Palliative Care in Cardiac Intensive Care Units

Palliative Care in Cardiac Intensive Care Units
Author: Massimo Romanò
Publisher: Springer Nature
Total Pages: 195
Release: 2021-09-29
Genre: Medical
ISBN: 3030801128

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This book analyzes the main topics of Palliative Care in Cardiac Intensive Care Units (CICU), from the changing epidemiology of patients admitted to the ICU, to the main clinical and ethical issues. The changing epidemiology of patients has led to new and emerging patient needs at the end of life. Care has shifted from acute coronary syndrome patients towards elderly patients, with a high prevalence of non-ischemic cardiovascular diseases and a high burden of non-cardiovascular comorbid conditions: both increase the susceptibility of patients to developing life-threatening critical conditions. These conditions are associated with a significant symptom burden, high mortality rate, and increased length of stay. The main new challenges involve shared decision-making, symptom control (pain, dyspnea, etc.), and ethical issues (withholding/withdrawing life sustaining treatments, deactivation of implanted cardiac devices, palliative sedation), all of which necessitate formal education on end-of-life care. Written by opinion leaders in their respective fields, who share their experience with improving the cultural and clinical competence of medical/nursing teams, this volume is chiefly intended for cardiologists, anesthesiologists, palliative care doctors and nursing staff.

Cardiac Intensive Care - E-Book

Cardiac Intensive Care - E-Book
Author: David L. Brown
Publisher: Elsevier Health Sciences
Total Pages: 736
Release: 2018-07-19
Genre: Medical
ISBN: 0323553494

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Using a multidisciplinary, team-oriented approach, this unique title expertly covers all the latest approaches to the assessment, diagnosis, and treatment of patients with critical cardiac illness. Led by Dr David L. Brown, a stellar team of authoritative writers guides you through cardiac pathophysiology, disease states presenting in the CICU, and state-of-the-art advanced diagnosis and therapeutic techniques. A visually appealing format, new chapters, and thorough updates ensure that you stay on the cutting edge of this rapidly advancing field. Discusses recent changes in cardiac intensive care, including new care paradigms, new mechanical support modalities, and new therapies and interventions. Contains 11 new chapters: Palliative Care, Temporary Pacemaker Insertion, Pericardiocentesis, Distributive Shock, Electrical Storm, Cardiopulmonary Cerebral Resuscitation after Cardiac Arrest, Temporary Mechanical Circulatory Support Devices, Cardiorenal Syndrome, Fulminant Myocarditis, Stress-Induced Cardiomyopathy, Diagnosis and Treatment of Unstable Supraventricular Tachycardia. Concisely yet thoroughly covers acute and severe heart failure, chronic pulmonary hypertension, life-threatening dysrhythmias, aortic dissection, and other cardiac conditions as they relate to intensive care. Explains drug therapy for key cardiac drugs, such as inotropes, vasodilators, anti-arrhythmics, diuretics, anticoagulants, and anti-platelets, and discusses important drug interactions. Ideal for all healthcare professionals involved in cardiac intensive care, including intensivists, cardiologists, cardiac surgeons, residents, fellows, cardiac nurses, respiratory therapists, physical therapists, and nutritionists.

Mount Sinai Expert Guides

Mount Sinai Expert Guides
Author: Stephan A. Mayer
Publisher: John Wiley & Sons
Total Pages: 658
Release: 2020-12-01
Genre: Medical
ISBN: 1119293308

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Part of the Mount Sinai Expert Guide series, this outstanding book provides rapid-access, clinical information on all aspects of Critical Care with a focus on clinical diagnosis and effective patient management. With strong focus on the very best in multidisciplinary patient care, it is the ideal point of care consultation tool for the busy physician.

Palliative Care in Critical Care, An Issue of Critical Care Nursing Clinics of North America

Palliative Care in Critical Care, An Issue of Critical Care Nursing Clinics of North America
Author: Tonja Hartjes
Publisher: Elsevier Health Sciences
Total Pages: 137
Release: 2015-09-07
Genre: Medical
ISBN: 0323395597

