Critical Care Nursing Quarterly最新文献

The gastrointestinal system alongside nutritional support, the endocrine system, and the hematological system has integral roles in sepsis. Understanding these systems can help clinicians better manage patients with sepsis and potentially improve outcomes. This chapter details these 3 important organ systems and, in particular, the clinical impact on each organ system in sepsis.

Acute kidney injury (AKI) is a common complication of sepsis due to a myriad of contributing factors and leads to significant morbidity and mortality in critically ill patients. Prompt identification and management are vital to reverse and/or prevent the worsening of AKI. When renal function is severely compromised, there may be a need for dialytic therapy to meet the metabolic needs of patients. This article will review the definition of AKI, epidemiology, risk factors, and pathophysiology of AKI in sepsis, along with both non-dialytic and dialytic treatment strategies. We will also review landmark trials in fluid resuscitation in sepsis.

Sepsis is a severe and often life-threatening condition which can lead to widespread organ dysfunction, septic shock, and even death. Antimicrobials are critical in improving outcomes for patients with sepsis. This chapter details the general principles of antimicrobial therapy, appropriate selection and de-escalation of antimicrobials, and challenges in antimicrobial stewardship.

The foremost challenge encountered by patients in intensive care units is nosocomial infections impacting their prognosis. Nurses play a vital role in infection control, necessitating adequate knowledge and adherence to protocols. Therefore, the study aims to assess nurses' knowledge, attitude, practice, and perceived barriers of infection control measures in the Intensive care units at the Northwest Bank Hospitals. The study employed a quantitative cross-sectional and observational design, utilizing a self-administration questionnaire and checklist distributed among 115 ICU nurse working in governmental hospitals in the Northwest Bank. The study revealed that the majority of nurses demonstrated a moderate to low knowledge level. However, 63.5% exhibited a positive attitude toward infection control measures, and 72.9% demonstrated good practice levels. Among the sociodemographic determinants, gender was the only significant factor in relation to practice, where male nurses demonstrated better practices than female nurses (P < .05). Nursing staff identified several barriers to achieving infection standards, including lack of equipment, inadequate training courses on infection control, challenges posed by visitors, absence of infection control policies and standards, insufficient isolation rooms, and heavy workload. The majority of nurses displayed good practice levels and positive attitudes toward infection prevention. Additionally, male nurses practiced infection control measures significantly more effectively than female nurses. The major barriers were lack of equipment, lack of training courses, and challenges related to visitors. Addressing these barriers is essential to improving infection control measures in critical care units.

Sepsis is a condition of life-threatening organ dysfunction caused by a dysregulated host response to infection. It is the result of a series of exaggerated physiologic responses that lead to simultaneous hyper- and hypoinflammatory states. In the hyperinflammatory phase, there is an exuberant release of cytokines, commonly referred to as a cytokine storm. The immune-suppressive phase is characterized by counterregulatory attempts to achieve homeostasis that sometimes "overshoot", leaving the host in a state of immunosuppression, thus predisposing to recurrent nosocomial and secondary infections. The aging population with comorbidities faces higher risks of immune dysfunction and inflammation. Thus, the number of sepsis survivors that develop subsequent infections is predicted to rise substantially in the next few decades. Understanding sepsis-induced immune dysregulation may enhance surveillance and outcomes. This review is intended to describe the pathophysiology of sepsis and its effects on the immune system.

It has been suggested that the use of statin pills beforehand could potentially influence the outcomes when individuals are hospitalized with COVID-19. In this study, we investigated how the prior use of statin medication could influence the COVID-19 severity parameters. In this retrospective cohort study, we categorized COVID-19 patients into 2 groups: statin users and non-users. Then, various data including age, gender, the patient's need for ventilation support, the lowest oxygen blood saturation level, the length of hospitalization, receiving remdesivir treatment, and their COVID-19 vaccination status were collected. Out of 168 patients, 62 had taken statin medication before being admitted. Using statins decreased the patient's need for ventilation support, length of hospitalization, ventilation duration, and oxygen saturation level (P < .001). Interaction effect analysis showed that receiving remdesivir statically affected the length of hospitalization, ventilation duration, and oxygen saturation level but did not significantly affect the association between statins and needing to ventilator. The use of statin pills before COVID-19 admission reduced the requirement for ventilator support.

The onset of cardiac arrest is unpredictable, and it is crucial to administer cardiopulmonary resuscitation (CPR). The flipped classroom has generated considerable interest in medical education in the last decade. To optimize the effectiveness of a flipped classroom intervention, there is a need to understand which component, if any, of the intervention may be successful in improving CPR competency. This study aimed to use mixed-method intervention development techniques to develop and validate a flipped classroom intervention to improve CPR competency. The theoretical framework underpinning the intervention is Competency Outcomes and Performance Assessment (COPA). The content validity index (CVI) and the content validity ratio (CVR) were calculated and found to be satisfactory. The results provided a clear specification of the intervention protocol for researchers in the next phase of the study - a pilot RCT to preliminarily explore the effect of the developed intervention.

Atrial fibrillation (AF) is a highly prevalent, progressive cardiac arrhythmia that significantly impacts the patient's health-related quality of life. AF is linked to a 5-fold and 2-fold higher risk of stroke and cognitive dysfunction, respectively. With advancements in cardiac electrophysiology, many risk factors have been identified, which increase the risk for the development of AF. These risk factors encompassing age, hypertension, smoking, diabetes mellitus, male gender, obesity, alcohol intake, obstructive sleep apnea and so on, can be categorized into 3 major groups: modifiable, non-modifiable, and cardiac. Multiple AF prediction models have been successfully validated to identify people at high risk of AF development using these risk factors. These prediction models, such as CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology) and HARMS2-AF score can be used in clinical practice because of their easy applicability. It is crucial to address modifiable risk factors in individuals with a high risk of developing AF. Furthermore, the implementation of primary AF prevention in individuals at high risk can contribute to improved long-term outcomes. This review aims to provide the most recent, concise explanation of the risk factors linked to AF, the prediction of AF, and strategies for the primary prevention of AF.

The transition period from undergraduate nursing education to professional practice is a time of uncertainty and great difficulty for new graduate nurses (NGNs). Nurse residency programs (NRPs) provide structured education, simulation-based learning, and preceptorship to ease the transition. Although its effect on improving retention of NGNs is well established in the literature, the effect on clinical competency has not been documented as well. The purpose of this integrative review is to appraise the available literature and synthesize the evidence that demonstrates the effect of NRPs on clinical competency of NGNs entering the critical care setting. Inclusion criteria were quantitative and qualitative studies, peer-reviewed studies published after 2004 and in English, identified through a systematic literature search using the CINAHL database. Critical appraisal of the articles was completed using Law et al's Critical Review Form. Eight articles (4 quantitative, 3 mixed method, and 1 qualitative study) met the inclusion criteria. The themes identified were common tools used to assess the efficacy of NRPs, improved clinical competency of NGNs, improved self-confidence, improved retention rates, and peer support among NGNs. Implications for nursing education and practice include applying evidence-based NRPs, incorporating simulation, enhancing sustainability, and reducing NRP variability through accreditation.