Psychische Komorbidität in der Intensivmedizin

2019 ◽  
Vol 144 (01) ◽  
pp. 54-60 ◽  
Author(s):  
Alexander Niecke ◽  
Valeska von Bassewitz ◽  
Guido Michels
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Intensive Care ◽  
Mental Disorders ◽  
Intensive Care Medicine ◽  
Treatment Strategies ◽  
Physical Illness ◽  
Psychische Komorbidität ◽  
Mental Comorbidity ◽  
Critical Care Patients

AbstractThis article aims to provide an overview of the nature and extent, risk factors and treatment strategies of co-morbid mental disorders in the context of intensive care medicine. Depressive, anxious and posttraumatic syndromes as well as deliria are common phenomena in critical care patients, which correspond with the course and outcome of the underlying physical illness. The most important factors for the occurrence of mental comorbidity and general principles of care are described.

scholarly journals Professional Quality of Life in intensive care medicine: The 2018 Faculty of Intensive Care Medicine Workforce survey

2019 ◽  
Vol 21 (4) ◽  
pp. 299-304
Author(s):  
Julie Highfield ◽  
Jack Parry-Jones
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Medicine ◽  
Critical Care Medicine ◽  
Professional Quality Of Life ◽  
Survey Tool ◽  
Professional Quality

Background Critical care is widely perceived, both within and outside of the speciality, as unremitting and emotionally burdensome. There is a perception of a higher risk to medical staff of burnout than other specialities. Critical care also has considerable emotional and professional rewards. We sought to examine this balance between emotional reward and stress in UK critical care consultants registered with the Faculty of Intensive Care Medicine. Method We conducted a Wellbeing survey of the Faculty of Intensive Care Medicine consultant membership utilising the Professional Quality of Life (Pro-QOL) survey tool. The survey was conducted as part of the Annual Workforce Census. Results In sum, 799 members completed the Pro-QOL survey, making this one of the largest surveys of physician wellbeing in critical care medicine. Data were analysed in accordance with the Pro-QOL manual. Conclusions The results demonstrate moderate risk for burnout and secondary traumatic stress, but this is balanced by moderate compassion satisfaction. No association was demonstrated between age, sex, or size of critical care unit worked in. Further follow-up of this consultant group is warranted to better understand risk factors for burnout and for future mitigation of these risk factors whilst also enhancing the positive aspects of working as a consultant in critical care medicine.

Identifying Risk Factors for Pressure Injury in Adult Critical Care Patients

2020 ◽  
Vol 29 (3) ◽  
pp. 204-213 ◽  
Author(s):  
Jill Cox ◽  
Marilyn Schallom ◽  
Christy Jung
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Critical Care ◽  
Intensive Care ◽  
Decision Tree ◽  
Scale Score ◽  
Critically Ill Patients ◽  
Braden Scale ◽  
Pressure Injury ◽  
Critical Care Patients

Background Critically ill patients have a variety of unique risk factors for pressure injury. Identification of these risk factors is essential to prevent pressure injury in this population. Objective To identify factors predicting the development of pressure injury in critical care patients using a large data set from the PhysioNet MIMIC-III (Medical Information Mart for Intensive Care) clinical database. Methods Data for 1460 patients were extracted from the database. Variables that were significant in bivariate analyses were used in a final logistic regression model. A final set of significant variables from the logistic regression was used to develop a decision tree model. Results In regression analysis, cardiovascular disease, peripheral vascular disease, pneumonia or influenza, cardiovascular surgery, hemodialysis, norepinephrine administration, hypotension, septic shock, moderate to severe malnutrition, sex, age, and Braden Scale score on admission to the intensive care unit were all predictive of pressure injury. Decision tree analysis revealed that patients who received norepinephrine, were older than 65 years, had a length of stay of 10 days or less, and had a Braden Scale score of 15 or less had a 63.6% risk of pressure injury. Conclusion Determining pressure injury risk in critically ill patients is complex and challenging. One common pathophysiological factor is impaired tissue oxygenation and perfusion, which may be nonmodifiable. Improved risk quantification is needed and may be realized in the near future by leveraging the clinical information available in the electronic medical record through the power of predictive analytics.

