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Loudet CI, Jorro Barón F, Reina R, Arias López MDP, Alegría SL, Barrios CDV, Buffa R, Cabana ML, Cunto ER, Fernández Nievas S, García MA, Gibbons L, Izzo G, Llanos MN, Meregalli C, Joaquín Mira J, Ratto ME, Rivet ML, Roberti J, Silvestri AM, Tévez A, Uranga LJ, Zakalik G, Rodríguez V, García-Elorrio E. Quality improvement collaborative for improving patient care delivery in Argentine public health sector intensive care units. BMJ Open Qual 2024; 13:e002618. [PMID: 38830729 PMCID: PMC11149125 DOI: 10.1136/bmjoq-2023-002618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 05/13/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND The demand for healthcare services during the COVID-19 pandemic was excessive for less-resourced settings, with intensive care units (ICUs) taking the heaviest toll. OBJECTIVE The aim was to achieve adequate personal protective equipment (PPE) use in 90% of patient encounters, to reach 90% compliance with objectives of patient flow (OPF) and to provide emotional support tools to 90% of healthcare workers (HCWs). METHODS We conducted a quasi-experimental study with an interrupted time-series design in 14 ICUs in Argentina. We randomly selected adult critically ill patients admitted from July 2020 to July 2021 and active HCWs in the same period. We implemented a quality improvement collaborative (QIC) with a baseline phase (BP) and an intervention phase (IP). The QIC included learning sessions, periods of action and improvement cycles (plan-do-study-act) virtually coached by experts via platform web-based activities. The main study outcomes encompassed the following elements: proper utilisation of PPE, compliance with nine specific OPF using daily goal sheets through direct observations and utilisation of a web-based tool for tracking emotional well-being among HCWs. RESULTS We collected 7341 observations of PPE use (977 in BP and 6364 in IP) with an improvement in adequate use from 58.4% to 71.9% (RR 1.2, 95% CI 1.17 to 1.29, p<0.001). We observed 7428 patient encounters to evaluate compliance with 9 OPF (879 in BP and 6549 in IP) with an improvement in compliance from 53.9% to 67% (RR 1.24, 95% CI 1.17 to 1.32, p<0.001). The results showed that HCWs did not use the support tool for self-mental health evaluation as much as expected. CONCLUSION A QIC was effective in improving healthcare processes and adequate PPE use, even in the context of a pandemic, indicating the possibility of expanding QIC networks nationwide to improve overall healthcare delivery. The limited reception of emotional support tools requires further analyses.
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Affiliation(s)
- Cecilia Inés Loudet
- Sociedad Argentina de Terapia Intensiva, Ciudad Autónoma de Buenos Aires, Argentina
- Hospital Interzonal General de Agudos General San Martín, La Plata, Buenos Aires, Argentina
| | - Facundo Jorro Barón
- Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
| | - Rosa Reina
- Sociedad Argentina de Terapia Intensiva, Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | | | | | | | - Eleonora Roxana Cunto
- Hospital de Infecciosas Dr Francisco Javier Muñiz, Ciudad Autónoma de Buenos Aires, Argentina
| | - Simón Fernández Nievas
- Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Luz Gibbons
- Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriela Izzo
- Hospital Simplemente Evita, González Catán, Buenos Aires, Argentina
| | | | - Claudia Meregalli
- Sociedad Argentina de Terapia Intensiva, Ciudad Autónoma de Buenos Aires, Argentina
| | - José Joaquín Mira
- Departamento de Salud Alicante-Sant Joan, Sant Joan d'Alacant, Spain
| | - María Elena Ratto
- Sociedad Argentina de Terapia Intensiva, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariano Luis Rivet
- Hospital General de Agudos Bernardino Rivadavia, Ciudad Autónoma de Buenos Aires, Argentina
| | - Javier Roberti
- Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
- CIESP/CONICET, Buenos Aires, Argentina
| | | | - Analía Tévez
- Hospital Balestrini, La Matanza, Buenos Aires, Argentina
| | | | | | - Viviana Rodríguez
- Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina
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Zee MS, Onwuteaka-Philipsen BD, Witkamp E, Heessels B, Goossensen A, Korfage IJ, Becqué YN, Nierop-van Baalen C, van der Heide A, Pasman HR. Distress among healthcare providers who provided end-of-life care during the COVID-19 pandemic: a longitudinal survey study (the CO-LIVE study). BMC Palliat Care 2024; 23:134. [PMID: 38802776 PMCID: PMC11131237 DOI: 10.1186/s12904-024-01446-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/28/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic had a significant impact on care at the end-of-life due to restrictions and other circumstances such as high workload and uncertainty about the disease. The objective of this study is to describe the degree of various signs experienced by healthcare providers throughout the first 18 months of the pandemic and to assess what provider's characteristics and care circumstances related to COVID-19 are associated with distress. METHODS A longitudinal survey study among healthcare providers from different healthcare settings who provided end-of-life care during the pandemic's first 18 months. Data of four time periods were analyzed using descriptive statistics, logistic regression analysis and Generalized Estimating Equation. RESULTS Of the respondents (n=302) the majority had a nursing background (71.8%) and most worked in a hospital (30.3%). Although reported distress was highest in the first period, during the first wave of COVID-19 pandemic, healthcare providers reported signs of distress in all four time periods. Being more stressed than usual and being regularly exhausted were the most common signs of distress. Healthcare providers working in nursing homes and hospitals were more likely to experience signs of distress, compared to healthcare providers working in hospice facilities, during the whole period of 1.5 years. When HCPs were restricted in providing post-death care, they were more likely to feel more stressed than usual and find their work more often emotionally demanding. CONCLUSION A substantial amount of healthcare providers reported signs of distress during the first 1.5 years of the COVID-19 pandemic. A cause of distress appears to be that healthcare providers cannot provide the care they desire due the pandemic. Even though the pandemic is over, this remains an important and relevant finding, as high workload can sometimes force healthcare providers to make choices about how they provide care. Given that this can cause prolonged stress and this can lead to burnout (and HCPs leaving their current positions), it is now especially important to continue observing the long term developments of the well-being of our healthcare providers in palliative care and provide timely and adequate support where needed.
