Australian Critical Care最新文献_第2页

“Because I couldn't understand and respond”: A mixed-method study examining the impact of language barriers on patient experiences of intensive care unit outreach team care

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE

Australian Critical Care

Pub Date : 2025-02-07 DOI: 10.1016/j.aucc.2025.101198

Cheryl Power RN, MN Adv Prac , Kylie O’Neill RN, MN , Shu-Kay Ng BSc, PhD , Edward Berry BN, Grad. Cert. Intens Care Nurs., RN , Matthew Grigg BSc, MBBS(Hons1), FCICM, FRACP , Gerald (Ged) Williams RN, MHA, LLM, FAAN, FACCCN , Adelene Luong BMedSc , Melissa J. Bloomer RN, PhD, FACCCN

Background

Almost 10% of hospitalised patients experience acute deterioration requiring emergency intervention. Language barriers can impede patient assessment and health outcomes.

Objective

The objective of this study was to explore the experiences of adult inpatients whose preferred language was not English, who received care from the intensive care unit (ICU) outreach team.

Methods

An explanatory sequential two-phase mixed-method design was used. A retrospective audit was undertaken to explore characteristics of and outcomes for recipients of ICU outreach team care, according to preferred language. In phase two, interpreter-mediated interviews were conducted with former patients whose preferred language was not English to explore their experience of critical illness and care by the ICU outreach team.

Results

From 4234 inpatients who received care from the ICU outreach team in 2022, there was a mean of 3.54 episodes of care (1–565) per patient. Those whose preferred language was not English had a higher proportion of admissions from the emergency department and were more likely to have a medical emergency team call as their first outreach episode of care but less likely to be admitted to the ICU. Vietnamese and Mandarin were the next most common languages spoken after English. Twenty-two former patients or delegated relatives were interviewed. Not all recalled receiving care from the ICU outreach team. There was strong support for involvement of professional interpreters for critical conversations and to aid autonomy. Family members acted as lay interpreters and fulfilled familial and cultural obligations, but visitor restrictions impeded this.

Conclusion

Patient deterioration requires an emergent response. This research demonstrates the importance of identifying and overcoming language barriers for patients in a way that protects and preserves patient autonomy and ensures information accuracy. Where time and the patient's condition allows, use of professional interpreters must become the norm.

{"title":"“Because I couldn't understand and respond”: A mixed-method study examining the impact of language barriers on patient experiences of intensive care unit outreach team care","authors":"Cheryl Power RN, MN Adv Prac , Kylie O’Neill RN, MN , Shu-Kay Ng BSc, PhD , Edward Berry BN, Grad. Cert. Intens Care Nurs., RN , Matthew Grigg BSc, MBBS(Hons1), FCICM, FRACP , Gerald (Ged) Williams RN, MHA, LLM, FAAN, FACCCN , Adelene Luong BMedSc , Melissa J. Bloomer RN, PhD, FACCCN","doi":"10.1016/j.aucc.2025.101198","DOIUrl":"10.1016/j.aucc.2025.101198","url":null,"abstract":"<div><h3>Background</h3><div>Almost 10% of hospitalised patients experience acute deterioration requiring emergency intervention. Language barriers can impede patient assessment and health outcomes.</div></div><div><h3>Objective</h3><div>The objective of this study was to explore the experiences of adult inpatients whose preferred language was not English, who received care from the intensive care unit (ICU) outreach team.</div></div><div><h3>Methods</h3><div>An explanatory sequential two-phase mixed-method design was used. A retrospective audit was undertaken to explore characteristics of and outcomes for recipients of ICU outreach team care, according to preferred language. In phase two, interpreter-mediated interviews were conducted with former patients whose preferred language was not English to explore their experience of critical illness and care by the ICU outreach team.</div></div><div><h3>Results</h3><div>From 4234 inpatients who received care from the ICU outreach team in 2022, there was a mean of 3.54 episodes of care (1–565) per patient. Those whose preferred language was not English had a higher proportion of admissions from the emergency department and were more likely to have a medical emergency team call as their first outreach episode of care but less likely to be admitted to the ICU. Vietnamese and Mandarin were the next most common languages spoken after English. Twenty-two former patients or delegated relatives were interviewed. Not all recalled receiving care from the ICU outreach team. There was strong support for involvement of professional interpreters for critical conversations and to aid autonomy. Family members acted as lay interpreters and fulfilled familial and cultural obligations, but visitor restrictions impeded this.</div></div><div><h3>Conclusion</h3><div>Patient deterioration requires an emergent response. This research demonstrates the importance of identifying and overcoming language barriers for patients in a way that protects and preserves patient autonomy and ensures information accuracy. Where time and the patient's condition allows, use of professional interpreters must become the norm.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101198"},"PeriodicalIF":2.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The effectiveness of a three-dimensional printed model for training novice healthcare professionals in central venous catheter insertion: A cross-sectional study in a critical care setting

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE

Australian Critical Care

Pub Date : 2025-02-06 DOI: 10.1016/j.aucc.2025.101197

Felicity Edwards APD, BHlthSc , Tara McCurdie PhD , Dougal Carlisle MBBS FCICM , George Pang MBBS FCICM , Fiona Coyer RN, PhD , Kevin B. Laupland MD, PhD, FCICM

Background

We have previously used three-dimensional printing to develop a novel manikin for simulation training of central venous catheter insertion in critical care. The objective of this study was to evaluate the fidelity of the model by testing with novice and experienced operators.

Methods

A convenience sample of intensivist physicians experienced in central venous catheter insertion and critical care nurses without prior central venous catheter training was assembled. Participants were offered a video educational clip and a one-on-one demonstration. All participants were then asked to insert a central venous catheter into the model. Outcomes included requests for assistance, success rate, time to insertion, and subjective feedback.

