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1. Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU

Author

Davidson, Judy E, Aslakson, Rebecca A, Long, Ann C, Puntillo, Kathleen A, Kross, Erin K, Hart, Joanna, Cox, Christopher E, Wunsch, Hannah, Wickline, Mary A, Nunnally, Mark E, Netzer, Giora, Kentish-Barnes, Nancy, Sprung, Charles L, Hartog, Christiane S, Coombs, Maureen, Gerritsen, Rik T, Hopkins, Ramona O, Franck, Linda S, Skrobik, Yoanna, Kon, Alexander A, Scruth, Elizabeth A, Harvey, Maurene A, Lewis-Newby, Mithya, White, Douglas B, Swoboda, Sandra M, Cooke, Colin R, Levy, Mitchell M, Azoulay, Elie, and Curtis, J Randall

Subjects
Clinical Practice Guideline, family-centered, family-centred, intensive care, critical care, adult, neonatal, pediatric, professional-family relations, family nursing
Abstract

Objective: To provide clinicians with evidence-based strategies to optimize support of the family of critically ill patients in the ICU.Methods: We used the Council of Medical Specialty Societies principles for the development of clinical guidelines as the framework for guideline development. We assembled an international multidisciplinary team of 29 members with expertise in guideline development, evidence analysis and family-centered care to revise the 2007 Clinical Practice Guidelines for Support of the Family in the Patient-Centered Intensive Care Unit. We conducted a scoping review of qualitative research that explored family-centered care in the ICU. Thematic analyses were conducted to support Population, Intervention, Comparison, Outcome (PICO) question development. Patients and families validated the importance of interventions and outcomes. We then conducted a systematic review using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology to make recommendations for practice. Recommendations were subjected to electronic voting with pre-established voting thresholds. No industry funding was associated with guideline development.Results: The scoping review yielded 683 qualitative studies; 228 were used for thematic analysis and PICO question development. The systematic review search yielded 4158 reports after de-duplication and 76 additional studies were added from alerts and hand searches; 238 studies met inclusion criteria. We made 23 recommendations from moderate, low and very low level of evidence on the topics of: communication with family members, family presence, family support, consultations and ICU team members, and operational and environmental issues. We provide recommendations for future research and work-tools to support translation of the recommendations into practice.Conclusions: These guidelines identify the evidence base for best practices for family-centered care in the ICU. All recommendations were weak, highlighting the relative nascency of this field of research and the importance of future research to identify the most effective interventions to improve this important aspect of ICU care.

