Clinical Pearls

Abstract

The significant morbidity and disability that family members of patients in the intensive care unit (ICU) can experience has been recognized in the past decade. The Society of Critical Care Medicine calls this condition post–intensive care syndrome (PICS). However, as more and more adult ICU patients require long-term acute care hospitalization (LTACH), little is known about PICS in the families of these patients.Petrinec studied LTACH family decision makers during the hospitalization and up to 2 months after discharge. She found the following:The author recommends early recognition of PICS in order to provide opportunities for focused family interventions.See Article, pp 416–422Infants with single-ventricle physiology undergo surgical palliation soon after birth but continue to have imbalance between pulmonary and systemic blood flow. Endotracheal tube suctioning (ETS) is a routine procedure to maintain tube patency but has been associated with various adverse events such as hypoxemia, bradycardia, and cardiac arrest. To date, no published research has been focused on the effects of this procedure in these children.Tume and colleagues examined the processes and adverse events associated with ETS conducted by bedside nurses in the first 48 hours after surgical palliation. They found the following:Because significant hemodynamic instability can occur, the authors recommend that ETS be planned early and with a consistent approach to reduce risks and variability in technique.See Article, pp 388–394Physical restraints are often used to prevent patients in intensive care units (ICUs) from pulling on or dislodging therapeutic devices such as endotracheal tubes and dialysis catheters. Researchers have examined the prevalence of restraint use in the ICU, but little is known about nursing determinants of restraint initiation and discontinuation.Dolan and Looby interviewed surgical ICU nurses about their experiences. They identified 3 general categories of factors considered:Nurses’ contributions are vital for determining best patient practices for educational initiatives and hospital policies related to use of restraints.See Article, pp 373–379The focus of palliative care is to improve the quality of life for patients with serious and complex illnesses and includes symptom management, emotional support, and family communication. Despite the success of nursing education programs such as the national End-of-Life Nursing Education Consortium (ELNEC) project, nurses continue to perceive barriers to integration of palliative care in the intensive care unit (ICU).Anderson and colleagues developed and implemented a system-wide training program called Integrating Multidisciplinary Palliative Care into the ICU (IMPACT-ICU) in 5 medical centers. The purpose was to train advanced practice nurses and nurse educators to provide palliative care education and support to bedside nurses. Findings from the program included the following:The authors note that engagement of stakeholders at multiple levels and disciplines facilitated the successful implementation of IMPACT-ICU.See Article, pp 361–371