scholarly journals Comparison between nurses' and families' opinion about priorities of immediate patient's family needs

2018 ◽  
Vol 9 (1) ◽  
pp. 113
Author(s):  
Intessar Mohamed Ahmad
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Time Frame ◽  
Medical Institute ◽  
Family Needs ◽  
The Family ◽  
The Mean ◽  
Individual Needs ◽  
Strongly Agree

Background and objective: Acute critical illness represents a crisis not just for the individual patient however conjointly for the members of the family. Moreover, the admission of the patient represents a sudden crisis allowing no time for its preparation. The responsibilities of critical care nurses extend beyond the patients in the intensive care unit (ICU) to incorporate the members of the family of these patients. Nurses are a primary resource for members of family of ICU patients and they are in a perfect position to assist patients’ members of the family in an applicable approach. For this reason, recognition of these needs by nursing personnel is very important for applying of holistic nursing care. The aims of this study were 1) Ranking the immediate needs of members of family of critically ill patients and nurses. 2) Comparing between nurses, and families, opinion regarding priorities of immediate patient's family needs using Critical Care Family Needs Inventory (CCFNI).Methods: This descriptive study was conducted at the general ICUs of Damanhour Medical Institute which has 15 beds, Damanhour chest hospital which has 7 beds and Itay Elbaroad General Hospital which has 11 beds. The three units have a total of 100 nurses. A questionnaire was used for data collection. It consisted of part one which comprised patient's condition whose families were studied participants, biosocial knowledge related to the members of family and part two which included CCFNI tool. The adapted CCFNI was translated into colloquial Arabic. Participant members of family were individually interviewed by the researcher. Members of family were required to answer each statement with strongly agree, agree, neutral, do not agree and strongly do not agree. The interview took approximately 45 to 60 minutes to be completed, and all interviews took place within the 72 hours' time frame of each patient's admission to the critical care unit. The nurses were approached and given the questionnaires to be filled in by themselves during handover, tea or lunch break.Results: Generally, families ranked their knowledge, proximity and comfort needs higher in importance than the nurses. Also, the knowledge and assurance needs were ranked above the needs for support, comfort, and proximity by our participating nurses and members of family. Moreover, the mean scores of knowledge, proximity, support and comfort needs for members of family were significantly higher than these for nurses. Out of 35 needs of the members of family in the CCFNI, there were no significant differences between the mean scores of the nurses and those of the members of family in 10 individual needs. Results show that the nurses were correct in 10 out of 35 members of family’ individual needs. The remaining mean scores from 25 individual needs showed significant differences between the nurses and actual family needs. Results show that did not meet all the specific family needs during the care of the critically ill patients. Results show that members of family scored significantly higher than nurses on 20 statements while, the nurses scored significantly higher than members of family on only 5 of the statements.Conclusions: Families considered that knowledge then assurance was the most important needs. While nurses considered that assurance then knowledge were the most important needs which indicate that nurses underestimated the needs of the family and family need may be inaccurately evaluated by heath care team and almost unmet. Furthermore, Members of family in this study considered the needs that bring comfort and support as less in priority needs.

scholarly journals Characteristics of Critically-Ill Patients at Two Tertiary Care Hospitals in Sudan

2018 ◽  
Vol 18 (2) ◽  
pp. 190 ◽  
Author(s):  
Hagir Sulieman ◽  
Wael El-Mahdi ◽  
Mohannad Awadelkareem ◽  
Lama Nazer
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
Apache Ii ◽  
The Mean ◽  
Tertiary Care Hospitals

Objectives: Knowledge of intensive care unit (ICU) admission patterns and characteristics is necessary for the development of critical care services, particularly in low-resource settings. This study aimed to describe the characteristics of critically-ill patients admitted to ICUs in Sudan. Methods: This prospective observational study was conducted between February and May 2017 in the ICUs of two government tertiary care hospitals inKhartoum, Sudan. A total of 100 consecutive adult patients admitted to the ICUs were included in the study. The patients’ demographic and clinical characteristics and Acute Physiologic Assessment and Chronic Health Evaluation (APACHE II) scores upon admission were recorded, as well as the reason for admission, presence of any underlying comorbidities, interventional requirements like mechanical ventilation or haemodialysis, length of stay in the ICU and patient outcome. Results: Of the sample, 58% were female and 42% were male. The mean age was 47.4 ± 18.3 years old. Upon admission, the mean APACHE II score was 14.2 ± 9.6. In total, 54% of the patients had no known underlying comorbidities. The most common reasons for ICU admission were neurological diseases (27%), sepsis or infectious diseases (19%) and postoperative management (12%). Mechanical ventilation and haemodialysis were required by 35% and 11% of the patients, respectively. The average length of stay was 10.0 ± 7.2 days and the mortality rate was 24%. Conclusion: Most of the patients admitted to the ICUs were middle-aged females with no known underlying comorbidities. Larger studies are necessary to provide a comprehensive understanding of the critical care needs of Sudanese hospitals.Keywords: Intensive Care Units; Patient Admission, trends; Critical Care Outcomes; Developing Countries; Sudan.

