American Journal of Critical Care最新文献

Background: Patient death caused by COVID-19 in an intensive care unit (ICU) may be a risk factor for posttraumatic stress disorder (PTSD) in family members.

Objective: To determine if bereaved family members of ICU patients with COVID-19 were more likely than those of patients without COVID-19 to experience PTSD and prolonged grief disorder and find the death unexpected.

Methods: In this cross-sectional survey study with embedded qualitative analysis conducted during the Omicron wave of the COVID-19 pandemic, family members of ICU patients at an academic medical center were enrolled at least 6 months after a patient's death. Participants completed Impact of Event Scale-Revised (IES-R) and Prolonged Grief Disorder-13-Revised (PG-13-R) and rated how unexpected the death was on a 5-point Likert scale. A subset participated in individual interviews.

Results: Of 162 total participants, 37 respective patients (23%) died of COVID-19. Family members of COVID-19 patients had significantly higher IES-R scores than did those of non-COVID-19 patients (32.4 vs 24.9, P = .03) but similar PG-13-R scores (26.1 vs 24.7, P = .43). Score on IES-R was associated with greater perception that death was unexpected (P < .001). Mediation analysis revealed a significant indirect effect between patient's COVID-19 status and family member's IES-R score via greater perceived unexpectedness of death (B = 2.27 [95% CI, 0.22-4.97]).

Conclusions: Among bereaved family members of ICU patients, perceiving the patient's death as unexpected was greater when death was due to COVID-19 versus other causes and was associated with PTSD symptoms.

Background: Post-intensive care syndrome affects 1.5 million US patients yearly, and understanding the modifiable risk factors for this syndrome can reduce its incidence.

Objectives: To investigate whether delusional memories after critical illness are associated with psychological distress and whether sedation practices affect the presence and character of intensive care unit (ICU) memories.

Methods: This was a retrospective study of patients in the Critical Illness Survivorship Clinic from October 2021 through August 2023. Clinic documentation included ICU memory descriptions and screening tests for post-traumatic stress disorder (PTSD), depression, and anxiety. Memories were coded as none, concrete, delusional, or concrete and delusional. Data from the ICU stay were collected from the electronic medical record. Logistic regression was used to evaluate whether delusional memories were associated with PTSD, depression, or anxiety and whether duration, depth, or type of sedation was associated with delusional memories.

Results: Sixty-six of 94 patients had sufficient data for inclusion. Their mean age was 54 years (SD, 13.6 years), and 48% were female. Development of PTSD, depression, and anxiety did not differ significantly between those with and without delusional memories (P > .05). Point estimates for PTSD, depression, and anxiety were lower for those with delusional or no memories than for those with concrete memories. Sedation variables were not associated with delusional memories (P > .05).

Conclusions: No association was found between memory type and post-ICU psychological distress or between memory type and sedation use. Patients' experience of sedation and its impact on outcomes need further study.

Background: Stroke is a devastating disease associated with long-term disability. Poststroke rehabilitation is tailored to improve the physical and cognitive functions of patients who have had a stroke. Virtual reality immerses users in experiences. There are no data supporting or refuting if a patient's age affects their willingness to use virtual reality as an adjunct to acute stroke rehabilitation.

Objective: To explore generational differences regarding the acceptability and feasibility of using virtual reality as an adjunct to existing poststroke rehabilitation modalities.

Methods: This was a prospective, nonrandomized, observational study of patients admitted to a critical care area with an acute stroke diagnosis. Patients wore a virtual reality headset and played a standardized virtual reality game for 5 minutes while in a hospital bed. They then completed the Acceptability of Intervention Measure and the Feasibility of Intervention Measure surveys.

Results: Of 30 consented patients, 5 opted out before the 5-minute mark and 25 completed the study. Nine patients (30%) were from Generation X, and 21 (70%) were baby boomers. The mean (SD) score on the Acceptability of Intervention Measure was similar for both Generation X and baby boomers (17.3 [6.0] vs 16.9 [4.2]; P = .25), as was the mean (SD) score on the Feasibility of Intervention Measure (16.7 [5.9] vs 16.5 [3.4]; P = .29).

