Clinical Pearls

Abstract

During the pandemic, extracorporeal membrane oxygenation (ECMO) was instituted for patients with COVID-19 hypoxemia refractory to mechanical ventilation support. Although some patients had favorable outcomes, many who survived hospitalization were left with significant functional disability. Palliative care consultation with family members of ECMO patients has been studied, but the focus has primarily been on end-of-life care and not on overall care expectations.Siddiqui and colleagues implemented an early, scripted palliative care intervention for families of patients with COVID-19 receiving ECMO. After interviewing families, most within 24 to 72 hours of ECMO initiation, they identified these themes: Social isolation and related grief of not being at the patient’s bedsideHelping patients’ children adjust to a new normalCoping with multiple family members suffering from COVID-19Importance of faith and spiritualityNeed for hope and gratitudeFutility of prolonged ECMO therapyPalliative care has expanded to care for patients at all stages of chronic illness. The study findings support early family engagement and assistance for those dealing with COVID-19 and similar illnesses.See Article, pp 166-174Workplace stress can contribute to negative consequences for both staff and patients. Caring for critically ill patients adds additional stressors for intensive care nurses, which were further exacerbated by the COVID-19 pandemic. Although some interventions exist for nurse support, none focus on nurses taking time out to meet their own needs.Smith and colleagues assessed nurses’ perceptions of their stress and the usability of a Lavender Lounge—a quiet room with items and activities available to help them destress. They found The very factors that lead to burnout were the ones perceived as barriers to use of the Lavender Lounge. The authors suggest an approach that includes organizational change that supports reduced staff workload.See Article, pp 198-204Thirst is a complex symptom that affects between 49% and 98% of adult patients. Unrelieved thirst can become a distressing experience that overshadows other ailments. Although nurses can alleviate the distress caused by thirst, there are no standard protocols for accurate assessment and evaluation.Ciftci and colleagues developed and tested the Thirst Discomfort Scale to standardize measurement of thirst in adult patients. They found Although further study with other types of patients is warranted, the Thirst Discomfort Scale can be used to assess and evaluate the symptom of thirst in adult patients.See Article, pp 176-183Pressure injury (PI) prevention and treatment guidelines have historically been geared toward adult patients and adapted by pediatric providers. However, children with congenital heart disease (CHD) have unique factors that increase their susceptibility to PIs.To prevent PIs, Shields and colleagues explored the specific risk factors of the care and management of PIs in pediatric patients with CHD. They found This study adds to the limited literature on key risk factors for pediatric patients with CHD developing PIs. Clinicians providing care for these patients should use this knowledge to decrease the incidence of PIs.See Article, pp 216-220