Experience of The National Emergency Tele-Critical Care Network.

The COVID-19 pandemic exposed significant frailties of the U.S. healthcare system, especially inequities facing rural areas during surges when critical access and small community hospitals could not transfer patients to referral centers that were already overcapacity.

Time-of-day dependent effects of midazolam administration on myocardial injury in non-cardiac surgery.

Background: Animal studies have shown that midazolam can increase vulnerability to cardiac ischemia, potentially circadian-mediated mechanisms. We hypothesized that perioperative midazolam administration is associated with an increased incidence of myocardial injury in patients undergoing non-cardiac surgery (MINS) and that circadian biology may underlie this relationship.

Methods: We analyzed intraoperative data from the Multicenter Perioperative Outcomes Group for the occurrence of MINS across 50 institutions from 2014 to 2019.

Telemedicine to Expand Access to Critical Care Around the World.

This multiauthored communication gives a state-of-the-art global perspective on the increasing adoption of tele-critical care. Exponentially increasing sophistication in the deployment of Computers, Information, and Communication Technology has ensured extending the reach of limited intensivists virtually and reaching the unreached. Natural disasters, COVID-19 pandemic, and wars have made tele-intensive care a reality.

A Survey of Tele-Critical Care State and Needs in 2019 and 2020 Conducted among the Members of the Society of Critical Care Medicine.

The study's objective was to assess facilitators and barriers of Tele-Critical Care (TCC) perceived by SCCM members. By utilizing a survey distributed to SCCM members, a cross-sectional study was developed to analyze survey results from December 2019 and July 2020. SCCM members responded to the survey ( = 15,502) with a 1.

Toxicology Screening Testing in Patients Undergoing Spine Surgery: A Prospective Observational Pilot Study.

Background: Chronic opioid use and polypharmacy are commonly seen in chronic pain patients presenting for spine procedures. Substance abuse and misuse have also been reported in this patient population. Negative perioperative effects have been found in patients exposed to chronic opioid, alcohol, and recreational substances.

Clinical Distancing and Mitigation of Coronavirus Disease 2019.

Social distancing as a technique to limit transmission of infectious disease has come into common parlance following the arrival and rapid spread of a novel coronavirus disease around the world in 2019 and 2020. But in the face of an emerging pandemic threat, it is crucial that we start to apply these principles to the clinic, the emergency department, and the hospital ward. We propose that this dynamic situation calls for a parallel "Clinical Distancing" in which we as a medical culture go against many of our fundamental instincts and, at least in the short term, begin to reduce unnecessary patient-care contacts for the benefit of our patients and our ability to continue to provide care to those who need it most.

Preoperatively Screened Obstructive Sleep Apnea Is Associated With Worse Postoperative Outcomes Than Previously Diagnosed Obstructive Sleep Apnea.

Background: Obstructive sleep apnea (OSA) affects up to 26% of US adults, is often undiagnosed, and increases perioperative morbidity. We hypothesized that patients screened on the day of surgery as moderate/high risk for OSA (S-OSA) present similar perioperative respiratory complications, hospital use, and mortality than patients with previously diagnosed OSA (D-OSA). Second, we hypothesized that both OSA groups have more respiratory complications than No-OSA patients.

Heated humidified high-flow nasal cannula oxygen after thoracic surgery - A randomized prospective clinical pilot trial.

Background: Thoracic surgery patients are at high-risk for adverse pulmonary outcomes. Heated humidified high-flow nasal cannula oxygen (HHFNC O) may decrease such events. We hypothesized that patients randomized to prophylactic HHFNC O would develop fewer pulmonary complications compared to conventional O therapy.

Disruption of Circadian Rhythms and Sleep in Critical Illness and its Impact on the Development of Delirium.

Purpose: This article reviews our current understanding of the relationships between critical illness, circadian disruption, and delirium.

Summary: Delirium is a common and morbid complication of hospitalization, particularly in the setting of critical illness and intensive care unit (ICU) admission. Critical illness involves a host of acute metabolic, hormonal and inflammatory responses that appear to disrupt normal sleep architecture and precipitate cerebral dysfunction.