Intensive and Critical Care Nursing最新文献

英文中文

Implementation and sustainability of an innovative ICU e-diary 创新ICU电子日记的实施和可持续性

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-11-08 DOI: 10.1016/j.iccn.2025.104266

Louise Rose , Amy Welch , Kemi Okelana , Fardusa Hassan , Chloe Apps , Kate Brooks , Erin Law , Andrew Slack , Katie Susser , Joel Meyer

Objectives

To characterise e-diary implementation exploring ICU staff uptake, family member engagement, perceived barriers/facilitators and perceived acceptability/feasibility and sustained use over time.

Methods

Service innovation and evaluation study of an e-diary (aTouchAway™, Aetonix, Canada) for patients with ≥ 2 days anticipated ICU stay. We implemented (Jan2022-Aug2022) in four ICUs (52 beds) across two UK hospitals. We conducted a one-day pre-implementation paper-diary snapshot audit. Implementation strategies included a dedicated implementation officer, repeated education, dedicated resources, completion reminders, live demonstrations, and e-diary completion prizes. We collected data on commencement rates, barriers/facilitators, and feasibility/acceptability using Acceptability and Feasibility of Intervention Measure (AIM/FIM) questionnaires. To assess sustained use, we completed three one-day audits (June2023), with subsequent monthly audits (Dec2023-Dec2024).

Results

Pre-implementation, 7/35 (20%) patients had a paper diary. During the implementation phase the monthly mean (SD) e-diary commencement rate was 65% (23%) with 380 patients having 1242 diary entries (nurses 807; therapists (physio/occupational/speech) 146; family members 289). We received 35/110 staff questionnaires (response rate 32%). Most perceived the e-diary easy to access (74%) and use (63%). Similar proportions perceived it less (20%) or more (26%) time consuming than paper diaries. Facilitators included reduced environmental impact, negligible loss, family participation, guaranteed legibility, data security, and easy accessibility. Barriers comprised need for login and education; difficulty for less technologically-competent families; and inability to personalise with pictures. Mean (SD) AIM and FIM scores were 16.6 (1.67) and 16.0 (1.9).

In the sustainability phase, our snapshot audit (June2023) found a commencement rate of 63%, with a mean (SD) monthly commencement rate of 45.6% (16.7%).

Conclusions

We developed a bespoke e-diary with moderate yet sustained implementation success. We identified facilitators to be harnessed by other centres considering e-diary implementation. Although some barriers are non-modifiable, strategies can support family members to engage.

Implications for clinical practice

For centres considering e-diary adoption, they appear an acceptable alternative with facilitators that can be harnessed to promote adoption but barriers that need consideration.

目的探讨ICU员工对电子日记的接受程度、家庭成员参与度、感知障碍/促进因素、感知可接受性/可行性和长期持续使用的特点。方法针对预期ICU住院≥2天的患者使用电子日记（aTouchAway™，Aetonix, Canada）进行服务创新和评估研究。我们在两家英国医院的四个icu（52张床位）中实施了（2022年1月至2022年8月）。我们进行了为期一天的实施前纸质日记快照审计。实施策略包括专门的实施官员、重复教育、专用资源、完成提醒、现场演示和电子日志完成奖励。我们使用可接受性和干预措施可行性（AIM/FIM）问卷收集了启动率、障碍/促进因素和可行性/可接受性的数据。为了评估持续使用，我们完成了三次为期一天的审计（2023年6月），随后进行了每月审计（2023年12月至2024年12月）。结果实施前，7/35（20%）患者有纸质日记。在实施阶段，每月平均（SD）电子日记的启动率为65%(23%)，380名患者有1242篇日记(护士807篇，治疗师（物理/职业/语言）146篇；家庭成员；收到35/110份员工问卷（回复率32%）。大多数人认为电子日记易于访问（74%）和使用（63%）。相似比例的人认为它比纸质日记更耗时（20%）或更多（26%）。促进因素包括减少环境影响、可忽略的损失、家庭参与、保证易读性、数据安全性和易于访问性。障碍包括登录和教育的需要；技术能力较差的家庭面临困难；也无法用图片进行个性化设置。平均（SD） AIM和FIM评分分别为16.6（1.67）和16.0（1.9）。在可持续发展阶段，我们的快照审计（2023年6月）发现开工率为63%，平均（SD）每月开工率为45.6%（16.7%）。我们开发了一个定制的电子日记，并取得了适度但持续的成功。我们确定了其他考虑实施电子日记的中心可以利用的辅助人员。虽然有些障碍是无法改变的，但策略可以支持家庭成员参与。对临床实践的启示对于考虑采用电子日记的中心来说，它们似乎是一种可接受的替代方案，可以利用促进采用的促进者，但需要考虑的障碍。

