Wallace, Lindsey

To identify medical phrases utilized by the critical care team that may have an unintended impact on the critically ill patient, we administered an anonymous survey to multi-professional critical care team members. We elicited examples of imprecise language that may have a negative emotional impact on the critically ill. Of the 1600 providers surveyed, 265 offered 1379 examples (912 unique) which were clustered into 5 categories. Medical jargon (eg, “riding the vent”) was most prevalent (n = 549). There were 217 negative suggestions (eg, “you will feel a stick and a burn”). Hyperboles (eg, “black cloud”) were common (n = 198) while homonyms (ie “he fibbed”) accounted for 150 examples. Phrases such as “code brown in there” were categorized as metonyms (n = 144). 121 metaphors/similes (eg, “rearranging deck chairs on the Titanic”) were provided. Phrases that have the potential to negatively impact critically ill patient perceptions are commonplace in critical care practice. Whether these everyday communication habits lead to an unintended nocebo effect on mental health outcomes of the critically ill deserves further study.

We present an unusual case of a woman in her 30s who was admitted for diabetic ketoacidosis (DKA) in the setting of newly diagnosed but late COVID-19 infection with associated Klebsiella pneumoniae infection. Her altered mental status, out of proportion with her metabolic decompensation, revealed a superimposed cerebral venous sinus thrombosis (CVST) with fulminant cerebral oedema and ultimately brain death. This unusual and fulminant case of cerebral oedema in the setting of COVID-19 infection with bacterial infection, DKA and CVST was the perfect storm with multiple interwoven factors. It offered diagnostic and treatment challenges with an unfortunate outcome. This unique case is a reminder that it is important to consider a broad neurological differential in patients with COVID-19 with unexplained neurological manifestations, which may require specific neurointensive care management.

Introduction: Older adult individuals often have acute illnesses predisposing them to developing acute respiratory distress syndrome (ARDS). We aimed to identify the relationship between age and the development of ARDS in a cohort of hospitalized patients. Methods: This was a secondary analysis of a prospective multicenter observational cohort study of hospitalized patients at risk of developing ARDS admitted to 22 hospitals from March 2009 to August 2009. Patients were classified as older adults if their age was 80 or greater. A multivariable logistic regression was performed, adjusting for severity of illness via Acute Physiology and Chronic Health Evaluation (APACHE II) and risk of ARDS via Lung Injury Prediction Score. Results: Of 5584 patients, 377 (6.8%) developed ARDS. Twenty-four (3.5%) of 694 patients aged 80 or older developed ARDS, compared to 353 (7.2%) of 4890 patients aged less than 80 ( P < .001). After adjusting for severity of illness and the risk of ARDS development, older adult patients had a lower incidence of ARDS compared to younger individuals (odds ratio: 0.28, 95% confidence interval: 0.18-0.42). Conclusion: Older adult patients aged 80 years or older have a reduced incidence of ARDS compared to younger patients, after adjusting for severity of illness and risk of ARDS development.