Critical Care Topics
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ICU Staff Report Severe Moral Distress, But Resources Are Underused
Unresolved ethical concerns not only cause individual moral distress, but can also change the staff relationships and clinical cohesiveness.
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Ethical Guidance for Research on Dying or Recently Deceased ICU Patients
There are no authoritative international ethical guidelines governing research on dying or recently deceased individuals. A group of investigators sought to start a conversation about challenges and potential solutions. They developed a preliminary framework for the ethical conduct of research with imminently dying patients.
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Patient Mortality Not Linked to Intensivist Caseloads
In this retrospective cohort study in the United States from 2018-2020, there was no significant association between intensivist-to-patient ratio and patient mortality and no effect modification by having physicians-in-training, nurse practitioners, and physician assistants present.
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Effectiveness of Aerosolized Bronchodilators in Patients Receiving High-Flow Nasal Cannula Oxygen Therapy
In a prospective, single-center study, bronchodilators delivered in line with a high-flow nasal cannula device improved forced expiratory volume in one second and forced vital capacity in patients with chronic obstructive pulmonary disease exacerbation.
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Videolaryngoscopy for Intubation of Critically Ill Patients
In a large, prospective, multicenter, randomized, pragmatic trial, the use of a video laryngoscope resulted in a higher incidence of successful intubation on the first attempt on critically ill patients in the emergency department and intensive care unit compared to the use of the direct laryngoscope.
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New Diagnostic Tools Expected to Revamp Sepsis Care
An expert panel agreed a test is needed to indicate the severity of dysregulated host immune response. Although there was some uncertainty over which patients would benefit most from such a test, the panel agreed the sepsis test should be conducted at triage and produce results in less than 30 minutes.
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Fewer Delays in Sepsis Treatment via Provider in Triage Model
However, more research is needed to identify which key elements of this process can be reliably replicated using cost-effective resources to balance liabilities and risks.
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Many Seriously Ill Older Adults Lack Documented Goals-of-Care Discussions
Benign nudges may advance those discussions. These conversations do not need to be lengthy. A few short inquiries asked by a respectful, attentive provider is all that is needed to help many patients share concerns and preferences for care.
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Some Hospice Medical Aid in Dying Policies Require Staff to Leave Room
Ethicists recommend hospices consider revising policies so nurses can support their patients clinically and emotionally at a critical moment.
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The Complicated Ethics of Medical Aid in Dying
Some patients and staff alike do not know what the process is, which can lead to misconceptions. Others might not want to ask about it, while some might object on moral grounds. Researchers are working on better education.