Australian Critical Care最新文献

{"title":"“How to navigate this new area”: Intensive care clinicians’ perceptions of voluntary assisted dying in the intensive care unit: A multisite exploratory study","authors":"Melissa J. Bloomer RN, PhD ,&nbsp;Kylie O'Neill RN, MN ,&nbsp;Jayne Hewitt RN, PhD ,&nbsp;Andrew Wheaton MNursStud, MBioeth, RN ,&nbsp;Margaret O'Connor BTheol, DN, RN ,&nbsp;Ann Bonner RN, PhD","doi":"10.1016/j.aucc.2024.05.007","DOIUrl":"10.1016/j.aucc.2024.05.007","url":null,"abstract":"<div><h3>Background</h3><div>There is growing momentum worldwide for assisted dying. In Australia, voluntary assisted dying may occur in any setting, including an intensive care unit (ICU). As the subject of much debate worldwide, exploring ICU clinicians’ perceptions of assisted dying is essential.</div></div><div><h3>Aim</h3><div>The aim of this study was to explore clinicians’ perceptions of and preparedness for voluntary assisted dying in the ICU.</div></div><div><h3>Method</h3><div>An exploratory qualitative descriptive design using individual interviews was used. Medical, nursing, and allied health clinicians from three ICUs were recruited. Interviews were conducted between Nov 2022 and Jan 2023, with a hypothetical scenario about voluntary assisted dying used to prompt discussion. Interviews were recorded, professionally transcribed, and analysed using inductive content analysis.</div></div><div><h3>Findings</h3><div>ICU registered nurses (n = 20), physicians (n = 2), and allied health clinicians (n = 4) participated with interviews lasting 18–45 min (mean: 28 min). Analysis revealed four themes: (i) <em>purpose of ICU</em> reflected that ICU care was not all about saving lives, yet recognising dying and changing priorities was challenging; (ii) <em>dying in the ICU is complex</em> due to difficulties in talking about dying, accepting death as the outcome and evaluating care efficacy; (iii) <em>voluntary assisted dying is a lot of grey</em> because of perceived clinical and ethicolegal challenges; and finally, (iv) r<em>especting choice</em> was about respecting patients' values, beliefs, and autonomy, as well as clinicians’ beliefs and right to exercise autonomy through conscientious objection.</div></div><div><h3>Conclusion</h3><div>Dying and death are inevitable, and views and perspectives about assisted dying will continue to evolve. Respecting patient choice is at the core of assisted dying, but respecting clinicians’ perspectives and choice is equally important. With voluntary assisted dying now legal in all Australian states, ensuring ICU team and individual clinician preparedness through access to education, resources, and specialist support services is key to raising awareness and easing uncertainty about deaths through voluntary assisted dying.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101070"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332468","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":"Intubation of critically ill patients: A pilot study of minute-by-minute physiological changes within an Australian tertiary intensive care unit","authors":"Zhen Ti Yong MBBS, BPharm ,&nbsp;Akinori Maeda MD ,&nbsp;Fumitaka Yanase MD, PhD ,&nbsp;Ary Serpa Neto MD, MSc, PhD ,&nbsp;Rinaldo Bellomo MD, PhD, MBBS","doi":"10.1016/j.aucc.2024.06.001","DOIUrl":"10.1016/j.aucc.2024.06.001","url":null,"abstract":"<div><h3>Background</h3><div><span><span>There are no published minute-by-minute physiological assessment data for endotracheal intubation (ETT) performed in the </span>intensive care unit (ICU). The majority of physiological data is available from Europe and North America where </span>etomidate<span> is the induction agent administered most commonly.</span></div></div><div><h3>Aims</h3><div>The aim of this study was to describe the feasibility of obtaining minute-by-minute physiological and medication data surrounding ETT in an Australian tertiary ICU and to assess its associated outcomes.</div></div><div><h3>Methods</h3><div>We performed a single-centre feasibility observational study. We obtained minute-by-minute data on physiological variables and medications for 15 min before and 30 min after ETT. We assessed feasibility as enrolled to screened patient ratio and completeness of data collection in enrolled patients. Severe hypotension (systolic blood pressure &lt; 65 mmHg) and severe hypoxaemia (pulse oximetry saturation &lt; 80%) were the secondary clinical outcomes.