Intensive and Critical Care Nursing最新文献_第7页

Antimicrobial infusion practices within intensive care units: Carbapenem infusion preparation and administration process errors 重症监护病房的抗菌输液实践：碳青霉烯输液准备和给药过程中的错误

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-08-22 DOI: 10.1016/j.iccn.2024.103786

Joan Rout , Petra Brysiewicz , Sabiha Essack

Objective

To describe nurse preparation and administration of intermittent carbapenem infusions.

Research methodology/design

This observational study documented the carbapenem infusion process to adult patients in three general intensive care units.

Main outcome measures

Timing and duration of infusions were observed. Volumetric analysis of infusion items was conducted to determine loss of reconstituted carbapenem during preparation and administration phases.

Results

Carbapenem infusions (n = 223) administered to twenty adult patients were observed. Infusion duration guidance was variable, with two ICUs following current literature recommendations, and one ICU referring to medication package insert information. Within these parameters, only 60 % of infusions complied with infusion duration. Non-compliance with planned time of administration impacted on desired dosing intervals. Incomplete delivery of intended dose was found during: sub-optimal reconstitution of vials, incorrect number of vials reconstituted, failure to administer a dose (missed dose), and discarding antibiotic residue in infusion items. Volumetric analysis of infusion items showed mean dose losses of 4.9 % and 1.2 % in discarded vials and syringes. Mean drug losses of 6.3 % and 30.8 % occurred in discarded infusion bags and infusion lines respectively. No flushing guidance or practice was observed.

Conclusion

Incorrect nurse administration of antibiotics resulted in varying durations of infusions and the non-delivery of prescribed dose. Under-dosing has the potential to contribute to selection pressure for bacterial antibiotic resistance. The increasing frequency of intravenous delivery of antimicrobial agents through infusions requires an understanding of the required duration of administration and how to manage residual drug remaining in the intravenous line once the infusion is completed.

Implications for clinical practice

Flushing of administration lines is not common practice following intermittent antimicrobial infusions. Although there are multi-factorial risk factors for antimicrobial resistance in the critical care arena, nurse infusion practice must ensure that patients receive intended antimicrobial treatment. Attention must be given to the potential for antimicrobial resistance from environmental contamination with the disposal of infusion items containing undelivered antimicrobial medication.

研究方法/设计这项观察性研究记录了在三个普通重症监护病房为成年患者输注碳青霉烯类药物的过程。结果观察了 20 名成年患者的碳青霉烯输液（n = 223）。输液持续时间的指导不尽相同，两家 ICU 遵循当前文献的建议，一家 ICU 参考了药品包装上的信息。在这些参数范围内，只有 60% 的输液符合输液持续时间要求。不遵守计划给药时间会影响理想的给药间隔。在以下情况下会出现未完全按计划给药的情况：药瓶重组不理想、重组药瓶数量不正确、未按计划给药（漏给药）以及丢弃输液物品中的抗生素残留物。输液物品的体积分析显示，平均剂量损失为 4.9%，废弃药瓶和注射器中的平均剂量损失为 1.2%。废弃输液袋和输液管中的平均药物损失率分别为 6.3% 和 30.8%。结论护士对抗生素的不正确管理导致输液时间长短不一和未按规定剂量输液。剂量不足有可能导致细菌产生抗药性。通过输液静脉注射抗菌药物的频率越来越高，因此需要了解所需的给药持续时间，以及输液结束后如何管理残留在静脉管路中的药物。对临床实践的意义间歇性抗菌药物输液后冲洗给药管路并不是常见的做法。尽管在重症监护领域抗菌药物耐药性的风险因素是多方面的，但护士输液实践必须确保患者接受预期的抗菌治疗。在处理含有未交付抗菌药物的输液物品时，必须注意环境污染对抗菌药物产生耐药性的可能性。

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引用次数: 0

Decibel level of coughing as a predictor of extubation outcome in mechanically ventilated intensive care patients: A prospective, observational study 预测机械通气重症监护患者拔管结果的咳嗽分贝水平：前瞻性观察研究

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-08-22 DOI: 10.1016/j.iccn.2024.103800

Huan Li , Tiantian Zhou , Haibin Ni , Tingting Wang , Yanli Wei , Xiaofei Huang , Jian Lyu

Aim

This study aims to evaluate the feasibility and clinical utility of measuring cough decibel level as predictive markers for extubation outcomes in mechanically ventilated patients.

