American Journal of Critical Care最新文献_第4页

Silence Kills 2.0: How Communication Failures Stifle Innovation and Harm Patients. 《沉默致死2.0：沟通失败如何扼杀创新并伤害患者》

IF 2.6 3区医学

American Journal of Critical Care Pub Date : 2026-05-01 DOI: 10.4037/ajcc2026203

Joseph Grenny, Vicki Good, Ramón Lavandero, Elizabeth Scruth

{"title":"Silence Kills 2.0: How Communication Failures Stifle Innovation and Harm Patients.","authors":"Joseph Grenny, Vicki Good, Ramón Lavandero, Elizabeth Scruth","doi":"10.4037/ajcc2026203","DOIUrl":"10.4037/ajcc2026203","url":null,"abstract":"Background: In health care organizations in which silence is the norm, questionable competence, rule-breaking, and mistakes (\"crucial moments\") often persist, putting patients and clinicians at risk. Silence may also impede an organization's behavioral agility-the speed at which care teams adopt new technologies and evidence-based practices.Objectives: Twenty years after the Silence Kills study, this study addressed these questions: Does silence still happen? Does silence kill innovation?Methods: In a quantitative cross-sectional descriptive study, clinicians across the United States, including nurses, other care providers, and leaders, completed an online instrument incorporating the 2005 Silence Kills survey and other measures to understand how often clinicians perform 4 behaviors related to crucial moments (speaking up, reminding, holding each other accountable, and challenging assumptions) that were hypothesized to increase behavioral agility. Demographic data also were collected.Results: Of 5163 respondents, 3500 provided analyzable data. Fewer than 10% of respondents spoke up during crucial moments in 2005; in 2025, it was 32%, suggesting significant progress in overcoming the culture of silence. A continued strong relationship between speaking up and health care outcomes was found. A culture of candid communication also strongly correlated with behavioral agility (r = 0.71), patient safety, patient experience, and employee engagement and retention (P < .001).Conclusions: Improvements in patient care, employee satisfaction, and adoption of evidence-based practices are possible when clinicians are empowered to speak up in crucial moments. Artificial intelligence use is expected to accelerate progress toward improved patient outcomes, reduced costs, and increased access to care, but only if the human systems required for implementation increase their capacity to absorb new ideas.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":" ","pages":"182-190"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508937","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

Verify, Then Trust: Using Artificial Intelligence in Publication of Research. 验证，然后信任：在研究发表中使用人工智能。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2026-05-01 DOI: 10.4037/ajcc2026508

Cindy L Munro, Lakshman Swamy

引用次数: 0

Posttraumatic Growth, Anxiety, Depression, and Posttraumatic Stress Disorder in Intensive Care Unit Survivors. 重症监护室幸存者的创伤后成长、焦虑、抑郁和创伤后应激障碍。

IF 2.6 3区医学

American Journal of Critical Care Pub Date : 2026-05-01 DOI: 10.4037/ajcc2026251

Kelly Calkins, Abigail C Jones, Maharaj Singh, Felicia Plebanski, Jill Guttormson, Leanne M Boehm

{"title":"Posttraumatic Growth, Anxiety, Depression, and Posttraumatic Stress Disorder in Intensive Care Unit Survivors.","authors":"Kelly Calkins, Abigail C Jones, Maharaj Singh, Felicia Plebanski, Jill Guttormson, Leanne M Boehm","doi":"10.4037/ajcc2026251","DOIUrl":"10.4037/ajcc2026251","url":null,"abstract":"Background: Intensive care unit (ICU) survivors often report poor physical health, cognitive dysfunction, and mental health sequelae (post-intensive care syndrome). However, critical illness and the associated treatments in ICUs can also lead to posttraumatic growth, defined as positive changes in life philosophy, relationships, and personal growth attributed to the process of gaining understanding and making sense of a traumatic event.Objectives: To characterize posttraumatic growth in ICU survivors.Methods: This secondary data analysis explored the in-hospital factors linked to posttraumatic growth 6 months after discharge and assessed the relationship of posttraumatic growth to anxiety, depression, posttraumatic stress disorder, global mental health, and physical health. To explore relationships among the variables, Pearson correlation coefficients were used to assess linear associations between pairs of continuous variables. Predictors of posttraumatic growth and their extent of association were determined using a general linear model.Results: The strongest associations observed with posttraumatic growth were a positive correlation with posttraumatic stress disorder (r = 0.32, P = .01) and weak positive correlations with anxiety (r = 0.11, P = .42) and depression (r = 0.12, P = .35). Notable in-hospital predictors of posttraumatic growth were mechanical ventilation (P = .04), educational level (P = .02), and age (P = .01).Conclusions: Understanding positive outcomes, such as posttraumatic growth, is important for the recovery and long-term outcomes of ICU survivors and for planning and developing interventions.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"35 3","pages":"216-223"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13297308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809675","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