Results

Thirteen intensivists and 14 nurses participated. Nurses were more likely to view the demonstration video prior to the procedure (13/14; 92.9% vs. 7/13; 53.9%; p = 0.033). Intensivists were more likely male (11/13; 84.6% vs. 3/14; 21.4%; p = 0.002) and tended to be older, with a higher proportion in the 35- to 44-year and 45- to 54-year age ranges than the nurses (92.3% vs. 71.4%; p = 0.426). Nurses requested more assistance and received more guidance but had similar overall success (100.0% vs 92.3%; p = 0.481). The median time taken for the procedure was 19 min and 59 s for nurses and 8 min and 14 s for intensivists (p = 0.004). All participants agreed that the model effectively prepared trainees for their first human central venous catheter insertion. Nurses also reported a significant increase in procedural confidence post simulation. Additionally, most participants agreed or strongly agreed that the model realistically simulated the femoral vein, an essential aspect of the central venous catheter insertion.

Conclusions

Nurses required additional assistance and took longer to complete the insertion, demonstrating preliminary evidence for the model's construct validity. Furthermore, the model was deemed a realistic training tool with successful insertion by nearly all participants.

{"title":"The effectiveness of a three-dimensional printed model for training novice healthcare professionals in central venous catheter insertion: A cross-sectional study in a critical care setting","authors":"Felicity Edwards APD, BHlthSc , Tara McCurdie PhD , Dougal Carlisle MBBS FCICM , George Pang MBBS FCICM , Fiona Coyer RN, PhD , Kevin B. Laupland MD, PhD, FCICM","doi":"10.1016/j.aucc.2025.101197","DOIUrl":"10.1016/j.aucc.2025.101197","url":null,"abstract":"<div><h3>Background</h3><div>We have previously used three-dimensional printing to develop a novel manikin for simulation training of central venous catheter insertion in critical care. The objective of this study was to evaluate the fidelity of the model by testing with novice and experienced operators.</div></div><div><h3>Methods</h3><div>A convenience sample of intensivist physicians experienced in central venous catheter insertion and critical care nurses without prior central venous catheter training was assembled. Participants were offered a video educational clip and a one-on-one demonstration. All participants were then asked to insert a central venous catheter into the model. Outcomes included requests for assistance, success rate, time to insertion, and subjective feedback.</div></div><div><h3>Results</h3><div>Thirteen intensivists and 14 nurses participated. Nurses were more likely to view the demonstration video prior to the procedure (13/14; 92.9% vs. 7/13; 53.9%; <em>p</em> = 0.033). Intensivists were more likely male (11/13; 84.6% vs. 3/14; 21.4%; <em>p</em> = 0.002) and tended to be older, with a higher proportion in the 35- to 44-year and 45- to 54-year age ranges than the nurses (92.3% vs. 71.4%; <em>p</em> = 0.426). Nurses requested more assistance and received more guidance but had similar overall success (100.0% vs 92.3%; <em>p</em> = 0.481). The median time taken for the procedure was 19 min and 59 s for nurses and 8 min and 14 s for intensivists (<em>p</em> = 0.004). All participants agreed that the model effectively prepared trainees for their first human central venous catheter insertion. Nurses also reported a significant increase in procedural confidence post simulation. Additionally, most participants agreed or strongly agreed that the model realistically simulated the femoral vein, an essential aspect of the central venous catheter insertion.</div></div><div><h3>Conclusions</h3><div>Nurses required additional assistance and took longer to complete the insertion, demonstrating preliminary evidence for the model's construct validity. Furthermore, the model was deemed a realistic training tool with successful insertion by nearly all participants.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101197"},"PeriodicalIF":2.6,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143277379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A retrospective review of the characteristics of patients deemed unsuitable for organ donation in a paediatric intensive care unit over a 5-year period

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE

Australian Critical Care

Pub Date : 2025-02-03 DOI: 10.1016/j.aucc.2024.101161

Mellissa Short MN , Fiona Newall PhD , Kate Masterson PhD

Introduction

Children on organ transplant lists are more likely than adult patients to develop complications or die whilst waiting for a transplant. This reflects children's frequent need for size-matched organs, which are rarely available.

Objectives

The aim of this study was to review characteristics of patients deemed unsuitable for organ donation in a paediatric intensive care unit over a 5-year period to identify opportunities for practice improvement.

Methods

This was a quantitative, retrospective, observational study, using a descriptive design. Data were extracted from the clinical intensive care database STATIC into Microsoft Excel for children who died between the 1st of January 2018 and the 31st of December 2022. Data were analysed descriptively.

Results

Across the 5 years, 226 children died; 94 (41%) were referred to the state organ donation service DonateLife, and 26 (11.5%) became organ donors. Most children died from a cardiac cause. Of the total children who died, 152 (66%) were deemed to be unsuitable for organ donation. The most common reasons for children being deemed unsuitable for organ donation were as follows: poor organ function (46%), pre-existing systemic disease (34%), sepsis (15%), too young (10.5%), and due to legislation (9.8%).

Conclusion

This study identified cohorts of patients who were deemed unsuitable for organ donation. Based on published evidence, some of these patients may have been suitable or could have been considered for organ donation. Identifying these cohorts may optimise knowledge translation regarding donor suitability, with the outcome of increasing organ donation opportunities.

