Aust Crit Care
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End-of-life decision making in the Intensive Care Unit (ICU), can be emotionally challenging and multifaceted. Doctors and nurses are sometimes placed in a precarious position where they are required to make decisions for patients who may be unable to participate in the decision-making process. There is an increasing frequency of the need for such decisions to be made in ICU, with studies reporting that most ICU deaths are heralded by a decision to withdraw or withhold life-sustaining treatment. ⋯ Further research is warranted to address the need for a more comprehensive, standardised approach to support clinicians (medical and nursing) in end-of-life decision making in the ICU.
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Patients admitted to an intensive care unit (ICU) often experience distressing memories during recovery that have been associated with poor psychological and cognitive outcomes. The aim of this literature review was to synthesise the literature reporting on relationships between elements of ICU treatment and memories after discharge in adult ICU survivors. ⋯ The body of literature on the relationship between elements of ICU treatment and memories after ICU discharge is small and at its early stages. Larger studies using rigorous study design are needed in order to evaluate the effects of different elements of ICU treatment on the development of memories of the ICU during recovery.
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The clinical handover of critically ill postoperative patients from the operating theatre to the intensive care unit is a dynamic and complex process that can lead to communication and technical errors. The objectives of this integrative review were to illustrate how the use of structured handover processes between the operating theatre and intensive care unit impacts information transfer, handover duration, post-handover technical error and high risk events. ⋯ The body of literature on clinical handover between operating theatre and the intensive care unit is in its early stages of development. Future research using rigorous study designs, broader populations and varied surgical procedures are needed to further evaluate the effect of clinical handover protocols.
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The aim of this review is to appraise current research which examines the impact of early rehabilitation practices on functional outcomes and quality of life in adult intensive care unit (ICU) survivors. ⋯ A limited body of research supports early rehabilitation interventions to optimise the short term outcomes and long term quality of life for ICU survivors. Critical care nurses are in an excellent position to drive change within their departments ensuring that early rehabilitation practices are adopted and implemented.
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To explore the association between patient volume in intensive care units (ICUs) and risk-adjusted mortality. ⋯ Patient mortality may be improved in large capacity ICUs. However, the association is not consistent across all diagnostic groups. Risk adjusted mortality is increased in low volume ICUs. There appears to be a high volume threshold at which point the risk adjusted mortality benefit is also lost suggesting a window of optimal ICU organisational performance exists between low and high volumes. Further prospective research is recommended into clinical outcomes in high volume ICUs to explore association between organisational efficiency and quality of care.