Perception of nurses regarding family needs of critically ill patients in a tertiary hospital of Kathmandu: A cross-sectional study

2019 ◽  
Vol 8 (1) ◽  
pp. 8-12
Author(s):  
Sabita Pandey ◽  
Roshanee Shrestha ◽  
Narayani Paudel
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Critical Care Unit ◽  
Family Members ◽  
Cross Sectional Study ◽  
Family Needs ◽  
Sectional Study ◽  
Cross Sectional

Background: Getting serious illness and being admitted in critical care unit is always stressful to patient and family members. Meeting the needs of family members of patients in the intensive care unit is a primary responsibility of intensive care unit staff and an important criterion in assessment of quality of care. Objectives: The aim of this study was to assess the family members’ needs of critically ill patients as perceived by nurses. Methodology: A descriptive cross sectional study was conducted among 50 nurses from different critical care unitsof Kathmandu Medical College Teaching Hospital using purposive sampling technique. Structured questionnaire was developed by referring to “Critical Care Family Needs Inventory”in our context for data collection and collected data was analyzed by using Statistical Package for Social Sciences version 16. Results: The mean age of the respondents was 24.98 ± SD 2.77.Regarding education and experience, 58% respondents had proficiency certificate level and 42% had bachelor level education and mean working experience in critical care unit was 37.54 months. Regarding the importance of family needs, 86% nurses perceived “explanation about the critical care unit environment before admitting the patient in critical care unit” as very important need for the relatives. Likewise, 58% nurses perceived “to know which staff members could give what type of information” and “to be alone at any time” as the least important needs. Conclusion: The study found that clear explanation about the critical care environment to the relatives is very important to gain co-operation from them in treatment of critically ill patients. Hence, staff of critical care unit needs to be aware in meeting the needs of relatives.

scholarly journals Report of the first AKI Round Table meeting: an initiative of the ESICM AKI Section

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
M. Ostermann ◽  
A. Schneider ◽  
T. Rimmele ◽  
I. Bobek ◽  
M. van Dam ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Critical Care ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Future Research ◽  
Knowledge Gaps ◽  
Blood Pressure Targets

Abstract Purpose Critical Care Nephrology is an emerging sub-specialty of Critical Care. Despite increasing awareness about the serious impact of acute kidney injury (AKI) and renal replacement therapy (RRT), important knowledge gaps persist. This report represents a summary of a 1-day meeting of the AKI section of the European Society of Intensive Care Medicine (ESICM) identifying priorities for future AKI research. Methods International Members of the AKI section of the ESICM were selected and allocated to one of three subgroups: “AKI diagnosis and evaluation”, “Medical management of AKI” and “Renal Replacement Therapy for AKI.” Using a modified Delphi methodology, each group identified knowledge gaps and developed potential proposals for future collaborative research. Results The following key research projects were developed: Systematic reviews: (a) epidemiology of AKI with stratification by patient cohorts and diagnostic criteria; (b) role of higher blood pressure targets in patients with hypertension admitted to the Intensive Care Unit, and (c) specific clearance characteristics of different modalities of continuous renal replacement therapy (CRRT). Observational studies: (a) epidemiology of critically ill patients according to AKI duration, and (b) current clinical practice of CRRT. Intervention studies:( a) Comparison of different blood pressure targets in critically ill patients with hypertension, and (b) comparison of clearance of solutes with various molecular weights between different CRRT modalities. Conclusion Consensus was reached on a future research agenda for the AKI section of the ESICM.

scholarly journals Feasibility of cardiac output measurements in critically ill patients by medical students

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Geert Koster ◽  
Thomas Kaufmann ◽  
Bart Hiemstra ◽  
Renske Wiersema ◽  
Madelon E. Vos ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Critical Care ◽  
Medical Students ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Left Ventricular ◽  
Percentage Error ◽  
Poor Agreement ◽  
Cardiac Output Measurements

