Australian Critical Care最新文献

{"title":"Tracking Outcomes Post Intensive Care: Findings of a longitudinal observational study","authors":"Dylan Flaws MBBS, FRANZCP, PhD ,&nbsp;Oystein Tronstad BPhys ,&nbsp;John F. Fraser MB ChB, FRCP (Glas), FFARCSI, FRCA, FCICM, FELSO, PhD ,&nbsp;Jayshree Lavana MBBS, MD (Gen Med), FCICM ,&nbsp;Kevin B. Laupland MD, FCICM, PhD ,&nbsp;Mahesh Ramanan MBBS, FCICM, PhD ,&nbsp;Alexis Tabah MD, FCICM, PhD ,&nbsp;Sue Patterson PhD","doi":"10.1016/j.aucc.2024.101164","DOIUrl":"10.1016/j.aucc.2024.101164","url":null,"abstract":"<div><h3>Background</h3><div>Many intensive care unit (ICU) survivors experience new or worsening impairments, termed post–intensive care syndrome. Substantial investment has been made in identifying patients at risk and developing interventions, but evidence remains equivocal. A more nuanced understanding of risk and outcomes is therefore warranted.</div></div><div><h3>Objectives</h3><div>This study aimed to describe patients’ health status 6 months after ICU discharge and characterise those with, and without, clinically significant physical, cognitive, or psychological impairments.</div></div><div><h3>Methods</h3><div>In this prospective, multisite observational study, patients discharged from four ICUs were screened and invited to participate. Consenting participants completed a questionnaire-based survey by telephone that encompassed preadmission characteristics and validated self-report questionnaires of physical and cognitive function, anxiety, depression, and post-traumatic stress disorder. Routine ICU data were collected from hospital records. Participants reporting clinically significant impairments were compared with those not reporting impairments on demographics and hospital data.</div></div><div><h3>Results</h3><div>A total of 132 participants completed 6-month follow-up: 30% reported impairments in any domain. Of these, 43% reported impairments in two or more domains. The rates of impairment varied between sites, ranging from 21% to 88%. Depression was most common, followed by physical impairment, anxiety, and cognitive impairment, with post-traumatic stress disorder being the least common.</div></div><div><h3>Participants</h3><div>Reporting impairments did not differ significantly from others on Acute Physiology and Chronic Health Evaluation II scores, delirium rates, mechanical ventilation rates, or duration and length of stay. Planned admissions were less common in the impairment group, as was inotrope use. Mental health diagnosis was not associated with post-ICU impairments.</div></div><div><h3>Conclusions</h3><div>This study demonstrates the heterogeneity of patients experiencing impairments after ICU discharge and highlights the importance of attending to patients’ unique circumstances, encompassing characteristics and treatment factors, when assessing risk and planning support. Whilst generalisability is uncertain, these findings support a whole of health service approach towards post-ICU recovery.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101164"},"PeriodicalIF":2.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025636","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}

{"title":"Clinician views on selective decontamination of the digestive tract in mechanically ventilated patients in intensive care units: A survey","authors":"David M. Golding MBBCh, BSc, PGDip ,&nbsp;Maxim Bloomfield MBChB, MSc, MPhil ,&nbsp;Joshua Davis MBBS, PhD ,&nbsp;Anthony Delaney MBBS, MSc, PhD ,&nbsp;Thomas Hills MBChB, MSc, DPhil ,&nbsp;Steven Y.C. Tong MBBS, PhD ,&nbsp;Paul J. Young MBChB, PhD","doi":"10.1016/j.aucc.2024.101155","DOIUrl":"10.1016/j.aucc.2024.101155","url":null,"abstract":"<div><h3>Objective</h3><div>Selective decontamination of the digestive tract (SDD) has been investigated as a strategy to reduce the incidence of ventilator-associated pneumonia (VAP) and other healthcare-associated infections in intensive care unit (ICU) patients receiving mechanical ventilation. There is some evidence to suggest that the use of SDD is associated with a reduction in healthcare-associated infection and mortality; however, the uptake of SDD in ICUs in Australia and New Zealand (ANZ) remains low. To better understand the potential reasons, we designed a questionnaire to gather views from specialists in intensive care medicine, infectious diseases, and medical microbiology.</div></div><div><h3>Design</h3><div>The study incorporated an online survey.</div></div><div><h3>Setting and participants</h3><div>An online survey was distributed to specialists in intensive care medicine, infectious diseases, and medical microbiology working in ANZ.</div></div><div><h3>Main outcome measures</h3><div>The main outcome measures are views about SDD and perceived barriers to implementation in ICUs in ANZ.