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Ely EW, Azoulay E, Sprung CL. Eight things we would never do regarding end-of-life care in the ICU. Intensive Care Med 2019; 45:1116-1118. [PMID: 30847514 DOI: 10.1007/s00134-019-05562-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/04/2019] [Indexed: 11/30/2022]
Affiliation(s)
- E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, 2525 West End Ave, Suite 450, Nashville, TN, USA. .,Veteran's Affair TN Valley Geriatric Research Education Clinical Center (GRECC), Nashville, TN, 37203, USA.
| | - Elie Azoulay
- Medical Intensive Care Unit and Department of Biostatistics, APHP, Hôpital Saint-Louis. ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Charles L Sprung
- General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
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102
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Kalvas LB. The Life Course Health Development Model: A theoretical research framework for paediatric delirium. J Clin Nurs 2019; 28:2351-2360. [PMID: 30653772 DOI: 10.1111/jocn.14776] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 12/05/2018] [Accepted: 01/07/2019] [Indexed: 12/31/2022]
Abstract
AIMS AND OBJECTIVES To create a framework for future research through application and critique of the Life Course Health Development Model to the phenomenon of paediatric delirium. BACKGROUND Delirium in the paediatric intensive care unit is associated with increased duration of mechanical ventilation, length of stay and mortality. Nurses are uniquely positioned at the bedside to identify, prevent and treat delirium. An understanding of the potential long-term consequences of paediatric delirium is necessary to provide impetus for nursing research and practice change. The Life Course Health Development Model is a valuable tool when considering the multiple mechanisms and processes through which the experience of delirium could affect a child's life trajectory. DESIGN Critical review of the literature through application and critique of the Life Course Health Development Model in the context of paediatric delirium. Gaps in the current understanding of paediatric delirium, as well as future directions for research and practice, are discussed. METHODS The seven core principles of the model are considered in the context of paediatric delirium. Each of the principles has the potential to further understanding of paediatric delirium and identify areas for future inquiry. This discussion leads to a critique of the ability of the model to lead future research and practice change. CONCLUSIONS The Life Course Health Development Model depicts a process in which the acute and severe stress of critical illness leads to maladaptive neurologic changes that contribute to the development of delirium and impair a child's life trajectory. RELEVANCE TO CLINICAL PRACTICE By emphasising the potential lifelong consequences for critically ill children who experience delirium, this application of the Life Course Health Development Model will stimulate discussion, research and practice change among paediatric clinicians and researchers.
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Robinson CC, Rosa RG, Kochhann R, Schneider D, Sganzerla D, Dietrich C, Sanchez ÉC, Dutra FH, Oliveira MQD, Anzolin LB, Menezes SFD, Jeffman R, Souza DD, Silva SFD, Cruz LN, Boldo R, Cardoso JR, Birriel DC, Gamboa MN, Machado AS, Andrade JMSD, Alencar C, Teixeira MC, Vieira SRR, Moreira FC, Amaral A, Silveira APM, Teles JMM, Oliveira DCD, Oliveira Júnior LCD, Castro LCE, Silva MSD, Neves RT, Gomes RDA, Ribeiro CM, Cavalcanti AB, Oliveira RPD, Maccari JG, Berto PP, Martins LA, Santos RLDS, Ue LY, Hammes LS, Sharshar T, Bozza F, Falavigna M, Teixeira C. Quality of life after intensive care unit: a multicenter cohort study protocol for assessment of long-term outcomes among intensive care survivors in Brazil. Rev Bras Ter Intensiva 2019; 30:405-413. [PMID: 30652780 PMCID: PMC6334490 DOI: 10.5935/0103-507x.20180063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/30/2018] [Indexed: 01/04/2023] Open
Abstract
Objective To establish the prevalence of physical, cognitive and psychiatric
disabilities, associated factors and their relationship with the qualities
of life of intensive care survivors in Brazil. Methods A prospective multicenter cohort study is currently being conducted at 10
adult medical-surgical intensive care units representative of the 5
Brazilian geopolitical regions. Patients aged ≥ 18 years who are
discharged from the participating intensive care units and stay 72 hours or
more in the intensive care unit for medical or emergency surgery admissions
or 120 hours or more for elective surgery admissions are consecutively
included. Patients are followed up for a period of one year by means of
structured telephone interviews conducted at 3, 6 and 12 months after
discharge from the intensive care unit. The outcomes are functional
dependence, cognitive dysfunction, anxiety and depression symptoms,
posttraumatic stress symptoms, health-related quality of life,
rehospitalization and long-term mortality. Discussion The present study has the potential to contribute to current knowledge of the
prevalence and factors associated with postintensive care syndrome among
adult intensive care survivors in Brazil. In addition, an association might
be established between postintensive care syndrome and health-related
quality of life.
