1
|
Mir-Tabar A, Pardo-Herrera L, Goñi-Blanco A, Martínez-Rodríguez MT, Goñi-Viguria R. Patient satisfaction with nursing care in an Intensive Care Unit measured through the Nursing Intensive-Care Satisfaction Scale (NICSS). ENFERMERIA INTENSIVA 2024; 35:201-212. [PMID: 38523052 DOI: 10.1016/j.enfie.2023.10.004] [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: 06/15/2023] [Accepted: 10/04/2023] [Indexed: 03/26/2024]
Abstract
BACKGROUND Patient satisfaction in relation with nursing care has become a key determinant of the quality of hospital care. OBJECTIVES To evaluate patient satisfaction in relation with nursing care in a critical care context; to determine the correlation between critical patient satisfaction and sociodemographic and clinical variables and to describe patient perceptions with nursing care. METHODS A descriptive, prospective, correlational study which includes the analysis of some open questions in the intensive care unit (ICU) of a tertiary level university hospital. The degree of satisfaction of all patients discharged from de ICU was evaluated. It was used the validated Spanish version of Nursing Intensive-Care Satisfaction-Scale (NICSS). There were also collected sociodemographic and clinical data and 3 open questions were asked. It was used the inferential and descriptive statistics considering statistically significant p<.05. Open questions were examined using a language context analysis. The approval of the hospital ethical committee was obtained. RESULTS 111 patients agreed to participate, with a mean age of 64.18 years (CI 95% 61.36-66.88) and with a medium level of satisfaction of 5.83 (CI 95% 5.78-5.88) being 6 the maximum score. Women, older patients and those who reflect a higher degree of recovery, are those who reported greater satisfaction. Three main themes emerged from the analysis of the open-ended questions of the surveys: nurse patient relationship, professional practice environment and ICU nature. CONCLUSION Patient satisfaction in relation with nursing care was elevated. Age, sex and degree of recovery significantly influenced their perception. Nurse patient relationship and the professional practice environment were aspects highlighted by patients. The professional model incorporated by the institution may encouraged these results.
Collapse
Affiliation(s)
- A Mir-Tabar
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Universidad de Navarra, Navarra, Spain.
| | - L Pardo-Herrera
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Universidad de Navarra, Navarra, Spain.
| | - A Goñi-Blanco
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Universidad de Navarra, Navarra, Spain.
| | - M T Martínez-Rodríguez
- Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Universidad de Navarra, Navarra, Spain.
| | - R Goñi-Viguria
- Práctica Avanzada del Área de Críticos, Clínica Universidad de Navarra, Universidad de Navarra, Navarra, Spain.
| |
Collapse
|
2
|
Kovacevic P, Meyer FJ, Gajic O. Challenges, obstacles, and unknowns in implementing principles of modern intensive care medicine in low-resource settings: an insider's perspective. Intensive Care Med 2024; 50:141-143. [PMID: 38095698 DOI: 10.1007/s00134-023-07270-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/07/2023] [Indexed: 01/27/2024]
Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, dvanaest beba bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina.
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina.
| | - F Joachim Meyer
- München Klinik gGmbH and Medical Faculty, Lung Center Munich, University of Heidelberg, Heidelberg, Germany
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
3
|
Deininger MM, Benner CF, Strudthoff LJ, Leonhardt S, Bruells CS, Marx G, Bleilevens C, Breuer T. Post-Mortem Extracorporeal Membrane Oxygenation Perfusion Rat Model: A Feasibility Study. Animals (Basel) 2023; 13:3532. [PMID: 38003149 PMCID: PMC10668677 DOI: 10.3390/ani13223532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
The development of biomedical soft- or hardware frequently includes testing in animals. However, large efforts have been made to reduce the number of animal experiments, according to the 3Rs principle. Simultaneously, a significant number of surplus animals are euthanized without scientific necessity. The primary aim of this study was to establish a post-mortem rat perfusion model using extracorporeal membrane oxygenation (ECMO) in surplus rat cadavers and generate first post vivo results concerning the oxygenation performance of a recently developed ECMO membrane oxygenator. Four rats were euthanized and connected post-mortem to a venous-arterial ECMO circulation for up to eight hours. Angiographic perfusion proofs, blood gas analyses and blood oxygenation calculations were performed. The mean preparation time for the ECMO system was 791 ± 29 s and sufficient organ perfusion could be maintained for 463 ± 26 min, proofed via angiographic imaging and a mean femoral arterial pressure of 43 ± 17 mmHg. A stable partial oxygen pressure, a 73% rise in arterial oxygen concentration and an exponentially increasing oxygen extraction ratio up to 4.75 times were shown. Considering the 3Rs, the established post-mortal ECMO perfusion rat model using surplus animals represents a promising alternative to models using live animals. Given the preserved organ perfusion, its use could be conceivable for various biomedical device testing.
Collapse
Affiliation(s)
- Matthias Manfred Deininger
- Department of Intensive and Intermediate Care, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (G.M.); (T.B.)
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany;
| | - Carl-Friedrich Benner
- Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (C.-F.B.); (S.L.)
| | - Lasse Johannes Strudthoff
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany;
| | - Steffen Leonhardt
- Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (C.-F.B.); (S.L.)
| | - Christian Simon Bruells
- Department of Anesthesia, Intensive and Emergency Medicine, Marien Kliniken, 57072 Siegen, Germany;
| | - Gernot Marx
- Department of Intensive and Intermediate Care, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (G.M.); (T.B.)
| | - Christian Bleilevens
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany;
| | - Thomas Breuer
- Department of Intensive and Intermediate Care, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (G.M.); (T.B.)
| |
Collapse
|
4
|
ElSaban M, Bhatt G, Lee J, Koshiya H, Mansoor T, Amal T, Kashyap R. A historical delve into neurotrauma-focused critical care. Wien Med Wochenschr 2023; 173:368-373. [PMID: 36729341 PMCID: PMC9892675 DOI: 10.1007/s10354-022-01002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/27/2022] [Indexed: 02/03/2023]
Abstract
Neurocritical care is a multidisciplinary field managing patients with a wide range of aliments. Specifically, neurotrauma is a rapidly growing field with increasing demands. The history of how neurotrauma management came to its current form has not been extensively explored before. Our review delves into the history, timeline, and noteworthy pioneers of neurotrauma-focused neurocritical care. We explore the historical development during early times, the 18th-20th centuries, and modern times, as well as warfare- and sports-related concussions. Research is ever growing in this budding field, with several promising innovations on the horizon.
Collapse
Affiliation(s)
- Mariam ElSaban
- Department of Anesthesiology, Mayo Clinic, Rochester, MN USA
| | - Gaurang Bhatt
- All India Institute of Medical Sciences, Rishikesh, India
| | - Joanna Lee
- David Tvildiani Medical University, Tbilisi, Georgia
| | - Hiren Koshiya
- Department of Hematology & Oncology, Mayo Clinic, Jacksonville, USA Florida
| | | | - Tanya Amal
- Maulana Azad Medical College, New Delhi, India
| | - Rahul Kashyap
- Department of Critical Care Medicine, Mayo Clinic, Rochester, MN USA
- Medical director research, WellSpan Health, New York, PA USA
| |
Collapse
|
5
|
Tronstad O, Flaws D, Patterson S, Holdsworth R, Fraser JF. Creating the ICU of the future: patient-centred design to optimise recovery. Crit Care 2023; 27:402. [PMID: 37865760 PMCID: PMC10589962 DOI: 10.1186/s13054-023-04685-2] [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: 09/05/2023] [Accepted: 10/13/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Intensive Care survival continues to improve, and the number of ICU services is increasing globally. However, there is a growing awareness of the detrimental impact of the ICU environment on patients, families, and staff. Excessive noise and suboptimal lighting especially have been shown to adversely impact physical and mental recovery during and after an ICU admission. Current ICU designs have not kept up with advances in medical technology and models of care, and there is no current 'gold-standard' ICU design. Improvements in ICU designs are needed to optimise care delivery and patient outcomes. METHODS This manuscript describes a mixed-methods, multi-staged participatory design project aimed at redesigning and implementing two innovative ICU bedspaces. Guided by the action effect method and the consolidated framework for implementation research, the manuscript describes the processes taken to ensure the patient-centred problems were properly understood, the steps taken to develop and integrate solutions to identified problems, and the process of implementation planning and rebuilding in a live ICU. RESULTS Two innovative ICU bedspaces were rebuilt and implemented. They feature solutions to address all identified problems, including noise reduction, optimisation of lighting, access to nature via digital solutions, and patient connectivity and engagement, with solutions developed from various specialty fields, including IT improvements, technological innovations, and design and architectural solutions. Early evaluation demonstrates an improved lighting and acoustic environment. CONCLUSIONS Optimising the ICU bedspace environment and improving the lighting and acoustic environment is possible. The impact on patient outcomes needs to be evaluated.
