The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.

• Klíčová slova
• Communication, Conflict management, Cultural variations, Decision-making, End of life, Family-centered care, GRADE, Intensive care unit, Palliative care,
• MeSH
• jednotky intenzivní péče * organizace a řízení   normy   MeSH
• komunikace MeSH
• lidé MeSH
• paliativní péče * normy   metody   MeSH
• péče o pacienty v kritickém stavu metody   normy   MeSH
• péče o umírající * normy   metody   MeSH
• rozhodování MeSH
• společnosti lékařské MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• směrnice pro lékařskou praxi MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND: The cultural competence of nurses is crucial in providing nursing care for patients from different cultures. The absence of cultural competence can negatively impact the entire course of care; however, implementing cultural competence in critical care unit can be complicated. AIM: This study aimed to determine nurses' perceptions regarding cultural competence in critical care units. STUDY DESIGN: This study used a qualitative design with semi-structured interviews with nurses (n = 10) working in critical unites. Data were collected from February to June 2022 and then categorized and evaluated. Atlas.ti was used for the inductive thematic content analysis. RESULTS: Three key areas identified were as follows: (1) nurses and culturally competent care in critical care, (2) cultural challenges in practice and (3) suggestions for improving culturally competent care. The participants expressed that culturally competent care in critical care units has specific limitations because of the nature of the intensive care units (ICUs). Additional learning included opportunities to improve culturally competent care, such as raising cultural awareness, developing language skills and promoting culturally competent care. CONCLUSIONS: Providing culturally competent care in critical care units is an understudied area. Identifying barriers and cultural challenges is one strategy nurses can use to improve culturally competent ICU care. RELEVANCE TO CLINICAL PRACTICE: Creating cultural awareness by training nurses in their own culture, in cultural diversity, and in overcoming prejudices and stereotypes is an essential step towards increasing cultural competence. Understanding nurses' perceptions on this topic can provide valuable insights into the challenges and opportunities for providing culturally sensitive care in a critical care setting.

• Klíčová slova
• critical care, cultural competence, cultural diversity, nurses, prejudice,
• MeSH
• dospělí MeSH
• jednotky intenzivní péče MeSH
• kulturně kompetentní péče * MeSH
• kulturní kompetence MeSH
• kvalitativní výzkum * MeSH
• lidé středního věku MeSH
• lidé MeSH
• ošetřovatelská péče o pacienty v kritickém stavu * MeSH
• péče o pacienty v kritickém stavu MeSH
• percepce MeSH
• postoj zdravotnického personálu MeSH
• rozhovory jako téma MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

INTRODUCTION: Use of albumin is suggested for some patients with shock, but preferences for its use may vary among intensive care unit (ICU) physicians. METHODS: We conducted an international online survey of ICU physicians with 20 questions about their use of albumin and their opinion towards a randomised trial among adults with shock comparing the use versus no use of albumin. RESULTS: A total of 1248 respondents participated, with a mean response rate of 37%, ranging from 18% to 75% across 21 countries. Respondents mainly worked in mixed ICUs and 92% were specialists in intensive care medicine. The reported use of albumin in general shock varied as 18% reported 'almost never', 22% 'rarely', 34% 'occasionally', 22% 'frequently' and 4% 'almost always' using albumin. In septic shock, 19% reported 'almost never', 22% 'rarely', 29% 'occasionally', 22% 'frequently' and 7% 'almost always' using albumin. Physicians' preferences were more consistent for haemorrhagic- and cardiogenic shock, with more than 45% reporting 'almost never' using albumin. While the reported use of albumin for other purposes than resuscitation was infrequent (40%-85% reported 'almost never' for five other indications), the most frequent other indications were low serum albumin levels and improvement of the efficacy of diuretics. Most respondents (93%) would randomise adult ICU patients with shock to a trial of albumin versus no albumin. CONCLUSIONS: In this international survey, the reported preferences for the use of albumin in adult ICU patients with shock varied considerably among surveyed ICU physicians. The support for a future randomised trial was high.

