Association of language concordance and restraint use in adults receiving mechanical ventilation.

PURPOSE: Clinician-patient language concordance improves patient outcomes in non-intensive care unit (ICU) settings. We sought to assess the association of ICU nurse-patient language concordance with delirium-related outcomes. METHODS: We conducted a retrospective cohort study of adult English- or Spanish-speaking mechanically ventilated ICU patients admitted to ICUs at the University of Miami Hospital and Clinics (January 2021-September 2022). Our primary exposure was nurse-patient language concordance on each shift. We used mixed-effects multivariable regression to evaluate the association of language concordance with the primary outcome of restraint use, and secondary outcomes of agitation and identification of delirium, during each shift (with patient as a random effect). RESULTS: Our cohort included 4326 shifts (3380 [78.1%] with language concordance) from 548 patients and 157 nurses. Spanish language was preferred by 269 (49.1%) of patients. English-speaking patients tended to be younger (65 [53, 75] vs 73 [61, 83], p < 0.001) and of non-Hispanic ethnicity (55.5% vs 7.1%, p < 0.001). English-speakers had restraints ordered on fewer of their included shifts (0 [0, 3] vs 1 [0, 3], p = 0.005). After adjustment, the odds of restraint use on shifts with language concordance was significantly lower (odds ratio [OR, 95% confidence interval [CI]]: 0.50 [0.39-0.63], p < 0.001). Agitation (18.6% vs 25.2%; OR [95% CI]: 0.71 [0.55-0.92], p = 0.009) and delirium identification (34.5% vs 41.3%; OR [95% CI]: 0.54 [0.34-0.88], p = 0.014) were also less common. CONCLUSIONS: We identified a twofold reduction in the odds of restraint use among mechanically ventilated patients for language concordant nurse-patient dyads. Ensuring nurse-patient language concordance may improve ICU delirium, agitation, and restraint use.

Same-Day Computed Tomographic Chest Imaging for Pulmonary Nodule Targeting with Electromagnetic Navigation Bronchoscopy May Decrease Unnecessary Procedures.

RATIONALE: Bronchoscopy is commonly used for the diagnosis of suspicious pulmonary nodules discovered on computed tomographic (CT) imaging of the chest. Procedural CT imaging for bronchoscopy planning is often completed weeks to months before the date of a scheduled bronchoscopy, which may not allow discovery of a decrease in nodule size or resolution before the bronchoscopic procedure. OBJECTIVES: To determine whether same-day CT imaging of the chest discovers partial or total resolution of some lung nodules and thereby reduces unnecessary bronchoscopic procedures. METHODS: We performed a prospective case series study of patients undergoing navigational bronchoscopy using a new technology requiring same-day preprocedural CT imaging at one university teaching hospital. Patients scheduled to undergo bronchoscopy who were found to have partial or complete resolution of their lesion on the same-day CT exam leading to the cancellation of their procedure were identified and further characterized. MEASUREMENTS AND MAIN RESULTS: From January 2015 to June 2016, 116 patients were scheduled for navigational bronchoscopy for the diagnosis of a pulmonary lesion. Of the 116 patients scheduled, 8 (6.9%) had a decrease in size or resolution of their lesion, leading to the cancellation of their procedure. The number needed to screen to prevent one unnecessary procedure was 15. For cancelled cases, the average time from initial CT prompting referral for bronchoscopy to the day of procedure scan was 53 days. CONCLUSIONS: Time from initial imaging to day of procedure is variable, occasionally allowing enough time for lesions to resolve, thereby obviating the need for biopsy. Same-day imaging may decrease unnecessary procedural risk.