scholarly journals Defining fluid removal in the intensive care unit: A national and international survey of critical care practice

2017 ◽  
Vol 18 (4) ◽  
pp. 282-288 ◽  
Author(s):  
Michael E O’Connor ◽  
Sarah L Jones ◽  
Neil J Glassford ◽  
Rinaldo Bellomo ◽  
John R Prowle
Keyword(s):  
Intensive Care Unit ◽  
United Kingdom ◽  
Intensive Care ◽  
New Zealand ◽  
Critically Ill ◽  
Fluid Overload ◽  
Venous Pressure ◽  
Diuretic Therapy ◽  
Care Practice ◽  
Fluid Removal

Design and objectives To identify and compare how intensive care unit specialists in the United Kingdom and Australia and New Zealand self-reportedly define, assess and manage fluid overload in critically ill patients using a structured online questionnaire. Results We assessed 219 responses. Australia and New Zealand and United Kingdom intensive care unit specialists reported using clinical examination findings, bedside tools and radiological features to assess fluid status, diagnose fluid overload and initiate fluid removal in the critically ill. An elevated central venous pressure is not regarded as helpful in diagnosing fluid overload and targeting a clinician-set fluid balance is the most popular management strategy. Renal replacement therapy is used ahead of more diuretic therapy in patients who are oligo/anuric, or when diuretic therapy has not generated an adequate response. Conclusions This self-reported account of practice by United Kingdom and Australia and New Zealand intensivists demonstrates that fluid overload remains poorly defined with variability in both management and practice.

Qua pote quisque, in ea conterat arte diem: COVID-19 and Australian and New Zealand intensive care

2020 ◽  
Vol 22 (2) ◽  
pp. 103-104
Author(s):  
Andrew Udy ◽  
◽  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
New Zealand ◽  
Severe Acute Respiratory Syndrome ◽  
Clinical Care ◽  
Public Health Emergency ◽  
Care Practice ◽  
Health Care Practice

The current global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has thrust intensive care medicine to the forefront of health care practice in Australia and New Zealand. Indeed, reports from other countries and jurisdictions convey highly confronting statistics about the scale of this public health emergency, particularly in terms of the demand on intensive care unit (ICU)services. Whether this occurs here remains to be seen, although if such a scenario does eventuate, it will represent an unprecedented challenge to our community. In parallel, these events offer the opportunity for greater coordination, improved communication, and innovation in clinical care, which are principles that in many ways define our specialty.

scholarly journals Telessaúde Enquanto Instrumento de Trabalho do Enfermeiro na UTI Adulto: uma Revisão Bibliográfica

2018 ◽  
Vol 20 (1) ◽  
pp. 55 ◽  
Author(s):  
Janaína Duarte Bender ◽  
Lisa Antunes Carvalho
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Disease Process ◽  
Critically Ill Patient ◽  
Care Practice ◽  
Working Process ◽  
Work Process ◽  
Adult Intensive Care Unit ◽  
Terapia Intensiva