Collapse
Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, QLD, Australia.
| | - Dylan Flaws
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
- Department of Mental Health, Metro North Mental Health, Caboolture Hospital, Caboolture, QLD, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sue Patterson
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
- School of Dentistry, University of Queensland, Brisbane, QLD, Australia
| | - Robert Holdsworth
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
6
|
Connolly E, Kasomekera N, Sonenthal PD, Nyirenda M, Marsh RH, Wroe EB, Scott KW, Bukhman A, Minyaliwa T, Katete M, Banda G, Mukherjee J, Rouhani SA. Critical care capacity and care bundles on medical wards in Malawi: a cross-sectional study. BMC Health Serv Res 2023; 23:1062. [PMID: 37798681 PMCID: PMC10557270 DOI: 10.1186/s12913-023-10014-8] [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: 05/22/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION As low-income countries (LICs) shoulder a disproportionate share of the world's burden of critical illnesses, they must continue to build critical care capacity outside conventional intensive care units (ICUs) to address mortality and morbidity, including on general medical wards. A lack of data on the ability to treat critical illness, especially in non-ICU settings in LICs, hinders efforts to improve outcomes. METHODS This was a secondary analysis of the cross-sectional Malawi Emergency and Critical Care (MECC) survey, administered from January to February 2020, to a random sample of nine public sector district hospitals and all four central hospitals in Malawi. This analysis describes inputs, systems, and barriers to care in district hospitals compared to central hospital medical wards, including if any medical wards fit the World Federation of Intensive and Critical Care Medicine (WFSICCM) definition of a level 1 ICU. We grouped items into essential care bundles for service readiness compared using Fisher's exact test. RESULTS From the 13 hospitals, we analysed data from 39 medical ward staff members through staffing, infrastructure, equipment, and systems domains. No medical wards met the WFSICCM definition of level 1 ICU. The most common barriers in district hospital medical wards compared to central hospital wards were stock-outs (29%, Cl: 21% to 44% vs 6%, Cl: 0% to 13%) and personnel shortages (40%, Cl: 24% to 67% vs 29%, Cl: 16% to 52%) but central hospital wards reported a higher proportion of training barriers (68%, Cl: 52% to 73% vs 45%, Cl: 29% to 60%). No differences were statistically significant. CONCLUSION Despite current gaps in resources to consistently care for critically ill patients in medical wards, this study shows that with modest inputs, the provision of simple life-saving critical care is within reach. Required inputs for care provision can be informed from this study.
Collapse
Affiliation(s)
- Emilia Connolly
- , Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi.
- Division of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, USA.
- Division of Hospital Medicine, Cincinnati Children's Hospital, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Noel Kasomekera
- , Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi
- Ministry of Health, P.O. Box 30377, Lilongwe 3, Malawi
| | - Paul D Sonenthal
- Partners In Health, 800 Boylston St Suite 300, Boston, MA, 02199, USA
- Brigham & Women's Hospital, Division of Pulmonary & Critical Care, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Mulinda Nyirenda
- Adult Emergency and Trauma Centre, Queen Elizabeth Central Hospital, P.O. Box 95, Blantyre, Malawi
- University of Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Regan H Marsh
- Partners In Health, 800 Boylston St Suite 300, Boston, MA, 02199, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham & Women's Hospital, Department of Emergency Medicine, 75 Francis St, Boston, MA, 02115, USA
| | - Emily B Wroe
- Partners In Health, 800 Boylston St Suite 300, Boston, MA, 02199, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham & Women's Hospital, Division of Global Health Equity, 75 Francis St, Boston, MA, 02115, USA
| | - Kirstin W Scott
- Department of Emergency Medicine, University of Washington, Seattle, USA
| | - Alice Bukhman
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham & Women's Hospital, Department of Emergency Medicine, 75 Francis St, Boston, MA, 02115, USA
| | - Tadala Minyaliwa
- , Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi
| | - Martha Katete
- , Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi
| | - Grace Banda
- Adult Emergency and Trauma Centre, Queen Elizabeth Central Hospital, P.O. Box 95, Blantyre, Malawi
| | - Joia Mukherjee
- Partners In Health, 800 Boylston St Suite 300, Boston, MA, 02199, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Shada A Rouhani
- Partners In Health, 800 Boylston St Suite 300, Boston, MA, 02199, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham & Women's Hospital, Department of Emergency Medicine, 75 Francis St, Boston, MA, 02115, USA
| |
Collapse
|
7
|
Boulet N, Boussere A, Mezzarobba M, Sofonea MT, Payen D, Lipman J, Laupland KB, Rello J, Lefrant JY, Muller L, Roger C, Pirracchio R, Mura T, Boudemaghe T. Intensive Care Unit activity in France from the national database between 2013 and 2019: More critically ill patients, shorter stay and lower mortality rate. Anaesth Crit Care Pain Med 2023; 42:101228. [PMID: 37031815 DOI: 10.1016/j.accpm.2023.101228] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/10/2023] [Accepted: 03/31/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Knowledge of the occurrence and outcome of admissions to Intensive Care Units (ICU) over time is important to inform healthcare services planning. This observational study aims at describing the activity of French ICUs between 2013 and 2019. METHODS Patient admission characteristics, organ dysfunction scores, therapies, ICU and hospital lengths of stay and case fatality were collected from the French National Hospital Database (population-based cohort). Logistic regression models were developed to investigate the association between age, sex, SAPS II, organ failure, and year of care on in-ICU case fatality. FINDINGS Among 1,594,801 ICU admissions, the yearly ICU admission increased from 3.3 to 3.5 per year per 1000 inhabitants (bed occupancy rate between 83.4 and 84.3%). The mean admission SAPS II was 42 ± 22, with a gradual annual increase. The median lengths of stay in ICU and in hospital were 3 (interquartile range (IQR) = [1-7]) and 11 days (IQR = [6-21]), respectively, with a progressive decrease over time. The in-ICU and hospital mortality case fatalities decreased from 18.0% to 17.1% and from 21.1% to 19.9% between 2013 and 2019, respectively. Male sex, age, SAPS II score, and the occurrence of any organ failure were associated with a higher case fatality rate. After adjustment on age, sex, SAPS II and organ failure, in-ICU case fatality decreased in 2019 as compared to 2013 (adjusted Odds Ratio = 0.87 [95% confidence interval, 0.85-0.89]). INTERPRETATION During the study, an increasing incidence of ICU admission was associated with higher severity of illness but lower in-ICU case fatality.
Collapse
Affiliation(s)
- Nicolas Boulet
- UR-UM103 IMAGINE, Univ. Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
| | - Amal Boussere
- Service Information Médicale, Méthodes et Recherche (SIMMER), Pôle Pharmacie, Santé Publique, CHU Nîmes, Nîmes, University of Montpellier, France
| | - Myriam Mezzarobba
- Service de Biostatistique, Epidémiologie Clinique, Santé Publique Innovation et Méthodologie (BESPIM), Pôle Pharmacie, Santé Publique, CHU Nîmes, Nîmes, University of Montpellier, France
| | | | | | - Jeffrey Lipman
- Scientific consultant at Nimes University Hospital, University of Montpellier, Nimes, France; Mayne Academy of Critical Care, The University of Queensland, Australia; Royal Brisbane and Women's Hospital, Australia
| | - Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia; Queensland University of Technology, Brisbane, Australia
| | - Jordi Rello
- Clinical Research/Epidemiology In Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research, Barcelona, Spain; Scientific consultant at Nimes University Hospital, University of Montpellier, Nimes, France
| | - Jean-Yves Lefrant
- UR-UM103 IMAGINE, Univ. Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France
| | - Laurent Muller
- UR-UM103 IMAGINE, Univ. Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France
| | - Claire Roger
- UR-UM103 IMAGINE, Univ. Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Thibault Mura
- Service de Biostatistique, Epidémiologie Clinique, Santé Publique Innovation et Méthodologie (BESPIM), Pôle Pharmacie, Santé Publique, CHU Nîmes, Nîmes, University of Montpellier, France
| | - Thierry Boudemaghe
- Service Information Médicale, Méthodes et Recherche (SIMMER), Pôle Pharmacie, Santé Publique, CHU Nîmes, Nîmes, University of Montpellier, France
| |
Collapse
|
8
|
Chander S, Kumari R, Sadarat F, Luhana S. The Evolution and Future of Intensive Care Management in the Era of Telecritical Care and Artificial Intelligence. Curr Probl Cardiol 2023; 48:101805. [PMID: 37209793 DOI: 10.1016/j.cpcardiol.2023.101805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Abstract
Critical care practice has been embodied in the healthcare system since the institutionalization of intensive care units (ICUs) in the late '50s. Over time, this sector has experienced many changes and improvements in providing immediate and dedicated healthcare as patients requiring intensive care are often frail and critically ill with high mortality and morbidity rates. These changes were aided by innovations in diagnostic, therapeutic, and monitoring technologies, as well as the implementation of evidence-based guidelines and organizational structures within the ICU. In this review, we examine these changes in intensive care management over the past 40 years and their impact on the quality of care available to patients. Moreover, the current state of intensive care management is characterized by a multidisciplinary approach and the use of innovative technologies and research databases. Advancements such as telecritical care and artificial intelligence are being increasingly explored, especially since the COVID-19 pandemic, to reduce the length of hospitalization and ICU mortality. With these advancements in intensive care and ever-changing patient needs, critical care experts, hospital managers, and policymakers must also explore appropriate organizational structures and future enhancements within the ICU.
