SARS-CoV-2 infection can cause virus-mediated endothelial dysfunction, which in turn may lead to coagulopathy and ischemic microangiopathy. In the critical care population, cutaneous skin manifestations related to vascular compromise due to COVID-19 include livedo and purpura. These lesions can be difficult to differentiate from other dermatologic conditions seen in this population, including skin failure and deep-tissue pressure injuries. In addition, similarities in underlying pathophysiological mechanisms of these skin conditions can cause diagnostic overlap. Skin failure is known to occur in critical care patients owing to disease severity and shunting of blood to vital organs. COVID-19-related ischemic lesions can mimic the clinical course of deep-tissue pressure injury. The viral endothelial dysfunction present in patients with COVID-19 decreases tissue tolerance, which can result in an increased risk of hospital-acquired pressure injury. Extrinsic factors can also complicate diagnosis of cutaneous lesions in patients with COVID-19.
{"title":"Cutaneous Manifestations of COVID-19 in Critical Care.","authors":"Laura Swoboda","doi":"10.4037/aacnacc2022483","DOIUrl":"https://doi.org/10.4037/aacnacc2022483","url":null,"abstract":"SARS-CoV-2 infection can cause virus-mediated endothelial dysfunction, which in turn may lead to coagulopathy and ischemic microangiopathy. In the critical care population, cutaneous skin manifestations related to vascular compromise due to COVID-19 include livedo and purpura. These lesions can be difficult to differentiate from other dermatologic conditions seen in this population, including skin failure and deep-tissue pressure injuries. In addition, similarities in underlying pathophysiological mechanisms of these skin conditions can cause diagnostic overlap. Skin failure is known to occur in critical care patients owing to disease severity and shunting of blood to vital organs. COVID-19-related ischemic lesions can mimic the clinical course of deep-tissue pressure injury. The viral endothelial dysfunction present in patients with COVID-19 decreases tissue tolerance, which can result in an increased risk of hospital-acquired pressure injury. Extrinsic factors can also complicate diagnosis of cutaneous lesions in patients with COVID-19.","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"33 2 1","pages":"186-195"},"PeriodicalIF":2.2,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48888781","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}
F. Razban, M. Arab, A. Radfar, Z. Karzari, Seyed Mohammad Amin Hosseini
BACKGROUND In survivors of critical illness, recall of an intensive care unit stay plays an important role in the development of post-intensive care unit syndrome, which includes psychological impairment after intensive care unit discharge. OBJECTIVE To investigate memories of the intensive care unit among survivors in southeast Iran. METHODS In this descriptive study, the intensive care unit memory tool was used to assess patients' memories of intensive care units. RESULTS All participants (N = 100) had 1 or more factual memories (89%), memories of feelings (66%), or delusional memories (34%) from the intensive care unit. Patients who received mechanical ventilation were 4 times as likely to have delusional memories as those who did not receive mechanical ventilation. Unmarried patients were 4.8 times as likely as married patients to have memories of feelings from the intensive care unit. CONCLUSIONS Steps should be taken to minimize distressing memories of an intensive care unit admission. Follow-up programs should take into account the psychological problems faced by intensive care unit survivors.
{"title":"Recall of Intensive Care Unit Stay in Critical Illness Survivors in Southeast Iran.","authors":"F. Razban, M. Arab, A. Radfar, Z. Karzari, Seyed Mohammad Amin Hosseini","doi":"10.4037/aacnacc2022823","DOIUrl":"https://doi.org/10.4037/aacnacc2022823","url":null,"abstract":"BACKGROUND\u0000In survivors of critical illness, recall of an intensive care unit stay plays an important role in the development of post-intensive care unit syndrome, which includes psychological impairment after intensive care unit discharge.\u0000\u0000\u0000OBJECTIVE\u0000To investigate memories of the intensive care unit among survivors in southeast Iran.\u0000\u0000\u0000METHODS\u0000In this descriptive study, the intensive care unit memory tool was used to assess patients' memories of intensive care units.\u0000\u0000\u0000RESULTS\u0000All participants (N = 100) had 1 or more factual memories (89%), memories of feelings (66%), or delusional memories (34%) from the intensive care unit. Patients who received mechanical ventilation were 4 times as likely to have delusional memories as those who did not receive mechanical ventilation. Unmarried patients were 4.8 times as likely as married patients to have memories of feelings from the intensive care unit.\u0000\u0000\u0000CONCLUSIONS\u0000Steps should be taken to minimize distressing memories of an intensive care unit admission. Follow-up programs should take into account the psychological problems faced by intensive care unit survivors.","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"33 1 1","pages":"23-30"},"PeriodicalIF":2.2,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49097439","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}
Infectious and inflammatory disorders of the gastrointestinal system are life-threatening and occur frequently in hospitalized adults. Inflammatory and inflammation-related diseases of the gastrointestinal tract seen in the acutely and critically ill have numerous causes. In acute pancreatitis and toxic infections caused by the bacterium Clostridium difficile, where severe infections can develop, inflammation plays a causative and crucial role. Severe acute pancreatitis puts a patient at risk for infected necrosis, which can result in septicemia and shock. Similarly, patients treated with antibiotics are at risk for C difficile colitis, which can progress to toxic megacolon. These conditions require volume resuscitation and interventions supported by current evidence. Percutaneous or surgical interventions are often undertaken at a critical point in these illnesses. Patients who require surgery for these diagnoses present challenges for the interprofessional team. Inflammatory and infectious disorders often can lead to complications of systemic inflammatory response syndrome, sepsis, and multiorgan failure. New strategies are on the horizon to prevent the onset of and improve care for patients with severe acute pancreatitis, fulminant C difficile infection, and megacolon.
