American Journal of Critical Care

BACKGROUND: Elderly patients frequently experience deteriorating health after critical illness, which may threaten their independence and predispose them to unplanned hospital readmissions and premature death. OBJECTIVES: To evaluate the operational feasibility of a 90-day home-based palliative care intervention in multimorbid elderly Veteran survivors of critical illness. METHODS: A multidisciplinary home-based palliative care intervention was provided for multimorbid elderly veterans who were discharged home after admission to the intensive care unit for sepsis, pneumonia, heart failure, or exacerbation of chronic obstructive lung disease...

BACKGROUND: Ethical challenges in clinical practice significantly affect frontline nurses, leading to moral distress, burnout, and job dissatisfaction, which can undermine safety, quality, and compassionate care. OBJECTIVES: To examine the impact of a longitudinal, experiential educational curriculum to enhance nurses' skills in mindfulness, resilience, confidence, and competence to confront ethical challenges in clinical practice. METHODS: A prospective repeated-measures study was conducted before and after a curricular intervention at 2 hospitals in a large academic medical system...

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BACKGROUND: Despite advances in treatment strategies, acute respiratory distress syndrome (ARDS) after cardiac surgery remains associated with high morbidity and mortality. A method of screening patients for risk of ARDS after cardiac surgery is needed. OBJECTIVES: To develop and validate an ARDS prediction score designed to identify patients at high risk of ARDS after cardiac or aortic surgery. METHODS: An ARDS prediction score was derived from a retrospective derivation cohort and validated in a prospective cohort...

BACKGROUND: Symptoms of anxiety and depression are common in adolescents with a loved one in an intensive care unit (ICU) and are known precursors of posttraumatic stress disorder (PTSD). OBJECTIVES: To assess the prevalence of PTSD and associated factors in adolescent (age 12-17 years) relatives of patients in an ICU with an open visitation policy. METHODS: One year after the patient was discharged from the ICU, eligible adolescent relatives completed a satisfaction survey, anxiety history questionnaire, and psychometric evaluations (Hospital Anxiety and Depression Scale and 8-item Children's Revised Impact of Event Scale)...

BACKGROUND: Despite increased emphasis on providing higher-quality patient- and family-centered care in the intensive care unit (ICU), there are no widely accepted definitions of such care in the ICU. OBJECTIVES: To determine (1) aspects of care that patients and families valued during their ICU encounter, (2) outcomes that patients and families prioritized after hospital discharge, and (3) outcomes perceived as equivalent to or worse than death. METHODS: Semistructured interviews (n = 49) of former patients of an urban, academic medical ICU and their family members...

BACKGROUND: Quantifying nurses' perceptions of workload burden when managing critically ill patients is essential for designing interventions to ease nurses' workday. OBJECTIVES: To explore pediatric intensive care unit (PICU) nurses' perceptions of their workload when caring for critically ill patients and managing protocolized therapies. METHODS: This study was embedded in a multicenter randomized clinical trial where participants were assigned to receive either lower-target or higher-target glucose control...

Accurate height measurement is critical for accurate dosing of medications, mechanical ventilation, and nutritional calculations. Prior research has identified inaccuracies with self-reported height, and height is notably important to measure accurately in critically ill patients. In this study, conducted in a large tertiary academic medical center, medical records rarely indicated the method of height measurement, and there were statistically significant variations in measured height across admissions.

BACKGROUND: Iliopsoas hematoma occasionally occurs in patients receiving anticoagulation therapy. It may be a life-threatening complication and can cause disseminated intravascular coagulation, which could develop into abdominal compartment syndrome. The incidence of and factors associated with iliopsoas hematoma during venovenous extracorporeal membrane oxygenation (ECMO) have not been well studied. OBJECTIVES: To describe the incidence of iliopsoas hematoma and associated factors among patients undergoing venovenous ECMO...

BACKGROUND: Communication is key to understanding the emotional state of critical care patients. OBJECTIVE: To analyze the effectiveness of the communicative intervention known as CONECTEM, which incorporates basic communication skills and augmentative alternative communication, in improving pain, anxiety, and posttraumatic stress disorder symptoms in critical care patients transported by ambulance. METHODS: This study had a quasi-experimental design with intervention and control groups...

BACKGROUND: Electrocardiographic telemetry monitors are ubiquitous in hospitals. Dedicated monitor watchers, either on the unit or in a centralized location, are often responsible for observing telemetry monitors and responding to their alarms. The impact of use of monitor watchers is not known. OBJECTIVES: To evaluate the association of monitor-watcher use with (1) nurses' knowledge of electrocardiographic (ECG) monitoring and (2) accuracy of arrhythmia detection...

BACKGROUND: For women undergoing median sternotomy, especially those with a bra cup size C or larger, breast support can reduce pain, wound breakdown, and infection. This study addressed a gap in research, identifying the best bra after sternotomy in terms of patient satisfaction and wear compliance. OBJECTIVES: To evaluate larger-breasted women's satisfaction and compliance with wearing 3 commercially available front-closure bras-with a hook-loop closure (the hospital's standard of care), a zipper closure, or a hook-eye closure-after cardiac surgery...

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