scholarly journals Withdrawal of mechanical ventilation from dying patients at emergency and critical care facilities in Japan: a qualitative study with physicians

2009 ◽  
Vol 20 (1) ◽  
pp. 16-30 ◽  
Author(s):  
Kaoruko Aita ◽  
Ichiro Kai
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Qualitative Study ◽  
Dying Patients ◽  
Care Facilities

Critical Care Documentation for the Dying Trauma Patient: Are We Recognizing Our Own Efforts?

2020 ◽  
pp. 000313482097298
Author(s):  
Samuel J. Zolin ◽  
Jasmin K. Bhangu ◽  
Brian T. Young ◽  
Sarah E. Posillico ◽  
Husayn A. Ladhani ◽  
...  
Keyword(s):  
Critical Care ◽  
Trauma Patients ◽  
Family Meeting ◽  
Comfort Care ◽  
Code Status ◽  
Family Meetings ◽  
Dying Patients ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Poor Outcomes

Background Missed documentation for critical care time (CCT) for dying patients may represent a missed opportunity for physicians to account for intensive care unit (ICU) services, including end-of-life care. We hypothesized that CCT would be poorly documented for dying trauma patients. Methods Adult trauma ICU patients who died between December 2014 and December 2017 were analyzed retrospectively. Critical care time was not calculated for patients with comfort care code status. Critical care time on the day prior to death and day of death was collected. Logistic regression was used to determine factors associated with documented CCT. Results Of 147 patients, 43% had no CCT on day prior to death and 55% had no CCT on day of death. 82% had a family meeting within 1 day of death. Family meetings were independently associated with documented CCT (OR 3.69, P = .008); palliative care consultation was associated with decreased documented CCT (OR .24, P < .001). Conclusions Critical care time is not documented in half of eligible trauma patients who are near death. Conscious (time spent in family meetings and injury acuity) and unconscious factors (anticipated poor outcomes) likely affect documentation.

scholarly journals The effect of reference position versus right lateral position on the intra-abdominal pressure in mechanically ventilated patients

2018 ◽  
Vol 8 (6) ◽  
pp. 93
Author(s):  
Ghada Shalaby Khalaf Mahran ◽  
Sayed K. Abd-Elshafy ◽  
Manal Mohammed Abd El Neem ◽  
Jehan A. Sayed
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Body Position ◽  
Critical Issue ◽  
Lateral Position ◽  
Abdominal Pressure ◽  
University Hospitals ◽  
Abdominal Hypertension

Background and objective: Intra-abdominal hypertension (IAH) is a frequent plentiful problem in patients admitted to critical care units. It ranges from a surge incidence of morbidity and mortality to a particular need for nursing health care, so recognition of the occurrence of IAH is a very critical issue for critical care nurses and physician. This study aimed to recognize the effects of various body position with the various head of bed elevation on the intra-abdominal pressure (IAP) in patients with mechanical ventilation.Methods: Design: A non-randomized, prospective observational study was used. Setting: Trauma and general intensive care units at Assuit University Hospitals. Method: In a prospective observational study, during the third day of mechanical ventilation, 60 patients were screened for IAP via a urinary catheter, in two various body positions in three separate degrees of the head of the bed (HOB) elevation (0º, 15º, and 30º). The position was changed at least 4 hours apart over a 24-h period.Results: In lateral recumbence, IAP measurements were significantly elevated compared to supine position, they were 19.70 ± 3.09 mmHg versus 16.00 ± 3.14 (p < .001), 22.80 ± 3.56 mmHg versus 19.03 ± 2.95 (p < .001), and 26.08 ± 3.59 mmHg versus 21.46 ± 2.90 versus (p < .001) at 0º, 15º, and 30º respectively. The mean of IAP difference was 3.7 ± 3.0 mmHg at 0º, 3.8 ± 1.00 mmHg at 15º, and 5.5 ± 1.01 mmHg at 30 º (p < .005).Conclusions: IAP reading is significantly elevated by changing from supine to lateral position especially with HOB elevation and significantly correlated with mortality rate in patients with mechanical ventilation

Plug and Play: Mechanical Ventilation Utilization During Critical Care Transport of Patients with Advanced Airway

2018 ◽  
Vol 37 (5) ◽  
pp. 296-297
Author(s):  
Christine Aspiotes ◽  
M. David. Gothard ◽  
Hamilton P. Schwartz ◽  
Michael T. Bigham
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Plug And Play ◽  
Advanced Airway

scholarly journals Does "Flattening the Curve" Affect Critical Care Services Delivery for COVID-19? A Global Health Perspective

2020 ◽  
Author(s):  
Ramiro E. Gilardino
Keyword(s):  
Critical Care ◽  
Health Systems ◽  
Essential Element ◽  
Protective Equipment ◽  
Care Providers ◽  
Care Services ◽  
Services Delivery ◽  
Medical Supplies ◽  
Global Pandemic ◽  
Care Facilities

During this coronavirus disease 2019 (COVID-19) global pandemic, nations are taking bold measures to mitigate the spread of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in order to avoid the overwhelming its critical care facilities. While these "flattening the curve" initiatives are showing signs of impeding the potential surge in COVID-19 cases, it is not known whether these measures alleviate the burden placed on intensive care units. Much has been made of the desperate need for critical care beds and medical supplies, especially personal protective equipment (PPE). But while these initiatives may provide health systems time to bolster their critical care infrastructure, they do little to protect the most essential element – the critical care providers. This article examines bolder initiatives that may be needed to both protect crucial health systems and the essential yet vulnerable providers during this global pandemic.

scholarly journals Death Notification in Italian Critical Care Unites and Emergency Services. A Qualitative Study with Physicians, Nurses and Relatives

2021 ◽  
Vol 18 (24) ◽  
pp. 13338
Author(s):  
Ines Testoni ◽  
Erika Iacona ◽  
Lorenza Palazzo ◽  
Beatrice Barzizza ◽  
Beatrice Baldrati ◽  
...  
Keyword(s):  
Critical Care ◽  
Qualitative Study ◽  
Protective Factors ◽  
Health Care Professionals ◽  
Emergency Services ◽  
Continuing Bonds ◽  
Critical Care Units ◽  
Death Notification ◽  
The Impact ◽  
Relational Difficulties

This qualitative study was conducted in critical care units and emergency services and was aimed at considering the death notification (DN) phenomenology among physicians (notifiers), patient relatives (receivers) and those who work between them (nurses). Through the qualitative method, a systemic perspective was adopted to recognise three different categories of representation: 23 clinicians, 13 nurses and 11 family members of COVID-19 victims were interviewed, totalling 47 people from all over Italy (25 females, mean age: 46,36; SD: 10,26). With respect to notifiers, the following themes emerged: the changes in the relational dimension, protective factors and difficulties related to DN. With respect to receivers, the hospital was perceived as a prison, bereavement between DN, lost rituals and continuing bonds. Among nurses, changes in the relational dimension, protective factors and the impact of the death. Some common issues between physicians and nurses were relational difficulties in managing distancing and empathy and the support of relatives and colleagues. The perspective of receivers showed suffering related to loss and health care professionals’ inefficacy in communication. Specifically, everyone considered DNs mismanaged because of the COVID-19 emergency. Some considerations inherent in death education for DN management among health professionals were presented.

Sign in / Sign up

Export Citation Format

Share Document