The New Yorker profiled intensive care unit (ICU) patient Charlie Atkinson and his struggle with the long-term outcomes of his care. “After a month in the I.C.U., Atkinson was well enough to leave the hospital. He had ‘made it.’ But he remained dependent on a ventilator and confused—able to recognize his own name and little else. He didn’t know it, but he had crossed an invisible threshold into a territory of protracted sickness and uncertain hope for improvement,” according to the article “The Limbo Between A Life Worth Living and Death.” The article details the challenges patients face after critical illness and signifies a rising awareness about post-intensive care syndrome.
The Society of Critical Care Medicine offers numerous resources to help educate patients about post-intensive care syndrome at www.MyICUCare.org, including several interviews with former ICU patients.
In addition, the Society’s ICU Liberation initiative offers clinicians tools to improve long-term outcomes. A recently added presentation from Alison Clay, MD, recounts her own ICU survivor story.
In two meta-analyses and one previous observational study, prone positioning was associated with improved survival for patients with severely hypoxemic acute respiratory distress syndrome (ARDS). However, the findings in these studies were in contradistinction to previously conducted randomized trials. To further evaluate the effectiveness of early prone positioning in severe ARDS, Guerin and colleagues from the PROSEVA Study Group designed a randomized controlled trial comparing early application of prone positioning versus supine positioning for patients with severe ARDS. Results were published in a recent issue of The New England Journal of Medicine.
There were 229 patients assigned to the supine group and 237 assigned to the prone group. Patients were similar within the two groups with the exception of a higher Sequential Organ Failure Assessment (SOFA) score and more vasopressor use in the supine group, as well as more neuromuscular blocker use in the prone group. Mortality at day 28 was significantly lower in the prone group (16%) compared to the supine group (32.8%; p<0.001). After adjustment for the SOFA score, patients in the prone group had a lower hazard of death compared to the supine group (hazard ratio = 0.42; 95% confidence interval [CI], 0.26-0.66; p<0.001). Patients in the prone group also had improved 90-day survival and more ventilator-free days compared to the supine group. The external generalizability of this work may be limited in centers where technical and logistical expertise for prone positioning is limited. Read the full Concise Critical Appraisal.