Critical care nurse最新文献

Background: Patients critically ill with COVID-19 develop acute respiratory distress syndrome (ARDS) and may undergo prone positioning.

Objective: To compare the effects of prone positioning on oxygenation, intensive care unit length of stay, and intubation days in patients with COVID-19 ARDS and patients with non-COVID-19 ARDS.

Methods: A convenience sample of intubated patients with COVID-19 and moderate to severe ARDS (per Berlin criteria) was compared with historical data from a retrospective, descriptive medical record review of patients with non-COVID-19 ARDS. The historical comparison group was age and sex matched.

Results: Differences in Po2 to fraction of inspired oxygen ratios between the COVID-19 ARDS group (n = 41) and the non-COVID-19 ARDS group (n = 6) during the first 7 days of prone positioning were significant at the end of prone positioning on day 1 (P = .01), day 3 (P = .04), and day 4 (P = .04). Wilcoxon signed-rank tests showed that prone positioning had a positive impact on Po2 to fraction of inspired oxygen ratios from day 1 through day 6 in the COVID-19 ARDS group and on day 2 in the non-COVID-19 ARDS group.

Conclusion: This retrospective review found greater improvement in oxygenation in the COVID-19 ARDS group than in the non-COVID-19 ARDS group. This finding may be attributed to the assertive prone positioning protocol during the pandemic and teams whose skills and training were likely enhanced by the pandemic demand. Prone positioning did not affect intensive care unit length of stay or intubation days in either group.

Background: The aim of this evidence-based practice project was to determine if a digital air leak detection device could speed the identification of chest tube air leak cessation in patients after pulmonary lobectomy. Staff members assessing air leaks have varying levels of expertise, and the digital device is a limited resource in the study institution. A chest tube management algorithm is necessary to standardize care and determine which patients are most likely to benefit.

Implementation: Twenty-five consecutive patients who underwent pulmonary lobectomy during the study period and continued to have a chest tube air leak on postoperative day 3 were monitored with digital air leak detection devices. The Mann-Whitney U test was used to compare chest tube duration and hospital length of stay between patients with digital devices and 259 patients who had traditional analog air leak detection devices (historical data from the departmental database over the previous 2 years).

Evaluation: Median chest tube duration and hospital stay were 1 day less in patients with digital devices than in those with traditional analog devices (P = .01 and P = .004, respectively), with a cost savings of $2659 per hospital day. Reductions in chest tube duration and length of stay aided in the development of a chest tube management algorithm.

Conclusions: Critical care nurses are valued team members who treat patients after lung resections. Digital air leak detection devices can help them assess air leaks more accurately, benefiting the patients in their care.

Background: Cerebrovascular accident, or stroke, is a common cause of death or disability. Timely diagnosis and intervention are critical for improving survival rates and reducing the long-term effects of stroke. For patients with ischemic stroke, thrombolytic drugs and endovascular intervention are time-sensitive treatment options.

Local problem: Patients living in rural areas often do not have access to rapid consultation with specialized neurologic teams for diagnosis and treatment of stroke. The use of telemedicine in the form of a telestroke consultation can improve timely diagnosis and treatment for rural patients exhibiting stroke symptoms.

Methods: A telestroke program was implemented in the upper Midwest. A team of 4 interventional neurologists provided telestroke consultation to a comprehensive stroke center and 5 other acute stroke-ready rural hospitals.

Results: A tiered stroke alert algorithm and telestroke workflow chart were developed to help health care professionals at rural sites determine eligibility for telestroke consultation. A teleneurologist connected with the originating site, and the National Institutes of Health Stroke Scale could be completed remotely with assistance from the originating site. Telestroke has increased the percentage of patients receiving thrombolytics in less than 60 minutes, and door-to-needle time has decreased.

Conclusion: Rural patients with stroke symptoms may experience a delay in care or stroke diagnosis due to distance to specialized neurologic services. Telestroke consultation is a successful method for timely diagnosis of stroke and recommendation for treatment.

Background: Family-centered rounds are standard practice in pediatrics. However, some parents of children in the pediatric intensive care unit cannot attend rounds.

Local problem: A 36-bed academic, tertiary care pediatric hospital implemented telerounds during the COVID-19 pandemic. After visiting restrictions were lifted, nurses were interested in continuing telerounds for families who could not attend daily rounds. The aim of this evidence-based quality improvement project was to develop a standardized, family-centered telerounding process that satisfied parents, nurses, and physicians.

Methods: Nurses offered telerounds to pediatric intensive care unit family members who could not attend rounds. Families received a unique link to telerounds using a secure connection. Nurses completed electronic satisfaction surveys after each session; physicians completed surveys at the end of their weeklong pediatric intensive care unit rotation; families received surveys at the end of the pediatric intensive care unit stay.

Results: Twenty families qualified for telerounds; 16 families completed sessions. Enrolled patients and families participated in 93 telerounding events. Nine family members (56%) returned satisfaction surveys revealing an overall satisfaction level of 9.9 out of 10. Thirty nurses reported an overall satisfaction level of 8.8 out of 10. Eleven physicians reported a mean satisfaction level of 8.8 out of 10.

Conclusions: This project demonstrated that a standardized process of secure telerounding was feasible in a pediatric intensive care unit. Families, nurses, and physicians reported satisfaction with the process. Telerounds can be implemented without considerable inconvenience to staff and enable continuation of family-centered care when parents are absent from the hospital.