Preparing the Intensive Care Unit for Disaster
Critical care teams can face a dramatic surge in demand for ICU beds and organ support during a disaster. Through effective preparedness, teams can enable a more effective response and hasten recovery back to normal operations. Disaster preparedness needs to balance an all-hazards approach with focused hazard-specific preparation guided by a critical care-specific hazard-vulnerability analysis. Broad stakeholder input from within and outside the critical care team is necessary to avoid gaps in planning. Evaluation of critical care disaster plans require frequent exercises, with a mechanism in place to ensure lessons learne...
Source: Critical Care Clinics - August 22, 2019 Category: Intensive Care Authors: Randy S. Wax Source Type: research
Principles and Practices of Establishing a Hospital-Based Ebola Treatment Unit
Outbreaks of Ebola virus disease and high-risk transmissible infections are increasing and pose threats to health care workers and global health systems. Previous outbreaks offer lessons for health system preparedness and response, including establishment of hospital-based high-risk pathogen treatment units. Their creation demands early preparation and interprofessional coordination; infection prevention and control; case management training; prepositioning of supplies; conversion of existing structures to treatment units; and strengthening communication and research platforms. Hospital-based Ebola and high-risk pathogen t...
Source: Critical Care Clinics - August 22, 2019 Category: Intensive Care Authors: Peter Kiiza, Neill K.J. Adhikari, Sarah Mullin, Koren Teo, Robert A. Fowler Source Type: research
Critical State of Disaster Preparedness
Disasters both natural and anthropogenic are increasing in intensity and frequency. 2018 marked the eighth consecutive year in which greater than seven high-consequence natural disasters occurred in the United States alone. These numbers do not include mass shootings or disease outbreaks, such as measles, influenza, and hepatitis A. (Source: Critical Care Clinics)
Source: Critical Care Clinics - August 22, 2019 Category: Intensive Care Authors: Marie R. Baldisseri, Mary Jane Reed, Randy S. Wax Tags: Preface Source Type: research
Intensive Care Unit in Disaster
CRITICAL CARE CLINICS (Source: Critical Care Clinics)
Source: Critical Care Clinics - August 22, 2019 Category: Intensive Care Authors: Marie R. Baldisseri, Mary Jane Reed, Randy S. Wax Source Type: research
This article describes the impact of disasters on special populations, provides a framework for future disaster preparation and planning, and identifies areas in need of further research. Gravid patients, who are often overlooked in disaster planning and preparation, are also discussed. (Source: Critical Care Clinics)
Source: Critical Care Clinics - July 31, 2019 Category: Intensive Care Authors: Timothy M. Dempsey, Stephanie C. Lapinsky, Eric Melnychuk, Stephen E. Lapinsky, Mary Jane Reed, Alexander S. Niven Source Type: research
This review provides an overview of triaging critically ill or injured patients during mass casualty incidents due to events such as disasters, pandemics, or terrorist incidents. Questions clinicians commonly have, including “what is triage?,” “when to triage?,” “what are the types of disaster triage?,” “how to triage?,” “what are the ethics of triage?,” “how to govern triage?,” and “what research is required on triage?,” are addressed. (Source: Critical Care Clinics)
Source: Critical Care Clinics - July 27, 2019 Category: Intensive Care Authors: Michael D. Christian Source Type: research
Intensive Care Role in Disaster Management Critical Care Clinics
The “daily disasters” within the ebb and flow of routine critical care provide a foundation of preparedness for the less-frequent, larger events that affect most health care organizations at some time. Although large disasters can overwhelm, those who strengthen processes and habits through daily pr actice will be the best prepared to manage them. (Source: Critical Care Clinics)
Source: Critical Care Clinics - July 25, 2019 Category: Intensive Care Authors: Tanzib Hossain, Marya Ghazipura, Jeffrey R. Dichter Source Type: research
Disasters Resulting from Radiologic and Nuclear Events
Radiation accidents are rare, but can produce large numbers of casualties with predictable patterns of injury. Casualties may suffer from a wide range of radiation exposures. Triage based on presence or absence of conventional injuries and an accurate assessment of radiation dose based on event history, symptoms, and laboratory testing, is critical. Treatment of acute radiation syndrome is supportive: including fluids, antibiotics, blood products, colony-stimulating factors, and stem cell or bone marrow transplantation. Care of radiation-injured patients with conventional trauma or burns needs to be modified to account for...
