The Going Home Initiative: Getting Critical Care Patients Home With Hospice

2011 ◽  
Vol 31 (5) ◽  
pp. 46-57 ◽  
Author(s):  
Paula Lusardi ◽  
Paul Jodka ◽  
Mark Stambovsky ◽  
Beth Stadnicki ◽  
Betty Babb ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Critical Care ◽  
Intensive Care ◽  
Hospice Care ◽  
Good Death ◽  
Small Scale ◽  
Considerable Effort ◽  
The Past ◽  
Critical Care Patients

Although considerable effort is being directed at providing patients and their families with a “good death,” most patients in intensive care units, if given the choice, would prefer to die at home. With little guidance from the literature, the palliative care committee of an intensive care unit developed guidelines to get patients home from the intensive care unit to die. In the past few years, the unit has transferred many patients home with hospice care, much to the delight of their families. Although several obstacles to achieving this goal exist, the unit has achieved success in a small-scale implementation of its Going Home Initiative.

scholarly journals Venous Thromboembolism in Intensive Care Unit

1970 ◽  
Vol 5 (2) ◽  
pp. 84-88 ◽  
Author(s):  
RJ Tamanna
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Preventive Measures ◽  
Common Complication ◽  
Vein Thrombosis ◽  
Randomized Controlled ◽  
The Past ◽  
Deep Vein ◽  
Critical Care Patients

Venous thromoboembolism (VTE) represents a spectrum of disease which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), a common complication in critically ill patients. VTE is difficult to diagnose, expensive to treat and occasionally lethal despite therapy. Therefore preventive measures are paramount. DVT and PE contribute significantly to morbidity and mortality associated with critical illness. But VTE remains an underestimated problem in ICU patients, despite the findings of many randomized controlled trials performed in the fields of DVT prophylaxis during the past few decades This article reviews the risk of VTE in critical care patients, thromboprophylaxis and suggests strategies to reduce the burden of thrombo-embloic disease in critical care unit. Key words: Venous thromoboembolism; Intensive Care Unit. DOI: 10.3329/uhj.v5i2.4562 University Heart Journal Vol.5(2) July 2009 pp.84-88

Measuring Height in Recumbent Critical Care Patients

2015 ◽  
Vol 24 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Diane M. Dennis ◽  
Emily E. Hunt ◽  
Charley A. Budgeon
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Gold Standard ◽  
Ventilatory Support ◽  
Whole Body ◽  
Standing Height ◽  
Preadmission Clinic ◽  
Practice Methods ◽  
Critical Care Patients

Background Estimates of the height of patients in the intensive care unit are required to adhere to clinical guidelines for drug dosages, ventilatory support, and nutrition. The gold standard of standing height cannot be used because these patients are often unconscious and recumbent. The ability of physiotherapists or dietitians to measure height in unconscious, recumbent patients has not been evaluated. Objectives To compare the accuracy of physicians, physiotherapists, and dietitians in estimating the height of recumbent critical care patients by using existing practice methods. Methods A total of 35 patients were recruited from the cardiothoracic preadmission clinic, where standing height is routinely measured by a physiotherapist. After surgery, in the intensive care unit, 1 physician, 2 physiotherapists, and 2 dietitians measured each recumbent patient’s height. Three methods were used: observation, whole-body measurement, and height estimated by using length of the forearm and the British Association for Parenteral and Enteral Nutrition normative chart. Difference from standing height was measured from zero and was compared across professions and methods, with zero indicating no difference. Results Overall, 17 physicians, 4 dietitians, and 9 physiotherapists consented to measure patients. After adjustments for method, measurements by physiotherapists did not differ significantly from the gold standard (P = .59), whereas those of physicians (P = .02) and dietitians (P < .001) did. Conclusions Physiotherapists’ measurements of supine height of recumbent critical care patients, obtained by using a nonrigid measuring tape, are more accurate than measurements obtained by physicians and dietitians.

scholarly journals Trends in Pediatric Palliative Care Research (TPPCR) 2021; Issue #3: Commentary on Guttmann et al and Dryden-Palmer et al.