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Affiliation(s)
- Masha S Zee
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Erica Witkamp
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Benthe Heessels
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | | | - Ida J Korfage
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Yvonne N Becqué
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Corine Nierop-van Baalen
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - H Roeline Pasman
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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Tong HH, Creutzfeldt CJ, Hicks KG, Kross EK, Sharma RK, Jennerich AL. Questions From Family Members During the Dying Process And Moral Distress Experienced by ICU Nurses. J Pain Symptom Manage 2024; 67:402-410.e1. [PMID: 38342474 DOI: 10.1016/j.jpainsymman.2024.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND For a hospitalized patient, transitioning to comfort measures only (CMO) involves discontinuation of life-prolonging interventions with a goal of allowing natural death. Nurses play a pivotal role during the provision of CMO, caring for both the dying patient and their family. OBJECTIVE To examine the experiences of ICU nurses caring for patients receiving CMO. METHODS Between October 2020 and June 2021, nurses in the neuro- and medical-cardiac intensive care units at Harborview Medical Center in Seattle, WA, completed surveys about their experiences providing CMO. Surveys addressed involvement in discussions about CMO and questions asked by family members of dying patients. We also assessed nurses' moral distress related to CMO and used ordinal logistic regression to examine predictors of moral distress. RESULTS Surveys were completed by 82 nurses (response rate 44%), with 79 (96%) reporting experience providing CMO in the previous year. Most preferred to be present for discussions between physicians or advanced practice providers and family members about transitioning to CMO (89% most of the time or always); however, only 31% were present most of the time or always. Questions from family about time to death, changes in breathing, and medications to relieve symptoms were common. Most nurses reported moral distress at least some of the time when providing CMO (62%). Feeling well-prepared to answer specific questions from family was associated with less moral distress. CONCLUSION There is discordance between nurses' preferences for inclusion in discussions about the transition to CMO and their actual presence. Moral distress is common for nurses when providing CMO and feeling prepared to answer questions from family members may attenuate distress.
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Affiliation(s)
- Hao H Tong
- University of Pennsylvania, Division of Pulmonary, Allergy and Critical Care (H.H.T.), Philadelphia, Pennsylvania, USA
| | - Claire J Creutzfeldt
- Harborview Medical Center, Department of Neurology (C.J.C.), Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington (C.J.C., E.K.K., R.K.S., A.L.J.), Seattle, Washington, USA
| | - Katherine G Hicks
- Baylor College of Medicine, Section of Geriatrics and Palliative Medicine (K.G.H.), Houston, Texas, USA
| | - Erin K Kross
- Cambia Palliative Care Center of Excellence, University of Washington (C.J.C., E.K.K., R.K.S., A.L.J.), Seattle, Washington, USA; Harborview Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington (E.K.K., A.L.J.), Seattle, Washington, USA
| | - Rashmi K Sharma
- Cambia Palliative Care Center of Excellence, University of Washington (C.J.C., E.K.K., R.K.S., A.L.J.), Seattle, Washington, USA; University of Washington, Division of General Internal Medicine (R.K.S.), Seattle, Washington, USA
| | - Ann L Jennerich
- Cambia Palliative Care Center of Excellence, University of Washington (C.J.C., E.K.K., R.K.S., A.L.J.), Seattle, Washington, USA; Harborview Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington (E.K.K., A.L.J.), Seattle, Washington, USA.