Collapse
Affiliation(s)
- Subhash Chander
- Department of Internal Medicine, Mount Sinai Beth Israel Hospital, New York, NY.
| | - Roopa Kumari
- Department of Internal Medicine, Mount Sinai Morningside and West, New York, NY
| | - Fnu Sadarat
- Department of Internal Medicine, University of Buffalo, NY, USA
| | - Sindhu Luhana
- Department of Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
9
|
Tagami T. Chronicles of change for the future: The imperative of continued data collection in French ICUs. Anaesth Crit Care Pain Med 2023; 42:101294. [PMID: 37573947 DOI: 10.1016/j.accpm.2023.101294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugimachi, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan.
| |
Collapse
|
10
|
Schell CO, Wellhagen A, Lipcsey M, Kurland L, Bjurling-Sjöberg P, Stålsby Lundborg C, Castegren M, Baker T. The burden of critical illness among adults in a Swedish region-a population-based point-prevalence study. Eur J Med Res 2023; 28:322. [PMID: 37679836 PMCID: PMC10483802 DOI: 10.1186/s40001-023-01279-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Patients with critical illness have a high risk of mortality. Key decision-making in the health system affecting the outcomes of critically ill patients requires epidemiological evidence, but the burden of critical illness is largely unknown. This study aimed to estimate the prevalence of critical illness in a Swedish region. Secondary objectives were to estimate the proportion of hospital inpatients who are critically ill and to describe the in-hospital location of critically ill patients. METHODS A prospective, multi-center, population-based, point-prevalence study on specific days in 2017-2018. All adult (> 18 years) in-patients, regardless of admitting specially, in all acute hospitals in Sörmland, and the patients from Sörmland who had been referred to university hospitals, were included. Patients in the operating theatres, with a psychiatric cause of admission, women in active labor and moribund patients, were excluded. All participants were examined by trained data collectors. Critical illness was defined as "a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and a potential for reversibility". The presence of one or more severely deranged vital signs was used to classify critical illness. The prevalence of critical illness was calculated as the number of critically ill patients divided by the number of adults in the region. RESULTS A total of 1269 patients were included in the study. Median age was 74 years and 50% of patients were female. Critical illness was present in 133 patients, resulting in an adult population prevalence of critical illness per 100,000 people of 19.4 (95% CI 16.4-23.0). The proportion of patients in hospital who were critically ill was 10.5% (95% CI 8.8-12.3%). Among the critically ill, 125 [95% CI 94.0% (88.4-97.0%)] were cared for in general wards. CONCLUSIONS The prevalence of critical illness was higher than previous, indirect estimates. One in ten hospitalized patients were critically ill, the large majority of which were cared for in general wards. This suggests a hidden burden of critical illness of potential public health, health system and hospital management significance.
Collapse
Affiliation(s)
- Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
- Department of Medicine, Nyköping Hospital, Sörmland Region, Nyköping, Sweden.
| | - Andreas Wellhagen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Anaesthesia and Intensive Care, Nyköping Hospital, Sörmland Region, Nyköping, Sweden
| | - Miklós Lipcsey
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
- Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University, Uppsala, Sweden
| | - Lisa Kurland
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Emergency Medicine, Örebro University, Örebro University Hospital, Örebro, Sweden
| | - Petronella Bjurling-Sjöberg
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Patient Safety, Region Sörmland, Eskilstuna, Sweden
| | | | - Markus Castegren
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology (FyFa), Karolinska Institutet, Stockholm, Sweden
| | - Tim Baker
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| |
Collapse
|
11
|
Herrera H, Wood D. Battling Alarm Fatigue in the Pediatric Intensive Care Unit. Crit Care Nurs Clin North Am 2023; 35:347-355. [PMID: 37532388 DOI: 10.1016/j.cnc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Pediatric intensive care unit nurses can be exposed to hundreds of alarms per patient they care for each shift. The exposure to so many alarms can cause nurses to be desensitized to future alarms and thus increase the time to respond to alarms. This is one of the largest patient safety concerns within health care today. Steps should be taken to mitigate the number of alarms nurses experience so that they can properly respond to actionable alarms.
Collapse
Affiliation(s)
- Heather Herrera
- Christus Children's, 333 North, Santa Rosa Street, San Antonio, TX 78207, USA
| | - Danielle Wood
- Duke University Hospital, 104 Lanier Valley Drive, Durham, NC 27703, USA.
| |
Collapse
|
12
|
Christensen M, Liang M. Critical care: A concept analysis. Int J Nurs Sci 2023; 10:403-413. [PMID: 37545780 PMCID: PMC10401358 DOI: 10.1016/j.ijnss.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/08/2023] [Accepted: 06/24/2023] [Indexed: 08/08/2023] Open
Abstract
Objective The terms critical care and the Intensive Care Unit (ICU) are often used interchangeably to describe a place of care. Defining critical care becomes challenging because of the colloquial use of the term. Using concept analysis allows for the development of definition and meaning. The aim of this concept analysis is to distinguish the use of the term critical care to develop an operational definition which describes what constitutes critical care. Method Walker and Avant's eight-step approach to concept analysis guided this study. Five databases (CINAHL, Scopus, PubMed, ProQuest Dissertation Abstracts and Medline in EBSCO) were searched for studies related to critical care. The search included both qualitative and quantitative studies written in English and published between 1990 and 2022. Results Of the 439 papers retrieved, 47 met the inclusion criteria. The defining attributes of critical care included 1) a maladaptive response to illness/injury, 2) admission modelling criteria, 3) advanced medical technologies, and 4) specialised health professionals. Antecedents were associated with illness/injury that progressed to a level of criticality with a significant decline in both physical and psychological functioning. Consequences were identified as either death or survival with/without experiencing post-ICU syndrome. Conclusion Describing critical care is often challenging because of the highly technical nature of the environment. This conceptual understanding and operational definition will inform future research as to the scope of critical care and allow for the design of robust evaluative instruments to better understand the nature of care in the intensive care environment.
Collapse
Affiliation(s)
- Martin Christensen
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- The Interdisciplinary Centre for Qualitative Research, The Hong Kong Polytechnic University, Hong Kong, China
| | - Mining Liang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- The Interdisciplinary Centre for Qualitative Research, The Hong Kong Polytechnic University, Hong Kong, China
| |
Collapse
|
13
|
Halpern NA, Scruth E, Rausen M, Anderson D. Four Decades of Intensive Care Unit Design Evolution and Thoughts for the Future. Crit Care Clin 2023; 39:577-602. [DOI: 10.1016/j.ccc.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
|
14
|
Yang HY, Feng F, Yang WW, Chen Y. Application of a flexible visitation system in critically ill patients: A randomized clinical trial. Sci Prog 2023; 106:368504231165663. [PMID: 36971698 PMCID: PMC10358547 DOI: 10.1177/00368504231165663] [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] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To determine the feasibility of a flexible visitation system in the intensive care unit (ICU). METHODS A randomized, open-label, parallel group clinical trial was conducted. All patients admitted to the ICU of the Lanzhou University Second Hospital from April to June 2022 were enrolled. The enrolled patients were randomly divided into an experimental group and a control group according to a computer-generated random sequence table. RESULTS A total of 410 patients were admitted. According to the inclusion and exclusion criteria, 140 patients were included in the experimental group (flexible visitation group) and 140 in the control group (normal visitation group). The average number of visitation minutes per day between the experimental group and the control group was 24.7 versus 23.9 min (p > 0.05).Among the outcome indicators, delirium occurred in 8 (5.7%) patients in the intervention group and in 24 (17.1%) patients in the control group (p = 0.003). Five complaints (mainly pressure ulcers) were received, with one in the experimental group and the others in the control group. There were 28 cases of nosocomial infection in the experimental group and 29 cases in the control group; therefore, the incidence of nosocomial infection was 20% versus 20.7% (p = 0.882). A total of 280 questionnaires were collected, with a retrieval rate of 100%. The satisfaction of patients in the experimental group and the control group was 98.6% and 92.1%, respectively (p = 0.011). The flexible visiting system reduced the ICU length of stay (LOS). The ICU LOS of the experimental group was 6 versus 8 days for the control group (p = 0.041). However, the flexible visiting system did not reduce the hospital stay (17 vs. 19 days, p = 0.923). CONCLUSION Conducting a flexible visitation system in ICUs could reduce the incidence of delirium in critically ill patients and improve the quality of nursing care; furthermore, the rate of nosocomial infections was not increased. These findings need to be further verified by a multicentre, large-scale clinical trial.
Collapse
Affiliation(s)
- Hu-yong Yang
- Intensive Care Unit, Peoples’ Hospital of Linxia State, Linxia, China
| | - Fang Feng
- Intensive Care Unit, Lanzhou University Second Hospital, Lanzhou, China
| | - Wei-wei Yang
- Intensive Care Unit, Peoples’ Hospital of Linxia State, Linxia, China
| | - Yu Chen
- Intensive Care Unit, Lanzhou University Second Hospital, Lanzhou, China
| |
Collapse
|
15
|
Popoff B, Occhiali É, Grangé S, Bergis A, Carpentier D, Tamion F, Veber B, Clavier T. Trends in major intensive care medicine journals: A machine learning approach. J Crit Care 2022; 72:154163. [PMID: 36209696 DOI: 10.1016/j.jcrc.2022.154163] [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: 07/04/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Intensive care medicine (ICM) has the particularity of being a multidisciplinary specialty and its literature reflects this multidisciplinarity. However, the proportion of each field in this literature and its trend dynamics are not known. The objective of this study was to analyze the ICM literature, extract latent topics and search for the presence of research trends. MATERIAL AND METHODS Abstracts of original articles from the top ICM journals, from their inception until December 31st, 2019, were included. This corpus was fed into a structural topic modeling algorithm to extract latent semantic topics. The temporal distribution was then analyzed and the presence of trends was searched by Mann-Kendall trends tests. RESULTS Finally, 49,276 articles from 10 journals were included. After topic modeling analysis and experts' feedback, 124 research topics were selected and labeled. Topics were categorized into 19 categories, the most represented being respiratory, fundamental and neurological research. Increasing trends were observed for research on mechanical ventilation and decreasing trends for cardiopulmonary resuscitation. CONCLUSIONS This study reviewed all articles from major ICM journals in a comprehensive way. It provides a better understanding of ICM research landscape by analyzing the temporal evolution of latent research topics in the ICM literature.