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Intensive care units (ICUs) provide comprehensive, advanced care to patients with serious or life-threatening conditions and consequently, a significant amount of end-of-life care (EOLC). Indeed, approximately 20% of deaths in the U.S. are associated with an ICU stay, and nearly half of U.S. patients who die in hospitals experience an ICU stay during the last 3 days of life. Despite the commonality of the ICU experience, ICU patients typically suffer from a range of distressing symptoms such as pain, fatigue, anxiety, and dyspnea, causing families significant distress on their behalf. Thus, there is a growing imperative for better provision of palliative care (PC) in the ICU, which may prevent and relieve suffering for patients with life threatening illnesses. Effective palliative care is accomplished through aggressive symptom management, communication about the patient and family's physical, psychosocial and spiritual concerns, and aligning treatments with each patient's goals, values, and preferences. PC is also patient-centered and uses a multidisciplinary, team-based approach that can be provided in conjunction with other life-sustaining treatments, or as a primary treatment approach. Failure to align treatment goals with individual and family preferences can create distress for patients, families, and providers. If implemented appropriately, palliative care may significantly reduce the health care costs associated with intensive hospital care, and help patients avoid the common, non-person centered treatment that is wasteful, distressing, and potentially harmful. Due to the success of many PC programs, administrators, providers, and accrediting bodies are beginning to understand that palliative care in the ICU is vital to optimal patient outcomes.

End-of-Life Care in Cardiovascular Disease

End-of-Life Care in Cardiovascular Disease
Author: Sarah J. Goodlin
Publisher: Springer
Total Pages: 251
Release: 2014-10-08
Genre: Medical
ISBN: 1447165217

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End-of-life issues in cardiology are becoming increasingly important in the management of patients in the cardiac unit, but there is frequently a lack of understanding regarding their impact on cardiology practice. The cardiac unit is increasingly becoming the location whereby a number of key clinical decisions relating to end-of-life care are being made, such as the decision to remove medications, the appropriate removal of cardiac devices, the management of do not resuscitate orders and the requirement for other cardiac procedures in light of the management of the terminally ill cardiac patients. Those working in palliative care need input from the cardiovascular team as the cardiologist is frequently still managing these patients until they are moved to the hospice. That this move into a hospice is often delayed until the very last moment, there is considerable onus on the cardiovascular management of these patients to be much broader in scope and take account of some of the more palliative medical decisions needed in this group of patients. This concise reference will detail the practical issues open to cardiovascular physicians and those medical professionals who manage patients reaching the end of their life from a cardiology perspective. It will detail the full management options open to them to ensure that their practice is in line with the requirements of the patient nearing the end of their life whether the cause be cardiovascular in origin or who need appropriate management of secondary cardiovascular symptoms. It will also include the various ethical, cultural and geographical issues that need to be considered when managing these patients.

Heart Failure and Palliative Care

Heart Failure and Palliative Care
Author: Richard Lehman
Publisher: CRC Press
Total Pages: 161
Release: 1998-02-05
Genre: Medical
ISBN: 1785230212

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MCQs are a standard part of undergraduate and postgraduate examinations, providing an easy and unbiased way of assessing performance. This updated edition of 240 MCQ questions covers a wide range of topics in medical microbiology and infectious diseases. The questions are accompanied by extended answers making them suitable for both revision and se

AACN Protocols for Practice

AACN Protocols for Practice
Author: Justine Medina
Publisher: Jones & Bartlett Learning
Total Pages: 78
Release: 2006
Genre: Medical
ISBN: 9780763740276

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AACN Protocols for Practice: Palliative Care and End-of-Life Issues in Critical Care sets forth the evidence-based guidelines for providing appropriate care, whether aggressively life-saving or palliative end-of-life care. the Protocols equip critical care nurses to effectively manage the following: symptom management. family issues and intervention. withholding and withdrawing life support. communication and conflict resolution. caring for the caregiver. Additionally, the text includes a state-of-the-science review that provides guidance to critical care nurses while acknowledging the limited

Evidence-Based Practice in Perioperative Cardiac Anesthesia and Surgery

Evidence-Based Practice in Perioperative Cardiac Anesthesia and Surgery
Author: Davy C.H. Cheng
Publisher: Springer Nature
Total Pages: 769
Release: 2020-11-06
Genre: Medical
ISBN: 3030478874

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This comprehensive yet concise book addresses current best practice in the combined areas of cardiac surgery and anesthesia, interventional minimally invasive cardiac procedures, perioperative management and monitoring, and critical care recovery. This book not only provides the latest best practices in the perioperative management of cardiac surgical patients, but also it summarizes the current clinical guidelines and algorithms from leading cardiac programs and professional societies. Contemporary best practice approaches are written by experts from leading cardiac surgical centers. The preoperative, intraoperative and postoperative management and recovery of surgical patients, including medication, monitoring techniques, and innovative surgical procedures, are presented by experts in the field of cardiac anesthesia and surgery. Perioperative clinical care guidelines, postoperative recovery pathways and models of care are presented with supporting protocols. Evidence-Based Practice in Perioperative Cardiac Anesthesia and Surgery is aimed at all cardiac anesthesiology consultants, fellows, and trainees; all cardiac surgery consultants, fellows, and trainees; nurses in perioperative care and those involved in patient recovery management; cardiac program administrative professionals; and all critical care consultants and trainees looking after cardiovascular surgical patients in the modern era.

