Intensive Care Environment Research Articles

O84 BLOOD PRESSURE MEASUREMENT VIA IMPEDANCE CARDIOGRAPHY: AN ARTIFICIAL INTELLIGENCE BASED PROOF-OF-CONCEPT

Objective: Accurate blood pressure (BP) measurement is crucial for the diagnosis, risk assessment, treatment decision-making, and monitoring of cardiovascular diseases. Unfortunately, the gold-standard, cuff-based BP measurement suffer from inaccuracies and discomfort. As a result, continuous, cuff-less, and non-invasive BP assessment methods are merging as promising alternatives. This study is the first to comprehensively assess impedance cardiography (ICG) for Machine Learning enabled BP measurement. Methods: We analysed ICG data from 71 young and healthy adults. Nine different Machine Learning algorithms were evaluated for their BP estimation performance. Accuracy measures comprised mean difference, standard deviation, Limits of Agreement, mean absolute error, and root mean squared error. Additionally, the B-Score was calculated to evaluate the “true”, relative performance of the best-performing model. Results: The Multi-Linear Regression model showed the highest performance (mean difference = -0.01, r = 0.82) for systolic BP. The Support Vector Regressor model achieved the best results (mean difference = 0.15, r = 0.51) for diastolic BP. Both models exhibited positive B-Scores, indicative of their predictive capability. All tested models’ estimations correlated with both systolic and diastolic reference BP (r > 0.72 / r > 0.34, p < 0.001). Conclusion: The study highlights the potential of ICG based Machine Learning algorithms for accurately estimating arterial BP. Such algorithms can provide accurate and continuous BP data. This offers the possibility of enhancing patient care, timely diagnostics, and treatment decision-making. Our approach is especially promising for post-surgical and intensive care environments.

Optimal presence: enhancing parent integration to maximize neurodevelopmental outcomes in preterm infants.

Preterm birth disrupts the natural progression of events in the parent-infant relationship and bestows many of the typical parent responsibilities to the clinical care team. In turn, the neonatal intensive care environment (NICU) introduces obstacles to parents that would not otherwise be encountered and forces parents to adapt to this artificial environment as they seek to bond with and care for their newborn. Facilitating parent presence at the bedside and incorporating them into the care of their preterm infant is critical for lessening the immediate burden to both the parent and offspring while also ensuring the best possible outcome for preterm infants. In this review, we explore the impact that parents exert on the neurodevelopmental outcome of preterm infants and identify several barriers and facilitators to parent presence.

Hyperosmolar therapy response in traumatic brain injury: Explainable artificial intelligence based long-term time series forecasting approach

In the neurological intensive care setting implementing tier-based therapy, osmotic therapy serves as an intermediate approach for reducing intracranial pressure (ICP). However, discussions regarding quantitative and specific criteria for the maintenance and transition of treatment remain limited. This study proposes an explainable neural network forecasting of physiological responses after osmotic therapy administration for the purpose of treatment guidance. Recordings of arterial blood pressure and intracranial pressure were obtained from 107 patients with traumatic brain injury. To maintain adequate intracranial pressure, arterial blood pressure, and cerebral perfusion pressure, 20 % mannitol (100 ml; no. infusion, 3,571) and 11.3 % hypertonic saline (40 ml; no. infusion, 574) were administered. The LTSF-NLinear model was used to predict the target signal response for the subsequent 1 h. Six prediction models were derived by combining two agents (mannitol or hypertonic saline) and three target signals (mean arterial blood pressure, mean intracranial pressure and cerebral perfusion pressure). To validate the model’s robustness while considering patient heterogeneity, group (5)-fold cross-validation was implemented. To assess the predictive ability of the proposed model for adverse clinical events, binary classification of hypotension, intracranial hypertension, and cerebral hypoperfusion was performed. The overall function of the model was elucidated using linear weight visualization. Additionally, the DeepSHAP application allows for a detailed investigation of the prediction process for a single case. The relationship between response to osmotic therapy and patient outcomes was statistically significant. The proposed models achieved reasonable performance, with R2 score > 0.8 for physiological signal predictions and accuracy > 0.9 for event predictions. Through global explanation, the recent values of mean arterial blood pressure, mean intracranial pressure, and cerebral perfusion pressure of input signals significantly influenced physiological responses after osmotic treatment. In the context of local explanation (a single case), it was possible to determine how physiological state influenced the response. The proposed model is expected to provide objective and quantitative information on osmotherapy in neurological intensive care environments, enabling guidance for alternative and aggressive treatments. Thus, it can potentially aid in enhancing the prognosis of patients with traumatic brain injury and improving the clinical workflow. Moreover, the global and local explanations of the proposed model can provide valuable insights for future researchers.

