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Prone positioning improves clinical outcomes in moderate-to-severe acute respiratory distress syndrome and has been widely adopted for the treatment of patients with acute respiratory distress syndrome due to coronavirus disease 2019. Little is known about the effects of prone positioning among patients with less severe acute respiratory distress syndrome, obesity, or those treated with pulmonary vasodilators.

We characterize the change in oxygenation, respiratory system compliance, and dead-space-to-tidal-volume ratio in response to prone positioning in patients with coronavirus disease 2019 acute respiratory distress syndrome with a range of severities. A subset analysis of patients treated with inhaled nitric oxide and subsequent prone positioning explored the influence of pulmonary vasodilation on the physiology of prone positioning.

Retrospective cohort study of all consecutively admitted adult patients with acute respiratory distress syndrome due to coronavirus disease 2019 treated with mechanicalation among patients treated with inhaled nitric oxide.

Prone positioning improves oxygenation across the acute respiratory distress syndrome severity spectrum, irrespective of supine respiratory system compliance, positive end-expiratory pressure, or body mass index. There was a greater relative benefit among patients with more severe disease. Prone positioning confers an additive benefit in oxygenation among patients treated with inhaled nitric oxide.

We conducted a pilot study using an experimental study protocol to evaluate the measurement error of arterial pulse contour analysis-derived stroke volume due to improper transducer leveling during the passive leg raising test and the impact of such error on the determination of fluid responsiveness.

Prospective observational study.

A medical-surgical ICU at a tertiary referral center in Kobe, Japan.

Consecutive critically ill adult patients using the FloTrac system Version 4.0 (Edwards Lifesciences, Irvine, CA) for hemodynamic monitoring between September 1, 2018, and November 31, 2018.

None.

Using 20 patients, we estimated the change in the zero-reference level of an arterial transducer during head-down tilting as the vertical distance between the zero-reference levels of the transducer in the 45° semi-recumbent and supine positions. Using the FloTrac system Version 4.0, we recorded the hemodynamic variables every 20 seconds for 180 seconds at each of the following three points 1) baseline, 2) ain stroke volume was observed after elevating the arterial transducer. Clinicians and researchers are advised that proper leveling of the arterial transducer is necessary in order to accurately assess the change in arterial pulse contour analysis-derived stroke volume during the passive leg raising test.This article examines work-related and Personality personality factors that could influence health providers in experiencing alarm fatigue. selleck chemicals llc The purpose of this study is to provide a basis to determine factors that may predict the potential of alarm fatigue in critical care staff.

A questionnaire-based survey and an observational study were conducted to assess factors that could contribute to indicators of alarm fatigue.

Factors included patient-to-staff ratio, criticality of the alarm, priority of different tasks, and personality traits.

The study was conducted at an eight-bed ICU in a mid-size hospital in Montana.

Data were collected for six day shifts and six night shifts involving 24 critical care professionals. Within each 12-hour shift, six 15-minute intervals were randomly generated through work sampling for 6 days; a total of 1,080 observations were collected.

Alarm fatigue was assessed with the subjective workload assessment technique and Boredom, Apathy, and Distrust Affects, which were measured through validated questionnaires. The Big Five Personality model was used to assess personality traits.

Work factors including task prioritization, nurse-to-patient ratio, and length of shifts were associated with indicators of alarm fatigue. Personality traits of openness, conscientiousness, and neuroticism were also associated.

We recommend assessing personality traits for critical care staff to be aware of how their individualities can affect their behavior towards alarm fatigue. We also recommend an examination of alternative strategies to reduce alarm fatigue, including examining the use of breaks, work rotation, or shift reduction.

We recommend assessing personality traits for critical care staff to be aware of how their individualities can affect their behavior towards alarm fatigue. We also recommend an examination of alternative strategies to reduce alarm fatigue, including examining the use of breaks, work rotation, or shift reduction.

To understand how patients and family members experience dehumanizing or humanizing treatment when in the ICU.

Qualitative study included web-based focus groups and open-ended surveys posted to ICU patient/family social media boards. Focus groups were audio recorded and transcribed. Social media responses were collected and organized by stakeholder group. Data underwent qualitative analysis.

Remote focus groups and online surveys.

ICU patient survivors, family members, and ICU teams.

Not available.

Semi-structured questions and open-ended survey responses. We enrolled 40 patients/family members and 31 ICU team members. Focus groups and surveys revealed three primary themes orienting humanizing/dehumanizing ICU experiences 1) communication, 2) outcomes, and 3) causes of dehumanization. Dehumanization occurred during "communication" exchanges when ICU team members talked "over" patients, made distressing remarks when patients were present, or failed to inform patients about ICU-related care. "Outcomams. Supporting ICU clinicians may enable a more empathic environment and in turn more humanizing clinician-patient encounters.

