Intensive and Critical Care Nursing最新文献

Objective

To systematically review the factors influencing thirst in ICU patients, providing a reference for effective management of thirst in ICU patients and the formulation of intervention measures.

Methods

A total of 12 electronic databases were searched from inception to July 2023. The synthesis method of JBI mixed methods research systematic review was used. The quantitative studies were analyzed by Stata17.0 and RevMan 5.3 software, and the qualitative studies by meta-aggregation.

Results

A total of 13 studies were included, including 2 qualitative studies and 11 quantitative studies. The quantitative study was carried out by meta-aggregation, extracting seven categories to form two synthesized findings. Quantitative meta-analysis revealed that 11 factors, including marital status, whether to use mechanical ventilation for the first time, air leakage, mechanical ventilation mode, simplified acute physiology score, respiratory rate, mask comfort, serum sodium concentration, breathing pattern, diuretics, and vasoactive drugs, were all associated with the occurrence of thirst in ICU patients. The qualitative and quantitative results were integrated into 5 categories, namely personal characteristics and lifestyle, disease factors, treatment factors, psychological factors, and nurse factors.

Conclusions

Thirst is a prevalent and severe issue among ICU patients, and effective interventions are required to address it. Considering its various causes, managing thirst in ICU patients should involve multiple levels of intervention. Treatment-related factors contribute significantly to thirst, and these factors should be taken into consideration when developing a thirst management strategy. Personal characteristics and lifestyle, psychological factors, drug-related factors, and nursing factors should be identified and optimized as soon as possible.

Implications for Clinical Practice

Healthcare professionals should pay attention to thirst symptoms in ICU patients and promptly take effective preventive or intervention measures based on the influencing factors.

Objective

This study aims to systematically review and critical evaluation of the risk of bias and the applicability of existing prediction models for acute kidney injury post liver transplantation.

Data source

A comprehensive literature search up until February 7, 2024, was conducted across nine databases: PubMed, Web of Science, EBSCO CINAHL Plus, Embase, Cochrane Library, CNKI, Wanfang, CBM, and VIP.

Study design

Systematic review of observational studies.

Extraction methods

Literature screening and data extraction were independently conducted by two researchers using a standardized checklist designed for the critical appraisal of prediction modelling studies in systematic reviews. The prediction model risk of bias assessment tool was utilized to assess both the risk of bias and the models’ applicability.

Principal findings

Thirty studies were included, identifying 34 prediction models. External validation was conducted in seven studies, while internal validation exclusively took place in eight studies. Three models were subjected to both internal and external validation, the area under the curve ranging from 0.610 to 0.921. A meta-analysis of high-frequency predictors identified several statistically significant factors, including recipient body mass index, Model for End-stage Liver Disease score, preoperative albumin levels, international normalized ratio, and surgical-related factors such as cold ischemia time. All studies were demonstrated a high risk of bias, mainly due to the use of unsuitable data sources and inadequate detail in the analysis reporting.

Conclusions

The evaluation with prediction model risk of bias assessment tool indicated a considerable bias risk in current predictive models for acute kidney injury post liver transplantation.

Implications for Clinical Practice

The recognition of high bias in existing models calls for future research to employ rigorous methodologies and robust data sources, aiming to develop and validate more accurate and clinically applicable predictive models for acute kidney injury post liver transplantation.

Objectives

This study aimed to assess the effectiveness of an architectural redesign and a multicomponent intervention bundle on noise reduction to enhance workplace safety.

Methods/Design

Quasi-experimental study with a time-series and intensified intervention design conducted in an intermediate care unit. Two interventions were sequential introduced: the installation of a partition wall in the medication preparation room (architectural redesign) and the implementation of an a bundle. Effects on outcomes were evaluated comparing baseline, after architectural redesign (period-1) and after implementation of the bundle (period-2).

Setting

Intermediate care unit.

Main Outcome Measures

A-weighted sound levels (LAeq), alarms/day/bed, annoyance ratings (numeric rating scale 0–10) and number of distractions of nurses during the medication preparation process.

