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Emergency intensive critical care

Jie Chen, Jian Yang, Fen Hu, Si-Hong Yu, Bing-Xiang Yang, Qian Liu, Xiao-Ping Zhu
BACKGROUND: Simulation-based curriculum has been demonstrated as crucial to nursing education in the development of students' critical thinking and complex clinical skills during a resuscitation simulation. Few studies have comprehensively examined the effectiveness of a standardised simulation-based emergency and intensive care nursing curriculum on the performance of students in a resuscitation simulation. OBJECTIVE: To evaluate the impact of a standardised simulation-based emergency and intensive care nursing curriculum on nursing students' response time in a resuscitation simulation...
March 14, 2018: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
Shannon M Fernando, Douglas P Barnaby, Christophe L Herry, E John Gallagher, Nathan I Shapiro, Andrew J E Seely
BACKGROUND: Early emergency department (ED) identification of septic patients at risk of deterioration is critical. Lactate is associated with 28-day mortality in admitted patients, but little evidence exists on its use in predicting short-term deterioration. OBJECTIVE: Our aim was to determine the role of initial serum lactate for prediction of short-term deterioration in stable ED patients with suspected sepsis. METHODS: We conducted a prospective cohort study of adult ED sepsis patients...
March 13, 2018: Journal of Emergency Medicine
Jean Louis Trouillet, Olivier Collange, Fouad Belafia, François Blot, Gilles Capellier, Eric Cesareo, Jean-Michel Constantin, Alexandre Demoule, Jean-Luc Diehl, Pierre-Grégoire Guinot, Franck Jegoux, Erwan L'Her, Charles-Edouard Luyt, Yazine Mahjoub, Julien Mayaux, Hervé Quintard, François Ravat, Sebastien Vergez, Julien Amour, Max Guillot
Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method...
March 15, 2018: Annals of Intensive Care
Livio Provenzi, Sara Broso, Rosario Montirosso
Preterm infants are hospitalized in the Neonatal Intensive Care Unit (NICU) and are precociously separated from their mothers. Although developmental care interventions are meant to facilitate mother-infant bonding, physical contact is not always possible. Maternal voice exposure has been proposed as a way to foster maternal closeness and support postnatal bonding. Here we present a systematic review on maternal voice effects on preterm infants' development. Literature search occurred on 4 databases (PubMed, Scopus, Web of Science and CINAHL)...
March 10, 2018: Neuroscience and Biobehavioral Reviews
Katherine Murphy, Tim Cooksley, Phil Haji-Michael
Background: There has been a significant increase in the number of patients presenting with cancer related emergencies and potentially requiring critical care admission. Aim: To analyse the short and long term outcomes of patients with solid tumours requiring unplanned medical admission to a specialist cancer intensive care unit (ICU). Design: An unplanned cohort study. Methods: A retrospective analysis of patients admitted to a United Kingdom specialist tertiary oncology CCU between September 2009 and September 2015...
March 9, 2018: QJM: Monthly Journal of the Association of Physicians
A García-Salido, G Heras la Calle, A Serrano González
The humanization of care emerges as a response to something that seems indisputable: the scientific and technological developments in Intensive Care Units. Such development has improved the care of the critically ill patient in quantitative terms, but has perhaps caused the emotional needs of patients, families and professionals to be regarded as secondary concerns. The humanization of healthcare should be discussed without confusing or discussing the humanity displayed by professionals. In this paper we review and describe the different strategic lines proposed in order to secure humanized care, and adopt a critical approach to their adaptation and current status in the field of pediatric critical care...
March 8, 2018: Medicina Intensiva
Karen Parsons, Alice Gaudine, Michelle Swab
BACKGROUND: Most developed countries throughout the world are experiencing an aging nursing workforce as their population ages. Older nurses often experience different challenges then their younger nurse counterparts. With the increase in older nurses relative to younger nurses potentially available to work in hospitals, it is important to understand the experience of older nurses on high paced hospital nursing units. This understanding will lend knowledge to ways of lessening the loss of these highly skilled experienced workers and improve patient outcomes...
March 2018: JBI Database of Systematic Reviews and Implementation Reports
Chong Sherry Cheever, Celestina Barbosa-Leiker
OBJECTIVE: The aims of this study were to determine the prevalence and describe the importance of alcohol screening for all patients with traumatic brain injury (TBI) and examine the relationship between gender, age, Abbreviated Injury Scale (AIS), emergent decompressive craniectomy, Glasgow Coma Scale (GCS) from the emergency department (ED), and the length of stay with alcohol screening. METHOD: This is a retrospective analysis of de-identified data from the 2012 TBI registry of a level 1 trauma center in the Pacific Northwest...