• Klíčová slova
• albumin, fluid therapy, intensive care unit, shock, survey,
• MeSH
• albuminy * terapeutické užití   MeSH
• dospělí MeSH
• internacionalita MeSH
• jednotky intenzivní péče * MeSH
• lékaři MeSH
• lidé středního věku MeSH
• lidé MeSH
• péče o pacienty v kritickém stavu metody   MeSH
• postoj zdravotnického personálu MeSH
• průzkumy a dotazníky MeSH
• randomizované kontrolované studie jako téma MeSH
• septický šok farmakoterapie   terapie   MeSH
• šok farmakoterapie   terapie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• albuminy * MeSH

PURPOSE: Providing high-quality end-of-life care is a challenging area in intensive care practice. The aim of the current study was to assess the practice of registered nurses (RNs) with respect to dying care and spiritual support interventions in intensive care units (ICUs) in the Czech Republic (CR) and find correlations between particular factors or conditions and the frequency of NIC interventions usage. DESIGN AND METHODS: A cross-sectional, descriptive study was designed. A questionnaire with Likert scales included the particular activities of dying care and spiritual support interventions and an evaluation of the factors influencing the implementation of the interventions in the ICU. The group of respondents consisted of 277 RNs working in 29 ICUs in four CR regions. The Mann-Whitney U test and Pearson correlation coefficient were used for statistical evaluation. FINDINGS: The most and least frequently reported RN activities were "treat individuals with dignity and respect" and "facilitate discussion of funeral arrangements," respectively. The frequencies of the activities in the biological, social, psychological, and spiritual dimensions were negatively correlated with the frequency of providing care to dying patients. A larger number of activities were related to longer lengths of stay in the ICU, higher staffing, more positive opinions of the RNs regarding the importance of education in a palliative care setting, and attending a palliative care education course. CONCLUSIONS: The psychosocial and spiritual activities in the care of dying patients are used infrequently by RNs in CR ICUs. The factors limiting the implementation of palliative care interventions and strategies improving implementation warrant further study. CLINICAL RELEVANCE: Assessment of nursing activities implemented in the care of dying patients in the ICU may help identify issues specific to nursing practice.

• Klíčová slova
• Dying, intensive care unit, intervention, nursing,
• MeSH
• dospělí MeSH
• jednotky intenzivní péče MeSH
• kvalita zdravotní péče MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• ošetřovatelská péče o pacienty v kritickém stavu * MeSH
• ošetřovatelství - výzkum vyhodnocovací MeSH
• ošetřovatelství - vzorové postupy * MeSH
• péče o umírající * MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• spiritualita * MeSH
• zdravotní sestry * statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

INTRODUCTION: The aim of the study was to assess whether adults admitted to hospitals with both Intensive Care Units (ICU) and Intermediate Care Units (IMCU) have lower in-hospital mortality than those admitted to ICUs without an IMCU. METHODS: An observational multinational cohort study performed on patients admitted to participating ICUs during a four-week period. IMCU was defined as any physically and administratively independent unit open 24 hours a day, seven days a week providing a level of care lower than an ICU but higher than a ward. Characteristics of hospitals, ICUs and patients admitted to study ICUs were recorded. The main outcome was all-cause in-hospital mortality until hospital discharge (censored at 90 days). RESULTS: One hundred and sixty-seven ICUs from 17 European countries enrolled 5,834 patients. Overall, 1,113 (19.1%) patients died in the ICU and 1,397 died in hospital, with a total of 1,397 (23.9%) deaths. The illness severity was higher for patients in ICUs with an IMCU (median Simplified Acute Physiology Score (SAPS) II: 37) than for patients in ICUs without an IMCU (median SAPS II: 29, P <0.001). After adjustment for patient characteristics at admission such as illness severity, and ICU and hospital characteristics, the odds ratio of mortality was 0.63 (95% CI 0.45 to 0.88, P = 0.007) in favour of the presence of IMCU. The protective effect of the IMCU was absent in patients who were admitted for basic observation, for example, after surgery (odds ratio 1.15, 95% CI 0.65 to 2.03, P = 0.630) but was strong in patients admitted to an ICU for other reasons (odds ratio 0.54, 95% CI 0.37 to 0.80, P = 0.002). CONCLUSIONS: The presence of an IMCU in the hospital is associated with significantly reduced adjusted hospital mortality for adults admitted to the ICU. This effect is relevant for the patients requiring full intensive treatment. TRIAL REGISTRATION: Clinicaltrials.gov NCT01422070. Registered 19 August 2011.