{"title":"Acute Responses to Infectious and Inflammatory Disorders of the Gastrointestinal System.","authors":"E. Fitzpatrick","doi":"10.4037/aacnacc2022486","DOIUrl":"https://doi.org/10.4037/aacnacc2022486","url":null,"abstract":"Infectious and inflammatory disorders of the gastrointestinal system are life-threatening and occur frequently in hospitalized adults. Inflammatory and inflammation-related diseases of the gastrointestinal tract seen in the acutely and critically ill have numerous causes. In acute pancreatitis and toxic infections caused by the bacterium Clostridium difficile, where severe infections can develop, inflammation plays a causative and crucial role. Severe acute pancreatitis puts a patient at risk for infected necrosis, which can result in septicemia and shock. Similarly, patients treated with antibiotics are at risk for C difficile colitis, which can progress to toxic megacolon. These conditions require volume resuscitation and interventions supported by current evidence. Percutaneous or surgical interventions are often undertaken at a critical point in these illnesses. Patients who require surgery for these diagnoses present challenges for the interprofessional team. Inflammatory and infectious disorders often can lead to complications of systemic inflammatory response syndrome, sepsis, and multiorgan failure. New strategies are on the horizon to prevent the onset of and improve care for patients with severe acute pancreatitis, fulminant C difficile infection, and megacolon.","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"33 1 1","pages":"85-98"},"PeriodicalIF":2.2,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41910508","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}
Liver transplantation has been underway for several decades, becoming a curative and life-prolonging treatment for individuals experiencing acute liver failure, end-stage liver disease, and/or hepatocellular carcinoma. Several trends have emerged to better select recipients and identify indicators for successful transplantation in light of the shortage of available organs relative to the number of people awaiting transplantation. In addition, different perfusion approaches have been studied to better understand how to achieve favorable outcomes during and after liver transplantation.
{"title":"Unfreezing What's Hot in Liver Transplantation: A Review of Current Trends.","authors":"H. Przybyl, Jennifer Grindler, Dana Lauer","doi":"10.4037/aacnacc2022728","DOIUrl":"https://doi.org/10.4037/aacnacc2022728","url":null,"abstract":"Liver transplantation has been underway for several decades, becoming a curative and life-prolonging treatment for individuals experiencing acute liver failure, end-stage liver disease, and/or hepatocellular carcinoma. Several trends have emerged to better select recipients and identify indicators for successful transplantation in light of the shortage of available organs relative to the number of people awaiting transplantation. In addition, different perfusion approaches have been studied to better understand how to achieve favorable outcomes during and after liver transplantation.","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"33 1 1","pages":"56-67"},"PeriodicalIF":2.2,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45417636","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}
{"title":"Future of Nursing 2020-2030: Supporting the Health and Well-being of Nurses.","authors":"N. Blake","doi":"10.4037/aacnacc2022286","DOIUrl":"https://doi.org/10.4037/aacnacc2022286","url":null,"abstract":"","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"33 1 1","pages":"99-102"},"PeriodicalIF":2.2,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43136988","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}
This article provides a broad overview of arrhythmogenic right ventricular cardiomyopathy, including evaluation, diagnosis, and treatment options. Nursing considerations and clinical management are reviewed through the lens of a case study. Early diagnosis to prevent sudden cardiac death is essential for patients with arrhythmogenic right ventricular cardiomyopathy.
{"title":"Arrhythmogenic Right Ventricular Cardiomyopathy: Overview and Case Study.","authors":"C. Tennyson, Rebecca Yapejian","doi":"10.4037/aacnacc2022384","DOIUrl":"https://doi.org/10.4037/aacnacc2022384","url":null,"abstract":"This article provides a broad overview of arrhythmogenic right ventricular cardiomyopathy, including evaluation, diagnosis, and treatment options. Nursing considerations and clinical management are reviewed through the lens of a case study. Early diagnosis to prevent sudden cardiac death is essential for patients with arrhythmogenic right ventricular cardiomyopathy.","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"33 1 1","pages":"14-22"},"PeriodicalIF":2.2,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49450397","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}
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