Intensive and Critical Care Nursing最新文献

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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

Annette M. Bourgault, Gennaro De Pascale, Mary Lou Sole

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

Mu-Hsing Ho, Andrea Glotta, Arnaud Bruyneel

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

Emilio Rodriguez-Ruiz , Jos M. Latour , Margo M.C. van Mol

引用次数: 0

Pressure ulcer risk assessment in the ICU: The importance of balancing systemic and body-site specific risk factors 重症监护病房的压疮风险评估：平衡全身性风险因素和特定体位风险因素的重要性

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-10-16 DOI: 10.1016/j.iccn.2024.103857

Tim Torsy, Brecht Serraes, Dimitri Beeckman

引用次数: 0

Nursing during ECMO: Learning from the past, thinking about the future ECMO 期间的护理：学习过去，思考未来。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-10-07 DOI: 10.1016/j.iccn.2024.103843

Alessandro Galazzi , Flippo Binda , Alberto Lucchini

引用次数: 0

Quantifying inspiratory effort: a future challenge for ICU nurses? 量化吸气量：重症监护室护士的未来挑战？

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-10-07 DOI: 10.1016/j.iccn.2024.103844

Enrico Bulleri, Stefano Bambi, Alberto Lucchini

引用次数: 0

Using electronic health records to classify risk for adverse safety events with ICU patient Mobility: A Cross-Sectional study 使用电子健康记录对重症监护病房患者流动性的不良安全事件风险进行分类：一项横断面研究。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-10-07 DOI: 10.1016/j.iccn.2024.103845

Anna Krupp , Kelly Potter , Linder Wendt , Karen Dunn Lopez , Heather Dunn

Background

Integrating early mobility (EM) expert consensus recommendations into an algorithm that uses electronic health record (EHR) data provides an opportunity for ICU nurse decision support.

Objective

This study aimed to compare clinical differences in ICU EM algorithm domains among patients with and without documented EM and examine discordance between algorithm classification and documented EM.

Methods

Secondary analysis of EHR data from adults admitted to the ICU from one health system’s electronic data warehouse. We extracted demographic, clinical, and EM data for up to the first three days after ICU admission and applied the algorithm to classify patients as low/high-risk by clinical domain (respiratory, cardiovascular, neurological, activity order, overall) each day. We used the Wilcoxon rank sum test or Fisher’s exact test to compare clinical criteria and algorithm classification between patients with and without documented EM.

Results

From a total of 4,088 patients, documented EM increased each ICU day. Patients with EM were more likely to be classified by the algorithm as low-risk than those who stayed in bed each day. While a large proportion of low-risk patients remained in bed each day (813 day 1; 920 day 2; 881 day 3), some patients classified as high-risk had documented EM.

Conclusions

A significant portion of patients identified as overall low-risk by the algorithm remained in bed, while some high-risk patients achieved EM. Variability between risk definitions and documented patient activity exists and understanding additional factors that nurses use to support EM decision-making is needed.

Implications for clinical practice

EHR data can be used with a mobility algorithm to classify patients at low and high-risk for ICU EM. In the future, with additional refinements, an algorithm may augment clinician decision-making.

背景：将早期移动性（EM）专家共识建议整合到使用电子健康记录（EHR）数据的算法中，为ICU护士决策支持提供了机会：本研究旨在比较有记录和无记录的EM患者在ICU EM算法领域的临床差异，并检查算法分类与有记录的EM之间的不一致性：对某医疗系统电子数据仓库中入住重症监护室的成人电子病历数据进行二次分析。我们提取了重症监护室入院后头三天的人口统计学、临床和EM数据，并应用该算法按临床领域（呼吸、心血管、神经、活动顺序、总体）将每天的患者分为低危/高危。我们使用Wilcoxon秩和检验或费雪精确检验来比较有记录和无记录的EM患者的临床标准和算法分类：结果：在总共 4088 名患者中，有记录的急性心肌梗死患者每天都在增加。与每天卧床的患者相比，有EM的患者更有可能被算法归类为低风险患者。虽然大部分低风险患者每天都卧床休息（第1天813人；第2天920人；第3天881人），但一些被归类为高风险的患者也有EM记录：结论：算法确定为总体低风险的患者中有很大一部分仍留在床上，而一些高风险患者则实现了EM。风险定义与记录的患者活动之间存在差异，因此需要了解护士用于支持急诊决策的其他因素：对临床实践的启示：电子病历数据可与移动性算法一起用于ICU EM低风险和高风险患者的分类。未来，在进一步完善后，该算法可增强临床医生的决策能力。

