Abstract:
OBJECTIVES:To examine perceptions of nurses and physicians in regard to ethical decision-making climate in the ICU and to test the hypothesis that the worse the ethical decision-making climate, the greater the discordance between nurses' and physicians' rating of ethical decision-making climate with physicians hypothesized to rate the climate better than the nurses. DESIGN:Prospective observational study. SETTING:A total of 68 adult ICUs in 13 European countries and the United States. SUBJECTS:ICU physicians and nurses. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Perceptions of ethical decision-making climate among clinicians were measured in April-May 2014, using a 35-items self-assessment questionnaire that evaluated seven factors (empowering leadership by physicians, interdisciplinary reflection, not avoiding end-of-life decisions, mutual respect within the interdisciplinary team, involvement of nurses in end-of-life care and decision-making, active decision-making by physicians, and ethical awareness). A total of 2,275 nurses and 717 physicians participated (response rate of 63%). Using cluster analysis, ICUs were categorized according to four ethical decision-making climates: good, average with nurses' involvement at end-of-life, average without nurses' involvement at end-of-life, and poor. Overall, physicians rated ethical decision-making climate more positively than nurses (p < 0.001 for all seven factors). Physicians had more positive perceptions of ethical decision-making climate than nurses in all 13 participating countries and in each individual participating ICU. Compared to ICUs with good or average ethical decision-making climates, ICUs with poor ethical decision-making climates had the greatest discordance between physicians and nurses. Although nurse/physician differences were found in all seven factors of ethical decision-making climate measurement, the factors with greatest discordance were regarding physician leadership, interdisciplinary reflection, and not avoiding end-of-life decisions. CONCLUSIONS:Physicians consistently perceived ICU ethical decision-making climate more positively than nurses. ICUs with poor ethical decision-making climates had the largest discrepancies.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Jensen HI,Hebsgaard S,Hansen TCB,Johnsen RFA,Hartog CS,Soultati I,Szucs O,Wilson ME,van den Bulcke B,Benoit DD,Piers Rdoi
10.1097/CCM.0000000000004017subject
Has Abstractpub_date
2019-12-01 00:00:00pages
1716-1723issue
12eissn
0090-3493issn
1530-0293journal_volume
47pub_type
杂志文章,多中心研究abstract:OBJECTIVE:To evaluate the effectiveness of lorazepam and midazolam for long-term sedation of critically ill, mechanically ventilated patients. DESIGN:Double-blind, randomized, controlled study. SETTING:Medical intensive care unit in a university teaching hospital. PATIENTS:Sixty-four evaluable adult patients admitte...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199908000-00009
更新日期:1999-08-01 00:00:00
abstract:OBJECTIVES:To determine the incidence and epidemiologic characteristics of cardiac arrests among tracheal intubations in PICUs. DESIGN:Retrospective cohort study of prospectively collected data. SETTING:Twenty-five diverse PICUs. PATIENTS:Critically ill children requiring tracheal intubation in PICUs. INTERVENTIONS...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000001741
更新日期:2016-09-01 00:00:00
abstract:OBJECTIVE:To determine the pharmacokinetics of fentanyl when used as a long-term continuous infusion for sedation/analgesia in mechanically ventilated critically ill infants and children. DESIGN:Prospective, case series. SETTING:A university hospital pediatric intensive care unit (ICU). PATIENTS:Nineteen mechanicall...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199307000-00012
更新日期:1993-07-01 00:00:00
abstract:OBJECTIVES:To compare usual care with a proactive case-finding approach for critically ill patients with terminal dementia using an inpatient palliative care service. DESIGN:Prospective comparison to historical control. SETTING:Urban, university-affiliated hospital. PATIENTS:Total of 52 men and women with end-stage ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000138560.56577.88
更新日期:2004-09-01 00:00:00
abstract::We compared the blood culture results obtained either by venipuncture or through an arterial catheter in 51 critically ill patients with 217 clinically suspected episodes of bacteremia. During each episode, three blood culture samples, two arterial and one venous, were drawn within 1 h. One or more cultures were posit...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:1985-08-01 00:00:00
abstract:OBJECTIVES:To determine the amount of spontaneous variability of cardiac output over time in critically ill patients, and to determine the effect of mechanical ventilation on cardiac output variability over time. DESIGN:Case series. SETTING:Medical intensive care unit in a Veterans Affairs Medical Center. PATIENTS:T...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199402000-00012
