Clinical Pearls

Abstract

Almost one-third of deaths in the United States take place in intensive care units. Critical care health providers report high levels of stress and burnout when working with end-of-life (EOL) care. Although various EOL care interventions have been developed, little evidence is available on their use in practice.Palma and colleagues conducted focus groups with physicians, nurses, and nursing assistants in Chile to explore their perceptions of EOL care. The major themes include The findings show the need for interprofessional collaborative strategies to support all critical care staff. The authors suggest communication training to build care providers’ confidence in EOL care.See Article, pp 24-32. Delirium affects up to 80% of all patients in intensive care units (ICUs). This costly complication (>$182 billion nationally) has been associated with long-term cognitive and functional deterioration. Standardized screening tools, such as the Confusion Assessment Method for the ICU (CAM-ICU), are widely used in practice by highly trained delirium experts and ICU providers. However, when used by bedside practitioners, the sensitivity of the tool for detecting delirium drops significantly.Sinvani and colleagues explored the feasibility of using a telehealth training program with a remotely located delirium specialist. They found Although further research is needed to examine the impact of telehealth on patient outcomes, the authors suggest use of tele-ICU platforms to share expertise from one remote location to numerous other sites.See Article, pp 73-76. Visitation of family members during the COVID-19 pandemic was not permitted in most hospitals, greatly affecting communication between the patient’s provider and the surrogate decision maker (SDM). Although many intensive care units instituted a daily telephone call between a senior physician and the SDM to provide patient-related information, perceptions of this practice are unknown.Fritz and colleagues surveyed SDMs, physicians, family members, and other health care providers to assess their experience with this practice. They found The practice was satisfactory for most physicians and SDMs; however, the authors suggest improvement with more frequent calls and use of videoconferencing.See Article, pp 77-81. Infants born with a congenital heart defect (CHD) are at risk for neurodevelopmental abnormalities such as cognitive disabilities, mental health problems, and gross motor deficits. Individualized family-centered developmental care (IFDC) interventions such as cue-based care and parent participation have been successfully used with premature infants to prevent neurodevelopmental problems; however, the practice with infants with a CHD varies.LaRonde and colleagues surveyed nurses from 25 cardiovascular programs to describe the current state of IFDC practice. They found Although most respondents described competence with IFDC, practice varied widely. The authors state that next steps should include development of guidelines for infants with CHD and then implementation and evaluation across pediatric critical care settings.See Article, pp e10-e19.