Goals of Care and End of Life in the ICU
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A Protocol for a Scoping Review of Tools Used to Improve Care Delivery
Standardising Care in the ICU: A Protocol for a Scoping Review of Tools used to Improve Care Delivery laura Allum ( [email protected] ) Guy's and Saint Thomas' NHS Foundation Trust https://orcid.org/0000-0002-8083-419X Chloe Apps Guy's and Saint Thomas' NHS Foundation Trust Nicholas Hart Guy's and Saint Thomas' NHS Foundation Trust Natalie Pattison University of Hertfordshire Bronwen Connolly Queen's University Belfast Faculty of Medicine Health and Life Sciences Louise Rose King's College London Protocol Keywords: Critical care, Patient care planning, Checklist, Delivery of Healthcare, Prolonged critical illness Posted Date: December 4th, 2019 DOI: https://doi.org/10.21203/rs.2.18217/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Version of Record: A version of this preprint was published on July 19th, 2020. See the published version at https://doi.org/10.1186/s13643-020-01414-6. Page 1/11 Abstract Background: Increasing numbers of critically ill patients experience a prolonged intensive care unit stay contributing to greater physical and psychological morbidity, strain on families, and cost to health systems. Healthcare providers report dissatisfaction with provision of care for these longer stay patients due to competing demands from higher acuity patients. Quality improvement tools such as checklists concisely articulate best practices with the aim of improving quality and safety. However, these tools have not been designed for the specic needs of patients with prolonged ICU stay. The objective of this review is to generate data to inform development and implementation of quality improvement tools for patients with prolonged ICU stay, namely: the content, design and effect of multicomponent tools designed to standardise or improve ICU care. -
Intensive Care Medicine in 10 Years
BOOKS,FILMS,TAPES &SOFTWARE are difficult to read, the editing is inconsis- tory for critical care medicine. The book is initiate a planning process for leaders who tent, and the content that was omitted indi- divided into sections entitled “Setting the recognize the imperative for change and ad- cates that “efforts to bring this work from Stage,” “Diagnostic, Therapeutic, and In- aptation in critical care. Accordingly, I rec- conception to fruition in less than one year” formation Technologies 10 Years From ommend this book to individuals and groups (as stated in the book’s acknowledgments Now,” “How Might Critical Care Medicine engaged in all aspects of critical care man- section) prevented this book from being a Be Organized and Regulated?” “Training,” agement, now and in the future. “gold standard” text. and “The Critical Care Agenda.” Each sec- J Christopher Farmer MD tion consists of a series of essays/chapters Marie E Steiner MD MSc Department of Medicine that discuss various aspects of the topic, and Department of Pediatrics Mayo Clinic all the sections have solid scientific support Divisions of Pulmonary/ Rochester, Minnesota and bibliographies. The individual topics Critical Care and Hematology/ span the entire range of critical-care clinical Oncology/Blood and Marrow The author reports no conflict of interest related practice, administration, quality and safety, Transplantation to the content of this book review. and so forth. The contributors are acknowl- University Children’s Hospital, Fairview edged senior clinical and scientific leaders University of Minnesota Mechanical Ventilation: Physiological in critical care medicine from around the Minneapolis, Minnesota and Clinical Applications, 4th edition. -
Basic Life Support + First Aid for Healthcare Providers 2020 Course Introduction
