Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3983
E. Smith, L. Nici
Rationale -For the aging and comorbid veteran population, COVID-19 has made “ventilator” a household word. With the excessive cost and low quality of life associated with aggressive end of life (EOL) care, the need for effective goals of care (GOC) conversations prior to development of acute illness has never been higher. Physicians are often reluctant to initiate these conversations, but patients could be prompted to broach the topic using standardized media delivered in the waiting room. Methods -We conducted a randomized controlled trial evaluating educational media in the outpatient setting. Veterans in the waiting room who were over 65 were randomized to one of two interventions or control. The interventions were a VHA produced brochure on GOC or a 7-minute video on GOC featuring a mock code. Participants were given a survey, and had a follow up phone interview to assess if they had brought up EOL care at their office visit. At 30 days, chart review assessed documentation of GOC. Primary endpoint was whether the patient initiated an EOL discussion at their office visit. Secondary endpoints included code status, GOC documentation, and evaluation of emotional response. Results -Despite hundreds of eligible patients, <10% opted to discuss enrollment, and <5% enrolled in this study. Needed sample size was 153, with only 30 enrolled at study conclusion. There was low rates of all endpoints. Only one participant initiated EOL discussions, but this discussion was not documented. Three filed new GOC documents (including one who died while CMO). Two found the material upsetting (including one in the control). None indicated that they would not trust their physician to make EOL decisions for them, though several were unsure. All participants thought that their material should be shown to other veterans. Due to underpowering, there was no statistical difference in any outcome (Table 1). Conclusion -EOL discussions remain an important job of the outpatient physician, though many patients do not discuss EOL care until they are acutely ill. A standardized patient centered format delivered in the clinic waiting room remains a promising option to facilitate these discussions, though there are still physician level barriers in documenting these conversations. Larger studies are required to demonstrate that this type of intervention is effective. Our study shows that patients have low rates of negative emotional responses to this type of material, and would universally recommend this material to other veterans.
{"title":"Patient Initiation of End-of-Life Discussions, a Randomized Control Trial","authors":"E. Smith, L. Nici","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3983","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3983","url":null,"abstract":"Rationale -For the aging and comorbid veteran population, COVID-19 has made “ventilator” a household word. With the excessive cost and low quality of life associated with aggressive end of life (EOL) care, the need for effective goals of care (GOC) conversations prior to development of acute illness has never been higher. Physicians are often reluctant to initiate these conversations, but patients could be prompted to broach the topic using standardized media delivered in the waiting room. Methods -We conducted a randomized controlled trial evaluating educational media in the outpatient setting. Veterans in the waiting room who were over 65 were randomized to one of two interventions or control. The interventions were a VHA produced brochure on GOC or a 7-minute video on GOC featuring a mock code. Participants were given a survey, and had a follow up phone interview to assess if they had brought up EOL care at their office visit. At 30 days, chart review assessed documentation of GOC. Primary endpoint was whether the patient initiated an EOL discussion at their office visit. Secondary endpoints included code status, GOC documentation, and evaluation of emotional response. Results -Despite hundreds of eligible patients, <10% opted to discuss enrollment, and <5% enrolled in this study. Needed sample size was 153, with only 30 enrolled at study conclusion. There was low rates of all endpoints. Only one participant initiated EOL discussions, but this discussion was not documented. Three filed new GOC documents (including one who died while CMO). Two found the material upsetting (including one in the control). None indicated that they would not trust their physician to make EOL decisions for them, though several were unsure. All participants thought that their material should be shown to other veterans. Due to underpowering, there was no statistical difference in any outcome (Table 1). Conclusion -EOL discussions remain an important job of the outpatient physician, though many patients do not discuss EOL care until they are acutely ill. A standardized patient centered format delivered in the clinic waiting room remains a promising option to facilitate these discussions, though there are still physician level barriers in documenting these conversations. Larger studies are required to demonstrate that this type of intervention is effective. Our study shows that patients have low rates of negative emotional responses to this type of material, and would universally recommend this material to other veterans.","PeriodicalId":369155,"journal":{"name":"C35. TOPICS IN CRITICAL CARE AND RESPIRATORY FAILURE","volume":"108 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115657164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3986