</div></div><div><h3>Results</h3><div><span>We screened 43 patients and studied 30 patients. The median age was 58.5 (interquartile range: 49–70) years, and 18 (60%) were male. Near-complete (97%) physiological and medication data were obtained in all patients at all times. Overall, 15 (50%) ETTs occurred after hours (17:30–08:00) and 90% were by video laryngoscopy with a 90% first-pass success rate. Prophylactic vasopressors were used in 50% of ETTs. </span>Fentanyl<span> was used in all except one ETT at a median dose of 2.5 mcg/kg. Propofol<span> (63%) or midazolam (50%) were used as adjuncts at low dose. Rocuronium<span> was used in all but one patient. There were no episodes of severe hypotension and only one episode of short-lived severe hypoxaemia.</span></span></span></div></div><div><h3>Conclusion</h3><div>Minute-by-minute recording of ETT-associated physiological changes in the ICU was feasible but only fully available in two-thirds of the screened patients. ETT was based on fentanyl induction, low-dose adjunctive sedation, and frequent prophylactic vasopressor therapy and was associated with no severe hypotension and a single short-lived episode of severe hypoxaemia.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101078"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535936","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":"How is work–family conflict linked to nurse-assessed patient safety among intensive care unit nurses? A serial multiple mediation analysis","authors":"Qianqian Yang RN, PhD ,&nbsp;Linlin Yang RN, MN ,&nbsp;Chunling Yang RN, MN ,&nbsp;Xia Wu RN, MN ,&nbsp;Zhen Xu RN, MN ,&nbsp;Xiaobing Wang MBBS, MN","doi":"10.1016/j.aucc.2024.03.008","DOIUrl":"10.1016/j.aucc.2024.03.008","url":null,"abstract":"<div><h3>Aim</h3><div><span>The aim of this study was to test whether rumination and negative affectivity mediate the relationship between work–family conflict and nurse-assessed patient safety among </span>intensive care unit nurses.</div></div><div><h3>Background</h3><div>Most intensive care unit nurses experience work–family conflicts that jeopardise patient safety. Although prior studies have explored the effect of work–family conflict on patient safety, few have investigated whether work–family conflict is associated with patient safety through rumination and negative affectivity among intensive care unit nurses.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Methods</h3><div>This study included 209 intensive care unit nurses from five general hospitals. The Work–Family Conflict Scale, the Ruminative Response Scale, the Positive and Negative Affect Schedule-Negative Affectivity, and three items indicating nurses’ perception of overall patient safety were used to gather data. Associations between work–family conflict, rumination, negative affectivity, and nurse-assessed patient safety were assessed using correlation and serial multiple mediation analysis.</div></div><div><h3>Results</h3><div>Work–family conflict, rumination, negative affectivity, and nurse-assessed patient safety were significantly correlated (<em>p</em> &lt; 0.01). Work–family conflict can have not only a direct negative impact on the nurse-assessed patient safety (effect = −0.0234; standard error [SE] = 0.0116; 95% confidence interval [CI]: lower limit [LL] = −0.0464, upper limit [UL] = −0.0005) but also an indirect impact on nurse-assessed patient safety through three paths: the independent mediating role of rumination (effect = −0.0118; SE = 0.0063; 95% CI: LL = −0.0251, UL = −0.0006), the independent mediating role of negative affectivity (effect = −0.0055; SE = 0.0039; 95% CI: LL = −0.0153, UL = −0.0001), and the chain-mediating role of rumination and negative affectivity (effect = −0.0078; SE = 0.0031; 95% CI: LL = −0.0152, UL = −0.0027).</div></div><div><h3>Conclusion</h3><div>Our findings indicated that work–family conflict could influence nurse-assessed patient safety through increasing rumination and negative affectivity among intensive care unit nurses. Based on the results, interventions aimed at decreasing work–family conflict would be beneficial for intensive care unit nurses’ emotional stability and patient safety.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101053"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141032061","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":"Physicians' decision making when weaning patients from mechanical ventilation: A qualitative content analysis","authors":"Catarina Tingsvik RN, CCRN, PhD ,&nbsp;Maria Henricson RN, CCRN, PhD ,&nbsp;Fredrik Hammarskjöld MD, PhD ,&nbsp;Jan Mårtensson RN, PhD","doi":"10.1016/j.aucc.2024.06.015","DOIUrl":"10.1016/j.aucc.2024.06.015","url":null,"abstract":"<div><h3>Background</h3><div>Weaning from mechanical ventilation is a complex and central intensive care process. This complexity indicates that the challenges of weaning must be explored from different perspectives. Furthermore, physicians' experiences and the factors influencing their decision-making regarding weaning are unclear.