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

Point-of-Care Potassium Measurement vs Artificial Intelligence-Enabled Electrocardiography for Hyperkalemia Detection. 用于检测高钾血症的护理点血钾测量与人工智能心电图。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-01-01 DOI: 10.4037/ajcc2025597

Chin Lin, Chien-Chou Chen, Chin-Sheng Lin, Hung-Sheng Shang, Chia-Cheng Lee, Tom Chau, Shih-Hua Lin

{"title":"Point-of-Care Potassium Measurement vs Artificial Intelligence-Enabled Electrocardiography for Hyperkalemia Detection.","authors":"Chin Lin, Chien-Chou Chen, Chin-Sheng Lin, Hung-Sheng Shang, Chia-Cheng Lee, Tom Chau, Shih-Hua Lin","doi":"10.4037/ajcc2025597","DOIUrl":"https://doi.org/10.4037/ajcc2025597","url":null,"abstract":"Background: Hyperkalemia can be detected by point-of-care (POC) blood testing and by artificial intelligence- enabled electrocardiography (ECG). These 2 methods of detecting hyperkalemia have not been compared.Objective: To determine the accuracy of POC and ECG potassium measurements for hyperkalemia detection in patients with critical illness.Methods: This retrospective study involved intensive care patients in an academic medical center from October 2020 to September 2021. Patients who had 12-lead ECG, POC potassium measurement, and central laboratory potassium measurement within 1 hour were included. The POC potassium measurements were obtained from arterial blood gas analysis; ECG potassium measurements were calculated by a previously developed deep learning model. Hyperkalemia was defined as a central laboratory potassium measurement of 5.5 mEq/L or greater.Results: Fifteen patients with hyperkalemia and 252 patients without hyperkalemia were included. The POC and ECG potassium measurements were available about 35 minutes earlier than central laboratory results. Correlation with central laboratory potassium measurement was better for POC testing than for ECG (mean absolute errors of 0.211 mEq/L and 0.684 mEq/L, respectively). For POC potassium measurement, area under the receiver operating characteristic curve (AUC) to detect hyperkalemia was 0.933, sensitivity was 73.3%, and specificity was 98.4%. For ECG potassium measurement, AUC was 0.884, sensitivity was 93.3%, and specificity was 63.5%.Conclusions: The ECG potassium measurement, with its high sensitivity and coverage rate, may be used initially and followed by POC potassium measurement for rapid detection of life-threatening hyperkalemia.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 1","pages":"41-51"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909198","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

Impact of a Quality Cardiopulmonary Resuscitation Coach on Pediatric Intensive Care Unit Resuscitation Teams. 优质心肺复苏教练对儿科重症监护病房复苏团队的影响。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-01-01 DOI: 10.4037/ajcc2025828

Katie L McDermott, Kari L Rajzer-Wakeham, Jennifer M Andres, Ke Yan, Melodee A Liegl, Christine A Schindler

{"title":"Impact of a Quality Cardiopulmonary Resuscitation Coach on Pediatric Intensive Care Unit Resuscitation Teams.","authors":"Katie L McDermott, Kari L Rajzer-Wakeham, Jennifer M Andres, Ke Yan, Melodee A Liegl, Christine A Schindler","doi":"10.4037/ajcc2025828","DOIUrl":"https://doi.org/10.4037/ajcc2025828","url":null,"abstract":"Background: The quality cardiopulmonary resuscitation (CPR) coach role was developed for hospital-based resuscitation teams. This supplementary team member (CPR coach) provides real-time, verbal feedback on chest compression quality to compressors during a cardiac arrest.Objectives: To evaluate the impact of a quality CPR coach training intervention on resuscitation teams, including presence of coaches on teams and physiologic metrics of quality CPR delivery in real compression events.Methods: The quality CPR coach curriculum and role implementation were designed and evaluated using a logic model framework. Medical records of patients who had in-unit cardiopulmonary arrests were reviewed retrospectively. Data included physiologic metrics of quality CPR delivery. Analysis included descriptive statistics and comparison of arrest data before and after the intervention.Results: A total of 79 cardiopulmonary arrests were analyzed: 40 before and 39 after the intervention. Presence of a quality CPR coach on resuscitation teams was more frequent after training, increasing from 35% before the intervention to 72% after (P = .002). No significant difference was found in the frequency of application of Zoll defibrillator pads. Metrics of quality CPR delivery and adherence with American Heart Association recommendations were either unchanged or improved after the intervention.Conclusions: The quality CPR coach training intervention significantly increased coach presence on code teams, which was associated with clinically significant improvements in some metrics of quality CPR delivery in real cardiopulmonary arrests.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 1","pages":"21-29"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909097","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

