Intensive and Critical Care Nursing最新文献_第3页

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

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

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

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

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

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

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

引用次数: 0

Practice recommendations for culturally sensitive communication at the end of life in intensive care: A modified eDelphi study 重症监护中生命末期文化敏感性沟通的实践建议：修改后的 eDelphi 研究

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-10-01 DOI: 10.1016/j.iccn.2024.103814

Background

Clinicians need specific knowledge and skills to effectively communicate with patients and their family when a patient is dying in the ICU. End-of-life communication is compounded by language differences and diverse cultural and religious beliefs.

Aim

The aim was to develop and evaluate practice recommendations for culturally sensitive communication at the end of life.

Method

Modified two-round eDelphi study. An Australian national sample of 58 expert ICU clinicians of nursing and medical backgrounds participated in an online survey to rate the relevance of 13 practice recommendations. Ten clinicians participated in a subsequent expert panel interview to provide face validity and comprehensive details about the practical context of the recommendations. Survey data were analysed using descriptive statistics, interview data using deductive content analysis.

Results

All 13 practice recommendations achieved item content validity index (I-CVI) above 0.8, and scale content validity index (S-CVI) of 0.95, indicating sufficient consensus. Recommendations prioritising use of professional interpreters and nurse involvement in family meetings achieved near perfect agreement amongst participants. Recommendations to facilitate family in undertaking cultural, spiritual and religious rituals and customs, advocate for family participation in treatment limitation discussions, and clinician access to professional development opportunities about culturally sensitive communication also achieved high level consensus.

Conclusion

These practice recommendations provide guidance for ICU clinicians in their communication with patients and families from culturally diverse backgrounds.

Implications for clinical practice

Clinicians want practice recommendations that are understandable and broadly applicable across diverse ICU contexts. The high consensus scores confirm these practice recommendations are relevant and feasible to clinicians who provide end-of-life care for patients and their family members. The recommendations also provide clear guidance for ICU leaders, managers and organisational policy makers.

背景当病人在重症监护室中濒临死亡时，临床医生需要具备特定的知识和技能才能与病人及其家属进行有效沟通。临终沟通因语言差异以及不同的文化和宗教信仰而变得更加复杂。方法经过修改的两轮 eDelphi 研究。澳大利亚全国共有 58 名具有护理和医学背景的重症监护室临床专家参与了在线调查，对 13 项实践建议的相关性进行评分。10 名临床医生参加了随后的专家小组访谈，以提供面效和有关建议实际背景的全面细节。结果所有 13 项实践建议的项目内容效度指数（I-CVI）均高于 0.8，量表内容效度指数（S-CVI）为 0.95，表明已达成充分共识。关于优先使用专业翻译人员和护士参与家庭会议的建议在参与者中几乎完全一致。结论这些实践建议为 ICU 临床医生与来自不同文化背景的患者和家属沟通提供了指导。较高的共识得分证实了这些实践建议对于为患者及其家属提供临终关怀的临床医生来说是相关和可行的。这些建议还为 ICU 领导、管理人员和组织决策者提供了明确的指导。

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引用次数: 0

The relationship between arterial partial pressure of oxygen and pressure injuries in intensive care unit patients: A multi-center cross-sectional study 重症监护室患者动脉血氧分压与压力损伤之间的关系：多中心横断面研究

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-09-26 DOI: 10.1016/j.iccn.2024.103785

Background

Pressure injuries significantly impact patients in intensive care units and the healthcare system. Hypoxia, a major contributor to pressure injury development, can be promptly identified by monitoring arterial partial pressure of oxygen. However, the dose–response relationship between arterial partial pressure of oxygen and pressure injuries remains unclear.

Objectives

To determine how mean arterial partial pressure of oxygen within 24 h before the appearance of a pressure injury influences pressure injury outcomes in ICU patients, elucidating the dose–response relationship, and underscoring the importance of including arterial oxygen pressure in routine pressure injury risk assessments.

Methods

We conducted this multi-center cross-sectional study in Gansu province of China from April 2021 to July 2023. The incidence and influencing factors of pressure injuries were collected. Logistic and restricted cubic spline regression analyses were used to assess the association between pressure injuries and arterial partial pressure of oxygen. Subgroup analyses stratified by age and sex were conducted to explore potential correlations.

Results

Among 6078 participants, the incidence of pressure injury was 2.34 %. After adjusting for all confounding factors, patients with low arterial partial pressure of oxygen were more likely to develop pressure injury than those with normal levels (OR 1.753, 95 %CI 1.142 ∼ 2.693). The dose–response relationship shows a significant non-linear dose–response correlation between arterial partial pressure of oxygen and pressure injury risk (P = 0.011). Layered analysis shows that the impact is more pronounced in older individuals and males.

Conclusions

As arterial partial pressure of oxygen decreases, the occurrence of pressure injuries gradually increases. Incorporating arterial partial pressure of oxygen into daily pressure injury risk assessments is crucial.

