scholarly journals Changing End-of-Life Care Practice for Liver Transplant Service Patients: Structured Palliative Care Intervention in the Surgical Intensive Care Unit

2012 ◽  
Vol 44 (4) ◽  
pp. 508-519 ◽  
Author(s):  
Sangeeta Lamba ◽  
Patricia Murphy ◽  
Susan McVicker ◽  
Janet Harris Smith ◽  
Anne C. Mosenthal
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Liver Transplant ◽  
End Of Life Care ◽  
Care Practice ◽  
Surgical Intensive Care Unit ◽  
Life Care ◽  
Surgical Intensive Care ◽  
Care Intervention

scholarly journals 108 Palliative care for neonates: Retrospective mixed methods review of infant death in the Neonatal Intensive Care Unit

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e45-e45
Author(s):  
Marina Journault ◽  
Simone Stenekes ◽  
Robin McClure ◽  
Chelsea Ruth
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Infant Death ◽  
End Of Life Care ◽  
Neonatal Intensive Care ◽  
Life Care ◽  
Specialist Palliative Care ◽  
Age At Death

Abstract Background Neonatal palliative care is an under researched yet growing field in the provision of intensive care to neonates. There are currently no studies which explore infant death in the Neonatal Intensive Care Unit (NICU) itself where a shift from intensive to palliative care may occur. Objectives The purpose of this study was to explore the circumstances of infant death in the NICU and understand current utilization of specialist palliative care in this area. It aimed to characterize the infants’ clinical course and add unique understanding by analyzing documentation related to end of life care. Design/Methods A retrospective chart review of infants who died in a single centre NICU between January 2017 and March 2018 was undertaken. Infants of any gestational and post-natal age were included, excluding infants who died prior to arrival to the NICU or were discharged or transferred prior to death. Chart notes relating to prognosis, advanced care planning, and palliative interventions were sampled, coded, and collated for thematic analysis. Results Twenty-five infants met study criteria. Of these, 92% were preterm with more than half below 28 weeks gestation. Median age at death was 5.2 days (IQR 1, 26.2). All infants required ventilator support with planned withdrawal occurring in 60%. Specialist palliative care was involved in 28%; these infants tended to be older (mean age at death = 78 days). Most infants were labelled as “critical” 2-5 days prior to death. Seventy-six percent of infants were held on their last day of life with 72% of families having memory making documented as part of their care. Qualitative excerpts revealed themes of hope and acceptance, parental presence, and framed discussion. Within these emerged concepts of “parental agreement” and “palliative language/approach”. Conclusion There is a growing need for both primary and specialist palliative care in the NICU. This study highlights an under researched area and generates many more important questions. By exploring documented language, we aim to understand and improve the ability to frame the discussion while ensuring quality end of life care for dying infants and their families in the NICU.

Staphylococcus AureusRectal Carriage and its Association with Infections in Patients in a Surgical Intensive Care Unit and a Liver Transplant Unit

2002 ◽  
Vol 23 (9) ◽  
pp. 495-501 ◽  
Author(s):  
Cheryl Squier ◽  
John D. Rihs ◽  
Kathleen J. Risa ◽  
Asia Sagnimeni ◽  
Marilyn M. Wagener ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Liver Transplant ◽  
Nasal Carriage ◽  
Pulsed Field Gel Electrophoresis ◽  
Surgical Intensive Care Unit ◽  
Transplant Recipients ◽  
Surgical Intensive Care ◽  
Liver Transplant Recipients

