共查询到20条相似文献，搜索用时 23 毫秒
1.
James M. Walter Chitaru Kurihara Thomas C. Corbridge Ankit Bharat 《Heart & lung : the journal of critical care》2018,47(4):398-400
Background
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is increasingly utilized in the management of severe acute respiratory distress syndrome (ARDS). Providers who care for patients on VV-ECMO should be familiar with common circuit complications.Objectives
To provide an example of a common complication, circuit “chugging,” and suggest a management algorithm which aims to avoid excessive fluid administration to patients with ARDS.Methods
We use a clinical case to illustrate chugging and discuss potential management strategies.Results
Our patient received frequent boluses of albumin for intermittent circuit chugging contributing to a net positive fluid balance of roughly 6 liters 4 days after cannulation.Conclusions
Chugging is a common complication for patients on VV ECMO. A thoughtful approach to management may help limit potentially harmful fluid administration for patients with ARDS. 相似文献2.
Halley Ruppel Marjorie Funk Holly Powell Kennedy Christopher P. Bonafide Shu-Fen Wung Robin Whittemore 《Heart & lung : the journal of critical care》2018,47(5):502-508
Background
Customizing monitor alarm settings to individual patients can reduce alarm fatigue in intensive care units (ICUs), but has not been widely studied.Objectives
To understand ICU nurses' approaches to customization of electrocardiographic (ECG) monitor alarms.Methods
A convergent mixed methods study was conducted in 3 ICUs in 1 hospital. Data on the type and frequency of ECG alarm customization were collected from patient monitors (n=298). Nurses' customization clinical reasoning was explored through semi-structured interviews (n=27).Results
Of the 298 patients, 58.7% had ≥1 alarm(s) customized. Heart rate limits, irregular heart rate, and atrial fibrillation were the most commonly customized alarms. Interviews revealed that customization practices varied widely and were influenced by factors including clinical expertise, lack of customization education, and negative experiences.Conclusion
Alarm customization is nuanced and requires adequate support to develop safe and effective practices. The challenges identified can inform development of strategies to improve alarm customization. 相似文献3.
Federica Dellafiore Harleah G. Buck Gianluca Pucciarelli Claudio Barbaranelli Marco Paturzo Rosaria Alvaro Ercole Vellone 《Heart & lung : the journal of critical care》2018,47(6):553-561
Background
Higher patient-caregiver mutuality is associated with improved patient and caregiver outcomes, but no studies have tested the psychometric characteristics of the mutuality scale (MS) in heart failure (HF) patient and caregiver population.Objectives
To test the validity and reliability of the MS.Methods
A cross-sectional design. The MS validity and reliability were tested with confirmatory factor analysis (CFA) and hypothesis testing, and with Cronbach's alpha and model-based internal consistency index, respectively.Results
CFA supported the validity of the MS in the HF patient and caregiver versions. Hypothesis testing showed significant correlations between both versions of the MS and anxiety, depression, quality of life, and self-care. Also, MS caregiver version scores correlated significantly with caregiver preparedness. Cronbach's alphas and the model-based internal consistency index ranged between 0.72 and 0.94 in both versions.Conclusions
The Mutuality Scale showed supportive validity and reliability for HF patients and caregivers. 相似文献4.
Jengyuan Wu Chienming Liu Shangsen Lee Yuhung Kuo Tengfu Hsieh 《Heart & lung : the journal of critical care》2018,47(2):157-161
Background
Patients with thoracic empyema have an increased risk of mortality, but their absolute rate of mortality depends on age and comorbidities.Objective
This study seeks to assess the predictive value of the Charlson Comorbidity Index score (CCIS), CHADS2 and CHA2DS2-VASc scores for mortality risk in patients with empyema thoracis.Methods
From Taiwan's National Health Insurance Research Database we identified a total of 484 participants diagnosed with thoracic empyema. The CCIS, CHADS2 and CHA2DS2-VASc scores were used to stratify mortality risk.Results
The incidence rate of mortality in the present study was 20.39 per 1000 person-months. A strong correlation was found between thoracic empyema and CCIS score.Conclusions
Our results show that patients with thoracic empyema have a significantly high incidence rate of mortality and that CCIS can be used as an indicator of risk for mortality. 相似文献5.
