CHEST critical care最新文献_第4页

CHEST critical care

Pub Date : 2025-07-07 DOI: 10.1016/j.chstcc.2025.100191

Audrey De Jong MD, PhD, Samir Jaber MD, PhD

引用次数: 0

Association Between Effects of Frailty and Delirium on Hospital Mortality in Critically Ill Patients in the ICU Requiring Noninvasive Ventilation 虚弱和谵妄对ICU无创通气危重患者住院死亡率的影响

CHEST critical care

Pub Date : 2025-07-07 DOI: 10.1016/j.chstcc.2025.100194

Ashwin Subramaniam PhD, FCICM , Ryan Ruiyang Ling MBBS , Wisam Al-Bassam FCICM , Neil Glassford PhD, FCICM , Kimberley Lewis MSc, FRCPC , Yahya Shehabi PhD, FCICM, FANZCA , David Pilcher FCICM

Background

An increasing number of patients with acute respiratory failure are supported with noninvasive ventilation (NIV). Although one-third of the patients receiving NIV experience delirium, its cause largely is unknown. It is hypothesized that frailty may be a contributing factor.

Research Question

Does delirium have an association with hospital mortality in patients with and without frailty receiving only NIV?

Study Design and Methods

This was a retrospective, multicenter registry-based observational study using the Australian and New Zealand Intensive Care Society Adult Patient Database. All adults (aged ≥ 16 years) with critical illness across 178 ICUs between January 1, 2018, and December 31, 2022, with a documented clinical frailty scale score requiring NIV were included. The primary outcome was hospital mortality. We assessed the association between delirium and hospital mortality in patients with and without frailty, adjusting for acute illness severity at ICU admission, sex, hospital type, unplanned ICU admission, and if ICU admission happened after rapid response team review.

Results

We included 30,534 patients, of whom 12,872 patients (42.2%) were frail. Delirium was more prevalent in patients with frailty (10.0% vs 5.6%; P < .001). The in-hospital mortality was higher in patients with frailty (22.5% vs 9.0%; P < .001) when compared with those without frailty. Delirium was associated independently with higher mortality across all patients, regardless of the frailty status (33.2% vs 21.0%; adjusted OR [aOR], 1.59; 95% CI, 1.40-1.80). Furthermore, delirium was associated with smaller increases in hospital mortality in patients with frailty (aOR, 1.42; 95% CI, 1.22-1.66) compared with those without frailty (aOR, 1.90; 95% CI, 1.53-2.35).

Interpretation

Although delirium was associated with higher hospital mortality, the relative impact of this association was greatest in patients without frailty. These findings challenge the 1-size-fits-all approach to delirium management in the ICU, advocating for nuanced strategies that consider the broader clinical context, including frailty.

背景：越来越多的急性呼吸衰竭患者采用无创通气（NIV）。虽然三分之一接受NIV治疗的患者会出现谵妄，但其原因尚不清楚。据推测，虚弱可能是一个促成因素。研究问题：谵妄与仅接受NIV的虚弱或不虚弱患者的住院死亡率有关吗？研究设计和方法这是一项回顾性的、多中心注册的观察性研究，使用了澳大利亚和新西兰重症监护协会成人患者数据库。纳入了2018年1月1日至2022年12月31日期间178个icu中所有患有危重疾病的成年人（年龄≥16岁），并记录了需要NIV的临床虚弱量表评分。主要终点是住院死亡率。我们评估了患有和不患有虚弱的患者谵妄与住院死亡率之间的关系，调整了ICU入院时的急性疾病严重程度、性别、医院类型、计划外ICU入院以及是否在快速反应小组审查后入住ICU。结果纳入30,534例患者，其中12,872例（42.2%）体弱。谵妄在虚弱患者中更为普遍（10.0% vs 5.6%; P < .001）。体弱患者的住院死亡率高于无体弱患者（22.5% vs 9.0%; P < .001）。在所有患者中，谵妄与较高的死亡率独立相关，无论虚弱状态如何（33.2% vs 21.0%；调整OR [aOR]， 1.59; 95% CI, 1.40-1.80）。此外，与无虚弱患者（aOR, 1.90; 95% CI, 1.53-2.35）相比，虚弱患者谵妄与住院死亡率的增加较小（aOR, 1.42; 95% CI, 1.22-1.66）。虽然谵妄与较高的住院死亡率相关，但这种关联的相对影响在没有虚弱的患者中最大。这些发现挑战了ICU谵妄管理的一刀切方法，提倡考虑更广泛的临床背景（包括虚弱）的细致策略。