VR-based Competence Training at Scale: Teaching Clinical Skills in the Context of Virtual Brain Death Examination

Teaching medical practical and soft skills in clinical routines is increasingly difficult, and manikin or actor-based simulations have gained popularity in the last decades. These simulations, however, hardly scale with the demand, are commonly insufficient to train crucial clinical competencies, and cannot portray complex visual and dynamic symptomatologies as required in, for example, brain death examinations. In this paper, we explore the requirements and challenges of integrating a large-scale high-throughput VR setup into a real medical curriculum and describe our approaches and implementation. Therefore we extend and evaluate an interactive virtual reality-based simulation for training brain death diagnostics in a virtual intensive care environment, featuring a fully reactive simulated patient. To enable the required scalability we integrated the simulation into a dedicated hardware and software framework, enabling 12 simultaneous VR trainings which are controlled by a centralized server system. Using this setup we continuously collected feedback on the application's usability and realism from hundreds of students to gain first insights into the applicability of large-scale VR-based learning systems in real course designs. After integrating this feedback, we conducted a controlled curricular study in which we compared the virtual brain death simulation with the classical manikin-based training approach. Our results indicate that the immersive learning experience is perceived to be more realistic and engaging and is overall preferred by the students while also providing the same learning effect as the alternatives.

Maternal Needs and Priorities in Neonatal Intensive Care Environment: A Cros- sectional study in the UAE


 
 
 Background: HospitalizaBon of neonates in the Neonatal Intensive Care Unit (NICU) pre- sents significant stress and adaptaBon challenges for mothers. Understanding their needs is crucial for opBmal care, as unmet needs can adversely affect both maternal and infant health outcomes.
 Purpose: This study aims to systemaBcally assess the maternal needs and prioriBes in the NICU seRng, emphasizing the significance of maternal well-being in neonatal care.
 Methods: Employing a cross-secBonal survey design, we engaged 200 mothers of hospi- talized neonates in Al Qassimi Women and Children Hospital, Sharjah. The Maternal Needs Inventory, comprising 25 items across five dimensions (Assurance, Proximity, InformaBon, Support, and Comfort), was uBlized. Mothers rated their needs and listed their top five prioriBes.
 Results: Assurance needs emerged as paramount, with 87.2% of mothers highlighBng them as criBcal. Comfort needs were deemed least important (52.4%). A significant associaBon was noted between maternal needs and certain demographic variables, underscoring the diversity of maternal experiences in the NICU.
 Conclusion: The Maternal Needs Inventory proves to be an effecBve tool in recognizing and addressing mothers’ needs in the NICU. Addressing these needs is vital for fostering a family-centered care approach, crucial for both maternal and neonatal well-being.
 
 

Noradrenaline: Can we Use it to Manage Hemodynamic Instability among Neonatal Septic Shock at the NICU?

Background: The osteopathological etiology of shock in newborn neonates is distinct and necessitates meticulous evaluation to guide targeted therapies. Timely diagnosis is essential for effective management. The prevalence of newborn septic shock in low-income nations is 26.8%, accompanied by a fatality rate of 35.4%. The research regarding the hemodynamic effects of noradrenaline in newborns is limited. Objective: This study aims to evaluate the effectiveness of noradrenaline on ventricular parameters and Vital parameters and blood gases in neonatal septic shock patients admitted to the neonatal critical care unit at Al-Azhar University hospitals. Methods: This prospective cohort study performed on 200 neonates with septic shock born in the delivery room of the Gynecology and Obstetrics Department admitted to the NICU at Al Azhar University Hospitals from September 2023 to June 2024. Parents and caregivers of neonates signed an informed consent form after explaining the advantages and possible risks of the study. The ethical committee of Al-Azhar University Hospitals approved the study protocol. Results: Neonatal characteristics distribution there were 71% patients had SGA (<10th centile), mean of birth weight ranged from 1230-3800 kg with mean of 2100.80±1740.11 kg, duration of shocked ranged from 4-12 days, with mean 7.96±6.13 days, NICU stay was ranged from 4-9 days with mean 6.82±3.10 days. Regarding the intraventricular hemorrhage among the studied neonates, most of patients had grade 1 by 20%, followed 9% had grades 3 and 7.5% had grades 2, then 2.5% only had grade 4. The mortality rate in neonates with septic shock under study was 26.5%. Regarding echocardiographic parameters, VO and FS were significantly higher at 1 hour of noradrenaline (288.30±163.9, 47.32±19.12) compared to an initiation (212.4±79.18, 29.50±14.01), (p˂0.05). MBP significantly improved after noradrenaline (37.82 ±8.22) compared to before noradrenaline (30.65 ±6.11). Conclusion: The death rate among infants with septic shock in this study was 26.5%. The administration of noradrenaline in addressing hemodynamic instability during neonatal septic shock plays a critical yet complex role in the neonatal intensive care environment. Noradrenaline significantly increases systemic vascular resistance and elevates mean arterial pressure, which is essential for preserving organ perfusion in at-risk newborns.

