Publications by authors named "Kirsten M Fiest"

Article Synopsis
  • Intravenous vasopressors are commonly used for unstable patients in critical care, but the potential of oral vasopressors like midodrine is still being explored.
  • A study was conducted at the University of Alberta Hospital to assess the feasibility of using midodrine in ICU patients who were reliant on IV vasopressors, involving random assignment to midodrine or placebo.
  • Results showed that midodrine had a slightly shorter ICU stay and lower hospital mortality compared to the placebo, indicating a need for further research on oral vasopressors in critically ill patients.
View Article and Find Full Text PDF

Objectives: To summarize the efficacy of midodrine as an adjunctive therapy in critically ill patients. Safety of midodrine was assessed as a secondary outcome.

Data Sources: We performed a systematic review and meta-analysis using a peer-reviewed search strategy combining the themes of vasopressor-dependent shock, critical care, and midodrine and including MEDLINE, Ovid Embase, CINAHL, and Cochrane library databases until September 14, 2023.

View Article and Find Full Text PDF
Article Synopsis
  • ICU patients often undergo a stressful process of weaning from sedation and ventilation, and a study pilot-tested a coaching tool led by family members to help ease this transition for both patients and their families.
  • Conducted in Calgary, the study involved 25 family-patient dyads from two ICUs, with surveys assessing family demographics, anxiety, tool feedback, and attitudes towards family presence during weaning trials.
  • Results showed that 60% of families found the coaching tool useful, 70% reported positive experiences with family involvement, and family anxiety significantly decreased after using the tool.
View Article and Find Full Text PDF
Article Synopsis
  • The Canadian Critical Care Trials Group (CCCTG) aims to promote Equity, Diversity, and Inclusion (EDI) in critical care research by creating a glossary of sociodemographic determinants of health to support educational initiatives and enhance inclusive language among professionals.
  • The glossary includes twelve key sociodemographic domains like age, sex, race, and income, with detailed definitions and examples related to healthcare disparities relevant to critical care.
  • Developed collaboratively with various stakeholders, this resource is meant to guide critical care professionals in addressing equity issues and improving health outcomes in their practices.
View Article and Find Full Text PDF

Purpose: The COVID-19 pandemic has resulted in increased job vacancies in Canadian intensive care units (ICUs). We aimed to identify, explore, and describe factors contributing to the decisions of health care workers to leave, or strongly consider leaving their ICU positions during the peri-COVID-19 pandemic era.

Methods: We undertook a qualitative descriptive study between June and August 2022.

View Article and Find Full Text PDF
Article Synopsis
  • The study compiled qualitative evidence on how COVID-19 visitation restrictions affected patients, families, and healthcare professionals in NICUs, PICUs, and adult ICUs.
  • Researchers analyzed 184 studies and found 54 key impacts, including disruptions to family-centered care, negative mental health effects, and loss of support systems and bonding opportunities.
  • The review emphasizes the need for compassionate family presence policies in future health crises to address these issues and improve care.
View Article and Find Full Text PDF

Key Points: For AKI prevention trial recruitment, patients prioritized technology enabled prescreening and involvement of family members in the consent process. For trial intervention delivery, participants prioritized measures to facilitate ease of trial intervention administration and return visits. For AKI prevention trial outcomes, patient participants identified effects on kidney-related and other clinical outcomes as top priorities.

View Article and Find Full Text PDF

Purpose: Opioids remain the mainstay of analgesia for critically ill patients, but its exposure is associated with negative effects including persistent use after discharge. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be an effective alternative to opioids with fewer adverse effects. We aimed to describe beliefs and attitudes towards the use of NSAIDs in adult intensive care units (ICUs).

View Article and Find Full Text PDF

Recovery from sepsis is a key global health issue, impacting 38 million sepsis survivors worldwide per year. Sepsis survivors face a wide range of physical, cognitive, and psychosocial sequelae. Readmissions to hospital following sepsis are an important driver of global healthcare utilization and cost.

View Article and Find Full Text PDF

Background: Our previous work synthesized published studies on well-being interventions during COVID-19. As we move into a post-COVID-19 pandemic period there is a need to comprehensively review published strategies, approaches, and interventions to improve child and youth well-being beyond deleterious impacts experienced during COVID-19.

Methods: Seven databases were searched from inception to January 2023.