</div></div><div><h3>Results</h3><div>A total of 103 responses were obtained, of which 55 were from intensive care medicine specialists and the remainder from infectious disease/medical microbiology specialists. No respondents currently used SDD in their hospital ICU. Intensive care medicine specialists self-reported better understanding of the evidence base regarding SDD (P = 0.032) and were more likely to believe that SDD was a safe therapy (P &lt; 0.001) and that it was associated with a reduction in the incidence of VAP (P &lt; 0.001) and ICU mortality (P &lt; 0.001). Infectious disease/medical microbiology specialists were more likely to believe there is currently a lack of evidence of benefit (P &lt; 0.001) and a risk of harm (P &lt; 0.001) associated with SDD.</div></div><div><h3>Conclusions</h3><div>Specialists in intensive care medicine had more positive views about use of SDD in ventilated patients than did specialists in infectious diseases/medical microbiology, but no respondents reported using SDD in their clinical practice.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101155"},"PeriodicalIF":2.6,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015879","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}

{"title":"Adverse events associated with umbilical vascular catheters in neonatal intensive care: Development of a risk prediction model","authors":"Kim Gibson BN, MN ,&nbsp;Amber Smith BN, MN ,&nbsp;Rebecca Sharp BN, BHSc (Hons), PhD ,&nbsp;Amanda Ullman BN, PhD ,&nbsp;Scott Morris MBBS, PhD, FRACP ,&nbsp;Adrian Esterman MSc, PhD, BSc (hons)","doi":"10.1016/j.aucc.2024.101146","DOIUrl":"10.1016/j.aucc.2024.101146","url":null,"abstract":"<div><h3>Background</h3><div>Adverse events associated with umbilical vascular catheters occur frequently in the neonatal intensive care unit. International guidelines recommend limiting catheter dwell time to reduce the risk of adverse events, and this drives clinical decision-making regarding catheter removal, yet other risk factors may also influence the risk of adverse events.</div></div><div><h3>Objectives</h3><div>The aim of this study was to develop a clinically useful risk prediction model that could be utilised in the neonatal intensive care unit to identify infants at a greater risk of developing an adverse event associated with umbilical vascular catheters.</div></div><div><h3>Methods</h3><div>A risk prediction model was developed for the umbilical venous catheter and umbilical arterial catheter based on the dataset of a published retrospective cohort study in a South Australian neonatal intensive care unit. Least absolute shrinkage and selection operator regression was used to develop the model. Deviance was used to evaluate the model's goodness of fit, and the Hosmer–Lemeshow test and calibration plot were used to assess calibration. The area under the receiver operating characteristic curve evaluated the model's discrimination.</div></div><div><h3>Results</h3><div>For adverse events associated with umbilical venous catheters, the least absolute shrinkage and selection operator model selected none of the potential predictor variables. Five predictors of adverse events were identified for umbilical arterial catheters: thrombocytopaenia, intrauterine growth restriction/small for gestational age, congenital heart disease/defects including patent ductus arteriosus, maternal diabetes, and a dwell time of &gt;7 days. The area under the receiver operating characteristic curve was 0.68 (95% confidence interval: 0.61–0.74). A link test found that the model was properly specified, and a Hosmer–Lemeshow test demonstrated that the model was well calibrated (p = 0.104).</div></div><div><h3>Conclusions</h3><div>A risk prediction model has been developed to identify infants at a greater risk of an adverse event associated with umbilical arterial catheters. The model needs to be externally validated before it can be implemented into clinical practice.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101146"},"PeriodicalIF":2.6,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015874","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}

{"title":"Adverse events during and after early mobilisation: A post hoc analysis of the TEAM trial","authors":"Tessa Broadley BBiomedSc(Hons) ,&nbsp;Ary Serpa Neto MD, PhD ,&nbsp;Michael Bailey PhD ,&nbsp;Rinaldo Bellomo MD, FCICM, PhD ,&nbsp;Kathy Brickell RGN ,&nbsp;Heidi Buhr RN, MScMed(ClinEpid) ,&nbsp;Belinda J. Gabbe BPhysio(Hons), PhD ,&nbsp;Doug W. Gould PhD ,&nbsp;Meg Harrold BSc Physiotherapy, PhD ,&nbsp;Sally Hurford PGDip ,&nbsp;Theodore J. Iwashyna MD, PhD ,&nbsp;Alistair D. Nichol MD, PhD ,&nbsp;Jeffrey J. Presneill MBBS(Hons), PhD ,&nbsp;Stefan J. Schaller MD ,&nbsp;Janani Sivasuthan MPH ,&nbsp;Claire J. Tipping BPT(Hons), PhD ,&nbsp;Steven Webb MD, PhD ,&nbsp;Paul J. Young FCICM, PhD ,&nbsp;Alisa M. Higgins MPH, PhD ,&nbsp;Carol L. Hodgson PT, PhD","doi":"10.1016/j.aucc.2024.101156","DOIUrl":"10.1016/j.aucc.2024.101156","url":null,"abstract":"<div><h3>Background</h3><div>The Treatment of Mechanically Ventilated Adults with Early Activity and Mobilisation (TEAM) trial reported a higher occurrence of adverse events with greater mobilisation. However, their timing and nature remained unexplored. We conducted an in-depth exploration of such events.