ICU Setting Research Articles

Saliva culture as a predictive indicator for current blood infections and antimicrobial resistance in the ICU setting

Antimicrobial resistance is a worldwide health problem and patients in intensive care are more vulnerable, requiring strict control measures and early identification. Currently, clinical culture materials are used to identify the bacterial agent, but saliva culture is not validated, which has great clinical relevance because it participates in several pathophysiological processes. The aim of this study was to validate saliva culture in an intensive care unit environment, determining its diagnostic value for infection. For this purpose, the results of the 39-month surveillance cultures, from the database of a private hospital were evaluated. A total of 323 cultures were paired between saliva, tracheal secretions, blood and urine from patients who were hospitalized for more than 5 days. The search for correlations between the results was performed using the Spearman correlation test. Severity and evolution data were also correlated. It was possible to correlate the presence of Klebsiella spp. between blood culture and saliva culture in 25% of the results (r = 0.01) and the correlation between saliva and tracheal secretion was 33% (r = 0.33447) with p < 0.0001. In conclusion, saliva can be an excellent discriminator of systemic infections, and can be considered a useful culture in clinical practice.

Delayed severe hemothorax caused by a staple line of a bullectomy performed 11 years earlier

BackgroundAt present, relatively few lung surgeries are performed without endostaplers. Although there are few staple-related adverse events, severe events must be shared to improve safety.Case presentationA 74-year-old male suddenly collapsed and was transferred to the Emergency Rescue department. He had shock vitals and contrast-enhanced CT revealed extensive right hemothorax with contrast leakage. He lost consciousness and tension massive hemothorax was suspected. We performed emergency thoracotomy at two sites and were able to achieve hemostasis and save the patient. Upon examining the patient's medical history after his condition stabilized, it was revealed that he was a lung cancer patient who was taking ramucirumab and cilostazol. In addition, the CT scan taken one month before onset revealed the bleeding site of the fifth intercostal artery were almost contact with the staple line from a prior right spontaneous pneumothorax surgery that was performed 11 years previously, which was seemed to damage the intercostal artery.ConclusionDespite the difficulty in achieving hemostasis due to drug administration history, we successfully treated a case of remote period massive hemothorax attributed to staples, thereby saving the patient. When using drugs that increase the risk of bleeding events, it may be important to consider the position of the staple line while assessing the risk. In the emergent or ICU setting, if the initial incision is not effective, the placement of a new second incision may be valuable.

The impact of hospice on end-of-life expenditures and total cost of care in episodic value-based care models at a community oncology network.

228 Background: The Institute of Medicine highlighted that multiple care transitions and fragmented care delivery at the end-of-life (EOL) is a burden to patients and caregivers. Hospice care has been shown to deliver high-quality, coordinated, and comprehensive EOL care while reducing unneeded healthcare interventions and improving EOL patient experience (preference of place of death, type of EOL care). The impact of timely hospice care on Total Cost of Care (TCOC) in episodic value-based care (VBC) models and patient experience at the EOL is largely unknown. The Oncology Care Model (OCM) was a 6-year long Medicare VBC program that encouraged care transformation at Oncology practices to drive better quality of care and patient experience, while decreasing TCOC. We studied the impact of timely hospice enrollment on TCOC, EOL expenditures, and patient experience. Methods: We obtained episode level data for patients who died in an episode (decedents) during the 6-years of the OCM (July 2016 to June 2022), for 15 practices in The US Oncology Network (The Network) participating in the OCM, along with several expenditure, clinical and episodic characteristics. We evaluated utilization and experience outcomes for episodes with and without hospice. Results: Of the 26,074 decedents during the 6-year period of the OCM, 55% were enrolled in hospice for 3 or more days (Hsp), and 45% were not enrolled or enrolled in hospice for less than 3 days (NoHsp). Mean TCOC for Hsp episodes ($41,297, n = 14,240) was significantly lower (Mann Whitney U test, p-value &lt; 0.0001, significance level = 0.01) than NoHsp ($47,601, n = 11,834) episodes. TCOC comparison by expense cohort results are provided in Table 1. Median duration of hospice for Hsp episodes was 9 days. Mean ICU and inpatient spend in last 30 days of life in NoHsp group was more than 2 times the spend in Hsp group. 44% of patients in NoHsp group died in a hospital or an ICU setting, whereas 97% of patients in Hsp group died at home or in a hospice setting. Conclusions: Patients enrolled in hospice for 3 or more days had lower EOL care expenditures, fewer acute care interventions, and died at home or in hospice. Timely and proactive enrollment in hospice and coordinated EOL care can improve patient experience, but also reduce EOL costs for the healthcare system and patients. CMMI Disclaimer: The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.[Table: see text]