Collapse
Affiliation(s)
- Benjamin Popoff
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France; Medical Intensive Care Unit, Rouen University Hospital, Rouen, France.
| | - Émilie Occhiali
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Steven Grangé
- Medical Intensive Care Unit, Rouen University Hospital, Rouen, France
| | - Alexandre Bergis
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | | | - Fabienne Tamion
- Medical Intensive Care Unit, Rouen University Hospital, Rouen, France; Normandie Univ, UNIROUEN, INSERM U1096, Rouen, France
| | - Benoit Veber
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Thomas Clavier
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France; Normandie Univ, UNIROUEN, INSERM U1096, Rouen, France
| |
Collapse
|
16
|
Buowari DY, Owoo C, Gupta L, Schell CO, Baker T. Essential Emergency and Critical Care: A Priority for Health Systems Globally. Crit Care Clin 2022; 38:639-656. [PMID: 36162903 DOI: 10.1016/j.ccc.2022.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Critical illness is a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided, and the potential for reversibility. An estimated 45 million adults become critically ill each year. While some are treated in emergency departments or intensive care units, most are cared for in general hospital wards. We outline a priority for health systems globally: the first-tier care that all critically ill patients should receive in all parts of all hospitals: Essential Emergency and Critical Care. We describe its relation to other specialties and care and opportunities for implementation.
Collapse
Affiliation(s)
- Dabota Yvonne Buowari
- Department of Accident and Emergency, University of Port Harcourt Teaching Hospital, Along East West Road, Alakahia, Port Harcourt, Rivers State 23401, Nigeria
| | - Christian Owoo
- Department of Anaesthesia, University of Ghana Medical School, College of Health Sciences, Guggisberg Avenue, Korle Bu, GA-029-4296 Accra, Ghana; Department of Anaesthesia, Korle Bu Teaching Hospital, Guggisberg Avenue, Korle Bu, GA-029-4296 Accra, Ghana; Ghana Infectious Disease Centre, Kwabenya, Ga East, Municipal Hospital, GE-255-9501 (PQ47+FGV), Accra, Ghana; University of Ghana Medical Centre, Indian Ocean Link, University of Ghana, GA-337-6980 (JRJ7+WJP) Accra, Ghana
| | - Lalit Gupta
- Department of Anaesthesia and Critical Care, Maulana Azad Medical College, 2 Bahadur Shah Zafar Marg, New Delhi 110002, India
| | - Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Solna Väg, Stockholm, 171 77, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Sveavägen entré 9 Mälarsjukhuset, Eskilstuna, 631 88 Sweden; Department of Medicine, Nyköping Hospital, Nyköping 61185, Sweden
| | - Tim Baker
- Department of Global Public Health, Karolinska Institutet, Solna Väg, Stockholm, 171 77, Sweden; Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, United Nations Road, Dar es Salaam, P.O. Box 65001, Tanzania; Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK; Ifakara Health Institute, 5 Ifakara Street, Plot 463 Mikocheni, Dar es Salaam, P.O. Box 78 373, Tanzania.
| |
Collapse
|
17
|
Hu WS, Lin CL. The risk of suicide in patients with critical illness: A population-based study in Taiwan. Medicine (Baltimore) 2022; 101:e30656. [PMID: 36181116 PMCID: PMC9524939 DOI: 10.1097/md.0000000000030656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The authors investigated retrospectively the association between critical illness and risk of suicide attempts. The data are from Taiwan's National Health Insurance Research Database. Propensity score matching, multivariable models, Kaplan-Meier analysis, and competing risk analysis were used to explore this association. The authors found that patients having an critical illness were associated with increased risk of suicide attempts after adjusting for risk factors (adjusted hazard ratio = 2.98; 95% confidence interval = 1.46-6.08). Among different subtypes of critical illness, patients with sepsis/septic shock exhibited the highest risk of suicide attempts (adjusted hazard ratio = 3.43, 95% confidence interval = 1.52-7.74). An association between critical illness and suicide attempts was shown. Sepsis/septic shock was found to confer the highest risk in these specific population.
Collapse
Affiliation(s)
- Wei-Syun Hu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
- *Correspondence: Wei-Syun Hu, MD, PhD, Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung 40447, Taiwan (e-mail: )
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
18
|
Jha RM. Do We Need an ICU for All Elective Postcraniotomy Patients? A Critical Appraisal. Crit Care Med 2022; 50:1408-1411. [PMID: 35984057 PMCID: PMC11302995 DOI: 10.1097/ccm.0000000000005609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ruchira Menka Jha
- Departments of Neurology, Neurological Surgery, Translational Neuroscience, Barrow Neurological Institute, St. Joseph's Hospital & Medical Center, Phoenix, AZ
| |
Collapse
|
19
|
Xie J, Wang Z, Yu Z, Guo B. Enabling Timely Medical Intervention by Exploring Health-Related Multivariate Time Series with a Hybrid Attentive Model. SENSORS (BASEL, SWITZERLAND) 2022; 22:6104. [PMID: 36015865 PMCID: PMC9414519 DOI: 10.3390/s22166104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
Modern healthcare practice, especially in intensive care units, produces a vast amount of multivariate time series of health-related data, e.g., multi-lead electrocardiogram (ECG), pulse waveform, blood pressure waveform and so on. As a result, timely and accurate prediction of medical intervention (e.g., intravenous injection) becomes possible, by exploring such semantic-rich time series. Existing works mainly focused on onset prediction at the granularity of hours that was not suitable for medication intervention in emergency medicine. This research proposes a Multi-Variable Hybrid Attentive Model (MVHA) to predict the impending need of medical intervention, by jointly mining multiple time series. Specifically, a two-level attention mechanism is designed to capture the pattern of fluctuations and trends of different time series. This work applied MVHA to the prediction of the impending intravenous injection need of critical patients at the intensive care units. Experiments on the MIMIC Waveform Database demonstrated that the proposed model achieves a prediction accuracy of 0.8475 and an ROC-AUC of 0.8318, which significantly outperforms baseline models.
Collapse
|
20
|
The use of metaraminol as a vasopressor in critically unwell patients: a narrative review and a survey of UK practice. J Crit Care Med (Targu Mures) 2022; 8:193-203. [PMID: 36062042 PMCID: PMC9396948 DOI: 10.2478/jccm-2022-0017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/14/2022] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background
Major international guidelines state that norepinephrine should be used as the first-line vasopressor to achieve adequate blood pressure in patients with hypotension or shock. However, recent observational studies report that in the United Kingdom and Australia, metaraminol is often used as second line medication for cardiovascular support.
Aim of the study
The aim of this study was to carry out a systematic review of metaraminol use for management of shock in critically unwell patients and carry out a survey evaluating whether UK critical care units use metaraminol and under which circumstances.
Methods
A systematic review literature search was conducted. A short telephone survey consisting of 6 questions regarding metaraminol use was conducted across 30 UK critical care units which included a mix of tertiary and district general intensive care units.
Results
Twenty-six of thirty contacted centres responded to our survey. Metaraminol was used in 88% of them in various settings and circumstances (emergency department, theatres, medical emergencies on medical wards), with 67% reporting use of metaraminol infusions in the critical care setting. The systematic literature review revealed several case reports and only two studies conducted in the last 20 years investigating the effect of metaraminol as a stand-alone vasopressor. Both studies focused on different aspects of metaraminol use and the data was incomparable, hence we decided not to perform a meta-analysis.
Conclusions
Metaraminol is widely used as a vasopressor inside and outside of the critical care setting in the UK despite limited evidence supporting its safety and efficacy for treating shock. Further service evaluation, observational studies and prospective randomised controlled trials are warranted to validate the role and safety profile of metaraminol in the treatment of the critically unwell patient.
Collapse
|
21
|
Tung A. 100 Years of Critical Care in the Pages of Anesthesia & Analgesia. Anesth Analg 2022; 135:S62-S67. [PMID: 35839834 DOI: 10.1213/ane.0000000000006045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The founding of Anesthesia & Analgesia (A&A) in 1922 was roughly contemporaneous with the creation of the first intensive care unit (ICU) in the United States at Johns Hopkins in 1923. Throughout the next 100 years, the pages of A&A have mirrored the development of critical care as its own distinct specialty. Although primarily a journal focused on intraoperative anesthesia, A&A has maintained a small but steady presence in critical care research. This review highlights the history and development of critical care publications in the pages of A&A from early observations on the physiology of critical illness (1922-1949) to the groundbreaking work of Peter Safar and others on cardiopulmonary resuscitation (1950-1970), the growth of modern critical care (1970-2010), and the 2020 to 2022 coronavirus disease 2019 (COVID-19) era.
Collapse
Affiliation(s)
- Avery Tung
- From the Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
| |
Collapse
|
22
|
Su L, Kudchadkar SR. Optimizing Human Performance in ICUs. Pediatr Crit Care Med 2022; 23:65-67. [PMID: 34989712 DOI: 10.1097/pcc.0000000000002845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Lillian Su
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Sapna R Kudchadkar
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
23
|
Toni T, Alverdy J, Gershuni V. Re-examining chemically defined liquid diets through the lens of the microbiome. Nat Rev Gastroenterol Hepatol 2021; 18:903-911. [PMID: 34594028 PMCID: PMC8815794 DOI: 10.1038/s41575-021-00519-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 12/13/2022]
Abstract
Trends in nutritional science are rapidly shifting as information regarding the value of eating unprocessed foods and its salutary effect on the human microbiome emerge. Unravelling the evolution and ecology by which humans have harboured a microbiome that participates in every facet of health and disease is daunting. Most strikingly, the host habitat has sought out naturally occurring foodstuff that can fulfil its own metabolic needs and also the needs of its microbiota, each of which remain inexorably connected to one another. With the introduction of modern medicine and complexities of critical care, came the assumption that the best way to feed a critically ill patient is by delivering fibre-free chemically defined sterile liquid foods (that is, total enteral nutrition). In this Perspective, we uncover the potential flaws in this assumption and discuss how emerging technology in microbiome sciences might inform the best method of feeding malnourished and critically ill patients.