{"title":"A retrospective review of the characteristics of patients deemed unsuitable for organ donation in a paediatric intensive care unit over a 5-year period","authors":"Mellissa Short MN , Fiona Newall PhD , Kate Masterson PhD","doi":"10.1016/j.aucc.2024.101161","DOIUrl":"10.1016/j.aucc.2024.101161","url":null,"abstract":"<div><h3>Introduction</h3><div>Children on organ transplant lists are more likely than adult patients to develop complications or die whilst waiting for a transplant. This reflects children's frequent need for size-matched organs, which are rarely available.</div></div><div><h3>Objectives</h3><div>The aim of this study was to review characteristics of patients deemed unsuitable for organ donation in a paediatric intensive care unit over a 5-year period to identify opportunities for practice improvement.</div></div><div><h3>Methods</h3><div>This was a quantitative, retrospective, observational study, using a descriptive design. Data were extracted from the clinical intensive care database STATIC into Microsoft Excel for children who died between the 1st of January 2018 and the 31st of December 2022. Data were analysed descriptively.</div></div><div><h3>Results</h3><div>Across the 5 years, 226 children died; 94 (41%) were referred to the state organ donation service DonateLife, and 26 (11.5%) became organ donors. Most children died from a cardiac cause. Of the total children who died, 152 (66%) were deemed to be unsuitable for organ donation. The most common reasons for children being deemed unsuitable for organ donation were as follows: poor organ function (46%), pre-existing systemic disease (34%), sepsis (15%), too young (10.5%), and due to legislation (9.8%).</div></div><div><h3>Conclusion</h3><div>This study identified cohorts of patients who were deemed unsuitable for organ donation. Based on published evidence, some of these patients may have been suitable or could have been considered for organ donation. Identifying these cohorts may optimise knowledge translation regarding donor suitability, with the outcome of increasing organ donation opportunities.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101161"},"PeriodicalIF":2.6,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A survey of healthcare providers about the feasibility and implementation of early mobilisation of patients in critical care units in a Lebanese hospital

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE

Australian Critical Care

Pub Date : 2025-02-01 DOI: 10.1016/j.aucc.2024.101169

Noura Jannoun MSN, RN , Samar Noureddine PhD, RN, FAHA, FAAN , Houry Puzantian PhD, RN, FAHA , Salah Zeineldine MD, FACP

Background

Many survivors of critical care experience complications from bed rest after recovering from the acute phase. Early mobilisation helps patients recover faster. However, anecdotal evidence suggests that patients in critical care units are rarely mobilised.

Aim

The aims of the study were to assess the feasibility of early mobilisation of patients in intensive care units from the clinicians' perspective in a Lebanese hospital during the COVID-19 pandemic, identify associated institutional factors, and describe the knowledge, attitude, practices, and perceived barriers to early mobilisation among Lebanese clinicians.

Methods

A descriptive correlational design was used. Forty-nine healthcare providers (response rate: 41%) who work in critical care at a tertiary medical centre in Lebanon were recruited. Data were collected online via LimeSurvey using the Modified Mobility Survey Questionnaire. Descriptive statistics, bivariate correlations, and hierarchical multiple linear regression were used.

Results

Most respondents were nurses, and also included two physicians, four physiotherapists, and four respiratory therapists. Most respondents (67%) perceived early mobility to be crucial or very important, but only 33% thought its implementation was feasible. Many patient, provider, and institutional barriers to implementation were identified. Most clinicians thought that mobility must be started early, but 60% reported lack of training in mobilisation and identified patient instability, safety concerns, and lack of guidelines as barriers. Lack of equipment (unstandardised regression coefficient B = −0.87, 95% confidence interval = −1.7, −0.05; p = 0.039) and lack of guidelines (B = −0.67, 95% confidence interval = −1.37, 0.04; p = 0.063) were associated with lower feasibility of implementing early mobility in the multivariable analysis.

Conclusion

Despite appreciating benefits of early mobility, the respondents identified many barriers to its implementation. The findings suggest the need for staff education and training in early mobility and development of a multidisciplinary protocol on mobilisation. In addition, the needed human and physical resources ought to be assessed.

{"title":"A survey of healthcare providers about the feasibility and implementation of early mobilisation of patients in critical care units in a Lebanese hospital","authors":"Noura Jannoun MSN, RN , Samar Noureddine PhD, RN, FAHA, FAAN , Houry Puzantian PhD, RN, FAHA , Salah Zeineldine MD, FACP","doi":"10.1016/j.aucc.2024.101169","DOIUrl":"10.1016/j.aucc.2024.101169","url":null,"abstract":"<div><h3>Background</h3><div>Many survivors of critical care experience complications from bed rest after recovering from the acute phase. Early mobilisation helps patients recover faster. However, anecdotal evidence suggests that patients in critical care units are rarely mobilised.</div></div><div><h3>Aim</h3><div>The aims of the study were to assess the feasibility of early mobilisation of patients in intensive care units from the clinicians' perspective in a Lebanese hospital during the COVID-19 pandemic, identify associated institutional factors, and describe the knowledge, attitude, practices, and perceived barriers to early mobilisation among Lebanese clinicians.</div></div><div><h3>Methods</h3><div>A descriptive correlational design was used. Forty-nine healthcare providers (response rate: 41%) who work in critical care at a tertiary medical centre in Lebanon were recruited. Data were collected online via LimeSurvey using the Modified Mobility Survey Questionnaire. Descriptive statistics, bivariate correlations, and hierarchical multiple linear regression were used.</div></div><div><h3>Results</h3><div>Most respondents were nurses, and also included two physicians, four physiotherapists, and four respiratory therapists. Most respondents (67%) perceived early mobility to be crucial or very important, but only 33% thought its implementation was feasible. Many patient, provider, and institutional barriers to implementation were identified. Most clinicians thought that mobility must be started early, but 60% reported lack of training in mobilisation and identified patient instability, safety concerns, and lack of guidelines as barriers. Lack of equipment (unstandardised regression coefficient B = −0.87, 95% confidence interval = −1.7, −0.05; p = 0.039) and lack of guidelines (B = −0.67, 95% confidence interval = −1.37, 0.04; p = 0.063) were associated with lower feasibility of implementing early mobility in the multivariable analysis.</div></div><div><h3>Conclusion</h3><div>Despite appreciating benefits of early mobility, the respondents identified many barriers to its implementation. The findings suggest the need for staff education and training in early mobility and development of a multidisciplinary protocol on mobilisation. In addition, the needed human and physical resources ought to be assessed.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101169"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Acceptability of a physiotherapy-led intensive prone positioning service in intensive care: A qualitative study with multidisciplinary clinicians

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE

Australian Critical Care

Pub Date : 2025-01-31 DOI: 10.1016/j.aucc.2024.101162

Stacey Haughton BExSci, DPT , Krisha Saravanan BHSc, BPsychHons , Luke A. McDonald BHlthSci, MPhysioPrac , Joleen W. Rose BSci(Hons), BPhysio(Hons) , Sue Berney BPT, PhD , David J. Berlowitz BAppSciPhty, PhD , Thomas C. Rollinson BPhysio(Hons) , Marnie Graco BPhysio(Hons), PhD

Background

The coronavirus disease 2019 (COVID-19) pandemic resulted in an increased number of patients with COVID-19–related respiratory failure requiring prone positioning. To reduce pressure on nursing and medical staff in the intensive care unit (ICU), a physiotherapy-led intensive prone positioning (PhLIP) service was implemented.

