New Innovations in Intensive Care

Patients in an intensive care unit (ICU) are not only at risk of dying from their primary illness but also from pneumonia that they contract in the ICU. Ventilator-associated pneumonia (VAP) remains one of the most lethal and frequently occurring infections among critically ill patients who must be mechanically ventilated (along with requisite endotracheal intubation) for more than 48 hours.

Most people will typically develop VAP after a traditional tracheal tube is used due to leakage of fluid that has pooled at the back of the throat, regurgitation, and aspiration of these secretions into the lungs. Removal of these secretions is extremely challenging for critical care nurses, and this allows micro-organisms to enter the normally sterile lower respiratory tract and produce a substantial infection.

Avoidance of mechanical ventilation is obviously the best way to prevent VAP, but that is not always possible for all patients. However, for those who must be intubated, there is now an effective way to reduce serious pulmonary problems and save lives in the ICU. A new low-volume, low-pressure endotracheal tube cuff with a special suction setup that provides effective airway seals at low pressure and allows all secretions to drain from the subglottic space just above the tube cuff, has recently been approved for use in the United Kingdom.

                                 

Critical illness and intensive care can disrupt both short- and long-term health among intensive care unit (ICU) survivors. Neurocognitive and functional abilities can be profoundly disturbed, decreasing quality of life. Acknowledged in the literature as post-intensive care syndrome (PICS), debilitation including posttraumatic stress disorder (PTSD) after intensive care can continue for years. This condition, when associated with ICU hospitalization and critical illness, is often unrecognized and therefore untreated. ICU-related PTSD appears to have a unique clinical profile, likely requiring comprehensive assessment and treatment upon discharge. Prevalence of PICS is as high as 50% among ICU survivors. This percentage will increase as the population ages and the corresponding use of critical care units goes up.

Family members of ICU survivors may also experience psychological symptoms including, but not limited to, depression, generalized anxiety, symptoms of posttraumatic stress, and sleep disorders. This syndrome is known as post-intensive care syndrome-family (PICS-F).

Cognitive impairment is experienced by as many as 1 in 4 ICU survivors for as long as 12 months after discharge, and the symptoms can have the same severity as mild Alzheimer disease. ICU diaries have been used to reduce the neuropsychiatric impact of critical illness and can help patients and their families recall daily events both outside and inside the ICU as well as emotions, thoughts, and well wishes from friends, family members, and clinicians. In a randomized controlled trial reported by Jones et al, ICU diaries resulted in a significant reduction in PICS 3 months after ICU discharge.

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