Management of pain and sedation in the intensive care unit.

Advances in our approach to treating pain and sedation when caring for patients in the intensive care unit (ICU) have been propelled by decades of robust trial data, knowledge gained from patient experiences, and our evolving understanding of how pain and sedation strategies affect patient survival and long term outcomes. These data contribute to current practice guidelines prioritizing analgesia-first sedation strategies (analgosedation) that target light sedation when possible, use of short acting sedatives, and avoidance of benzodiazepines. Together, these strategies allow the patient to be more awake and able to participate in early mobilization and family interactions.

Early physical rehabilitation dosage in the IntensiveCare Unit predicts hospital outcomes after criticalCOVID-19.

Objective: to examine the relationship between physical rehabilitation parameters including a novel approach to quantifying dosage with hospital outcomes for patients with critical COVID-19.

Design: Retrospective practice analysis from March 5, 2020, to April 15, 2021.

Setting: Intensive care units (ICU) at four medical institutions.

Long-term outcomes after treatment of delirium during critical illness with antipsychotics (MIND-USA): a randomised, placebo-controlled, phase 3 trial.

Background: Delirium is common during critical illness and is associated with long-term cognitive impairment and disability. Antipsychotics are frequently used to treat delirium, but their effects on long-term outcomes are unknown. We aimed to investigate the effects of antipsychotic treatment of delirious, critically ill patients on long-term cognitive, functional, psychological, and quality-of-life outcomes.

Sustainable and Environmentally Friendly Approach for the Synthesis of Azoxybenzenes from the Reductive Dimerization of Nitrosobenzenes and the Oxidation of Anilines.

This study demonstrates a comparative synthesis of azoxybenzenes through the reductive dimerization of nitrosobenzenes and the oxidation of anilines. Utilizing the cost-effective DIPEA catalyst at room temperature with water as a green solvent, the one-pot procedure involves in situ generation of nitrosobenzene derivatives from anilines in the presence of oxone, followed by DIPEA addition. Both methods yield azoxybenzenes with high selectivity, showcasing the versatility of DIPEA in facilitating the synthesis of azoxybenzenes with various substituents in ortho, meta, and para positions, encompassing electron-donating and electron-withdrawing groups.

Thinking Clearly: The History of Brain Dysfunction in Critical Illness.

Brain dysfunction during critical illness (ie, delirium and coma) is extremely common, and its lasting effect has only become increasingly understood in the last two decades. Brain dysfunction in the intensive care unit (ICU) is an independent predictor of both increased mortality and long-term impairments in cognition among survivors. As critical care medicine has grown, important insights regarding brain dysfunction in the ICU have shaped our practice including the importance of light sedation and the avoidance of deliriogenic drugs such as benzodiazepines.

Association of Vitamin C, Thiamine, and Hydrocortisone Infusion With Long-term Cognitive, Psychological, and Functional Outcomes in Sepsis Survivors: A Secondary Analysis of the Vitamin C, Thiamine, and Steroids in Sepsis Randomized Clinical Trial.

Importance: Sepsis is associated with long-term cognitive impairment and worse psychological and functional outcomes. Potential mechanisms include intracerebral oxidative stress and inflammation, yet little is known about the effects of early antioxidant and anti-inflammatory therapy on cognitive, psychological, and functional outcomes in sepsis survivors.

Objective: To describe observed differences in long-term cognitive, psychological, and functional outcomes of vitamin C, thiamine, and hydrocortisone between the intervention and control groups in the Vitamin C, Thiamine, and Steroids in Sepsis (VICTAS) randomized clinical trial.

ognitive utcomes in the ragmatic nvestigation of optimaxygen argets (CO-PILOT) trial: protocol and statistical analysis plan.

Introduction: Long-term cognitive impairment is one of the most common complications of critical illness among survivors who receive mechanical ventilation. Recommended oxygen targets during mechanical ventilation vary among international guidelines. Different oxygen targets during mechanical ventilation have the potential to alter long-term cognitive function due to cerebral hypoxemia or hyperoxemia.

Oxygen as an Essential Medicine.

Supplemental oxygen is an essential medication in critical care. The optimal oxygen dose delivery system remains unclear, however. The "dose" and "delivery" of oxygen carry significant importance for resource-limited settings, such as low- and middle-income countries (LMICs).

Analysis of Differences in DNA Damage and Repair Efficacy in Lymphocytes of Patients with Bipolar Disorder.

Objective: The aim of this study was to determine DNA damage during euthymic and attack periods, and the oxidative metabolism states that may cause this damage in the pathophysiology of bipolar disorder. The role of DNA repair mechanisms in this process was also investigated.

Method: The study included a total of 90 patients aged between 18-65 years who were diagnosed with bipolar disorder according to DSM- 5 diagnostic criteria, with 30 patients in euthymic, 30 in manic and 30 in depressive periods.

Physiologic responses to exercise in survivors of critical illness: an exploratory pilot study.

Background: ICU survivors suffer from impaired physical function and reduced exercise capacity, yet the underlying mechanisms are poorly understood. The goal of this exploratory pilot study was to investigate potential mechanisms of exercise limitation using cardiopulmonary exercise testing (CPET) and 6-min walk testing (6MWT).