Collapse
Affiliation(s)
- Tiffany Toni
- University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | - John Alverdy
- University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | - Victoria Gershuni
- University of Pennsylvania, Department of Surgery, Philadelphia, PA, USA and Washington University in St Louis, Department of Surgery, St Louis, MO, USA,Corresponding author
| |
Collapse
|
24
|
Bang MJ, Yoon SK, Yoon KW, Gil E, Yoo K, Choi KJ, Park CM. Analysis of Medical Consultation Patterns in Medical and Surgical Intensive Care Units: Changes in the Pattern of Consultation after the Implementation of Intensivist-Directed Care. JOURNAL OF ACUTE CARE SURGERY 2021. [DOI: 10.17479/jacs.2021.11.3.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: Critically ill patients often require multidisciplinary treatment for both acute illnesses and pre-existing medical conditions. Since different medical conditions are managed in the intensive care unit (ICU), consultation is often required. This study aimed to identify the frequency and type of consultation required and analyze changes in consultation patterns after the introduction of intensivist-directed care in the surgical ICU (SICU).Methods: Between June 2006 and December 2013, a retrospective cohort study was conducted to identify the frequency and type of consultation at 3 different ICUs. Consultations for patients who were admitted to the ICUs for more than 48 consecutive hours were included. The pattern of consultations in each ICU was investigated. In addition, the pattern of consultations before and after the implementation of intensivist-directed care in the SICU was compared.Results: During the study, 11,053 consultations were requested for 7,774 critically ill patients in a total of 3 ICUs. Consultations with the Departments of Cardiology, Infectious Diseases, and Pulmonology were requested most frequently in the SICU. However, after the implementation of the intensivist-directed care approach, there was an increase in the frequency of consultation requests to the Department of Neurology, followed by the Departments of Cardiology, and Infectious Diseases.Conclusion: Analysis of consultation patterns is an important method of assessing the complexity and severity of illnesses, and of evaluating the needs of available health system resources. Based on our findings, we suggest the development of an appropriate protocol for frequently consulted services.
Collapse
|
25
|
Fijačko N, Masterson Creber R, Gosak L, Kocbek P, Cilar L, Creber P, Štiglic G. A Review of Mortality Risk Prediction Models in Smartphone Applications. J Med Syst 2021; 45:107. [PMID: 34735603 PMCID: PMC8566656 DOI: 10.1007/s10916-021-01776-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/27/2021] [Indexed: 01/08/2023]
Abstract
Healthcare professionals in healthcare systems need access to freely available, real-time, evidence-based mortality risk prediction smartphone applications to facilitate resource allocation. The objective of this study is to evaluate the quality of smartphone mobile health applications that include mortality prediction models, and corresponding information quality. We conducted a systematic review of commercially available smartphone applications in Google Play for Android, and iTunes for iOS smartphone applications. We performed initial screening, data extraction, and rated smartphone application quality using the Mobile Application Rating Scale: user version (uMARS). The information quality of smartphone applications was evaluated using two patient vignettes, representing low and high risk of mortality, based on critical care data from the Medical Information Mart for Intensive Care (MIMIC) III database. Out of 3051 evaluated smartphone applications, 33 met our final inclusion criteria. We identified 21 discrete mortality risk prediction models in smartphone applications. The most common mortality predicting models were Sequential Organ Failure Assessment (SOFA) (n = 15) and Acute Physiology and Clinical Health Assessment II (n = 13). The smartphone applications with the highest quality uMARS scores were Observation-NEWS 2 (4.64) for iOS smartphones, and MDCalc Medical Calculator (4.75) for Android smartphones. All SOFA-based smartphone applications provided consistent information quality with the original SOFA model for both the low and high-risk patient vignettes. We identified freely available, high-quality mortality risk prediction smartphone applications that can be used by healthcare professionals to make evidence-based decisions in critical care environments.
Collapse
Affiliation(s)
- Nino Fijačko
- Faculty of Health Sciences, University of Maribor, Zitna 15, Maribor, Slovenia.
| | - Ruth Masterson Creber
- Department of Population Health Sciences, Division of Health Informatics, Weill Cornell Medicine, New York, NY, USA
| | - Lucija Gosak
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Primož Kocbek
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Leona Cilar
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Peter Creber
- Department of Respiratory Medicine, North Bristol NHS Trust, Bristol, UK
| | - Gregor Štiglic
- Faculty of Health Sciences and Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
| |
Collapse
|
26
|
|
27
|
DiLibero J. Resuscitation in Critical Care. Crit Care Nurs Clin North Am 2021; 33:ix-x. [PMID: 34340797 DOI: 10.1016/j.cnc.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Justin DiLibero
- Rhode Island College, 350 Eddy Street, Providence, RI 02903, USA.
| |
Collapse
|
28
|
Abstract
OBJECTIVES To provide a multiorganizational statement to update recommendations for critical care pharmacy practice and make recommendations for future practice. A position paper outlining critical care pharmacist activities was last published in 2000. Since that time, significant changes in healthcare and critical care have occurred. DESIGN The Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health-Systems Pharmacists convened a joint task force of 15 pharmacists representing a broad cross-section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (> 66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. MAIN RESULTS There are 82 recommendation statements: 44 original recommendations and 38 new recommendation statements. Thirty-four recommendations represent the domain of patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations were made in the domain of training and education and eight recommendations regarding professional development. CONCLUSIONS Critical care pharmacists are essential members of the multiprofessional critical care team. The statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.
Collapse
|
29
|
Abstract
OBJECTIVES Provide a multiorganizational statement to update the statement from a paper in 2000 about critical care pharmacy practice and makes recommendations for future practice. DESIGN The Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health-Systems Pharmacists convened a joint task force of 15 pharmacists representing a broad cross-section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (> 66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting, and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. MAIN RESULTS There are 82 recommendation statements: forty-four original recommendations and 38 new recommendation statements. Thirty-four recommendations were made for patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations are in the domain of training and education and eight recommendations regarding professional development. CONCLUSIONS The statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.
Collapse
|
30
|
|
31
|
Tanigawa K. Case review of severe acute radiation syndrome from whole body exposure: concepts of radiation-induced multi-organ dysfunction and failure. JOURNAL OF RADIATION RESEARCH 2021; 62:i15-i20. [PMID: 33978174 PMCID: PMC8114211 DOI: 10.1093/jrr/rraa121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/08/2020] [Indexed: 06/12/2023]
Abstract
Acute radiation syndrome (ARS) due to whole body exposure (WBE) presents various clinical pictures, occasionally leading to fatal consequences. In this report, the literature providing details of the clinical course of severe ARS owing to WBE is reviewed and the lessons learned from recent accidents are discussed, to better prepare for another radiological event. Studies investigating radiological accidents that provided details of medical care for severe ARS were searched in official reports from the International Atomic Energy Agency and through the databases of PubMed, Medline, CiNii and Google Scholar and reviewed. Four fatal cases of severe ARS due to WBE in Soreq 1990 and Nesvizh 1992, and two cases in JCO Tokaimura 1999 were reviewed. A common set of medical interventions was carried out, that put a focus on medical management assuming the occurrence of hematopoietic disorders. However, clinicians were faced with a mixture of chronic hematological and non-hematological events including persistent gastrointestinal disorders, gradual and progressive skin disorders, liver and renal dysfunction and respiratory failure. Clinical pictures following high-dose WBE have become more complicated as treatment modalities improve. To address these issues, a concept of severe ARS due to WBE has been proposed with respect to radiation-induced multi-organ dysfunction syndrome (RI-MODS) and failure (RI-MOF). These patients need to be managed at institutions where multidisciplinary, resource-intensive therapy can be provided.
Collapse
|
32
|
Addinsall AB, Cacciani N, Akkad H, Salah H, Tchkonia T, Kirkland JL, Larsson L. JAK/STAT inhibition augments soleus muscle function in a rat model of critical illness myopathy via regulation of complement C3/3R. J Physiol 2021; 599:2869-2886. [PMID: 33745126 DOI: 10.1113/jp281220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/15/2021] [Indexed: 12/23/2022] Open
Abstract
KEY POINTS Critical illness myopathy (CIM) is a frequently observed negative consequence of modern critical care. Chronic Janus kinase (JAK)/signal transducer and activator of transcription activation impairs muscle size and function and is prominent following mechanical ventilation. We identify pSTAT-3 activation in tibialis anterior of CIM patients, before examining the potential benefits of JAK1/2 inhibition in an experimental model of CIM, where muscle mass and function are impaired. CIM activates complement cascade and increased monocyte infiltration in the soleus muscle, which was ameliorated by JAK1/2 inhibition, leading to reduced muscle degeneration and improved muscle force. Here, we demonstrate that JAK1/2 inhibition augments CIM muscle function through regulation of the complement cascade. ABSTRACT Critical illness myopathy (CIM) is frequently observed in response to modern critical care with negative consequences for patient quality of life, morbidity, mortality and healthcare costs. Janus kinase (JAK)/signal transducer and activator of transcription (STAT) activation is observed in limb muscles following controlled mechanical ventilation. Chronic JAK/STAT activation promotes loss of muscle mass and function. Thus, we hypothesized that JAK1/2 inhibition would improve muscle outcomes for CIM. Following 12 days of intensive care unit conditions, pSTAT-3 levels increased in tibialis anterior muscle of CIM patients (P = 0.0489). The potential of JAK1/2 inhibition was assessed in an experimental model of CIM, where soleus muscle size and force are impaired. JAK1/2 inhibition restores soleus force (P < 0.0001). CIM activated muscle complement cascade, which was ameliorated by JAK1/2 inhibition (P < 0.05, respectively). Soleus macrophage number corresponded with complement activity, leading to reduced muscle degeneration and augmented muscle function (P < 0.05). Thus, JAK/STAT inhibition improves soleus function by modulating the complement cascade and muscle monocyte infiltration. Collectively, we demonstrate that JAK/STAT inhibition augments muscle function in CIM.
