scholarly journals Additional considerations for "checklists to guide the supportive and critical care of tuberculous meningitis"

2020 ◽  
Vol 5 ◽  
pp. 64
Author(s):  
Anuradha Behl ◽  
Sumeet Dhawan
Keyword(s):  
Health Care ◽  
Critical Care ◽  
Intensive Care ◽  
Tuberculous Meningitis ◽  
Inpatient Care ◽  
Neurological Complications ◽  
Prolonged Hospital Stay ◽  
Invasive Procedures ◽  
Systematic Assessment ◽  
Prolonged Hospital

Checklists are pivotal in the systematic assessment of critically ill patients, pre-operative assessments and for patients with multisystem involvements. Management of tuberculous meningitis is challenging due to prolonged hospital stay, multiple neurological complications like seizures, stroke, raised intracranial tension, stroke, neurosurgical interventions, multiple invasive procedures, health-care-associated sepsis, and ventilation. All these complications are managed by separate checklists to avoid treatment-related errors. The current manuscript aims to ensure completeness of inpatient care addressing issues addressing diagnostic issues, supportive care, and intensive care related issues.

Intensive care unit waiting time in the emergency room is related to more prolonged hospital stay and increases in costs of hospitalization

2017 ◽  
Vol 42 ◽  
pp. 417
Author(s):  
Fernanda Ribeiro Quintino dos Santos ◽  
Juliana Pedroli Nepomuceno ◽  
Mauricio de Nassau Machado ◽  
Suzana Margareth Lobo
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Emergency Room ◽  
Hospital Stay ◽  
Waiting Time ◽  
Prolonged Hospital Stay ◽  
Prolonged Hospital

scholarly journals The Ethics of Rationing of Critical Care Services: Should Technology Assessment Play a Role?

2009 ◽  
Vol 2009 ◽  
pp. 1-8 ◽  
Author(s):  
Eric L. Bloomfield
Keyword(s):  
United States ◽  
Health Care ◽  
Decision Making ◽  
Critical Care ◽  
Intensive Care ◽  
Risk Analysis ◽  
Technology Assessment ◽  
The United States ◽  
Electronic Records ◽  
Care Services

The costs of health care continue to increase rapidly and steeply in the United States. One area of great expense is that of intensive care units (ICUs). The causes of inflation have not been addressed effectively. ICU resources could become stretched such that they may no longer be available. This paper discusses some of the ethics and concerns behind decision making when providing ICU services in the United States. In particular, the use of electronic records with decision making tools, risk-analysis methods, and documentation of patient wishes for extraordinary care may help with better utilization of resources in the future.

scholarly journals Association of Social Network Use With Increased Anxiety Related to the COVID-19 Pandemic in Anesthesiology, Intensive Care, and Emergency Medicine Teams: Cross-Sectional Web-Based Survey Study (Preprint)

2020 ◽  
Author(s):  
Thomas Clavier ◽  
Benjamin Popoff ◽  
Jean Selim ◽  
Marion Beuzelin ◽  
Melanie Roussel ◽  
...  
Keyword(s):  
Health Care ◽  
Social Networks ◽  
Emergency Medicine ◽  
Critical Care ◽  
Intensive Care ◽  
Social Network ◽  
Health Care Workers ◽  
Survey Study ◽  
Web Based ◽  
Care Workers

