Interprofessional Team Staffing in U.S. Intensive Care Units.

Rationale: There is a paucity of data, and no consensus, about the composition of interdisciplinary teams of healthcare worker (HCW) that provide care in intensive care units (ICU).

Objective: Delineate the nature and variation of HCW staff composition in US adult ICUs before the COVID-19 pandemic.

Methods: A national survey of 574 adult ICUs inquired about ICU staffing.

Evaluation of Etomidate Use and Association with Mortality Compared with Ketamine among Critically Ill Patients.

Uncertainty remains regarding the risks associated with single-dose use of etomidate. To assess the use of etomidate in critically ill patients and compare outcomes for patients who received etomidate versus ketamine. We assessed patients who received invasive mechanical ventilation (IMV) and were admitted to an ICU in the Premier Healthcare Database between 2008 and 2021.

Interprofessional Staffing Pattern Clusters in U.S. ICUs.

Objectives: To identify interprofessional staffing pattern clusters used in U.S. ICUs.

Opioid Administration Practice Patterns in Patients With Acute Respiratory Failure Who Undergo Invasive Mechanical Ventilation.

Importance: The opioid crisis is impacting people across the country and deserves attention to be able to curb the rise in opioid-related deaths.

Objectives: To evaluate practice patterns in opioid infusion administration and dosing for patients with acute respiratory failure receiving invasive mechanical ventilation.

Design: Retrospective cohort study.

Intravenous Opioid Administration During Mechanical Ventilation and Use After Hospital Discharge.

Importance: Guidelines recommend an analgesia-first strategy for sedation during mechanical ventilation, but associations between opioids provided during mechanical ventilation and posthospitalization opioid-related outcomes are unclear.

Objective: To evaluate associations between an intravenous opioid dose received during mechanical ventilation and postdischarge opioid-related outcomes in medical (nonsurgical) patients.

Design, Setting, And Participants: This retrospective cohort study evaluated adults receiving mechanical ventilation lasting 24 hours or more for acute respiratory failure and surviving hospitalization.

ICU Staffing in the United States.

Background: The last national estimates of US ICU physician staffing are 25 years old and lack information about interprofessional teams.

Research Question: How are US adult ICUs currently staffed?

Study Design And Methods: We conducted a cross-sectional survey (May 4, 2022-February 2, 2023) of adult ICU clinicians (targeting nurse/physician leadership) contacted using 2020 American Hospital Association (AHA) database information and, secondarily, through professional organizations. The survey included questions about interprofessional ICU staffing availability and roles at steady state (pre-COVID-19).

Determinants and Practice Variability of Oxygen Administration during Surgery in the United States: A Retrospective Cohort Study.

Background: The best approaches to supplemental oxygen administration during surgery remain unclear, which may contribute to variation in practice. This study aimed to assess determinants of oxygen administration and its variability during surgery.

Methods: Using multivariable linear mixed-effects regression, the study measured the associations between intraoperative fraction of inspired oxygen and patient, procedure, medical center, anesthesiologist, and in-room anesthesia provider factors in surgical cases of 120 min or longer in adult patients who received general anesthesia with tracheal intubation and were admitted to the hospital after surgery between January 2016 and January 2019 at 42 medical centers across the United States participating in the Multicenter Perioperative Outcomes Group data registry.

Complication Rates of Central Venous Catheters: A Systematic Review and Meta-Analysis.

Importance: Central venous catheters (CVCs) are commonly used but are associated with complications. Quantifying complication rates is essential for guiding CVC utilization decisions.

Objective: To summarize current rates of CVC-associated complications.

Effectiveness of Fludrocortisone Plus Hydrocortisone versus Hydrocortisone Alone in Septic Shock: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

The use of hydrocortisone in adult patients with septic shock is controversial, and the effectiveness of adding fludrocortisone to hydrocortisone remains uncertain. To assess the comparative effectiveness and safety of fludrocortisone plus hydrocortisone, hydrocortisone alone, and placebo or usual care in adults with septic shock. A systematic review and a Bayesian network meta-analysis of peer-reviewed randomized trials were conducted.

