Essential care of critical illness must not be forgotten in the COVID-19 pandemic.
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ABSTRACT:
SUBMITTER: Baker T
PROVIDER: S-EPMC7270584 | biostudies-literature | 2020 Apr
REPOSITORIES: biostudies-literature
Publications
Essential care of critical illness must not be forgotten in the COVID-19 pandemic.
Baker Tim T Schell Carl Otto CO Petersen Dan Brun DB Sawe Hendry H Khalid Karima K Mndolo Samson S Rylance Jamie J McAuley Daniel F DF Roy Nobhojit N Marshall John J Wallis Lee L Molyneux Elizabeth E
Lancet (London, England) 20200401 10232
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Project description:BackgroundEthical conflict is a problem with negative consequences, which can compromise the quality and ethical standards of the nursing profession and it is a source of stress for health care practitioners', especially for nurses.ObjectivesThe main aim of this study was to analyze Spanish critical care nurses' level of exposure to ethical conflict and its association with sociodemographic, occupational, and COVID-19-related variables. Research Design, Participants, and Research context: This was a quantitative cross-sectional descriptive study conducted among 117 nurses working in critical care units. Data collection tools were sociodemographic, occupational, and COVID-19-related questionnaires and previously validated Spanish version of Ethical Conflict in Nursing Questionnaire-Critical Care Version.Ethical considerationsWe obtained permission from the Ethics Committee and participants' informed consent.FindingsData indicates a moderate level of exposure to ethical conflicts. The most frequent ethical conflicts were related to situations about "treatment and clinical procedures." The most intensity of ethical conflicts was related to situations about "treatment and clinical procedures" and "dynamics of the service and working environment." No statistical significance was identified between the socio-demographic variables and level of exposure to ethical conflicts. However, for critical care nurses working in ICU, nurses with perceived worked stress had a higher level of exposure to ethical conflicts. Likewise, critical care nurses whose family/friends were infected with COVID-19 had a higher level of exposure.ConclusionsCritical care nurses experience a moderate level of exposure to ethical conflicts which is consistent with the results of previous studies. A deeper understanding of ethical conflicts in conflictive situations allows recognition of the situations that occur in everyday clinical practice, identification of the ethical conflicts, and facilitation of the nurses working in the challenging clinical situation.
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Project description:BackgroundThe COVID-19 pandemic has placed an extraordinary strain on healthcare systems across North America. Defining the optimal approach for managing a critically ill COVID-19 patient is rapidly changing. Goal-directed transesophageal echocardiography (TEE) is frequently used by physicians caring for intubated critically ill patients as a reliable imaging modality that is well suited to answer questions at bedside.MethodsA multidisciplinary (intensive care, critical care cardiology, and emergency medicine) group of experts in point-of-care echocardiography and TEE from the United States and Canada convened to review the available evidence, share experiences, and produce a consensus statement aiming to provide clinicians with a framework to maximize the safety of patients and healthcare providers when considering focused point-of-care TEE in critically ill patients during the COVID-19 pandemic.ResultsAlthough transthoracic echocardiography can provide the information needed in most patients, there are specific scenarios in which TEE represents the modality of choice. TEE provides acute care clinicians with a goal-directed framework to guide clinical care and represents an ideal modality to evaluate hemodynamic instability during prone ventilation, perform serial evaluations of the lungs, support cardiac arrest resuscitation, and guide veno-venous ECMO cannulation. To aid other clinicians in performing TEE during the COVID-19 pandemic, we describe a set of principles and practical aspects for performing examinations with a focus on the logistics, personnel, and equipment required before, during, and after an examination.ConclusionsIn the right clinical scenario, TEE is a tool that can provide the information needed to deliver the best and safest possible care for the critically ill patients.
