An evidence-based, nurse-led communication intervention for families of critically-ill patients with grave prognosis in ICU

Physiotherapists are involved in the management of patients with critical illness. Physiotherapy assessment of critically ill patients is less driven by medical diagnosis; instead, there is a strong focus on deficiencies at a pathophysiological and functional level. An accurate and valid assessment of respiratory conditions (retained airway secretions, atelectasis, and respiratory muscle weakness), physical deconditioning, and related problems (muscle weakness, joint stiffness, impaired functional exercise capacity, physical inactivity, and emotional function) allows the identifying of targets for physiotherapy. Evidence-based targets for physiotherapy are deconditioning, impaired airway clearance, atelectasis, (re-)intubation avoidance, and weaning failure. Early physical activity and mobility are key in the prevention, attenuation, or reversion of physical deconditioning related to critical illness. A variety of modalities for exercise training and early mobility are evidence-based and are implemented, depending on the stage of critical illness, comorbid conditions, and cooperation of the patient. The physiotherapist should be responsible for implementing mobilization plans and exercise prescription and make recommendations for their progression, jointly with medical and nursing staff.

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Duration of antibiotic therapy in critically ill patients: a randomized controlled trial of a clinical and C-reactive protein-based protocol versus an evidence-based best practice strategy without biomarkers

Critical Care ◽

10.1186/s13054-020-02946-y ◽

2020 ◽

Vol 24 (1) ◽

Cited By ~ 1

Author(s):

Isabela Borges ◽

◽

Rafael Carneiro ◽

Rafael Bergo ◽

Larissa Martins ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Antibiotic Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Best Practice ◽

Controlled Trial ◽

Evidence Based ◽

C Reactive Protein ◽

Reactive Protein ◽

Randomized Controlled

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Physiotherapy in critically ill patients

The ESC Textbook of Intensive and Acute Cardiovascular Care ◽

10.1093/med/9780198849346.003.0031 ◽

2021 ◽

pp. 373-384

Author(s):

Rik Gosselink ◽

Jean Roeseler

Keyword(s):

Critical Illness ◽

Critically Ill ◽

Muscle Weakness ◽

Critically Ill Patients ◽

Joint Stiffness ◽

Evidence Based ◽

Strong Focus ◽

Functional Exercise ◽

Valid Assessment ◽

Physical Deconditioning

Physiotherapists are involved in the management of patients with critical illness. Physiotherapy assessment of critically ill patients is less driven by medical diagnosis; instead, there is a strong focus on deficiencies at a pathophysiological and functional level. An accurate and valid assessment of respiratory conditions (retained airway secretions, atelectasis, and respiratory muscle weakness), physical deconditioning, and related problems (muscle weakness, joint stiffness, impaired functional exercise capacity, physical inactivity, and emotional function) allows the identifying of targets for physiotherapy. Evidence-based targets for physiotherapy are deconditioning, impaired airway clearance, atelectasis, (re-)intubation avoidance, and weaning failure. Early physical activity and mobility are key in the prevention, attenuation, or reversion of physical deconditioning related to critical illness. A variety of modalities for exercise training and early mobility are evidence-based and are implemented, depending on the stage of critical illness, comorbid conditions, and cooperation of the patient. The physiotherapist should be responsible for implementing mobilization plans and exercise prescription and make recommendations for their progression, jointly with medical and nursing staff.

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Enhancing the Communication of Suddenly Speechless Critical Care Patients

American Journal of Critical Care ◽

10.4037/ajcc2016217 ◽

2016 ◽

Vol 25 (3) ◽

pp. e40-e47 ◽

Cited By ~ 21

Author(s):

Carmen S. Rodriguez ◽

Meredeth Rowe ◽

Loris Thomas ◽

Jonathan Shuster ◽

Brent Koeppel ◽

...