• MeSH
• jednotky intenzivní péče trendy   MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mortalita v nemocnicích trendy   MeSH
• nemocnice trendy   MeSH
• pečovatelské domovy se zprostředkovatelskou péčí trendy   MeSH
• příjem pacientů trendy   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze I MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH

PURPOSE: Apart from organizational issues, quality of inter-professional collaboration during ethical decision-making may affect the intention to leave one's job. To determine whether ethical climate is associated with the intention to leave after adjustment for country, ICU and clinicians characteristics. METHODS: Perceptions of the ethical climate among clinicians working in 68 adult ICUs in 12 European countries and the US were measured using a self-assessment questionnaire, together with job characteristics and intent to leave as a sub-analysis of the Dispropricus study. The validated ethical decision-making climate questionnaire included seven factors: not avoiding decision-making at end-of-life (EOL), mutual respect within the interdisciplinary team, open interdisciplinary reflection, ethical awareness, self-reflective physician leadership, active decision-making at end-of-life by physicians, and involvement of nurses in EOL. Hierarchical mixed effect models were used to assess associations between these factors, and the intent to leave in clinicians within ICUs, within the different countries. RESULTS: Of 3610 nurses and 1137 physicians providing ICU bedside care, 63.1% and 62.9% participated, respectively. Of 2992 participating clinicians, 782 (26.1%) had intent to leave, of which 27% nurses, 24% junior and 22.7% senior physicians. After adjustment for country, ICU and clinicians characteristics, mutual respect OR 0.77 (95% CI 0.66- 0.90), open interdisciplinary reflection (OR 0.73 [95% CI 0.62-0.86]) and not avoiding EOL decisions (OR 0.87 [95% CI 0.77-0.98]) were all associated with a lower intent to leave. CONCLUSION: This is the first large multicenter study showing an independent association between clinicians' intent to leave and the quality of the ethical climate in the ICU. Interventions to reduce intent to leave may be most effective when they focus on improving mutual respect, interdisciplinary reflection and active decision-making at EOL.

• Klíčová slova
• Decision-making, Ethical climate, Intent to leave, Interdisciplinary reflection, Respect,
• MeSH
• dospělí MeSH
• jednotky intenzivní péče etika   organizace a řízení   statistika a číselné údaje   MeSH
• lékařská etika MeSH
• lidé MeSH
• organizační kultura * MeSH
• péče o pacienty v kritickém stavu etika   psychologie   normy   MeSH
• postoj zdravotnického personálu MeSH
• průzkumy a dotazníky MeSH
• úmysl * MeSH
• zdravotnický personál psychologie   statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Geografické názvy
• Evropa MeSH
• Spojené státy americké MeSH