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引用次数: 0

Rheological Theory of Ergotrauma 角外伤的流变理论

CHEST critical care

Pub Date : 2025-07-05 DOI: 10.1016/j.chstcc.2025.100190

Vicent Modesto i Alapont MD, PhD

引用次数: 0

The Role of Calibration Practices in Optimizing Continuous Glucose Monitor Accuracy in Critically Ill Patients 校准实践在优化危重患者连续血糖监测准确性中的作用

CHEST critical care

Pub Date : 2025-07-05 DOI: 10.1016/j.chstcc.2025.100193

Melanie Natasha Rayan MD, MPH , Eileen R. Faulds PhD, RN , Brooke Lee , Molly McNett PhD, RN , Matthew Exline MD, MPH , Chyongchiou J. Lin PhD , Laureen Jones RN , Amanie Rasul , Kathleen M. Dungan MD, MPH

Background

In the ICU, continuous glucose monitors (CGMs) may improve glycemia and reduce the need for point-of-care blood glucose (POC BG) monitoring, but face challenges because of clinical conditions that affect accuracy.

Research Question

What is the feasibility of using POC BG calibration to improve CGM accuracy?

Study Design and Methods

This feasibility study pooled data from a retrospective study of patients with COVID-19 in the ICU and a prospective single-arm clinical trial of patients in the ICU. Our sample included 110 patients receiving IV insulin monitored using a hybrid CGM plus POC BG protocol with a factory-calibrated Dexcom G6 CGM (Dexcom, Inc.). Validation was required for initial and ongoing nonadjunctive use or for standalone use and was defined as CGM ± 20% of POC BG measurement for values of ≥ 100 mg/dL or ± 20 mg/dL for values of < 100 mg/dL. In the cohort with COVID-19, calibration was performed at the nurse’s discretion. In the prospective study, calibration was performed after persistent failure to achieve validation.

Results

A total of 55 patients (50%) underwent 167 calibrations. Those with a calibration had a mean age of 57.9 ± 13.6 years, 49% were male, 83% were White, and 60% had type 2 diabetes. After calibration, validation was achieved in 72.6%, 66.7%, and 77.8% of patients at 6, 12, and 24 hours after calibration, respectively. The mean absolute relative difference (MARD) was 25% at calibration, decreasing to 9.6%, 12.7%, and 13.2% at 6, 12, and 24 hours. Similar percentages were observed after eliminating pairs with multiple calibrations. Calibration was timely, within 5 minutes of the POC BG measurement in 70% and < 10 minutes in 83%. No statistical difference in MARD was found between timely and late calibrations or based on sensor rate of change at the time of calibration.

Interpretation

Our feasibility study demonstrated an improvement in CGM accuracy with POC BG calibrations in ICU patients. Further research is needed to understand optimal implementation strategies and impact on outcomes.

