Intensive and Critical Care Nursing最新文献

{"title":"Scandinavian healthcare professionals’ perceptions of rehabilitation practices in the intensive care unit. A cross-sectional survey","authors":"Anne Højager Nielsen ,&nbsp;Ranveig Lind ,&nbsp;Eva Åkerman ,&nbsp;Anne Sophie Ågård ,&nbsp;Marie Oxenbøll Collet ,&nbsp;Hanne Birgit Alfheim ,&nbsp;Anna Holm ,&nbsp;Helle Svenningsen","doi":"10.1016/j.iccn.2024.103842","DOIUrl":"10.1016/j.iccn.2024.103842","url":null,"abstract":"<div><h3>Objective</h3><div>To describe healthcare professionals’ perception of current early rehabilitation practices and their preconditions, focusing on functional and cognitive stimulation facilitated by nurses and other healthcare professionals in Scandinavian intensive care units (ICUs).</div></div><div><h3>Design</h3><div>Cross-sectional electronic survey administered to healthcare professionals. The survey was developed in Danish, translated into Norwegian and Swedish, and delivered using Google Forms. The qualitative data were analysed using the framework method.</div></div><div><h3>Setting</h3><div>Scandinavian ICUs.</div></div><div><h3>Results</h3><div>Practices facilitated by nurses and other healthcare professionals in the ICU often began with weaning from the ventilator and reducing sedation. This was followed by increased mobilisation and building physical strength. There was attention to optimising nutrition, swallowing function, and oral intake. Enabling communication and employing cognitively stimulating activities and bodily stimulation to engage the patient’s mind were also framed as rehabilitation. To avoid delirium and overexertion, it was important to balance rest and activity and to shield the patient from unnecessary stimulation. Furthermore, it was important to support the patient’s will to live and to involve the family in rehabilitation. Post-discharge rehabilitation activities included reaching out to patients discharged to wards and homes.</div></div><div><h3>Conclusion</h3><div>Rehabilitation was described as progressing from passive to active as patients gained consciousness and strength. Weaning, balancing rest and activity, supporting the patient’s life courage and will to recover, open visitation policies, and multi-professional collaboration were important prerequisites for rehabilitation.</div></div><div><h3>Implications for practice</h3><div>All aspects of patient care can function as important opportunities for physical and cognitive rehabilitation. Balancing rest and activity is important for conserving the patient’s energy for rehabilitation.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"86 ","pages":"Article 103842"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407396","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":"Risk factors for colonisation by Multidrug-Resistant bacteria in critical care units","authors":"Yolanda Garcia-Parejo ,&nbsp;Jesus Gonzalez-Rubio ,&nbsp;Jesus Garcia Guerrero ,&nbsp;Ana Gomez-Juarez Sango ,&nbsp;Jose Miguel Cantero Escribano ,&nbsp;Alberto Najera","doi":"10.1016/j.iccn.2024.103760","DOIUrl":"10.1016/j.iccn.2024.103760","url":null,"abstract":"<div><h3>Introduction</h3><div>Antimicrobial resistance is a major public health challenge recognised by the WHO as an urgent global healthcare concern. Patients in Intensive Care Units (ICUs) are particularly prone to colonisation and/or infection by multidrug-resistant organisms (MDROs).</div></div><div><h3>Objectives</h3><div>Delineate the epidemiological characteristics and risk factors for MDROs colonisation in mixed ICUs and Resuscitation Units by focusing on initial and nosocomial colonisation.</div></div><div><h3>Material and Methods</h3><div>A descriptive observational study with analytical elements. It uses the Zero-Resistance register from the Preventive Medicine Service of the Albacete General University Hospital (Spain) from April 2016 to December 2021. It identifies the risk factors for MDROs colonisation.</div></div><div><h3>Results</h3><div>Of 7,541 cases, 61.0 % with initial colonisation had risk factors for MDROs <em>versus</em> 34.0 % not colonised upon hospitalisation (p &lt; 0.001). Significant risk factors for initial colonisation included hospitalisation for ≥ 5 days within the last 3 months, prior MDROs colonisation/infection and institutionalization. No significant risk factor differences were found for nosocomial colonisation. An association between longer ICU stays and nosocomial colonisation (p &lt; 0.001) was noted.</div></div><div><h3>Conclusions</h3><div>Significant risk factors for initial MDROs colonisation were hospitalisation for ≥ 5 days in the last 3 months, prior MDROs colonisation/infection and institutionalisation. Longer ICU stays increased the nosocomial colonisation risk.