April 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Wolf B Kratzert, Eva K Boyd, Johanna C Schwarzenberger
Survival of adults with congenital heart disease (CHD) has improved significantly over the last 2 decades, leading to an increase in hospital and intensive care unit (ICU) admissions of these patients. Whereas most of the ICU admissions in the past were related to perioperative management, the incidence of medical emergencies from long-term sequelae of palliative or corrective surgical treatment of these patients is rising. Intensivists now are confronted with patients who not only have complex anatomy after congenital cardiac surgery, but also complex pathophysiology due to decades of living with abnormal cardiac anatomy and diseases of advanced age...
November 16, 2017: Journal of Cardiothoracic and Vascular Anesthesia
Philippe Montravers, Florence Tubach, Thomas Lescot, Benoit Veber, Marina Esposito-Farèse, Philippe Seguin, Catherine Paugam, Alain Lepape, Claude Meistelman, Joel Cousson, Antoine Tesniere, Gaetan Plantefeve, Gilles Blasco, Karim Asehnoune, Samir Jaber, Sigismond Lasocki, Herve Dupont
PURPOSE: Shortening the duration of antibiotic therapy (ABT) is a key measure in antimicrobial stewardship. The optimal duration of ABT for treatment of postoperative intra-abdominal infections (PIAI) in critically ill patients is unknown. METHODS: A multicentre prospective randomised trial conducted in 21 French intensive care units (ICU) between May 2011 and February 2015 compared the efficacy and safety of 8-day versus 15-day antibiotic therapy in critically ill patients with PIAI...
February 26, 2018: Intensive Care Medicine
Keibun Liu, Takayuki Ogura, Kunihiko Takahashi, Mitsunobu Nakamura, Hiroaki Ohtake, Kenji Fujiduka, Emi Abe, Hitoshi Oosaki, Dai Miyazaki, Hiroyuki Suzuki, Mitsuaki Nishikimi, Alan Kawarai Lefor, Takashi Mato
Background: There are numerous barriers to early mobilization (EM) in a resource-limited intensive care unit (ICU) without a specialized team or an EM culture, regarding patient stability while critically ill or in the presence of medical devices. We hypothesized that ICU physicians can overcome these barriers. The aim of this study was to investigate the safety of EM according to the Maebashi EM protocol conducted by ICU physicians. Methods: This was a single-center prospective observational study...
2018: Journal of Intensive Care
Jennifer P Stevens, Tenzin Dechen, Richard Schwartzstein, Carl O'Donnell, Kathy Baker, Michael D Howell, Robert B Banzett
CONTEXT: Dyspnea is an uncomfortable and distressing sensation experienced by hospitalized patients. OBJECTIVES: There is no large-scale study of the prevalence and intensity of patient-reported dyspnea at the time of admission to the hospital. METHODS: Between March 2014 and September 2016, we conducted a prospective cohort study among all consecutive hospitalized patients at a single tertiary care center in Boston, MA. During the first 12 hours of admission to medical-surgical and obstetric units, nurses at our institution routinely collect a patient's (1) current level of dyspnea on a 0-10 scale with 10 anchored at "unbearable", (2) worst dyspnea in the past 24 hours prior to arrival at the hospital on the same 0-10 scale, and (3) what activities were associated with dyspnea prior to admission...
February 21, 2018: Journal of Pain and Symptom Management
Dora Wood, Sophie Geoghegan, Padmanabhan Ramnarayan, Peter J Davis, John V Pappachan, Sarah Goodwin, Jo Wray
Critically ill adolescents are usually treated on intensive care units optimised for much older adults or younger children. The way they access and experience health services may be very different to most adolescent service users, and existing quality criteria may not apply to them. The objectives of this pilot study were, firstly, to determine whether adolescents and their families were able to articulate their experiences of their critical care admission and secondly, to identify the factors that are important to them during their intensive care unit (ICU) or high dependency unit (HDU) stay...