背景：在ICU，连续血糖监测仪（cgm）可以改善血糖，减少对即时血糖（POC BG）监测的需求，但由于临床条件影响准确性而面临挑战。使用POC BG校准提高CGM精度的可行性是什么？研究设计和方法本可行性研究汇集了一项针对ICU患者的COVID-19回顾性研究和一项针对ICU患者的前瞻性单组临床试验的数据。我们的样本包括110名接受静脉注射胰岛素监测的患者，使用工厂校准的Dexcom G6 CGM （Dexcom, Inc）的CGM + POC BG混合方案。初始和持续的非辅助使用或单独使用需要验证，并且定义为CGM±20%的POC BG测量值≥100mg /dL或±20mg /dL值为<； 100mg /dL。在COVID-19队列中，由护士自行进行校准。在前瞻性研究中，在持续未能获得验证后进行校准。结果55例患者（50%）共进行了167次校准。校正者平均年龄57.9±13.6岁，49%为男性，83%为白人，60%患有2型糖尿病。校准后，72.6%、66.7%和77.8%的患者分别在校准后6、12和24小时获得验证。平均绝对相对差（MARD）在校准时为25%，在6、12和24小时分别降至9.6%、12.7%和13.2%。在多次校准消除配对后，观察到相似的百分比。校正及时，70%的POC BG测量在5分钟内，83%的校正在10分钟内。在及时和延迟校准之间或基于校准时传感器变化率的MARD未发现统计学差异。我们的可行性研究表明，在ICU患者中使用POC BG校准可以提高CGM的准确性。需要进一步研究以了解最佳实施策略及其对结果的影响。

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引用次数: 0

Addressing Language Barriers to ICU Delirium Detection 解决重症监护病房谵妄检测的语言障碍

CHEST critical care

Pub Date : 2025-07-05 DOI: 10.1016/j.chstcc.2025.100192

Ana Lucia Fuentes MD , Charlotte C. Ellberg MD , Guillermo Jimenez MD , Paola Alicea Reyes MD , Arianna Rodriguez MD , Jorge A. Muñoz Pineda MD , Humberto Parada Jr. PhD, MPH , Robert L. Owens MD , Atul Malhotra MD , Biren B. Kamdar MD, MHS

Background

Delirium is a common and serious condition in the ICU associated with adverse outcomes. However, delirium can be challenging to detect, especially among patients with limited English language proficiency. Given the rise in the Spanish-speaking Hispanic and Latino population in the United States, we sought to translate into Spanish and culturally adapt for Hispanic and Latino adults an alternative delirium screening tool, the Family-Confusion Assessment Method for the ICU (Family-CAM).

Research Question

Our objective was to translate and culturally adapt the Family-CAM into Spanish (the Spanish-Language Family-Confusion Assessment Method for the ICU [Spanish-FAM]) and to evaluate its performance among Spanish-speaking patients in the ICU.

Study Design and Methods

The translation and cross-cultural adaptation process included double-forward and back translations and harmonization by a team of bilingual physicians representing multiple Spanish-speaking global regions. We then identified 20 Spanish-speaking patients in the ICU and their family caregivers (dyads) on admission. A trained bilingual assessor administered the validated Spanish-language Confusion Assessment Method for the ICU (Spanish-CAM), which served as the gold standard for delirium assessments. The performances of the Spanish-FAM (performed by family caregivers) and usual care (the Confusion Assessment Method for the ICU documented by bedside providers) then were compared with those of the Spanish-CAM using Cohen’s κ to assess for agreement between assessments.

Results

The Spanish-FAM maintained conceptual equivalence to the original English version. The Spanish-FAM demonstrated substantial agreement with the gold standard Spanish-CAM (κ = 0.68), with high sensitivity (91%) and specificity (85%). In contrast, usual care showed minimal agreement with the gold standard Spanish-CAM (κ = 0.16), with a sensitivity of only 18%.

Interpretation

These findings suggest that usual care may be unreliable in Spanish-speaking patients in the ICU, whereas the Spanish-FAM may be a strong alternative tool for more accurate delirium assessments in this population.