</div></div><div><h3>Objectives</h3><div>This study aimed to explore and describe the factors influencing physicians' decision-making when weaning patients from invasive mechanical ventilation in Swedish intensive care units (ICUs).</div></div><div><h3>Methods</h3><div>This qualitative study used an exploratory and descriptive design with qualitative content analysis. Sixteen physicians from five ICUs across Sweden were purposively included and interviewed regarding their weaning experiences.</div></div><div><h3>Findings</h3><div>The physicians expressed that prioritising the patient's well-being was evident, and there was agreement that both the physical and mental condition of the patient had a substantial impact on decision-making. Furthermore, there was a lack of agreement on whether patients should be involved in the weaning process and how their resources, needs, and wishes should be included in decision-making. In addition, there were factors not directly linked to the patient but which still influenced decision-making, such as the available resources and teamwork. Sometimes, it was difficult to point out the basis for decisions; in that decisions were made by gut feeling, intuition, or clinical experience.</div></div><div><h3>Conclusion</h3><div>Physicians' decision-making regarding weaning was a dynamic process influenced by several factors. These factors were related to the patient's condition and the structure for weaning. Increased understanding of weaning from the physicians' and ICU teams’ perspectives may improve the weaning process by broadening the knowledge about the aspects influencing the decision-making.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101096"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914556","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":"‘White lies and safety nets’: The perceptions of nurses on the use of early warning systems and the development of higher-order thinking skills","authors":"Deb Massey RN, PhD ,&nbsp;Tracy Flenady RN, PhD ,&nbsp;Amy-Louise Byrne RN, PhD ,&nbsp;Justine Connor RN, MPhil ,&nbsp;Danielle Le Lagadec RN, PhD","doi":"10.1016/j.aucc.2024.04.007","DOIUrl":"10.1016/j.aucc.2024.04.007","url":null,"abstract":"<div><h3>Background</h3><div>Algorithmic tools such as early warning systems (EWSs) have been embedded into clinical practice globally to facilitate the early recognition of patient deterioration and to guide the escalation of care. Concerns have been raised that the mandated use of these EWS tools may impact the development of nurses' higher-order thinking. However, the relationship between EWS tools and the development of higher-order thinking is poorly understood.</div></div><div><h3>Objectives</h3><div>This paper provides the qualitative results of a larger study that sought to explore the impact of EWS tools on the development of nurses' higher-order thinking. The objective of this component of the study was to ascertain the thoughts and perceptions of nurses on the use of EWSs and how this related to the development of higher-order thinking skills.</div></div><div><h3>Methods</h3><div>A mixed-method, concurrent study design was used to explore the concept of the development of nurses' higher-order thinking in the context of EWS tools. The qualitative responses from a Qualtrics survey were thematically analysed and presented.</div></div><div><h3>Findings</h3><div>Two major themes were uncovered: <em>White Lies</em> and <em>Safety Nets</em>. Our analysis of the data suggested that some nurses amend their documentation practice to accommodate the EWS’s escalation process, uncovering a view that the tool did not account for clinical reasoning. Parallel to this, some nurses found that these systems supported clinical decision-making and helped to build confidence, thus acting as a safety net for their practice.</div></div><div><h3>Conclusion</h3><div>Reliance on EWSs can both hinder and/or support the development of higher-order thinking. Early warning systems are useful tools in ensuring patient safety but should be used in conjunction with nurses' higher-order thinking.