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Project description:BackgroundSince the beginning of the coronavirus disease 2019 (COVID-19) outbreak, the Critical Care Outreach Team (CCOT) remained operational to provide critical care support to acutely ill and deteriorating patients on the wards. We aimed to evaluate the demand and efficacy of the critical care outreach service during the COVID-19 pandemic.MethodWe prospectively evaluated all patients referred to critical care outreach enrolled during a twelve-month period. We reported the cumulative number of activities and interventions and baseline characteristics, acuity level and patients' clinical outcome. The rate of ICU admissions, activity plan, patients' acuity and mortality are compared to historical data pre-pandemic.ResultsAmongst 4849 patients referred, 3913 had a clinical review and of those 895 were COVID-19 positive. Non-invasive ventilation was mostly delivered to COVID-19 patients (COVID-19 +VE: 853/895, 95% vs. COVID-19 -VE: 119/3018, 4%) alongside awake prone positioning (COVID-19 +VE: 232/895, 26% vs. COVID-19 -VE: 0/3018, 0%). Compared to pre-pandemic, the cumulative number of patients assessed increased (observed: 3913 vs. historical: 3615; p = 0.204), patients meeting Level 2 acuity were higher (observed: 51% vs. historical: 21%; p = 0.003), but ICU admission rate did not increase significantly (observed: 12% vs. historical: 9%; p = 0.065), and greater mortality rate (observed: 14% vs. historical: 8%; p = 0.046) was observed.ConclusionCritical care outreach bridges the gap between the intensive care unit and general wards and supports the concept of 'critical care without walls' acting as a valuable resource in optimizing and triaging acutely unwell patients and potentially averting critical care admissions.Relevance to clinical practiceThe COVID-19 pandemic has generated an unprecedented surge of deteriorating and critically ill patients with has caused severe and sustained pressures on intensive care units (ICUs) and general wards. Acutely ill patients can deteriorate quickly, and early recognition is vital to commence critical intervention on the wards or transfer timely to ICU. The Critical Care Outreach Team can help staff and optimize acutely ill and deteriorating patients by providing timely critical care interventions at the patient bedside.
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Project description:BackgroundWhen the workload for critical care nurses becomes too high, this can have consequences for both personal health as well as patient care. During the COVID-19 pandemic, critical care nurses were confronted with new and dynamic changes.ObjectiveThe aim of this study was to describe the experiences of critical care nurses regarding the ad hoc measures taken and the perceived physical and psychological burden experienced during the coronavirus disease 2019 (COVID-19) pandemic.MethodsThis was a cross-sectional study conducted at two hospitals using an online survey. The open questions addressing the challenges faced during the COVID-19 pandemic were subjected to content analysis according to Mayring.ResultsA total of 179 critical care nurses participated in the online survey. From the results, the following four categories were developed: "not meeting one's own quality of care requirements," "uncertainties in everyday professional and private life," "increased responsibility with lack of relief," and "insufficient coping strategies for physical and psychological burden."ConclusionCritical care nurses require structures and processes which support them in situations of high workload. The focus should be on the self-imposed requirements of quality of care as well as potentially relieving measures.
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Project description:BackgroundThe Cybersecurity and Infrastructure Security Agency (CISA) produced an advisory list identifying essential critical infrastructure workers (ECIW) during the coronavirus disease 2019 (COVID-19) response. The CISA advisory list is the most common national definition of ECIW but has not been mapped to United States (U.S.) Census industry codes (CICs) to readily identify these worker populations in public health data sources.MethodsWe identified essential critical infrastructure industry designations corresponding to v4.0 of the CISA advisory list for all six-digit North American Industry Classification System (NAICS) codes and cross-walked NAICS codes to CICs. CICs were grouped as essential, non-essential, or mixed essential/non-essential according to component NAICS industries. We also obtained national estimated population sizes for NAICS and Census industries and cross-tabulated Census industry and occupation codes to identify industry-occupation pairs.ResultsWe produced and made publicly available spreadsheets containing essential industry designations corresponding to v4.0 of the CISA advisory list for NAICS and Census industry titles and codes and population estimates by six-digit NAICS industry, Census industry, and Census industry-occupation pair. The CISA advisory list is highly inclusive and contains most industries and U.S. workers; 71.0% of Census industries comprising 80.6% of workers and 80.7% of NAICS industries comprising 87.1% of workers were designated as essential.ConclusionsWe identified workers in essential critical infrastructure industries as defined by CISA using standardized industry codes. These classifications may support public health interventions and analyses related to the COVID-19 pandemic and future public health crises.
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