To conduct a scoping review to 1) describe findings and determinants of physical functioning in children during and/or after PICU stay, 2) identify which domains of physical functioning are measured, 3) and synthesize the clinical and research knowledge gaps.

A systematic search was conducted in PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library databases following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews guidelines.

Two investigators independently screened and included studies against predetermined criteria.

One investigator extracted data with review by a second investigator. A narrative analyses approach was used.

A total of 2,610 articles were identified, leaving 68 studies for inclusion. Post-PICU/hospital discharge scores show that PICU survivors report difficulties in physical functioning during and years after PICU stay. Although sustained improvements in the long-term have been reported, assess physical functioning in children admitted to the PICU.

Sepsis is a common cause of morbidity and mortality. A reliable, rapid, and early indicator can help improve efficiency of care and outcomes. To assess the IntelliSep test, a novel in vitro diagnostic that quantifies the state of immune activation by measuring the biophysical properties of leukocytes, as a rapid diagnostic for sepsis and a measure of severity of illness, as defined by Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation-II scores and the need for hospitalization.

Adult patients presenting to two emergency departments in Baton Rouge, LA, with signs of infection (two of four systemic inflammatory response syndrome criteria, with at least one being aberration of temperature or WBC count) or suspicion of infection (a clinician order for culture of a body fluid), were prospectively enrolled. Sepsis status, per Sepsis-3 criteria, was determined through a 3-tiered retrospective and blinded adjudication process consisting of objective review, site-level clinicianfor the rapid diagnosis and risk stratification for sepsis.

In patients presenting to the emergency department with signs or suspicion of infection, the IntelliSep Index is a promising tool for the rapid diagnosis and risk stratification for sepsis.

There has been controversy about the timing and indications for intubation and mechanical ventilation in novel coronavirus disease 2019. This study assessed the effect of early intubation and mechanical ventilation on all-cause, inhospital mortality for coronavirus disease 2019 patients.

Multicenter retrospective cohort study.

Eleven municipal hospitals in New York City from March 1, 2020, to December 1, 2020.

Adult patients who tested positive for coronavirus disease 2019 in the emergency department were subsequently admitted. Patients with do-not-intubate orders at admission were excluded.

Intubation within 48 hours of triage and intubation at any point during hospital stay.

Data from 7,597 coronavirus disease 2019 patients were included; of these, 1,628 (21%) were intubated overall and 807 (11%) were intubated within 48 hours of triage. After controlling for available confounders, intubation rates for coronavirus disease 2019 patients varied significantly across hospitals and decreased steadily as the pandemic progressed. After nearest neighbor propensity score matching, intubation within 48 hours of triage was associated with higher all-cause mortality (hazard ratio, 1.30 [1.15-1.48];

< 0.0001), as was intubation at any time point (hazard ratio, 1.62 [1.45-1.80];

< 0.0001). Among intubated patients, intubation within 48 hours of triage was not significantly associated with differences in mortality (hazard ratio, 1.09 [0.94-1.26];

= 0.26). These results remained robust to multiple sensitivity analyses.

Intubation within 48 hours of triage, as well as at any time point in the hospital course, was associated with increased mortality in coronavirus disease 2019 patients in this observational study.

Intubation within 48 hours of triage, as well as at any time point in the hospital course, was associated with increased mortality in coronavirus disease 2019 patients in this observational study.Due to a shortage of perfusionists and increasing utilization of extracorporeal membrane oxygenation in the United States, many programs are training nurses as bedside extracorporeal membrane oxygenation specialists (i.e., nurse-run extracorporeal membrane oxygenation). Our objective was to evaluate if a nurse-run extracorporeal membrane oxygenation program has noninferior survival to discharge and complication rates compared with a perfusionist-run extracorporeal membrane oxygenation program. Additionally, to sought to describe increases in extracorporeal membrane oxygenation capacity and the potential for cost savings by implementing a nurse-run extracorporeal membrane oxygenation program.To characterize prearrest hemodynamic trajectories of children suffering inhospital cardiac arrest.

Exploratory retrospective analysis of arterial blood pressure and electrocardiogram waveforms.

PICU and cardiac critical care unit in a tertiary-care children's hospital.

Twenty-seven children with invasive blood pressure monitoring who suffered a total of 31 inhospital cardiac arrest events between June 2017 and June 2019.

None.

We assessed changes in cardiac output, systemic vascular resistance, stroke volume, and heart rate derived from arterial blood pressure waveforms using three previously described estimation methods. We observed substantial prearrest drops in cardiac output (population median declines of 65-84% depending on estimation method) in all patients in the 10 minutes preceding inhospital cardiac arrest. Most patients' mean arterial blood pressure also decreased, but this was not universal. We identified three hemodynamic patterns preceding inhospital cardiac arrest subacute pulseless arrest (

= 18), acute pulseless arrest (

= 7), and bradycardic arrest (

= 6).