O-67 Challenges of eolc and following advance care plans in critical care medicine

2015 ◽  
Vol 5 (Suppl 2) ◽  
pp. A21.4-A21
Author(s):  
Jean-Louis Vincent
Keyword(s):  
Critical Care ◽  
Critical Care Medicine ◽  
Care Plans ◽  
Advance Care

Parallel planning and the paediatric critical care patient

2019 ◽  
Vol 104 (10) ◽  
pp. 994-997 ◽  
Author(s):  
Peter Sidgwick ◽  
James Fraser ◽  
Peter-Marc Fortune ◽  
Renee McCulloch
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Critical Illness ◽  
Critical Care Patient ◽  
Care Patient ◽  
Number Of Children ◽  
Care Plans ◽  
Advance Care ◽  
Paediatric Critical Care

A growing number of children with life-limiting conditions (LLCs) are being cared for in paediatric critical care (PCC) settings. Children with LLCs admitted to PCC are at a high risk of developing complications and many die after prolonged admissions. Relatively few of these patients and their parents or carers have had documented discussions about their wishes for care in the event of a serious clinical deterioration before admission to PCC. There is a need for improved understanding of (1) how parents arrive at decisions regarding what is best for their child at times of critical illness and (2) the role of parallel planning and advance care plans in that process. This review examines the complexities of decision-making in children with LLCs who are admitted to PCC settings.

scholarly journals Healthcare Providers' Perception of Advance Care Plans for Patients with Critical Illnesses in Acute-Care Hospitals: A Cross-Sectional Study

2021 ◽  
Author(s):  
KANAKO YAMAMOTO
Keyword(s):  
Critical Care ◽  
Acute Care ◽  
Healthcare Providers ◽  
Acute Care Hospitals ◽  
Cross Sectional Study ◽  
Decision Making Process ◽  
Sectional Study ◽  
Cross Sectional ◽  
Care Plans ◽  
Advance Care

Abstract BackgroundIt is unclear how healthcare providers provide advance care plans (ACPs) support to the patients treated in ICUs. The purpose of this study is to clarify healthcare providers’ perceptions of the ACPs support provided to patients receiving critical care in acute-care hospitals.MethodsA cross-sectional study was conducted using questionnaires. In this study, 400 acute-care hospitals with ICUs in Japan were randomly selected, and 1490 subjects, including intensivists, surgeons, ICU nurses, surgical floor nurses, and surgical outpatient nurses, participated. Survey items examined whether ICU patients received ACPS support, the participants’ degree of confidence in providing ACPS support, the patients’ treatment preferences and the decision-making process, and whether there was any discussion on and succession of values.ResultsResponses were obtained from 598 participants from 157 hospitals. Sixty-five hospitals (41.4%) reportedly supported ACPs provision to ICU patients. The subjects with the highest level of ACPs understanding were surgeons, 27 out of 59 (45.8%), and differences in understanding were observed across specialties (p < 0.001). Among the respondents, physicians and nurses expressed high levels of confidence in providing ACPs support to patients requiring critical care. However, 15.2% of all the subjects mentioned that they would not attempt to resuscitate the patients. In addition, 25.7% of the participants handed over patients’ values to other departments or hospitals, whereas 25.3% handed over the decision-making process.ConclusionsAmong the participating hospitals, 40% provided ACPs support to patients receiving critical care. This is probably because support providers lack ACPs knowledge and it is sometimes too late to start providing ACPs support after ICU admission. In addition, the perception of ACPs, widely considered an ambiguous concept, differs among healthcare providers. Finally, in acute-care hospitals with different healthcare settings, it is necessary to confirm and integrate the changes in feelings and thoughts of patients’ family members and healthcare providers.

scholarly journals Evaluation of Clinical Outcomes after Introduction of a Dedicated Infectious Diseases- Critical Care Medicine Service in Critical Care Units

2021 ◽  
Author(s):  
Polina Trachuk ◽  
Vagish Hemmige ◽  
Ruth Eisenberg ◽  
Kelsie Cowman ◽  
Victor Chen ◽  
...  
Keyword(s):  
Critical Care ◽  
Infectious Diseases ◽  
Clinical Outcomes ◽  
Broad Spectrum ◽  
Critical Care Medicine ◽  
Care Hospital ◽  
Intervention Period ◽  
Broad Spectrum Antibiotics ◽  
Antibiotic Utilization ◽  
The Impact

