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Kattan E, Elgueta MF, Merino S, Retamal J. Sedation and Analgesia for Toxic Epidermal Necrolysis in the Intensive Care Unit: Few Certainties, Many Questions Ahead. J Pers Med 2023; 13:1194. [PMID: 37623445 PMCID: PMC10455435 DOI: 10.3390/jpm13081194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
Toxic epidermal necrolysis (TEN) is a rare, acute mucocutaneous life-threatening disease. Although research has focused on the pathophysiological and therapeutic aspects of the disease, there is a paucity of data in the literature regarding pain management and sedation in the intensive care unit (ICU). Most therapies have been extrapolated from other situations and/or the general ICU population. These patients present unique challenges during the progression of the disease and could end up requiring invasive mechanical ventilation due to inadequate pain management, which is potentially avoidable through a comprehensive treatment approach. In this review, we will present clinical and pathophysiological aspects of TEN, analyze pain pathways and relevant pharmacology, and propose therapeutic alternatives based on a rational and multimodal approach.
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Affiliation(s)
- Eduardo Kattan
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile;
| | - Maria Francisca Elgueta
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile;
| | - Sebastian Merino
- Servicio de Anestesiología, Complejo Asistencial Sótero del Río, Santiago 8330077, Chile;
| | - Jaime Retamal
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile;
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile
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Langer T, Depalo FC, Forlini C, Landini S, Mezzetti A, Previtali P, Monti G, de Toma C, Biscardi D, Giannini A, Fumagalli R, Mistraletti G. Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey. BMC Anesthesiol 2022; 22:187. [PMID: 35710331 PMCID: PMC9203262 DOI: 10.1186/s12871-022-01726-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/09/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. METHODS A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. RESULTS Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0-6]%, 0 [0-4]% and 11 [2-25]%, respectively, p < 0.001). Habits of pediatric ICUs were less affected by the pandemic. CONCLUSIONS Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was widely adopted as a surrogate for family meetings. New strategies to favor a family-centered approach during the current and future pandemics are warranted.
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Affiliation(s)
- Thomas Langer
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Francesca Carmela Depalo
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Clarissa Forlini
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Silvia Landini
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | | | - Paola Previtali
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Gianpaola Monti
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Carolina de Toma
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Davide Biscardi
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Roberto Fumagalli
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy. .,Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy.
| | - Giovanni Mistraletti
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Frivold G, Ågård AS, Jensen HI, Åkerman E, Fossum M, Alfheim HB, Rasi M, Lind R. Family involvement in the intensive care unit in four Nordic countries. Nurs Crit Care 2021; 27:450-459. [PMID: 34405494 DOI: 10.1111/nicc.12702] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/20/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Relevance to clinical practice The findings from the study highlighting family involvement, high-quality communication and flexible visiting policy as central aspects of family care may inspire clinicians to identify aspects of everyday family care in their ICUs calling for further improvement. AIMS AND OBJECTIVES To describe family involvement, communication practices and visiting policies in adult ICUs. DESIGN A cross-sectional survey. METHOD A questionnaire consisting of 11 sections was developed, pilot tested and e-mailed to 196 ICUs. The participants were intensive care nurses in adult ICUs in four Nordic countries. RESULTS The survey was conducted in October to December 2019. The response rate was 81% (158/196) of the invited ICUs. Most of the units had fewer than 11 beds. Family participation in patient care, including involvement in ward rounds and presence during cardiopulmonary resuscitation, varied between the countries, whereas most families in all countries were involved in decision-making. Family conferences were generally initiated by staff or family members. Children under 18 did not always receive information directly from the staff, and parents were not advised about how to inform their children. Although most respondents described open visiting, restrictions were also mentioned in free-text comments. CONCLUSIONS The level of family care in ICUs in the four Nordic countries is generally based on nurses' discretion. Although most Nordic ICUs report having an open or flexible visiting policy, a wide range of potential restrictions still exists. Children and young relatives are not routinely followed up. Family members are included in communication and decision-making, whereas family involvement in daily care, ward rounds and family-witnessed resuscitation seem to be areas with a potential for improvement.
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Affiliation(s)
- Gro Frivold
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Anne Sophie Ågård
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark.,Department of Science in Nursing, Aarhus University, Aarhus, Denmark
| | - Hanne Irene Jensen
- Departments of Anaesthesiology and Intensive Care, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Eva Åkerman
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Mariann Fossum
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Hanne Birgit Alfheim
- Faculty of Health, VID Specialized University, Oslo, Norway.,Postoperative and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Matias Rasi
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ranveig Lind
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Intensive Care Unit, University Hospital of North Norway, Tromsø, Norway
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Abstract
Surviving a critical illness can have long-term effects on both patients and families. These effects can be physical, emotional, cognitive, and social, and they affect both the patient and the family. Family members play a key role in helping their loved one recover, and this recovery process can take considerable time. Transferring out of an intensive care unit, and discharging home from a hospital, are important milestones, but they represent only the beginning of recovery and healing after a critical illness. Recognizing that these challenges exist both for patients and families is important to improve critical illness outcomes.