Objectives

The aim of this study was to explore the acceptability of the PhLIP service from the perspective of nurses and doctors working in the ICU and the physiotherapists who delivered the service.

Methods

A qualitative evaluation was conducted using semistructured interviews and focus groups, guided by the theoretical framework of acceptability (TFA). Participants included doctors, nurses, and physiotherapists who interacted with or delivered the PhLIP service.

Results

A total of 19 interviews (eight doctors and 11 physiotherapists) and four focus groups (13 nurses) were conducted. Eleven themes were identified within the eight domains of the TFA. Overall, the PhLIP team was highly valued and appreciated (TFA: affective attitude); enabled high-quality care and improved ICU efficiency (TFA: perceived effectiveness); reduced risks to patients and staff (TFA: perceived safety and risk); and was empowering for the clinicians involved (TFA: self-efficacy). Being in the PhLIP team was physically and mentally exhausting, and the service put strain on the physiotherapy department due to reallocation of staff (TFA: burden). Having trust in the physiotherapists leading the prone positioning service was a key influence on nursing and medical acceptance of the service.

Conclusion

The PhLIP team delivered an acceptable service that improved clinical care and efficiency during the COVID-19 pandemic. Other ICUs should consider the availability, skills, and confidence in the team selected to implement an intensive prone positioning service, should the need arise again. Researchers using the TFA to explore acceptability of healthcare innovations should also consider the recipients’ trust in those delivering the intervention.

{"title":"Acceptability of a physiotherapy-led intensive prone positioning service in intensive care: A qualitative study with multidisciplinary clinicians","authors":"Stacey Haughton BExSci, DPT , Krisha Saravanan BHSc, BPsychHons , Luke A. McDonald BHlthSci, MPhysioPrac , Joleen W. Rose BSci(Hons), BPhysio(Hons) , Sue Berney BPT, PhD , David J. Berlowitz BAppSciPhty, PhD , Thomas C. Rollinson BPhysio(Hons) , Marnie Graco BPhysio(Hons), PhD","doi":"10.1016/j.aucc.2024.101162","DOIUrl":"10.1016/j.aucc.2024.101162","url":null,"abstract":"<div><h3>Background</h3><div>The coronavirus disease 2019 (COVID-19) pandemic resulted in an increased number of patients with COVID-19–related respiratory failure requiring prone positioning. To reduce pressure on nursing and medical staff in the intensive care unit (ICU), a physiotherapy-led intensive prone positioning (PhLIP) service was implemented.</div></div><div><h3>Objectives</h3><div>The aim of this study was to explore the acceptability of the PhLIP service from the perspective of nurses and doctors working in the ICU and the physiotherapists who delivered the service.</div></div><div><h3>Methods</h3><div>A qualitative evaluation was conducted using semistructured interviews and focus groups, guided by the theoretical framework of acceptability (TFA). Participants included doctors, nurses, and physiotherapists who interacted with or delivered the PhLIP service.</div></div><div><h3>Results</h3><div>A total of 19 interviews (eight doctors and 11 physiotherapists) and four focus groups (13 nurses) were conducted. Eleven themes were identified within the eight domains of the TFA. Overall, the PhLIP team was highly valued and appreciated (TFA: affective attitude); enabled high-quality care and improved ICU efficiency (TFA: perceived effectiveness); reduced risks to patients and staff (TFA: perceived safety and risk); and was empowering for the clinicians involved (TFA: self-efficacy). Being in the PhLIP team was physically and mentally exhausting, and the service put strain on the physiotherapy department due to reallocation of staff (TFA: burden). Having trust in the physiotherapists leading the prone positioning service was a key influence on nursing and medical acceptance of the service.</div></div><div><h3>Conclusion</h3><div>The PhLIP team delivered an acceptable service that improved clinical care and efficiency during the COVID-19 pandemic. Other ICUs should consider the availability, skills, and confidence in the team selected to implement an intensive prone positioning service, should the need arise again. Researchers using the TFA to explore acceptability of healthcare innovations should also consider the recipients’ trust in those delivering the intervention.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101162"},"PeriodicalIF":2.6,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association of net ultrafiltration intensity and clinical outcomes among critically ill patients receiving continuous renal replacement therapy: A systematic review, meta-analysis, and trial sequential analysis

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE

Australian Critical Care

Pub Date : 2025-01-30 DOI: 10.1016/j.aucc.2024.101170

Lu Jin MBBS, Peiyun Li MM, Qing Xu MBBS, Fang Wang MD, Ling Zhang MD, PhD

Background

Net ultrafiltration (UF^net) has been used in the fluid management of critically ill patients undergoing continuous renal replacement therapy for an extended duration. Despite its widespread application, the correlation between UF^net intensity and clinical outcomes remains controversial.

Methods

Electronic databases (PubMed, Embase, Web of Science, and the Cochrane database) were searched from inception to November 30, 2023. All possible studies that examined the following outcomes were included: all-cause mortality, recovery of kidney function, and length of hospital stay.

