospital mortality (OR 0.96 per 0.1 W, 95% CI 0.0.93-0.99, p=0.03). Hospital mortality was highest in patients with low CPO coupled with reduced LVEF, increased vasopressor requirements, or higher admission lactate. Hospital mortality was higher among patients with a CPO <0.6 W (adjusted OR 1.57, 95% CI 1.13-2.19, p = 0.007), particularly in the presence of admission lactate level >4 mmol/L (50.9%). Conclusions: Echocardiographic CPO was inversely associated with hospital mortality in CICU patients, particularly among patients with increased lactate and vasopressor requirements. Routine measurement of CPO provides important information beyond LVEF and should be considered in CICU patients.

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Abstract 13131: The Priority of Coronary Arteriography and Therapeutic Hypothermia After Return of Spontaneous Circulation in Patients With Out-of-hospital Cardiac Arrest. the Result of Sos-kanto 2012 Study

Circulation ◽

10.1161/circ.130.suppl_2.13131 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Shuichi Hagiwara ◽

Kiyohiro Oshima ◽

Masato Murata ◽

Makoto Aoki ◽

Kei Hayashida ◽

...

Keyword(s):

Cardiac Arrest ◽

Therapeutic Hypothermia ◽

Statistical Significance ◽

Coronary Arteriography ◽

Spontaneous Circulation ◽

P Value ◽

Return Of Spontaneous Circulation ◽

Overall Performance ◽

The Mean ◽

Hospital Cardiac Arrest

Aim: To evaluate the priority of coronary angiography (CAG) and therapeutic hypothermia therapy (TH) after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). Patients and Methods: SOS-KANTO 2012 study is a prospective, multicenter (69 emergency hospitals) and observational study and includes 16,452 patients with OHCA. Among the cases with ROSC in that study, we intended for patients treated with both CAG and TH within 24 hours after arrival. Those patients were divided into two groups; patients in whom TH was firstly performed (TH group), and the others in whom CAG was firstly done (CAG group). We statistically compared the prognosis between the two groups. SPSS Statistics 22 (IBM, Tokyo, Japan) was used for the statistical analysis. Statistical significance was assumed to be present at a p value of less than 0.05. Result: 233 patients were applied in this study. There were 86 patients in the TH group (M/F: 74/12, mean age; 60.0±15.2 y/o) and 147 in the CAG group (M/F: 126/21, mean age: 63.4±11.1 y/o) respectively, and no significant differences were found in the mean age and M/F ratio between the two groups. The overall performance categories (OPC) one month after ROSC in the both groups were as follows; in the TH group, OPC1: 21 (24.4%), OPC2: 3 (3.5%), OPC3: 7 (8.1%), OPC4: 8 (9.3%), OPC5: 43 (50.0%), unknown: 4 (4.7%), and in the CAG group, OPC1: 38 (25.9%), OPC2: 13 (8.8%), OPC3: 15 (10.2%), OPC4: 18 (12.2%), OPC5: 57 (38.8%), unknown: 6 (4.1%). There were no significant differences in the prognosis one month after ROSC between the two groups. Conclusion: The results which of TH and CAG you give priority to over do not affect the prognosis in patients with OHCA.

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Abstract 3091: Image Sharing Prior To Transfer Of Patients With Stroke

Stroke ◽

10.1161/str.43.suppl_1.a3091 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Minal Jain ◽

Anunaya Jain ◽

Abhijit R Kanthala ◽

Kate C Young ◽

Babak S Jahromi

Keyword(s):