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Kim TW, Kim WY, Park S, Lee SH, Park O, Kim T, Yeo HJ, Jang JH, Cho WH, Huh JW, Lee SM, Chung CR, Lee J, Kim JS, Lim SY, Baek AR, Yoo JW, Kim HC, Choi EY, Park C, Kim TO, Moon DS, Lee SI, Moon JY, Kwon SJ, Seong GM, Jung WJ, Baek MS. Risk Factors for the Mortality of Patients With Coronavirus Disease 2019 Requiring Extracorporeal Membrane Oxygenation in a Non-Centralized Setting: A Nationwide Study. J Korean Med Sci 2024; 39:e75. [PMID: 38442718 PMCID: PMC10911941 DOI: 10.3346/jkms.2024.39.e75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/03/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Limited data are available on the mortality rates of patients receiving extracorporeal membrane oxygenation (ECMO) support for coronavirus disease 2019 (COVID-19). We aimed to analyze the relationship between COVID-19 and clinical outcomes for patients receiving ECMO. METHODS We retrospectively investigated patients with COVID-19 pneumonia requiring ECMO in 19 hospitals across Korea from January 1, 2020 to August 31, 2021. The primary outcome was the 90-day mortality after ECMO initiation. We performed multivariate analysis using a logistic regression model to estimate the odds ratio (OR) of 90-day mortality. Survival differences were analyzed using the Kaplan-Meier (KM) method. RESULTS Of 127 patients with COVID-19 pneumonia who received ECMO, 70 patients (55.1%) died within 90 days of ECMO initiation. The median age was 64 years, and 63% of patients were male. The incidence of ECMO was increased with age but was decreased after 70 years of age. However, the survival rate was decreased linearly with age. In multivariate analysis, age (OR, 1.048; 95% confidence interval [CI], 1.010-1.089; P = 0.014) and receipt of continuous renal replacement therapy (CRRT) (OR, 3.069; 95% CI, 1.312-7.180; P = 0.010) were significantly associated with an increased risk of 90-day mortality. KM curves showed significant differences in survival between groups according to age (65 years) (log-rank P = 0.021) and receipt of CRRT (log-rank P = 0.004). CONCLUSION Older age and receipt of CRRT were associated with higher mortality rates among patients with COVID-19 who received ECMO.
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Affiliation(s)
- Tae Wan Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Won-Young Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sunghoon Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Su Hwan Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Onyu Park
- BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Taehwa Kim
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hye Ju Yeo
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jin Ho Jang
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Woo Hyun Cho
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jin-Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jongmin Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Soo Kim
- Division of Critical Care Medicine, Department of Hospital Medicine, Inha Collage of Medicine, Incheon, Korea
| | - Sung Yoon Lim
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ae-Rin Baek
- Division of Allergy and Pulmonary Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jung-Wan Yoo
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Ho Cheol Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Eun Young Choi
- Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, Korea
| | - Chul Park
- Division of Pulmonology and Critical Care Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Tae-Ok Kim
- Division of Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Do Sik Moon
- Department of Pulmonology and Critical Care Medicine, Chosun University Hospital, Gwangju, Korea
| | - Song-I Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jae Young Moon
- Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Sun Jung Kwon
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea
| | - Gil Myeong Seong
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Won Jai Jung
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Moon Seong Baek
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
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Wang YY, Zhang WW, Lu ZX, Sun JL, Jing MX. Optimal resource allocation model for COVID-19: a systematic review and meta-analysis. BMC Infect Dis 2024; 24:200. [PMID: 38355468 PMCID: PMC10865525 DOI: 10.1186/s12879-024-09007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND A lack of health resources is a common problem after the outbreak of infectious diseases, and resource optimization is an important means to solve the lack of prevention and control capacity caused by resource constraints. This study systematically evaluated the similarities and differences in the application of coronavirus disease (COVID-19) resource allocation models and analyzed the effects of different optimal resource allocations on epidemic control. METHODS A systematic literature search was conducted of CNKI, WanFang, VIP, CBD, PubMed, Web of Science, Scopus and Embase for articles published from January 1, 2019, through November 23, 2023. Two reviewers independently evaluated the quality of the included studies, extracted and cross-checked the data. Moreover, publication bias and sensitivity analysis were evaluated. RESULTS A total of 22 articles were included for systematic review; in the application of optimal allocation models, 59.09% of the studies used propagation dynamics models to simulate the allocation of various resources, and some scholars also used mathematical optimization functions (36.36%) and machine learning algorithms (31.82%) to solve the problem of resource allocation; the results of the systematic review show that differential equation modeling was more considered when testing resources optimization, the optimization function or machine learning algorithm were mostly used to optimize the bed resources; the meta-analysis results showed that the epidemic trend was obviously effectively controlled through the optimal allocation of resources, and the average control efficiency was 0.38(95%CI 0.25-0.51); Subgroup analysis revealed that the average control efficiency from high to low was health specialists 0.48(95%CI 0.37-0.59), vaccines 0.47(95%CI 0.11-0.82), testing 0.38(95%CI 0.19-0.57), personal protective equipment (PPE) 0.38(95%CI 0.06-0.70), beds 0.34(95%CI 0.14-0.53), medicines and equipment for treatment 0.32(95%CI 0.12-0.51); Funnel plots and Egger's test showed no publication bias, and sensitivity analysis suggested robust results. CONCLUSION When the data are insufficient and the simulation time is short, the researchers mostly use the constructor for research; When the data are relatively sufficient and the simulation time is long, researchers choose differential equations or machine learning algorithms for research. In addition, our study showed that control efficiency is an important indicator to evaluate the effectiveness of epidemic prevention and control. Through the optimization of medical staff and vaccine allocation, greater prevention and control effects can be achieved.
