Managing ICU surge during the COVID-19 crisis: rapid guidelines.

Given the rapidly changing nature of COVID-19, clinicians and policy makers require urgent review and summary of the literature, and synthesis of evidence-based guidelines to inform practice. The WHO advocates for rapid reviews in these circumstances. The purpose of this rapid guideline is to provide recommendations on the organizational management of intensive care units caring for patients with COVID-19 including: planning a crisis surge response; crisis surge response strategies; triage, supporting families, and staff.

Pharmacologic prevention and treatment of delirium in intensive care patients: A systematic review.

PURPOSE: The purpose of the study is to determine if pharmacologic approaches are effective in prevention and treatment of delirium in critically ill patients. MATERIALS AND METHODS: We performed a systematic search to identify publications (from January 1980 to September 2014) that evaluated the pharmacologic interventions to treat or prevent delirium in intensive care unit (ICU) patients. RESULTS: From 2646 citations, 15 studies on prevention (6729 patients) and 7 studies on treatment (1784 patients) were selected and analyzed. Among studies that evaluated surgical patients, the pharmacologic interventions were associated with a reduction in delirium prevalence, ICU length of stay, and duration of mechanical ventilation, but with high heterogeneity (respectively, I(2) = 81%, P = .0013; I(2) = 97%, P < .001; and I(2) = 97%). Considering treatment studies, only 1 demonstrated a significant decrease in ICU length of stay using dexmedetomidine compared to haloperidol (Relative Risk, 0.62 [1.29-0.06]; I(2) = 97%), and only 1 found a shorter time to resolution of delirium using quetiapine (1.0 [confidence interval, 0.5-3.0] vs 4.5 [confidence interval, 2.0-7.0] days; P = .001). CONCLUSION: The use of antipsychotics for surgical ICU patients and dexmedetomidine for mechanically ventilated patients as a preventive strategy may reduce the prevalence of delirium in the ICU. None of the studied agents that were used for delirium treatment improved major clinical outcome, including mortality.

Mechanical ventilation in cancer patients: clinical characteristics and outcomes.

Acute respiratory failure with the need for mechanical ventilation is a severe and frequent complication, and a leading reason for admission to the intensive care unit (ICU) in patients with malignancies. Nevertheless, improvements in patient survival have been observed over the last decade. This article reviews the epidemiology of adult patients with malignancies requiring ventilatory support. Criteria used to assist decisions to admit a patient to the ICU and to select the initial ventilatory strategy are discussed.

Intensive care physicians' attitudes and perceptions on nutrition therapy: a web-based survey. / Atitutes e percepções em terapia nutricional entre médicos intensivistas: um inquérito via internet.

OBJECTIVE: Nutritional therapy is an important element in critical ill patient care. Although recognized as specialty, multidisciplinary teams in nutrition support are scarce in our country. Possibly, nutrition support therapy is applied by intensive care physicians and this may vary. The aim of the study is describe these specialists perceptions about theirs attitudes in enteral nutrition support. METHODS: A questionnaire was elaborated in an on-line platform. After pre-validation, it was sent by electronic mail to intensivists. In 30 days answers were collected, considering only the full-filled questionnaires. RESULTS: One hundred an fourteen forms were returned, 112 were analyzed. The responders were localized at majority in southeastern region. About beggining of nutritional support, the majority of answers reflect perceptions in accord to specialists societies recommendations. The responders' perception the frequent utilization of assistentials protocols in nutrition care. After support beginning, the responders perceptions about theirs participation in changes in therapeutic plan seems to be lower. The self-knowledge about the theme among the responders was 6.0 (arithmetic media) in a 1 to 10 scale. CONCLUSIONS: More studies are necessary to evaluate nutritional support practices among intensive care physicians. Alternatives to on-line platform should be considered. Possibly, intensive care physicians do better in the initial phases of enteral support than in continuity of care. Intensive care physicians knowledge about the issue is suboptimal.

Atitutes e percepções em terapia nutricional entre médicos intensivistas: um inquérito via internet / Intensive care physicians' attitudes and perceptions on nutrition therapy: a web-based survey

OBJETIVO: Terapia nutricional é elemento importante no cuidado ao paciente grave. Mesmo reconhecida enquanto especialidade, a existência de equipes multidisciplinares ainda é escassa nas unidades terapia intensiva. Possivelmente a aplicação de cuidados em terapia nutricional seja variada entre intensivistas. O objetivo do estudo foi descrever percepções destes especialistas sobre atitudes e práticas em terapia nutricional enteral. MÉTODOS: Elaboramos questionário em plataforma on-line. Após fase de pré-validação, o instrumento foi distribuído via eletrônica. Após 30 dias as respostas foram computadas, considerando-se apenas os formulários completos. RESULTADOS: Cento e quatorze formulários foram devolvidos, 112 foram analisados. Os respondedores concentraram-se predominantemente na região sudeste do país. Sobre a instituição do suporte enteral, a maioria das respostas reflete percepções coadunadas às orientações de sociedades de especialistas. Os respondedores percebem frequentemente a aplicação de protocolos assistenciais relativos aos cuidados nutricionais. Após o início dos cuidados nutricionais, a percepção dos respondedores sobre a participação em modificações no plano terapêutico nutricional aparenta ser menor. O auto-conhecimento sobre o tema "terapia enteral" entre os respondedores foi quantificado em 6,0 (média aritmética), em escala de 1 a 10. CONCLUSÕES: Mais estudos para avaliação de práticas nutricionais entre médicos intensivistas são necessários. Alternativas à distribuição via plataforma on-line devem ser consideradas. Possivelmente intensivistas lidam melhor com as fases iniciais de instituição dos cuidados com nutrição enteral do que em relação à continuidade dos cuidados ou mudança na programação nutricional. Médicos intensivistas percebem em geral conhecimento sub-ótimo sobre o tema terapia nutricional enteral.

OBJECTIVE: Nutritional therapy is an important element in critical ill patient care. Although recognized as specialty, multidisciplinary teams in nutrition support are scarce in our country. Possibly, nutrition support therapy is applied by intensive care physicians and this may vary. The aim of the study is describe these specialists perceptions about theirs attitudes in enteral nutrition support. METHODS: A questionnaire was elaborated in an on-line platform. After pre-validation, it was sent by electronic mail to intensivists. In 30 days answers were collected, considering only the full-filled questionnaires. RESULTS: One hundred an fourteen forms were returned, 112 were analyzed. The responders were localized at majority in southeastern region. About beggining of nutritional support, the majority of answers reflect perceptions in accord to specialists societies recommendations. The responders' perception the frequent utilization of assistentials protocols in nutrition care. After support beginning, the responders perceptions about theirs participation in changes in therapeutic plan seems to be lower. The self-knowledge about the theme among the responders was 6.0 (arithmetic media) in a 1 to 10 scale. CONCLUSIONS: More studies are necessary to evaluate nutritional support practices among intensive care physicians. Alternatives to on-line platform should be considered. Possibly, intensive care physicians do better in the initial phases of enteral support than in continuity of care. Intensive care physicians knowledge about the issue is suboptimal.