</div></div><div><h3>Objective</h3><div>The purpose of this paper is to thoroughly examine the timing and characteristics of adverse events reported within the TEAM trial.</div></div><div><h3>Methods</h3><div>Adverse event data were collected daily in real time. Categorical data were compared using the Fisher's exact test. The relationship between adverse events and patient survival was analysed using a Cox-regression frailty model.</div></div><div><h3>Results</h3><div>Overall, 37 out of 371 patients (10.0%) in the early mobilisation group and 16 out of 370 patients (4.3%) in the usual care group experienced adverse events, with 71 events in the early mobilisation group compared to 24 events in the usual care group. The most common adverse events were altered blood pressure in 21 out of 53 patients (39.6%), arrhythmia in 17 out of 53 patients (32.1%), and oxygen desaturation in nine of 53 patients (17.0%). Patients with an adverse event were more likely to have congestive heart failure (absolute percentage difference: 16.1, 95% confidence interval [CI]: 6.1 to 26.1), peripheral vascular disease (absolute percentage difference: 6.4, 95% CI: 1.3 to 11.5), heart attack (absolute percentage difference: 13.5, 95% CI: 5.9 to 21.1), or stroke (absolute percentage difference: 9.3, 95% CI: 3.5 to 15.1). Adverse events occurred at a median of 4 days with early mobilisation and 7 days with usual care. There was no significant difference in survival for patients who experienced an adverse event compared to those without an adverse event.</div></div><div><h3>Conclusion</h3><div>Adverse events were more common in patients randomised to early active mobilisation, were cardiovascular and respiratory in nature, tended to occur earlier with active mobilisation, and cardiovascular comorbidities were more common in such patients. This information can help guide future studies in this field.</div></div><div><h3>Trial registration</h3><div>TEAM <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> number, NCT03133377, registered 28 April 2017.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101156"},"PeriodicalIF":2.6,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015878","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}

{"title":"Short- and long-term outcomes of pulmonary emphysema patients on mechanical ventilation admitted to the intensive care unit for acute respiratory failure: A retrospective observational study","authors":"Alexandre Ponsin M.D. ,&nbsp;Coralie Barbe M.D. ,&nbsp;Leïla Bouazzi B.S.T. ,&nbsp;Clémence Loiseau ,&nbsp;Philippe Cart M.D. ,&nbsp;Jérémy Rosman M.D.","doi":"10.1016/j.aucc.2024.101151","DOIUrl":"10.1016/j.aucc.2024.101151","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute respiratory failure is a leading cause of admission to the intensive care unit (ICU), with mortality rates remaining stagnant despite advances in resuscitation techniques. Comorbidities, notably chronic obstructive pulmonary disease, significantly impact ICU patient outcomes. Pulmonary emphysema, commonly associated with chronic obstructive pulmonary disease, poses a significant risk, yet its influence on ICU mortality remains understudied.</div></div><div><h3>Objectives</h3><div>The aim of this study was to assess the short- and long-term outcomes of ICU patients with pulmonary emphysema requiring mechanical ventilation for acute respiratory failure, evaluating the impact of emphysema severity.</div></div><div><h3>Methods</h3><div>A single-centre retrospective cohort study was conducted from 2015 to 2021. Patients with pulmonary emphysema requiring invasive ventilation were included. Emphysema severity was assessed using chest computed tomography scans. Data on mortality, length of stay, and ventilator-free days were collected. Statistical analyses were performed to identify factors associated with outcomes.</div></div><div><h3>Results</h3><div>Of the 89 included patients, 31.5% died during their ICU stay, with a 39.3% mortality within 12 months postdischarge. Emphysema severity did not significantly correlate with mortality or ventilator-free days. Chronic heart failure emerged as a significant predictor of ICU and in-hospital mortality.</div></div><div><h3>Conclusions</h3><div>Emphysema severity does not appear to independently affect mortality in intubated ICU patients with acute respiratory failure. However, mortality rates remain high, warranting further investigation into contributing factors. Our findings underline the complexity of managing critically ill patients with pulmonary emphysema and emphasise the need for comprehensive patient assessment and personalised treatment approaches.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101151"},"PeriodicalIF":2.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015884","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}

