Journal of Intensive Care Medicine最新文献

{"title":"Transtracheal Ultrasound as a Preventive Tool for ETT Related Adverse Events and Malpositioning in the ICU.","authors":"David Yamane, Philip Dela Cruz, Mary Heekin Wilby, Sasa Ivanovic, Mark Munoz, Katrina Hawkins, Danielle Davison","doi":"10.1177/08850666241296523","DOIUrl":"https://doi.org/10.1177/08850666241296523","url":null,"abstract":"<p><strong>Introduction: </strong>Endotracheal tube (ETT) malpositioning can result in a myriad of complications. Daily chest radiographs (CXR) is the gold standard in monitoring these complications. Point-of-care transtracheal ultrasound (TTUS) is an emerging imaging modality for ETT positioning. We compared ETT malpositioning related adverse events and diagnostic accuracy of ETT malpositioning of a combined TTUS and CXR surveillance protocol to CXR alone.</p><p><strong>Methods: </strong>We performed a randomized control trial of mechanically ventilated patients in an academic multidisciplinary ICU. In the intervention group, the clinical team was provided the results of the TTUS with CXR results to aid in clinical decision making. In the control group only CXR results were used. Adverse events included bronchial migration, vocal cord herniation, balloon rupture, unplanned extubation, and the development of aspiration pneumonia. Data was analyzed via Fisher's Exact Test. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666241296523"},"PeriodicalIF":3.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical Care Management of Acute Pulmonary Embolism.","authors":"Eugene Yuriditsky, Mads Dam Lyhne, James M Horowitz, David M Dudzinski","doi":"10.1177/08850666241311512","DOIUrl":"https://doi.org/10.1177/08850666241311512","url":null,"abstract":"<p><p>The unprimed right ventricle is exquisitely sensitive to acute elevations in afterload. High pulmonary vascular tone incurred with acute pulmonary embolism has the potential to induce obstructive shock and circulatory collapse. While emergent pulmonary reperfusion is essential in severe circumstances, an important subset of pulmonary embolism patients may exhibit a less extreme presentation posing a management dilemma. As intensive care therapies have the potential to both salvage and harm the failing right ventricle, a keen understanding of the pathophysiology is requisite in the care of the contemporary patient with hemodynamically significant pulmonary embolism. Here, we review right ventricular pathophysiology, an approach to risk stratification, and offer guidance on the medical and mechanical supportive and therapeutic strategies for the critically ill patient with acute pulmonary embolism.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666241311512"},"PeriodicalIF":3.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a Checklist Tool to Improve Understanding of Rapid Response Team Protocols.","authors":"Maria C Pliakas, Erin F Carlton, Sarah Brennan, Diane Brown, Laura Getchell, Debra O'Neal, Kayla B Phelps, Rebekah Shaw, Courtney Strohacker, Anisha K Coughlin","doi":"10.1177/08850666241309860","DOIUrl":"https://doi.org/10.1177/08850666241309860","url":null,"abstract":"<p><p><b>Background and Objectives:</b> Rapid response teams (RRT) are multidisciplinary teams activated to assess patients outside of the Intensive Care Unit (ICU) and require a shared framework for approaching a deteriorating patient. In this project, we aimed to improve the understanding of RRT protocols through the development and implementation of the RRT Huddle Checklist. <b>Methods:</b> This quality improvement project took place from 2019 to 2022. A multidisciplinary workgroup conducted a current state analysis and defined the ideal RRT process. To improve the RRT process, we developed and implemented an RRT Huddle Checklist based on the SBAR framework, standardized education, and created a process for regular feedback. The primary aim was to improve understanding of RRT protocols among participants. RRT duration was used as a balancing measure. <b>Results:</b> A total of 301 stakeholders completed surveys, including 127 nurses, 101 residents, 45 RRT nurses, 10 Hospital Medicine faculty and fellows, and 18 PICU fellows. After implementation of the RRT Huddle Checklist, the proportion of respondents who agreed with knowing RRT protocols increased from 69% in 2020 to 75% in 2022, with no increase in RRT duration. <b>Conclusions:</b> The implementation of the RRT Huddle Checklist resulted in an increased proportion of key stakeholders that understood RRT protocols without increasing the duration of RRTs. The RRT Huddle Checklist tool utilizes a widely known, validated framework that can be adapted at other institutions to standardize the RRT process and promote ongoing just-in-time education.