Essentials of intensive care medicine
Adverse effects of critical care treatment, prevention & safety
Critical care interventions, while lifesaving, can lead to a range of adverse effects that impact patient recovery and long-term health. Understanding and mitigating these complications are essential to improving outcomes and ensuring patient safety in intensive care settings.
This section addresses key adverse effects associated with critical care, including pain, agitation, delirium, immobility, and sleep disruption, which can prolong ICU stays and impair recovery. It also covers hospital-acquired complications such as pneumonia, hyperglycemia, and corticosteroid insufficiency, which require proactive management to reduce morbidity and mortality.
Additionally, conditions like ICU-acquired swallowing disorders and chronic critical illness/post-intensive care syndrome (PICS) highlight the long-term consequences of intensive care and the need for structured rehabilitation and follow-up care.
By integrating evidence-based guidelines, reviews, and expert recommendations, this section provides clinicians with strategies for prevention, early detection, and management of these complications, ensuring safer, more effective critical care delivery.
Pain, agitation, delirium, immobility, and sleep disruption
For more on sedation and analgesia, have a look here.
Hospital-acquired pneumonia
For the treatment of hospital-acquired pneumonia, have a look here.
Hyperglycaemia
Hyperglycemia
Society of Critical Care Medicine Guidelines on Glycemic Control for Critically Ill Children and Adults 2024
Kimia Honarmand et al., Critical Care Medicine (2024)
What’s inside
This article presents the 2024 Society of Critical Care Medicine (SCCM) guidelines on glycemic control for critically ill children and adults, offering evidence-based recommendations for managing blood glucose levels in intensive care settings.
Why it’s relevant
Glycemic control is crucial in critically ill patients, as both hyperglycemia and hypoglycemia are associated with increased morbidity and mortality. These guidelines provide updated strategies to optimize glucose management and improve patient outcomes.
Key focus
- Target blood glucose ranges for critically ill children and adults
- Recommendations for insulin therapy and monitoring protocols
- Special considerations for specific patient populations (e.g., diabetic vs. non-diabetic patients)
- Strategies to minimize risks of hypoglycemia and glycemic variability
Takeaway
The guidelines emphasize individualized glycemic control, balancing the benefits of tight glucose management with the risks of hypoglycemia. They advocate for frequent monitoring, tailored insulin therapy, and a multidisciplinary approach to ensure safe and effective care for critically ill patients.
Critical illness-related corticosteroid insufficiency (CIRCI)
Critical illness-related corticosteroid insufficiency (CIRCI)
Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017
Djillali Annane et al., Intensive Care Medicine (2017)
What’s inside
The 2017 guidelines from the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) provide recommendations for diagnosing and managing critical illness-related corticosteroid insufficiency (CIRCI) in critically ill adult and pediatric patients.
Why it’s relevant
CIRCI is a condition characterized by inadequate corticosteroid activity during critical illness, potentially leading to poor patient outcomes. These guidelines aim to standardize care and improve survival rates by offering evidence-based recommendations.
Key focus
- Criteria for diagnosing CIRCI, including clinical signs and laboratory assessments.
- Recommendations for corticosteroid therapy in conditions like septic shock and acute respiratory distress syndrome ( ARDS).
- Guidance on appropriate corticosteroid dosing regimens to balance efficacy and safety.
- Strategies for monitoring treatment response and potential side effects.
Takeaway
Implementing these guidelines can help clinicians effectively diagnose and manage CIRCI, enhancing patient outcomes in critical care settings.
ICU-acquired swallowing disorders
Swallowing disorders
Management of swallowing disorders in ICU patients - A multinational expert opinion
Rudolf Likar et al., Journal of Critical Care (2024)
What’s inside
This multinational expert opinion addresses the diagnosis and management of dysphagia in ICU patients, emphasizing the need for standardized care protocols to improve patient outcomes.
Why it’s relevant
Dysphagia is common among ICU patients and is associated with life-threatening complications and prolonged hospital stays. Despite its prevalence, it often remains underrecognized and unmanaged.
Key focus
- Development of clinical algorithms to standardize dysphagia screening, assessment, and treatment in extubated and tracheostomized ICU patients.
- Recommendations for multidisciplinary team involvement in the management of swallowing disorders.
- Consideration of emerging therapeutic options, such as neurostimulation, to enhance dysphagia care.
Takeaway
Implementing standardized clinical algorithms can lead to early detection and effective management of dysphagia in ICU patients, potentially reducing complications and improving recovery.
Chronic critical illness and post-intensive care syndrome
Post-intensive care syndrome (PICS)
Chronic critical illness and post-intensive care syndrome: from pathophysiology to clinical challenges
Guillaume Voiriot et al., Annals of Intensive Care (2022)
What’s inside
This review explores the multifaceted aspects of chronic critical illness (CCI) and post-intensive care syndrome (PICS), focusing on their pathophysiology and the clinical challenges they present.
Why it’s relevant
As survival rates from critical illnesses improve, a growing number of patients experience long-term complications encompassed by CCI and PICS, significantly affecting their quality of life and increasing healthcare resource utilization.
Key focus
- Mechanisms underlying ICU-acquired weakness, including muscle wasting and impaired contractility.
- Cognitive impairments and neuropsychological disabilities following intensive care.
- Persistent alterations in immune responses post-ICU.
- Long-term pulmonary consequences of acute respiratory distress syndrome (ARDS) and prolonged mechanical ventilation.
- Specific considerations for pediatric patients recovering from critical illness.
Takeaway
A comprehensive understanding of the biological and clinical facets of CCI and PICS is essential for developing effective strategies to enhance long-term recovery and quality of life in ICU survivors.