Dimensions of Critical Care Nursing最新文献

Background: Recurrent episodes of infection and subsequent sepsis are a frequent cause of readmission after sepsis hospitalization. Although persistent immune dysregulation initiated during the sepsis episode may play a role, the impact of preexisting immune suppression (including HIV, organ transplantation, and cancer) and common chronic diseases associated with immune suppression (diabetes and chronic kidney disease) on the risk of recurrent infections after sepsis is unknown.

Objectives: To investigate the role of preexisting immune-suppressive conditions (PISCs) and other common chronic diseases on infection-related readmissions after a sepsis admission.

Methods: Using the US 2015 Nationwide Readmissions Database, we identified a retrospective cohort of adult patients with an unplanned sepsis index admission from April to September, excluding patients with sepsis during the preceding 90 days. We followed all sepsis survivors for subsequent infection-related admissions for 90 days. We identified clinical conditions using International Classification of Diseases coding.

Results: We identified 649 029 unique unplanned sepsis admissions over 6 months; 189 604 (29.2%) had sepsis with PISC, and 459 425 (70.8%) had sepsis without PISC. Overall, sepsis survivors were older (median age, 70 years), and 145 156 (22.4%) experienced at least 1 infection-related readmission within 90 days. The incidence of infection-related readmission among sepsis survivors with PISC was 26.1%, whereas it was 20.8% for those without PISC. The excess risk of infection-related readmissions attributed to PISC was 5.3%, whereas the excess risk attributed to diabetes and chronic kidney disease was 3.7% and 4.7%, respectively. The background risk attributed to new-onset sepsis among participants with none of these conditions was 16.3%. Multivariable regression analysis adjusting for age, gender, and acute illness factors indicated that odds of infection-related readmission were strongly associated with PISC (odds ratio 1.30; 95% confidence interval, 1.29-1.32), closely followed by chronic kidney disease (1.28 [1.27-1.32]) and diabetes (1.17 [1.16-1.19]).

Conclusion: The risk of subsequent infection is higher among patients with PISC, although chronic kidney disease and diabetes are also important risk factors for subsequent infection and sepsis readmissions.

Objective: To map nursing interventions that contribute to preventing posttraumatic stress in people hospitalized in the context of intensive care.

Design: Scoping review according to the Joanne Briggs Institute methodology.

Methods: The search was carried out in the databases PubMed, CINAHL via EBSCO, Joanna Briggs Institute Database of Systematic Reviews, COCHRANE Database of Systematic Reviews, Repositório Científico de Acesso Aberto de Portugal, Dans Easy, and Dart-Europe. Published and unpublished studies (gray literature) were considered. This review integrates articles focused on nursing interventions that contribute to preventing posttraumatic stress in people hospitalized in intensive care in English, Portuguese, and Spanish. Studies with quantitative, qualitative, or mixed designs are covered, as well as systematic reviews and guidelines. The research has 3 eligibility criteria, following the PPC mnemonic: participants (studies involving adults hospitalized in intensive care), concept (studies that address nursing interventions that prevent posttraumatic stress), and context (studies developed in any contextual settings).

Results: The present scoping review included 11 articles. Autonomous, nonpharmacologic, pharmacologic, and interdependent nursing interventions were identified, capable of contributing to prevent posttraumatic stress in people hospitalized in intensive care.

Conclusion: Identifying nursing interventions that prevent posttraumatic stress in people hospitalized in intensive care allows nurses to develop care plans that include these interventions in the context of intensive care, with a view to improving the quality of nursing care provided.

Implications for clinical practice: This scoping review demonstrated that nurses have a crucial role in the prevention of posttraumatic stress in the context of intensive care. It is intended to make nurses aware of this issue, specifically to obtain highly significant and clinically relevant results, sensitive to nursing interventions. It is hoped that this review will be the precursor of research studies, centered on evaluating the degree of effectiveness of the nursing interventions mapped in this review.

Background: Research continues to be conducted on rapid response systems as patient outcomes associated with rapid response team activations are still not consistently showing benefit. One particular area of focus that is a growing area is the literature regarding training and education for individual team members of the rapid response team.

Objective: The purpose of this narrative review was to describe the current literature regarding educational interventions for rapid response team members.

Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. To be included in the narrative review, studies needed to be reporting on educational interventional research for rapid response team members of the efferent limb. No studies were excluded based upon study design or publication years.

Results: This narrative review included 6 studies. Four studies assessed outcomes associated with rapid response team members, and 2 of the studies assessed patient outcomes associated with implementing education routinely for rapid response teams. All studies found a positive impact of implementing educational interventions.

Discussion: Our narrative review found that limited research has been conducted in the area of educational interventions for rapid response team members, and of the articles identified, most did not assess patient-associated outcomes. The findings demonstrate that this area of research is in its early stages, and further work is needed to identify what content should be provided in the education and what educational methodologies should be employed, and to continue to assess patient health outcomes associated with educational interventions for rapid response team members.

Background: Many patients critically ill with COVID-19 develop acute respiratory distress syndrome (ARDS) necessitating mechanical ventilation and proning. Although proning is lifesaving, it has been linked to the occurrence of facial pressure injuries (PIs).

Objectives: To evaluate the incidence and use of prevention strategies and identify predictors of facial PIs in patients who received ventilator and proning treatments in COVID-designated intensive care units at 2 large quaternary medical centers in the Midwest.