Gbolahan O. Ogunbayo Le Dung Ha Qamar Ahmad Naoki Misumida Ayman Elbadawi Odunayo Olorunfemi Andrew Kolodziej Adrian W. Messerli Ahmed Abdel-Latif Claude S. Elayi Maya Guglin 《Heart & lung : the journal of critical care》2018,47(4):392-397
Introduction
This study compared inpatient outcomes related to the use of these two devices among patients who developed cardiogenic shock not due to acute myocardial infarction or coronary revascularization.Methods
We extracted admission-level records of patients with a diagnosis of cardiogenic shock who underwent either PVAD or IABP implantation from the National Inpatient Sample (NIS) database from 2010 to 2014. Our outcomes of interest were mortality and length of stay.Results
Inpatient mortality was significantly higher in the PVAD cohort. In multivariate analysis, PVAD use in these patients was associated with higher mortality. There was no difference in the length of stay between both groups among patients that survived to discharge.Conclusion
In our analysis of the NIS database, the use of PVADs in patients with cardiogenic shock of non-ischemic origin was associated with higher mortality when compared to IABP use. 相似文献6.
7.
Iliana S. Hurtado Rendón Diego Alcivar Juan Pablo Rodriguez-Escudero Kevin Silver 《The American journal of medicine》2018,131(2):202-205
Background
Stress cardiomyopathy is a transient cardiac syndrome characterized by reversible left ventricular systolic dysfunction precipitated by emotional or physiologic stress. The presence of obstructive coronary artery disease has been noted in stress cardiomyopathy.Methods
We describe 3 case reports of patients with acute coronary syndrome and transient wall motion abnormalities not usually seen in the distribution of coronary artery disease.Results
In these 3 cases of acute myocardial infarction, the distribution of the culprit coronary occlusion was not concordant with the territory of transient wall motion abnormality. Follow-up demonstrated resolution of the wall motion abnormalities without intervention in these territories.Conclusion
We believe that the physiologic stress of the acute coronary syndrome may have precipitated the stress cardiomyopathy as presented by these patients. This is the first demonstration that stress cardiomyopathy may be precipitated by acute coronary syndrome. 相似文献8.
9.
Jemima Boyd Jenny Paratz Oystein Tronstad Lawrence Caruana Paul McCormack James Walsh 《Heart & lung : the journal of critical care》2018,47(2):81-86
Rationale
Consensus recommendations have been developed to guide exercise rehabilitation of mechanically ventilated patients in the intensive care unit.Objective
This study aimed to investigate the safety of exercise rehabilitation of mechanically ventilated patients and evaluate the consensus recommendations.Methods
This was a prospective, single-centre, cohort study conducted in a specialist cardiothoracic intensive care unit of a tertiary, university affiliated hospital in Australia.Results
91 mechanically ventilated participants; 54 (59.3%) male; mean age of 56.52 (16.3) years; were studied with 809 occasions of service recorded. Ten (0.0182%) minor adverse events were recorded, with only one adverse event occurring when a patient was receiving moderate level of vasoactive support.Conclusions
The consensus recommendations are a useful tool in guiding safe exercise rehabilitation of mechanically ventilated patients. Our findings suggest that there is further scope to safely commence exercise rehabilitation in patients receiving vasoactive support. 相似文献10.
Gianfranco Sanson Yuliya Khlopenyuk Sara Milocco Massimiliano Sartori Lorella Dreas Adam Fabiani 《Heart & lung : the journal of critical care》2018,47(4):408-417
Background
In cardiac surgical patients little is known about different phenotypes of delirium and how the symptoms fluctuate over time.Objectives
Evaluate risk factors, incidence, fluctuations, phenotypic characteristics and impact on patients' outcomes of delirium.Methods
Prospective longitudinal study. In postoperative intensive care unit 199 patient were assessed three-times a day through an adapted versions of the Intensive Care Delirium Screening Checklist.Results
Delirium and subsyndromal delirium incidence were 30.7% and 31.2%, respectively. Delirium manifested mostly in the hypoactive form and showed a fluctuating trend for several days.Atrial fibrillation, benzodiazepine/opioids dosages, hearing impairment, extracorporeal circulation length, SAPS-II and mean arterial pressure were independent predictors for delirium. Delirium was a statistically significant predictor of chemical/physical restraint use and hospital length of stay.Conclusions
Given the fluctuating and phenotypic characteristics, delirium screening should be a systematic/intentional activity. Multidisciplinary prevention strategies should be implemented to identify and treat the modifiable risk factors. 相似文献11.
Robyn Gallagher Sue Randall Stella H.M. Lin Janice Smith Alexander M. Clark Lis Neubeck 《Heart & lung : the journal of critical care》2018,47(5):471-476
Background
The mechanisms contributing to the success of cardiac rehabilitation (CR) are poorly understood and may include assessment, monitoring and review activities enabled by continuity of care and this is investigated in this study.Objectives
To identify active assessment components of CR.Methods
A qualitative study using focus groups and individual interviews. CR staff (n = 39) were recruited via professional association email and network contacts and organised into major themes.Results
CR staff assessment strategies and timely actions undertaken provided a sophisticated post-discharge safety net for patients. Continuity of care enabled detection of adverse health indicators, of which medication issues were prominent. Interventions were timely and personalised and therefore likely to impact outcomes, but seldom documented or reported and thus invisible to audit.Conclusion
CR staff assessment and intervention activities provide an unrecognised safety net of activities enabled by continuity of care, potentially contributing to the effectiveness of CR. 相似文献12.
