Pub Date : 2024-06-18DOI: 10.1016/j.iccn.2024.103743
Weipeng Huang , Yiyan Huang , Li Ke , Chang Hu , Pengyu Chen , Bo Hu
Background
Capillary refill time (CRT) is defined as the time taken for color to return to an external capillary bed after pressure is applied to cause blanching. Recent studies demonstrated the benefits of CRT in guiding fluid therapy for sepsis. However, lack of consistency among physicians in how to perform and interpret CRT has led to a low interobserver agreement for this assessment tool, which prevents its availability in sepsis clinical settings.
Objective
To give physicians a concise overview of CRT and explore recent evidence on its reliability and value in the management of sepsis.
Research design
A narrative review.
Results
This narrative review summarizes the factors affecting CRT values, for example, age, sex, temperature, light, observation techniques, work experience, training level and differences in CRT measurement methods. The methods of reducing the variability of CRT are synthesized. Based on studies with highly reproducible CRT measurements and an excellent inter-rater concordance, we recommend the standardized CRT assessment method. The threshold of normal CRT values is discussed. The application of CRT in different phases of sepsis management is summarized.
Conclusions
Recent data confirm the value of CRT in critically ill patients. CRT should be detected by trained physicians using standardized methods and reducing the effect of ambient-related factors. Its association with severe infection, microcirculation, tissue perfusion response, organ dysfunction and adverse outcomes makes this approach a very attractive tool in sepsis. Further studies should confirm its value in the management of sepsis.
Implications for clinical practice
As a simple assessment, CRT deserves more attention even though it has not been widely applied at the bedside. CRT could provide nursing staff with patient’s microcirculatory status, which may help to develop individualized nursing plans and improve the patient’s care quality and treatment outcomes.
{"title":"Perspectives for capillary refill time in clinical practice for sepsis","authors":"Weipeng Huang , Yiyan Huang , Li Ke , Chang Hu , Pengyu Chen , Bo Hu","doi":"10.1016/j.iccn.2024.103743","DOIUrl":"https://doi.org/10.1016/j.iccn.2024.103743","url":null,"abstract":"<div><h3>Background</h3><p>Capillary refill time (CRT) is defined as the time taken for color to return to an external capillary bed after pressure is applied to cause blanching. Recent studies demonstrated the benefits of CRT in guiding fluid therapy for sepsis. However, lack of consistency among physicians in how to perform and interpret CRT has led to a low interobserver agreement for this assessment tool, which prevents its availability in sepsis clinical settings.</p></div><div><h3>Objective</h3><p>To give physicians a concise overview of CRT and explore recent evidence on its reliability and value in the management of sepsis.</p></div><div><h3>Research design</h3><p>A narrative review.</p></div><div><h3>Results</h3><p>This narrative review summarizes the factors affecting CRT values, for example, age, sex, temperature, light, observation techniques, work experience, training level and differences in CRT measurement methods. The methods of reducing the variability of CRT are synthesized. Based on studies with highly reproducible CRT measurements and an excellent inter-rater concordance, we recommend the standardized CRT assessment method. The threshold of normal CRT values is discussed. The application of CRT in different phases of sepsis management is summarized.</p></div><div><h3>Conclusions</h3><p>Recent data confirm the value of CRT in critically ill patients. CRT should be detected by trained physicians using standardized methods and reducing the effect of ambient-related factors. Its association with severe infection, microcirculation, tissue perfusion response, organ dysfunction and adverse outcomes makes this approach a very attractive tool in sepsis. Further studies should confirm its value in the management of sepsis.</p></div><div><h3>Implications for clinical practice</h3><p>As a simple assessment, CRT deserves more attention even though it has not been widely applied at the bedside. CRT could provide nursing staff with patient’s microcirculatory status, which may help to develop individualized nursing plans and improve the patient’s care quality and treatment outcomes.</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141424456","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}
Pub Date : 2024-06-15DOI: 10.1016/j.iccn.2024.103747
Rafael Lima Rodrigues Carvalho, Daniela Ponce, Milena Soriano Marcolino
{"title":"Artificial intelligence in nursing care: The gap between research and the real world","authors":"Rafael Lima Rodrigues Carvalho, Daniela Ponce, Milena Soriano Marcolino","doi":"10.1016/j.iccn.2024.103747","DOIUrl":"https://doi.org/10.1016/j.iccn.2024.103747","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141328836","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}
Pub Date : 2024-06-14DOI: 10.1016/j.iccn.2024.103748
Lars Krüger , Armin Zittermann , Thomas Mannebach , Franziska Wefer , Tobias Becker , Sarah Lohmeier , Anna Lüttermann , Vera von Dossow , Sebastian V. Rojas , Jan Gummert , Gero Langer
Objective
We tested the feasibility of a randomized controlled trial for comparing primary nursing with standard care.