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101062"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285315","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":"Flexible fibreoptic bronchoscopy is beneficial in children on extracorporeal membrane oxygenation support","authors":"Pravin Babhalgaonkar MBBS ,&nbsp;Gareth Forster FRACP ,&nbsp;Ian B. Masters FRACP ,&nbsp;Emma Haisz RN ,&nbsp;Adrian Mattke FCICM ,&nbsp;Sarfaraz Rahiman FCICM","doi":"10.1016/j.aucc.2024.05.008","DOIUrl":"10.1016/j.aucc.2024.05.008","url":null,"abstract":"<div><h3>Background</h3><div>Flexible fibreoptic bronchoscopy<span><span> (FFB) has the potential to enhance diagnostic capabilities and improve pulmonary function in children on </span>extracorporeal membrane oxygenation (ECMO).</span></div></div><div><h3>Objectives</h3><div>The objective of this study was to evaluate the benefits (clinical, radiological, and microbiological) of FFB and assess associated complications in children on ECMO.</div></div><div><h3>Methods</h3><div>We conducted a single-centre retrospective observational cohort study in a tertiary paediatric intensive care unit. All FFB episodes performed during the study period on children aged 0–18 years on ECMO were included.</div></div><div><h3>Results</h3><div>Out of the 155 children who received ECMO, 36 (23%) underwent a total of 92 episodes of FFB. FFB provided anatomical and pathological information in 53% (19/36) of cases and proved beneficial in clearing the airways in 62% (54/87) of the episodes.</div><div><span>Overall, patients exhibited transient increases in ECMO and mechanical ventilation<span> support 1 h post FFB in 14% (13/92) and 9.7% (9/92) episodes, respectively. At 6 h, the mean fraction of inspired oxygen on the mechanical ventilator was lower (0.46 [±0.21] vs 0.53 [±0.21] </span></span><em>p</em><span> &lt; 0.01), with no change in mean airway pressure. Similarly, compared to pre-FFB, the fraction of inspired oxygen on the mechanical ventilator on ECMO was lower at 6 h and 24 h (0.65 [±0.25] vs 0.71 [±0.23] </span><em>p</em> &lt; 0.01 and 0.006, respectively), with no significant change in the sweep gas flow and ECMO flow.</div><div>The radiological imaging indicated improved or stable findings in 91% (83/91) of FFB episodes. FFB contributed to the identification of new and previously unknown microbiological information in 75% (27/36) of the patients. The incidence of major complications was 7.6%. Minor self-resolving bleeding occurred in 25% (23/92) episodes, and major bleeding occurred in two episodes, with a total of 10 episodes needing blood product transfusion.</div></div><div><h3>Conclusions</h3><div>FFB is a valuable adjunct in managing children with severe respiratory failure on ECMO, offering clinical benefits with a low rate of major complications. Further studies should aim to develop a consensus approach encompassing criteria and clinical management around FFB in patients on ECMO.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101071"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499624","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":"Risk prediction models for intensive care unit–acquired weakness in critically ill patients: A systematic review","authors":"Yue Zhou RN, BSN,&nbsp;YuJian Sun RN, BSN,&nbsp;YuFan Pan RN, BSN,&nbsp;Yu Dai RN, BSN,&nbsp;Yi Xiao RN, BSN,&nbsp;YuFeng Yu BSN","doi":"10.1016/j.aucc.2024.05.003","DOIUrl":"10.1016/j.aucc.2024.05.003","url":null,"abstract":"<div><h3>Background</h3><div>Intensive care unit<span> (ICU)-acquired weakness (ICU-AW) is a critical complication that significantly worsens patient prognosis. It is widely thought that risk prediction models can be harnessed to guide preventive interventions. While the number of ICU-AW risk prediction models is increasing, the quality and applicability of these models in clinical practice remain unclear.</span></div></div><div><h3>Objective</h3><div>The objective of this study was to systematically review published studies on risk prediction models for ICU-AW.</div></div><div><h3>Methods</h3><div>We searched electronic databases (PubMed, Web of Science, The Cochrane Library<span>, Embase<span>, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), China Science and Technology Periodical Database (VIP), and Wanfang Database) from inception to October 2023 for studies on ICU-AW risk prediction models. Two independent researchers screened the literature, extracted data, and assessed the risk of bias and applicability of the included studies.</span></span></div></div><div><h3>Results</h3><div><span>A total of 2709 articles were identified. After screening, 25 articles were selected, encompassing 25 risk prediction models. The area under the curve for these models ranged from 0.681 to 0.926. Evaluation of bias risk indicated that all included models exhibited a high risk of bias, with three models demonstrating poor applicability. The top five predictors among these models were </span>mechanical ventilation<span> duration, age, Acute Physiology and Chronic Health Evaluation II score, blood lactate levels, and the length of ICU stay. The combined area under the curve of the ten validation models was 0.83 (95% confidence interval: 0.77–0.88), indicating a strong discriminative ability.