Education Directory. 教育目录。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2026-05-01

引用次数: 0

The Importance of Careful Evaluation of All Recorded ECG Leads in a Patient With Chest Pain and Hypotension. 仔细评估胸痛和低血压患者所有心电图导联记录的重要性。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2026-05-01 DOI: 10.4037/ajcc2026928

Sukardi Suba, Mary G Carey, Michele M Pelter

引用次数: 0

Discussion Guide for the Oldham Article. 奥尔德姆文章讨论指南。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2026-05-01 DOI: 10.4037/ajcc2026952

Grant A Pignatiello

引用次数: 0

Use of the TALK Tool for Interprofessional Team Self-Debrief During Everyday Opportunities for Learning in Critical Care. 在重症监护学习的日常机会中使用TALK工具进行跨专业团队自我汇报。

IF 2.6 3区医学

American Journal of Critical Care Pub Date : 2026-05-01 DOI: 10.4037/ajcc2026814

Iago Enjo-Perez, Cristina Diaz-Navarro, Esther Leon-Castelao, Miquel Sanz-Moncusí, Inma Carmona-Delgado, Javier Pérez-Dueñas, Rocío Ponce-Muñoz, Sara Fernandez-Mendez, Jose-Ramón Alonso-Viladot, Jose María Nicolàs-Arfelis, Pedro Castro

{"title":"Use of the TALK Tool for Interprofessional Team Self-Debrief During Everyday Opportunities for Learning in Critical Care.","authors":"Iago Enjo-Perez, Cristina Diaz-Navarro, Esther Leon-Castelao, Miquel Sanz-Moncusí, Inma Carmona-Delgado, Javier Pérez-Dueñas, Rocío Ponce-Muñoz, Sara Fernandez-Mendez, Jose-Ramón Alonso-Viladot, Jose María Nicolàs-Arfelis, Pedro Castro","doi":"10.4037/ajcc2026814","DOIUrl":"10.4037/ajcc2026814","url":null,"abstract":"Background: Clinical debriefing is a key strategy to promote iterative team adaptation and Safety-II learning (from successes, failures, and performance variation).Objectives: To explore changes in communication behaviors after implementation of the TALK framework for voluntary team self-debriefing.Methods: A 12-month, single-center interventional study in critical care at a university hospital. Data were collected on debriefing frequency, use of structured debriefing, perceived barriers, and the nature of improvement actions resulting from debriefing episodes.Results: At baseline, 45.4% of the 653 shift teams reported considering debriefing; after the intervention, 65.4% to 95.0% of teams did so. A mean of 7.2 debriefings per week were completed. The gap between consideration and completion widened significantly, primarily due to the perception of having \"no issues to discuss.\" Use of structured debriefing and the TALK framework increased from 0% to 100%. Concurrently, reporting of barriers to debriefing declined from 25% at baseline to 0% at 12 months.Conclusions: Voluntary, spontaneous team self-debriefing occurred more often than previously reported. Introduction of the TALK framework led to substantial reductions in barriers to reflective conversations, a 3-fold increase in structured debriefings, and greater team-driven engagement in improvement. As consideration of debriefing increased, so did the \"intention-behavior gap,\" largely due to a lack of identified issues to discuss, highlighting the need for targeted strategies to promote Safety-II learning.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"35 3","pages":"171-181"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809637","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

Evaluation of Feeding Tube Migration in Critical Care Patients. 危重病人饲管移位的评价。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2026-05-01 DOI: 10.4037/ajcc2026431

Jan Powers, Annette M Bourgault, Janette Richardson, Brandon T McDaniel, Melissa Stelnicki

{"title":"Evaluation of Feeding Tube Migration in Critical Care Patients.","authors":"Jan Powers, Annette M Bourgault, Janette Richardson, Brandon T McDaniel, Melissa Stelnicki","doi":"10.4037/ajcc2026431","DOIUrl":"https://doi.org/10.4037/ajcc2026431","url":null,"abstract":"Background: Small-bore feeding tubes are often used to provide nutrition and medications to critically ill patients. Ensuring a proper distal location of the feeding tube is important to minimize aspiration risk and promote absorption of nutrients. Current guidelines call for routine verification of feeding tube location every 4 hours, yet no validated methods are available to routinely perform this bedside assessment.Objective: To assess distal migration of the tip of small-bore feeding tubes over time in critically ill adults and to identify factors affecting migration. A secondary aim was to evaluate the effect of endotracheal tube extubation on feeding tube migration.Methods: A prospective, repeated-measures cohort study was performed in 2 intensive care units. An electromagnetic placement device was used daily to assess distal feeding tube location for up to 5 days.Results: Clinically significant feeding tube migration occurred in 6 of 108 patients (5.6%). No distal feeding tubes were displaced into the esophagus. The primary factor associated with retrograde feeding tube migration (clinically and statistically significant) was the patient pulling on the tube. Endotracheal intubation was another factor identified, but that factor's association with retrograde migration was not statistically significant.Conclusions: The study findings offer additional evidence that may challenge the practice of routinely verifying feeding tube location every 4 hours. Verification every 24 hours may be adequate for patients if migration is not suspected and if patient factors, such as pulling on the feeding tube, are not present.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"35 3","pages":"225-232"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809664","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

