American Journal of Critical Care最新文献_第3页

Bioelectrical Impedance Analysis to Assess Energy Expenditure in Critically Ill Patients: A Cross-Sectional Study. 生物电阻抗分析评估重症患者的能量消耗：一项横断面研究

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-09-01 DOI: 10.4037/ajcc2024240

Qingru Zheng, Feng Li, Wenqi Tang, Xiaoli Huang, Shuaijun Cao, Feng Ping, Yingchuan Li, Zuoyan Zhang, Weifeng Huang

{"title":"Bioelectrical Impedance Analysis to Assess Energy Expenditure in Critically Ill Patients: A Cross-Sectional Study.","authors":"Qingru Zheng, Feng Li, Wenqi Tang, Xiaoli Huang, Shuaijun Cao, Feng Ping, Yingchuan Li, Zuoyan Zhang, Weifeng Huang","doi":"10.4037/ajcc2024240","DOIUrl":"https://doi.org/10.4037/ajcc2024240","url":null,"abstract":"Background: Evaluating energy expenditure is important for establishing optimal goals for nutrition treatment. However, indirect calorimetry, the reference standard for measuring energy expenditure, is difficult to apply widely in clinical practice.Objective: To test the consistency of bioelectrical impedance analysis (BIA) relative to indirect calorimetry for evaluating energy expenditure in critically ill patients.Methods: A cross-sectional study of 140 critically ill adult patients was conducted. Within 24 hours of a patient being transferred to the intensive care unit, trained researchers assessed the patient's energy expenditure by use of BIA and indirect calorimetry simultaneously. Consistency of the 2 measurements was detected by intraclass correlation coefficients with a 2-way random-effects model. Factors affecting consistency were analyzed.Results: Median energy expenditure measured by indirect calorimetry was 1430.0 kcal/d (IQR, 1190.5-1650.8 kcal/d). Median energy expenditure measured by BIA was 1407.0 kcal/d (IQR, 1248.5-1563.5 kcal/d). The correlation coefficient between indirect calorimetry and BIA was 0.813 (95% CI, 0.748-0.862; P < .001). The consistency of the 2 measurements was lower in patients with comorbidities than in those without (P = .004).Conclusions: Results of BIA were highly consistent with indirect calorimetry assessments of energy expenditure in critically ill patients. Few factors except comorbidity affect the accuracy of BIA when assessing energy expenditure. Therefore, as a low-cost, easy-to-use, and noninvasive method, BIA is a valuable clinical tool for assessing energy expenditure in critically ill patients.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 5","pages":"382-389"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103512","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

E Is for Early Mobility and Improved Patient Outcomes. E 代表早期行动能力和改善患者疗效。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-09-01 DOI: 10.4037/ajcc2024137

Sarah K Wells

引用次数: 0

Patient, Practice, and Organizational Factors Associated With Early Mobility Performance in Critically Ill Adults. 与重症成人早期行动能力相关的患者、实践和组织因素。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-09-01 DOI: 10.4037/ajcc2024939

Anna E Krupp, Alai Tan, Eduard E Vasilevskis, Lorraine C Mion, Brenda T Pun, Audrey Brockman, Breanna Hetland, E Wesley Ely, Michele C Balas

{"title":"Patient, Practice, and Organizational Factors Associated With Early Mobility Performance in Critically Ill Adults.","authors":"Anna E Krupp, Alai Tan, Eduard E Vasilevskis, Lorraine C Mion, Brenda T Pun, Audrey Brockman, Breanna Hetland, E Wesley Ely, Michele C Balas","doi":"10.4037/ajcc2024939","DOIUrl":"https://doi.org/10.4037/ajcc2024939","url":null,"abstract":"Background: Adoption of early mobility interventions into intensive care unit (ICU) practice has been slow and varied.Objectives: To examine factors associated with early mobility performance in critically ill adults and evaluate factors' effects on predicting next-day early mobility performance.Methods: A secondary analysis of 66 ICUs' data from patients admitted for at least 24 hours. Mixed-effects logistic regression modeling was done, with area under the receiver operating characteristic curve (AUC) calculated.Results: In 12 489 patients, factors independently associated with higher odds of next-day mobility included significant pain (adjusted odds ratio [AOR], 1.16; 95% CI, 1.09-1.23), documented sedation target (AOR, 1.09; 95% CI, 1.01-1.18), performance of spontaneous awakening trials (AOR, 1.77; 95% CI, 1.59-1.96), spontaneous breathing trials (AOR, 2.35; 95% CI, 2.14-2.58), mobility safety screening (AOR, 2.26; 95% CI, 2.04-2.49), and prior-day physical/occupational therapy (AOR, 1.44; 95% CI, 1.30-1.59). Factors independently associated with lower odds of next-day mobility included deep sedation (AOR, 0.44; 95% CI, 0.39-0.49), delirium (AOR, 0.63; 95% CI, 0.59-0.69), benzodiazepine administration (AOR, 0.85; 95% CI, 0.79-0.92), physical restraints (AOR, 0.74; 95% CI, 0.68-0.80), and mechanical ventilation (AOR, 0.73; 95% CI, 0.68-0.78). Black and Hispanic patients had lower odds of next-day mobility than other patients. Models incorporating patient, practice, and between-unit variations displayed high discriminant accuracy (AUC, 0.853) in predicting next-day early mobility performance.Conclusions: Collectively, several modifiable and nonmodifiable factors provide excellent prediction of next-day early mobility performance.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 5","pages":"324-333"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103532","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