As low as reasonably practicable (ALARP): a moral model for clinical risk management in the setting of technology dependence

Children dependent on life-prolonging medical technology are often subject to a constant background risk of sudden death or catastrophic complications. Such children can be cared for in hospital, in an...

1993. Donor-Derived Transmission of Candida species: 10-year Analysis from the OPTN ad hoc Disease Transmission Advisory Committee (DTAC)

Abstract Background Solid organ transplantation (SOT) is lifesaving, but donor-derived infections can be associated with significant morbidity and mortality. Candida species are common colonizers in deceased donors managed in the intensive care environment, and transmission to the recipient through transplantation is a described phenomenon. We sought to characterize Candida transmission events in the US SOT population. Methods Cases referred to Organ Procurement and Transplantation Network (OPTN) Disease Transmission Advisory Committee (DTAC) between 2012 and 2022 as potential donor disease transmission events (PDDTE) were adjudicated by DTAC based on consensus definitions. We included all recipients from any donor in which ≥1 proven or probable (P/P) or possible transmission of Candida occurred. Results Forty deceased donors were identified (characteristics, Table 1). 124 SOT recipients received organs from these donors including 60 kidney, 27 liver, 15 heart, 14 lung, and 8 multivisceral or other. DTAC adjudications of recipients included 8 proven, 16 probable, 24 possible, 1 unlikely, 51 excluded, and 24 intervention without disease transmission (IWDT). Growth of Candida in culture occurred in 24 of 40 donors and 63 of 124 recipients. Recipients were frequently bacteremic and had Candida growth at site of explanted kidney (Table 2). Mycotic aneurysm, bleed or hematoma occurred in 22 SOT recipients, 10 of which were P/P. Allograft explant was performed in 14 recipients (13 kidney and 1 other), 7 of which were P/P. Within 45 days of PDDTE reports, death occurred in 17 SOT recipients (1 proven, 7 possible, 7 excluded, 1 unlikely, 1 unknown). Only 6 of the 17 recipients who died received antifungal therapy. Seven deaths occurred in the 49 mate recipients of the 24 P/P transmissions, though lack of culture results did not support escalating adjudications beyond possible. Conclusion Donor-derived Candida infections occur with significant associated morbidity, including graft loss, and mortality, especially in kidney recipients. Opportunity exists to further identify risks, improve communication across transplant centers, initiate appropriate antifungal therapy, and improve management of mycotic aneurysm due to candidiasis. Disclosures Jason D. Goldman, MD, MPH, Adaptive Biotechnologies: Collaborative services agreements|Eli Lilly: Advisor/Consultant|Eli Lilly: Grant/Research Support|Eli Lilly: Honoraria|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Gilead Sciences: Honoraria|GSK: Advisor/Consultant|Karius, Inc.: Advisor/Consultant|Merck: Grant/Research Support|Monogram Biosciences / Labcorp: Collaborative services agreements|Regeneron: Grant/Research Support Anil J. Trindade, MD, CareDx, Inc.: Advisor/Consultant|CareDx, Inc.: Grant/Research Support|Veloxis Pharmaceuticals, Inc.: Grant/Research Support Ricardo M. La Hoz, MD, Takeda: Advisor/Consultant Lara A. Danziger-Isakov, MD, MPH, Aicuris: Contracted Clinical Research|Ansun Biopharma: Contracted Clinical Research|Astellas: Contracted Clinical Research|GSK: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Contracted Clinical Research|Pfizer: Contracted Clinical Research|Roche Diagnostics: Advisor/Consultant|Takeda: Advisor/Consultant|Takeda: Contracted Clinical Research