Results

A total of 6209 patients from six cohort studies were included. There was no significant association observed between UF^net intensity and either mortality (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.68–1.21, p = 0.49, I² = 84%) or renal recovery (OR = 0.96, 95% CI = 0.57–1.61, p = 0.87, I² = 75%) among critically ill patients. However, a high intensity of UF^net was associated with lower mortality in patients with acute kidney injury (AKI) (OR = 0.73, 95% CI = 0.59–0.90, p = 0.004, I² = 67%). Furthermore, the study revealed a noteworthy correlation between a high UF^net intensity and a longer length of hospital stay (weighted mean difference = 3.34 d, 95% CI = 2.64–4.03, p² = 0%).

Conclusions

The association between UF^net intensity and mortality or renal recovery in critically ill patients is insufficient. However, a high UF^net intensity is associated with an increasing length of hospital stay among critically ill patients.

{"title":"Association of net ultrafiltration intensity and clinical outcomes among critically ill patients receiving continuous renal replacement therapy: A systematic review, meta-analysis, and trial sequential analysis","authors":"Lu Jin MBBS, Peiyun Li MM, Qing Xu MBBS, Fang Wang MD, Ling Zhang MD, PhD","doi":"10.1016/j.aucc.2024.101170","DOIUrl":"10.1016/j.aucc.2024.101170","url":null,"abstract":"<div><h3>Background</h3><div>Net ultrafiltration (UF<sup>net)</sup> has been used in the fluid management of critically ill patients undergoing continuous renal replacement therapy for an extended duration. Despite its widespread application, the correlation between UF<sup>net</sup> intensity and clinical outcomes remains controversial.</div></div><div><h3>Methods</h3><div>Electronic databases (PubMed, Embase, Web of Science, and the Cochrane database) were searched from inception to November 30, 2023. All possible studies that examined the following outcomes were included: all-cause mortality, recovery of kidney function, and length of hospital stay.</div></div><div><h3>Results</h3><div>A total of 6209 patients from six cohort studies were included. There was no significant association observed between UF<sup>net</sup> intensity and either mortality (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.68–1.21, p = 0.49, I<sup>2</sup> = 84%) or renal recovery (OR = 0.96, 95% CI = 0.57–1.61, p = 0.87, I<sup>2</sup> = 75%) among critically ill patients. However, a high intensity of UF<sup>net</sup> was associated with lower mortality in patients with acute kidney injury (AKI) (OR = 0.73, 95% CI = 0.59–0.90, p = 0.004, I<sup>2</sup> = 67%). Furthermore, the study revealed a noteworthy correlation between a high UF<sup>net</sup> intensity and a longer length of hospital stay (weighted mean difference = 3.34 d, 95% CI = 2.64–4.03, p<sup>2</sup> = 0%).</div></div><div><h3>Conclusions</h3><div>The association between UF<sup>net</sup> intensity and mortality or renal recovery in critically ill patients is insufficient. However, a high UF<sup>net</sup> intensity is associated with an increasing length of hospital stay among critically ill patients.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101170"},"PeriodicalIF":2.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Airborne personal protective equipment availability and preparedness in Australian and New Zealand intensive care units: A point prevalence survey

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE

Australian Critical Care

Pub Date : 2025-01-29 DOI: 10.1016/j.aucc.2024.101163

Adrian Regli FCICM, PhD , Edward Litton FCICM, PhD , Annemarie Palermo RN , Naomi Hammond RN, PhD , Serena Knowles RN, PhD , Britta Sylvia von Ungern-Sternberg FANZCA, PhD , the Point Prevalence Program Management Committee, The Australian and New Zealand Intensive Care Society Clinical Trials Group and The George Institute for Global Health

Background

Personal protective equipment is essential to protect healthcare workers when exposed to aerosol-generating procedures in patients with airborne respiratory pathogens.

Aim

This study aimed to provide information regarding the level of airborne protection offered to nursing staff and other healthcare workers in Australian and New Zealand intensive care units (ICUs) 1 year into the coronavirus disease 2019 pandemic.

Methods

In this cross-sectional survey, ICUs in Australia and New Zealand were asked to participate in the Australian and New Zealand Intensive Care Society Clinical Trials Group Point Prevalence Program in June 2021. Sites were asked to contribute to questions regarding airborne protection offered to nursing staff and other healthcare workers.

Results

There were 51 participating sites. Negative-pressure bed space availability within participating ICUs included 24 with more than two, 15 with two, eight with one, and one ICU that did not have any. The median (interquartile range) number of different models and sizes of N95/P2 masks available to ICU staff was 6 (4–7). Of the 1018 nursing staff working that day in the units, 799 (78.5%) had at least one fit-tested N95/P2 mask in the correct size available. A total of 712 patients (461 medical and 251 surgical) were cared for by 700 bedside nurses in these ICUs. Overall, adequate airborne protection preparedness (airborne personal protective equipment training and fit-testing since the pandemic) was present in 548 (78.3%) bedside nurses.

Conclusions

Over a year into the coronavirus disease 2019 pandemic, airborne protection provided to nursing and other healthcare staff in Australia and New Zealand was often inadequate.

