American Journal of Critical Care最新文献_第6页

Serum Albumin Level at Intensive Care Unit Admission and Delirium Duration and Severity in Critically Ill Adults. 重症监护病房入院时的血清白蛋白水平与重症成人谵妄的持续时间和严重程度。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-11-01 DOI: 10.4037/ajcc2024650

Rosalyn Chi, Anthony J Perkins, Yara Khalifeh, Parth Savsani, Samreen Jawaid, Salwa Moiz, Sophia Wang, Sikandar H Khan, Sujuan Gao, Babar A Khan

{"title":"Serum Albumin Level at Intensive Care Unit Admission and Delirium Duration and Severity in Critically Ill Adults.","authors":"Rosalyn Chi, Anthony J Perkins, Yara Khalifeh, Parth Savsani, Samreen Jawaid, Salwa Moiz, Sophia Wang, Sikandar H Khan, Sujuan Gao, Babar A Khan","doi":"10.4037/ajcc2024650","DOIUrl":"10.4037/ajcc2024650","url":null,"abstract":"Background: Hypoalbuminemia has been associated with an increased risk of in-hospital delirium. However, the relationship between serum albumin levels and the duration and severity of delirium is not well defined.Objective: To investigate the relationship between albumin levels and delirium duration and severity.Methods: Study data were from a randomized controlled trial involving adult intensive care unit patients (≥ 18 years old) admitted to 3 academic hospitals from 2009 to 2015 who had positive delirium screening results on the Confusion Assessment Method for the Intensive Care Unit-7. Delirium severity was defined by mean Confusion Assessment Method for the Intensive Care Unit-7 scores by day 8. Delirum duration was defined by the number of delirium-free and coma-free days by day 8. Serum albumin levels within 72 hours of intensive care unit admission were collected from electronic medical records.Results: The study included 237 patients (mean age, 60.3 years; female sex, 52.7%; receiving mechanical ventilation, 59.5%; acute respiratory failure or sepsis, 57.8%). Serum albumin levels were categorized as 3 g/dL or greater (n = 13), 2.5 to 2.99 g/dL (n = 142), and less than 2.5 g/dL (n = 82). After adjustment for demographic and clinical characteristics, no significant associations between albumin levels and delirium duration or severity were found. However, patients with normal albumin levels (≥3 g/dL) had shorter stays than did patients with hypoalbuminemia.Conclusion: In patients with delirium, higher albumin levels were associated with shorter hospital stays but not with delirium duration or severity.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 6","pages":"412-420"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556927","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

Nurses' Lived Experience, Part 1: The COVID-19 Pandemic. 护士的亲身经历，第一部分：COVID-19 大流行。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-11-01 DOI: 10.4037/ajcc2024418

Margo A Halm, Jeannette Kassem Warren, Laura Yee, Katie Franz, Jennifer Fehlman

引用次数: 0

Medical Decision-Making and Bereavement Experiences After Cardiac Arrest: Qualitative Insights From Surrogates. 心脏骤停后的医疗决策和丧亲体验：来自代理人的定性洞察。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-11-01 DOI: 10.4037/ajcc2024211

Christine E DeForge, Arlene Smaldone, Sachin Agarwal, Maureen George

{"title":"Medical Decision-Making and Bereavement Experiences After Cardiac Arrest: Qualitative Insights From Surrogates.","authors":"Christine E DeForge, Arlene Smaldone, Sachin Agarwal, Maureen George","doi":"10.4037/ajcc2024211","DOIUrl":"10.4037/ajcc2024211","url":null,"abstract":"Background: Surrogates of incapacitated patients in the intensive care unit (ICU) face decisions related to life-sustaining treatments. Decisional conflict is understudied.Objectives: To compare experiences of ICU surrogates by reported level of decisional conflict related to treatment decisions after a patient's cardiac arrest preceding death.Methods: Convergent mixed methods were used. Bereaved surrogates recruited from a single northeastern US academic medical center completed surveys including the low-literacy Decisional Conflict Scale (moderate-to-high cut point >25) and individual interviews about 1 month after the patient's death. Interview data were analyzed by directed and conventional content analysis. Surrogates were stratified by median total survey score, and interview findings were compared by decisional conflict level.Results: Of 16 surrogates, 7 reported some decisional conflict (median survey score, 0; range, 0-25). About two-thirds decided to withdraw treatments. Three themes emerged from interviews: 2 reflecting decision-making experiences (\"the ultimate act\"; \"the legacy of clinician communication\") and 1 reflecting bereavement experiences (\"I wish there was a handbook\"). Surrogates reporting decisional conflict included those who first pursued but later withdrew treatments after a patient's in-hospital cardiac arrest. Surrogates with decisional conflict described suboptimal support, poor medical understanding, and lack of clarity about patients' treatment preferences.Conclusions: These findings provide insight into bereaved ICU surrogates' experiences. The low overall survey scores may reflect retrospective measurement. Surrogates who pursued treatment were underrepresented. Novel approaches to support bereaved surrogates are warranted.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 6","pages":"433-445"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556922","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