Developing a Machine Learning Algorithm for Improved Management of Congestive Heart Failure Patients in the Emergency Department

Background and aim: Congestive heart failure is a prevalent and serious condition that poses significant challenges in the emergency department setting. Prompt and accurate management of congestive heart failure patients is crucial for improving outcomes and optimizing resource utilization. This study aims to address these challenges by developing a machine learning algorithm and comparing it to a traditional logistic regression model that can assist in the triage, resource allocation, and long-term prognostication of congestive heart failure patients. Methods: In this investigation, we used the MIMIC-III database, a publicly accessible resource containing patient data from ICU settings. Traditional logistic regression, along with the robust XGBoost and random forest algorithms, was harnessed to construct predictive models. These models were built using a range of pretreatment clinical variables. To pinpoint the most pertinent features, we carried out a univariate analysis. Ensuring robust performance and broad applicability, we adopted a nested cross-validation approach. This method enhances the precision and validation of our models by implementing multiple cross-validation iterations. Results: The performance of machine learning algorithms was assessed using the area under the receiver operating characteristic curve (AUC). Notably, the random forest algorithm, despite having lower performance among the machine learning models still demonstrated significantly higher AUC than traditional logistic regression. The AUC for the XGBoost was 0.99, random forest 0.98, while traditional logistic regression was 0.57. The most important pretreatment variables associated with congestive heart failure include total bilirubin, creatine kinase, international normalized ratio (INR), sodium, age, creatinine, potassium, gender, alkaline phosphatase, and platelets. Conclusion: Machine learning techniques utilizing multiple pretreatment clinical variables outperform traditional logistic regression in aiding the triage, resource allocation, and long-term prognostication of congestive heart failure patients in the intensive care unit setting using MIMIC III data.

Antimicrobial Susceptibility Pattern and Prevalence of the Emerging Nosocomial Pathogen Achromobacter xylosoxidans in a North Indian Tertiary Care Hospital

Achromobacter xylosoxidans is an emerging nosocomial pathogen which is commonly found in the environment. In hospital settings, especially in ICU, it can be a cause of nosocomial infection. It is commonly found in the humidifiers in ICU settings and it is also commonly associated with the immunocompromised state of patient having comorbidities. The objective of the study was to study the prevalence of Achromobacter xylosoxidans and its antimicrobial sensitivity pattern. The Retrospective analysis was done of the culture reports positive for Achromobacter xylosoxidans by VITEK 2 method and its Antimicrobial sensitivity pattern was analysed from the period of September 2021 to February 2023.The maximum (54.54%) infection was seen in the age group &gt;50 years. The maximum number (66.2%) of Achromobacter xylosoxidans were isolated from Suction tip, followed by blood (8%) and Tracheal Tip (5%). Surgical ICU contributed to the maximum number of infections i.e. 40.2%, followed by Respiratory ICU (22.1%). Maximum sensitivity was seen for Cotrimoxazole and Meropenem (around 80%), followed by Cefoperazone-Sulbactam (74%), Imipenem, Levofloxacin, Ceftazidime (around 65%). The sensitivity was minimal for Ceftriaxone (0%), Aztreonam (1.3%), and Gentamicin (5.2%). The most common risk factors/ comorbidities associated with Achromobacter infections was recent ICU admission (87.01%). The antibiotic sensitivity trends to all the antibiotics used, declined from 2021 to 2022. The antibiotic of choice to our conclusion is Cotrimoxazole, followed by Piperacillin-Tazobactam. Colistin should be kept as a reserve drug for the last resort treatment. The bacteria should not be ignored as it can lead to various opportunistic infections in immunocompromised patients, causing hindrance in the treatment.

Safety Summary of the Selective Cytopheretic Device: A Review of Safety Data Across Multiple Clinical Trials in ICU Patients With Acute Kidney Injury and Multiple Organ Failure.