Published
2017

2. Management and outcomes in critically ill nonagenarian versus octogenarian patients

Author

Bruno, Raphael Romano, Wernly, Bernhard, Kelm, Malte, Boumendil, Ariane, Morandi, Alessandro, Andersen, Finn H., Artigas, Antonio, Finazzi, Stefano, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Lichtenauer, Michael, Muessig, Johanna M., Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Öhman, Christina Agvald, Pinto, Bernardo Bollen, Soliman, Ivo W., Szczeklik, Wojciech, Valentin, Andreas, Watson, Ximena, Leaver, Susannah, Boulanger, Carole, Walther, Sten, Schefold, Joerg C., Joannidis, Michael, Nalapko, Yuriy, Elhadi, Muhammed, Fjølner, Jesper, Zafeiridis, Tilemachos, De Lange, Dylan W., Guidet, Bertrand, Flaatten, Hans, Jung, Christian, Eller, Philipp, Helbok, Raimund, Schmutz, René, Nollet, Joke, de Neve, Nikolaas, Buysscher, Pieter De, Swinnen, Walter, Mikačić, Marijana, Bastiansen, Anders, Husted, Andreas, Dahle, Bård E. S., Cramer, Christine, Sølling, Christoffer, Ørsnes, Dorthe, Thomsen, Jakob Edelberg, Pedersen, Jonas Juul, Enevoldsen, Mathilde Hummelmose, Elkmann, Thomas, Kubisz-Pudelko, Agnieszka, Pope, Alan, Collins, Amy, Raj, Ashok S., Frey, Christian, Hart, Ciaran, Bolger, Clare, Spray, Dominic, Randell, Georgina, Filipe, Helder, Welters, Ingeborg D., Grecu, Irina, Evans, Jane, Cupitt, Jason, Lord, Jenny, Henning, Jeremy, Jones, Joanne, Ball, Jonathan, North, Julie, Salaunkey, Kiran, De Gordoa, Laura Ortiz-Ruiz, Bell, Louise, Balasubramaniam, Madhu, Vizcaychipi, Marcela, Faulkner, Maria, Mupudzi, Mc Donald, Lea-Hagerty, Megan, Reay, Michael, Spivey, Michael, Love, Nicholas, Spittle, Nick Spittle Nick, White, Nigel, Williams, Patricia, Morgan, Patrick, Wakefield, Phillipa, Savine, Rachel, Jacob, Reni, Innes, Richard, Kapoor, Ritoo, Humphreys, Sally, Rose, Steve, Dowling, Susan, Mane, Tarkeshwari, Lawton, Tom, Ogbeide, Vongayi, Khaliq, Waqas, Baird, Yolanda, Romen, Antoine, Galbois, Arnaud, Vinsonneau, Christophe, Charron, Cyril, Thevenin, Didier, Guerot, Emmanuel, Besch, Guillaume, Savary, Guillaume, Mentec, Hervé, Chagnon, Jean-Luc, Rigaud, Jean-Philippe, Quenot, Jean-Pierre, Castanera, Jeremy, Rosman, Jérémy, Maizel, Julien, Tiercelet, Kelly, Vettoretti, Lucie, Hovaere, Maud Mousset, Messika, Messika, Djibré, Michel, Rolin, Nathalie, Burtin, Philippe, Garcon, Pierre, Nseir, Saad, Valette, Xavier, Rabe, Christian, Barth, Eberhard, Ebelt, Henning, Fuest, Kristina, Franz, Marcus, Horacek, Michael, Schuster, Michael, Meybohm, Patrick, Allgäuer, Sebastian, Dubler, Simon, Schaller, Stefan J., Schering, Stefan, Steiner, Stephan, Dieck, Thorben, Rahmel, Tim, Graf, Tobias, Koutsikou, Anastasia, Vakalos, Aristeidis, Raitsiou, Bogdan, Flioni, Elli Niki, Neou, Evangelia, Tsimpoukas, Fotios, Papathanakos, Georgios, Marinakis, Giorgos, Koutsodimitropoulos, Ioannis, Aikaterini, Kounougeri, Rovina, Nikoletta, Kourelea, Stylliani, Tasioudis, Polychronis, Zidianakis, Vasiiios, Konstantinia, Vryza, Aidoni, Zoi, Motherway, Catherine, Read, Chris, Martin-Loeches, Ignacio, Cracchiolo, Andrea Neville, Morigi, Aristide, Calamai, Italo, Brusa, Stefania, Elhadi, Ahmed, Tarek, Ahmed, Khaled, Ala, Ahmed, Hazem, Belkhair, Wesal Ali, Cornet, Alexander D., Gommers, Diederik, van Boven, Eva, Haringman, Jasper, Haas, Lenneke, van den Berg, Lettie, Hoiting, Oscar, de Jager, Peter, Gerritsen, Rik T., Dormans, Tom, Dieperink, Willem, Breidablik, Alena Breidablik Alena, Slapgard, Anita, Rime, Anne-Karin, Jannestad, Bente, Sjøbøe, Britt, Rice, Eva, Strietzel, Hans Frank, Jensen, Jan Peter, Langørgen, Jørund, Tøien, Kirsti, Strand, Kristian, Hahn, Michael, Klepstad, Pål, Biernacka, Aleksandra, Kluzik, Anna, Kudlinski, Bartosz, Maciejewski, Dariusz, Studzińska, Dorota, Hymczak, Hubert, Stefaniak, Jan, Solek-Pastuszka, Joanna, Zorska, Joanna, Cwyl, Katarzyna, Krzych, Lukasz J., Zukowski, Maciej, Lipińska-Gediga, Małgorzata, Pietruszko, Marek, Piechota, Mariusz, Serwa, Marta, Czuczwar, Miroslaw, Ziętkiewicz, Mirosław, Kozera, Natalia, Nasiłowski, Paweł, Sendur, Paweł, Zatorski, Paweł, Galkin, Piotr, Gawda, Ryszard, Kościuczuk, Urszula, Cyrankiewicz, Waldemar, Gola, Wojciech, Fernandes Pinto, Alexandre, Fernandes, Ana Margarida, Santos, Ana Rita, Sousa, Cristina, Barros, Inês, Ferreira, Isabel Amorim, Blanco, Jacobo Bacariza, Carvalho, João Teles, Maia, Jose, Candeias, Nuno, Catorze, Nuno, Belskiy, Vladislav, Lores, Africa, Mira, Angela Prado, Cilloniz, Catia, Perez-Torres, David, Maseda, Emilio, Rodriguez, Enver, Prol-Silva, Estefania, Eixarch, Gaspar, Gomà, Gemma, Aguilar, Gerardo, Velasco, Gonzalo Navarro, Jaimes, Marián Irazábal, Villamayor, Mercedes Ibarz, Fernández, Noemí Llamas, Cubero, Patricia Jimeno, López-Cuenca, Sonia, Tomasa, Teresa, Sjöqvist, Anders, Brorsson, Camilla, Schiöler, Fredrik, Westberg, Henrik, Nauska, Jessica, Sivik, Joakim, Berkius, Johan, Thiringer, Karin Kleiven, De Geer, Lina, Boroli, Filippo, Hergafi, Leila, Eckert, Philippe, Yıldız, Ismail, Yovenko, Ihor, Pugh, Richard, and on behalf of the VIP2 study group, [missing]