Source: Critical Care Clinics - July 25, 2019 Category: Intensive Care Authors: John S. Parrish, Gilbert Seda Source Type: research
Augmenting Critical Care Capacity in a Disaster
A health care facility must develop a comprehensive disaster plan that has a provision for critical care services. Mass critical care requires surge capacity: augmentation of critical care services during a disaster. Surge capacity involves staff, supplies, space, and structure. Measures to increase critical care staff include recalling essential personnel, using noncritical care staff, and emergency credentialing of volunteers. Having an adequate supply chain and a cache of critical care supplies is essential. Virtual critical care or tele-critical care can augment critical care capacity by assisting with patient monitori...
Source: Critical Care Clinics - July 25, 2019 Category: Intensive Care Authors: Gilbert Seda, John S. Parrish Source Type: research
Battling Superstorm Sandy at Lenox Hill Hospital
In preparation for Superstorm Sandy, the emergency control center at Lenox Hill Hospital (LHH) was activated. Patients were evacuated safely to increase hospital capacity, including increased critical care beds, hospital equipment and supplies, including ventilators. A triage center was established in the emergency department at LHH. Efforts were coordinated between LHH and New York University (NYU) Langone Medical Center. NYU medical staff was granted Disaster Emergency privileges, credentialed at LHH, and oriented to LHH. NYU residents and fellows were added by the Office of Graduate Medical Education. (Source: Critical Care Clinics)
Source: Critical Care Clinics - July 25, 2019 Category: Intensive Care Authors: Maciej Walczyszyn, Shalin Patel, Maly Oron, Bushra Mina Source Type: research
Anthropogenic disasters may be defined as any disaster caused by human action or inaction. Natural disasters occur without human interference. Injuries caused by terrorists and related criminal activities may be broadly grouped into 3 categories: blunt, blast, and penetrating trauma. Most terrorist and criminal activities that create a mass-casualty situation are performed using the weapons most readily available, such as firearms or explosives. A consistent pattern, comparing terrorism with interpersonal violence, is the greater severity of impact on the victim. (Source: Critical Care Clinics)
Source: Critical Care Clinics - July 19, 2019 Category: Intensive Care Authors: Michael Powers, Michael James Ellett Monson, Frederic S. Zimmerman, Sharon Einav, David J. Dries Source Type: research
This article considers the ethical issues that arise when health providers are confronted with the challenges of caring for victims of disaster. (Source: Critical Care Clinics)
Source: Critical Care Clinics - July 18, 2019 Category: Intensive Care Authors: Valerie Bridget Satkoske, David A. Kappel, Michael A. DeVita Source Type: research
Natural disasters are extreme events generally caused by abrupt climate change and other environmental factors. Intensive care units (ICUs) need to be prepared, because in the event of a natural disaster, the number of patients that require service stresses an already occupied facility. It is critical that personnel be able to do a proper ICU triage. Efforts have been made to prepare the health care system to be ready for a disaster. A natural disaster can disrupt the daily routine of a hospital and ICU personal need to be equipped with the necessary tools to be able to respond appropriately. (Source: Critical Care Clinics)
Source: Critical Care Clinics - July 15, 2019 Category: Intensive Care Authors: Jorge Hidalgo, Amado Alejandro Baez Source Type: research
Chemical Agents in Disaster
Chemical agents of warfare are divided into lung agents, blood agents, vesicants, and nerve agents. Intensivists must familiarize themselves with the clinical presentation and management principles in the event of a chemical attack. Key principles in management include aggressive supportive care and early administration of specific antidotes, if available. Management includes proper personal protection for critical care providers. Patients may make complete recovery with aggressive supportive care, even if they appear to have a poor prognosis. Hospitals must have an emergency response disaster plan in place to deal with al...
Source: Critical Care Clinics - July 15, 2019 Category: Intensive Care Authors: Rashmi Mishra, James Geiling Source Type: research
Intensive Care Unit Preparedness During Pandemics and Other Biological Threats
In the twenty-first century, severe acute respiratory syndrome (SARS), 2009 A(H1N1) influenza, and Ebola have all placed strains on critical care systems. In addition to the increased patient needs common to many disasters, epidemics may further degrade ICU capability when staff members fall ill, including in the course of direct patient care. In a large-scale pandemic, shortages of equipment and medications can further limit an ICU ’s ability to provide the normal standard of care. Hospital preparedness for epidemics must include strategies to maintain staff safety, secure adequate supplies, and have plans for triag...
