American Journal of Critical Care

BACKGROUND: Adoption of early mobility interventions into intensive care unit (ICU) practice has been slow and varied. OBJECTIVES: To examine factors associated with early mobility performance in critically ill adults and evaluate factors' effects on predicting next-day early mobility performance. METHODS: A secondary analysis of 66 ICUs' data from patients admitted for at least 24 hours. Mixed-effects logistic regression modeling was done, with area under the receiver operating characteristic curve (AUC) calculated...

BACKGROUND: Sepsis is a complex condition with high morbidity and mortality. Prompt treatment can improve survival, but for survivors the risk of deterioration and readmission remains high. Little is known about the association between discharge setting and readmission among sepsis survivors. OBJECTIVE: To examine 30-day hospital readmission rates in adult sepsis survivors by the type of setting to which patients were discharged. METHODS: The Medical Information Mart for Intensive Care database was used to identify adult sepsis survivors and evaluate 30-day readmission by discharge setting...

BACKGROUND: Communication and collaboration among health care professionals during bedside rounds improve patient outcomes and nurses' and physicians' satisfaction. OBJECTIVES: To determine barriers to nurse-physician communication during bedside rounds and identify opportunities to improve nurse-physician collaboration at an academic medical center. METHODS: A survey with Likert-scale and open-ended questions regarding professional attitudes toward nurse-physician communication was administered to 220 nurses and physicians in medical-surgical units to assess perceptions of participation in bedside rounds...

BACKGROUND: Hospital-acquired pressure injuries (HAPIs) have a major impact on patient outcomes in intensive care units (ICUs). Effective prevention relies on early and accurate risk assessment. Traditional risk-assessment tools, such as the Braden Scale, often fail to capture ICU-specific factors, limiting their predictive accuracy. Although artificial intelligence models offer improved accuracy, their "black box" nature poses a barrier to clinical adoption. OBJECTIVE: To develop an artificial intelligence-based HAPI risk-assessment model enhanced with an explainable artificial intelligence dashboard to improve interpretability at both the global and individual patient levels...

BACKGROUND: Little is known about differences in patient characteristics before and after implementation of the new definition of sepsis (Sepsis-3) and whether the new definition is affecting clinical practice in intensive care units. OBJECTIVE: To examine and compare the clinicoepidemiologic characteristics of patients with sepsis or septic shock before and after implementation of Sepsis-3. METHODS: In this population-based cohort study, a nationwide registration database in South Korea was used to identify patients with sepsis or septic shock...

BACKGROUND: Promoting bonding and neurodevelopmental care is an important element in the cardiovascular intensive care unit (CICU); however, holding of infants by family members is inconsistently practiced. OBJECTIVES: This quality improvement study aimed to safely increase the holding of medically complex infants in the CICU by developing a holding guideline and offering simulation-based staff education. METHODS: Using consensus methodology and high-fidelity simulation, an expert work group created a holding guideline and training to increase staff confidence and competence in holding critically ill infants in the CICU...

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BACKGROUND: Evaluating energy expenditure is important for establishing optimal goals for nutrition treatment. However, indirect calorimetry, the reference standard for measuring energy expenditure, is difficult to apply widely in clinical practice. OBJECTIVE: To test the consistency of bioelectrical impedance analysis (BIA) relative to indirect calorimetry for evaluating energy expenditure in critically ill patients. METHODS: A cross-sectional study of 140 critically ill adult patients was conducted...

BACKGROUND: Music therapy has been used as a complementary intervention to provide synergistic analgesia for various procedures. OBJECTIVE: To evaluate the effects of natural sound therapy on pain intensity and agitation scores in intubated adult Chinese patients who received endotracheal suctioning in a critical care unit. METHODS: A prospective, real-world, randomized, double-blind, controlled study was conducted from July 2021 through February 2022 among intubated surgical intensive care unit patients in a Chinese hospital...

BACKGROUND: Death after resuscitation from cardiac arrest is common. Although associated factors have been identified, knowledge about their relationship with specific modes of death is limited. OBJECTIVE: To identify clinical factors associated with specific modes of death following cardiac arrest. METHODS: This study involved a retrospective medical record review of patients admitted to a single health care center from January 2015 to March 2020 after resuscitation from cardiac arrest who died during their index hospitalization...

BACKGROUND: Use of noninvasive ventilation in patients with acute respiratory distress syndrome (ARDS) is debated. The COVID-19 pandemic posed challenges due to high patient volumes and worldwide resource strain. OBJECTIVES: To determine associations between use of noninvasive ventilation in adult patients with moderate to severe ARDS due to SARS-CoV-2 pneumonia, progression to intubation, and hospital mortality. METHODS: This retrospective cohort study included patients in an institutional COVID-19 registry...

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Continuous electrocardiographic (ECG) monitoring was first introduced into hospitals in the 1960s, initially into critical care, as bedside monitors, and eventually into step-down units with telemetry capabilities. Although the initial use was rather simplistic (ie, heart rate and rhythm assessment), the capabilities of these devices and associated physiologic (vital sign) monitors have expanded considerably. Current bedside monitors now include sophisticated ECG software designed to identify myocardial ischemia (ie, ST-segment monitoring), QT-interval prolongation, and a myriad of other cardiac arrhythmia types...

BACKGROUND: Pain is a significant burden for children with neurodevelopmental disabilities but is difficult for clinicians to identify. No pain assessment tools for children with neurodevelopmental disabilities have been validated for use in pediatric intensive care units. The Individualized Numeric Rating Scale (INRS) is an adapted 0-to-10 rating that includes parents' input on their child's pain indicators. OBJECTIVES: To evaluate the reliability, validity, and feasibility and acceptability of use of the INRS for assessing pain in critically ill children with neurodevelopmental disabilities...

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BACKGROUND: Pediatric patients receiving neurologic and neurosurgical critical care undergo many procedures that result in stimulation of the sympathetic nervous system, which increases their risk of poor outcomes. Nurses typically implement a variety of interventions to minimize such stimulation; however, minimal stimulation has not been specifically defined in the literature or described as a standardized bundle of care. OBJECTIVE: To examine pediatric intensive care unit nurses' interpretation and practice of minimal stimulation in patients with neurologic and neurosurgical conditions and specifically to triangulate nurses' descriptions of this practice with related findings in the literature...

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