Predictors of Pressure Ulcers in Adult Critical Care Patients

2011 ◽  
Vol 20 (5) ◽  
pp. 364-375 ◽  
Author(s):  
Jill Cox
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pressure Ulcers ◽  
Critical Care Patients

BackgroundPressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate. Currently, consensus is lacking on the most important risk factors for pressure ulcers in critically ill patients, and no risk assessment scale exclusively for pressure ulcers in these patients is available.ObjectiveTo determine which risk factors are most predictive of pressure ulcers in adult critical care patients. Risk factors investigated included total score on the Braden Scale, mobility, activity, sensory perception, moisture, friction/shear, nutrition, age, blood pressure, length of stay in the intensive care unit, score on the Acute Physiology and Chronic Health Evaluation II, vasopressor administration, and comorbid conditions.MethodsA retrospective, correlational design was used to examine 347 patients admitted to a medical-surgical intensive care unit from October 2008 through May 2009.ResultsAccording to direct logistic regression analyses, age, length of stay, mobility, friction/shear, norepinephrine infusion, and cardiovascular disease explained a major part of the variance in pressure ulcers.ConclusionCurrent risk assessment scales for development of pressure ulcers may not include risk factors common in critically ill adults. Development of a risk assessment model for pressure ulcers in these patients is warranted and could be the foundation for development of a risk assessment tool.

Challenging Concepts in Paediatric Critical Care

2020 ◽  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Medicine ◽  
Evidence Base ◽  
Paediatric Intensive Care ◽  
Circulatory Support ◽  
Cell Transplant ◽  
Patient Journey ◽  
Expert Commentary ◽  
Paediatric Critical Care

This textbook, ‘Challenging concepts in paediatric critical care’, has been designed to cater to the needs of paediatric intensivists, current trainees and those intending to train in the future. Similar to its predecessors in this ‘Challenging concepts’ series, this book aims to educate clinicians by describing clinical situations that are both common, such as bronchiolitis, sepsis etc., and complex, such as mechanical circulatory support, stem cell transplant etc., in paediatric intensive care medicine. The textbook contains 18 chapters based on challenging scenarios involving variety of diseases and organ dysfunctions. Each chapter contains several “Learning Points”, “Clinical Tips” and “Evidence Base” boxes embedded in the text with the aim to promote memory and stimulate learning. These run alongside an “Expert Commentary” written by an international group of experts in the field, to give practical advice of how they approach these difficult situations. Many chapters include results and imaging to enhance the fidelity and narrative style of text, that encourage the reader to understand the patient journey and feel part of the decision making process. The clinical topics in this book are aligned to match the Royal College of Paediatrics and Child Health’s paediatric intensive care medicine curriculum in the UK, as well as the curriculum of Paediatric Basic assessment and support in intensive care (BASIC) course and the various domains of Paediatric/neonatal European Diploma in Intensive Care (PEDIC) curriculum.

scholarly journals Sonographic and Clinical Features of Upper Extremity Deep Venous Thrombosis in Critical Care Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Michael Blaivas ◽  
Konstantinos Stefanidis ◽  
Serafim Nanas ◽  
John Poularas ◽  
Mitchell Wachtel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Upper Extremity ◽  
Strong Predictor ◽  
Venous Catheter ◽  
Acute Thrombosis ◽  
Vein Thrombosis ◽  
Therapeutic Anticoagulation ◽  
Deep Vein ◽  
Critical Care Patients

Background-Aim. Upper extremity deep vein thrombosis (UEDVT) is an increasingly recognized problem in the critically ill. We sought to identify the prevalence of and risk factors for UEDVT, and to characterize sonographically detected thrombi in the critical care setting.Patients and Methods. Three hundred and twenty patients receiving a subclavian or internal jugular central venous catheter (CVC) were included. When an UEDVT was detected, therapeutic anticoagulation was started. Additionally, a standardized ultrasound scan was performed to detect the extent of the thrombus. Images were interpreted offline by two independent readers.Results. Thirty-six (11.25%) patients had UEDVT and a complete scan was performed. One (2.7%) of these patients died, and 2 had pulmonary embolism (5.5%). Risk factors associated with UEDVT were presence of CVC [(odds ratio (OR) 2.716,P=0.007)], malignancy (OR 1.483,P=0.036), total parenteral nutrition (OR 1.399,P=0.035), hypercoagulable state (OR 1.284,P=0.045), and obesity (OR 1.191,P=0.049). Eight thrombi were chronic, and 28 were acute. We describe a new sonographic sign which characterized acute thrombosis: a double hyperechoic line at the interface between the thrombus and the venous wall; but its clinical significance remains to be defined.Conclusion. Presence of CVC was a strong predictor for the development of UEDVT in a cohort of critical care patients; however, the rate of subsequent PE and related mortality was low.