BACKGROUND Critical care teams are on the front line of managing the COVID-19 pandemic, which is stressful for members of these teams. OBJECTIVE Our objective was to assess whether the use of social networks is associated with increased anxiety related to the COVID-19 pandemic among members of critical care teams. METHODS We distributed a web-based survey to physicians, residents, registered and auxiliary nurses, and nurse anesthetists providing critical care (anesthesiology, intensive care, or emergency medicine) in several French hospitals. The survey evaluated the respondents’ use of social networks, their sources of information on COVID-19, and their levels of anxiety and information regarding COVID-19 on analog scales from 0 to 10. RESULTS We included 641 respondents in the final analysis; 553 (86.3%) used social networks, spending a median time of 60 minutes (IQR 30-90) per day on these networks. COVID-19–related anxiety was higher in social network users than in health care workers who did not use these networks (median 6, IQR 5-8 vs median 5, IQR 3-7) in univariate (<i>P</i>=.02) and multivariate (<i>P</i>&lt;.001) analyses, with an average anxiety increase of 10% in social network users. Anxiety was higher among health care workers using social networks to obtain information on COVID-19 than among those using other sources (median 6, IQR 5-8 vs median 6, IQR 4-7; <i>P</i>=.04). Social network users considered that they were less informed about COVID-19 than those who did not use social networks (median 8, IQR 7-9 vs median 7, IQR 6-8; <i>P</i>&lt;.01). CONCLUSIONS Our results suggest that social networks contribute to increased anxiety in critical care teams. To protect their mental health, critical care professionals should consider limiting their use of these networks during the COVID-19 pandemic.

scholarly journals Prevalence and Clinical Significance of Hyponatremia in Pediatric Intensive Care

2019 ◽  
Vol 08 (03) ◽  
pp. 130-137
Author(s):  
Khouloud A. Al-Sofyani
Keyword(s):  
Intensive Care ◽  
Independent Risk Factor ◽  
Chart Review ◽  
Pediatric Intensive Care ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Prolonged Hospital Stay ◽  
Severe Hyponatremia ◽  
Risk Of Mortality ◽  
Prolonged Hospital

AbstractA retrospective chart review was conducted to estimate the prevalence and severity level of hyponatremia on admission at the pediatric intensive care unit (PICU) in a Saudi tertiary hospital. Hyponatremia was highly prevalent (67.2%) and severe hyponatremia was frequent among patients with Pediatric Risk of Mortality score > 10%. Severe hyponatremia was also associated with increased length of stay (p = 0.04) and a trend of increased mortality (p = 0.054). However, disease severity was not an independent risk factor of mortality in PICU, but might confound other risk factors that render the children requiring prolonged hospital stay, mechanical ventilation, and increased health costs.

Nurse Project Consultant: Critical Care Nurses Move Beyond the Bedside to Affect Quality and Safety

2018 ◽  
Vol 38 (3) ◽  
pp. 54-66 ◽  
Author(s):  
Lynn G. Mackinson ◽  
Juliann Corey ◽  
Veronica Kelly ◽  
Kristin P. O’Reilly ◽  
Jennifer P. Stevens ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Delivery ◽  
Critical Care Nurses ◽  
Lessons Learned ◽  
Scope Of Practice ◽  
Clinical Expertise ◽  
Health Care Delivery Systems

A nurse project consultant role empowered 3 critical care nurses to expand their scope of practice beyond the bedside and engage within complex health care delivery systems to reduce harms in the intensive care unit. As members of an interdisciplinary team, the nurse project consultants contributed their clinical expertise and systems knowledge to develop innovations that optimize care provided in the intensive care unit. This article discusses the formal development of and institutional support for the nurse project consultant role. The nurse project consultants’ responsibilities within a group of quality improvement initiatives are described and their challenges and lessons learned discussed. The nurse project consultant role is a new model of engaging critical care nurses as leaders in health care redesign.

Critical Care Clinicians’ Knowledge of Evidence-Based Guidelines for Preventing Ventilator-Associated Pneumonia

2010 ◽  
Vol 19 (3) ◽  
pp. 272-276 ◽  
Author(s):  
Mohamad F. El-Khatib ◽  
Salah Zeineldine ◽  
Chakib Ayoub ◽  
Ahmad Husari ◽  
Pierre K. Bou-Khalil
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Evidence Based ◽  
Ventilator Associated Pneumonia ◽  
Care Providers ◽  
Care Experience ◽  
Respiratory Therapists ◽  
Evidence Based Guidelines

