Journal of the Intensive Care Society最新文献

We evaluated whether non-invasive estimated inspiratory muscle pressure (P_mus) predicts extubation outcomes in ICU patients. Estimated P_mus, reflecting the pressure generated by respiratory muscles, was measured before and after the spontaneous breathing trial (SBT). Lower pre-SBT estimated P_mus (<4.1 cmH₂O) and post-SBT (<4.4 cmH₂O) were associated with extubation failure (AUC ≈ 0.73). P0.1 and dynamic transpulmonary pressure (P_L,dyn) showed no significant association. Estimated P_mus offers a simple bedside method to assess inspiratory muscle strength and may help identify patients at risk of extubation failure. Further multicenter studies are needed to validate these findings.

Objective: A scoping review was performed to understand the extent and type of published evidence in relation to restricting feeding of critically ill patients to the daytime only, with a nighttime fasting period.

Introduction: Time-restricted feeding has been shown to be beneficial to long-term health. Critically ill patients admitted to intensive care units (ICUs) are traditionally fed continuously. The potential benefits or harms of daytime only feeding in the critically ill are unknown.

Inclusion criteria: Studies of critically ill patients, cared for in any critical care environment, where feeding was stopped for a minimum of 6 h overnight, with any primary outcome, were included.

Methods: Using the JBI framework, a search of OVID Embase, OVID Medline, CINHAL, PROSPERO, The Cochrane database and Web of Science was performed in July 2023.

Results: Fourteen studies that included 868 participants, published between 1989 and 2023 met the inclusion criteria and were reported on. The patient cohorts were from general or mixed ICUs, and neurosurgical and paediatric cohorts. Feed was either administered by bolus, in cyclic patterns or continuously. The overnight fasting times ranged from 6 to 12 h, with reported primary outcomes of feed intolerance, nutritional delivery, ketosis, gastric pH, ventilator associated pneumonia and circadian rhythms. Daytime only feeding was found to increase ketosis and lower gastric acidity.

Conclusions: Daytime only feeding in the critically ill has been reported, but details of its potential harms or benefits are limited by inconsistently defined outcomes and study small sample sizes.

Enhanced recovery after surgery (ERAS) programmes are well established across many surgical specialties. Successful implementation requires both multidisciplinary engagement and active patient participation. At our hospital, many patients were unaware they had a role in their recovery. To improve education, we developed a poster highlighting seven key elements using the acronym PROMOTE: Pain relief, Respiratory exercises, Own clothes, Mobilisation, Oral hygiene, Taking away attachments, and Eating and drinking. Feedback from patients in the post-operative critical care unit showed the resource was well received, easily understood, and most wished they had received it pre-operatively to help manage expectations and reduce anxiety.

Objectives: This study aimed to: (a) determine the levels of burnout, secondary traumatic stress, and compassion satisfaction among intensive care unit nurses at the university hospital in Sfax, Tunisia, and (b) explore the relationship between resilience and the three dimensions of professional quality of life in this nursing specialty.

Design and methods: This was a descriptive and predictive study using validated self-reporting instruments: Professional Quality of Life Scale version 5 and Brief Resilience Scale. Multiple regression using stepwise solution was employed to explore the relationship between resilience and the three dimensions of professional quality of life (burnout (BO), compassion satisfaction (CS), and secondary traumatic stress (STS)). Statistical significance was set at p < 0.05.

Results: The results revealed that 61.3%, 63.2%, and 47.2% of ICU nurses were in the moderate range for BO, CS, and STS, respectively. Resilience score was the critical predictor contributing to Professional Quality of Life subscales scores: Burnout (β = -0.26, p = 0.001), secondary traumatic stress (β = -0.23, p = 0.001) scores were negatively predicted by resilience score. However, CS score was positively predicted by resilience score (β = 0.28, p = 0.002).

Conclusion: The current study's findings support the argument for the development of training programs to promote psychological resilience among ICU nurses in order to improve the quality of professional life.

In 2022, the Royal Liverpool University Hospital moved premises. As part of the move, the patients from its existing Critical Care Unit (consisting of an independent Intensive Care Unit, a High Dependency Unit and a Post-Operative Critical Care Unit), had to be transferred from the old hospital to an entirely new one. Whilst relocation of an Intensive Care Unit, its critically ill patients, staff and equipment has undoubtedly happened elsewhere in the past, very little has been written about such an undertaking. On each occasion, therefore, the teams facing this task may be starting afresh without the benefit of knowing what problems others have previously encountered and how they solved them. In an attempt to highlight some of the modifiable risks, this article serves to explain some of the planning we undertook prior to our move (i.e. forward planning), and reflects on some of the lessons learnt in the process.

In this exploratory analysis of 35 patients with ischemic cardiogenic shock, we evaluated the correlation between tricuspid regurgitation velocity (TRV) and pulmonary artery catheter-derived pressures. TRV correlated best with pulmonary artery mean pressure (r = 0.54, p = 0.0009), more than with systolic or diastolic pressures. A TRV threshold of 2.3 m/s identified mean pressure >25 mmHg with 81% sensitivity and 62% specificity. These findings suggest that TRV may serve as a non-invasive indicator of elevated pulmonary pressure in critically ill patients when invasive monitoring is unavailable. Further validation in larger, diverse cohorts is needed.

Background: Radial arterial catheters are frequently used for monitoring and blood sampling in critical care patients. Ischaemic complications are rare but can cause significant morbidity. The use of vascular ultrasound in critical care is becoming increasingly commonplace. This service evaluation aims to assess the feasibility of training novices in advanced vascular ultrasound assessment, prior to radial arterial cannulation.

Methods: Over a 4-month period, data was collected from patients admitted to the intensive care unit at the William Harvey Hospital, Ashford, Kent. Ultrasound was used to assess for the presence, size and flow of the radial and ulnar arteries. The assessments were performed by two novice residents in intensive care, who were trained in advanced ultrasound assessment of the radial and ulnar arteries, by an intensive care consultant with expertise in vascular ultrasound.

Results: One hundred and five limbs were assessed in 53 patients. Novices were deemed to be sufficiently competent, after performing scans on 15 patients over a 2-week period. Satisfactory images were acquired in 100% of patients. The most common finding was a small diameter ulnar artery, present in 30 limbs (29%), while only 1 patient (1%) was found to have an absent ulnar artery. Thirty-two limbs had a radial arterial catheter in-situ. There were no ischaemic complications.

Conclusion: This service evaluation demonstrates that the training of novices in advanced ultrasound assessment of the radial and ulnar arteries by an intensive care consultant, is feasible. Moreover, this modality may identify patients at risk of critical limb ischaemia. This particular investigation may be considered for incorporation into existing vascular ultrasound assessments.