Research Methodology
Elective cardiac surgical patients were eligible for inclusion. Patients with an intensive care unit stay of ≥ 3 days were followed up until intensive care unit discharge. Recruitment period was one year.
Setting
Two intensive care units at a university hospital specialized in cardiovascular and diabetic diseases.
Main Outcome Measures
Primary outcomes were recruitment and delivery rate. Primary clinical outcome was duration of delirium, as assessed by the Confusion Assessment Method for Intensive Care Units. Secondary outcomes included the incidence of delirium, anxiety (10-point Numeric Rating Scale), and the satisfaction of patient relatives (validated questionnaire).
Results
Of 369 patients screened, 269 could be allocated to primary nursing (n = 134) or standard care (n = 135), of whom 46 patients and 48 patients, respectively, underwent an intensive care unit stay ≥ 3 days. Thus, recruitment and delivery rates were 73 and 26 %, respectively. During primary nursing and standard care, 18 and 24 patients developed a delirium, with a median duration of 32 (IQR: 14–96) and 24 (IQR: 8–44) hours (P = 0.10). The risk difference of delirium for primary nursing versus standard care was 11 % and the relative risk was 0.65 (95 % CI: 0.28–1.46; P = 0.29). The extent of anxiety was similar between groups (P = 0.13). Satisfaction could be assessed in 73.5 % of relatives, without substantial differences between groups.
Conclusion
Data demonstrate that a trial for comparing primary nursing with standard care is generally feasible. However, the incidence of delirium may be a better primary outcome parameter than delirium duration, both in terms of long-term patient outcome and robustness of data quality.
Implications for clinical practice
A randomized clinical trial regarding nursing organization during intensive care unit stay requires detailed planning of patient recruitment, data evaluation, and power calculation.
{"title":"Randomized feasibility trial for evaluating the impact of primary nursing on delirium duration during intensive care unit stay","authors":"Lars Krüger , Armin Zittermann , Thomas Mannebach , Franziska Wefer , Tobias Becker , Sarah Lohmeier , Anna Lüttermann , Vera von Dossow , Sebastian V. Rojas , Jan Gummert , Gero Langer","doi":"10.1016/j.iccn.2024.103748","DOIUrl":"10.1016/j.iccn.2024.103748","url":null,"abstract":"<div><h3>Objective</h3><p>We tested the feasibility of a randomized controlled trial for comparing primary nursing with standard care.</p></div><div><h3>Research Methodology</h3><p>Elective cardiac surgical patients were eligible for inclusion. Patients with an intensive care unit stay of ≥ 3 days were followed up until intensive care unit discharge. Recruitment period was one year.</p></div><div><h3>Setting</h3><p>Two intensive care units at a university hospital specialized in cardiovascular and diabetic diseases.</p></div><div><h3>Main Outcome Measures</h3><p>Primary outcomes were recruitment and delivery rate. Primary clinical outcome was duration of delirium, as assessed by the Confusion Assessment Method for Intensive Care Units. Secondary outcomes included the incidence of delirium, anxiety (10-point Numeric Rating Scale), and the satisfaction of patient relatives (validated questionnaire).</p></div><div><h3>Results</h3><p>Of 369 patients screened, 269 could be allocated to primary nursing (n = 134) or standard care (n = 135), of whom 46 patients and 48 patients, respectively, underwent an intensive care unit stay ≥ 3 days. Thus, recruitment and delivery rates were 73 and 26 %, respectively. During primary nursing and standard care, 18 and 24 patients developed a delirium, with a median duration of 32 (IQR: 14–96) and 24 (IQR: 8–44) hours (P = 0.10). The risk difference of delirium for primary nursing versus standard care was 11 % and the relative risk was 0.65 (95 % CI: 0.28–1.46; P = 0.29). The extent of anxiety was similar between groups (P = 0.13). Satisfaction could be assessed in 73.5 % of relatives, without substantial differences between groups.