Multidimensional Sleep Health in Surrogate Decision-Makers of Critically Ill Patients. 重症患者代理决策者的多维睡眠健康。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-11-01 DOI: 10.4037/ajcc2024174

Grant A Pignatiello, Stephanie Griggs, Seth Alan Hoffer, Ronald L Hickman

{"title":"Multidimensional Sleep Health in Surrogate Decision-Makers of Critically Ill Patients.","authors":"Grant A Pignatiello, Stephanie Griggs, Seth Alan Hoffer, Ronald L Hickman","doi":"10.4037/ajcc2024174","DOIUrl":"https://doi.org/10.4037/ajcc2024174","url":null,"abstract":"Background: Supporting the sleep health of surrogate decision-makers of patients in the intensive care unit is a research priority. However, few studies have approached sleep health as a multidimensional construct, instead focusing on 1 or 2 dimensions in isolation.Objective: To holistically examine the sleep health (satisfaction, timing, efficiency, duration) of surrogate decision-makers of critically ill patients.Methods: This secondary analysis involved surrogate decision-makers of incapacitated intensive care unit patients at a tertiary medical center in northeastern Ohio (n = 19). Sleep-health data were captured by means of a subjective scale (satisfaction) and objectively (timing, efficiency, duration) by means of a wrist-worn accelerometer (Actiwatch Spectrum Plus; Philips Respironics). Upon enrollment, participants completed the satisfaction scale and wore the Actiwatch Spectrum Plus for 3 consecutive days. Descriptive statistics of the study variables were evaluated.Results: A minority (15%) of the sample reported poor sleep satisfaction. Sleep timing variables were comparable to those found in other adult studies. Participants averaged approximately 6 hours of sleep per day with an average sleep efficiency of 83.7%.Conclusions: Despite adequate satisfaction scores, intensive care unit surrogate decision-makers' sleep duration is inadequate and sleep efficiency is suboptimal. Sleep-health interventions may be needed in this at-risk population. Future research should consider the impact of surrogate decision-maker sleep health on their capacity to serve in the surrogate decision-maker role.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 6","pages":"468-472"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556923","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 : 2024-11-01 DOI: 10.4037/ajcc2024691

Rhonda Board

引用次数: 0

Picturing Empathy in the Intensive Care Unit: Patient Photographs at an Urban Community Teaching Hospital. 重症监护室中的感同身受：一家城市社区教学医院的病人照片。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-11-01 DOI: 10.4037/ajcc2024637

Dhruv Shah, Kuldeep Ghosh, Robin Singh, Ivonne Bonfante, Josette Nagales, Andrew Wuthrich, Christopher Wilson, Natoushka Trenard, Armeen D Poor

{"title":"Picturing Empathy in the Intensive Care Unit: Patient Photographs at an Urban Community Teaching Hospital.","authors":"Dhruv Shah, Kuldeep Ghosh, Robin Singh, Ivonne Bonfante, Josette Nagales, Andrew Wuthrich, Christopher Wilson, Natoushka Trenard, Armeen D Poor","doi":"10.4037/ajcc2024637","DOIUrl":"10.4037/ajcc2024637","url":null,"abstract":"Background: Intensive care unit (ICU) clinicians are at risk for burnout, which can be driven by depersonalization. Photographs of patients in their baseline state of health before ICU admission may enhance the connection between clinicians and patients. The use of patient photographs has not been evaluated in an urban community teaching hospital.Objective: To evaluate whether an interprofessional group of clinicians perceive that patient photographs in the ICU help them connect with patients and enhance empathy.Methods: A prospective observational quality improvement study was performed in the medical ICU of an urban community teaching hospital. Patients' families could display patients' photographs in the unit. Registered nurses, physicians, respiratory therapists, and patient care associates completed anonymous surveys.Results: Families of 21 patients provided photographs; 82 clinicians (47 physicians, 25 nurses, 5 respiratory therapists, and 5 patient care associates) completed surveys. Most clinicians (83%) agreed that the patient's personality and character were emphasized by photographs, 77% agreed that photographs facilitated communication with the patient and/or family, 89% agreed that patient photographs helped them relate to the patient as an individual, and 76% were not upset by comparing the photograph with the patient. Responses did not significantly differ by clinician type. Survey comments highlighted themes of humanization, fulfillment, and hope.Conclusion: Patient photographs may enhance connections between clinicians and patients in the ICU, potentially reducing depersonalization and burnout.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 6","pages":"455-461"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556926","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 Wool Article. 羊毛文章讨论指南》。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-11-01 DOI: 10.4037/ajcc2024358