Acute kidney injury (AKI) requiring continuous kidney replacement therapy is a significant complication in ICU patients with mortality rates exceeding 50%. A dysregulated immune response can lead to systemic inflammation caused by hyperactivity of pro-inflammatory neutrophils and monocytes leading to tissue damage. The selective cytopheretic device (SCD) is an investigational medical device in a new class of cell-directed extracorporeal therapies distinct from cytokine adsorbers or filters, as it targets activated leukocytes. These leukocytes are the cellular sources driving this hyperinflammatory process. The objective of this report is to summarize the safety experience from clinical studies of the SCD in ICU patients with AKI or acute respiratory distress syndrome (ARDS) and multiple organ dysfunction (MOD). The studies included in this report represent all relevant trials of the SCD conducted in patients with AKI or ARDS and MOD. Adverse event data, clinical laboratory data and mortality rates were described and summarized in this report. Five clinical studies were included in this report, including four adult studies of AKI and/or ARDS and one pediatric AKI study, which involved 151 patients treated with the SCD in an ICU setting. Over 800 SCD sessions were deployed with an estimated 19,000 exposure hours with no device-related infections or attributable serious adverse events. Furthermore, there were no safety signals of leukopenia, thrombocytopenia, or other indications of immunodepletion or immunosuppression. The SCD has shown to be a promising extracorporeal therapy with promising clinical results and a favorable safety profile. These studies support that the SCD can be added as a therapeutic intervention in critically ill AKI patient populations with multiple organ failure without adding additional safety risks.

Pre- and Post-COVID-19 Appraisal of Antimicrobial Susceptibility for Urinary Tract Infections at an Outpatient Setting of a Tertiary Care Hospital in Delhi.

This study was conducted to understand the effect of the COVID-19 pandemic on urine culture and sensitivity results in an outpatient setting. There are plenty of data from inpatient and ICU settings but there is a paucity of data in outpatient or community settings. Thus, this study primarily targeted change in antibiotic resistance of urinary tract infection (UTI) agents in the pre- and post-COVID-19 period. In the study, urine samples received in the Department of Laboratory Medicine (microbiology laboratory) with a preliminary diagnosis of UTI between April 2019 and March 2021 were analyzed. Urine cultures and antibiotic susceptibility tests of the patients included in the study were examined in two periods (pre-pandemic and post-pandemic). A total of 22,372 urine samples were received in the pre-pandemic period (April 2019 to March 2020) and 4885 samples in the post-pandemic period (April 2020 to March 2021). The positivity rate obtained from urine cultures sent post-COVID-19 pandemic (16%) was significantly higher than those sent before the COVID-19 pandemic (8%). According to cultures and antibiogram results, resistance to ampicillin, amikacin, ceftazidime (p < 0.05), co-trimoxazole, levofloxacin, gentamicin (p < 0.05), nitrofurantoin, fosfomycin, and tetracycline decreased compared with the pre-COVID-19 period. In this study, we found that the frequency of significant bacteriuria increased significantly in the post-pandemic period. However, resistance to antibiotics decreased significantly in the post-COVID-19 period compared to the pre-COVID-19 period. There was no significant change in the etiology of UTI during the two time periods.

Ventilator-associated pneumonia due to Aeromonas hydrophila: A rare case report

Introduction. Aeromonas hydrophila is an opportunistic pathogen that can cause various infections, including pneumonia, in immunocompromised individuals. This case report presents a rare occurrence of ventilator-associated pneumonia (VAP) caused by Aeromonas hydrophila in an apparently non-immunocompromised patient. Case presentation. The patient exhibited signs and symptoms of VAP and was successfully treated with intravenous ciprofloxacin. The discussion highlights the characteristics of Aeromonas species, its virulence factors, risk factors for infection, and antibiotic profile. Conclusion. It emphasizes the need for awareness and suspicion of Aeromonas as a potential cause of VAP in ICU settings, as well as the importance of early detection and appropriate treatment for improved outcomes.

