Am J Crit Care 2002 May;11(3):200-9
University of Utah College of Nursing, Salt Lake City, USA.
[Medline record in process]
BACKGROUND: Lack of communication from healthcare providers contributes to the anxiety and distress reported by patients' families after a patient's death in the intensive care unit. OBJECTIVE: To obtain a detailed picture of the experiences offamily members during the hospitalization and death of a loved one in the intensive care unit. METHODS: A qualitative study with 4 focus groups was used. All eligible family members from 8 intensive care units were contacted by telephone; 8 members agreed to participate. RESULTS: The experiences of the family members resembled a vortex: a downward spiral of prognoses, difficult decisions, feelings of inadequacy, and eventual loss despite the members' best efforts, and perhaps no good-byes. Communication, or its lack, was a consistent theme. The participants relied on nurses to keep informed about the patients' condition and reactions. Although some participants were satisfied with this information, they wishedfor more detailed explanations ofprocedures and consequences. Those family members who thought that the best possible outcome had been achieved had had a physician available to them, options for treatment presented and discussed, andfamily decisions honored. CONCLUSIONS: Uncertainty about the prognosis of the patient, decisions that families make before a terminal condition, what to expect during dying, and the extent of a patient s suffering pervade families' end-of-life experiences in the intensive care unit. Families' information about the patient is often lacking or inadequate. The best antidote for families' uncertainty is effective communication.
PMID: 12022483, UI: 22017174
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Anaesthesist 2002 Feb;51(2):123-33
Klinik fur Chirurgie und Zentrum fur Minimal Invasive Chirurgie, Kliniken Essen-Mitte/Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen. mkwalz@kliniken-essen-mitte.de
Tracheostomy is one of the oldest procedures in surgery. Although it was traditionally used for treatment of upper airway stenosis, the primary surgical indication is now in the long-term intensive care unit patient. Here, the aims are avoidance of damage to the larynx, earlier weaning from artificial respiration and improved nursing care. Apart from the conventional operating method, minimally invasive procedures have been increasingly employed. More than 20,000 ICU patients per annum are now treated in Germany by these modern methods. Common features of these procedures are the initial puncture of the trachea with subsequent dilatation of the puncture channel. Current meta-analyses of prospectively randomised studies show a lower complication rate than with conventional methods. Furthermore, serious sequelae such as tracheal stenosis are rare in the long-term course. However, conventional operative tracheostomy still has its place, particularly in circumstances where the new methods are contraindicated.
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PMID: 11963305, UI: 21960615
Anaesthesist 2002 Jan;51(1):33-41
Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin Universitatsklinikum Gottingen, Robert-Koch-Strasse 40, 37075 Gottingen. hburcha@gwdg.de
PMID: 11963298, UI: 21960604
Arch Dis Child 2002 May;86(5):370-1
Paediatric Intensive Care Unit, Emma Children's Hospital, Academic Medical Centre, Amsterdam, Netherlands. j.b.vanwoensel@amc.uva.nl
In order to analyse trends in the bronchiolitis hospitalisations in the Netherlands from 1991 to 1999 for children aged 0-4 years, the national number of bronchiolitis hospitalisations were compared with those of asthma and pneumonia hospitalisations of the same age group. The number of bronchiolitis hospitalisations significantly increased, whereas the number of asthma and pneumonia hospitalisations remained unchanged.
PMID: 11970935, UI: 21965925
Arch Dis Child 2002 May;86(5):352-5
Paediatric Intensive Care Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
AIMS: To document the patterns of presentation and outcome of severe anticholinesterase insecticide poisoning in children requiring intensive care. METHODS: Retrospective case note review of all 5541 children admitted to the paediatric intensive care unit (PICU) of a university hospital during the 10 years from January 1990 to May 2000. Fifty four children (1%) with anticholinesterase insecticide poisoning were identified. Presenting features, route of exposure, treatment, complications, and mortality were recorded. Data were analysed by the Fisher's exact and Mann-Whitney tests. RESULTS: More children than expected were from a rural area (46% versus 25%). Decontamination occurred in 50% of children prior to PICU admission. Enteral exposure was most common (n = 27; 50%). Median pseudocholinesterase level was 185 IU/l (range 75-7404). Median total dose of atropine required to maintain mydriasis was 0.3 mg/kg (range 0.03-16.7) over a median of 10 hours (range 1-160). Complications included coma (31%), seizures (30%), shock (9%), arrhythmias (9%), and respiratory failure requiring ventilation (35%). No significant differences were detected in incidence of seizures, cardiac arrhythmias, respiratory failure, mortality, duration of ventilation, or PICU stay, according to route of exposure, or state of decontamination. Four children died (7%). Mortality was associated with the presence of a cardiac arrhythmia (likelihood ratio 8.3) and respiratory failure (likelihood ratio 3.3). CONCLUSION: The mortality and morbidity of severe anticholinesterase insecticide poisoning in childhood is not related to route of exposure, or to delay in decontamination. However, the presence of either a cardiac arrhythmia or respiratory failure is associated with a poor prognosis.