{"title":"Airborne personal protective equipment availability and preparedness in Australian and New Zealand intensive care units: A point prevalence survey","authors":"Adrian Regli FCICM, PhD , Edward Litton FCICM, PhD , Annemarie Palermo RN , Naomi Hammond RN, PhD , Serena Knowles RN, PhD , Britta Sylvia von Ungern-Sternberg FANZCA, PhD , the Point Prevalence Program Management Committee, The Australian and New Zealand Intensive Care Society Clinical Trials Group and The George Institute for Global Health","doi":"10.1016/j.aucc.2024.101163","DOIUrl":"10.1016/j.aucc.2024.101163","url":null,"abstract":"<div><h3>Background</h3><div>Personal protective equipment is essential to protect healthcare workers when exposed to aerosol-generating procedures in patients with airborne respiratory pathogens.</div></div><div><h3>Aim</h3><div>This study aimed to provide information regarding the level of airborne protection offered to nursing staff and other healthcare workers in Australian and New Zealand intensive care units (ICUs) 1 year into the coronavirus disease 2019 pandemic.</div></div><div><h3>Methods</h3><div>In this cross-sectional survey, ICUs in Australia and New Zealand were asked to participate in the Australian and New Zealand Intensive Care Society Clinical Trials Group Point Prevalence Program in June 2021. Sites were asked to contribute to questions regarding airborne protection offered to nursing staff and other healthcare workers.</div></div><div><h3>Results</h3><div>There were 51 participating sites. Negative-pressure bed space availability within participating ICUs included 24 with more than two, 15 with two, eight with one, and one ICU that did not have any. The median (interquartile range) number of different models and sizes of N95/P2 masks available to ICU staff was 6 (4–7). Of the 1018 nursing staff working that day in the units, 799 (78.5%) had at least one fit-tested N95/P2 mask in the correct size available. A total of 712 patients (461 medical and 251 surgical) were cared for by 700 bedside nurses in these ICUs. Overall, adequate airborne protection preparedness (airborne personal protective equipment training and fit-testing since the pandemic) was present in 548 (78.3%) bedside nurses.</div></div><div><h3>Conclusions</h3><div>Over a year into the coronavirus disease 2019 pandemic, airborne protection provided to nursing and other healthcare staff in Australia and New Zealand was often inadequate<strong>.</strong></div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101163"},"PeriodicalIF":2.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Risk factors of anxiety, depression, stress, job burnout, and characteristics of sleep disorders in critical care nurses: An observational study

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE

Australian Critical Care

Pub Date : 2025-01-29 DOI: 10.1016/j.aucc.2024.101165

Francesco Gravante RN, MSN , Gianluca Pucciarelli RN, PhD, FAHA , Francesca Sperati BSc, MStat , Luciano Cecere RN, MSN , Giuliano Anastasi RN, MSN , Stefano Mancin RN, PhD , Teresa Rea RN, PhD , Roberto Latina RN, PhD

Aim/Objective

The aim of this study was to determine risk factors and associations between anxiety, depression, stress, and job burnout and describe sleep disorders in critical care nurses.

Setting

Data were collected in six intensive care units.

Methods

A descriptive cross-sectional design was used. Multivariate and univariate regressions were used to determine significant risk factors. Significance levels were established at p <0.05. We use Depression Anxiety Stress Scales to determine anxiety, depression, and stress. Work burnout was detected using the Maslach Burnout Inventory scale, and sleep quality was determined by the Pittsburgh Sleep Quality Index.

Results

A total of 140 critical care nurses were included. The female gender was associated with high levels of anxiety (odds ratio [OR] = 3.03; 95% confidence interval [CI] = [1.12–8.23]; p = 0.029), depression (OR = 10.55; 95% CI = [2.17–51.19]; p = 0.003), and stress (OR = 2.87; 95% CI = [1.02–8.07]; p = 0.045). Multivariate regression showed that critical care nurses with intention of leaving were exposed to high levels of anxiety (OR = 3.65; 95% CI = [1.40–9.53]; p = 0.008), depression (OR = 6.79; 95% CI = [2.01–22.95]; p = 0.002), stress [OR = 4.13; 95% CI = [1.49–11.45]; p = 0.006), and burnout (OR = 4.15; 95% CI = [1.63–10.56]; p = 0.003). Sleep quality is influenced by high latency, low duration, the use of medications, and daytime dysfunction.

Conclusion

Females were exposed to a higher risk of developing mental health problems such as anxiety, depression, and stress than men. The intention to leave was an independent predictor of anxiety, depression, and stress. Characteristics such as high sleep latency, low duration, use of medications, and daytime dysfunction have a negative impact on sleep quality. Early detection of mental health would allow nursing managers to implement nonpharmacological preventive interventions to improve well-being at work.

{"title":"Risk factors of anxiety, depression, stress, job burnout, and characteristics of sleep disorders in critical care nurses: An observational study","authors":"Francesco Gravante RN, MSN , Gianluca Pucciarelli RN, PhD, FAHA , Francesca Sperati BSc, MStat , Luciano Cecere RN, MSN , Giuliano Anastasi RN, MSN , Stefano Mancin RN, PhD , Teresa Rea RN, PhD , Roberto Latina RN, PhD","doi":"10.1016/j.aucc.2024.101165","DOIUrl":"10.1016/j.aucc.2024.101165","url":null,"abstract":"<div><h3>Aim/Objective</h3><div>The aim of this study was to determine risk factors and associations between anxiety, depression, stress, and job burnout and describe sleep disorders in critical care nurses.</div></div><div><h3>Setting</h3><div>Data were collected in six intensive care units.</div></div><div><h3>Methods</h3><div>A descriptive cross-sectional design was used. Multivariate and univariate regressions were used to determine significant risk factors. Significance levels were established at p <0.05. We use Depression Anxiety Stress Scales to determine anxiety, depression, and stress. Work burnout was detected using the Maslach Burnout Inventory scale, and sleep quality was determined by the Pittsburgh Sleep Quality Index.</div></div><div><h3>Results</h3><div>A total of 140 critical care nurses were included. The female gender was associated with high levels of anxiety (odds ratio [OR] = 3.03; 95% confidence interval [CI] = [1.12–8.23]; p = 0.029), depression (OR = 10.55; 95% CI = [2.17–51.19]; p = 0.003), and stress (OR = 2.87; 95% CI = [1.02–8.07]; p = 0.045). Multivariate regression showed that critical care nurses with intention of leaving were exposed to high levels of anxiety (OR = 3.65; 95% CI = [1.40–9.53]; p = 0.008), depression (OR = 6.79; 95% CI = [2.01–22.95]; p = 0.002), stress [OR = 4.13; 95% CI = [1.49–11.45]; p = 0.006), and burnout (OR = 4.15; 95% CI = [1.63–10.56]; p = 0.003). Sleep quality is influenced by high latency, low duration, the use of medications, and daytime dysfunction.</div></div><div><h3>Conclusion</h3><div>Females were exposed to a higher risk of developing mental health problems such as anxiety, depression, and stress than men. The intention to leave was an independent predictor of anxiety, depression, and stress. Characteristics such as high sleep latency, low duration, use of medications, and daytime dysfunction have a negative impact on sleep quality. Early detection of mental health would allow nursing managers to implement nonpharmacological preventive interventions to improve well-being at work.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101165"},"PeriodicalIF":2.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intensive care clinician attitudes and perceptions towards whānau participation in adult intensive care bedside ward rounds in Aotearoa New Zealand: An online survey