</div></div><div><h3>Implications for Clinical Practice</h3><div>This study underscores the importance to early identify and manage patients at risk for MDROs colonisation in ICUs. By recognising factors (i.e. previous hospitalisations, existing colonisation or infection, impact of prolonged ICU stay), healthcare providers can implement targeted strategies to mitigate the spread of MDROs; e.g. enhanced surveillance, stringent infection control measures and judicious antibiotics use. Our findings highlight the need for a comprehensive approach to manage antimicrobial resistance in critical care settings to ultimately improve patient outcomes and reduce MDROs burden in hospitals.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"86 ","pages":"Article 103760"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581867","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":"Independent risk factors for ventilator-associated pneumonia: A multi-ICU cohort study","authors":"Ana Sabrina Sousa ,&nbsp;Celeste Bastos ,&nbsp;Cândida Ferrito ,&nbsp;Liliana Matos Pereira ,&nbsp;José Artur Paiva","doi":"10.1016/j.iccn.2024.103763","DOIUrl":"10.1016/j.iccn.2024.103763","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"86 ","pages":"Article 103763"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602357","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":"Taste in ICU: An unmet need","authors":"Lois Nunn ,&nbsp;James McEntee ,&nbsp;Suveer Singh","doi":"10.1016/j.iccn.2024.103855","DOIUrl":"10.1016/j.iccn.2024.103855","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"86 ","pages":"Article 103855"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402495","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":"Early changes in skin surface temperature to predict fever – Letter to Chung et al.","authors":"Fengju Xie ,&nbsp;Xiaoping Feng","doi":"10.1016/j.iccn.2024.103779","DOIUrl":"10.1016/j.iccn.2024.103779","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"86 ","pages":"Article 103779"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984215","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":"Reliability, validity and practicability of the Chelsea Critical Care Physical Assessment tool (CPAx) following an e-learning programme: A clinimetric study","authors":"Sabrina Eggmann ,&nbsp;Angela Kindler ,&nbsp;Roger Hilfiker ,&nbsp;Peter Nydahl","doi":"10.1016/j.iccn.2025.103959","DOIUrl":"10.1016/j.iccn.2025.103959","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate inter- and intra-rater reliability, content and concurrent validity, and practicability of the Chelsea Critical Care Physical Assessment tool (CPAx) – a measurement instrument for physical function and activity for patients with a critical illness – from multidisciplinary, German-speaking healthcare professionals.</div></div><div><h3>Methods</h3><div>This was a prospective, longitudinal, clinimetric study. Participants who completed a novel German CPAx e-learning were invited to participate in a voluntary, web-based, piloted, two-round survey. The two rounds were separated by 3–4 weeks to limit recollection of the two patient videos within the e-learning. Following informed consent, we collected participants’ characteristics, their CPAx ratings and scoring-duration for the two video cases, content validity indexes along with questions on the practicability of the CPAx. Data was analysed descriptively, quantitatively using Bayesian methods, and qualitatively with an inductive content approach.</div></div><div><h3>Results</h3><div>In total, 61 clinicians (53 (87 %) physiotherapists, 6 (10 %) nurses, 2 (3 %) occupational therapists) from Switzerland (37 (64 %)), Germany (13 (22 %)), and Austria (8 (14 %)) participated. Inter- (n = 61) and intra-rater (n = 35) reliability for the CPAx were excellent (intraclass correlation coefficients of &gt; 0.8). Content validity index of the CPAx showed a high relevance (&gt; 0.9), though novice users slightly differed from the expert rating (concurrent validity). Healthcare professionals described the CPAx as a practical tool to plan and evaluate physical rehabilitation with a total scoring duration of 5 min, whereby lack of routine, time, and application were seen as barriers in clinical practice.</div></div><div><h3>Conclusions</h3><div>This study demonstrated the German CPAx as a highly reliable (between and within raters), relevant and practical tool across professions, settings, and countries. These results support an online training, whereby future work should focus on consensus and application into clinical practice.