History of British Intensive Care, c. 1950–c. 2000

Annotated and edited transcript of a Witness Seminar held on 16 June 2010. Introduction by Professor Sir Ian Gilmore, Royal Liverpool Hospital and University of Liverpool.Annotated and edited transcript of a Witness Seminar held on 16 June 2010. Introduction by Professor Sir Ian Gilmore, Royal Liverpool Hospital and University of Liverpool.Annotated and edited transcript of a Witness Seminar held on 16 June 2010. Introduction by Professor Sir Ian Gilmore, Royal Liverpool Hospital and University of Liverpool.Annotated and edited transcript of a Witness Seminar held on 16 June 2010. Introduction by Professor Sir Ian Gilmore, Royal Liverpool Hospital and University of Liverpool.Annotated and edited transcript of a Witness Seminar held on 16 June 2010. Introduction by Professor Sir Ian Gilmore, Royal Liverpool Hospital and University of Liverpool.Annotated and edited transcript of a Witness Seminar held on 16 June 2010. Introduction by Professor Sir Ian Gilmore, Royal Liverpool Hospital and University of Liverpool.Annotated and edited transcript of a Witness Seminar held on 16 June 2010. Introduction by Professor Sir Ian Gilmore, Royal Liverpool Hospital and University of Liverpool.Annotated and edited transcript of a Witness Seminar held on 16 June 2010. Introduction by Professor Sir Ian Gilmore, Royal Liverpool Hospital and University of Liverpool.Intensive care developed in the UK as a medical specialty as the result of some extraordinary circumstances and the involvement of some extraordinary people. In 1952, the polio epidemic in Copenhagen demonstrated that tracheostomy with intermittent positive pressure ventilation saved lives and those infected with tetanus (common in agricultural areas) soon benefited. War-time developments such as triage, monitoring, transfusion and teamwork, and different specialists such as respiratory physiologists, anaesthetists and manufacturers of respiratory equipment all improved emergency treatment. These advances were rapidly extended to the care of post-operative patients, particularly with developments in cardiac surgery. Dedicated units appeared in the early 1960s in Cambridge, London and Liverpool, and later specialist care units were created for prenatal, cardiac and dialysis patients. The importance of specialist nursing care led to the development of nurse training, education and the eventual appointment of nurse consultants in the NHS in 1999. The specialty of intensive care was granted Faculty status by the GMC in 2010. Introduced by Professor Sir Ian Gilmore, this transcript includes, inter alia, the development of cardiac catheters, monitoring equipment, data collection techniques and the rise of multidisciplinarity, national audit, and scoring systems

Management of Mechanical Ventilation in Decompensated Heart Failure.

Mechanical ventilation (MV) is a life-saving intervention for respiratory failure, including decompensated congestive heart failure. MV can reduce ventricular preload and afterload, decrease extra-vascular lung water, and decrease the work of breathing in heart failure. The advantages of positive pressure ventilation must be balanced with potential harm from MV: volutrauma, hyperoxia-induced injury, and difficulty assessing readiness for liberation. In this review, we will focus on cardiac, pulmonary, and broader effects of MV on patients with decompensated HF, focusing on practical considerations for management and supporting evidence

Developing minimum clinical standards for physiotherapy in South African ICUs: A qualitative study

Rationale, aims, and objectives: Physiotherapists are integral members of the intensive care unit (ICU) team. Clinicians working in ICU are dependent on their own experience when making decisions regarding individual patient management thus resulting in variation in clinical practice. No formalized clinical practice guidelines or standards exist for the educational profile or scope of practice requirements for ICU physiotherapy. This study explored perceptions of physiotherapists on minimum clinical standards that ICU physiotherapists should adhere to for delivering safe, effective physiotherapy services to critically ill patients. Method: Experienced physiotherapists offering a service to South African ICUs were purposively sampled. Three focus group sessions were held in different parts of the country to ensure national participation. Each was audio recorded. The stimulus question posed was “What is the minimum standard of clinical practice needed by physiotherapists to ensure safe and independent practice in South African ICUs?” Three categories were explored, namely, knowledge, skill, and attributes. Themes and subthemes were developed using the codes identified. An inductive approach to data analysis was used to perform conventional content analysis. Results: Twenty-five physiotherapists participated in 1 of 3 focus group sessions. Mean years of ICU experience was 10.8 years (±7.0; range, 3-33). Three themes emerged from the data namely, integrated medical knowledge, multidisciplinary teamwork, and physiotherapy practice. Integrated medical knowledge related to anatomy and physiology, conditions that patients present with in ICU, the ICU environment, pathology and pathophysiology, and pharmacology. Multidisciplinary teamwork encompassed elements related to communication, continuous professional development, cultural sensitivity, documentation, ethics, professionalism, safety in ICU, and technology. Components related to physiotherapy practice included clinical reasoning, handling skills, interventions, and patient care. Conclusions: The information obtained will be used to inform the development of a list of standards to be presented to the wider national physiotherapy and ICU communities for further consensus-building activities

Bronchopulmonary Dysplasia: Executive Summary of a Workshop

Comment in Bronchopulmonary Dysplasia: The Ongoing Search for One Definition to Rule Them All. [J Pediatr. 2018] Midlife crisis? In its 50th year, BPD redefines itself. [J Pediatr. 2018

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

OBJECTIVE: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012." DESIGN: A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS: The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. RESULTS: The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. CONCLUSIONS: Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality

Cost-effectiveness of Implementing Low-Tidal Volume Ventilation in Patients With Acute Lung Injury

Background: Despite widespread guidelines recommending the use of lung-protective ventilation (LPV) in patients with acute lung injury (ALI), many patients do not receive this lifesaving therapy. We sought to estimate the incremental clinical and economic outcomes associated with LPV and determined the maximum cost of a hypothetical intervention to improve adherence with LPV that remained cost-effective. Methods: Adopting a societal perspective, we developed a theoretical decision model to determine the cost-effectiveness of LPV compared to non-LPV care. Model inputs were derived from the literature and a large population-based cohort of patients with ALI. Cost-effectiveness was determined as the cost per life saved and the cost per quality-adjusted life-years (QALYs) gained. Results: Application of LPV resulted in an increase in QALYs gained by 15% (4.21 years for non-LPV vs 4.83 years for LPV), and an increase in lifetime costs of $7,233 per patient with ALI ($99,588 for non-LPV vs $106,821 for LPV). The incremental cost-effectiveness ratios for LPV were$22,566 per life saved at hospital discharge and $11,690 per QALY gained. The maximum, cost-effective, per patient investment in a hypothetical program to improve LPV adherence from 50 to 90$9,482. Results were robust to a wide range of economic and patient parameter assumptions. Conclusions: Even a costly intervention to improve adherence with low-tidal volume ventilation in patients with ALI reduces death and is cost-effective by current societal standards.NIH F32HL090220.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/84154/1/Cooke - CEA LPV.pd

Committed to Safety: Ten Case Studies on Reducing Harm to Patients

Presents case studies of healthcare organizations, clinical teams, and learning collaborations to illustrate successful innovations for improving patient safety nationwide. Includes actions taken, results achieved, lessons learned, and recommendations