American Journal of Critical Care最新文献_第10页

"It Haunts Me": Impact of COVID-19 Deaths on Frontline Clinicians In Acute Care Settings-A Qualitative Study. “它困扰着我”：新冠肺炎死亡对急性护理环境中一线临床医生的影响——一项定性研究。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023257

Julia I Bandini, Sangeeta C Ahluwalia, George Timmins, Armenda Bialas, Lisa Meredith, Courtney Gidengil

{"title":"\"It Haunts Me\": Impact of COVID-19 Deaths on Frontline Clinicians In Acute Care Settings-A Qualitative Study.","authors":"Julia I Bandini, Sangeeta C Ahluwalia, George Timmins, Armenda Bialas, Lisa Meredith, Courtney Gidengil","doi":"10.4037/ajcc2023257","DOIUrl":"10.4037/ajcc2023257","url":null,"abstract":"Background: The COVID-19 pandemic created unprecedented conditions for clinicians providing end-of-life care in acute care settings, yet almost 2 years since the start of the pandemic, little is known about its impact on clinicians.Objectives: To qualitatively explore how clinicians experienced their role as they cared for dying patients with COVID-19 during the pandemic and the impact of these experiences on their lives as health care professionals.Methods: In-depth, hour-long interviews were conducted by phone in the spring of 2022 at a single time point with 23 physicians and nurses in critical care and emergency department settings from 2 health systems in California. The goal was to elicit perspectives on experiences with end-of-life care and the long-term impact of these experiences. Clinicians were asked to reflect on the different stages of the pandemic, and interviews were analyzed using a thematic analysis.Results: The interviews highlighted 2 primary themes around provision of end-of-life care during the COVID-19 pandemic. First, clinicians described challenges around their clinical duties of providing care to dying patients, which included decision-making dilemmas and professionalism challenges. Second, clinicians described the emotional aspects around end-of-life care situations they experienced, including communication with family members, \"being patients' family members\" at the end of life, and various degrees of meaning-making and remembrance of these experiences.Conclusions: The findings highlight the sustained and cumulative emotional challenges and burden clinicians are still shouldering more than 2 years after the start of the pandemic.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"32 5","pages":"368-374"},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10135682","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}

引用次数: 0

Response. 回应。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023860

Norma A Metheny, Stephen J Taylor, Kathleen L Meert

引用次数: 0

Assessing Pain in the Pediatric Intensive Care Unit: Not as Easy as the 1-10 Scale. 评估儿科重症监护室的疼痛：没有1-10量表那么容易。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023996

Sarah K Wells

引用次数: 0

Pain Assessment and Management for a Chemically Paralyzed Child Receiving Mechanical Ventilation. 接受机械通气的化学性瘫痪儿童的疼痛评估和管理。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023403

Elyse L Laures, Cynthia M LaFond, Barbara St Marie, Ann Marie McCarthy

{"title":"Pain Assessment and Management for a Chemically Paralyzed Child Receiving Mechanical Ventilation.","authors":"Elyse L Laures, Cynthia M LaFond, Barbara St Marie, Ann Marie McCarthy","doi":"10.4037/ajcc2023403","DOIUrl":"10.4037/ajcc2023403","url":null,"abstract":"Background: Pain assessment in the pediatric intensive care unit (PICU) is complex, specifically for children receiving mechanical ventilation who require neuromuscular blockade (NMB). No valid pain assessment method exists for this population. Guidelines are limited to using physiologic variables; it remains unknown how nurses are assessing and managing pain for this population in practice.Objectives: To describe how PICU nurses are assessing and managing pain for children who require NMB.Methods: A cross-sectional quantitative design was used with an electronic survey. Nurses were asked to respond to 4 written vignettes depicting a child who required NMB and had a painful procedure, physiologic cues, both, or neither.Results: A total of 107 PICU nurses answered the survey. Nurses primarily used behavioral assessment scales (61.0%) to assess the child's pain. All nurses reported that physiologic variables are either moderately or extremely important, and 27.3% of nurses used the phrase \"assume pain present\" formally at their organization. When physiologic cues were present, the odds of a nurse intervening with a pain intervention were 23.3 times (95% CI, 11.39-53.92; P < .001) higher than when such cues were absent.Conclusions: These results demonstrate variation in how nurses assess pain for a child who requires NMB. The focus remains on behavioral assessment scales, which are not valid for this population. When intervening with a pain intervention, nurses relied on physiologic variables. Decision support tools to aid nurses in conducting an effective pain assessment and subsequent management need to be created.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"32 5","pages":"346-354"},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10144429","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}