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Affiliation(s)
- Yu-Yuan Wang
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, 832003, PR China
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, Urumqi, China
| | - Wei-Wen Zhang
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, 832003, PR China
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, Urumqi, China
| | - Ze-Xi Lu
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, 832003, PR China
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, Urumqi, China
| | - Jia-Lin Sun
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, 832003, PR China.
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, Urumqi, China.
- Department of Nutrition and Food Hygiene School of Public Health Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Ming-Xia Jing
- Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, 832003, PR China.
- Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, The Xinjiang Production and Construction Corps, Urumqi, China.
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da Silva MMD, Klever EK, da Rocha JC, Silva GDOL, de Amorim JDR, Dode AD, Simionato BM, da Cunha LG, Zaupa APB, Krauzer JRM, Pires ADA, Cabral FC, Moreira TDC, Constant HMRM. Impact of Telemedicine use on clinical care indicators of pediatric intensive care units: protocol for a cluster randomized clinical trial. CRITICAL CARE SCIENCE 2023; 35:266-272. [PMID: 38133156 PMCID: PMC10734809 DOI: 10.5935/2965-2774.20230223-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 12/23/2023]
Abstract
The objective of this study is to present the protocol of a cluster randomized clinical trial to be conducted through the TeleICU project - Qualification of Intensive Care by Telemedicine. The study will consist of a cluster randomized clinical trial, open label, in pediatric intensive care units, with an allocation ratio of 1:1, to compare the intervention group (support of Telemedicine for patients admitted to the pediatric intensive care unit) with a control group (pediatric intensive care unit usual care). The study proposed to select 16 pediatric intensive care units, including 100 participants per site, with a total of 1,600 participants. The intervention group will receive telerounds from Monday to Friday and will have specialists and continuing education activities available. The primary outcome measure will be the length of stay in the pediatric intensive care unit, defined as the difference between the date of discharge of the participant and the date of admission to the intensive care unit. The secondary outcomes will be mortality rate, invasive mechanical ventilation-free days, days using antibiotics, days using vasoactive drugs and days using sedoanalgesia. This study will be conducted in accordance with Resolution 466/12 of the National Health Council, with approval by the Research Ethics Committee of the institutions involved. The present study has the potential to reproduce studies on Telemedicine in intensive care and may make important contributions to care in intensive care units in Brazil and other settings. If Telemedicine shows positive clinical care results compared to conventional treatment, more pediatric patients may benefit. ClinicalTrials.gov registry: NCT05260710.
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Affiliation(s)
| | | | | | | | | | - Andressa Dutra Dode
- Social Responsibility, Hospital Moinhos de Vento - Porto Alegre
(RS), Brazil
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7
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Freire MP, de Assis DB, Tavares BDM, Brito VOC, Marinho I, Lapchik M, Guedes AR, Madalosso G, Oliveira MS, de Lima ACP, Levin AS. Impact of COVID-19 on healthcare-associated infections: Antimicrobial consumption does not follow antimicrobial resistance. Clinics (Sao Paulo) 2023; 78:100231. [PMID: 37348255 DOI: 10.1016/j.clinsp.2023.100231] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/17/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND This study aimed to analyze the Healthcare-Associated Infections (HAI) rates and antimicrobial consumption in Intensive Care Units (ICU) in São Paulo city during the COVID-19 pandemic and compare them with the pre-pandemic period. METHODS This cohort included all hospitals that reported HAI rates (Central-Line-Associated Bloodstream Infection ‒ CLABSI and Ventilator-Associated Pneumonia ‒ VAP), the proportion of microorganisms that caused CLABSI, the proportion of resistant microorganisms, and antimicrobial consumption from January 2017 ‒ December 2020. Hospitals were stratified by the number of beds, Central Venous Catheter (CVC) utilization rate, Mechanical-Ventilation (MV) utilization rate, and type of funding. Statistical analyses were based on time-series plots and regression models. RESULTS 220 ICUs were included. The authors observed an abrupt increase in CLABSI rates after the pandemic onset. High CLABSI rates during the pandemic were associated with hospital size, funding (public and non-profit private), and low CVC use (≤ 50%). An increase in VAP rates was associated with public hospitals, and high MV use (> 35%). The susceptibility profile of microorganisms did not differ from that of the pre-pandemic period. polymyxin, glycopeptides, and antifungal use increased, especially in COVID-19 ICUs. CONCLUSIONS HAI increased during COVID-19. The microorganisms' susceptibility profile did not change with the pandemic, but the authors observed a disproportionate increase in large-spectrum antimicrobial drug use.