A. Qazi, M. Ambreen, R. Pizzuti, F. Buchanan, A. Gershon, L. Rose, R. Amin
{"title":"\"Lo and Behold, a Pandemic, Right?\" A Virtual Care and Remote Monitoring Program for Individuals Using Long-Term Home Mechanical Ventilation - Healthcare Providers' Respond","authors":"A. Qazi, M. Ambreen, R. Pizzuti, F. Buchanan, A. Gershon, L. Rose, R. Amin","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3986","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3986","url":null,"abstract":"","PeriodicalId":369155,"journal":{"name":"C35. TOPICS IN CRITICAL CARE AND RESPIRATORY FAILURE","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125393173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3981
H. Al-Jahdali, A. Al-Harbi, M. Al-Gamedi, A. Almuttari, S.M. Alyami, A. Khan, H. Al Hayyan
{"title":"The Most Common Pulmonary Diseases and Characteristics of Patients Frequently Admitted to Pulmonary Service","authors":"H. Al-Jahdali, A. Al-Harbi, M. Al-Gamedi, A. Almuttari, S.M. Alyami, A. Khan, H. Al Hayyan","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3981","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3981","url":null,"abstract":"","PeriodicalId":369155,"journal":{"name":"C35. TOPICS IN CRITICAL CARE AND RESPIRATORY FAILURE","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133753489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3979
S. Guleria, F. Adams, E. Kapania, A. Trivedi
{"title":"A Summarized Literature Tool to Improve Implementation of Evidence-Based Medicine in the Medical Intensive Care Unit","authors":"S. Guleria, F. Adams, E. Kapania, A. Trivedi","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3979","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3979","url":null,"abstract":"","PeriodicalId":369155,"journal":{"name":"C35. TOPICS IN CRITICAL CARE AND RESPIRATORY FAILURE","volume":"83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123929020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3985
A. Qazi, M. Ambreen, R. Pizzuti, F. Buchanan, A. Gershon, L. Rose, R. Amin
{"title":"\"Lo and Behold, a Pandemic, Right?\" A Virtual Care and Remote Monitoring Program for Individuals Using Long-Term Home Mechanical Ventilation - Patients' Respond","authors":"A. Qazi, M. Ambreen, R. Pizzuti, F. Buchanan, A. Gershon, L. Rose, R. Amin","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3985","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3985","url":null,"abstract":"","PeriodicalId":369155,"journal":{"name":"C35. TOPICS IN CRITICAL CARE AND RESPIRATORY FAILURE","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125676471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3978
P. Tiberio, J. Kennedy, J. Holton, N. Prendergast, C. Onyemekwu, K. Potter, P. Roy, B. McVerry, T. Girard
{"title":"Specificity and Sensitivity of ICD Codes for Alcohol and Substance Use in ICU Patients","authors":"P. Tiberio, J. Kennedy, J. Holton, N. Prendergast, C. Onyemekwu, K. Potter, P. Roy, B. McVerry, T. Girard","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3978","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3978","url":null,"abstract":"","PeriodicalId":369155,"journal":{"name":"C35. TOPICS IN CRITICAL CARE AND RESPIRATORY FAILURE","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134131272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3977
S. Singh, M. Nurek, S. Mason, M. Vizcaychipi
{"title":"WHY STOP: A Behavioural Approach to Study the Factors Influencing Antibiotic Stop Decisions in ICU. The Impact of Point of Care Tests (POCT) on Decision Making","authors":"S. Singh, M. Nurek, S. Mason, M. Vizcaychipi","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3977","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3977","url":null,"abstract":"","PeriodicalId":369155,"journal":{"name":"C35. TOPICS IN CRITICAL CARE AND RESPIRATORY FAILURE","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131393412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3980
J. Howe, J. McSparron, D. Claar, T. Valley, M. Sjoding
{"title":"Acute Respiratory Failure: Prevalence and Correlates of Diagnostic Error","authors":"J. Howe, J. McSparron, D. Claar, T. Valley, M. Sjoding","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3980","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3980","url":null,"abstract":"","PeriodicalId":369155,"journal":{"name":"C35. TOPICS IN CRITICAL CARE AND RESPIRATORY FAILURE","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126988154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3982
S. Tuthill, H. Freeman, S. Nonas, M. Drake, K. Vranas
