Articles: critical-care.
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Randomized Controlled Trial
Ultrasound guided transcutaneous phrenic nerve stimulation in critically ill patients: a new method to evaluate diaphragmatic function.
Diaphragm dysfunction is common in intensive care unit and associated with weaning failure and mortality. The diagnosis gold standard is the transdiaphragmatic or tracheal pressure induced by magnetic phrenic nerve stimulation. However, the equipment is not commonly available and requires specific technical skills. This study aimed to evaluate ultrasound-guided transcutaneous phrenic nerve stimulation for daily bedside assessment of diaphragm function by targeted electrical phrenic nerve stimulation. ⋯ The SONOTEPS method is a simple and accurate tool for bedside assessment of diaphragm function with ultrasound-guided transcutaneous phrenic nerve stimulation in sedated patients with no or minimal spontaneous respiratory activity.
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J Pain Symptom Manage · Mar 2025
Bereaved family quality of life varies with comorbid psychological distress and ICU-care quality.
Health-related quality of life (HRQOL) is highly endorsed, but HRQOL studies scarcely investigate the following: ICU family members; modifiable end-of-life (EOL) ICU-care factors; conjoint associations with prolonged grief disorder (PGD), post-traumatic stress disorder (PTSD), and depression; and long-term bereavement outcomes. ⋯ Bereaved family members' HRQOL was significantly associated with PGD-PTSD-depressive-symptom states and QODD classes-both modifiable through high-quality EOL ICU care.
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Critical care medicine · Feb 2025
Associations Between Social Economic Determinants and Long-Term Outcomes of Critically Ill Patients.
Differences in socioeconomic status (SES) may influence long-term physical, psychological, and cognitive health outcomes of ICU survivors. However, the relationship between SES and these three long-term health outcomes is rarely studied. The aim of this study was to investigate associations between SES and the occurrence of long-term outcomes 1-year post-ICU. ⋯ Indicators of lower SES, including low education level, low income, unemployment and migrants were associated with an increased risk of post-ICU health problems. Gaining insight into the complex relationship between SES and long-term health problems is necessary to decrease disparities in healthcare.
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Critical care medicine · Feb 2025
Ableism After Critical Illness: A Qualitative Translation of Key Concepts to the Post-ICU Context.
Ableism-discrimination and social prejudice against people with disabilities-defines people by their disability and assumes that disabled people require fixing. We sought to characterize ableism after critical illness and to describe its relationship with care delivery. ⋯ Ableism presents multifaceted barriers to participation after critical illness, undermining resilience and wellbeing. We hypothesize that anti-ableist interventions could reduce disability-related barriers to resilience to optimize recovery after critical illness.
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The incidence of hepatocellular carcinoma (HCC) is on the rise worldwide, due to the increasing prevalence of liver diseases associated with metabolic dysfunction and better management of cirrhosis and its complications. The diversification of HCC treatments has recently increased, with the choice of strategy based on HCC characteristics, liver function and comorbidities. The combination of new therapies has transformed the prognosis, with up to 70% survival at 5 years. ⋯ The importance of preanaesthetic evaluation will depend largely on the procedure proposed, associated co-morbidities and the stage of liver disease. This assessment should verify stabilisation of all comorbidities, and evaluate the degree of portal hypertension, cirrhosis severity and sarcopenia. Liver resection and liver transplantation for HCC present specific surgical challenges, and minimally invasive techniques improve recovery. Nonsurgical procedures considered as therapeutic (ablation) or standby (regional embolisation) are diverse, and all expose patients to specific intra-anaesthetic complications, sometimes requiring intensive care management. Peri-operative anaesthetic strategies deployed in the management of liver resection or nonsurgical procedures involve specific management of fluids, coagulation, narcosis and analgesia, which can impact on patients' overall, and cancer prognosis. Lastly, new down-staging strategies combining several types of procedure and possibly immunotherapy, also call for collegial reflection on posthepatic transplant immunosuppression, which must remain tailored to each individual patient.