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Effectiveness of intermittent pneumatic compression cushion in preventing sacrococcygeal intraoperative acquired pressure injuries during cardiac surgery: a randomized controlled trial 间歇气动压缩垫预防心脏手术中骶尾骨术后获得性压力损伤的有效性:一项随机对照试验。
IF 4.7 2区 医学 Q1 NURSING Pub Date : 2025-11-22 DOI: 10.1016/j.iccn.2025.104278
Yan Zhang , Wei Gao , Yi Zhang , Yuyan Lin , Na Chen , Caixia Sun , Yaoyao Hu , Huijun Chen , Min Xu , Weijian Wang

Background

Intraoperative Acquired Pressure Injury (IAPI) is a common complications in cardiac surgery, with reported incidence rates of 14.3–30%. Conventional pressure redistribution methods have limited effectiveness during lengthy procedures. This study evaluated the efficacy of intermittent pneumatic compression (IPC) cushions in preventing sacrococcygeal IAPI in cardiac surgery patients and developed a predictive nomogram for risk assessment.

Methods

In this prospective, single-center randomized controlled trial, patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) were randomized to receive either IPC cushion (n = 94) or standard gel pad (n = 95). The primary outcome was the incidence of sacrococcygeal IAPI. Secondary outcomes included intraoperative changes in regional tissue oxygen saturation (rSO2) and postoperative skin temperature differentials (ΔT). Risk factors were identified through logistic regression analysis, and a predictive nomogram was constructed and validated.

Results

The IAPI incidence was significantly lower in the IPC group compared to the control group (3.19 % vs. 18.95 %, P = 0.001). The IPC group demonstrated higher sacrococcygeal rSO2 values during CPB and rewarming phases (P < 0.05). Postoperative sacrococcygeal ΔT was significantly lower in the IPC group [0.0 (–0.1, 0.1) vs 0.3 (–0.3, 0.5); P = 0.001]. Multivariate logistic regression identified lower preoperative sacrococcygeal rSO2 (OR = 0.94, 95 % CI: 0.90–0.98), absence of IPC intervention (OR = 0.06, 95 % CI: 0.01–0.28), and diabetes mellitus (OR = 7.98, 95 % CI: 2.20–29.01) as independent risk factors for IAPI. The nomogram demonstrated excellent discrimination (AUC = 0.857, 95 % CI: 0.776–0.937) and calibration (χ2 = 1.09, P = 0.997).

Conclusion

IPC cushions effectively reduce IAPI incidence during cardiac surgery by improving sacrococcygeal tissue perfusion. Skin temperature differentials correlate with IAPI risk and may serve as early indicators for prevention. The validated predictive nomogram offers a practical tool for risk assessment and targeted preventive strategies in clinical practice.

