Anaesthesia Critical Care & Pain Medicine最新文献

Background: Emotions significantly influence decision-making and performance in critical care settings. In situ simulation (ISS) has emerged as an educational tool that replicates real scenarios in clinical environments, potentially evoking authentic emotional responses. This scoping review examined how emotions have been studied in critical care ISS and their impact on learning and performance.

Methods: Following PRISMA-ScR guidelines, we conducted a comprehensive search across SCOPUS, PubMed, Web of Science, and CINAHL databases for articles published between January 2014 and June 2024. Studies examining emotional responses during ISS among healthcare professionals in critical care settings were included. Data were extracted using a standardized form and analyzed through narrative synthesis.

Results: Nine studies met the inclusion criteria. Analysis revealed that ISS evokes both positive and negative emotions comparable to real clinical scenarios, demonstrating psychological fidelity measured through standardized scales and physiological variables. While negative emotions like stress and anxiety were most extensively studied, positive emotions showed a significant correlation with enhanced performance. The concept of affective bonding emerged as a key component for knowledge retention and skill transfer.

Conclusions: ISS can recreate both technical and certain emotional aspects of clinical environments, particularly stress responses. The dual presence of positive and negative emotions contributes to learning effectiveness, with positive emotions enhancing performance and negative emotions building resilience when properly managed. The reported equivalence between emotional responses in simulated and real clinical scenarios validates ISS as an effective preparatory tool for critical care practice through the mechanism of affective bonding.

Background: Acute kidney injury (AKI) is a common and severe complication in burn patients, significantly increasing morbidity and mortality. Recent classifications distinguish acute kidney disease (AKD) as persistent kidney dysfunction beyond seven days; however, its trajectory in burn patients remains poorly understood. This study aimed to identify renal injury phenotypes in critically ill burn patients and assess their associations with clinical outcomes.

Methods: We conducted a single-center retrospective cohort study from 2013 to 2023 of adult (> 18 years) ICU burn patients with total burn surface area >15%. Renal injury was classified using KDIGO serum creatinine criteria and renal replacement therapy needs. AKI was defined as occurring within 7 days of injury, secondary AKI as occurring beyond day 7 but lasting <7 days, and AKD as dysfunction persisting >7 days. Phenotype classification was supported by stepwise logistic regression, XGBoost, and random forest analyses.

Results: Among 733 patients, 158 (21.6%) developed primary AKI, and overall mortality in this group was 95/158 (60.1%). Of the 121 primary AKI survivors, 58 (45.7%) developed further renal injury: secondary AKI alone (16.5%), AKD alone (10.7%), or both (20.7%). Secondary AKI and AKD were associated with mortality rates of 39% and 41%, and were independently linked to increased mortality. Primary AKI was mainly driven by baseline patient vulnerability (dementia, smoke inhalation, chronic alcohol use, age) and burn severity (TBSA full thickness, SAPS II), with dementia, hydroxocobalamin treatment, and smoke inhalation showing the strongest associations. In contrast, secondary AKI and AKD were characterized by complications occurring during ICU stay, particularly infection, cardiovascular support, digestive bleeding, and organ failures, with infection emerging as the dominant predictor across both phenotypes.

Conclusion: Primary AKI represents the most severe renal complication post-burn, while secondary injuries reflect later complications such as infection, hemorrhagic complications, or ARDS.

Context: The incidence of burnout is high among healthcare providers in intensive care units. Hot debriefing after critical situations remains rare. The main objective of this prospective, controlled, bicentric, before-and-after study was to evaluate the impact of implementing systematic debriefing, using a high-fidelity in-situ simulation program.

Methods: The study involved healthcare providers in two intensive care units. In one unit (debrief group), the physicians received theoretical training in debriefing, followed by practice during a 6-day interprofessional in-situ high-fidelity simulation program. Then, for 6 months, hot debriefing was encouraged after each critical situation. The other unit (control group) showed no change. A before-and-after online survey assessed psychosocial risk factors, work-related distress, and the number of debriefings in both units. The main endpoint was the incidence of severe burnout assessed by the Maslach Burnout Inventory (MBI).

Results: Sixteen physicians were trained to debrief, 133 professionals participated in the simulation program, and the survey was completed by 54 (debrief group) and 40 (control group) professionals. Severe burnout incidence did not vary before (9.3% and 7.5% respectively in the debrief and control groups) and after (1.8% and 10%) the study between groups (p =  0.358). In the debrief group, the rate of participation in hot debriefing increased from 22.2% to 53.7% and the MBI score and its accomplishment component were improved in the nurse subgroup.

Conclusion: The in-situ simulation program was effective in implementing hot debriefing in the intensive care unit. Despite no change in the overall burnout prevalence, a favorable effect on nurses occurred in the debrief group.

Background: Neurological intensive care units (neuro-ICU) prioritise maintaining homeostasis and monitoring for secondary brain injuries. These injuries can worsen primary lesions, such as those caused by subarachnoid haemorrhage (SAH) or traumatic brain injury (TBI). Cortical spreading depolarisations (SDs) are both markers and mechanisms of secondary brain damage. We evaluated the feasibility and safety of electrocorticography monitoring to identify SD in a neuro-ICU without SD monitoring experience.

Methods: We conducted a single-centre prospective study on adults admitted with either SAH or severe TBI. Each participant's involvement lasted up to 7 days for TBI, and up to 15 days for SAH. The primary endpoint was the availability of a high-quality electrocorticography signal, with or without SD, for ≥12 hours per patient. The adverse events of interest were neurological infection, skin infection, cerebrospinal fluid leak, peri-electrode intracranial bleeding, and all-cause mortality. We used subdural Wyler-strip or Spencer-type electrodes, or Intraparenchymal Spencer-type electrodes in patients not requiring surgery.

Outcomes: A total of 20 patients were included (SAH [n = 12] or a TBI [n = 8]). The primary endpoint was achieved in 19 patients monitored for a median [IQR] of 6 days [4-9]. At least 1 SD was observed in 10 patients (50%; SAH: n = 6/12, TBI: n = 4/8). There was 1 cerebrospinal fluid leakage; 1 local skin infection with a Spencer-type intracortical electrode; and 1 EVD-related ventriculitis with a subdural Spencer-type electrode.

Conclusions: Monitoring SD with electrocorticography is feasible and safe in a neuro-ICU with no prior experience. Further studies are needed to optimise techniques and assess clinical outcomes.

Study registration: ClinicalTrials.gov (NCT04585503). Registered 7 October 2020.