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Affiliation(s)
- Caroline Cabral Robinson
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Regis Goulart Rosa
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil.,Centro de Tratamento Intensivo Adulto, Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Renata Kochhann
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Daniel Schneider
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Daniel Sganzerla
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Camila Dietrich
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Évelin Carneiro Sanchez
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Francine Hoffmann Dutra
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Maicon Quadro de Oliveira
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Luisa Barbosa Anzolin
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Suelen Fardim de Menezes
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Rodrigo Jeffman
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Denise de Souza
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Sâmia Faria da Silva
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Luciane Nascimento Cruz
- Escritório de Projetos Programa de Apoio ao Desenvolvimento Institucional/Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Rodrigo Boldo
- Unidade de Tratamento Intensivo, Hospital Santa Clara, Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brasil
| | - Juliana Rezende Cardoso
- Unidade de Tratamento Intensivo, Hospital Santa Clara, Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brasil
| | - Daniella Cunha Birriel
- Unidade de Tratamento Intensivo, Pavilhão Pereira Filho, Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brasil
| | - Mariana Nunes Gamboa
- Unidade de Tratamento Intensivo, Pavilhão Pereira Filho, Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brasil
| | | | | | - Cesar Alencar
- Centro de Tratamento Intensivo, Hospital Conceição, Grupo Hospitalar Conceição - Porto Alegre (RS), Brasil
| | - Michelle Carneiro Teixeira
- Centro de Tratamento Intensivo, Hospital Conceição, Grupo Hospitalar Conceição - Porto Alegre (RS), Brasil
| | - Silvia Regina Rios Vieira
- Centro de Tratamento Intensivo, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Fernanda Caleffe Moreira
- Centro de Tratamento Intensivo, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Alexandre Amaral
- Unidade de Tratamento Intensivo, Hospital de Urgências de Goiânia - Goiânia (GO), Brasil
| | | | - José Mario Meira Teles
- Unidade de Tratamento Intensivo, Hospital de Urgências de Goiânia - Goiânia (GO), Brasil
| | | | | | - Lívia Correa E Castro
- Unidade de Tratamento Intensivo, Hospital Regional do Baixo Amazonas - Santarém (PA), Brasil
| | - Marli Sarmento da Silva
- Unidade de Tratamento Intensivo, Hospital Regional do Baixo Amazonas - Santarém (PA), Brasil
| | | | | | | | | | | | | | - Paula Pinheiro Berto
- Centro de Tratamento Intensivo, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Lucieda Araújo Martins
- Coordenação Geral de Atenção Hospitalar, Departamento de Atenção Hospitalar e de Urgência, Secretaria de Atenção à Saúde, Ministério da Saúde - Brasília (DF), Brasil
| | - Rui Leandro da Silva Santos
- Coordenação Geral de Atenção Hospitalar, Departamento de Atenção Hospitalar e de Urgência, Secretaria de Atenção à Saúde, Ministério da Saúde - Brasília (DF), Brasil
| | - Luciana Yumi Ue
- Coordenação Geral de Atenção Hospitalar, Departamento de Atenção Hospitalar e de Urgência, Secretaria de Atenção à Saúde, Ministério da Saúde - Brasília (DF), Brasil
| | - Luciano Serpa Hammes
- Superintendência de Educação, Pesquisa e Responsabilidade Social, Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Tarek Sharshar
- Department of Histopathology and Animal Models, Institute Pasteur - Paris, France.,General Intensive Care, Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines - Paris, France
| | - Fernando Bozza
- Instituto D'Or de Pesquisa e Ensino - Rio de Janeiro (RJ), Brasil
| | - Maicon Falavigna
- Centro de Tratamento Intensivo Adulto, Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Cassiano Teixeira
- Centro de Tratamento Intensivo Adulto, Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
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Darby J, Falco C. Infection Control and the Need for Family-/Child-Centered Care. HEALTHCARE-ASSOCIATED INFECTIONS IN CHILDREN 2019. [PMCID: PMC7122132 DOI: 10.1007/978-3-319-98122-2_4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient- and family-centered care (FCC) has become central to the delivery of medical care over the last 20 years and has been shown to improve patient outcomes. Infection control practices have the potential to greatly influence family centeredness and care providers, and hospital personnel must consider the potential impacts of isolation and the use of personal protective equipment (PPE). Approaching infection control with the perspective of FCC requires balancing patient safety and overall patient well-being. In this chapter, authors consider infection control and the benefits of FCC, family and sibling visitation, the use of playrooms, animals in healthcare settings including animal-assisted interventions, the potential adverse effects of infection control practices, and strategies to mitigate these impacts.