引用次数: 0

Acute Symptom Onset During Exercise Stress Testing. 运动压力测试期间出现的急性症状。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023381

Dillon J Dzikowicz, Teri M Kozik, Michele M Pelter

引用次数: 0

Associations Between Core Temperature Disorders and Outcomes of Pediatric Intensive Care Unit Patients. 核心体温障碍与儿科重症监护病房患者预后的关系。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023567

Panagiotis Kiekkas, Grigorios Kourtis, Paraskevi Feizidou, Michael Igoumenidis, Eleni Almpani, Anastasios Tzenalis

{"title":"Associations Between Core Temperature Disorders and Outcomes of Pediatric Intensive Care Unit Patients.","authors":"Panagiotis Kiekkas, Grigorios Kourtis, Paraskevi Feizidou, Michael Igoumenidis, Eleni Almpani, Anastasios Tzenalis","doi":"10.4037/ajcc2023567","DOIUrl":"10.4037/ajcc2023567","url":null,"abstract":"Background: The few studies of associations between fever and outcomes in pediatric intensive care unit (PICU) patients have conflicting findings. Associations between hypothermia and patient outcomes have not been studied.Objective: To investigate the incidence and characteristics of fever and hypothermia and their associations with adverse outcomes among PICU patients.Methods: Patients consecutively admitted to 2 PICUs in a 2-year period were prospectively studied. Core temperature was mainly measured by rectal or axillary thermometry. Fever and hypothermia were defined as core temperatures of greater than 38.0 °C and less than 36.0 °C, respectively. Prolonged mechanical ventilation, prolonged PICU stay, and PICU mortality were the adverse patient outcomes studied. Associations between patient outcomes and core temperature disorders were evaluated with univariate comparisons and multivariate analyses.Results: Of 545 patients enrolled, fever occurred in 299 (54.9%) and hypothermia occurred in 161 (29.5%). Both temperature disorders were independently associated with prolonged mechanical ventilation and prolonged PICU stay (P < .001) but not with PICU mortality. Late onset of fever (P < .001) and hypothermia (P = .009) were independently associated with prolonged mechanical ventilation, fever magnitude and duration (both P < .001) were independently associated with prolonged PICU stay, and fever magnitude (P < .001) and infectious cause of hypothermia (P= .01) were independently associated with higher PICU mortality.Conclusions: These findings provide evidence that the manifestation and characteristics of fever and hypothermia are independent predictors of adverse outcomes in PICU patients.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"32 5","pages":"338-345"},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10144427","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}

引用次数: 0

Discussion Guide for the Laures Article. 劳雷斯文章讨论指南

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023696

Grant A Pignatiello

引用次数: 0

Factors Associated With Initiation of Mechanical Ventilation in Patients With Sepsis: Retrospective Observational Study. 脓毒症患者开始机械通气的相关因素：回顾性观察研究。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023299

