American Journal of Critical Care最新文献_第8页

Understanding and Managing Anxiety Sensitivity During Critical Illness and Long-Term Recovery. 了解和管理危重症和长期康复期间的焦虑敏感性。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-11-01 DOI: 10.4037/ajcc2023975

Leanne M Boehm, Claire M Bird, Ann Marie Warren, Valerie Danesh, Megan M Hosey, Joanne McPeake, Kelly M Potter, Han Su, Tammy L Eaton, Mark B Powers

{"title":"Understanding and Managing Anxiety Sensitivity During Critical Illness and Long-Term Recovery.","authors":"Leanne M Boehm, Claire M Bird, Ann Marie Warren, Valerie Danesh, Megan M Hosey, Joanne McPeake, Kelly M Potter, Han Su, Tammy L Eaton, Mark B Powers","doi":"10.4037/ajcc2023975","DOIUrl":"10.4037/ajcc2023975","url":null,"abstract":"Anxiety sensitivity is a fear of symptoms associated with anxiety (eg, rapid respiration and heart rate, perspiration), also known as \"fear of fear.\" This fear is a misinterpretation of nonthreatening symptoms as threatening across 3 domains: physical (\"When my heart rate increases, I'm afraid I may have a heart attack\"), social (\"If people see me perspire, I fear they will negatively evaluate me\"), and cognitive (\"When I feel these symptoms, I fear it means I'm going crazy or will lose control and do something dangerous like disconnect my IV\"). These thoughts stimulate the sympathetic nervous system, resulting in stronger sensations and further catastrophic misinterpretations, which may spiral into a panic attack. Strategies to address anxiety sensitivity include pharmacologic and nonpharmacologic interventions. In intensive care unit settings, anxiety sensitivity may be related to common monitoring and interventional procedures (eg, oxygen therapy, repositioning, use of urine collection systems). Anxiety sensitivity can be a barrier to weaning from mechanical ventilation when patients are uncomfortable following instructions to perform awakening or breathing trials. Fortunately, anxiety sensitivity is a malleable trait with evidence-based intervention options. However, few health care providers are aware of this psychological construct and available treatment. This article describes the nature of anxiety sensitivity, its potential impact on intensive care, how to assess and interpret scores from validated instruments such as the Anxiety Sensitivity Index, and treatment approaches across the critical care trajectory, including long-term recovery. Implications for critical care practice and future directions are also addressed.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10718181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71419713","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

Bed Rest Reduction Following Cardiac Catheterizations Using Vascular Closure Devices. 使用血管闭合装置进行心脏导管置入术后减少卧床休息。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-11-01 DOI: 10.4037/ajcc2023536

Kristin A Tuozzo, Reena Morris, Nicole Moskowitz, Kathleen McCauley, Anvar Babaev, Michael Attubato

{"title":"Bed Rest Reduction Following Cardiac Catheterizations Using Vascular Closure Devices.","authors":"Kristin A Tuozzo, Reena Morris, Nicole Moskowitz, Kathleen McCauley, Anvar Babaev, Michael Attubato","doi":"10.4037/ajcc2023536","DOIUrl":"10.4037/ajcc2023536","url":null,"abstract":"Background: Bed rest duration following deployment of a vascular closure device after transfemoral left-sided cardiac catheterization is not standardized. Despite research supporting reduced bed rest, many hospitals require prolonged bed rest. Delayed ambulation is associated with back pain, urine retention, difficulty eating, and longer stay.Objective: To study length of stay, safety, and opportunity cost savings of reduced bed rest at a large urban hospital.Methods: A single-site 12-week study of 1-hour bed rest after transfemoral cardiac catheterizations using vascular closure devices. Results were compared with historical controls treated similarly.Results: The standard bed rest group included 295 patients (207 male, 88 female; mean [SD] age, 64.4 [8.6] years). The early ambulation group included 260 patients (188 male, 72 female; mean [SD] age, 64 [9.3] years). The groups had no significant difference in age (t634 = 1.18, P = .21) or sex (χ12=0.2, P = .64). Three patients in the standard bed rest group and 1 in the early ambulation group had hematomas (P = .36). The stay for diagnostic cardiac catheterizations was longer in the standard bed rest group (mean [SD], 220.7 [55.2] minutes) than in the early ambulation group (mean [SD], 182.1 [78.5] minutes; t196 = 4.06; P < .001). Stay for percutaneous coronary interventions was longer in the standard bed rest group (mean [SD], 400.2 [50.8] minutes) than in the early ambulation group (mean [SD], 381.6 [54.7] minutes; t262 = 2.86; P = .005).Conclusion: Reduced bed rest was safe, shortened stays, and improved efficiency by creating opportunity cost savings.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71419704","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

