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Before the exit exam, shall it be a national exam or an European Diploma in Intensive Care (EDIC), ESICM offers exam-focused preparatory courses. To fill this gap, the European Society of Intensive Care Medicine (ESICM) is now launching a new educational initiative called Intensive Care Fundamentals (ICF). Launching "Intensive Care Fundamentals": an ESICM educational initiative for newcomers to intensive care unit. [Extracted from the article]

Purpose: During the initial phase of the pandemic, healthcare professionals faced difficulties due to the limited availability of comprehensive learning resources on managing patients affected with coronavirus disease 2019 (COVID-19). The COVID-19 Skills Preparation Course (C19_SPACE) was tailored to meet the overwhelming demand for specialized training. The primary objective of this study was to assess the efficacy and impact of this program on enhancing clinical knowledge and to identify factors affecting this improvement. Methods: As part of the project, data were collected prospectively to measure the baseline knowledge. After the descriptive statistics, multiple and multivariate logistic regression models were executed to identify the factors associated with knowledge increase. Results: The final sample included 3140 medical doctors (MDs) and 3090 nurses (RNs). For the primary analysis, the mean value of the baseline knowledge test score of MDs was 62.41 (standard deviation, SD = 13.48), and it significantly (p < 0.001) increased to 84.65 (SD = 11.95). Factors influencing overall knowledge scores were female sex (AOR = 1.34 [1.04–1.73]), being a specialist qualified for intensive care medicine (adjusted odds ratio, AOR = 0.56, [0.33–0.96]), and performance on the pre-test (AOR = 0.91, [0.90–0.92]). As for the RNs, the mean value of the total knowledge score was 63.25 (SD = 13.53), which significantly (p < 0.001) increased to 81.51 (SD = 14.21). Factor associated with knowledge was performance on the pre-test (AOR = 0.92 [0.92–0.93]). Conclusions: C19_SPACE effectively increased the clinical knowledge of doctors and nurses. The effect was more pronounced in the program's target group of healthcare workers with less experience in the intensive care unit (ICU). Other factors associated with knowledge enhancement were sex and being a specialist in intensive care. [ABSTRACT FROM AUTHOR]

This document summarizes a study conducted by the UNITE-COVID investigators group on co-infection and secondary infection among critically ill COVID-19 patients. The study compared the rates of bacterial co-infection and secondary infections in COVID-19 patients with those in patients with other severe respiratory viral infections. The researchers found that COVID-19 patients had a lower rate of bacterial co-infection on presentation but higher rates of secondary infections. Factors contributing to the high rates of secondary infections included the use of broad-spectrum antimicrobials, immunomodulation with glucocorticoids, and breakdowns in infection control procedures. The study also examined the differences in management and infections between 2020 and 2021, finding changes in adjunctive therapies and reduced use of certain medications. The text discusses the prevalence of secondary infections in COVID-19 patients in 2021, with bacterial pneumonia being the most common. There was also an increase in fungal pneumonia and multi-drug-resistant organisms. Despite changes in treatment practices, the risk of secondary infections increased. The study emphasizes the need for further research on the impact of secondary infections and the use of antimicrobials in COVID-19 patients. The document includes a list of medical professionals and hospitals from various countries involved in the study, as well as the funding source and ethical approval information. Supplementary information in the form of a graph is also provided. [Extracted from the article]

Introduction: There is an inverse relationship between cardiac output and the central venous-arterial difference of partial pressures of carbon dioxide (pCO2 gap), and pCO2 gap has been used to guide early resuscitation of septic shock. It can be hypothesized that pCO2 gap can be used outside the context of sepsis to distinguish type A and type B lactic acidosis and thereby avoid unnecessary fluid resuscitation in patients with high lactate, but without organ hypoperfusion.Methods: We performed a structured review of the literature enlightening the physiological background. Next, we retrospectively selected a series of case reports of nonseptic critically ill patients with elevated lactate, in whom both arterial and central venous blood gases were simultaneously measured and the diagnosis of either type A or type B hyperlactataemia was conclusively known. In these cases, we calculated venous-arterial CO2 and O2 content differences and pCO2 gap.Results: Based on available physiological data, pCO2 can be considered as an acceptable surrogate of venous-arterial CO2 content difference, and it should better reflect cardiac output than central venous saturation or indices based on venous-arterial O2 content difference. In our case report of nonseptic patients, we observed that if global hypoperfusion was present (i.e., in type A lactic acidosis), pCO2 gap was elevated (>1 kPa), whilst in the absence of it (i.e., in type B lactic acidosis), pCO2 gap was low (<0.5 kPa).Conclusion: Physiological rationale and a small case series are consistent with the hypothesis that low pCO2 gap in nonseptic critically ill is suggestive of the absence of tissue hypoperfusion, mandating the search for the cause of type B lactic acidosis rather than administration of fluids or other drugs aimed at increasing cardiac output. [ABSTRACT FROM AUTHOR]

