Intensive care medicine: Overview

Abstract
Objectives: Continuous arterial pressure monitoring is crucial for critically ill patients. However, the impact of catheter type on arterial line insufficiency remains unexamined.

Design: Double-blinded, superiority, randomized controlled trial.

Setting: A cardiovascular center in Japan.

Patients: Adult patients scheduled for elective cardiovascular surgery and postoperative admission to the ICU.

Interventions: Patients were randomly assigned either polyethylene or polyurethane catheters.

Measurements and main results: The outcome of interest was arterial line insufficiency, defined by one or more of the following four criteria: flattened or overdamped blood pressure waveform, sluggish free backflow of blood (> 2 s) when the stopcock was opened to the atmosphere, inability to draw blood from the arterial line, and inability to flush the catheter. The frequency of arterial line insufficiency was observed at the first noon after ICU admission. An interim analysis using the chi-square test was performed after half of the participants were enrolled, with early termination if p value of less than 0.005 based on the O'Brien-Fleming method. Interim analysis of 132 patients revealed significant differences in primary outcomes, leading to early termination of the trial. Arterial line insufficiency occurred in four of 69 patients (5.8%) with polyethylene catheters and 18 of 63 patients (28.6%) with polyurethane catheters (relative risk, 0.15; 95% CI, 0.05-0.48; p = 0.001).

Conclusions: This study demonstrated a lower occurrence rate of arterial line insufficiency with polyethylene arterial catheters than polyurethane catheters.

Abstract
Purpose: Although healthcare crises are infrequent, they may place extraordinary stress on Intensive Care Units (ICUs), often exposing critical weaknesses in workforce planning and resulting in acute staffing shortages. This study presents a comprehensive economic evaluation of large-scale, rapid ICU workforce upskilling as a strategic response to such pressures. Specifically, we assess the cost-effectiveness, economic sustainability, and resilience-building potential of these interventions during crisis conditions.

Methods: C19_SPACE, a Europe-wide upskilling initiative led by the European Society of Intensive Care Medicine (ESICM), was implemented across 24 countries between 2020 and 2021. A societal economic evaluation and return on investment (ROI) was calculated through deterministic modeling and validated using probabilistic sensitivity analysis across a range of plausible scenarios, including variations in patient throughput, training efficacy, and healthcare system parameters.

Results: The total societal investment in the program was €20.1 million, translating to an average cost of €1146 per participant and €1720 per Quality-Adjusted Healthcare Worker (QAHW). Deterministic modeling estimated an ROI of 478%, with program costs fully recovered in just 5.1 days. Probabilistic sensitivity analysis confirmed the robustness of these findings, with a mean ROI of 455% (95% CI 130-1029%) and a median break-even point of 5.4 days (95% CI 2.66-13.04 days).

Conclusion: Rapid, structured ICU workforce upskilling initiatives deliver substantial economic returns and significantly expands healthcare capacity. Strategic investment in emergency workforce upskilling is economically sound and crucial for healthcare system resilience during future crises.