Integrating intensive care unit (ICU) surveillance into an ICU clinical care electronic system

The current global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has thrust intensive care medicine to the forefront of health care practice in Australia and New Zealand. Indeed, reports from other countries and jurisdictions convey highly confronting statistics about the scale of this public health emergency, particularly in terms of the demand on intensive care unit (ICU)services. Whether this occurs here remains to be seen, although if such a scenario does eventuate, it will represent an unprecedented challenge to our community. In parallel, these events offer the opportunity for greater coordination, improved communication, and innovation in clinical care, which are principles that in many ways define our specialty.

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Clinical Decision Making in the ICU: Dysphagia Screening, Assessment, and Treatment

Seminars in Speech and Language ◽

10.1055/s-0039-1688980 ◽

2019 ◽

Vol 40 (03) ◽

pp. 170-187 ◽

Cited By ~ 4

Author(s):

Martin B. Brodsky ◽

Emily B. Mayfield ◽

Roxann Diez Gross

Keyword(s):

Intensive Care Unit ◽

Decision Making ◽

Intensive Care ◽

Clinical Decision Making ◽

Clinical Care ◽

Clinical Decision ◽

Level Of Care ◽

Assessment And Treatment ◽

Proper Training ◽

Screening Assessment

AbstractClinicians often perceive the intensive care unit as among the most intimidating environments in patient care. With the proper training, acquisition of skill, and approach to clinical care, feelings of intimidation may be overcome with the great rewards this level of care has to offer. This review—spanning the ages of birth to senescence and covering oral/nasal endotracheal intubation and tracheostomy—presents a clinically relevant, directly applicable review of screening, assessment, and treatment of dysphagia in the patients who are critically ill for clinical speech–language pathologists and identifies gaps in the clinical peer-reviewed literature for researchers.

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Methodology for Low-Field, Portable Magnetic Resonance Neuroimaging at the Bedside

Frontiers in Neurology ◽

10.3389/fneur.2021.760321 ◽

2021 ◽

Vol 12 ◽

Author(s):

Anjali M. Prabhat ◽

Anna L. Crawford ◽

Mercy H. Mazurek ◽

Matthew M. Yuen ◽

Isha R. Chavva ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Magnetic Resonance ◽

Brain Injuries ◽

Massachusetts General Hospital ◽

Clinical Care ◽

Mri Imaging ◽

Specific Patient ◽

Secondary Injuries ◽

Patients At Risk

Neuroimaging is a critical component of triage and treatment for patients who present with neuropathology. Magnetic resonance imaging and non-contrast computed tomography are the gold standard for diagnosis and prognostication of patients with acute brain injuries. However, these modalities require intra-hospital transport to strict, access-controlled environments, which puts critically ill patients at risk for complications and secondary injuries. A novel, portable MRI (pMRI) device that can be deployed at the patient's bedside provides a needed solution. In a dual-center investigation, Yale New Haven Hospital has obtained regular neuroimaging on patients using the pMRI as part of routine clinical care in the Emergency Department and Intensive Care Unit (ICU) since August of 2020. Massachusetts General Hospital has begun using pMRI in the Neuroscience Intensive Care Unit since January 2021. This technology has expanded the population of patients who can receive MRI imaging by increasing accessibility and timeliness for scan completion by eliminating the need for transport and increasing the potential for serial monitoring. Here we describe our methods for screening, coordinating, and executing pMRI exams and provide further detail on how to scan specific patient populations.

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Clinical Care Needs of Patients with Severe Traumatic Brain Injury in the Intensive Care Unit

Trauma Monthly ◽

10.5812/traumamon.57883 ◽

2018 ◽

Vol 23 (2) ◽

Author(s):

Nasrollah Alimohammadi ◽

Marzieh Ziaeirad ◽

Alireza Irajpour ◽

Bahram Aminmansour

Keyword(s):

Intensive Care Unit ◽

Traumatic Brain Injury ◽

Intensive Care ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Clinical Care ◽

Care Needs

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Enhancing Communication With Family Members in the Intensive Care Unit: A Mixed-Methods Study

Critical Care Nurse ◽

10.4037/ccn2020595 ◽

2020 ◽

Vol 40 (6) ◽

pp. 23-32

Author(s):

Karen-leigh Edward ◽

Alessandra Galletti ◽

Minh Huynh

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Mixed Methods ◽

Care Delivery ◽

Clinical Care ◽

Family Members ◽

Staff Members ◽

Confidence Levels ◽

Decision Making Model ◽

Intensive Care Unit Nurses

Background Nurses in the intensive care unit are central to clinical care delivery and are often the staff members most accessible to family members for communication. Family members’ ratings of satisfaction with the intensive care unit admission are affected more by communication quality than by the level of care for the patient. Family members may feel that communication in the intensive care unit is inconsistent. Objectives To use a shared decision-making model to deliver a communication education program for intensive care unit nurses, evaluate the confidence levels of nurses who undertook the education, and examine changes in family members’ satisfaction with communication from intensive care unit nurses after the nurses received the education. Methods A mixed-methods design was used. Seventeen nurses and 81 family members participated. Results Staff members were overall very confident with communicating with family members of critically ill patients. This finding was likely linked to staff members’ experience in the position, with 88% of nurses having more than 11 years’ experience. Family members were happy with care but dissatisfied with the environment. Conclusions Environmental factors can negatively affect communication with family members in the intensive care unit.

