Valve disease in critical illness

2017 ◽  
Author(s):  
Claire Colebourn ◽  
Jim Newton
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Infective Endocarditis ◽  
Critical Illness ◽  
Care Setting ◽  
Valve Disease ◽  
Mitral Valves ◽  
Valve Lesion ◽  
The Impact ◽  
Valve Lesions

This chapter describes the pathophysiology and methods of assessment of valve lesions affecting the aortic and mitral valves. It describes the management of these valve lesions in the critical care setting and guides decision-making about the impact of the valve lesion on the critical illness. The diagnosis and management of infective endocarditis are described in detail.

Normal physiology of the renal system

2016 ◽  
Author(s):  
Bruce Andrew Cooper
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Renal Dysfunction ◽  
Critical Role ◽  
Renal Physiology ◽  
Electrolyte Balance ◽  
Care Environment ◽  
System P ◽  
Urine Production ◽  
The Impact

Patients with critical illness often have renal dysfunction, either primary or secondary, that can both complicate and prolong their medical management. Therefore, an understanding of normal renal physiology can help recognize the process or processes that caused the renal dysfunction, and determine the most appropriate corrective and supportive care. The kidney has many important roles other than just urine production. The impact of kidney disease is often predictable. The kidney plays a critical role in fluid and electrolyte balance via many specialized transmembrane pathways. The kidney is also involved in the production and modification of two key hormones and one enzyme. Understanding normal renal physiology can help determine clinical management.This chapter summarizes the important aspects of renal physiology relevant to those who work in a critical care environment.

scholarly journals Enhanced Recovery after Intensive Care (ERIC): study protocol for a German stepped wedge cluster randomised controlled trial to evaluate the effectiveness of a critical care telehealth program on process quality and functional outcomes

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036096 ◽  
Author(s):  
Christine Adrion ◽  
Bjoern Weiss ◽  
Nicolas Paul ◽  
Elke Berger ◽  
Reinhard Busse ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Critical Illness ◽  
Stepped Wedge ◽  
Link Type ◽  
Cluster Randomised ◽  
Icu Discharge ◽  
Randomised Controlled ◽  
The Impact

IntroductionSurvival after critical illness has noticeably improved over the last decades due to advances in critical care medicine. Besides, there is an increasing number of elderly patients with chronic diseases being treated in the intensive care unit (ICU). More than half of the survivors of critical illness suffer from medium-term or long-term cognitive, psychological and/or physical impairments after ICU discharge, which is recognised as post-intensive care syndrome (PICS). There are evidence-based and consensus-based quality indicators (QIs) in intensive care medicine, which have a positive influence on patients’ long-term outcomes if adhered to.Methods and analysisThe protocol of a multicentre, pragmatic, stepped wedge cluster randomised controlled, quality improvement trial is presented. During 3 predefined steps, 12 academic hospitals in Berlin and Brandenburg, Germany, are randomly selected to move in a one-way crossover from the control to the intervention condition. After a multifactorial training programme on QIs and clinical outcomes for site personnel, ICUs will receive an adapted, interprofessional protocol for a complex telehealth intervention comprising of daily telemedical rounds at ICU. The targeted sample size is 1431 patients. The primary objective of this trial is to evaluate the effectiveness of the intervention on the adherence to eight QIs daily measured during the patient’s ICU stay, compared with standard of care. Furthermore, the impact on long-term recovery such as PICS-related, patient-centred outcomes including health-related quality of life, mental health, clinical assessments of cognition and physical function, all-cause mortality and cost-effectiveness 3 and 6 months after ICU discharge will be evaluated.Ethics and disseminationThis protocol was approved by the ethics committee of the Charité—Universitätsmedizin, Berlin, Germany (EA1/006/18). The results will be published in a peer-reviewed scientific journal and presented at international conferences. Study findings will also be disseminated via the website (www.eric-projekt.net).Trial registration numberClinicalTrials.gov Registry (NCT03671447).

scholarly journals Differential cell-matrix responses in hypoxia-stimulated aortic versus mitral valves

2016 ◽  
Vol 13 (125) ◽  
pp. 20160449 ◽  
Author(s):  
Matthew C. Sapp ◽  
Varun K. Krishnamurthy ◽  
Daniel S. Puperi ◽  
Saheba Bhatnagar ◽  
Gabrielle Fatora ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Oxygen Diffusion ◽  
Computational Models ◽  
Valve Disease ◽  
Low Oxygen ◽  
Mitral Valve Leaflet ◽  
Altered Expression ◽  
Mitral Valves ◽  
The Impact ◽  
Diffusion Profiles