背景：谵妄是ICU中一种常见且严重的疾病，并伴有不良后果。然而，谵妄的检测是具有挑战性的，特别是在英语能力有限的患者中。鉴于美国讲西班牙语的西班牙裔和拉丁裔人口的增加，我们试图将西班牙语翻译成西班牙语，并在文化上适应西班牙裔和拉丁裔成年人的另一种谵妄筛查工具，ICU家庭混淆评估方法（Family-CAM）。研究问题：我们的目标是将Family-CAM翻译并在文化上适应为西班牙语（ICU的西班牙语家庭混淆评估方法[西班牙语fam]），并评估其在ICU中讲西班牙语的患者中的表现。研究设计和方法翻译和跨文化适应过程包括由代表多个讲西班牙语的全球地区的双语医生团队进行双向前后翻译和协调。然后，我们在ICU中确定了20名讲西班牙语的患者及其家庭护理人员（二人组）。一名训练有素的双语评估员使用经过验证的ICU西班牙语混淆评估方法（Spanish-CAM），这是谵妄评估的金标准。然后将西班牙- fam（由家庭护理人员执行）和常规护理（床边提供者记录的ICU混淆评估方法）的表现与西班牙- cam的表现进行比较，使用Cohen 's κ来评估评估之间的一致性。结果西班牙语fam与英文原版fam在概念上保持一致。西班牙- fam与金标准西班牙- cam （κ = 0.68）基本一致，具有高灵敏度（91%）和特异性（85%）。相比之下，常规护理显示与金标准西班牙- cam的一致性最小（κ = 0.16），敏感性仅为18%。这些发现表明，在ICU中，西班牙语患者的常规护理可能不可靠，而西班牙语fam可能是该人群中更准确的谵妄评估的强大替代工具。

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引用次数: 0

Revisiting an Old Drug and a New Challenge 重温旧药，迎接新挑战

CHEST critical care

Pub Date : 2025-06-19 DOI: 10.1016/j.chstcc.2025.100188

Arsh Chowdhary MD, T.S. Dharmarajan MD

引用次数: 0

Fluids in Septic Shock 感染性休克的液体

CHEST critical care

Pub Date : 2025-06-19 DOI: 10.1016/j.chstcc.2025.100184

Bram Rochwerg MD , Diane Heels-Ansdell , Peggy Austin , Tina Millen , Lisa Buckingham , Frederick D’Aragon , Lori Hand , Gordon Guyatt , Roman Jaeschke , François Lamontagne , Maureen Meade , Sangeeta Mehta , Michelle Zeller , Deborah Cook , Canadian Critical Care Trials Group

Background

The Fluids in Septic Shock (FISSH) randomized controlled trial (RCT) aims to determine the impact of using Ringer’s lactate (RL) as compared with 0.9% normal saline (NS) on 30-day mortality and other end points in critically ill adults with septic shock.

Research Question

What are the rationale, methodology, ethics, implementation, and statistical analysis of the FISSH trial?

Study Design and Methods

The FISSH trial is an international, randomized, concealed allocation, masked, parallel-group, individual patient RCT. Eligible patients are critically ill adults aged ≥ 16 years who require fluid resuscitation for hypotension or organ hypoperfusion, have a clinical suspicion of infection, and are within 6 hours of emergency department presentation or within 6 hours of consultation by the critical care team for patients from the ward. Participants are randomized to receive either RL or NS for all maintenance and bolus fluids as needed throughout the ICU stay. The primary outcome is 30-day mortality. Secondary outcomes include acute kidney injury, length of ICU and hospital stays, and receipt of organ support.

Results

After an interim analysis of results from 548 patients (50% total), the data safety monitoring board recommended continuing the trial. The FISSH trial is conducted in collaboration with the Canadian Critical Care Trials Group. The FISSH trial was launched in October 2017. As of May 12, 2025, 1,019 patients (91.1%) of the target sample size of 1,118 patients have been recruited from 29 study centers. We anticipate recruitment to be complete by the end of 2025.

Interpretation

This protocol and statistical analysis plan outlines the design and conduct of the international FISSH randomized controlled trial. The FISSH trial may inform clinical practice guidelines worldwide.