{"title":"Critical care nurses’ prioritisation of patient care, including delirium prevention and management strategies: A mixed-method study","authors":"Sarah Crowe MN, PMD-NP, NP ,&nbsp;A. Fuchsia Howard PhD, RN","doi":"10.1016/j.aucc.2024.101154","DOIUrl":"10.1016/j.aucc.2024.101154","url":null,"abstract":"<div><h3>Background</h3><div>Delirium is a common issue in critical care, yet its prevention and management strategies are often inconsistent. Understanding the factors that lead to the omission or delay in delirium-related care by critical care nurses is essential for enhancing patient outcomes.</div></div><div><h3>Objectives</h3><div>This study aimed to identify the specific delirium-related prevention and management strategies that are frequently missed or delayed by critical care nurses. It also explored factors influencing nurses’ prioritisation of care, including delirium-related strategies.</div></div><div><h3>Methods</h3><div>A mixed-method approach was utilised, combining quantitative data from online surveys and qualitative insights from interviews with critical care nurses in a Canadian health authority. The Missed Nursing Care Survey identified instances of missed or delayed care, while interviews provided deeper insights into care prioritisation decisions.</div></div><div><h3>Results</h3><div>Quantitative findings indicated frequent delays in patient mobilisation and physical care that were attributed to staffing shortages, high patient volume, and increased admissions and discharges. Qualitative findings revealed that factors such as patient acuity, structured routines, knowledge gaps, limited support, unit culture, and resource inadequacies influenced the prioritisation of delirium-related care, often leading to its inadvertent deprioritisation.</div></div><div><h3>Conclusion</h3><div>This study underscores the need to integrate delirium care into patient acuity assessments and establish sustainable education programs to enhance the recognition and prioritisation of delirium by critical care nurses. Addressing these factors is critical for improving patient outcomes in critical care settings.</div></div><div><h3>Implications for clinical practice</h3><div>Strengthening critical care nurses’ capacity to consistently recognise and prioritise delirium-related care through targeted education and system-level support could potentially contribute to better patient outcomes.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101154"},"PeriodicalIF":2.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015880","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}

{"title":"Navigating the referral boundaries for organ and tissue donation: An interpretive description study","authors":"Kim Lecuyer RN, BNurs(Hons) ,&nbsp;Cindy Weatherburn RN, DHlth ,&nbsp;Melanie Greenwood PhD","doi":"10.1016/j.aucc.2024.101158","DOIUrl":"10.1016/j.aucc.2024.101158","url":null,"abstract":"<div><h3>Background</h3><div>The gap between organ availability and the number of people waiting for a transplant remains a major healthcare issue. Most transplanted organs and tissue are received from donors who have died in intensive care units (ICUs). To increase the number of donors, national guidelines and professional bodies in Australia support routine consideration of organ and tissue donation at the end of life. Referral to donation specialists is the first important step to explore a patient's donation wishes and consider the potential for donation, but practice is variable, and not all patients receiving end-of-life care in the ICU are referred.</div></div><div><h3>Objectives</h3><div>The aim of this study was to investigate health professionals’ experiences of making a referral for organ and tissue donation in the intensive care setting and to identify barriers and facilitators that influence practice.</div></div><div><h3>Methods</h3><div>A qualitative research approach with semistructured interviews and interpretive description analysis methods was used in this study. Doctors and nurses from a single tertiary referral hospital in Australia who had worked in the intensive care setting were invited to participate. Content from interviews was analysed through a process of coding and inductive thematic analysis. Nine health professionals were interviewed.