PMID: 11970930, UI: 21965920
Br J Anaesth 2002 Mar;88(3):456; discussion 456-7
PMID: 11990290, UI: 21985669
Br J Anaesth 2002 Mar;88(3):454; discussion 454-5
PMID: 11990287, UI: 21985666
Crit Care Nurse 2001 Aug;21(4):96, 95
Bellin Health Systems, Green Bay, Wis, USA. cmobri@bellin.org
PMID: 11858694, UI: 21847497
Crit Care Nurse 2001 Aug;21(4):8, 10, 14, 16
PMID: 11858693, UI: 21847486
Crit Care Nurse 2001 Aug;21(4):60-9; quiz 70-1
Metabolic Support Service, Brigham and Women's Hospital, Boston, Mass, USA.
Provision of nutritional support to critically ill patients can be challenging. Critical care nurses must be aware of which patients require specific nutritional support, when to initiate nutritional support, and by which route to provide nutritional support. Consultation with a dietitian or nutritional support service can help facilitate this process. The key points in addressing these questions are (1) the nutritional status of the patient or the length of time he or she has been without significant nutrient intake, (2) whether the patient has a hypermetabolic condition that warrants the early use of nutritional support, and (3) the function of the patient's gastrointestinal tract. What to feed depends on the physiological state of the patient. Adjusting the nutrient composition of the feeding solution may prevent metabolic complications and may improve the overall outcome for the patient.
PMID: 11858690, UI: 21847494
Crit Care Nurse 2001 Aug;21(4):25-7, 29-32; quiz 33-4
Summa Health System, Akron, Ohio, USA.
PMID: 11858686, UI: 21847490
Crit Care Nurse 2002 Feb;Suppl:6-9
Cardiology Services, Keesler Medical Center, Keesler AFB, Biloxi, MS, USA.
PMID: 11852494, UI: 21842261
Crit Care Nurse 2002 Feb;Suppl:29-36; quiz 37-8
Critical Care Aspect Medical Systems in Newton, Massachusetts, USA.
As sedation assessment continues to evolve towards a more disciplined and standard part of clinical practice, the use of subjective sedation scales and objective sedation tools such as the BIS monitor continues to grow and show promise. The efforts of critical care nurses and their colleagues to better understand the value of these tools is integral to guiding their use and optimizing patient comfort.
PMID: 11852493, UI: 21842265
Crit Care Nurse 2002 Feb;Suppl:12-6, 74
Faculty in the Acute Care Nurse Practitioner Program, Rush University College of Nursing, Our Lady of the Resurrection Medical Center, Chicago, Ill., USA.
PMID: 11852492, UI: 21842264
Crit Care Nurse 2002 Feb;Suppl:10
Virginia Commonwealth University Health System, USA.
PMID: 11852490, UI: 21842262
Intensive Care Med 2002 May;28(5):656-9
Department of Medical Informatics and Department of Intensive Care, Academic Medical Center, P.O.Box 22700, 1100 DE Amsterdam, The Netherlands, D.G.Arts@amc.uva.nl
OBJECTIVE: To analyse the quality of data used to measure severity of illness in the Dutch National Intensive Care Evaluation (NICE) registry, after implementation of quality improving procedures.DESIGN: Data were re-abstracted from the paper records of patients or the Patient Data Management System and compared to the data contained in the registry. The re-abstracted data were considered to be the gold standard.SETTING: ICUs of nine Dutch hospitals that had been collecting data for the NICE registry for at least 1 year.MEASUREMENT AND RESULTS: The mean percentages of inaccurate and incomplete data, per hospital, over all variables, were 6.1%+/-4.4 (SD) and 2.7%+/-4.4 (SD), respectively. The mean difference in severity of illness scores between registry data and re-abstracted data was 0.2 points for APACHE II and 0.4 points for SAPS II. The mean difference in predicted mortality according to APACHE II and SAPS II between registry data and re-abstracted data was 0.4% and 0.02%, respectively.CONCLUSIONS: The current data quality of the NICE registry is good and justifies evaluative research. These positive results might be explained by the implementation of several quality assurance procedures in the NICE registry, such as training and automatic data checks. Electronic supplementary material to this paper can be obtained by using the Springer LINK server located at http://dx.doi.org/10.1007/s00134-002-1272-z
PMID: 12029418, UI: 22024561
Respir Care 2002 Apr;47(4):496-505; discussion 505-7
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington 98104-2499, USA. jrc@u.washington.edu
In the critical care setting, usually the most important outcome is survival. However, this is not the only important outcome of critical care. There are increasing data that the patient's quality of life and functional status can be affected long after an intensive care unit stay, and some data suggest that mechanical ventilation strategies could influence those outcomes. Critical care clinicians' decisions regarding mechanical ventilation and related treatments such as level of sedation might have more profound and far-reaching residual effects than has been previously recognized. To deliver effective, cost-effective, and patient-centered care, critical-care clinicians must consider outcomes other than survival. These outcomes include such diverse concepts as quality of life, functional status, and neuropsychological function. This review addresses theoretical and practical challenges to measuring and interpreting those other outcomes.
PMID: 11929620, UI: 21927722
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