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5
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Connelly C, Jarvie L, Daniel M, Monachello E, Quasim T, Dunn L, McPeake J. Understanding what matters to patients in critical care: An exploratory evaluation. Nurs Crit Care 2019; 25:214-220. [PMID: 31304999 DOI: 10.1111/nicc.12461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/14/2019] [Accepted: 06/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The delivery of person-centred care is a key priority for managers, policy makers, and clinicians in health care. The delivery person-centred care in critical care is challenging because of competing demands. AIMS AND OBJECTIVES The aim of this quality improvement project was to understand what mattered to patients on a daily basis within the critical care environment. It aimed to understand personal goals and what patients needed to improve their experience. This paper reports on the outputs from this quality improvement project. DESIGN AND DATA ANALYSIS During each daily ward round, patients were asked "what matters to you today?" Outputs from this were entered into the Daily Goals Sheet, which is utilized for every patient in our critical care unit or in the nursing notes. Using Framework Analysis, prevalent themes were extracted from the patient statements documented. RESULTS A total of 196 unique patients were included in this analysis alongside 592 patient statements. Four broad themes were generated: medical outcomes and information, the critical care environment, personal care, and family and caregivers. CONCLUSION The analysis of the data from this quality improvement project has demonstrated that, by asking a simple question within the context of a ward round, care can be enhanced and personalized and long-term outcomes potentially improved. More research is required to understand what the optimal methods are of implementing these requests. RELEVANCE TO CLINICAL PRACTICE Two main recommendations from practice emerged from this quality improvement project: asking patients "what matters to you?" on a daily basis may help support the humanization of the critical care environment, and visiting and access by families must be discussed with patients to ensure this is appropriate for their needs.
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Affiliation(s)
- Christine Connelly
- Critical Care, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Lyndsey Jarvie
- Critical Care, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Malcolm Daniel
- Critical Care, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Emma Monachello
- Critical Care, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Tara Quasim
- Critical Care, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Lelia Dunn
- Critical Care, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Joanne McPeake
- Critical Care, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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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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8
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Effectiveness and Safety of an Extended ICU Visitation Model for Delirium Prevention: A Before and After Study. Crit Care Med 2017; 45:1660-1667. [PMID: 28671901 DOI: 10.1097/ccm.0000000000002588] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the effect of an extended visitation model compared with a restricted visitation model on the occurrence of delirium among ICU patients. DESIGN Prospective single-center before and after study. SETTING Thirty-one-bed medical-surgical ICU. PATIENTS All patients greater than or equal to 18 years old with expected length of stay greater than or equal to 24 hours consecutively admitted to the ICU from May 2015 to November 2015. INTERVENTIONS Change of visitation policy from a restricted visitation model (4.5 hr/d) to an extended visitation model (12 hr/d). MEASUREMENTS AND MAIN RESULTS Two hundred eighty-six patients were enrolled (141 restricted visitation model, 145 extended visitation model). The primary outcome was the cumulative incidence of delirium, assessed bid using the confusion assessment method for the ICU. Predefined secondary outcomes included duration of delirium/coma; any ICU-acquired infection; ICU-acquired bloodstream infection, pneumonia, and urinary tract infection; all-cause ICU mortality; and length of ICU stay. The median duration of visits increased from 133 minutes (interquartile range, 97.7-162.0) in restricted visitation model to 245 minutes (interquartile range, 175.0-272.0) in extended visitation model (p < 0.001). Fourteen patients (9.6%) developed delirium in extended visitation model compared with 29 (20.5%) in restricted visitation model (adjusted relative risk, 0.50; 95% CI, 0.26-0.95). In comparison with restricted visitation model patients, extended visitation model patients had shorter length of delirium/coma (1.5 d [interquartile range, 1.0-3.0] vs 3.0 d [interquartile range, 2.5-5.0]; p = 0.03) and ICU stay (3.0 d [interquartile range, 2.0-4.0] vs 4.0 d [interquartile range, 2.0-6.0]; p = 0.04). The rate of ICU-acquired infections and all-cause ICU mortality did not differ significantly between the two study groups. CONCLUSIONS In this medical-surgical ICU, an extended visitation model was associated with reduced occurrence of delirium and shorter length of delirium/coma and ICU stay.