Clinical Trial Registration

ClinicalTrials.gov; No.: NCT03677102; URL: www.clinicaltrials.gov

脓毒性休克液体（fish）随机对照试验（RCT）旨在确定与0.9%生理盐水（NS）相比，使用林格氏乳酸（RL）对脓毒性休克危重成人患者30天死亡率和其他终点的影响。fish试验的基本原理、方法、伦理、实施和统计分析是什么？研究设计和方法fish试验是一项国际性、随机、隐蔽分配、平行组、个体患者的随机对照试验。符合条件的患者是年龄≥16岁、因低血压或器官灌注不足需要液体复苏、临床怀疑有感染、在急诊室就诊6小时内或重症监护小组会诊6小时内就诊的危重症成年人。参与者随机接受RL或NS进行所有维持和在ICU住院期间所需的大剂量液体。主要结果是30天死亡率。次要结局包括急性肾损伤、ICU和住院时间以及接受器官支持。在对548例患者（总数50%）的结果进行中期分析后，数据安全监测委员会建议继续进行试验。fish试验是与加拿大重症监护试验小组合作进行的。fish试验于2017年10月启动。截至2025年5月12日，从29个研究中心招募了1118名患者的目标样本量中的1019名患者（91.1%）。我们预计招聘工作将于2025年底完成。本方案和统计分析计划概述了国际fish随机对照试验的设计和实施。fish试验可能为全世界的临床实践指南提供信息。临床试验注册网站clinicaltrials .gov；否。: NCT03677102;URL: www.clinicaltrials.gov

{"title":"Fluids in Septic Shock","authors":"Bram Rochwerg MD , Diane Heels-Ansdell , Peggy Austin , Tina Millen , Lisa Buckingham , Frederick D’Aragon , Lori Hand , Gordon Guyatt , Roman Jaeschke , François Lamontagne , Maureen Meade , Sangeeta Mehta , Michelle Zeller , Deborah Cook , Canadian Critical Care Trials Group","doi":"10.1016/j.chstcc.2025.100184","DOIUrl":"10.1016/j.chstcc.2025.100184","url":null,"abstract":"<div><h3>Background</h3><div>The Fluids in Septic Shock (FISSH) randomized controlled trial (RCT) aims to determine the impact of using Ringer’s lactate (RL) as compared with 0.9% normal saline (NS) on 30-day mortality and other end points in critically ill adults with septic shock.</div></div><div><h3>Research Question</h3><div>What are the rationale, methodology, ethics, implementation, and statistical analysis of the FISSH trial?</div></div><div><h3>Study Design and Methods</h3><div>The FISSH trial is an international, randomized, concealed allocation, masked, parallel-group, individual patient RCT. Eligible patients are critically ill adults aged ≥ 16 years who require fluid resuscitation for hypotension or organ hypoperfusion, have a clinical suspicion of infection, and are within 6 hours of emergency department presentation or within 6 hours of consultation by the critical care team for patients from the ward. Participants are randomized to receive either RL or NS for all maintenance and bolus fluids as needed throughout the ICU stay. The primary outcome is 30-day mortality. Secondary outcomes include acute kidney injury, length of ICU and hospital stays, and receipt of organ support.</div></div><div><h3>Results</h3><div>After an interim analysis of results from 548 patients (50% total), the data safety monitoring board recommended continuing the trial. The FISSH trial is conducted in collaboration with the Canadian Critical Care Trials Group. The FISSH trial was launched in October 2017. As of May 12, 2025, 1,019 patients (91.1%) of the target sample size of 1,118 patients have been recruited from 29 study centers. We anticipate recruitment to be complete by the end of 2025.</div></div><div><h3>Interpretation</h3><div>This protocol and statistical analysis plan outlines the design and conduct of the international FISSH randomized controlled trial. The FISSH trial may inform clinical practice guidelines worldwide.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: NCT03677102; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100184"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145333762","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}

引用次数: 0

Needs of Acute Respiratory Failure Survivors Throughout 1 Year of Recovery 急性呼吸衰竭幸存者在1年康复期间的需要

CHEST critical care

Pub Date : 2025-06-19 DOI: 10.1016/j.chstcc.2025.100185

Jasmine A. Silvestri MPH , Craig Kwiatkowski BA , Erich M. Dress MPH, MBE , Taara V. Prasad MPH, MBE , Eric Ryu , Meeta Prasad Kerlin MD, MSCE , Michael O. Harhay PhD , Tamar Klaiman PhD, MPH , Rachel Kohn MD, MSCE

Background

Although ICU mortality is declining for the > 1 million Americans with acute respiratory failure (ARF) annually, little evidence exists to guide care after hospital discharge, and few studies have explored longitudinal care needs among survivors.

