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While clinicians working in the ICU experienced burnout symptoms during COVID-19, several were associated with moral distress, such as scarcity of resources and not working with qualified colleagues, a researcher said.
Moral distress from scarcity of time, personnel, and resources, as well as from unsafe colleagues, were significantly associated with burnout symptoms in ICU clinicians, such as emotional exhaustion, depersonalization, and reduced feeling of personal accomplishment, reported Niek Kok, MSc, a PhD candidate at Radboud Institute for Health Sciences in Nijmegen, the Netherlands, at the Society of Critical Care Medicine (SCCM) virtual Critical Care Congress. The findings were simultaneously published in
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Compliance with a relaxed care bundle was associated with lower 30-day mortality and shorter median hospital stays among children with sepsis, according to interim data from the Improving Pediatric Sepsis Outcomes (IPSO) FACTO trial.
The relaxed, or liberalized, sepsis bundle i.e., a group of best evidence-based interventions involved delivering an initial fluid bolus within 60 minutes, as opposed to 20 minutes; and delivering antibiotics within 180 instead of 60 minutes. The bundle also involved accepted sepsis recognition protocols (screen, huddle, or care order).
The trial data, presented at the virtual Society of Critical Care Medicine s Critical Care Congress, involved approximately 40,000 patients with IPSO-confirmed critical and non-critical sepsis or suspected sepsis treated at children s hospitals across the U.S. from 2017 through 2019.
During the presentation, Hughes noted that prior studies showed improvement with dexmedetomidine compared with lorazepam and midazolam with regard to delirium, coma, time receiving mechanical ventilation, and cost, though noninferiority studies found no significant impact on duration of mechanical ventilation, length of stay, or short-term mortality.
Researchers said SCCM recommends sedation with either light levels of dexmedetomidine or propofol for adults receiving mechanical ventilation and continuous sedation. The authors noted that dexmedetomidine has anti-inflammatory and bacterial properties superior to gamma-aminobutyric acid (GABA) agonists such as propofol and reduces neuronal apoptosis and promotes biomimetic sleep, which could improve clinical outcomes.
Hughes also reported lower rates of subsequent infection versus midazolam and reduced 28-day mortality in sepsis patients versus lorazepam.
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In facilities where 24/7 intensivist care was not available, outcomes were better when care was delivered by tele-intensivists versus traditional care models, researchers reported.
Among patients treated at one of nine hospitals within the Cleveland Clinic Health System, those who received ICU telemedicine were 18% less likely to die and were released from the hospital an average of 2 days sooner than patients who received traditional ICU care, without round-the-clock on-site intensivist care.
Findings from the study, which included around 154,000 ICU patients, were presented at the Society of Critical Care Medicine s virtual 50th Critical Care Congress.
Cleveland Clinic intensivist Chiedozie Udeh, MD, who presented the findings, noted that the COVID-19 pandemic has put the spotlight on ICU telemedicine.
Telehealth Helps Cut Mortality Risk Among ICU Patients medscape.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from medscape.com Daily Mail and Mail on Sunday newspapers.