</p></div><div><h3>Conclusion</h3><p>Data demonstrate that a trial for comparing primary nursing with standard care is generally feasible. However, the incidence of delirium may be a better primary outcome parameter than delirium duration, both in terms of long-term patient outcome and robustness of data quality.</p></div><div><h3>Implications for clinical practice</h3><p>A randomized clinical trial regarding nursing organization during intensive care unit stay requires detailed planning of patient recruitment, data evaluation, and power calculation.</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0964339724001332/pdfft?md5=ccb2c7d4075faa78d2d54d9d30cdb436&pid=1-s2.0-S0964339724001332-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141322192","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":"The metronome as a resuscitator support tool during “Compressions-Only” cardiopulmonary resuscitation. A quasi-experimental study","authors":"Breogán Carballo Álvarez , Jorge Alcántara Espinosa , Sandra Vidal Martínez","doi":"10.1016/j.iccn.2024.103745","DOIUrl":"10.1016/j.iccn.2024.103745","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141322193","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}
Pub Date : 2024-06-10DOI: 10.1016/j.iccn.2024.103730
Jan Kottner , Ulrike Blume-Peytavi
{"title":"Skin lesions in infant compared to adult ICU patients: Is it any different?","authors":"Jan Kottner , Ulrike Blume-Peytavi","doi":"10.1016/j.iccn.2024.103730","DOIUrl":"https://doi.org/10.1016/j.iccn.2024.103730","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0964339724001150/pdfft?md5=10bbe20160dbab1e1c46e1542d955046&pid=1-s2.0-S0964339724001150-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141302751","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}
Pub Date : 2024-06-10DOI: 10.1016/j.iccn.2024.103728
Sevilay Senol Celik , Athanasios Chalkias , Seda Sariköse , Hande Nur Arslan , Ali Bahramifar , Farshid Rahimi-Bashar , Ali Ait Hssain , Saeed Hashemi , Amir Vahedian-Azimi
Objectives
To evaluate the effectiveness of peri-intubation non-pharmacological interventions in reducing postoperative sore throat (POST), cough (PEC), and hoarseness in surgical patients.
Design
A systematic review with meta-analysis and meta-regression.
Setting
Elective surgery under general anesthesia in operating rooms.
Main Outcome Measures
Evaluate the impact of non-pharmacological interventions, including pre-intubation (gargling with Sodium Azulene Sulfonate, licorice, or using Strepsils tablets of honey and lemon lozenge), during-intubation (inflating the TT cuff with normal saline and softening the ETT cuff with warm normal saline), and post-intubation (cold vapor therapy, gargling with honey lemon water, and using green tea gargle), on the occurrence of POST, PEC, and hoarseness.
Results
Nineteen trials with 2,136 participants were included. Pre-intubation intervention significantly reduced POST immediately after extubation (n = 861; OR: 0.28, 95 % CI: 0.20–0.38, P < 0.001), and 24 h post-extubation (n = 1006; OR: 0.21, 95 % CI: 0.16–0.28, P < 0.001). During-intubation intervention did not show significant effects on POST. Pre-intubation intervention also reduced POST-associated pain score at 24 h post-extubation (n = 440; MD: −0.50, 95 % CI: −0.81 to −0.18, P < 0.001). Post-intubation interventions were effective in reducing POST-associated pain scores at different time points post-extubation (P < 0.05). Pre-intubation intervention significantly reduced PEC (OR: 0.13, 95 % CI: 0.02–0.70, P = 0.02) and hoarseness (OR: 0.36, 95 %CI: 0.15–0.86, P = 0.02) at 24 h post-extubation. However, during-intubation interventions did not reduce hoarseness at 24 h post-extubation.
Conclusion
Pre-intubation non-pharmacological interventions were found to be the most effective in reducing the incidence and severity of POST, PEC, and hoarseness.
