Chronically critically ill - interesting hot topics

meanmaryjean, DNP, RN · Apr 27, 2018

Sleep- improving sleep for this patient population is crucial. Because you cannot get well unless you sleep.

ICUoneofthenurses · Apr 27, 2018

True!! any other suggestions?

offlabel · Apr 27, 2018

No real "hot" interesting topics with these patients. Sleep is a good one. Nutrition is another. Mental health is another. Maybe all 3.

chacha82, ADN, BSN · Apr 29, 2018

progressive mobility!

Home Health Columnist / Guide · Apr 29, 2018

From Philadelphia Inquirer

2013: A new frontier in ICU research: Postintensive care syndrome

...Doctors used to think patients returned to normal after the delusions and hallucinations of ICU delirium stopped. They're learning instead that some leave the hospital with terrifying false memories, often of being assaulted or imprisoned. The horrible visions help explain why a recent Johns Hopkins study found that one in four patients had post-traumatic stress symptoms two years after going home.
Now that ICU doctors have gotten better at saving patients' lives, they are asking what comes next. The answers are disturbing.
Researchers are finding that months - even years - after patients leave the hospital, many struggle with physical weakness, thinking problems, anxiety, depression, and PTSD. Even younger patients often cannot return to work.
Last year, the Society of Critical Care Medicine gave the constellation of problems a name - postintensive care syndrome - and ICU doctors around the country are revamping care in hopes that the lives they save will be less troubled.
Many of the changes - less sedation, more exercise, 24-hour visitation, dark rooms at night to encourage more normal sleep - are meant to reduce delirium. About 75 percent of ICU patients develop delirium, which is associated with poorer survival and more long-term problems....

April 20, 2018: Words that heal: ICU journals at Penn help patients and staff

..... The 53-year-old Chester County man, already depleted by cancer treatments and a December bout with pneumonia, was unconscious and hooked to a breathing machine. His family was told he might not make it through the night.
They also were given a small spiral notebook labeled ICU Healing Journal. The family could fill it with words that could help hospital staff understand who Nappi is. Doctors, nurses, and therapists would add entries offering support and explaining what Nappi was going through. The journal could help him adjust to life after the ICU - if he survived....
...The power of human connection
After years of planning, Penn Presbyterian began offering the journals in January to help prevent post-intensive care syndrome, or PICS, a set of physical and emotional problems gaining attention as more people survive an ICU stay but struggle afterward.
The journals have proven powerful for patients, as well as families and staff, said Mark Mikkelsen, a critical care doctor, who, along with Julie Rogan, an ICU clinical nurse specialist, helped start the project...

Caprica6 · Apr 29, 2018

I think as you dive into the literature, you will find a gap or two and that's where your interesting topic will come from. Good luck, and please share with us what you find!

Susie2310 · Apr 29, 2018

Important topics: Sleep; clustering care to promote rest; comfort; nutrition; preventing delirium; carefully evaluating possible causes of delirium and fixing the causes where possible prior to intervening; interventions to treat delirium that avoid using drugs (especially those known to contribute to delirium); over-sedation; early mobility where feasible; effective pain management; review of treatment goals with patient/family; family centered care; removal of invasive lines where possible; prevention of infection/sepsis/VAP; prevention of skin breakdown; prevention/treatment of constipation; polypharmacy.