scholarly journals Association of an Emergency Department–embedded Critical Care Unit with Hospital Outcomes and Intensive Care Unit Use

2020 ◽  
Vol 17 (12) ◽  
pp. 1599-1609
Author(s):  
George L. Anesi ◽  
Jayaram Chelluri ◽  
Zaffer A. Qasim ◽  
Marzana Chowdhury ◽  
Rachel Kohn ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Critical Care ◽  
Intensive Care ◽  
Critical Care Unit ◽  
Hospital Outcomes

scholarly journals In-Hospital Outcomes in Patients Admitted to the Intensive Care Unit after a Return Visit to the Emergency Department

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 431
Author(s):  
Chun-Fu Lin ◽  
Yi-Syun Huang ◽  
Ming-Ta Tsai ◽  
Kuan-Han Wu ◽  
Chien-Fu Lin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Regression Analysis ◽  
Intensive Care ◽  
Medical Cost ◽  
Total Medical Cost ◽  
Hospital Outcomes ◽  
Return Visit ◽  
Icu Admission ◽  
Ed Visits

Background: Intensive care unit (ICU) admission following a short-term emergency department (ED) revisit has been considered a particularly undesirable outcome among return-visit patients, although their in-hospital prognosis has not been discussed. We aimed to compare clinical outcomes between adult patients admitted to the ICU after unscheduled ED revisits and those admitted during index ED visits. Method: This retrospective study was conducted at two tertiary medical centers in Taiwan from 1 January 2016 to 31 December 2017. All adult non-trauma patients admitted to the ICU directly via the ED during the study period were included and divided into two comparison groups: patients admitted to the ICU during index ED visits and those admitted to the ICU during return ED visits. The outcomes of interest included in-hospital mortality, mechanical ventilation (MV) support, profound shock, hospital length of stay (HLOS), and total medical cost. Results: Altogether, 12,075 patients with a mean (standard deviation) age of 64.6 (15.7) years were included. Among these, 5.3% were admitted to the ICU following a return ED visit within 14 days and 3.1% were admitted following a return ED visit within 7 days. After adjusting for confounding factors for multivariate regression analysis, ICU admission following an ED revisit within 14 days was not associated with an increased mortality rate (adjusted odds ratio (aOR): 1.08, 95% confidence interval (CI): 0.89 to 1.32), MV support (aOR: 1.06, 95% CI: 0.89 to 1.26), profound shock (aOR: 0.99, 95% CI: 0.84 to 1.18), prolonged HLOS (difference: 0.04 days, 95% CI: −1.02 to 1.09), and increased total medical cost (difference: USD 361, 95% CI: −303 to 1025). Similar results were observed after the regression analysis in patients that had a 7-day return visit. Conclusion: ICU admission following a return ED visit was not associated with major in-hospital outcomes including mortality, MV support, shock, increased HLOS, or medical cost. Although ICU admissions following ED revisits are considered serious adverse events, they may not indicate poor prognosis in ED practice.

Terminal Withdrawal of Mechanical Ventilation: A Hospice Perspective for the Intensivist

2018 ◽  
Vol 34 (2) ◽  
pp. 156-164 ◽  
Author(s):  
John Bodnar
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Critical Care Unit ◽  
Inpatient Unit

The intensive care unit (ICU) and hospice inpatient unit (IPU) environments differ in many ways. Although both endeavor to provide the best care possible for their patients, the day-to-day goals of these environments are almost antithetical. Similarly, the experiences and expertise of the staff differ. When performing a similar clinical task, it may be addressed in different ways because each group is engrained in their primary day-to-day focus. Terminal withdrawal of mechanical ventilation is a procedure that is performed in both ICUs and some hospice IPUs. Previous examinations of this subject have been based largely upon the correlative background, practices, and perceptions of the ICU prescriber. The purpose of this review is to examine how the manner in which this procedure is performed in the hospice environment may differ in ways that the intensivist can incorporate into their own plan of care, or better appreciate when making the decision to remove mechanical ventilation in the critical care unit or transfer the patient to a hospice environment for the procedure to be completed.

scholarly journals Rapid Ultrasound Methods in Anesthesiology and Critical Care Medicine

2015 ◽  
Vol 25 (2) ◽  
pp. 94-102
Author(s):  
Andrius Macas ◽  
Asta Mačiulienė ◽  
Sandra Ramanavičiūtė ◽  
Alina Vilkė ◽  
Kęstutis Petniūnas ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Critical Care ◽  
Intensive Care ◽  
Trauma Patient ◽  
Standard Of Care ◽  
Intensive Care Unit Setting ◽  
Critically Ill Patient ◽  
Essential Information ◽  
Ultrasound Applications

The variety of focus assessed ultrasound applications and protocols in emergency department and intensive care unit setting is growing. Focus assessed protocols can provide essential information about critically ill patient. It is now the standard of care to perform focused assessment using sonography for trauma - FAST early in the evaluation of trauma patient. Other focus assessed protocols can prove to be useful as well as FAST.

