American Journal of Critical Care最新文献_第9页

Acute Symptom Onset During Exercise Stress Testing. 运动压力测试期间出现的急性症状。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023381

Dillon J Dzikowicz, Teri M Kozik, Michele M Pelter

引用次数: 0

Associations Between Core Temperature Disorders and Outcomes of Pediatric Intensive Care Unit Patients. 核心体温障碍与儿科重症监护病房患者预后的关系。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023567

Panagiotis Kiekkas, Grigorios Kourtis, Paraskevi Feizidou, Michael Igoumenidis, Eleni Almpani, Anastasios Tzenalis

{"title":"Associations Between Core Temperature Disorders and Outcomes of Pediatric Intensive Care Unit Patients.","authors":"Panagiotis Kiekkas, Grigorios Kourtis, Paraskevi Feizidou, Michael Igoumenidis, Eleni Almpani, Anastasios Tzenalis","doi":"10.4037/ajcc2023567","DOIUrl":"10.4037/ajcc2023567","url":null,"abstract":"Background: The few studies of associations between fever and outcomes in pediatric intensive care unit (PICU) patients have conflicting findings. Associations between hypothermia and patient outcomes have not been studied.Objective: To investigate the incidence and characteristics of fever and hypothermia and their associations with adverse outcomes among PICU patients.Methods: Patients consecutively admitted to 2 PICUs in a 2-year period were prospectively studied. Core temperature was mainly measured by rectal or axillary thermometry. Fever and hypothermia were defined as core temperatures of greater than 38.0 °C and less than 36.0 °C, respectively. Prolonged mechanical ventilation, prolonged PICU stay, and PICU mortality were the adverse patient outcomes studied. Associations between patient outcomes and core temperature disorders were evaluated with univariate comparisons and multivariate analyses.Results: Of 545 patients enrolled, fever occurred in 299 (54.9%) and hypothermia occurred in 161 (29.5%). Both temperature disorders were independently associated with prolonged mechanical ventilation and prolonged PICU stay (P < .001) but not with PICU mortality. Late onset of fever (P < .001) and hypothermia (P = .009) were independently associated with prolonged mechanical ventilation, fever magnitude and duration (both P < .001) were independently associated with prolonged PICU stay, and fever magnitude (P < .001) and infectious cause of hypothermia (P= .01) were independently associated with higher PICU mortality.Conclusions: These findings provide evidence that the manifestation and characteristics of fever and hypothermia are independent predictors of adverse outcomes in PICU patients.","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":"10144427","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 Laures Article. 劳雷斯文章讨论指南

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023696

Grant A Pignatiello

引用次数: 0

Factors Associated With Initiation of Mechanical Ventilation in Patients With Sepsis: Retrospective Observational Study. 脓毒症患者开始机械通气的相关因素：回顾性观察研究。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023299

Robert E Freundlich, Gen Li, Aleda Leis, Milo Engoren

{"title":"Factors Associated With Initiation of Mechanical Ventilation in Patients With Sepsis: Retrospective Observational Study.","authors":"Robert E Freundlich, Gen Li, Aleda Leis, Milo Engoren","doi":"10.4037/ajcc2023299","DOIUrl":"10.4037/ajcc2023299","url":null,"abstract":"Background: Patients with sepsis are at risk for mechanical ventilation. This study aimed to identify risk factors for initiation of mechanical ventilation in patients with sepsis and assess whether these factors varied with time.Methods: Data from the electronic health record were used to model risk factors for initiation of mechanical ventilation after the onset of sepsis. A time-varying Cox model was used to study factors that varied with time.Results: Of 35 020 patients who met sepsis criteria, 28 747 were eligible for inclusion. Mechanical ventilation was initiated within 30 days after sepsis onset in 3891 patients (13.5%). Factors that were independently associated with increased likelihood of receipt of mechanical ventilation were race (White: adjusted hazard ratio [HR], 1.59; 95% CI, 1.39-1.83; other/unknown: adjusted HR, 1.97; 95% CI, 1.54-2.52), systemic inflammatory response syndrome (adjusted HR [per point], 1.23; 95% CI, 1.17-1.28), Sequential Organ Failure Assessment score (adjusted HR [per point], 1.28; 95% CI, 1.26-1.31), and congestive heart failure (adjusted HR, 1.30; 95% CI, 1.17-1.45). Hazard ratios decreased with time for Sequential Organ Failure Assessment score and congestive heart failure and varied with time for 4 comorbidities and 3 culture results.Conclusions: The risk for mechanical ventilation associated with different factors varied with time after sepsis onset, increasing for some factors and decreasing for others. Through a better understanding of risk factors for initiation of mechanical ventilation in patients with sepsis, targeted interventions may be tailored to high-risk patients.","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10577809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10144431","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