Source: Critical Care Clinics - July 12, 2019 Category: Intensive Care Authors: Ryan C. Maves, Christina M. Jamros, Alfred G. Smith Source Type: research
Provision of Care for Critically Ill Children in Disasters
This article discusses key points of pediatric disaster planning, specific vulnerabilities, and the care of children in general and in specific disaster situations. (Source: Critical Care Clinics)
Source: Critical Care Clinics - July 11, 2019 Category: Intensive Care Authors: Mitchell Hamele, Ramon Gist, Niranjan Kissoon Source Type: research
Evolution of the Intensive Care Unit Telemedicine Value Proposition
Advances in clinical information sciences, telecommunication technologies, electronic health records, early warning systems, automated acuity assessment, and clinician communication support systems have allowed current-generation intensive care (ICU) telemedicine systems to address the inefficiencies of the failed advice-upon-request ICU telemedicine model. Value is related to the ability of health care systems to leverage ICU telemedicine resources to provide care. Local financial benefits of ICU telemedicine program implementation depend on changing behavior to better focus on activities that reduce the duration of criti...
Source: Critical Care Clinics - May 8, 2019 Category: Intensive Care Authors: Craig M. Lilly, Jared T. Mickelson Source Type: research
Intensive Care Unit Telemedicine
CRITICAL CARE CLINICS (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 8, 2019 Category: Intensive Care Authors: Kianoush B. Kashani Source Type: research
Important Administrative Aspects of Critical Care Telemedicine Programs
Conceptualizing, designing, implementing, and sustaining a successful critical care telemedicine program is a complex undertaking. All of these steps must be fully accomplished as a joint effort between a host facility and the telemedicine service provider. Important administrative considerations that must be incorporated into planning and execution steps include managing change. We briefly discuss critical aspects of establishing a sustainable business model, and aligning the critical care telemedicine program with institutional vision, goals, and mission. Discussed are important telemedicine provider infrastructure, key ...
Source: Critical Care Clinics - April 11, 2019 Category: Intensive Care Authors: Joseph Christopher Farmer Source Type: research
TeleICU Interdisciplinary Care Teams
This article examines the optimal TeleICU team composition, which is one that incorporates the use of an interdisciplinary approach, leverages technology, and is cognizant of varying geographic locations. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 11, 2019 Category: Intensive Care Authors: Cindy Welsh, Teresa Rincon, Iris Berman, Tom Bobich, Theresa Brindise, Theresa Davis Source Type: research
Impact of Intensive Care Unit Telemedicine on Outcomes
Intensive care unit (ICU) telemedicine lowers mortality, shortens length of stay and improves best practice compliance when implemented effectively. As a review of the literature shows, program success is not guaranteed. The model of ICU telemedicine with published results is the one designed to leverage an intensivist-led remote critical care team, assisted by technology, data streaming, and analytics. The value of ICU telemedicine lies in how well the model is applied, leveraged, and integrated into the existing staff, structure, and processes at the bedside. Key domains to master to achieve this integration are discusse...
Source: Critical Care Clinics - April 10, 2019 Category: Intensive Care Authors: Isabelle C. Kopec Source Type: research
Tele-ICU improves access to high-quality critical care using a variety of information technology (IT) solutions. Recent advances in computing and telecommunications have expanded telemedicine programs nationwide. This review covers the basic principles of delivery models, technological needs, cybersecurity, health IT standards, and interoperability required for a Tele-ICU system. This will enable a better definition of Tele-ICU platforms and build robust programs. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 8, 2019 Category: Intensive Care Authors: Vitaly Herasevich, Sanjay Subramanian Source Type: research
Intensive Care Unit Telemedicine
Intensive care unit (ICU) telemedicine is an established entity that has the ability to not only improve the effectiveness, efficiency, and safety of critical care, but to also serve as a tool to combat staffing shortages and resource-limited environments. Several areas for future innovation exist within the field, including the use of advanced practice providers, robust inclusion in medical education, and concurrent application of advanced machine learning. The globalization of critical care services will also likely be predominantly delivered by ICU telemedicine. Limitations faced by the field include technical issues, f...
Source: Critical Care Clinics - April 8, 2019 Category: Intensive Care Authors: William Bender, Cheryl A. Hiddleson, Timothy G. Buchman Source Type: research
Expansion of Telemedicine Services
As more specialized care gets centralized in centers of excellence, patients admitted to rural hospitals may be at a disadvantage at the time of accessing expertise or receiving advanced care. In this setting, telemedicine models provide a justification to equalize care across different levels. The diversity in telemedicine services is vast and is expanding. Even with all the subsets of telemedicine, including telepharmacy, telestroke, teledialysis, and tele –emergency medicine, the reasons for providing services and associated limitations are similar. However, there is a lack of empirical research including best pra...
