American Journal of Critical Care

BACKGROUND: Sepsis risk stratification tools typically predict mortality, although stays in the intensive care unit (ICU) of 24 hours or longer may be more clinically relevant for emergency department disposition. OBJECTIVE: To explore predictors of ICU stay of 24 hours or longer among infected, hypotensive emergency department patients. METHODS: A secondary analysis of 2 prospective, observational studies of adult patients with severe sepsis or an infection with a systolic blood pressure less than 90 mm Hg in 3 urban, academic emergency departments was performed...

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BACKGROUND: Data on outcomes of critically ill patients requiring mechanical ventilation at the onset of stroke are limited. OBJECTIVE: To assess the hospital and long-term functional outcomes of patients with stroke who require mechanical ventilation. METHODS: This retrospective single-center cohort study performed from 1994 to 2008 involved adult patients within 7 days of stroke onset and who required intensive care unit admission and mechanical ventilation...

BACKGROUND: Post-intensive care syndrome-family (PICS-F) refers to acute and chronic psychological effects of critical care on family members of patients in intensive care units (ICUs). Evidence suggests that increased distress during the ICU stay increases risk of PICS-F. Sensation Awareness Focused Training (SĀF-T) is a new, promising stress management intervention, but the feasibility of such training during the ICU stay for family caregivers who are acting as the surrogate decision-maker for patients who are undergoing mechanical ventilation is unknown...

BACKGROUND: Serum level of interleukin 6 (IL-6) is known to be associated with postoperative delirium. However, no consensus has emerged on the postoperative time point at which IL-6 level may predict postoperative delirium after coronary artery bypass graft surgery. OBJECTIVES: To compare trends in IL-6 levels in patients with and without postoperative delirium and to examine the relationship between IL-6 levels at different times and postoperative delirium after coronary artery bypass graft...

BACKGROUND: Little evidence supports use of chlorhexidine gluconate (CHG) baths to reduce health care-associated infections, including central catheter-associated bloodstream infections in infants less than 2 months old. OBJECTIVE: To describe the safety of biweekly CHG baths in infants less than 2 months old by measuring blood levels of CHG, liver and renal function, skin reactions, and adverse events. METHODS: Study participants received twice-weekly 2% CHG baths, weekly blood tests, and twice-daily skin assessments...

OBJECTIVE: To synthesize evidence of the safety and effectiveness of phonation in patients with fenestrated tracheostomy tubes. METHODS: PubMed, CINAHL, Scopus, Cochrane, and Web of Science databases were searched. The research question was, "Are fenestrated tracheostomy tubes a safe and effective option to facilitate early phonation in patients undergoing tracheostomy?" Studies of fenestrated tracheostomy tubes were assessed for risk of bias and quality of evidence...

BACKGROUND: To promote the use of appropriate testing, and decrease unnecessary treatments, the ABIM Foundation established the Choosing Wisely campaign in 2012. Initially targeting physicians, the campaign has evolved to encourage all providers to promote high-value care; however, information related to critical care nursing is limited. OBJECTIVES: To assess nurses' reports of the use of Choosing Wisely recommendations in critical care settings. METHODS: Responses from nurses were examined as part of a critical care survey of members of 4 societies in order to assess awareness and use of the Choosing Wisely recommendations...

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BACKGROUND: Morbidity and mortality after discharge from an intensive care unit appear to be higher in patients with sepsis than in patients without sepsis. OBJECTIVE: To evaluate morbidity and mortality in patients with and without sepsis within 2 years after intensive care unit discharge. METHODS: A prospective cohort study was conducted in 2 intensive care units. Patients who stayed in the intensive care unit longer than 24 hours were followed up for 2 years after discharge...

BACKGROUND: Little empirical evidence is available to guide decisions on what type of dressing to use and how often to change the dressing after placement of a thoracostomy tube. OBJECTIVES: This prospective randomized controlled study was conducted to compare various dressing types and procedures after placement of thoracic and mediastinal chest tubes. Outcome measures included length of time between dressing changes, skin integrity, air leak presence, and patient-reported pain...

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BACKGROUND: The number of patients surviving critical care is increasing. Quality of life after critical care is known to be poor for some patients. The evidence base for effective rehabilitation interventions in the period following a stay in an intensive care unit is limited. OBJECTIVES: To understand what rehabilitation goals are important to patients after critical care discharge. METHODS: This prospective study, which was undertaken during an intensive care unit recovery program, explored the recovery goals of 43 patients...

BACKGROUND: Patient immobility and a lack of physical activity in the intensive care unit results in a myriad of negative patient and hospital outcomes. OBJECTIVE: To report research findings related to the use of exercise physiologists in promoting and providing aggressive and progressive early mobilization within the intensive care unit. METHODS: This observational cohort study used the researcher-generated 12-point Activity Mobilization Evaluation Scale and delirium prevention bundle in 3 medical-surgical intensive care units to track patients' progress with mobilization...

BACKGROUND: Despite a lack of data from intensive care patients, bispectral index monitors are often used to measure the depth of sedation for critically ill patients with acute respiratory distress syndrome (ARDS) who require continuous neuromuscular blocking agents. OBJECTIVE: To evaluate differences in the effectiveness and safety of monitoring sedation by using bispectral index or traditional methods in patients with ARDS who are receiving continuous neuromuscular blocking agents...