Accuracy of intra-arterial line transducer levelling practice in a general intensive care unit

BackgroundThe intra-arterial line is a common device intervention used in the intensive care environment to provide continuous blood pressure measurement. The transducer line is levelled to the patient's phlebostatic axis to provide accurate measurements. AimThe aim of this study was to investigate registered nurses' accuracy at levelling the transducer to the correct anatomical position using visual judgement, compared to one done using a laser level. MethodsPatient transducers were levelled by visual judgement and then by using a laser level. Time and mean arterial pressure (MAP) were recorded with each measurement along with any difference in transducer level between the two methods and subsequent changes in inotrope administration. ResultsA total of 577 MAP measurements were recorded from 178 patients; 70% of observations had a difference in transducer level, 30% of the time the inotrope rate was increased and 18% of the time the inotrope rate was reduced. The prevalence of clinically significant observations with an absolute difference of 50 mm or more in transducer placement was 25%. The mean difference in MAP measurements when a cut-off of 64 mmHg or more for laser was applied to the data was 0.22 (95% confidence interval: −0.14, 0.58, n = 513, p = 0.23), and for a cut-off of less than 64 for laser, a larger mean difference of 4.36 (95% confidence interval: 3.75, 5.28], n = 64, p < 0.001) was observed. ConclusionsTransducers were unable to be accurately levelled for haemodynamic monitoring using visual means alone. Over the range of patient MAP values examined, 25% of all observations had a clinically significant absolute difference of 50 mm or more in the transducer level position between the two methods. The visual method became increasingly inaccurate and unreliable at low MAP levels requiring medical intervention.

Complex decision making in an intensive care environment: Perceived practice versus observed reality.

Advancing our understanding of how decisions are made in cognitively, sociallyand technologically complex hospital environments may reveal opportunities to improve healthcare delivery, medical educationand the experience of patients, familiesand clinicians. Explore factors impacting clinician decision making in the Boston Children's Hospital Cardiac Intensive Care Unit. A convergent mixed methods design was used. Quantitative and qualitative data sources consisted of a faculty survey, direct observations of clinical rounds in a specific patient population identified by a clinical decision support system (CDSS)and semistructured interviews (SSIs). Deductive and inductive coding was used for qualitative data. Qualitative data were translated into images using social network analysis which illustrate the frequency and connectivity of the codes in each data set. A total of 25 observations of eightfaculty-led interprofessional teams were performed between 12 Februaryand 31 March 2021. Individual patient characteristics were noted by faculty in SSIs to be the most important factor in their decision making, yet ethnographic observations suggested faculty cognitive traits, team expertiseand value-based decisions were more heavily weighted. The development of expertise was impacted by role modeling. Decisions were perceived to be influenced by the system and environment. Clinician perception of decision making was not congruent with the observed behaviours in a complicated and dynamic system. This study identifies important considerations in clinical curricula as well as the design and implementation of CDSS. Our method of using social network analysis to visualize components of decision making could be adopted to explore other complex environments.

Comparing nursing workload for critically ill adults with and without COVID-19: Retrospective cohort study.

Intensive care environments already required complex work, and, furthermore, the recent COVID-19 pandemic increased health care demands, disorganized work teams and limited resources. Nonetheless, the real workload of nursing workers in the care for critical patients during this period was seldom investigated. To compare the workload of nursing workers, estimated using the Nursing Activities Score (NAS), in patients with and without COVID-19 who had been hospitalized in an adult intensive care unit (ICU). This study was developed in the ICU of a public university hospital in the south of Brazil. The workload of nursing workers was estimated using the NAS, which was developed through a retrospective cohort using reports of the assistance registered in electronic records, including the first 10 days of hospitalization of all patients admitted into the ICU in 2020 and 2021, who had at least one NAS evaluation; then, the workload was compared between patients with and without COVID-19. Generalized estimating equations models were used. The project was approved by the research ethics committee of the institution where the study took place. The follow-up of 3485 patients resulted in 20 506 days of observation during the first 10 days of ICU hospitalization. The mean NAS score for the entire patient/day sample was 85.6 ± 18.1%, with 87.8 ± 17.8% in the COVID-19 group and 82.6 ± 18.2% in the non-COVID-19 group (p < .001). The use of mechanical ventilation, noradrenaline, sedation and neuromuscular blocking drugs, extracorporeal membrane oxygenation and haemodialysis increased the value of NAS for patients with or without COVID-19. The workload of nursing professionals was higher for COVID-19 patients than for patients who did not present the disease in the first 10 days of ICU hospitalization. This study presents the impact of COVID-19 on the ICU nursing workload in Brazil. The high workload found can support management decisions regarding quantity and quality of workforce composition.

