Critical Care Medicine最新文献

Objectives: Delays in emergency medical care (EMC) can increase sepsis mortality. Sepsis symptoms, however, are less known in the public compared with signs of stroke and myocardial infarction. Using case vignettes, we investigated the decision to seek EMC in sepsis-related compared with other emergencies.

Design: Cross-sectional survey.

Settings and subjects: A representative nationwide survey was conducted in December 2023 among 1013 persons in Germany.

Interventions: None.

Measurements and main results: A standardized questionnaire was administered via face-to-face interviews to assess perceived urgency, the tendency to seek EMC, sepsis knowledge, and barriers to EMC utilization. Multiple regression analyses were conducted to identify predictors for the perceived urgency and the tendency to seek EMC. Across ten case vignettes, the perceived urgency was lower for sepsis-related (mean = 3.93, sd = 0.64) than for nonsepsis-related emergencies (mean=4.15, sd = 0.67). In sepsis-related vignettes, the immediate EMC option ("Call emergency medical services or go to the emergency department [ED] immediately") was chosen by 18.3-43.2% of respondents, compared with 20.1-71.9% in nonsepsis-related vignettes. Even when situations were rated as very urgent, EMC use was less likely for sepsis-related emergencies (35%) than for nonsepsis-related emergencies (17%). In regression analyses, sepsis knowledge was the only predictor of perceived urgency, and perceived urgency was the strongest predictor of EMC use. The likelihood of EMC use in sepsis-related emergencies was 14.9 percentage points lower ( p < 0.01) than in nonsepsis-related emergencies; "long waiting times in the ED" was the only significant barrier for EMC use.

Conclusions: Compared with nonsepsis emergencies, sepsis-related emergencies are perceived as less urgent and less often lead to EMC use, even if the level of perceived urgency is the same. As the perceived urgency is associated with sepsis knowledge, this underlines the need to increase efforts to improve sepsis knowledge and the awareness that sepsis requires timely emergency care in the general public.

Objective: To determine the characteristics and effectiveness of nurse-led family communication interventions in the ICU.

Data sources: PubMed, Web of Science, PsychInfo, CINAHL, Embase, Cochrane Library, and relevant article citations from January 1995 to July 2025.

Study selection: We included randomized controlled trials (RCTs) and quasi-experimental studies evaluating nurse-led family communication interventions in adult ICUs.

Data extraction: Two independent reviewers assessed evidence levels and risk of bias using the Cochrane tool and the Joanna Briggs Institute's Critical Appraisal Tools. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews guidelines, and interventions were summarized with the Template for Intervention Description and Replication Checklist.

Data synthesis: Seven RCTs and seven quasi-experimental studies were included. The most common nurse-family communication model was an in-person, structured, and dynamically tailored intervention during the patient's ICU stay. Nurses played five core roles: information delivery and clarification, emotional support, family assessment, family meeting facilitation, and transitional support. Bedside ICU nurses led information delivery and multidimensional family assessments. Internal research nurses handled information clarification, structured needs assessment, and family meeting coordination. External research nurses focused on family meeting support, structured emotional support, and transitional care. Although the interventions may improve communication quality (standardized mean differences [SMD] = 0.26) and reduce hospital length of stay (LOS) (mean differences [MD] = -3.87 d), they appear to have limited effects on psychologic distress, satisfaction, ICU LOS, or mortality; they may also increase family meeting frequency/duration and lower overall costs.

Conclusions: The conclusions of our systematic review are limited by considerable heterogeneity in intervention intensity, implementer profiles, and adaptation descriptions. Future interventions should define optimal dosage and outline best practices for evidence-based intervention tailoring and implementation. Healthcare institutions should integrate specialized nursing roles, such as training bedside nurses or establishing dedicated communication facilitators. This approach may leverage nurses' expertise to enhance communication quality and improve outcomes.

Objectives: To evaluate the compatibility of the Society of Critical Care Medicine's (SCCM) Critical Care Data Dictionary (C2D2) with the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) and initiate a set of steps extending OMOP to accommodate specialized critical care data elements.

Design: Systematic analysis and mapping study using a three-tiered semantic matching approach to demonstrate technical feasibility and identify fundamental challenges in critical care data standardization.

Setting: Critical care medicine informatics research environment.

Subjects: The SCCM's C2D2 elements.

Interventions: None.

Measurements and main results: We evaluated the compatibility of C2D2 clinical variables with the OMOP CDM using a three-tier classification system (full match, partial match, and no match). Our analysis of 226 C2D2 elements revealed that 49.6% of concepts had full OMOP equivalents, 46.4% required modification, and 4.0% had no suitable mapping. Key incompatibilities were identified in ventilator parameters, composite scoring systems, and advanced organ support documentation. A large language model-based semantic matching system yielded a precision of 59.5%, recall of 87.0%, and F1 score of 70.7% at an optimized similarity threshold of 0.90. These findings highlight the need to harmonize data standardization approaches within the field of critical care, including how to handle concept stacking within single variables, age-specific criteria, and specialized constructs that were curated through the SCCM Delphi process, but reveal an OMOP mapping incompatibility or missing variables.

Conclusions: Extending the OMOP CDM for critical care is technically feasible and requires targeted modifications to accommodate composite scores, temporal precision, and specialized critical care concepts as well as the resources needed to support this build. The community acutely faces crucial decisions about whether to pursue OMOP integration, adapt the C2D2 for version 2.0 compatibility, work toward OMOP vocabulary inclusion through Observational Health Data Sciences and Informatics processes, or collaborate with electronic health record vendors for native critical care standards support. These decisions require balancing technical feasibility with long-term sustainability and maintenance considerations.