Intensive Care ◽

Sinus Thrombosis ◽

Statistical Significance ◽

Tertiary Care ◽

Admission Diagnosis ◽

Stroke Severity ◽

Image Sharing ◽

Interhospital Transfer ◽

Significant Difference ◽

The Mean

Introduction: The lack of 24X7 availability of sub-specialty neurologists and neurosurgeons in regional county hospitals frequently leads to transfer of patients with stroke/ICH to higher tertiary care centers. Transfer of patients without prior communication may delay both diagnosis as well as time sensitive treatments. Recently our institution adopted image sharing prior to transfer to facilitate triage of inter-hospital transfers. Aim: To analyze if image sharing enabled judicious selection of patients more likely to require intensive care/intervention. Methods: We analyzed consecutive adult patients with an admission diagnosis of stroke/TIA/carotid stenosis/carotid-dissection/aneursym/hemiplegia/cerebral venous sinus thrombosis for whom an interhospital transfer request was made. Results: The cohort had 197 subjects with 52.6% females. The mean age of subjects was 61.1 years (SD 16.1 years). The mean distance of healthcare facilities requesting transfer from our center was 47.7 miles (SD 28.5 miles). Of all transfer requests, 78.7% (155) were accepted to our facility, 14.7% (29) were asked to follow up in outpatient clinics, 3% (6) transfers were cancelled because a higher level of care was deemed unnecessary, 1% (2) patients declined transfer and 2.5% (5) were lost to other facilities. The median stroke severity measured by NIHSS on arrival was 3 (IQR 1 to 8). Images were shared prior to decision making for transfer for 20.3% (40) patients. Fewer patients were accepted for transfer with image sharing (73%) than without (83.7%), although this did not reach statistical significance (z statistic -1.51; p=0.132). There was no significant difference in NIHSS (p=0.3919), neurological status measured by GCS (p=0.294) or age (p=0.9942) between subjects who had image sharing versus those who did not. Amongst all accepted patients 45.1% were deemed to need intensive care and 47.7% received interventions (surgical, medical or advanced diagnostic testing). The proportion of patients who underwent intervention or were admitted to an intensive care unit was much higher when patients’ images were shared prior to transfer (85.2%) when compared to patients transferred without image sharing (56.8%; z statistic 2.755; p=0.006). The odds of undergoing intervention when patients were transferred after image sharing was 4.37 as compared to patients transferred without image sharing (95% CI 1.43 to 13.39). Conclusion: Subjects who had their images shared prior to transfer had significantly higher intervention rate. Thus image sharing is a possible tool to increase specificity for selecting patients with stroke related diagnoses, who would benefit from transfer to a tertiary care center.

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Comparison of ICU Outcomes between Intravenous Immunoglobulin and Plasma Exchange in Treatment of Mechanically Ventilated Patients with GuillainBarré Syndrome in a Neuro-Intensive Care Unit in a Govt. Hospital of Bangladesh: A Observational Cohort Study

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v5i2.43015 ◽

2019 ◽

Vol 5 (2) ◽

pp. 118-122

Author(s):

Uzzwal Kumar Mallick ◽

Mohammad Shah Jahirul Hoque Chowdhury ◽

Mohammad Enayet Hussain ◽

Mohammad Asaduzzaman ◽

Md Sirajul Islam ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intravenous Immunoglobulin ◽

Statistical Significance ◽

Axonal Neuropathy ◽

Male Predominance ◽

Icu Stay ◽

The Mean ◽

Group 2 ◽

Group 1

Background: The management of Guillain-Barré Syndrome is very crucial for the outcome of the patient. Objective: The aim of the study was to compare efficacy of IvIg(Intravenous Immunoglobulin) versus PE(Plasmaexchange) in treatment of mechanically ventilation adults with GBS in neuro-intensive care unit of Bangladesh. Methodology: Thiswas a prospective, observationalcohort study, in a Neuro-ICU from 2017 to 2018. We included all patients with GBS who required mechanical ventilation (MV). We defined two groups: group 1 (group treated by IvIg: 0.4 g/kg/day for 5 days) and group 2 (group treated by PE: 5 PE during 10days, every alternate day). We collectedclinical and therapeutic aspects and outcome. Results: A total number of 49 patients (34 in group 1 and 15 in group 2) were enrolled. The mean age was 37.4±9.2 years, with a male predominance (65.3%). on electrophysiological findings, in 4(32.7%) patients had acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy (AMAN) in 26 (53.1%) patients and acute motor-sensory axonal neuropathy (AMSAN) was 3(6.1%)and NCS was not done in 4(8.2%) cases. The mean length of ICU stay was 20±19.10 days and 46.60±30.02 days in IVIG and PE group respectively. The ICU stay was significantly shorter (p = 0.001) in the IvIg group than PE group. Patients receiving IvIg were early weaned of MV (p = 0.002) compared to those receiving PE with a statistical significance. Also, duration of M/V (P=.002), Need of tracheostomy (p=.005) and over all surval rate (p=.007) was significantly in favoue of IvIg group than PE group. Out of 49 patients, total 3 patients were died and they all were AMAN variety. Conclusion: Our work reveals a meaningful difference for the MV duration, ICU stay, weaning and excellent recovery in IvIg group compared to PE group in terms of less complcations. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 118-122

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In vivo Elimination of Clonidine by Continuous Venovenous Hemofiltration in Critically Ill Patients

Blood Purification ◽

10.1159/000505610 ◽

2020 ◽

Vol 49 (5) ◽

pp. 622-626

Author(s):

Huub L.A. van den Oever ◽

Marieke Zeeman ◽

Polina Nassikovker ◽

Carmen Bles ◽

Fred A.L. van Steveninck ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Continuous Venovenous Hemofiltration ◽

Kidney Dysfunction ◽

Sieving Coefficient ◽

The Mean ◽

Ventilated Patients

Background: Clonidine is an α2-agonist that is commonly used for sedation in the intensive care unit. When patients are on continuous venovenous hemofiltration (CVVH) in the presence of kidney dysfunction, the sieving coefficient of clonidine is required to estimate how much drug is removed by CVVH. In the present study, we measured the sieving coefficient of clonidine in critically ill, ventilated patients receiving CVVH. Methods: A total of 20 samples of plasma and ultrafiltrate of 3 patients on CVVH, using a standard 1.5 m2 polyacrylonitrile AN69 membrane, during continuous clonidine infusion were collected. After correction for the effect of predilution, we calculated the sieving coefficient for clonidine. Results: The mean sieving coefficient of clonidine was 0.52 (SD 0.097). Conclusion: Using a polyacrylonitrile AN69 membrane in a CVVH machine, the in vivo sieving coefficient of clonidine was 0.52.