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引用次数: 0

Epidemiology and outcomes of patients with tuberculosis requiring extracorporeal membrane oxygenation: An ELSO registry analysis 需要接受体外膜肺氧合治疗的肺结核患者的流行病学和治疗效果：ELSO 登记分析。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-10-07 DOI: 10.1016/j.iccn.2024.103841

Ali AIT Hssain , Amir Vahedian-Azimi , Matthieu Schmidt , Abdulsalam Saif Ibrahim , Kollengode Ramanathan , Ibrahim Fawzy Hassan , Amirhossein Sahebkar

Purpose

This study aimed to analyze data from the Extracorporeal Life Support Organization (ELSO) registry to elucidate the epidemiology and outcomes of patients with tuberculosis necessitating extracorporeal membrane oxygenation (ECMO), an intervention typically employed in treating severe acute respiratory distress syndrome (ARDS), but infrequently reported in tuberculosis contexts.

Methods

A retrospective analysis was conducted utilizing the ELSO registry data spanning from 2003 to 2022, specifically targeting patients with tuberculosis who underwent ECMO. Primary outcomes included survival to hospital discharge, while secondary outcomes encompassed pre-ECMO support, ECMO duration, complications, and discharge destinations. Univariate and multivariate Cox proportional hazard regression analyses were employed to identify factors influencing survival rates.

Results

The analysis included 169 patients with tuberculosis, with a median ECMO support duration of 233 h. The weaning success rate was recorded at 62.7 %, and 55 % of patients achieved survival to hospital discharge. Complications arose in 69.8 % of cases, predominantly mechanical complications (46.6 %). Multivariate Cox regression analysis identified complications (HR: 0.448, 95 % CI: 0.222–0.748, P=0.001), infections (HR: 0.483, 95 % CI: 0.241–0.808, P=0.001), and prolonged intervals from admission to ECMO initiation (HR: 0.698, 95 % CI: 0.396–0.901, P=0.018) as significant factors correlated with decreased survival likelihood.

Conclusion

ECMO presents as a viable treatment option for patients with tuberculosis; however, timely initiation and meticulous management are critical to mitigate complications and enhance patient outcomes.

Implication for clinical practice

Accurate identification of optimal ECMO initiation timing for eligible patients with tuberculosis can significantly enhance clinical outcomes in critical care settings, such as intensive care units.

目的：本研究旨在分析体外生命支持组织（ELSO）登记处的数据，以阐明需要接受体外膜肺氧合（ECMO）治疗的肺结核患者的流行病学和治疗效果：方法：我们利用 2003 年至 2022 年的 ELSO 登记数据进行了一项回顾性分析，特别针对接受 ECMO 的结核病患者。主要结果包括出院存活率，次要结果包括ECMO前支持、ECMO持续时间、并发症和出院去向。采用单变量和多变量考克斯比例危险回归分析来确定影响存活率的因素：分析对象包括 169 名肺结核患者，ECMO 支持时间中位数为 233 小时。据记录，断血成功率为 62.7%，55% 的患者能够存活至出院。69.8%的病例出现并发症，主要是机械并发症（46.6%）。多变量考克斯回归分析发现，并发症（HR： 0.448，95% CI： 0.222-0.748，P=0.001）、感染（HR： 0.483，95% CI： 0.241-0.808，P=0.001）和从入院到开始使用 ECMO 的时间间隔过长（HR： 0.698，95% CI： 0.396-0.901，P=0.018）是与存活可能性降低相关的重要因素：结论：ECMO 是肺结核患者的可行治疗方案；然而，及时启动和精心管理对于减少并发症和提高患者预后至关重要：对临床实践的启示：为符合条件的肺结核患者准确确定最佳 ECMO 启动时机，可显著提高重症监护病房等重症监护环境的临床疗效。

