Nursing in Critical Care最新文献

Background: Anxiety, depressive symptoms and delirium are common among patients undergoing coronary artery bypass graft surgery (CABG). Postoperative delirium is associated with diverse negative outcomes among those patients, including delayed extubation and prolonged length of stay (LoS). Existing literature has recorded the incidence and associated risk factors with delirium among patients undergoing CABG, but limited studies have checked the particular impacts of preoperative anxiety and depressive symptoms (ADS) on the incidence of postoperative delirium.

Aim: To determine the impact of ADS on the incidence of postoperative delirium among patient undergoing elective CABG.

Study design: This was a prospective cohort study among 400 patients, 220 (55%) males and 180 (45%) females, who underwent elective CABG. The sample was recruited from six major hospitals in Jordan. ADS were measured prior to the operation using the Hospital Anxiety and Depression Scale. Delirium was screened using the Confusion Assessment Method for the Intensive Care Unit by trained research assistants twice daily from the second to the fifth day postoperatively. Data were analysed using logistic and multiple regression analyses.

Results: 160 patients (40%) developed delirium postoperatively. Regression analysis showed that older age, female sex, duration of surgery ≥7 h, depressed, anxious, and anxious and depressed categories were independent predictors for higher incidence rates of delirium. Additionally, the occurrence of delirium was an independent predictor for longer hospital/ICU LoS.

Conclusions: CABG patients may experience delirium more frequently and require a longer hospital stay if they have prior anxiety or depression. Controlling ADS might decrease delirium incidence and shorten the LoS.

Relevance to clinical practice: Our findings underscore the critical role nurses play in identifying and addressing psychological issues before CABG. By recognising and managing preoperative ADS, nurses can potentially reduce the risk of delirium following CABG.

Background: Prone positioning improves oxygenation in adults with acute respiratory distress syndrome (ARDS) and has been extensively applied in intensive care units (ICU) during the COVID-19 pandemic. Although some complications due to the manoeuvre are well known, brachial plexus injury after prone positioning is reported as a rare complication and the phenomenon could be either very rare or underestimated.

Aim: This study aimed to evaluate the effect of swimmer position during prone ventilation on the onset of brachial plexus injury in patients admitted to ICU for ARDS. The study will also evaluate the safety of prolonged prone positioning collecting data on any adverse events occurred.

Study design: A prospective, observational cohort study will be conducted in a tertiary level ICU in the metropolitan area of Milano (Italy) specialized in advanced treatment of patients with ARDS. This observational study will report clinical data on the electromyography (EMG) and the muscle strength assessment, including comorbidities and cardio-respiratory status. A baseline EMG will be performed within 2 h from the first pronation manoeuvre and immediately at the end of each pronation cycle. The functional assessment of patients will be also performed at the end of ICU stay and at hospital discharge.

Results: The primary outcome is to estimate the prevalence of brachial plexus injury in patients with ARDS placed in the swimmer position during prone ventilation. Secondary outcomes will also include the safety of the manoeuvre by evaluation of all adverse events classified as skin or ocular damage, loss of tube and vascular access and new pressure ulcers.

Relevance to clinical practice: The findings of this study will contribute to understand the possible benefits/harms of prone ventilation performed using swimmer position. Eventually, this will call for the development of specific and tailored rehabilitation programs for patients with upper limb injuries during ICU stay, including also timely follow-up upon ICU-discharge.

Background: Retinopathy is frequently seen in the neonatal intensive care unit (NICU), and its examination is a painful procedure for infants.

Aim: This randomized active-controlled trial aimed to investigate the impact of multisensory stimulation (MSS) on neonatal pain during retinopathy of prematurity (ROP) examinations, in comparison with a white noise (WN) and control group receiving standard care.

Study design: Conducted as a three-arm, randomized controlled trial, the study was implemented in the NICU of a local university hospital. Recruitment spanned from July 2023 to November 2023, with preterm infants (gestational age < 37 weeks) randomly assigned to either a MSS, WN or a control group. MSS components included visual, auditory, tactile, olfactory and gustatory stimuli, all designed to create a synergistic, comforting environment for the infant during the procedure. Procedural pain, heart rate and oxygen saturation were assessed at various stages before and after ROP examinations.

Results: Analysis of 90 participants revealed that the MSS group exhibited lower Premature Infant Pain Profile (PIPP) scores than the WN and control groups (mean difference: -2.12, 95% confidence interval [CI]: -2.62 to -1.62; odds ratio [OR]: 0.004, 95% CI [0.001, 0.012], p < 0.001). Additionally, heart rates were significantly lower in the MSS group (mean difference: -15.3 beats/min, 95% CI: -20.5 to -10.1; OR: 0.025, 95% CI [0.008, 0.073], p < .001) and oxygen saturation levels were higher (mean difference: 3.2%, 95% CI: 1.8% to 4.6%; OR: 1.12, 95% CI [1.05, 1.20], p < .001) than in the other groups.

