Australian Critical Care最新文献

{"title":"The clinical utility of shock index in hospitalised patients requiring activation of the rapid response team","authors":"Hasan M. Al-Dorzi MD ,&nbsp;Yasser A. AlRumih MBBS ,&nbsp;Mohammed Alqahtani MBBS ,&nbsp;Mutaz H. Althobaiti MBBS ,&nbsp;Thamer T. Alanazi MD ,&nbsp;Kenana Owaidah MBBS ,&nbsp;Saud N. Alotaibi MBBS ,&nbsp;Monirah Alnasser MBBS, MPH ,&nbsp;Abdulaziz M. Abdulaal MBBS ,&nbsp;Turki Z. Al Harbi MBBS ,&nbsp;Ahmad O. AlBalbisi MBBS ,&nbsp;Saad Al-Qahtani MD ,&nbsp;Yaseen M. Arabi MD, FCCP, FCCM, ATSF","doi":"10.1016/j.aucc.2024.101150","DOIUrl":"10.1016/j.aucc.2024.101150","url":null,"abstract":"<div><h3>Background</h3><div>The systolic shock index (SSI) is used to direct management and predict outcomes, but its utility in patients requiring rapid response team (RRT) activation is unclear.</div></div><div><h3>Objectives</h3><div>We explored whether SSI can predict the outcomes of ward patients experiencing clinical deterioration and compared its performance with other parameters.</div></div><div><h3>Methods</h3><div>This retrospective study included adult patients in medical/surgical wards who required RRT activation. We calculated SSI (heart rate/systolic blood pressure [BP]), diastolic shock index (DSI, heart rate/diastolic BP), modified shock index (heart rate/mean BP), and quick Sequential Organ Failure Assessment (qSOFA) score at activation. We categorised patients into two groups (SSI: ≥1.0 and &lt;1.0). We performed univariate and multivariable logistic regression analyses to evaluate the association of SSI with intensive care unit (ICU) admission, vasopressor therapy, and in-hospital mortality. The covariates included demographics, comorbidities, and reasons for RRT activation.</div></div><div><h3>Results</h3><div>Among the 837 study patients, 297 (35.5%) had an SSI ≥1.0. On univariate analysis, SSI was associated with vasopressor therapy (odds ratio [OR]: 2.04, 95% confidence interval [CI]: 1.40–2.99) but not ICU admission or in-hospital mortality. On multivariable logistic regression analysis, an SSI ≥1.0 was associated with ICU admission (adjusted OR: 1.55, 95% CI: 1.05–2.28), vasopressor therapy (adjusted OR: 3.05, 95% CI: 1.86–5.00), and in-hospital mortality (adjusted OR: 2.18, 95% CI: 1.42–3.33). A systolic BP &lt;90 mmHg, mean BP &lt; 65 mmHg, and qSOFA score ≥2 were associated with these outcomes in univariate and multivariable regression analyses (adjusted ORs close to those of SSI). Separate receiver operating characteristic curve analysis found that SSI, diastolic shock index, and modified shock index poorly discriminated between survivors and nonsurvivors (area under the curve: &lt;0.60 for all).</div></div><div><h3>Conclusions</h3><div>In ward patients experiencing clinical deterioration, an SSI ≥1.0 was associated with adverse outcomes but did not perform better than systolic and mean BP and qSOFA. This limits its standalone clinical utility in these patients.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101150"},"PeriodicalIF":2.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848128","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":"Assessing the feasibility of handheld scanning technologies in neonatal intensive care: Trueness, acceptability, and suitability for personalised medical devices","authors":"Deanne August RN, PhD ,&nbsp;Isabel Byram BBus, BFA ,&nbsp;David Forrestal BEng, PhD ,&nbsp;Mathilde Desselle MEng, PhD ,&nbsp;Nathan Stevenson BEng, PhD ,&nbsp;Kartik Iyer BEng, PhD ,&nbsp;Mark W. Davies MBBS, PhD ,&nbsp;Katherine White MBBS ,&nbsp;Linda Cobbald BN, PGCertNg ,&nbsp;Lynette Chapple BN, GradDipNg ,&nbsp;Kellie McGrory CN, CertAdvNg ,&nbsp;Margaret McLean BN ,&nbsp;Stephanie Hall Bn, MNursPrac ,&nbsp;Brittany Schoenmaker BN, MClinNurs ,&nbsp;Jackie Clement BN, GradDipNg ,&nbsp;Melissa M. Lai MBBS, PhD","doi":"10.1016/j.aucc.2024.09.012","DOIUrl":"10.1016/j.aucc.2024.09.012","url":null,"abstract":"<div><h3>Background</h3><div>Nasal continuous positive airway pressure (CPAP) injuries are common for premature infants. Clinical use of three-dimensional (3D) scanning is established in adult medicine, but the possibilities in neonatal care are still emerging. Custom printed CPAP devices have the potential to reduce injuries and disfigurement in this vulnerable population.