Nurses' worry or concern and early recognition of deteriorating patients on general wards in acute care hospitals: a systematic review. Critical Care, 2015, 19: 230
Douw, G., et al.
http://ccforum.com/content/pdf/s13054-015-0950-5.pdf
Nurses often recognize deterioration in patients through intuition rather than through routine vital signs measurement. Adding the ‘worry/concern’ sign to the Rapid Response System provides opportunities for nurses to act upon their intuitive feelings. Identifying what triggers nurses to be ‘worried/concerned’ might help to put intuition into words and potentially empower nurses to act upon their intuitive feelings and obtain medical assistance in an early stage of deterioration. The aim of this systematic review is to identify the signs and symptoms that trigger nurses’ ‘worry/concern’ about a patients’ condition. Method We searched the databases Pubmed, CINAHL, Psychinfo and Cochrane Library (Clinical Trials) using synonyms related to the three concepts:“nurses”, “worry/concern” and “deterioration”. We included studies concerning adult patients on general wards in acute care hospitals. The search was performed from start of the databases until February 14, 2014. Results: The search resulted in 4006 references, 18 studies (5 quantitative, 9 qualitative and 4 mixed-methods designs) were included in the review. Thirty-seven signs and symptoms reflecting the nature of ‘worry/concern’, emerged from the data and were summarized in 10 general indicators. ‘Worry/concern’ can be present both with or without change in vital signs. Conclusions: The signs and symptoms we found in the literature reflect the nature of nurses’ ‘worry/concern’ and nurses may incorporate these signs in their assessment of the patient and the decision to call for assistance. Its presence before vital signs have changed, suggests potential for improving care in an early stage of deterioration.
Thursday, 28 May 2015
Management and outcome of mechanically ventilated patients after cardiac arrest
Management and outcome of mechanically ventilated patients after cardiac arrest. Critical Care 2015, 19: 215
Sutherasan, Y., et al.
http://ccforum.com/content/pdf/s13054-015-0922-9.pdf
The aim of this study was to describe and compare the changes in ventilator management and complications over time as well as variables associated with 28-day hospital mortality in patients receiving mechanical ventilation (MV) after cardiac arrest. Methods Secondary analysis of three prospective, observational multicenter studies conducted in 1998, 2004 and 2010 in 927 intensive care units (ICUs) from 40 countries. We screened 18,302 patients receiving MV for longer than 12 hours during a one-month period. We included 812 patients receiving MV after cardiac arrest. We collected demographics, daily ventilator settings, complications during ventilation and outcomes. Multivariate logistic regression analysis was performed to calculate odds ratios determining that which variables within 24 hours of hospital admission were associated with 28-day hospital mortality and the occurrence of ARDS and pneumonia acquired during ICU stay at 48 hours after admission. Results: Among 812 patients, 100 were included from 1998, 239 from 2004 and 473 from 2010. Ventilatory management changed over time with decreased tidal volumes (VT) [from a mean 8.9 (standard deviation 2) ml/kg actual body weight (ABW) in 1998 to 6.7(2) ml/kg ABW in 2010 and from 9(2.3) ml/kg predicted body weight (PBW) in 2004 to 7.95(1.7) ml/kg PBW in 2010] and increased positive end-expiratory pressure (PEEP) [from 3.5(3) in 1998 to 6.5(3) in 2010] (p <0.001). Patients included in 2010 had more sepsis, cardiovascular dysfunction and neurologic failure but 28-day hospital mortality was similar over the time (52% in 1998, 57% in 2004 and 52% in 2010). Variables independently associated with 28-day hospital mortality were: older age, PaO2 < 60 mmHg, cardiovascular dysfunction and less use of sedative agents. Higher VT, and plateau pressure with lower PEEP were associated with the occurrence of ARDS and pneumonia acquired during ICU stay. Conclusions: Protective mechanical ventilation with lower VT and higher PEEP is more commonly used after cardiac arrest. The incidence of pulmonary complications decreased, while other non-respiratory organ failures increased with time. The application of protective mechanical ventilation and the prevention of single and multiple organ failure may be considered to improve outcome in patients after cardiac arrest.
