Intensive and Critical Care Nursing最新文献

{"title":"Prevalence and risk factors of subsyndromal delirium in ICU: A systematic review and meta-analysis","authors":"","doi":"10.1016/j.iccn.2024.103834","DOIUrl":"10.1016/j.iccn.2024.103834","url":null,"abstract":"<div><h3>Objective</h3><p>To systematically assess the prevalence and risk factors for subsyndromal delirium (SSD) in the intensive care unit.</p></div><div><h3>Design</h3><p>A systematic review<!--> <!-->and <em>meta</em>-analysis.</p></div><div><h3>Methodology</h3><p>This systematic review and <em>meta</em>-analysis was conducted in eight databases, including PubMed, Web of Science, Ovid,<!--> <!-->Scopus, China Knowledge Resource Integrated Database, Wanfang Database,<!--> <!-->Weipu Database and Chinese Biomedical Database. All original observational studies of subsyndromal delirium in the ICU were included, with languages limited to English and Chinese. The methodological quality was assessed by the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality recommendation checklist. Meta-analysis was performed using Stata software (version 18.0).</p></div><div><h3>Result</h3><p>A total of 27 studies involving 7,286 participants were included in this review. The pooled prevalence of SSD was 32.4 % (95 %CI: 27.1 %-37.7 %).<!--> <!-->Fourteen studies reported 34 independent risk factors, and the following ten factors were significantly associated with SSD: older age, higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score, lower Mini-mental Status Examination (MMSE) score, pain, mechanical ventilation, hypoproteinemia, blood transfusion, longer ICU stay, infection, and physical restraint.</p></div><div><h3>Conclusion</h3><p>We conducted a systematic review and <em>meta</em>-analysis to evaluate the prevalence of SSD in the ICU and identified 10 risk factors associated with SSD. However, the studies have significant heterogeneity, future research should be conducted in multicenter with large samples to strengthen the current evidence.</p></div><div><h3>Implications for clinical practice</h3><p>Subsyndromal delirium is a frequently occurring adverse event in the ICU, so it is recommended that clinicians and nurses incorporate the assessment of SSD into their daily routine. In this study, we also identified ten risk factors associated with SSD, and some of which could be modified or intervened. These findings provide a basis for ICU medical staff to identify patients at high risk of SSD and then implement individualized interventions to reduce the prevalence of SSD.</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prone position in the post COVID-19 era: Old lessons and new challenges for intensive care nurses","authors":"","doi":"10.1016/j.iccn.2024.103837","DOIUrl":"10.1016/j.iccn.2024.103837","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142240805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of new lighting technology versus traditional fluorescent bulbs on sedation and delirium in the ICU","authors":"","doi":"10.1016/j.iccn.2024.103833","DOIUrl":"10.1016/j.iccn.2024.103833","url":null,"abstract":"<div><h3>Background</h3><p>Critically ill patients frequently encounter disruptions in their circadian rhythms in the intensive care unit (ICU) environment. New lighting systems have been developed to enhance daytime light levels and to promote circadian alignment.</p></div><div><h3>Objectives</h3><p>To investigate the impact of implementing an innovative lighting technology that mimics natural light and reproduce the colour of the sky.</p></div><div><h3>Design</h3><p>Prospective, observational, non-randomized comparative trial. ICU patients were exposed to either a cutting-edge lighting system based on new technology (intervention group) or a conventional lighting system using fluorescent bulbs (control group).</p></div><div><h3>Setting</h3><p>An Italian intensive care unit with ten beds and five windowless rooms, thereby denying access to natural light. Three rooms had new lighting technology.</p></div><div><h3>Main Outcome Measures</h3><p>The two groups were compared to assess the prevalence or absence of delirium and the need for sedatives during ICU stay. The secondary aim was to assess the presence of anxiety, depression, and post-traumatic stress disorder in patients at 3, 6, and 12 months after ICU discharge.</p></div><div><h3>Results</h3><p>86 patients were included: 52 (60 %) in the intervention group and 34 (40 %) in the control group. Seventy-nine patients (82 %) were alive at ICU discharge. Fourteen patients (16 %) developed delirium (intervention group: n = 8 [15 %] vs. control group: n = 6 [18 %] in the control group, (P=0.781). The use of sedative drugs and neuromuscular blocking agents was similar in both the groups. No differences in the incidence of anxiety, depression, or post-traumatic stress disorders were observed among patients who underwent follow-up visits.