</div></div><div><h3>Findings</h3><div>A local protocol was in place to support multidisciplinary referral for organ and tissue donation; however, there were organisational barriers and referral misconceptions that discouraged clinicians to make a referral. Nurses felt disempowered to refer and had limited knowledge of what was required. Doctors supported nurses making referrals, acknowledging that the responsibility should be shared to minimise the chance that a referral will be missed. Donation specialist nurses provided valuable support for health professionals navigating the organ and tissue donation process.</div></div><div><h3>Conclusions</h3><div>Research outcomes suggest the need for greater interprofessional collaboration to support a more inclusive referral culture in the ICU to optimise opportunities for organ and tissue donation.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101158"},"PeriodicalIF":2.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015882","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}

{"title":"Intensive care unit nurses’ redeployment experiences during the COVID-19 pandemic: A qualitative study","authors":"Louise White RN, BSc ,&nbsp;Nantanit van Gulik RN, PhD ,&nbsp;Jordana Schlieff RN, MSc ,&nbsp;Leanne Boyd RN, PhD ,&nbsp;Lauren Walker RN, BN ,&nbsp;Julie Considine RN, PhD","doi":"10.1016/j.aucc.2024.101157","DOIUrl":"10.1016/j.aucc.2024.101157","url":null,"abstract":"<div><h3>Background</h3><div>The pandemic response required the large-scale redeployment of nurses to support the care of patients with COVID-19. Surveys of staff and analysis of staff feedback indicated that the frequent redeployment of intensive care unit (ICU) registered nurses (RNs) led to dissatisfaction and contributed to voluntary reductions in hours and increased intentions to resign. Whilst much is understood about the redeployment of non-ICU RNs into ICUs to support patient care during periods of high demand, less is known about ICU RNs’ experiences of being redeployed to general wards. ICU RNs are often required to work in other areas to cover staff shortages within the organisation when ICU beds are available.</div></div><div><h3>Aim</h3><div>The aim of this study was to explore ICU RNs’ experiences of redeployment to hospital wards during 2021 and 2022.</div></div><div><h3>Methods</h3><div>A descriptive qualitative study using semi-structured interviews with 26 ICU RNs was conducted at three hospitals within a major health service in Melbourne, Australia. Participants were interviewed in July 2023. Transcribed audio recordings of interviews were analysed using reflexive thematic analysis.</div></div><div><h3>Results</h3><div>Six major themes and 12 subthemes were constructed from the data: (i) risk (subthemes: absenteeism, bad for patients—ICU and ward); (ii) choice (subthemes: no choice, security of the ICU); (iii) lost (subthemes: lack of orientation, unfamiliar everything); (iv) distress (subthemes: clinical and emotional stress); (v) a number (subthemes: undervalued, unfair); and (vi) positive perspectives (subthemes: good experience, has to happen, helping out).</div></div><div><h3>Conclusion</h3><div>ICU RNs’ experiences of redeployment out of the ICU were predominantly negative. However, positive aspects were noted regarding the support of colleagues during staff shortages and the opportunity to provide care to patients. The findings highlight the risks associated with redeployment and its impact on both the ICU and the broader health service. Suggested strategies include implementing through orientation practices, adopting a sustainable team nursing approach, and prioritising staff wellbeing.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101157"},"PeriodicalIF":2.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015881","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}

{"title":"Acceptability of implementing a communication board for mechanically ventilated patients in intensive care units: A cross-sectional substudy of the intervention arm of a pilot randomised controlled trial","authors":"Nipuna R. Kuruppu RN, BNurs (Hons) ,&nbsp;Kristen Ranse RN, PhD ,&nbsp;Georgia Tobiano RN, PhD ,&nbsp;Anuja Abayadeera MD, FRCA ,&nbsp;Wendy Chaboyer RN, PhD","doi":"10.1016/j.aucc.2024.101153","DOIUrl":"10.1016/j.aucc.2024.101153","url":null,"abstract":"<div><h3>Background</h3><div>Communication boards are a low-technology tool used to facilitate interactions with mechanically ventilated patients in intensive care units (ICUs). Research on the acceptability of communication boards in resource-limited intensive care settings is lacking.</div></div><div><h3>Aim</h3><div>The aim of this study was to assess patients' and nurses’ experienced acceptability of implementing a communication board in Sri Lankan ICUs.</div></div><div><h3>Design</h3><div>This was a cross-sectional substudy of the intervention group patients and nurses who participated in a pilot randomised controlled trial that assessed the feasibility of implementing a communication board in two ICUs in one Sri Lankan hospital.