Intensive and Critical Care Nursing最新文献_第10页

What are the perceived barriers for nurses providing end-of-life care for patients and their families from culturally diverse backgrounds in ICU? An integrative review 在重症监护病房，护士为来自不同文化背景的患者及其家属提供临终关怀时会遇到哪些障碍？综述。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-11-20 DOI: 10.1016/j.iccn.2024.103883

Kylie O’Neill , Melissa J. Bloomer

Background

Cultural diversity is increasing worldwide. The provision of end-of-life care for people who have culturally diverse rituals, customs and beliefs can present barriers for critical care nurses in delivering high quality end-of-life care.

Aim

To synthesise research evidence about the perceived barriers for critical care nurses providing end-of-life care for patients and their families from diverse cultural backgrounds in ICU.

Research Question

What are the perceived barriers for nurses providing end-of-life care for patients and their families from culturally diverse backgrounds in ICU?

Design

Following protocol registration, a structured integrative review was undertaken across Medline, Embase, APA PsycINFO, CINAHL Complete, Cochrane library, Google Scholar and ProQuest Dissertation and Theses Global databases. A total of 823 records were independently assessed against inclusion and exclusion criteria. All included studies were assessed for quality. Narrative synthesis was used to report findings.

Results

Fifteen studies published between 2010 and 2022 were included. Findings are presented according to four themes: (i) Language and communication, (ii) (Dis) Comfort with religion, (iii) Consensus challenges and (iv) Caring at the end of life.

Conclusion

Recognising cultural diversity provides opportunity for critical care nurses to build awareness and understanding of cultural diversity as a way of optimising end-of-life care, through routine cultural assessment, advocating for professional interpreters to enhance communication and demonstrating openness to diverse cultural needs, preferences and practices.

Implications for Clinical Practice

The obvious first step in countering perceived challenges to end-of-life care is to increase awareness by acknowledging and respecting difference and diversity. Cultural assessments for all patients admitted to critical care would be an ideal first step in addressing challenges associated with cultural diversity. Greater access to professional interpreters to overcome language barriers is also essential to optimising communication and consensus in decision-making at the end of life.

背景：文化多样性在全球范围内日益增加。为具有不同文化礼仪、习俗和信仰的人提供临终关怀可能会给重症监护护士提供高质量的临终关怀带来障碍。目的：综合研究证据，说明重症监护病房中为来自不同文化背景的患者及其家属提供临终关怀的重症监护护士感知到的障碍：研究问题：重症监护病房护士为来自不同文化背景的患者及其家属提供临终关怀服务时，会遇到哪些障碍？在协议注册后，我们在 Medline、Embase、APA PsycINFO、CINAHL Complete、Cochrane library、Google Scholar 和 ProQuest Dissertation and Theses Global 数据库中进行了结构化综合综述。共根据纳入和排除标准对 823 条记录进行了独立评估。对所有纳入的研究进行了质量评估。研究结果采用叙事综合法进行报告：结果：纳入了 2010 年至 2022 年间发表的 15 项研究。研究结果按照四个主题进行阐述：(i) 语言与沟通；(ii) (Dis) 对宗教的适应；(iii) 达成共识的挑战；(iv) 临终关怀：认识到文化多样性为重症监护护士提供了机会，通过常规文化评估、倡导使用专业翻译人员以加强沟通，以及展示对不同文化需求、偏好和习俗的开放态度，建立对文化多样性的认识和理解，从而优化临终关怀：要应对临终关怀所面临的挑战，显而易见的第一步就是通过承认和尊重差异与多样性来提高意识。对所有接受重症监护的患者进行文化评估将是应对与文化多样性相关的挑战的理想的第一步。增加专业翻译人员以克服语言障碍，对于优化生命末期决策中的沟通和共识也至关重要。

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引用次数: 0

Feasibility of implementing a communication board to improve communication interactions of mechanically ventilated patients in intensive care units at one Sri Lankan hospital − A pilot randomised controlled trial 在斯里兰卡一家医院的重症监护病房实施交流板改善机械通气患者交流互动的可行性--随机对照试验。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-11-20 DOI: 10.1016/j.iccn.2024.103891

Nipuna R. Kuruppu , Wendy Chaboyer , Georgia Tobiano , Anuja Abayadeera , Kristen Ranse

Objective

To evaluate the feasibility of implementing a communication board in intensive care units in terms of participant recruitment and retention, intervention fidelity, and ability to collect patient outcome data.