Implications for Clinical Practice
Implementing pre-intubation non-pharmacological interventions can be beneficial for bedside nurses and healthcare professionals in reducing postoperative complications and nurses can contribute to improving patient comfort and recovery outcomes following surgery.
Systematic Review Protocol
The protocol was registered in the PROSPERO international prospective register of systematic reviews on 2 January 2024 (CRD42023492813).
{"title":"Effect of peri-intubation non-pharmacological interventions on postoperative laryngeal symptoms: A systematic review with meta-analysis and meta-regression","authors":"Sevilay Senol Celik , Athanasios Chalkias , Seda Sariköse , Hande Nur Arslan , Ali Bahramifar , Farshid Rahimi-Bashar , Ali Ait Hssain , Saeed Hashemi , Amir Vahedian-Azimi","doi":"10.1016/j.iccn.2024.103728","DOIUrl":"https://doi.org/10.1016/j.iccn.2024.103728","url":null,"abstract":"<div><h3>Objectives</h3><p>To evaluate the effectiveness of <em>peri</em>-intubation non-pharmacological interventions in reducing postoperative sore throat (POST), cough (PEC), and hoarseness in surgical patients.</p></div><div><h3>Design</h3><p>A systematic review with <em>meta</em>-analysis and <em>meta</em>-regression.</p></div><div><h3>Setting</h3><p>Elective surgery under general anesthesia in operating rooms.</p></div><div><h3>Main Outcome Measures</h3><p>Evaluate the impact of non-pharmacological interventions, including pre-intubation (gargling with Sodium Azulene Sulfonate, licorice, or using Strepsils tablets of honey and lemon lozenge), during-intubation (inflating the TT cuff with normal saline and softening the ETT cuff with warm normal saline), and post-intubation (cold vapor therapy, gargling with honey lemon water, and using green tea gargle), on the occurrence of POST, PEC, and hoarseness.</p></div><div><h3>Results</h3><p>Nineteen trials with 2,136 participants were included. Pre-intubation intervention significantly reduced POST immediately after extubation (n = 861; OR: 0.28, 95 % CI: 0.20–0.38, P < 0.001), and 24 h post-extubation (n = 1006; OR: 0.21, 95 % CI: 0.16–0.28, P < 0.001). During-intubation intervention did not show significant effects on POST. Pre-intubation intervention also reduced POST-associated pain score at 24 h post-extubation (n = 440; MD: −0.50, 95 % CI: −0.81 to −0.18, P < 0.001). Post-intubation interventions were effective in reducing POST-associated pain scores at different time points post-extubation (P < 0.05). Pre-intubation intervention significantly reduced PEC (OR: 0.13, 95 % CI: 0.02–0.70, P = 0.02) and hoarseness (OR: 0.36, 95 %CI: 0.15–0.86, P = 0.02) at 24 h post-extubation. However, during-intubation interventions did not reduce hoarseness at 24 h post-extubation.</p></div><div><h3>Conclusion</h3><p>Pre-intubation non-pharmacological interventions were found to be the most effective in reducing the incidence and severity of POST, PEC, and hoarseness.</p></div><div><h3>Implications for Clinical Practice</h3><p>Implementing pre-intubation non-pharmacological interventions can be beneficial for bedside nurses and healthcare professionals in reducing postoperative complications and nurses can contribute to improving patient comfort and recovery outcomes following surgery.</p></div><div><h3>Systematic Review Protocol</h3><p>The protocol was registered in the PROSPERO international prospective register of systematic reviews on 2 January 2024 (CRD42023492813).</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141302750","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}
Pub Date : 2024-06-08DOI: 10.1016/j.iccn.2024.103742
Tainá Costa Pereira Lopes , Alexia Gabriela da Silva Vieira , Sarah Almeida Cordeiro , Alexandre Lopes Miralha , Edson de Oliveira Andrade , Raquel Lima de Lima , Marcello Facundo do Valle Filho , Antônio Luiz Boechat , Roberta Lins Gonçalves
Objective
To identify the most effective non-pharmacological measures for pain control in preterm infants in the Neonatal Intensive Care Unit (NICU).