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666241309860"},"PeriodicalIF":3.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning Approach for Sepsis Risk Assessment in Ischemic Stroke Patients.","authors":"Fengkai Mao, Leqing Lin, Dongcheng Liang, Weiling Cheng, Ning Zhang, Ji Li, Siming Wu","doi":"10.1177/08850666241308195","DOIUrl":"https://doi.org/10.1177/08850666241308195","url":null,"abstract":"<p><strong>Background: </strong>Ischemic stroke is a critical neurological condition, with infection representing a significant aspect of its clinical management. Sepsis, a life-threatening organ dysfunction resulting from infection, is among the most dangerous complications in the intensive care unit (ICU). Currently, no model exists to predict the onset of sepsis in ischemic stroke patients. This study aimed to develop the first predictive model for sepsis in ischemic stroke patients using data from the MIMIC-IV database, leveraging machine learning techniques.</p><p><strong>Methods: </strong>A total of 2238 adult patients with a diagnosis of ischemic stroke, admitted to the ICU for the first time, were included from the MIMIC-IV database. The outcome of interest was the development of sepsis. Model development adhered to the TRIPOD guidelines. Feature selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) regression, identifying 28 key variables. Multiple machine learning algorithms, including logistic regression, k-nearest neighbors, support vector machines, decision trees, and XGBoost, were trained and internally validated. Performance metrics were assessed, and XGBoost was selected as the optimal model. The SHAP method was used to interpret the XGBoost model, revealing the impact of individual features on predictions. The model was also deployed on a user-friendly platform for practical use in clinical settings.</p><p><strong>Results: </strong>The XGBoost model demonstrated superior performance in the validation set, achieving an area under the curve (AUC) of 0.863 and offering greater net benefit compared to other models. SHAP analysis identified key factors influencing sepsis risk, including the use of invasive mechanical ventilation on the first day, excessive body weight, a Glasgow Coma Scale verbal score below 3, age, and elevated body temperature (>37.5 °C). A user interface had been developed to enable clinicians to easily access and utilize the model.</p><p><strong>Conclusions: </strong>This study developed the first machine learning-based model to predict sepsis in ischemic stroke patients. The model exhibited high accuracy and holds potential as a clinical decision support tool, enabling earlier identification of high-risk patients and facilitating preventive measures to reduce sepsis incidence and mortality in this population.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666241308195"},"PeriodicalIF":3.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oxygen Targets for Mechanically Ventilated Adults with Sepsis: Secondary Analysis of the PILOT Trial.","authors":"Jack C Shapiro, Jonathan D Casey, Edward T Qian, Kevin P Seitz, Li Wang, Bradley D Lloyd, Joanna L Stollings, Robert E Freundlich, Wesley H Self, Todd W Rice, Jonathan P Wanderer, Matthew W Semler","doi":"10.1177/08850666241299378","DOIUrl":"https://doi.org/10.1177/08850666241299378","url":null,"abstract":"<p><strong>Background: </strong>Patients with sepsis frequently require invasive mechanical ventilation. How oxygenation during mechanical ventilation affects clinical outcomes for patients with sepsis remains uncertain.</p><p><strong>Research question: </strong>To evaluate the effects of different oxygen saturation targets on clinical outcomes for patients with sepsis receiving mechanical ventilation.</p><p><strong>Study design and methods: </strong>We performed a secondary analysis of the <u>P</u>ragmatic <u>I</u>nvestigation of optima<u>L</u> <u>O</u>xygen <u>T</u>argets (PILOT) trial dataset among patients who met criteria for sepsis by the Sepsis-3 definition at the time of enrollment. We compared patients randomized to a lower oxygen saturation target (90%; range, 88-92%), an intermediate target (94%; range, 92-96%), and a higher target (98%; range, 96-100%) with regard to the outcomes of 28-day in-hospital mortality and ventilator-free days to study day 28.