</div></div><div><h3>Aim</h3><div>We sought to identify the most feasible portable 3D scanner for use in the neonatal intensive care environment towards the development of custom-fitting CPAP devices for premature infants.</div></div><div><h3>Methods</h3><div>Four handheld 3D scanners were assessed and compared, Artec Leo, Revopoint POP 2, iPad Pro/Metascan, and iPhone/Scandy Pro. Trained neonatal clinicians (medical and nursing) undertook mock scans in a simulated neonatal intensive care environment.</div></div><div><h3>Results</h3><div>Sixty scans were performed by 13 neonatal clinicians (four medical/nurse practitioners and nine nurses). The median mean absolute error was 0.21 mm (interquartile range [IQR]: 0.19–0.26), 0.17 mm (IQR: 0.15–0.21), and 1.08 mm (IQR: 1.0–1.63) for Artec Leo, Revopoint POP 2, and Scandy Pro, respectively. Scan times were the quickest for Artec Leo at 22.9 sec (IQR: 18.5–27), followed by Revopoint POP 2 at 25.2 sec (IQR: 22–34.4). Artec Leo was rated most expensive, but Revopoint POP 2 was rated more ergonomic. Both app-based 3D scanners (Metascan and Scandy Pro) presented data security issues.</div></div><div><h3>Conclusions</h3><div>Artec Leo and Revopoint POP 2 were identified as most feasible for use to perform 3D scans on premature infants in the neonatal intensive care environment.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101127"},"PeriodicalIF":2.6,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814972","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":"Outcomes in early mobilisation research in critically ill children: A scoping review","authors":"Barbara M. Geven RN, MSc ,&nbsp;Erwin Ista RN, PhD ,&nbsp;Job B.M. van Woensel MD, PhD ,&nbsp;Sascha C.A.T. Verbruggen MD, PhD ,&nbsp;Faridi S. van Etten-Jamaludin BSc ,&nbsp;Jolanda M. Maaskant RN, PhD","doi":"10.1016/j.aucc.2024.101139","DOIUrl":"10.1016/j.aucc.2024.101139","url":null,"abstract":"<div><h3>Objective</h3><div>Early mobilisation in critically ill children is safe and feasible. However, the effectiveness of early mobilisation on short- and long-term outcomes is understudied. The aim of this scoping review was to generate an overview of outcomes used in previous research regarding early mobilisation in critically ill children.</div></div><div><h3>Data sources</h3><div>A systematic search was performed in Medline, Embase, Cochrane library, and CINAHL, without restricting on design, on April 3rd, 2023.</div></div><div><h3>Study selection</h3><div>Two independent reviewers assessed titles, abstracts, and full texts. Studies were included if they described any outcomes related to early mobilisation in critically ill children.</div></div><div><h3>Data charting process</h3><div>One reviewer performed data extraction, which was subsequently verified by another reviewer. Seven domains were used to categorise the outcomes: mortality, physiological, life impact, resource use, adverse events, process indicators, and perception of early mobilisation.</div></div><div><h3>Data synthesis</h3><div>Out of 3380 screened titles, 25 studies were included. Data extraction yielded 148 unique outcomes, which were clustered into 40 outcomes. Outcomes spanned in all seven domains, with “length of paediatric intensive care unit stay” (resource use) and “adverse events involving unintentional removal of catheters, tubes, and/or lines” (adverse events) being the most frequently reported. Process indicators such as mobilisation activities were well documented. Mortality and functionality outcomes were chosen the least.</div></div><div><h3>Conclusions</h3><div>This scoping review provides a categorised overview of outcomes that have been used to assess the effectiveness of early mobilisation in critically ill children. The findings show a great heterogeneity in used outcomes and are input for paediatric intensive care unit experts and parents to prioritise outcomes developing a Core Outcome Set.