AACN Advanced Critical Care最新文献

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Bundled Bispectral Index Monitoring and Sedation During Paralysis in Acute Respiratory Distress Syndrome. 急性呼吸窘迫综合征瘫痪期间捆绑双谱指数监测与镇静。

IF 2.2 Q2 Medicine

AACN Advanced Critical Care

Pub Date : 2022-09-15 DOI: 10.4037/aacnacc2022240

Sunitha Abraham, Bethany L Lussier

Background: Clinical assessments of depth of sedation are insufficient for patients undergoing neuromuscular blockade during treatment of acute respiratory distress syndrome (ARDS). This quality initiative was aimed to augment objective assessment and improve sedation during therapeutic paralysis using the bispectral index (BIS).

Methods: This quality improvement intervention provided education and subsequent implementation of a BIS monitoring and sedation/analgesia bundle in a large, urban, safety-net intensive care unit. After the intervention, a retrospective review of the first 70 admissions with ARDS assessed use and documented sedation changes in response to BIS.

Results: Therapeutic neuromuscular blockade was initiated for 58 of 70 patients (82.8%) with ARDS, of whom 43 (74%) had BIS monitoring and 29.3% had bundled BIS sedation-titration orders. Explicit documentation of sedation titration in response to BIS values occurred in 27 (62.8%) of those with BIS recordings.

Conclusions: BIS sedation/analgesia bundled order sets are underused, but education and access to BIS monitoring led to high use of monitoring alone and subsequent sedation changes.

背景:在急性呼吸窘迫综合征(ARDS)治疗过程中，对神经肌肉阻滞患者镇静深度的临床评估不足。这项质量倡议旨在利用双谱指数(BIS)增强客观评估和改善治疗性瘫痪期间的镇静作用。方法:这种质量改善干预提供了教育和随后实施BIS监测和镇静/镇痛束在大型，城市，安全网重症监护病房。干预后，对前70例ARDS入院患者进行回顾性审查，评估使用情况并记录镇静变化对BIS的反应。结果:70例ARDS患者中有58例(82.8%)采用了治疗性神经肌肉阻断，其中43例(74%)有BIS监测，29.3%有BIS镇静滴定单。有BIS记录的患者中，有27人(62.8%)明确记录了镇静滴定对BIS值的反应。结论:BIS镇静/镇痛捆绑单套使用不足，但教育和获得BIS监测导致单独监测和随后镇静变化的高使用率。

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引用次数: 0

Use of Albumin as a Resuscitative Fluid in the Intensive Care Unit. 在重症监护病房使用白蛋白作为复苏液。

IF 2.2 Q2 Medicine

AACN Advanced Critical Care

Pub Date : 2022-09-15 DOI: 10.4037/aacnacc2022946

Nicolas Tran, Christopher Allen

引用次数: 0

Ethical Challenges and Implications of Deactivating Mechanical Circulatory Support for Patients With Preserved Cognitive Function. 对保留认知功能的患者停用机械循环支持的伦理挑战和意义。

IF 2.2 Q2 Medicine

AACN Advanced Critical Care

Pub Date : 2022-09-15 DOI: 10.4037/aacnacc2022757

Caitlin B McGeehan, Cynda Hylton Rushton

引用次数: 0

Use of Extracorporeal Membrane Oxygenation Therapy During Pregnancy and COVID-19: A Case Study. 妊娠期体外膜氧合治疗与COVID-19的应用:一个案例研究

IF 2.2 Q2 Medicine

AACN Advanced Critical Care

Pub Date : 2022-09-15 DOI: 10.4037/aacnacc2022111

Roberta Kaplow, Casey Miller

Extracorporeal membrane oxygenation is emerging as a vital resource for survival of patients with acute respiratory distress syndrome related to COVID-19. Although recent research provides much insight into the advantages of extracorporeal membrane oxygenation in this patient population, little has been published on its use in pregnancy. This case study describes the use of venovenous extracorporeal membrane oxygenation in a young pregnant woman with acute respiratory distress syndrome due to COVID-19. It illustrates the benefits of a multidisciplinary approach to this treatment modality, allowing time for a fetus to become viable while preserving the life of the mother. In this case, the mother was able to return home after receiving this therapy and resume normal activities of daily living independently.

