Latest news with #criticalcare
Medscape
2 days ago
- Health
- Medscape
Inhaled Isoflurane Matches Midazolam in Critically Ill Kids
TOPLINE: Inhaled isoflurane demonstrated noninferior sedation efficacy compared with intravenous midazolam in critically ill children aged 3-17 years on mechanical ventilation, while also lowering opioid requirements and time to extubation along with maintaining an acceptable safety profile. METHODOLOGY: Amid safety concerns over intravenous midazolam, inhaled isoflurane has emerged as an alternative sedative for critically ill patients requiring mechanical ventilation. However, supporting evidence remains limited. Researchers conducted a randomized phase 3 trial (IsoCOMFORT) across multiple pediatric ICUs to assess whether inhaled isoflurane was noninferior to intravenous midazolam as an alternate sedative strategy. They included 92 children who were critically ill and required invasive mechanical ventilation and sedation for ≥ 12 hours. They were randomly assigned to either inhaled isoflurane (n = 59; mean age, 8.1 years; 63% boys) or intravenous midazolam (n = 33; mean age, 7 years; 61% boys). At baseline after randomization, depth of sedation was assessed using the COMFORT Behavior scale, and children were assigned to light (score, 17-22), moderate (score, 11-16), or deep (score, 6-10) sedation target. Sedatives were titrated accordingly for up to 48 ± 6 hours during the treatment period. The primary outcome was the percentage of time maintaining adequate sedation within prescribed COMFORT Behavior scale target range — without rescue sedation, assessed every 2 hours over 12-48 hours. TAKEAWAY: Isoflurane maintained sedation within the COMFORT Behavior target range for a greater proportion of time (68.94%) than midazolam (62.37%), with a mean difference of 6.57 percentage points (95% CI, -8.99 to 22.13), confirming isoflurane's noninferiority to midazolam. The opioid requirements were lower in the isoflurane group (least squares mean dose, 2.1 μg/kg/h) than in the midazolam group (least squares mean dose, 4.6 μg/kg/h; P = .0004). Additionally, the time for extubation was significantly shorter with isoflurane (median, 0.75 hours) than with midazolam group (median, 1.09 hours). One child in each arm experienced treatment-related severe hypotension; three children receiving isoflurane discontinued due to adverse events, however, there were no treatment-related deaths. IN PRACTICE: 'Based on [the study] results and on the regulatory support from the EMA [European Medicines Agency], inhaled sedation can be regarded as a therapeutic option for sedation during mechanical ventilation in pediatric intensive care,' the authors of the study wrote. SOURCE: This study was led by Jordi Miatello, PhD, from the IHU-SEPSIS Comprehensive Sepsis Centre and Paediatric Intensive Care in Le Kremlin-Bicêtre, France, and Alba Palacios-Cuesta, MD, from the 12 de Octubre University Hospital in Madrid, Spain. It was published online on July 15, 2025, in The Lancet Respiratory Medicine. LIMITATIONS: This study excluded children younger than 3 years, limiting the generalizability of the findings to younger pediatric ICU patients. The choice of inhaled sedative, as sevoflurane has replaced isoflurane for general anesthesia in many countries. Lastly, masking only the COMFORT Behavior assessor, rather than the entire clinical team, could lead to bias in outcome assessment. DISCLOSURES: This study was funded by Sedana Medical, Stockholm, Sweden. Few authors received honoraria from the funding organization for participation in the IsoCOMFORT Study Steering Committee. Two authors were employees of the funding organization. Two authors also reported being consultant with other pharmaceutical organizations. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
BBC News
6 days ago
- Health
- BBC News
Dad's illness inspires Peterborough nurse to run ultramarathon
A nurse who got into running less than a year ago while her father was in intensive care has completed an ultramarathon, raising money for people going through a similar Cooper, 27, works in the emergency department at Peterborough City Hospital and completed the 50k (31 miles) Boudicca Way ultramarathon in Norwich on Saturday. After her dad fell ill in December, she has been fundraising to help a new Peterborough branch of charity ICU Steps, which supports patients and families affected by critical said: "To help cope, and to stop myself staring at four walls, I started running and training became my way of managing everything emotionally while Dad was in intensive care." Ms Cooper, who has raised £465 from the run so far, said her father was admitted to the intensive care unit and had to be said: "Having the consultants sit me, my mum and my brother down and tell us to say our goodbyes was the most heart-breaking thing I've ever gone through." Without the intensive care unit team, she says her dad, who is a retired paramedic, "wouldn't be here today". The new support branch in Peterborough will be an informal group for critical care patients and their families and Cooper said: "I'm incredibly grateful, and proud to be supporting ICU Steps and raising awareness of just how much this kind of support can mean for families like mine."I ended up falling in love with running and decided to push myself even further with this ultramarathon - and doing it for such an amazing charity is what keeps me going." Follow Peterborough news on BBC Sounds, Facebook, Instagram and X.