</p></div><div><h3>Conclusions</h3><p>Compared to traditional fluorescent tube lighting, the innovative lighting system did not provide any significant benefit in reducing the frequency of delirium or the necessity for sedative medications.</p></div><div><h3>Implications for Clinical Practice</h3><p>A single intervention, the use of lights that mimic sunny light and the sky, did not result in a statistically significant reduction in the incidence of delirium. Delirium has a multifactorial aetiology, necessitating interventions that are multifaceted and address different domains.</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Perme ICU Physical Competency Assessment – Response to Javaid et al.","authors":"","doi":"10.1016/j.iccn.2024.103838","DOIUrl":"10.1016/j.iccn.2024.103838","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educational interventions reduce the severity of Post Intensive Care Syndrome-Family – Response to Rahimi-Bashar et al.","authors":"","doi":"10.1016/j.iccn.2024.103836","DOIUrl":"10.1016/j.iccn.2024.103836","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moving on from a “good death”: Child- and family-centred end-of-life care in paediatric critical care","authors":"","doi":"10.1016/j.iccn.2024.103832","DOIUrl":"10.1016/j.iccn.2024.103832","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0964339724002179/pdfft?md5=6f9d7d25f7b497e4ca37cb8f0ad3b075&pid=1-s2.0-S0964339724002179-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142240806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice and confidence in electrocardiogram interpretation among ICU nurses: A cross-sectional study","authors":"","doi":"10.1016/j.iccn.2024.103835","DOIUrl":"10.1016/j.iccn.2024.103835","url":null,"abstract":"<div><h3>Objectives</h3><p>This study aimed to determine practice and confidence in electrocardiogram (ECG) interpretation among intensive care unit (ICU) nurses in Fujian Province, China, and identify predictors of ECG interpretation practice.</p></div><div><h3>Research methodology/design</h3><p>A quantitative cross-sectional study was conducted between October 2021 and December 2021 among 357 respondents.</p></div><div><h3>Setting</h3><p>Conducted online at twenty-one hospitals in all nine cities of Fujian Province.</p></div><div><h3>Main outcome measures</h3><p>Purposive and convenient sampling techniques were employed in selecting hospitals and respondents, respectively. A validated and pre-tested Chinese version of the questionnaire was used in data collection. We conducted binary logistic regression to identify the predictors of ICU nurses’ ECG interpretation practice, and linear regression to analyze the relationship between ECG interpretation practice and confidence. We considered statistically significant a p-value &lt; 0.05.</p></div><div><h3>Results</h3><p>The practice mean score of the respondents was 5.54 (SD = 2.26) out of 10 points, and only 2.2 % of nurses correctly interpreted all the patient ECG strips. Few ICU nurses (25.5 %) had good ECG interpretation practice, with a confidence mean score of 2.02 (SD = 0.99) out of 4 points in their overall ability to interpret patient ECG strips. Currently working unit in comparison to cardiac ICU (emergency ICU: AOR = 5.71, 95 % CI: 1.84–17.75); previous ECG training (AOR = 2.02, 95 % CI: 1.10–3.70); source of ECG training (university/school) (AOR = 2.02, 95 % CI: 1.12–3.65); and ECG knowledge (AOR = 16.18, 95 % CI: 7.43–35.25) were significantly associated with the ECG interpretation practice.</p></div><div><h3>Conclusions</h3><p>ICU nurses’ ECG interpretation practice in the current study was relatively poor. An ECG education program is recommended to impart ICU nurses with basic ECG knowledge for enhancing good ECG interpretation practice and confidence in nursing care provision.</p></div><div><h3>Implications for clinical practice</h3><p>Good ECG interpretation skills are paramount among ICU nurses for better patient outcomes. ECG knowledge among ICU nurses is an important predictor of effective ECG monitoring for cardiac arrhythmias. Therefore, frequent, continuouszgood practice and boost confidence in the provision of quality nursing care.</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory effort in mechanical ventilation weaning Prediction: An observational, case-control study","authors":"","doi":"10.1016/j.iccn.2024.103831","DOIUrl":"10.1016/j.iccn.2024.103831","url":null,"abstract":"<div><h3>Background</h3><p>The diaphragm is crucial for ventilator weaning, but its specific impact on weaning indicators needs further clarification. This study investigated the variability in weaning outcomes across different diaphragm function populations and the value of respiratory drive and inspiratory effort in weaning.