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101139"},"PeriodicalIF":2.6,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792773","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":"Early prediction of intensive care unit admission in emergency department patients using machine learning","authors":"Dinesh Pandey BEng, MSc, PhD ,&nbsp;Hossein Jahanabadi BSc, MEng, PhD ,&nbsp;Jack D'Arcy MB BCh, BAO(Hons), FCICM, FACEM ,&nbsp;Suzanne Doherty MB BCh, BAO(Hons), FACEM ,&nbsp;Hung Vo GradDipPsych ,&nbsp;Daryl Jones BSc(Hons), MB BS, FRACP, FCICM, MD, PhD ,&nbsp;Rinaldo Bellomo MB BS(Hons), MD, PhD, FRACP, FCICM","doi":"10.1016/j.aucc.2024.101143","DOIUrl":"10.1016/j.aucc.2024.101143","url":null,"abstract":"<div><h3>Background</h3><div>The timely identification and transfer of critically ill patients from the emergency department (ED) to the intensive care unit (ICU) is important for patient care and ED workflow practices.</div></div><div><h3>Objective</h3><div>We aimed to develop a predictive model for ICU admission early in the course of an ED presentation.</div></div><div><h3>Methods</h3><div>We extracted retrospective data from the electronic medical record and applied natural language processing and machine learning to information available early in the course of an ED presentation to develop a predictive model for ICU admission.</div></div><div><h3>Results</h3><div>We studied 484 094 adult (≥18 years old) ED presentations, amongst which direct admission to the ICU occurred in 3955 (0.82%) instances. We trained machine learning in 323 678 ED presentations and performed testing/validation in 160 416 (70 546 for testing and 89 870 for validation). Although the area under the receiver operating characteristics curve was 0.92, the F1 score (0.177) and Matthews correlation coefficient (0.257) suggested substantial imbalance in the dataset. The strongest weighted variables in the predictive model at the 30-min timepoint were ED triage category, arrival via ambulance, quick Sequential Organ Failure Assessment score, baseline heart rate, and the number of inpatient presentations in the prior 12 months. Using a likelihood of ICU admission of more than 75%, for activation of automated ICU referral, we estimated the model would generate 2.7 triggers per day.</div></div><div><h3>Conclusions</h3><div>The infrequency of ICU admissions as a proportion of ED presentations makes accurate early prediction of admissions challenging. Such triggers are likely to generate a moderate number of false positives.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101143"},"PeriodicalIF":2.6,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792811","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":"Characteristics and outcomes of adults with acute brain injuries admitted to intensive care units in Australia and New Zealand from 2013 to 2022","authors":"David Golding MBChB ,&nbsp;Anis Chaba MD, MSc ,&nbsp;Anthony Delaney PhD, FCICM ,&nbsp;Valery L. Feigin MD, PhD ,&nbsp;Edward Litton PhD, FCICM ,&nbsp;Champ Mendis PhD ,&nbsp;Alex Poole RN, PhD ,&nbsp;Andrew Udy PhD, FCICM ,&nbsp;Paul J. Young PhD, FCICM ,&nbsp;the Australian & New Zealand Intensive Care Society (ANZICS) Centre for Outcomes & Resource Evaluation (CORE)","doi":"10.1016/j.aucc.2024.101145","DOIUrl":"10.1016/j.aucc.2024.101145","url":null,"abstract":"<div><h3>Background</h3><div>The characteristics and outcomes of patients with acute brain injuries admitted to the intensive care unit (ICU) in Australia and New Zealand (ANZ) are insufficiently described.</div></div><div><h3>Objective</h3><div>This study aimed to describe the epidemiology of acute brain injury in ICU patients in ANZ.