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Resource Intensivist

Jim Q Ho, Christopher D Nguyen, Richard Lopes, Stephen C Ezeji-Okoye, Ware G Kuschner
Spiritual care is an important component of high-quality health care, especially for critically ill patients and their families. Despite evidence of benefits from spiritual care, physicians and other health-care providers commonly fail to assess and address their patients' spiritual care needs in the intensive care unit (ICU). In addition, it is common that spiritual care resources that can improve both patient outcomes and family member experiences are underutilized. In this review, we provide an overview of spiritual care and its role in the ICU...
January 1, 2017: Journal of Intensive Care Medicine
Margo M C van Mol, Marjan D Nijkamp, Jan Bakker, Wilmar B Schaufeli, Erwin J O Kompanje
BACKGROUND AND OBJECTIVES: Working in an Intensive Care Unit (ICU) is increasingly complex and is also physically, cognitively and emotionally demanding. Although the negative emotions of work-related stress have been well studied, the opposite perspective of work engagement might also provide valuable insight into how these emotional demands may be countered. This study focused on the work engagement of ICU professionals and explored the complex relationship between work engagement, job demands and advantageous personal resources...
May 20, 2017: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Elisa Estenssoro, Leyla Alegría, Gastón Murias, Gilberto Friedman, Ricardo Castro, Nicolas Nin Vaeza, Cecilia Loudet, Alejandro Bruhn, Manuel Jibaja, Gustavo Ospina-Tascon, Fernando Ríos, Flavia R Machado, Alexandre Biasi Cavalcanti, Arnaldo Dubin, F Javier Hurtado, Arturo Briva, Carlos Romero, Guillermo Bugedo, Jan Bakker, Maurizio Cecconi, Luciano Azevedo, Glenn Hernandez
OBJECTIVE: Latin America bears an important burden of critical care disease, yet the information about it is scarce. Our objective was to describe structure, organization, processes of care, and research activities in Latin-American ICUs. DESIGN: Web-based survey submitted to ICU directors. SETTINGS: ICUs located in nine Latin-American countries. SUBJECTS: Individual ICUs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two hundred fifty-seven of 498 (52%) of submitted surveys responded: 51% from Brazil, 17% Chile, 13% Argentina, 6% Ecuador, 5% Uruguay, 3% Colombia, and 5% between Mexico, Peru, and Paraguay...
April 21, 2017: Critical Care Medicine
Thomas E Robertson, Andrea R Levine, Avelino C Verceles, Jessica A Buchner, James H Lantry, Alfred Papali, Marc T Zubrow, L Nathalie Colas, Marc E Augustin, Michael T McCurdy
PURPOSE: Ultrasound (US) is a burgeoning diagnostic tool and is often the only available imaging modality in low- and middle-income countries (LMICs). However, bedside providers often lack training to acquire or interpret US images. We conducted a study to determine if a remote tele-intensivist could mentor geographically removed LMIC providers to obtain quality and clinically useful US images. MATERIALS AND METHODS: Nine Haitian non-physician health care workers received a 20-minute training on basic US techniques...
April 7, 2017: Journal of Critical Care
Marc A Benoit, Sean M Bagshaw, Colleen M Norris, Mohamad Zibdawi, Wu Dat Chin, David B Ross, Sean van Diepen
OBJECTIVES: Nighttime intensivist staffing does not improve patient outcomes in general ICUs. Few studies have examined the association between dedicated in-house 24/7 intensivist coverage on outcomes in specialized cardiac surgical ICUs. We sought to evaluate the association between 24/7 in-house intensivist-only management of cardiac surgical patients on postoperative complications and health resource utilization. DESIGN: Before-and-after propensity matched cohort study...
April 3, 2017: Critical Care Medicine
Kam Lun Hon, Karen Ka Yan Leung
We present 2 anonymized cases to identify issues and challenges associated with long-haul in-flight medical emergencies. The first case involved a middle-aged man with a history of carditis on a systemic steroid who developed vomiting and rigor. Four physicians, including a pediatric intensivist, responded to the emergency call. In the second case, a pediatric trainee who was the only onboard medical personnel was summoned for help when a middle-aged man developed acute shortness of breath while traveling on a commercial flight...
