American Journal of Critical Care最新文献

Background: Parents of children in pediatric intensive care units have varied communication experiences with health care professionals. Little is known about factors associated with parents' perceptions of miscommunication.

Objective: To examine children's clinical and parents' demographic and psychosocial factors associated with perceptions of miscommunication in the pediatric intensive care unit.

Methods: This study was a cross-sectional survey of parents of children admitted to the pediatric intensive care unit between January 1, 2018, and February 29, 2020, with a stay of greater than 24 hours.

Results: Most of the 200 parent respondents were female (83.4%), White (71.4%), and non-Hispanic (87.9%); median age was 39 years (mean [SD], 40.2 [8.75] years); 17.6% were Black or African American. Among 210 children, mean (SD) age was 6.1 (6.02) years, mean (SD) stay was 4.5 (6.2) days, 38.6% were admitted because of respiratory illness, and the admission was the first for 51.0%. Of the parents, 16.5% reported miscommunication in the pediatric intensive care unit. In multivariable linear regressions, parents' stress (β = 0.286), parents' views of clinician communication (β = -0.400), parents' trust in physicians (β = -0.147), and length of stay (β = 0.122) accounted for 45% of the explained variance in parent-perceived miscommunication (R2 = 0.448, F = 41.19, P < .001).

Conclusions: Parental stress and trust in physician scores were associated with perceived miscommunication. Further research is needed to understand the causes and consequences of miscommunication in order to support hospitalized children and their parents.

Background: Social constructs like race can affect how patients are perceived and impact care. This study investigated whether mentions of race in notes for critically ill patients differed according to patients' race.

Methods: This retrospective cohort study included intensive care unit notes for adults (≥18 years old) admitted to any of 6 intensive care units at University of California, San Francisco, from 2012 through 2020. Notes were linked to National Provider Identifier records to obtain note writer characteristics. Logistic regression analysis with robust SEs clustered on note writers was adjusted for patient-, note- and clinician-level characteristics. Any race or ethnicity mention was the outcome of interest.

Results: Among 5573 patients with 292 457 notes by 9742 unique note writers, 3225 patients (57.9%) self-reported their race as White, 997 (17.9%) as Asian, 860 (15.4%) as Latinx, and 491 (8.8%) as Black. Note writers documented race/ethnicity for 20.8% of Black, 10.9% of Latinx, 9.1% of White, and 4.4% of Asian patients. Black patients were more likely than White patients to have race mentioned in notes (adjusted odds ratio, 2.05 [95% CI, 1.49-2.82]).

Conclusions: Black patients were more than twice as likely as White patients to have race mentioned in notes. Note language containing information on social constructs has consequences for clinicians and patients reading notes and for algorithms trained on clinical notes.

Background: Hypoalbuminemia has been associated with an increased risk of in-hospital delirium. However, the relationship between serum albumin levels and the duration and severity of delirium is not well defined.

Objective: To investigate the relationship between albumin levels and delirium duration and severity.

Methods: Study data were from a randomized controlled trial involving adult intensive care unit patients (≥ 18 years old) admitted to 3 academic hospitals from 2009 to 2015 who had positive delirium screening results on the Confusion Assessment Method for the Intensive Care Unit-7. Delirium severity was defined by mean Confusion Assessment Method for the Intensive Care Unit-7 scores by day 8. Delirum duration was defined by the number of delirium-free and coma-free days by day 8. Serum albumin levels within 72 hours of intensive care unit admission were collected from electronic medical records.

Results: The study included 237 patients (mean age, 60.3 years; female sex, 52.7%; receiving mechanical ventilation, 59.5%; acute respiratory failure or sepsis, 57.8%). Serum albumin levels were categorized as 3 g/dL or greater (n = 13), 2.5 to 2.99 g/dL (n = 142), and less than 2.5 g/dL (n = 82). After adjustment for demographic and clinical characteristics, no significant associations between albumin levels and delirium duration or severity were found. However, patients with normal albumin levels (≥3 g/dL) had shorter stays than did patients with hypoalbuminemia.

Conclusion: In patients with delirium, higher albumin levels were associated with shorter hospital stays but not with delirium duration or severity.

