Articles: intensive-care-units.
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Strict visitor restrictions during the COVID-19 pandemic have been associated with staff moral distress in numerous clinical settings, yet little is known about effects on perceptions of pediatric end-of-life care. ⋯ The findings support affording some flexibility to visitation at end of life, which may mitigate negative staff perceptions of quality of dying and death. With the profound effects of COVID-19 on end-of-life care provision, these results may have implications for future global challenges.
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Southern medical journal · May 2023
Impact of Preoperative Echocardiograms on In-Hospital Outcomes of Patients Undergoing Surgical Hip Fracture Repair and Their Clinical Appropriateness.
Preoperative transthoracic echocardiograms (TTE) before hip fracture repairs are controversial. This study aimed to quantify the frequency of ordering TTE, the appropriateness of testing based on current guidelines, and the impact of TTE on in-hospital morbidity and mortality outcomes. ⋯ Patients subjected to TTE before hip fracture surgery had a longer LOS and time to surgery, with higher mortality and intensive care unit up triage rates. TTE evaluations were typically conducted for inappropriate indications, which rarely made meaningful changes to patient management.
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Critical care medicine · May 2023
Observational StudyOccurrence Rate and Outcomes of Weaning Groups According to a Refined Weaning Classification: A Retrospective Observational Study.
The weaning according to a new definition (WIND) classification groups mechanically ventilated (MV) patients into "short weaning," "difficult weaning," "prolonged weaning," and "no weaning." The aims of the study were: 1) to describe the weaning group distribution, 2) to evaluate if "short weaning" patients can be divided into groups with distinct characteristics and outcomes depending on the MV duration, and 3) to study 1-year outcomes related to weaning groups. ⋯ The high proportion of "short weaning" patients in this mainly surgical ICU population could be divided into two groups with distinct characteristics. This refined WIND classification allowed to enhance prognostication, also beyond hospitalization, highlighting the need to further optimize the weaning process.
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Objective: To identify and describe characteristics of patients with sepsis who could be treated with minimally invasive sepsis (MIS) approach without intensive care unit (ICU) admission and to develop a prediction model to select candidates for MIS approach. Methods: A secondary analysis of the electronic database of patients with sepsis at Mayo Clinic, Rochester, MN. Candidates for the MIS approach were adults with septic shock and less than 48 hours of ICU stay, who did not require advanced respiratory support and were alive at hospital discharge. ⋯ The MIS score cutoff of 3 resulted in a model odds ratio of 0.15 (95% confidence interval, 0.08-0.28) and a negative predictive value of 91% (95% confidence interval, 88.69-92.92). Conclusions: This study identifies a subset of low-risk septic shock patients who can potentially be managed outside the ICU. Once validated in an independent, prospective sample our prediction model can be used to identify candidates for MIS approach.
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Factors such as the thought of losing the patient, the uncertainty of the course of the disease, and the inability to obtain sufficient information about the patient are frightening and alarming for relatives of patients in the intensive care unit. ⋯ In addition to the uncertainty and fear associated with the COVID-19 pandemic, it is very distressing to have a relative who is a patient in the intensive care unit. In this context, it is especially important to improve the level of coping with stress of the relatives of patients in the intensive care unit and to increase their quality of life.