Critical Care Nursing Quarterly最新文献

Despite limited evidence to support it, resuscitation in sepsis has primarily targeted aggressive fluid administration and liberal administration of oxygen. In 2024, new thought paradigms emerged to suggest that dysregulation of aerobic metabolism are essential underpinnings of sepsis, and that in fact, aggressive resuscitation with fluids liberal oxygen could potentially aggravate oxidative stress and organ failure in sepsis. As sepsis continues to be shaped and molded by the latest research; therapies targeting sepsis and septic shock management warrant similar scrutiny.

Methods: We searched literature pertaining to what is known about metabolic dysregulation in sepsis, to consider approaches to identifying new targets for resuscitation and management in sepsis.

Results: Therapeutic hypoxemic targets of 88-92% have been shown to have some benefit in sepsis resuscitation in a limited number of studies. The benefit is believed to result from protection from excessive accumulation of harmful reactive oxygen species.

Conclusion: Limited supporting evidence exists in the literature to recommend targeted hypoxemia or hypercapnia in patients with sepsis. Mixed results have been observed in the literature, including minimal benefit to mortality. New research designs with consideration to the dysregulated metabolic sequelae in sepsis could improve the meaningfulness of these therapies in sepsis.

Both adults and pediatric patients who are on mechanical ventilation face high rates of mortality and morbidity due to ventilator-associated pneumonia (VAP), which is the most prevalent deadly hospital-acquired infection. Healthcare organizations provide evidence-based guidelines to help nurses decrease VAP in ICUs; however, there are obstacles to putting these guidelines into practice. An extensive investigation was conducted for pertinent English studies published from January 2014 to February 2024 in the databases of Science Direct, Scopus, PubMed, and CINAHL. The study centered on nurses' understanding, adherence, and obstacles regarding introducing VAP prevention guidelines. The majority of ICU nurses have a basic to intermediate understanding of evidence-based methods to reduce VAP. The nurses in the ICUs typically followed the guidelines for preventing VAP about 60% of the time. A basic analysis of descriptive content identified the obstacles preventing critical care nurses (CCNs) from following VAP PGs. The obstacles were separated into 2 groups: barriers related to nurses (such as education, experience, and training) and barriers related to the work environment (such as lack of supplies, staffing shortage, lack of policies, and ineffective supervision). To improve their skills, CCNs should get frequent updates on courses and seminars related to the VAP PG implementation. Healthcare administrators must be aware of these obstacles and implement work procedures that help CCNs overcome them if they want to increase compliance.

This study aims to assess the crisis management and problem-solving skills of nurses caring for patients with COVID-19. The participants of this descriptive cross-sectional were 132 nurses who cared for patients with COVID-19 in a public hospital. The crisis management scale (CMS), problem-solving inventory (PSI), and Nurse Introduction Form were used to collect data. In this study, the nurses' CMS total score average was 3.75 ± 0.442, the average PSI total score was 86.32 ± 24.420, and it was determined that their crisis management ability was at a good level and their problem-solving skills were at a medium level. A significant difference was found between the nurses' descriptive characteristics of having children (P = .029), being informed about crisis management (P = .035), and their total average score on the CMS (P < .05). A statistically significant negative relationship was found between the nurses' total CMS and PSI scores (P < .05).This study showed that the problem-solving skill levels of nurses caring for patients with COVID-19 affected their crisis management skills.

Sepsis remains a major concern in health care globally. Despite decades of research, incidence is on the rise, and mortality remains high. Costs are staggering. Additionally, the outdated sepsis bundle established based on SIRS, remains the standard by which providers are held accountable. It is now accepted that organ dysfunction in sepsis is secondary to cellular metabolic dysregulation. Technology for metabolic monitoring should be explored for improved, early recognition of sepsis. We sought to investigate the underlying metabolic profile of patients with sepsis, to determine the value of continuous metabolic monitoring technology. The investigators partnered with industry, to trial noninvasive monitoring of the cellular metabolite carbon dioxide, under a prospective, observational design. During the 6-month trial, the investigators collected data from the electronic medical record of patients using the technology, to determine the specific metabolic differences between patients with and without sepsis. The investigators found serum carbon dioxide (paCO2) was significantly lower in patients with sepsis, and, low paCO2 had a significant inverse relationship to serum lactate. This finding supports the notion that paCO2 is low in sepsis secondary to metabolic dysregulation and not hyperventilation, which had historically explained low paCO2 under the SIRS model. Metabolic monitoring is available, easy to apply and manage, and contributes valuable information in the detection of sepsis. Further research should be done to understand trends in serum CO2 and its relationship to the development of sepsis. This study also provides important further support for the emerging understanding of the dysregulated host response in sepsis.