Law and ethics in intensive care

2020 ◽  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Medicine ◽  
Ethical Issues ◽  
Daily Basis ◽  
Scarce Resources ◽  
Ethical Concerns ◽  
Law And Ethics ◽  
Invasive Management ◽  
Legal And Ethical Issues

The practice of intensive care medicine raises multiple legal and ethical issues on a daily basis, making it increasingly difficult to know whom to admit and when, at what stage invasive management should be withdrawn, and who, importantly, should decide? These profound dilemmas, already complicated in a setting of scarce resources, mandate an understanding of law and ethics for those working in intensive care medicine. Clinically focused, the book explains the relevance of landmark rulings to aid the day-to-day decision making of critical care professionals. A spectrum of ethical and legal controversies in critical care are addressed to demonstrate how law and ethics affect the care available to patients, and how patients’ responses to advances in treatment in turn influence legal and ethical concerns. Discussion of conflict resolution advises on the options that are open to doctors when agreement on treatment decisions or withdrawal cannot be reached. The literature and variations surrounding ‘Do not attempt resuscitation’ (DNAR) decisions are outlined. This edition also provides an up-to-date analysis of issues such as futility and deprivation of liberty.

scholarly journals Advanced Critical Care Practitioners – Practical experience of implementing the Advanced Critical Care Practitioner Faculty of Intensive Care Medicine Curriculum in a London Critical Care Unit

2017 ◽  
Vol 19 (2) ◽  
pp. 147-154 ◽  
Author(s):  
Geraldine Lee ◽  
Jo-Anne Gilroy ◽  
Alistair Ritchie ◽  
Vimal Grover ◽  
Keetje Gull ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Medicine ◽  
Practical Experience ◽  
Advanced Practice ◽  
Clinical Role ◽  
Shortage Of Doctors ◽  
Practitioner Faculty ◽  
And Training

With a chronic shortage of doctors in intensive care, alternative roles are being explored. One of these is the role of the Advanced Critical Care Practitioner. The Advanced Critical Care Practitioner Curriculum was developed by the Faculty of Intensive Care Medicine and is used to provide a structured programme of training. The Advanced Critical Care Practitioner programme consists of an academic and clinical component. This article outlines a practical approach of how the programme was developed and is currently being delivered at a single institution. This new advanced practice role offers opportunities to fill gaps in the medical workforce, improve continuity of patient care, provide mentoring and training for less experienced staff as well as offering a rewarding clinical role.

Rectal and Bladder Temperatures vs Forehead Core Temperatures Measured With SpotOn Monitoring System

2018 ◽  
Vol 27 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Hildy M. Schell-Chaple ◽  
Kathleen D. Liu ◽  
Michael A. Matthay ◽  
Kathleen A. Puntillo
Keyword(s):  
Heat Flux ◽  
Critical Care ◽  
Intensive Care ◽  
Body Temperature ◽  
Urinary Bladder ◽  
Core Temperature ◽  
Continuous Monitoring ◽  
Limits Of Agreement ◽  
The Mean ◽  
Critical Care Patients

BackgroundMethods and frequency of temperature monitoring in intensive care unit patients vary widely. The recently available SpotOn system uses zero-heat-flux technology and offers a noninvasive method for continuous monitoring of core temperature of critical care patients at risk for alterations in body temperature.ObjectiveTo evaluate agreement between and precision of a zero-heat-flux thermometry system (SpotOn) and continuous rectal and urinary bladder thermometry during fever and defervescence in adult patients in intensive care units.MethodsProspective comparison of SpotOn vs rectal and urinary bladder thermometry in eligible patients enrolled in a randomized clinical trial on the effect of acetaminophen on core body temperature and hemodynamic status.ResultsA total of 748 paired temperature measurements from 38 patients who had both SpotOn monitoring and either continuous rectal or continuous bladder thermometry were analyzed. Temperatures during the study were from 36.6°C to 39.9°C. The mean difference for SpotOn compared with bladder thermometry was −0.07°C (SD, 0.24°C; 95% limits of agreement, ± 0.47°C [−0.54°C, 0.40°C]). The mean difference for SpotOn compared with rectal thermometry was −0.24°C (SD, 0.29°C; 95% limits of agreement, ± 0.57°C [−0.81°C, 0.33°C]). Most differences in temperature between methods were within ± 0.5°C in both groups (96% bladder and 85% rectal).ConclusionsThe SpotOn thermometry system has excellent agreement and good precision and is a potential alternative for noninvasive continuous monitoring of core temperature in critical care patients, especially when alternative methods are contraindicated or not available.

Sign in / Sign up

Export Citation Format

Share Document