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引用次数: 0

The patient experience of a nurse-written ICU-diary intervention: A cross sectional survey 病人对护士撰写的重症监护病房日记干预措施的体验：横断面调查。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-10-03 DOI: 10.1016/j.iccn.2024.103846

Lisa Maria Högvall , Suzanne Forsyth Herling , Ingrid Egerod , Antonija Petosic , Mette Elisabeth Riise Danielsen , Uta Rüdiger , Tone Rustøen , Helene Berntzen

Background

A diary written for intensive care patients might help fill in memory gaps and promote psychological recovery. In Norway intensive care diaries are mainly authored by nurses and national recommendations ensure a systematic approach to the intervention. Studies describing the patient experience of nurse-written intensive care diaries are needed.

Objectives

The aim of this exploratory study is to investigate patientś experience of receiving and reading a nurse-written diary.

Design and setting

This is a cross-sectional multicentre survey among patients discharged from seven intensive care units in Norway.

Results

Among the 88 patients included, 90 % were satisfied with the diary handover process. As many as 88 % of the respondents agreed that the diary demonstrated good care, helped them realize how critically ill they had been and understand why recovery takes time (76 %), and made them grateful for surviving (74 %). One third of the respondents (30 %) reported that the diary saddened them, 6 % reported that the diary reminded them of a time in their lives they would rather forget, while 17 % reported that critical events were missing in the diary. However, nearly all patients were in favour of continuing the diary intervention (98 %).

Conclusion

Overall, the respondents were satisfied with the nurse-written diary, the handover as well as the content, and they recommended that the intervention should be sustained.

Implications for clinical practice

The handover of the diary should be tailored to meet the individual preferences of the patients in terms of timing and approach, since the diary intervention may not suit all patients. Improvements to the intervention could be a more complete narrative in the diary including both positive and critical events during the intensive care trajectory.

背景：为重症监护患者撰写日记可能有助于填补记忆空白并促进心理康复。在挪威，重症监护日记主要由护士撰写，国家建议确保采用系统的干预方法。需要对护士撰写的重症监护日记的患者体验进行研究：这项探索性研究的目的是调查患者接受和阅读护士撰写的日记的体验：这是一项横断面多中心调查，调查对象为从挪威七家重症监护病房出院的患者：在88名患者中，90%的人对日记交接过程表示满意。多达88%的受访者认为，日记体现了良好的护理，帮助他们认识到自己的病情有多危重，并理解为什么康复需要时间（76%），还让他们对幸存下来心存感激（74%）。三分之一的受访者（30%）表示，日记让他们感到悲伤，6%的受访者表示，日记让他们想起了生命中一段他们宁愿遗忘的时光，17%的受访者表示，日记中缺少关键事件。然而，几乎所有患者都赞成继续进行日记干预（98%）：总的来说，受访者对护士撰写的日记、交接和内容都表示满意，并建议继续进行干预：对临床实践的启示：日记的交接在时间和方式上应符合患者的个人偏好，因为日记干预不一定适合所有患者。干预措施的改进措施可以是在日记中更完整地叙述重症监护过程中的积极和关键事件。

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引用次数: 0

Clinical prediction models for acute kidney injury 急性肾损伤临床预测模型

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-10-01 DOI: 10.1016/j.iccn.2024.103852

Yunlin Feng, Stijn Blot, Martin Gallagher

引用次数: 0

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