scholarly journals View. The Dutch Critical Care Triage Guideline on Covid-19: Not Necessarily Discriminatory

2020 ◽  
Vol 27 (5) ◽  
pp. 495-498
Author(s):  
André den Exter
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Selection Criterion ◽  
The Elderly ◽  
Medical Doctors ◽  
Age Limit ◽  
National Emergency

Abstract Recently, the Dutch Medical Doctors Association (Federatie Medisch Specialisten en de Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst) drafted the ‘Covid-19 triage guideline ICU admission’ that has age cut-offs that deprioritise or exclude the elderly. Such an age limit for intensive care unit (ICU) admission in case of a national emergency seems discriminatory, and thus, is it inappropriate to use, or not? The question is whether age in itself can be considered as an acceptable selection criterion.

Characteristics of Nonpharmacological Interventions for Pain Management in the ICU: A Scoping Review

2019 ◽  
Vol 30 (4) ◽  
pp. 388-397 ◽  
Author(s):  
Geraldine Martorella
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pain Management ◽  
Pain Relief ◽  
Scoping Review ◽  
Elderly Women ◽  
The Elderly ◽  
Self Report ◽  
Pharmacological Interventions

Pain relief in the intensive care unit (ICU) is of particular concern since patients are exposed to multiple painful stimuli associated with care procedures. Considering the adverse effects of pharmacological approaches, particularly in vulnerable populations such as the elderly, the use of non-pharmacological interventions has recently been recommended in the context of critical care. The main goal of this scoping review was to systematically map the research done on non-pharmacological interventions for pain management in ICU adults and describe the characteristics of these interventions. A wide variety of non-pharmacological interventions have been tested, with music and massage therapies being the most frequently used. An interesting new trend is the use of combined or bundle interventions. Lastly, it was observed that these interventions have not been studied in specific subgroups, such as the elderly, women, and patients unable to self-report.

Clinical Pharmacology in Aged Intensive Care Unit Patients

1993 ◽  
Vol 8 (6) ◽  
pp. 289-297
Author(s):  
Edward T. Zawada ◽  
John L. Boice
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Medical Technology ◽  
The Elderly ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Population Demographics ◽  
Drug Dosing ◽  
Care Services ◽  
Age Related

Elderly patients are presenting themselves for advanced critical care services in ever-increasing numbers due to changing population demographics coupled with advances in medical technology and pharmacology. Medical management of the elderly in critical care settings is complicated by pre-existing multisystem chronic disease, polypharmacy, and age-related changes in pharmacokinetics and pharmacodynamics. Three principles in the management of the elderly in an intensive care unit (ICU) setting are discussed: (1) the protection of renal function from common nephrotic drugs; (2) the necessity of altered drug dosing due to changes in pharmacokinetics and pharmacodynamics; and (3) the necessity of avoiding polypharmacy. Strategies for the prevention of acute renal failure in ICU contrast studies are described. A review of pharmacodynamics and pharmacokinetics in the elderly is presented with examples of commonly seen ICU medication problems.

scholarly journals A Timely Call to Arms: COVID-19, the Circadian Clock, and Critical Care

2021 ◽  
Vol 36 (1) ◽  
pp. 55-70
Author(s):  
Jeffrey Haspel ◽  
Minjee Kim ◽  
Phyllis Zee ◽  
Tanja Schwarzmeier ◽  
Sara Montagnese ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Human Physiology ◽  
Critical Care ◽  
Intensive Care ◽  
Severe Acute Respiratory Syndrome ◽  
Circadian Clock ◽  
Clinical Course ◽  
Disease Expression ◽  
Severe Manifestation ◽  
Novel Coronavirus

We currently find ourselves in the midst of a global coronavirus disease 2019 (COVID-19) pandemic, caused by the highly infectious novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we discuss aspects of SARS-CoV-2 biology and pathology and how these might interact with the circadian clock of the host. We further focus on the severe manifestation of the illness, leading to hospitalization in an intensive care unit. The most common severe complications of COVID-19 relate to clock-regulated human physiology. We speculate on how the pandemic might be used to gain insights on the circadian clock but, more importantly, on how knowledge of the circadian clock might be used to mitigate the disease expression and the clinical course of COVID-19.

scholarly journals Quality improvement of delirium status communication and documentation for intensive care unit patients during daily multidisciplinary rounds

2018 ◽  
Vol 7 (2) ◽  
pp. e000239 ◽  
Author(s):  
Krishna Aparanji ◽  
Shreedhar Kulkarni ◽  
Megan Metzke ◽  
Yvonne Schmudde ◽  
Peter White ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Patients ◽  
Quality Metric ◽  
Risk Of Mortality ◽  
Simulation Based ◽  
Multidisciplinary Rounds

Delirium is a key quality metric identified by The Society of Critical Care Medicine for intensive care unit (ICU) patients. If not recognised early, delirium can lead to increased length of stay, hospital and societal costs, ventilator days and risk of mortality. Clinical practice guidelines recommend ICU patients be assessed for delirium at least once per shift. An initial audit at our urban tertiary care hospital in Illinois, USA determined that delirium assessments were only being performed 31% of the time. Nurses completed simulation based education and were trained using delirium screening videos. After the educational sessions, delirium documentation increased from 40% (12/30) to 69% (41/59) (two-proportion test, p<0.01) for dayshift nurses and from 27% (8/30) to 61% (36/59) (two-proportion test, p<0.01) during the nightshift. To further increase the frequency of delirium assessments, the delirium screening tool was standardised and a critical care progress note was implemented that included a section on delirium status, management strategy and discussion on rounds. After the documentation changes were implemented, delirium screening during dayshift increased to 93% (75/81) (two-proportion test, p<0.01). Prior to this project, physicians were not required to document delirium screening. After the standardised critical care note was implemented, documentation by physicians was 95% (106/111). Standardising delirium documentation, communication of delirium status on rounds, in addition to education, improved delirium screening compliance for ICU patients.

scholarly journals The Impact of Implementing Critical Care Team on Open General Intensive Care Unit

2012 ◽  
Vol 73 (2) ◽  
pp. 100 ◽  
Author(s):  
Ick Hee Kim ◽  
Seung Bae Park ◽  
Seonguk Kim ◽  
Sang-Don Han ◽  
Seung Seok Ki ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Team ◽  
General Intensive Care Unit ◽  
The Impact ◽  
Critical Care Team
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