scholarly journals Age, Frailty, Resuscitation and Intensive Care: With Reference to COVID-19

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 36
Author(s):  
David G Smithard ◽  
Nadir Abdelhameed ◽  
Thwe Han ◽  
Angelo Pieris
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Distributive Justice ◽  
Older Age ◽  
Distribution Of Resources ◽  
Utilitarian Approach ◽  
The Individual

Discussion regarding cardiopulmonary resuscitation and admission to an intensive care unit is frequently fraught in the context of older age. It is complicated by the fact that the presence of multiple comorbidities and frailty adversely impact on prognosis. Cardiopulmonary resuscitation and mechanical ventilation are not appropriate for all. Who decides and how? This paper discusses the issues, biases, and potential harms involved in decision-making. The basis of decision making requires fairness in the distribution of resources/healthcare (distributive justice), yet much of the printed guidance has taken a utilitarian approach (getting the most from the resource provided). The challenge is to provide a balance between justice for the individual and population justice.

The swallowing telerehabilitation in COVID-19 (Preprint)

2020 ◽  
Author(s):  
Tomoo Mano ◽  
Shigeto Soyama
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Severe Acute Respiratory Syndrome ◽  
Protective Equipment ◽  
Video Conference ◽  
Rehabilitation Professionals ◽  
Swallowing Rehabilitation ◽  
Swallowing Difficulty ◽  
The Individual

UNSTRUCTURED Direct swallowing rehabilitation is not recommended for patients who is positive or suspected for the severe acute respiratory syndrome coronavirus 2（SARS-CoV-2），because SARS-CoV-2 is extremely infectious and may transmit to the individual performing rehabilitation. Some of patients in the intensive care unit and on mechanical ventilation undergo the swallowing difficulty. To feed normally again and be discharged, an assessment of dysphagia and eventual targeted swallowing training by specialized rehabilitation professionals are provided. We analysis the benefit of telerehabilitation, and we experienced the case with COVID-19 of contactless swallowing rehabilitation using video conference software on the tablet-type devices. Telerehabilitation offers the risk reduction of infection and the prevention the shortage of personal protective equipment. Protecting the medical staff from nosocomial infection of COVID-19 is therefore extremely important, and we suggest telerehabilitation as a useful approach in the swallowing rehabilitation.

scholarly journals Echocardiography in the intensive care unit: an essential tool for diagnosis, monitoring and guiding clinical decision-making

Imaging ◽  
2021 ◽  
Author(s):  
Hatem Soliman-Aboumarie ◽  
Maria Concetta Pastore ◽  
Eftychia Galiatsou ◽  
Luna Gargani ◽  
Nicola Riccardo Pugliese ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Response To Therapy ◽  
Circulatory Support ◽  
Positive Pressure ◽  
Essential Tool

AbstractIn the last years, new trends on patient diagnosis for admission in cardiac intensive care unit (CICU) have been observed, shifting from acute myocardial infarction or acute heart failure to non-cardiac diseases such as sepsis, acute respiratory failure or acute kidney injury. Moreover, thanks to the advances in scientific knowledge and higher availability, there has been increasing use of positive pressure mechanical ventilation which has its implications on the heart. Therefore, there is a growing need for Cardiac intensivists to quickly, noninvasively and repeatedly evaluate various hemodynamic conditions and the response to therapy.Transthoracic critical care echocardiography (CCE) currently represents an essential tool in CICU, as it is used to evaluate biventricular function and complications following acute coronary syndromes, identify the mechanisms of circulatory failure, acute valvular pathologies, tailoring and titrating intravenous treatment or mechanical circulatory support. This could be completed with trans-oesophageal echocardiography (TOE), advanced echocardiography and lung ultrasound to provide a thorough evaluation and monitoring of CICU patients. However, CCE could sometimes be challenging as the acquisition of good-quality images is limited by mechanical ventilation, suboptimal patient position or recent surgery with drains on the chest. Moreover, there are some technical caveats that one should bear in mind while performing CCE in order to optimize its use and avoid misleading findings. The aim of this review is to highlight the key role of CCE, providing an updated overview of its main applications and possible pitfalls in order to facilitate its use in CICU for clinical decision-making.