Hypertension (HTN) and heart failure (HF) can chronically activate the renin-angiotensin-aldosterone system, a mechanism designed to maintain hemodynamic stability by reabsorption of water and electrolytes. Additionally, this system activates the sympathetic nervous system to increase vagal tone. When these patients face acute illness requiring hospitalization, the acute stressor or pathogen also activates the sympathetic nervous system. The combination of activation of both systems puts patients at increased risk of organ failure, specifically renal failure. With early recognition of renal insult, organ damage can be reversed. C-reactive protein (CRP) and D-dimer are commonly used to measure acute inflammation. These biomarkers can alert critical care nurses to excessive inflammation in patients with underlying HTN and HF, enabling nurses to make informed decisions to intervene at the earliest sign of renal failure. This retrospective study of adult SARS-CoV-2 patients in an intensive care unit setting sought to examine the relationship of CRP, D-dimer, and the need for eventual renal support in patients with HF and HTN. Of the sample (n + 189), mean age was 62 (SD = 14.0), and most (70.9%) were male. Thirty-nine patients (20.6%) required renal support. Of the cases requiring renal support, 21 (53.8%) had a history of prior renal disease (P < 0.001, r = 0.351). History of HTN was significantly correlated with requirement for renal support (P = 0.010, r = 0.187). D-dimer (P = 0.038, η = 1.0) and CRP (P = 0.018, η = 0.924) were also significant. Survival was significantly worse in the renal support group (P < 0.001, r = -0.310). D-dimer and CRP were correlated with more severe illness and need for renal support. Study findings have implications for future validation research of chronic inflammation and risk for renal support during acute severe illness.

To determine the effectiveness of using earplugs and eye masks on the melatonin and cortisol levels of patients hospitalized in cardiac critical care units (CCUs). The research population of this study included all patients with acute coronary syndrome hospitalized in the CCU of Shahid Rajaei Hospital affiliated with to Alborz University of Medical Sciences. A total of 60 patients were selected by the available sampling method based on the inclusion criteria and then were divided into 2 control and intervention groups by block randomization method with blocks of 4 (n = 30 in the intervention group, and n = 30 in the control group). Patients in the intervention groups used blindfolds and earmuffs during the night sleep for 3 nights, but patients in the control group received the routine care. Cortisol and melatonin levels of both groups were measured at 8 am, using the urine samples. The findings of the 2 groups were compared and statistically analyzed by SPSS software version 16. The findings showed no significant difference between the 2 groups in terms of demographic characteristics and clinical variables. The intervention had no effect on the cortisol level of patients in the intervention group (P = .24). After the intervention, a statistically significant difference was observed between the control and intervention groups in terms of the melatonin level in the nocturnal urine (P ≤ .001). A statistically significant difference was also observed between the 2 groups in terms of the time taken for patients to fall asleep (P ≤ .001) and the number of times waking up at night (P ≤ .001). The use of earplugs and eye masks had no impact on the level of cortisol hormone, but it affected the level of melatonin hormone and the sleep quality of patients hospitalized in the CCU.

Several studies attempt to identify predictors for weaning and extubation from mechanical ventilation (MV) and none have been shown to be particularly accurate. Therefore, the objective of the study was to evaluate whether markers of renal function may be associated with extubation failure. This retrospective study collected data through electronic medical records for 2 consecutive years. The inclusion criteria were: ≥18 years old and requiring invasive MV for a period of ≥48 hours. Extubation failure was determined when subjects needed to return to invasive MV within 48 hours of the tracheal tube withdrawal. Acute kidney injury (AKI) was assessed according to the KDIGO classification. From a total of 167 subjects, 15% evolved with extubation failure. Lower creatinine clearance and higher fluid balance was observed in the extubation failure group compared to the successful extubation group (42 mL/min vs 100 mL/min, P = 0.01 and 739 mL vs - 189 mL, P = 0.01, respectively). Subjects with AKI are 51% more likely to evolve with extubation failures than those with normal renal function (OR = 2.7; 95% CI: 1.6-4.7; P < 0.01). Renal dysfunction was related to the rate of extubation failure. Fluid balance and serum creatinine may be aspects to be considered when making the extubation decision.

Background: Approximately 48% of patients with chronic respiratory disorders experience post-extubation respiratory failure necessitating noninvasive respiratory support or reintubation, which is linked to higher morbidity and mortality. So, it is necessary to determine patients' preparedness for weaning and extubation.

Objectives: To examine the effect of implementing respiratory care unit (RCC) ventilator weaning assessment checklist on weaning and extubation outcomes.

Methods: Randomized controlled trial, carried out in 70 patients receiving mechanical ventilation from January 2023 to September 2023 at the respiratory intensive care units at Assiut University Hospital, Egypt. Patients were randomly assigned to a study and a usual care group, with 35 patients for each group. The usual care group weaned using the routine method, while the study group weaned using (RCC) ventilator weaning assessment checklist; the 2 groups were compared concerning weaning and extubation outcomes.

Results: Compared to the usual care group, the study group's weaning success rate was significantly higher than that of the usual care group (88.6% vs 51.4%; P = .008), and extubation failure rate was significantly lower (17.1% vs 45.7%; P = .010).

Conclusions: Using RCC ventilator weaning assessment checklist improving weaning and extubation outcomes.