The care of critically ill adults with COVID-19 in Ontario pediatric intensive care units.

Purpose: To describe and review the experience of two pediatric intensive care units (PICUs) in Ontario, Canada, adapting and providing care to critically ill adults during the COVID-19 pandemic.

Clinical Features: At a time of extreme pressure to adult intensive care unit (ICU) capacity, two PICUs provided care to critically ill adults with COVID-19 pneumonia. Substantial yet rapid planning was required to facilitate safe delivery of critical care to adult patients while maintaining PICU services, including thoughtful development of care pathways and patient selection.

Canadian public perception of anesthesiologists: results from a national survey.

Purpose: As Canadian health systems experience greater pressure to deliver timely perioperative care, public opinion is likely to influence health care policy decisions. Since Canadian public perception of anesthesiologists is unknown, the goal of this Canadian-wide survey was to begin to quantify public opinion regarding anesthesiologists in Canada.

Methods: The Maru/Blue international market research group was contracted to survey the Canadian public on their perceptions of anesthesiologists.

Cost of Futile ICU Care in One Ontario Hospital.

Critical care is a costly and finite resource that provides the ability to manage patients with life-threatening illnesses in the most advanced forms available. However, not every condition benefits from critical care. There are unrecoverable health states in which it should not be used to perpetuate.

The Clinical Utility of Continuous QT Interval Monitoring in Patients Admitted With COVID-19 Compared With Standard of Care: A Prospective Cohort Study.

Background: QT interval monitoring has gained much interest during the COVID-19 pandemic because of the use of QT-prolonging medications and the concern about viral transmission with serial electrocardiograms (ECGs). We hypothesized that continuous telemetry-based QT monitoring is associated with better detection of prolonged QT episodes.

Methods: We introduced continuous cardiac telemetry (CCT) with an algorithm for automated QT interval monitoring to our designated COVID-19 units.

Therapeutic alternatives and strategies for drug conservation in the intensive care unit during times of drug shortage: a report of the Ontario COVID-19 ICU Drug Task Force.

During the coronavirus disease (COVID-19) global pandemic, urgent strategies to alleviate shortages are required. Evaluation of the feasibility, practicality, and value of drug conservation strategies and therapeutic alternatives requires a collaborative approach at the provincial level. The Ontario COVID-19 ICU Drug Task Force was directed to create recommendations suggesting drug conservation strategies and therapeutic alternatives for essential drugs at risk of shortage in the intensive care unit during the COVID-19 pandemic.

An Analysis of Pay-for-Performance Schemes and Their Potential Impacts on Health Systems and Outcomes for Patients.

Pay-for-performance (P4P) programs have been introduced into the Canadian medical system in the last decades. This paper examines the underlying characteristics of P4P and describes both their advantages and drawbacks. Most P4P programs provide the advantage of rewarding medical acts, thus providing an incentive to take on complex patients.

Addressing bullying behaviour by patients and families.

This article explores the ethical dilemma of maintaining patient experience and care team well-being when faced with coercive behaviour, specifically bullying by patients, families and substitute decision-makers, which is directed toward providers and health support workers. We discuss some of the contributing societal and environmental factors, the ethical implications for health leaders, and suggest some practical options for managing bullying situations in hospitals.

Ethical failings of CPSO policy and the health care consent act: case review.

End-of-life disputes in Ontario are currently overwhelmingly assessed through the singular lens of patient autonomy. The current dispute resolution mechanism(s) does not adequately consider evidence-based medical guidelines, standards of care, the patient's best interests, expert opinion, or distributive justice. We discuss two cases adjudicated by the Consent and Capacity board of Ontario that demonstrate the over emphasis on patient autonomy.

Dynamic Assessment of Fluid Responsiveness in Surgical ICU Patients Through Stroke Volume Variation is Associated With Decreased Length of Stay and Costs: A Systematic Review and Meta-Analysis.

Static indices, such as the central venous pressure, have proven to be inaccurate predictors of fluid responsiveness. An emerging approach uses dynamic assessment of fluid responsiveness (FT-DYN), such as stroke volume variation (SVV) or surrogate dynamic variables, as more accurate measures of volume status. Recent work has demonstrated that goal-directed therapy guided by FT-DYN was associated with reduced intensive care unit (ICU) mortality; however, no study has specifically assessed this in surgical ICU patients.

Implementation of a multimodal patient safety improvement program "SafetyLEAP" in intensive care units.

Purpose Patient safety remains a top priority in healthcare. Many organizations have developed systems to monitor and prevent harm, and have invested in different approaches to quality improvement. Despite these organizational efforts to better detect adverse events, efficient resolution of safety problems remains a significant challenge.

Monitoring intensive care unit performance-impact of a novel individualised performance scorecard in critical care medicine: a mixed-methods study protocol.