Results

LAeq baseline vs period-1, decreased in the medication preparation area from 56.8 (±5.0) to 53.7 (±7.2) dBA (p < 0.001) and in the nursing station from 56.8 (±5.0) to 54.3 (±4.0) dBA (p < 0.001). During period-2, further noise reduction was minimal to absent. Distractions decreased from 58 % during baseline to 45 % (p < 0.001) during period-1, with no further reduction during period-2.

The median [IQR] number of alarms/day/bed increased from 263 [IQR 193–320] during baseline to 394 [IQR 258–474] during period-1 (p < 0.001), then decreased to 303 [IQR 264–370] (p < 0.05) during period-2. Median annoyance ratings decreased from baseline 3.0 [IQR 2.0–6.0] to 2.0 [IQR 1.0–3.0] (p < 0.001) during period-2.

Conclusion

An architectural redesign resulted in a significant, clinically relevant decrease in sound levels along with a notable reduction in distractions. The multicomponent bundle lowered alarms and annoyance ratings; however, its effectiveness on other outcomes seems less persuasive.

Implications for Clinical Practice

Architectural redesign seems to be effective in controlling environmental noise.

Architectural redesign results in a decrease in nurses’ distractions during the medication preparation process.

The effect of an intervention bundle is, despite a positive effect on alarms and perceived annoyance, still insufficiently clear.

Background

Hospitalization in the ICU can have long-term physiological and psychological impacts, affecting functional recovery and quality of life of post-ICU patients. Despite systematic reviews showing the impact of music interventions on physiological and psychological outcomes in ICU patients, their applicability and effectiveness in the post-ICU context remain unclear.

Aim

This review aimed to summarize: a) the types and characteristics of music/sound of interventions used in the rehabilitation of ICU patients, b) evidence on the feasibility, safety and acceptability of sound and music interventions for post ICU survivors, c) the types of post-ICU outcomes explored and the effects of sound and music interventions on any type of outcome in post-ICU survivors, and d) potential mechanisms or theoretical frameworks underlying the effects of sound and music interventions.

Method

We combined current systematic review search methods with a critical narrative approach to synthesize a diverse body of evidence.

Results

Results showed that music interventions positively affect the psychological well-being and health outcomes of post-ICU patients. Outcomes included improvements in stress, anxiety, mood, movement, sleep, and pain, despite differences in patient populations and intervention design. No safety concerns were reported. The identified theoretical frameworks described physiological, neurobiological and/or psycho-social pathways as key mediators, however, these mechanisms are not completely understood.

Conclusion

Research evidence supports the positive effects of music interventions in post-ICU patients. Further experimental studies are required, especially in adult post-ICU populations to elucidate the characteristics, components, feasibility, and long-term effects of sound/music interventions.

Implication to practice

1. Music interventions help in post-ICU patients’ recovery benefitting stress, anxiety, PTSD, mood, movement, sleep, and pain.

2. Integrating theoretical frameworks into music interventions can expand outcome measures to include physiological markers alongside psychological ones, improving quality of life.

3. Further rigorous interventional studies are required to identify the effectiveness of sound and music interventions in post-ICU patients.

Objective

Intensive care unit (ICU) stay for a serious illness has a long-term impact on patients’ physical and psychological well-being, affecting their ability to return to their everyday life. We aimed to investigate whether there are differences in health status between those who return to work and those who do not, and how demographic characteristics and illness severity impact patients’ ability to return to work 12 months after intensive care for COVID-19.

Research methodology

This was a prospective longitudinal cohort study. The participants were patients who had been in intensive care for COVID-19 and had worked before contracting COVID-19. Data on return to previous occupational status, demographic data, comorbidities, intensive care characteristics, and health status were collected at a 12-month follow-up visit.

Setting

General ICU at the Uppsala University Hospital in Sweden.

