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1.
Am J Nurs ; 121(8): 36-43, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1307559

ABSTRACT

ABSTRACT: Gastric tube feeding is a common and valuable intervention for patients in a variety of care settings. While tube feeding can save the lives of patients for whom oral feeding isn't possible, intolerance to tube feeding is a potential complication. This article discusses risk factors for feeding intolerance; the assessment of signs and symptoms of feeding intolerance; the various means of assessing gastric emptying, including the practice of monitoring gastric residual volume (GRV); the controversy surrounding GRV monitoring in assessing feeding tolerance; and the special considerations for monitoring feeding tolerance in acutely and critically ill adults with coronavirus disease 2019. The author, a nurse researcher with extensive experience in the area of enteral feeding, briefly summarizes recommendations and guidelines for enteral feeding published by national and international health care organizations between 2015 and 2020, and offers her perspective on best nursing practices for monitoring food tolerance in adults.


Subject(s)
Education, Continuing , Enteral Nutrition/nursing , Gastric Emptying/physiology , Critical Illness/nursing , Critical Illness/rehabilitation , Enteral Nutrition/instrumentation , Enteral Nutrition/methods , Guidelines as Topic , Humans
2.
Chest ; 160(6): 2101-2111, 2021 12.
Article in English | MEDLINE | ID: covidwho-1271599

ABSTRACT

BACKGROUND: The extent to which the degree of baseline frailty, as measured using standardized multidimensional health assessments before hospital admission, predicts survival among older adults after admission to an ICU remains unclear. RESEARCH QUESTION: Is baseline frailty an independent predictor of survival among older adults receiving care in an ICU? STUDY DESIGN AND METHODS: Retrospective cohort study of community-dwelling older adults (age, ≥ 65 years) receiving public home services who were admitted to any ICU in Ontario, Canada, between April 1, 2009, and March 31, 2015. All individuals underwent an interRAI Resident Assessment Instrument-Home Care (RAI-HC) assessment completed within 180 days of ICU admission. These assessments were linked to hospital discharge abstract records. Patients were categorized using frailty measures each calculated from the RAI-HC: a classification tree version of the Clinical Frailty Scale; the Frailty Index-Acute Care; and the Changes in Health, End-Stage Disease, Signs, and Symptoms Scale. One-year survival models were used to compare their performance. Patients were stratified based on the receipt of mechanical ventilation in the ICU. RESULTS: Of 24,499 individuals admitted to an ICU within 180 days of a RAI-HC assessment, 26.4% (n = 6,467) received mechanical ventilation. Overall, 43.0% (95% CI, 42.4%-43.6%) survived 365 days after ICU admission. In general, among the overall cohort and both mechanical ventilation subgroups, mortality hazards increased with the severity of baseline frailty. Models predicting survival 30, 90, and 365 days after admission to an ICU that adjusted for one of the frailty measures were more discriminant than reference models that adjusted only for age, sex, major clinical category, and area income quintile. INTERPRETATION: Severity of baseline frailty is independently associated with survival after ICU admission and should be considered when determining goals of care and treatment plans for people with critical illness.


Subject(s)
Critical Illness/mortality , Critical Illness/nursing , Frail Elderly , Geriatric Assessment , Home Care Services , Aged , Female , Humans , Male , Ontario , Predictive Value of Tests , Reproducibility of Results , Retrospective Studies , Survival Analysis
3.
J Nurs Adm ; 51(2): 63-66, 2021 Feb 01.
Article in English | MEDLINE | ID: covidwho-1066480

ABSTRACT

This article explores the experiences and learnings of 2 ambulatory care nurse leaders on the front lines of the Covid-19 pandemic using the theory "navigating through chaos" as a framework.


Subject(s)
COVID-19/nursing , Critical Illness/nursing , Leadership , Nurse Administrators/psychology , Nurse's Role/psychology , COVID-19/psychology , Critical Illness/psychology , Humans , Job Satisfaction , Nurse-Patient Relations
4.
Int Heart J ; 62(1): 148-152, 2021.
Article in English | MEDLINE | ID: covidwho-1054895