Mechanical Ventilation Management for Aneurysmal Subarachnoid Hemorrhage in ICU Settings: A Literature Review

Aneurysmal Subarachnoid Hemorrhage (aSAH) is one of the challenging neurologic emergencies with a high mortality rate along with various permanent disabilities. In order to provide the patient with the most appropriate and accurate treatment, as well as to prevent further complications, a multidiscipline approach is required. This study aimed to review the various mechanisms, indications, management, and sedation of mechanical ventilation in aSAH, along with a review of prone positioning and acute respiratory distress management in aSAH. Although the main injured organ is the brain, aSAH also affects the respiratory system through various mechanisms. The usage of mechanical ventilation plays an important part in brain oxygenation and perfusion and helps prevent related complications. Levels of oxygen and carbon dioxide in the blood might play some roles in aSAH patients. No significant difference was found in using various sedative regimens. Prone positioning is indeed beneficial for the oxygenation of aSAH patients, provided that continuous monitoring is done. Blood glucose and calcium levels might be able to help predict the outcome of aSAH patients. Mechanical ventilation plays an important part in aSAH management. Clinicians must be aware of the impact of mechanical ventilation on neurological organs and the cardiopulmonary system. Balancing between oxygenation, ventilation, and sedation must be in line with aSAH condition. Several prognostic factors and tools can help predict aSAH mortality that might be able to help the clinician tailor aSAH management to their patient's needs.&#x0D;

Potential application of ultra-low field portable MRI in the ICU to improve CT and MRI access in Canadian hospitals: a multi-center retrospective analysis.

To highlight the value of Portable MRI in ICU and to recommend use case scenarios for portable MRI in ICU patients that may increase capacity for fixed CT and MRI units. Urgent neuroimaging is commonly required in ICU. Typically, ICU patients are transported to Radiology for assessment in fixed CT and MRI units. Portable MRI use in Canadian ICU settings offers the potential advantages of reduced transport risk, earlier diagnosis, improved triaging, as well as the ability to perform frequent re-imaging at the bedside. This frees up time on fixed CT and MRI units, leading to enhanced capacity to perform CT and MRI on other patients. Portable MRI use case scenarios in Canadian institutions have not been established and potential beneficial effect on wait times has not been analyzed. A retrospective semi-quantitative descriptive analysis was performed using all ICU neuroimaging requisitions (CT and MRI) over a 12-month period between January and December 2021, at Kingston Health Sciences Centre, Queen's University (Kingston, Ontario) and St. Michael's Hospital, Unity Health, University of Toronto (Toronto, Ontario). Indications for portable MRI in ICU patients were established. The number of ICU patients who could potentially undergo portable MRI was determined. Fixed CT and MRI scan times saved were calculated. In ICU patients, portable MRI could potentially replace fixed CT in 21% and fixed MRI in 26.5% of cases. This equates to annual capacity increase of 1,676 additional patients being able to undergo fixed CT scans and 324 additional patients being able to undergo fixed MRI. Implementation of portable MRI in the ICU for select neurological indications can have a significant positive impact on CT and MRI wait times in Canadian hospitals.

A Comparative Study on Caprini RAM Vs DOH Tool for Thromboprophylaxis in ICU Setting at Tertiary Care Hospital

The aim of the study was to assess DVT prophylaxis using two models (Caprini RAM &amp; DOH tool) for the prevention of DVT in postoperative or critically ill patients and for better predictability of disease. In this prospective observational study, we compared the Caprini RAM and DOH tool in the ICU setting on 229 patients (140 men and 89 women). 205 patients were considered in the study, out of which 97 had Caprini RAM and 108 had DOH tool. A Prospective, observational comparative study was carried out in a tertiary care hospital for a period of 6 months. Patients were divided into two groups according to the RAM. The data were analyzed using SPSS software and the results were compared using the student t-test. Both GROUP A and GROUP B revealed that the majority of the patients (67.1% &amp; 55.6%) were above 60 years and a large proportion of them required DVT prophylaxis. In GROUP A 93% of forms were complete with 79% accuracy. In GROUP B 83% were complete. The most appropriate prophylaxis received by patients was Enoxaparin sodium 40 mg OD for about 97 (30%) patients and Heparin 5000 IU BD for 108 (30%) based on their Caprini scores and NICE guidelines respectively. The majority of patients in Group A did not require dosage adjustments, but in 20% of cases, it was necessary. Statistical significance was achieved with a p-value less than 0.05. The study demonstrates DOH tool is better than Caprini RAM to be used in hospitals, for risk assessment of VTE in both medical and surgical patients for accuracy and predictability of the prophylaxis.&#x0D; Keywords: DVT, Risk assessment, Caprini RAM, DOH tool, pharmacological and mechanical Prophylaxis.