Jungeun Lee Huong Q. Nguyen Monica E. Jarrett Pamela H. Mitchell Kenneth C. Pike Vincent S. Fan 《Heart & lung : the journal of critical care》2018,47(2):149-156
Background
Chronic obstructive pulmonary disease (COPD) patients experience multiple symptoms including dyspnea, anxiety, depression, and fatigue, which are highly correlated with each other. Together, those symptoms may contribute to impaired physical performance.Objectives
The purpose of this study was to examine interrelationships among dyspnea, anxiety, depressive symptoms, and fatigue as contributing factors to physical performance in COPD.Methods
This study used baseline data of 282 COPD patients from a longitudinal observational study to explore the relationship between depression, inflammation, and functional status. Data analyses included confirmatory factor analyses and structural equation modeling.Results
Dyspnea, anxiety and depression had direct effects on fatigue, and both dyspnea and anxiety had direct effects on physical performance. Higher levels of dyspnea were significantly associated with impaired physical performance whereas higher levels of anxiety were significantly associated with enhanced physical performance.Conclusion
Dyspnea was the strongest predictor of impaired physical performance in patients with COPD. 相似文献13.
Connie Schumacher Leslie Hussey Vincent Hall 《Heart & lung : the journal of critical care》2018,47(4):297-303
Objective
To explore the decision making processes undertaken by community-dwelling individuals with heart failure as they experience symptom changes.Background
Heart failure patients are responsible for daily self-management that includes responding to symptom fluctuations between exacerbations. Despite education, some patients fail to seek timely medical intervention when symptoms change.Methods
Semi-structured interviews were conducted with homecare patients after receiving self-management education. Grounded theory methods and qualitative software were used to collect and analyze the data.Results
Five themes were identified: perceiving symptoms, alleviating actions and control, normalizing symptoms, absence of help seeking behaviors, and decreased functional capacity. Normalizing symptoms included actions taken by participants to mitigate symptom fluctuations. Daily fluctuations were assimilated into normal life resulting in desensitization of symptom recognition and decreased functional capacity.Conclusions
Findings support the need to educate on early symptom recognition, the benefits of safe physical activity, and building a system to support self-management patient-physician collaboration. 相似文献14.
Chunhua Ma 《Heart & lung : the journal of critical care》2018,47(2):136-141
Objectives
To explore whether five variables of the health belief model were factors influencing self-care behaviors in young and middle-aged adults with hypertension.Background
The self-care behaviors of young and middle-aged adults with hypertension are suboptimal in China, and the factors associated with self-care behaviors have rarely been studied in the population.Methods
A questionnaire survey was adopted in the study. 382 eligible participants were recruited from two tertiary teaching hospitals using the convenience sampling.Results
The predictors of self-care behaviors in young and middle-aged adults with hypertension included age, complications related to hypertension, perceived susceptibility, severity, benefits, barriers and self-efficacy. Five aspects of health beliefs model accounted for 47.0% of total variance.Conclusions
The perceived susceptibility, severity, benefits, barriers, and self-efficacy were key factors affecting self-care behaviors in young and middle-aged adults with hypertension. A health education program targeting improving health beliefs for the population should be developed. 相似文献15.
Bülent Özlek Eda Özlek Oğuzhan Çelik Cem Çil Volkan Doğan Murat Biteker 《Heart & lung : the journal of critical care》2018,47(4):360-362
Background
Allergic myocardial infarction is a rare clinical entity.Objectives
Although a few number of case reports with severe anaphylactic reactions to recombinant human insulin have been reported, allergic myocardial infarction, known as Kounis Syndrome, has not been reported before.Methods
Herein, we report a 57-year-old woman with myocardial infarction, referred for urticarial rash, chest pain, and palpitations developed after the first subcutaneous dose of recombinant human insulin.Results
The patient treated with antihistamines and steroids and discharged from hospital in a good condition.Conclusions
Physicians should be aware of allergic myocardial infarction. The diagnosis of Kounis Syndrome should be entertained when allergic symptoms, electrocardiographic changes, and high cardiac enzymes accompany acute-onset chest pain. All patients admitted to the emergency department with chest pain and ST elevation on electrocardiography should be asked about allergic insults. 相似文献16.