Robert E Freundlich, Gen Li, Aleda Leis, Milo Engoren

{"title":"Factors Associated With Initiation of Mechanical Ventilation in Patients With Sepsis: Retrospective Observational Study.","authors":"Robert E Freundlich, Gen Li, Aleda Leis, Milo Engoren","doi":"10.4037/ajcc2023299","DOIUrl":"10.4037/ajcc2023299","url":null,"abstract":"Background: Patients with sepsis are at risk for mechanical ventilation. This study aimed to identify risk factors for initiation of mechanical ventilation in patients with sepsis and assess whether these factors varied with time.Methods: Data from the electronic health record were used to model risk factors for initiation of mechanical ventilation after the onset of sepsis. A time-varying Cox model was used to study factors that varied with time.Results: Of 35 020 patients who met sepsis criteria, 28 747 were eligible for inclusion. Mechanical ventilation was initiated within 30 days after sepsis onset in 3891 patients (13.5%). Factors that were independently associated with increased likelihood of receipt of mechanical ventilation were race (White: adjusted hazard ratio [HR], 1.59; 95% CI, 1.39-1.83; other/unknown: adjusted HR, 1.97; 95% CI, 1.54-2.52), systemic inflammatory response syndrome (adjusted HR [per point], 1.23; 95% CI, 1.17-1.28), Sequential Organ Failure Assessment score (adjusted HR [per point], 1.28; 95% CI, 1.26-1.31), and congestive heart failure (adjusted HR, 1.30; 95% CI, 1.17-1.45). Hazard ratios decreased with time for Sequential Organ Failure Assessment score and congestive heart failure and varied with time for 4 comorbidities and 3 culture results.Conclusions: The risk for mechanical ventilation associated with different factors varied with time after sepsis onset, increasing for some factors and decreasing for others. Through a better understanding of risk factors for initiation of mechanical ventilation in patients with sepsis, targeted interventions may be tailored to high-risk patients.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"32 5","pages":"358-367"},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10577809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10144431","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}

引用次数: 0

Residual Psychomotor Skills of Orderlies After a Novel Chest Compression Training Intervention. 新型胸部按压训练干预后勤务兵剩余心理运动技能。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023772

Philippe Voizard, Christian Vincelette, François Martin Carrier, Catalina Sokoloff

{"title":"Residual Psychomotor Skills of Orderlies After a Novel Chest Compression Training Intervention.","authors":"Philippe Voizard, Christian Vincelette, François Martin Carrier, Catalina Sokoloff","doi":"10.4037/ajcc2023772","DOIUrl":"10.4037/ajcc2023772","url":null,"abstract":"Background: High-quality chest compressions are essential to favorable patient outcomes after in-hospital cardiac arrest. Without frequent training, however, skill in performing compressions declines considerably. The Timely Chest Compression Training (T-CCT) intervention was introduced in 2019 as a quality improvement initiative to address this problem. The long-term impact of the T-CCT is unknown.Methods: A cohort study was conducted at a university-affiliated hospital in Quebec, Canada. Chest compression performance among orderlies was measured by using a subtractive scoring model and mannequins. The association of exposure to the T-CCT 10 months earlier with having an excellent chest compression performance (score ≥90 out of 100), after adjusting for potential confounders, was examined.Results: A total of 412 orderlies participated in the study. More than half (n = 232, 56%) had been exposed to the T-CCT, and the rest (n = 180, 44%) had not. Nearly half (n = 106, 46%) of orderlies exposed to the T-CCT had an excellent performance, compared with less than one-third (n = 53, 30%) of nonexposed orderlies. In univariable analysis, previous exposure to the T-CCT was associated with 1.53 times greater risk of having an excellent performance (risk ratio, 1.53; 95% CI, 1.17-1.99). This effect remained after adjustment for potential confounders (risk ratio, 1.57; 95% CI, 1.19-2.07).Conclusion: The results of this study suggest that the T-CCT has a lasting effect on the psychomotor skills of orderlies 10 months after initial exposure. Further research should investigate the impact of the intervention on patient outcomes after in-hospital cardiac arrest.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"32 5","pages":"381-386"},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10135679","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}

引用次数: 0

Clinical Pearls. 临床珍珠。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023578

Rhonda Board

引用次数: 0