scholarly journals Effects of hospice palliative care on medical service utilisation by patients on prolonged mechanical ventilation: A nationwide cohort study

2021 ◽  
Author(s):  
Chin-Jung Liu ◽  
Yeong-Ruey Chu ◽  
Chia-Chen Chu ◽  
Pei-Tseng Kung ◽  
Wei-Yin Kuo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Palliative Care ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Prolonged Mechanical Ventilation ◽  
Hospitalisation Cost ◽  
Total Hospitalisation ◽  
Hospice Palliative Care ◽  
Total Hospitalisation Cost

Abstract Background: Several studies have shown that hospice palliative care interventions for cancer patients can reduce medical utilisation. In Taiwan, 20–25% of mechanical ventilation patients have been on prolonged mechanical ventilation (PMV), but only a few studies have discussed the effectiveness of hospice palliative care on these patients. This study aimed to explore the effectiveness of medical utilisation on patients undergoing PMV in hospice palliative care.Methods: From the Health Insurance database of a nationwide population-based study, we identified patients who had been on mechanical ventilation for over 21 days, were 18 years or older between 2009 to 2017, and had undergone hospice palliative care. The control group was obtained by 1:1 matching using propensity scoring after excluding patients who had participated in palliative care for less than 15 or more than 181 days. Furthermore, we used conditional logistic regression analysis to explore intensive care unit readmission, emergency department presentation, and cardiopulmonary resuscitation incidents, 14 days prior to death.Results: A total of 186,533 new PMV patients aged ≥ 18 years with terminal diseases were admitted between 2009 and 2017. Additionally, the number of patients receiving palliative care increased annually, from 0.6% in 2009 to 41.33% in 2017. The number of prolonged mechanical ventilation during emergency visits (odds ratio [OR]=0.68, 95%CI: 0.63-0.74), intensive care unit hospitalisation (OR=0.59, 95%CI: 0.53-0.46), cardiopulmonary resuscitation (OR=0.40, 95%CI: 0.35-0.46), and total hospitalisation cost (USD 1319.9.57 ± 1821.67 vs. 1544.37 ± 2309.27) was lower in the palliative care group.Conclusion: Patients undergoing PMV whilst in hospice palliative care can significantly reduce total hospitalisation cost, intensive care unit admittance, cardiopulmonary resuscitation utilisation, and medical expenses at ≤14 days prior to death.

scholarly journals Respiratory Modalities in Preventing Reintubation in a Pediatric Intensive Care Unit

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199153
Author(s):  
Ameer Al-Hadidi ◽  
Morta Lapkus ◽  
Patrick Karabon ◽  
Begum Akay ◽  
Paras Khandhar
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Noninvasive Positive Pressure Ventilation ◽  
Pediatric Intensive Care ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Positive Pressure ◽  
P Value

Post-extubation respiratory failure requiring reintubation in a Pediatric Intensive Care Unit (PICU) results in significant morbidity. Data in the pediatric population comparing various therapeutic respiratory modalities for avoiding reintubation is lacking. Our objective was to compare therapeutic respiratory modalities following extubation from mechanical ventilation. About 491 children admitted to a single-center PICU requiring mechanical ventilation from January 2010 through December 2017 were retrospectively reviewed. Therapeutic respiratory support assisted in avoiding reintubation in the majority of patients initially extubated to room air or nasal cannula with high-flow nasal cannula (80%) or noninvasive positive pressure ventilation (100%). Patients requiring therapeutic respiratory support had longer PICU LOS (10.92 vs 6.91 days, P-value = .0357) and hospital LOS (16.43 vs 10.20 days, P-value = .0250). Therapeutic respiratory support following extubation can assist in avoiding reintubation. Those who required therapeutic respiratory support experienced a significantly longer PICU and hospital LOS. Further prospective clinical trials are warranted.

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