Beyond the Intensive Care Unit: Posttraumatic Stress Disorder in Critically Ill Patients

Current State of Critical Care Nursing Worldwide: Current Training, Roles, Barriers, and Facilitators

This review provides insights on the current state of roles and responsibilities, on-the-job training, barriers, and facilitators of critical care nursing (CCN) practice. Some of the established roles and training of CCN were providing care for acutely ill patients, delivering expert and specialist care, working as a part of a multidisciplinary team, monitoring, and initiating timely treatment, and providing psychosocial support and advanced system treatment, especially in high-income countries. In low-resource settings, critical care nurses work as health care assistants, technical or ancillary staff, and clinical educators; manage medications; care for mechanically ventilated patients; and provide care to deteriorating patients.

Uncontrolled pain in critically ill patients and acute kidney injury: a hypothesis-generating cohort study

Background

In critically ill patients, acute pain occurs frequently, causes sympathetic activation, release of inflammatory mediators, and potential organ dysfunction, with the kidneys potentially sensitive to inflammation-mediated injury. This study aimed to explore the association between acute pain in critically ill patients and the occurrence of acute kidney injury (AKI).

Methods

Data from a retrospective cohort of adult patients admitted between June 2013 and June 2016 to the Intensive Care Unit (ICU) of a tertiary hospital in São Paulo, Brazil, were analyzed. The main exclusion criteria were ICU length of stay < 48 h, coma, and prior kidney dysfunction. The outcome (AKI) was defined as an elevation in the baseline serum creatinine level of ≥ 0.3 mg/dl and/or > 50% at any time after the first 48 h in the ICU. Multivariable logistic regression and hierarchical cluster analysis were performed.

Results

The isolated incidence of pain was 23.6%, and the incidence of pain duration > 5 days was 10.6%. AKI occurred in 31.7% of the cohort. In multivariable logistic analysis, duration of pain > 5 days (OR 5.25 CI 2.19–12.57 p < 0.01) and mechanical ventilation (MV) ≥ 3 days (OR 5.5 CI 2.3–13.5 p < 0.01) were the variables with positive association with AKI. The hierarchical cluster analysis reinforced the relation between AKI, MV and duration of pain.

Conclusions

Pain is an especially important issue in critically ill patients and in this exploratory study it appears to be associated with AKI development. The search for more rigorous pain control in ICU is crucial and can influence organ dysfunction.

Graphical Abstract

Reducing Severity of Posttraumatic Stress Disorder in Intensive Care Unit Survivors

When patients are in the intensive care unit (ICU), they are in their most vulnerable and fragile state. These critically ill patients are often unable to make their needs known, which can produce an overwhelming feeling of helplessness and fear. The environment can seem threatening and foreign, and patients are often subjected to a multitude of disturbances that can be detrimental to their physical and psychological recovery. Loud noises, diagnostic tests performed at all hours, and poor natural lighting contribute to debilitating delirium and disturbed diurnal rhythms. Loss of privacy and basic human dignity, as well as painful procedures, has been associated with traumatic memories and distress in the post-ICU survivor population. All of these factors have contributed to patients developing ICU-related posttraumatic stress disorder after they leave the hospital. Recently, there has been an increase in awareness regarding this phenomenon within the medical community, which has generated more literature on the topic. Evidence suggests that ICU-related posttraumatic stress disorder can be mitigated. This article proposes the implementation of interventions by critical care health care providers that focus on reducing sleep disturbances, delirium, and benzodiazepine use in ICU patients, thereby improving patient comfort and reducing the severity of posttraumatic stress disorder in ICU survivors.

Use of Diaries in Intensive Care Unit Delirium Patients: German Nursing Perspectives

Diaries are written for patients in intensive care units by staff and relatives, especially when patients experience a disorder of their consciousness, such as delirium. Diary entries are written in common language, describing the situation of the patient. The diary can be read by the patient and the family and support the coping and understanding of what happened. It can function as a tool for supporting communication about different experiences and views of critical illness.

Mitochondrial Dysregulation in Sepsis: A Literature Review

BACKGROUND

Until 2016, the condition Sepsis was widely understood to be the systemic immune response syndrome in the presence or suspicion of an infectious source. Systemic immune response syndrome, an adaptive response, has been repeatedly demonstrated to lack specificity for sepsis. The current definition of sepsis describes a dysregulated host response to infection, yet the dysregulated nature of the response has yet to be defined. Successful recognition and management of sepsis are critically dependent on understanding and operationalizing the definition of sepsis.

OBJECTIVE

The authors sought to review the current literature on sepsis and its relationship to oxygen downregulation within the mitochondria along the electron transport chain.

METHODS

Articles retrieved from databases PubMed and CINAHL, pertaining to human cells, post 2001, in English, original experimental, quasi-experimental, or cohort design. Articles were selected and retrieved by the first author and synthesized by both authors.

RESULTS

The 10 articles included in the review were all bench science cellular studies. They demonstrated consistent, statistically significant differences when investigating mitochondrial oxygen downregulation in sepsis versus control, offering strong, statistically significant support for the hypothesis of mitochondrial dysregulation in the septic host.

CONCLUSIONS

The evidence makes a compelling case for mitochondrial dysregulation to inform the current definition of sepsis as a dysregulated host response. As the evidence points to a linear, progressive time/exposure-dependent disruption in oxygen downregulation in sepsis at the cellular level, it lends credence to the recommendations for early intervention and its relationship with survivability. Time is not on the side of the individual with sepsis.