更新日期:1994-02-01 00:00:00
abstract:OBJECTIVES:To investigate the frequency, types, and implications of complications during intensive care in patients after status epilepticus has been successfully terminated. DESIGN:Retrospective study. SETTING:ICUs at a Swiss tertiary academic medical care center. PATIENTS:Data were collected from the digital patie...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004642
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVES:Glucose is the primary substrate for the energy requirements of the nervous system. Nevertheless, administration of glucose to critically ill patients with central nervous system trauma may have adverse effects on their neurologic recovery. The purpose of this study was to evaluate the effects of other sourc...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:1994-11-01 00:00:00
abstract:OBJECTIVES:To evaluate the preload dependence of femoral maximal change in pressure over time (dP/dtmax) during volume expansion in preload dependent and independent critically ill patients. DESIGN:Retrospective database analysis. SETTING:Two adult polyvalent ICUs. PATIENTS:Twenty-five critically ill patients with a...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004515
更新日期:2020-10-01 00:00:00
abstract:OBJECTIVES:To create a novel tool to predict favorable neurologic outcomes during ICU stay among children with critical illness. DESIGN:Logistic regression models using adaptive lasso methodology were used to identify independent factors associated with favorable neurologic outcomes. A mixed effects logistic regressio...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002753
更新日期:2018-01-01 00:00:00
abstract::Gastric mucosal damage produced by topical application of necrotizing agents is diminished by topical or systemic pretreatment with a variety of E and F prostaglandins. The rat restraint model of gastric mucosal injury is more analogous to clinical stress ulceration than are models using intragastric application of to...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198901000-00011
更新日期:1989-01-01 00:00:00
abstract:OBJECTIVE:To determine which of a series of disposable or interchangeable positive end-expiratory pressure (PEEP) devices functions with the least imposition of inspiratory and expiratory work during continuous positive airway pressure. DESIGN:Prospective laboratory evaluation performed on a lung model. SETTING:Resea...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199408000-00004
更新日期:1994-08-01 00:00:00
abstract:OBJECTIVES:To evaluate the ability of central venous-to-arterial carbon dioxide pressure difference, central venous oxygen saturation, and the combination of these two parameters to detect extubation failure in critically ill patients. DESIGN:Multicentric, prospective, observational study. SETTING:Three ICUs. PATIEN...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004446
更新日期:2020-10-01 00:00:00
abstract:OBJECTIVE:In 1991, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) convened a "Consensus Conference," the goals of which were "to provide a conceptual and a practical framework to define the systemic inflammatory response to infection, which is a progressive injurious pr...
journal_title:Critical care medicine
pub_type: 共识发展会议,杂志文章,评审
doi:10.1097/01.CCM.0000050454.01978.3B
更新日期:2003-04-01 00:00:00
abstract:OBJECTIVE:The flow rate of a liquid drainage from the lungs is limited because of the elastic nature of the airways. This study was designed to clarify the relationship between intrapulmonary liquid volume and the development of the flow limitation or choked flow phenomenon as a function of expiratory flow rate during ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000104918.48411.91
更新日期:2004-01-01 00:00:00
abstract:OBJECTIVE:To examine the frequency of obtaining Institutional Review Board (IRB) approval and informed consent in critical care research. DATA SOURCES AND DATA EXTRACTION:One-year retrospective review of original critical care research in humans published in seven journals, including American Journal of Respiratory an...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199809000-00035
更新日期:1998-09-01 00:00:00
abstract:OBJECTIVE:The genetic background of hypertensive crisis is unknown. We examined the association of polymorphisms in genes involved in the renin-angiotensin-aldosterone-system with hypertensive crisis. DESIGN:Population-based case-control study. SETTING:Emergency department at a tertiary care university hospital. PAT...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200210000-00010
更新日期:2002-10-01 00:00:00
abstract::A new device has been developed to estimate continuously and noninvasively cardiac output from the thoracic electrical bioimpedance (CObi). CObi was compared to cardiac output by thermodilution (COtd) in five anesthetized dogs. Blood pressure, blood volume, and blood flow were manipulated by hemorrhage and infusions o...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198603000-00013
更新日期:1986-03-01 00:00:00