ABSTRACT

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is erupting and spreading globally. Cardiovascular complications secondary to the infection have caught notice. This study aims to delineate the relationship of cardiac biomarkers and outcomes in severe cases of corona virus disease 2019 (COVID-19). One hundred forty-eight critically ill adult patients with COVID-19 were enrolled. From these patients, the demographic data, symptoms, cardiac biomarkers, treatments, and clinical outcomes were collected. Data were compared between survivors and non-survivors. Four patients in the non-survivor group were selected, and their cardiac biomarkers were collected and analyzed. Among the 148 patients, the incidence of cardiovascular complications was 19 (12.8%). Five of them were survivors (5.2%), and 14 of them were non-survivors (26.9%). Compared with the survivors, the non-survivors had higher levels of high-sensitivity cardiac troponin I, creatine kinase isoenzyme-MB, myoglobin, and N-terminal pro-brain natriuretic peptide (P < 0.05). The occurrence of cardiovascular events began at 11-15 days after the onset of the disease and reached a peak at 14-20 days. COVID-19 not only is a respiratory disease but also causes damage to the cardiovascular system. Cardiac biomarkers have the potential for early warning and prognostic evaluation in patients with COVID-19. It is recommended that cardiac biomarker monitoring in patients with COVID-19 should be initiated at least from the 11th day of the disease course.


Subject(s)
Biomarkers/metabolism , COVID-19/complications , Cardiovascular Diseases/etiology , Cardiovascular Diseases/metabolism , Adult , Aged , Atrial Natriuretic Factor/metabolism , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Cardiovascular Diseases/epidemiology , Case-Control Studies , China/epidemiology , Creatine Kinase, MB Form/metabolism , Critical Illness/mortality , Critical Illness/nursing , Female , Humans , Incidence , Male , Middle Aged , Prognosis , Protein Precursors/metabolism , SARS-CoV-2/genetics , Survival Rate , Survivors/statistics & numerical data , Troponin I/metabolism
6.
Nursing ; 51(1): 46-51, 2021 Jan 01.
Article in English | MEDLINE | ID: covidwho-990820

ABSTRACT

ABSTRACT: In Europe, the novel coronavirus outbreak started in the northern regions of Italy at the end of February 2020. Initially, resources were insufficient to deal with the abrupt influx of critically ill patients requiring respiratory support. This article recounts the authors' experiences caring for patients with COVID-19 in an Italian ICU during this period in order to help colleagues in the international critical care nursing community successfully manage similar circumstances in the ongoing pandemic.


Subject(s)
COVID-19/nursing , Critical Illness/nursing , Nurse's Role , Respiration, Artificial/nursing , Critical Care/methods , Humans , Intensive Care Units , Italy , Positive-Pressure Respiration/nursing
7.
CMAJ Open ; 8(4): E788-E795, 2020.
Article in English | MEDLINE | ID: covidwho-970110

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is responsible for millions of infections worldwide, and a substantial number of these patients will be admitted to the intensive care unit (ICU). Our objective was to describe the characteristics, outcomes and management of critically ill patients with COVID-19 pneumonia at a single designated pandemic centre in Montréal, Canada. METHODS: A descriptive analysis was performed on consecutive critically ill patients with COVID-19 pneumonia admitted to the ICU at the Jewish General Hospital, a designated pandemic centre in Montréal, between Mar. 5 and May 21, 2020. Complete follow-up data corresponding to death or discharge from hospital health records were included to Aug. 4, 2020. We summarized baseline characteristics, management and outcomes, including mortality. RESULTS: A total of 106 patients were included in this study. Twenty-one patients (19.8%) died during their hospital stay, and the ICU mortality was 17.0% (18/106); all patients were discharged home or died, except for 4 patients (2 awaiting a rehabilitation bed and 2 awaiting long-term care). Twelve of 65 patients (18.5%) requiring mechanical ventilation died. Prone positioning was used in 29 patients (27.4%), including in 10 patients who were spontaneously breathing; no patient was placed on extracorporeal membrane oxygenation. High-flow nasal cannula was used in 51 patients (48.1%). Acute kidney injury was the most common complication, seen in 20 patients (18.9%), and 12 patients (11.3%) required renal replacement therapy. A total of 53 patients (50.0%) received corticosteroids. INTERPRETATION: Our cohort of critically ill patients with COVID-19 had lower mortality than that previously described in other jurisdictions. These findings may help guide critical care decision-making in similar health care systems in further COVID-19 surges.