Methods
A Systematic review and network meta-analysis of randomized clinical trials published in English, Portuguese, and Spanish from April 2020 to December 2023. The data sources used were MedLine via PubMed, LILACS, EMBASE, The Cochrane Central Register of Controlled Trials, and Pedro. We performed the risk of bias analysis with Rob 2 and the certainty of the evidence and strength of the recommendation using the Grading of Recommendations Assessment, Development, and Evaluation system. We assessed heterogeneity using the Higgins and Thompson I2 test, the classification of interventions using the P-score, and inconsistencies using the Direct Evidence Plot.
Results
From 210 publications identified, we utilized 12 studies in analysis with 961 preterm infants, and we combined ten studies in network meta-analysis with 716 preterm infants, and 12 combinations of non-pharmacological measures. With moderate confidence, sensory saturation, sugars, non-nutritive sucking, maternal heart sound, lullaby, breast milk odor/taste, magnetic acupuncture, skin-to-skin contact, and facilitated tucking have been shown to reduce pain in preterm infants when compared to no intervention, placebo, proparacaine or standard NICU routine: sensory saturation [SMD 5,25 IC 95%: −8,98; −1,53], sugars [SMD 2,32 IC 95%: −3,86; −0,79], pacifier [SMD 3,74 IC 95%: −7,30; 0,19], and sugars and pacifier SMD [3,88 IC 95% −7,72; −0,04].
Conclusion
Non-pharmacological measures are strongly recommended for pain management in preterm infants in the NICU.
Implications for clinical practice
The findings of this study have important implications for policy and practice. This is the only systematic review that compared the effectiveness of non-pharmacological measures, thus making it possible to identify which measure presents the best results and could be the first choice in clinical decision making.
方法对 2020 年 4 月至 2023 年 12 月期间用英语、葡萄牙语和西班牙语发表的随机临床试验进行系统综述和网络荟萃分析。使用的数据来源包括通过 PubMed 进行的 MedLine、LILACS、EMBASE、Cochrane 对照试验中央注册中心和 Pedro。我们使用 Rob 2 进行了偏倚风险分析，并使用建议分级评估、制定和评价系统对证据的确定性和建议的力度进行了评估。我们使用 Higgins 和 Thompson I2 检验评估了异质性，使用 P 评分对干预措施进行了分类，并使用直接证据图谱评估了不一致性。结果从 210 篇已确定的出版物中，我们利用 12 项研究对 961 名早产儿进行了分析，并结合 10 项研究对 716 名早产儿进行了网络荟萃分析，同时结合了 12 种非药物措施。在中等可信度的情况下，与无干预、安慰剂、丙卡因或标准新生儿重症监护室常规相比，感觉饱和度、糖类、非营养性吸吮、母体心音、摇篮曲、母乳气味/味道、磁针灸、皮肤接触和促进性掖被均可减轻早产儿的疼痛：感觉饱和度[SMD 5,25 IC 95%：-8,98；-1,53]、糖[SMD 2,32 IC 95%：-3,86；-0,79]、奶嘴[SMD 3,74 IC 95%：-7,30；0,19]、糖和奶嘴SMD[3,88 IC 95%：-7,72；-0,04]。对临床实践的启示本研究结果对政策和实践具有重要意义。这是唯一一项对非药物治疗措施的有效性进行比较的系统性综述，因此可以确定哪种措施效果最好，并可作为临床决策的首选。
{"title":"Effectiveness of non-pharmacological interventions in reducing pain in preterm infants: A systematic review and network meta-analysis","authors":"Tainá Costa Pereira Lopes , Alexia Gabriela da Silva Vieira , Sarah Almeida Cordeiro , Alexandre Lopes Miralha , Edson de Oliveira Andrade , Raquel Lima de Lima , Marcello Facundo do Valle Filho , Antônio Luiz Boechat , Roberta Lins Gonçalves","doi":"10.1016/j.iccn.2024.103742","DOIUrl":"https://doi.org/10.1016/j.iccn.2024.103742","url":null,"abstract":"<div><h3>Objective</h3><p>To identify the most effective non-pharmacological measures for pain control in preterm infants in the Neonatal Intensive Care Unit (NICU).</p></div><div><h3>Methods</h3><p>A Systematic review and network meta-analysis of randomized clinical trials published in English, Portuguese, and Spanish from April 2020 to December 2023. The data sources used were MedLine via PubMed, LILACS, EMBASE, The Cochrane Central Register of Controlled Trials, and Pedro. We performed the risk of bias analysis with Rob 2 and the certainty of the evidence and strength of the recommendation using the Grading of Recommendations Assessment, Development, and Evaluation system. We assessed heterogeneity using the Higgins and Thompson I<sup>2</sup> test, the classification of interventions using the P-score, and inconsistencies using the Direct Evidence Plot.