Patient- and Family-Centered Outcomes After Intensive Care Unit Admission. 入住重症监护室后以患者和家属为中心的结果。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-01-01 DOI: 10.4037/ajcc2025684

Misty N Schreiner, Perry M Gee, Ramona O Hopkins, Jorie M Butler, Danielle Groat, Stephanie C Stokes, Sarah Beesley, Samuel M Brown, Eliotte L Hirshberg

{"title":"Patient- and Family-Centered Outcomes After Intensive Care Unit Admission.","authors":"Misty N Schreiner, Perry M Gee, Ramona O Hopkins, Jorie M Butler, Danielle Groat, Stephanie C Stokes, Sarah Beesley, Samuel M Brown, Eliotte L Hirshberg","doi":"10.4037/ajcc2025684","DOIUrl":"https://doi.org/10.4037/ajcc2025684","url":null,"abstract":"Background: Family satisfaction with intensive care is a measure of patient experience and patient-centered care. Among the factors that might influence family satisfaction are the timing of patient admittance to the intensive care unit (ICU), the ICU environment, and individual health care providers.Objective: To evaluate family satisfaction with the ICU and to explore associations between satisfaction and specific characteristics of the ICU stay.Methods: Participants were adult family members of ICU patients. One family member per patient was enrolled. Regression was used to test the association between time or day of admittance and scores on the Family Satisfaction With Care in the Intensive Care Unit survey. Additionally, we explored exposure to admitting physicians and registered nurses. Free-text survey comments were grouped by using qualitative content analysis.Results: Surveys were completed by 401 family members. There was no association between survey scores and providers, nor between scores and the time or day of the ICU admission. Three major themes emerged as important to patient and family satisfaction: (1) communication and information, (2) personalization or the patient as expert, and (3) staff and environment.Conclusions: Family satisfaction with an ICU admission was not influenced by the timing of the admission. Overall satisfaction with the ICU was high. The qualitative analysis points to the importance of collecting qualitative data in addition to using standard survey tools to capture the richness of patient experience. Ongoing efforts to engage with families remain critical to the practice of family- and patient-centered care in the ICU.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 1","pages":"12-20"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909197","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 : 2025-01-01 DOI: 10.4037/ajcc2025738

Rhonda Board

引用次数: 0

From Moral Distress to Moral Integrity: Qualitative Evaluation of a New Moral Conflict Assessment Tool. 从道德困境到道德正直：新道德冲突评估工具的定性评估。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-01-01 DOI: 10.4037/ajcc2025500

Soudabeh Jolaei, Patricia Rodney, Rosalie Starzomski, Peter Dodek

{"title":"From Moral Distress to Moral Integrity: Qualitative Evaluation of a New Moral Conflict Assessment Tool.","authors":"Soudabeh Jolaei, Patricia Rodney, Rosalie Starzomski, Peter Dodek","doi":"10.4037/ajcc2025500","DOIUrl":"https://doi.org/10.4037/ajcc2025500","url":null,"abstract":"Background: Moral distress affects the well-being of health care professionals and can lead to burnout and attrition. Assessing moral distress and taking action based on this assessment are important. A new moral conflict assessment (MCA) designed to prompt action was developed and tested.Objective: To evaluate the utility of the MCA.Methods: All intensive care unit professionals in 3 hospitals were invited to attend a presentation about the MCA and to participate in semistructured interviews that followed the steps of the MCA. Transcriptions of interviews were interpreted by using qualitative content analysis.Results: Analysis of individual interviews of 7 participants and 1 focus group of 3 participants revealed that the MCA was a catalyst for expressing feelings and characterizing moral distress, but optimal use required a facilitator. Participants noted that prevention and amelioration of moral distress were determined by organizational culture issues such as consistent understanding of what can be accomplished in the intensive care unit, resolution of power imbalances among staff, and psychological safety to mention moral issues. Structural determinants included disparate work and education schedules between nurses and physicians. Leader determinants included listening to staff and ensuring accountability to address causes and consequences of moral distress. Education and communication were proposed most often as solutions for moral distress.Conclusions: The evaluation revealed positive and negative features of the MCA. Prevention and amelioration of moral distress require attention to cultural, structural, and leadership issues through education and communication.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 1","pages":"52-59"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909096","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