Implications for clinical practice

This study introduced an innovative application of IPC for preventing intraoperative IAPI in cardiac surgery patients, demonstrating its effectiveness in lowering the incidence of IAPI.
背景:术中获得性压力损伤(IAPI)是心脏手术中常见的并发症,据报道发病率为14.3-30%。在漫长的过程中,传统的压力再分配方法的有效性有限。本研究评估了间歇气动压缩(IPC)缓冲垫预防心脏手术患者骶尾骨IAPI的效果,并开发了一种用于风险评估的预测图。方法:在这项前瞻性、单中心随机对照试验中,接受心脏手术合并体外循环(CPB)的患者被随机分为IPC缓冲垫(n = 94)和标准凝胶垫(n = 95)。主要观察指标为骶尾骨IAPI的发生率。次要结果包括术中局部组织氧饱和度(rSO2)和术后皮肤温差的变化(ΔT)。通过logistic回归分析识别危险因素,构建预测模态图并进行验证。结果:IPC组IAPI发生率明显低于对照组(3.19% vs. 18.95%, P = 0.001)。IPC组在CPB和复温阶段的骶尾骨rSO2值较高(P < 2 (OR = 0.94, 95% CI: 0.90-0.98)),缺乏IPC干预(OR = 0.06, 95% CI: 0.01-0.28)和糖尿病(OR = 7.98, 95% CI: 2.20-29.01)是IAPI的独立危险因素。模态图具有良好的鉴别性(AUC = 0.857, 95% CI: 0.776 ~ 0.937)和校准性(χ2 = 1.09, P = 0.997)。结论:IPC缓冲垫通过改善骶尾骨组织灌注,有效降低心脏手术中IAPI的发生率。皮肤温差与IAPI风险相关,可作为预防的早期指标。经过验证的预测图为临床实践中的风险评估和有针对性的预防策略提供了实用的工具。临床意义:本研究介绍了IPC在心脏手术患者术中预防IAPI的创新应用,证明了其在降低IAPI发生率方面的有效性。
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引用次数: 0
Humanising paediatric care in the PICU: current strategies and emerging insights 在PICU人性化儿科护理:当前的策略和新兴的见解。
IF 4.7 2区 医学 Q1 NURSING Pub Date : 2025-11-22 DOI: 10.1016/j.iccn.2025.104287
Daniel Joseph E. Berdida , Jos M. Latour
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引用次数: 0
Association between 1-h bundle and clinical outcomes in patients with sepsis: Treatment effect is greater for sicker patients! – Letter on Hong et al. 脓毒症患者1-h束与临床结局的关系:病情较重的患者治疗效果更好!——关于洪等人的信
IF 4.7 2区 医学 Q1 NURSING Pub Date : 2025-11-21 DOI: 10.1016/j.iccn.2025.104282
Vincent Garrouste , Benoît Vivien , Papa Gueye , Romain Jouffroy
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引用次数: 0
Dehumanization in healthcare: is artificial intelligence a threat or a salvation? 医疗保健的非人性化:人工智能是威胁还是拯救?
IF 4.7 2区 医学 Q1 NURSING Pub Date : 2025-11-20 DOI: 10.1016/j.iccn.2025.104284
Marieke Geldof , Athiana Ryland , Simon Malfait
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引用次数: 0
Effective nursing interventions for infection prevention and control in acute and critically ill patients with a peripherally inserted venous catheter: an umbrella review 有效的护理干预预防和控制感染的急性和危重病人与周围静脉导管:总括回顾。
IF 4.7 2区 医学 Q1 NURSING Pub Date : 2025-11-20 DOI: 10.1016/j.iccn.2025.104250
José Costa , Joana Teixeira , Eliana Sousa , Maria do Rosário Pinto

Introduction

Infections related to peripherally inserted venous catheters are among the most serious and frequent complications in acute and critical care. If unaddressed, these infections markedly escalate morbidity, mortality, and healthcare expenditures.

Objective

To synthesize scientific evidence about effective nursing interventions that prevent and control infections in acute and critically ill patients with peripherally inserted venous catheters.

Methods

This umbrella review followed Joanna Briggs Institute guidelines and the PRISMA statement for reporting systematic reviews. A systematic search was carried out in CINAHL, MEDLINE, JBI Evidence Synthesis, Cochrane Database of Systematic Reviews, Web of Science, and SCOPUS. Rayyan software supported study extraction and selection. Each study was assessed for methodological quality, grade of recommendation, and level of evidence.

Results

Six systematic reviews were included, allowing the identification of nursing-led interventions that demonstrably reduce catheter-related infection. Evidence supports infection risk reduction through chlorhexidine gluconate for skin preparation, insertion and maintenance bundles, and strategies to support bundle implementation. Additional effective interventions include in-line filters, limiting device dwell time, minimizing continuous antibiotic infusions, and avoiding using Teflon cannulas, instead of polyethylene or Vialon cannulas. For patients with peripherally inserted central catheters (PICCs), quantified grip exercises improved circulation and reduced infection and thrombosis risk. Integrated short peripheral catheters were associated with significantly fewer complications than non-integrated ones.

Conclusions

Nurses are pivotal in preventing peripherally inserted venous catheter-related infection through specific evidence-based interventions. Nurse leaders should also prioritize selecting lower-risk devices to enhance patient outcomes and reduce complications.