Abstract Background Critical care ultrasonography (CCUS) is increasingly applied also in the intensive care unit (ICU) and performed by non-experts, including even medical students. There is limited data on the training efforts necessary for novices to attain images of sufficient quality. There is no data on medical students performing CCUS for the measurement of cardiac output (CO), a hemodynamic variable of importance for daily critical care. Objective The aim of this study was to explore the agreement of cardiac output measurements as well as the quality of images obtained by medical students in critically ill patients compared to the measurements obtained by experts in these images. Methods In a prospective observational cohort study, all acutely admitted adults with an expected ICU stay over 24 h were included. CCUS was performed by students within 24 h of admission. CCUS included the images required to measure the CO, i.e., the left ventricular outflow tract (LVOT) diameter and the velocity time integral (VTI) in the LVOT. Echocardiography experts were involved in the evaluation of the quality of images obtained and the quality of the CO measurements. Results There was an opportunity for a CCUS attempt in 1155 of the 1212 eligible patients (95%) and in 1075 of the 1212 patients (89%) CCUS examination was performed by medical students. In 871 out of 1075 patients (81%) medical students measured CO. Experts measured CO in 783 patients (73%). In 760 patients (71%) CO was measured by both which allowed for comparison; bias of CO was 0.0 L min−1 with limits of agreement of − 2.6 L min−1 to 2.7 L min−1. The percentage error was 50%, reflecting poor agreement of the CO measurement by students compared with the experts CO measurement. Conclusions Medical students seem capable of obtaining sufficient quality CCUS images for CO measurement in the majority of critically ill patients. Measurements of CO by medical students, however, had poor agreement with expert measurements. Experts remain indispensable for reliable CO measurements. Trial registration Clinicaltrials.gov; http://www.clinicaltrials.gov; registration number NCT02912624

A Systematic Review of Anticoagulation Strategies for Patients With Atrial Fibrillation in Critical Care.

2021 ◽  
Author(s):  
Alexandra Jayne Nelson ◽  
Brian W Johnston ◽  
Alicia Achiaa Charlotte Waite ◽  
Gedeon Lemma ◽  
Ingeborg Dorothea Welters
Keyword(s):  
Atrial Fibrillation ◽  
Critical Care ◽  
Critically Ill ◽  
Major Bleeding ◽  
Critically Ill Patients ◽  
Thromboembolic Events ◽  
Bleeding Events ◽  
Major Bleeding Events ◽  
The Impact ◽  
Anticoagulated Patients

Background. Atrial fibrillation (AF) is the most common cardiac arrhythmia in critically ill patients. There is a paucity of data assessing the impact of anticoagulation strategies on clinical outcomes for general critical care patients with AF. Our aim was to assess the existing literature to evaluate the effectiveness of anticoagulation strategies used in critical care for AF. Methodology. A systematic literature search was conducted using MEDLINE, EMBASE, CENTRAL and PubMed databases. Studies reporting anticoagulation strategies for AF in adults admitted to a general critical care setting were assessed for inclusion. Results. Four studies were selected for data extraction. A total of 44087 patients were identified with AF, of which 17.8-49.4% received anticoagulation. The reported incidence of thromboembolic events was 0-1.4% for anticoagulated patients, and 0-1.3% in non-anticoagulated patients. Major bleeding events were reported in three studies and occurred in 7.2-8.6% of the anticoagulated patients and up to 7.1% of the non-anticoagulated patients. Conclusions. There was an increased incidence of major bleeding events in anticoagulated patients with AF in critical care compared to non-anticoagulated patients. There was no significant difference in the incidence of reported thromboembolic events within studies, between patients who did and did not receive anticoagulation. However, the outcomes reported within studies were not standardised, therefore, the generalisability of our results to the general critical care population remains unclear. Further data is required to facilitate an evidence-based assessment of the risks and benefits of anticoagulation for critically ill patients with AF.