Source: Critical Care Clinics - April 7, 2019 Category: Intensive Care Authors: Sandra L. Kane-Gill, Fred Rincon Source Type: research
Quality Improvement and Telemedicine Intensive Care Unit
This article outlines how quality improvement tools can be used to facilitate the patient-centered collaboration with a focus on defining evidence-practice gaps, developing actionable metrics, analyzing the impact of proposed interventions, quantifying resources, prioritizing improvement plans, evaluating results, and diffusing best practices. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 6, 2019 Category: Intensive Care Authors: Devang K. Sanghavi, Pramod K. Guru, Pablo Moreno Franco Source Type: research
Intensive Care Unit Telemedicine in the Era of Big Data, Artificial Intelligence, and Computer Clinical Decision Support Systems
This article examines the history of the telemedicine intensive care unit (tele-ICU), the current state of clinical decision support systems (CDSS) in the tele-ICU, applications of machine learning (ML) algorithms to critical care, and opportunities to integrate ML with tele-ICU CDSS. The enormous quantities of data generated by tele-ICU systems is a major driver in the development of the large, comprehensive, heterogeneous, and granular data sets necessary to develop generalizable ML CDSS algorithms, and deidentification of these data sets expands opportunities for ML CDSS research. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 6, 2019 Category: Intensive Care Authors: Ryan D. Kindle, Omar Badawi, Leo Anthony Celi, Shawn Sturland Source Type: research
Satisfaction in Intensive Care Unit Telemedicine Programs
For well over a decade, intensive care unit (ICU) telemedicine programs have been providing care to patients and families and an invaluable service to many receiving sites that are otherwise outside the traditional reach of high-quality critical care. It will be important that during this growth, outcomes regarding the unique services provided by ICU telemedicine are accurately measured, not the least of which is nursing, provider, and patient and family satisfaction. More work is required to ensure that the voices of those most intimately affected by ICU telemedicine services are heard and that programs are evaluated and ...
Source: Critical Care Clinics - April 6, 2019 Category: Intensive Care Authors: Annie B. Johnson Source Type: research
Telemedicine in Intensive Care Units: A Luxury or Necessity?
The advent of telemedicine programs and their utilization in intensive care units (ICU), started in the 1970s, was initially designed to enhance the ability of local providers by simple verbal or video consultation with an ICU expert. Over the course of years with evolution of clinical informatics and connectivity, the idea has grown to the contemporary Tele-ICU practices, which not only provide expert opinion to the local providers but also offer a wide range of services, including monitoring, supervisions, communications with patients, families, and local providers of many disciplines, active resuscitation and stabilizat...
Source: Critical Care Clinics - April 6, 2019 Category: Intensive Care Authors: Kianoush B. Kashani Tags: Preface Source Type: research
Intensive Care Unit Telemedicine Care Models
This review outlines various care models used in tele –intensive care unit (tele-ICU) programs. They may be differentiated by personnel and approach to care. Low-intensity models, such as nocturnal coverage, may be adequate for some ICU practices. Others might benefit from a high-intensity model, especially those practices that desire a proactive app roach to care. Also discussed is the incorporation of the education of trainees into tele-ICU models. (Source: Critical Care Clinics)
Source: Critical Care Clinics - March 28, 2019 Category: Intensive Care Authors: Sean M. Caples Source Type: research
Modern Critical Care Endocrinology and Its Impact on Critical Care Medicine
Endocrinology and issues related to the role of hormones in critical care medicine remain a dominant component of physiologic investigations, pathophysiologic manipulation, and treatment in patients admitted to intensive care units (ICUs) worldwide. As an example, only in the last 12 months, three major multicenter phase 3 randomized controlled trials (RCTs) have been published, which involved the assessment of hormonal therapy (hydrocortisone and angiotensin II) in patients with septic shock.1–5 (Source: Critical Care Clinics)
Source: Critical Care Clinics - February 19, 2019 Category: Intensive Care Authors: Rinaldo Bellomo Tags: Preface Source Type: research
Modern Critical Care Endocrinology
CRITICAL CARE CLINICS (Source: Critical Care Clinics)
Source: Critical Care Clinics - February 19, 2019 Category: Intensive Care Authors: Rinaldo Bellomo Source Type: research
Melatonin in Critical Care
This article reviews the principal properties of melatonin and how these could find clinical applications in care of the critically ill patients. (Source: Critical Care Clinics)