Effects of the neonatal intensive care environment on circadian health and development of preterm infants.

The circadian system in mammals ensures adaptation to the light-dark cycle on Earth and imposes 24-h rhythmicity on metabolic, physiological and behavioral processes. The central circadian pacemaker is located in the brain and is entrained by environmental signals called Zeitgebers. From here, neural, humoral and systemic signals drive rhythms in peripheral clocks in nearly every mammalian tissue. During pregnancy, disruption of the complex interplay between the mother's rhythmic signals and the fetal developing circadian system can lead to long-term health consequences in the offspring. When an infant is born very preterm, it loses the temporal signals received from the mother prematurely and becomes totally dependent on 24/7 care in the Neonatal Intensive Care Unit (NICU), where day/night rhythmicity is usually blurred. In this literature review, we provide an overview of the fetal and neonatal development of the circadian system, and short-term consequences of disruption of this process as occurs in the NICU environment. Moreover, we provide a theoretical and molecular framework of how this disruption could lead to later-life disease. Finally, we discuss studies that aim to improve health outcomes after preterm birth by studying the effects of enhancing rhythmicity in light and noise exposure.

A Critical Reassessment of the Kidney Risk Caused by Tetrastarch Products in the Perioperative and Intensive Care Environments.

Purpose: To reassess the results of former meta-analyses focusing on the relationship between novel HES preparations (130/0.4 and 130/0.42) and acute kidney injury. Previous meta-analyses are based on studies referring to partially or fully unpublished data or data from abstracts only. Methods: The studies included in the former meta-analyses were scrutinized by the authors independently. We completed a critical analysis of the literature, including the strengths, weaknesses and modifiers of the studies when assessing products, formulations and outcomes. Results: Both the published large studies and meta-analyses show significant bias in the context of the deleterious effect of 6% 130/0.4-0.42 HES. Without (1) detailed hemodynamic data, (2) the exclusion of other nephrotoxic events and (3) a properly performed evaluation of the dose-effect relationship, the AKI-inducing property of 6% HES 130/0.4 or 0.42 should not be considered as evidence. The administration of HES is safe and effective if the recommended dose is respected. Conclusions: Our review suggests that there is questionable evidence for the deteriorating renal effect of these products. Further well-designed, randomized and controlled trials are needed. Additionally, conclusions formulated for resource-rich environments should not be extended to more resource-scarce environments without proper qualifiers provided.

Determination of Stress and Anxiety Levels of Parents of Infants Staying in Neonatal Intensive Care Unit

Introduction: Anxiety and stress in parents’ lives during their babies' NICU stays can have a negative impact on all family members. This study aimed to measure the stress and anxiety levels of parents of infants in the neonatal intensive care unit receiving oxygen support.&#x0D; Methods: This study was conducted based on cross-sectional design with 123 parents of infants between 1 August 2020 and 01 May 2021. Data was gathered using the "State-Trait Anxiety Inventory (STAI)", "Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU)", and "Parent Information Form and Infant Information Form".&#x0D; Results: The STAI scores of the parents were considered "moderately anxious" and the parents were "moderately stressed" based on the overall mean scores on the PSS: NICU and the mean scores on the subscales of the scale. It was found that parents’ number of children, employment, infant gender, type of delivery, intensive care environment characteristics, parents' communication with health personnel, and health condition all influenced their scores on the STAI and PSS: NICU subscales.&#x0D; Conclusion: Providing a holistic and family-centred approach to parents, the closest relatives of their infants who will create future generations as well as educational and counselling roles played by nurses and reducing stress and anxiety experienced by parents, will have a positive impact on neonatal health.

