Postacute Sequelae of COVID-19 Critical Illness
With an ever-increasing number of COVID-19 survivors, providers are tasked with addressing the longer lasting symptoms of COVID-19, or postacute sequelae of SARS-CoV-2 infection (PASC). For critically ill patients, existing knowledge about postintensive care syndrome (PICS) represents a useful structure for understanding PASC. Post-ICU clinics leverage a multidisciplinary team to evaluate and treat the physical, cognitive, and psychological sequelae central to both PICS and PASC in critically ill patients. While management through both pharmacologic and nonpharmacologic modalities can be used, further research into both th...
Source: Critical Care Clinics - January 9, 2022 Category: Intensive Care Authors: Kristin Schwab, Emily Schwitzer, Nida Qadir Source Type: research

Severe COVID-19 and multisystem inflammatory syndrome in children in Children and Adolescents
Severe complications related to COVID-19 occur infrequently in children and adolescents. these life-threatening complications are mainly acute respiratory failure from acute COVID-19 and multisystem inflammatory syndrome in children (MIS-C). MIS-C is a postinfectious complication occurring approximately 3 to 6 weeks mostly after an asymptomatic or mild SARS-CoV-2 infection. For both types of complications, supportive ICU care is often required. For MIS-C critical illness, immunomodulation is prescribed to reverse hyperinflammation and its cardiac and other sequelae. (Source: Critical Care Clinics)
Source: Critical Care Clinics - January 9, 2022 Category: Intensive Care Authors: Allison M. Blatz, Adrienne G. Randolph Source Type: research

High-Flow Nasal Oxygen and Noninvasive Ventilation for COVID-19
High-flow nasal oxygen (HFNO) and noninvasive ventilation (NIV) via facemask or helmet have been increasingly used in managing acute hypoxemic respiratory failure (AHRF) owing to COVID-19 with the premise of reducing the need for invasive mechanical ventilation and possibly mortality. Their use carries the risk of delaying intubation and nosocomial infection transmission. To date, most studies on the effectiveness of these modalities are observational and suggest that HFNO and NIV have a role in the management of AHRF owing to COVID-19. Trials are ongoing and are evaluating different aspects of noninvasive respiratory supp...
Source: Critical Care Clinics - January 9, 2022 Category: Intensive Care Authors: Hasan M. Al-Dorzi, John Kress, Yaseen M. Arabi Source Type: research

Post-Acute Sequelae of COVID-19 Critical Illness
With an ever-increasing number of COVID-19 survivors, providers are tasked with addressing the longer lasting symptoms of COVID-19, or post-acute sequelae of SARS-CoV-2 infection (PASC). For critically ill patients, existing knowledge about post-intensive care syndrome (PICS) represents a useful structure for understanding PASC. Post-ICU clinics leverage a multidisciplinary team to evaluate and treat the physical, cognitive, psychological sequelae central to both PICS and PASC in critically ill patients. While management through both pharmacologic and nonpharmacologic modalities can be utilized, further research into both ...
Source: Critical Care Clinics - January 9, 2022 Category: Intensive Care Authors: Kristin Schwab, Emily Schwitzer, Nida Qadir Source Type: research

COVID-19 and Acute Kidney Injury
Initial reporting suggested that kidney involvement following COVID-19 infection was uncommon but this is now known not to be the case. Acute kidney injury (AKI) may arise through several mechanisms and complicate up to a quarter of patients hospitalised with COVID-19 infection being associated with an increased risk for both morbidity and death. Mechanisms of injury include direct kidney damage predominantly through tubular injury, although glomerular injury has been reported; the consequences of the treatment of patients with severe hypoxic respiratory failure; secondary infection; and exposure to nephrotoxic drugs. The ...
Source: Critical Care Clinics - January 9, 2022 Category: Intensive Care Authors: James Hilton, Naomi Boyer, Mitra K. Nadim, Lui G. Forni, John A. Kellum Source Type: research

COVID-19 in the Critically Ill Pregnant Patient
Pregnant women are at increased risk for severe coronavirus disease 2019 (COVID-19) and COVID-19 related complications. Their increased risk in conjuncture with the normal physiologic changes of pregnancy poses unique challenges for the management of the critically ill pregnant patient. This paper will review the initial management of pregnant patients who develop acute hypoxic respiratory failure and subsequent treatment of those that deteriorate to acute respiratory distress syndrome and require advanced therapies. Moreover, fetal monitoring and timing of delivery will be reviewed. (Source: Critical Care Clinics)
Source: Critical Care Clinics - January 9, 2022 Category: Intensive Care Authors: Matthew Levitus, Scott A. Shainker, Mai Colvin Source Type: research

Extracorporeal Membrane Oxygenation in COVID-19
Extracorporeal membrane oxygenation (ECMO) is an intervention for severe acute respiratory distress syndrome (ARDS). Despite COVID-19 related ARDS might have some distinct features, its overall clinical presentation resembles ARDS from other etiologies. Thus, similar evidence-based practices for its management should be applied. These include lung-protective ventilation, prone positioning, and adjuvant strategies such as ECMO, when appropriate. Current evidence suggests that ECMO in COVID-19 related ARDS has similar efficacy and safety profile as for non-COVID-19 ARDS. The high number of severe COVID-19 cases and demand fo...
Source: Critical Care Clinics - January 9, 2022 Category: Intensive Care Authors: Manuel Tisminetzky, Bruno L. Ferreyro, Eddy Fan Source Type: research

