Clinical Pearls

Abstract

Extubating patients as soon as possible is recommended to prevent adverse physical and cognitive outcomes. Hemodynamic stability is often listed as a criterion for extubation; however, the evidence is conflicting regarding the safety of extubation while the patient is receiving vasopressor medications. In addition, little is known about actual bedside practice in such situations.Costa and colleagues surveyed clinicians to examine their reported practice of extubation with patients receiving vasopressor therapy. They found One-third of respondents stated that they would extubate a patient receiving a continuous infusion of vasopressors.About one-quarter reported that it would depend on the type of medication being used.Almost 58% stated that their unit did not have a protocol or that they did not know if there was a protocol for this practice.Clinicians working in a surgical intensive care unit (ICU) and those who provide direct patient care at least 50% of the time more often said they would extubate patients receiving vasopressors.Extubation of patients receiving a vasopressor varied significantly by unit type and provider role. The authors recommend further research to explore the safety of this practice and examine existing protocols in ICUs.See Article, pp 127-130Parents with children in the pediatric intensive care unit (PICU) rely on the health care team to discuss their child’s possible morbidities and risk of mortality. These are called prognostic conversations. However, very little research has addressed the impact of prognostic conversations on post–intensive care syndrome in families in the PICU.Rissman and colleagues surveyed parents and health care providers at discharge from the PICU. They found Findings support the need for prognostic conversations to occur multiple times and using multiple formats throughout the PICU hospitalization, in order to appropriately prepare families for possible post-PICU morbidities.See Article, pp 118-126Although a necessary therapy, mechanical ventilation can cause significant stress and anxiety in patients. Management of these responses continues to be via medications such as antipsychotics, analgesics, and sedatives. However, these may produce adverse effects that could increase length of stay and cost of care and could contribute to long-term adverse outcomes.Golino and colleagues evaluated the impact of live music therapy as a nonpharmacologic intervention to reduce anxiety, pain, and agitation in adult patients receiving mechanical ventilation. They found Findings show music therapy reduces pain and agitation in adults receiving mechanical ventilation. Further research is needed, but nonpharmacologic interventions such as music therapy may reduce the need for pain and anxiety medications.See Article, pp 109-115The implementation of checklists during intensive care unit (ICU) rounds helps facilitate evidence-based practice and improve patient outcomes. However, checklists are sometimes not used as intended, and customization of the checklist may affect reliability and quality of care.King and colleagues created a paper-based assessment tool that one critical care nurse could use to reliably assess ABCDEF bundle care checklist items during rounds. They evaluated the tool with 2 independent nurses during rounds on 53 patients and found that Although tool item improvements are needed, findings support having one critical care nurse serve as checklist prompter to reliably assess ABCDEF bundle care during ICU rounds.See Article, pp 92-99