Factors that may threaten or protect the wellbeing of staff working in paediatric intensive care environments

ObjectiveThis study explored the risk and protective factors for wellbeing from the perspectives of multidisciplinary paediatric intensive care unit staff. DesignUsing a qualitative, descriptive study design we purposively recruited a sample of nurses, physicians, and allied health professionals to participate in semi-structured interviews which explored staff perceptions of risk and protective factors relating to their daily paediatric intensive care roles. Data was analysed using thematic analysis. SettingFour paediatric intensive care units in Australia. FindingsTwenty staff were recruited. Braun and Clarke’s thematic analysis approach identified perceived risks for wellbeing included a lack of preparation for the role, and clinical situations that contributed to psychological distress, including perceived worst shift, moral distress, non-accidental injuries, and isolation. Themes perceived as protective to wellbeing included: finding the work stimulating and meaningful, belonging to the team, and using humour. ConclusionStaff perceptions of wellbeing in the paediatric intensive care unit suggested that risk factors often co-existed simultaneously with protective factors. These results are not consistent with the notion that wellbeing as a phenomenon can be considered on a risk-protection continuum. Strategies that enhance this work as meaningful and stimulating, promote a sense of belonging to the team, and support the use of humour, may assist health professionals to achieve a balance between risk and protective factors for wellbeing. Implications for clinical practiceEducation and training on end-of-life care, and how to have difficult conversations and manage the consistent psychological distress of intensive care work, is essential at orientation and requires regular formal interventions.Experiencing the work as stimulating highlights the need for advanced scope of practice work. Opportunities for individual and team reflection about the meaning and purpose of their work, and ensuring staff feel valued and experience a sense of belonging to the team, are critical to the intensive care context.

Airway management in paediatric emergencies outside of an intensive care setting: a quality improvement project using Lean/Six Sigma methodology

Use of a Lean/Six Sigma methodology in a quality improvement project to reduce variation and improve safety in airway management outside of the intensive care environment in a tertiary paediatric...

Respiratory Rate Extraction from Neonatal Near-Infrared Spectroscopy Signals.

Background: Near-infrared spectroscopy (NIRS) relative concentration signals contain 'noise' from physiological processes such as respiration and heart rate. Simultaneous assessment of NIRS and respiratory rate (RR) using a single sensor would facilitate a perfectly time-synced assessment of (cerebral) physiology. Our aim was to extract respiratory rate from cerebral NIRS intensity signals in neonates admitted to a neonatal intensive care unit (NICU). Methods: A novel algorithm, NRR (NIRS RR), is developed for extracting RR from NIRS signals recorded from critically ill neonates. In total, 19 measurements were recorded from ten neonates admitted to the NICU with a gestational age and birth weight of 38 ± 5 weeks and 3092 ± 990 g, respectively. We synchronously recorded NIRS and reference RR signals sampled at 100 Hz and 0.5 Hz, respectively. The performance of the NRR algorithm is assessed in terms of the agreement and linear correlation between the reference and extracted RRs, and it is compared statistically with that of two existing methods. Results: The NRR algorithm showed a mean error of 1.1 breaths per minute (BPM), a root mean square error of 3.8 BPM, and Bland-Altman limits of agreement of 6.7 BPM averaged over all measurements. In addition, a linear correlation of 84.5% (p < 0.01) was achieved between the reference and extracted RRs. The statistical analyses confirmed the significant (p < 0.05) outperformance of the NRR algorithm with respect to the existing methods. Conclusions: We showed the possibility of extracting RR from neonatal NIRS in an intensive care environment, which showed high correspondence with the reference RR recorded. Adding the NRR algorithm to a NIRS system provides the opportunity to record synchronously different physiological sources of information about cerebral perfusion and respiration by a single monitoring system. This allows for a concurrent integrated analysis of the impact of breathing (including apnea) on cerebral hemodynamics.

Alcohol use disorder treatment delivered outside hepatology clinic.

Alcohol use disorder treatment delivered outside hepatology clinic.