Collapse
Affiliation(s)
- Alex B Addinsall
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Nicola Cacciani
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Hazem Akkad
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Heba Salah
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Present address: Department of Basic-Medical Sciences, An-Najah National University, Nablus, Palestinian Territory
| | - Tamara Tchkonia
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
| | - James L Kirkland
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
| | - Lars Larsson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
33
|
Lefrant JY, Pirracchio R, Benhamou D, Dureuil B, Pottecher J, Samain E, Joannes-Boyau O, Bouaziz H. ICU bed capacity during COVID-19 pandemic in France: From ephemeral beds to continuous and permanent adaptation. Anaesth Crit Care Pain Med 2021; 40:100873. [PMID: 33910085 PMCID: PMC8069631 DOI: 10.1016/j.accpm.2021.100873] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jean-Yves Lefrant
- UR-UM103 IMAGINE, Université de Montpellier, Pôle Anesthésie Réanimation Douleur Urgence, CHU Nîmes, Nîmes, France.
| | - Romain Pirracchio
- Department of Anaesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Centre, University of California San Francisco, San Francisco, California, United States
| | - Dan Benhamou
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, AP-HP, Université Paris Saclay, Hôpital Bicêtre - 78, rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex, France
| | - Bertrand Dureuil
- Department of Anaesthesia and Critical Care, Rouen University Hospital, Rouen, France
| | - Julien Pottecher
- Hôpitaux Universitaires de Strasbourg, Pôle d'Anesthésie-Réanimation & Médecine Péri-Opératoire, Service d'Anesthésie-Réanimation & Médecine Péri-Opératoire Hôpital de Hautepierre - Université de Strasbourg, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), UR3072 Strasbourg, France
| | - Emmanuel Samain
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Besancon, EA 3920, Bourgogne Franche-Comte University, France
| | - Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, 33000 Bordeaux, France
| | - Hervé Bouaziz
- Département d'Anesthésie Réanimation, Hôpital Central - CHRU Nancy, Nancy, France
| |
Collapse
|
34
|
Fuller C, Wooldridge G, Liomba A, Ray STJ. Severe stridor and profound weakness after cerebral malaria. BMJ Case Rep 2021; 14:e237681. [PMID: 33849863 PMCID: PMC8051417 DOI: 10.1136/bcr-2020-237681] [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] [Accepted: 03/29/2021] [Indexed: 11/03/2022] Open
Abstract
Cerebral malaria (CM) is defined by WHO as coma (Blantyre Coma Score 2 or less) in a patient with Plasmodium falciparum parasitaemia and no alternative cause of coma identified. Mortality is approximately 15%-30% in African children and up to one-third of survivors have neurological sequelae. We present a patient with severe stridor and prolonged profound weakness during an intensive care admission with CM. These complications initially presented a diagnostic dilemma in our limited resourced setting. The stridor failed to improve with empiric steroids and a subsequent opportunistic ENT consult diagnosed vocal cord paresis. The weakness was so profound that the patient was unable to lift his head during the acute illness. The child received intensive physiotherapy, and at 1-month follow-up, the stridor and weakness had resolved.
Collapse
Affiliation(s)
| | | | - Alice Liomba
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
| | - Stephen Thomas James Ray
- Department of Neurosciences, Alder Hey Children's Hospital, Liverpool, UK
- University of Liverpool, Institue of Infection and Global Health, Liverpool, UK
| |
Collapse
|
35
|
Liu G, Li N, Chen L, Yang Y, Zhang Y. Registered Trials on Artificial Intelligence Conducted in Emergency Department and Intensive Care Unit: A Cross-Sectional Study on ClinicalTrials.gov. Front Med (Lausanne) 2021; 8:634197. [PMID: 33842500 PMCID: PMC8024618 DOI: 10.3389/fmed.2021.634197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/19/2021] [Indexed: 02/05/2023] Open
Abstract
Objective: Clinical trials contribute to the development of clinical practice. However, little is known about the current status of trials on artificial intelligence (AI) conducted in emergency department and intensive care unit. The objective of the study was to provide a comprehensive analysis of registered trials in such field based on ClinicalTrials.gov. Methods: Registered trials on AI conducted in emergency department and intensive care unit were searched on ClinicalTrials.gov up to 12th January 2021. The characteristics were analyzed using SPSS21.0 software. Results: A total of 146 registered trials were identified, including 61 in emergency department and 85 in intensive care unit. They were registered from 2004 to 2021. Regarding locations, 58 were conducted in Europe, 58 in America, 9 in Asia, 4 in Australia, and 17 did not report locations. The enrollment of participants was from 0 to 18,000,000, with a median of 233. Universities were the primary sponsors, which accounted for 43.15%, followed by hospitals (35.62%), and industries/companies (9.59%). Regarding study designs, 85 trials were interventional trials, while 61 were observational trials. Of the 85 interventional trials, 15.29% were for diagnosis and 38.82% for treatment; of the 84 observational trials, 42 were prospective, 14 were retrospective, 2 were cross-sectional, 2 did not report clear information and 1 was unknown. Regarding the trials' results, 69 trials had been completed, while only 10 had available results on ClinicalTrials.gov. Conclusions: Our study suggest that more AI trials are needed in emergency department and intensive care unit and sponsors are encouraged to report the results.
Collapse
Affiliation(s)
- Guina Liu
- Department of Periodical Press and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Nian Li
- Department of Medical Administration, West China Hospital, Sichuan University, Chengdu, China
| | - Lingmin Chen
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Yi Yang
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Yonggang Zhang
- Department of Periodical Press and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.,Nursing Key Laboratory of Sichuan Province, Chengdu, China
| |
Collapse
|
36
|
Lat I, Paciullo C, Daley MJ, MacLaren R, Bolesta S, McCann J, Stollings JL, Gross K, Foos SA, Roberts RJ, Acquisto NM, Taylor S, Bentley M, Jacobi J, Meyer TA. Position paper on critical care pharmacy services (executive summary): 2020 update. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ishaq Lat
- Department of Pharmacy Services Shirley Ryan Ability Lab Chicago Illinois USA
| | | | - Mitchell J. Daley
- Dell Seton Medical Center at the University of Texas Austin Texas USA
- Dell Medical School at the University of Texas Austin Texas USA
| | - Robert MacLaren
- Department of Pharmacy Practice, Skaggs School of Pharmacy University of Colorado Aurora Colorado USA
| | - Scott Bolesta
- Department of Pharmacy Practice, Nesbitt School of Pharmacy Wilkes University Wilkes‐Barre Pennsylvania USA
| | - Jennifer McCann
- Department of Pharmacy Practice School of Pharmacy and Health Sciences, Butler University Indianapolis Indiana USA
| | - Joanna L. Stollings
- Department of Pharmaceutical Services Vanderbilt University Medical Center Nashville Tennessee USA
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center Nashville Tennessee USA
| | - Kendall Gross
- Department of Pharmacy UCSF Health San Francisco California USA
| | - Sarah A. Foos
- Department of Pharmacy Services OhioHealth Doctors Hospital Columbus Ohio USA
| | - Russel J. Roberts
- Department of Pharmacy Massachusetts General Hospital Boston Massachusetts USA
| | - Nicole M. Acquisto
- Department of Pharmacy University of Rochester Medical Center Rochester New York USA
- Department of Emergency Medicine University of Rochester Medical Center Rochester New York USA
| | | | - Michael Bentley
- Virginia Tech Carilion School of Medicine Roanoke Virginia USA
- AstraZeneca Pharmaceuticals Wilmington Delaware USA
| | | | - Tricia A. Meyer
- Baylor Scott and White Health‐Temple Region Temple Texas USA
- Department of Anesthesiology Texas A&M College of Medicine Temple Texas USA
| |
Collapse
|
37
|
Holm A, Viftrup A, Karlsson V, Nikolajsen L, Dreyer P. Nurses' communication with mechanically ventilated patients in the intensive care unit: Umbrella review. J Adv Nurs 2020; 76:2909-2920. [PMID: 32893350 DOI: 10.1111/jan.14524] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 12/30/2022]
Abstract
AIM To conduct a review summarizing evidence concerning communication with mechanically ventilated patients in the intensive care unit (ICU). BACKGROUND ICU patients undergoing mechanical ventilation are unable to communicate verbally, causing many negative emotions. Due to changes in sedation practice, a growing number of patients are conscious and experience communication difficulties. DESIGN The umbrella review method guided by the Joanna Briggs Institute was applied. DATA SOURCES A systematic search was done in the Cochrane Library, the Joanna Briggs Institute database, Cinahl, Pubmed, PsycINFO and Scopus between January -April 2019. Search terms were 'nurse-patient communication', 'mechanical ventilation', 'intensive care', and 'reviews as publication type'. Literature from 2009-2019 was included. REVIEW METHODS Following recommendations by the Joanna Briggs Institute, a quality appraisal, data extraction, and synthesis were done. RESULTS Seven research syntheses were included. There were two main themes and six subthemes: (1) Characterization of the nurse-patient communication: (a) Patients' communication; (b) Nurses' communication; (2) Nursing interventions that facilitate communication: (a) Communication assessment and documentation; (b) Communication methods and approaches; (c) Education and training of nurses; and (d) Augmentative and alternative communication. CONCLUSION Nurse-patient communication was characterized by an unequal power relationship with a common experience - frustration. Four key interventions were identified and an integration of these may be key to designing and implementing future ICU communication packages. IMPACT Nurse-patient communication is characterized by an unequal power relationship with one joint experience - frustration. Four key interventions should be integrated when designing and implementing communication packages in the ICU. Findings are transferable to ICU practices where patients are conscious and experience communication difficulties.