Sutherasan, Y., et al.
http://ccforum.com/content/pdf/s13054-015-0922-9.pdf
The aim of this study was to describe and compare the changes in ventilator management and complications over time as well as variables associated with 28-day hospital mortality in patients receiving mechanical ventilation (MV) after cardiac arrest. Methods Secondary analysis of three prospective, observational multicenter studies conducted in 1998, 2004 and 2010 in 927 intensive care units (ICUs) from 40 countries. We screened 18,302 patients receiving MV for longer than 12 hours during a one-month period. We included 812 patients receiving MV after cardiac arrest. We collected demographics, daily ventilator settings, complications during ventilation and outcomes. Multivariate logistic regression analysis was performed to calculate odds ratios determining that which variables within 24 hours of hospital admission were associated with 28-day hospital mortality and the occurrence of ARDS and pneumonia acquired during ICU stay at 48 hours after admission. Results: Among 812 patients, 100 were included from 1998, 239 from 2004 and 473 from 2010. Ventilatory management changed over time with decreased tidal volumes (VT) [from a mean 8.9 (standard deviation 2) ml/kg actual body weight (ABW) in 1998 to 6.7(2) ml/kg ABW in 2010 and from 9(2.3) ml/kg predicted body weight (PBW) in 2004 to 7.95(1.7) ml/kg PBW in 2010] and increased positive end-expiratory pressure (PEEP) [from 3.5(3) in 1998 to 6.5(3) in 2010] (p <0.001). Patients included in 2010 had more sepsis, cardiovascular dysfunction and neurologic failure but 28-day hospital mortality was similar over the time (52% in 1998, 57% in 2004 and 52% in 2010). Variables independently associated with 28-day hospital mortality were: older age, PaO2 < 60 mmHg, cardiovascular dysfunction and less use of sedative agents. Higher VT, and plateau pressure with lower PEEP were associated with the occurrence of ARDS and pneumonia acquired during ICU stay. Conclusions: Protective mechanical ventilation with lower VT and higher PEEP is more commonly used after cardiac arrest. The incidence of pulmonary complications decreased, while other non-respiratory organ failures increased with time. The application of protective mechanical ventilation and the prevention of single and multiple organ failure may be considered to improve outcome in patients after cardiac arrest.
A comphrensive method to develop a checklist to increase safety of intra-hospital transport of critically ill patients
A comprehensive method to develop a checklist to increase safety of intra-hospital transport of critically ill patients. Critical Care 2015, 19: 214
Brunsveld-Reinders, A.H., et al.
http://ccforum.com/content/19/1/214
Transport of critically ill patients from the Intensive Care Unit (ICU) to other departments for diagnostic or therapeutic procedures is often a necessary part of the critical care process. Transport of critically ill patients is potentially dangerous with up to 70% adverse events occurring. The aim of this study was to develop a checklist to increase safety of intra-hospital transport (IHT) in critically ill patients.
Brunsveld-Reinders, A.H., et al.
http://ccforum.com/content/19/1/214
Transport of critically ill patients from the Intensive Care Unit (ICU) to other departments for diagnostic or therapeutic procedures is often a necessary part of the critical care process. Transport of critically ill patients is potentially dangerous with up to 70% adverse events occurring. The aim of this study was to develop a checklist to increase safety of intra-hospital transport (IHT) in critically ill patients.
The volume-outcome relationship in critically ill patients in relation to the ICU-to-hospital bed ratio
The volume-outcome relationship in critically ill patients in relation to the ICU-to-hospital-bed ratio. Critical Care Medicine, June 2015, Vol. 43(6), p.1239-45.
Sasabuchi, Y., et al.
http://journals.lww.com/ccmjournal/Abstract/2015/06000/The_Volume_Outcome_Relationship_in_Critically_Ill.13.aspx
A volume-outcome relationship in ICU patients has been suggested in recent studies. However, it is unclear whether the ICU-to-hospital bed ratio affects the volume-outcome relationship. The aim of this study is to investigate the relationship between hospital volume and in-hospital mortality of adult ICU patients in relation to the ratio of ICU beds to regular hospital beds.
Sasabuchi, Y., et al.
http://journals.lww.com/ccmjournal/Abstract/2015/06000/The_Volume_Outcome_Relationship_in_Critically_Ill.13.aspx
A volume-outcome relationship in ICU patients has been suggested in recent studies. However, it is unclear whether the ICU-to-hospital bed ratio affects the volume-outcome relationship. The aim of this study is to investigate the relationship between hospital volume and in-hospital mortality of adult ICU patients in relation to the ratio of ICU beds to regular hospital beds.