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105
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Kleinpell R, Heyland DK, Lipman J, Sprung CL, Levy M, Mer M, Koh Y, Davidson J, Taha A, Curtis JR. Patient and family engagement in the ICU: Report from the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care 2018; 48:251-256. [DOI: 10.1016/j.jcrc.2018.09.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/31/2018] [Accepted: 09/07/2018] [Indexed: 12/15/2022]
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106
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107
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Sganzerla D, Teixeira C, Robinson CC, Kochhann R, Santos MMS, de Moura RM, Barbosa MG, da Silva DB, Ribeiro T, Eugênio C, Schneider D, Mariani D, Jeffman RW, Bozza F, Cavalcanti AB, Azevedo LCP, Machado FR, Salluh JI, Pellegrini JAS, Moraes RB, Damiani LP, da Silva NB, Falavigna M, Rosa RG. Statistical analysis plan for a cluster-randomized crossover trial comparing the effectiveness and safety of a flexible family visitation model for delirium prevention in adult intensive care units (the ICU Visits Study). Trials 2018; 19:636. [PMID: 30454019 PMCID: PMC6245900 DOI: 10.1186/s13063-018-3006-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most adult intensive care units (ICUs) worldwide adopt restrictive family visitation models (RFVMs). However, evidence, mostly from non-randomized studies, suggests that flexible adult ICU visiting hours are safe policies that can result in benefits such as prevention of delirium and increase in satisfaction with care. Accordingly, the ICU Visits Study was designed to compare the effectiveness and safety of a flexible family visitation model (FFVM) vs. an RFVM on delirium prevention among ICU patients, and also to analyze its potential effects on family members and ICU professionals. METHODS/DESIGN The ICU Visits Study is a cluster-randomized crossover trial which compares an FFVM (12 consecutive ICU visiting hours per day) with an RFVM (< 4.5 ICU visiting hours per day) in 40 Brazilian adult ICUs. Participant ICUs are randomly assigned to either an FFVM or RFVM in a 1:1 ratio. After enrollment and follow-up of 25 patients, each ICU is crossed over to the other visitation model, until 25 more patients per site are enrolled and followed. The primary outcome is the cumulative incidence of delirium measured by the Confusion Assessment Method for the ICU. Secondary and tertiary outcomes include relevant measures of effectiveness and safety of ICU visiting policies among patients, family members, and ICU professionals. Herein, we describe all primary statistical procedures that will be used to evaluate the results and perform exploratory and sensitivity analyses of this study. This pre-specified statistical analysis plan was written and submitted without knowledge of the study data. DISCUSSION This a priori statistical analysis plan aims to enhance the transparency of our study, facilitating unbiased analyses of ICU visit study data, and provide guidance for statistical analysis for groups conducting studies in the same field. TRIAL REGISTRATION ClinicalTrials.gov, NCT02932358 . Registered on 11 October 2016.
