Carole Boulanger

National Health Service | NHS

Cardiopulmonary resuscitation (CPR) in intensive care units (ICUs) differs in several ways from treatment of a cardiac arrest occurring outside the hospital or in other areas of the hospital, not only in the availability of advanced invasive treatment options (such as extracorporeal life support) but also in pre-existing conditions and severity of...

Caring for the critically ill patient is complex and challenging. Every day there are new issues to react to and new treatment plans to provide. Uninterrupted, patient-centered, multidisciplinary daily ward round is the platform where the treatment plan is formulated for each patient. The key element of ICU care is indeed the treatment of the under...

An understanding of human factors can help intensive care health professionals enhance patient safety, reduce medical error, and boost personal well-being within the team. Non-technical skills encompass cognitive and interpersonal skills that contribute to safe and efficient team performance. In the ICU, there are four key teamwork processes which...

Background The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary an...

Objectives Hospital-acquired pressure injuries (PIs) are a source of morbidity and mortality, and many are potentially preventable. Design This study prospectively evaluated the prevalence and the associated factors of PIs in adult critical care patients admitted to intensive care units (ICU) in the UK. Setting This service evaluation was part of...

Shortage of nurses on the ICU is not a new phenomenon, but has been exacerbated by the COVID-19 pandemic. The underlying reasons are relatively well-recognized, and include excessive workload, moral distress, and perception of inappropriate care, leading to burnout and increased intent to leave, setting up a vicious circle whereby fewer nurses resu...

Following publication of the original article [1], an error was identified in the article title: COVID‑19 was incorrectly captured as COIVD‑19. The article title has been updated above and in the original article.

Purpose: To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organization...

Purpose The aim of this study was to identify and define core competencies for advanced nursing roles in adult intensive care units across Europe. Methods Three round electronic Delphi conducted between September 2018 and November 2019, with an expert panel of 184 nurses from 20 countries, supplemented by consensus meetings with 16 participants fr...

Background Pressure injuries are a frequent complication in intensive care unit (ICU) patients, especially in those with comorbid conditions such as chronic obstructive pulmonary disease (COPD). Yet no epidemiological data on pressure injuries in critically ill COPD patients are available. Objective To assess the prevalence of ICU-acquired pressur...

Background Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods We i...

Background: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score...

The original version of this article unfortunately contained a mistake. The members of the ESICM Trials Group Collaborators were not shown in the article but only in the ESM. The full list of collaborators is shown below. The original article has been corrected.

Background Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear. Objective To...

Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prev...

Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prev...

Female and male very elderly intensive patients (VIPs) might differ in characteristics and outcomes. We aimed to compare female versus male VIPs in a large, multinational collective of VIPs with regards to outcome and predictors of mortality. In total, 7555 patients were included in this analysis, 3973 (53%) male and 3582 (47%) female patients. The...

Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prev...

Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-p...

In many critically ill patients, it is uncertain whether the chance of survival and recovery justifies the suffering that is associated with (prolonged) life support. This chapter discusses the circumstances when limiting life-sustaining therapies may be permissible, advisable, or even imperative. Differences between withholding and withdrawing are...

This book aims to provide a holistic and multiprofessional approach to maximising the chances of a successful recovery for the ICU patient surviving a period of critical illness. Admission to ICU with a critical illness has a signficant well-recognised physical, psychological and social impact. This impact has wide-ranging consequences affecting th...

This book provides a holistic and multi professional approach to maximising the chances of a successful recovery for the ICU patient surviving a period of critical illness. An admission to ICU with a critical illness has a well-recognised physical, psychological and social impact all on the individual and their loved ones of which need to remain in...

Purpose Premorbid conditions affect prognosis of acutely-ill aged patients. Several lines of evidence suggest geriatric syndromes need to be assessed but little is known on their relative effect on the 30-day survival after ICU admission. The primary aim of this study was to describe the prevalence of frailty, cognition decline and activity of dail...

Introduction Diversity has become a key-strategic element of success in various political and economic fields. The European Society of Intensive Care Medicine (ESICM) decided to make diversity a key strategic priority for the future and appointed a Task-Force on this topic. Methods In a consensus process, three Working-Groups, nominated by Task-Fo...

INTRODUCTION. The goal of sedation, with regular orientation, is often not achieved in ICU (1,2) despite evidence that sedation stops are safe (3). Careful assessment and management of sedation is essential in order to enable timely weaning and extubation. Responsibility for sedation decisions is different in England and Australia; it is unclear wh...

Objectives: To explore factors perceived to contribute to 'a good death' and the quality of end of life care in two countries with differing legal and cultural contexts. Design and methods: Multi-centre study consisting of focus group and individual interviews with intensive care nurses. Data were analysed using qualitative thematic analysis; em...

Background: Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point prevalence study, the Extended Prevalence of Infection...

Background Infections are a leading cause of death in patients with advanced cirrhosis, but there are relatively few data on the epidemiology of infection in intensive care unit (ICU) patients with cirrhosis. AimsWe used data from the Extended Prevalence of Infection in Intensive Care (EPIC) II one-day point-prevalence study to better define the ch...

To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and...

To examine documentation of medication administration in medical and surgical patients. (1) Determine the point prevalence of non-therapeutic medication omissions; (2) identify documented reasons for non-therapeutic medication omissions; (3) examine the relationship between length of stay and medication omissions; and (4) explore the impact of outl...

Tracheal mucosal blood flow is impaired when tracheal tube cuff pressure is above 30 cm of water, with the potential for tracheal mucosal necrosis. Previous studies have found excessive cuff pressures in simulated patients intubated by North American emergency physicians as well as patients intubated in the prehospital setting and emergency departm...

This article aims to provide registered nurses with knowledge, skills and practical advice to improve the assessment, recording and reporting of patient observations. Using guidance from Patient Safety First's intervention on reducing harm from deterioration, common issues forward staff are illustrated and practical advice is given.

Contemporary nursing leadership roles in critical care are a reflection of the changing environment in which critical care is provided. In the UK, critical care nursing faces challenges in the form of: reduced number and seniority of medical staff cover for acute wards; mandated responsibility for management of patients outside of critical care uni...

Nurses need to be trained to make rapid and accurate clinical decisions in a rapidly changing and complex environment. Unfortunately, a reliance on traditional training methods (lectures, small group sessions, experiential learning) will probably prove inadequate in a context characterised by increasing pressures of time and limited resources. The...

Nurses need to be able to make rapid and effective clinical decisions, solving complex problems in situations where accurate judgement is vital. Traditional methods of developing accurate decision making include lectures, small group sessions, practical scenarios and 'on the job' training. This study reports work in progress to develop a series of...