Collapse
Affiliation(s)
- Anna Holm
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Anette Viftrup
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lone Nikolajsen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pia Dreyer
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Section of Nursing Science, Aarhus University, Aarhus, Denmark.,University of Bergen, Bergen, Norway
| |
Collapse
|
38
|
Lat I, Paciullo C, Daley MJ, MacLaren R, Bolesta S, McCann J, Stollings JL, Gross K, Foos SA, Roberts RJ, Acquisto NM, Taylor S, Bentley M, Jacobi J, Meyer TA. Position Paper on Critical Care Pharmacy Services (Executive Summary): 2020 Update. Am J Health Syst Pharm 2020; 77:1619-1624. [PMID: 32814962 DOI: 10.1093/ajhp/zxaa217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Provide a multiorganizational statement to update the statement from a paper in 2000 about critical care pharmacy practice and make recommendations for future practice. DESIGN The Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health-System Pharmacists convened a joint task force of 15 pharmacists representing a broad cross-section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (>66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting, and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. MAIN RESULTS There are 82 recommendation statements: forty-four original recommendations and 38 new recommendation statements. Thirty-four recommendations were made for patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations are in the domain of training and education and eight recommendations regarding professional development. CONCLUSIONS The statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.
Collapse
Affiliation(s)
- Ishaq Lat
- Department of Pharmacy Services, Shirley Ryan Ability Lab, Chicago, IL
| | | | - Mitchell J Daley
- Dell Seton Medical Center at the University of Texas, Austin, TX.,Dell Medical School at the University of Texas, Austin, TX
| | - Robert MacLaren
- Department of Pharmacy Practice, Skaggs School of Pharmacy, University of Colorado, Aurora, CO
| | - Scott Bolesta
- Department of Pharmacy Practice, Nesbitt School of Pharmacy, Wilkes University, Wilkes-Barre, PA
| | - Jennifer McCann
- Department of Pharmacy Practice, School of Pharmacy and Health Sciences, Butler University, Indianapolis, IN
| | - Joanna L Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN.,Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
| | - Kendall Gross
- Department of Pharmacy, UCSF Health, San Francisco, CA
| | - Sarah A Foos
- Department of Pharmacy Services, OhioHealth Doctors Hospital, Columbus, OH
| | - Russel J Roberts
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA
| | - Nicole M Acquisto
- Department of Pharmacy, University of Rochester Medical Center, Rochester, NY.,Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY
| | | | - Michael Bentley
- Virginia Tech Carilion School of Medicine, Roanoke, VA.,AstraZeneca Pharmaceuticals, Wilmington, DE
| | | | - Tricia A Meyer
- Baylor Scott and White Health-Temple Region, Temple, TX.,Department of Anesthesiology, Texas A&M College of Medicine, Temple, TX
| |
Collapse
|
39
|
Cacciani N, Salah H, Li M, Akkad H, Backeus A, Hedstrom Y, Jena BP, Bergquist J, Larsson L. Chaperone co-inducer BGP-15 mitigates early contractile dysfunction of the soleus muscle in a rat ICU model. Acta Physiol (Oxf) 2020; 229:e13425. [PMID: 31799784 PMCID: PMC7187345 DOI: 10.1111/apha.13425] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 12/13/2022]
Abstract
Aim Critical illness myopathy (CIM) represents a common consequence of modern intensive care, negatively impacting patient health and significantly increasing health care costs; however, there is no treatment available apart from symptomatic and supportive interventions. The chaperone co‐inducer BGP‐15 has previously been shown to have a positive effect on the diaphragm in rats exposed to the intensive care unit (ICU) condition. In this study, we aim to explore the effects of BGP‐15 on a limb muscle (soleus muscle) in response to the ICU condition. Methods Sprague‐Dawley rats were subjected to the ICU condition for 5, 8 and 10 days and compared with untreated sham‐operated controls. Results BGP‐15 significantly improved soleus muscle fibre force after 5 days exposure to the ICU condition. This improvement was associated with the protection of myosin from post‐translational myosin modifications, improved mitochondrial structure/biogenesis and reduced the expression of MuRF1 and Fbxo31 E3 ligases. At longer durations (8 and 10 days), BGP‐15 had no protective effect when the hallmark of CIM had become manifest, that is, preferential loss of myosin. Unrelated to the effects on skeletal muscle, BGP‐15 had a strong positive effect on survival compared with untreated animals. Conclusions BGP‐15 treatment improved soleus muscle fibre and motor protein function after 5 days exposure to the ICU condition, but not at longer durations (8 and 10 days) when the preferential loss of myosin was manifest. Thus, long‐term CIM interventions targeting limb muscle fibre/myosin force generation capacity need to consider both the post‐translational modifications and the loss of myosin.
Collapse
Affiliation(s)
- Nicola Cacciani
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
| | - Heba Salah
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
| | - Meishan Li
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
| | - Hazem Akkad
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
| | - Anders Backeus
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
| | - Yvette Hedstrom
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
| | - Bhanu P. Jena
- Department of Physiology Wayne State University School of Medicine Detroit MI USA
| | - Jonas Bergquist
- Analytical Chemistry Department of Chemistry–Biomedical Centre Uppsala University Uppsala Sweden
| | - Lars Larsson
- Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
- Department of Clinical Neuroscience Clinical Neurophysiology Karolinska Institutet Stockholm Sweden
- Department of Biobehavioral Health The Pennsylvania State University University Park PA USA
| |
Collapse
|
40
|
Piredda M, Bambi S, Biagioli V, Marchetti A, Ianni A, Lusignani M, Rasero L, Matarese M, De Marinis MG. Cross-validation of the Care Dependency Scale in intensive care unit (ICU-CDS). Intensive Crit Care Nurs 2019; 57:102787. [PMID: 31883756 DOI: 10.1016/j.iccn.2019.102787] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/01/2019] [Accepted: 12/09/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The Care Dependency Scale is a theory-based, comprehensive tool widely used in low-intensity care settings to evaluate patients' dependency. This study aimed to test the psychometric properties of the Care Dependency Scale in intensive care units. RESEARCH METHODOLOGY/DESIGN A multicentre cross-sectional validation study was conducted. Exploratory factor analysis and confirmatory factor analysis were performed using a Maximum Likelihood robust estimator with Geomin oblique rotation. SETTING Adult patients admitted to intensive care units of four Italian hospitals. RESULTS The sample included 453 patients (mean age = 68 years, 62% male). The exploratory factor analysis, conducted on a subsample of 227 patients, revealed a two-factor structure (Physical care dependency and Psychosocial care dependency) with good fit indexes. The confirmatory factor analysis was conducted on another subsample of 226 patients and a second-order factor was specified. The model tested yielded adequate fit indexes. Concurrent and known-groups validity, and reliability, were also adequate. CONCLUSION The Care Dependency Scale is a multidimensional, valid and reliable tool able to assess the care dependency of critically ill patients. It can help to distinguish between physical and psychosocial needs and to create a base for patient-customised and holistic care.
Collapse
Affiliation(s)
- Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy.
| | - Stefano Bambi
- Medical & Surgical Intensive Care Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy.
| | - Valentina Biagioli
- Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy.
| | - Anna Marchetti
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy.
| | - Andrea Ianni
- Research Unit in Hygiene, Statistics and Public Health, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy.
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Via Pascal 36, 20133 Milan, Italy.
| | - Laura Rasero
- Department of Health Sciences, University of Florence, Viale Morgagni 48, 50134 Florence, Italy.
| | - Maria Matarese
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy.
| | - Maria Grazia De Marinis
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy.
| |
Collapse
|
41
|
Schietroma M, Pessia B, Mattei A, Romano L, Giuliani A, Carlei F. Temperature-Neutrophils-Multiple Organ Failure Grading for Complicated Intra-Abdominal Infections. Surg Infect (Larchmt) 2019; 21:69-74. [PMID: 31460841 DOI: 10.1089/sur.2019.092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: The grading systems for intra-abdominal sepsis (IAS) are not employed commonly in clinical practice because they are too complicated or too specific. We propose to grade IAS with a simple grading system: the TNM system, which is an acronym borrowed from cancer staging, where T indicates Temperature, N indicates Neutrophils, and M indicates Multiple organ failure (MOF). The aim of this prospective observational study is to assess the predictive value of the TNM score on deaths of patients with complicated IAS. Patients and Methods: We considered 147 patients with complicated IAS. Three classes of attribute were chosen: Temperature (T), Neutrophil count (N), and MOF (M). After defining the categories T (T0-T4), N (N0-N3), and M (M0-M2), they were grouped in stages (0-IV). We analyzed specific variables for their possible relation to death: Age, gender, blood transfusion, causes of IAS, T, N, pre-operative organ failure, immunocompromised status, stage 0, I, II, III, and IV. Odds ratios were calculated in a uni-variable and multi-variable analysis. Results: This was the distribution in classes, based on TNM stages: One patient was in stage 0; 15 patients in stage I; 47 patients in stage II; 56 patients in stage III; 28 patients in stage IV. Death occurred in 45 (30.6%) patients. The N, pre-operative organ failure, immunocompromised status, stage III-IV were potential predictors of post-operative death in uni-variable analysis. Only pre-operative organ failure and stage IV were significant independent predictors of post-operative death in multi-variable analysis. Conclusions: The TNM classification is an easy system that could be considered to define the death risk of patients with IAS and to compare patients with sepsis.