Design

A prospective observational study.

Setting

Three interdisciplinary medical-surgical intensive care units across China.

Main outcome measures

The primary outcomes assessed were extubation results in patients. Secondary measures included the cough decibel level, semiquantitative cough intensity scores, and white card test results recorded prior to extubation.

Results

A total of 71 patients were included, 55 patients were in the extubation success group and 16 in the failure group. The mean age was 78(71,83) years, mainly male (73.2 %). Despite the baseline characteristics being mostly consistent across both groups, significant differences were noted in duration of mechanical ventilation, and intensive care units and hospital stay. Remarkably, the cough decibel was substantially lower in the extubation failure group compared to the other group (78.69 ± 8.23 vs 92.28 ± 7.01 dB). The Receiver Operating Characteristic curve analysis revealed that a cough decibel below 85.77 dB is the optimal threshold for predicting extubation failure, exhibiting an 80 % sensitivity and 91.67 % specificity.

Conclusion

The study corroborates that the cough decibel level serves as a quantifiable metric in patients undergoing mechanical ventilation. It posits that the likelihood of extubation failure escalates when the cough decibel falls below 85.77 dB.

Implications for clinical practice

Quantification of coughing capacity in decibels may be a good predictor of extubation outcome, thus offering assistance to healthcare professionals in evaluating the readiness of patients for extubation.

目的本研究旨在评估测量咳嗽分贝水平作为机械通气患者拔管结果预测指标的可行性和临床实用性。结果共纳入 71 例患者，其中 55 例为拔管成功组，16 例为拔管失败组。平均年龄为 78（71,83）岁，主要为男性（73.2%）。尽管两组患者的基线特征基本一致，但在机械通气时间、重症监护病房和住院时间方面存在显著差异。值得注意的是，拔管失败组的咳嗽分贝大大低于另一组（78.69 ± 8.23 vs 92.28 ± 7.01 dB）。接收者操作特征曲线分析显示，咳嗽分贝低于 85.77 dB 是预测拔管失败的最佳阈值，其敏感性为 80%，特异性为 91.67%。对临床实践的启示以分贝为单位的咳嗽能力量化可以很好地预测拔管结果，从而帮助医护人员评估患者是否准备好拔管。

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引用次数: 0

Fathers’ experiences of nurses’ roles and care practices during their preterm infant’s stay in the neonatal intensive care unit 父亲在早产儿入住新生儿重症监护室期间对护士角色和护理措施的体验。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-08-21 DOI: 10.1016/j.iccn.2024.103803

Alberto Stefana , Stefano Barlati , Renzo Beghini , Paolo Biban

Introduction

Neonatal intensive care unit (NICU) nurses play a crucial role in providing infant care, as well as in bridging the communication gap with parents.

Aim

Explore fathers’ perceptions and interactions with nurses during their preterm infants’ stay in a NICU.

Design

Qualitative study using ethnographic data collection techniques.

Methods

Twenty fathers of preterm infants were purposively sampled in a level III NICU in Italy. Data collection comprised 120 h of participant observation, 68 informal conversations, and 20 semi-structured interviews. Data analysis was performed using reflexive thematic analysis.

Results

Analysis revealed five primary themes: (i) communication and clarity about infants’ health condition and progress, (ii) inclusiveness and guidance from nurses, (iii) fathers’ satisfaction with nurses’ support for mother, (iv) nurses’ personal attention to the babies, and (v) nurses’ varied personalities.

Conclusion

Nurses are crucial in facilitating father-infant bonding in the NICU. Although the content of nurse communication is critical for fathers, the delivery style becomes especially relevant during their infant’s hospitalization. Discrepancies in messages and guidance can negatively impact fatherly confidence and their ability to care for their preterm infants and support partners. Thus, training that emphasizes the recognition of the unique ways that fathers exhibit distress is crucial.

