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Am J Crit Care 2021 Apr 29:e1-e7. Epub 2021 Apr 29.

Alberto Lucchini is a nurse coordinator in the general intensive care unit, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.

Background: Caring for patients with COVID-19 requires wearing a full set of personal protective equipment (PPE) to avoid contamination. Personal discomfort has been associated with use of PPE, and anecdotal reports describe pressure injuries related to wearing PPE.

Objectives: To investigate the occurrence of device-related pressure injuries due to wearing PPE among Italian nurses caring for patients with COVID-19 in critical care settings. Read More

Am J Crit Care 2021 Apr 29:e1-e5. Epub 2021 Apr 29.

Karthik Raghunathan is an associate professor in the Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Division of Critical Care Medicine, and in the Department of Population Health Sciences, Duke University, Durham, North Carolina.

Background: The COVID-19 pandemic created pressure to delay inpatient elective surgery to increase US health care capacity. This study examined the extent to which common inpatient elective operations consume acute care resources.

Methods: This cross-sectional study used the Premier Healthcare Database to examine the distribution of inpatient elective operations in the United States from the fourth quarter of 2015 through the second quarter of 2018. Read More

Am J Crit Care 2021 Apr 19:e1-e10. Epub 2021 Apr 19.

Daniel Garros is a clinical professor, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, and a member of the Ethics Committee and senior attending physician in the pediatric intensive care unit, Stollery Children's Hospital, Edmonton, Alberta, Canada.

During the COVID-19 pandemic, evidence-based resources have been sought to support decision-making and strategically inform hospitals' policies, procedures, and practices. While greatly emphasizing protection, most guiding documents have neglected to support and protect the psychosocial needs of frontline health care workers and patients and their families during provision of palliative and end-of-life care. Consequently, the stage has been set for increased anxiety, moral distress, and moral injury and extreme moral hazard. Read More

Am J Crit Care 2021 Mar 26:e1-e9. Epub 2021 Mar 26.

Xiaolian Jiang is a professor, West China School of Nursing/West China Hospital, Sichuan University.

Background: Emergency and intensive care unit nurses are the main workforce fighting against COVID-19. Their professional identity may affect whether they can actively participate and be competent in care tasks during the pandemic.

Objective: To examine the level of and changes in professional identity of Chinese emergency and intensive care unit nurses as the COVID-19 pandemic builds. Read More

Am J Crit Care 2021 Mar 15:e1-e5. Epub 2021 Mar 15.

Akiva Leibowitz is assistant professors of anesthesia, Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.

The sudden surge in cases of novel coronavirus disease 2019 (COVID-19) has presented unprecedented challenges in the care of critically ill patients with the disease. A disease-focused checklist was developed to supplement and streamline the existing structure of rounds during a time of significant resource constraint. A total of 51 critical care consultants across multiple specialties at a tertiary academic medical center were surveyed regarding their preference for a structured checklist. Read More

Am J Crit Care 2021 03;30(2):e48-e53

Apostolos Armaganidis is a professor and department head, Department of 2nd Critical Care, Attikon University Hospital.

Background: The association between peripheral striated muscle strength and respiratory muscle strength has been confirmed in a number of disorders. However, this association is unknown in intensive care unit patients with tracheostomies.

Objective: To examine correlations between handgrip force, maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) in intensive care unit patients with tracheostomies. Read More

Am J Crit Care 2021 03;30(2):e32-e38

Thanh H. Neville is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.

Background: Significant resources have been allocated to decreasing the number of preventable deaths in hospitals, but identifying preventable factors and then leveraging them to effect system-wide change remains challenging.

Objective: To determine the ability of a novel in-person, multidisciplinary "rapid mortality review" process to identify deaths that are preventable and action items that lead to improvements in care.

Methods: Rapid mortality review sessions were conducted weekly for patients who died in the medical intensive care unit. Read More

Am J Crit Care 2021 03;30(2):e40-e47

Zhan Liang is an assistant professor, School of Nursing and Health Studies, University of Miami, Coral Gables, Florida.

Background: Sleep duration and proportion of daytime versus nighttime sleep may affect cognitive function in older patients in the transition out of the intensive care unit.

Objective: To explore the relationship between the daytime-to-nighttime sleep ratio and cognitive impairment in older intensive care unit survivors.

Methods: The study enrolled 30 older adults within 24 to 48 hours after intensive care unit discharge. Read More

Am J Crit Care 2021 03;30(2):156-160

Margo A. Halm is associate chief nurse executive, nursing research and evidence-based practice, VA Portland HealthCare System, Portland, Oregon.

Am J Crit Care 2021 03;30(2):161-162

Mary G. Carey is director for clinical nursing research, Strong Memorial Hospital, Rochester, New York.

