Clinical Pearls

Patients with COVID-19 can develop pneumonia that leads to acute respiratory distress syndrome requiring invasive care such as extracorporeal membrane oxygenation (ECMO). Although reported mortality is high (39%) for patients with COVID-19 undergoing ECMO, it is not clear what other factors may be associated with this outcome.Using a national database, Gallegos-Koyner and colleagues matched comorbidities and socioeconomic factors and compared outcomes between patients with COVID-related pneumonia and those with non–COVID-19 pneumonia who were treated with ECMO. They found the following: Patients in both groups were similar in age (45–46 years) and mostly male.Those with COVID-19 had higher mortality, longer stays, higher hospital costs, and less likelihood of being discharged home.Findings show that patients with COVID-19 undergoing ECMO had poorer outcomes than patients with non–COVID-19 pneumonia undergoing ECMO.See Article, pp 104–110Nurse burnout remains a significant problem affecting nurses’ health and patients’ satisfaction and care. Although stand-alone mindfulness interventions have been developed and studied, no “gold standard” exists for providing mindful care.Bazan and colleagues developed a 6-week mindfulness bundle toolkit (MBT) that includes guided mindfulness activities including yoga, spirituality training, and use of a therapeutic room. They tested the effectiveness of the MBT with frontline critical care nurses and found the following: Study findings suggest that a 6-week MBT intervention can mitigate the effects of negative factors leading to burnout. The authors recommend a bundle approach to allow individualization of the intervention.See Article, pp 119–126Clinician care is often focused on improving outcomes that patients and families in the intensive care unit (ICU) can experience during and after hospitalization. What is often not addressed with families is the financial hardship that many experience and its impact on their psychological outcomes.Dotolo and colleagues interviewed ICU physicians, nurses, and social workers to characterize their experiences with addressing financial hardship directly with patients and their families and to determine what barriers participants perceived to doing so. They identified 2 major themes: Study participants recognized the importance of including financial assessment in patients’ care. The authors suggest normalizing discussions of financial impact as the first step in addressing barriers.See Article, pp 137–144Approximately 13% to 20% of patients in an intensive care unit or step-down unit die each year. Although bereavement care is supported by critical care consensus groups, formal bereavement practices are inconsistent across units, and many do not routinely provide family follow-up.McAdam and colleagues surveyed health care professionals (HCPs) in the intensive care unit, step-down unit, and emergency department to understand their views and practices related to bereavement support. They found the following: Although further research is recommended, study findings provide the views of multiple types of HCPs regarding bereavement care practice. This information can be used to improve educational support and protocols on bereavement care.See Article, pp 84–94