March 2017: Air Medical Journal
Steven A Conrad, Peter T Rycus
Extracorporeal cardiopulmonary resuscitation (ECPR) is the use of rapid deployment venoarterial (VA) extracorporeal membrane oxygenation to support systemic circulation and vital organ perfusion in patients in refractory cardiac arrest not responding to conventional cardiopulmonary resuscitation (CPR). Although prospective controlled studies are lacking, observational studies suggest improved outcomes compared with conventional CPR when ECPR is instituted within 30-60 min following cardiac arrest. Adult and pediatric patients with witnessed in-hospital and out-of-hospital cardiac arrest and good quality CPR, failure of at least 15 min of conventional resuscitation, and a potentially reversible cause for arrest are candidates...
January 2017: Annals of Cardiac Anaesthesia
Donald P Frush
Radiation and potential risk during medical imaging is one of the foremost issues for the imaging community. Because of this, there are growing demands for accountability, including appropriate use of ionizing radiation in diagnostic and image-guided procedures. Factors contributing to this include increasing use of medical imaging; increased scrutiny (from awareness to alarm) by patients/caregivers and the public over radiation risk; and mounting calls for accountability from regulatory, accrediting, healthcare coverage (e...
February 2017: Health Physics
Adrienne N Cobb, Yee M Wong, Sarah A Brownlee, Barbara A Blanco, Yoshiki Ezure, Heather N Paddock, Paul C Kuo, Anai N Kothari
BACKGROUND: This study examines the relationship between hospital volume of surgical cases for necrotizing enterocolitis (NEC) and patient outcomes. METHODS: A retrospective cross-sectional review was performed using the HCUP SID for California from 2007 to 2011. Patients with NEC who underwent surgery were identified using ICD-9CM codes. Risk-adjusted models were constructed with mixed-effects logistic regression using patient and demographic covariates. RESULTS: 23 hospitals with 618 patients undergoing NEC-related surgical intervention were included...
March 2017: American Journal of Surgery
Andrea Blotsky, Louay Mardini, Dev Jayaraman
Background. Medical emergency teams (METs) or rapid response teams (RRTs) facilitate early intervention for clinically deteriorating hospitalized patients. In healthcare systems where financial resources and intensivist availability are limited, the establishment of such teams can prove challenging. Objectives. A low-cost, ward-based response system was implemented on a medical clinical teaching unit in a Montreal tertiary care hospital. A prospective before/after study was undertaken to examine the system's impact on time to intervention, code blue rates, and ICU transfer rates...
2016: Critical Care Research and Practice
Moninne Howlett, Michael Curtin, Dermot Doherty, Paula Gleeson, Michelle Sheerin, Cormac Breatnach
AIM: Wide scale implementation of paediatric standardised concentration infusions (SCIs) and the use of smart pump technology has been slow despite international safety agency recommendations. Implementation rates in European hospitals fall far below those in the United States, where for the last decade accreditation has been linked to implementation.1 2 Multidisciplinary collaboration is essential, with pharmacy input and the creation of a smart pump drug library recognised as often being limiting, yet crucial factors, to implementation...
September 2016: Archives of Disease in Childhood
N Chrimes
Factors influencing performance during emergency airway management can be broadly divided into issues with preparation and those with implementation. Effective design of resources that provide guidance on management requires consideration of the context in which they are to be used. Many of the major airway guidelines do not specify whether they are intended to be used during preparation or implementation and may not take the context for use into account in their design. This can produce tools which may be not only ineffective but actively disruptive to team function in an emergency...
September 2016: British Journal of Anaesthesia
Marcio Soares, Fernando A Bozza, Luciano C P Azevedo, Ulysses V A Silva, Thiago D Corrêa, Fernando Colombari, André P Torelly, Pedro Varaschin, William N Viana, Marcos F Knibel, Moyzés Damasceno, Rodolfo Espinoza, Marcus Ferez, Juliana G Silveira, Suzana A Lobo, Ana Paula P Moraes, Ricardo A Lima, Alexandre G R de Carvalho, Pedro E A A do Brasil, Jeremy M Kahn, Derek C Angus, Jorge I F Salluh
PURPOSE: To investigate the impact of organizational characteristics and processes of care on hospital mortality and resource use in patients with cancer admitted to intensive care units (ICUs). PATIENTS AND METHODS: We performed a retrospective cohort study of 9,946 patients with cancer (solid, n = 8,956; hematologic, n = 990) admitted to 70 ICUs (51 located in general hospitals and 19 in cancer centers) during 2013. We retrieved patients' clinical and outcome data from an electronic ICU quality registry...