Abstract Objective Infection is a leading cause of admission to intensive care units (ICU), with critically ill patients often receiving empiric broad-spectrum antibiotics. Nevertheless, a dedicated infectious diseases (ID) consultation and stewardship team is not routinely established. An ID-Critical Care Medicine (ID-CCM) pilot program was designed at a 400-bed tertiary care hospital in which an ID attending was assigned to participate in daily rounds with the ICU team, as well as provide ID consultation on select patients. We sought to evaluate the impact of this dedicated ID program on antibiotic utilization and clinical outcomes in patients admitted to the ICU. Method In this single site retrospective study, we analyzed antibiotic utilization and clinical outcomes in patients admitted to an ICU during post-intervention period from January 1, 2017 to December 31, 2017 and compared it to antibiotic utilization in the same ICUs during the pre-intervention period from January 1, 2015 to December 31, 2015. Results Our data showed a statistically significant reduction in usage of most frequently prescribed antibiotics including vancomycin, piperacillin-tazobactam and cefepime during the intervention period. When compared to pre-intervention period there was no difference in-hospital mortality, hospital length of stay and re-admission. Conclusion With this multidisciplinary intervention, we saw a decrease in the use of the most frequently prescribed broad-spectrum antibiotics without a negative impact on clinical outcomes. Our study shows that the implementation of an ID-CCM service is a feasible way to promote antibiotic stewardship in the ICU and can be used as a strategy to reduce unnecessary patient exposure to broad-spectrum agents.

scholarly journals Systematic review and bibliometric analysis of African anesthesia and critical care medicine research part II: a scientometric analysis of the 116 most cited articles

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ulrick Sidney Kanmounye ◽  
Joel Noutakdie Tochie ◽  
Aimé Mbonda ◽  
Cynthia Kévine Wafo ◽  
Leonid Daya ◽  
...  
Keyword(s):  
Critical Care ◽  
South African ◽  
Web Of Science ◽  
Descriptive Analysis ◽  
World Journal ◽  
Critical Care Medicine ◽  
Scientometric Analysis ◽  
Medicine Research ◽  
Qualitative Descriptive ◽  
The Impact

Abstract Background Scientometrics is used to assess the impact of research in several health fields, including Anesthesia and Critical Care Medicine. The purpose of this study was to identify contributors to highly-cited African Anesthesia and Critical Care Medicine research. Methods The authors searched Web of Science from inception to May 4, 2020, for articles on and about Anesthesia and Critical Care Medicine in Africa with ≥2 citations. Quantitative (H-index) and qualitative (descriptive analysis of yearly publications and interpretation of document, co-authorship, author country, and keyword) bibliometric analyses were done. Results The search strategy returned 116 articles with a median of 5 (IQR: 3–12) citations on Web of Science. Articles were published in Anesthesia and Analgesia (18, 15.5%), World Journal of Surgery (13, 11.2%), and South African Medical Journal (8, 6.9%). Most (74, 63.8%) articles were published on or after 2013. Seven authors had more than 1 article in the top 116 articles: Epiu I (3, 2.6%), Elobu AE (2, 1.7%), Fenton PM (2, 1.7%), Kibwana S (2, 1.7%), Rukewe A (2, 1.7%), Sama HD (2, 1.7%), and Zoumenou E (2, 1.7%). The bibliometric coupling analysis of documents highlighted 10 clusters, with the most significant nodes being Biccard BM, 2018; Baker T, 2013; Llewellyn RL, 2009; Nigussie S, 2014; and Aziato L, 2015. Dubowitz G (5) and Ozgediz D (4) had the highest H-indices among the authors referenced by the most-cited African Anesthesia and Critical Care Medicine articles. The U.S.A., England, and Uganda had the strongest collaboration links among the articles, and most articles focused on perioperative care. Conclusion This study highlighted trends in top-cited African articles and African and non-African academic institutions’ contributions to these articles.

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