Tissue oxygenation often plays a significant role in disease and is an essential design consideration for tissue engineering. Here, oxygen diffusion profiles of porcine aortic and mitral valve leaflets were determined using an oxygen diffusion chamber in conjunction with computational models. Results from these studies revealed the differences between aortic and mitral valve leaflet diffusion profiles and suggested that diffusion alone was insufficient for normal oxygen delivery in mitral valves. During fibrotic valve disease, leaflet thickening due to abnormal extracellular matrix is likely to reduce regional oxygen availability. To assess the impact of low oxygen levels on valve behaviour, whole leaflet organ cultures were created to induce leaflet hypoxia. These studies revealed a loss of layer stratification and elevated levels of hypoxia inducible factor 1-alpha in both aortic and mitral valve hypoxic groups. Mitral valves also exhibited altered expression of angiogenic factors in response to low oxygen environments when compared with normoxic groups. Hypoxia affected aortic and mitral valves differently, and mitral valves appeared to show a stenotic, rheumatic phenotype accompanied by significant cell death. These results indicate that hypoxia could be a factor in mid to late valve disease progression, especially with the reduction in chondromodulin-1 expression shown by hypoxic mitral valves.

scholarly journals Impact of Chronic Critical Illness on the Psychological Outcomes of Family Members

2010 ◽  
Vol 21 (1) ◽  
pp. 80-91
Author(s):  
Ronald L. Hickman ◽  
Sara L. Douglas
Keyword(s):  
Decision Making ◽  
Psychological Distress ◽  
Critical Illness ◽  
Family Members ◽  
Significant Proportion ◽  
Psychological Needs ◽  
Distress Symptoms ◽  
Chronic Critical Illness ◽  
Chronically Critically Ill ◽  
The Impact

The uncertain trajectory of chronic critical illness exposes the patient’s family to heightened levels of psychological distress. Symptoms of psychological distress affect more than half of family members exposed to the patient’s chronic critical illness. Although symptoms often dissipate over time, a significant proportion of family members will remain at moderate to high risk for psychological distress well after the patient’s death or discharge from the intensive care unit. Family members of chronically critically ill patients are often involved in the decision making for the patients. Irrational or uninformed decision making can occur when family members experience high levels of psychological distress. Attention to the psychological needs and provision of support to family members enhance the formulation of treatment decisions consistent with the patient’s preferences and mitigate unnecessary resource use. In this article, the impact of chronic critical illness on family members’ risk for depression, anxiety, and posttraumatic stress disorder is described and a review of evidence-based strategies to support the psychological needs of family members coping with a patient’s chronic critical illness is provided.

scholarly journals The introduction of regular group reflective practice sessions for junior doctors in a critical care setting during the second wave of COVID-19 pandemic – a Pilot

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S124-S124
Author(s):  
Itunuayo V Ayeni ◽  
Elizabeth Headon
Keyword(s):  
Critical Care ◽  
Reflective Practice ◽  
Care Setting ◽  
Critical Care Setting ◽  
Junior Doctors ◽  
Regular Group ◽  
Feedback Questionnaire ◽  
The Impact ◽  
Second Wave ◽  
Insight Into

AimsReflective practice is a core component of undergraduate as well as post graduate training. Reflective practice provides an opportunity for individuals to learn through their experience as well as gaining insight into themselves and their practice. If completed effectively, it has been shown to reduce stress and improve mental well-being. Our aim therefore was to provide regular group reflective practice sessions with the aim of supporting junior doctor's mental wellbeing during the second wave of the COVID-19 pandemic.MethodJunior doctors within a critical care setting were offered two-weekly group reflective practice sessions focusing on ‘difficult or challenging cases and encounters.’ The sessions were offered to all junior and middle grade doctors within a critical care department in a small district general hospital. Consultants were also able to attend. The groups were facilitated by a consultant liaison psychiatrist and an accredited balint group leader. Critical care doctors were provided a feedback questionnaire assessing the impact of the sessions and the levels of stress and burnout. The themes emerging from the sessions were also explored.ResultA total of six reflective practice sessions were offered during a three-month period. A total of four reflective practice sessions were completed; two sessions were cancelled due to high workload on the department. Each session lasted approximately 50mins. On average a total of 3-4 junior doctors attended each session. The sessions were conducted face to face in a socially distanced manner and with all participants wearing face masks. The sessions were predominately attended by foundation doctors and SHOs. There was occasional attendance by middle grades and a consultant.The predominant themes that emerged included: guilt, prolonged suffering, desensitisation, support and exhaustion. Despite the challenges associated with the pandemic and lockdown, many of the doctors also acknowledged the benefit of being at work during both waves of the pandemic. There was a sense of collectiveness and group belonging. The group found it beneficial to be able to share their experiences and challenges faced; this was most striking amongst the very junior members of the team.Questionnaires were also provided to gain additional insight into the wellbeing of the critical care doctors. Worryingly the results highlighted a significant proportion of doctors were experiencing signs of burnout including fatigue (77%), lack of energy (54%), cynicism (31%), frustration and irritability (45%) and detachment (38%). Many of the issues highlighted were in response to the demand created by the pandemic and a lack of medical staffing wth 69% of doctors requesting regular feedback on staffing issues.ConclusionBurnout and low morale were already highlighted in a significant number of junior doctors prior to the pandemic. COVID-19 has identified a clear need for NHS employers and medical leaders to provide emotional and psychological support to staff. It is vital that we create an open environment where individuals can express their feelings openly without fear that they will be judged. Group reflective practice provides an avenue to build on collectiveness created during both waves of the COVID-19 pandemic. This pilot has demonstrated that if introduced as part of a wellbeing support package, junior doctors within a critical care setting are able to utilise the sessions in an effective and productive manner.