Current Practices and Opinions Related to Hemodynamic Optimization in Patients With Sepsis: An International Survey. 脓毒症患者血流动力学优化的当前实践和观点：一项国际调查。

IF 2.6 3区医学

American Journal of Critical Care Pub Date : 2026-05-01 DOI: 10.4037/ajcc2026584

Alexander J Ruehman, Emma Covington, Trisha N Branan, W Anthony Hawkins, Susan E Smith

{"title":"Current Practices and Opinions Related to Hemodynamic Optimization in Patients With Sepsis: An International Survey.","authors":"Alexander J Ruehman, Emma Covington, Trisha N Branan, W Anthony Hawkins, Susan E Smith","doi":"10.4037/ajcc2026584","DOIUrl":"10.4037/ajcc2026584","url":null,"abstract":"Background: The Surviving Sepsis Campaign guidelines were last updated in 2021, with many recommendations based on evidence of low or very low quality.Objective: To assess practices and opinions regarding hemodynamic optimization in patients with sepsis and the adoption of updated recommendations.Methods: A cross-sectional survey of members of the Society of Critical Care Medicine addressed practices and opinions regarding initial fluid resuscitation and thresholds for initiation of adjunctive vasopressors and corticosteroids. Responses were analyzed for patients with vs without obesity and stratified by respondent profession and experience. The primary outcome was guideline-suggested use of ideal body weight to dose initial fluids in patients without obesity. Variables were compared using the χ2 test, with P < .05 indicating statistical significance.Results: Completed questionnaires were returned by 485 society members. In patients without obesity, 17% of respondents dosed initial resuscitation fluids by using ideal body weight, whereas 80% and 3% used total and adjusted body weights, respectively. Respondents with more than 20 years in practice were more likely to use ideal body weight (20%) than those with less than 5 years (12%) (P = .008). In terms of opinions, 57% of respondents preferred use of total body weight in patients without obesity, whereas 37% and 6% preferred ideal body weight and adjusted body weight, respectively.Conclusions: This study showed differences in practices based on experience. Clinicians' opinions aligned more closely with guideline statements than did actual practices.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"35 3","pages":"191-198"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809707","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

Transforming Care: Insourcing Acute Care Dialysis Services to Improve Patient Care. 转变护理：内包急性护理透析服务以改善患者护理。

IF 2.6 3区医学

American Journal of Critical Care Pub Date : 2026-05-01 DOI: 10.4037/ajcc2026766

Brittni McGill, Denny Hinkle, Christine McMurray, Steve Singley, Brandon Felts

{"title":"Transforming Care: Insourcing Acute Care Dialysis Services to Improve Patient Care.","authors":"Brittni McGill, Denny Hinkle, Christine McMurray, Steve Singley, Brandon Felts","doi":"10.4037/ajcc2026766","DOIUrl":"10.4037/ajcc2026766","url":null,"abstract":"Background: Quality improvement and cost-reduction efforts among health systems have led to critical evaluation of acute dialysis delivery models.Objective: To understand the clinical and financial impact of transitioning from contracted third-party (outsourced) dialysis services to health system-owned (insourced) dialysis services.Methods: Real-world dialysis data at a regional hospital before and after insourcing using the Tablo Hemodialysis System (Outset Medical, Inc) were compared. Previous outsourcing data were compared with data from the first 12 months of insourced dialysis (presented by quarter). Analysis included number of treatments, success of treatments (by clinician determination and by successful fluid removal), and central line (catheter)-associated bloodstream infection (CLABSI) rates. Satisfaction surveys of patients and staff also were collected.Results: Insourced dialysis achieved higher treatment success, lower CLABSI rates, and high patient and staff satisfaction. Amid a posttransition increase in the number of treatments of 279%, insourced dialysis achieved a 27% increase in treatment success by clinician determination, with more than 97% of treatments considered successful. Successful fluid removal improved from 50.8% to more than 70% across all quarters. The CLABSI rate decreased 72.7% (from 1.1 to 0.3). Retention of dialysis staff was 100% for 12 months. High staff satisfaction with their role in dialysis and insourcing was complemented with high patient satisfaction scores. Capital secured upfront was paid for within the first quarter of insourcing.Conclusions: Insourcing dialysis with the Tablo Hemodialysis System at a regional hospital markedly improved multiple clinical and financial metrics with high staff and patient satisfaction.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"35 3","pages":"233-236"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809655","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