Relevance to Clinical Practice

Nurses play a critical role in shaping the fathers’ experiences in NICU. Emphasizing clear communication and individualized care is vital. To strengthen father support in NICU settings, recommended approaches include regular training, holistic care, fostering inclusivity, emotional support, and improving bonding opportunities.

Reporting Method

Adherence to the COREQ guidelines.

简介：新生儿重症监护室（NICU）的护士在为婴儿提供护理以及弥合与父母之间的沟通鸿沟方面发挥着至关重要的作用。目的：探讨父亲在早产儿入住 NICU 期间对护士的看法以及与护士之间的互动：设计：采用人种学数据收集技术进行定性研究：在意大利的一家三级新生儿重症监护室有目的地抽取了 20 位早产儿的父亲。数据收集包括 120 小时的参与观察、68 次非正式谈话和 20 次半结构化访谈。数据分析采用反思性主题分析法：分析揭示了五个主要主题：(i) 关于婴儿健康状况和进展的沟通和清晰度，(ii) 护士的包容性和指导，(iii) 父亲对护士支持母亲的满意度，(iv) 护士对婴儿的个人关注，以及 (v) 护士的不同个性：护士对促进新生儿重症监护室中的父婴关系至关重要。尽管护士沟通的内容对父亲来说至关重要，但在婴儿住院期间，沟通方式变得尤为重要。信息和指导的不一致会对父亲的信心以及他们照顾早产儿和支持伴侣的能力产生负面影响。因此，强调识别父亲表现出困扰的独特方式的培训至关重要：护士在塑造父亲在新生儿重症监护室的经历方面发挥着至关重要的作用。强调清晰的沟通和个性化护理至关重要。为加强对新生儿重症监护室中父亲的支持，建议采取的方法包括定期培训、整体护理、促进包容性、情感支持和增加亲子机会：报告方法：遵守 COREQ 指南。

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引用次数: 0

Upper limb peripheral nerve injuries in patients with ARDS requiring prone positioning: A systematic review with proportion meta-analysis 需要俯卧位的 ARDS 患者上肢周围神经损伤：带比例荟萃分析的系统综述。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-08-10 DOI: 10.1016/j.iccn.2024.103766

Filippo Binda , Simone Gambazza , Federica Marelli , Veronica Rossi , Maura Lusignani , Giacomo Grasselli

Objective

To investigate the prevalence of upper limb peripheral nerve injuries (PNI) in adult patients admitted to the intensive care unit (ICU) with acute respiratory distress syndrome (ARDS) undergoing prone positioning.

Methods

This systematic review with meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Four electronic databases including PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), The Cochrane Library, and EMBASE were searched from inception to January 2024. The quality of the included studies was evaluated according to the Joanna Briggs Institute Critical Appraisal Tools. A proportion meta-analysis was conducted to examine the combined prevalence of upper limb PNI among patients requiring prone positioning.

Results

A total of 8 studies (511 patients) were pooled in the quantitative analysis. All studies had a low or moderate risk of bias in methodological quality. The overall proportion of patients with upper limb PNI was 13% (95%CI: 5% to 29%), with large between-study heterogeneity (I² = 84.6%, P<0.001). Both ulnar neuropathy and brachial plexopathy were described in 4 studies.

Conclusion

During the COVID-19 pandemic, prone positioning has been used extensively. Different approaches among ICU teams and selective reporting by untrained staff may be a factor in interpreting the large variability between studies and the 13% proportion of patients with upper limb PNI found in the present meta-analysis. Therefore, it is paramount to stress the importance of patient assessment both after discharge from the ICU and during subsequent follow-up evaluations.

Implications for clinical practice

Specialized training is essential to ensure safe prone positioning, with careful consideration given to arms and head placement to mitigate potential nerve injuries. Therefore, healthcare protocols should incorporate preventive strategies, with patient assessments conducted by expert multidisciplinary teams.