</p></div><div><h3>Results</h3><p>From 210 publications identified, we utilized 12 studies in analysis with 961 preterm infants, and we combined ten studies in network meta-analysis with 716 preterm infants, and 12 combinations of non-pharmacological measures. With moderate confidence, sensory saturation, sugars, non-nutritive sucking, maternal heart sound, lullaby, breast milk odor/taste, magnetic acupuncture, skin-to-skin contact, and facilitated tucking have been shown to reduce pain in preterm infants when compared to no intervention, placebo, proparacaine or standard NICU routine: sensory saturation [SMD 5,25 IC 95%: −8,98; −1,53], sugars [SMD 2,32 IC 95%: −3,86; −0,79], pacifier [SMD 3,74 IC 95%: −7,30; 0,19], and sugars and pacifier SMD [3,88 IC 95% −7,72; −0,04].</p></div><div><h3>Conclusion</h3><p>Non-pharmacological measures are strongly recommended for pain management in preterm infants in the NICU.</p></div><div><h3>Implications for clinical practice</h3><p>The findings of this study have important implications for policy and practice. This is the only systematic review that compared the effectiveness of non-pharmacological measures, thus making it possible to identify which measure presents the best results and could be the first choice in clinical decision making.</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141289242","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}
Pub Date : 2024-06-08DOI: 10.1016/j.iccn.2024.103726
Sara Michelly Gonçalves Brandão , Maristela Belletti Mutt Urasaki , Dayanna Machado Pires Lemos , Ligia Neres Matos , Mariana Takahashi , Paula Cristina Nogueira , Vera Lucia Conceição de Gouveia Santos
Background
Evidence on infection risk factors is scarce, and precise localization of the site of infection and its treatment remain clinically challenging.
Objectives
This study aimed to map the recommendations for adult patients undergoing left ventricular assist device implantation.
Design
This is a scoping review, registered in the Open Science Framework under DOI10.17605/OSF.IO/Q76B3(https://osf.io/q76b3/).
Method
This is a scoping review limited to the period between 2015 and 2022.The results of this scoping review are discussed and presented separately in 3 articles. This second paper synthesizes research evidence on the risk factors, diagnostic methods and treatment of infection in adult patients undergoing left ventricular assist device implantation.
Results
The initial searches identified 771 studies. Sixty-nine patients met the eligibility criteria and were included in the scoping review. Forty-three articles addressing the risk factors, diagnosis and treatment of infection were included to answer the questions of this review.
Conclusion
Obesity has been shown to be the most common risk factor for the described process of infection by left ventricular assist devices.18F-fluorodeoxyglucose positron emission tomography showed high sensitivity in detecting cardiac device infection, and labeled leukocyte or gallium citrate-67 scintigraphy showed high specificity for left ventricular assist device infections; therefore, it can help differentiate infection from inflammation, particularly in patients with equivocal fluorodeoxyglucose positron emission tomography. Also, this review brings and discusses the limitations and strengths of diagnostic tests, the knowledge regarding the risk factors for left ventricular assist device infection, the therapeutic heterogeneity, the methodological issues of the studies, and the vast opportunity for future research on left ventricular assist device.
Implications for Clinical Practice
Ventricular assist device professionals should evaluate risk factors prior to device implantation and periodically.18F-fluorodeoxyglucose positron emission tomography should be considered as diagnostic tool in detecting superficial and deep driveline infections. Early treatment, including chronic suppressive therapy and serial surgical debridement, combined with driveline exteriorization and delayed driveline relocation may constitute a potential therapeutic strategy for deep driveline infections.