Keyword(s):

Critical Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Repeated Measures ◽

Intervention Group ◽

Communication Intervention ◽

Control Group ◽

Repeated Measures Design ◽

Quasi Experimental ◽

The Impact

Background Sudden speechlessness is common in critically ill patients who are intubated or have had surgery for head and neck cancer. Sudden inability to speak poses challenges for hospitalized patients because strategies to facilitate communication are often limited and unreliable. Objective To determine the impact of a technology-based communication intervention on patients’ perception of communication difficulty, satisfaction with communication methods, and frustration with communication. Methods A quasi-experimental, 4-cohort (control and intervention) repeated-measures design was used. Data were collected daily for up to 10 days. Patients in adult critical care units were followed up as they were transferred to other units within the institutions selected for the study. The impact of a technology-based communication system (intervention) was compared with usual care (control). Patients’ communication outcomes pertinent to communication with nursing staff that were evaluated included perception of communication ease, satisfaction with methods used for communication, and frustration with communication. Results Compared with participants in the control group, participants in the intervention group reported lower mean frustration levels (−2.68; SE, 0.17; 95% CI, −3.02 to −2.34; P < .001) and higher mean satisfaction levels (0.59; SE, 0.16; 95% CI, 0.27 to 0.91; P < .001) with use of the communication intervention. Participants in the intervention group reported a consistent increase in perception of communication ease during the hospital stay. Conclusions The results facilitated evaluation of a bedside technology-based communication intervention tailored to the needs of suddenly speechless critically ill patients.

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Development of Institutional Guidelines for Management of Gram-Negative Bloodstream Infections: Incorporating Local Evidence

Hospital Pharmacy ◽

10.1177/0018578717720506 ◽

2017 ◽

Vol 52 (10) ◽

pp. 691-697 ◽

Cited By ~ 9

Author(s):

Elizabeth B. Nimmich ◽

P. Brandon Bookstaver ◽

Joseph Kohn ◽

Julie Ann Justo ◽

Katie L. Hammer ◽

...

Keyword(s):

Health Care ◽

Critically Ill ◽

Antimicrobial Therapy ◽

Critically Ill Patients ◽

Severity Of Illness ◽

Bloodstream Infections ◽

Evidence Based ◽

Gram Negative ◽

Empirical Antimicrobial Therapy ◽

Hospital Acquired

Background: Appropriate empirical antimicrobial therapy is associated with improved outcomes of patients with Gram-negative bloodstream infections (BSI). Objective: Development of evidence-based institutional management guidelines for empirical antimicrobial therapy of Gram-negative BSI. Methods: Hospitalized adults with Gram-negative BSI in 2011-2012 at Palmetto Health hospitals in Columbia, SC, USA, were identified. Logistic regression was used to examine the association between site of infection acquisition and BSI due to Pseudomonas aeruginosa or chromosomally mediated AmpC-producing Enterobacteriaceae (CAE). Antimicrobial susceptibility rates of bloodstream isolates were stratified by site of acquisition and acute severity of illness. Retained antimicrobial regimens had predefined susceptibility rates ≥90% for noncritically ill and ≥95% for critically ill patients. Results: Among 390 patients, health care–associated (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.5-6.3] and hospital-acquired sites of acquisition (OR: 3.7, 95% CI: 1.6-8.4) were identified as risk factors for BSI due to P aeruginosa or CAE, compared with community-acquired BSI (referent). Based on stratified bloodstream antibiogram, ceftriaxone met predefined susceptibility criteria for community-acquired BSI in noncritically ill patients (95%). Cefepime and piperacillin-tazobactam monotherapy achieved predefined susceptibility criteria in noncritically ill (95% both) and critically ill patients with health care–associated and hospital-acquired BSI (96% and 97%, respectively) and critically ill patients with community-acquired BSI (100% both). Conclusions: Incorporation of site of acquisition, local antimicrobial susceptibility rates, and acute severity of illness into institutional guidelines provides objective evidence-based approach for optimizing empirical antimicrobial therapy for Gram-negative BSI. The suggested methodology provides a framework for guideline development in other institutions.

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