目的调查因急性呼吸窘迫综合征（ARDS）入住重症监护室（ICU）的成年患者在接受俯卧位治疗时上肢周围神经损伤（PNI）的发生率：本系统综述和荟萃分析是根据《系统综述和荟萃分析首选报告项目》（PRISMA）和《流行病学观察性研究荟萃分析》（MOOSE）报告指南进行的。检索了从开始到 2024 年 1 月的四个电子数据库，包括 PubMed、Cumulative Index to Nursing and Allied Health Literature (CINAHL)、The Cochrane Library 和 EMBASE。根据乔安娜-布里格斯研究所（Joanna Briggs Institute）的关键评估工具对纳入研究的质量进行了评估。进行了比例荟萃分析，以研究需要俯卧位的患者中上肢PNI的综合患病率：定量分析共汇总了 8 项研究（511 名患者）。所有研究的方法学质量均存在低度或中度偏倚风险。上肢PNI患者的总比例为13%（95%CI：5%至29%），研究间存在较大的异质性（I2 = 84.6%，PC结论：在 COVID-19 大流行期间，俯卧位被广泛使用。ICU 团队采用的不同方法以及未经培训人员的选择性报告可能是解释不同研究之间的巨大差异以及本荟萃分析中发现的 13% 的上肢 PNI 患者比例的一个因素。因此，强调从重症监护室出院后和后续随访评估中对患者进行评估的重要性至关重要：临床实践的启示：为确保安全的俯卧位，必须进行专门培训，并仔细考虑手臂和头部的位置，以减轻潜在的神经损伤。因此，医疗保健方案应纳入预防性策略，并由多学科专家团队对患者进行评估。

{"title":"Upper limb peripheral nerve injuries in patients with ARDS requiring prone positioning: A systematic review with proportion meta-analysis","authors":"Filippo Binda , Simone Gambazza , Federica Marelli , Veronica Rossi , Maura Lusignani , Giacomo Grasselli","doi":"10.1016/j.iccn.2024.103766","DOIUrl":"10.1016/j.iccn.2024.103766","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the prevalence of upper limb peripheral nerve injuries (PNI) in adult patients admitted to the intensive care unit (ICU) with acute respiratory distress syndrome (ARDS) undergoing prone positioning.</p></div><div><h3>Methods</h3><p>This systematic review with meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Four electronic databases including PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), The Cochrane Library, and EMBASE were searched from inception to January 2024. The quality of the included studies was evaluated according to the Joanna Briggs Institute Critical Appraisal Tools. A proportion meta-analysis was conducted to examine the combined prevalence of upper limb PNI among patients requiring prone positioning.</p></div><div><h3>Results</h3><p>A total of 8 studies (511 patients) were pooled in the quantitative analysis. All studies had a low or moderate risk of bias in methodological quality. The overall proportion of patients with upper limb PNI was 13% (95%CI: 5% to 29%), with large between-study heterogeneity (I<sup>2</sup> = 84.6%, P<0.001). Both ulnar neuropathy and brachial plexopathy were described in 4 studies.</p></div><div><h3>Conclusion</h3><p>During the COVID-19 pandemic, prone positioning has been used extensively. Different approaches among ICU teams and selective reporting by untrained staff may be a factor in interpreting the large variability between studies and the 13% proportion of patients with upper limb PNI found in the present meta-analysis. Therefore, it is paramount to stress the importance of patient assessment both after discharge from the ICU and during subsequent follow-up evaluations.</p></div><div><h3>Implications for clinical practice</h3><p>Specialized training is essential to ensure safe prone positioning, with careful consideration given to arms and head placement to mitigate potential nerve injuries. Therefore, healthcare protocols should incorporate preventive strategies, with patient assessments conducted by expert multidisciplinary teams.</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"85 ","pages":"Article 103766"},"PeriodicalIF":4.9,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0964339724001514/pdfft?md5=ebd8dcc5a59a7a7d571df08f4e0d1d13&pid=1-s2.0-S0964339724001514-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914906","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}

引用次数: 0

The clinical effectiveness of the corrected nose-earlobe-xiphoid distance formula in determining the internal length of a nasogastric tube in adults: A retrospective study 校正鼻-耳垂-剑突距离公式在确定成人鼻胃管内部长度方面的临床效果：回顾性研究。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-08-08 DOI: 10.1016/j.iccn.2024.103783

Eva De Lange , Kurt Boeykens , Dimitri Beeckman , Tim Torsy

Introduction

Accurate determination of the internal length of nasogastric tubes is essential for the safe and effective completion of blind insertions, a routine nursing procedure. The widely used nose-earlobe-xiphoid distance lacks evidence and effectiveness. A recent randomized controlled trial proposed an alternative, the corrected nose-earlobe-xiphoid distance formula. However, its effectiveness in real-world clinical practice has not yet been studied.