Conclusions: MSS emerges as a favourable, safe and non-pharmacological intervention for pain management in ROP and similar procedures.

Relevance to clinical practice: Multisensory stimulation can be effectively integrated into the routine care provided by critical care nurses during retinopathy of prematurity examinations in preterm infants. This non-pharmacological intervention offers a practical approach for critical care nurses to reduce procedural pain and improve physiological stability in this vulnerable population.

Background: Regional citrate anticoagulation-continuous renal replacement therapy (RCA-CRRT) has a wide range of applications in clinical practice, but unplanned downtime due to RCA-CRRT circuit coagulation is as high as 15.75%-66.70%.

Aim: To build a nomogram model for predicting the lifespan circuits of RCA-CRRT.

Study design: A prospective observational cohort study was conducted in Sichuan, China. The collected clinical data from 404 RCA-CRRT sessions involving 135 patients were utilized. The patients' basic information, laboratory indicators and RCA-CRRT parameters were used as independent variables, and the survival status and survival time of RCA-CRRT circuits were used as dependent variables. A Cox multivariate analysis was performed to build the nomogram model for predicting the lifespan of RCA-CRRT circuits. The model was validated internally and externally.

Results: The median lifespan of RCA-CRRT circuits was 28.0 (12.0-46.5) h, and the unplanned downtime rate was 23.76%. In the Cox multivariate analysis, venous pressure, haemoglobin, Sequential Organ Failure Assessment (SOFA), lactate, and blood transfusion were identified as statistically significant predictive factors for the lifespan of RCA-CRRT circuits (p < .05). Subsequently, a nomogram model for predicting the lifespan of RCA-CRRT circuits was developed. The AUC values for internal and external validation within the 12-72-h timeframe ranged from 0.648 to 0.816 and 0.613 to 0.956, respectively. Both the calibration curve and clinical decision curve demonstrated the model's good performance.

Conclusion: The nomogram model developed in this study demonstrates its efficacy in accurately predicting the lifespan circuits of RCA-CRRT.

Relevance to clinical practice: Clinical nurses can use the prediction model to assess the lifespan of RCA-CRRT circuits, so as to formulate a personalized RCA-CRRT treatment plan for patients, thus reducing the unplanned downtime of RCA-CRRT.

Background: Critically ill patients experience cognitive impairment throughout their intensive care unit trajectory, in the acute phase and the long-term alike. Cognitive impairment may negatively impact patients' quality of life and rehabilitation outcomes.

Aim: To provide an overall examination of literature concerning non-pharmacological interventions that can enhance cognitive functioning in critically ill patients or facilitate their rehabilitation pathway during and after their intensive care unit stay.

Study design: This study was conducted as an umbrella review. A systematic search was conducted in CINAHL, Embase, PubMed and PsychINFO, including all types of peer-reviewed research syntheses published between 2008 and 2023. Eligible studies had to describe interventions capable of improving adult patients' cognitive functioning or supporting their cognitive rehabilitation process throughout the intensive care unit trajectory. All eligible research syntheses were screened systematically; those included were critically appraised.

Result: Based on 13 research syntheses, this review summarizes rehabilitative interventions that may be delivered during different phases of critical illness and recovery, in relation to content, delivery and timing. Interventions were: (1) cognitive activities and training, (2) mobilization and physical exercises, (3) emotional, psychological and social support and (4) information.

Conclusion: Due to limited evidence, no definitive conclusion can be drawn about which type of intervention is most supportive or effective. Additionally, no recommendations can be made about the optimal timing for intervention delivery.

Relevance to clinical practice: Clinicians involved in developing and implementing cognitive rehabilitation measures should consider designing individualized, multicomponent interventions with a focus on content, delivery and timing.

Background: Endotracheal tube suctioning is an effective measure to ensure airway patency during mechanical ventilation; however, inappropriate suction pressure often leads to many adverse effects.

Aims: This study aimed to investigate safe and effective suction pressures and intracatheter pressure ranges during artificial airway open suctioning procedures.

Study design: In this double-blind randomized controlled trial, 438 patients receiving mechanical ventilation in China were divided into nine groups according to their sputum viscosity grades and suction pressure. A random sampling method was used to select one of the three pressure groups (low-, medium- and high-pressure groups). Registered intensive care unit (ICU) nurses performed open suction manoeuvres of the artificial airway based on the pressures set by the researchers. Two teaching supervisors observed and recorded the sputum viscosity, suction pressure, minimum intracatheter pressure, maximum intracatheter pressure, heart rate, mean arterial pressure, pulse oxygen saturation, airway mucosal bleeding and sputum sound improvement score.

Results: This study finally included 438 patients. The results showed that the safe and effective suction pressures were 80-120 mmHg for grade I sputum viscosity, 150 mmHg for grade II sputum viscosity and 200 mmHg for grade III sputum viscosity in open suction procedures for ICU patients. These pressure values were associated with the lowest changes in heart rate, mean arterial pressure and pulse oxygen saturation; the lowest incidence of airway mucosal bleeding; and the highest sputum sound improvement score.