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Affiliation(s)
- Daniel Sganzerla
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Cassiano Teixeira
- Intensive Care Unit, HMV. Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Caroline Cabral Robinson
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Renata Kochhann
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Mariana Martins Siqueira Santos
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Rafaela Moraes de Moura
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Mirceli Goulart Barbosa
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Daiana Barbosa da Silva
- Intensive Care Unit, HMV. Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Tarissa Ribeiro
- Intensive Care Unit, HMV. Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Cláudia Eugênio
- Intensive Care Unit, HMV. Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Daniel Schneider
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Débora Mariani
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Rodrigo Wiltgen Jeffman
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Fernando Bozza
- Department of Critical Care, Instituto D'Or de Pesquisa e Ensino (IDOR), Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
| | | | - Luciano Cesar Pontes Azevedo
- Intensive Care Unit, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - Flávia Ribeiro Machado
- Department of Anesthesiology, Pain and Intensive Care, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 737, Vila Clementino, São Paulo, SP, 04024-900, Brazil
| | - Jorge Ibrain Salluh
- HCor Research Institute, Rua Abílio Soares, 250, Paraíso, São Paulo, SP, 04005-909, Brazil
| | - José Augusto Santos Pellegrini
- Intensive Care Unit, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Santa Cecília, Porto Alegre, RS, 90035-903, Brazil
| | - Rafael Barberena Moraes
- Institute for Education and Research, HMV, Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Lucas Petri Damiani
- HCor Research Institute, Rua Abílio Soares, 250, Paraíso, São Paulo, SP, 04005-909, Brazil
| | - Nilton Brandão da Silva
- Department of Internal Medicine, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Centro Histórico, Porto Alegre, RS, 90050-170, Brazil
| | - Maicon Falavigna
- Institute for Education and Research, HMV, Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Regis Goulart Rosa
- Intensive Care Unit, HMV. Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil.
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Abstract
An estimated 14 million patients survive sepsis hospitalization each year. However, survivors commonly experience new functional disability, cognitive impairment, and a high rate of further medical setbacks, including hospital readmission and late death. One in 5 older survivors has a potentially preventable hospital admission with in 90 days, most commonly for infection. Treatment should focus on preventing the common sequelae of critical illness during the initial hospitalization, tailoring medical care to minimize the risk for common and potentially preventable causes of hospital readmission, and promoting functional recovery.
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109
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Abstract
Although family is an essential unit of every society, many intensive care units continue to impose limitations on families' access to their loved ones. Unlimited family presence is backed both by data and the guidelines of multiple professional societies. We propose that the obligation to protect the integrity and needs of our patients and families extends past our immediate relationship to them at the bedside, and is also a societal imperative. In a society rife with implicit bias, restrictions on family visitation risk selective enforcement of these rules, and further propagate social injustice. Restrictions on family presence, including rigid hours, reflect an arbitrary vision based on increasingly obsolete socioeconomic realities. The time is now to open our intensive care units both on behalf of our patients and families, and for the betterment of our society as a whole.