</div></div><div><h3>Methods</h3><div>A binational retrospective cohort study was conducted using the ANZ Intensive Care Society Adult Patient Database. Adult unplanned admissions from 2013 to 2022 were eligible unless the presence of acute brain injury could not be determined or the admission was for end-of-life care. In cases where a patient had multiple admissions, only the first was included. The population was divided into two cohorts: acute brain injury diagnoses and other diagnoses. The primary outcome was in-hospital mortality. Secondary outcomes included 90- and 180-day mortality, ICU and hospital lengths of stay, duration of invasive ventilation, and the proportion discharged home.</div></div><div><h3>Results</h3><div>Acute brain injuries accounted for 92 948 of 684 981 unplanned ICU admissions (14%). Hypoxic ischaemic encephalopathy, traumatic brain injury, and seizures were the most common diagnoses. A total of 24 568 of 92 948 (26%) and 62 603 of 592 033 (10%) patients with acute brain injuries and other diagnoses, respectively, died in hospital. Among the patients with brain injury the highest hospital mortality was in hypoxic ischaemic encephalopathy (53%), intracerebral haemorrhage (36%), subarachnoid haemorrhage (22%), and ischaemic stroke (22%); the lowest mortality was in traumatic brain injury (14%), central nervous system infection (10%), and seizures (4%). Acute brain injury patients were more likely to receive invasive mechanical ventilation, had longer ICU and hospital lengths of stay, had higher 90- and 180-day mortality, and were more likely to be discharged to chronic care than other patients.</div></div><div><h3>Conclusions</h3><div>Acute brain injuries accounted for a disproportionally high number of in-hospital deaths occurring in our cohort of adults who received unplanned ICU care; however, the mortality rates varied, and patients with central nervous system infections and seizures had similar or lower mortality compared to patients without brain injury.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101145"},"PeriodicalIF":2.6,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786565","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":"“You need to be supported”: An integrative review of nurses’ experiences after death in neonatal and paediatric intensive care","authors":"Melissa J. Bloomer RN, PhD, FACCCN ,&nbsp;Laura A. Brooks RN, MN, MACCCN ,&nbsp;Alysia Coventry RN, MPhil, MACCCN ,&nbsp;Kristen Ranse RN, PhD, MACCCN ,&nbsp;Jessie Rowe RN, Grad Dip Nurs Pract (Paediatric Crit Care), MACCCN ,&nbsp;Shontelle Thomas RN, Grad Cert Nurs Pract (Paediatric Intens Care), MACCCN","doi":"10.1016/j.aucc.2024.101149","DOIUrl":"10.1016/j.aucc.2024.101149","url":null,"abstract":"<div><h3>Background</h3><div>The death of a child can have a profound impact on critical care nurses, shaping their professional practice and personal lives in diverse, enduring ways. Whilst end-of-life care is recognised as a core component of critical care nursing practice and a research priority, evidence about nurses’ experiences after death in neonatal and paediatric intensive care is poorly understood.</div></div><div><h3>Research question</h3><div>What is the experience of the nurse after death of a patient in neonatal and/or paediatric intensive care?</div></div><div><h3>Method</h3><div>Following registration with Open Science Framework, an integrative review of the empirical literature was undertaken. A combination of keywords, synonyms, and Medical Subject Headings was used across the Cumulative Index Nursing and Allied Health Literature (CINAHL) Complete, Medline, APA PsycInfo, Scopus, and Embase databases. Records were independently assessed against inclusion and exclusion criteria. All included papers were assessed for quality. Narrative synthesis was used to analyse and present the findings.</div></div><div><h3>Findings</h3><div>From 13,018 records screened, 32 papers reporting primary research, representing more than 1850 nurses from 15 countries, were included. Three themes were identified: (i) postmortem care; (ii) caring for bereaved families; and (iii) nurses’ emotional response, which includes support for nurses. Nurses simultaneously cared for the deceased child and family, honouring the child and child–family relationship. Nurses were expected to provide immediate grief and bereavement support to families. In response to their own emotions and grief, nurses described a range of strategies and supports to aid coping.