Background Ventilator-associated pneumonia is the most common hospital-acquired infection among patients receiving mechanical ventilation in an intensive care unit. Different initiatives for the prevention of ventilator-associated pneumonia have been developed and recommended.Objective To evaluate knowledge of critical care providers (physicians, nurses, and respiratory therapists in the intensive care unit) about evidence-based guidelines for preventing ventilator-associated pneumonia.Methods Ten physicians, 41 nurses, and 18 respiratory therapists working in the intensive care unit of a major tertiary care university hospital center completed an anonymous questionnaire on 9 nonpharmacological guidelines for prevention of ventilator-associated pneumonia.Results The mean (SD) total scores of physicians, nurses, and respiratory therapists were 80.2% (11.4%), 78.1% (10.6%), and 80.5% (6%), respectively, with no significant differences between them. Furthermore, within each category of health care professionals, the scores of professionals with less than 5 years of intensive care experience did not differ significantly from the scores of professionals with more than 5 years of intensive care experience.Conclusions A health care delivery model that includes physicians, nurses, and respiratory therapists in the intensive care unit can result in an adequate level of knowledge on evidence-based nonpharmacological guidelines for the prevention of ventilator-associated pneumonia.

scholarly journals Deep Impact of Ultrasound in the Intensive Care Unit

2012 ◽  
Vol 117 (4) ◽  
pp. 801-809 ◽  
Author(s):  
Emilpaolo Manno ◽  
Mauro Navarra ◽  
Luciana Faccio ◽  
Mohsen Motevallian ◽  
Luca Bertolaccini ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Ultrasound Examination ◽  
Treatment Plan ◽  
Invasive Procedures ◽  
Deep Impact ◽  
High Prevalence ◽  
Critical Patients ◽  
Critical Care Ultrasonography

Background Ultrasound can influence the diagnosis and impact the treatment plan in critical patients. The aim of this study was to determine whether, without encountering major environment- or patient-related limitations, ultrasound examination under a critical care ultrasonography protocol can be performed to detect occult anomalies, to prompt urgent changes in therapy or induce further testing or interventions, and to confirm or modify diagnosis. Methods One hundred and twenty-five consecutive patients admitted to a general intensive care unit were assessed under a critical care ultrasonography protocol, and the data were analyzed prospectively. Systematic ultrasound examination of the optic nerve, thorax, heart, abdomen, and venous system was performed at the bedside. Results Environmental conditions hampered the examination slightly in 101/125 patients (80.8%), moderately in 20/125 patients (16%), and strongly in 4/125 patients (3.2%). Ultrasonographic findings modified the admitting diagnosis in 32/125 patients (25.6%), confirmed it in 73/125 patients (58.4%), were not effective in confirming or modifying it in 17/125 patients (13.6%), and missed it in 3/125 patients (2.4%). Ultrasonographic findings prompted further testing in 23/125 patients (18.4%), led to changes in medical therapy in 22/125 patients (17.6%), and to invasive procedures in 27/125 patients (21.6%). Conclusions In this series of patients consecutively admitted to an intensive care unit, ultrasound examination revealed a high prevalence of unsuspected clinical abnormalities, with the highest number of new ultrasound abnormalities detected in patients with septic shock. As part of rapid global assessment of the patient on admission, our ultrasound protocol holds potential for improving healthcare quality.

scholarly journals Leveraging a Cloud-Based Critical Care Registry for COVID-19 Pandemic Surveillance and Research in Low- and Middle-Income Countries (Preprint)

2020 ◽  
Author(s):  
◽  
Madiha Hashmi ◽  
Abi Beane ◽  
Srinivas Murthy ◽  
Arjen M Dondorp ◽  
...  
Keyword(s):  
Health Care ◽  
Critical Care ◽  
Intensive Care ◽  
Real Time ◽  
Sub Saharan Africa ◽  
Common Data Model ◽  
Middle Income ◽  
Middle Income Countries ◽  
Severe Acute Respiratory Infection ◽  
Low And Middle Income