Methods: We enrolled adults aged 18 years or older who were treated for respiratory failure or shock in medical, surgical, or trauma ICUs at Vanderbilt University Medical Center (Nashville, TN, United States).

In-Hospital Depressed Level of Consciousness and Long-Term Functional Outcomes in ICU Survivors.

Objectives: Among critically ill patients, acutely depressed level of consciousness is associated with mortality, but its relationship to long-term outcomes such as disability and physical function is unknown. We investigated the relationship of level of consciousness during hospitalization with long-term disability and physical function in ICU survivors.

Design: Multi-center observational cohort study.

Efficient catalyst-free direct amidation of non-activated carboxylic acids from carbodiimides.

A novel and efficient catalyst- and activating agent-free amidation method direct amidation of carboxylic acids where carbodiimides act as a reagent instead of an activating agent is reported. The reaction is conducted under non-traditional coupling conditions where a higher temperature is employed. Besides not using stoichiometric ratios of activating agent or catalyst, this approach is made even more attractive by occurring in the presence of the environmentally friendly and recyclable non-toxic solvent of DMSO.

Malignant Catatonia: A Review for the Intensivist.

Catatonia is a clinical syndrome characterized by psychomotor, neurological and behavioral changes. The clinical picture of catatonia ranges from akinetic stupor to severe motoric excitement. Catatonia can occur in the setting of a primary psychiatric condition such as bipolar disorder or secondary to a general medical illness like autoimmune encephalitis.

Effects of social influence and implementation climate and leadership on nurse-led early mobility behaviours in critical care.

Introduction: Early mobility (EM), initiating and advancing physical activity in the earliest days of critical illness, has been described as the most difficult component of the ABCDEF bundle to implement and coordinate. Successful implementation of EM in clinical practice requires multiple targeted implementation strategies.

Objective: Describe the associations of nurses' EM attitudes, subjective norms, perceived behavioural control, intention, and implementation climate and leadership with self-reported and documented EM behaviour in the intensive care unit (ICU).

Early posthospitalization recovery after extracorporeal membrane oxygenation in survivors of COVID-19.

Objective: We sought to determine the influence of venovenous extracorporeal membrane oxygenation (ECMO) on outcomes of mechanically ventilated patients with COVID-19 during the first 120 days after hospital discharge.

Methods: Five academic centers conducted a retrospective analysis of mechanically ventilated patients with COVID-19 admitted during March through May 2020. Survivors had access to a multidisciplinary postintensive care recovery clinic.

Iconic Memory in Obsessive Compulsive Disorder.

Objective: In this study, we aimed to investigate whether there is a fast decay in the iconic memory of patients with Obsessive Compulsive Disorder (OCD) compared to healthy individuals by taking into consideration the clinical OCD subtypes.

Method: The study included 74 patients diagnosed with OCD on the basis of the DSM 5 criteria and 63 healthy individuals. The OCD patients were grouped as washers, checkers, both washers and checkers, and non-washers and non-checkers.

Establishing Medicaid incentives for liberating nursing home patients from ventilators.

Background: Chronic ventilator use in Tennessee nursing homes surged following 2010 increases in respiratory care payment rates. Tennessee's Medicaid program implemented multiple policies between 2014 and 2017 to promote ventilator liberation in 11 nursing homes, including quality reporting, on-site monitoring, and pay-for-performance incentives.

Methods: Using repeated cross-sectional analysis of Medicare and Medicaid nursing home claims (2011-2017), hospital discharge records (2010-2017), and nursing home quality reports (2015-2017), we examined how service use changed as Tennessee implemented policies designed to promote ventilator liberation in nursing homes.

Iconic Memory in Obsessive Compulsive Disorder.

Objective: In this study, we aimed to investigate whether there is a fast decay in the iconic memory of patients with Obsessive Compulsive Disorder (OCD) compared to healthy individuals by taking into consideration the clinical OCD subtypes.

Method: The study included 74 patients diagnosed with OCD on the basis of the DSM 5 criteria and 63 healthy individuals. The OCD patients were grouped as washers, checkers, both washers and checkers, and non-washers and non-checkers.

Nutritional Risk at intensive care unit admission and outcomes in survivors of critical illness.

Background And Aims: Risk factors for poor outcomes after critical illness are incompletely understood. While nutritional risk is associated with mortality in critically ill patients, its association with disability, cognitive, and health-related quality of life is unclear in survivors of critical illness. This study's objective was to determine whether greater nutritional risk at ICU admission is associated with greater disability, worse cognition, and worse HRQOL at 3 and 12-month follow-up.

ICU Survivorship-The Relationship of Delirium, Sedation, Dementia, and Acquired Weakness.

The advent of modern critical care medicine has revolutionized care of the critically ill patient in the last 50 years. The Society of Critical Care Medicine (was formed in recognition of the challenges and need for specialized treatment for these fragile patients. As the specialty has grown, it has achieved impressive scientific advances that have reduced mortality and saved lives.