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Affiliation(s)
- Maristela Pinheiro Freire
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Denise Brandão de Assis
- Division of Hospital Infections, Center for Epidemiologic Surveillance "Prof. Alexandre Vranjac", Center for Disease Control, Sao Paulo State Health Department, São Paulo, SP, Brazil
| | - Bruno de Melo Tavares
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Valquiria O C Brito
- Núcleo Municipal de Controle de Infecção Hospitalar, São Paulo City Health Department, São Paulo, SP, Brazil
| | - Igor Marinho
- Department of Infectious Diseases, Laboratório de Investigacao Médica ‒ LIM 49, and Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Milton Lapchik
- Núcleo Municipal de Controle de Infecção Hospitalar, São Paulo City Health Department, São Paulo, SP, Brazil
| | - Ana Rubia Guedes
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Geraldine Madalosso
- Division of Hospital Infections, Center for Epidemiologic Surveillance "Prof. Alexandre Vranjac", Center for Disease Control, Sao Paulo State Health Department, São Paulo, SP, Brazil
| | - Maura Salaroli Oliveira
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | - Anna S Levin
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Department of Infectious Diseases, Laboratório de Investigacao Médica ‒ LIM 49, and Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, SP, Brazil
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Boussarsar M, Meddeb K, Toumi R, Ennouri E, Ayed S, Jarraya F, Ben Khelil J, Jaoued O, Nouira H, El Atrous S, Essafi F, Talik I, Merhabane T, Trifi A, Seghir E, Abdellatif S, Doghri H, Bahri B, Borsali N, Fathallah I, Ksouri M, Kouraichi N, Ben Jazia A, Ben Ghezala H, Brahmi N. Resource utilization and preparedness within the COVID-19 pandemic in Tunisian medical intensive care units: A nationwide retrospective multicentre observational study. J Infect Public Health 2023; 16:727-735. [PMID: 36947950 PMCID: PMC9998281 DOI: 10.1016/j.jiph.2023.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/17/2023] [Accepted: 02/26/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND The worldwide SARS-CoV-2 pandemic represents the most recent global healthcare crisis. While all healthcare systems suffered facing the immense burden of critically-ill COVID-19 patients, the levels of preparedness and adaptability differed highly between countries. AIM to describe resource mobilization throughout the COVID-19 waves in Tunisian University Medical Intensive Care Units (MICUs) and to identify discrepancies in preparedness between the provided and required resource. METHODS This is a longitudinal retrospective multicentre observational study conducted between March 2020 and May 2022 analyzing data from eight University MICUs. Data were collected at baseline and at each bed expansion period in relation to the nation's four COVID-19 waves. Data collected included epidemiological, organizational and management trends and outcomes of COVID-19 and non-COVID-19 admissions. RESULTS MICU-beds increased from 66 to a maximum of 117 beds. This was possible thanks to equipping pre-existing non-functional MICU beds (n = 20) and creating surge ICU-beds in medical wards (n = 24). MICU nurses increased from 53 to 200 of which 99 non-ICU nurses, by deployment from other departments and temporary recruitment. The nurse-to-MICU-bed ratio increased from 1:1 to around 1·8:1. Only 55% of beds were single rooms, 80% were equipped with ICU ventilators. These MICUs managed to admit a total of 3368 critically-ill patients (15% of hospital admissions). 33·2% of COVID-19-related intra-hospital deaths occurred within the MICUs. CONCLUSION Despite a substantial increase in resource mobilization during the COVID-19 pandemic, the current study identified significant persisting discrepancies between supplied and required resource, at least partially explaining the poor overall prognosis of critically-ill COVID-19 patients.
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Affiliation(s)
- Mohamed Boussarsar
- University of Sousse, Faculty of Medicine of Sousse, 4002 Sousse, Tunisia; Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory "Heart Failure", LR12SP09, 4000 Sousse, Tunisia.
| | - Khaoula Meddeb
- University of Sousse, Faculty of Medicine of Sousse, 4002 Sousse, Tunisia; Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory "Heart Failure", LR12SP09, 4000 Sousse, Tunisia
| | - Radhouane Toumi
- University of Sousse, Faculty of Medicine of Sousse, 4002 Sousse, Tunisia; Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory "Heart Failure", LR12SP09, 4000 Sousse, Tunisia
| | - Emna Ennouri
- University of Sousse, Faculty of Medicine of Sousse, 4002 Sousse, Tunisia; Farhat Hached University Hospital, Medical Intensive Care Unit, Research Laboratory "Heart Failure", LR12SP09, 4000 Sousse, Tunisia
| | - Samia Ayed
- University of Tunis El Manar, Faculty of Medicine of Tunis, 1006 Tunis, Tunisia; Abderrahmane Mami Hospital, Medical Intensive Care Unit, Research Unit "UR22SP01″2080, Ariana, Tunisia
| | - Fatma Jarraya
- University of Tunis El Manar, Faculty of Medicine of Tunis, 1006 Tunis, Tunisia; Abderrahmane Mami Hospital, Medical Intensive Care Unit, Research Unit "UR22SP01″2080, Ariana, Tunisia
| | - Jalila Ben Khelil