Am J Crit Care 2021 03;30(2):144

Am J Crit Care 2021 03;30(2):135-139

Hallie C. Prescott is an associate professor, Department of Internal Medicine, University of Michigan and a core investigator, US Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan.

Background: Existing sepsis quality improvement initiatives focus on recognition and treatment of sepsis upon hospital admission. Yet many patients are evaluated in the clinic within 1 day of sepsis hospitalization.

Objectives: To determine the circumstances of clinic visits that precede sepsis hospitalization, including illness severity, whether patients are referred to the hospital, and time lapse and change in illness severity between clinic and hospital evaluation. Read More

Am J Crit Care 2021 03;30(2):104-112

Rebecca Rich is a critical care clinical pharmacy specialist, Lakeland Regional Health, Lakeland, Florida.

Background: Prone positioning is a standard treatment for moderate to severe acute respiratory distress syndrome (ARDS), but the outcomes associated with manual versus automatic prone positioning have not been evaluated.

Objective: To retrospectively evaluate outcomes associated with manual versus automatic prone positioning as part of a pronation quality improvement project implemented by a multidisciplinary team.

Methods: A retrospective, descriptive-comparative approach was used to analyze data from 24 months of a prone positioning protocol for ARDS. Read More

Am J Crit Care 2021 03;30(2):140-144

Kathie S. Zimbro is director, Quality Research Institute, Department of Enterprise Analytics, Sentara Healthcare; nurse executive for research, Sentara Healthcare; and adjunct professor, College of Health Sciences, Old Dominion University, Norfolk, Virginia.

Background: Patients in intensive care units are 5 times more likely to have skin integrity issues develop than patients in other units. Identifying the most appropriate assessment tool may be critical to preventing pressure injuries in intensive care patients.

Objectives: To validate the Cubbin-Jackson skin risk assessment in the critical care setting and to compare the predictive accuracy of the Cubbin-Jackson and Braden scales for the same patients. Read More

Am J Crit Care 2021 03;30(2):128-132

Devendra Mehta is a pediatric gastroenterologist, Pediatric Specialty Diagnostic Laboratory, Arnold Palmer Hospital, Orlando, Florida.

Background: Interest in the pulmonary microbiome is growing, particularly in patients undergoing mechanical ventilation.

Objectives: To explore the pulmonary microbiome over time in patients undergoing prolonged mechanical ventilation and to evaluate the effect of an oral suctioning intervention on the microbiome.

Methods: This descriptive subanalysis from a clinical trial involved a random sample of 16 participants (7 intervention, 9 control) who received mechanical ventilation for at least 5 days. Read More

Am J Crit Care 2021 03;30(2):95-102

Patricia Hickey is vice president and associate chief nurse in Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital and an assistant professor in the Department of Pediatrics, Harvard Medical School.

Background: Findings from 3 nurse-led research studies conducted in a large pediatric institution resulted in a call to action to support intensive and progressive care nurses experiencing moral and ethical challenges.

Objective: To evaluate the feasibility of and satisfaction with implementation of a Nurse Education and Support Team (NEST) coach role.

Methods: An interdisciplinary work group identified solutions for just-in-time support, including a new NEST coach role. Read More

Am J Crit Care 2021 03;30(2):133-134

Grant A. Pignatiello is a National Institutes of Health Clinical Research KL2 Scholar and an instructor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.

Am J Crit Care 2021 03;30(2):121

Am J Crit Care 2021 03;30(2):122-127

Mary Zellinger is a clinical nurse specialist at Emory University Hospital, Atlanta, Georgia.

Background: With telemedicine technology, off-site expert clinicians can consult in real time with bedside nurses and providers. The success of telemedicine may depend on its acceptance by bedside nurses and providers.

Objectives: To compare nurses' perceptions of telemedicine in 2 intensive care units (ICUs) at Emory University Hospital, an academic medical center, and to determine the relation between nurses' years of ICU experience and their perceptions of telemedicine in the hospital's ICUs (Emory e-ICU Center). Read More

Am J Crit Care 2021 03;30(2):113-120

Michael Todd is a research professor, Edson College of Nursing and Health Innovation, Arizona State University.

Background: As the role of a health care system's influence on nurse burnout becomes better understood, an under-standing of the impact of a nurses' work environment on burnout and well-being is also imperative.

Objective: To identify the key elements of a healthy work environment associated with burnout, secondary trauma, and compassion satisfaction, as well as the effect of burnout and the work environment on nurse turnover.

Methods: A total of 779 nurses in 24 critical care units at 13 hospitals completed a survey measuring burnout and quality of the work environment. Read More

Am J Crit Care 2021 03;30(2):88-90

Cindy L. Munro is coeditor in chief of the American Journal of Critical Care. She is dean and professor, School of Nursing and Health Studies, University of Miami, Coral Gables, Florida.