</p><p><strong>Results: </strong>Of 2541 patients in the PILOT dataset, 805 patients with sepsis were included in the current analysis. In-hospital mortality by day 28 did not differ significantly between the lower target group (48%; 95% confidence interval [CI], 42% to 54%), the intermediate target group (50%; 95% CI, 43% to 56%), and the higher target group (51%; 95% CI, 45% to 56%) (P = 0.83). The number of ventilator-free days to day 28 did not significantly differ between the trial groups, with a mean of 9.9 (standard deviation [SD], 11.8) in the lower oxygen saturation target group, 9.5 (SD, 11.2) in the intermediate group, and 9.4 (SD, 11.4) in the higher group (P = 0.65).</p><p><strong>Interpretation: </strong>Among mechanically ventilated patients with sepsis in a large, randomized trial, the incidence of 28-day in-hospital mortality was not statistically significantly different between the use of a lower, intermediate, or higher oxygen target. However, the confidence intervals included treatment effects that would be clinically meaningfully and further randomized trials of oxygen targets in sepsis are required.</p><p><strong>Referenced trial name: </strong>Pragmatic Investigation of optimaL Oxygen Targets Trial (PILOT)ClinicalTrials.gov number NCT03537937URL: https://clinicaltrials.gov/study/NCT03537937.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"8850666241299378"},"PeriodicalIF":3.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Diagnostic Performance of Nasal Methicillin-Resistant <i>Staphylococcus aureus</i> Polymerase Chain Reaction in Hospital-Acquired Pneumonia Within the Intensive Care Unit. A Retrospective Study.","authors":"Mahmoud Alwakeel, Mohammed Obeidat, Abdelrahman Nanah, Fatima Abdeljaleel, Xiaofeng Wang, Francois Fadell","doi":"10.1177/08850666241264774","DOIUrl":"10.1177/08850666241264774","url":null,"abstract":"<p><p><b>Background:</b> The methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) accounts for 20% to 40% of all hospital-acquired pneumonia (HAP) cases with mortality rates up to 55%. Prompt and accurate diagnosis is essential, especially in intensive care unit (ICU) patients. Nasal MRSA polymerase chain reaction (PCR) diagnostic utility evidence is conflicting in the literature for HAP due to a low number of HAP patients included in prior studies or due to the lack of high-yield gold standard cultures defined for comparisons. <b>Methods:</b> This was a retrospective cohort study conducted in a 65-bed medical ICU, and encompassing all adult patients admitted from January 2015 to March 2023 for HAP. Respiratory cultures included were those obtained by bronchoalveolar lavage or endotracheal suction within 7 days of nasal MRSA PCR testing. <b>Results:</b> The study included 412 patients; 56.8% were males and 65% were Whites. The mean age was 60.5 years. Most patients (82.5%) underwent MRSA-PCR before intubation, and the average time between MRSA-PCR and lower respiratory cultures was 2.15 days. The diagnostic performance of nasal MRSA PCR in diagnosing HAP in the ICU yielded a sensitivity (Sen) of 47.83%, specificity (Sp) of 92.29%, positive predictive value (PPV) of 26.83%, and negative predictive value (NPV) of 96.77%. For nonventilator HAP (nv-HAP) cases sensitivity was at 50%, specificity 92.83%, PPV 28.57%, and NPV at 97.00%. In ventilator-acquired pneumonia (VAP-HAP), the corresponding values were 42.86%, 90.91%, 23.08%, and 96.15%, respectively. <b>Conclusion:</b> The nasal MRSA PCR shows a high NPV and low false negative rate, suggesting it is a reliable tool for ruling out MRSA HAP in ICU patients. Care should be taken into account for disease prevalence and clinical context, as these factors may influence test performance. Further validation through prospective large-sample studies utilizing high-yield lower respiratory tract cultures is necessary to confirm our findings.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"54-59"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of SAT and SBT Conduct During the ABC Trial and PILOT Trial.","authors":"Tuqa Alkhateeb, Matthew W Semler, Timothy D Girard, E Wesley Ely, Joanna L Stollings","doi":"10.1177/08850666231213337","DOIUrl":"10.1177/08850666231213337","url":null,"abstract":"<p><strong>Background: </strong>Implementation of the \"B\" element-both spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs)-of the ABCDEF bundle improves the outcomes for mechanically ventilated patients. In 2021, the Pragmatic Investigation of optimal Oxygen Targets (PILOT) trial investigating optimal oxygenation targets in patients on mechanical ventilation was completed.