Current Practices for Withdrawal of Life Support in Intensive Care Units

2010 ◽  
Vol 19 (6) ◽  
pp. 532-541 ◽  
Author(s):  
Karin T. Kirchhoff ◽  
Jennifer A. Kowalkowski
Keyword(s):  
Intensive Care ◽  
Nursing Education ◽  
Intensive Care Units ◽  
Life Support ◽  
Quality Care ◽  
The United States ◽  
Health Care Team ◽  
Intensive Care Nurses ◽  
Care Plans

BackgroundNurses are present at the bedside of patients undergoing withdrawal of life support more often than any other member of the health care team, yet most publications on this topic are directed at physicians.ObjectivesTo describe the training, guidance, and support related to withdrawal of life support received by nurses in intensive care units in the United States, how the nurses participated, and how the withdrawal of life support occurred.MethodsA questionnaire about withdrawal of life support was sent to 1000 randomly selected members of the American Association of Critical-Care Nurses, with 2 follow-up mailings.ResultsResponses were received from 48.4% of the nurses surveyed. Content on withdrawal of life support was required in only 15.5% of respondents’ basic nursing education and was absent from work site orientations for 63.1% of respondents. Nurses’ actions during withdrawal were most often guided by individual physician’s orders (63.8%), followed by standardized care plans (20%) and standing orders (11.8%). Nurses rated the importance of emotional support during and after the withdrawal of life support very highly, but they did not believe they were receiving that level of support. Most respondents (87.5%) participated in family conferences where withdrawal of life support was discussed. After physicians, nurses were most influential concerning administration of palliative medications. Patients’ families were present during withdrawal procedures between 32.3% and 58.4% of the time.ConclusionsTo improve their practice, intensive care nurses should receive formal training on withdrawal of life support, and institutions should develop best practices that support nurses in providing the highest quality care for patients undergoing this procedure.

scholarly journals The creation of meaning – Intensive care nurses’ experiences of conducting nurse-led follow-up on intensive care units

2019 ◽  
Vol 53 ◽  
pp. 30-36 ◽  
Author(s):  
Stine Irene Flinterud ◽  
Asgjerd Litleré Moi ◽  
Eva Gjengedal ◽  
Lisbet Narvestad Grenager ◽  
Anne-Kristine Muri ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Intensive Care Nurses ◽  
The Creation

scholarly journals Use of hospitals, physician visits, and hospice care during last six months of life among cohorts loyal to highly respected hospitals in the United States

BMJ ◽  
2004 ◽  
Vol 328 (7440) ◽  
pp. 607 ◽  
Author(s):  
John E Wennberg ◽  
Elliott S Fisher ◽  
Thérèse A Stukel ◽  
Jonathan S Skinner ◽  
Sandra M Sharp ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Hospice Care ◽  
Clinical Care ◽  
Quality Care ◽  
The United States ◽  
Healthcare Resources ◽  
Physician Visits ◽  
Medicare Programme ◽  
The Us

AbstractObjective To evaluate the use of healthcare resources during the last six months of life among patients of US hospitals with strong reputations for high quality care in managing chronic illness.Design Retrospective cohort study based on claims data from the US Medicare programme.Participants Cohorts receiving most of their hospital care from 77 hospitals that appeared on the 2001 US News and World Report “best hospitals” list for heart and pulmonary disease, cancer, and geriatric services.Main outcome measures Use of healthcare resources in the last six months of life: number of days spent in hospital and in intensive care units; number of physician visits; percentage of patients seeing 10 or more physicians; percentage enrolled in hospice. Terminal care: percentage of deaths occurring in hospital; percentage of deaths occurring in association with a stay in an intensive care unit.Results Extensive variation in each measure existed among the 77 hospital cohorts. Days in hospital per decedent ranged from 9.4 to 27.1 (interquartile range 11.6-16.1); days in intensive care units ranged from 1.6 to 9.5 (2.6-4.5); number of physician visits ranged from 17.6 to 76.2 (25.5-39.5); percentage of patients seeing 10 or more physicians ranged from 16.9% to 58.5% (29.4-43.4%); and hospice enrolment ranged from 10.8% to 43.8% (22.0-32.0%). The percentage of deaths occurring in hospital ranged from 15.9% to 55.6% (35.4-43.1%), and the percentage of deaths associated with a stay in intensive care ranged from 8.4% to 36.8% (20.2-27.1%).Conclusion Striking variation exists in the utilisation of end of life care among US medical centres with strong national reputations for clinical care.

scholarly journals Efficacy of chest X-ray in the diagnosis of COVID-19 pneumonia: comparison with computed tomography through a simplified scoring system designed for triage

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Akın Çinkooğlu ◽  
Selen Bayraktaroğlu ◽  
Naim Ceylan ◽  
Recep Savaş
Keyword(s):  
Computed Tomography ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Scoring System ◽  
Imaging Modality ◽  
Ground Glass Opacity ◽  
Initial Presentation ◽  
X Ray ◽  
Chest X Ray