- University of Tunis El Manar, Faculty of Medicine of Tunis, 1006 Tunis, Tunisia; Abderrahmane Mami Hospital, Medical Intensive Care Unit, Research Unit "UR22SP01″2080, Ariana, Tunisia
| | - Oussama Jaoued
- University of Monastir, Faculty of Medicine of Monastir, 5019 Monastir, Tunisia; Tahar Sfar Hospital, Medical Intensive Care Unit, 5100 Mahdia, Tunisia
| | - Hajer Nouira
- University of Monastir, Faculty of Medicine of Monastir, 5019 Monastir, Tunisia; Tahar Sfar Hospital, Medical Intensive Care Unit, 5100 Mahdia, Tunisia
| | - Souheil El Atrous
- University of Monastir, Faculty of Medicine of Monastir, 5019 Monastir, Tunisia; Tahar Sfar Hospital, Medical Intensive Care Unit, 5100 Mahdia, Tunisia
| | - Fatma Essafi
- University of Tunis El Manar, Faculty of Medicine of Tunis, 1006 Tunis, Tunisia; Zaghouan Regional Hospital, Medical Intensive Care Unit, 1100 Zaghouan, Tunisia
| | - Imen Talik
- University of Tunis El Manar, Faculty of Medicine of Tunis, 1006 Tunis, Tunisia; Zaghouan Regional Hospital, Medical Intensive Care Unit, 1100 Zaghouan, Tunisia
| | - Takoua Merhabane
- University of Tunis El Manar, Faculty of Medicine of Tunis, 1006 Tunis, Tunisia; Zaghouan Regional Hospital, Medical Intensive Care Unit, 1100 Zaghouan, Tunisia
| | - Ahlem Trifi
- University of Tunis El Manar, Faculty of Medicine of Tunis, 1006 Tunis, Tunisia; La Rabta University Hospital, Medical Intensive Care Unit, 1007 Tunis, Tunisia
| | - Eya Seghir
- University of Tunis El Manar, Faculty of Medicine of Tunis, 1006 Tunis, Tunisia; La Rabta University Hospital, Medical Intensive Care Unit, 1007 Tunis, Tunisia
| | - Sami Abdellatif
- University of Tunis El Manar, Faculty of Medicine of Tunis, 1006 Tunis, Tunisia; La Rabta University Hospital, Medical Intensive Care Unit, 1007 Tunis, Tunisia
| | - Hamdi Doghri
- University of Tunis El Manar, Faculty of Medicine of Tunis, 1006 Tunis, Tunisia; Habib Thameur University Hospital, Medical Intensive Care Unit, 1089 Tunis, Tunisia
| | - Badra Bahri
- University of Tunis El Manar, Faculty of Medicine of Tunis, 1006 Tunis, Tunisia; Habib Thameur University Hospital, Medical Intensive Care Unit, 1089 Tunis, Tunisia
| | - Nebiha Borsali
- University of Tunis El Manar, Faculty of Medicine of Tunis, 1006 Tunis, Tunisia; Habib Thameur University Hospital, Medical Intensive Care Unit, 1089 Tunis, Tunisia
| | - Ines Fathallah
- University of Tunis El Manar, Faculty of Medicine of Tunis, 1006 Tunis, Tunisia; Yasminet Regional Hospital, Medical Intensive Care Unit, 2063 Ben Arous, Tunisia
| | - Meriam Ksouri
- University of Tunis El Manar, Faculty of Medicine of Tunis, 1006 Tunis, Tunisia; Yasminet Regional Hospital, Medical Intensive Care Unit, 2063 Ben Arous, Tunisia
| | - Nadia Kouraichi
- University of Tunis El Manar, Faculty of Medicine of Tunis, 1006 Tunis, Tunisia; Yasminet Regional Hospital, Medical Intensive Care Unit, 2063 Ben Arous, Tunisia
| | - Amira Ben Jazia
- University of Tunis El Manar, Faculty of Medicine of Tunis, 1006 Tunis, Tunisia; CAMU Center, Medical Intensive Care Unit, 1089 Tunis, Tunisia
| | - Hassan Ben Ghezala
- University of Tunis El Manar, Faculty of Medicine of Tunis, 1006 Tunis, Tunisia; CAMU Center, Medical Intensive Care Unit, 1089 Tunis, Tunisia
| | - Nozha Brahmi
- University of Tunis El Manar, Faculty of Medicine of Tunis, 1006 Tunis, Tunisia; CAMU Center, Medical Intensive Care Unit, 1089 Tunis, Tunisia
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Atallah FC, Caruso P, Nassar Junior AP, Torelly AP, Amendola CP, Salluh JIF, Romano TG. High-value care for critically ill oncohematological patients: what do we know thus far? CRITICAL CARE SCIENCE 2023; 35:84-96. [PMID: 37712733 PMCID: PMC10275311 DOI: 10.5935/2965-2774.20230405-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/26/2023] [Indexed: 09/16/2023]
Abstract
The number of patients with cancer requiring intensive care unit admission is increasing around the world. The improvement in the pathophysiological understanding of this group of patients, as well as the increasingly better and more targeted treatment options for their underlying disease, has led to a significant increase in their survival over the past three decades. Within the organizational concepts, it is necessary to know what adds value in the care of critical oncohematological patients. Practices in medicine that do not benefit patients and possibly cause harm are called low-value practices, while high-value practices are defined as high-quality care at relatively low cost. In this article, we discuss ten domains with high-value evidence in the care of cancer patients: (1) intensive care unit admission policies; (2) intensive care unit organization; (3) etiological investigation of hypoxemia; (4) management of acute respiratory failure; (5) management of febrile neutropenia; (6) urgent chemotherapy treatment in critically ill patients; (7) patient and family experience; (8) palliative care; (9) care of intensive care unit staff; and (10) long-term impact of critical disease on the cancer population. The disclosure of such policies is expected to have the potential to change health care standards. We understand that it is a lengthy process, and initiatives such as this paper are one of the first steps in raising awareness and beginning a discussion about high-value care in various health scenarios.
