The role of intensive care unit diaries in the grieving process: A monocentric qualitative study.

BACKGROUND: The growing importance of psychological recovery for patients and their families following intensive care unit (ICU) experiences in recent years cannot be overemphasized. The ICU diary is used to aid patients in reducing the prevalence of post-traumatic stress disorder, anxiety, and depression. The usefulness of maintaining a diary during the grieving process has not yet been thoroughly investigated. AIM: To investigate the role of ICU diaries in the grief process experienced by family members of a person who died in the intensive care unit. STUDY DESIGN: Nine family members of seven deceased ICU patients with an ICU diary were contacted and interviewed by phone using a semi-structured interview. A qualitative data analysis was performed using thematic synthesis. SETTING: Italian general intensive care unit. FINDINGS: Interviewed family members felt that the diary helped them during the grieving process. The return of diaries was desired by family members for support and to remember one's loved one. The diary helped them process their losses in various ways, including signs of evidence of care, emotional involvement, consideration, and coping with grief. Four main themes emerged from the analysis: writing the diary, reading the diary, talking about the diary, and the diary during the grieving process. CONCLUSIONS: The overall perception of the ICU diary was positive. The diary mostly helped relatives to "give back something of what we lost". This study also affirms the positive link between ICU diaries and bereavement in Italian ICU. Further studies are required to confirm the usefulness of this tool in the grieving process. RELEVANCE TO CLINICAL PRACTICE: The ICU diary can help patients' family members understand what happened to their loved one and play an important role in the grieving process. The diary served as a valuable source of information that aided in providing bereavement support to the family by helping them to gain a rational and emotional understanding of the patient's death.

One hundred ECMO retrivals before and during the Covid-19 pandemic: an observational study.

OBJECTIVES: Patients with severe acute respiratory distress syndrome may require veno-venous extracorporeal membrane oxygenation (V-V ECMO) support. For patients in peripheral hospitals, retrieval by mobile ECMO teams and transport to high-volume centers is associated with improved outcomes, including the recent COVID-19 pandemic. To enable a safe transport of patients, a specialised ECMO-retrieval program needs to be implemented. However, there is insufficient evidence on how to safely and efficiently perform ECMO retrievals. We report single-centre data from out-of-centre initiations of VV-ECMO before and during the COVID-19 pandemic. DESIGN & SETTING: Single-centre retrospective study. We include all the retrievals performed by our ECMO centre between January 1st, 2014, and April 30th, 2021. RESULTS: One hundred ECMO missions were performed in the study period, for a median retrieval volume of 13 (IQR: 9-16) missions per year. the cause of the acute respiratory distress syndrome was COVID-19 in 10 patients (10 %). 98 (98 %) patients were retrieved and transported to our ECMO centre. To allow safe transport, 91 of them were cannulated on-site and transported on V-V ECMO. The remaining seven patients were centralised without ECMO, but they were all connected to V-V ECMO in the first 24 hours. No complications occurred during patient transport. The median duration of the ECMO mission was 7 hours (IQR: 6-9, range: 2 - 17). Median duration of ECMO support was 14 days (IQR: 9-24), whereas the ICU stay was 24 days (IQR:18-44). Overall, 73 patients were alive at hospital discharge (74 %). Survival rate was similar in non-COVID-19 and COVID-19 group (73 % vs 80 %, p = 0.549). CONCLUSION: In this single-centre experience, before and during COVID-19 era, retrieval and ground transportation of ECMO patients was feasible and was not associated with complications. Key factors of an ECMO retrieval program include a careful selection of the transport ambulance, training of a dedicated ECMO mobile team and preparation of specific checklists and standard operating procedures.

Nursing Activities Score (NAS): 5 years of experience in the intensive care units of an Italian University hospital.

OBJECTIVE: To retrospectively analyse the application of the Nursing Activities Score (NAS) in an intensive care department from January 2006 to December 2011. METHOD: The sample consists of 5856 patients in three intensive care units (GICU: General Intensive Care Unit, NeuroICU: Neurosurgical Intensive Care Unit, CICU: Cardiothoracic Intensive Care Unit) of an Italian University hospital. The NAS was calculated for each patient every 24 hours. In patients admitted to general ICU, the following scores: SAPS 2 and SAPS 3 (Simplified Acute Physiology Score), RASS (Richmond Agitation Sedation Scale) and Braden were also recorded along with the NAS. RESULTS: The mean NAS for all patients was 65.97% (Standard Deviation ± 2.53), GICU 72.55% (± 16.28), NeuroICU 59.33% (± 16.54), CICU 63.51% (SD ± 14.69). The average length of hospital stay (LOS) was 4.82 (SD ± 8.68). The NAS was high in patients with increasing LOS (p<0.003) whilst there were no significant differences for age groups except for children 0-10 years (p<0.002). The correlation of NAS and SAPS 2 was r=0.24 (p=0.001), NAS and SAPS 3 r=-0.26 (p=0.77), NAS and RASS r=-0.23 (p=0.001), NAS and Braden r=0.22 (p=0.001). CONCLUSIONS: This study described the daily use of the NAS for the determination of nursing workload and defines the staff required.

[Application of endotracheal suctioning AARC guidelines: impact on the performance of vital signs in a population of cardiac patients]. / Applicazione delle nuove linee guida AARC per l'aspirazione endotracheale : impatto sui parametri vitali in pazienti sottoposti a rivascolarizzazione miocardica (BPAC).

INTRODUCTION: Endotracheal suctioning is a procedure that exposes the patient to critical changes in vital signs. New AARC guidelines have emphasized both the importance of correct identification when to perform the procedure, and the routine use of closed system. OBJECTIVE: To implement the new guidelines AARC using a sound detector for identifying the presence of secretions (TBA care ©) , closed suctioning circuit and analyze the performance of vital signs in a population of cardiac patients. METHODS: The study is observational. Were investigated 15 patients undergoing CABG, cardiac surgery ICU. Were continuously recorded the following vital signs HR, SBP, SBP * HR, ST various leads, SpO2, PEEP, RRV, TVC in four time windows, 5 minutes before the suctioning maneuver at the time of operation (time 0), 5 minutes from the same and 10 minutes later. RESULTS: Vital signs remain stable in the four steps investigated, with minor variations (percent change from baseline during the maneuver: HR +2.93% 5.66% PAS +, SpO2 - 0.13%). There were no ST segment changes. There is an increase in the cardiac work, but within 5 minutes from the execution of the maneuver. There were no arterial desaturation. CONCLUSIONS: The observed changes in vital signs, albeit small, suggest to keep the maximum hemodynamic and respiratory monitoring. The use of technologies for the diagnosis associated with the closed system of broncoaspiration has prevented the onset of complications related to the maneuver.