Persepsi Perawat Neurosurgical Critical Care Unitterhadap Perawatan Pasien Menjelang Ajal

1970 ◽  
Vol 2 (1) ◽  
Author(s):  
Meilita Enggune ◽  
Kusman Ibrahim ◽  
Hana Rizmadewi Agustina
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life Care ◽  
Critical Care Unit ◽  
Life Care ◽  
Dying Patients ◽  
The Family ◽  
Dying Patient

Tingginya angka kematian yang terjadi di unit perawatan intensif, menuntut peningkatan pelayanan perawatan paliatif termasuk perawatan pasien menjelang ajal, yang melibatkan perawat perawatan kritis. Tujuan penelitian ini untuk memperoleh gambaran persepsi perawat terhadap perawatan pasien menjelang ajal di ruang Neurosurgical Critical Care Unit(NCCU). Delapan perawat pelaksana di ruang NCCU RSHS Bandung dilibatkan dalam penelitian deskriptif kualitatif ini dengan rentang usia antara 27– 43 tahun, dan bekerja selama 3–20 tahun. Teknik sampling yang digunakan adalah purposive samplingdan jumlah informan dibatasi setelah data jenuh. Pengumpulan data dengan melakukan wawancara semi terstruktur, dan analisis yang digunakan adalah content analysis. Hasil penelitian didapatkan 4 tema dan 15 subtema yaitu: (1) Pemahaman perawat tentang perawatan pasien menjelang ajal yaitu: membantu pasien meninggal dengan tenang, menghadirkan keluarga untuk memberikan dukungan, dan lebih berfokus pada bimbingan spiritual; (2) Cara menghadapi kematian yang sering terjadi yaitu: adaptasi perawat terhadap kondisi pasien menjelang ajal, kesulitan menentukan fase menjelang ajal pasien kritis, dilema dalam pengambilan keputusan, dan empati; (3) Peran perawat dalam mempersiapkan pasien menjelang ajal yaitu: pembimbing spiritual pasien, komunikator, fasilitator, dan pemberi dukungan emosional keluarga; (4) Hal-hal yang perlu diperbaiki dalam perawatan menjelang ajal yaitu: diperlukan pelatihan perawatan paliatif pada pasien kritis, diperlukan ruangan khusus pasien menjelang ajal, diperlukan pembimbing rohani khusus, dan diperlukan standar operasional prosedur (SOP) perawatan pasien menjelang ajal. Perawat perlu memberikan perawatan yang membantu pasien meninggal dengan tenang, memberikan dukungan untuk keluarga, dan lebih difokuskan untuk memenuhi kebutuhan spiritual pasien.Kata kunci: Intensive Care Unit, perawatan akhir hidup, persepsi perawat AbstractThe high number of death that occurred in the Intensive Care Unit, strive to improve palliative care services including the provision of care of dying patients by critical care nurses. The purpose of this study was to obtain a perception of nurses toward the care of dying patients in the Neurosurgical Critical Care Unit ( NCCU ). Eight nurses who work at NCCU were involved in this study, age between 27- 43 and have been working from 3 to 20 years. The sampling technique used the purposive sampling method and a limited number of informants after data saturated. Data collection was done by conducting semi- structured interviews, content analysis was used to analyse the data. There are four themes with 15 sub-themes include: 1) Nurse understanding about caring for dying patients: help the patients to die peacefully, presenting the family to provide supports, and more focused on spiritual guidance. 2) Way of handling the frequent of death occurance: adaptation of nurses to dying condition, difficulty determining the critical phase of the dying patient, dilemmas in decision-making, and empathy. 3) The role of nurses in preparing for the dying patient: the patient spiritual guides, communicators, facilitators, and providers of family emotional support. 4) The Things that need to be improved in end of life care: the palliative care training is required in critically ill patients as well as separate unit for dying patients, exclusive spiritual guide, and standard operating procedures (SOP) of care for the dying patients. It can be concluded that nurses need to provide treatment that helping patients to die peacefully, and providing support for the family, which is focused on meeting the spiritual needs of patients.Key words:Intensive Care Unit, end of life care, nurses perception

scholarly journals Electroencephalogram Monitoring in Critical Care

2020 ◽  
Vol 40 (06) ◽  
pp. 675-680
Author(s):  
Clio Rubinos ◽  
Ayham Alkhachroum ◽  
Caroline Der-Nigoghossian ◽  
Jan Claassen
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Critical Care Unit ◽  
Care Setting ◽  
Eeg Monitoring ◽  
Electroencephalogram Eeg ◽  
Brain Monitoring

AbstractSeizures are common in critically ill patients. Electroencephalogram (EEG) is a tool that enables clinicians to provide continuous brain monitoring and to guide treatment decisions—brain telemetry. EEG monitoring has particular utility in the intensive care unit as most seizures in this setting are nonconvulsive. Despite the increased use of EEG monitoring in the critical care unit, it remains underutilized. In this review, we summarize the utility of EEG and different EEG modalities to monitor patients in the critical care setting.

Case Report: When all claims that it is necrotizing fasciitis but Point of care ultrasound (POCUS) proves the opposite!

POCUS Journal ◽  
2018 ◽  
Vol 3 (1) ◽  
pp. 13-14
Author(s):  
Hadiel Kaiyasah, MD, MRCS (Glasgow), ABHS-GS ◽  
Maryam Al Ali, MBBS
Keyword(s):  
Emergency Department ◽  
Critical Care ◽  
Case Report ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Soft Tissue Infection ◽  
Critical Care Unit ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Soft Tissue Infections

Soft tissue ultrasound (ST-USS) has been shown to be of utmost importance in assessing patients with soft tissue infections in the emergency department or critical care unit. It aids in guiding the management of soft tissue infection based on the sonographic findings.

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.

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