Key Elements of the Critical Care Work Environment Associated With Burnout and Compassion Satisfaction

2021 ◽  
Vol 30 (2) ◽  
pp. 113-120
Author(s):  
Lesly A. Kelly ◽  
Karen L. Johnson ◽  
R. Curtis Bay ◽  
Michael Todd
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Critical Care ◽  
Work Environment ◽  
Compassion Satisfaction ◽  
Well Being ◽  
Nurse Turnover ◽  
Effective Decision ◽  
Effective Decision Making ◽  
The Impact

Background As the role of a health care system’s influence on nurse burnout becomes better understood, an under-standing of the impact of a nurses’ work environment on burnout and well-being is also imperative. Objective To identify the key elements of a healthy work environment associated with burnout, secondary trauma, and compassion satisfaction, as well as the effect of burnout and the work environment on nurse turnover. Methods A total of 779 nurses in 24 critical care units at 13 hospitals completed a survey measuring burnout and quality of the work environment. Actual unit-level data for nurse turnover during a 5-month period were queried and compared with the survey results. Results Among nurses in the sample, 61% experience moderate burnout. In models controlling for key nurse characteristics including age, level of education, and professional recognition, 3 key elements of the work environment emerged as significant predictors of burnout: staffing, meaningful recognition, and effective decision-making. The latter 2 elements also predicted more compassion satisfaction among critical care nurses. In line with previous research, these findings affirm that younger age is associated with more burnout and less compassion satisfaction. Conclusions Efforts are recommended on these 3 elements of the work environment (staffing, meaningful recognition, effective decision-making) as part of a holistic, systems-based approach to addressing burnout and well-being. Such efforts, in addition to supporting personal resilience-building activities, should be undertaken especially with younger members of the workforce in order to begin to address the crisis of burnout in health care.

A Muslim Neonatologist in a Canadian NICU

2019 ◽  
pp. 110-123
Author(s):  
Juzer M. Tyebkhan
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Critical Illness ◽  
Neonatal Intensive Care ◽  
High Stress ◽  
The United Kingdom ◽  
Spiritual Leader ◽  
Dawoodi Bohra ◽  
The Impact

What is the impact on a Muslim family of having a baby in the neonatal intensive care unit (NICU)? This chapter is written by a Muslim neonatologist, trained in the United Kingdom and Canada, who now works in a level III NICU in Edmonton, Canada. In addition to describing religious requirements and community traditions, the author suggests ways that these can be incorporated into the care of Muslim babies and families in our high-stress, technology-based NICUs. As a member of the Dawoodi Bohra sect (a subset of the Shi’a Muslim community), the author provides a brief background of the community’s spiritual heritage and their viewpoint on modern medical treatment. The living spiritual leader of the Dawoodi Bohras, the Da’i, is their source of authoritative decision making. The author explains how and why decision making in situations of critical illness is referred to the Da’i for His trusted advice.

Contributions to Critical Care from Psychological Science and Practice

2021 ◽  
pp. 58-100
Author(s):  
Nancy Merbitz ◽  
Joan Fleishman ◽  
Hannah Kamsky ◽  
Stephanie Sundborg ◽  
Jamie Lynne Tingey ◽  
...  
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Health Effects ◽  
Healthcare System ◽  
Patient Centered ◽  
Rehabilitation Psychology ◽  
Behavioral Psychology ◽  
History Of ◽  
Social Organizational ◽  
The Impact

In this chapter we highlight findings and practices from Psychology that can be applied to mitigate the impact of critical illness and the ICU environment on patients, families and staff. The substantial accumulating evidence for detrimental health effects of traumatic stress is highly relevant for the care of patients on the ICU, who are potentially traumatized by the experience and who may bring a history of trauma with them. The fields of trauma psychology and rehabilitation psychology share foundational principles to guide patient-centered and systemic changes to ICU care, and these principles guided our selection and presentation of material. Our discussion of how to implement these principles within a healthcare system is informed by selected findings from social, organizational and behavioral psychology, which also are summarized.

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