</div></div><div><h3>Conclusion</h3><div>Recognising neonatal and paediatric critical care nurses' experience after death is key to comprehensively understanding the professional and personal impacts, including the shared grief of a young life lost. Enabling nurses to acknowledge and reflect upon their experiences of death and seek their preferred supports is critically important. Thus, ensuring organisational and system processes similarly align with nurses’ preferences is key.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101149"},"PeriodicalIF":2.6,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786612","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":"In-person, virtual visiting and telephone calls in Australia and New Zealand intensive care units: A point prevalence multicentre study mapping daytime and nighttime interactions","authors":"Alexis Tabah FCICM, MD ,&nbsp;Mahesh Ramanan FCICM, MMed ,&nbsp;Kevin B. Laupland MD, PhD ,&nbsp;Kimberley Haines PhD, B.HSc (Physio) ,&nbsp;Naomi Hammond PhD ,&nbsp;Serena Knowles PhD ,&nbsp;Kylie Jacobs RN, M.Nr (Critical Care) ,&nbsp;Stuart Baker MBBS, FCICM ,&nbsp;Edward Litton MBChB, PhD ,&nbsp;the Point Prevalence Program Investigators and 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.2024.101144","DOIUrl":"10.1016/j.aucc.2024.101144","url":null,"abstract":"<div><h3>Background</h3><div>Family presence, in-person and via virtual visiting (video calls) and the telephone, is an integral part of patient- and family-centred critical care. Previous studies focussed on visiting policies and their effects. Data mapping the frequency and timing of these interactions are not available.</div></div><div><h3>Objectives</h3><div>The aims of this study were to describe the prevalence of in-person visiting and the use of telephone or video conferencing in Australia and New Zealand intensive care units (ICUs).</div></div><div><h3>Design</h3><div>A point prevalence survey was conducted to map visiting policies, hourly family presence at the bedside, telephone or video calls, and reasons for each interaction.</div></div><div><h3>Setting</h3><div>The research was conducted in a 24-h study period in October 2020, corresponding to the end of the 2nd COVID-19 pandemic wave in 40 Australia and New Zealand ICUs.</div></div><div><h3>Measurements and main results</h3><div>At the time of survey, 77% of ICUs had restrictions to visiting, median (interquartile range [IQR]) time of 9 (2; 24) hours with permitted visiting per day, a mean of 8 hours less than before the COVID-19 pandemic. There were 532 patients, a median (IQR) of 13 (6; 25) patients per ICU. Two patients had COVID-19. Over 24 h, 65% of patients had at least one in-person visit, median (IQR) of 1 (0; 3) hours with visitors. Telephone calls were received for 52% patients, median (IQR) of 1 (0; 2) calls. Video calls were received for 6% of the patients. In-person visits peaked between 10:00 and 12:00, with a second smaller peak between 16:00 and 17:00. Visiting continued through the evening, and 2% of the patients had visitors overnight. Telephone calls peaked at 10:00, continued through the day and evening, with few calls received overnight. In-person visits were predominantly motivated by family interactions (81%) and telephone calls by clinical updates (51%) and family interactions (47%).</div></div><div><h3>Conclusions</h3><div>In a low COVID-19 prevalence period, Australia and New Zealand ICUs had partially reopened to visitors. Most visits happened during the day and evening but persisted overnight. ICU resourcing and visiting policies should take these data into account to facilitate family presence at the bedside, virtual visiting, and obtaining clinical updates via telephone.