</div></div><div><h3>Methods</h3><div>In the parent trial conscious, ventilated adult ICU patients were recruited. This substudy included all patients in the intervention group in the parent trial and ICU nurses who used the communication board. Sekhon's generic acceptability questionnaire, adapted and translated into Sinhala, was administered to both patients and nurses. The questionnaire comprised eight items; seven items represented the seven constructs of the framework (possible scores ranging from 7 to 35), and a single item measured general acceptability. Descriptive and inferential statistics were used to analyse the data. Additionally, nurses were asked three open-ended questions regarding their views on using the communication board, and data were analysed using content analysis.</div></div><div><h3>Results</h3><div>Of the 123 patients screened in the parent trial, 60 met the inclusion criteria and were randomised, with 30 randomly allocated to the intervention group. In total, 30 patients and 50 nurses completed the survey (response rate: 100%). Both patients and nurses rated all items positively except “burden”. Patient and nurse total mean scores for the seven items, excluding the single-item general acceptability, were 27.5 (standard deviation: 2.6) and 27.2 (standard deviation: 2.2), respectively. Patients and nurses both scored high on the single-item general acceptability, with a median (interquartile range) of 4.0 (4.0–5.0) and 4.0 (4.0–4.0), respectively. Two patient items and five nurse items significantly correlated with the single-item general acceptability. Two categories, (i) drivers for using the communication board and (ii) obstacles to communication board use, were found through content analysis.</div></div><div><h3>Conclusion</h3><div>This substudy demonstrated that the communication board was acceptable to both patients and nurses despite its perceived “burden”.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101153"},"PeriodicalIF":2.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015772","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}

{"title":"Nonpharmacological interventions to promote sleep in the adult critical patients unit: A scoping review","authors":"Maria P. Carrera RN, MSc ,&nbsp;Leyla Alegria RN, MSc ,&nbsp;Pablo Brockmann MD, PhD ,&nbsp;Paula Repetto Ps, PhD ,&nbsp;Douglas Leonard PhD ,&nbsp;Rodrigo Cádiz PhD ,&nbsp;Fabio Paredes MSc ,&nbsp;Idalid Rojas RN ,&nbsp;Ana Moya RN ,&nbsp;Vanessa Oviedo RN, MSc ,&nbsp;Patricio García PT, MSc ,&nbsp;Mario Henríquez-Beltrán PT, MSc ,&nbsp;Jan Bakker MD, PhD","doi":"10.1016/j.aucc.2024.101159","DOIUrl":"10.1016/j.aucc.2024.101159","url":null,"abstract":"<div><h3>Background</h3><div>Sleep and circadian rhythms are markedly altered in intensive care unit (ICU) patients. Numerous factors related to the patient and the ICU environment affect the ability to initiate and maintain sleep. Therefore, nonpharmacological interventions could play an essential role in improving sleep and circadian rhythm.</div></div><div><h3>Objective</h3><div>The aim of this study was to examine nonpharmacological interventions evaluated for promoting sleep in adult ICUs.</div></div><div><h3>Methods</h3><div>A scoping review was conducted, including randomised controlled trials, nonrandomised controlled trials, quasi-experimental trials, and other controlled studies investigating the effects of nonpharmacological interventions promoting sleep in adult ICU patients.</div></div><div><h3>Results</h3><div>A total of 57 articles and 14 ongoing trials were included in the review, of which 38 were randomised clinical trials. Nine nonpharmacological interventions to improve sleep in critically ill patients were evaluated: earplugs and/or eye masks, aromatherapy, bundles, music intervention, massage or acupressure, noise masking, bright light, and dynamic light. Most included trials simultaneously assessed the effect of more than one intervention on perceived sleep quality using questionnaires. The association between the interventions and improved sleep varied. In the case of multicomponent interventions, it is difficult to identify which components might have influenced sleep improvement.</div></div><div><h3>Conclusions</h3><div>Numerous studies have evaluated various nonpharmacological interventions to promote sleep in critically ill patients, several of which improved perceived sleep quality. However, the substantial variability of the assessed interventions and their implementation complicates drawing reliable conclusions.</div></div><div><h3>Registration</h3><div>The protocol for this scoping review was registered with the Open Science Framework under the identifier <span><span>https://doi.org/10.17605/OSF.IO/MPEQ5</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101159"},"PeriodicalIF":2.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015883","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}