Nosocomial Infection in MICU: An Observational Study

Introduction: Nosocomial infections are infections; patients acquire while admitted to a health-care facility and generally develop 48 h or later after admission. These infections can lead to serious problems such as sepsis and even death. Materials and Methods: A prospective observational study was conducted for 6 months to estimate the incidence of nosocomial infections acquired in the medical intensive care unit (MICU), their risk factors, the causative pathogens, and the outcome. The patients admitted for more than 48 h to the MICU and willing to give consent were included in the study. Of 496 patients in MICU, 216 patients stayed 48 h and Acute Physiology and Chronic Health Evaluation II (APACHE II) score during the first 24 h of admission to the MICU. Results: The incidence of nosocomial infections in MICU was 14.9% (32 out of 216). Age, APACHE II score &gt;13, MICU stay &gt;7 days, and comorbidities such as peripheral venous line, central venous catheter, duration of urinary catheterization, duration of endotracheal intubation, nasogastric tube, and mechanical ventilator of &gt;7 days were found to be independent risk factors of acquiring nosocomial infections (P &lt; 0.05). Important causative organisms for nosocomial infections were Pseudomonas aeruginosa in 18 patients (32.72%), Escherichia coli in 11 (20.0%), Acinetobacter species in 8 (14.54%), and Klebsiella pneumoniae in seven patients (12.72%). Mortality among patients with nosocomial infections was 25% (8/32) and among those without nosocomial infections was 6.5% (12/184), P = 0.002. The length of ICU stay was higher in patients with nosocomial infections (15.42 ± 6.93 days) than in those without nosocomial infections (6.7 ± 5.14 days), P &lt; 0.001. Conclusion: Nosocomial infections are common in ICU settings and contribute to significant mortality and morbidity. Infection control strategies are necessary to reduce nosocomial infection rates as well as ICU mortality and morbidity.

Massage Therapy May be Safe and Reduce Pain in Critically Ill Patients with Acute Neurological Injury: a Case Control Study.

Massage therapy is an important adjunctive treatment for physiologic and psychologic symptoms and has been shown to benefit patients among a wide variety of patient populations. Few studies have investigated the utility of massage therapy in the general ICU setting, and even fewer have done so in the neurological ICU (NeuroICU). If massage therapy was determined to improve objective outcomes-or even subjective outcomes in the absence of harm-massage may be more readily employed as a complementary therapy, particularly in the ICU setting or in patients with acute neurological injury. This pilot study aimed to assess the safety of massage in the neurocritical care unit and its impact on patient vital signs, subjective pain assessment, and other clinical outcomes. Twenty-one patients who received massage therapy during admission to the neurocritical care service were compared to matched controls in a retrospective case control study design. We found a statistically significant reduction in pain scores among patients with acute neurological injury who received massage therapy. There was no statistical difference in hospital length of stay, discharge destination, in-hospital mortality, adverse events, or incidence/duration of delirium between patients who received massage therapy and those who did not. No adverse events were ascribed to the massage therapy when evaluated by blinded neurocritical care specialists. This study found that massage therapy may be safe for many patients in the NeuroICU and may offer additional subjective benefits.

The Impact of COVID-19 Vaccination on Bulgarian Patients with Uncomplicated Type 2 Diabetes Mellitus as the Only Chronic Condition

Abstract Objective: This retrospective study aimed to investigate the impact of COVID-19 vaccination on Bulgarian patient cohorts with uncomplicated diabetes mellitus type 2 as the only documented chronic comorbidity. We conducted a comparison of fully vaccinated and non-vaccinated populations, considering gender, age groups and vaccine type, across ambulatory, hospital, and ICU settings. Design: Between March 2020 and June 2022, a comprehensive retrospective analysis was conducted on a national level, utilizing data from the Ministry of Health of the Republic of Bulgaria database obtained after a formal written request. The study included a total of 1,126,946 confirmed COVID-19 patients. Results: Among the 1,126,946 confirmed COVID-19 patients, 3,792 individuals (0.33% of the total confirmed cases) had diabetes mellitus as a single chronic condition. Among the 247,441 hospitalized COVID-19 cases, 1,382 patients (0.56% of the total) had type 2 diabetes mellitus. Notably, the majority of patients requiring hospitalization due to supplemental oxygen requirement were unvaccinated women aged between 60 and 69, accounting for 240 patients. The highest mortality rates were observed in both unvaccinated men and women aged between 70 and 79, with 88 patients in each group. Statistical analysis revealed significant findings in favor of reduced rates of ambulatory care [OR = 0.76 (95% CI 0.6471 to 0.8891); p = 0.0006], intensive care admission [OR = 0.38 (95% CI 0.2698 to 0.5282); p &lt; 0.0001], in-hospital mortality [OR = 0.18 (95% CI 0.0864 to 0.3604); p &lt; 0.0001], and ICU-related mortality [OR = 0.17 (95% CI 0.0893 to 0.3436); p &lt; 0.0001]. The vaccinated cohorts who received BNT162b2 demonstrated the lowest observed death rates, with 9 deaths out of 485 individuals (1.8%) across all age groups. Conclusion: In conclusion, this retrospective analysis indicates reduced mortality in patients with uncomplicated type II diabetes mellitus who received vaccination against SARS-CoV-2. Vaccinated individuals also showed significant reduction in ICU admissions.