Subject(s)
COVID-19/diagnosis , Critical Illness/mortality , Intensive Care Units/statistics & numerical data , SARS-CoV-2/genetics , Acute Kidney Injury/epidemiology , Acute Kidney Injury/therapy , Adrenal Cortex Hormones/therapeutic use , Aged , COVID-19/epidemiology , COVID-19/mortality , COVID-19/virology , Canada/epidemiology , Cannula/statistics & numerical data , Cohort Studies , Critical Illness/nursing , Female , Hospitalization/statistics & numerical data , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Practice Patterns, Physicians'/trends , Prone Position , Renal Replacement Therapy/methods , Respiration, Artificial/mortality , Respiration, Artificial/statistics & numerical data , Retrospective Studies , Treatment Outcome
8.
Rev Bras Enferm ; 73(suppl 2): e20200798, 2020.
Article in English, Portuguese | MEDLINE | ID: covidwho-895104

ABSTRACT

OBJECTIVE: to describe the theoretical construction process of nursing process support documents in COVID-19 care scenarios. METHODS: an experience report of the joint activity of the Brazilian Nursing Process Research Network (Rede de Pesquisa em Processo de Enfermagem) composed of Higher Education and Health Institution researchers in Brazil. RESULTS: five instruments were organized collectively, involving the elements of nursing practice (nursing diagnoses, outcomes and interventions) in assistance for community; for patients (with suspected or mild, moderate, and critical COVID-19 and residents in Nursing Homes); for nursing workers' health support, also subsidizing registration and documentation during the COVID-19 pandemic. FINAL CONSIDERATIONS: valuing the phenomena manifested by families/communities, patients and health professionals is essential for early detection, intervention, and prevention of diseases.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/nursing , Nursing Process , Nursing Research , Pneumonia, Viral/epidemiology , Pneumonia, Viral/nursing , Age Factors , Brazil/epidemiology , COVID-19 , Coronavirus Infections/prevention & control , Critical Illness/nursing , Homes for the Aged , Humans , Nursing Diagnosis , Nursing Homes , Nursing Staff , Occupational Diseases/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Terminology as Topic
10.
J Hosp Palliat Nurs ; 22(6): 428-431, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-760056

ABSTRACT

In this case report, an elderly patient with COVID-19 pneumonia and a protracted intensive care course, who was unable to wean from mechanical ventilation, was transferred to the hospice unit for ventilator withdrawal and end of life care. Although symptom management was anticipated to focus on treating acute dyspnea, conditions mandated a shift to addressing the psychological challenges associated with prolonged critical illness. The interventions typical to hospice care-patient centered, family focused, and culturally sensitive-served to alleviate psychological symptoms of demoralization and despair, contributing to an outcome that pointed beyond pulmonary pathophysiology. Thought to be facing imminent death once the ventilator was removed, this patient defied the science behind weaning protocols, which can only be explained by a "will to live," through loving engagement with his family, his favorite music, and a dedicated multidisciplinary hospice team.


Subject(s)
Coronavirus Infections/epidemiology , Critical Illness/nursing , Critical Illness/psychology , Demoralization , Hospice Care , Pneumonia, Viral/epidemiology , Aged , Betacoronavirus , COVID-19 , Humans , Male , Pandemics , Respiration, Artificial , SARS-CoV-2 , Terminal Care
11.
Crit Care Nurse ; 40(6): e1-e16, 2020 Dec 01.
Article in English | MEDLINE | ID: covidwho-721565

ABSTRACT

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) rippled across the world from Wuhan, China, to the shores of the United States within a few months. Hospitals and intensive care units were suddenly faced with a "tsunami" warning requiring instantaneous implementation and escalation of disaster plans. EVIDENCE REVIEW: An evidence-based question was developed and an extensive review of the literature was completed, resulting in a structured plan for the intensive care units to manage a surge of patients critically ill with COVID-19 in March 2020. Twenty-five sources of evidence focusing on pandemic intensive care unit and COVID-19 management laid the foundation for the team to navigate the crisis. IMPLEMENTATION: The Critical Care Services task force adopted recommendations from the CHEST consensus statement on surge capacity principles and other sources, which served as the framework for the organized response. The 4 S's became the focus: space, staff, supplies, and systems. Development of algorithms, workflows, and new processes related to treating patients, staffing shortages, and limited supplies. New intensive care unit staffing solutions were adopted. EVALUATION: Using a framework based on the literature reviewed, the Critical Care Services task force controlled the surge of patients with COVID-19 in March through May 2020. Patients received excellent care, and the mortality rate was 0.008%. The intensive care unit team had the needed respiratory and general supplies but had to continually adapt to shortages of personal protective equipment, cleaning products, and some medications. SUSTAINABILITY: The intensive care unit pandemic response plan has been established and the team is prepared for the next wave of COVID-19.


Subject(s)
COVID-19/nursing , Critical Care Nursing/methods , Critical Care Nursing/organization & administration , Critical Illness/nursing , Intensive Care Units/organization & administration , Adult , Aged , Aged, 80 and over , California , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2
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