</p><p><strong>Objectives: </strong>To compare SAT and SBT conduct between a randomized controlled trial and current clinical care.</p><p><strong>Methods: </strong>The 2008 Awakening and Breathing Controlled (ABC) Trial (2003-2006) randomized mechanically ventilated patients to paired SATs and SBTs versus sedation per usual care plus SBTs. The PILOT trial (2018-2021) enrolled patients years later where SAT + SBT conduct was observed. We compared SAT and SBT conduct in ABC's interventional group (SAT + SBT; n = 167, 1140 patient days) to that in PILOT (n = 2083, 8355 patient days).</p><p><strong>Results: </strong>Spontaneous awakening trial safety screens were done in all 1140 ABC patient-days on sedation and/or analgesia and in 3889 of 4228 (92%) in PILOT. Spontaneous awakening trial safety screens were passed in 939 of 1140 (82%) instances in ABC versus only 1897 of 3889 (49%) in PILOT. Interestingly, SAT was performed in ≥95% of passed SAT safety screens in both trials and was passed in 837 of 895 (94%) in ABC versus 1145 of 1867 (61%) in PILOT. SBT safety screens were performed in all 983 ABC instances and 8031 of 8370 (96%) in PILOT. SBT safety screens were passed in 647 of 983 (66%) in ABC versus 4475 of 8031 (56%) in PILOT. Spontaneous breathing trial was performed in ≥93% of passed SBT safety screens in both trials and was passed in 319 of 603 (53%) in ABC versus 3337 of 4454 (75%) in PILOT.</p><p><strong>Conclusion: </strong>This study compared SAT/SBT conduction in an ideal setting to real-world practice, 13 years later. Performance of SAT/SBT safety screens, SATs, and SBTs between a definitive clinical trial (ABC) as compared to current clinical care (PILOT) remained high.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"3-9"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138047080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-Guided Venous Catheter Placement in Prone Position.","authors":"Kuan-Pen Yu, Tzu-Chun Wang, Yu-Chung Kung, Kuang-Hua Cheng","doi":"10.1177/08850666241298224","DOIUrl":"10.1177/08850666241298224","url":null,"abstract":"<p><p>The prone position is often used for patients with adult respiratory distress syndrome and specific surgical postures. When performing venous cannulation in this position, it is important to have a structured review to introduce the available major veins and ultrasound-guided procedure. In this review, we discuss the techniques of ultrasound-guided cannulation and provide insights into various aspects, including the anatomical locations of veins, vein sizes, placement techniques, surrounding structures at risk, and reported experiences with catheter placements. Eight major veins can be accessed in the prone position: the internal jugular vein, external jugular vein, brachiocephalic vein, basilic vein, mid-thigh femoral vein, popliteal vein, posterior tibial vein, and small saphenous vein. To minimize the risk of venous thromboembolism, the ratio of catheter diameter to vessel diameter should be less than 0.67. The review also presents the minimal requirement of venous diameter for different catheters in a tabulated form. For larger veins, real-time ultrasound guidance with the long-axis view/in-plane technique is suggested, while for smaller vessels, the short-axis view/out-of-plane technique is recommended. The review includes sonographic illustrations of the two techniques and surrounding arteries and nerves for the eight major veins. The aim of this review is to help clinicians assess the eight major veins and safely insert various types of catheters for patients in the prone position.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"94-108"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Midline Catheters as an Alternative for Central Venous Catheters in Venous Oxygen Saturation Monitoring: A Single Center Experience.","authors":"Justin S Kim, Sasa Ivanovic, Danielle Davison, Rishika Bheem, Maria Wu, Brendan Sweeney, Eduard Shaykhinurov, David Yamane","doi":"10.1177/08850666241265190","DOIUrl":"10.1177/08850666241265190","url":null,"abstract":"<p><strong>Background: </strong>Central venous oxygen saturation (ScvO2) obtained from a central venous catheter (CVC) is often used to approximate oxygen delivery in critically ill patients. Despite their importance in administering medications and monitoring oxygen delivery, the use of CVCs can be associated with significant complications. Midline catheters are inserted via a peripheral vein above the antecubital fossa and provide a safe alternative to CVCs. This study aimed to determine the equivalence of ScvO2 and midline catheter oxygen saturation (SmO2) in critically ill patients.