Subjects
Octogenarians, INTENSIVE-CARE-UNIT, Frailty, PREDICTION, SURGERY, MORTALITY, Nonagenarians, ICU, Medicine and Health Sciences, OLD PATIENTS, SHORT-TERM, Intensive care medicine, Geriatrics and Gerontology, ELDERLY-PATIENTS, Outcome
Abstract

Background: Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods: We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80-89.9 years) and nonagenarian (>= 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results: The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 +/- 5 vs. 7 +/- 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90-1.74; p = 0.19)). Conclusion: After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered- together with illness severity and pre-existing functional capacity - to effectively guide triage decisions.

Published
2021

3. Determinants of Procedural Pain Intensity in the Intensive Care Unit. The Europain® Study

Author

Puntillo, Kathleen A., Max, Adeline, Timsit, Jean-Francois, Vignoud, Lucile, Chanques, Gerald, Robleda, Gemma, Roche-Campo, Ferran, Mancebo, Jordi, Divatia, Jigeeshu V., Soares, Marcio, Ionescu, Daniela C., Grintescu, Ioana M., Vasiliu, Irena L., Maggiore, Salvatore Maurizio, Rusinova, Katerina, Owczuk, Radoslaw, Egerod, Ingrid, Papathanassoglou, Elizabeth D. E., Kyranou, Maria, Joynt, Gavin M., Burghi, Gastón, Freebairn, Ross C., Ho, Kwok M., Kaarlola, Anne, Gerritsen, Rik T., Kesecioglu, Jozef, Sulaj, Miroslav M. S., Norrenberg, Michelle, Benoit, Dominique D., Seha, Myriam S. G., Hennein, Akram, Periera, Fernando J., Benbenishty, Julie S., Abroug, Fekri, Aquilina, Andrew, Monte, Júlia R. C., An, Youzhong, and Azoulay, Elie

Published
2014
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6. Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA

Author

Benoit, D. D., Jensen, H. I., Malmgren, J., Metaxa, V., Reyners, A. K., Darmon, M., Rusinova, K., Talmor, D., Meert, A. P., Cancelliere, L., Zubek, L., Maia, P., Michalsen, A., Vanheule, S., Kompanje, E. J. O., Decruyenaere, J., Vandenberghe, S., Vansteelandt, S., Gadeyne, B., Van den Bulcke, B., Azoulay, E., Piers, R. D., Spapen, Herbert, Van Malderen, Marie-Claire, Opdenacker, Godelieve, Meyfroidt, Geert, Mesotten, Dieter, Wauters, Joost, Van Laer, Marie, Wilmer, Alexander, Ceunen, Helga, De Laet, Inneke E., Jans, Anita, Benoit, Dominique, Oeyen, Sandra, Herck, Ingrid, Bracke, Stephanie, Clauwaert, Charlotte, Meert, Anne-Pascale, Leclercq, Nathalie, Jacques, Devriendt, Philippe, Dechamps, Zykova, Ivana, Malaska, Jan, Schmidt, Matous, Satinsky, Igor, Kieslichova, Eva, Krizova, Jarmila, Janda, Robert, Fortova, Magdalena, Matyas, Jiri, Rusinova, Katerina, Kopecky, Ondrej, Pedersen, Christian Alves Køhler, Hebsgaard, Stine, Johnsen, Rikke Frank Aagaard, Hansen, Tina Charlotte Bitsch, Darmon, Michael, Reuter, Danielle, Azoulay, Elie, Mokart, Djamel, Vincent, François, Hartog, Christiane S., Gretenkort, Peter, Michalsen, Andrej, Kounougeri, Aikaterini, Nanas, Serafim, Papachristou, Despina, Soultati, Ioanna, Lathyris, Dimitrios, Pasakiotou, Marili, Oikonomou, Marina, Elö, Gabor, Szücs, Orsolya, Fogas, János, Bobek, Ilona, Corte, Francesco Della, Olivieri, Carlo, Vaschetto, Rosanna, Cancelliere, Laura, Marinangeli, Franco, Pozone, Tullio, Ciccozzi, Alessandra, Schouten, A., Bruns, Monique, Gerritsen, Rik T., Koopmans, Matty, Kompanje, Erwin, Van Duijn, Ditty, Zijlstra, Jan G., Reyners, Anne Kl., Lutisan, Johan G., Monte, Raquel, Pinho, José António, Pimenta, Pedro, Fernandes, Paula, Paixão, Ana Isabel, Faria, Filomena, Malmgren, Johan A., Andersson, Bertil, Akerman, Eva, Hvarfner, Andreas, Svensson, Robert, Metaxa, Victoria, Talmor, Daniel, Mueller, Ariel, Banner-Goodspeed, Valerie, Rickett, Dee, Wilson, Michael E., Hinds, Richard, Supporting clinical sciences, Internal Medicine Specializations, Intensive Care, Wilmer, Peter Alexander, Meyfroidt, Geert, Wauters, Joost, Targeted Gynaecologic Oncology (TARGON), and Guided Treatment in Optimal Selected Cancer Patients (GUTS)