A 12-Lead Electrocardiography Patch for Continuous Arrhythmia Monitoring: A Case Example. 用于持续心律失常监测的12导联心电图贴片：一例。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-01-01 DOI: 10.4037/ajcc2025802

Dillon J Dzikowicz, Sukardi Suba, Salah Al-Zaiti

引用次数: 0

Noninvasive Ventilation and Mortality During COVID-19: What Could Have Been Wrong? COVID-19期间的无创通气和死亡率：可能出了什么问题？

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-01-01 DOI: 10.4037/ajcc2025543

Stefano Bambi, Pasquale Iozzo, Yari Bardacci, Carolina Forciniti, Alberto Lucchini

引用次数: 0

Skilled Communication and the Pursuit of Perfect Cardiopulmonary Resuscitation. 娴熟的沟通和追求完美的心肺复苏。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-01-01 DOI: 10.4037/ajcc2025920

Cindy Cain

引用次数: 0

The Intensive Care Unit: Tomorrow and Beyond. 重症监护室：明天和未来。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-11-01 DOI: 10.4037/ajcc2024936

Lakshman Swamy, Cindy L Munro

引用次数: 0

Factors Associated With Parent-Perceived Miscommunication in the Pediatric Intensive Care Unit. 儿科重症监护室中家长认为沟通不畅的相关因素。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-11-01 DOI: 10.4037/ajcc2024596

Jesse R Wool, Jesse Chittams, Salimah Meghani, Wynne Morrison, Janet Deatrick, Connie M Ulrich

{"title":"Factors Associated With Parent-Perceived Miscommunication in the Pediatric Intensive Care Unit.","authors":"Jesse R Wool, Jesse Chittams, Salimah Meghani, Wynne Morrison, Janet Deatrick, Connie M Ulrich","doi":"10.4037/ajcc2024596","DOIUrl":"https://doi.org/10.4037/ajcc2024596","url":null,"abstract":"Background: Parents of children in pediatric intensive care units have varied communication experiences with health care professionals. Little is known about factors associated with parents' perceptions of miscommunication.Objective: To examine children's clinical and parents' demographic and psychosocial factors associated with perceptions of miscommunication in the pediatric intensive care unit.Methods: This study was a cross-sectional survey of parents of children admitted to the pediatric intensive care unit between January 1, 2018, and February 29, 2020, with a stay of greater than 24 hours.Results: Most of the 200 parent respondents were female (83.4%), White (71.4%), and non-Hispanic (87.9%); median age was 39 years (mean [SD], 40.2 [8.75] years); 17.6% were Black or African American. Among 210 children, mean (SD) age was 6.1 (6.02) years, mean (SD) stay was 4.5 (6.2) days, 38.6% were admitted because of respiratory illness, and the admission was the first for 51.0%. Of the parents, 16.5% reported miscommunication in the pediatric intensive care unit. In multivariable linear regressions, parents' stress (β = 0.286), parents' views of clinician communication (β = -0.400), parents' trust in physicians (β = -0.147), and length of stay (β = 0.122) accounted for 45% of the explained variance in parent-perceived miscommunication (R2 = 0.448, F = 41.19, P < .001).Conclusions: Parental stress and trust in physician scores were associated with perceived miscommunication. Further research is needed to understand the causes and consequences of miscommunication in order to support hospitalized children and their parents.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 6","pages":"402-409"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556921","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