{"title":"Risk factors, diagnostic methods and treatment of infection in adult patients undergoing left ventricular assist device implantation: A scoping review","authors":"Sara Michelly Gonçalves Brandão , Maristela Belletti Mutt Urasaki , Dayanna Machado Pires Lemos , Ligia Neres Matos , Mariana Takahashi , Paula Cristina Nogueira , Vera Lucia Conceição de Gouveia Santos","doi":"10.1016/j.iccn.2024.103726","DOIUrl":"https://doi.org/10.1016/j.iccn.2024.103726","url":null,"abstract":"<div><h3>Background</h3><p>Evidence on infection risk factors is scarce, and precise localization of the site of infection and its treatment remain clinically challenging.</p></div><div><h3>Objectives</h3><p>This study aimed to map the recommendations for adult patients undergoing left ventricular assist device implantation.</p></div><div><h3>Design</h3><p>This is a scoping review, registered in the Open Science Framework under DOI10.17605/OSF.IO/Q76B3(https://osf.io/q76b3/).</p></div><div><h3>Method</h3><p>This is a scoping review limited to the period between 2015 and 2022.The results of this scoping review are discussed and presented separately in 3 articles. This second paper synthesizes research evidence on the risk factors, diagnostic methods and treatment of infection in adult patients undergoing left ventricular assist device implantation.</p></div><div><h3>Results</h3><p>The initial searches identified 771 studies. Sixty-nine patients met the eligibility criteria and were included in the scoping review. Forty-three articles addressing the risk factors, diagnosis and treatment of infection were included to answer the questions of this review.</p></div><div><h3>Conclusion</h3><p>Obesity has been shown to be the most common risk factor for the described process of infection by left ventricular assist devices.<sup>18</sup>F-fluorodeoxyglucose positron emission tomography showed high sensitivity in detecting cardiac device infection, and labeled leukocyte or gallium citrate-67 scintigraphy showed high specificity for left ventricular assist device infections; therefore, it can help differentiate infection from inflammation, particularly in patients with equivocal fluorodeoxyglucose positron emission tomography. Also, this review brings and discusses the limitations and strengths of diagnostic tests, the knowledge regarding the risk factors for left ventricular assist device infection, the therapeutic heterogeneity, the methodological issues of the studies, and the vast opportunity for future research on left ventricular assist device.</p></div><div><h3>Implications for Clinical Practice</h3><p>Ventricular assist device professionals should evaluate risk factors prior to device implantation and periodically.<sup>18</sup>F-fluorodeoxyglucose positron emission tomography should be considered as diagnostic tool in detecting superficial and deep driveline infections. Early treatment, including chronic suppressive therapy and serial surgical debridement, combined with driveline exteriorization and delayed driveline relocation may constitute a potential therapeutic strategy for deep driveline infections.</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141289241","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}
Pub Date : 2024-06-04DOI: 10.1016/j.iccn.2024.103716
Objectives
This study evaluated the association between refeeding syndrome (RFS) risk and intensive care unit (ICU)/in-hospital mortality and length of stay (LOS) and ICU readmission in critically ill patients.
Methods
This secondary analysis of a cohort study included patients aged ≥ 18 years admitted at ICU 24 h before data collection. We evaluated RFS risk based on the National Institute for Health and Clinical Excellence (NICE), stratifying it into four categories (no, low, high, and very-high risk).
Setting
Five adult ICUs in Brazil.
Main outcome measures
ICU/in-hospital mortality and LOS and ICU readmission data were obtained from electronic medical records analysis, following patients until discharge (alive or not).
Results
The study involved 447 patients, categorized into no (19.2 %), low (28.6 %), high (48.8 %), and very-high (3.4 %) RFS risk groups. No significant differences emerged between the two groups (at RFS risk and no RFS risk) regarding the ICU death ratio (34.3 % versus 23.4 %) and LOS (5 versus 4 days), respectively. In contrast, patients at RFS risk experienced higher in-hospital mortality rates (34.3 % versus 23.4 %) prolonged hospital LOS (21 days versus 17 days), and increased ICU readmission rates (15 % versus 8.4 %) than patients without RFS risk. After adjusting for age and Sequential Organ Failure Assessment (SOFA) Score, we found no association between RFS risk and increased mortality in the ICU or hospital. Also, there was no significant association between RFS risk and prolonged LOS in the ICU or hospital setting. However, patients identified as at risk of RFS showed nearly double the odds of ICU readmission (Odds ratio, 1.90; 95 % CI 1.02–3.43).