Am J Crit Care 2021 03;30(2):145-149

Kimberley J. Haines is physiotherapy lead and senior ICU physiotherapist, Department of Physiotherapy, Western Health, Sunshine Hospital, St Albans, Australia and an associate professor, Centre for Integrated Critical Care, University of Melbourne, Australia.

Background: After critical illness, patients are often left with impairments in physical, social, emotional, and cognitive functioning. Peer support interventions have been implemented internationally to ameliorate these issues.

Objective: To explore what patients believed to be the key mechanisms of effectiveness of peer support programs implemented during critical care recovery. Read More

Am J Crit Care 2021 Feb 15:e1-e5. Epub 2021 Feb 15.

Cydni Williams is an associate professor, Department of Pediatrics, Division of Pediatric Critical Care, Oregon Health & Science University, Portland.

Am J Crit Care 2021 01;30(1):e12-e31

Sachin Yende is a vice-president, Critical Care Service Line, VA Pittsburgh Healthcare System, and a professor, Clinical Research, Investigation, and Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh.

Background: Elderly patients frequently experience deteriorating health after critical illness, which may threaten their independence and predispose them to unplanned hospital readmissions and premature death.

Objectives: To evaluate the operational feasibility of a 90-day home-based palliative care intervention in multimorbid elderly Veteran survivors of critical illness.

Methods: A multidisciplinary home-based palliative care intervention was provided for multimorbid elderly veterans who were discharged home after admission to the intensive care unit for sepsis, pneumonia, heart failure, or exacerbation of chronic obstructive lung disease. Read More

Am J Crit Care 2021 01;30(1):e1-e11

Ginger C. Hanson is an assistant professor at Johns Hopkins School of Nursing.

Background: Ethical challenges in clinical practice significantly affect frontline nurses, leading to moral distress, burnout, and job dissatisfaction, which can undermine safety, quality, and compassionate care.

Objectives: To examine the impact of a longitudinal, experiential educational curriculum to enhance nurses' skills in mindfulness, resilience, confidence, and competence to confront ethical challenges in clinical practice.

Methods: A prospective repeated-measures study was conducted before and after a curricular intervention at 2 hospitals in a large academic medical system. Read More

Am J Crit Care 2021 01;30(1):83-84

Mary G. Carey is director for clinical nursing research, Strong Memorial Hospital, Rochester, New York.

Am J Crit Care 2021 01;30(1):64-71

Guangfa Zhu is a professor, Department of Pulmonary and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.

Background: Despite advances in treatment strategies, acute respiratory distress syndrome (ARDS) after cardiac surgery remains associated with high morbidity and mortality. A method of screening patients for risk of ARDS after cardiac surgery is needed.

Objectives: To develop and validate an ARDS prediction score designed to identify patients at high risk of ARDS after cardiac or aortic surgery. Read More

Am J Crit Care 2021 01;30(1):72-76

Hossein Mehdaoui is an intensivist, Intensive Care Unit, CHU Martinique (Centre Hospitalier Universitaire de Martinique), Fort-de-France, France.

Background: Symptoms of anxiety and depression are common in adolescents with a loved one in an intensive care unit (ICU) and are known precursors of posttraumatic stress disorder (PTSD).

Objectives: To assess the prevalence of PTSD and associated factors in adolescent (age 12-17 years) relatives of patients in an ICU with an open visitation policy.

Methods: One year after the patient was discharged from the ICU, eligible adolescent relatives completed a satisfaction survey, anxiety history questionnaire, and psychometric evaluations (Hospital Anxiety and Depression Scale and 8-item Children's Revised Impact of Event Scale). Read More

Am J Crit Care 2021 01;30(1):11-20

Sarah M. Lyon is a pulmonary and critical care physician, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania; and Department of Medicine, Division of Pulmonary & Critical Care Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.

Background: Despite increased emphasis on providing higher-quality patient- and family-centered care in the intensive care unit (ICU), there are no widely accepted definitions of such care in the ICU.

Objectives: To determine (1) aspects of care that patients and families valued during their ICU encounter, (2) outcomes that patients and families prioritized after hospital discharge, and (3) outcomes perceived as equivalent to or worse than death.

Methods: Semistructured interviews (n = 49) of former patients of an urban, academic medical ICU and their family members. Read More

Am J Crit Care 2021 01;30(1):27-35

Martha A. Q. Curley is the Ruth M. Colket Endowed Chair in Pediatric Nursing, Department of Family and Community Health, School of Nursing, University of Pennsylvania, Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, and Research Institute, Children's Hospital of Philadelphia.

Background: Quantifying nurses' perceptions of workload burden when managing critically ill patients is essential for designing interventions to ease nurses' workday.

Objectives: To explore pediatric intensive care unit (PICU) nurses' perceptions of their workload when caring for critically ill patients and managing protocolized therapies.

Methods: This study was embedded in a multicenter randomized clinical trial where participants were assigned to receive either lower-target or higher-target glucose control. Read More