Background:The role of rectal carriage ofStaphylococcus aureusas a risk factor for nosocomialS. aureusinfections in critically ill patients has not been fully discerned.Methods:Nasal and rectal swabs forS. aureuswere obtained on admission and weekly thereafter until discharge or death from 204 consecutive patients admitted to the surgical intensive care unit and liver transplant unit.Results:Overall, 49.5% (101 of 204) of the patients never harboredS. aureus, 21.6% (44 of 204) were nasal carriers only, 3.4% (7 of 204) were rectal carriers only, and 25.5% (52 of 204) were both nasal and rectal carriers. Infections due toS. aureusdeveloped in 15.7% (32 of 204) of the patients; these included 3% (3 of 101) of the non-carriers, 18.2% (8 of 44) of the nasal carriers only, 0% (0 of 7) of the rectal carriers only, and 40.4% (21 of 52) of the patients who were both nasal and rectal carriers (P= .001). Patients with both rectal and nasal carriage were significantly more likely to developS. aureusinfection than were those with nasal carriage only (odds ratio, 3.9; 95% confidence interval, 1.18 to 7.85;P= .025). By pulsed-field gel electrophoresis, the infecting rectal and nasal isolates were clonally identical in 82% (14 of 17) of the patients withS. aureusinfections.Conclusions:Rectal carriage represents an underappreciated reservoir forS. aureusin patients in the intensive care unit and liver transplant recipients. Rectal plus nasal carriage may portend a greater risk forS. aureusinfections in these patients than currently realized.

Candida auris outbreak involving liver transplant recipients in a surgical intensive care unit

2020 ◽  
Vol 20 (12) ◽  
pp. 3673-3679 ◽  
Author(s):  
Nicole M. Theodoropoulos ◽  
Barbara Bolstorff ◽  
Adel Bozorgzadeh ◽  
Christina Brandeburg ◽  
Melissa Cumming ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Liver Transplant ◽  
Surgical Intensive Care Unit ◽  
Transplant Recipients ◽  
Candida Auris ◽  
Surgical Intensive Care ◽  
Liver Transplant Recipients

Practical methods for effective vancomycin-resistant enterococci (VRE) surveillance: experience in a liver transplant surgical intensive care unit

2018 ◽  
Vol 39 (10) ◽  
pp. 1178-1182 ◽  
Author(s):  
Rebecca Y. Linfield ◽  
Shelley Campeau ◽  
Patil Injean ◽  
Aric Gregson ◽  
Fady Kaldas ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Liver Transplant ◽  
Tertiary Care ◽  
Point Prevalence ◽  
Surgical Intensive Care Unit ◽  
Fisher Exact Test ◽  
Surgical Intensive Care ◽  
Stool Samples ◽  
Vancomycin Resistant

AbstractObjectiveWe evaluated the utility of vancomycin-resistant Enterococcus (VRE) surveillance by varying 2 parameters: admission versus weekly surveillance and perirectal swabbing versus stool sampling.DesignProspective, patient-level surveillance program of incident VRE colonization.SettingLiver transplant surgical intensive care unit (SICU) of a tertiary-care referral medical center with a high prevalence of VRE.PatientsAll patients admitted to the SICU from June to August 2015.MethodsWe conducted a point-prevalence estimate followed by admission and weekly surveillance by perirectal swabbing and/or stool sampling. Incident colonization was defined as a negative screen followed by positive surveillance. VRE was detected by culture on Remel Spectra VRE chromogenic agar. Microbiologically-confirmed VRE bloodstream infections (BSIs) were tracked for 2 months. Statistical analyses were calculated using the McNemar test, the Fisher exact test, the t test, and the χ2 test.ResultsIn total, 91 patients underwent VRE surveillance testing. The point prevalence of VRE colonization was 60.9%; VRE prevalence on admission was 30.1%. Weekly surveillance identified an additional 7 of 28 patients (25.0%) with incident colonization. VRE BSIs were more common in VRE-colonized patients than in noncolonized patients (8 of 43 vs 2 of 48; P=.028). In a direct comparison, perirectal swabs were more sensitive than stool samples in detecting VRE (64 of 67 vs 56 of 67; P=.023). Compliance with perirectal swabbing was 89% (201 of 226) compared to 56% (127 of 226) for stool collection (P≤0.001).ConclusionsWe recommend weekly VRE surveillance over admission-only screening in high-burden units such as liver transplant SICUs. Perirectal swabs had greater collection compliance and sensitivity than stool samples, making them the preferred methodology. Further work may have implications for antimicrobial stewardship and infection control.

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