Critical Care Commons^™

Summary Of: Feasibility Of Continuous Home Monitoring Of Particulate Matter And Lung Function In Patients With Chronic Obstructive Lung Disease Who Are Exposed To Wood Smoke, S Wayne, K Cowan, L.M. Paulin, J Emery, D.A. Kaminsky

Northern New England Clinical & Translational Research

Particulate matter (PM) contains microscopic solids or liquids that are so small they can be inhaled and cause serious health problems. Examples include smoke, dust, soot, and fumes.

There is increasing evidence that small particles have harmful effects on people’s breathing. Wood stoves are a source of indoor PM.

A Continuous Objective Shivering Monitor During Targeted Temperature Management After Cardiac Arrest, Richard R. Riker, Erica Schlichting, David Seder, Mary Weatherbee, David J Gagnon, Teresa May

Costas T. Lambrew Research Retreat 2024

Background:

• Shivering during targeted temperature management (TTM) after cardiac arrest is stressful and linked to cerebral metabolic crisis.

• Few publications report shivering incidence, timing, or severity during TTM, and shivering treatment recommendations conflict.

• To evaluate multimodal shivering assessments, we studied patients during TTM managed with surface cooling, moderate analgosedation, surface counterwarming, and intermittent neuromuscular blockade (NMB) and evaluated surface electromyographic (EMG) power in decibels using the Medtronic bispectral index (BIS) monitor.

Machine Learning Approaches For Neurological Risk Stratification Within 6 Hours Of Cardiac Arrest, Richard R. Riker, Qingchu Jin, Hunter Williams, Teresa May, David Seder, Raimond L. Winslow

Costas T. Lambrew Research Retreat 2024

Background:

• Prognostication of neurological outcome should be delayed at least 72 hours after cardiac arrest. Early stratification of risk severity provides important information enabling improved medical decision making, research enrollment, and precision medicine approaches.

• We propose that electroencephalography (EEG)-derived indices are valid biomarkers of severity of neurological injury very early after cardiac arrest.

• This study was designed to assess the relative impact of early clinical data and processed EEG indices in the first 6 hours after recovery of spontaneous circulation (ROSC) after cardiac arrest.

Sustaining Care Team Engagement Using A Hierarchy Of Needs Framework, Katherine Skroski, Sam Canonico, Hailey Frager, Mary Beeaker, Natalia Johnson, Rebecca A. Brookes

Operations Transformation

Cardiology Intensive Care & Cardiovascular Interventional (CICU & R9 West) teams provide superb care to critically ill cardiac patients at Maine Medical Center. Covid Pandemic revealed the importance of physical and mental health wellbeing, as well as care team engagement in order to continue to provide outstanding care to patients. CICU/R9 West Leadership looked for ways to improve team engagement and ensure that care team members’ needs are met and sustained.

Neurocope: A Novel Intervention To Increase Professional Fulfillment And Reduce Burnout By Connecting Neuro-Icu Healthcare Workers To Their Post-Recovery Patients, Angela Leclerc, Mary Sorcher, David Seder, Sara Penrod, Meghan Searight, Alison Daley, Sarah Hanken, Christine Lord, Whitney Trosper, Stephanie Chan, Jennifer Cote

Costas T. Lambrew Research Retreat 2023

Background:

Healthcare workers (HCWs) caring for patients with acute neurologic injury in the ICU rarely receive detailed information on the recovery of their patients. The missing connection between the period of acute neurologic injury and long-term outcomes is a psychological burden that contributes to moral fatigue and burnout.

We hypothesize that attending an Interprofessional conference series through which patients describe their acute brain injury and recovery to Neuro-ICU HCWs may ease moral fatigue, increasing professional fulfillment and reducing burnout.

Impact Of Bowel Management Guidelines On Documentation And Patient Outcomes In The Intensive Care Unit, Alana Trottier, Paul Blakeslee, Kristiina Hyrkas

Costas T. Lambrew Research Retreat 2021

Introduction

• Bowel management (BM) is an inadvertently overlooked aspect of patient care for critically ill patients who have complex, immediate life-threatening health issues.

• Bowel dysfunction is common with the reported incidence of diarrhea between 3.3%-78% and constipation between 20-83%

• Studies suggest that BM guidelines can standardize care, improve documentation, and impact patient outcomes

• Use of BM guidelines has remained low, probably influenced by clinicians’ resistance to change, resulting in small to moderate improvements and difficulties sustaining new practices

• We anticipated that sustained changes require recognizing clinicians’ current practice, integrating modifications into existing workflow, and engaging …

Parent Experience Of Hie And Hypothermia: A Call For Trauma Informed Care, Anna Sagaser, Betsy Pilon, Annie Goeller, Monica Lemmon, Alexa Craig

Costas T. Lambrew Research Retreat 2021

Objective:

To assess parents’ experience of communication with the medical team and involvement with their infant during HIE treatment.

Prolonged Thunder Before The Storm – Diagnosis Of Aortobronchial Fistula After 28 Months Of Recurrent Hemoptysis, Hilamber Subba, Truc Ta, Edmund Sears

Costas T. Lambrew Research Retreat 2021

Aortobronchial fistula (ABF) should always be considered in patients with hemoptysis and previous thoracic surgery, however the diagnosis is known to be difficult both clinically and radiographically1. We present a case with the longest indolent course of hemoptysis reported to date .