Challenges Associated With Waveform Morphology Interpretation of 12-Lead Electrocardiograms. 与12导联心电图波形形态解释相关的挑战。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-11-01 DOI: 10.4037/ajcc2023896

Salah S Al-Zaiti, Sukardi Suba, Mary G Carey

引用次数: 0

Self-Care Mental Health App Intervention for Post-Intensive Care Syndrome-Family: A Randomized Pilot Study. 重症监护后综合征家庭的自我护理心理健康应用干预：一项随机试点研究。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-11-01 DOI: 10.4037/ajcc2023800

Amy B Petrinec, Cindy Wilk, Joel W Hughes, Melissa D Zullo, Richard L George

{"title":"Self-Care Mental Health App Intervention for Post-Intensive Care Syndrome-Family: A Randomized Pilot Study.","authors":"Amy B Petrinec, Cindy Wilk, Joel W Hughes, Melissa D Zullo, Richard L George","doi":"10.4037/ajcc2023800","DOIUrl":"10.4037/ajcc2023800","url":null,"abstract":"Background: Post-intensive care syndrome-family (PICS-F) is a constellation of adverse psychological symptoms experienced by family members of critically ill patients during and after acute illness. Cognitive behavioral therapy delivered using smartphone technology is a novel approach for PICS-F symptom self-management.Objective: To determine the efficacy of smartphone delivery of cognitive behavioral therapy in reducing the prevalence and severity of PICS-F symptoms in family members of critically ill patients.Methods: The study had a randomized controlled longitudinal design with control and intervention groups composed of family members of patients admitted to 2 adult intensive care units. The intervention consisted of a mental health app loaded on participants' personal smartphones. The study time points were upon enrollment (within 5 days of intensive care unit admission; time 1), 30 days after enrollment (time 2), and 60 days after enrollment (time 3). Study measures included demographic data, PICS-F symptoms, mental health self-efficacy, health-related quality of life, and app use.Results: The study sample consisted of 60 predominantly White (72%) and female (78%) family members (30 intervention, 30 control). Anxiety and depression symptom severity decreased significantly over time in the intervention group but not in the control group. Family members logged in to the app a mean of 11.4 times (range, 1-53 times) and spent a mean of 50.16 minutes (range, 1.87-245.92 minutes) using the app.Conclusions: Delivery of cognitive behavioral therapy to family members of critically ill patients via a smartphone app shows some efficacy in reducing PICS-F symptoms.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71419710","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 : 2023-11-01 DOI: 10.4037/ajcc2023192

Rhonda Board

引用次数: 0

Describing Anisocoria in Neurocritically Ill Patients. 描述神经危重症患者的嗅觉障碍。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-11-01 DOI: 10.4037/ajcc2023558

Ciji Saju, Arianna Barnes, Joji B Kuramatsu, Jade L Marshall, Hirofumi Obinata, Ava M Puccio, Shoji Yokobori, DaiWai M Olson

{"title":"Describing Anisocoria in Neurocritically Ill Patients.","authors":"Ciji Saju, Arianna Barnes, Joji B Kuramatsu, Jade L Marshall, Hirofumi Obinata, Ava M Puccio, Shoji Yokobori, DaiWai M Olson","doi":"10.4037/ajcc2023558","DOIUrl":"10.4037/ajcc2023558","url":null,"abstract":"Background: Anisocoria (unequal pupil size) has been defined using cut points ranging from greater than 0.3 mm to greater than 2.0 mm for absolute difference in pupil size. This study explored different pupil diameter cut points for assessing anisocoria as measured by quantitative pupillometry before and after light stimulus.Methods: An exploratory descriptive study of international registry data was performed. The first observations in patients with paired left and right quantitative pupillometry measurements were included. Measurements of pupil size before and after stimulus with a fixed light source were used to calculate anisocoria.Results: The sample included 5769 patients (mean [SD] age, 57.5 [17.6] years; female sex, 2558 patients [51.5%]; White race, 3669 patients [75.5%]). Anisocoria defined as pupil size difference of greater than 0.5 mm was present in 1624 patients (28.2%) before light stimulus; 645 of these patients (39.7%) also had anisocoria after light stimulus (P < .001). Anisocoria defined as pupil size difference of greater than 2.0 mm was present in 79 patients (1.4%) before light stimulus; 42 of these patients (53.2%) also had anisocoria after light stimulus (P < .001).Discussion: The finding of anisocoria significantly differed before and after light stimulus and according to the cut point used. At most cut points, fewer than half of the patients who had anisocoria before light stimulus also had anisocoria after light stimulus.Conclusion: The profound difference in the number of patients adjudicated as having anisocoria using different cut points reinforces the need to develop a universal definition for anisocoria.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71419708","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

"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":null,"pages":null},"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":null,"pages":null},"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