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Affiliation(s)
- Fernanda Chohfi Atallah
- Discipline of Anaesthesiology, Pain and Intensive Care, Escola
Paulista de Medicina, Universidade Federal de São Paulo - São Paulo
(SP), Brazil
| | - Pedro Caruso
- AC Camargo Cancer Center - São Paulo (SP), Brazil
| | | | - Andre Peretti Torelly
- Hospital Santa Rita - Santa Casa de Misericórdia de Porto
Alegre - Porto Alegre (RS), Brazil
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10
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LGBTQ+ Identity and Ophthalmologist Burnout. Am J Ophthalmol 2023; 246:66-85. [PMID: 36252675 DOI: 10.1016/j.ajo.2022.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE To evaluate lesbian, gay, bisexual, transgender, questioning, and other sexual/gender minority (LGBTQ+) orientation as a burnout risk factor among an international ophthalmologist cohort. METHODS An anonymous, cross-sectional electronic survey was distributed via an Internet platform to characterize the relationship among demographic factors, including LGBTQ+ orientation, and burnout as measured by the Copenhagen Burnout Inventory (CBI). Univariable data analysis (linear) by sexual orientation was performed and variables with an association with a P value of <0.15 in univariable analysis were included in the multiple linear regression modeling. RESULTS A total of 403 ophthalmologists participated in the survey. The majority self-identified as "White" (69.2%), were from North America (72.0% United States, 18.6% Canada) and were evenly distributed between age of 30 and 65 years. Overall, 13.2% of participants identified as LGBTQ+ and 98.2% as cisgender. Approximately 12% had witnessed or experienced LGBTQ+-related workplace discrimination or harassment. The personal and work-related burnout scores and confidence limits of persons identified as LGBTQ+ were higher and nonoverlapping compared with those reported as non-LGBTQ+. Multivariable analysis identified significant risk factors for higher personal and work-related burnout scores: LGBTQ+ (11.8 and 11.1, P = .0005 and .0023), female gender (5.36 and 4.83, P = .0153 and .0434), older age (19.1 and 19.2, P = .0173 and .0273). and caretaker stress (6.42 and 5.97, P = .0085 and .0239). CONCLUSIONS LGBTQ+ orientation is a burnout risk factor among ophthalmologists, and LGBTQ+ workplace discrimination may be a contributing factor. Support from ophthalmology organizations to address LGBTQ+-, gender-, and age-related workplace discrimination may decrease burnout. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Alzailai N, Barriball KL, Alkhatib A, Xyrichis A. Factors that contributed to burnout among intensive care nurses during the COVID-19 pandemic in Saudi Arabia: A constructivist grounded theory. Aust Crit Care 2023; 36:19-27. [PMID: 36437164 PMCID: PMC9643309 DOI: 10.1016/j.aucc.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/27/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Intensive care unit (ICU) nurses experience high levels of burnout during the COVID-19 pandemic due to multiple stressors. It has long been known that burnout is negatively associated with patient and staff outcomes. Understanding the triggers for intensive care nurses' burnout during the pandemic can help to develop appropriate mitigation measures. OBJECTIVE The objective of this study was to examine intensive care nurses' experiences during the COVID-19 pandemic in Saudi Arabia to develop insights into the factors that influenced burnout. METHODS The study was informed by a constructivist grounded theory design. The study was conducted in an adult ICU in a tertiary hospital in the Makkah province in the Kingdom of Saudi Arabia. All participants were registered nurses with at least 6 months' experience in intensive care and experienced caring for COVID-19 patients. FINDINGS This paper reports on preliminary findings from interviews with 22 intensive care nurses. A core category 'pandemic pervasiveness' was identified from the interview data, which makes reference to the ever-present nature of the pandemic beyond the ICU context. Family, work, and the wider world context are the three groups of contextual factors that influenced nurses' experience and perception of burnout. CONCLUSION Many issues identified from the findings in this study can be attributed to shortages in the intensive care nursing workforce. Thus, we join others in calling for healthcare organisations and policymakers to be creative in finding new ways to meet nurses' needs, motivate, and empower them to maintain and sustain the nursing workforce in highly demanding areas, such as ICUs. Nursing managers can play a crucial role in mitigating nurses' burnout by identifying and tackling sources of stress that exist among their staff, specifically team conflict, workplace harassment, and discrimination.
