Editorial September 3, 2021 Safety Surveillance of COVID-19 mRNA Vaccines Through the Vaccine Safety Datalink Kimberly G. Blumenthal, Neelam A. Phadke, David W. Bates JAMA. 2021;326(14):1375-1377. doi:10.1001/jama.2021.14808 Vaccines represent one of the greatest public health achievements of modern medicine. They must pass rigorous and predetermined efficacy and safety metrics prior to licensure. Additionally, postmarketing safety surveillance is essenti...

ICU Management & Practice, Volume 19 - Issue 4, Winter 2019/2020 Future ICU Design: Return to High Visibility Future ICU designs must feature high visibility to ensure safety. The ability for critical care nurses, physician intensivists, and other caregivers to visualise their patients has always been a high priority as it plays a major role in patient and staff safety. Architects and designers have responded with configurations for intensive care units ...

Early vs Late Tracheostomy and Ventilator-Associated Pneumonia Surgically opening the windpipe, or trachea, within the first seven days of the start of mechanical ventilation decreases the time patients spend on ventilators, shortens their ICU stay and lowers their risk of ventilator-associated pneumonia, according to a new systematic review. "We analysed the existing medical literature to unravel a question that is very pertinent to adult critical care," said s...

RAPID Trial: Therapeutic Heparin vs Prophylactic Heparin in COVID-19 Patients A study was conducted to evaluate the effects of therapeutic heparin compared with prophylactic heparin among moderately ill patients with COVID-19 admitted to the hospital. Heparin has anticoagulant properties, anti-inflammatory effects and potential antiviral effects and may also improve endothelial function. Early initiation of therapeutic heparin can decrease the thrombo-inflammato...

Prone Positioning During ECMO for ARDS There is sufficient evidence to show that prone positioning improves oxygenation and respiratory mechanics and is also associated with lower mortality in patients with moderate to severe ARDS. However, some patients can develop refractory hypoxaemia and hypercapnia that could require the use of venovenous extracorporeal membrane oxygenation (VV-ECMO) support and need to be cared for in a supine position. Hence, the physiologic...

AKI in Critically Ill Patients With COVID-19 Acute kidney injury is highly prevalent among severely ill COVID-19 patients. However, there is very limited data on the progression of AKI and long-term outcomes in these patients. In this study, researchers aimed to describe the prevalence and risk factors for the development of acute kidney injury, its clinical course and progression and renal recovery or dialysis dependence and survival. The study was conducted...

Ethics in Extracorporeal Life Support Extracorporeal life support has had a significant impact on modern medicine. However, the use of this technology has significant ethical challenges. In this review, the authors identify three ethical discourses: trials and evidence accompanying the use of ECLS, the ECLS allocation, decision-making and limiting care and death on ECLS and ECLS in organ donation. They then provide a narrative synthesis of all major arguments ex...

Trends in Sepsis-Related Mortality in the U.S. Sepsis is a life-threatening organ dysfunction. It is the leading cause of death in the U.S. It is also one of the most expensive conditions to treat. However, the burden of sepsis-related mortality in the U.S. in recent years is not well-characterised. Previous studies utilise hospital databases and electronic health records to determine trends, but these have been limited to only a few hospital systems and geogr...

Mental Disorders and Risk of Severe COVID-19 Over the last few months, several risk factors have been identified for severe COVID-19 illness and mortality. These include age, male sex, obesity and cardiovascular disease. Recent evidence from a meta-analysis also demonstrates an increased risk of severe or fatal COVID-19 among patients with a pre-existing mental disorder.  Since then, several studies have found that patients with psychiatric disorders are also ...

Association of Higher vs Lower PEEP on Mortality Mechanical ventilation is a life-saving strategy for critically ill patients. However, it can promote and/or exacerbate lung injury through several mechanisms, including alveolar overdistension and repetitive opening and closing of the alveoli and small airways. Positive end-expiratory pressure (PEEP) has been employed to prevent end-expiratory alveolar collapse and counteract mechanical strain. However, excessive PE...