Design

A prospective, two-arm, unblinded, pilot randomised controlled trial.

Research methodology

Adult, conscious, mechanically ventilated intensive care patients were recruited between August and November 2023. All participants received routine communication practices; the intervention group also received the communication board. Prior to the study, all nurses were trained on using the communication board. Patient or proxy consent was obtained. Data were collected from patients, nurses, patients’ medical records, and screening, tracking, intervention fidelity, and contamination logs.

Main outcome measures

The primary outcome data was feasibility of participant recruitment, retention, and intervention fidelity, which was recorded daily until seven days of follow-up or pre-defined trial endpoints. Secondary patient outcomes (anxiety, satisfaction, ease of communication) were assessed at recruitment and approximately 24 h after recruitment or soon after extubation, whichever occurred first.

Setting

Two intensive care units in one Sri Lankan tertiary care hospital.

Results

Of the 123 patients, 60 (75.0%) were recruited and randomised (30 control; 30 intervention). All intervention group patients received the communication board (100% intervention fidelity), and 58 (96.7%) completed the follow-up. On recruitment, 12.5% of secondary patient outcome data was missing, and 9.9% on follow-up, predominantly associated with the 10-item ease of communication scale.

Conclusions

Conducting a larger, definitive communication board trial is feasible but collecting secondary patient outcome data, especially ease of communication was challenging. Study procedures need to be refined prior to a larger trial.

Implications for clinical practice

The use of communication boards in intensive care units may improve patient-centred care for ventilated patients but requires further, high quality effectiveness trials.

目的：评估在重症监护病房实施交流板的可行性：从参与者的招募和保留、干预的忠实性以及收集患者结果数据的能力等方面，评估在重症监护病房实施沟通板的可行性：设计：前瞻性、双臂、非盲目、试验性随机对照试验：研究方法：在 2023 年 8 月至 11 月期间招募成年、神志清醒、接受机械通气的重症监护患者。所有参与者都接受了常规沟通实践；干预组还接受了沟通板。研究前，所有护士都接受了使用沟通板的培训。研究获得了患者或代理人的同意。从患者、护士、患者病历以及筛查、跟踪、干预忠实度和污染日志中收集数据：主要结果数据是参与者招募的可行性、保留率和干预的忠实性，这些数据每天记录，直到七天的随访或预设的试验终点。次要患者结果（焦虑、满意度、沟通方便程度）在招募时、招募后约 24 小时或拔管后不久（以先发生者为准）进行评估：地点：斯里兰卡一家三级医院的两个重症监护病房：在 123 名患者中，有 60 名（75.0%）被招募并随机分配（30 名对照组；30 名干预组）。所有干预组患者都接受了沟通板（干预忠实度为 100%），58 人（96.7%）完成了随访。在招募时，有12.5%的患者次要结果数据缺失，在随访时有9.9%的患者次要结果数据缺失，主要与10项沟通难易度量表有关：结论：开展一项规模更大、更具权威性的沟通委员会试验是可行的，但收集次要患者结果数据，尤其是沟通难易度数据，则具有挑战性。在进行更大规模的试验之前，需要对研究程序进行改进：对临床实践的启示：在重症监护病房使用交流板可改善以患者为中心的通气患者护理，但需要进一步开展高质量的有效性试验。

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引用次数: 0

The link between norepinephrine administration and pressure injury risk in patients with COVID-19-related ARDS – Response to Tang et al. 去甲肾上腺素用药与 COVID-19 相关 ARDS 患者压力损伤风险之间的联系 - 对 Tang 等人的回应

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-11-19 DOI: 10.1016/j.iccn.2024.103899

Farshid Rahimi-Bashar, Athanasios Chalkias, Keivan Gohari-Moghadam, Morteza Izadi, Amir Vahedian-Azimi

引用次数: 0

Sustainability in ICU: Less plastic, greener future - Letter on Eid et al. 重症监护室的可持续性：更少的塑料，更环保的未来--关于 Eid 等人的信

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-11-19 DOI: 10.1016/j.iccn.2024.103897

Alberto Lucchini, Emanuele Rezoagli, Marco Giani, Stefano Bambi

引用次数: 0

The effect of the Yakson and Gentle Human Touch methods applied to preterm infants during endotracheal aspiration on pain, comfort, and physiological parameters 早产儿在气管内吸痰时采用雅克森法和轻柔人体抚触法对疼痛、舒适度和生理参数的影响。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-11-19 DOI: 10.1016/j.iccn.2024.103898

Seda Çağlar , Şadiye Dur , Nagehan Ustabaş Yıldız , İpek Güney Varal

Background

Preterm infants in the neonatal intensive care unit are exposed to various painful procedures; thus, different non-pharmacological pain control techniques are used to alleviate pain.

Objectives

The aim of this study is to determine the effect of Yakson and Gentle Human Touch (GHT) methods during endotracheal suctioning on pain, comfort, and physiological parameters response in preterm infants.

Design

A randomised controlled crossover trial.

Setting

This study was conducted in the neonatal intensive care unit between July 2022 and June 2023.

Methods

Thirty infants were included in this study based on inclusion criteria. The samples randomly received a sequence of suctioning with Yakson and GHT and routine care. Neonatal Pain Agitation and Sedation Scale (N-PASS) and COMFORTneo were used to collect the data.

Results

The pain and comfort scores of preterm infants who received GHT and Yakson touch during and after endotracheal suctioning were statistically significantly lower than the infants in the routine care (p < 0.001). It was determined that the difference was in favour of the Yakson group (p < 0.001). The infants who received GHT and Yakson application had lower heart rates and higher oxygen saturation levels after the application compared to the control group (p < 0.001).

Conclusion

The application of Yakson and GHT during endotracheal aspiration in preterm infants has been found to be effective in pain and comfort management, as well as in the regulation of physiological parameters.

背景：新生儿重症监护室中的早产儿会经历各种疼痛过程，因此采用了不同的非药物止痛技术来减轻疼痛：本研究旨在确定在气管内吸痰过程中，雅克森法和轻柔人体抚触法（GHT）对早产儿疼痛、舒适度和生理参数反应的影响：随机对照交叉试验：本研究于 2022 年 7 月至 2023 年 6 月期间在新生儿重症监护室进行：根据纳入标准，30 名婴儿被纳入本研究。这些样本随机接受了雅克森和 GHT 抽吸以及常规护理的顺序。采用新生儿疼痛、激动和镇静量表（N-PASS）和COMFORTneo收集数据：结果：在气管内吸痰过程中和吸痰后，接受 GHT 和 Yakson 触摸的早产儿的疼痛和舒适度评分在统计学上明显低于接受常规护理的早产儿（P 结论：GHT 和 Yakson 触摸的早产儿的疼痛和舒适度评分在统计学上明显低于接受常规护理的早产儿：在早产儿气管内吸痰期间应用雅克森和 GHT 对减轻疼痛和舒适感以及调节生理参数非常有效。

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引用次数: 0

The role of inclusive leadership in optimizing patient-centered care among ICU nurses 包容性领导力在优化重症监护室护士以患者为中心的护理中的作用。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-11-19 DOI: 10.1016/j.iccn.2024.103900

Daniel Joseph E. Berdida, Rizal Angelo N. Grande

引用次数: 0

Survival rates with favorable neurological outcomes after in-hospital and out-of-hospital cardiac arrest: A prospective cohort study 院内和院外心脏骤停后神经功能良好的存活率：前瞻性队列研究。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-11-19 DOI: 10.1016/j.iccn.2024.103889

Ali AIT Hssain , Athanasios Chalkias , Amir Vahedian-Azimi , Hussam Elmelliti , Ans Alamami , Rabee Tawel , Marwa Morgom , Fatima Jamal Ullah , Rida Arif , Murad Mehmood , Hamas El Melliti , Mohamad Talal Basrak , Anzila Akbar , Abdulsalam Saif Ibrahim

Objectives

To evaluate the survival rates with favorable neurological outcomes among patients who experienced in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA).

Design

This prospective cohort study assessed 554 adult patients with IHCA or OHCA referred to Hamad General Hospital, Qatar, between February 2015 and November 2021. Neurologic outcomes were measured using the Cerebral Performance Category (CPC) score. Survival rate and neurologic status were re-evaluated at 28 days, hospital discharge, and one year after cardiac arrest (CA).

Findings

For all participants, the hospital discharge and one-year survival rates with a favorable neurological outcome (CPC ≤ 2) were 18.5 % and 19.5 %, respectively. Specifically, among patients with IHCA, the rates were 20.5 % and 19 %, while in patients with OHCA, the rates were 16.4 % and 19.9 %, respectively. Multivariate regression analysis indicated that factors male sex (OR: 2.129, 95 % CI: 1.168–3.881, P = 0.014), initial shockable rhythm (OR: 1.691, 95 % CI: 1.024–2.788, P = 0.041), and the use of ECPR (OR: 1.944, 95 % CI: 1.178–3.209, P = 0.009) were associated with increased likelihood of survival with favorable neurological outcomes at 28 days. Conversely, older age, presence of comorbidities, infection, higher APACHE II score, longer hospital stays, and undergoing tracheostomy were linked to decreased chances of survival with favorable neurological outcomes at different time points.

Conclusion

Survival with good neurological outcomes after OHCA was 20.3 %, 16.4 %, and 19.9 % at 28 days, hospital discharge, and one year, respectively. Among patients with IHCA, survival with good neurological outcomes was 20.5 %, 20.5 %, and 19 % at 28 days, hospital discharge, and one year, respectively.

Implications for Clinical Practice

Care of CA patients in a cardiac arrest center is associated with improved long-term survival with favorable neurological outcomes. Prioritizing early intervention for shockable rhythms and utilizing ECPR where appropriate could enhance patient prognosis.

目的评估院内心脏骤停（IHCA）和院外心脏骤停（OHCA）患者的存活率和良好的神经系统预后：这项前瞻性队列研究评估了2015年2月至2021年11月期间转诊至卡塔尔哈马德总医院的554名IHCA或OHCA成人患者。神经功能结果采用脑功能分类（CPC）评分进行测量。在心脏骤停（CA）后 28 天、出院和一年时重新评估存活率和神经系统状况：在所有参与者中，神经功能良好（CPC ≤ 2）的出院存活率和一年存活率分别为 18.5 % 和 19.5 %。其中，IHCA 患者的出院率和一年存活率分别为 20.5% 和 19%，而 OHCA 患者的出院率和一年存活率分别为 16.4% 和 19.9%。多变量回归分析表明，男性性别（OR：2.129，95 % CI：1.168-3.881，P = 0.014）、初始可电击心律（OR：1.691，95 % CI：1.024-2.788，P = 0.041）和使用 ECPR（OR：1.944，95 % CI：1.178-3.209，P = 0.009）等因素与患者在 28 天内存活并获得良好神经功能结果的可能性增加有关。相反，年龄较大、存在合并症、感染、APACHE II评分较高、住院时间较长以及接受气管切开术与不同时间点良好神经预后的存活率降低有关：结论：OHCA 患者在 28 天、出院和一年后神经功能良好的存活率分别为 20.3%、16.4% 和 19.9%。在 IHCA 患者中，28 天、出院和一年后神经功能良好的存活率分别为 20.5%、20.5% 和 19%：临床实践的启示：在心脏骤停中心救治心脏骤停患者可提高长期存活率，并获得良好的神经系统预后。优先考虑对可电击心律进行早期干预，并在适当的情况下使用 ECPR 可以改善患者的预后。

{"title":"Survival rates with favorable neurological outcomes after in-hospital and out-of-hospital cardiac arrest: A prospective cohort study","authors":"Ali AIT Hssain , Athanasios Chalkias , Amir Vahedian-Azimi , Hussam Elmelliti , Ans Alamami , Rabee Tawel , Marwa Morgom , Fatima Jamal Ullah , Rida Arif , Murad Mehmood , Hamas El Melliti , Mohamad Talal Basrak , Anzila Akbar , Abdulsalam Saif Ibrahim","doi":"10.1016/j.iccn.2024.103889","DOIUrl":"10.1016/j.iccn.2024.103889","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the survival rates with favorable neurological outcomes among patients who experienced in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA).</div></div><div><h3>Design</h3><div>This prospective cohort study assessed 554 adult patients with IHCA or OHCA referred to Hamad General Hospital, Qatar, between February 2015 and November 2021. Neurologic outcomes were measured using the Cerebral Performance Category (CPC) score. Survival rate and neurologic status were re-evaluated at 28 days, hospital discharge, and one year after cardiac arrest (CA).</div></div><div><h3>Findings</h3><div>For all participants, the hospital discharge and one-year survival rates with a favorable neurological outcome (CPC ≤ 2) were 18.5 % and 19.5 %, respectively. Specifically, among patients with IHCA, the rates were 20.5 % and 19 %, while in patients with OHCA, the rates were 16.4 % and 19.9 %, respectively. Multivariate regression analysis indicated that factors male sex (OR: 2.129, 95 % CI: 1.168–3.881, P = 0.014), initial shockable rhythm (OR: 1.691, 95 % CI: 1.024–2.788, P = 0.041), and the use of ECPR (OR: 1.944, 95 % CI: 1.178–3.209, P = 0.009) were associated with increased likelihood of survival with favorable neurological outcomes at 28 days. Conversely, older age, presence of comorbidities, infection, higher APACHE II score, longer hospital stays, and undergoing tracheostomy were linked to decreased chances of survival with favorable neurological outcomes at different time points.</div></div><div><h3>Conclusion</h3><div>Survival with good neurological outcomes after OHCA was 20.3 %, 16.4 %, and 19.9 % at 28 days, hospital discharge, and one year, respectively. Among patients with IHCA, survival with good neurological outcomes was 20.5 %, 20.5 %, and 19 % at 28 days, hospital discharge, and one year, respectively.</div></div><div><h3>Implications for Clinical Practice</h3><div>Care of CA patients in a cardiac arrest center is associated with improved long-term survival with favorable neurological outcomes. Prioritizing early intervention for shockable rhythms and utilizing ECPR where appropriate could enhance patient prognosis.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103889"},"PeriodicalIF":4.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683967","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}

引用次数: 0

Kotter’s 8-step change model to improve hand hygiene compliance in intensive care unit: A 41-month prospective longitudinal quality improvement study 科特的 8 步变革模式改善重症监护病房手部卫生依从性：为期 41 个月的前瞻性纵向质量改进研究。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-11-18 DOI: 10.1016/j.iccn.2024.103877

Fen Hu , Ying Wang , Rui Cao , Chang Hu , Bilong Feng , Jin Li , Xinbo Ding , Jing Ma , Huilin Li , Pei Wang , Ying Xu , Dandan Xu , Juanjuan Pei , Xiaoping Zhu , Jie Chen , Ke Liang , Zhiyong Peng , Kianoush Kashani , Bo Hu , Yufeng Yuan

Background

Despite numerous studies assessing bundled interventions to enhance hand hygiene compliance (HHC), compliance rates persist at suboptimal levels. Our objective was to employ Kotter’s Change Model (KCM) to enhance HHC and conduct a comprehensive process evaluation among medical staff within the intensive care unit (ICU).

Methods

KCM was implemented at the ICU of Zhongnan Hospital of Wuhan University from March 2018 to August 2021, with a 41-month longitudinal monitoring of HHC. The primary outcome focused on the absolute monthly change in HHC. Secondary outcomes encompassed the HHC characteristics across different phases, varying trends in HHC concerning different hand hygiene opportunities and occupations, quarterly incidences of central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI).

Results

This study included 20,222 hand hygiene actions and 24,195 opportunities. The overall HHC was 83.58 % (95 %CI, 83.11 %-84.04 %). Following the KCM implementation, HHC surged from 35.71 % (95 % CI, 22.99 %–50.83 %) to 87.75 % (95 % CI, 85.53 %–89.67 %), reflecting a notable increase of 145.73 %. The most rapid growth in HHC occurred post-patient contact, elevating from 35.29 % to 89.8 %. Despite escalating patient numbers and treatment complexities annually, the quarterly rates of CLABSI (0 ‰–3.53 ‰) and CAUTI (0.96 ‰-4.26 ‰) remained consistently low.

Conclusion

Utilizing KCM systematically alters healthcare providers’ perception of hand hygiene, fostering an environment that advocates for and sustains improved HHC among ICU personnel.

Implications for clinical practice

The Kotter’s change model can be an effective framework for healthcare organizations to systematically improve and maintain hand hygiene compliance among healthcare providers, which can in turn help reduce healthcare-associated infections.

背景：尽管有许多研究评估了旨在提高手部卫生依从性（HHC）的捆绑干预措施，但依从率仍处于不理想的水平。我们的目标是采用科特变革模型（KCM）来提高手卫生依从性，并对重症监护病房（ICU）内的医务人员进行全面的过程评估：方法：2018 年 3 月至 2021 年 8 月，武汉大学中南医院 ICU 实施了 KCM，对 HHC 进行了为期 41 个月的纵向监测。主要结果是 HHC 的绝对月变化。次要结果包括不同阶段的HHC特征、不同手卫生机会和职业的HHC变化趋势、中心静脉相关血流感染（CLABSI）和导管相关尿路感染（CAUTI）的季度发病率：这项研究包括 20,222 次手卫生行动和 24,195 次机会。总体 HHC 为 83.58 %（95 %CI，83.11 %-84.04 %）。实施 KCM 后，HHC 从 35.71 %（95 % CI，22.99 %-50.83 %）飙升至 87.75 %（95 % CI，85.53 %-89.67 %），显著增加了 145.73 %。HHC 的增长速度最快，从接触病人后的 35.29% 上升到 89.8%。尽管患者人数和治疗复杂性每年都在增加，但 CLABSI（0 ‰-3.53 ‰）和 CAUTI（0.96 ‰-4.26 ‰）的季度发生率始终保持在较低水平：结论：利用 KCM 系统性地改变了医疗服务提供者对手卫生的认识，营造了一种倡导并维持 ICU 人员改善手卫生的环境：科特变革模型可以作为医疗机构的有效框架，系统地改善和维持医疗服务提供者的手部卫生依从性，进而帮助减少医疗相关感染。

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引用次数: 0

Effect size estimates of risk factors for post-intensive care syndrome: A systematic review and meta-analysis 重症监护后综合征风险因素的效应大小估计：系统回顾和荟萃分析。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-11-18 DOI: 10.1016/j.iccn.2024.103888

Shuang Gao , Xifeng Liang , Zhixiu Pan , Xiuping Zhang , Liwen Zhang

Objective

To provide updated evidence on the risk factors and accurately quantify the effect size of the risk factors associated with post-intensive care syndrome (PICS), encompassing cognitive, mental, physical and socio-economic domains.