Grant A Pignatiello

引用次数: 0

Optimizing Patient Care and Health Care Equity Through Accurate Data Collection. 通过准确的数据收集优化患者护理和医疗公平。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-11-01 DOI: 10.4037/ajcc2024715

Meredith Padilla

引用次数: 0

Association of Area Deprivation Index With Mortality in Critically Ill Adults With COVID-19. 地区贫困指数与 COVID-19 重症成人死亡率的关系。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-11-01 DOI: 10.4037/ajcc2024898

Ronald Harris, Morgan Rosser, Anand M Chowdhury, Tetsu Ohnuma, Karthik Raghunathan, Krista L Haines, Vijay Krishnamoorthy

{"title":"Association of Area Deprivation Index With Mortality in Critically Ill Adults With COVID-19.","authors":"Ronald Harris, Morgan Rosser, Anand M Chowdhury, Tetsu Ohnuma, Karthik Raghunathan, Krista L Haines, Vijay Krishnamoorthy","doi":"10.4037/ajcc2024898","DOIUrl":"https://doi.org/10.4037/ajcc2024898","url":null,"abstract":"Background: Various social determinants of health have been established as significant risk factors for COVID-19 transmission, prevalence, incidence, and mortality. Area deprivation index (ADI, a composite score made up of educational, housing, and poverty markers) is an accepted multidimensional social determinants of health measure. Little is known about how structural social determinants of health before hospitalization, including ADI, may affect mortality related to COVID-19 in critically ill patients.Objectives: To examine the association of ADI with intensive care unit (ICU) mortality in patients with COVID-19 and compare its predictive power with that of clinical factors.Methods: This was a retrospective cohort study of critically ill adults with COVID-19 in 3 hospitals within a single health system. Multivariable logistic regression models (adjusted for demographic and clinical variables) were used to examine the association of ADI with ICU mortality.Results: Data from 1784 patients hospitalized from 2020 to 2022 were analyzed. In multivariable models, no association was found between national ADI and ICU mortality. Notable factors associated with ICU mortality included treatment year, age, van Walraven weighted score, invasive mechanical ventilation, and body mass index.Conclusion: In this study, clinical factors were more predictive of mortality than ADI and other social determinants of health. The influence of ADI may be most relevant before hospital admission. These findings could serve as a foundation for shaping targeted public health strategies and hospital interventions, enhancing care delivery, and potentially contributing to better outcomes in future pandemics.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 6","pages":"446-454"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556917","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

The Lived Experiences of Telemedicine Intensive Care Unit Nurses. 远程医疗重症监护室护士的生活经历。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-11-01 DOI: 10.4037/ajcc2024930

Annie George

{"title":"The Lived Experiences of Telemedicine Intensive Care Unit Nurses.","authors":"Annie George","doi":"10.4037/ajcc2024930","DOIUrl":"https://doi.org/10.4037/ajcc2024930","url":null,"abstract":"Background: Although nurses are the primary clinicians in telemedicine intensive care units (tele-ICUs), their experiences remain underresearched.Objective: To describe and interpret the lived experiences of tele-ICU nurses.Methods: A qualitative, hermeneutical, phenomenological approach based on van Manen's methodology was used to collect and interpret interview data. In-depth interviews were conducted with 11 tele-ICU nurses affiliated with a health system in the northeastern United States. The interviews were intended to elicit direct reports of specific incidents to capture the phenomenological experience. Field observations of the practice setting were conducted to enhance data richness.Results: The participants were primarily female, aged 34 to 67 years, with 11 to 45 years of nursing experience. The following 4 major themes and 12 subthemes were identified: (1) watching intensively and panoptically, with subthemes (a) affirming unremitting diligence, (b) uncovering virtual knowing, and (c) easing perceptions of intrusion; (2) transcending complex boundaries, with subthemes (a) building trustful collaboration, (b) discerning vigilant interventions, and (c) exercising skillful investigation; (3) transforming nursing practice, with subthemes (a) mastering tact, (b) delineating the critical wholeness, and (c) augmenting safety and quality of care; and (4) developing an e-identity, with subthemes (a) tempering feelings of working in shadows, (b) evolving to the enhanced specialist role, and (c) achieving professional gratification.Conclusions: Tele-ICU nurses play a transformative role in nursing practice. These findings have implications for nursing practice, education, health policy, enhancement of the current American Association of Critical-Care Nurses (AACN) Tele-ICU Nursing Practice Model, and future research on ICU telemedicine.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 6","pages":"421-432"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556929","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