A Telessaúde é um sistema inovador, formado por um conjunto de fenômenos promovido pelo avanço das telemáticas, seus maquinismos e redes sócio técnicas participativas. Assim, a telessaúde possibilita um diagnóstico mais preciso e fidedigno, auxiliando a equipe de enfermagem em UTI a intervir nas situações de risco, de modo mais seguro e eficiente. O presente artigo tem como objetivo conhecer a produção científica acerca da Telessaúde, enquanto instrumento de trabalho do enfermeiro na Unidade de Terapia Intensiva Adulto. Trata-se de uma revisão bibliográfica de caráter descritivo, exploratório, com abordagem qualitativa. Foram analisadas publicações no período de 2010 a 2015, nas bases de dados: Lilacs, BdenF, SciELO e Pubmed, utilizando os seguintes descritores: telemedicina ou telessaúde, instrumento de trabalho ou processo de trabalho, unidade de terapia intensiva ou unidade de terapia intensiva adulto. Emergiram deste estudo 27 publicações, que sustentaram a ideia da inter-relação da telessaúde, em ambiente hospitalar, no processo de trabalho do enfermeiro. A relevância da telessaúde no processo de trabalho em enfermagem proporciona inovações na prática do cuidado, interligando a visão humanizada, futurística e tecnológica de atendimento à saúde, fortalecendo a rede de assistência e apoio ao paciente grave. Esta ferramenta auxilia na prevenção de intercorrências pelos profissionais especializados junto ao paciente, reduzindo o tempo de espera do cuidado e do custos dentro do serviço de saúde. Situa-se no trabalho do enfermeiro a ligação necessária para se obter maior segurança no cuidado ao doente grave, por meio do uso e de compreensão da telessaúde, enquanto ferramenta transformadora na práxis em UTI.Palavras-chaves: Telemedicina. Processo Saúde-Doença. Unidade de Terapia Intensiva.Abstract Telehealth is an innovator system, which is formed by a set of phenomena promoted by the telematics advancement, its mechanisms, and participative social-technical networks. Thus, telehealth enables a more precise and reliable diagnosis, which helps the nursing team to intervene more safely and efficiently in risky situations in the ICU. The aim of this study is know the scientific production on telehealth while a tool for nurses in the Adult Intensive Care Unit. This literature review has a descriptive, exploratory and qualitative approach. Publications were analyzed in the period from 2010 to 2015, in the databases: Lilacs, Bdenf, SciELO and Pubmed. The following descriptors were used: telemedicine or telehealth, work tool or work process, intensive care unit or adult intensive therapeutic unit. From this study 27 publications emerged that sustained the idea of telehealth interrelation in hospitals during the nurse’s work process. The telehealth relevance in the nursing working process provides innovation in the care practice, connecting humanized, futuristic and technological point of views to health assistance, which strengthen the assistance and support networks to critically ill patients. This tool helps in the intercurrences prevention by specialized professionals within the patient, reduce the waiting time and the health services costs. The necessary connection to obtain more safety in care to the critically ill patient is a part of the nurse’s job, by using and comprehending telehealth while tool for changes in the praxis in ICU.Keywords: Telemedicine. Health-Disease Process. Intensive Care Units.

scholarly journals Treatment of a Critically Ill COVID-19 Patient with the Seraph 100 Microbind Affinity Filter

TH Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e134-e138
Author(s):  
Anke Pape ◽  
Jan T. Kielstein ◽  
Tillman Krüger ◽  
Thomas Fühner ◽  
Reinhard Brunkhorst
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomized Trials ◽  
Clinical Course ◽  
Pharmacological Therapy ◽  
The European Union ◽  
Positive Effects ◽  
Special Patient

AbstractThe coronavirus disease 2019 (COVID-19) pandemic has a serious impact on health and economics worldwide. Even though the majority of patients present with moderate and mild symptoms, yet a considerable portion of patients need to be treated in the intensive care unit. Aside from dexamethasone, there is no established pharmacological therapy. Moreover, some of the currently tested drugs are contraindicated for special patient populations like remdesivir for patients with severely impaired renal function. On this background, several extracorporeal treatments are currently explored concerning their potential to improve the clinical course and outcome of critically ill patients with COVID-19. Here, we report the use of the Seraph 100 Microbind Affinity filter, which is licensed in the European Union for the removal of pathogens. Authorization for emergency use in patients with COVID-19 admitted to the intensive care unit with confirmed or imminent respiratory failure was granted by the U.S. Food and Drug Administration on April 17, 2020.A 53-year-old Caucasian male with a severe COVID-19 infection was treated with a Seraph Microbind Affinity filter hemoperfusion after clinical deterioration and commencement of mechanical ventilation. The 70-minute treatment at a blood flow of 200 mL/minute was well tolerated, and the patient was hemodynamically stable. The hemoperfusion reduced D-dimers dramatically.This case report suggests that the use of Seraph 100 Microbind Affinity filter hemoperfusion might have positive effects on the clinical course of critically ill patients with COVID-19. However, future prospective collection of data ideally in randomized trials will have to confirm whether the use of Seraph 100 Microbind Affinity filter hemoperfusion is an option of the treatment for COVID-19.