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Affiliation(s)
- Nawal Alzailai
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care at King College London, James Clerk Maxwell Building, 57 Waterloo Road London, SE1 8WA, UK; Umm AL-Qura University, Makkah, Saudi Arabia.
| | - K Louise Barriball
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care at King College London, James Clerk Maxwell Building, 57 Waterloo Road London, SE1 8WA, UK.
| | | | - Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care at King College London, James Clerk Maxwell Building, 57 Waterloo Road London, SE1 8WA, UK.
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Lumlertgul N, Baker E, Pearson E, Dalrymple KV, Pan J, Jheeta A, Weerapolchai K, Wang Y, Leach R, Barrett NA, Ostermann M. Changing epidemiology of acute kidney injury in critically ill patients with COVID-19: a prospective cohort. Ann Intensive Care 2022; 12:118. [PMID: 36575315 PMCID: PMC9794481 DOI: 10.1186/s13613-022-01094-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is common in critically ill patients with coronavirus disease-19 (COVID-19). We aimed to explore the changes in AKI epidemiology between the first and the second COVID wave in the United Kingdom (UK). METHODS This was an observational study of critically ill adult patients with COVID-19 in an expanded tertiary care intensive care unit (ICU) in London, UK. Baseline characteristics, organ support, COVID-19 treatments, and patient and kidney outcomes up to 90 days after discharge from hospital were compared. RESULTS A total of 772 patients were included in the final analysis (68% male, mean age 56 ± 13.6). Compared with wave 1, patients in wave 2 were older, had higher body mass index and clinical frailty score, but lower baseline serum creatinine and C-reactive protein (CRP). The proportion of patients receiving invasive mechanical ventilation (MV) on ICU admission was lower in wave 2 (61% vs 80%; p < 0.001). AKI incidence within 14 days of ICU admission was 76% in wave 1 and 51% in wave 2 (p < 0.001); in wave 1, 32% received KRT compared with 13% in wave 2 (p < 0.001). Patients in wave 2 had significantly lower daily cumulative fluid balance (FB) than in wave 1. Fewer patients were dialysis dependent at 90 days in wave 2 (1% vs. 4%; p < 0.001). CONCLUSIONS In critically ill adult patients admitted to ICU with COVID-19, the risk of AKI and receipt of KRT significantly declined in the second wave. The trend was associated with less MV, lower PEEP and lower cumulative FB. TRIAL REGISTRATION NCT04445259.
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Affiliation(s)
- Nuttha Lumlertgul
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK ,grid.411628.80000 0000 9758 8584Division of Nephrology and Excellence Centre for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand ,grid.7922.e0000 0001 0244 7875Centre of Excellence in Critical Care Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Eleanor Baker
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
| | - Emma Pearson
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
| | - Kathryn V. Dalrymple
- grid.13097.3c0000 0001 2322 6764Department of Population Health Sciences, King’s College London, London, UK
| | - Jacqueline Pan
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
| | - Anup Jheeta
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
| | - Kittisak Weerapolchai
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK ,grid.420545.20000 0004 0489 3985Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Yanzhong Wang
- grid.13097.3c0000 0001 2322 6764Department of Population Health Sciences, King’s College London, London, UK
| | - Richard Leach
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
| | - Nicholas A. Barrett
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
| | - Marlies Ostermann
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
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Coronavirus disease 2019 aftermath: psychological trauma in ICU healthcare workers. Curr Opin Crit Care 2022; 28:686-694. [PMID: 36302198 DOI: 10.1097/mcc.0000000000000994] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW We aim to describe the extent of psychological trauma and moral distress in healthcare workers (HCW) working in the intensive care unit (ICU) during the coronavirus disease 2019 (COVID-19) pandemic. Specifically, we review reports on prevalence of mental health symptoms, highlight vulnerable populations and summarize modifiable risk factors associated with mental health symptoms in ICU HCW. RECENT FINDINGS The pandemic has resulted in a multitude of closely intertwined professional and personal challenges for ICU HCW. High rates of posttraumatic stress disorder (14-47%), burnout (45-85%), anxiety (31-60%), and depression (16-65%) have been reported, and these mental health symptoms are often interrelated. Most studies suggest that nurses and female HCW are at highest risk for developing mental health symptoms. The main personal concerns associated with reporting mental health symptoms among ICU HCW were worries about transmitting COVID-19 to their families, worries about their own health, witnessing colleagues contract the disease, and experiencing stigma from their communities. Major modifiable work-related risk factors were experiencing poor communication from supervisors, perceived lack of support from administrative leadership, and concerns about insufficient access to personal protective equipment, inability to rest, witnessing hasty end-of-life decisions, and restriction of family visitation policies. SUMMARY The COVID-19 pandemic has severely impacted ICU HCW worldwide. The psychological trauma, manifesting as posttraumatic stress disorder, burnout, anxiety, and depression, is substantial and concerning. Urgent action by lawmakers and healthcare administrators is required to protect ICU HCW and sustain a healthy workforce.
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McPeake J, Iwashyna TJ, Salluh JI. Learning Systems as a Path to Improve ICU Staff Wellbeing. Chest 2022; 162:30-32. [PMID: 35809933 PMCID: PMC9257198 DOI: 10.1016/j.chest.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 11/05/2022] Open
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