September 20, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Lluís Blanch, Fayez François Abillama, Pravin Amin, Michael Christian, Gavin M Joynt, John Myburgh, Joseph L Nates, Paolo Pelosi, Charles Sprung, Arzu Topeli, Jean-Louis Vincent, Susan Yeager, Janice Zimmerman
Demand for intensive care unit (ICU) resources often exceeds supply, and shortages of ICU beds and staff are likely to persist. Triage requires careful weighing of the benefits and risks involved in ICU admission while striving to guarantee fair distribution of available resources. We must ensure that the patients who occupy ICU beds are those most likely to benefit from the ICU's specialized technology and professionals. Although prognosticating is not an exact science, preference should be given to patients who are more likely to survive if admitted to the ICU but unlikely to survive or likely to have more significant morbidity if not admitted...
December 2016: Journal of Critical Care
C Saillard, D Blaise, D Mokart
The outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients has significantly improved over the past decade. Still, a significant number of patients require intensive care unit (ICU) management because of life-threatening complications. Literature from the 1990s reported extremely poor prognosis for critically ill allo-HSCT patients requiring ICU management. Recent data justify the use of ICU resources in hematologic patients. Yet, allo-HSCT remains an independent variable associated with mortality...
August 2016: Bone Marrow Transplantation
Zaher Fanari, Sumaya Hammami, Armin Barekatain
There are many changes in the demographics of patients admitted to Cardiac Care Unit (CCU) due to the aging of US population and coexistence of chronic illnesses, such as diabetes mellitus, hypertension, renal dysfunction, and obstructive lung disease. There is increasing evidence that intensivist staffing in the critical care settings is associated with not only improvements in both Intensive Care Unit (ICU) and in-hospital mortality, but also with better medical resource use. Evidence for decreased mortality has led to increased involvement of critical care trained physicians in multidisciplinary care teams in both medical and surgical ICUs, a trend that has not been adopted to any significant extent in CCUs...
February 2016: Delaware Medical Journal
Eduardo Casaroto, Tatiana Mohovic, Lilian Moreira Pinto, Tais Rodrigues de Lara
The echocardiography has become a vital tool in the diagnosis of critically ill patients. The use of echocardiography by intensivists has been increasing since the 1990's. This tool has become a common procedure for the cardiovascular assessment of critically ill patients, especially because it is non-invasive and can be applied in fast and guided manner at the bedside. Physicians with basic training in echocardiography, both from intensive care unit or emergency department, can assess the left ventricle function properly with good accuracy compared with assessment made by cardiologists...
October 2015: Einstein
Rebecca C Bell, Phoebe H Yager, Maureen E Clark, Serguei Roumiantsev, Heather L Venancio, Daniel W Chipman, Robert M Kacmarek, Natan N Noviski
BACKGROUND: Mechanical ventilation is one of the most important therapeutic interventions in neonatal and pediatric ICUs. Telemedicine has been shown to reliably extend pediatric intensivist expertise to facilities where expertise is limited. If reliable, telemedicine may extend the reach of pediatric respiratory therapists (RTs) to facilities where expertise does not exist or free up existing RT resources for important face-to-face activities in facilities where expertise is limited...
February 2016: Respiratory Care
Chae-Man Lim, Sang-Hyun Kwak, Gee Young Suh, Younsuck Koh
Critical (or intensive) care medicine (CCM) is a branch of medicine concerned with the care of patients with potentially reversible life-threatening conditions. Numerous studies have demonstrated that adequate staffing is of crucial importance for patient outcome. Adequate staffing also showed favorable cost-effectiveness in terms of ICU stay, decreased use of resources, and lower re-admission rates. The current status of CCM of our country is not comparable to that of advanced countries. The global pandemic episodes in the past decade showed that our society is not well prepared for severe illnesses or mass casualty...
November 2015: Journal of Korean Medical Science
David M Axelrod, Jeffrey A Alten, John T Berger, Mark W Hall, Ravi Thiagarajan, Ronald A Bronicki
Since the inception of the Pediatric Cardiac Intensive Care Society (PCICS) in 2003, remarkable advances in the care of children with critical cardiac disease have been developed. Specialized surgical approaches, anesthesiology practices, and intensive care management have all contributed to improved outcomes. However, significant morbidity often results from immunologic or infectious disease in the perioperative period or during a medical intensive care unit admission. The immunologic or infectious illness may lead to fever, which requires the attention and resources of the cardiac intensivist...
October 2015: World Journal for Pediatric & Congenital Heart Surgery
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