Patient and Caregiver-Derived Health Service Improvements for Better Critical Care Recovery.

Objectives: To engage critical care end-users (survivors and caregivers) to describe their emotions and experiences across their recovery trajectory, and elicit their ideas and solutions for health service improvements to improve the ICU recovery experience.

Design: End-user engagement as part of a qualitative design using the Framework Analysis method.

Setting: The Society of Critical Care Medicine's THRIVE international collaborative sites (follow-up clinics and peer support groups).

An International Study Exploring the Experience of Survivors of Critical Illness as Volunteers Within ICU Recovery Services.

Unlabelled: Many clinicians have implemented follow-up and aftercare to support patients following ICU. Some of this care is supported and facilitated by peer volunteers. There is limited contemporary work that has explicitly explored volunteer roles within ICU recovery services or the experience of volunteers undertaking these roles.

Transitions of Care After Critical Illness-Challenges to Recovery and Adaptive Problem Solving.

Objectives: Investigate the challenges experienced by survivors of critical illness and their caregivers across the transitions of care from intensive care to community, and the potential problem-solving strategies used to navigate these challenges.

Design: Qualitative design-data generation via interviews and data analysis via the framework analysis method.

Setting: Patients and caregivers from three continents, identified through the Society of Critical Care Medicine's THRIVE international collaborative sites (follow-up clinics and peer support groups).

Optimizing Critical Illness Recovery: Perspectives and Solutions From the Caregivers of ICU Survivors.

Objectives: To understand the unmet needs of caregivers of ICU survivors, how they accessed support post ICU, and the key components of beneficial ICU recovery support systems as identified from a caregiver perspective.

Design: International, qualitative study.

Subjects: We conducted 20 semistructured interviews with a diverse group of caregivers in the United States, the United Kingdom, and Australia, 11 of whom had interacted with an ICU recovery program.

Benefits of Peer Support for Intensive Care Unit Survivors: Sharing Experiences, Care Debriefing, and Altruism.

Background: After critical illness, patients are often left with impairments in physical, social, emotional, and cognitive functioning. Peer support interventions have been implemented internationally to ameliorate these issues.

Objective: To explore what patients believed to be the key mechanisms of effectiveness of peer support programs implemented during critical care recovery.

Key Components of ICU Recovery Programs: What Did Patients Report Provided Benefit?

Unlabelled: To understand from the perspective of patients who did, and did not attend ICU recovery programs, what were the most important components of successful programs and how should they be organized.

Design: International, qualitative study.

Setting: Fourteen hospitals in the United States, United Kingdom, and Australia.

Enablers and Barriers to Implementing ICU Follow-Up Clinics and Peer Support Groups Following Critical Illness: The Thrive Collaboratives.

Objectives: Data are lacking regarding implementation of novel strategies such as follow-up clinics and peer support groups, to reduce the burden of postintensive care syndrome. We sought to discover enablers that helped hospital-based clinicians establish post-ICU clinics and peer support programs, and identify barriers that challenged them.

Design: Qualitative inquiry.

Key mechanisms by which post-ICU activities can improve in-ICU care: results of the international THRIVE collaboratives.

Objective: To identify the key mechanisms that clinicians perceive improve care in the intensive care unit (ICU), as a result of their involvement in post-ICU programs.

Methods: Qualitative inquiry via focus groups and interviews with members of the Society of Critical Care Medicine's THRIVE collaborative sites (follow-up clinics and peer support). Framework analysis was used to synthesize and interpret the data.

Contemporary cardiac surgery for adults with congenital heart disease.

Objective: Advances in early management of congenital heart disease (CHD) have led to an exponential growth in adults with CHD (ACHD). Many of these patients require cardiac surgery. This study sought to examine outcome and its predictors for ACHD cardiac surgery.

Association of haemodynamic changes measured by serial central venous saturation during ultrafiltration for acutely decompensated heart failure with diuretic resistance and change in renal function.