Research Question

To ultimately develop dynamic, adaptable care plans across recovery trajectories, what are the barriers and facilitators to ARF survivor recovery?

Study Design and Methods

After hospital discharge, we enrolled survivors of ARF discharged from 4 University of Pennsylvania Health System hospitals from June 2022 through April 2023 who underwent mechanical ventilation for ≥ 24 hours into a longitudinal cohort study. We enrolled a subset of this cohort to conduct qualitative structured phone interviews at 3, 6, and 12 months regarding barriers and facilitators to recovery using the Timing It Right (TIR) framework, which identifies longitudinal changing needs. We coded interview data and performed thematic analysis to identify unmet and met needs. Using TIR framework recovery constructs, we sequentially mapped needs categorically and then across time points.

Results

Thirty-two patients participated in 59 interviews. Themes mapped to informational, instrumental, and emotional TIR framework recovery aspects across discharge preparation, transition to community, and long-term adjustment recovery phases. During discharge preparation, patients required rapport with inpatient clinicians and comprehensive information about the rehabilitation process. During transition to community, patients needed instrumental support, including increased touchpoints from health care professionals. As recovery continued, the mental and emotional burden of recovery became prominent.

Interpretation

Survivors of ARF encountered evolving support needs throughout the recovery trajectory from informational needs during discharge preparation to instrumental needs during transition to community and emotional needs during long-term adjustment. Understanding needs trajectories is a critical first step toward developing guidance to mitigate unmet needs and developing dynamic, adaptable care plans across recovery trajectories among survivors of ARF.

背景：尽管美国每年有100万急性呼吸衰竭（ARF）患者在ICU的死亡率正在下降，但很少有证据可以指导出院后的护理，也很少有研究探讨幸存者的纵向护理需求。研究问题：为了最终制定跨康复轨迹的动态、适应性强的护理计划，ARF幸存者康复的障碍和促进因素是什么？研究设计和方法出院后，我们将2022年6月至2023年4月从4所宾夕法尼亚大学卫生系统医院出院的ARF幸存者纳入纵向队列研究，这些患者接受机械通气≥24小时。我们招募了该队列的一个子集，在第3、6和12个月进行定性结构化电话访谈，使用时机正确（TIR）框架来确定纵向变化的需求，以了解恢复的障碍和促进因素。我们对访谈数据进行编码，并进行专题分析，以确定未满足和已满足的需求。使用TIR框架恢复结构，我们按顺序对需求进行分类映射，然后跨时间点进行映射。结果32例患者共接受59次访谈。主题映射到出院准备、社区过渡和长期调整恢复阶段的信息、工具和情感TIR框架恢复方面。在出院准备期间，患者需要与住院临床医生保持良好的关系，并了解有关康复过程的全面信息。在向社区过渡期间，患者需要工具性支持，包括卫生保健专业人员的接触点增加。随着康复的继续，康复的精神和情感负担变得突出。在整个康复过程中，ARF幸存者遇到了不断演变的支持需求，从出院准备期间的信息需求到过渡期间的工具需求，再到长期适应期间的社区和情感需求。了解需求轨迹是制定指南以减轻未满足需求的关键第一步，并在ARF幸存者的恢复轨迹中制定动态的、适应性强的护理计划。

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引用次数: 0

Response 响应

CHEST critical care

Pub Date : 2025-06-19 DOI: 10.1016/j.chstcc.2025.100189

Sarah N. Obeidalla MEd , Gordon R. Bernard MD , Lorraine B. Ware MD , V. Eric Kerchberger MD

引用次数: 0

Exploring Racial Differences in Family Expressions of Emotion and Clinician Empathy in ICU Family Meetings ICU家庭会议中家庭情绪表达和临床医生共情的种族差异研究