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A First-line management team’s strategies for sustaining resilience in a specialised intensive care unit—a qualitative observational study

BMJ Open ◽

10.1136/bmjopen-2020-040358 ◽

2021 ◽

Vol 11 (3) ◽

pp. e040358

Author(s):

Karl Hybinette ◽

Karin Pukk Härenstam ◽

Mirjam Ekstedt

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Observational Study ◽

Neonatal Intensive Care ◽

Clinical Care ◽

Care Quality ◽

Future Research ◽

First Line ◽

Line Managers ◽

Team Members

ObjectivesAcute care units manage high risk patients at the edge of scientifically established treatments and organisational constraints while aiming to balance reliability to standards with the needs of situational adaptation (resilience). First-line managers are central in coordinating clinical care. Any systemic brittleness will be evident only in retrospect through, for example, care quality measures and accident statistics. This challenges us to understand what successful managerial strategies for adaptation are and how they could be improved. The managerial work of balancing reliability and adaptation is only partially understood. This study aims to explore and describe how system resilience is enhanced by naturally occurring coordination performed in situ by a management team under variable circumstances.DesignAn explorative observational study of a tertiary neonatal intensive care unit (NICU) in Sweden. One year of broad preparatory work followed by focused shadowing observations of coordination analysed through inductive–deductive content analysis from a perspective of resilience engineering.ParticipantsA team of managers (ie, clinical coordinators, head nurses, senior medical doctors).ResultsThe results describe a functional relationship between operational stress and a progression of adjustments in the actual situation, expressed through recurring patterns of adaptation. Managers focused on maintaining coherence in escalating problematic situations by facilitating teamwork through goalsetting, problem-solving and circumventing the technical systems’ limitations.ConclusionsCoordination supports a coherent goal setting by increased team collaboration and is supported by team members’ abilities to predict the behaviour of each other. Our findings suggest that in design of future research or training for coordination, the focus of assessment and reflection on adaptive managerial responses may lie on situations where the system was ‘stretched’ or ‘needed reorganisation’ and that learning should be about whether the actions were able to achieve short-term goals while preserving the long-term goals.

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The Negative Impact of Obesity on the Occurrence and Prognosis of the 2019 Novel Coronavirus (COVID-19) Disease: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-86237/v1 ◽

2020 ◽

Author(s):

Tahereh Raeisi ◽

Hadis Mozaffari ◽

Nazaninzahra Sepehri ◽

Mohammad Alizadeh ◽

Mina Darand ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Risk Factor ◽

Intensive Care ◽

Clinical Outcomes ◽

Meta Analysis ◽

Clinical Care ◽

Icu Admission ◽

Prevalence Of Obesity ◽

Novel Coronavirus

Abstract Background: the 2019 novel coronavirus (COVID-19) is an emerging pandemic, with a disease course varying from asymptomatic infection to critical disease resulting to death. Recognition of prognostic factors is essential because of its growing prevalence and high clinical costs. This meta-analysis aimed to evaluate the global prevalence of obesity in COVID-19 patients and to investigate whether obesity is a risk factor for the COVID-19, COVID-19 severity, and its poor clinical outcomes including hospitalization, intensive care unit (ICU) admission, need for mechanical ventilation, and mortality.Methods: The study protocol was registered on to PROSPERO (CRD42020203386). A systematic search of Scopus, Medline, and Web of Sciences was conducted on June 2020, to find pertinent studies. After selection, 54 studies from 10 different countries were included in the quantitative analyses. Pooled odds ratios (OR) with 95% confidence intervals (CIs) were calculated to assess the associations. Results: The prevalence of obesity was 33% (95% CI, 30.0%–35.0%) among patients with COVID-19. Obesity was significantly associated with susceptibility to COVID-19 (OR=2.42, 95% CI: 1.58 to 3.70; moderate certainty) and COVID-19 severity (OR=1.62, 95% CI: 1.48 to 1.76; low certainty). Furthermore, obesity was a significant risk factor for hospitalization (OR=1.75, 95% CI: 1.47 to 2.09; very low certainty), mechanical ventilation (OR=2.24, 95% CI: 1.70 to 2.94; low certainty), intensive care unit (ICU) admission (OR=1.75, 95% CI: 1.38 to 2.22; low certainty), and death (OR=1.23, 95% CI: 1.06 to 1.41; low certainty) in COVID-19 patients. In the subgroup analyses, these associations were supported by the majority of subgroups. Conclusions: Obesity is associated with COVID-19 and its poor clinical outcomes. Thus, it is highly recommended to consider obesity status in prognostic scores and improvement of guidelines for the clinical care of patients with COVID-19.