Conclusions: In an open suction procedure, accurate setting of safe and effective suction pressure for sputum of different viscosity grades can not only achieve the suction effect but also have minimal impact on the vital signs and airway mucosal bleeding of patients.

Relevance to clinical practice: The findings can guide critical care nurses to accurately select safe and effective initial suction pressure values rather than use general ranges when performing artificial airway open suctioning procedures.

The invasive intra-arterial approach is the gold standard for measuring blood pressure in intensive care units where accuracy is crucial. However, invasive procedures increase the risk of infections and mortality. This evidence-based review aimed to determine whether continuous non-invasive blood pressure (CNIBP) monitoring, using Radial Artery Applanation Tonometry (RAAT) devices, is as accurate as invasive methods. Six papers were included: three prospective cohort studies and three comparative studies. Most studies showed that mean arterial pressure is accurately recorded through RAAT monitoring; however, more research is needed to assess the accuracy of non-invasive readings of systolic and diastolic blood pressures, as data are not always concordant.

Background: In recent years, some studies classified patients with sepsis and predicted their mortality by using some evaluation scales. Several studies reported significant differences in the predictive values of several tools, and the non-uniformity of the cut-off value.

Aim: To determine and compare the prognostic accuracy of Sequential Organ Failure Assessment (SOFA) score, Modified Early Warning Score (MEWS), and Systemic Inflammatory Response Syndrome (SIRS) criteria in predicting the mortality of patients with sepsis.

Methods: This study comprised of systematic literature review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched PubMed, Embase, Web of Science and Cochrane Library databases from their establishment to July 31, 2022. The research articles published in the index journals provide sufficient data (true positive, false positive, true negative, and false negative results) for patients with sepsis. The combined sensitivity and specificity of the 95% confidence interval (CI) were calculated using the bivariate random effect model (BRM). The hierarchical overall subject working characteristics (HSROC) curve was drawn to evaluate the accuracy of the overall prognosis.

Results: Data of 55 088 patients from 32 studies were included in this meta-analysis. SOFA had an intermediate sensitivity of 0.73 (95% CI: 0.67-0.78) and a specificity of 0.70 (0.63-0.76). SIRS criteria had the highest sensitivity of 0.75 (0.66-0.82) and the lowest specificity of 0.40 (0.29-0.52). MEWS had the lowest sensitivity of 0.49 (0.40-0.59) and the highest specificity of 0.82 (0.78-0.86).

Conclusions: Among SOFA, MEWS, and SIRS criteria, SOFA showed moderate sensitivity and specificity for predicting mortality in patients with sepsis, the highest sensitivity of SIRS and the strongest specificity of MEWS for predicting mortality in patients with sepsis. The future research direction is to combine the relevant indicators of MEWS and SIRS to develop a measurement tool with high reliability and validity.

Relevance to clinical practice: The review provides useful insights into the prognostic accuracy of different assessment tools in predicting mortality in sepsis patients, which will help clinicians choose the most appropriate tool for early identification and treatment of sepsis. The findings may also contribute to the development of more accurate and reliable prognostic models for sepsis.

Background: Intensive care units (ICUs) are environments where nurses are open to emotional interactions because of complex structures and dynamic relationships. Nurses' susceptibility to emotional contagion and their spiritual care competence may affect the quality of care by influencing their ability to manage and respond to the emotional dynamics present in these environments.

Aim: This study aimed to determine the level of emotional contagion and spiritual care competence in intensive care nurses.

Study design: This study is a descriptive cross-sectional study conducted with 199 nurses working in the ICUs of a training and research hospital in Turkey. The data were collected between December 2021 and June 2022 using the Emotional Contagion Scale (ECS) and the Spiritual Care Competence Scale (SCCS).

Results: The mean score of the nurses was 50.29 ± 15.36 on the ECS and 90.29 ± 29.53 on the SCCS. A statistically significant difference was found between the ECS and SCCS and gender, marital status, weekly working hours and some approaches about spiritual care (p < .05). It was determined that there was a statistically significant positive correlation between the total scales and sub-dimensions of the ECS and SCCS (p < .05). In this study, it was found that intensive care nurses' susceptibility to emotional contagion was high, and that their spiritual care competence was at a moderate level. The results show that gender, marital status, weekly working hours, type of ICU and some approaches about spiritual care are crucial factors in nurses' emotional contagion and spiritual care competence. In addition, as the intensive care nurses' susceptibility to emotional contagion increased, their spiritual care competence also increased.

Conclusions: The results of this study will guide the planning of interventions to protect intensive care nurses from the negative effects of emotional contagion and increase their spiritual care competence.

Relevance to clinical practice: It is necessary to protect intensive care nurses from the negative effects of emotional contagion and to increase their competences in spiritual care.