American Journal of Critical Care

BACKGROUND: Patients with sepsis are at risk for mechanical ventilation. This study aimed to identify risk factors for initiation of mechanical ventilation in patients with sepsis and assess whether these factors varied with time. METHODS: Data from the electronic health record were used to model risk factors for initiation of mechanical ventilation after the onset of sepsis. A time-varying Cox model was used to study factors that varied with time. RESULTS: Of 35 020 patients who met sepsis criteria, 28 747 were eligible for inclusion...

BACKGROUND: Pain assessment in the pediatric intensive care unit (PICU) is complex, specifically for children receiving mechanical ventilation who require neuromuscular blockade (NMB). No valid pain assessment method exists for this population. Guidelines are limited to using physiologic variables; it remains unknown how nurses are assessing and managing pain for this population in practice. OBJECTIVES: To describe how PICU nurses are assessing and managing pain for children who require NMB...

BACKGROUND: Despite efforts to improve early detection of deterioration in a patient's condition, delays in activating the rapid response team remain common. OBJECTIVES: To evaluate delays in activating the rapid response team and the occurrence of serious adverse events before and after implementation of a quality improvement initiative aimed at nurses' performing systems-based physical assessments. METHODS: A retrospective observational cohort design was used to evaluate all patients who had a rapid response team activation during the study period...

BACKGROUND: The few studies of associations between fever and outcomes in pediatric intensive care unit (PICU) patients have conflicting findings. Associations between hypothermia and patient outcomes have not been studied. OBJECTIVE: To investigate the incidence and characteristics of fever and hypothermia and their associations with adverse outcomes among PICU patients. METHODS: Patients consecutively admitted to 2 PICUs in a 2-year period were prospectively studied...

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BACKGROUND: High-quality chest compressions are essential to favorable patient outcomes after in-hospital cardiac arrest. Without frequent training, however, skill in performing compressions declines considerably. The Timely Chest Compression Training (T-CCT) intervention was introduced in 2019 as a quality improvement initiative to address this problem. The long-term impact of the T-CCT is unknown. METHODS: A cohort study was conducted at a university-affiliated hospital in Quebec, Canada...

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BACKGROUND: After an intensive care unit (ICU) admission, nearly 20% of survivors of chronic critical illness require admission to a long-term acute care hospital (LTACH) for continued subspecialty care. The effect of the burden of medical comorbidities on discharge disposition after LTACH admission remains unclear. METHODS: A retrospective cohort study was performed involving patients with chronic critical illness who were discharged from the medical ICU and admitted to an LTACH between 2016 and 2018...

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BACKGROUND: The COVID-19 pandemic created unprecedented conditions for clinicians providing end-of-life care in acute care settings, yet almost 2 years since the start of the pandemic, little is known about its impact on clinicians. OBJECTIVES: To qualitatively explore how clinicians experienced their role as they cared for dying patients with COVID-19 during the pandemic and the impact of these experiences on their lives as health care professionals. METHODS: In-depth, hour-long interviews were conducted by phone in the spring of 2022 at a single time point with 23 physicians and nurses in critical care and emergency department settings from 2 health systems in California...

BACKGROUND: Function-focused care is an approach used to increase physical activity in hospitalized older adults with dementia. OBJECTIVE: To explore factors associated with participation in function-focused care in this patient population. METHODS: This was a cross-sectional descriptive study using baseline data from the first 294 participants in an ongoing study on testing function-focused care for acute care using the evidence integration triangle...

BACKGROUND: Critical care nurses working in urban settings have reported obstacles in caring for dying patients. However, the perceptions of such obstacles by nurses working in critical access hospitals (CAHs), which are located in rural areas, are unknown. OBJECTIVE: To study stories and experiences related to obstacles in providing end-of-life care reported by CAH nurses. METHODS: This exploratory, cross-sectional study presents the qualitative stories and experiences of nurses working in CAHs as reported on a questionnaire...

BACKGROUND: Intensive care unit (ICU) utilization has increased among patients with Alzheimer disease and related dementia (ADRD), although outcomes are poor. OBJECTIVES: To compare ICU discharge location and subsequent mortality between patients with and patients without ADRD enrolled in Medicare Advantage. METHODS: This observational study used Optum's Clinformatics Data Mart Database from years 2016 to 2019 and included adults aged >67 years with continuous Medicare Advantage coverage and a first ICU admission in 2018...

BACKGROUND: Identifying potentially modifiable factors that mediate adverse outcomes in frail adults with critical illness may facilitate development of interventions to improve intensive care unit (ICU) survivorship. OBJECTIVES: To estimate the relationship between frailty, acute brain dysfunction (as reflected by delirium or persistent coma), and 6-month disability outcomes. METHODS: Older adults (aged ≥50 years) admitted to the ICU were enrolled prospectively...

Ethical challenges are inherent in nursing practice. They affect patients, families, teams, organizations, and nurses themselves. These challenges arise when there are competing core values or commitments and diverse views on how to balance or reconcile them. When ethical conflict, confusion, or uncertainty cannot be resolved, moral suffering ensues. The consequences of moral suffering in its many forms undermine safe, high-quality patient care, erode teamwork, and undermine well-being and integrity. My experience as a nurse in the pediatric intensive care unit and later as a clinical nurse specialist in confronting these moral and ethical challenges has been the foundation of my program of research...