February 21, 2018: European Journal of Pediatrics
C Nafati, M Gardette, M Leone, L Reydellet, V Blasco, A Lannelongue, F Sayagh, S Wiramus, F Antonini, J Albanèse, L Zieleskiewicz
BACKGROUND: In critical patients, left ventricular ejection fraction and fractional shortening are used to reflect left ventricular systolic function. An emerging technique, two-dimensional-strain echocardiography, allows assessment of the left ventricle systolic longitudinal deformation (global longitudinal strain) and the speed at which this deformation occurs (systolic strain rate). This technique is of increasing use in critical patients in intensive care units and in the peri-operative period where preload constantly varies...
February 21, 2018: Annals of Intensive Care
Sarah Crowe
ICU care has traditionally focused on curative treatment, but making the decision to withdraw life-sustaining therapies, the there is an increasing awareness of the key role palliative and barriers to providing good end-of-life care, factors that support comfort care play. Through a review of recent literature on end- good end-of-life care, and specific guidelinesfor the withdrawal of-life care and withdrawal of life-sustaining therapies in the of life-sustaining therapies. Using this information, a checklist to intensive care unit, four themes have emerged: the challenges of support end-of-life care by critical care nurses was created...
May 2017: Canadian Journal of Critical Care Nursing
Philip Emerson, Naomi Dodds, David R Green, Jan O Jansen
Background: Critical illness requires specialist and timely management. The aim of this study was to create a geographic accessibility profile of the Scottish population to emergency departments and intensive care units. Methods: This was a descriptive, geographical analysis of population access to 'intermediate' and 'definitive' critical care services in Scotland. Access was defined by the number of people able to reach services within 45 to 60 min, by road and by helicopter...
February 2018: Journal of the Intensive Care Society
Takahiro Niimura, Yoshito Zamami, Toru Imai, Kanako Nagao, Masafumi Kayano, Hidenori Sagara, Mitsuhiro Goda, Naoto Okada, Masayuki Chuma, Kenshi Takechi, Masaki Imanishi, Toshihiro Koyama, Tadashi Koga, Hironori Nakura, Toshiaki Sendo, Keisuke Ishizawa
PURPOSE: Although the 2016 Japanese guidelines for the management of sepsis recommend de-escalation of treatment after identification of the causative pathogen, adherence to this practice remain unknown. The objective of this study was to evaluate the benefits of de-escalating treatment for sepsis patients at an advanced critical care and emergency medical centre. METHODS: Based on electronic patient information, 85 patients who were transported to the centre by ambulance, and diagnosed with sepsis between January 2008 and September 2013 were enrolled and evaluated...
2018: Journal of Pharmacy & Pharmaceutical Sciences: a Publication of the Canadian Society for Pharmaceutical Sciences
Alexandros Rovas, Alexander-Henrik Lukasz, Hans Vink, Marc Urban, Jan Sackarnd, Hermann Pavenstädt, Philipp Kümpers
BACKGROUND: Deterioration of the endothelial glycocalyx (eGC), a protective carbohydrate-rich layer lining the luminal surface of the endothelium, plays a key role in vascular barrier dysfunction and eventually organ-failure in systemic inflammatory response syndrome and sepsis. Early detection of glycocalyx damage could thus become an important goal in critical care. This study was designed to determine the feasibility and reproducibility of quantitative, real-time glycocalyx measurements performed at bedside in the emergency room (ER) and intensive care unit (ICU)...
February 14, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Steven J Campbell, Rabih Bechara, Shaheen Islam
Spreading beyond the realm of tertiary academic medical centers, point-of-care ultrasound in the intensive care unit is an important diagnostic tool. The real-time feedback garnered can lead to critical and clinically relevant changes in management and decrease potential complications. Bedside ultrasound evaluation in the intensive care setting with a small, portable equipment is well-suited for placement of central lines, lumbar puncture, thoracentesis or other bedside ICU procedures and in the evaluation of cardiac activity, pleural and abdominal cavity and the overall fluid volume...
March 2018: Clinics in Chest Medicine
Blair Wendlandt, Thomas Bice, Shannon Carson, Lydia Chang
PURPOSE: Intermediate care units (IMCUs) represent an alternative care setting with nurse staffing levels between those of the general ward and the intensive care unit (ICU). Despite rising prevalence, little is known about IMCU practices across US hospitals. The purpose of this study is to characterize utilization patterns and assess for variation. MATERIALS AND METHODS: A 14-item survey was distributed to a random nationwide sample of pulmonary and critical care physicians between January and April 2017...
January 1, 2018: Journal of Intensive Care Medicine
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