Subjects
PERCEPTIONS, Palliative care, Original, Decision-making, Ethical climate, Interdisciplinary collaboration, Patient outcomes, Perceived excessive care, Treatment-limitation decisions, Critical Care and Intensive Care Medicine, PALLIATIVE CARE, law.invention, PHYSICIANS, 0302 clinical medicine, law, Medicine and Health Sciences, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, DEATH, Age Factors, Sciences bio-médicales et agricoles, Intensive care unit, Intensive Care Units -- ethics, Europe, Intensive Care Units, HEALTH, Life Sciences & Biomedicine, medicine.medical_specialty, education, Unnecessary Procedures, Disease cluster, 03 medical and health sciences, Critical Care Medicine, General & Internal Medicine, INAPPROPRIATE CARE, Anesthesiology, Intensive care, medicine, Humans, In patient, Science & Technology, business.industry, 030208 emergency & critical care medicine, Organizational Culture, ICU, Emergency medicine, Quality of Life, Observational study, OF-LIFE CARE, NURSES, business
Abstract

Whether the quality of the ethical climate in the intensive care unit (ICU) improves the identification of patients receiving excessive care and affects patient outcomes is unknown., SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2018

7. Pain distress : the negative emotion associated with procedures in ICU patients

Author

Puntillo, Kathleen A., Max, Adeline, Timsit, Jean Francois, Ruckly, Stephane, Chanques, Gerald, Robleda, Gemma, Roche-Campo, Ferran, Mancebo, Jordi, Divatia, Jigeeshu V., Soares, Marcio, Ionescu, Daniela C., Grintescu, Ioana M., Maggiore, Salvatore Maurizio, Rusinova, Katerina, Owczuk, Radoslaw, Egerod, Ingrid, Papathanassoglou, Elizabeth D.E., Kyranou, Maria, Joynt, Gavin M., Burghi, Gaston, Freebairn, Ross C., Ho, Kwok M., Kaarlola, Anne, Gerritsen, Rik T., Kesecioglu, Jozef, Sulaj, Miroslav M.S., Norrenberg, Michelle, Benoit, Dominique D., Seha, Myriam S.G., Hennein, Akram, Pereira, Fernando J., Benbenishty, Julie S., Abroug, Fekri, Aquilina, Andrew, Monte, Julia R.C., An, Youzhong, Azoulay, Elie, Puntillo, Kathleen A., Max, Adeline, Timsit, Jean Francois, Ruckly, Stephane, Chanques, Gerald, Robleda, Gemma, Roche-Campo, Ferran, Mancebo, Jordi, Divatia, Jigeeshu V., Soares, Marcio, Ionescu, Daniela C., Grintescu, Ioana M., Maggiore, Salvatore Maurizio, Rusinova, Katerina, Owczuk, Radoslaw, Egerod, Ingrid, Papathanassoglou, Elizabeth D.E., Kyranou, Maria, Joynt, Gavin M., Burghi, Gaston, Freebairn, Ross C., Ho, Kwok M., Kaarlola, Anne, Gerritsen, Rik T., Kesecioglu, Jozef, Sulaj, Miroslav M.S., Norrenberg, Michelle, Benoit, Dominique D., Seha, Myriam S.G., Hennein, Akram, Pereira, Fernando J., Benbenishty, Julie S., Abroug, Fekri, Aquilina, Andrew, Monte, Julia R.C., An, Youzhong, and Azoulay, Elie