Basic Life Support + First Aid for Healthcare Providers 2020 Course Introduction SECTION 1: Foundational concepts of BCLS SECTION 2: Response to an adult in cardiac arrest SECTION 3: Basic Life Support for infants and children SECTION 4: Automated external defibrillation in infants and children SECTION 5: Preventing cardiac arrest SECTION 6: First aid for adults SECTION 7: First aid for children Activity Summary • Activity Title: Basic Life Support (BLS) & First Aid (Cardiopulmonary Resuscitation (CPR), Automated External Defibrillator (AED), and First Aid) • Release date: 2021-06-01 • Expiration date: 2024-06-01 • Estimated time to complete activity: 8 hours • This course is accessible with any web browser. We recommend recent versions of • Google Chrome, Internet Explorer 9 and later, or Apple iPad. • This course is jointly provided by Pacific Medical Training and Postgraduate Institute for Medicine (PIM). You may reach PIM at [email protected]. Target Audience This activity has been designed to meet the educational needs of physicians, physician assistants, nurse practitioners, registered nurses, pharmacists and dentists involved in the care of patients who require advanced life support. 3103 Philmont Ave, Suite 308 • Huntingdon Valley, PA 19006 • 800-417-1748 page 1 Educational Objectives After completing this activity, the participant should be better able to: • Explain the change in emphasis from airway and ventilation to compressions and perfusion. • Select the correct order of interventions for the victim of cardiopulmonary arrest. • List the steps required to safely operate an AED. • Differentiate between adult and pediatric guidelines for CPR. • Explain how to apply the various first aid interventions. • Describe how to apply the various pediatric first aid interventions. -
Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality 1
Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality 1 Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality Web-based Integrated 2010 & 2015 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Key Words: cardiac arrest cardiopulmonary resuscitation defibrillation emergency 1 Highlights & Introduction 1.1 Highlights: Lay Rescuer CPR Summary of Key Issues and Major Changes Key issues and major changes in the 2015 Guidelines Update recommendations for adult CPR by lay rescuers include the following: The crucial links in the out-of-hospital adult Chain of Survival are unchanged from 2010, with continued emphasis on the simplified universal Adult Basic Life Support (BLS) Algorithm. The Adult BLS Algorithm has been modified to reflect the fact that rescuers can activate an emergency response (ie, through use of a mobile telephone) without leaving the victim’s side. It is recommended that communities with people at risk for cardiac arrest implement PAD programs. Recommendations have been strengthened to encourage immediate recognition of unresponsiveness, activation of the emergency response system, and initiation of CPR if the lay rescuer finds an unresponsive victim is not breathing or not breathing normally (eg, gasping). Emphasis has been increased about the rapid identification of potential cardiac arrest by dispatchers, with immediate provision of CPR instructions to the caller (ie, dispatch-guided CPR). The recommended sequence for a single rescuer has been confirmed: the single rescuer is to initiate chest compressions before giving rescue breaths (C-A-B rather than A-B-C) to reduce delay to first compression. The single rescuer should begin CPR with 30 chest compressions followed by 2 breaths. -
Chronic Critical Illness: the Price of Survival
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Archivio istituzionale della ricerca - Università di Modena e Reggio Emilia DOI: 10.1111/eci.12547 REVIEW Chronic critical illness: the price of survival Alessandro Marchioni, Riccardo Fantini, Federico Antenora, Enrico Clini and Leonardo Fabbri Respiratory Disease Clinic Department of Oncology, Haematology and Respiratory Disease, University of Modena and Reggio Emilia, Modena, Italy ABSTRACT Background The evolution of the techniques used in the intensive care setting over the past decades has led on one side to better survival rates in patients with acute conditions and severely impaired vital functions. On the other side, it has resulted in a growing number of patients who survive an acute event, but who then become dependent on one or more life support techniques. Such patients are called chronically critically ill patients. Materials & Methods No absolute definition of the disease is currently available, although most patients are characterized by the need for prolonged mechanical ventilation. Mortality rates are still high even after dismissal from intensive care unit (ICU) and transfer to specialized rehabilitation care settings. Results In recent years, some studies have tried to clarify the pathophysiological characteristics underlying chronic critical illness (CCI), a disease that is also characterized by severe endocrine and inflammatory impair- ments, partly accounting for the almost constant set of symptoms. Discussion Currently, no specific treatment is available. However, a strategic early therapeutic approach on ICU admission might try to prevent the progress of the acute disease towards chronic critical illness. Keywords chronic critical illness, mechanical ventilation, systemic inflammation, wasting syndrome. -