Rationale: High flow nasal cannula (HFNC) is first line therapy for patients with acute hypoxic respiratory failure (AHRF). HFNC utilization among hospitalized patients with AHRF has increased substantially during the COVID-19 pandemic. While good evidence exists to guide initiation of HFNC, evidence-based strategies for HFNC weaning are lacking. Therefore, we sought to characterize HFNC weaning practices among respiratory therapists (RTs) to determine the degree of practice variability and assess general approaches to HFNC weaning. Methods: We conducted a cross-sectional survey evaluating HFNC weaning practices of adult inpatient RTs at an academic, tertiary care medical center in the United States. Survey participants were asked about their practice of HFNC weaning and whether use of an institutional protocol provided guidance for HFNC weaning. Survey questions also assessed RT knowledge of institutional policies regarding HFNC use in hospitalized patients, including location of HFNC use within the hospital, personnel involved in HFNC titration, and methods of weaning through clinical vignettes. Survey responses were analyzed using descriptive statistics. Results: Overall, 21 of 68 RTs surveyed completed the survey (response rate 31%). The majority of participants (95%) worked primarily in an ICU, general wards, or emergency department. Approximately one-third of participants were unaware of a HFNC weaning protocol at their institution. Among those who endorsed the existence of a HFNC weaning protocol at their institution, 79% reported using the protocol “always or often.” We found substantial variation in RT knowledge of institutional policies regarding which practitioners were permitted to wean HFNC, with approximately one-half of participants believing that any practitioner could wean FiO2 and 43% believing that only RTs could wean flow. Additionally, participants' approaches to weaning varied substantially in response to clinical vignettes. For example, in the vignette of a clinically stable patient on HFNC at 60L and 100%, 62% of participants chose to wean only FiO2, 14% to wean only flow, and 24% to wean both. Conclusion: Nearly one-third of respiratory therapists were unaware of the existing HFNC weaning protocol at their institution, potentially contributing to the substantial variability in HFNC weaning practices between surveyed RTs. More research is needed to identify and successfully implement optimal weaning strategies for HFNC among patients hospitalized with AHRF.
{"title":"High Flow Nasal Cannula Use: A Survey on Weaning Practices","authors":"S. Tuthill, H. Freeman, S. Nonas, M. Drake, K. Vranas","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3982","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3982","url":null,"abstract":"Rationale: High flow nasal cannula (HFNC) is first line therapy for patients with acute hypoxic respiratory failure (AHRF). HFNC utilization among hospitalized patients with AHRF has increased substantially during the COVID-19 pandemic. While good evidence exists to guide initiation of HFNC, evidence-based strategies for HFNC weaning are lacking. Therefore, we sought to characterize HFNC weaning practices among respiratory therapists (RTs) to determine the degree of practice variability and assess general approaches to HFNC weaning. Methods: We conducted a cross-sectional survey evaluating HFNC weaning practices of adult inpatient RTs at an academic, tertiary care medical center in the United States. Survey participants were asked about their practice of HFNC weaning and whether use of an institutional protocol provided guidance for HFNC weaning. Survey questions also assessed RT knowledge of institutional policies regarding HFNC use in hospitalized patients, including location of HFNC use within the hospital, personnel involved in HFNC titration, and methods of weaning through clinical vignettes. Survey responses were analyzed using descriptive statistics. Results: Overall, 21 of 68 RTs surveyed completed the survey (response rate 31%). The majority of participants (95%) worked primarily in an ICU, general wards, or emergency department. Approximately one-third of participants were unaware of a HFNC weaning protocol at their institution. Among those who endorsed the existence of a HFNC weaning protocol at their institution, 79% reported using the protocol “always or often.” We found substantial variation in RT knowledge of institutional policies regarding which practitioners were permitted to wean HFNC, with approximately one-half of participants believing that any practitioner could wean FiO2 and 43% believing that only RTs could wean flow. Additionally, participants' approaches to weaning varied substantially in response to clinical vignettes. For example, in the vignette of a clinically stable patient on HFNC at 60L and 100%, 62% of participants chose to wean only FiO2, 14% to wean only flow, and 24% to wean both. Conclusion: Nearly one-third of respiratory therapists were unaware of the existing HFNC weaning protocol at their institution, potentially contributing to the substantial variability in HFNC weaning practices between surveyed RTs. More research is needed to identify and successfully implement optimal weaning strategies for HFNC among patients hospitalized with AHRF.","PeriodicalId":369155,"journal":{"name":"C35. TOPICS IN CRITICAL CARE AND RESPIRATORY FAILURE","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126600958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3984
E. Viglianti, E. Carlton, J. McPeake, X.Q. Wang, S. Seelye, T. Iwashyna
{"title":"The Acquisition of New Medical Devices in Patients with Persistent Critical Illness: A Retrospective Cohort Study in the Veteran Affairs","authors":"E. Viglianti, E. Carlton, J. McPeake, X.Q. Wang, S. Seelye, T. Iwashyna","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3984","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3984","url":null,"abstract":"","PeriodicalId":369155,"journal":{"name":"C35. TOPICS IN CRITICAL CARE AND RESPIRATORY FAILURE","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132776337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：