Published
2018

8. Pain distress:the negative emotion associated with procedures in ICU patients

Author

Puntillo, Kathleen A, Max, Adeline, Timsit, Jean-Francois, Ruckly, Stephane, Chanques, Gerald, Robleda, Gemma, Roche-Campo, Ferran, Mancebo, Jordi, Divatia, Jigeeshu V, Soares, Marcio, Ionescu, Daniela C, Grintescu, Ioana M, Maggiore, Salvatore Maurizio, Rusinova, Katerina, Owczuk, Radoslaw, Egerod, Ingrid, Papathanassoglou, Elizabeth D E, Kyranou, Maria, Joynt, Gavin M, Burghi, Gaston, Freebairn, Ross C, Ho, Kwok M, Kaarlola, Anne, Gerritsen, Rik T, Kesecioglu, Jozef, Sulaj, Miroslav M S, Norrenberg, Michelle, Benoit, Dominique D, Seha, Myriam S G, Hennein, Akram, Pereira, Fernando J, Benbenishty, Julie S, Abroug, Fekri, Aquilina, Andrew, Monte, Julia R C, An, Youzhong, Azoulay, Elie, Puntillo, Kathleen A, Max, Adeline, Timsit, Jean-Francois, Ruckly, Stephane, Chanques, Gerald, Robleda, Gemma, Roche-Campo, Ferran, Mancebo, Jordi, Divatia, Jigeeshu V, Soares, Marcio, Ionescu, Daniela C, Grintescu, Ioana M, Maggiore, Salvatore Maurizio, Rusinova, Katerina, Owczuk, Radoslaw, Egerod, Ingrid, Papathanassoglou, Elizabeth D E, Kyranou, Maria, Joynt, Gavin M, Burghi, Gaston, Freebairn, Ross C, Ho, Kwok M, Kaarlola, Anne, Gerritsen, Rik T, Kesecioglu, Jozef, Sulaj, Miroslav M S, Norrenberg, Michelle, Benoit, Dominique D, Seha, Myriam S G, Hennein, Akram, Pereira, Fernando J, Benbenishty, Julie S, Abroug, Fekri, Aquilina, Andrew, Monte, Julia R C, An, Youzhong, and Azoulay, Elie

Abstract

PURPOSE: The intensity of procedural pain in intensive care unit (ICU) patients is well documented. However, little is known about procedural pain distress, the psychological response to pain.METHODS: Post hoc analysis of a multicenter, multinational study of procedural pain. Pain distress was measured before and during procedures (0-10 numeric rating scale). Factors that influenced procedural pain distress were identified by multivariable analyses using a hierarchical model with ICU and country as random effects.RESULTS: A total of 4812 procedures were recorded (3851 patients, 192 ICUs, 28 countries). Pain distress scores were highest for endotracheal suctioning (ETS) and tracheal suctioning, chest tube removal (CTR), and wound drain removal (median [IQRs] = 4 [1.6, 1.7]). Significant relative risks (RR) for a higher degree of pain distress included certain procedures: turning (RR = 1.18), ETS (RR = 1.45), tracheal suctioning (RR = 1.38), CTR (RR = 1.39), wound drain removal (RR = 1.56), and arterial line insertion (RR = 1.41); certain pain behaviors (RR = 1.19-1.28); pre-procedural pain intensity (RR = 1.15); and use of opioids (RR = 1.15-1.22). Patient-related variables that significantly increased the odds of patients having higher procedural pain distress than pain intensity were pre-procedural pain intensity (odds ratio [OR] = 1.05); pre-hospital anxiety (OR = 1.76); receiving pethidine/meperidine (OR = 4.11); or receiving haloperidol (OR = 1.77) prior to the procedure.CONCLUSIONS: Procedural pain has both sensory and emotional dimensions. We found that, although procedural pain intensity (the sensory dimension) and distress (the emotional dimension) may closely covary, there are certain factors than can preferentially influence each of the dimensions. Clinicians are encouraged to appreciate the multidimensionality of pain when they perform procedures and use this knowledge to minimize the patient's pain experience.

Published
2018

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