Articles: intensive-care-units.
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The integration of nurse practitioners (NPs) and physician assistants (PAs) into the medical ICU (MICU) is becoming increasingly vital due to the rising number of critically ill patients and the shortage of board-certified intensivists. Successful recruitment and utilization of NPs and PAs in the MICU setting require a unique understanding of potential variations of the scope of practice based on state law and educational backgrounds, as well as the implementation of best practices around training and leadership support. The purpose of this article was to review the best strategies for creating a MICU team with NPs and PAs. ⋯ There are variations in state laws and institutional policies that affect NP and PA practice that should be understood by the organization to manage expectations for the NP and PA job responsibilities. Effective productivity measurement methods are proposed to accurately assess the contributions of NPs and PAs in the MICU. This article provides comprehensive strategies for successfully hiring, onboarding, and integrating these professionals into MICU teams, ensuring high-quality care delivery in critical care settings.
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Observational Study
Obstetric Intensive Care Admissions and Neonatal Outcomes: 15 Years of Experience from a Single Center.
Background and Objectives: Maternal severe morbidity and mortality are measures for assessing maternal healthcare, and admissions to the intensive care unit (ICU) can be used to study these metrics. Here, we analyze ICU admissions of pregnant or postpartum women in a tertiary hospital. Materials and Methods: This is a retrospective, single-center, observational cohort study of obstetric intensive care admissions at a Portuguese hospital spanning 15 years. ⋯ We recorded one fetal death at 25 weeks and no neonatal deaths. Conclusions: The unique needs of obstetric ICU patients emphasize the need for specialized training of multidisciplinary teams. Severe postpartum hemorrhage was responsible for significant morbidity and disability, prompting a reassessment of delivery practices.
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The use of inhaled antibiotics for treating pneumonia in invasively ventilated patients offers a direct approach, allowing for high local concentrations of the drug in the lower respiratory tract while simultaneously reducing systemic toxicity. However, the real efficacy and safety of nebulized antibiotics remain unclear. The aim of the present is to assess among critically adult patients with pneumonia and invasive ventilation, whether receiving adjuvant inhaled antibiotics improves the rate of microbiological eradication. ⋯ In conclusion, compared to the sole intravenous therapy, the use of adjuvant inhaled antibiotics for treatment of pneumonia in invasively ventilated critically ill patients was associated with a greater incidence of microbiological eradication (low GRADE and high risk of publication bias), but not with clinical recovery and survival.
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Review
Promoting Family Involvement in the Management of Delirium in Intensive Care: Scoping Review.
Background: In recent years, family involvement in ICU patient care has become increasingly significant. Family involvement in delirium management, while desirable, can be difficult for loved ones. Therefore, every attempt should be made and interventions developed to promote and support the family in this process. ⋯ After removing duplicates and checking for inclusion and exclusion criteria, four articles were finally included in the analysis. Research gaps and content analysis identified promotional and supportive interventions for family involvement in delirium management: (I) Education; (II) Mentoring; (III) Partnership. Conclusions: Research gaps to be filled are as follows: (I) the scope of interventions that support and promote family involvement in delirium management; (II) interventions that enhance feelings of efficacy among family members and reduce symptoms of anxiety and depression; and (iii) the impact of specific interventions on patients' delirium outcomes.