Objective

This study assessed the real-world clinical effectiveness of the corrected nose-earlobe-xiphoid distance formula for determining the internal nasogastric tube length in adult patients admitted to hospitalization or intensive care units.

Design

A single-center retrospective clinical effectiveness study was conducted, utilizing routinely collected observational data.

Setting and main outcome measures

Between October 2020 and November 2022, 358 adult patients in a general hospital requiring a nasogastric feeding tube were included. The primary outcome involved assessing nasogastric tube tip positioning (>3 cm below the lower esophageal sphincter) by an advanced practice nurse through X-ray verification. Secondary outcomes, obtained from patient records for a random subgroup of 100 participants, were reporting clarity and evaluation of the tip position by reviewing radiologists.

Results

Following evaluation by an advanced practice nurse, all nasogastric feeding tubes were determined to be correctly positioned. Among the subgroup of 100 tubes, X-ray protocols, as documented by the reviewing radiologists, showed varying levels of reporting clarity for the tube tip: 4.0 % lacked reporting, 33.0 % had ambiguous reporting and 63.0 % had unambiguous reporting.

Conclusion

The corrected nose-earlobe-xiphoid distance formula demonstrates potential to emerge as a safer alternative to existing methods for determining the internal length of nasogastric tubes.

Implications for clinical practice

In addition to healthcare provider education and training, a checklist-based framework is recommended for radiologists to unambiguously report nasogastric tube tip positions.

介绍：准确测定鼻胃管的内部长度对于安全有效地完成盲插这一常规护理程序至关重要。广泛使用的鼻-耳垂-剑突距离缺乏证据和有效性。最近的一项随机对照试验提出了一种替代方法，即校正鼻-耳垂-剑突距离公式。然而，该公式在实际临床实践中的有效性尚未得到研究：本研究评估了校正鼻-耳垂-剑突距离公式在确定住院或重症监护室成人患者鼻胃管内口长度时的实际临床效果：设计：利用常规收集的观察数据，进行单中心回顾性临床有效性研究：在 2020 年 10 月至 2022 年 11 月期间，纳入了 358 名需要鼻胃喂养管的综合医院成人患者。主要结果包括由一名高级执业护士通过 X 光检查评估鼻胃管尖端定位（低于食管下括约肌 3 厘米）。次要结果来自随机分组的 100 名参与者的患者记录，包括报告的清晰度和放射科医生对尖端位置的评估：结果：经过高级执业护士的评估，所有鼻胃喂养管的位置都被确定为正确。在 100 例输液管子组中，放射科复查医生记录的 X 光方案显示，输液管尖端的报告清晰度各不相同：4.0% 缺乏报告，33.0% 报告不明确，63.0% 报告不明确：结论：经校正的鼻-耳垂-剑突距离公式有可能成为确定鼻胃管内部长度的现有方法之外的一种更安全的替代方法：除了对医护人员进行教育和培训外，建议放射科医生采用基于核对表的框架，以明确报告鼻胃管尖端位置。

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引用次数: 0

Effects of sitting position on ventilation distribution determined by electrical impedance tomography in ventilated ARDS patients 坐姿对通过电阻抗断层扫描测定的 ARDS 通气分布的影响。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-08-07 DOI: 10.1016/j.iccn.2024.103782

Xiaofeng Chen , Ruyang Xiong , Ming Zhang , Chunming Guan , Liwei Feng , Zhipeng Yao , Yue Li , Wenhua Liu , Ming Ye , Yunlong Li , Xuesong Jiang , Yonglin Tang , Hongliang Wang , Junbo Zheng

Objective

The study aimed to evaluate the improvements in pulmonary ventilation following a sitting position in ventilated ARDS patients using electrical impedance tomography.