</p><p><strong>Methods: </strong>This was a single-center observational study of critically ill adult patients who had concurrently placed CVCs (internal jugular and subclavian) and midline catheters as part of standard ICU care. Venous oxygen saturation and lactate levels were measured from both catheters using the Abbott point-of-care i-STAT analyzer. Demographic and ICU admission data were collected. Continuous variables were compared using the paired t-test. Pearson's correlation was used to evaluate the linear correlation between ScvO2 and SmO2. The systematic error (bias) was calculated using Bland-Altman analysis. Receiver operating characteristic curves were constructed to evaluate the sensitivities and specificities for different values of SmO2 to predict ScvO2.</p><p><strong>Results: </strong>Forty-eight patients (n = 48) were enrolled in the study. The mean ScvO2 and SmO2 were 65.5% +/- 11.2% and 62.7% +/- 17.6% respectively (p = 0.1197). In the Bland-Altman analysis, the mean bias between ScvO2 and SmO2 was 2.8% +/- 12.3% with 95% limits of agreement of -21.3% to 26.9%. More than 60% of the ScvO2 and SmO2 values diverged by ≥ 5%.</p><p><strong>Conclusions: </strong>The difference between the mean SmO2 and ScvO2 was not statistically significant and the mean bias between SmO2 and ScvO2 is low. Despite this, the substantially large standard deviation and limits of agreement preclude the use of SmO2 as a direct surrogate of ScvO2.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"47-53"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Quality Improvement: Utilizing a Novel Education Platform to Enhance Care for the Caregiver in the Neurosciences Intensive Care Unit.","authors":"Dana Klavansky, Helaina Lehrer, Ruth Levy, Golda Boahene-Nartey, Elka Riley, Neha S Dangayach","doi":"10.1177/08850666241262284","DOIUrl":"10.1177/08850666241262284","url":null,"abstract":"<p><p><b>Background:</b> Timely patient and family communication is fundamental to the delivery of patient and family-centered care in the intensive care unit (ICU). However, repetitive, non-urgent communication with patients and designated patient contacts (DPCs) may lead to workflow disruptions, patient safety concerns and burnout. Implementing media-rich, educational content via a web-app could promote a more communication-friendly environment and reduce redundant communication. This may lower workflow disruptions and save time for more meaningful interactions with providers. The goal of this study was to deliver relevant, high-quality content via a web-app, assess time savings, and patient satisfaction with the web-app. <b>Methods:</b> A pre-implementation survey was distributed to Neurosciences intensive care unit (NSICU) staff to assess the burden of repetitive non-urgent communication and perceived duration of disruptions. Patients admitted to the NSICU from September 2022 to February 2023, n = 221 were included in the study. Patients were enrolled in the web-app. Patients and their DPC were granted access. Demographics including patient diagnosis, age, gender, and race were collected, along with data on weekly patient enrollment, number of DPCs granted access, total, frequency, and average view times of each piece of web-app content, and expected time saved due to review of web-app-based content by patient and/or DPCs to reduce repetitive communication by NSICU caregivers. The time saved for each piece of web-app content was calculated after getting feedback from providers (attendings, fellows, advanced practice providers, nurses) for how long it generally took them to convey each piece of information to patients and families. <b>Results:</b> Based on web-app content reviewed by patients and/or DPCs, the estimated average amount of NSICU caregiver time saved over the study period, based on application content views, was 82 min per week, and the cumulative total provider time saved for all content views was 26 h and 53 min. Twenty-one of 59 applications were rated by patients or their DPC and received five-star reviews (out of 5). <b>Conclusion:</b> The implementation of a web-app to facilitate and increase efficiency in communication leads to time savings for NSICU providers and patient/DPC satisfaction with the media-rich educational content.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"40-46"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141331123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}