Functional near-infrared spectroscopy as a tool to assess residual and covert consciousness in the intensive care unit (P11-7.003)

<h3>Objective:</h3> We evaluate the feasibility of using functional near-infrared spectroscopy (fNIRS) to detect the neural correlates of conscious processing with one patient in the intensive care unit and 25 healthy controls. <h3>Background:</h3> Little is known about the extent of covert cognitive processing in unresponsive critically ill patients. Advanced neuroimaging techniques offer new ways of enhancing our understanding of brain function in this population by providing objective and quantifiable markers of neural activity. fNIRS is a promising modality for this application since the technology is portable, inexpensive, and susceptible to motion, making it ideal for the intensive care environment. <h3>Design/Methods:</h3> A series of validated neuroimaging paradigms were employed to assess somatosensory perception, auditory processing, and covert command following in a behaviourally unresponsive patient who sustained a brainstem stroke and with 25 healthy controls. An fNIRS system with 129 channels providing full head coverage was used. A channel was considered activated if there was a significant concurrent increase in oxyhemoglobin and decrease in deoxyhemoglobin (<i>p</i>&lt;0.05). <h3>Results:</h3> For the somatosensory perception task, 100% of healthy controls showed activity in somatosensory areas. 88% of healthy participants demonstrated responses in the superior and medial temporal gyrus in response to the auditory processing task, while 92% of healthy participants had responses to the motor imagery task. When employed in the ICU with one patent, fNIRS activity revealed preserved somatosensory and auditory processing abilities. Moreover, the patient was able to reliably and consistently perform the motor imagery task, demonstrating preserved conscious awareness despite being behaviourally unresponsive. <h3>Conclusions:</h3> This work demonstrates the feasibility of using fNIRS as an assessment tool for covert cognitive function in the ICU. Future research will focus on evaluating the diagnostic and prognostic efficacy of fNIRS with acute critically ill patients. <b>Disclosure:</b> Mr. Kazazian has nothing to disclose. Dr. Abdalmalak has nothing to disclose. Loretta Norton has nothing to disclose. Dr. Junio has nothing to disclose. Mr. Moulavi Ardakani has nothing to disclose. Mr. Kolisnyk has nothing to disclose. The institution of Dr. Gofton has received research support from Government of Canada. The institution of Dr. Gofton has received research support from Canadian Institutes of Health Research. The institution of Dr. Gofton has received research support from Academic Medical Organisation of Southwestern Ontario. Dr. Gofton has a non-compensated relationship as a Medical Advisory Board Member with NORSE Institute that is relevant to AAN interests or activities. Adrian Owen has nothing to disclose. Dr. Debicki has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB Canada Inc.. The institution of Dr. Debicki has received research support from Academic Medical Association of Southwestern Ontario. The institution of Dr. Debicki has received research support from Western BrainScan. The institution of Dr. Debicki has received research support from Lawson Research. The institution of Dr. Debicki has received research support from Canadian Institutes of Health Research.

Providers’ perspectives of the neonatal intensive care unit context and care provision for adolescent parents: an interpretive description

BackgroundThe neonatal intensive care unit (NICU) is a complex care environment, with the NICU patient population among the most vulnerable in a hospital setting. Adolescent parents are a unique group within the broader NICU parent population and admission of their infant to the NICU contributes to an already complex situation as adolescent pregnancy and parenting is often associated with a range of psychosocial challenges. How the NICU care context influences care provision for adolescent parents is a significant gap in the NICU parenting and support discourse. Therefore, this study aimed to explore health and social care providers’ perspectives of the NICU care context and how providers perceive the context as influencing the experiences of adolescent parents in the NICU.MethodsThis was a qualitative, interpretive description study design. In-depth interviews were conducted with providers, including nurses and social workers, caring for adolescent parents in the NICU. Data was collected between December 2019 and November 2020. Data were analyzed concurrently with data collection. Constant comparison, analytic memos, and iterative diagramming techniques were used to challenge developing analytic patterns.ResultsProviders (n = 23) described how the unit context influenced care provision as well as experiences for adolescent parents. We learned that having a baby in the NICU was perceived by providers as a traumatic experience for parents – impacting attachment, parenting confidence and competence, and mental health. Environmental factors – such as privacy and time – and perceptions that adolescent parents are treated differently in the NICU were also seen as influencing this overall experience.ConclusionsProviders involved in the care of adolescent parents in the neonatal intensive care unit described the distinctiveness of this group within the broader parent population and how quality of care may be impacted by contextual factors as well as experiences of age-related stigma. Further understanding of NICU experiences from the parents’ perspectives are warranted. Findings highlight opportunities for strengthened interprofessional collaboration and trauma- and violence-informed care strategies within the neonatal intensive care environment to mitigate the potential negative influence of this experience and improve care for adolescent parents.