Abstract Background There is no consensus on the imaging modality to be used in the diagnosis and management of Coronavirus disease 2019 (COVID-19) pneumonia. The purpose of this study was to make a comparison between computed tomography (CT) and chest X-ray (CXR) through a scoring system that can be beneficial to the clinicians in making the triage of patients diagnosed with COVID-19 pneumonia at their initial presentation to the hospital. Results Patients with a negative CXR (30.1%) had significantly lower computed tomography score (CTS) (p < 0.001). Among the lung zones where the only infiltration pattern was ground glass opacity (GGO) on CT images, the ratio of abnormality seen on CXRs was 21.6%. The cut-off value of X-ray score (XRS) to distinguish the patients who needed intensive care at follow-up (n = 12) was 6 (AUC = 0.933, 95% CI = 0.886–0.979, 100% sensitivity, 81% specificity). Conclusions Computed tomography is more effective in the diagnosis of COVID-19 pneumonia at the initial presentation due to the ease detection of GGOs. However, a baseline CXR taken after admission to the hospital can be valuable in predicting patients to be monitored in the intensive care units.

Trends in Catheter-Associated Urinary Tract Infections in Adult Intensive Care Units—United States, 1990–2007

2011 ◽  
Vol 32 (8) ◽  
pp. 748-756 ◽  
Author(s):  
Deron C. Burton ◽  
Jonathan R. Edwards ◽  
Arjun Srinivasan ◽  
Scott K. Fridkin ◽  
Carolyn V. Gould
Keyword(s):  
United States ◽  
Intensive Care ◽  
Urinary Tract ◽  
Intensive Care Units ◽  
Urinary Tract Infections ◽  
Asymptomatic Bacteriuria ◽  
The United States ◽  
Symptomatic Urinary Tract Infection ◽  
Prevention Guidelines ◽  
Tract Infections

Background.Over the past 2 decades, multiple interventions have been developed to prevent catheter-associated urinary tract infections (CAUTIs). The CAUTI prevention guidelines of the Healthcare Infection Control Practices Advisory Committee were recently revised.Objective.To examine changes in rates of CAUTI events in adult intensive care units (ICUs) in the United States from 1990 through 2007.Methods.Data were reported to the Centers for Disease Control and Prevention (CDC) through the National Nosocomial Infections Surveillance System from 1990 through 2004 and the National Healthcare Safety Network from 2006 through 2007. Infection preventionists in participating hospitals used standard methods to identify all CAUTI events (categorized as symptomatic urinary tract infection [SUTI] or asymptomatic bacteriuria [ASB]) and urinary catheter–days (UC-days) in months selected for surveillance. Data from all facilities were aggregated to calculate pooled mean annual SUTI and ASB rates (in events per 1,000 UC-days) by ICU type. Poisson regression was used to estimate percent changes in rates over time.Results.Overall, 36,282 SUTIs and 22,973 ASB episodes were reported from 367 facilities representing 1,223 adult ICUs, including combined medical/surgical (505), medical (212), surgical (224), coronary (173), and cardiothoracic (109) ICUs. All ICU types experienced significant declines of 19%–67% in SUTI rates and 29%–72% in ASB rates from 1990 through 2007. Between 2000 and 2007, significant reductions in SUTI rates occurred in all ICU types except cardiothoracic ICUs.Conclusions.Since 1990, CAUTI rates have declined significantly in all major adult ICU types in facilities reporting to the CDC. Further efforts are needed to assess prevention strategies that might have led to these decreases and to implement new CAUTI prevention guidelines.

scholarly journals Nursing care time and quality indicators for adult intensive care: correlation analysis

2012 ◽  
Vol 20 (4) ◽  
pp. 651-658 ◽  
Author(s):  
Paulo Carlos Garcia ◽  
Fernanda Maria Togeiro Fugulin
Keyword(s):  
Intensive Care ◽  
Correlation Analysis ◽  
Intensive Care Units ◽  
Quality Indicators ◽  
Nursing Care ◽  
Nursing Staff ◽  
Care Delivery ◽  
Average Length ◽  
Quality Care ◽  
Descriptive Study

The objective of this quantitative, correlational and descriptive study was to analyze the time the nursing staff spends to assist patients in Adult Intensive Care Units, as well as to verify its correlation with quality care indicators. The average length of time spent on care and the quality care indicators were identified by consulting management instruments the nursing head of the Unit employs. The average hours of nursing care delivered to patients remained stable, but lower than official Brazilian agencies' indications. The correlation between time of nursing care and the incidence of accidental extubation indicator indicated that it decreases with increasing nursing care delivered by nurses. The results of this investigation showed the influence of nursing care time, provided by nurses, in the outcome of care delivery.