Integrating Palliative Care in the Intensive Care Unit

Integrating Palliative Care in the Intensive Care Unit
Author: Carrie Copenhaver Ogilvie
Publisher:
Total Pages: 0
Release: 2010
Genre: Communication
ISBN:

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Problem: Patients in the intensive care unit (ICU) hang in a delicate balance between life and death and this uncertainty creates anguish for patients and families. They need information, guidance and support as they try to navigate the course of a critical illness; however, studies indicate these needs are not met. The primary recommendation for meeting these needs is integrating palliative care (PC) into the comprehensive care of critically ill patient. Although Clinical Practice Guidelines (CPGs) were developed to help facilitate this integration, gaps in adherence to the CPG were identified within a selected health care organization. Purpose: The primary purpose of this capstone project was to evaluate the provision of evidence-based PC to critically ill patients by assessing the level of adherence to CPGs. A secondary purpose was to promote evidence-based practice by identifying strategies and developing interventions to enhance the provision of evidence-based PC in ICU. Goal: The goal of this project was to identify and implement an evidence-based practice change that would improve the provision of PC to critically ill patients. Objectives: First, determine current state of PC provision in the ICU. Second, locate and analyze the best evidence regarding the provision of PC to critically ill patients. Third, design interventions and develop strategies that supported the provision of evidence-based PC in the ICU. Fourth, implement and evaluate the effectiveness of the practice change on improving the provision of evidence-based PC. Fifth, integrate PC into the comprehensive care of all critically ill patients as standard practice and set a measurement for ongoing monitoring. Plan: This project was an evidence-based practice change and the plan consisted of five phases, which mirrored the five aforementioned objectives. The plan engaged key stakeholders throughout the process. Outcomes and Results: Key findings revealed an improvement in the adherence to CPGs for PC and reduction in resource utilization. Baseline CPG adherence rate was calculated at 59% and increased to 73% after the implementation of the practice change. Additionally, practice changes that improved the provision of PC care to the imminently dying patient were directly associated with a decrease in resource utilization and included a reduction in ICU length of stay by 0.8 days; a reduction in direct costs by $4200; and a cost avoidance of $2.5 million.

New Prediction Model For Cardiac Arrest Time Of Palliative Care Patients In The Intensive Care Unit

New Prediction Model For Cardiac Arrest Time Of Palliative Care Patients In The Intensive Care Unit
Author: Shuta Morishige
Publisher:
Total Pages:
Release: 2017
Genre:
ISBN:

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Background: In the palliative care setting, family members of terminally ill patients wish to be present for the last moments of the patientu2019s life. However, it is difficult to provide family members with an estimated time of patientu2019s death with accuracy. We hypothesized that dysfunction of the autonomic nervous system resulting in an imbalance between systolic blood pressure (SBP) and heart rate(HR) might precede cardiac arrest with a certain time interval. The aim of this study was to develop the algorithm to predict cardiac arrest in terminally ill patients.Methods: We retrospectively collected data of patients who were admitted to the intensive care unit (ICU) of Yokohama City University Hospital between 2010 and 2016. Exponential decay model was used to develop the formula to calculate the predicted HR from SBP. The disparity between predicted HR and real HR was evaluated as the predictor of cardiac arrest in the following 2 hours. Patient data were randomly divided into two groups. One was used to determine the threshold of the HR disparity with the receiver operating characteristic curve, and the other was used to validate the formula by determining the diagnostic power of the threshold.Results:u3000Of 4330 patients who were admitted to the ICU, 32 died in the ICU and 19 patients were included in this study. Exponential decay model determined the following formula: Predicted HR =SBP x(0.995 +5.936 e -0.035 x SBP). Area under the ROC of the disparity between real HR and predicted HR was 0.650 (95% confidence interval 0.512 to 0.788), p