体外膜氧合正成为COVID-19相关急性呼吸窘迫综合征患者生存的重要资源。尽管最近的研究为体外膜氧合在这一患者群体中的优势提供了很多见解，但很少有关于其在妊娠中的应用的研究发表。本病例研究描述了在一例因COVID-19引起急性呼吸窘迫综合征的年轻孕妇中使用静脉-静脉体外膜氧合。它说明了这种治疗方式的多学科方法的好处，允许胎儿在保留母亲生命的同时变得可行。在本例中，母亲在接受治疗后能够返回家中，并独立恢复正常的日常生活活动。

引用次数: 1

An Interprofessional Approach to Mobilizing Patients With COVID-19 Receiving Extracorporeal Membrane Oxygenation. 动员COVID-19患者接受体外膜氧合的跨专业方法

IF 2.2 Q2 Medicine

AACN Advanced Critical Care

Pub Date : 2022-09-15 DOI: 10.4037/aacnacc2022293

Jenelle Sheasby, Suzanne Krais, Monica Do, Amy Hall, Holland Pace, David P Myers, Timothy J George

Objective: To assess survival outcomes with the intervention of an interprofessional mobilization program for patients with COVID-19 who were receiving venovenous extracorporeal membrane oxygenation (VV-ECMO).

Design: Preintervention and postintervention retrospective cohort study.

Methods: Survival outcomes of nonmobilized, adult patients (n = 16) with COVID-19 who were receiving VV-ECMO (May 2020 through December 2020) were compared with those of 26 patients who received a mobility care plan (January 2021 through November 2021). In the preintervention group, full sedation and paralysis were used. In the postintervention group, an early mobilization strategy involving interprofessional collaboration was introduced.

Results: The postintervention group had improved survival (73.1% vs 43.8%; P < .04); fewer days of receiving paralytics, fentanyl, and midazolam (P < .01 for all); but more days of dexmedetomidine, morphine, and ketamine administration (P < .01 for all). Concomitantly, more patients in the postintervention cohort received oral or transdermal analgesics, oral anxiolytics, and oral antipsychotics (P < .01 for all), and also required more VV-ECMO cannula adjustments (P = .03).

Conclusion: Early mobilization of patients with COVID-19 who were receiving VV-ECMO improved survival rates but led to more cannula adjustments.

目的:评估接受静脉-静脉体外膜氧合(VV-ECMO)治疗的COVID-19患者在跨专业动员方案干预下的生存结局。设计:干预前和干预后回顾性队列研究。方法:将接受VV-ECMO(2020年5月至2020年12月)的非活动性成年COVID-19患者(n = 16)与接受活动护理计划(2021年1月至2021年11月)的26例患者的生存结果进行比较。干预前组采用完全镇静和麻痹。在干预后组，引入了涉及跨专业合作的早期动员策略。结果:干预后组患者生存率提高(73.1% vs 43.8%;P < .04);使用麻醉剂、芬太尼和咪达唑仑的天数较短(P < 0.01);但右美托咪定、吗啡和氯胺酮的使用时间更长(P < 0.01)。同时，干预后队列中更多的患者接受口服或透皮镇痛药、口服抗焦虑药和口服抗精神病药(均P < 0.01)，并且需要更多的VV-ECMO插管调整(P = 0.03)。结论:早期动员接受VV-ECMO的COVID-19患者可提高生存率，但会导致更多的插管调整。

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引用次数: 0

Appropriate Staffing After the Pandemic: A New Challenge for Healthy Work Environments. 大流行后适当的人员配备:健康工作环境的新挑战。

IF 2.2 Q2 Medicine

AACN Advanced Critical Care

Pub Date : 2022-09-15 DOI: 10.4037/aacnacc2022746

Nancy Blake

引用次数: 1

Pressure Injury Risk Assessment and Prevention in Patients With COVID-19 in the Intensive Care Unit. 重症监护室新冠肺炎患者压力损伤风险评估和预防。