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101144"},"PeriodicalIF":2.6,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786619","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":"Disaster preparedness for intensive care units: Priorities to inform crisis standards of care","authors":"David Sellers RN, MCritCareNursing ,&nbsp;Julia Crilly RN, PhD ,&nbsp;Lynda Hughes RN, PhD ,&nbsp;Jamie Ranse RN, PhD","doi":"10.1016/j.aucc.2024.101142","DOIUrl":"10.1016/j.aucc.2024.101142","url":null,"abstract":"<div><h3>Background</h3><div>The number of disasters occurring globally is increasing. Natural hazards, changing geopolitical situations, and increasing population densities may lead to an increased likelihood of a surge of patients requiring health care, some of whom might be requiring intensive care–level treatment. There is a dearth of literature on intensive care unit (ICU) practitioner's priorities regarding disaster preparedness and crisis standards of care.</div></div><div><h3>Objectives</h3><div>This study aimed to understand what nurses working in ICUs within Australia prioritise regarding ICU disaster preparedness and the implementation of crisis standards of care.</div></div><div><h3>Methods</h3><div>A modified three-round Delphi design was used for this study. A snowballing recruitment method facilitated the purposive sampling of ICU nurses, starting with members of the Australian College of Critical Care Nurses. Eligible participants were asked to rate statements according to their priorities when addressing disaster preparedness of the Australian ICU in which they work. Statements that achieved the 10 highest scores in the final round were tabulated to indicate the broader areas of disaster preparedness that the respondents considered priorities.</div></div><div><h3>Results</h3><div>A total of 16 participants completed both round two and round three of this Delphi study. Out of 38 statements across six domains, 33 statements achieved consensus. Healthcare practitioner protection, wellbeing, and the management of space populated the top 10 priorities. These priorities included adequate personal protection equipment, services to support healthcare practitioners, and clear communication and debriefing pathways. Another key priority identified was the need for a clear plan on how the ICU footprint will expand to accommodate a surge of patients.</div></div><div><h3>Conclusion</h3><div>Healthcare practitioner wellbeing followed by adequate plans for ICU expansion are key priorities of nursing staff working in ICUs within Australia. Understanding the priorities of those who work in the ICU gives a pragmatic insight into what is required to further develop the disaster preparedness of Australian ICUs.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101142"},"PeriodicalIF":2.6,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786588","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":"Nurses' and physicians’ experience of a new algorithm for tapering analgosedation in the paediatric intensive care unit: A focus-group investigation","authors":"Mette Dokken RN, MNSc ,&nbsp;Tone Rustøen RN, PhD ,&nbsp;Thordis Thomsen RN, PhD ,&nbsp;Gunnar K. Bentsen MD, PhD ,&nbsp;Ingrid Egerod RN, PhD","doi":"10.1016/j.aucc.2024.101141","DOIUrl":"10.1016/j.aucc.2024.101141","url":null,"abstract":"<div><h3>Aim/objective</h3><div>Iatrogenic withdrawal syndrome occurs frequently during the tapering phase of opioids and benzodiazepines in paediatric intensive care units. The aim of this study was to explore physicians' and nurses' experiences in patient care and staff collaboration during the tapering phase using a new “algorithm for tapering analgosedation”</div></div><div><h3>Methods</h3><div>We used a qualitative explorative design with focus groups. The framework method was followed including transcription, familiarisation, coding, developing a framework, applying the framework, charting data into the framework matrix, and interpreting the data. The study was conducted at two paediatric intensive care units at Oslo University Hospital in Norway. Nurses and physicians who had used the new algorithm participated in the study.