An Observational Study from Northern India to Evaluate Catheter-associated Urinary Tract Infection in Medical Intensive Care Unit at a Tertiary Care Center.

Healthcare-associated infections are the leading cause of morbidity and mortality in hospitalized patients. Catheter-associated urinary tract infection (CAUTI) is a leading infection in ICU settings. This study aims to evaluate the patient and catheter-related factors contributing to the urinary tract infection as well as implementing the preventive measures ultimately curbing down the burden of healthcare-associated infections. This is a hospital-based observational study conducted in Department of Microbiology, from October 2020 to September 2021. A total of 150 patients admitted to Medical Intensive Care Unit (MICU) with the indwelling urinary catheter were included. Urine samples were collected with proper aseptic precautions and processed within 2 hours of collection. Identification and antimicrobial susceptibility testing of the isolated pathogens was done as per CLSI guidelines 2019. In this study, the CAUTI rate was 9.4 per 1000 urinary catheter days, while the overall magnitude was 14.67%. It was predominantly reported in 51-70-years age group (34%), and females (63.63%) outnumbered males (36.36%), with Escherichia coli being the commonest pathogen. The highest incidence was reported in the 3rd week of catheterization with diabetes being a predominant risk factor (17.24%). This study provides baseline data on CAUTI rate, pathogens isolated, and risk factors at our institute. The overall goal is to identify, educate, and implement best-practice measures for prevention and curbing down the incidence rates of catheter-associated urinary tract infections. Parihar S, Sharma R, Kinimi SV, Choudhary S. An Observational Study from Northern India to Evaluate Catheter-associated Urinary Tract Infection in Medical Intensive Care Unit at a Tertiary Care Center. Indian J Crit Care Med 2023;27(9):642-646.

Platelet transfusion in critical care: A new method to analyze transfusion practice based on decision time intervals.

While prior studies of platelet transfusion in critical care have focused on transfusions given, proper analysis of clinical transfusion practice also requires consideration of the decision not to transfuse. We introduce a new method to assess transfusion practice based on decision time intervals (DTIs). Each patient's intensive care (ICU) stay was segmented into a series of DTIs defined by a time interval following results of a complete blood count (CBC). We studied the presence of 17 clinical factors during each DTI whether transfusion was given or not. We used a generalized linear mixed model to assess the most influential clinical triggers for platelet transfusion. Among 6125 ICU patients treated between October 2016 and October 2021, we analyzed 39,745 DTIs among patients (n = 2921) who had at least one DTI with thrombocytopenia (≤150,000/μL). We found no association between platelet count and two markers of bleeding: drop in hemoglobin and chest tube drainage. We found that the majority of DTIs were associated with no platelet transfusion regardless of the platelet count; that no specific platelet value triggered transfusion; but rather that multiple clinical factors in conjunction with the platelet count influenced the decision to transfuse. DTI analysis represents a new method to assess transfusion practice that considers both transfusions given and not given, and that analyzes clinical circumstances present when decisions regarding transfusion are made. The method is easily adapted to blood components other than platelet transfusions and is easily extended to other ICU and other hospital settings.

A Clinical Review of Physical Rehabilitation Protocol and Early Mobilization Patterns for Post-COVID-19 Patients: Tertiary Healthcare Facility Experience

Several studies have emphasized the urgent need for Physical Rehabilitation guidelines for COVID-19 patients and the effect of Early Mobilization in these patients. Previous reports revealed that dealing with COVID-19 patients was based on expert opinion, evidence from patients with other lung diseases, and not on the recent literature concerning COVID-19. International guidelines have also reported that early mobilization is safe and feasible, starting in the ICU setting. Therefore, this clinical literature review aimed to designate the indications for physical rehabilitation programs and early mobilization benefits to add to the existing literature the necessary up-to-date recommendations and to share the experience of a tertiary healthcare facility in the Kingdom of Saudi Arabia (KSA) in dealing with different stages of post-COVID-19 patients. Conclusion: The multidisciplinary approach of KFSH&amp;RC for rehabilitating COVID-19 patients was integrated through early mobilization and remarkable follow-up of different clinical service divisions, including physical and occupational rehabilitation, respiratory therapy, and nutrition, with the collaboration of the medical and psychological teams aiming to regain optimal physical function, psychological well-being, and better quality of life for those populations.

