Intensive Care and Biostatistics Departments of the Saint-Louis Teaching Hospital and Paris 7 University; Intensive Care Unit of the Cochin Teaching Hospital, Paris; Intensive Care Unit of the Henri Mondor Teaching Hospital, Creteil, France; and the Ethics Committee of the French Society for Critical Care.
[Record supplied by publisher]
Comprehension and satisfaction are relevant criteria for evaluating the effectiveness of information provided to family members of intensive care unit (ICU) patients. We performed a prospective randomized trial in 34 French ICUs to compare comprehension of diagnosis, prognosis, treatment, and satisfaction with information provided by ICU caregivers, in ICU patient family representatives who did (n = 87) or did not (n = 88) receive a family information leaflet (FIL) in addition to standard information. An FIL designed specifically for this study was delivered at the first visit of the family representative: it provided general information on the ICU and hospital, the name of the ICU physician caring for the patient, a diagram of a typical ICU room with the names of all the devices, and a glossary of 12 terms commonly used in ICUs. Characteristics of the ICUs, patients, and family representatives were similar in the two groups. The FIL reduced the proportion of family members with poor comprehension from 40.9% to 11.5% (p < 0.0001). In the representatives with good comprehension, the FIL was associated with significantly better satisfaction (21 [18 to 24, quartiles] versus 27 [24 to 29, quartiles], p = 0.01). These results indicate that ICU caregivers should consider using an FIL to improve the effectiveness of the information they impart to families.
PMID: 11850333
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Chest 2002 Jan;121(1):185-8
Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
STUDY OBJECTIVE: To report the outcome of patients with autologous peripheral blood stem cell transplantation (PBSCT) receiving mechanical ventilation. DESIGN: Retrospective observational study. SETTING: Active hematopoietic stem cell transplantation center and a university hospital medical ICU. PATIENTS: Patients with autologous PBSCT receiving mechanical ventilation. METHOD: A review of the medical records of patients with autologous PBSCT receiving mechanical ventilation. Data collection was restricted to the first episode of mechanical ventilation. RESULTS: A total of 78 autologous PBSCT patients received mechanical ventilation for > 24 h. Twenty patients (26%) were extubated and discharged alive from the hospital. Thirteen hospital survivors (60%) were alive at 6 months. Lung injury (LI), vasopressor use, and hepatic and renal failure (HRF) were used to predict survival after mechanical ventilation. Sixty patients (76%) had no organ failure, or had isolated LI or only required treatment with vasopressors. Their hospital survival and 6-month survival were 32% and 20%, respectively. Hospital and 6-month survival for the patients with HRF or LI and vasopressor use was 6% and 0%, respectively. CONCLUSIONS: Prolonged mechanical ventilation and aggressive ICU support is justified for autologous PBSCT patients receiving mechanical ventilation with no organ failure, or who have only isolated LI, or who only require treatment with vasopressors.
PMID: 11796449, UI: 21654852
Chest 2002 Jan;121(1):178-84
Medical and Respiratory Intensive Care Unit, Antoine Beclere Teaching Hospital, Paris, France.
STUDY OBJECTIVES: To assess the impact of routine thoracentesis on diagnostic assessment and therapeutic measures in patients with clinically documented pleural effusions. DESIGN AND SETTING: Prospective, 1-year, three-center study in medical ICU (MICU) patients with physical and radiographic evidence of pleural effusion. PATIENTS: Of 1,351 patients admitted to three MICUs during the study period, 113 patients had physical and radiographic evidence of pleural effusion, yielding an annual incidence of 8.4%. INTERVENTION: Routine thoracentesis in 82 patients without contraindications to thoracentesis. MEASUREMENTS AND RESULTS: Twenty patients (24.4%) had a transudate, 35 patients (42.7%) had an infectious exudate (parapneumonic, n = 21; empyema, n = 14), and 27 patients (32.9%) had a noninfectious exudate. Laboratory parameters including the leukocyte count, the neutrophil percentage in pleural fluid, and the fluid/serum protein and lactate dehydrogenase ratios differed significantly among the three groups. Thoracentesis yielded improvements in the diagnosis and/or treatment in 46 patients (56%): the presumptive (prethoracentesis) diagnosis was changed in 37 patients (32 patients with certain benefit and 5 patients with probable benefit from thoracentesis), of whom 27 patients received a change in treatment based on the new diagnosis; 9 other patients received a change in treatment although the diagnosis remained the same. The only complications were pneumothorax in six patients (7%), all with a favorable outcome after drainage. CONCLUSION: Infection was the main cause of pleural effusions detected based on physical and radiographic findings in our MICU population. Routine thoracentesis proved a simple and safe means of improving the diagnosis and treatment.
PMID: 11796448, UI: 21654851
Chest 2002 Jan;121(1):1
Publication Types:
PMID: 11796420, UI: 21654823
Crit Care Nurse 2001 Aug;21(4):52-9
Neonatal intensive care unit, Strong Memorial Hospital, Rochester, NY, USA.
[Medline record in process]
Nursing staff and leadership in a resource-intensive NICU identified an innovative process for covering the unit's scheduling needs. Early concerns about the feasibility of achieving self-scheduling with a large staff were unwarranted. The use of a unit-based committee and the support of the nurse manager allowed us to develop a process that met the needs of the staff members and maintained the staffing standards of the unit. Contributing to the success of the self-scheduling is a mechanism for recognizing and rewarding staff members who adjust their work schedules to meet the needs of the unit. Satisfaction among staff members with self-scheduling is high, and new employees cite the opportunity for self-scheduling as a contributing factor in their decisions to work in the NICU.
PMID: 11858689, UI: 21847493
Crit Care Nurse 2001 Aug;21(4):45-51
University of Rhode Island, Kingston, USA.
PMID: 11858688, UI: 21847492
Crit Care Nurse 2002 Feb;Suppl:11
Patient Care Services, Shriners Hospital for Children in Spokane, Washington, USA.
PMID: 11852491, UI: 21842263
Thorax 2002 Jan;57(1):79-85
Unit of Critical Care, NHLI Division, Imperial College of Science, Technology & Medicine, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
This is the first in a series of reviews of the role of the pulmonary physician in critical care medicine. The investigation of mechanically ventilated patients is discussed, with particular reference to those presenting with acute respiratory failure and diffuse pulmonary infiltrates.
PMID: 11809996, UI: 21669362
Thorax 2002 Jan;57(1):77-8
Unit of Critical Care, NHLI Division, Imperial College of Science, Technology & Medicine, Royal Brompton Hospital, London SW3 6NP, UK.
This overview of intensive care medicine in Europe and the United States is an introduction to the review series on "The pulmonary physician in critical care" which starts in this issue of Thorax.
PMID: 11809995, UI: 21669361
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