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Exclusively for SCCM Select and Professional members, Critical Pulse contains late-breaking and important information to help your practice.

Deaths Occurring Shortly After ICU Admission are Usually Preceded by LST-L Decisions

A multicenter, observational, exploratory study in Critical Care Explorations aimed to determine the proportion of patients subjected to a decision of life-supporting treatment limitation (LST-L) among patients who died within 48 hours after ICU admission. Of 1615 patients admitted to 12 participating ICUs in France during the study period, 100 died (6.2%) within 48 hours, including 62 with LST-L. In the LST-L group, patients were significantly older (72 yr [64-77.8 yr] vs. 63 yr [59-69.8 yr]; P = 0.002), Charlson Comorbidity Index significantly higher (5.5 [2.0-8.0] vs. 4.0 [2.0-5.0]; P < 0.001), and management less invasive compared with the full-care group. Patients’ wishes were rarely considered when making LST-L decisions. Efforts are needed to better consider patients' wishes and to ensure appropriate care, even when patients' wishes are unknown. 

Methadone May Improve Outcomes in Mechanically Ventilated ICU Patients 

A systematic review of 12 studies including 773 mechanically ventilated patients in Critical Care Science compared the use of methadone to the standard of care or to other analgosedation strategies in mechanically ventilated patients in the ICU. The use of methadone was associated with more ventilator-free days, shorter weaning times, and a greater probability of successful weaning on day 5. The findings are based on low-quality evidence; therefore further research is needed.

Post-Acute Interventions Can Improve Outcomes in Sepsis Survivors

A systematic review of 14 studies comprising 383,680 sepsis survivors, published in Critical Care (London, England), assessed the effectiveness of post-acute interventions and follow-up services on patient-relevant long-term outcomes. Rehabilitation interventions were associated with long-term survival benefits for 10 years, according to 3 observational studies. Additionally, 1 RCT found that an 8-week exercise-based intervention improved the anaerobic threshold in sepsis survivors. Interventions targeting care coordination and follow-up bundles led to reductions in rehospitalization rates and mortality for 12 months post-discharge and were associated with improvements in long-term physical function and PTSD symptoms. High-quality prospective follow-up studies are needed to strengthen the evidence regarding the effectiveness and acceptability of interventions across all domains of post-sepsis impairments.

Supplemental Hydrocortisone Does Not Improve Short-Term Survival in Cirrhotic Patients With Septic Shock

An RCT in Liver International evaluated the use of low-dose supplemental hydrocortisone to improve short-term survival in cirrhotic patients with septic shock. Patients were assigned to receive IV hydrocortisone (100 mg followed by a continuous infusion of 200 mg/24 h) or placebo, for at least 3 days, followed by a tapering period of 3-7 days, depending on the time of shock resolution. After 83 patients were enrolled, the trial was stopped early due to slow inclusions. There was no difference in 28-day mortality (35% vs. 39.5%; P = 0.84) between hydrocortisone and placebo groups. Shock resolution (85% vs. 72.1%; P = 0.25) and days to shock resolution (3 days [IQR, 2.2-4] vs. 4 days [IQR, 2-7.5]) were also similar between groups. 

Combination of Nonpharmacologic Interventions Improve Sleep in Preterm Infants in NICUs

A systematic review and network meta-analysis of 17 RCTs involving 709 preterm infants in Intensive Critical Care Nursing found that touch and massage combined with kangaroo care (T + M + KC) most effectively improved proportion of time spent in active (20.41%; 95 % CI, 0.06-40.77) and quiet (8.33%; 95 % CI, 3.97-12.69) sleep phases compared with standard care. P-score analysis supported this finding, revealing that T + M + KC was most likely to be the optimal nonpharmacologic treatment for both active (96%) and quiet (94%) sleep. Future large-scale, high-quality RCTs are necessary to confirm these findings.

Virtual Reality-Based Therapies Improve Functional Ability After Stroke

A systematic review and meta-analysis of 24 RCTs involving 768 participants in Journal of Medical Internet Research evaluated the effectiveness of virtual reality (VR) therapy on the recovery of lower limb function in stroke survivors. Meta-analysis results showed that VR therapy, compared to conventional therapy, significantly improved Berg Balance Scale (BBS) (mean difference [MD] = 3.29; 95% CI, 0.52-6.06; P = 0.02), Timed Up and Go (TUG) Test (MD = −1.67; 95% CI, −2.89 to −0.46; P = 0.007), and step length (MD = 3.59; 95% CI, 0.50-6.69; P = 0.02). In the subgroup analyses, significant improvements in balance and mobility were observed in patients receiving ≥ 20 sessions, with BBS improved by 5.14 points (95% CI, 0.43-9.85; P = 0.03) and TUG reduced by 1.98 seconds (95% CI, −3.33 to −0.63; P = 0.004).

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