Implications for clinical practice

This review underscores the need for nurses to consistently implement evidence-based interventions to prevent infections related to venous catheters, reduce complications, and improve patient outcomes. It reinforces the importance of ongoing education, institutional support, and leadership in fostering safer practices in acute and critical care environments.
前言:与外周静脉导管置入相关的感染是急性和危重症护理中最严重和最常见的并发症之一。如果不加以解决,这些感染会显著增加发病率、死亡率和医疗支出。目的:为预防和控制急性危重病人外周静脉置管感染的有效护理措施提供科学依据。方法:本综述遵循乔安娜布里格斯研究所的指南和PRISMA报告系统评价的声明。在CINAHL、MEDLINE、JBI Evidence Synthesis、Cochrane Database of systematic Reviews、Web of Science和SCOPUS中进行系统检索。Rayyan软件支持研究提取和选择。对每项研究的方法学质量、推荐等级和证据水平进行评估。结果:纳入了六项系统评价,确定了护理主导的干预措施,可明显减少导管相关感染。证据支持通过葡萄糖酸氯己定用于皮肤准备、插入和维护包以及支持包实施的策略来降低感染风险。其他有效的干预措施包括在线过滤器,限制装置停留时间,尽量减少抗生素连续输注,避免使用特氟龙套管,而不是聚乙烯或维亚龙套管。对于外周插入中心导管(PICCs)的患者,量化的握力练习可以改善血液循环,降低感染和血栓形成的风险。整合短外周导管的并发症明显少于非整合短外周导管。结论:护士是通过循证干预措施预防静脉导管相关感染的关键。护士领导还应优先选择低风险设备,以提高患者的预后和减少并发症。对临床实践的启示:本综述强调护士需要始终如一地实施循证干预措施,以预防与静脉导管相关的感染,减少并发症,改善患者预后。它强调了在急性和重症监护环境中促进更安全做法的持续教育、机构支持和领导的重要性。
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引用次数: 0
“Do we still need physical restraints in ICU? No!” “我们在重症监护室还需要身体约束吗?”不!”
IF 4.7 2区 医学 Q1 NURSING Pub Date : 2025-11-14 DOI: 10.1016/j.iccn.2025.104262
Rens Kooken, Bram Tilburgs, Mark van den Boogaard
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引用次数: 0
The Ideal Human Care in Green ICU: An integrated AI framework for future ICU care – Letter on Arabfard et al. 绿色ICU中的理想人类护理:未来ICU护理的集成AI框架-关于Arabfard等人的信。
IF 4.7 2区 医学 Q1 NURSING Pub Date : 2025-11-13 DOI: 10.1016/j.iccn.2025.104272
Tarun Madan Kanade , Vandana Sonwaney , Sampada V. Bende
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引用次数: 0
Impact of delirium in cardiosurgical patients on short- and long-term mortality 心外科患者谵妄对短期和长期死亡率的影响。
IF 4.7 2区 医学 Q1 NURSING Pub Date : 2025-11-11 DOI: 10.1016/j.iccn.2025.104252
Baland Mohammad , Peter Nydahl , Hanna Gravert , Christina Grothusen , Katharina Huenges , Christine Friedrich , Wiebke Sommer , Assad Haneya , Gregor Warnecke , Bernd Panholzer

Background

Postoperative delirium (POD) is a common and serious complication in intensive care unit (ICU) patients after cardiac surgery. Its long-term impact remains uncertain. The aim was to determine the association between postoperative delirium and 8-year all-cause mortality in adult cardiac ICU patients.

Methods

This retrospective cohort study analysed patients admitted to a university hospital ICU following cardiac surgery. Data from pre-, peri-, and postoperative phases were collected. The primary outcome was mortality up to 8 years after ICU discharge. Secondary outcomes included POD incidence, ICU readmission, mortality at day 7 and 30 post-discharge, and ICU and hospital length of stay (LoS). Regression analyses were conducted to examine associations.

Results

The study included 551 patients, predominantly male (71 %, n = 397), with a median age of 72 (IQR 64–77) years. POD was diagnosed in 18.7 % (n = 103). Overall, the 8-year mortality rate was 16.7 % (n = 92). Compared to non-POD patients, those with POD had significantly higher 6–8 years mortality (n = 9 (8.7 %) vs. n = 16 (3.6 %), p = 0.033). Patients with POD had a longer LoS in ICU (median 4 vs. 2 days, p < 0.001) and hospital (15 vs. 12 days, p < 0.001), as well as higher ICU readmission rates within 30 days (12.3 % vs. 6.6 %, p = 0.037). POD patients also showed higher mortality at 30 days (3.8 % vs. 0.9 %, p = 0.028). However, after adjusting for confounders, POD was no longer significantly associated with long-term 6–8 years mortality (p = 0.205).