</div></div><div><h3>Implications for Clinical practice</h3><div>Following an e-learning, the CPAx can be used reliably by multidisciplinary, German-speaking healthcare professionals potentially enhancing physical rehabilitation.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103959"},"PeriodicalIF":4.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070501","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":"Regional variations in incidence of surgical site infection and associated risk factors in women undergoing cesarean section: A systematic review and Meta-Analysis","authors":"Nazmul Islam ,&nbsp;Lukman Thalib ,&nbsp;Sadia Mahmood ,&nbsp;Sameed Akif Varol ,&nbsp;Ibrahim Adel ,&nbsp;Abdelrahman Aqel ,&nbsp;Fatemeh Atashbari ,&nbsp;Ozer Cinar","doi":"10.1016/j.iccn.2025.103951","DOIUrl":"10.1016/j.iccn.2025.103951","url":null,"abstract":"<div><h3>Background</h3><div>Surgical site infections (SSIs) are the most common postoperative complications after cesarean section (CS), with increased mortality, prolonged hospital stays, and increased healthcare costs.</div></div><div><h3>Objective</h3><div>To systematically estimate the global incidence and identify the risk factors associated with SSI, focusing on the variation between high- and low-income countries.</div></div><div><h3>Search strategy and selection criteria</h3><div>Observational studies reporting on the incidence of SSI after CS were systematically searched in PubMed, Embase and SCOPUS.</div></div><div><h3>Data collection and analysis</h3><div>Multiple authors independently screened, extracted the data, and assessed the<!--> <!-->risk of bias. The primary outcome was the incidence of SSI within 30 days. Subgroup and sensitivity analyses and <em>meta</em>-regression examined SSI-related heterogeneity.</div></div><div><h3>Main results</h3><div>49 cohort studies with 271,954 participants met the inclusion criteria. We found with moderate certainty that the overall SSI incidence in CS patients was 7.0 % (95 % CI: 6.0 %–8.0 %). The SSI incidence in LMICs was 8.0 % (95 % CI: 6.0 %–10.0 %) with moderate certainty, while the incidence in HICs was 5.0 % (95 % CI: 4.0 %–7.0 %) with low certainty. Subgroup analysis indicated a significantly higher incidence in Africa and the Western Pacific. Meta-regression showed a significant decrease in SSI incidence in HICs. Maternal factors, procedural aspects, and care quality were associated with SSI.</div></div><div><h3>Conclusions</h3><div>Our findings offer valuable insights into the global incidence of SSIs following CS and provide a reliable estimate for benchmarking and quality improvement. This study adds to the evidence on SSI determinants and highlights the need for targeted preventative measures across various regional and healthcare settings.</div></div><div><h3>Implications for clinical practice</h3><div>Higher SSI rates in LMICs call for targeted infection prevention strategies, including improved preoperative preparation, antibiotic prophylaxis, and enhanced antenatal care services. In HICs, addressing lifestyle factors, managing comorbidities, and refining surgical protocols can further mitigate risks, emphasizing the need for region-specific, evidence-based interventions.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"89 ","pages":"Article 103951"},"PeriodicalIF":4.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070502","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":"Should we still use chlorhexidine oral care? No!","authors":"Stijn Blot ,&nbsp;Elena Conoscenti ,&nbsp;Michael Klompas","doi":"10.1016/j.iccn.2025.103954","DOIUrl":"10.1016/j.iccn.2025.103954","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103954"},"PeriodicalIF":4.9,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054622","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":"Risk stratification for violent behavior in critically ill patients: Current assessment tools","authors":"Sebastian Berger ,&nbsp;Simon A. Amacher ,&nbsp;Martin Lohri ,&nbsp;Sabina Hunziker ,&nbsp;Caroline E. Gebhard ,&nbsp;Anja Frei ,&nbsp;Raoul Sutter","doi":"10.1016/j.iccn.2025.103957","DOIUrl":"10.1016/j.iccn.2025.103957","url":null,"abstract":"<div><h3>Background</h3><div>Workplace violence (WPV) presents challenges in intensive care units (ICUs) calling for reliable prediction of violence. This narrative review aimed to identify and evaluate risk assessment tools from acute care settings which are or might be used to predict violent behavior in adult ICU patients focusing on their performance and clinical utility.</div></div><div><h3>Methods</h3><div>A screening of PubMed, Scopus and Google Scholar was conducted to identify risk scores used in the acute care setting such as emergency departments, hospitals and ICUs. Risk factors, predictive validity of scores and their relevance to the ICU setting were evaluated.