Conclusions
This study found no significant association between RFS risk and increased mortality in both the ICU and hospital settings, nor was there a significant association with prolonged LOS in the ICU or hospital among critically ill patients. However, patients at risk of RFS exhibited nearly double the odds of ICU readmission.
Implications for Clinical Practice
Our findings may contribute to understanding risks associated with ICU readmissions, highlighting the complexity of discharge decision-making through comprehensive assessments.
{"title":"Refeeding syndrome risk at ICU admission is an independent predictor of ICU readmission but it is not associated with mortality or length of stay in critically ill patients","authors":"","doi":"10.1016/j.iccn.2024.103716","DOIUrl":"10.1016/j.iccn.2024.103716","url":null,"abstract":"<div><h3>Objectives</h3><p><span>This study evaluated the association between refeeding syndrome<span> (RFS) risk and intensive care unit (ICU)/in-hospital mortality and length of stay (LOS) and ICU </span></span>readmission in critically ill patients.</p></div><div><h3>Methods</h3><p>This secondary analysis of a cohort study included patients aged ≥ 18 years admitted at ICU 24 h before data collection. We evaluated RFS risk based on the National Institute for Health and Clinical Excellence (NICE), stratifying it into four categories (no, low, high, and very-high risk).</p></div><div><h3>Setting</h3><p>Five adult ICUs in Brazil.</p></div><div><h3>Main outcome measures</h3><p>ICU/in-hospital mortality and LOS and ICU readmission data were obtained from electronic medical records analysis, following patients until discharge (alive or not).</p></div><div><h3>Results</h3><p><span>The study involved 447 patients, categorized into no (19.2 %), low (28.6 %), high (48.8 %), and very-high (3.4 %) RFS risk groups. No significant differences emerged between the two groups (at RFS risk and no RFS risk) regarding the ICU death ratio (34.3 % versus 23.4 %) and LOS (5 versus 4 days), respectively. In contrast, patients at RFS risk experienced higher in-hospital mortality rates (34.3 % versus 23.4 %) prolonged hospital LOS (21 days versus 17 days), and increased ICU readmission rates (15 % versus 8.4 %) than patients without RFS risk. After adjusting for age and Sequential Organ Failure Assessment (SOFA) Score, we found no association between RFS risk and increased mortality in the ICU or hospital. Also, there was no significant association between RFS risk and prolonged LOS in the ICU or hospital setting. However, patients identified as at risk of RFS showed nearly double the odds of ICU readmission (Odds ratio, 1.90; 95 % CI 1.02</span><strong>–</strong>3.43).</p></div><div><h3>Conclusions</h3><p>This study found no significant association between RFS risk and increased mortality in both the ICU and hospital settings, nor was there a significant association with prolonged LOS in the ICU or hospital among critically ill patients. However, patients at risk of RFS exhibited nearly double the odds of ICU readmission.</p></div><div><h3>Implications for Clinical Practice</h3><p>Our findings may contribute to understanding risks associated with ICU readmissions, highlighting the complexity of discharge decision-making through comprehensive assessments.</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249137","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}
Pub Date : 2024-06-01DOI: 10.1016/j.iccn.2024.103724
Marta Sánchez Mora , Beatriz Lázaro Álvarez , Amaya Arboníes Cabodevilla , Mónica Vázquez-Calatayud
{"title":"Emotional intelligence of nurses in intensive care units: A systematic review","authors":"Marta Sánchez Mora , Beatriz Lázaro Álvarez , Amaya Arboníes Cabodevilla , Mónica Vázquez-Calatayud","doi":"10.1016/j.iccn.2024.103724","DOIUrl":"10.1016/j.iccn.2024.103724","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":null,"pages":null},"PeriodicalIF":5.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0964339724001095/pdfft?md5=cdf5aac24518a5372fec08f01269a1f9&pid=1-s2.0-S0964339724001095-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141201644","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}
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