Methodology

A total of 17 patients with ARDS under mechanical ventilation participated in this study, including 8 with moderate ARDS and 9 with severe ARDS. Each patient was initially placed in the supine position (S1), transitioned to sitting position (SP) for 30 min, and then returned to the supine position (S2). Patients were monitored for each period, with parameters recorded.

Main Outcome measures

The primary outcome included the spatial distribution parameters of EIT, regional of interest (ROI), end-expiratory lung impedance (ΔEELI), and parameters of respiratory mechanics.

Results

Compared to S1, the SP significantly altered the distribution in ROI1 (11.29 ± 4.70 vs 14.88 ± 5.00 %, p = 0.003) and ROI2 (35.59 ± 8.99 vs 44.65 ± 6.97 %, p ＜ 0.001), showing reductions, while ROI3 (39.71 ± 11.49 vs 33.06 ± 6.34 %, p = 0.009), ROI4 (13.35 ± 8.76 vs 7.24 ± 5.23 %, p ＜ 0.001), along with peak inspiratory pressure (29.24 ± 3.96 vs 27.71 ± 4.00 cmH₂O, p = 0.036), showed increases. ΔEELI decreased significantly ventrally (168.3 (40.33 – 189.5), p ＜ 0.0001) and increased significantly dorsally (461.7 (297.5 – 683.7), p ＜ 0.0001). The PaO₂/FiO₂ ratio saw significant improvement in S2 compared to S1 after 30 min in the seated position (108 (73 – 130) vs 96 (57 – 129) mmHg, p = 0.03).

Conclusions

The sitting position is associated with enhanced compliance, improved oxygenation, and more homogenous ventilation in patients with ventilated ARDS compared to the supine position.

Implications for Clinical Practice

It is important to know the impact of postural changes on patient pulmonary ventilation in order to standardize safe practices in critically ill patients. It may be helpful in the management among ventilated patients.

研究目的该研究旨在利用电阻抗断层扫描评估通气的 ARDS 患者在采取坐姿后肺通气的改善情况：共有 17 名接受机械通气的 ARDS 患者参与了这项研究，其中包括 8 名中度 ARDS 患者和 9 名重度 ARDS 患者。每位患者起初都采取仰卧位（S1），30 分钟后转为坐位（SP），然后恢复仰卧位（S2）。每个阶段都对患者进行监测，并记录参数：主要结果包括 EIT 空间分布参数、感兴趣区（ROI）、呼气末肺阻抗（ΔEELI）和呼吸力学参数：与 S1 相比，SP 显著改变了 ROI1（11.29 ± 4.70 vs 14.88 ± 5.00 %，p = 0.003）和 ROI2（35.59 ± 8.99 vs 44.65 ± 6.97 %，p ＜ 0.001）的分布，显示出减少，而 ROI3（39.71 ± 11.49 vs 33.06 ± 6.34 %，p = 0.009）、ROI4（13.35 ± 8.76 vs 7.24 ± 5.23 %，p ＜ 0.001）以及吸气峰压（29.24 ± 3.96 vs 27.71 ± 4.00 cmH2O，p = 0.036）均呈上升趋势。ΔEELI 向腹侧明显下降（168.3 (40.33 - 189.5)，p ＜ 0.0001），向背侧明显上升（461.7 (297.5 - 683.7)，p ＜ 0.0001）。坐位 30 分钟后，S2 的 PaO2/FiO2 比率比 S1 有明显改善（108 (73 - 130) vs 96 (57 - 129) mmHg, p = 0.03）：结论：与仰卧位相比，坐位与 ARDS 患者顺应性增强、氧合改善和通气更均匀有关：了解体位变化对患者肺通气的影响对于规范重症患者的安全操作非常重要。对临床实践的启示：了解体位变化对患者肺通气的影响对于规范重症患者的安全操作非常重要，它可能有助于通气患者的管理。

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引用次数: 0

Prevalence of use of physical restraints in pediatric intensive care units and correlated variables: A Spanish multicenter study 儿科重症监护室使用人身限制措施的普遍性及相关变量：一项西班牙多中心研究。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-08-07 DOI: 10.1016/j.iccn.2024.103788