</span></div></div><div><h3>Conclusions</h3><div>Overall, ICU-AW risk prediction models demonstrate promising discriminative ability. However, further optimisation is needed to address limitations, including data source heterogeneity, potential biases in study design, and the need for robust statistical validation. Future efforts should prioritise external validation of existing models or the development of high-quality predictive models with superior performance.</div></div><div><h3>Registration</h3><div>The protocol for this study is registered with the International Prospective Register of Systematic Reviews (registration number: CRD42023453187).</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101066"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629313","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":"Clinical practices for defining, detecting, and diagnosing postoperative atrial fibrillation after coronary revascularization surgery – A scoping review","authors":"Megan Higgs RN, MN ,&nbsp;Julee McDonagh RN, PhD ,&nbsp;Jenny Sim RN, PhD","doi":"10.1016/j.aucc.2024.06.006","DOIUrl":"10.1016/j.aucc.2024.06.006","url":null,"abstract":"<div><h3>Objectives</h3><div>This scoping review was undertaken to understand the degree of variation in clinical practices associated with postoperative atrial fibrillation (POAF), following coronary revascularization surgery by collating and synthesising key concepts from current published literature.</div></div><div><h3>Review methods and data sources</h3><div>This scoping review was conducted following the framework outlined by Askey and O'Malley. Reporting of this scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.</div><div>Initial searches were completed in September 2020 and updated in January 2023. Comprehensive searches to identify relevant published literature were carried out within CINAHL, MEDLINE, and ProQuest databases. All searches were limited to full-text papers published in English with human adult participants. Deductive content analysis using NVivo software was performed to synthesise the data.</div></div><div><h3>Results</h3><div>A total of 692 studies were identified during the database searches. After the deletion of duplicates and the application of the inclusion and exclusion criteria, 73 studies were included in the scoping review. The included studies were published between 2001 and 2022 and included a total of 24,833 participants. Forty-six studies included a definition of POAF, with four of these citing a peak-body definition. A total of 24 included studies reported on electrocardiogram diagnostic criteria for POAF, with 13/24 [54%] describing these characteristics within their definition. The time-based diagnostic criteria ranged from a minimum duration of greater than 30 seconds to greater than 1 hour. The most frequently reported minimum-time thresholds were ≥30 seconds, reported in 12 of 51 (24%) studies and ≥5 min, reported in 13 of 51 (25%) studies.</div></div><div><h3>Conclusions</h3><div>There is a lack of consistency in clinical practice for defining, detecting, and diagnosing POAF, following coronary revascularization surgery. Consensus and standardisation of clinical practices are urgently needed.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101083"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767932","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":"N95 respirator seal integrity following extended-use by healthcare workers in the intensive care unit: A cohort study","authors":"Samuel J. Reade MBChB, MRes,&nbsp;Ahmad Bassam MBBS, BMedSci,&nbsp;Wisam Al-Bassam FCICM, MBChB,&nbsp;Umesh Kadam MD, MRCP UK, FCICM","doi":"10.1016/j.aucc.2024.07.080","DOIUrl":"10.1016/j.aucc.2024.07.080","url":null,"abstract":"<div><h3>Aim/objectives</h3><div>Fit testing of N95/FFP2 respirators is universally recommended before exposure to airborne infectious diseases such as COVID-19. Respirator supply shortage in the COVID-19 pandemic encouraged extended-use for up to 4 h, despite uncertainty about seal integrity over time. The aim of our study was to assess N95 seal integrity after at least 2 h of continuous clinical use in the intensive care unit (ICU). We hypothesised that seal integrity would deteriorate over time, with variability between respirator shapes.