abstract:OBJECTIVES:Inhaled nitric oxide is being utilized as a selective pulmonary vasodilator in the treatment of persistent pulmonary hypertension of the newborn. However, the effects of inhaled nitric oxide on cerebral hemodynamics and distribution of left ventricular output in newborn subjects have not been studied. This s...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199508000-00013
更新日期:1995-08-01 00:00:00
abstract:OBJECTIVE:Prolonged stay in the intensive care unit (ICU) is associated with high mortality, morbidity, and costs. Identifying those patients who are most likely to benefit from an extended ICU stay would be helpful in guiding clinical decisions. We sought to describe the characteristics and outcomes for a heterogeneou...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000178184.97813.52
更新日期:2005-09-01 00:00:00
abstract:OBJECTIVES:To compare sleep, work hours, and behavioral alertness in faculty and fellows during a randomized trial of nighttime in-hospital intensivist staffing compared with a standard daytime intensivist model. DESIGN:Prospective observational study. SETTING:Medical ICU of a tertiary care academic medical center du...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003773
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVES:Ventilator-associated pneumonia diagnosis remains a debatable topic. New definitions of ventilator-associated conditions involving worsening oxygenation have been recently proposed to make surveillance of events possibly linked to ventilator-associated pneumonia as objective as possible. The objective of the...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0000000000000674
更新日期:2015-01-01 00:00:00
abstract:OBJECTIVES:Prophylactic levetiracetam is currently used in ~40% of patients with intracerebral hemorrhage, and the potential impact of levetircetam on health-related quality of life is unknown. We tested the hypothesis that prophylactic levetiracetam is independently associated with differences in cognitive function he...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003272
更新日期:2018-09-01 00:00:00
abstract::Pulmonary mechanics were studied in ten anemic preterm infants using an esophageal balloon and mask, before and after transfusion with 10 ml/kg of packed RBC. Their mean birth weight was 1212 +/- 323 g and gestational age was 29.27 +/- 2.4 wk. Transfusions were carried out at a mean postnatal age of 41.9 +/- 21.8 days...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199012000-00010
更新日期:1990-12-01 00:00:00
abstract::A safe, simple, reliable technique for sampling uncontaminated peripheral bronchial secretions in patients with endotracheal tubes has been developed. It is easily performed and requires no special training or equipment. This report summarizes the techniques's usefulness in providing diagnostic samples of peripheral a...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197703000-00003
更新日期:1977-03-01 00:00:00
abstract:CONTEXT:Reducing aspiration of gastric contents by placing mechanically ventilated patients in a semirecumbent position has been associated with lower incidences of ventilator-associated pneumonia (VAP). The feasibility and efficacy of this intervention in a larger patient population, however, are unknown. OBJECTIVE:A...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/01.ccm.0000198529.76602.5e
更新日期:2006-02-01 00:00:00
abstract::The venous-arterial PCO2 gradient may increase in certain low-flow states, such as CPR and canine endotoxemia. To determine whether venous hypercarbia also occurs in hemorrhagic shock, we studied 12 anesthetized, mechanically ventilated dogs. We performed laparotomies on the animals, inserting catheters into their ren...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198705000-00013
更新日期:1987-05-01 00:00:00
abstract:OBJECTIVE:To evaluate the relationship between the acute inflammatory response after surgical trauma and changes in hepatic cytochrome P450 3A4 activity, compare changes in cytochrome P450 3A4 activity after procedures with varying degrees of surgical stress, and to explore the time course of any potential drug-cytokin...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000063040.24541.49
更新日期:2003-05-01 00:00:00
abstract:BACKGROUND:Resuscitation from hemorrhagic shock (HS) predisposes to subsequent infections. Susceptibility to infection following sepsis has been attributed to apoptosis. Interleukin (IL)-6 has been shown to have antiapoptotic properties and to decrease postresuscitation inflammation in rodent and porcine models of HS. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000201901.30292.c2
更新日期:2006-03-01 00:00:00
abstract:BACKGROUND:Although thrombocytopenia in the intensive care unit (ICU) is associated with a poorer outcome, the precise relationship between the time course of platelet counts and the mortality rate has not been well defined. OBJECTIVE:To describe the time course of the platelet count in relation to the mortality rate ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/00003246-200204000-00005
更新日期:2002-04-01 00:00:00