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110
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Van Rompaey B, Sabbe K, Dilles T, van den Boogaard M. Delirium, introduction to a confused mind. Intensive Crit Care Nurs 2018; 47:1-4. [DOI: 10.1016/j.iccn.2018.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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111
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Salluh JIF, Latronico N. Does this critically ill patient with delirium require any drug treatment? Intensive Care Med 2018; 45:501-504. [PMID: 30043275 DOI: 10.1007/s00134-018-5310-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 07/06/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Jorge I F Salluh
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil. .,Programa de Pós-Graduação em Clinica médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
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112
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Rosa RG, Falavigna M, Robinson CC, da Silva DB, Kochhann R, de Moura RM, Santos MMS, Sganzerla D, Giordani NE, Eugênio C, Ribeiro T, Cavalcanti AB, Bozza F, Azevedo LCP, Machado FR, Salluh JIF, Pellegrini JAS, Moraes RB, Hochegger T, Amaral A, Teles JMM, da Luz LG, Barbosa MG, Birriel DC, Ferraz IDL, Nobre V, Valentim HM, Corrêa E Castro L, Duarte PAD, Tregnago R, Barilli SLS, Brandão N, Giannini A, Teixeira C. Study protocol to assess the effectiveness and safety of a flexible family visitation model for delirium prevention in adult intensive care units: a cluster-randomised, crossover trial (The ICU Visits Study). BMJ Open 2018; 8:e021193. [PMID: 29654049 PMCID: PMC5905750 DOI: 10.1136/bmjopen-2017-021193] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Flexible intensive care unit (ICU) visiting hours have been proposed as a means to improve patient-centred and family-centred care. However, randomised trials evaluating the effects of flexible family visitation models (FFVMs) are scarce. This study aims to compare the effectiveness and safety of an FFVM versus a restrictive family visitation model (RFVM) on delirium prevention among ICU patients, as well as to analyse its potential effects on family members and ICU professionals. METHODS AND ANALYSIS A cluster-randomised crossover trial involving adult ICU patients, family members and ICU professionals will be conducted. Forty medical-surgical Brazilian ICUs with RFVMs (<4.5 hours/day) will be randomly assigned to either an RFVM (visits according to local policies) or an FFVM (visitation during 12 consecutive hours per day) group at a 1:1 ratio. After enrolment and follow-up of 25 patients, each ICU will be switched over to the other visitation model, until 25 more patients per site are enrolled and followed. The primary outcome will be the cumulative incidence of delirium among ICU patients, measured twice a day using the Confusion Assessment Method for the ICU. Secondary outcome measures will include daily hazard of delirium, ventilator-free days, any ICU-acquired infections, ICU length of stay and hospital mortality among the patients; symptoms of anxiety and depression and satisfaction among the family members; and prevalence of burnout symptoms among the ICU professionals. Tertiary outcomes will include need for antipsychotic agents and/or mechanical restraints, coma-free days, unplanned loss of invasive devices and ICU-acquired pneumonia, urinary tract infection or bloodstream infection among the patients; self-perception of involvement in patient care among the family members; and satisfaction among the ICU professionals. ETHICS AND DISSEMINATION The study protocol has been approved by the research ethics committee of all participant institutions. We aim to disseminate the findings through conferences and peer-reviewed journals. TRIAL REGISTRATION NCT02932358.
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Affiliation(s)
- Regis Goulart Rosa
- Intensive Care Unit, Hospital Moinhos de Vento (HMV), Porto Alegre, Brazil
| | - Maicon Falavigna
- Institute for Education and Research, Hospital Moinhos de Vento (HMV), Porto Alegre, Brazil
| | | | | | - Renata Kochhann
- Research Projects Office, Hospital Moinhos de Vento (HMV), Porto Alegre, Brazil
| | | | | | - Daniel Sganzerla
- Research Projects Office, Hospital Moinhos de Vento (HMV), Porto Alegre, Brazil
| | | | - Cláudia Eugênio
- Intensive Care Unit, Hospital Moinhos de Vento (HMV), Porto Alegre, Brazil
| | - Tarissa Ribeiro
- Intensive Care Unit, Hospital Moinhos de Vento (HMV), Porto Alegre, Brazil
| | | | - Fernando Bozza
- Department of Critical Care, Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
| | | | - Flávia Ribeiro Machado
- Department of Anesthesiology, Pain and Intensive Care, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | | | - Taís Hochegger
- Intensive Care Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Alexandre Amaral
- Intensive Care Unit, Hospital de Urgências de Goiânia, Goiânia, Brazil
| | | | | | | | | | - Iris de Lima Ferraz
- Intensive Care Unit, Hospital de Urgência e Emergência de Rio Branco, Rio Branco, Brazil
| | - Vandack Nobre
- Intensive Care Unit, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Péricles Almeida Delfino Duarte
- Intensive Care Unit, Hospital do Câncer de Cascavel, Cascavel, Brazil
- Intensive Care, Hospital Universitário do Oeste do Paraná, Cascavel, Brazil
| | | | | | - Nilton Brandão
- Department of Internal Medicine, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Ospedale dei Bambini - ASST Spedali Civili, Brescia, Italy
| | - Cassiano Teixeira
- Intensive Care Unit, Hospital Moinhos de Vento (HMV), Porto Alegre, Brazil
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Westphal GA, Moerschberger MS, Vollmann DD, Inácio AC, Machado MC, Sperotto G, Cavalcanti AB, Koenig Á. Effect of a 24-h extended visiting policy on delirium in critically ill patients. Intensive Care Med 2018; 44:968-970. [PMID: 29605880 DOI: 10.1007/s00134-018-5153-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Glauco Adrieno Westphal
- Centro Hospitalar Unimed de Joinville, Joinville, Santa Catarina, Brazil. .,Brazilian Research in Intensive Care Network (BRICNet), Rio de Janeiro, Brazil.