Method: This was a retrospective cohort study using data extracted from an electronic health record between October 2020 and February 2022. Demographics, clinical and care variables, and PI outcomes were analyzed to identify predictors of PI using logistic and Cox regression.

Results: The cohort (N = 150) included patients from 2 units, unit a (n = 97) and unit b (n = 53) with a mean age of 60 years, with 68% identifying as male. Patients were vented for an average of 18 (SD, 16.2) days and proned for an average of 3 (SD, 2.5) days. Many (71%) died. Over half (56%) developed facial PI with a proning-exposure-adjusted incidence rate of 18.5%. Patients with PI were significantly different in several factors. Logistic regression showed predictors of PIs were duration of mechanical ventilation (in days; P = .02) and head turned (P = .01). Cox regression also identified head turn as predictive (P < .01), with Black/African American race as protective (P = .03).

Discussion: Critically ill patients with COVID-19 receiving ventilator and proning therapy developed facial PIs despite the use of recommended prevention practices. Further research on effective PI prevention strategies is needed.

Background: Determining appropriate extracorporeal membrane oxygenation (ECMO) candidacy ensures appropriate utilization of this costly resource. The current ECMO survival prediction scores do not consider clinician assessment of patient viability. This study compared clinician prediction of survival to hospital discharge versus prediction scores.

Objectives: The aim of this study was to compare clinician prediction of patients' survival to hospital discharge versus prognostic prediction scores (Respiratory ECMO Survival Prediction [RESP] or Survival After Veno-Arterial ECMO [SAVE] score) to actual survival.

Methods: This was an observational descriptive study from January 2020 to November 2021 conducted with interviews of nurses, perfusionists, and physicians who were involved during the initiation of ECMO within the first 24 hours of cannulation. Data were retrieved from the medical record to determine prediction scores and survival outcomes at hospital discharge. Accuracy of clinician prediction of survival was compared to the RESP or SAVE prediction scores and actual survival to hospital discharge.

Results: Accurate prediction of survival to hospital discharge for veno-venous ECMO by nurses was 47%, 64% by perfusionists, 45% by physicians, and 45% by the RESP score. Accurate predictions of patients on veno-arterial ECMO were correct in 54% of nurses, 77% of physicians, and 14% by the SAVE score. Physicians were more accurate than the SAVE score, P = .021, and perfusionists were significantly more accurate than the RESP score, P = .044. There was no relationship between ECMO specialists' years of experience and accuracy of predications.

Conclusion: Extracorporeal membrane oxygenation clinicians may have better predictions of survival to hospital discharge than the prediction scores. Further research is needed to develop accurate prediction tools to help determine ECMO eligibility.

Skin tears are a major problem for patients and the health care professionals who treat them. Although opinions on their prevalence differ, it is estimated that they are encountered more frequently than pressure sores but are overlooked. Recommendations based on strong evidence were presented for the prevention and treatment of skin tears as classified by the International Skin Tear Advisory Panel. This case series includes the clinical status of 3 patients who developed skin tears while receiving care in the hospital, and the corrective and preventive practices related to skin tears. This article will contribute to raising the awareness of health care professionals in predicting, preventing, evaluating, and treating skin tears.

Background: Artificial airways are essential in various clinical settings to maintain a patient's airway and provide necessary support for ventilation and oxygenation. These devices are commonly temporary and come in several types, each serving specific purposes. Understanding the indications, types, and proper care of artificial airways is crucial for health care professionals to ensure patients receive optimal care and prevent complications.

Objective: This article aims to review the indications for using artificial airways and discuss the most commonly used types, including supraglottic airway devices, endotracheal tubes, tracheostomy tubes, and laryngectomy tubes. It also provides insights into the procedures involved in intubation and percutaneous tracheostomy and offers guidance on patient management, emphasizing assessment, oral care, suctioning, and humidification for patients with these airway devices.

Conclusion: This article underscores the significance of understanding artificial airways, not just as a set of skills but as a commitment to patient welfare. Health care professionals who master the knowledge and care of these devices can significantly contribute to their patients' well-being and quality of life.

Background: Changes in healthcare delivery were required during the first year of the COVID-19 pandemic.

Objective: The purpose of this study was to determine the impact of the approach to care of the COVID-19 patient on nursing sensitive indicators and nutrition therapy and the utilization of rehabilitation services during the first year of the pandemic in the acute care setting.

Method: A retrospective study of 894 patients admitted with a COVID-19 diagnosis was conducted between March 2020 and February 2021 in 3-month cohorts. All charts were reviewed for general demographics and hospital data, nursing quality indicators, and nutritional and rehabilitation services for the first 30 days of admission.

Results: Differences in patient characteristics were noted among the cohorts. Variations were observed between time points in hospital-acquired pressure injury occurrence, with mechanical ventilation and proning being independent predictors of hospital-acquired pressure injuries. There were differences noted in the percentage of patients with a central line-associated bloodstream infection among the time points (P < .001), but there were no differences noted in catheter-associated urinary tract infections (P = .20). Overall, 15.5% had a malnutrition diagnosis, with most patients receiving 50% of prescribed calorie and protein needs. Rehabilitation services increased over time with these services being initiated earlier in the later cohorts (P < .001).

Discussion: The results of this study demonstrated the impact of the pandemic on outcomes in the areas of nursing, nutrition, and rehabilitation, which varied across quarterly cohorts as we learned and developed new practices and adapted to a novel pandemic.