ABSTRACT
Background: Acute respiratory distress syndrome (ARDS) occurs commonly in intensive care units. The reported mortality rates in studies evaluating ARDS are highly variable. Objective: To investigate mortality rates due to ARDS from before the 2009 H1N1 influenza pandemic began until the start of coronavirus disease 2019 (COVID-19) pandemic. Design: We performed a systematic search and then ran a proportional meta-analysis for mortality. We ran our analysis in three ways: for randomised controlled trials only, for observational studies only, and for randomised controlled trials and observational studies combined. Data sources: MEDLINE and Embase, using a highly sensitive criterion and limiting the search to studies published from January 2009 to December 2019. Review methods: Two of us independently screened titles and s to first identify studies and then complete full text reviews of selected studies. We assessed risk of bias using the Cochrane RoB-2 (a risk-of-bias tool for randomised trials) and the Cochrane ROBINS-1 (a risk-of-bias tool for non-randomised studies of interventions). Results: We screened 5844 citations, of which 102 fully met our inclusion criteria. These included 34 randomised controlled trials and 68 observational studies, with a total of 24 158 patients. The weighted pooled mortality rate for all 102 studies published from 2009 to 2019 was 39.4% (95% CI, 37.0–41.8%). Mortality was higher in observational studies compared with randomised controlled trials (41.8% [95% CI, 38.9–44.8%] v 34.5% [95% CI, 30.6–38.5%];P = 0.005). Conclusions: Over the past decade, mortality rates due to ARDS were high. There is a clear distinction between mortality in observational studies and in randomised controlled trials. Future studies need to report mortality for different ARDS phenotypes and closely adhere to evidence-based medicine. PROSPERO registration: CRD42020149712 (April 2020). © 2022, College of Intensive Care Medicine. All rights reserved.
ABSTRACT
INTRODUCTION: Up to 80% of intensive care unit (ICU) survivors experience post-intensive care syndrome (PICS) which is a constellation of new or worsening physical, mental and cognitive impairment that can last for years following ICU admission. Post-intensive care unit recovery clinics (PIRCs) are multidisciplinary clinics which have been developed to promote patient and family recovery following critical illness and pharmacist involvement has helped to optimize medication therapy and promote recovery. METHODS: A retrospective chart review of patients who attended PIRC at the Cleveland Clinic from December 2019-September 2020 was completed. Patients were evaluated for baseline characteristics, in-hospital and PIRC variables, and number and type of pharmacist interventions. RESULTS: A total of 63 patients were seen in PIRC during the study period. The median (IQR) age was 59.1 (49.2-71.6) years and 37 (58.7%) patients were male. The median ICU and hospital length of stay were 7 (3-12.5) and 14 (10- 22) days, respectively. A total of 26 (41.3%) patients had acute respiratory distress syndrome and 52 (82.5%) had COVID-19. The median time from hospital discharge to PIRC visit was 52.5 (32-78) days and the majority of appointments were virtual (61.3%). At PIRC, 21 (45%) patients had a new oxygen requirement, 6 (38%) had an abnormal cognitive test, 11 (52%) screened positive for new anxiety or depression, and 3 (19%) screened positive for post-traumatic stress disorder. Pharmacists made a median (IQR) 4 (1-6.5) interventions per patient. The majority of interventions were discontinuation of medications from a patient's medication list (59.4%), followed by adding medications which were omitted from the patient's medication list (25.5%) and updating medication records to reflect current doses and frequencies (15.2%). Routine vaccinations were recommended for 33 (52.4%) patients and education frequently included medication adherence, proper inhaler technique, management of medication adverse effects and optimal use of as needed medications. CONCLUSIONS: Pharmacists are an integral member of the multidisciplinary PIRC care team. Pharmacists optimize medication therapy and provide valuable patient education. Further studies evaluating long-term outcomes of patients presenting to PIRCs and pharmacist involvement are warranted.