Disaster Reanimatology Potentials: A Structured Interview Study in Armenia I. Methodology and Preliminary Results

1989 ◽  
Vol 4 (2) ◽  
pp. 135-152 ◽  
Author(s):  
Miroslav Klain ◽  
Edmund Ricci ◽  
Peter Safar ◽  
Victor Semenov ◽  
Ernesto Pretto ◽  
...  
Keyword(s):  
Intensive Care ◽  
Life Support ◽  
Medical Personnel ◽  
The United States ◽  
Structured Interview ◽  
Advanced Trauma Life Support ◽  
Mass Casualties ◽  
Medical Systems ◽  
Preliminary Results ◽  
Medical Teams

AbstractIn general, preparations for disasters which result in mass casualties do not incorporate a modern resuscitation approach. We explored the life-saving potential of, and time limits for life-supporting first aid (LSFA), advanced trauma life support (ATLS), resuscitative surgery, and prolonged life support (PLS: intensive care) following the earthquake in Armenia on 7 December 1988. We used a structured, retrospective interview method applied previously to evaluation of emergency medical services (EMS) in the United States. A total of 120 survivors of, and participants in the earthquake in Armenia were interviewed on site (49 lay eyewitnesses, 20 search-rescue personnel, 39 medical personnel and records, and 12 administrators). Answers were verified by crosschecks. Preliminary results permit the following generalizations: 1) a significant number of victims died slowly as the result of injuries such as external hemorrhage, head injury with coma, shock, or crush syndrome; 2) early search and rescue was performed primarily by uninjured covictims using hand tools; 3) many lives potentially could have been saved by the use of LSFA and ATLS started during extrication of crushed victims. 4) medical teams from neighboring EMS systems started to arrive at the site at 2-3 hours and therefore, A TLS could have been provided in time to save lives and limbs; 5) some amputations had to be performed in the field to enable extrication; 6) the usefulness of other resuscitative surgery in the field needs to be clarified; 7) evacuations were rapid; 8) air evacuation proved essential; 9) hospital intensive care was well organized; and 10) international medical aid, which arrived after 48 hours, was too late to impact on resuscitation. Definitive analysis of data in the near future will lead to recommendations for local, regional, and National Disaster Medical Systems (NDMS).

scholarly journals Cause and Predictors of Neonatal Mortality among Neonates Admitted to the Neonatal Intensive Care Units of Public Hospitals in Eastern Ethiopia: Facilities Based Prospective Follow-up Study

2020 ◽  
Author(s):  
Assefa Desalew ◽  
Yitagesu Sintayehu ◽  
Nardos Teferi ◽  
Firehiwot Amare ◽  
Bifitu Geda ◽  
...  
Keyword(s):  
Intensive Care ◽  
Neonatal Mortality ◽  
Intensive Care Units ◽  
Neonatal Death ◽  
Neonatal Intensive Care ◽  
Causes Of Death ◽  
Public Hospitals ◽  
Neonatal Intensive Care Units ◽  
Eastern Ethiopia

Abstract Background The first month is the most crucial period for child survival. Neonatal mortality continues to remain high with little improvement over the years in Sub-Saharan Africa including Ethiopia. This region shows the least progress to reducing neonatal mortality and it continues to be a significant public health issue. The facilities-based causes and predictors of neonatal death in the neonatal intensive care unit are not well documented in this study setting. Hence, the aim of this study was to determine the causes and predictors of neonatal mortality among infants admitted to the neonatal intensive care units in Eastern Ethiopia. Methods Facilities-based prospective follow-up study was conducted among neonates admitted to the neonatal intensive care units of public hospitals in Eastern Ethiopia from November to December 2018. Data were collected using a pre-tested, structured questionnaire and a follow-up checklist. The main outcomes and causes of death were set by pediatricians and medical residents. Epi-Data 3.1 and Statistical Package for Social Sciences Version 25 software were used for data entry and analysis respectively. Multivariable logistic regression was used to find out the predictors of facilities-based neonatal mortality. Results The proportion of facilities-based neonatal mortality was 20%(95% CI: 16.7-23.8%) The causes of death were complications of preterm birth 28.58%, birth asphyxia 22.45%, infection 18.36%, meconium aspiration syndrome 9.18%, respiratory distress syndrome 7.14% and congenital malformation 4.08%. Low birth weight, preterm births, length of stay in NICU, low 5 minute Apgar score, hyperthermia and initiation of feeding were predictors of neonatal death among infants admitted to the neonatal intensive care units in public hospitals, Eastern Ethiopia. Conclusion The proportion of facilities-based neonatal deaths was unacceptably high. The main causes of death were preventable and treatable. Hence, improving timing and quality of ANC is essential for early detection, anticipating high-risk newborns and timely interventions. Furthermore, early initiation of feeding and a better referral linkage to tertiary facilities could lead to a reduction of neonatal death in this setting.

Variation in Performance of Neonatal Intensive Care Units in the United States

2017 ◽  
Vol 171 (3) ◽  
pp. e164396 ◽  
Author(s):  
Jeffrey D. Horbar ◽  
Erika M. Edwards ◽  
Lucy T. Greenberg ◽  
Kate A. Morrow ◽  
Roger F. Soll ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
The United States ◽  
Neonatal Intensive Care Units
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