Temporal Trends in Mortality of Critically Ill Patients with Sepsis in the United Kingdom, 1988-2019.

Sepsis is a frequent cause of ICU admission and mortality. To evaluate temporal trends in the presentation and outcomes of patients admitted to the ICU with sepsis and to assess the contribution of changing case mix to outcomes. We conducted a retrospective cohort study of patients admitted to 261 ICUs in the United Kingdom during 1988-1990 and 1996-2019 with nonsurgical sepsis.

New antipsychotic prescription and recurrent infections among adult sepsis survivors: A population-based cohort study.

Purpose: Antipsychotic agents, which may increase the risk of infection through dopaminergic dysregulation, are prescribed to a fraction of patients following critical illness. We compared the rate of recurrent sepsis among patients who filled a prescription for antipsychotics with high- or low-D affinity.

Methods: Population-based cohort with active comparator design.

Accounting for Competing Events When Evaluating Long-Term Outcomes in Survivors of Critical Illness.

The clinical trajectory of survivors of critical illness after hospital discharge can be complex and highly unpredictable. Assessing long-term outcomes after critical illness can be challenging because of possible competing events, such as all-cause death during follow-up (which precludes the occurrence of an event of particular interest). In this perspective, we explore challenges and methodological implications of competing events during the assessment of long-term outcomes in survivors of critical illness.

Use of Mechanical Ventilation Across 3 Countries.

Importance: The ability to provide invasive mechanical ventilation (IMV) is a mainstay of modern intensive care; however, whether rates of IMV vary among countries is unclear.

Objective: To estimate the per capita rates of IMV in adults across 3 high-income countries with large variation in per capita intensive care unit (ICU) bed availability.

Design, Setting, And Participants: This cohort study examined 2018 data of patients aged 20 years or older who received IMV in England, Canada, and the US.

Palliative Care in the Intensive Care Unit: Past, Present, and Future.

In this article, the authors review the origins of palliative care within the critical care context and describe the evolution of symptom management, shared decision-making, and comfort-focused care in the ICU from the 1970s to the early 2000s. The authors also review the growth of interventional studies in the past 20 years and indicate areas for future study and quality improvement for end-of-life care among the critically ill.

The Association Between Opioid Prescribing and Opioid-Related Mortality Within Neighborhoods in Ontario, Canada: A Case-Control Study.

Objective: Recent Canadian data show that the prescribing of opioids has declined while the number of opioid deaths continues to rise. This study aimed to assess the relationship between neighborhood-level opioid prescription rates and opioid-related mortality among individuals without an opioid prescription.

Method: This was a nested case-control study using data in Ontario from 2013 to 2019.

The incidence of postoperative vasopressor usage: protocol for a prospective international observational cohort study (SQUEEZE).

Background: Postoperative hypotension is common after major non-cardiac surgery, due predominantly to vasodilation. Administration of infused vasopressors postoperatively may often be considered a surrogate indicator of vasodilation. The incidence of postoperative vasopressors has never been described for non-cardiac surgery, nor have outcomes associated with their use.

Oxygenation thresholds for invasive ventilation in hypoxemic respiratory failure: a target trial emulation in two cohorts.

Background: The optimal thresholds for the initiation of invasive ventilation in patients with hypoxemic respiratory failure are unknown. Using the saturation-to-inspired oxygen ratio (SF), we compared lower versus higher hypoxemia severity thresholds for initiating invasive ventilation.

Methods: This target trial emulation included patients from the Medical Information Mart for Intensive Care (MIMIC-IV, 2008-2019) and the Amsterdam University Medical Centers (AmsterdamUMCdb, 2003-2016) databases admitted to intensive care and receiving inspired oxygen fraction ≥ 0.