Conclusions

POD affects nearly one in five patients after cardiac surgery and is associated with adverse short-term outcomes, including longer stays and higher readmission and early mortality rates. Its independent effect on long-term mortality may be limited. Further studies are needed to explore its influence on quality of life and cognitive function.
背景:术后谵妄(POD)是心脏手术后重症监护病房(ICU)患者常见且严重的并发症。其长期影响仍不确定。目的是确定成人心脏ICU患者术后谵妄与8年全因死亡率之间的关系。方法:本回顾性队列研究分析了一所大学医院心脏手术后ICU收治的患者。收集术前、围手术期和术后各阶段的数据。主要终点是ICU出院后8年的死亡率。次要结局包括POD发生率、ICU再入院率、出院后第7天和第30天的死亡率、ICU和住院时间(LoS)。进行回归分析以检验相关性。结果:该研究纳入551例患者,主要为男性(71%,n = 397),中位年龄为72岁(IQR 64-77)。18.7% (n = 103)诊断为POD。总体而言,8年死亡率为16.7% (n = 92)。与非POD患者相比,POD患者的6-8年死亡率显著高于非POD患者(n = 9 (8.7%) vs. n = 16 (3.6%), p = 0.033)。POD患者在ICU的生存期较长(中位4天vs. 2天,p)。结论:POD影响近五分之一的心脏手术后患者,并与不良的短期预后相关,包括更长的住院时间、更高的再入院率和早期死亡率。它对长期死亡率的独立影响可能有限。其对生活质量和认知功能的影响有待进一步研究。
{"title":"Impact of delirium in cardiosurgical patients on short- and long-term mortality","authors":"Baland Mohammad ,&nbsp;Peter Nydahl ,&nbsp;Hanna Gravert ,&nbsp;Christina Grothusen ,&nbsp;Katharina Huenges ,&nbsp;Christine Friedrich ,&nbsp;Wiebke Sommer ,&nbsp;Assad Haneya ,&nbsp;Gregor Warnecke ,&nbsp;Bernd Panholzer","doi":"10.1016/j.iccn.2025.104252","DOIUrl":"10.1016/j.iccn.2025.104252","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative delirium (POD) is a common and serious complication in intensive care unit (ICU) patients after cardiac surgery. Its long-term impact remains uncertain. The aim was to determine the association between postoperative delirium and 8-year all-cause mortality in adult cardiac ICU patients.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analysed patients admitted to a university hospital ICU following cardiac surgery. Data from pre-, peri-, and postoperative phases were collected. The primary outcome was mortality up to 8 years after ICU discharge. Secondary outcomes included POD incidence, ICU readmission, mortality at day 7 and 30 post-discharge, and ICU and hospital length of stay (LoS). Regression analyses were conducted to examine associations.</div></div><div><h3>Results</h3><div>The study included 551 patients, predominantly male (71 %, n = 397), with a median age of 72 (IQR 64–77) years. POD was diagnosed in 18.7 % (n = 103). Overall, the 8-year mortality rate was 16.7 % (n = 92). Compared to non-POD patients, those with POD had significantly higher 6–8 years mortality (n = 9 (8.7 %) vs. n = 16 (3.6 %), p = 0.033). Patients with POD had a longer LoS in ICU (median 4 vs. 2 days, p &lt; 0.001) and hospital (15 vs. 12 days, p &lt; 0.001), as well as higher ICU readmission rates within 30 days (12.3 % vs. 6.6 %, p = 0.037). POD patients also showed higher mortality at 30 days (3.8 % vs. 0.9 %, p = 0.028). However, after adjusting for confounders, POD was no longer significantly associated with long-term 6–8 years mortality (p = 0.205).</div></div><div><h3>Conclusions</h3><div>POD affects nearly one in five patients after cardiac surgery and is associated with adverse short-term outcomes, including longer stays and higher readmission and early mortality rates. Its independent effect on long-term mortality may be limited. Further studies are needed to explore its influence on quality of life and cognitive function.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104252"},"PeriodicalIF":4.7,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145508687","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}
引用次数: 0
The Ideal human care in Green ICU: An integrated AI framework for future ICU care − Response to Kanade Tarun Madan et al. 绿色ICU中的理想人类护理:未来ICU护理的集成AI框架——对Kanade Tarun Madan等人的回应。
IF 4.7 2区 医学 Q1 NURSING Pub Date : 2025-11-11 DOI: 10.1016/j.iccn.2025.104275
Masoud Arabfard , SeyedTayeb Moradian , Vinciya Pandian , Hong-Gu He , Amir Vahedian-Azimi , On the behalf of the ideal human care in green ICU research Team
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引用次数: 0
Nurses’ impact on blood pressure after sedation bolus use: Untangling “nurse effects” 镇静丸使用后护士对血压的影响:解开“护士效应”。
IF 4.7 2区 医学 Q1 NURSING Pub Date : 2025-11-10 DOI: 10.1016/j.iccn.2025.104276
Christian Vincelette , Francois Martin Carrier , Michael Yu , Michael Chassé
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引用次数: 0
期刊
Intensive and Critical Care Nursing
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