Alejandro Bosch Alcaraz , Sylvia Belda Hofheinz , Jesús Corrionero Alegre , José Miguel García Piñero , Sonia Gil Domínguez , Rocío Fernández Lorenzo , María Mata Ferro , Ainhoa Martín Gómez , Marta Serradell Orea , Patricia Luna Castaño , M. Ángeles Saz Roy , Esperanza Zuriguel Pérez , Marta Martínez Oliva , Susana González Rivas , Nerea Añaños Montoto , María José Espildora González , Elena Martín-Peñasco Osorio , Eva Carracedo Muñoz , Eduardo López Fernández , Gema Lozano Almendral , Pedro Piqueras Rodríguez

Objective

To calculate the prevalence of physical restraint (PR) use in Spanish PICUs and (2) to analyze the correlation between the prevalence of PR use and the sociodemographic, clinical variables of the patients and the PICU structural and organizational variables.

Methods

We conducted a multicenter prevalence study from January 2022 to January 2023 in Spanish PICUs. The method of data collection was by direct observation, review of the patient’s medical history, and asking the professionals involved in the patient’s care. Three weekly 24-hour prevalence observations (morning, afternoon, and night) were conducted for 6 months.

Results

A total of 336 patients were included in the study, obtaining an overall crude prevalence of PR use of 16 % (95 %CI: 15 %-17.7 %). Pediatric patients with respiratory pathology received the highest number of hours of PR, with significant differences observed when comparing respiratory cases with post-surgical cases. Statistical significance was also observed when comparing the mean scores of hours of PR according to admission diagnosis (p = 0.01), with respiratory patients being the ones who were restrained the longest (24 h [20–24]) and infectious patients the least (15 h [14–20]). Patients who receive PR upon admission remain in this situation for more hours (24 h [15–24] and in the PICUs that specifically recorded PR application, fewer hours of PR occurred (20 h [4–24]).

Conclusions

The use of PR is still present in the PICUs analyzed, with a crude prevalence of 16%. Factors such as the reason for admission, the use of respiratory support, and the reason for application of PR were linked to the hours of use of PR.

Implications for clinical practice

Knowing the prevalence of PR use will make professionals aware that it is still necessary to implement policies that avoid its use to prevent the side effects they have in pediatric patients.

目的计算西班牙 PICU 中使用物理约束（PR）的流行率；（2）分析使用物理约束的流行率与患者的社会人口学、临床变量以及 PICU 结构和组织变量之间的相关性：我们于 2022 年 1 月至 2023 年 1 月在西班牙 PICU 开展了一项多中心流行率研究。数据收集方法包括直接观察、回顾患者病史和询问参与患者护理的专业人员。在为期 6 个月的时间里，每周进行三次 24 小时流行观察（上午、下午和夜间）：研究共纳入 336 名患者，使用 PR 的总粗流行率为 16%（95%CI：15%-17.7%）。患有呼吸系统疾病的儿科患者接受 PR 的小时数最多，呼吸系统病例与手术后病例相比差异显著。根据入院诊断比较 PR 的平均时长也有统计学意义（p = 0.01），呼吸系统患者被限制的时间最长（24 小时 [20-24]），而感染性患者被限制的时间最少（15 小时 [14-20]）。入院时接受 PR 的患者被限制的时间更长（24 小时 [15-24]），而在专门记录 PR 使用情况的 PICU 中，被限制的时间更短（20 小时 [4-24]）：结论：在所分析的 PICU 中，仍存在使用 PR 的情况，粗略流行率为 16%。入院原因、使用呼吸支持和使用 PR 的原因等因素与使用 PR 的时数有关：对临床实践的启示：了解 PR 的使用率将使专业人员意识到，仍有必要实施避免使用 PR 的政策，以防止其对儿科患者产生副作用。

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引用次数: 0

Considering bias in a model to predict pressure injuries in ICU patients – Response to Dai et al. 考虑重症监护室患者压力损伤预测模型的偏差 - 对 Dai 等人的回应

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-08-03 DOI: 10.1016/j.iccn.2024.103781

Lin Han, Yuting Wei, Juhong Pei, Yuxia Ma

引用次数: 0

Non-medical prescribing in critical care 重症监护中的非医疗处方。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-08-02 DOI: 10.1016/j.iccn.2024.103780

Thomas Holgate