Understanding and reducing disability in older adults following critical illness
Understanding and reducing disability in older adults following critical illness. Critical Care Medicine, May 2015, Vol. 43(6), p.1265-75.
Brummel, N.E., et al.
http://journals.lww.com/ccmjournal/Abstract/2015/06000/Understanding_and_Reducing_Disability_in_Older.16.aspx
To review how disability can develop in older adults with critical illness and to explore ways to reduce long-term disability following critical illness.
Brummel, N.E., et al.
http://journals.lww.com/ccmjournal/Abstract/2015/06000/Understanding_and_Reducing_Disability_in_Older.16.aspx
To review how disability can develop in older adults with critical illness and to explore ways to reduce long-term disability following critical illness.
Stress disorders following prolonged critical illness in survivors of severe sepsis
Stress disorders following prolonged critical illness in survivors of severe sepsis. Critical Care Medicine, May 2015, Vol. 43(6), p.1213-22.
Wintermann, G.B., et al.
http://journals.lww.com/ccmjournal/Abstract/2015/06000/Stress_Disorders_Following_Prolonged_Critical.10.aspx
To examine the frequency of acute stress disorder and posttraumatic stress disorder in chronically critically ill patients with a specific focus on severe sepsis, to classify different courses of stress disorders from 4 weeks to 6 months after transfer from acute care hospital to postacute rehabilitation, and to identify patients at risk by examining the relationship between clinical, demographic, and psychological variables and stress disorder symptoms.
Wintermann, G.B., et al.
http://journals.lww.com/ccmjournal/Abstract/2015/06000/Stress_Disorders_Following_Prolonged_Critical.10.aspx
To examine the frequency of acute stress disorder and posttraumatic stress disorder in chronically critically ill patients with a specific focus on severe sepsis, to classify different courses of stress disorders from 4 weeks to 6 months after transfer from acute care hospital to postacute rehabilitation, and to identify patients at risk by examining the relationship between clinical, demographic, and psychological variables and stress disorder symptoms.
Hospitals with the highest intensive care utilization provide lower quality pneumonia care to the elderly
Hospitals with the highest intensive care utilization provide lower quality pneumonia care to the elderly. Critical Care Medicine, May 2015, Vol. 43(6), p.1178-86.
Sjoding, M.W., et al.
http://journals.lww.com/ccmjournal/Abstract/2015/06000/Hospitals_With_the_Highest_Intensive_Care.6.aspx
Quality of care for patients admitted with pneumonia varies across hospitals, but causes of this variation are poorly understood. Whether hospitals with high ICU utilization for patients with pneumonia provide better quality care is unknown. We sought to investigate the relationship between a hospital’s ICU admission rate for elderly patients with pneumonia and the quality of care it provided to patients with pneumonia.
Sjoding, M.W., et al.
http://journals.lww.com/ccmjournal/Abstract/2015/06000/Hospitals_With_the_Highest_Intensive_Care.6.aspx
Quality of care for patients admitted with pneumonia varies across hospitals, but causes of this variation are poorly understood. Whether hospitals with high ICU utilization for patients with pneumonia provide better quality care is unknown. We sought to investigate the relationship between a hospital’s ICU admission rate for elderly patients with pneumonia and the quality of care it provided to patients with pneumonia.
Long-term association between frailty and health-related quality of life amongst survivors of critical illness
Long-term association between frailty and health-related quality of life among survivors of critical illness: A prospective multi-center cohort study. Critical Care Medicine, May 2015, Vol. 34(5), p.973-82.
Bagshaw, S.M., et al.
http://journals.lww.com/ccmjournal/Abstract/2015/05000/Long_Term_Association_Between_Frailty_and.7.aspx
Frailty is a multidimensional syndrome characterized by loss of physiologic reserve that gives rise to vulnerability to poor outcomes. We aimed to examine the association between frailty and long-term health-related quality of life among survivors of critical illness.
Bagshaw, S.M., et al.
http://journals.lww.com/ccmjournal/Abstract/2015/05000/Long_Term_Association_Between_Frailty_and.7.aspx
Frailty is a multidimensional syndrome characterized by loss of physiologic reserve that gives rise to vulnerability to poor outcomes. We aimed to examine the association between frailty and long-term health-related quality of life among survivors of critical illness.