| | | | | | | | - Míriam C Machado
- Centro Hospitalar Unimed de Joinville, Joinville, Santa Catarina, Brazil
| | - Geonice Sperotto
- Centro Hospitalar Unimed de Joinville, Joinville, Santa Catarina, Brazil
| | - Alexandre Biasi Cavalcanti
- Brazilian Research in Intensive Care Network (BRICNet), Rio de Janeiro, Brazil.,HCor Research Institute, São Paulo, Brazil
| | - Álvaro Koenig
- Centro Hospitalar Unimed de Joinville, Joinville, Santa Catarina, Brazil
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114
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Schwanda M, Gruber R. Extended visitation policy may lower risk for delirium in the intensive care unit. Evid Based Nurs 2018; 21:80. [PMID: 29592860 PMCID: PMC6047156 DOI: 10.1136/eb-2018-102884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Manuel Schwanda
- Department of Health Sciences, University of Applied Sciences St Pölten, Sankt Pölten, Austria
| | - Rita Gruber
- Department of Health Sciences, University of Applied Sciences St Pölten, Sankt Pölten, Austria
- School of Nursing, Bildungszentrum Diakonissen Linz, Linz, Austria
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115
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Azoulay E, Vincent JL, Angus DC, Arabi YM, Brochard L, Brett SJ, Citerio G, Cook DJ, Curtis JR, Dos Santos CC, Ely EW, Hall J, Halpern SD, Hart N, Hopkins RO, Iwashyna TJ, Jaber S, Latronico N, Mehta S, Needham DM, Nelson J, Puntillo K, Quintel M, Rowan K, Rubenfeld G, Van den Berghe G, Van der Hoeven J, Wunsch H, Herridge M. Recovery after critical illness: putting the puzzle together-a consensus of 29. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:296. [PMID: 29208005 PMCID: PMC5718148 DOI: 10.1186/s13054-017-1887-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/07/2017] [Indexed: 02/06/2023]
Abstract
In this review, we seek to highlight how critical illness and critical care affect longer-term outcomes, to underline the contribution of ICU delirium to cognitive dysfunction several months after ICU discharge, to give new insights into ICU acquired weakness, to emphasize the importance of value-based healthcare, and to delineate the elements of family-centered care. This consensus of 29 also provides a perspective and a research agenda about post-ICU recovery.
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Affiliation(s)
- Elie Azoulay
- Medical Intensive Care Unit, Hôpital Saint-Louis, ECSTRA team, Biostatistics and clinical epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France.
| | | | - Derek C Angus
- The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yaseen M Arabi
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Stephen J Brett
- Department of Surgery and Cancer Imperial College, London, UK
| | | | - Deborah J Cook
- McMaster University Medical Center, Hamilton, ON, Canada
| | | | | | - E Wesley Ely
- Vanderbilt University School of Medicine, and TN Valley Veteran's Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, TN, USA
| | - Jesse Hall
- The University of Chicago, Chicago, IL, USA
| | | | | | - Ramona O Hopkins
- Intermountain Medical Center, Murray, UT, USA.,Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Theodore J Iwashyna
- University of Michigan Health System, and Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI, USA
| | | | | | | | - Dale M Needham
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Judith Nelson
- Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College New York, New York, NY, USA
| | | | | | - Kathy Rowan
- Intensive Care National Audit & Research Centre, London, UK
| | | | | | | | - Hannah Wunsch
- Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Margaret Herridge
- Toronto General Research Institute, University of Toronto, UHN - University Health Network, Toronto, ON, Canada
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116
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