American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Randomized Controlled Trial
Effect of Live Versus Recorded Music on Children Receiving Mechanical Ventilation and Sedation.
Music is often used as a nonpharmacological pain management strategy, but little evidence is available about its role in pediatric critical care patients. ⋯ The results of this study indicate that live music interventions may be more effective than recorded music interventions in reducing pain and anxiety in pediatric critical care patients. The advantage of live music may be due to the adaptability of the music delivery by a trained music therapist.
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Multicenter Study
Decreased Incidence of Rib Fractures in Pregnant Patients After Motor Vehicle Collisions.
Rib fractures are common after motor vehicle collisions. The hormonal changes associated with pregnancy decrease the stiffness and increase the laxity of cartilage and tendons. The effect of these changes on injury mechanics is not completely understood. ⋯ Pregnant patients have a lower rate of rib fracture after a motor vehicle collision than nonpregnant patients. The difference in injury mechanics may be due to hormonal changes that increase elasticity and resistance to bony injury of the ribs. In pregnant trauma patients, intrathoracic injury without rib fracture should raise concerns about injury severity. A multicenter evaluation of these findings is needed.
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Although use of mechanical circulatory support is increasing, it is unclear how providing such care affects clinicians' moral distress. ⋯ Moral distress was high among clinicians who commonly care for patients receiving mechanical circulatory support, suggesting that use of this therapy may affect well-being among intensive care unit clinicians.
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Health care professionals working in intensive care units report a high degree of burnout, but this topic has not been extensively studied from an interdisciplinary perspective. ⋯ Multiple factors contribute to work-related stress and burnout across different professions in the intensive care unit. Improved communication and increased receptivity to diverse opinions among members of the multidisciplinary team may help reduce stress.
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Pediatric traumatic brain injury (TBI) protocols vary widely among institutions, despite the existence of published guidelines. This study seeks to identify significant differences in management of pediatric TBI across several institutions. Severe pediatric TBI protocols were collected from major US pediatric hospitals through direct communication with trauma staff. ⋯ However, significant variation across institutions was found regarding timing of cerebrospinal fluid drainage, hyperventilation, and neuromuscular blockade. When included in institutional protocols, most therapies are in line with the 2019 guidelines, except for diversion of cerebrospinal fluid, hyperventilation, maintenance of cerebral perfusion pressure, and use of neuromuscular blocking agents. Although these variations may represent differences in style or preference, the optimal timing of these specific treatment variations should be studied to determine the impact of each protocol on clinical outcomes.