UNSTRUCTURED The COVID-19 pandemic has revealed limitations in real-time surveillance needed for responsive health care action in low- and middle-income countries (LMICs). The Pakistan Registry for Intensive CarE (PRICE) was adapted to enable International Severe Acute Respiratory and emerging Infections Consortium (ISARIC)–compliant real-time reporting of severe acute respiratory infection (SARI). The cloud-based common data model and standardized nomenclature of the registry platform ensure interoperability of data and reporting between regional and global stakeholders. Inbuilt analytics enable stakeholders to visualize individual and aggregate epidemiological, clinical, and operational data in real time. The PRICE system operates in 5 of 7 administrative regions of Pakistan. The same platform supports acute and critical care registries in eleven countries in South Asia and sub-Saharan Africa. ISARIC-compliant SARI reporting was successfully implemented by leveraging the existing PRICE infrastructure in all 49 member intensive care units (ICUs), enabling clinicians, operational leads, and established stakeholders with responsibilities for coordinating the pandemic response to access real-time information on suspected and confirmed COVID-19 cases (N=592 as of May 2020) via secure registry portals. ICU occupancy rates, use of ICU resources, mechanical ventilation, renal replacement therapy, and ICU outcomes were reported through registry dashboards. This information has facilitated coordination of critical care resources, health care worker training, and discussions on treatment strategies. The PRICE network is now being recruited to international multicenter clinical trials regarding COVID-19 management, leveraging the registry platform. Systematic and standardized reporting of SARI is feasible in LMICs. Existing registry platforms can be adapted for pandemic research, surveillance, and resource planning.

scholarly journals Leveraging a Cloud-Based Critical Care Registry for COVID-19 Pandemic Surveillance and Research in Low- and Middle-Income Countries

10.2196/21939 ◽  
2020 ◽  
Vol 6 (4) ◽  
pp. e21939
Author(s):  
◽  
Madiha Hashmi ◽  
Abi Beane ◽  
Srinivas Murthy ◽  
Arjen M Dondorp ◽  
...  
Keyword(s):  
Health Care ◽  
Critical Care ◽  
Intensive Care ◽  
Real Time ◽  
Sub Saharan Africa ◽  
Common Data Model ◽  
Middle Income ◽  
Middle Income Countries ◽  
Severe Acute Respiratory Infection ◽  
Low And Middle Income

The COVID-19 pandemic has revealed limitations in real-time surveillance needed for responsive health care action in low- and middle-income countries (LMICs). The Pakistan Registry for Intensive CarE (PRICE) was adapted to enable International Severe Acute Respiratory and emerging Infections Consortium (ISARIC)–compliant real-time reporting of severe acute respiratory infection (SARI). The cloud-based common data model and standardized nomenclature of the registry platform ensure interoperability of data and reporting between regional and global stakeholders. Inbuilt analytics enable stakeholders to visualize individual and aggregate epidemiological, clinical, and operational data in real time. The PRICE system operates in 5 of 7 administrative regions of Pakistan. The same platform supports acute and critical care registries in eleven countries in South Asia and sub-Saharan Africa. ISARIC-compliant SARI reporting was successfully implemented by leveraging the existing PRICE infrastructure in all 49 member intensive care units (ICUs), enabling clinicians, operational leads, and established stakeholders with responsibilities for coordinating the pandemic response to access real-time information on suspected and confirmed COVID-19 cases (N=592 as of May 2020) via secure registry portals. ICU occupancy rates, use of ICU resources, mechanical ventilation, renal replacement therapy, and ICU outcomes were reported through registry dashboards. This information has facilitated coordination of critical care resources, health care worker training, and discussions on treatment strategies. The PRICE network is now being recruited to international multicenter clinical trials regarding COVID-19 management, leveraging the registry platform. Systematic and standardized reporting of SARI is feasible in LMICs. Existing registry platforms can be adapted for pandemic research, surveillance, and resource planning.

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