View Article and Find Full Text PDF
Article Synopsis
  • Women, older individuals, and racial and ethnic minorities are often underrepresented in research studies, prompting an evaluation of participant demographics in randomized controlled trials and observational studies conducted by the Canadian Critical Care Trials Group.
  • From 1994 to 2022, 120 publications were analyzed, involving 211,144 participants, with most studies lacking comprehensive demographic reporting, including pregnancy status and socioeconomic factors.
  • Findings indicated that while women made up 42.3% of participants, racial and ethnic diversity was limited, with 59.7% identified as White, suggesting a disparity between study demographics and the broader Canadian population.
View Article and Find Full Text PDF
Article Synopsis
  • The COVID-19 pandemic had significant negative effects on the daily lives of children and youth, leading to poorer relationships with family and friends, and increased mental health issues such as worsened mood, anxiety, and irritability.
  • A national online survey conducted in Canada from April to May 2022 analyzed self-reported mental health symptoms among children (11-14 years) and youth (15-18 years), focusing on how social factors like relationship quality affected their mental well-being.
  • Results showed that over a third of participants reported worsened mood, anxiety, or irritability during the pandemic compared to before, with poor familial relationships being a significant contributing factor to these symptoms.
View Article and Find Full Text PDF

We sought in-depth understanding on the evolution of factors influencing COVID-19 booster dose and bivalent vaccine hesitancy in a longitudinal semi-structured interview-based qualitative study. Serial interviews were conducted between July 25th and September 1, 2022 (Phase I: univalent booster dose availability), and between November 21, 2022 and January 11, 2023 (Phase II: bivalent vaccine availability). Adults (≥18 years) in Canada who had received an initial primary series and had not received a COVID-19 booster dose were eligible for Phase I, and subsequently invited to participate in Phase II.

View Article and Find Full Text PDF

Background: Patient engagement in research is the meaningful and collaborative interaction between patients and researchers throughout the research process. Patient engagement can help to ensure patient-oriented values and perspectives are incorporated into the development, conduct, and dissemination of research. While patient engagement is increasingly prevalent in clinical research, it remains relatively unrealized in preclinical laboratory research.

View Article and Find Full Text PDF

Background: Untreated pain is associated with short-term and long-term consequences, including post-traumatic stress disorder and insomnia. Side effects of some analgesic medications include dysphoria, hallucinations and delirium. Therefore, both untreated pain and analgesic medications may be risk factors for delirium.

View Article and Find Full Text PDF

Purpose: The ABCDEF bundle may improve delirium outcomes among intensive care unit (ICU) patients, however population-based studies are lacking. In this study we evaluated effects of a quality improvement initiative based on the ABCDEF bundle in adult ICUs in Alberta, Canada.

Material And Methods: We conducted a pre-post, registry-based clinical trial, analysed using interrupted time series methodology.

View Article and Find Full Text PDF

Background: A significant gap exists between ideal evidence-based practice and real-world application of evidence-informed therapies for patients with hypoxaemic respiratory failure (HRF) and acute respiratory distress syndrome (ARDS). Pathways can improve the quality of care provided by helping integrate and organise the use of evidence informed practices, but barriers exist that can influence their adoption and successful implementation. We sought to identify barriers to the implementation of a best practice care pathway for HRF and ARDS and design an implementation science-based strategy targeting these barriers that is tailored to the critical care setting.

View Article and Find Full Text PDF

Background: The COVID-19 pandemic had a widespread impact on families with dependent children. To better understand the impact of the pandemic on families' health and relationships, we examined the association between mothers' and children's mental distress and family strain.

Methods: Three waves of the COVID-19 Impact Survey were analyzed, collected from a subsample of mother-child pairs ( = 157) from the Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal cohort in Alberta, Canada.

View Article and Find Full Text PDF
Article Synopsis
  • The study investigates factors contributing to COVID-19 vaccine booster hesitancy among Canadian adults, highlighting how knowledge, beliefs, and behaviors influence vaccination decisions.
  • A national survey collected 2202 responses, revealing that lower education levels and parental status increased hesitancy, while higher income decreased it.
  • Disbelief in vaccine effectiveness, disagreement with government decisions, and concerns about over-vaccination were significant factors linked to booster dose hesitancy, indicating areas for targeted public health strategies.
View Article and Find Full Text PDF

Background: Delirium commonly occurs in hospitalized adults. Psychiatric disorders such as anxiety, depression, and post-traumatic stress disorder (PTSD) can co-occur with delirium, and can be recognized and managed by clinicians using recommendations found in methodological guiding statements called Clinical Practice Guidelines (CPGs). The specific aims of this review were to: [1] synthesize CPG recommendations for the diagnosis and management of anxiety, depression, and PTSD in adults with delirium in acute care; and [2] identify recent published literature in addition to those identified and reported in a 2017 review on delirium CPG recommendations and quality.

View Article and Find Full Text PDF

Introduction: Many patients in the intensive care unit (ICU) cannot communicate. For these patients, family caregivers (family members/close friends) could assist in pain assessment. We previously adapted the Critical Care Pain Observation Tool (CPOT) for family caregiver use (CPOT-Fam).

View Article and Find Full Text PDF

Background: Children are increasingly discharged directly from the PICU. Transitions have been recognized as a period of increased patient and caregiver stress and risk of adverse events. No study has evaluated patient and caregiver outcomes after direct discharge from the PICU.

View Article and Find Full Text PDF

Introduction: Titrated application of positive end-expiratory pressure (PEEP) is an important part of any mechanical ventilation strategy. However, the method by which the optimal PEEP is determined and titrated varies widely. Methods for determining optimal PEEP have been assessed using a variety of different study designs and patient populations.

View Article and Find Full Text PDF