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Pie Crust Technique of the Deep Medial Collateral Ligament in Knee Arthroscopy: Ultrasound and Anatomic Study

The Journal of Knee Surgery ◽

10.1055/s-0038-1668125 ◽

2018 ◽

Vol 32 (08) ◽

pp. 764-769

Author(s):

Guillem Claret-Garcia ◽

Jordi Montañana-Burillo ◽

Eduard Tornero-Dacasa ◽

Manel Llusá-Pérez ◽

Dragos Popescu ◽

...

Keyword(s):

Medial Collateral Ligament ◽

Statistical Significance ◽

Mean Value ◽

Saphenous Nerve ◽

Medial Compartment ◽

P Value ◽

Collateral Ligament ◽

Anatomical Dissection ◽

Ultrasound Measurements ◽

The Mean

AbstractThis article determines compartment opening of the medial articular space of the knee after pie crust (PC) technique of the medial collateral ligament (MCL) by ultrasound measurements and anatomic dissection. This is a cadaveric study of 12 specimens. Four anatomic references were marked on the skin. Distances between the femur and tibia in the internal compartment at 30 degrees of flexion were obtained with ultrasound measurements in four situations: with and without applying valgus force both prior and after the PC technique. Ultrasound measurements of the medial articular compartment were made twice and mean value was calculated. An anatomical dissection was performed and distances between the puncture marks and the infrapatellar branch of the saphenous nerve was measured. Lilliefors test of normality was applied and variables were expressed as mean and standard deviation (SD). Qualitative variables were expressed by absolute frequencies and percentages. Statistical significance was a two-tailed p-value of < 0.05. Prior to the PC technique, mean (SD) distance between the femur and tibia in the medial compartment were 14.2 (4.0) mm in basal conditions and 17.1 (3.7) mm when applying valgus force (p = 0.003). PC technique increased the mean (SD) distance by 1.9 (1.9) mm under basal conditions (p < 0.01) and 2.9 (1.6) mm when applying valgus force (p < 0.01). The infrapatellar branches of the saphenous nerve were not damaged and the mean (SD) distance between the punctures and the nerve was 9.0 (3.3) mm. The PC is a reproducible, safe, and measurable surgical technique that opens controllably the medial compartment. PC as described avoided damage to the nerve branches.

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Unravelling the mystery of the ‘minimum important difference’ using practical outcome measures in chronic respiratory disease

Chronic Respiratory Disease ◽

10.1177/1479973118816491 ◽

2019 ◽

Vol 16 ◽

pp. 147997311881649 ◽

Cited By ~ 3

Author(s):

Linzy Houchen-Wolloff ◽

Rachael A Evans

Keyword(s):

Outcome Measures ◽

Outcome Measure ◽

Statistical Significance ◽

Minimum Clinically Important Difference ◽

Chronic Respiratory Disease ◽

Important Change ◽

P Value ◽

Minimum Important Difference ◽

The Mean ◽

Functional Outcome Measures

It is important for clinicians and researchers to understand the effects of treatments on their patients, both at an individual and group level. In clinical studies, treatment effects are often reported as a change in the outcome measure supported by a measure of variability; for example, the mean change with 95% confidence intervals and a probability ( p) value to indicate the level of statistical significance. However, a statistically significant change may not indicate a clinically meaningful or important change for clinicians or patients to interpret. The minimum clinically important difference (MCID) or minimally important difference (MID) has therefore been developed to add clinical relevance or patient experience to the reporting of an outcome measure. In this article, we consider the concept of the MID using the example of practical outcome measures in patients with CRD. We describe the various ways in which an MID can be calculated via anchor- and distribution-based methods, looking at practical examples and considering the importance of understanding how an MID was derived when seeking to apply it to a particular situation. The terms MID and MCID are challenging and often used interchangeably. However, we propose all MIDs are described as such, but they could be qualified by a suffix: MIDS (MID – Statistical), MID-C (MID – Clinical outcome), MID-P (MID – Patient determined). However, this type of classification would only work if accepted and adopted. In the meantime, we advise clinicians and researchers to use an MID where possible to aid their interpretation of functional outcome measures and effects of interventions, to add meaning above statistical significance alone.

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