Objectives: Critical care ultrasonography has become established within ICUs as a diagnostic tool and to guide management strategies and practical procedures. Following an international consensus statement in 2011, various national professional societies and organizations have sought to develop and deliver training program. The aim of this review was to assess the similarities and differences among these postgraduate intensive care/critical care training program.Data Sources: A systematic review was performed in two steps. First, we searched medical databases and national societies' websites for documents meeting predefined inclusion criteria. If not found, professionals related to critical care ultrasonography were contacted.Data Extraction: Data were extracted independently by two authors. Analyses were conducted on general training requirements as well as specific competencies defined in the documents.Data Synthesis: Eight national program from seven countries were identified from a total of 25 countries; all identified program have defined competencies for core critical care ultrasonography. Although there were common themes across these program, significant variations in training requirements and assessments existed, for example, number of scans required for echocardiography training ranged from 10 to 100. Furthermore, the specifics of each ultrasound module varied between program.Conclusions: Despite widespread and increasing use of ultrasound in ICUs, the majority of countries lacked a formal training program and clearly defined competencies. Even among the countries where these are available, there remains variability. There is a need to better define the competencies required in core critical care ultrasonography and standardize the assessment process. [ABSTRACT FROM AUTHOR]

Background: Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods: This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results: Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions: Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021). [ABSTRACT FROM AUTHOR]

Intensive care medicine is a constantly evolving discipline and this is why ESICM CoBaTrICE Committee decided to update the list of competences and the training syllabus. Recommendations for core critical care ultrasound competencies as a part of specialist training in multidisciplinary intensive care: a framework proposed by the European Society of Intensive Care Medicine (ESICM). In line, standards for postgraduate training and training programmes in ICM have been proposed [[2]] and later adopted by Union Européenne des Médecins Spécialistes (UEMS) as Common Training Framework [[3]] as well as into the training programs of several European countries. [Extracted from the article]

Procedural aspects of compassionate care such as the terminal extubation are understudied. We used machine learning methods to determine factors associated with the decision to extubate the critically ill patient at the end of life, and whether the terminal extubation shortens the dying process. We performed a secondary data analysis of a large, prospective, multicentre, cohort study, death prediction and physiology after removal of therapy (DePPaRT), which collected baseline data as well as ECG, pulse oximeter and arterial waveforms from WLST until 30 min after death. We analysed a priori defined factors associated with the decision to perform terminal extubation in WLST using the random forest method and logistic regression. Cox regression was used to analyse the effect of terminal extubation on time from WLST to death. A total of 616 patients were included into the analysis, out of which 396 (64.3%) were terminally extubated. The study centre, low or no vasopressor support, and good respiratory function were factors significantly associated with the decision to extubate. Unadjusted time to death did not differ between patients with and without extubation (median survival time extubated vs. not extubated: 60 [95% CI: 46; 76] vs. 58 [95% CI: 45; 75] min). In contrast, after adjustment for confounders, time to death of extubated patients was significantly shorter (49 [95% CI: 40; 62] vs. 85 [95% CI: 61; 115] min). The decision to terminally extubate is associated with specific centres and less respiratory and/or vasopressor support. In this context, terminal extubation was associated with a shorter time to death. [ABSTRACT FROM AUTHOR]

Purpose: To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods: Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results: 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%–50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions: ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality. [ABSTRACT FROM AUTHOR]