Source: Critical Care Clinics - January 29, 2019 Category: Intensive Care Authors: Annachiara Marra, Tracy J. McGrane, Christopher Patrick Henson, Pratik P. Pandharipande Source Type: research
Therapeutic Opportunities for Hepcidin in Acute Care Medicine
This article highlights the potential therapeutic benefit of exogenous hepcidin to prevent and treat iron-induced injury, specifically in the management of infection from enteric gram-negative bacilli or fungi, malaria, sepsis, acute kidney injury, trauma, transfusion, cardiopulmonary bypass surgery, and liver disease. (Source: Critical Care Clinics)
Source: Critical Care Clinics - January 29, 2019 Category: Intensive Care Authors: Lakhmir S. Chawla, Blaire Beers-Mulroy, George F. Tidmarsh Source Type: research
Diabetes Insipidus and Syndrome of Inappropriate Antidiuretic Hormone in Critically Ill Patients
Diabetes insipidus and the syndrome of inappropriate antidiuretic hormone secretion lie at opposite ends of the spectrum of disordered renal handling of water. Whereas renal retention of water insidiously causes hypotonic hyponatremia in syndrome of inappropriate antidiuretic hormone secretion, diabetes insipidus may lead to free water loss, hypernatremia, and volume depletion. Hypernatremia and hyponatremia are associated with worse outcomes and longer intensive care stays. Moreover, pathologies causing polyuria and hyponatremia in patients in intensive care may be multiple, making diagnosis challenging. We provide an app...
Source: Critical Care Clinics - January 28, 2019 Category: Intensive Care Authors: Anatole Harrois, James R. Anstey Source Type: research
Classic and Nonclassic Renin-Angiotensin Systems in the Critically Ill
Classic and nonclassic renin-angiotensin systems (RAS) are 2 sides of an ubiquitous endocrine/paracrine cascade regulating blood pressure and homeostasis. Angiotensin II and angiotensin-converting enzyme (ACE) levels are associated with severity of disease in the critically ill, and are central to the physiology and the pathogenesis of circulatory shock. Angiotensin (1 –7) and ACE2 act as an endogenous counterregulatory arm to the angiotensin II/ACE axis. The tissue-based RAS has paracrine effects dissociated from those of the circulating RAS. Exogenous angiotensin II or ACE2 may improve the outcome of septic shock a...
Source: Critical Care Clinics - January 28, 2019 Category: Intensive Care Authors: Laurent Bitker, Louise M. Burrell Source Type: research
Hydrocortisone in Vasodilatory Shock
Vasodilatory shock is the most common type of circulatory shock in critically ill patients; sepsis the predominant cause. Steroid use in septic shock gained favor in the 1970s; however, studies of high-dose steroids demonstrated excess morbidity and mortality. Lower dosage steroid use was driven by trials demonstrating improved hemodynamic status and the possibility of relative adrenal insufficiency; however, divergent results led to uncertainty about hydrocortisone treatment. Two recent trials are likely to reinforce the role of steroids in septic shock and change the recommendation in future clinical practice guidelines....
Source: Critical Care Clinics - January 28, 2019 Category: Intensive Care Authors: Balasubramanian Venkatesh, Jeremy Cohen Source Type: research
Osteoporosis and the Critically Ill Patient
Improved survival after critical illness has led to recognition of impaired recovery following critical illness as a major public health problem. A consistent association between critical illness and accelerated bone loss has been described, including changes in bone turnover markers, bone mineral density, and fragility fracture rate. An association between accelerated bone turnover and increased mortality after critical illness is probable. Assessment of the effect of antifracture agents on fracture rate and mortality in the high-risk population of postmenopausal women with prolonged ventilation is warranted. (Source: Critical Care Clinics)
Source: Critical Care Clinics - January 28, 2019 Category: Intensive Care Authors: Neil R. Orford, Julie A. Pasco, Mark A. Kotowicz Source Type: research
Erythropoietin in Critical Illness and Trauma
Erythropoietin (EPO) is a 34kD pleiotropic cytokine that was first identified as being essential for red blood cell (RBC) production. It is now recognized however that EPO is produced by many tissues. It plays a key role in the modulation of the response to injury, inflammation, and tissue hypoxia via the inhibition of apoptosis. Large clinical trials in the critically ill failed to demonstrate a role for EPO as an RBC transfusion sparing agent; however, improved clinical outcomes, attributable to EPO role in tissue protection are observed in critically ill trauma patients. Further research to confirm or refute these obser...
Source: Critical Care Clinics - January 28, 2019 Category: Intensive Care Authors: Craig French Source Type: research