Collapse
Affiliation(s)
- Mario Schietroma
- Department of Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Beatrice Pessia
- Department of Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Antonella Mattei
- Department of Life, Health &Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Lucia Romano
- Department of Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Antonio Giuliani
- Department of Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Francesco Carlei
- Department of Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| |
Collapse
|
42
|
McCarthy KF, de Leeuw TG. Trickle-down healthcare in paediatric chronic pain. Br J Anaesth 2019; 123:e188-e190. [PMID: 31128880 PMCID: PMC6676048 DOI: 10.1016/j.bja.2019.04.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/19/2019] [Indexed: 01/05/2023] Open
Affiliation(s)
| | - Tom G de Leeuw
- Department of Anesthesia and Pain Medicine, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| |
Collapse
|
43
|
Mattiussi E, Danielis M, Venuti L, Vidoni M, Palese A. Sleep deprivation determinants as perceived by intensive care unit patients: Findings from a systematic review, meta-summary and meta-synthesis. Intensive Crit Care Nurs 2019; 53:43-53. [DOI: 10.1016/j.iccn.2019.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 03/16/2019] [Accepted: 03/19/2019] [Indexed: 11/28/2022]
|
44
|
The Present State of Neurointensivist Training in the United States: A Comparison to Other Critical Care Training Programs. Crit Care Med 2019; 46:307-315. [PMID: 29239885 DOI: 10.1097/ccm.0000000000002876] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This manuscript describes the state of neurocritical care fellowship training, compares its written standards to those of other critical care fellowship programs, and discusses how programmatic oversight by the United Council for Neurological Subspecialties should evolve to meet American College of Graduate Medical Education standards. This review is a work product of the Society of Critical Care Medicine Neuroscience section and was reviewed and approved by the Council of the Society of Critical Care Medicine. DATA SOURCES We evaluated the published training criteria and requirements of American College of Graduate Medical Education Critical Care subspecialty fellowships programs of Internal Medicine, Surgery, and Anesthesia and compared them with the training criteria and required competencies for neurocritical care. STUDY SELECTION We have reviewed the published training standards from American College of Graduate Medical Education as well as the United Council for Neurologic Subspecialties subspecialty training documents and clarified the definition and responsibilities of an intensivist with reference to the Leapfrog Group, the National Quality Forum, and the Joint Commission. DATA EXTRACTION No data at present exist to test the concept of similarity across specialty fellowship critical care training programs. DATA SYNTHESIS Neurocritical care training differs in its exposure to clinical entities that are directly associated to other critical care subspecialties. However, the core critical care knowledge, procedural skills, and competencies standards for neurocritical care appears to be similar with some important differences compared with American College of Graduate Medical Education critical care training programs. CONCLUSIONS The United Council for Neurologic Subspecialties has developed a directed program development strategy to emulate American College of Graduate Medical Education standards with the goal to have standards that are similar or identical to American College of Graduate Medical Education standards.
Collapse
|
45
|
Butler CR, O'Hare AM. Complex Decision Making about Dialysis in Critically Ill Older Adults with AKI. Clin J Am Soc Nephrol 2019; 14:485-487. [PMID: 30898871 PMCID: PMC6450338 DOI: 10.2215/cjn.01870219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Catherine R Butler
- Department of Medicine and Kidney Research Institute, University of Washington and Hospital and Specialty Medicine and Seattle Denver Center of Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Ann M O'Hare
- Department of Medicine and Kidney Research Institute, University of Washington and Hospital and Specialty Medicine and Seattle Denver Center of Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| |
Collapse
|
46
|
Vincent JL, Creteur J. Critical care medicine in 2050: less invasive, more connected, and personalized. J Thorac Dis 2019; 11:335-338. [PMID: 30863612 DOI: 10.21037/jtd.2018.11.66] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
47
|
Reid JC, Unger J, McCaskell D, Childerhose L, Zorko DJ, Kho ME. Physical rehabilitation interventions in the intensive care unit: a scoping review of 117 studies. J Intensive Care 2018; 6:80. [PMID: 30555705 PMCID: PMC6286501 DOI: 10.1186/s40560-018-0349-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/22/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Physical rehabilitation (PR) interventions in the intensive care unit (ICU) can improve patients' functional outcomes, yet systematic reviews identified discordant effects and poor reporting. We conducted a scoping review to determine the extent of ICU PR interventions and how they were reported and measured. METHODS We searched five databases from inception to December 2016 for prospective studies evaluating adult ICU PR interventions. Two independent reviewers screened titles, abstracts, and full texts for inclusion. We assessed completeness of reporting using the Consolidated Standards of Reporting Trials, Strengthening the Reporting of Observational Studies in Epidemiology, or Standards for Quality Improvement Reporting Excellence guidelines, as appropriate. For planned PR interventions, we evaluated reporting with the Consensus on Exercise Reporting Template (CERT) and assessed intervention and control groups separately. We calculated completeness of reporting scores for each study; scores represented the proportion of reported items. We compared reporting between groups using Kruskal-Wallis with Bonferroni corrections and t tests, α = 0.05. RESULTS We screened 61,774 unique citations, reviewed 1429 full-text publications, and included 117: 39 randomized trials, 30 case series, 9 two-group comparison, 14 before-after, and 25 cohort. Interventions included neuromuscular electrical stimulation (NMES) (14.5%), passive/active exercises (15.4%), cycling (6.8%), progressive mobility (32.5%), and multicomponent (29.9%). The median (first,third quartiles) study reporting score was 75.9% (62.5, 86.7) with no significant differences between reporting guidelines. Of 87 planned intervention studies, the median CERT score was 55.6%(44.7,75.0); cycling had the highest (85.0%(62.2,93.8)), and NMES and multicomponent the lowest (50.0% (39.5, 70.3) and 50.0% (41.5, 58.8), respectively) scores. Authors reported intervention groups better than controls (p < 0.001). CONCLUSIONS We identified important reporting deficiencies in ICU PR interventions, limiting clinical implementation and future trial development.
Collapse
Affiliation(s)
- Julie C. Reid
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main Street West, Hamilton, ON L8S 1C7 Canada
| | - Janelle Unger
- Rehabilitation Sciences Institute, University of Toronto, Rehabilitation Sciences Building, 500 University Avenue, Suite 160, Toronto, ON M5G 1V7 Canada
| | - Devin McCaskell
- Department of Physiotherapy, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Laura Childerhose
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main Street West, Hamilton, ON L8S 1C7 Canada
| | - David J. Zorko
- Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Michelle E. Kho
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main Street West, Hamilton, ON L8S 1C7 Canada
- Department of Physiotherapy, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| |
Collapse
|
48
|
Current technologies in body composition assessment: advantages and disadvantages. Nutrition 2018; 62:25-31. [PMID: 30826596 DOI: 10.1016/j.nut.2018.11.028] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 09/14/2018] [Accepted: 11/14/2018] [Indexed: 12/19/2022]
Abstract
The interest in non-invasive methods of body composition assessment is on the rise in health care, especially because of its association with clinical outcomes. Technology has revolutionized our understanding of body composition abnormalities, clinical prognostication, and disease follow-up, but translation to bedside is limited, especially in terms of cost effectiveness. Computed tomography gained increased attention in cancer and sarcopenia studies, for instance. Other methods also have interesting features and applications, including bedside ultrasonography, bioelectrical impedance analysis, and dual x-ray absorptiometry. Compelling evidence indicates these methods can be used to accurately and precisely measure skeletal muscle mass, adipose tissue, and edema; diagnose malnutrition-related diseases; and aid in determining prognoses. To apply this technology properly, it is important to understand the advantages and disadvantages of each technique in specific situations of interest. This review introduces concepts and reference studies published in the scientific literature about these techniques and describes important limitations and considerations necessary to incorporate these methods into clinical practice.
Collapse
|
49
|
Schell CO, Gerdin Wärnberg M, Hvarfner A, Höög A, Baker U, Castegren M, Baker T. The global need for essential emergency and critical care. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:284. [PMID: 30373648 PMCID: PMC6206626 DOI: 10.1186/s13054-018-2219-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/04/2018] [Indexed: 01/09/2023]
Abstract
Critical illness results in millions of deaths each year. Care for those with critical illness is often neglected due to a lack of prioritisation, co-ordination, and coverage of timely identification and basic life-saving treatments. To improve care, we propose a new focus on essential emergency and critical care (EECC)—care that all critically ill patients should receive in all hospitals in the world. Essential emergency and critical care should be part of universal health coverage, is appropriate for all countries in the world, and is intended for patients irrespective of age, gender, underlying diagnosis, medical specialty, or location in the hospital. Essential emergency and critical care is pragmatic and low-cost and has the potential to improve care and substantially reduce preventable mortality.
Collapse
Affiliation(s)
- Carl Otto Schell
- Global Health-Health Systems & Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Martin Gerdin Wärnberg
- Global Health-Health Systems & Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Anna Hvarfner
- Faculty of Medicine, Uppsala University, Uppsala, Sweden
| | - Andreas Höög
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Ulrika Baker
- Global Health-Health Systems & Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,College of Medicine, Blantyre, Malawi
| | - Markus Castegren
- Perioperative medicine and intensive care (PMI), Karolinska University Hospital, Stockholm, Sweden
| | - Tim Baker
- Global Health-Health Systems & Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. .,College of Medicine, Blantyre, Malawi. .,Perioperative medicine and intensive care (PMI), Karolinska University Hospital, Stockholm, Sweden.
| |
Collapse
|
50
|
Wheeler DS, Stalets EL. A day in the life. Transl Pediatr 2018; 7:242-245. [PMID: 30460174 PMCID: PMC6212388 DOI: 10.21037/tp.2018.09.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Derek S Wheeler
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Erika L Stalets
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|