Māori health outcomes in an intensive care unit in Aotearoa New Zealand

2021 ◽  
pp. 0310057X2198971
Author(s):  
M Atif Mohd Slim ◽  
Hamish M Lala ◽  
Nicholas Barnes ◽  
Robert A Martynoga
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
New Zealand ◽  
Renal Replacement Therapy ◽  
Confidence Interval ◽  
Health Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
One Year ◽  
Maori Health

Māori are the indigenous people of New Zealand, and suffer disparate health outcomes compared to non-Māori. Waikato District Health Board provides level III intensive care unit services to New Zealand’s Midland region. In 2016, our institution formalised a corporate strategy to eliminate health inequities for Māori. Our study aimed to describe Māori health outcomes in our intensive care unit and identify inequities. We performed a retrospective audit of prospectively entered data in the Australian and New Zealand Intensive Care Society database for all general intensive care unit admissions over 15 years of age to Waikato Hospital from 2014 to 2018 ( n = 3009). Primary outcomes were in–intensive care unit and in-hospital mortality. The secondary outcome was one-year mortality. In our study, Māori were over-represented relative to the general population. Compared to non-Māori, Māori patients were younger (51 versus 61 years, P < 0.001), and were more likely to reside outside of the Waikato region (37.2% versus 28.0%, P < 0.001) and in areas of higher deprivation ( P < 0.001). Māori had higher admission rates for trauma and sepsis ( P < 0.001 overall) and required more renal replacement therapy ( P < 0.001). There was no difference in crude and adjusted mortality in–intensive care unit (16.8% versus 16.5%, P = 0.853; adjusted odds ratio 0.98 (95% confidence interval 0.68 to 1.40)) or in-hospital (23.7% versus 25.7%, P = 0.269; adjusted odds ratio 0.84 (95% confidence interval 0.60 to 1.18)). One-year mortality was similar (26.1% versus 27.1%, P=0.6823). Our study found significant ethnic inequity in the intensive care unit for Māori, who require more renal replacement therapy and are over-represented in admissions, especially for trauma and sepsis. These findings suggest upstream factors increasing Māori risk for critical illness. There was no difference in mortality outcomes.

scholarly journals Bereavement interventions to support informal caregivers in the intensive care unit: a systematic review

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Stephana J. Moss ◽  
Krista Wollny ◽  
Therese G. Poulin ◽  
Deborah J. Cook ◽  
Henry T. Stelfox ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Traumatic Stress ◽  
Critically Ill Patients ◽  
Informal Caregivers ◽  
Post Traumatic Stress ◽  
Bereavement Support ◽  
Complex Needs ◽  
Post Traumatic

Abstract Background Informal caregivers of critically ill patients in intensive care unit (ICUs) experience negative psychological sequelae that worsen after death. We synthesized outcomes reported from ICU bereavement interventions intended to improve informal caregivers’ ability to cope with grief. Data sources MEDLINE, EMBASE, CINAHL and PsycINFO from inception to October 2020. Study selection Randomized controlled trials (RCTs) of bereavement interventions to support informal caregivers of adult patients who died in ICU. Data extraction Two reviewers independently extracted data in duplicate. Narrative synthesis was conducted. Data synthesis Bereavement interventions were categorized according to the UK National Institute for Health and Clinical Excellence three-tiered model of bereavement support according to the level of need: (1) Universal information provided to all those bereaved; (2) Selected or targeted non-specialist support provided to those who are at-risk of developing complex needs; and/or (3) Professional specialist interventions provided to those with a high level of complex needs. Outcome measures were synthesized according to core outcomes established for evaluating bereavement support for adults who have lost other adults to illness. Results Three studies of ICU bereavement interventions from 31 ICUs across 26 hospitals were included. One trial examining the effect of family presence at brain death assessment integrated all three categories of support but did not report significant improvement in emotional or psychological distress. Two other trials assessed a condolence letter intervention, which did not decrease grief symptoms and may have increased symptoms of depression and post-traumatic stress disorder, and a storytelling intervention that found no significant improvements in anxiety, depression, post-traumatic stress, or complicated grief. Four of nine core bereavement outcomes were not assessed anytime in follow-up. Conclusions Currently available trial evidence is sparse and does not support the use of bereavement interventions for informal caregivers of critically ill patients who die in the ICU.

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