Conclusions: Virtual reality is feasible and acceptable for use in a critical care setting across generational cohorts.

Background: The compounding effects of providing care during the COVID-19 pandemic and subsequent post-pandemic staffing shortages have led many experienced nurses to leave the bedside, with novice nurses being hired to fill the gap. Less experienced nurses need access to team members for the consultation, collaboration, and support required for intensive care work. Decentralization of nursing work stations and large, private rooms have resulted in intensive care units with long corridors that separate coworkers and make activities such as coaching, mentoring, and finding assistance more challenging.

Objectives: To examine relationships between critical care unit layouts and nurses' perceptions of teamwork, breaks, unit layout, and visibility.

Methods: A national sample of nurses participated via an online survey in which respondents selected their unit layout from a variety of newly developed unit graphics and subsequently answered survey questions. Researchers explored relationships between teamwork and break-taking behaviors, unit layout, and both patient and coworker visibility with the aim of guiding health care leaders, design professionals, and the nursing profession in critical care unit design and operations.

Results: A statistically significant relationship was found between nurses' perceptions of teamwork and the likelihood of taking both meal breaks and nonmeal breaks, but no correlation was identified between unit layout and teamwork.

Conclusions: Although more research is needed to understand how unit layouts influence nursing outcomes, units that foster connection and collaboration between critical care team members may encourage break-taking behaviors.

Background: Subsyndromal delirium is common in intensive care unit (ICU) patients and can prolong hospital stay, increase costs, and worsen prognosis. Advance intervention to prevent subsyndromal delirium would be valuable.

Objective: To construct a machine learning-based model to predict the risk of subsyndromal delirium in ICU patients.

Methods: This prospective cohort study included data from 447 patients hospitalized in the ICU between September 2023 and August 2024. Eight independent predictors of subsyndromal delirium were identified by least absolute shrinkage and selection operator and multivariate logistic regression analyses. Four machine learning models and a logistic regression model were constructed and validated to obtain the optimal algorithmic model.

Results: Subsyndromal delirium occurred in 90 ICU patients (20.1%). Richards-Campbell Sleep Questionnaire score, sedative use, restraint tape use, receipt of continuous renal replacement therapy or extracorporeal membrane oxygenation, intra-abdominal pressure, prealbumin level, history of alcohol consumption, and stroke were independent predictors of subsyndromal delirium. Of the 4 machine learning models constructed, the random forest model had the best comprehensive performance (area under the receiver operating characteristic curve, 0.885; F1 score, 0.629).

Conclusions: Four machine learning-based risk prediction models and 1 traditional logistic regression model were developed to predict risk of subsyndromal delirium in ICU patients. Choosing a suitable model for early screening of ICU patients at high risk of subsyndromal delirium would allow medical staff to formulate individualized early intervention plans, which could improve patients' prognosis and save medical costs.

Background: Recognition of alarm fatigue in cardiac intensive care units is critical to prevent possible patient harm.

Objectives: To assess the level of alarm fatigue among nurses in cardiac intensive care units, identify contributing factors, and explore nurses' suggestions for reducing alarm fatigue.

Methods: The study used a mixed-methods approach, combining quantitative and qualitative designs. A total of 78 nurses from 2 hospitals were included in the study, 41 of whom worked in the coronary intensive care unit and 37 of whom worked in the cardiovascular surgery intensive care unit. Sixty nurses participated in the collection of quantitative data, and qualitative data were collected until data saturation was reached. Quantitative data were collected using an occupational information form and an alarm fatigue questionnaire form, and qualitative data were collected using a semistructured interview guide. Quantitative data were collected via email, and qualitative data were collected through individual in-depth interviews.

Results: The study revealed that nurses experienced moderate levels of alarm fatigue, which correlated with greater discomfort with alarms. Through qualitative analysis, 5 themes emerged: the organizational dimension of alarms, nurses' awareness of alarms, causes of alarms, effects of alarms on nurses, and effects of alarms on conscious patients.

Conclusions: The study findings indicate that alarm fatigue among nurses in cardiac intensive care units is multidimensional, involving nurses, patients, institutions, and other stakeholders. Future studies should incorporate considerations of organizational culture and dynamics, including comprehensive training for nurses on alarm management.