Residual Psychomotor Skills of Orderlies After a Novel Chest Compression Training Intervention. 新型胸部按压训练干预后勤务兵剩余心理运动技能。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023772

Philippe Voizard, Christian Vincelette, François Martin Carrier, Catalina Sokoloff

{"title":"Residual Psychomotor Skills of Orderlies After a Novel Chest Compression Training Intervention.","authors":"Philippe Voizard, Christian Vincelette, François Martin Carrier, Catalina Sokoloff","doi":"10.4037/ajcc2023772","DOIUrl":"10.4037/ajcc2023772","url":null,"abstract":"Background: High-quality chest compressions are essential to favorable patient outcomes after in-hospital cardiac arrest. Without frequent training, however, skill in performing compressions declines considerably. The Timely Chest Compression Training (T-CCT) intervention was introduced in 2019 as a quality improvement initiative to address this problem. The long-term impact of the T-CCT is unknown.Methods: A cohort study was conducted at a university-affiliated hospital in Quebec, Canada. Chest compression performance among orderlies was measured by using a subtractive scoring model and mannequins. The association of exposure to the T-CCT 10 months earlier with having an excellent chest compression performance (score ≥90 out of 100), after adjusting for potential confounders, was examined.Results: A total of 412 orderlies participated in the study. More than half (n = 232, 56%) had been exposed to the T-CCT, and the rest (n = 180, 44%) had not. Nearly half (n = 106, 46%) of orderlies exposed to the T-CCT had an excellent performance, compared with less than one-third (n = 53, 30%) of nonexposed orderlies. In univariable analysis, previous exposure to the T-CCT was associated with 1.53 times greater risk of having an excellent performance (risk ratio, 1.53; 95% CI, 1.17-1.99). This effect remained after adjustment for potential confounders (risk ratio, 1.57; 95% CI, 1.19-2.07).Conclusion: The results of this study suggest that the T-CCT has a lasting effect on the psychomotor skills of orderlies 10 months after initial exposure. Further research should investigate the impact of the intervention on patient outcomes after in-hospital cardiac arrest.","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":"10135679","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 : 2023-09-01 DOI: 10.4037/ajcc2023578

Rhonda Board

引用次数: 0

Systems-Based Physical Assessments: Earlier Detection of Clinical Deterioration and Reduced Mortality. 基于系统的身体评估：早期发现临床恶化和降低死亡率。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023113

Shannan K Hamlin, Nicole M Fontenot, Steven J Hooker, Hsin-Mei Chen

{"title":"Systems-Based Physical Assessments: Earlier Detection of Clinical Deterioration and Reduced Mortality.","authors":"Shannan K Hamlin, Nicole M Fontenot, Steven J Hooker, Hsin-Mei Chen","doi":"10.4037/ajcc2023113","DOIUrl":"10.4037/ajcc2023113","url":null,"abstract":"Background: Despite efforts to improve early detection of deterioration in a patient's condition, delays in activating the rapid response team remain common.Objectives: To evaluate delays in activating the rapid response team and the occurrence of serious adverse events before and after implementation of a quality improvement initiative aimed at nurses' performing systems-based physical assessments.Methods: A retrospective observational cohort design was used to evaluate all patients who had a rapid response team activation during the study period.Results: A total of 1080 patients were included in the analysis: 536 patients before the quality improvement initiative and 544 patients after the quality improvement initiative. The delay in activating the rapid response team decreased from 11.7 hours in the before group to 9.6 hours in the after group (P < .001). In the after group, fewer patients were transferred to the intensive care unit (36% vs 41%, P = .02) and those who were transferred had 3.58 times greater odds of death than those who stayed at the same level of care. The after group had a 44% reduction in the odds of mortality compared with the before group.Conclusions: When nurses focus on conducting a systems-based physical assessment early in their shift, delays in recognizing a patient's deteriorating condition are reduced, fewer patients are admitted to the intensive care unit, and mortality is significantly reduced.","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":"10135680","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

Safe Placement of Feeding Tubes. 喂食管的安全放置。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023326

Jan Powers, Annette Bourgault, Lillian Aguirre

引用次数: 0

Resilience Through Growth. 通过成长增强复原力

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023146

Richard H Savel

引用次数: 0

Artificial Intelligence in Critical Care Practice and Research. 重症监护实践和研究中的人工智能。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023958

Cindy L Munro, Aluko A Hope

引用次数: 0