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE

Australian Critical Care

Pub Date : 2025-01-28 DOI: 10.1016/j.aucc.2024.101167

Kadilu Chinyama-Kulakov RN, MN , John Parsons NZRP, PhD , Rachael L. Parke RN, PhD

Background

Clinical practice guidelines endorse family involvement in ward rounds to improve communication and engagement between patients, whānau (family), and healthcare teams, yet the practice has not been universally implemented. Whānau inclusion in adult bedside rounds is often met with hesitation by intensive care unit (ICU) healthcare clinicians, and reasons for this have not been explored in Aotearoa, New Zealand.

Objectives

The aim of this study was to assess attitudes and perceptions of ICU clinicians towards whānau-family inclusion in adult ICU ward rounds in Aotearoa New Zealand.

Methods

A national, prospective, cross-sectional survey using a self-administered online questionnaire was distributed to three metropolitan ICUs in Aotearoa, New Zealand, and members of the New Zealand College of Critical Care Nurses and the College of Intensive Care Medicine of Australia and New Zealand in the period July–December 2020.

Results

In total, 188 ICU physicians, nurses, and allied health professionals responded. Over half of respondents strongly (23.4%) or somewhat agreed (29.3%) that whānau-family members should be given the option to attend bedside rounds, whereas more than half reported having had a positive experience when whānau-family had been present on rounds. Less experienced nurses were more likely to ask whānau-family to leave during rounds than more experienced nurses (46.5% vs 38.2%, respectively, p = 0.006). Clinicians voiced concern that whānau-family inclusion would prolong rounds, reduce teaching opportunities, constrain discussion of sensitive information, and compromise patient confidentiality. However, they also said that whānau-family-centred rounds were useful to better inform whānau-family members and to facilitate culturally safe practice.

Conclusion

Intensive care clinicians demonstrated positive attitudes and perceptions towards whānau-family-centred ward rounds, but concerns regarding the structure and quality of rounds were raised. Clinicians recognise whānau-family-centred rounds as an opportunity to enhance communication and facilitate culturally safe practice. Education regarding the benefits of whānau-family-centred rounds to facilitate implementation is required.

{"title":"Intensive care clinician attitudes and perceptions towards whānau participation in adult intensive care bedside ward rounds in Aotearoa New Zealand: An online survey","authors":"Kadilu Chinyama-Kulakov RN, MN , John Parsons NZRP, PhD , Rachael L. Parke RN, PhD","doi":"10.1016/j.aucc.2024.101167","DOIUrl":"10.1016/j.aucc.2024.101167","url":null,"abstract":"<div><h3>Background</h3><div>Clinical practice guidelines endorse family involvement in ward rounds to improve communication and engagement between patients, whānau (family), and healthcare teams, yet the practice has not been universally implemented. Whānau inclusion in adult bedside rounds is often met with hesitation by intensive care unit (ICU) healthcare clinicians, and reasons for this have not been explored in Aotearoa, New Zealand.</div></div><div><h3>Objectives</h3><div>The aim of this study was to assess attitudes and perceptions of ICU clinicians towards whānau-family inclusion in adult ICU ward rounds in Aotearoa New Zealand.</div></div><div><h3>Methods</h3><div>A national, prospective, cross-sectional survey using a self-administered online questionnaire was distributed to three metropolitan ICUs in Aotearoa, New Zealand, and members of the New Zealand College of Critical Care Nurses and the College of Intensive Care Medicine of Australia and New Zealand in the period July–December 2020.</div></div><div><h3>Results</h3><div>In total, 188 ICU physicians, nurses, and allied health professionals responded. Over half of respondents strongly (23.4%) or somewhat agreed (29.3%) that whānau-family members should be given the option to attend bedside rounds, whereas more than half reported having had a positive experience when whānau-family had been present on rounds. Less experienced nurses were more likely to ask whānau-family to leave during rounds than more experienced nurses (46.5% vs 38.2%, respectively, p = 0.006). Clinicians voiced concern that whānau-family inclusion would prolong rounds, reduce teaching opportunities, constrain discussion of sensitive information, and compromise patient confidentiality. However, they also said that whānau-family-centred rounds were useful to better inform whānau-family members and to facilitate culturally safe practice.</div></div><div><h3>Conclusion</h3><div>Intensive care clinicians demonstrated positive attitudes and perceptions towards whānau-family-centred ward rounds, but concerns regarding the structure and quality of rounds were raised. Clinicians recognise whānau-family-centred rounds as an opportunity to enhance communication and facilitate culturally safe practice. Education regarding the benefits of whānau-family-centred rounds to facilitate implementation is required.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101167"},"PeriodicalIF":2.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Inspiratory effort and respiratory muscle activation during different breathing conditions in patients with weaning difficulties: An exploratory study

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE

Australian Critical Care

Pub Date : 2025-01-21 DOI: 10.1016/j.aucc.2024.101152

Diego Poddighe PT, MSc , Marine Van Hollebeke PT, PhD , Beatrix Clerckx PT, MSc , Luc Janssens MSc , Geert Molenberghs PhD , Lisa Van Dyck MD, PhD , Jan Muller MD , Jan Gunst MD, PhD , Philippe Meersseman MD, PhD , Marijke Peetermans MD, PhD , Greet Hermans MD, PhD , Rik Gosselink PT, PhD , Daniel Langer PT, PhD

Background

Recent studies suggest that fast and deep inspirations against either low or high external loads may provide patients with weaning difficulties with a training stimulus during inspiratory muscle training (IMT). However, the relationship between external IMT load, reflected by changes in airway pressure swings (ΔPaw), and total inspiratory effort, measured by oesophageal pressure swings (ΔPes), remains unexplored. Additionally, the association between ΔPes, ΔPaw, and inspiratory muscle activations remains unclear.