Introduction: Patients admitted to a critical care medicine (CCM) environment, including an intensive care unit (ICU), are susceptible to harm and significant resource utilisation. Therefore, a strategy to optimise provider performance is required. Performance scorecards are used by institutions for the purposes of driving quality improvement.

Approach to economic analysis in critical care.

There are 4 general economic analyses used in health care: cost minimization, cost-benefit, cost-effectiveness, and cost utility. In this review, we provide an overview of each of these analyses and examine their appropriateness and effectiveness in assessing critical care costs. In the intensive care unit setting, it is particularly important to consider the patients' quality of life following the treatment of critical illness and to adopt a societal perspective when conducting economic analyses.

Drug shortages in Canadian anesthesia: a national survey.

Background: Canadian physicians are faced with an increasing frequency of drug shortages. We hypothesized that drug shortages have a clinical impact on anesthesia care in Canada.

Methods: We conducted a self-administered survey of anesthesiologists in Canada using the membership list of the Canadian Anesthesiologists' Society.

STAR VaS--Short Term Atorvastatin Regime for Vasculopathic Subjects: a randomized placebo-controlled trial evaluating perioperative atorvastatin therapy in noncardiac surgery.

Purpose: Evidence suggests that statins reduce cardiovascular complications in patients undergoing noncardiac surgery, although questions remain regarding the mechanism of benefit and the preferred dosing strategy. In this trial, we evaluated the perioperative effects on C-reactive protein (CRP) that resulted from starting atorvastatin within seven days of noncardiac surgery. The objective was to identify anti-inflammatory effects of atorvastatin prior to conducting a large randomized trial with clinical end points.

Efficiency and safety of a standardized protocol for intravenous insulin therapy in ICU patients with neurovascular or head injury.

Background: To evaluate the safety and efficiency of a protocol for glycemic control in intensive care unit (ICU) patients with neurovascular or head injury.

Methods: Two cohorts of 50 consecutive patients admitted to the ICU with an admission diagnosis of neurovascular or head injury before and after protocol implementation were evaluated. All patients in the interventional cohort received insulin using a standardized intravenous insulin infusion protocol targeting blood glucose levels of 7-9 mmol/l.

Substantial variation of both opinions and practice regarding perioperative fluid resuscitation.

Background: There are no current standards of care guiding perioperative fluid administration, and clinicians continue to debate restrictive versus liberal fluid administration. We sought to simultaneously evaluate the opinions and practice of surgeons, intensivists and anesthesiologists in a single centre regarding perioperative fluid resuscitation.

Methods: A postal survey sent to surgeons, intensivists and anesthesiologists in a single academic health care centre presented case-based scenarios followed by questions on fluid requirements and 5-point Likert scales involving statements about resuscitation.

A comparison of global rating scale and checklist scores in the validation of an evaluation tool to assess performance in the resuscitation of critically ill patients during simulated emergencies (abbreviated as "CRM simulator study IB").

Background: Crisis resource management (CRM) skills are a set of nonmedical skills required to manage medical emergencies. There is currently no gold standard for evaluation of CRM performance. A prior study examined the use of a global rating scale (GRS) to evaluate CRM performance.

No evidence for decreased incidence of aspiration after rapid sequence induction.

Purpose: The purpose of this structured, evidence-based, clinical update was to determine if rapid sequence induction is a safe or effective technique to decrease the risk of aspiration or other complications of airway management.

Source: In June 2006 a structured search of MEDLINE from 1966 to present using OVID software was undertaken with the assistance of a reference librarian. Medical subject headings and text words describing rapid sequence induction or intubation (RSI), crash induction or intubation, cricoid pressure and emergency airway intubation were employed.

A pilot study using high-fidelity simulation to formally evaluate performance in the resuscitation of critically ill patients: The University of Ottawa Critical Care Medicine, High-Fidelity Simulation, and Crisis Resource Management I Study.

Objective: Resuscitation of critically ill patients requires medical knowledge, clinical skills, and nonmedical skills, or crisis resource management (CRM) skills. There is currently no gold standard for evaluation of CRM performance. The primary objective was to examine the use of high-fidelity simulation as a medium to evaluate CRM performance.

Cell salvage does not minimize perioperative allogeneic blood transfusion in abdominal vascular surgery: a systematic review.

Purpose: To determine whether the use of cell salvage reduces the proportion of patients receiving at least one unit of allogeneic packed red blood cells during the perioperative period of an elective vascular surgery.

Source: We identified all relevant articles through the combined use of electronic searches of the MEDLINE and EMBASE databases, the Cochrane library as well as hand searching of all randomized clinical trials and review articles. The electronic search included articles published between 1966 and April 2001.

Tranexamic acid for major spinal surgery.

Patients who undergo major spinal surgery often require multiple blood transfusions. The antifibrinolytics are medications that can reduce blood-transfusion requirements in cardiac surgery and total knee arthroplasty. The present role of synthetic antifibrinolytics, especially tranexamic acid, in reducing peri-operative blood-transfusion requirements in spine surgery is still unclear.