A Fatal Rectus Sheath Hematoma After A Myasthenia Crisis Case Report, Robert G. Michaud, Lesley B. Gordon

Journal of Maine Medical Center

Introduction: Rectus sheath hematomas (RSH) generally occur due to damage to the inferior epigastric artery. They are rare causes of abdominal pain or acute blood loss anemia, but are an important diagnostic consideration because they can be cryptic and are potentially fatal.

Clinical Findings: An 85-year-old female who had been admitted to the hospital for 10 days with a myasthenia crisis was found to be abruptly hypotensive with a tender abdominal mass in the left lower quadrant subtly crossing midline. She was on prophylactic anticoagulation during her hospitalization.

Main diagnosis, therapeutics, interventions, and outcomes: The patient was initially stabilized with …

Development Of Mechanical Ventilator Educational Brochure For Patients/Families, Cathy Palleschi, Wendy Osgood, Mark Parker

Operations Transformation

Patients on mechanical ventilation often have no memory of events while being ventilated. In addition, families during this time, are often overwhelmed and unable to retain information provided to them by caregivers.

In attempt to address these issues, a team of care providers in an tertiary academic hospital established a goal to create a mechanical educational brochure with the goal to reduce associated anxiety and improve overall understanding of information provided.

As part of a clinical transformation project, a root cause analysis was conducted and a number of countermeasures were initiated. Some of these included a survey to capture feedback …

Reduction Of Catheter Associated Urinary Tract Infections (Cauti) In A Critical Care Setting, Deborah Jackson, Lindsey Lucas, Shawn Taylor, Jonathan Archibald, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

Urinary tract infections (UTIs) are the most common type of healthcare associated infections. Seventy five percent are related to indwelling urinary catheters. These infections come with increased morbidity and mortality risk. A team of intensive care providers at a large academic tertiary medical center initiated a quality improvement project to reduce the number of CAUTIs.

Baseline data established the total number of catheter days and CAUTIs by month. A subsequent root cause analysis was completed and several counter measures were developed to include a KPI implementation to track that all intensive care providers are educated in CAUTI and creation of …

Implementation Of Trauma Service Guideline For The Use Of Phenobarbital In The Management Of The Non-Icu Trauma Patient At Risk Or Experiencing Severe Alcohol Withdrawal, Joseph Rappold, Julianne Ontengco, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

The trauma service in a large academic tertiary medical center admits a large proportion of patients with the secondary diagnosis of alcohol use disorder. Given the successful use of phenobarbital in the critical care unit for withdrawal prophylaxis and treatment of acute withdrawal, a quality improvement project was established to create and implement guidelines for the non ICU patient.

A root cause analysis demonstrated several issues to include inconsistent clinical decision documentation. As a result, several countermeasures were initiated to address the various issues.

Post implementation of countermeasures, a decrease in the amount of severe alcohol withdrawal as well as …

Intensive Care To Intermediate Care Bridge Program, Natasha Bartlett, Sally Langerak, Lindsey Lucas, Jonathan Archibald, Tayla Robbins, Miranda Thompson, Patrice Tetu, Calla Hastings, Megan Garland, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks

Operations Transformation

To deliver the highest quality of care across the continuum, a large academic tertiary medical center envisioned a project that would provide an internal source of cross trained nurses for their medical intensive care unit (SCU2) and their medical intermediate care unit (R4/IMC/AVU). The hope for this program was to improve communication and collaboration between nurses and enhance the care that they provide to patients and their families.

A highly qualified team of nurses was established to create a performance improvement project. The overall goal of this endeavor was to build a more collaborative relationship between the units and ultimately …

Safe Care For Seizure Patients On An Epilepsy Monitoring Unit, Deborah Bachand, Lauri Wilson, Rachel Caiola, Lynne Keller, Megan Selvitelli, Mary Jo Farley, Jennifer O'Neill, Sara Shrock, Hannah Plummer, Sally Prokey, Amy Sparks, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

Operations Transformation

Seizure patients admitted to an Epilepsy Monitoring Unit located within an academic tertiary medical center have a high potential to impact patient safety. As a result, a unit based team identified a need for a higher level of training for both their staff and float companions to ensure safe and standardized care for this group of patients.

The goal of this quality improvement project was to create an educational tool that would assist 100% of staff in better recognizing and responding to seizures. Baseline metrics and root cause analysis demonstrated a lack of consistent information being taught, a poorly identified …

Delirium Reduction Strategies For The Critically Ill, June Chaves, Sam Canonico, Will Cheney, Tammy Corey, Gil Fraser, Alex Kowalewski, Jen Low, Cardiac Intensive Care Unit, Haley Pelletier, Cathy Palleschi, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

MaineHealth Maine Medical Center

Delirium, an acute and fluctuating disturbance of consciousness and cognition, is a common manifestation of acute brain dysfunction in critically ill patients. Patients with delirium have longer hospital stays and a lower 6-month survival rate than do patients without delirium. Preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after discharge.

In a large acute care hospital, the cardiac intensive care staff became interested in mitigating their unit’s high delirium rate of ventilated patients. At baseline, many members of the healthcare team did not believe that delirium could be prevented and the predominant …