American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Sleep duration and proportion of daytime versus nighttime sleep may affect cognitive function in older patients in the transition out of the intensive care unit. ⋯ The daytime-to-nighttime sleep ratio was abnormally high in the study population, revealing an altered sleep/wake cycle. Higher daytime-to-nighttime sleep ratios were associated with worse cognition, suggesting that proportionally greater daytime sleep may predict cognitive impairment.
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Observational Study
Handgrip Force and Maximum Inspiratory and Expiratory Pressures in Critically Ill Patients With a Tracheostomy.
The association between peripheral striated muscle strength and respiratory muscle strength has been confirmed in a number of disorders. However, this association is unknown in intensive care unit patients with tracheostomies. ⋯ Strength of the hand flexors and strength of the expiratory muscles (abdominal) were significantly correlated in intensive care unit patients. Handgrip strength appears to be an easy, fast way to evaluate expiratory muscle strength by using a simple handhold command without special equipment. A strong handhold may also correspond to strong expiratory muscles. ClinicalTrials.gov: NCT03457376.
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Multicenter Study
Benefits of Peer Support for Intensive Care Unit Survivors: Sharing Experiences, Care Debriefing, and Altruism.
After critical illness, patients are often left with impairments in physical, social, emotional, and cognitive functioning. Peer support interventions have been implemented internationally to ameliorate these issues. ⋯ Peer support is a relatively simple intervention that could be implemented to support patients during recovery from critical illness. However, more research is required into how these programs can be implemented in a safe and sustainable way in clinical practice.
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Existing sepsis quality improvement initiatives focus on recognition and treatment of sepsis upon hospital admission. Yet many patients are evaluated in the clinic within 1 day of sepsis hospitalization. ⋯ One in 10 patients hospitalized for sepsis had been evaluated in a clinic within 1 day of admission. At that clinic visit, most patients had an elevated qSOFA score or abnormal vital signs and a majority were sent directly to the emergency department/hospital. Half experienced clinical deterioration between the clinic visit and arrival in the emergency department/hospital.
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Prone positioning is a standard treatment for moderate to severe acute respiratory distress syndrome (ARDS), but the outcomes associated with manual versus automatic prone positioning have not been evaluated. ⋯ Manual prone positioning has outcomes similar to those of automatic prone positioning with less risk of interruptions in therapy, fewer complications, and lower expense. Further research is needed to determine whether manual prone positioning is superior to automatic prone positioning in patients with ARDS.