Implications for clinical practice

Our study results will offer targeted insights for the prevention and management of pressure injuries.

背景压力性损伤对重症监护病房的患者和医疗保健系统造成严重影响。缺氧是导致压力性损伤的主要因素，可通过监测动脉血氧分压及时发现。目的确定压力性损伤出现前 24 小时内平均动脉血氧分压对 ICU 患者压力性损伤结果的影响，阐明剂量-反应关系，并强调将动脉血氧分压纳入常规压力性损伤风险评估的重要性。方法我们于 2021 年 4 月至 2023 年 7 月在甘肃省开展了这项多中心横断面研究。收集了压力性损伤的发生率和影响因素。采用逻辑回归分析和限制性三次样条回归分析评估压力性损伤与动脉血氧分压之间的关系。结果在 6078 名参与者中，压力性损伤的发生率为 2.34%。在调整了所有干扰因素后，动脉血氧分压过低的患者比动脉血氧分压正常的患者更容易发生压力性损伤（OR 1.753, 95 %CI 1.142 ∼ 2.693）。剂量-反应关系显示，动脉血氧分压与压力损伤风险之间存在显著的非线性剂量-反应相关性（P = 0.011）。分层分析表明，这种影响对老年人和男性更为明显。我们的研究结果将为压力性损伤的预防和管理提供有针对性的见解。

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引用次数: 0

Infection epidemiology, preventive measures and principles of best practices involving the skin and dressing of patients with a ventricular assist device: A scoping review 涉及心室辅助装置患者皮肤和敷料的感染流行病学、预防措施和最佳实践原则：范围综述。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-09-21 DOI: 10.1016/j.iccn.2024.103840

Background

Specific knowledge of several domains for managing care in the driveline externalization area may be necessary for the broader application of left ventricular assist devices.

Objectives

This study aimed to map the recommendations for adult patients undergoing left ventricular assist device implantation.

Design

This scoping review, is being registered in the Open Science Framework under DOI https://doi.org/10.17605/OSF.IO/Q76B3 (https://osf.io/q76b3/).

Method

Left ventricular assist device coordinators and nurse specialists in dermatology and stomatherapy conducted a scoping review limited to the period between 2015 and 2022. The results of this scoping review will be discussed and presented separately in 3 articles. This third article synthesizes research evidence on the epidemiology of device infections, infection preventive measures, local skin care and dressings in adult patients with left ventricular assist devices.

Results

The initial search resulted in 771 studies. Sixty nine met the eligibility criteria and were included in the scoping review. Eighteen articles addressing the epidemiology of device infections, infection preventive measures, and local skin and dressing care that answered the question of this article were included. The most common bacterial pathogens reported have been Gram-positive bacteria, typically Staphylococcus species. With respect to infection preventive measures, there are evidence gaps in local skin care and transmission system dressings.

Conclusion

The driveline still remains the most common type of device infection. There exists imperfect knowledge on the standardization of care with the dressing and the area of skin for left ventricular assist device patients. Furthermore, there is a methodological fragility of the studies. These elements imply an opportunity for future research on these subjects.

Implications for clinical practice

This review provides an overview of the principles of best practices involving the skin and dressing of patients with a ventricular assist device without local dermatological diseases or infectious diseases. The central figure of an experienced professional can make a difference.

背景：为了更广泛地应用左心室辅助装置，有必要对动力线外置区域的护理管理的几个领域进行具体了解：本研究旨在为接受左心室辅助装置植入术的成年患者提供建议：本范围综述在开放科学框架下注册，DOI https://doi.org/10.17605/OSF.IO/Q76B3 (https://osf.io/q76b3/)。方法：左心室辅助装置协调员和皮肤科及口腔治疗专科护士对 2015 年至 2022 年期间进行了范围界定审查。此次范围界定审查的结果将在 3 篇文章中分别讨论和介绍。第三篇文章综合了有关左心室辅助装置成人患者的装置感染流行病学、感染预防措施、局部皮肤护理和敷料的研究证据：最初的搜索结果是 771 项研究。有 69 篇符合资格标准，被纳入了范围界定审查。其中有 18 篇文章涉及装置感染的流行病学、感染预防措施以及局部皮肤和敷料护理，回答了本文的问题。报告中最常见的细菌病原体是革兰氏阳性菌，通常是葡萄球菌。关于感染预防措施，在局部皮肤护理和传输系统敷料方面存在证据差距：结论：传动系统仍然是最常见的器械感染类型。对于左心室辅助装置患者的敷料和皮肤区域的标准化护理，目前还存在不完善的认识。此外，研究方法也很不完善。这些因素都为今后研究这些课题提供了机会：这篇综述概述了最佳实践的原则，涉及无局部皮肤病或感染性疾病的心室辅助装置患者的皮肤和敷料。一位经验丰富的专业人士的核心作用可以起到事半功倍的效果。

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引用次数: 0