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Ørn S, van Hall G. Does a normal peripheral lactate value always indicate an aerobic tissue metabolism? Eur J Heart Fail 2017; 19:1034-1035. [PMID: 28547836 DOI: 10.1002/ejhf.863] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/27/2017] [Accepted: 03/31/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Stein Ørn
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Department of Mathematics and Natural Sciences, University of Stavanger, Stavanger, Norway
| | - Gerrit van Hall
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Di Bernardo V, Grignoli N, Marazia C, Andreotti J, Perren A, Malacrida R. Sharing intimacy in "open" intensive care units. J Crit Care 2015; 30:866-70. [PMID: 26160723 DOI: 10.1016/j.jcrc.2015.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 04/03/2015] [Accepted: 05/16/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Opening intensive care units (ICUs) is particularly relevant because of a new Swiss law granting the relatives of patients without decision-making capability a central role in medical decisions. The main objectives of the study were to assess how the presence of relatives is viewed by patients, health care providers, and relatives themselves and to evaluate the perception of the level of intrusiveness into the personal sphere during admission. MATERIAL AND METHODS In a longitudinal and prospective design, qualitative questionnaires were submitted concomitantly to patients, relatives, and health care providers consecutively over a 6-month period. The study was conducted in the 4 ICUs of the public hospitals of Canton Ticino (Switzerland). RESULTS The questionnaires collected from patients, relatives, and health care providers were 176, 173, and 134, respectively. The analysis of the answers of 120 patient-relative pairs showed consistent results (P < .0001), whereas those of health care providers were significantly different (P < .0001), regarding both the usefulness of opening ICUs to patient relatives and what was stressful during admission. CONCLUSIONS Relatives in these "open" ICUs share a great deal of intimacy with the patients. Their presence and the deriving benefits were seen as very positive by patients and relatives themselves. Skepticism, instead, prevailed among health care providers.
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Affiliation(s)
- Valentina Di Bernardo
- Intensive Care Unit, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland; Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
| | - Nicola Grignoli
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland; Psychiatry Consultation Liaison Service, Organizzazione Sociopsichiatrica Cantonale, Mendrisio, Switzerland.
| | - Chantal Marazia
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland; Département d'Histoire des Sciences et de la Vie et de la Santé, University of Strasbourg, Strasbourg, France
| | - Jennifer Andreotti
- Department of Psychiatric Neurophysiology, University Hospital of Psychiatry, Bern, Switzerland
| | - Andreas Perren
- Intensive Care Unit, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Roberto Malacrida
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
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Azoulay E, Chaize M, Kentish-Barnes N. Involvement of ICU families in decisions: fine-tuning the partnership. Ann Intensive Care 2014; 4:37. [PMID: 25593753 PMCID: PMC4273688 DOI: 10.1186/s13613-014-0037-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/06/2014] [Indexed: 11/10/2022] Open
Abstract
Families of patients are not simple visitors to the ICU. They have just been separated from a loved one, often someone they live with, either abruptly or, in nearly half the cases, because a chronic condition has suddenly worsened. They must cope with a serious illness of a loved one, while having to adapt to the unfamiliar and intimidating ICU environment. In many cases, the outcome of the critical illness is uncertain, a situation that causes considerable distress to the relatives. As shown by our research group and others, families exhibit symptoms of anxiety (70%) and depression (35%) in the first few days after admission, as well as symptoms of stress (33%) and difficulty understanding the information delivered by the healthcare staff (50%). Furthermore, relatives of patients who die in the ICU are at risk for psychiatric syndromes such as generalized anxiety, panic attacks, depression, and posttraumatic stress syndrome. In this setting of psychological distress, families are asked to consider sharing in healthcare decisions about their loved one in the ICU. This article aims to foster the debate about the shared decision-making process. We have three objectives: to transcend the overly simplistic position that opposes paternalism and autonomy, to build a view founded only on an evaluation of actual practice and experience in the field, and to keep the focus squarely on the patient. Families want information and communication time from the staff. Nurses and physicians need to understand that families can share in decisions only if the entire ICU staff actively promotes family involvement and, of course, if the family wants to participate in all or part of the decision-making process.
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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 Biostatistic Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Marine Chaize
- Medical Intensive Care Unit, Hôpital Saint-Louis, ECSTRA team, Biostatistics and clinical epidemiology, UMR 1153 (Center of Epidemiology and Biostatistic Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Nancy Kentish-Barnes
- Medical Intensive Care Unit, Hôpital Saint-Louis, ECSTRA team, Biostatistics and clinical epidemiology, UMR 1153 (Center of Epidemiology and Biostatistic Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
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12
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Giannini A, Garrouste-Orgeas M, Latour JM. What's new in ICU visiting policies: can we continue to keep the doors closed? Intensive Care Med 2014; 40:730-3. [PMID: 24687297 DOI: 10.1007/s00134-014-3267-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Alberto Giannini
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 9, 20122, Milan, Italy,
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