The Relationships Among Emotion Regulation, Role Stress, And
THE RELATIONSHIPS AMONG EMOTION REGULATION, ROLE STRESS, AND PSYCHOLOGICAL DISTRESS IN SURROGATE DECISION MAKERS OF THE CHRONICALLY CRITICALLY ILL PATIENTS by MARY NJALIAN VARIATH Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Frances Payne Bolton School of Nursing CASE WESTERN RESERVE UNIVERSITY May, 2019 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the thesis/dissertation of Mary Njalian Variath candidate for the degree of Doctor in Philosophy*. Committee Chair Ronald L. Hickman, Jr. PhD, RN, ACNP-BC, FNAP, FAAN Committee Member Jaclene A. Zauszniewski, PhD, RN-BC, FAAN Committee Member Mathew Plow, PhD Committee Member Arin Connell, PhD Date of Defense March 21, 2019 *We also certify that written approval has been obtained for any proprietary material contained therein. ii Dedication This dissertation is dedicated to my family. Behind this accomplishment stand the two strong pillars of my life, Variath Njalian (late) and Thressiamma Njalian, my parents. They taught me many important life lessons, instilled the values of hard work and sacrifice, showered unconditional love, and shared their passionate desire for education; all of which inspired me to accomplish this milestone. To Anice Sebastian, Lissy Jose, and Varghese Njalian, my siblings, whose encouragement, love, and support boosted my wavering confidence during this prolonged endeavor. And to my husband, whose love, constant support, and encouragement helped me to get through the obstacles of this journey. -
Developed by the Patient and Family Support Committee of the Society Of
'HYHORSHGE\WKH3DWLHQWDQG )DPLO\6XSSRUW&RPPLWWHHRIWKH 6RFLHW\RI&ULWLFDO&DUH0HGLFLQH +HDGTXDUWHUV 0LGZD\'ULYH 0RXQW3URVSHFW,/ ZZZVFFPRUJ , V V X H V $QVZHUV Chronic Critical Illness in Adults Requiring Prolonged Mechanical Ventilation :**4 Who Is This Brochure For? If an adult member of your family has been in the intensive care unit (ICU) on a breathing machine (mechanical ventilator or respirator) for many days, this brochure about chronic critical illness is for you. We hope that the brochure will help you understand chronic critical illness and feel more informed when you talk with the doctors and nurses about important decisions for your family member. What Is Chronic Critical Illness? Most patients who need care in the ICU get better quickly. After a few days in the ICU, they no longer need a breathing machine or other critical care treatments. But even with the best ICU care, some patients remain critically ill and have trouble breathing on their own, without a machine, for a much longer time. These patients have chronic critical illness. What Causes Chronic Critical Illness? We do not know why some ICU patients get better quickly, whereas others remain critically ill and need a breathing machine for a long time. But we are learning how to take better care of patients with chronic critical illness and their families. We are also learning more about what to expect from treatments that exist today. How Do Doctors and Nurses Know a Person Has Chronic Critical Illness? There is no test to diagnose chronic critical illness. Doctors and nurses know that adult patients have chronic critical illness when they still need a breathing machine even after weeks in the ICU. -
Understanding Your ICU Stay