Severe COVID-19 and MIS-C In Children & Adolescents
Severe complications related to COVID-19 occur infrequently in children and adolescents. The two major types of life-threatening complications are acute respiratory failure from acute COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C). MIS-C is a post-infectious complication occurring approximately 3-6 weeks after an asymptomatic or mild SARS-CoV-2 infection. For both types of complications, supportive ICU care is provided. For MIS-C critical illness, immunomodulation is prescribed to reverse hyperinflammation and its cardiac and other sequelae. (Source: Critical Care Clinics)
Source: Critical Care Clinics - January 9, 2022 Category: Intensive Care Authors: Allison M. Blatz, Adrienne G. Randolph Source Type: research

High-flow nasal oxygen and non-invasive ventilation for COVID-19
High-flow nasal oxygen (HFNO) and non-invasive ventilation (NIV) via face-mask or helmet have been increasingly used in the management of acute hypoxemic respiratory failure (AHRF) due to COVID-19 with the premise of reducing the need for invasive mechanical ventilation and possibly mortality. However, their use carries the risk of delaying intubation and nosocomial infection transmission. To this date, most studies on the effectiveness of these modalities are observational and suggest that HFNO and NIV have a role in the management of AHRF due to COVID-19. A randomized controlled trial among patients with COVID-19 showed ...
Source: Critical Care Clinics - January 9, 2022 Category: Intensive Care Authors: Hasan M Al-Dorzi, John Kress, Yaseen M. Arabi Source Type: research

Dual Process Theory and Cognitive Load
Improving clinical reasoning in order to reduce frequency of diagnostic errors is an important area of study. The authors discuss dual process theory as a model of clinical reasoning and explore the role that cognitive load plays in clinical reasoning in the intensive care unit environment. (Source: Critical Care Clinics)
Source: Critical Care Clinics - November 16, 2021 Category: Intensive Care Authors: Emily Harris, Lekshmi Santhosh Source Type: research

Decision Making
Critical care settings are unpredictable, dynamic environments where clinicians face high decision density in suboptimal conditions (stress, time constraints, competing priorities). Experts have described two systems of human decision making: one fast and intuitive; the other slow and methodical. Heuristics, or mental shortcuts, a key feature of intuitive reasoning, are often accurate, applied instinctively, and essential for efficient diagnostic decision making. Heuristics are also prone to failures, or cognitive biases, which can lead to diagnostic errors. A variety of strategies have been proposed to mitigate biases; ho...
Source: Critical Care Clinics - November 16, 2021 Category: Intensive Care Authors: Courtney W. Mangus, Prashant Mahajan Source Type: research

A Research Agenda for Diagnostic Excellence in Critical Care Medicine
Diagnosing critically ill patients in the intensive care unit is difficult. As a result, diagnostic errors in the intensive care unit are common and have been shown to cause harm. Research to improve diagnosis in critical care medicine has accelerated in past years. However, much work remains to fully elucidate the diagnostic process in critical care. To achieve diagnostic excellence, interdisciplinary research is needed, adopting a balanced strategy of continued biomedical discovery while addressing the complex care delivery systems underpinning the diagnosis of critical illness. (Source: Critical Care Clinics)
Source: Critical Care Clinics - November 16, 2021 Category: Intensive Care Authors: Christina L. Cifra, Jason W. Custer, James C. Fackler Source Type: research

Diagnostic Error
Diagnostic errors remain relatively understudied and underappreciated. They are particularly concerning in the intensive care unit, where they are more likely to result in harm to patients. There is a lack of consensus on the definition of diagnostic error, and current methods to quantify diagnostic error have numerous limitations as noted in the sentinel report by the National Academy of Medicine. Although definitive definition and measurement remain elusive goals, increasing our understanding of diagnostic error is crucial if we are to make progress in reducing the incidence and harm caused by errors in diagnosis. (Sourc...
Source: Critical Care Clinics - November 16, 2021 Category: Intensive Care Authors: Grant Shafer, Kanekal Suresh Gautham Source Type: research

Promoting Critical Thinking in Your Intensive Care Unit Team
Effective and efficient critical thinking skills are necessary to engage in accurate clinical reasoning and to make appropriate clinical decisions. Teaching and promoting critical thinking skills in the intensive care unit is challenging because of the volume of data and the constant distractions of competing obligations. Understanding and acknowledging cognitive biases and their impact on clinical reasoning are necessary to promote and support critical thinking in the ICU. Active educational strategies such as concept or mechanism mapping can help to diagnose disorganized thinking and reinforce key connections and importa...
Source: Critical Care Clinics - November 16, 2021 Category: Intensive Care Authors: Jeremy B. Richards, Richard M. Schwartzstein Source Type: research

Intensive Care Unit Decision-Making in Uncertain and Stressful Conditions Part 2
Diagnostic errors are considered a blind spot of health care delivery and occur in up to 15% of patient cases. Cognitive failures are a leading cause of diagnostic error and often occur as a result of overreliance on system 1 thinking. This narrative review describes why diagnostic errors occur by shedding additional light on systems 1 and 2 forms of thinking, reviews literature on debiasing strategies in medicine, and provides a framework for teaching critical thinking in the intensive care unit as a strategy to promote learner development and minimize cognitive failures. (Source: Critical Care Clinics)
Source: Critical Care Clinics - November 16, 2021 Category: Intensive Care Authors: Megan Christenson, Anuj Shukla, Jayshil J. Patel Source Type: research