Background: Patients with acute decompensated heart failure with diuretic resistance (ADHF-DR) have a poor prognosis. The aim of this study was to assess in patients with ADHF-DR, whether haemodynamic changes during ultrafiltration (UF) are associated with changes in renal function (Δcreatinine) and whether Δcreatinine post UF is associated with mortality.

Methods: Seventeen patients with ADHF-DR underwent 20 treatments with UF.

Systemic inflammation and oxidative stress post-lung resection: Effect of pretreatment with N-acetylcysteine.

Background And Objective: N-acetylcysteine has been used to treat a variety of lung diseases, where is it thought to have an antioxidant effect. In a randomized placebo-controlled double-blind study, the effect of N-acetylcysteine on systemic inflammation and oxidative damage was examined in patients undergoing lung resection, a human model of acute lung injury.

Methods: Eligible adults were randomized to receive preoperative infusion of N-acetylcysteine (240 mg/kg over 12 h) or placebo.

Clinical outcomes of surgical pulmonary valve replacement after repair of tetralogy of Fallot and potential prognostic value of preoperative cardiopulmonary exercise testing.

Background: Indications for surgical pulmonary valve replacement (PVR) after repair of tetralogy of Fallot have recently been broadened to include asymptomatic patients.

Methods And Results: The outcomes of PVR in adults after repair of tetralogy of Fallot at a single tertiary center were retrospectively studied. Preoperative cardiopulmonary exercise testing was included.

Acute kidney injury after cardiac surgery according to Risk/Injury/Failure/Loss/End-stage, Acute Kidney Injury Network, and Kidney Disease: Improving Global Outcomes classifications.

Purpose: The epidemiology of acute kidney injury (AKI) after cardiac surgery depends on the definition used. Our aims were to evaluate the Risk/Injury/Failure/Loss/End-stage (RIFLE) criteria, the AKI Network (AKIN) classification, and the Kidney Disease: Improving Global Outcomes (KDIGO) classification for AKI post-cardiac surgery and to compare the outcome of patients on renal replacement therapy (RRT) with historical data.

Methods: Retrospective analysis of 1881 adults who had cardiac surgery between May 2006 and April 2008 and determination of the maximum AKI stage according to the AKIN, RIFLE, and KDIGO classifications.

Extracorporeal membrane oxygenation for severe acute respiratory failure in adults: NICE guidance.

Extracorporeal membrane oxygenation (ECMO) is a modified form of cardiopulmonary bypass that allows short-term support for potentially reversible severe acute respiratory and/or cardiac failure in critically ill adults and children. There is increasing interest in veno-venous (VV) ECMO for severe acute respiratory failure in adults. The National Institute for Health and Clinical Excellence has recently updated its interventional procedure guidance, which summarises available data on efficacy and safety of this procedure and provides guidance for clinicians wishing to undertake VV ECMO.

Breathlessness after pneumonectomy: consider postpneumonectomy syndrome.

A 59-year-old woman presented with increasing breathlessness several weeks after right pneumonectomy. Imaging confirmed features of postpneumonectomy syndrome with marked mediastinal shift, and compression of the left main bronchus and pulmonary vein. The mediastinum was repositioned by insertion of saline-filled prostheses into the pneumonectomy space with symptomatic and radiologic improvement.

Biomarkers of lung injury after one-lung ventilation for lung resection.

Background And Objective: Acute lung injury contributes to the mortality of patients after lung resection and one-lung ventilation (OLV). The objective of this study was to characterise the effect of lung resection and OLV on proposed biomarkers of lung injury in exhaled breath condensate (EBC) and plasma.

Methods: In adults undergoing lung resection, EBC was collected before and at 30-min intervals during OLV.

New flow cytometric technique for the evaluation of circulating endothelial progenitor cell levels in various disease groups.

Circulating endothelial progenitor cells (EPC) localise to sites of ischaemia and play a role in vascular repair and re-endothelialisation of injured blood vessels. Low levels of EPCs are associated with cardiovascular disease (CVD) in the general population. It is not clear at present whether and how the numbers of circulating EPCs vary in diseases other than CVD.