Background: Surrogates of incapacitated patients in the intensive care unit (ICU) face decisions related to life-sustaining treatments. Decisional conflict is understudied.

Objectives: To compare experiences of ICU surrogates by reported level of decisional conflict related to treatment decisions after a patient's cardiac arrest preceding death.

Methods: Convergent mixed methods were used. Bereaved surrogates recruited from a single northeastern US academic medical center completed surveys including the low-literacy Decisional Conflict Scale (moderate-to-high cut point >25) and individual interviews about 1 month after the patient's death. Interview data were analyzed by directed and conventional content analysis. Surrogates were stratified by median total survey score, and interview findings were compared by decisional conflict level.

Results: Of 16 surrogates, 7 reported some decisional conflict (median survey score, 0; range, 0-25). About two-thirds decided to withdraw treatments. Three themes emerged from interviews: 2 reflecting decision-making experiences ("the ultimate act"; "the legacy of clinician communication") and 1 reflecting bereavement experiences ("I wish there was a handbook"). Surrogates reporting decisional conflict included those who first pursued but later withdrew treatments after a patient's in-hospital cardiac arrest. Surrogates with decisional conflict described suboptimal support, poor medical understanding, and lack of clarity about patients' treatment preferences.

Conclusions: These findings provide insight into bereaved ICU surrogates' experiences. The low overall survey scores may reflect retrospective measurement. Surrogates who pursued treatment were underrepresented. Novel approaches to support bereaved surrogates are warranted.

Background: Supporting the sleep health of surrogate decision-makers of patients in the intensive care unit is a research priority. However, few studies have approached sleep health as a multidimensional construct, instead focusing on 1 or 2 dimensions in isolation.

Objective: To holistically examine the sleep health (satisfaction, timing, efficiency, duration) of surrogate decision-makers of critically ill patients.

Methods: This secondary analysis involved surrogate decision-makers of incapacitated intensive care unit patients at a tertiary medical center in northeastern Ohio (n = 19). Sleep-health data were captured by means of a subjective scale (satisfaction) and objectively (timing, efficiency, duration) by means of a wrist-worn accelerometer (Actiwatch Spectrum Plus; Philips Respironics). Upon enrollment, participants completed the satisfaction scale and wore the Actiwatch Spectrum Plus for 3 consecutive days. Descriptive statistics of the study variables were evaluated.

Results: A minority (15%) of the sample reported poor sleep satisfaction. Sleep timing variables were comparable to those found in other adult studies. Participants averaged approximately 6 hours of sleep per day with an average sleep efficiency of 83.7%.

Conclusions: Despite adequate satisfaction scores, intensive care unit surrogate decision-makers' sleep duration is inadequate and sleep efficiency is suboptimal. Sleep-health interventions may be needed in this at-risk population. Future research should consider the impact of surrogate decision-maker sleep health on their capacity to serve in the surrogate decision-maker role.

Background: Intensive care unit (ICU) clinicians are at risk for burnout, which can be driven by depersonalization. Photographs of patients in their baseline state of health before ICU admission may enhance the connection between clinicians and patients. The use of patient photographs has not been evaluated in an urban community teaching hospital.

Objective: To evaluate whether an interprofessional group of clinicians perceive that patient photographs in the ICU help them connect with patients and enhance empathy.

Methods: A prospective observational quality improvement study was performed in the medical ICU of an urban community teaching hospital. Patients' families could display patients' photographs in the unit. Registered nurses, physicians, respiratory therapists, and patient care associates completed anonymous surveys.

Results: Families of 21 patients provided photographs; 82 clinicians (47 physicians, 25 nurses, 5 respiratory therapists, and 5 patient care associates) completed surveys. Most clinicians (83%) agreed that the patient's personality and character were emphasized by photographs, 77% agreed that photographs facilitated communication with the patient and/or family, 89% agreed that patient photographs helped them relate to the patient as an individual, and 76% were not upset by comparing the photograph with the patient. Responses did not significantly differ by clinician type. Survey comments highlighted themes of humanization, fulfillment, and hope.

Conclusion: Patient photographs may enhance connections between clinicians and patients in the ICU, potentially reducing depersonalization and burnout.