Correction to: Intensive Care Medicine (2022) 48:690-705 https://doi.org/10.1007/s00134-022-06705-1 In the original version of this article, the given and family names of Kristina Fuest, Tobias Lahmer, Johannes Herrmann, Patrick Meybohm, Nikolaos Markou, Georgia Vasileiadou were incorrectly structured. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. [Extracted from the article]

Kratom is a mixture of compounds that are present in the leaves of the tropical tree Mitragyna speciosa. It is used as a psychoactive agent with both opiate and stimulant-like effects. In this case series we describe the signs, symptoms, and the management of kratom overdose in the prehospital setting and in intensive care. We retrospectively searched for cases in the Czech Republic. Over 36 months we found 10 cases of kratom poisoning, which healthcare records were analyzed and reported as per CARE guidelines. The dominant symptoms in our series were neurological and included quantitative (n = 9) or qualitative (n = 4) disorder of consciousness. Signs and symptoms of vegetative instability [hypertension (n = 3) and tachycardia (n = 3) vs. bradycardia/cardiac arrest (n = 2), mydriasis (n = 2) vs. miosis (n = 3)] were noticed. Prompt response to naloxone in two cases and lack of response in one patient were observed. All patients survived and the effect of intoxication wore off within two days. Kratom overdose toxidrome is variable and, in keeping with its receptor physiology, consists of signs and symptoms of opioid-like overdose, sympathetic overactivation and serotonin-like syndrome. Naloxone can help to avoid intubation in some cases. [Display omitted] • Kratom is a relatively new and rapidly spreading plant-based legal high in Europe. • Overdose presents with impaired consciousness. • Overdose presents with opioid-like symptoms, sympathetic and serotonin syndromes. • There is no diagnostic test for the use at bedside. • Naloxone can be tried to avoid the need of intubation. [ABSTRACT FROM AUTHOR]

Using skeletal muscle homogenates for respirometry has many advantages, but the main challenge is avoiding the damage to outer mitochondrial membrane (OMM) and complex I. By optimising the amount of muscle and careful titration of substrates and inhibitors we developed a new protocol and compared it to isolated mitochondria. We found acceptable damage to OMM (~ 10–15% increment of oxygen flux after addition of cytochrome c) and to complex I (~ 70% of electron flux). Homogenate retained ~ 90% of phosphorylation capacity of isolated mitochondria. The use of fresh homogenate was crucial as mitochondrial function declined rapidly after 2–3 h of cold storage. [ABSTRACT FROM AUTHOR]

Background: Dipeptide alanyl-glutamine is a commonly used substrate in major trauma patients. Its importance and effects are widely discussed; as yet, it has not been elucidated whether its administration influences glucose homeostasis.Objective: We studied the effect of alanyl-glutamine administration on insulin resistance.Design: Prospective, randomized, controlled trial.Setting: Intensive care unit of a tertiary level hospital.Patients: Multiple-trauma patients.Interventions: Patients were randomized into two groups and assigned to receive parenterally an equal dose of amino acids either with alanyl-glutamine in the dose of 0.4 g x kg body weight(-1) x 24 hrs(-1) (group AG) or without alanyl-glutamine (control group C). This regimen started 24 hrs after injury and continued for 7 days. To assess insulin sensitivity, we performed an euglycemic clamp on day 4 and day 8 after injury.Measurements and Main Results: We randomized 40 patients, 20 into each group. At day 4, insulin-mediated glucose disposal was higher in group AG (2.4 +/- 0.7 mg x kg(-1) x min(-1) glucose), with significant difference from group C (1.9 +/- 0.6 mg x kg(-1) x min(-1), p = .044). At day 8, glucose disposal was higher in group AG (2.2 +/- 0.7 mg x kg(-1) x min(-1) glucose), with significant difference in comparison with group C (1.2 +/- 0.6, p < .001). Diminution of the main glucose homeostasis variables in group C between days 4 and 8 of the study was statistically significant (p < .001); however, differences in these variables in group AG were without statistical significance.Conclusions: Parenteral supplementation of alanyl-glutamine dipeptide was associated with better insulin sensitivity in multiple-trauma patients. [ABSTRACT FROM AUTHOR]