Vladimira Timkova Iveta Nagyova Sijmen A. Reijneveld Ruzena Tkacova Jitse P. van Dijk Ute Bültmann 《Heart & lung : the journal of critical care》2018,47(4):371-379
Background
Social support and mastery are important aspects in the treatment of chronic diseases, however their role in connection with Obstructive Sleep Apnoea (OSA) remains unclear.Objectives
The study examined the associations between social support, mastery, sleep-related problems and functional status in untreated OSA patients.Methods
All patients in this cross-sectional study completed the Multidimensional Scale of Perceived Social Support, the Pearlin Mastery Scale, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale and the Functional Outcomes of Sleep Questionnaire. Multiple linear regression and mediation analyses were used to analyse the data.Results
Participants were 150 newly diagnosed OSA patients (Apnoea-Hypopnoea Index–AHI≥5; 68% male; mean age 48.9 ± 9.5years). Compared with social support, mastery was more strongly associated with functional status. The indirect effects of sleep-related problems on functional status via mastery varied between 17.7% and 23.3%.Conclusions
Supporting OSA patients' sense of mastery may significantly contribute to better disease management. 相似文献17.
Alex Studemeister Lucy Studemeister Francisco Brun 《Heart & lung : the journal of critical care》2018,47(3):261-263
Background
Severe coccidioidal pneumonia with acute respiratory distress syndrome (ARDS) is associated with high mortality. Extracorporeal membrane oxygenation (ECMO) has been applied successfully to other severe fungal pneumonia associated with ARDS. We review our experience with the use of ECMO in severe coccidioidal ARDS.Objectives
To review indications and outcome of ECMO in severe pulmonary coccidioidomycosis.Methods
Three cases of severe ARDS caused by coccidioidomycosis are presented. All were managed with ECMO. Clinical course, complications, antifungal therapy and outcome are reviewed.Results
Three cases of severe coccidioidal ARDS survived after treatment with ECMO. Common complications included bacterial pneumonia, encephalopathy and critical illness myopathy. They received liposomal amphotericin during ECMO, and transitioned to azole therapy. All required prolonged hospitalization and rehabilitation.Conclusions
ECMO was life-saving in cases of coccidioidal ARDS. Common complications included pneumonia, encephalopathy and critical illness myopathy. All cases were successfully managed with liposomal amphotericin followed by azole therapy. They required prolonged hospitalization and rehabilitation. 相似文献18.
JiYeon Choi Jennifer H. Lingler Michael P. Donahoe Mary Beth Happ Leslie A. Hoffman Judith A. Tate 《Heart & lung : the journal of critical care》2018,47(4):401-407
Background
Few studies have longitudinally explored the experience and needs of family caregivers of ICU survivors after patients' home discharge.Methods
Qualitative content analysis of interviews drawn from a parent study that followed family caregivers of adults ICU survivors for 4 months post-ICU discharge.Results
Family caregivers (n = 20, all white, 80% woman) viewed home discharge as positive progress, but reported having insufficient time to transition from family visitor to the active caregiver role. Caregivers expressed feelings of relief during the steady recovery of family members' physical and cognitive function. However, the slow pace of improvement conflicted with their expectations. Even after patients achieved independent physical function, emotional needs persisted and these issues contributed to caregivers' anxiety, worry, and view that recovery was incomplete.Conclusion
Family caregivers of ICU survivors need information and skills to help managing patients' care needs, pacing expectations with actual patients' progress, and caregivers' health needs. 相似文献19.
Nancy M. Albert James F. Bena Denise Buxbaum Linda Martensen Shannon L. Morrison Marilyn A. Prasun Kelly D. Stamp 《Heart & lung : the journal of critical care》2018,47(3):184-191
Background
Research findings on the value of nurse certification were based on subjective perceptions or biased by correlations of certification status and global clinical factors. In heart failure, the value of certification is unknown.Objectives
Examine the value of certification based nurses' decision-making.Methods
Cross-sectional study of nurses who completed heart failure clinical vignettes that reflected decision-making in clinical heart failure scenarios. Statistical tests included multivariable linear, logistic and proportional odds logistic regression models.Results
Of nurses (N = 605), 29.1% were heart failure certified, 35.0% were certified in another specialty/job role and 35.9% were not certified. In multivariable modeling, nurses certified in heart failure (versus not heart failure certified) had higher clinical vignette scores (p = 0.002), reflecting higher evidence-based decision making; nurses with another specialty/role certification (versus no certification) did not (p = 0.62).Conclusions
Heart failure certification, but not in other specialty/job roles was associated with decisions that reflected delivery of high-quality care. 相似文献20.
Sikandar H. Khan Michelle Kitsis Dmitriy Golovyan Sophia Wang Linda L. Chlan Malaz Boustani Babar A. Khan 《Heart & lung : the journal of critical care》2018,47(5):489-496