Abstract 15293: Noninvasive Echocardiographic Cardiac Power Output Predicts Mortality in Cardiac Intensive Care Unit Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Barry Burstein ◽  
Vidhu Anand ◽  
Bradley Ternus ◽  
Meir Tabi ◽  
Nandan S Anavekar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Power Output ◽  
Critically Ill Patients ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Power ◽  
The Mean ◽  
Cardiac Intensive Care

Introduction: A low cardiac power output (CPO), measured invasively, identifies critically ill patients at increased risk of mortality. CPO can also be measured non-invasively with transthoracic echocardiography (TTE), although prognostic data in critically ill patients is not available. Hypothesis: Reduced CPO measured by TTE is associated with increased hospital mortality in cardiac intensive care unit (CICU) patients. Methods: Using a database of CICU patients admitted between 2007 and 2018, we identified patients with TTE within one day (before or after) of CICU admission who had data necessary for calculation of CPO. Multivariable logistic regression determined the relationship between CPO and adjusted hospital mortality. Results: We included 5,585 patients with a mean age of 68.3±14.8 years, including 36.7% females. Admission diagnoses included acute coronary syndrome (ACS) in 57%, heart failure (HF) in 50%, cardiac arrest (CA) in 12%, and cardiogenic shock (CS) in 13%. The mean left ventricular ejection fraction (LVEF) was 47±16%, and the mean CPO was 1.0±0.4 W. CPO was inversely associated with the risk of hospital mortality (Figure A), including among patients with ACS, HF, and CS (Figure B). On multivariable analysis, lower CPO was associated with higher hospital mortality (OR 0.96 per 0.1 W, 95% CI 0.0.93-0.99, p=0.03). Hospital mortality was highest in patients with low CPO coupled with reduced LVEF, increased vasopressor requirements, or higher admission lactate. Hospital mortality was higher among patients with a CPO <0.6 W (adjusted OR 1.57, 95% CI 1.13-2.19, p = 0.007), particularly in the presence of admission lactate level >4 mmol/L (50.9%). Conclusions: Echocardiographic CPO was inversely associated with hospital mortality in CICU patients, particularly among patients with increased lactate and vasopressor requirements. Routine measurement of CPO provides important information beyond LVEF and should be considered in CICU patients.

Efficacy of Epidural Analgesia for Pain Management of Critically Ill Patients and the Implications for Nursing Care

1991 ◽  
Vol 2 (4) ◽  
pp. 729-740 ◽  
Author(s):  
Jeanne F. Slack ◽  
Margaret Faut-Callahan
Keyword(s):  
Critical Care ◽  
Pain Relief ◽  
Epidural Analgesia ◽  
Critically Ill ◽  
Nursing Care ◽  
Critically Ill Patients ◽  
Continuous Epidural Analgesia ◽  
Analgesic Agents ◽  
Care Problems ◽  
Critical Care Patients

Management of pain for critically ill patients has been shown to be inadequately controlled and can have serious deleterious effects on a patient’s recovery. Continuous epidural analgesia can be used to control pain in critical care patients. This mode of analgesia administration provides pain relief without the delays inherent in the as-needed administration of analgesics. Fifteen critical care unit patients were part of a multidisciplinary, prospective, randomized, double-blind study of various epidural analgesic agents in 43 thoracic and 66 abdominal surgery patients. The purpose of the study was to identify the benefits and problems associated with continuous epidural analgesia administration and the implications for the nursing care of critically ill patients. Evaluation of the effectiveness of the analgesia was based on the following measures: 1) pain measured at regular intervals in the 72-hour period with a visual analog; 2) pain as measured after 72 hours with the word descriptor section of the McGill pain questionnaire; 3) amount of supplemental systemic narcotic analgesic needed; 4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; 5) occurrence of adverse effects, and 6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used as-needed systemic administration of narcotics. Although some nursing care problems were identified, continuous epidural analgesia can be used for pain relief in critical care patients, if the analgesia is administered by accurate reliable infusion systems and carefully monitored by nursing staff who are knowledgeable about the pharmacologic considerations of epidural analgesic agents and the management of patient care

scholarly journals Iatrogenic forearm compartment syndrome

2016 ◽  
Vol 18 (1) ◽  
pp. 63-65
Author(s):  
Ahmed Elmorsy ◽  
James Nutt ◽  
Nick Taylor ◽  
Justin Kirk-Bayley ◽  
Sean Hughes
Keyword(s):  
Critical Care ◽  
Compartment Syndrome ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Sampling ◽  
Forearm Compartment Syndrome ◽  
Arterial Damage

Limb compartment syndrome may be sequelae of trauma, but in the context of critical care blood sampling, arterial damage may have profound consequences. We describe a series of three cases and their progress and discuss guidelines for prevention of this potentially devastating occurrence in critically ill patients.

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