ii Understanding Your ICU Stay Copyright 2017 Society of Critical Care Medicine, exclusive of any U.S. Government material. All rights reserved. No part of this book may be reproduced in any manner or media, including but not limited to print or electronic format, without prior written permission of the copyright holder. The views expressed herein are those of the authors and do not necessarily reflect the views of the Society of Critical Care Medicine. Use of trade names or names of commercial sources is for information only and does not imply endorsement by the Society of Critical Care Medicine. This publication is intended to provide accurate information regarding the subject matter addressed herein. However, it is published with the understanding that the Society of Critical Care Medicine is not engaged in the rendering of medical, legal, financial, accounting, or other professional service and THE SOCIETY OF CRITICAL CARE MEDICINE HEREBY DISCLAIMS ANY AND ALL LIABILITY TO ALL THIRD PARTIES ARISING OUT OF OR RELATED TO THE CONTENT OF THIS PUBLICATION. The information in this publication is subject to change at any time without notice and should not be relied upon as a substitute for professional advice from an experienced, competent practitioner in the relevant field. NEITHER THE SOCIETY OF CRITICAL CARE MEDICINE, NOR THE AUTHORS OF THE PUBLICATION, MAKE ANY GUARANTEES OR WARRANTIES CONCERNING THE INFORMATION CONTAINED HEREIN AND NO PERSON OR ENTITY IS ENTITLED TO RELY ON ANY STATEMENTS OR INFORMATION CONTAINED HEREIN. If expert assistance is required, please seek the services of an experienced, competent professional in the relevant field. -
Preparing Your ICU for Disaster Response
PREPARING YOUR ICU FOR DISASTER RESPONSE J. Christopher Farmer, MD, FCCM, Editor Randy S. Wax, MD, FCCM, Editor Marie R. Baldisseri, MD, FCCM, Editor ix CONTENTS FOREWORD xi CHAPTER ONE What Matters? The Role of an ICU During Disaster 1 D. E. Amundson, MS, DO, FCCM; Mary J. Reed, MD, FCCM TWO Assessing Your ICU: Are You Ready to Respond to Disaster? 9 John S. Parrish, MD; Jeffry L. Kashuk, MD THREE Leadership During a Disaster 23 Asha Devereaux, MD, MPH; Jeffrey R. Dichter, MD FOUR Building an ICU Response Plan for Disasters 49 Christian Sandrock, MD, MPH, FCCP FIVE Implementing an Effective ICU Disaster Response Plan 67 Vincent M. Nicolais, MD, Macp, FCCM; Elizabeth Bridges, PhD, RN, CCNS, FAAN, FCCM SIX Communication During Disaster 79 James A. Geiling, MD, FCCM SEVEN How to Build ICU Surge Capacity 93 Lisa Burry, PharmD; Dauryne L. Shaffer, MSN EIGHT Ethical Decision Making in Disasters: Key Ethical Principles 107 and the Role of the Ethics Committee Dan R. Thompson, MD, MA, Facp, FCCM NINE Behavioral Health Issues 117 Merritt Schreiber, PhD; Sandra Stark Shields, LMFT, ATR-BC, CTS; Dan Hanfling, MD TEN Pediatric Considerations: What Is Needed in My ICU to 127 Care for These Casualties? Dana A. Braner, MD, FCCM; JoDee M. Anderson, MD, MEd APPENDIX ONE Disaster Education and Training Resources 141 Abhijit Duggal, MD, MPH, Facp; Jonathan Simmons, DO, MS; Pablo A. Perez D’Empaire, MD TWO Additional Resources and Websites 151 Brittany A. Williams, MS, Bsrt, NREMT-P x THREE Clinical Strategies During Disaster Response 155 John L. Hick, MD FOUR Developing an ICU Supply and Other Templates for 173 Disaster Response Lisa Burry, PharmD; Jana A. -
Recommendations for End-Of-Life Care in the Intensive Care Unit: a Consensus Statement by the American College of Critical Care Medicine
Special Articles Recommendations for end-of-life care in the intensive care unit: A consensus statement by the American College of Critical Care Medicine Robert D. Truog, MD, MA; Margaret L. Campbell, PhD, RN, FAAN; J. Randall Curtis, MD, MPH; Curtis E. Haas, PharmD, FCCP; John M. Luce, MD; Gordon D. Rubenfeld, MD, MSc; Cynda Hylton Rushton, PhD, RN, FAAN; David C. Kaufman, MD Background: These recommendations have been developed to to die, and between consequences that are intended vs. those that improve the care of intensive care unit (ICU) patients during the are merely foreseen (the doctrine of double effect). Improved dying process. The recommendations build on those published in communication with the family has been shown to improve pa- 2003 and highlight recent developments in the field from a U.S. tient care and family outcomes. Other knowledge unique to end- perspective. They do not use an evidence grading system because of-life care includes principles for notifying families of a patient’s most of the recommendations are based on ethical and legal death and compassionate approaches to discussing options for principles that are not derived from empirically based evidence. organ donation. End-of-life care continues even after the death of Principal Findings: Family-centered care, which emphasizes the patient, and ICUs should consider developing comprehensive the importance of the social structure within which patients are bereavement programs to support both families and the needs of embedded, has emerged as a comprehensive ideal for managing the clinical staff. Finally, a comprehensive agenda for improving end-of-life care in the ICU. -