</div></div><div><h3>Methods</h3><div>A prospective cohort study of healthcare workers in a metropolitan ICU setting in Australia between April 2021 and August 2022. Following consent and screening, participants underwent qualitative fit testing in the ICU, and fit tests were repeated following a continuous period of at least 2-h usage. The primary outcome was N95 fit-test failure rate measured by qualitative fit testing of &gt;2 h compared to baseline. Secondary outcomes evaluated effects of respirator shape, demographic characteristics, and duration of respirator use on respirator fit after 2 h use.</div></div><div><h3>Results</h3><div>Fifty-one participants were recruited and consented. Six participants were excluded; four failed baseline fit test, one could not taste saccharin, and one did not complete 2 h of usage. Fourteen of 45 participants (∼31%) failed the extended-use fit test (median duration: 2 h 10 min [interquartile range: 2:07–2:20]). Fit-test rates differed between respirator shapes; three-piece flat-fold respirators had lower failure rates (6/32; 19%) than duckbill-shaped respirators (6/11; 55%) p = 0.046. No other demographic characteristic or respirator shape was significantly associated with increased failure rate.</div></div><div><h3>Conclusions</h3><div>Following 2 h of use, approximately 30% of participants failed repeat fit testing, suggesting incomplete respiratory protection. Three-piece flat-fold respirators outperformed duckbill respirators. Extended use of respirators, even without respirator reuse, may put healthcare workers at risk of inadequate respiratory protection, in particular when using duckbill-shaped respirators.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101099"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047485","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":"Ventilator-tube holder for mobilising patients with a tracheostomy: A pilot usability study (TrachVest)","authors":"Paul Twose MSc, BSc ,&nbsp;Susan Peirce PhD, MSc, BSc ,&nbsp;John Maisey BSc ,&nbsp;Laura Jones MSc, BSc ,&nbsp;Jason Nunn BSc","doi":"10.1016/j.aucc.2024.05.014","DOIUrl":"10.1016/j.aucc.2024.05.014","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients in intensive care may have a tracheostomy and be dependent on a respiratory ventilator while yet conscious and able to mobilise. Early rehabilitation is known to be key to patient recovery. However, for these patients, therapy staff members are required to manage the ventilator tubing in addition to other patient-connected equipment whilst focussing on patient mobility and progress. A technical garment (TrachVest) was designed to hold the ventilator tubing securely during these therapeutic mobilisations.</div></div><div><h3>Methods</h3><div>We conducted a mixed-methods study to evaluate the use of this garment in an intensive care unit setting. The aim was to determine potential effects on patient safety, its potential benefits, and usability. Research methods included direct observations, user questionnaires (quantitative and qualitative), and staff focus groups.</div></div><div><h3>Results</h3><div>A total of 14 therapy sessions with the garment were observed, involving nine patients and 10 staff. Eleven staff members participated in two focus groups, including two previously involved in the therapy sessions. Therapy sessions consisted of a range of activities including sitting on the edge of the bed, transferring from bed to chair (including use of hoists), and mobilising with walking aids. Overall, staff members felt that the garment was easy to use and would likely improve patient safety during mobilisations. The main benefits were staff reassurance, allowing them to focus on therapy, and in potentially reducing the number of staff members needed for particular activities. Patient characteristics were found to be influential on the perceived utility, and TrachVest may have greater benefit for patients who have greater physical function (e.g., able to actively participate in rehabilitation) and can mobilise at least from bed to chair. Experience of using the TrachVest and of patient capabilities was thought to be key to knowing when it would be most useful.</div></div><div><h3>Conclusion</h3><div>Within this pilot usability study, participants, both staff and patients, reported that the TrachVest garment designed to support ventilator tubing during rehabilitation to be highly useable and beneficial to supporting rehabilitation in this patient group.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101077"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499626","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}