Efficacy of endotracheal tube clamping to prevent positive airways pressure loss and pressure behavior after reconnection: a bench study.

Background: Endotracheal tube (ETT) clamping before disconnecting the patient from the mechanical ventilator is routinely performed in patients with acute respiratory distress syndrome (ARDS) to minimize alveolar de-recruitment. Clinical data on the effects of ETT clamping are lacking, and bench data are sparse. We aimed to evaluate the effects of three different types of clamps applied to ETTs of different sizes at different clamping moments during the respiratory cycle and in addition to assess pressure behavior following reconnection to the ventilator after a clamping maneuver.

Obstacles to patient inclusion in CPR/DNAR decisions and challenging conversations: A qualitative study with internal medicine physicians in Southern Switzerland.

Despite cardiopulmonary resuscitation (CPR) and do-not-attempt-resuscitation (DNAR) decisions are increasingly considered an essential component of hospital practice and patient inclusion in these conversations an ethical imperative in most cases, there is evidence that such discussions between physicians and patients/surrogate decision-makers (the person or people providing direction in decision making if a person is unable to make decisions about personal health care, e.g., family members or friends) are often inadequate, excessively delayed, or absent.

Stellate ganglion block combined with intra-arterial treatment: a "one-stop shop" for cerebral vasospasm after aneurysmal subarachnoid hemorrhage-a pilot study.

Purpose: Delayed cerebral ischemia (DCI) is a frequent cause of morbidity and mortality in patients with cerebral vasospasm (CV) following aneurysmal subarachnoid hemorrhage (aSAH). Refractory CV remains challenging to treat and often leads to permanent deficits and death despite aggressive therapy. We hereby report the feasibility and safety of stellate ganglion block (SGB) performed with a vascular roadmap-guided technique to minimize the risk of accidental vascular puncture and may be coupled to a diagnostic or therapeutic cerebral angiography.

Initiative for Burnout of ICU Caregivers: Feasibility and Preliminary Results of a Psychological Support.

Background: Intensive care unit (ICU) caregivers are at high risk of burnout and the shortage of this highly specialized personal is a problem. The feasibility and impact of a psychological intervention were never assessed in this special context.

Methods: A randomized controlled single-blind study in an ICU.

Determinants of the calibration of SAPS II and SAPS 3 mortality scores in intensive care: a European multicenter study.

Background: The aim of the Simplified Acute Physiology Score (SAPS) II and SAPS 3 is to predict the mortality of patients admitted to intensive care units (ICUs). Previous studies have suggested that the calibration of these scores may vary across countries, centers, and/or characteristics of patients. In the present study, we aimed to assess determinants of the calibration of these scores.

Impact of a communication strategy on family satisfaction in the intensive care unit.

Background: Family satisfaction of critically ill patients has gained increased interest as important indicator to evaluate the quality of care in the intensive care unit (ICU). The family satisfaction in the ICU questionnaire (FS-ICU 24) is a well-established tool to assess satisfaction in such settings. We tested the hypothesis that an intervention, aiming at improved communication between health professionals and patients' next of kin in the ICU improves family satisfaction, as assessed by FS-ICU 24.

Reproducibility of transpulmonary thermodilution cardiac output measurements in clinical practice: a systematic review.

Measuring cardiac output (CO) is an integral part of the diagnostic and therapeutic strategy in critically ill patients. During the last decade, the single transpulmonary thermodilution (TPTD) technique was implemented in clinical practice. The purpose of this paper was to systematically review and critically assess the existing data concerning the reproducibility of CO measured using TPTD (COTPTD).

Advance Directives and Communication Skills of Prehospital Physicians Involved in the Care of Cardiovascular Patients.

Advance directives (AD) were developed to respect patient autonomy. However, very few patients have AD, even in cases when major cardiovascular surgery is to follow. To understand the reasons behind the low prevalence of AD and to help decision making when patients are incompetent, it is necessary to focus on the impact of prehospital practitioners, who may contribute to an increase in AD by discussing them with patients.

[Between the poles of life and death].

Sometimes, conditions of critically ill patients unable to communicate, force us to decide whether or not to continue treatment. The most frequent elements we have to consider in individual patients, are survival at any cost and reduced future physical functioning and quality of life. In this article, we highlight existing literature's inability to precisely determine a given patient's preferences or to guess what they might be.

Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people.

Background: There is evidence that water-loss dehydration is common in older people and associated with many causes of morbidity and mortality. However, it is unclear what clinical symptoms, signs and tests may be used to identify early dehydration in older people, so that support can be mobilised to improve hydration before health and well-being are compromised.

Objectives: To determine the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs and tests to be used as screening tests for detecting water-loss dehydration in older people by systematically reviewing studies that have measured a reference standard and at least one index test in people aged 65 years and over.

Swiss physicians' perspectives on advance directives in elective cardiovascular surgery.

Background: When patients are incompetent, advance directives (AD) can help physicians take crucial medical decisions. However, prevalence remains low. The objective was to investigate physicians' perspectives and attitudes towards AD in order to determine potential targets for improvement.

SwissScoring--a nationwide survey of SAPS II assessing practices and its accuracy.

Objective: The first description of the simplified acute physiology score (SAPS) II dates back to 1993, but little is known about its accuracy in daily practice. Our purpose was to evaluate the accuracy of scoring and the factors that affect it in a nationwide survey.

Methods: Twenty clinical scenarios, covering a broad range of illness severities, were randomly assigned to a convenience sample of physicians or nurses in Swiss adult intensive care units (ICUs), who were asked to assess the SAPS II score for a single scenario.

Potential predictors of visiting hours policies in the intensive care setting.

Background: Restrictions on visiting hours in the intensive care unit (ICU) are usually adopted worldwide. Current knowledge shows that these limitations are not necessary. In order to identify potential variables that are associated with restricted visiting times we carried out an observational study on visiting policy.

Feasibility of a multiple-choice mini mental state examination for chronically critically ill patients.

Objectives: Following treatment in an ICU, up to 70% of chronically critically ill patients present neurocognitive impairment that can have negative effects on their quality of life, daily activities, and return to work. The Mini Mental State Examination is a simple, widely used tool for neurocognitive assessment. Although of interest when evaluating ICU patients, the current version is restricted to patients who are able to speak.

SwissScoring--a nationwide survey of NEMS assessing practices and its accuracy.

Background: The nine equivalents of nursing manpower use score (NEMS) is used to evaluate critical care nursing workload and occasionally to define hospital reimbursements. Little is known about the caregivers' accuracy in scoring, about factors affecting this accuracy and how validity of scoring is assured.

Methods: Accuracy in NEMS scoring of Swiss critical care nurses was assessed using case vignettes.

The short-term prognosis of cardiogenic shock can be determined using hemodynamic variables: a retrospective cohort study*.

Objectives: Few reports address the relationship between hemodynamic variables and the cardiogenic shock outcome in critically ill patients. The present study aimed to investigate the association between hemodynamic variables and early cardiogenic shock mortality in critically ill patients.

Design: Retrospective, single-center cohort study.

ICU research: the impact of invasiveness on informed consent.

Purpose: Studies into the preferences of patients and relatives regarding informed consent for intensive care unit (ICU) research are ongoing. We investigated the impact of a study's invasiveness on the choice of who should give consent and on the modalities of informed consent.

Methods: At ICU discharge, randomized pairs of patients and relatives were asked to answer a questionnaire about informed consent for research.

[Burnout in intensive care units].

Intensive care units are highly stressful for the patients but for the caregivers as well, including nurse-assistants, nurses and physicians. The psychological syndrome of work exhaustion more commonly named burnout threatens these caregivers. The aims of the present paper are to describe: a) the incidence of burnout in intensive care units; b) the factors favoring burnout and c) the impacts of burnout at the individual, at the unit and institutional level.

Prognosis and quality of life of elderly patients after intensive care.

Ageing of the world's population raises important questions about the utilisation of the health care system. It is not clear how much should be invested in the last years of life whereas the costs are known to increase in parallel. Since intensive care units (ICU) are costly with highly specialised personnel, it seems of paramount importance that they would be used efficiently.

Critical Care Nurses Inadequately Assess SAPS II Scores of Very Ill Patients in Real Life.

Background. Reliable ICU severity scores have been achieved by various healthcare workers but nothing is known regarding the accuracy in real life of severity scores registered by untrained nurses. Methods.