Long-term survival in out-of-hospital cardiac arrest patients treated with targeted temperature control at 33 °C or 36 °C: A national registry study.

AIM: There are limited data on long-term outcome in out-of-hospital cardiac arrest patients following the treatment shift of target temperature management (TTM) from 33 °C to 36 °C outside the controlled settings of randomised trials. The aim of this study was to evaluate the adherence to TTM guidelines after the publication of the TTM trial and if the change in temperature level influence six-month survival. METHODS: OHCA patients admitted to intensive care units (ICU) and recorded in the Swedish Intensive Care Registry (January 2010-March 2016) were included. Each ICU in Sweden provided information on their TTM target (i.e. 33 °C [TTM33] or 36 °C [TTM36]) used and the date of shift to 36 °C. The primary outcome was six-months survival. Multivariate logistic regression and propensity score match was used to adjust for confounders. RESULTS: In total, 2899 OHCA patients from 69 ICUs were assessed; of those, 1038 patients were treated with TTM (TTM33, n = 755 and TTM36, n = 283). Patients receiving any TTM decreased during the study period from 70.5% to 54.5% (p for trend <0.001). There was no significant difference in six-month survival between the TTM33 (47.2%) and the TTM36 (47.3%) groups (adjusted OR 1.12 [0.80-1.56]. In the propensity score matched analysis the six-months survival was 52.7 vs 47.3 %, OR 1.29 [0.90-1.85]). CONCLUSIONS: The proportion of patients receiving therapeutic hypothermia in Sweden has decreased significantly since the publication of the TTM-trial indicating lower adherence to guidelines. This was not associated with any significant difference in long term outcome.

Effect of Sedation Regimen on Weaning from Mechanical Ventilation in the Intensive Care Unit.

BACKGROUND: Intensive care unit patients undergoing mechanical ventilation have traditionally been sedated to make them comfortable and to avoid pain and anxiety. However, this may lead to prolonged mechanical ventilation and a longer length of stay. OBJECTIVE: The aim of this retrospective study was to explore whether different sedation regimens influence the course and duration of the weaning process. PATIENTS AND METHODS: Intubated adult patients (n = 152) from 15 general intensive care units in Sweden were mechanically ventilated for ≥ 24 h. Patients were divided into three groups according to the sedative(s) received during the weaning period (i.e. from being assessed as 'fit for weaning' until extubation): dexmedetomidine alone (DEX group, n = 32); standard of care with midazolam and/or propofol (SOC group, n = 67); or SOC plus dexmedetomidine (SOCDEX group, n = 53). RESULTS: Patients receiving dexmedetomidine alone were weaned more rapidly than those in the other groups despite spending longer time on mechanical ventilation prior to weaning. Anxiety during weaning was present in 0, 9 and 24% patients in the DEX, SOC and SOCDEX groups, respectively. Anxiety after extubation was present in 41, 20 and 34% in the DEX, SOC and SOCDEX groups, respectively. Delirium during weaning was present in 1, 2 and 1 patient in the DEX, SOC and SOCDEX groups, respectively. Delirium at ICU discharge was present in 1, 0 and 3 patients in the DEX, SOC and SOCDEX groups, respectively. Few patients fulfilled criteria for post-traumatic stress disorder. CONCLUSION: Dexmedetomidine, used as a single sedative, may have contributed to a shorter weaning period than SOC or SOCDEX. Patients who received dexmedetomidine-only sedation tended to report better health-related quality of life than those receiving other forms of sedation.

[Large regional differences in Swedish intensive care. A nation-wide inquiry shows that the lowest number of beds is in big cities]. / Stora regionala skillnader i svensk intensivvård. Lägst antal vårdplatser i storstadsregionerna visar rikstäckande enkätstudie.

Shortage of beds in intensive care units has been an issue of intense debate. We studied the distribution of ICU-beds and staffing by sending two web-based questionnaires (Oct 2001 and April 2002) to the director of all single- and multi-disciplinary intensive care units (ICUs) in Sweden. Responses were received from 90% and 95% of a total of 89 ICU directors. During April 2002 782 ICU-beds were available (8.7 per 100 000 inhabitants). Almost 200 beds were not available due to budgetary reasons or lack of personnel. Bed availability and staffing varied from 4.82 ICU-beds and 8.2 staff per bed in the Stockholm area to 13.85 ICU-beds and 3.7 staff per bed in one of the other healthcare regions (Northern Healthcare Region). These differences in regional distribution of ICU-beds and staffing must be discussed carefully taking factors such as distance between units and case-mix into consideration.

Side effects of endotracheal suction in pressure- and volume-controlled ventilation.

STUDY OBJECTIVES: To investigate the effects of endotracheal suction in volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) with an open suction system (OSS) or a closed suction system (CSS). DESIGN: Randomized comparison. SETTING: Animal research laboratory. PATIENTS: Twelve healthy anesthetized pigs. INTERVENTIONS: The effects of endotracheal suction during VCV and PCV with tidal volume (VT) of 14 mL/kg were compared. A 60-mm inner-diameter endotracheal tube was used. Ten-second suction was performed using OSS and CSS with 12F and 14F catheters connected to - 14 kPa vacuum. MEASUREMENTS AND RESULTS: Thirty minutes after suction in PCV, VT was still decreased by 27% (p < 0.001), compliance (Crs) by 28% (p < 0.001), and PaO(2) by 26% (p < 0.001); PaCO(2) was increased by 42% (p < 0.0001) and venous admixture by 158% (p = 0.003). Suction in VCV affected only Crs (decreased by 23%, p < 0.001) and plateau pressure (increased by 24%, p < 0.001). The initial impairment of gas exchange following suction in VCV was no longer statistically significant after 30 min. CONCLUSIONS: In conclusion, endotracheal suction causes lung collapse leading to impaired gas exchange, an effect that is more severe and persistent in PCV than in VCV.