CHEST critical care

Pub Date : 2025-06-19 DOI: 10.1016/j.chstcc.2025.100186

Matthew E. Modes MD, MPP , Deborah B. Ejem PhD , Whitney Welsh PhD , Doreet Preiss PhD , Jessica Sperling PhD , Kathryn I. Pollak PhD , Christopher E. Cox MD, MPH , Erin K. Kross MD , Teryl K. Nuckols MD, MSHS , Kimberly S. Johnson MD , Sungjin Kim MS , Shannon S. Carson MD , Catherine L. Hough MD , Douglas B. White MD, MAS , Deepshikha C. Ashana MD

Background

Critical care guidelines recommend that clinicians provide emotional support to families of critically ill patients during family meetings. Little is known about how family member race impacts how emotions are expressed and supported in meetings.

Research Question

Are there differences in family members' expression of emotion and clinicians' provision of empathy in ICU family meetings involving Black and White family members?

Study Design and Methods

We conducted a directed content analysis of 40 audio-recorded meetings, matching 20 meetings with Black families and 20 meetings with White families on key characteristics including meeting length. Meetings included Black or White family members of patients receiving prolonged mechanical ventilation and critical care clinicians. We used an established coding scheme to code family expressions of negative emotion and clinician empathic statements. Two analysts, unaware of patient and family race, independently coded all meetings. After coding completion, we unmasked the data, compared code frequencies by family race, and calculated the percent of expressions of negative emotions followed by an empathic response.

Results

Family members were mostly middle-aged (mean [SD], 50 [10] years) and women (n = 29 [73%]). Physicians leading meetings were mostly young (mean [SD], 38 [7] years), men (n = 27 [68%]), and White (n = 36 [90%]); none were Black. Black families expressed fewer negative emotions than White families (median, 1 [interquartile range, 0-3] vs 4 [interquartile range, 2.5-7.5] expressions of emotions per meeting; P < .001). When families expressed negative emotions, clinicians infrequently responded with empathy to all families and did so less frequently with Black families compared with White families (15% vs 30% of family expressions; P = .099).

Interpretation

Our results indicate that racial differences exist in family expression of emotion and potentially in clinician empathic responses in ICU family meetings. Empathic communication warrants improvement, with greater improvement needed with Black families. Future interventions may be needed to enhance clinician provision of equitable emotional support.

背景：重症监护指南建议临床医生在家庭会议期间为重症患者家属提供情感支持。关于家庭成员的种族如何影响会议中情绪的表达和支持，我们知之甚少。研究问题：在黑人和白人ICU家庭会议中，家庭成员的情绪表达和临床医生提供的共情是否存在差异？研究设计和方法我们对40个录音会议进行了直接内容分析，将20个与黑人家庭的会议和20个与白人家庭的会议在会议长度等关键特征上进行匹配。会议包括接受延长机械通气患者的黑人或白人家庭成员和重症监护临床医生。我们使用一个既定的编码方案来编码家庭消极情绪的表达和临床医生的共情陈述。两名分析师，不知道病人和家属的种族，独立地对所有会议进行编码。编码完成后，我们揭开了数据的面纱，比较了家庭种族的编码频率，并计算了负面情绪表达后共情反应的百分比。结果家庭成员多为中年人（平均[SD] 50 ~ 50岁）和女性（n = 29[73%]）。主持会议的医生主要是年轻人（平均[SD]， 38 - 50岁）、男性（n = 27[68%]）和白人（n = 36 [90%]）；没有一个是黑人。黑人家庭比白人家庭表达更少的负面情绪（中位数，每次会议表达1[四分位数范围，0-3]对4[四分位数范围，2.5-7.5];P < .001）。当家庭表达负面情绪时，临床医生很少对所有家庭做出同理心的反应，与白人家庭相比，黑人家庭的同理心反应更少（15%对30%的家庭表达；P = 0.099）。研究结果表明，在ICU家庭会议中，家庭情绪表达和临床医生共情反应存在种族差异。移情沟通需要改进，黑人家庭需要更大的改进。未来的干预措施可能需要加强临床医生提供公平的情感支持。

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引用次数: 0