Clinical Pearls

Alarm noise in the intensive care unit (ICU) comes from essential monitoring devices such as cardiac monitors, infusion pumps, and mechanical ventilators. Alarm fatigue occurs when health care providers become desensitized to monitor alarms, creating stress that can affect clinicians’ performance and patient safety.Güner and colleagues assessed the extent of alarm fatigue and its contributing factors among cardiac ICU nurses. They found Moderate levels of discomfort with alarms (mean, 6.3; range, 1-10) and alarm fatigue (mean, 22.8; range, 1-48)As nurses’ discomfort levels with alarms increased, so did their alarm fatigue.Contributing factors were multidimensional and fit into 4 categories: nurse-related, patient-related, institutional, and stakeholder-related.The study participants offered many suggestions for institutional level alarm management and prioritization strategies to enhance patient safety, improve work conditions, and reduce the negative effects of alarm fatigue.See Article, pp 32–43Strokes are associated with high morbidity and mortality. Early rehabilitation in the critical care unit is crucial for improving outcomes. Virtual reality (VR) has been used in stroke recovery care with chronic or nonspecific strokes but has not been used in acute stroke recovery.Sloan-Garza and colleagues tested the feasibility of using VR after an acute stroke across different age groups. They found that These results suggest that VR is both feasible and acceptable to patients recovering from acute stroke. Although further study is needed, VR provides instant, real-time feedback and evaluation that should be considered in acute stroke recovery care.See Article, pp 62–67Post–intensive care syndrome (PICS) is a collective grouping of psychological and physical impairments occurring after a critical illness; PICS affects about 1.5 million US patients yearly. Although sedation use has been identified as a risk factor for PICS, the relationship between sedation, intensive care unit (ICU) memories, and psychological outcomes remains unclear.Patel and colleagues explored the relationship between memories, sedation, and PICS in adult ICU patients. They found Although findings were not significant, many patients in this study received more than one type of agent, thus making it challenging to isolate the effect of an individual medication. The authors recommend further research on understanding patients’ experience with sedation.See Article, pp 10–19Families may experience psychological stress that continues after hospital discharge of their loved one; this is called post–intensive care syndrome–family (PICS-F). During the COVID-19 pandemic, restrictions of in-person contact meant that practices that reduce PICS-F (eg, bedside visitation and in-person care meetings) were not used. Further, patient death from COVID-19 is a risk factor for family posttraumatic stress disorder (PTSD) and symptoms of prolonged grief disorder.White and colleagues examined the prevalence of PTSD and symptoms of prolonged grief disorder in families of intensive care unit patients with COVID-19. They found that The authors recommend further research to determine the benefits of tailored psychosocial interventions and other long-term support for families following an intensive care unit admission.See Article, pp 45–53