Curative to palliative care transition challenges in the intensive care unit. A narrative review.

Abstract&#x0D; Introduction: The need for high quality palliative care services for critically ill patients and their families remains of high importance.&#x0D; Purpose: This review aims to present the benefits and barriers to implementing palliative care in Intensive Care Units and suggest ways to facilitate the shift from therapeutic to palliative care.&#x0D; Methods: PubMed, Scopus, and Google Scholar databases were searched online. Studies included were eligible for the provision of palliative care in the intensive care unit, published in English from 2012 through 2022.&#x0D; Review: Evidence shows that integrating palliative care impacts the quality of life in intensive care unit and increases rates of use of palliative care facilities. On the other hand decrease length of stay and impacts the cost and the opportunity cost of the intensive care unit. The data suggest that a large subset of intensive care units patients would benefit from palliative care, but palliative care remains underutilized in the ICU setting. Lack of training in palliative care, organizational factors, decisions about end of life, lack of defined criteria for inclusion, and life-saving culture of the intensive care unit are barriers to providing palliative care. Efforts should focus on education, support for effective communication and decision-making, early integration of a palliative approach, redesign of clinical protocols, and reallocation of resources to provide an environment conducive to quality at the end of life.&#x0D; Conclusion: Involving palliative care in critically ill patients has reduced intensive care unit resource use. Nurses need to define their essential management roles within the multidisciplinary critical care team and help develop systems by which these roles can be implemented.

Impact of Interprofessional Communication on Safety in the Neonatal Intensive Care Unit.

In light of the complex advances in neonatal intensive care units (NICU), it is essential that healthcare providers (HCPs) are equipped with the appropriate skills to effectively communicate between disciplines to provide safe, quality care. However, many HCPs acknowledge that they are not confident in their ability to communicate effectively with peers. This study aimed to identify perceived barriers and facilitators of communication among HCPs in a NICU setting. This study took place in a 60-bed NICU that utilized multiple disciplines of HCPs. Using a qualitative, cross-sectional design, 2 surveys were administered, namely, a demographic survey with open-ended questions and the Safety Attitudes Questionnaire (SAQ). Findings indicated inverse relationships in age/experience and perceptions of management. Total SAQ scores ranged from 45 to 77 (N = 28, M = 62.47, SD = 9.40). The SAQ highlight that total scores above 75 correspond with positive perceptions of safety in the NICU. The statistical evidence derived from this study contributes to the evaluation of HCP-perceived communication barriers and facilitators. The identification of perceived barriers and facilitators of communication in an ICU setting may serve as a distinct, evidence-based foundation to develop interventions that emphasize the value of communication.

A Clinical Review of Physical Rehabilitation Protocol and Early Mobilization Patterns for Post-Covid-19 Patients: Tertiary Health-Care Facility Experience

Several studies have emphasized the urgent need for Physical Rehabilitation guidelines for COVID-19 patients and the effect of Early Mobilization (EM) in these patients. previous reports revealed that dealing with COVID-19 patients was based on expert opinion, evidence from patients with other lung diseases, and not on the recent literature concerning COVID-19. International guidelines also reported that early mobilization is safe and feasible, starting in the ICU setting. Therefore, this clinical literature review aimed to designate the indications of physical rehabilitation programs and early mobilization benefits to add to the existing literature the necessary up-to-date recommendations and share the experience of a tertiary healthcare facility in dealing with different stages of post-COVID-19 patients. Conclusion: The multidisciplinary approach of KFSH&amp;RC for rehabilitating COVID-19 patients was integrated through early mobilization and remarkable follow-up of different clinical services divisions including physical and occupational rehabilitation, respiratory therapy, and nutrition, with the collaboration of the medical and psychological teams aiming to regain optimal physical function, psychological well-being, and better quality of life for those populations.