American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Observational Study
Unplanned Transfers From Intermediate Care Units to Intensive Care Units: A Cohort Study.
This study evaluated unplanned transfers from the intermediate care unit (IMCU) to the intensive care unit (ICU) among urgent admissions. This retrospective, observational study was conducted in 2 ICUs and 1 IMCU. Three patterns of urgent admission were assessed: admissions to the ICU only, admissions to the IMCU only, and admissions to the IMCU with subsequent transfer to the ICU. ⋯ Mortality was higher in patients transferred from the IMCU to the ICU than in the 3900 ICU-only patients (odds ratio, 3.22; 95% CI, 1.52-6.80). Most transfers from the IMCU to the ICU (135; 78.5%) were due to deterioration of the condition for which the patient was admitted. Patient transfers from the IMCU to the ICU were common, were associated with increased hospital mortality, and were mostly due to deterioration in the condition that was the reason for admission.
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Multicenter Study
Decreased Incidence of Rib Fractures in Pregnant Patients After Motor Vehicle Collisions.
Rib fractures are common after motor vehicle collisions. The hormonal changes associated with pregnancy decrease the stiffness and increase the laxity of cartilage and tendons. The effect of these changes on injury mechanics is not completely understood. ⋯ Pregnant patients have a lower rate of rib fracture after a motor vehicle collision than nonpregnant patients. The difference in injury mechanics may be due to hormonal changes that increase elasticity and resistance to bony injury of the ribs. In pregnant trauma patients, intrathoracic injury without rib fracture should raise concerns about injury severity. A multicenter evaluation of these findings is needed.
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Randomized Controlled Trial
Effect of Live Versus Recorded Music on Children Receiving Mechanical Ventilation and Sedation.
Music is often used as a nonpharmacological pain management strategy, but little evidence is available about its role in pediatric critical care patients. ⋯ The results of this study indicate that live music interventions may be more effective than recorded music interventions in reducing pain and anxiety in pediatric critical care patients. The advantage of live music may be due to the adaptability of the music delivery by a trained music therapist.
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Although use of mechanical circulatory support is increasing, it is unclear how providing such care affects clinicians' moral distress. ⋯ Moral distress was high among clinicians who commonly care for patients receiving mechanical circulatory support, suggesting that use of this therapy may affect well-being among intensive care unit clinicians.