AIM: To describe the characteristics of patients with severe pneumonia treated in Czech intensive care units (ICU) and to compare this study group with the available European and world literature data. MATERIAL AND METHODS: The prospective observational study launched on 1 September 2017 includes adult patients with community-acquired pneumonia from three Czech ICUs. It focuses on demographic data, chronic comorbidity, clinical and laboratory parameters, X-ray findings, microbiological findings, therapeutic procedures, and treatment outcomes. Results: As of 31 May 2019, 74 patients, 21 females and 53 males, were included in the study. Fifty-three (71.6%) patients had an underlying chronic disease. Only one patient was vaccinated against influenza and pneumococcal infections. The main symptoms were cough and dyspnea, in 63 (85.1%) patients, pathology on auscultation, in 64 (86.5%) patients, and fever, in 23 (31.1%) patients. Bilateral pathology on X-ray was observed in 34 (45.9%) patients. The most commonly detected pathogens were Streptococcus pneumoniae, in 22 (29.7%) patients, and influenza virus, in 16 (21.6%) patients. The etiology was not established in 23 (31.1%) patients. Third-generation cephalosporins and potentiated aminopenicillin as the most common initial empirical therapies were used in 39 (52.7%) and 20 (27%) patients, respectively. The initial therapy turned out to be effective in 59 (79.7%) patients. Forty-six (62.2%) patients required mechanical ventilation, 40 (54.1%) patients required vasopressors, and 10 (13.5%) patients required the use of renal replacement therapy. The average length of ICU stay was 15.5 days. Forty-seven (63.5%) patients were discharged home, 17 (23%) patients were transferred to long-term care facilities, and 10 (13.5%) patients died. CONCLUSIONS: The study presents the first results characterizing patients with severe community-acquired pneumonia in the Czech Republic. For most indicators, the characteristics of the Czech patients are comparable with the data from other countries, but differences were found in the pneumococcal and influenza vaccine coverage rates, which were low in the Czech Republic. Despite the appropriate empirical antibiotic therapies, severe pneumonia was associated with high mortality and prolonged morbidity.

• Klíčová slova
• Influenza, Streptococcus pneumoniae, community-acquired pneumonia, influenza, intensive care,
• MeSH
• infekce získané v komunitě * diagnóza   farmakoterapie   epidemiologie   MeSH
• jednotky intenzivní péče MeSH
• lidé MeSH
• péče o pacienty v kritickém stavu MeSH
• pneumonie * diagnóza   farmakoterapie   epidemiologie   MeSH
• prospektivní studie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

OBJECTIVES: To determine the level of cultural competence of European critical care nurses. DESIGN: A multi-country survey performed in 2017 as a part of the European project Multicultural Care in European Intensive Care Units. METHOD: Online survey of critical care nurses in 15 European countries (n = 591) using the Healthcare Provider Cultural Competence Instrument consisting of 49 items divided into five subscales: awareness and sensitivity, behaviour, patient-centred orientation, practice orientation and self-assessment. Descriptive and correlational analyses were performed. RESULTS: Critical care nurses scored highest for 'awareness and sensitivity' (M = 5.09, SD = 0.76), and lowest for 'patient-centred communication' (M = 3.26, SD = 0.94). Nurses from northern and southern Europe scored higher across all subsets of the cultural competence instrument (all subsets, p < 0.001) than nurses from central Europe. Speaking other languages significantly correlated with higher scores in all subscales (all > 0.05) except 'practice orientation'. Previous education on multicultural nursing significantly correlated with higher scores in all subscales (all > 0.01) except patient-centred communication; and visits to other countries was negatively correlated with all subscales (all, p > 0.001) except patient-centred communication. CONCLUSION: Being exposed to cultural diversity in different ways, like living in a multicultural country, speaking a second language and visiting other countries may influence development of cultural competence. Therefore, programmes which facilitate multicultural clinical practice are strongly recommended in nursing education.