Objectives

The ai of this study was to compare ΔPes and ΔPaw and their relationship with inspiratory muscle activation in patients with weaning difficulties during different breathing conditions.

Methods

ΔPes and scalene, sternocleidomastoid, and parasternal intercostal muscles activation were recorded during the following conditions: 1) (proportional) pressure support ventilation; 2) unsupported spontaneous breathing; 3) low-load IMT (load: <10% maximal inspiratory pressure, PImax = 3 cmH₂O) executed with slow and deep inspirations (low-load slow) and 4) low-load IMT (load: <10% maximal inspiratory pressure, PImax = 3 cmH₂O) executed with fast deep inspirations (low-load fast); and 5) high-load IMT (load ∼ 30% PImax) executed with fast and deep inspirations. ΔPaw, end-inspiratory lung volume, and peak inspiratory flow were recorded during conditions 2–5. Variables were compared across conditions using mixed-model analysis. Spearman's rank correlations were calculated between inspiratory muscle activations and both ΔPes and ΔPaw.

Results

Five patients (age: 68 ± 1 y; 20% male; PImax: 37 ± 7 cmH₂O [59 ± 23% predicted]; forced vital capacity: 0.66 ± 0.16 L [21 ± 6% predicted]) were included in the study. ΔPes values were 3–4 times larger than ΔPaw values during unsupported spontaneous breathing and IMT conditions. ΔPes, sternocleidomastoid activation, end-inspiratory lung volume, and peak inspiratory flow were larger during low-load fast IMT than during low-load slow IMT and unsupported spontaneous breathing but were similar between low-load fast and high-load IMTs. Inspiratory muscle activations correlated weakly to moderately with ΔPaw and moderately with ΔPes.

Conclusions

In five patients with weaning difficulties, low-load fast IMT provided a training stimulus similar to high-load IMT. Both yielded significantly higher training stimulus than low-load slow IMT and unsupported spontaneous breathing. These results should be considered in future trials comparing IMT with sham conditions.

Clinical trial registration numbers

NCT03240263 and NCT04658498.

{"title":"Inspiratory effort and respiratory muscle activation during different breathing conditions in patients with weaning difficulties: An exploratory study","authors":"Diego Poddighe PT, MSc , Marine Van Hollebeke PT, PhD , Beatrix Clerckx PT, MSc , Luc Janssens MSc , Geert Molenberghs PhD , Lisa Van Dyck MD, PhD , Jan Muller MD , Jan Gunst MD, PhD , Philippe Meersseman MD, PhD , Marijke Peetermans MD, PhD , Greet Hermans MD, PhD , Rik Gosselink PT, PhD , Daniel Langer PT, PhD","doi":"10.1016/j.aucc.2024.101152","DOIUrl":"10.1016/j.aucc.2024.101152","url":null,"abstract":"<div><h3>Background</h3><div>Recent studies suggest that fast and deep inspirations against either low or high external loads may provide patients with weaning difficulties with a training stimulus during inspiratory muscle training (IMT). However, the relationship between external IMT load, reflected by changes in airway pressure swings (ΔPaw), and total inspiratory effort, measured by oesophageal pressure swings (ΔPes), remains unexplored. Additionally, the association between ΔPes, ΔPaw, and inspiratory muscle activations remains unclear.</div></div><div><h3>Objectives</h3><div>The ai of this study was to compare ΔPes and ΔPaw and their relationship with inspiratory muscle activation in patients with weaning difficulties during different breathing conditions.</div></div><div><h3>Methods</h3><div>ΔPes and scalene, sternocleidomastoid, and parasternal intercostal muscles activation were recorded during the following conditions: 1) (proportional) pressure support ventilation; 2) unsupported spontaneous breathing; 3) low-load IMT (load: <10% maximal inspiratory pressure, PImax = 3 cmH<sub>2</sub>O) executed with slow and deep inspirations (low-load slow) and 4) low-load <span>IMT</span> (load: <10% maximal inspiratory pressure, PImax = 3 cmH<sub>2</sub>O) executed with fast deep inspirations (low-load fast); and 5) high-load IMT (load ∼ 30% PImax) executed with fast and deep inspirations. ΔPaw, end-inspiratory lung volume, and peak inspiratory flow were recorded during conditions 2–5. Variables were compared across conditions using mixed-model analysis. Spearman's rank correlations were calculated between inspiratory muscle activations and both ΔPes and ΔPaw.</div></div><div><h3>Results</h3><div>Five patients (age: 68 ± 1 y; 20% male; PImax: 37 ± 7 cmH<sub>2</sub>O [59 ± 23% predicted]; forced vital capacity: 0.66 ± 0.16 L [21 ± 6% predicted]) were included in the study. ΔPes values were 3–4 times larger than ΔPaw values during unsupported spontaneous breathing and IMT conditions. ΔPes, sternocleidomastoid activation, end-inspiratory lung volume, and peak inspiratory flow were larger during low-load fast IMT than during low-load slow IMT and unsupported spontaneous breathing but were similar between low-load fast and high-load IMTs. Inspiratory muscle activations correlated weakly to moderately with ΔPaw and moderately with ΔPes.</div></div><div><h3>Conclusions</h3><div>In five patients with weaning difficulties, low-load fast IMT provided a training stimulus similar to high-load IMT. Both yielded significantly higher training stimulus than low-load slow IMT and unsupported spontaneous breathing. These results should be considered in future trials comparing IMT with sham conditions.</div></div><div><h3>Clinical trial registration numbers</h3><div>NCT03240263 and NCT04658498.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101152"},"PeriodicalIF":2.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0