</div></div><div><h3>Findings</h3><div>Three focus-group interviews were conducted with a total of 15 informants. Three main themes were identified with relevant subthemes: “Caring for a child in withdrawal”, “Advantages of the algorithm”, and “Challenges of the algorithm”. The algorithm positively affected patient care and staff collaboration during tapering. The use of the Withdrawal Assessment Tool-1 integrated in the algorithm required experienced nurses due to the risk of false-positive patient assessments.</div></div><div><h3>Conclusion</h3><div>Nurses and physicians in our study experienced that the new algorithm promoted staff collaboration and positively affected patient care. The use of the Withdrawal Assessment Tool-1 integrated in the algorithm required experienced staff and resources for continuous staff education.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101141"},"PeriodicalIF":2.6,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786671","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":"Comparing arterial catheterisation by palpation or ultrasound guidance by novice nurses in an adult intensive care unit: A prospective cohort study","authors":"Manuela León RN ,&nbsp;Daniel N. Marco MD ,&nbsp;Marta Cubedo PhD ,&nbsp;Cristina González RN ,&nbsp;Ana Guirao RN ,&nbsp;María del Carmen Cañueto RN ,&nbsp;Laura Salvador RN ,&nbsp;Àlvar Farré RN ,&nbsp;Javier Pérez RN ,&nbsp;Inmaculada Carmona RN ,&nbsp;Pamela-Inés Doti MD ,&nbsp;Sara Fernández MD ,&nbsp;Adrián Téllez MD, PhD ,&nbsp;Juan Carlos López-Delgado MD, PhD ,&nbsp;Eric Mayor-Vázquez MD ,&nbsp;Laura Almorín MD ,&nbsp;Josep M. Nicolás MD, PhD ,&nbsp;Pedro Castro MD, PhD","doi":"10.1016/j.aucc.2024.101135","DOIUrl":"10.1016/j.aucc.2024.101135","url":null,"abstract":"<div><h3>Background</h3><div>Arterial catheterisation is a common procedure in intensive care units (ICUs), typically performed using the palpation technique. Ultrasound (US)-guided catheterisation remains underutilised, particularly when performed by nonphysician operators.</div></div><div><h3>Objective</h3><div>The objective of this study was to assess the effectiveness of US-guided arterial catheterisation performed by nurses in critically ill patients.</div></div><div><h3>Methods</h3><div>This prospective cohort study took place in a medical ICU at a tertiary university hospital, comparing outcomes before and after a training program. Critically ill patients requiring arterial catheterisation were included. The study examined the performance and complications associated with two catheterisation techniques used by critical care nurses: palpation (PP) and US-guided. Nurses inexperienced with the US technique completed a brief training program consisting of two 3-h workshops followed by supervised clinical practice before performing the procedure. Collected data included the first-attempt success rate (primary endpoint), overall success rate, procedure time, the number of attempts, the number of cannulas used, complication rate, and catheter durability.</div></div><div><h3>Results</h3><div>The study included 175 patients, with 89 in the PP group and 86 in the US group. Baseline characteristics were similar between groups. The first-attempt success rate was 50% in the PP group and 58% in the US group (p = 0.39, 95% confidence interval -23.4% to +8.3%). No significant differences were observed between groups in terms of failed attempts (21.3% vs. 14%, p = 0.28), procedure time (284 s vs 350 s, p = 0.44), or rates of immediate (haematoma) and late (catheter infection or dysfunction) complications. Catheter durability was also comparable. Although radial artery cannulation was preferred in both groups, femoral and brachial access were more frequently used in the US group (12.9% and 2.9% vs. 17.6% and 14.9%, respectively, p = 0.02).</div></div><div><h3>Conclusions</h3><div>Arterial catheterisation using US guidance, performed by nurses with limited prior experience after a brief training course, demonstrated similar performance and complications rates compared to the traditional PP technique in a medical ICU setting.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101135"},"PeriodicalIF":2.6,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640317","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}