BBC News
19-07-2025
- Health
- BBC News
Firm raises funds to help William Harvey Hospital grant wishes
A construction firm in Kent has raised almost £50,000 to help a hospital grant wishes to patients in its critical care have supported East Kent Hospitals Charity with funding for its 3 Wishes project at the William Harvey Hospital in Ashford since then, staff have been able to grant 222 wishes, ranging from transport to bring people together for the last hours of a loved one's life to creating mementoes like hand prints and manager Natalie Daly said: "It is a real privilege to be able to grant the wishes of our patients and their families at such a heart-breaking time. "Families tell us it makes a real difference and it is an honour to be able to provide truly personalised care that reflects what was important to their loved one throughout their life." 'Most difficult moments' Bauvill has raised funds through events for staff and partners, including a charity football director Matt Gurr said: "The project resonates deeply with us, not just because of the care it provides during life's most difficult moments, but because we've seen first-hand the compassion and dedication of the clinical teams behind it."Knowing our fundraising has helped make hundreds of final wishes possible is incredibly humbling, and something we're immensely proud of."A woman whose husband died was able to say goodbye to him in the unit's garden, with his favourite music said: "It was devastating, but a nice way to say goodbye. I feel the project offers so much comfort in a very sad time."Jane Kirk-Smith, critical care matron, added: "Each of those 222 wishes represents an incredibly special moment for a family losing a loved one."Words simply are not enough to thank the Bauvill team for their ongoing support in making those moments possible."
Medscape
09-07-2025
- Health
- Medscape
Hyponatremia: Is Rapid Correction a Risk or Relief?
Sodium correction limits have been around since bed rest for back pain. The latter is gone but the former persists. While bed rest simply delays recovery, rapid sodium correction may cause osmotic demyelination syndrome (ODS). ODS can manifest as central pontine myelinolysis (CPM), otherwise known as the 'locked in' syndrome. The patient is cognitively aware but unable to move. It's equivalent to paralytics without sedation. CPM paranoia has slowed infusion rates for decades. As an intern, I was warned about CPM and made to read a seminal hyponatremia review published the previous year. The authors cautioned against sodium correction rates greater than 8 mEq/L over 24 hours. The recommendation was juxtaposed with a frightening cartoon diagram of a swollen brain with the label 'osmotic demyelination.' The result of rapid correction of course. After a critical care fellowship and tour managing head trauma in Afghanistan, my aversion to rapid correction remained intact. I never bothered to check whether CPM was an apocryphal tale or an evidence-based phenomenon. Several studies, all of them observational, show rapid correction is associated with ODS. Association means little without context, though. For example, in a large series of patients with admission sodium levels < 120 mEq/L (41% of whom had a correction rate > 8 mEq/L over the first 24 hours), the ODS incidence was only 0.5%. ODS is clearly conditional; rapid correction alone isn't enough. Additional ODS risk factors include the severity and chronicity of the hyponatremia (lower and longer equates to higher risk) along with alcoholism, malnutrition, hypokalemia, and liver disease. Guidelines and reviews endorse conservative correction. While the definition of 'conservative' varies, most recommend 6-10 mEq/L over the first 24 hours. Short of engaging System 2 thinking, there's ample reason to adopt the practice. Besides, apocryphal or not, ODS gets blamed on you if the sodium goes up by more than 6 mEq/L overnight. A study published last year flips the conventional wisdom. The authors conducted a systematic review and meta-analysis on sodium correction rates and found a dose-dependent relationship with hospital length of stay (LOS) and mortality. As opposed to what I'd read and been taught, the relationship was inverted. Rapid correction decreased mortality and LOS. Correction rates weren't associated with ODS. What now? Is this a casus belli for war on correction limits? Probably not. The study is well done, but don't be fooled by the fancy title. They included 16 studies; all were observational, convenience samples and 14 were retrospective. Combining poor quality studies is like bundling faulty mortgages in a collateralized debt obligation circa 2008. The result can serve as a statistical weapon of mass destruction, where uncertainty is amplified under a veneer of respectability. There's also type 2 error when examining ODS rates. Of the 11,811 patients included across all 16 studies, only 32 (0.3%) experienced ODS. This may reflect the true incidence, or it could be an underestimate due to a lack of systematic assessment. Either way, statistical power is a problem. It's also notable that the only subgroup analysis they were able to perform was for those with alcoholism — and the only outcome analyzed was ODS (no difference). So, for those with comorbid alcoholism, hypokalemia, malnutrition, or liver disease we're not sure how correction rates affect LOS and mortality. The study highlights how little we know. The authors did an excellent job considering what they were working with. This is as evidence-based as it's going to get. Not sure how others will interpret this data, but I think it confirms ODS is rare and conservative sodium correction rates might lead to harm. In the absence of high-risk features, I'll be liberalizing my sodium infusions, a little, particularly when baseline sodium is > 120 mEq/L.
Daily Mail
05-07-2025
- Health
- Daily Mail
Boy is fighting for life after a freak accident at a popular camping spot
A boy has been airlifted to hospital in a critical condition after a horrific fall from a swing at a popular camping spot. Paramedics were called to Double Island Point Conservation Park in Queensland 's Gympie region shortly before 11.30am on Saturday after a primary school-aged boy fell from the playground equipment. The LifeFlight helicopter was also deployed at the scene. 'The LifeFlight critical care doctor and Queensland Ambulance Service flight paramedic treated the boy for head injuries,' a statement read. He was airlifted to Brisbane 's Queensland Children's Hospital with life-threatening injuries, where he's now fighting for life. Double Island Point Conservation Park is a popular spot with locals and tourists.