Tracheal Intubation Intubação Traqueal
0021-7557/07/83-02-Suppl/S83 Jornal de Pediatria Copyright © 2007 by Sociedade Brasileira de Pediatria ARTIGO DE REVISÃO Tracheal intubation Intubação traqueal Toshio Matsumoto1, Werther Brunow de Carvalho2 Resumo Abstract Objetivo: Revisar os conceitos atuais relacionados ao procedimento Objective: To review current concepts related to the procedure of de intubação traqueal na criança. tracheal intubation in children. Fontes dos dados: Seleção dos principais artigos nas bases de Sources: Relevant articles published from 1968 to 2006 were dados MEDLINE, LILACS e SciELO, utilizando as palavras-chave selected from the MEDLINE, LILACS and SciELO databases, using the intubation, tracheal intubation, child, rapid sequence intubation, keywords intubation, tracheal intubation, child, rapid sequence pediatric airway, durante o período de 1968 a 2006. intubation and pediatric airway. Síntese dos dados: O manuseio da via aérea na criança está Summary of the findings: Airway management in children is relacionado à sua fisiologia e anatomia, além de fatores específicos related to their physiology and anatomy, in addition to specific factors (condições patológicas inerentes, como malformações e condições (inherent pathological conditions, such as malformations or acquired adquiridas) que influenciam decisivamente no seu sucesso. As principais conditions) which have a decisive influence on success. Principal indicações são manter permeável a aérea e controlar a ventilação. A indications are in order to maintain the airway patent and to control laringoscopia e intubação traqueal determinam alterações ventilation. Laryngoscopy and tracheal intubation cause cardiovascular cardiovasculares e reatividade de vias aéreas. O uso de tubos com alterations and affect airway reactivity. The use of tubes with cuffs is not balonete não é proibitivo, desde que respeitado o tamanho adequado prohibited, as long as the correct size for the child is chosen. -
Improving Outcomes for Patients with Sepsis. a Cross-System Action Plan
Improving outcomes for patients with sepsis A cross-system action plan OFFICIAL NHS England INFORMATION READER BOX Directorate Medical Commissioning Operations Patients and Information Nursing Trans. & Corp. Ops. Commissioning Strategy Finance Publications Gateway Reference: 04457 Document Purpose Report Document Name Improving outcomes for patients with sepsis Author NHS England Publication Date December 2015 Target Audience CCG Clinical Leaders, Care Trust CEs, Foundation Trust CEs , Medical Directors, Directors of PH, Directors of Nursing, Directors of Adult SSs, NHS Trust Board Chairs, Allied Health Professionals, GPs, Emergency Care Leads, Directors of Children's Services, NHS Trust CEs Additional Circulation #VALUE! List Description This document contains a summary of the key actions that health and care organisations across the country will take to improve identification and treatment of sepsis. Cross Reference N/A Superseded Docs N/A (if applicable) Action Required To take note of the guidance contained in the document and use as appropriate to review and make improvements to services. Timing / Deadlines N/A (if applicable) Contact Details for Domain 1 further information NHS England Quality Strategy Medical Directorate 6th Floor Skipton House https://www.england.nhs.uk/ourwork/part-rel/sepsis/ Document Status This is a controlled document. Whilst this document may be printed, the electronic version posted on the intranet is the controlled copy. Any printed copies of this document are not controlled. As a controlled document, this document should not be saved onto local or network drives but should always be accessed from the intranet. 2 OFFICIAL Improving outcomes for patients with sepsis A cross-system action plan Version number: 1 First published: 23 December 2015 Prepared by: Elizabeth Stephenson Classification: OFFICIAL The National Health Service Commissioning Board was established on 1 October 2012 as an executive non-departmental public body.