Psychosocial outcomes in informal caregivers of the critically ill
Psychosocial outcomes in informal caregivers of the critically ill: A systematic review. Critical Care Medicine, May 2015, Vol. 43(5), p.1112-20.
Haines, K.J., et al.
http://journals.lww.com/ccmjournal/Abstract/2015/05000/Psychosocial_Outcomes_in_Informal_Caregivers_of.24.aspx
The objective of the review was to evaluate and synthesize the prevalence, risk factors, and trajectory of psychosocial morbidity in informal caregivers of critical care survivors.
Haines, K.J., et al.
http://journals.lww.com/ccmjournal/Abstract/2015/05000/Psychosocial_Outcomes_in_Informal_Caregivers_of.24.aspx
The objective of the review was to evaluate and synthesize the prevalence, risk factors, and trajectory of psychosocial morbidity in informal caregivers of critical care survivors.
Rehabilitation during mechanical ventilation
Rehabilitation during mechanical ventilation: Review of the recent literature. Intensive and Critical Care Nursing, 2015 [in press]
Ntoumenopoulos, G.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(15)00006-3/abstract?rss=yes
Mechanically ventilated patients are at increased risk of developing physical and psychological complications that are associated with prolonged weaning from mechanical ventilation, increased morbidity and mortality. These complications include intensive care unit acquired weakness, delirium and a loss of physical function that may persist well beyond ICU and hospital discharge.
Ntoumenopoulos, G.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(15)00006-3/abstract?rss=yes
Mechanically ventilated patients are at increased risk of developing physical and psychological complications that are associated with prolonged weaning from mechanical ventilation, increased morbidity and mortality. These complications include intensive care unit acquired weakness, delirium and a loss of physical function that may persist well beyond ICU and hospital discharge.
Contributors to fatigue in patients receiving mechanical ventilatory support
Contributors to fatigue in patients receiving mechanical ventilatory support: A descriptive correlational study. Intensive and Critical Care Nursing, May 2015 [in press]
Chlan, L.L. and Savik, K.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(15)00024-5/abstract?rss=yes
To describe levels of fatigue and explore clinical factors that might contribute to fatigue in critically ill patients receiving mechanical ventilation.
Chlan, L.L. and Savik, K.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(15)00024-5/abstract?rss=yes
To describe levels of fatigue and explore clinical factors that might contribute to fatigue in critically ill patients receiving mechanical ventilation.
ICU family communication and health care professionals
ICU family communication and health care professionals: A qualitative analysis of perspectives. Intensive and Critical Care Nursing, May 2015 [in press]
Schubart, J.R. et al.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(15)00019-1/abstract?rss=yes
Although ineffective communication is known to influence patient and family satisfaction with care in intensive care unit [ICU] settings, there has been little systematic analysis of the features of the perceived problem from a communication theory perspective. This study was undertaken to understand perceptions of miscommunication and the circumstances in which they present.
Schubart, J.R. et al.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(15)00019-1/abstract?rss=yes
Although ineffective communication is known to influence patient and family satisfaction with care in intensive care unit [ICU] settings, there has been little systematic analysis of the features of the perceived problem from a communication theory perspective. This study was undertaken to understand perceptions of miscommunication and the circumstances in which they present.
Severity of delirium in the ICU is associated with short term cognitive impairment
Severity of delirium in the ICU is associated with short term cognitive impairment. A prospective cohort study. Intensive and Critical Care Nursing, May 2015 [in press]
Sakuramoto, H. et al.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(15)00002-6/abstract?rss=yes
To examine the hypothesis that severity of delirium in the intensive care unit (ICU) is positively associated with cognitive impairment at the time of hospital discharge.
Sakuramoto, H. et al.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(15)00002-6/abstract?rss=yes
To examine the hypothesis that severity of delirium in the intensive care unit (ICU) is positively associated with cognitive impairment at the time of hospital discharge.
Intensive care patients' perceptions of how their dignity is maintained
Intensive care patients' perceptions of how their dignity is maintained: A phenomomenalogical study. Intensive and Critical Care Nursing, May 2015 [in press]
Moen, E.K. and Naden, D.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(15)00022-1/abstract?rss=yes
The aim of the study was to acquire knowledge of what contributes to maintaining and promoting the dignity of intensive care patients.
Moen, E.K. and Naden, D.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(15)00022-1/abstract?rss=yes
The aim of the study was to acquire knowledge of what contributes to maintaining and promoting the dignity of intensive care patients.
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