2021 ◽  
Author(s):  
Christina Vadeboncoeur ◽  
TPPCR
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Critical Care ◽  
Intensive Care ◽  
Symptom Management ◽  
Neonatal Intensive Care ◽  
Moral Distress ◽  
Pediatric Palliative Care ◽  
Pediatric Critical Care ◽  
Intensive Care Unit Staff

This TPPCR commentary discusses the 2021 paper by Guttmann et al and Dryden-Palmer et al., “Goals of Care Discussions and Moral Distress among Neonatal Intensive Care Unit Staff” published in the Journal of Pain and Symptom Management and the 2021 paper by Dryden-Palmer et al., “Moral Distress of Clinicians in Canadian Pediatric and Neonatal ICUs” published in Pediatric Critical Care Medicine.

scholarly journals DYSNATREMIAS;

2017 ◽  
Vol 24 (07) ◽  
pp. 1076-1080
Author(s):  
Riffat Omer ◽  
Muhammad Khalid Masood ◽  
Saima Asghar ◽  
Muhammad Jawad ◽  
Amir Afzal ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Serum Sodium ◽  
Prospective Observational Study ◽  
Pediatric Intensive Care ◽  
Pediatric Critical Care ◽  
Life Threatening ◽  
Study Setting ◽  
Critical Care Patients

Dysnatremias (hyponatremia and hypernatremia) are common electrolytedisorders encountered in pediatric critical care patients. The spectrum of both hypo- andhypernatremia varies from mild to severe, being life threatening occasionally. We carried outa study to determine the etiology, epidemiology and effect of dysnatremias on outcomes ofpediatric critical care patients. Objectives: To determine the etiology, epidemiology and effectof dysnatremias on outcomes of pediatric critical care patients. Study Design: Prospective,observational study. Setting: Paediatric Intensive Care Unit (PICU) Services Hospital Lahore.Period: October 2014 to March 2015. Results: 185 patients were included. 19 (10.3%) patientshad hyponatremia and 22 (11.9%) patients had hypernatremia. A weak but significant inverserelationship between presentation serum sodium and mortality was observed (r = - 0.39,n=185, p= <0.001, two-tailed). Conclusions: Presentation serum sodium may influence theoutcomes of the patients admitted to the pediatric intensive care unit.

Patients With Advanced Cancer Requiring Intensive Care: Reasons for ICU Admission, Mortality Outcomes, and the Role of Palliative Care

2021 ◽  
Vol 32 (3) ◽  
pp. 324-331
Author(s):  
Varsha N. Patel ◽  
Stephanie D. Stone
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
Intensive Care ◽  
Critical Care Nurses ◽  
Factors Associated ◽  
Patients With Cancer ◽  
The Past ◽  
Care Services ◽  
Palliative Care Services

Medical advancements in oncology and critical care during the past 2 decades have led to more patients with cancer being admitted to intensive care units. This article discusses the most common reasons for intensive care unit admission and factors associated with mortality among patients with cancer. It also reviews the multiple benefits of palliative care services in caring for critically ill patients with cancer and opportunities for critical care nurses working with these patients.

scholarly journals Development and Evaluation of a Guideline for Monitoring Propylene Glycol Toxicity in Pediatric Intensive Care Unit Patients Receiving Continuous Infusion Lorazepam

2015 ◽  
Vol 20 (5) ◽  
pp. 367-372
Author(s):  
Lizbeth Hansen ◽  
Rebecca Lange ◽  
Sameer Gupta
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Continuous Infusion ◽  
Propylene Glycol ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Pediatric Critical Care ◽  
Clinical Toxicity ◽  
Critical Care Patients

OBJECTIVES: To develop and determine the safety of a guideline, by using osmol gap as an indicator of propylene glycol toxicity for pediatric patients receiving continuous infusion lorazepam. METHODS: From existing adult data, a guideline was developed for the use of continuous infusion lorazepam in pediatric critical care patients with recommendations for using osmol gap as an indicator of propylene glycol toxicity. A retrospective medical chart review was performed of patients receiving continuous infusion lorazepam from February 2012 to September 2012 for whom the guideline was used. RESULTS: Twenty-one patients received continuous infusion lorazepam for sedation in the pediatric intensive care unit during the 9-month study period for a total of 23 infusions. Eight patients (34.8%) had an osmol gap of ≥ 12 mOsm/kg during lorazepam infusion, and 7 patients (30.4%) did not have an elevated osmol gap at any point during the infusion. Two patients (8.6%) had clinical toxicity as indicated by elevated anion gap or lactate in addition to an osmol gap ≥ 12 mOsm/kg, while no patients experienced clinical toxicity with an osmol gap &lt; 12 mOsm/kg. CONCLUSIONS: A guideline for the use of lorazepam infusion in pediatric critical care patients was developed and evaluated for safety. Lorazepam continuous infusions appeared to be associated with minimal toxicity in pediatric intensive care unit patients when the osmol gap monitoring guideline was used.

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