Effect of Sepsis-3 Definition on the Classification of Patients with Sepsis or Septic Shock in South Korea. 脓毒症-3 定义对韩国脓毒症或脓毒性休克患者分类的影响。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-09-01 DOI: 10.4037/ajcc2024864

Tak Kyu Oh, In-Ae Song

{"title":"Effect of Sepsis-3 Definition on the Classification of Patients with Sepsis or Septic Shock in South Korea.","authors":"Tak Kyu Oh, In-Ae Song","doi":"10.4037/ajcc2024864","DOIUrl":"https://doi.org/10.4037/ajcc2024864","url":null,"abstract":"Background: Little is known about differences in patient characteristics before and after implementation of the new definition of sepsis (Sepsis-3) and whether the new definition is affecting clinical practice in intensive care units.Objective: To examine and compare the clinicoepidemiologic characteristics of patients with sepsis or septic shock before and after implementation of Sepsis-3.Methods: In this population-based cohort study, a nationwide registration database in South Korea was used to identify patients with sepsis or septic shock. Patients admitted to hospitals from 2012 to 2015 constituted the Sepsis-2 group, and patients admitted from 2017 to 2020 constituted the Sepsis-3 group.Results: The study involved 443 217 patients, of whom 170 660 (38.5%) were in the Sepsis-2 group and 272 557 (61.5%) were in the Sepsis-3 group. The mean (SD) age was 73.3 (14.5) years in the Sepsis-2 group and 75.5 (14.5) years in the Sepsis-3 group. The intensive care unit admission rate was higher in the Sepsis-2 group (34.6%, 59 081 of 170 660) than in the Sepsis-3 group (21.3%, 57 997 of 272 557). Multivariable Cox regression analysis showed that 1-year all-cause mortality was 21% lower in the Sepsis-3 group than in the Sepsis-2 group (hazard ratio, 0.79; 95% CI, 0.78-0.79; P < .001).Conclusions: Implementation of the Sepsis-3 definition was associated with an increased number of patients with sepsis. Other findings suggested that patients in the Sepsis-2 group had more severe illness, with increased 1-year all-cause mortality, compared with those in the Sepsis-3 group.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 5","pages":"347-352"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103529","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 : 2024-09-01 DOI: 10.4037/ajcc2024782

Rhonda Board

引用次数: 0

Courage to Soar in Clinical Research. 临床研究中翱翔的勇气。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-09-01 DOI: 10.4037/ajcc2024935

Cindy L Munro, Lakshman Swamy

引用次数: 0

Individualized Numeric Rating Scale to Assess Pain in Critically Ill Children With Neurodevelopmental Disabilities. 评估神经发育障碍重症儿童疼痛的个性化数字评分量表

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-07-01 DOI: 10.4037/ajcc2024343

Shaneel Rowe, Kaitlin M Best

{"title":"Individualized Numeric Rating Scale to Assess Pain in Critically Ill Children With Neurodevelopmental Disabilities.","authors":"Shaneel Rowe, Kaitlin M Best","doi":"10.4037/ajcc2024343","DOIUrl":"10.4037/ajcc2024343","url":null,"abstract":"Background: Pain is a significant burden for children with neurodevelopmental disabilities but is difficult for clinicians to identify. No pain assessment tools for children with neurodevelopmental disabilities have been validated for use in pediatric intensive care units. The Individualized Numeric Rating Scale (INRS) is an adapted 0-to-10 rating that includes parents' input on their child's pain indicators.Objectives: To evaluate the reliability, validity, and feasibility and acceptability of use of the INRS for assessing pain in critically ill children with neurodevelopmental disabilities.Methods: This observational study enrolled critically ill patients with neurodevelopmental disabilities aged 3 to 17 years in 2 pediatric intensive care units at a children's hospital using a prospective repeated-measures cohort design. Structured parent interviews were used to populate each patient's INRS. Bedside nurses assessed pain using the INRS throughout the study. The research team completed independent INRS ratings using video clips. Participating parents and nurses completed feasibility and acceptability surveys. Psychometric properties of the INRS and survey responses were evaluated with appropriate statistical methods.Results: For 481 paired INRS pain ratings in 34 patients, interrater reliability between nurse and research team ratings was moderate (weighted κ = 0.56). Parents said that creating the INRS was easy, made them feel more involved in care, and helped them communicate with nurses.Conclusions: The INRS has adequate measurement properties for assessing pain in critically ill children with neurodevelopmental disabilities. It furthers goals of patient- and family-centered care but may have implementation barriers.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 4","pages":"280-288"},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141465594","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

Wide QRS Complex Rhythm in an Unresponsive Community-Based Patient. 一名反应迟钝的社区患者的宽 QRS 波群心律不齐。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-07-01 DOI: 10.4037/ajcc2024224

Sukardi Suba, Dillon J Dzikowicz, Mary G Carey, Michele M Pelter, Salah S Al-Zaiti

引用次数: 0

Caring for Children With Neurodevelopmental Disabilities in the Pediatric Intensive Care Unit. 在儿科重症监护室照顾有神经发育障碍的儿童。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-07-01 DOI: 10.4037/ajcc2024366

Cindy Cain

引用次数: 0

Climate Change and the Intensive Care Unit. 气候变化与重症监护室。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-07-01 DOI: 10.4037/ajcc2024761

Lakshman Swamy, Cindy L Munro

引用次数: 0