</div></div><div><h3>Results</h3><div>24 studies were included. Two studies reported the use in general ICU populations, while eight studies were conducted in psychiatric ICUs and 14 studies implemented the use of risk tools in emergency departments or general wards. Ten risk scores were identified using 30 different variables. Those could be categorized into patient demographics, behavior, history of violence, mental status and other items such as sleep disturbances. The Broset Violence Checklist (BVC) was the most commonly used risk score. It showed moderate predictive accuracy in psychiatric settings including psychiatric ICUs, but limited validation for general ICUs. The overall evidence level was low with serious risk of bias. Other tools demonstrated varying sensitivity and specificity but lacked validation in ICUs.</div></div><div><h3>Implications for clinical practice</h3><div>ICU nurses and physicians are often subjected to violence. There is little evidence on scores to predict patients‘ behavior. Most assessments come from outside the ICU, but may be promising in critical care.</div></div><div><h3>Conclusion</h3><div>This review underscores the need for the development of violence risk assessment tools tailored to the ICU, as the challenges with violent ICU patients differ from other populations. New predictive models must be developed including factors associated with patients’ violent behavior in ICUs as compiled in this review.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"89 ","pages":"Article 103957"},"PeriodicalIF":4.9,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049309","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":"Effects of routine postural repositioning on the distribution of lung ventilation and perfusion in mechanically ventilated patients","authors":"María Dolores Rodríguez Huerta ,&nbsp;Juan Antonio Sánchez Giralt ,&nbsp;Ana Díez-Fernández ,&nbsp;María Jesús Rodríguez Alonso ,&nbsp;Nuria Montes ,&nbsp;Fernando Suárez-Sipmann","doi":"10.1016/j.iccn.2025.103952","DOIUrl":"10.1016/j.iccn.2025.103952","url":null,"abstract":"<div><h3>Objectives</h3><div>To analyse the effects on respiratory function, lung volume and the regional distribution of ventilation and perfusion of routine postural repositioning in mechanically ventilated critically ill patients.</div></div><div><h3>Methods</h3><div>Prospective descriptive physiological study. We evaluated gas-exchange, lung mechanics, and Electrical Impedance Tomography (EIT) determined end-expiratory lung impedance and regional ventilation and perfusion distribution in five body positions: supine-baseline (S1); first lateralisation at 30° (L1); second supine position (S2), second contralateral lateralisation (L2) and third final supine position (S3). To evaluate the effects of lateral repositioning we compared S1 with S2 and with the changes during L1 and L2.</div></div><div><h3>Results</h3><div>We included 32 patients. The lateralisation sequence was well tolerated. When comparing S1 with S3 respiratory system compliance increased by 7 % (p = 0.021), the partial pressure to inspired oxygen fraction ratio (PaO₂/FiO₂) by 16 % (p = 0.06) and dead-space decreased by 5 % (p = 0.09). During lateralisation, haemodynamic parameters and PaO₂/FiO₂ did not change, while dead-space and PaCO₂ presented small non-significant increases. Although with great inter-individual variability, end-expiratory lung impedance increased in the non-dependent 163 ± 123 ml and dependent lung 69 ± 119 ml, both p &lt; 0.009). Regional ventilation decreased in the non-dependent and increased in the dependent lung, while regional perfusion decreased in the dependent lung, especially in dorsal regions.</div></div><div><h3>Conclusions</h3><div>Postural changes are well tolerated, result in improved lung mechanics and have a positive effect on gas exchange. Lateralisation does not result in a decrease in lung volume in the dependent lung.</div></div><div><h3>Implications for clinical practice</h3><div>Postural repositioning can be safely performed in ICU patients to foster its known benefits. To the known beneficial effects on the prevention of pressure wounds, postural changes can improve regional end-expiratory lung volume (i.e., the functional volume of the lung). Regional changes vary among patients and extended monitoring options such as EIT can help to individualise this useful therapeutic intervention.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103952"},"PeriodicalIF":4.9,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049248","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}