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PPV Before Extubation Showed No Effect on Breathing Work or Lung Volume After Extubation in Patients Receiving Mechanical Ventilation in the ICU

A crossover RCT published in The Journal of Medical Investigation evaluated the effects of extubation on breathing and lung volume in 16 patients who received mechanical ventilation and planned to undergo extubation in the ICU. Electrical impedance tomography and an esophageal balloon catheter were used to evaluate work of breathing and lung volume after simulated extubation. No significant differences were found in changes in end-expiratory lung impedance (P = 0.53), anterior-to-posterior ventilation ratio (P = 0.75), esophageal pressure swing (P = 0.61), dynamic transpulmonary pressure (P = 0.93), and pressure time product (P = 0.84) with and without PPV before simulated extubation.

ABCDEF Bundled Approaches Remain a Promising Strategy to Deduce Delirium in ICU Patients

An umbrella meta-analysis of RCTs and cohort studies published in Nursing in Critical Care evaluated the pooled effects of ABCDEF bundle interventions on ICU delirium and duration. A total of 4534 records were identified, encompassing 62,949 participants. Meta-analyses demonstrated a 50% reduction in ICU delirium incidence, which was significant (OR = 0.50; 95% CI, 0.39-0.65; P < 0.001; I2 = 0%). Meta-analyses showed a significant reduction in delirium duration (SMD = −1.39; 95% CI, −2.38 to −0.40; P = 0.006; I2 = 0%). The findings showed a significant reduction in in-hospital mortality (P < 0.01), ICU length of stay (P = 0.021), and duration of mechanical ventilation (P = 0.043). The umbrella meta-analysis provided moderate to high certainty of evidence supporting the efficacy of bundle interventions in reducing the incidence of delirium in the ICU and improving clinical outcomes.

Arterial Catheter Failure Occurs in Up to One in Five Catheters in Intensive Care

A systematic review and meta-analysis in Anaesthesia aimed to quantify the incidence of arterial catheter-related complications and failure in the ICU. Thirty-nine studies (22 observational studies and 17 RCTs), comprising 19,018 arterial catheters, were included. The pooled proportion of all-cause arterial catheter failure was 13.0% (95% CI, 7.6-19.5). Non-infectious arterial catheter failures occurred in 19.8% (95% CI, 12.2-28.7) of arterial catheters. The pooled proportion of all-cause catheter-associated or bloodstream-related infections was 1.3% (95% CI, 0.7-2.1). And local infection occurred in 1.2% (95% CI, 0.4-2.4). The evidence was of moderate to high certainty. The authors concluded that hospitals need better systems, clearer ways to describe infections, and more consistent reporting of results to reduce these events and improve patient outcomes.

tDCS can Reduce Postoperative Opioid Consumption and Alleviate Pain After General Anesthesia

A systematic review and meta-analysis of RCTs in Complementary Therapies in Medicine explored the efficacy of transcranial direct current stimulation (tDCS) as a supplementary technique during the perioperative period to reduce opioid consumption and pain. A total of 13 RCTs, including 827 participants (442 in the tDCS group and 385 in the control group) were included. tDCS significantly reduced postoperative opioid consumption (P < 0.001) and pain scores (P < 0.001). tDCS also led to a significant decrease in fatigue scores (P < 0.001). However, there were no statistical differences in anxiety scores (P = 0.110). tDCS could increase adverse events (RR = 3.88; 95% CI, 1.64- 9.19, P = 0.002), but these were mild and temporary. Future studies are needed to provide evidence on the effects of tDCS on fatigue, anxiety, depression, quality of recovery, and sleep quality.

Intermittent Feeding Provided Superior Glycemic Control and Reduced Risk of Developing Intolerance Compared to Bolus or Continuous Methods in ICU Patients With Sepsis

An RCT in Science Progress assessed the effects of three enteral nutrition (EN) methods on blood glucose levels (BGLs), and development of feeding intolerance. Ninety-three patients with sepsis were randomized into 3 groups: bolus, intermittent, and continuous EN. Intermittent feeding was associated with more stable BGLs within days and between days (P = 0.001 and P = 0.003, respectively). The bolus group had the highest risk, and the intermittent group had the lowest risk of developing intolerance (P = 0.014). The continuous feeding group had the highest insulin requirement (P = 0.025). There were no significant differences between groups in terms of time to target calorie value or requirement of dextrose administration (P = 0.414 and P = 0.579, respectively). Future larger studies consisting of a broader cohort of patients should be conducted to confirm the findings.

Rescue NIV for Post-Extubation Respiratory Failure Is Associated With High Failure Rates

A post-hoc analysis of an RCT published in Critical Care (London, England) assessed the clinical outcomes of rescue NIV for post-extubation respiratory failure. The RCT compared high-flow with Venturi mask oxygen in hypoxemic patients after extubation. Among 494 extubated patients, 147 developed respiratory failure while receiving oxygen therapy, occurring at a median of 37 hours (IQR 13-85) after extubation: 83 (57%) were treated with rescue NIV and 64 (43%) received immediate reintubation. The rate of NIV failure was 58%, without differences between patients with hypoxemic respiratory failure and those with hypercapnia and/or respiratory distress (60% vs. 56%, P = 0.82). When applied with well-defined criteria for reintubation, rescue NIV does not appear to be clearly associated with increases in hospital mortality. A future RCT should be conducted to reevaluate the efficacy of rescue NIV for post-extubation respiratory failure.

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