• Klíčová slova
• Critical care nurses, Cross-sectional survey, Cultural competency, Europe,
• MeSH
• dospělí MeSH
• internacionalita * MeSH
• kulturní kompetence * MeSH
• lidé středního věku MeSH
• lidé MeSH
• ošetřovatelská péče o pacienty v kritickém stavu metody   normy   statistika a číselné údaje   MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• zdravotní sestry psychologie   normy   statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND: Antibiotic exposure in intensive care patients with sepsis is frequently inadequate and is associated with poorer outcomes. Antibiotic dosing is challenging in the intensive care, as critically ill patients have altered and fluctuating antibiotic pharmacokinetics that make current one-size-fits-all regimens unsatisfactory. Real-time bedside dosing software is not available yet, and therapeutic drug monitoring is typically used for few antibiotic classes and only allows for delayed dosing adaptation. Thus, adequate and timely antibiotic dosing continues to rely largely on the level of pharmacokinetic expertise in the ICU. Therefore, we set out to assess the level of knowledge on antibiotic pharmacokinetics among these intensive care professionals. METHODS: In May 2018, we carried out a cross-sectional study by sending out an online survey on antibiotic dosing to more than 20,000 intensive care professionals. Questions were designed to cover relevant topics in pharmacokinetics related to intensive care antibiotic dosing. The preliminary pass mark was set by members of the examination committee for the European Diploma of Intensive Care using a modified Angoff approach. The final pass mark was corrected for clinical relevance as assessed for each question by international experts on pharmacokinetics. RESULTS: A total of 1448 respondents completed the survey. Most of the respondents were intensivists (927 respondents, 64%) from 97 countries. Nearly all questions were considered clinically relevant by pharmacokinetic experts. The pass mark corrected for clinical relevance was 52.8 out of 93.7 points. Pass rates were 42.5% for intensivists, 36.1% for fellows, 24.8% for residents, and 5.8% for nurses. Scores without correction for clinical relevance were worse, indicating that respondents perform better on more relevant topics. Correct answers and concise clinical background are provided. CONCLUSIONS: Clinically relevant pharmacokinetic knowledge on antibiotic dosing among intensive care professionals is insufficient. This should be addressed given the importance of adequate antibiotic exposure in critically ill patients with sepsis. Solutions include improved education, intensified pharmacy support, therapeutic drug monitoring, or the use of real-time bedside dosing software. Questions may provide useful for teaching purposes.

• Klíčová slova
• Antibiotics, Drug dosing, Intensive care, Pharmacokinetics,
• MeSH
• antibakteriální látky aplikace a dávkování   farmakokinetika   terapeutické užití   MeSH
• dospělí MeSH
• jednotky intenzivní péče organizace a řízení   statistika a číselné údaje   MeSH
• klinické kompetence normy   statistika a číselné údaje   MeSH
• kritický stav terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• monitorování léčiv metody   MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• sepse farmakoterapie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antibakteriální látky MeSH

UNLABELLED: Introduction-Aim: Newer methods, such as infrared digital pupillometry and electrodermal activity (EDA) measurement have been suggested as good alternatives for analgesia monitoring in critically ill patients. This study analyzed EDA changes due to pain stimulus in sedated adult critical care patients Methods: Skin conductance variability, selected hemodynamic and respiratory parameters, Bispectral index (BIS) and ambient noise level, were monitored during 4 hour routine daytime in an adult ICU. 4h-Measurements were divided into 2 groups, based upon the sedation level of the patients: Group A - Ramsay Sedation Score 2-4 and Group B - Ramsay Sedation Score of 5-6. Selected recordings before and after pain stimulus were performed. The stimulus chosen was the pressure applied to nail bed for 10 sec, which was performed routinely during neurological examination. Patients' demographics, laboratory exams and severity scores were recorded. Pain status evaluation before every event was also performed by 2 independent observers via Critical Care Pain Observation Tool (CPOT) and Adult Non Verbal Pain Score (ANVPS) Results: In both groups the rate of EDA changes was greater than other monitoring parameters: more in Group A than in Group B. Yet, the difference between groups was not statistically significant. CONCLUSION: EDA measurements are greater to pain stimuli, than cardiovascular, respiratory or even BIS monitoring. These encouraging results suggest that, further studies are needed to better define EDA role in ICU.

• Klíčová slova
• electrodermal activity, intensive care, pain,
• MeSH
• analgosedace * MeSH
• fyzikální stimulace * MeSH
• galvanická kožní odpověď * MeSH
• jednotky intenzivní péče MeSH
• lidé středního věku MeSH
• lidé MeSH
• měření bolesti * MeSH
• monitorování fyziologických funkcí * MeSH
• pilotní projekty MeSH
• prospektivní studie MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH