Intensive and Critical Care Nursing最新文献

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Treatment futility: Continuation or withdrawal of life-sustaining treatment in intensive care units 治疗无效：在重症监护室继续或撤消维持生命的治疗。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-10-22 DOI: 10.1016/j.iccn.2024.103813

引用次数: 0

Do we still need to talk about antimicrobial resistance? 我们还需要讨论抗菌药耐药性吗？

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-10-21 DOI: 10.1016/j.iccn.2024.103860

引用次数: 0

A guide to the guidelines: Closing the gap from practice guidelines to quality of care improvement in ventilator-associated pneumonia 指南指南：缩小从实践指南到呼吸机相关肺炎护理质量改进之间的差距。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-10-21 DOI: 10.1016/j.iccn.2024.103870

引用次数: 0

Non-timely and incomplete carbapenem infusions: A plea to include administration practices as a key element in antimicrobial stewardship 卡巴培南输注不及时和不完全：呼吁将管理方法作为抗菌药物管理的关键要素。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-10-21 DOI: 10.1016/j.iccn.2024.103872

引用次数: 0

Validity and reliability of the Endotracheal Suction Assessment Tool© in adult ICU patients: A methodological study 成人重症监护病房患者气管内吸入评估工具©的有效性和可靠性：方法学研究。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-10-19 DOI: 10.1016/j.iccn.2024.103862

Background

Novice nurses often find endotracheal suctioning signs unfamiliar. The Endotracheal Suction Assessment Tool© (ESAT©) aids pediatric nurses in suctioning but lacks an adult equivalent. A valid and reliable ESAT© for assessing intensive care unit patients’ suction needs across different populations is necessary.

Aim

To test the validity and reliability of the ESAT© in adult ICU patients.

Methods

This methodological study assessed suction needs in patients at a tertiary adult ICU of a university hospital. Two independent observers used the ESAT© to determine suction needs. Data from 106 suction procedures were collected using a patient characteristics form, the ESAT©, and a suction monitoring form. The ESAT© includes eight respiratory and ventilation parameters and seven clinical consideration parameters. Hemodynamic and respiratory parameters were measured before, and one and five minutes after suction. Linguistic validity, content validity, and pilot testing were conducted. Interobserver agreement was evaluated, and psychometric evaluation was done using content validity index (CVI) and intraclass correlation coefficient (ICC). Data were analyzed with paired samples t-test and ANOVA.

Results

Item CVI ranged from 0.80 to 1.00, and scale CVI was 0.96. Inter-item correlation and ICC for inter-rater reliability were both 0.933 (95 % CI = 0.903–0.954, p < 0.001 for ICC). Cohen’s Kappa coefficients ranged from 0.690 to 1.000 (p < 0.001), indicating high consistency between raters for all tool items. All scale items showed near-perfect agreement except SpO2, which showed substantial agreement.

Conclusion

The S-CVI was good, indicating near-perfect agreement among raters. ESAT© is highly reliable and valid for determining suction needs in adult intensive care patients.

Implications for Practice

The ESAT© aids autonomous decision-making for suctioning needs. Originally for novice pediatric nurses, the ESAT© was adapted for adult intensive care nurses. The ESAT© is valid and reliable for adult intensive care patients.

背景：新手护士往往对气管内吸引的体征感到陌生。气管内吸引评估工具©（ESAT©）可帮助儿科护士进行吸引，但缺乏与之对应的成人工具。目的：测试 ESAT©在成人 ICU 患者中的有效性和可靠性：这项方法学研究评估了一家大学医院三级成人重症监护病房患者的吸痰需求。两名独立观察员使用 ESAT© 确定吸痰需求。研究人员使用患者特征表、ESAT© 和吸痰监测表收集了 106 例吸痰过程的数据。ESAT© 包括八个呼吸和通气参数以及七个临床考虑参数。在吸痰前、吸痰后 1 分钟和 5 分钟测量血液动力学和呼吸参数。进行了语言有效性、内容有效性和试点测试。对观察者之间的一致性进行了评估，并使用内容效度指数（CVI）和类内相关系数（ICC）进行了心理测量学评估。数据采用配对样本 t 检验和方差分析：项目 CVI 为 0.80 至 1.00，量表 CVI 为 0.96。项目间相关性和评分者间可靠性的 ICC 均为 0.933（95 % CI = 0.903-0.954，p 结论：S-CVI 良好，表明评分者间可靠性的 ICC 为 0.933（95 % CI = 0.903-0.954，p 结论）：S-CVI 结果良好，表明评分者之间的一致性接近完美。ESAT© 在确定成人重症监护患者的吸痰需求方面具有高度可靠性和有效性：ESAT©有助于自主决定吸痰需求。ESAT© 最初是为儿科新手护士设计的，后被成人重症监护护士所采用。ESAT© 对成人重症监护患者有效且可靠。

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引用次数: 0

Effects of Wab-WPPEP on post-intensive care syndrome-family in family caregivers of heart valve replacement patients: A randomized controlled trial Wab-WPPEP 对心脏瓣膜置换术患者家庭护理人员重症监护后综合征的影响：随机对照试验

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-10-18 DOI: 10.1016/j.iccn.2024.103817

Objectives

To evaluate the effects of a WeChat applet-based whole process psychological empowerment program (Wab-WPPEP) on post-intensive care syndrome-family in family caregivers of heart valve replacement patients.

Design

Two-arm, parallel, randomized controlled clinical trial.

Settings

A tertiary general hospital in Fuzhou, China.

Methods

Participants were randomly assigned to two groups. The intervention group received Wab-WPPEP, while the control group received routine care. The intervention was implemented from ICU admission to one month post-discharge. The primary outcome was anxiety, while secondary outcomes included depression, post-traumatic stress disorder (PTSD), and quality of life. Outcomes were assessed at baseline (T0), before ICU transfer (T1), pre-discharge (T2), and one month post-discharge (T3) using standardized questionnaires. Generalized estimating equations were used to analyze the repeated-measures data.

Results

The intervention group exhibited greater improvements in anxiety (T1: β = −1.92, 95 % CI: −2.35 to −1.49, P < 0.001; T2: β = −1.66, 95 % CI: −2.03 to −1.29, P < 0.001; T3: β = −3.98, 95 % CI: −4.34 to −3.62, P < 0.001), depression (T1: β = −1.32, 95 % CI: −1.79 to −0.85, P < 0.001; T2: β = −1.70, 95 % CI: −2.08 to −1.32, P < 0.001), and quality of life (T2: β = 31.16, 95 % CI: 21.35 to 40.98, P < 0.001) compared to the routine-care group. PTSD scores were also significantly lower in the intervention group (t = −6.454, P < 0.001).

Conclusions

Wab-WPPEP significantly reduced anxiety and depression, improved quality of life, and alleviated PTSD symptoms in family caregivers of heart valve replacement patients.

Implications for clinical practice

Comprehensive psychological interventions should be implemented throughout the ICU stay and recovery period to improve family caregiver well-being.

目的评估基于微信小程序的全过程心理赋权项目（Wab-WPPEP）对心脏瓣膜置换术后患者家庭护理人员重症监护后综合征-家庭的影响：双臂、平行、随机对照临床试验：方法：将参与者随机分为两组：方法：参与者被随机分配到两组。干预组接受 Wab-WPPEP，对照组接受常规护理。干预措施从重症监护室入院到出院后一个月内实施。主要结果是焦虑，次要结果包括抑郁、创伤后应激障碍（PTSD）和生活质量。采用标准化问卷对基线（T0）、转入 ICU 前（T1）、出院前（T2）和出院后一个月（T3）的结果进行评估。采用广义估计方程分析重复测量数据：结果：干预组在焦虑方面有更大的改善（T1：β =-1.92，95 % CI：-2.35 至-1.49，P 结论：Wab-WPPEP 显著降低了患者的焦虑：Wab-WPPEP能明显减轻心脏瓣膜置换术患者家属照顾者的焦虑和抑郁，提高生活质量，减轻创伤后应激障碍症状：临床实践的启示：应在重症监护室住院和康复期间实施全面的心理干预措施，以改善家庭护理人员的福祉。

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引用次数: 0

Simulated haemodynamic parameters and different infusion set-up affect drug delivery during syringe pump change over: A bench-top study in a laboratory setting 模拟血流动力学参数和不同的输液设置会影响注射泵切换时的药物输送：实验室环境下的台式研究

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-10-17 DOI: 10.1016/j.iccn.2024.103861

Background

Infusion therapy is widely used in clinical settings, particularly in intensive care units.

Aim

to explore the influence of simulated cardiac output on “bolus” or “backflow” events that can occur during syringe pump changeover, considering several factors that have been previously outlined in published research. Syringe infusion pumps are commonly used for precise continuous intravenous drug delivery. Syringe pump changeover can be a challenging procedure.

Methods

Bench-top study in a laboratory setting. An extracorporeal circuit was used to simulate a cardiac output of 5 l/min. The following variables were used: three levels of vertical position of the syringe pump (−50 cm, 0, +50 cm), three levels of Central Venous Pressure (−5, 10, and 15 mmHg), presence/absence of carrier infusion (5 ml/h), and presence/absence of a needle-free connector between the syringe and extension line.

Results

A total of 108 syringe pump changes were performed with different combinations of the investigated variables. The mean time for syringe pump changeover was equal to 9.48 ± 2.45 s and the overall fluid displacement was 8 ± 40 µL (microlitres) (range, −262–156 µL). The CVP level and vertical position of the pump always statistically affected the overall displacement during syringe pump changeover. When a second infusion with an equal velocity rate to that of a syringe pump infusion is present in the same lumen, the presence of a needle-free device reduces the overall volume of displacement.

Conclusions

Syringe pump changeover can be a critical moment for patients when vasoactive drugs are administered.

Implications for clinical practice

In a simulated environment with a cardiac output of 5 L/min, the CVP level and vertical position of the syringe pump generated bolus or backflow events during the syringe pump changeover. The application of carrier infusion appeared to intensify these phenomena. Employing a neutral, needle-free system can potentially aid in reducing the development of boluses or backflows.

背景输液治疗广泛应用于临床环境，尤其是重症监护病房。目的探讨模拟心输出量对注射泵转换过程中可能发生的 "栓剂 "或 "回流 "事件的影响，同时考虑之前发表的研究中概述的几个因素。注射器输液泵通常用于精确连续的静脉给药。注射泵的更换可能是一个具有挑战性的过程。使用体外循环模拟 5 升/分钟的心输出量。使用了以下变量：注射泵的三个垂直位置（-50 厘米、0、+50 厘米）、三个中心静脉压（-5、10 和 15 毫米汞柱）、有无载体输注（5 毫升/小时）以及注射器和延长管之间有无无针连接器。注射泵切换的平均时间为 9.48±2.45 秒，总液体排量为 8 ± 40 µL（微升）（范围为 -262-156 µL）。在注射泵转换过程中，CVP 水平和泵的垂直位置始终对总排量有统计学影响。在心输出量为 5 升/分钟的模拟环境中，CVP 水平和注射泵的垂直位置会在注射泵转换期间产生栓塞或回流事件。应用载体输注似乎会加剧这些现象。采用中性无针系统可能有助于减少栓塞或回流的发生。

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引用次数: 0

Microaspiration in mechanically ventilated adults 机械通气成人的微呼吸

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-10-17 DOI: 10.1016/j.iccn.2024.103854

引用次数: 0

Strengthening ICU care: How policies affect staffing and patient outcomes 加强重症监护室护理：政策如何影响人员配备和患者疗效

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-10-16 DOI: 10.1016/j.iccn.2024.103859

引用次数: 0

Promoting an inclusive and humanised environment in the intensive care unit: Shift happens 在重症监护室营造包容和人性化的环境：转变

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-10-16 DOI: 10.1016/j.iccn.2024.103856

引用次数: 0

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