Research methodology

We conducted a systematic review of literature from January 2010 to October 2023. The meta-analysis was conducted to calculate an effect size for every risk factor, and odds ratio and 95% confidence intervals were used as summary statistics.

Results

Of 67,468 retrieved studies, 160 were included in qualitative synthesis, 102 were included in quantitative synthesis. A total of 60 factors were identified, categorized into 17 person-related, 23 disease-related and 20 ICU-related categories. The strongest correlations with cognitive health were observed for previous cognitive problems, sedatives and delirium. Factors most strongly correlated with mental health included previous mental problems, delirium, lack of social support, illicit drug and bad experience in ICU. The strongest correlations with physical health involved previous mental problem, delirium, organ dysfunction of neurologic and respiratory support. For socio-economic domains, older age and female were identified as significant risk factors.

Conclusions

This systematic review and meta-analysis identified and quantified the person, disease, and ICU-related risk factors associated with PICS. These findings may enable clinicians to better recognize the patient at high risk for PICS at an early stage during their stay in ICU.

Implications for clinical practice

A thorough investigation of risk factors across the four domains of PICS is necessary to gain a holistic understanding.

The identification and integration of risk factors associated with PICS empower critical care multidisciplinary teams to optimize management strategies, thereby assisting ICU survivors a better recovery.

Since multiple risk factors may be simultaneously associated with the four domains of post-intensive care syndrome, it is imperative to develop a comprehensive prediction algorithm.

目的：提供与重症监护后综合征（PICS）相关的风险因素的最新证据，并准确量化与重症监护后综合征（PICS）相关的风险因素的效应大小，包括认知、精神、身体和社会经济领域：我们对 2010 年 1 月至 2023 年 10 月期间的文献进行了系统回顾。研究方法：我们对 2010 年 1 月至 2023 年 10 月的文献进行了系统综述，通过荟萃分析计算了每个风险因素的效应大小，并使用几率比和 95% 置信区间作为汇总统计：在检索到的 67468 项研究中，160 项被纳入定性综合，102 项被纳入定量综合。共确定了 60 个因素，分为 17 个与人相关、23 个与疾病相关和 20 个与重症监护病房相关的类别。与认知健康相关性最强的是既往认知问题、镇静剂和谵妄。与心理健康相关性最强的因素包括既往的心理问题、谵妄、缺乏社会支持、非法药物和在重症监护室的不良经历。与身体健康关系最密切的因素包括既往精神问题、谵妄、神经和呼吸支持器官功能障碍。在社会经济领域，年龄较大和女性被认为是重要的风险因素：本系统综述和荟萃分析确定并量化了与 PICS 相关的个人、疾病和 ICU 相关风险因素。这些发现可帮助临床医生在病人入住重症监护病房的早期阶段更好地识别PICS的高风险病人：对临床实践的启示：为了全面了解 PICS，有必要对其四个领域的风险因素进行彻底调查。识别并整合与 PICS 相关的风险因素，可帮助重症监护多学科团队优化管理策略，从而帮助 ICU 幸存者更好地康复。由于多种风险因素可能同时与重症监护后综合征的四个领域相关，因此开发一种全面的预测算法势在必行。

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引用次数: 0

The link between norepinephrine administration and pressure injury risk in patients with COVID-19-related ARDS - Letter on Mahmoodpoor et al. 去甲肾上腺素用药与 COVID-19 相关 ARDS 患者压力损伤风险之间的联系 - 致 Mahmoodpoor 等人的信

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-11-10 DOI: 10.1016/j.iccn.2024.103865

Wei-Zhen Tang, Wei-Ze Xu, Run-Ren Pan, Hong-Yu Xu, Tai-Hang Liu

引用次数: 0