IF 2.2 Q2 Medicine

AACN Advanced Critical Care

Pub Date : 2022-06-15 DOI: 10.4037/aacnacc2022335

J. Alderden, S. Kennerly, Jill N. Cox, T. Yap

BACKGROUNDPatients critically ill with COVID-19 are at risk for hospital-acquired pressure injury, including device-related pressure injury.METHODSBraden Scale predictive validity was compared between patients with and without COVID-19, and a logistic regression model was developed to identify risk factors for device-related pressure injury.RESULTSA total of 1920 patients were included in the study sample, including 407 with COVID-19. Among the latter group, at least 1 hospital-acquired pressure injury developed in each of 120 patients (29%); of those, device-related pressure injury developed in 55 patients (46%). The Braden Scale score area under the receiver operating characteristic curve was 0.72 in patients without COVID-19 and 0.71 in patients with COVID-19, indicating fair to poor discrimination.CONCLUSIONSFragile skin and prone positioning during mechanical ventilatory support were risk factors for device-related pressure injury. Clinicians may consider incorporating factors not included in the Braden Scale (eg, oxygenation and perfusion) in routine risk assessment and should maintain vigilance in their efforts to protect patients with COVID-19 from device-related pressure injury.

背景新冠肺炎危重患者有医院所需压力损伤的风险，包括与设备相关的压力损伤。方法比较新冠肺炎患者和未患患者的raden量表预测有效性，并建立逻辑回归模型以确定设备相关压力损伤的危险因素。结果共有1920名患者被纳入研究样本，其中包括407名新冠肺炎患者。在后一组中，120名患者中每名患者至少发生1例医院获得性压力损伤（29%）；其中，55名患者（46%）出现了与设备相关的压力损伤。受试者操作特征曲线下的Braden量表评分区域在无新冠肺炎患者中为0.72，在新冠肺炎患者中为0.7，表明存在公平到差的歧视。结论机械通气支持过程中皮肤粗糙和俯卧位是设备相关压力损伤的危险因素。临床医生可以考虑在常规风险评估中纳入布雷登量表中未包括的因素（如氧合和灌注），并应保持警惕，以保护新冠肺炎患者免受设备相关压力损伤。

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引用次数: 3

Analgesia and Sedation in Critically Ill Patients With Burns. 危重烧伤患者的镇痛和镇静。

IF 2.2 Q2 Medicine

AACN Advanced Critical Care

Pub Date : 2022-06-15 DOI: 10.4037/aacnacc2022588

P. Weaver, Rochelle Brual, David Blair

引用次数: 0

Cutaneous Anomalies of the Critically Ill Patient. 危重病人的皮肤异常。

IF 2.2 Q2 Medicine

AACN Advanced Critical Care

Pub Date : 2022-06-15 DOI: 10.4037/aacnacc2022402

Melania Howell, Salomé Loera, H. Kirkland-Kyhn

Critically ill patients are at high risk for organ failure, including that of the integumentary system. Nurses working in intensive care are adept at performing comprehensive assessments that include the skin. Although pressure injury is a well-known complication associated with critical illness, patients may also have debilitating and life-threatening dermatoses. Conditions such as skin failure and medical adhesive-related skin damage are commonly seen in the critically ill. Infectious processes, such as Fournier gangrene, invasive candidiasis, mucormycosis, and herpetic lesions, can result in severe or superimposed critical illness and elude detection. Similarly, cutaneous manifestations of COVID-19 may develop prior to commonly recognized symptoms of infection. Nurses and providers caring for critically ill patients should be aware of common, but less widely known, skin conditions to facilitate early detection and treatment.

危重患者有很高的器官衰竭风险，包括表皮系统衰竭。在重症监护室工作的护士擅长进行包括皮肤在内的全面评估。尽管压力损伤是一种众所周知的与危重症相关的并发症，但患者也可能患有使人衰弱和危及生命的皮肤病。危重症患者常见皮肤衰竭和医用粘合剂相关皮肤损伤等情况。感染过程，如福尼尔坏疽、侵袭性念珠菌感染、毛霉菌病和疱疹性病变，可能导致严重或叠加的危重症，无法检测。同样，新冠肺炎的皮肤表现可能在公认的感染症状之前出现。护理危重患者的护士和提供者应该意识到常见但不太为人所知的皮肤状况，以便于早期发现和治疗。

引用次数: 0

Primer on Artificial Intelligence Used in Electronic Health Records. 电子健康记录中使用的人工智能入门。

IF 2.2 Q2 Medicine

AACN Advanced Critical Care

Pub Date : 2022-06-15 DOI: 10.4037/aacnacc2022390

L. Harrington

引用次数: 1

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