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Objective To assess the impact of introducing a devastating brain injury (DBI) pathway on patient outcome, intensive care unit (ICU) resources, and organ donation practice in the first 3 years of implementation in a regional neurosciences ICU in the South West of England. Methods Patients with DBI admitted to our ICU between 2015 and 2018 were identified from our ICU database and their outcomes compared to those of non-DBI patients. Data were also obtained from the national potential donor audit to compare organ donation metrics before and after the introduction of the DBI pathway. Organ donation metrics in DBI patients and non-DBI patients were compared once the pathway had been implemented. Results We admitted 85 DBI patients (1.3% of all admissions), with a significantly shorter median length of ICU stay than in non-DBI patients, 1.14 versus 2.93 days ( p  < 0.001). Decisions for withdraw life-sustaining treatments (WLST) were made significantly earlier in DBI patients, median 26.2 versus 84.8 h ( p  < 0.001). Over 8% of DBI patients survived, while 31% progressed to brain death compared to 7.1% in the general population ( p  < 0.001), and 25% become solid organ donors compared to 1.3% of the general population ( p  < 0.001). There was an increase in the proportion of donors after brain death (DBD) to donors after circulatory death (DCD) in the 3 years following the introduction of the DBI pathway ( p  = 0.024). There was also an increased proportion of DBD donors to DCD donors of 76% versus 24% in the DBI group compared to 62% versus 38% ( p  = 0,002) in the non-DBI population. Prognostic scoring systems do not provide accurate estimates of survival rate in this population. Conclusions Admitting patients with perceived DBI to ICU and avoiding the early WLST allows identification of unexpected survivors and gives families more time in decision making at the end of life. The DBI pathway increases the potential for organ donation and increases the proportion of DBD donors. These benefits outweigh the small impact of a DBI pathway on ICU resources.

To examine whether admission to bed number 13 on our intensive care unit has any negative impact on the patient's hospital mortality. We conducted a retrospective cohort study of 1568 patients admitted to our ICU over a two-year period. Observed hospital mortality, predicted mortality using the ICNARC and APACHE II scoring systems and standardised mortality ratios were used to compared patients admitted to bed number 13 with those admitted to beds number 14–24. Of the 1568 patients admitted to ICU, 110 were placed in bed number 13 and 1458 into bed numbers 14–24. Demographics and ICNARC and APACHE II scores were similar between the two groups. There was no significant difference in the ICNARC predicted hospital mortality (mean 21.0%, median8.5% in bed 13 compared with a mean 17.5%, median 6.4% in beds 14–24, p = 0.33), APACHE II predicted hospital mortality (mean 18.4%, median 9.9% in bed 13 compared with mean 18.7%, median 8.9% in beds 14–24, p = 0.74), or observed hospital mortality (20.2% compared with 15.2%, OR 1.41 (CI 0.87 to 2.30), p = 0.17). Admission to bed number 13 was not associated with a significant increase in hospital mortality when compared to admission to other bed numbers. •Phobia and superstition of the number 13 exist in popular Western culture.•No previous work has examined a link between bed number 13 and patient outcome.•We conclude admission to ICU bed 13 is not associated with reduced chance of survival.

Gastroparesis often precludes gastric enteral nutrition (EN) in critically ill patients. Our aim was to determine the feasibility of bedside microendoscopic placement of nasointestinal feeding tubes to facilitate enteral nutrition in critically ill patients with poor gastric emptying. Nine mechanically ventilated patients with proven gastroparesis underwent 10 nasointestinal intubations using a microendoscope. These were compared with 35 patients who underwent pH sensor-guided intubation. Blind pH-guided intubation was faster than microendoscopic placement (21.4 +/- 10.7 v 32 +/- 11.6 min, P = 0.016) and cheaper in terms of disposables [87 pounds sterling (132 dollars) vs 222 pounds sterling (337 dollars) per intubation, P < 0.0001]. Depth of placement (postpyloric: 64% vs 50% including 32% vs 50% reaching duodenum part 3, 4, or jejunum, both NS) was similar. We conclude that microendoscopy failed to improve transpyloric intubation due to poor visualization of gastrointestinal anatomy and difficulty maneuvering the tube-endoscope ensemble. However, when successful, transpyloric placement was always deep, permitting immediate and full EN. To date, the technique and equipment is not superior to pH-guided placement and is not suitable for use by personnel with minimal training.

Purpose The shortage of organs for transplantation is an important medical and societal problem because transplantation is often the best therapeutic option for end-stage organ failure. Methods We review the potential deceased organ donation pathways in adult ICU practice, i.e. donation after brain death (DBD) and controlled donation after circulatory death (cDCD), which follows the planned withdrawal of life-sustaining treatments (WLST) and subsequent confirmation of death using cardiorespiratory criteria. Results Strategies in the ICU to increase the number of organs available for transplantation are discussed. These include timely identification of the potential organ donor, optimization of the brain-dead donor by aggressive management of the physiological consequence of brain death, implementation of cDCD protocols, and the potential for ex vivo perfusion techniques. Conclusions Organ donation should be offered as a routine component of the end-of-life care plan of every patient dying in the ICU where appropriate, and intensivists are the key professional in this process.