Results

Seventy-three participants were included in the study. Twelve months after discharge from the ICU, 77 % (n = 56) had returned to work. The participants who were unable to return to work reported more severe health symptoms. The (odds ratio [OR] for not returning to work was high for critical illness OR, 12.05; 95 % confidence interval [CI], 2.07–70.29, p = 0.006) and length of ICU stay (OR, 1.06; 95 % CI, 1.01–1.11, p = 0.01)

Conclusion

Two-thirds of the participants were able to return to work within 1 year after discharge from the ICU. The primary factors contributing to the failure to work were duration of the acute disease and presence of severe and persistent long-term symptoms.

Implications for clinical practice

Patients’ health status must be comprehensively assessed and their ability to return to work should be addressed in the rehabilitation process. Therefore, any complications faced by the patients must be identified and treated early to increase the possibility of their successful return to work.

Purpose

To review the literature on thirst in intensive care unit (ICU) patients and report potential causes, risk factors, diagnosis and measurement tools, as well as potential co-occurrence with other distressing symptoms, and the management of thirst in the ICU.

Design

A scoping review employing the Joanna Briggs Institute methodology.

Methods

PubMed, MEDLINE, EMBASE and CINAHL were searched from inception to April 2024. Any type of empirical study reporting thirst or associated xerostomia in adult patients (≥18 years) admitted to an ICU or high dependency unit for more than 24 h were included.

Results

The search yielded 907 unique records, and after evaluating 65 full-text publications, 21 studies were included. Thirst intensity was addressed most often (eleven studies), whereas the experience (or quality) of thirst and the validation of a measurement instrument, were addressed in only one study. Although co-occurrence of symptoms was addressed in four studies, only one pilot study looked into the interaction of thirst with other symptoms. Intervention studies have been focussing primarily on mouth-care interventions.

Conclusion

Thirst is a distressing symptom in the ICU, with reported high prevalence and intensity. Knowledge about its causes, interventions that incorporate minimising its risk, occurrence and intensity are limited.

Implications for clinical practice

Health care providers should acknowledge thirst as a prominent symptom for ICU patients. They should possess knowledge on the factors that potentially evoke or aggravate thirst. Regular and timely relief of thirst by oral care with cold swabs and the application of menthol can be regarded as a first choice of intervention.

Objective

This study aimed to develop a reliable and effective nomogram model to identify high-risk populations with non-response to prone position ventilation (PPV) in acute respiratory distress syndrome (ARDS) patients.

Methods

This retrospective cohort study included 175 patients with ARDS undergoing PPV. An improvement of ≥ 20 mmHg in the PaO₂/FiO₂ after the first PPV was defined as a 'response'. For the construction of the model, all patients were randomly assigned to the train and validation cohort according to 2:1. Multivariate logistic regression was useed to develop the nomogram. The area under the receiver operating characteristic curve (AUC), decision curve and calibration curve were assessed to evaluate the efficiency, clinical utility and calibration of the model.

Results

The overall rate of non-response to PPV in ARDS patients was approximately 32.6 %. In the training cohort and validation cohort, the rate are 29.9 % and 34.5 % respectively. Murray score ≥ 2.5 (OR: 4.29), procalcitonin (PCT) ≥ 2 ng/mL (OR: 2.52), N-terminal pro-B-type natriuretic peptide (Nt-proBNP) ≥ 2000 pg/ml (OR: 2.44), and hemoglobin ≤ 90 g/L (OR: 2.39) were independently associated with the rate of non-response to PPV and combined in prediction model. The model demonstrated good predictive value with AUC of 0.817 and 0.828 in the train and validation cohort. Calibration curve showed good calibration and decision curve analysis indicated favorable clinical utility.

Conclusions

This study constructed a risk prediction model for non-response to PPV, which demonstrated good predictive value and clinical utility.

Implications for clinical practice

Early identification of prone position response in ARDS is essential for timely alternative treatments, improving patient prognosis and healthcare efficiency. The predictive model included representative indicators of patients with ARDS, encompassing parameters such as the acute lung injury (Murray score), cardiac function (Nt-proBNP), infectious status (PCT), and hemoglobin levels.