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Telerobotic Operation of Intensive Care Unit Ventilators

Frontiers in Robotics and AI ◽

10.3389/frobt.2021.612964 ◽

2021 ◽

Vol 8 ◽

Author(s):

Balazs P. Vagvolgyi ◽

Mikhail Khrenov ◽

Jonathan Cope ◽

Anton Deguet ◽

Peter Kazanzides ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Visual Servoing ◽

Clinical Care ◽

The United States ◽

Prototype System ◽

Engineering System ◽

Preliminary Evaluation ◽

Usability Tests ◽

Ventilator Settings

Since the first reports of a novel coronavirus (SARS-CoV-2) in December 2019, over 33 million people have been infected worldwide and approximately 1 million people worldwide have died from the disease caused by this virus, COVID-19. In the United States alone, there have been approximately 7 million cases and over 200,000 deaths. This outbreak has placed an enormous strain on healthcare systems and workers. Severe cases require hospital care, and 8.5% of patients require mechanical ventilation in an intensive care unit (ICU). One major challenge is the necessity for clinical care personnel to don and doff cumbersome personal protective equipment (PPE) in order to enter an ICU unit to make simple adjustments to ventilator settings. Although future ventilators and other ICU equipment may be controllable remotely through computer networks, the enormous installed base of existing ventilators do not have this capability. This paper reports the development of a simple, low cost telerobotic system that permits adjustment of ventilator settings from outside the ICU. The system consists of a small Cartesian robot capable of operating a ventilator touch screen with camera vision control via a wirelessly connected tablet master device located outside the room. Engineering system tests demonstrated that the open-loop mechanical repeatability of the device was 7.5 mm, and that the average positioning error of the robotic finger under visual servoing control was 5.94 mm. Successful usability tests in a simulated ICU environment were carried out and are reported. In addition to enabling a significant reduction in PPE consumption, the prototype system has been shown in a preliminary evaluation to significantly reduce the total time required for a respiratory therapist to perform typical setting adjustments on a commercial ventilator, including donning and doffing PPE, from 271 to 109 s.

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P0503 / #2118: CARING FOR THE INVISIBLE. HOW TO HUMANIZE CLINICAL CARE IN A PEDIATRIC AND NEONATAL INTENSIVE CARE UNIT

Pediatric Critical Care Medicine ◽

10.1097/01.pcc.0000740348.25501.a4 ◽

2021 ◽

Vol 22 (Supplement 1 3S) ◽

pp. 253-253

Author(s):

M. Brezmes-Raposo ◽

L. Bermudez ◽

C. Dominguez ◽

C. Fernandez ◽

A. Franco ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Clinical Care ◽

The Invisible

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Physician and Nurse Research in Multidisciplinary Intensive Care Units

American Journal of Critical Care ◽

10.4037/ajcc2020136 ◽

2020 ◽

Vol 29 (6) ◽

pp. 450-457

Author(s):

Kevin B. Laupland ◽

Fiona Coyer

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Interprofessional Collaboration ◽

Clinical Care ◽

Journal Articles ◽

Medical Journals ◽

Medical Study ◽

Nurse Research ◽

Study Participants ◽

Study Designs

Background Although clinical care is multidisciplinary, intensive care unit research commonly focuses on single-discipline themes. We sought to characterize intensive care unit research conducted by physicians and nurses. Methods One hundred randomly selected reports of clinical studies published in critical care medical and nursing journals were reviewed. Results Of the 100 articles reviewed, 50 were published in medical journals and 50 were published in nursing journals. Only 1 medical study (2%) used qualitative methods, compared with 9 nursing studies (18%) (P = .02). The distribution of quantitative study designs differed between medical and nursing journals (P < .001), with medical journals having a predominance of cohort studies (29 articles [58%]). Compared with medical journal articles, nursing journal articles had significantly fewer authors (median [interquartile range], 5 [3-6] vs 8 [6-10]; P < .001) and study participants (94 [51-237] vs 375 [86-4183]; P < .001) and a significantly lower proportion of male study participants (55% [26%-65%] vs 60% [51%-65%]; P = .02). Studies published in medical journals were much more likely than those published in nursing journals to exclusively involve patients as participants (47 [94%] vs 25 [50%]; P < .001). Coauthorship between physicians and nurses was evident in 14 articles (14%), with infrequent inclusion of authors from other health care disciplines. Conclusions Physician research and nurse research differ in several important aspects and tend to occur within silos. Increased interprofessional collaboration is possible and worthwhile.

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