</p></div><div><h3>Methods</h3><p>This observational case-control study enrolled patients on mechanical ventilation for more than 48 h and completed a 30-minute spontaneous breathing trial (SBT) with pressure-support ventilation for the first time. After the SBT, airway pressure at 100 ms during occlusion (P_0.1), inspiratory effort, and diaphragmatic ultrasound were evaluated to predict weaning outcomes. Weaning failure was defined as re-intubation within 48 h of weaning, the need for therapeutic non-invasive ventilation, or death.</p></div><div><h3>Results</h3><p>68 patients with a mean age of 63.21 ± 15.15 years were included. In patients with diaphragm thickness (DT) ≥ 2 mm, P_0.1 (<em>P</em>=0.002), pressure-muscle index (PMI) (<em>P</em>=0.012), and occluded expiratory airway pressure swing (ΔP_occ) (<em>P</em>=0.030) were significantly higher in those who failed weaning. Conversely, for patients with DT&lt;2 mm, PMI (<em>P</em>=0.003) and ΔP_occ (<em>P</em>=0.002) were lower in the weaning failure group. Additionally, within the DT≥2 mm group, P_0.1 demonstrated a higher area under the curve (AUC) for weaning prediction (0.889 vs. 0.739) compared to those with DT&lt;2 mm.</p></div><div><h3>Conclusions</h3><p>PMI and ΔP_occ are predictive of weaning outcomes in patients with diaphragm thickness ≥ 2 mm, where the assessment value of P_0.1 is notably higher. Diaphragm function significantly influences the accuracy of weaning predictions based on respiratory drive and inspiratory effort.</p></div><div><h3>Implications for Clinical Practice</h3><p>Our findings indicate that the effectiveness of respiratory drive and inspiratory effort in predicting successful weaning from mechanical ventilation may vary across different patient populations. Diaphragm function plays a crucial role in weaning assessments, particularly when using P_0.1, the pressure-muscle index (PMI), and occluded expiratory airway pressure swing (ΔP_occ).</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0964339724002167/pdfft?md5=d0e5a2d9b0ae4e047e9d457bcbe1fb92&pid=1-s2.0-S0964339724002167-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Music as healing in ICU survivors: The road ahead in seeking the right tone","authors":"","doi":"10.1016/j.iccn.2024.103828","DOIUrl":"10.1016/j.iccn.2024.103828","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Objective assessment of nursing workload in an intermediate care unit: A prospective observational study","authors":"","doi":"10.1016/j.iccn.2024.103767","DOIUrl":"10.1016/j.iccn.2024.103767","url":null,"abstract":"<div><h3>Objectives</h3><p>To systematically assess the nursing workload in an Intermediate Care Unit.</p></div><div><h3>Design</h3><p>Single-centre prospective observational study. The nursing activities within the initial 72 h of hospitalization were recorded on a prespecified chart and standardized as activities/5 min/patient/day.</p></div><div><h3>Setting</h3><p>This study was conducted at the Intermediate Care Unit of the Altovicentino Hospital (Italy) from September 1 to December 31, 2022.</p></div><div><h3>Main outcome measure</h3><p>We considered working overload as an average number of nursing activities/5 min/patient/day higher than the 85th percentile and investigated independent risk factors associated with it.</p></div><div><h3>Results</h3><p>A total of 183 patients were included. During their hospital stay, the average number of nursing activities per patient was 30 per 5-minute interval per day (range: 22–40). On the first day of hospitalization, the primary activities were predominantly administrative and managerial tasks. In contrast, on the second day, activities related to therapeutic management and primary care predominated. Various scores related to the patient’s condition, including comorbidity, functionality, frailty, intensity, and severity, were analyzed for their association with nursing workload using multivariate analysis. However, only the National Early Warning Score was found to be an independent risk factor for nursing workload overload (OR 1.399, 95 % CI 1.205–1.624, p &lt; 0.001).</p></div><div><h3>Conclusion</h3><p>The study results demonstrated a significant variation in nursing workload within the same department. Subsequent studies are necessary to confirm the ability of the National Early Warning Score in predicting nursing over workload.</p></div><div><h3>Implication for clinical practice</h3><p>This study provides a detailed analysis of nursing workload in intermediate care settings, emphasizing the need for adequate resource allocation due to the potential for rapid deterioration in patients’ conditions. By correlating nursing activities with patient severity indices, such as the National Early Warning Score, the findings support more effective organizational strategies to enhance care for patients at high risk of health decline.</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142158055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}