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引用次数: 0

From coping to conservation: understanding acoustic burden in ICU nursing – Letter on Song et al. 从应对到保护：理解ICU护理中的声负担——宋氏信等。

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-11-08 DOI: 10.1016/j.iccn.2025.104277

Tang Li, Tao Yu

引用次数: 0

Launching the “Methods in Focus” series in intensive & critical care nursing 推出重症监护“重点方法”系列

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-11-08 DOI: 10.1016/j.iccn.2025.104274

Stijn Blot, Mark van den Boogaard

引用次数: 0

Infections in long-term care: Challenges in an ageing Europe 长期护理中的感染：老龄化欧洲的挑战

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-11-08 DOI: 10.1016/j.iccn.2025.104271

Jordi Rello , Niccolò Buetti , Hagar L. Mowafy

Background

The demographic shift towards an ageing population, especially in Europe, place a significant burden on healthcare systems and increasing demand for long-term care facility (LTCF) services. These facilities provide support to both older individuals and patients with disabilities. Despite their importance, LTCFs continue to face challenges in infection prevention and control (IPC) contributing to increase the burden of healthcare-associated infections (HAIs) and antimicrobial resistance (AMR).

Objective

The aim of this opinion review is to summarize current global and regional IPC guidance applicable to LTCFs and identifies critical gaps that must be addressed to improve residents’ safety.

Discussion

Global and regional organizations including the World Health Organization (WHO), European Centre for Disease Prevention and Control (ECDC), United States Centre for Disease Control and Prevention (CDC), and other professional organizations provides basic IPC recommendations mostly adapted from acute healthcare settings. Despite these valuable resources, major gaps persist, especially within the European context. One of the major gaps is that most of these IPC guidance are adapted from acute care settings without taking into consideration the unique structural and social differences of LTCFs. The inherent heterogeneity of LTCFs within European countries, the scarcity of high-quality studies assessing different IPC interventions across diverse LTCF types, compounded by the limitations in workforce capacity and surveillance gaps further pose critical challenges to effective IPC guidance.

Implications for Clinical Practice

Unified, evidence-based guidelines specifically designed for LTCFs are urgently needed to warrant the safety and equity of service provided to LTCF residents across different countries and sectors. Such a framework must emphasize continuous surveillance, workforce development, and practical, applicable strategies that can be easily incorporated into the unique nature of LTCFs.

人口结构向老龄化的转变，特别是在欧洲，给医疗保健系统带来了沉重的负担，并增加了对长期护理设施（LTCF）服务的需求。这些设施为老年人和残疾患者提供支持。尽管它们很重要，但ltcf在感染预防和控制（IPC）方面继续面临挑战，从而增加了卫生保健相关感染（HAIs）和抗菌素耐药性（AMR）的负担。本意见审查的目的是总结当前适用于ltcf的全球和区域IPC指南，并确定必须解决的关键差距，以提高居民的安全。讨论包括世界卫生组织（世卫组织）、欧洲疾病预防和控制中心（ECDC）、美国疾病控制和预防中心（CDC）在内的全球和区域组织以及其他专业组织提供了基本的IPC建议，这些建议大多改编自紧急医疗保健环境。尽管有这些宝贵的资源，但主要的差距仍然存在，特别是在欧洲范围内。其中一个主要差距是，这些IPC指南大多改编自急性护理环境，而没有考虑到长期护理中心独特的结构和社会差异。欧洲国家LTCF的内在异质性，评估不同LTCF类型的不同IPC干预措施的高质量研究的缺乏，再加上劳动力能力的限制和监测差距，进一步对有效的IPC指导构成了严峻的挑战。临床实践的意义迫切需要专门为LTCF设计的统一的循证指南，以保证向不同国家和部门的LTCF居民提供的服务的安全性和公平性。这样的框架必须强调持续的监督、劳动力的发展和实际的、适用的战略，这些战略可以很容易地融入到ltcf的独特性质中。

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引用次数: 0

Simulation and validation: re-evaluating gastric tube-tip manometry for nasogastric tube verification – Response to Tao Zhang 模拟与验证：重新评估胃管尖端测压法在鼻胃管验证中的应用——对张涛的回应。

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-10-27 DOI: 10.1016/j.iccn.2025.104130

Yunxia Chen, Zhiyuan Sheng

引用次数: 0

Language, culture and communication vulnerability – Letter on Istanboulian et al. 语言、文化和沟通脆弱性——伊斯坦布尔等人的信。

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-10-27 DOI: 10.1016/j.iccn.2025.104270

Melissa J Bloomer , Krishnaswamy Sundararajan

引用次数: 0

Observational research in critical care: Harnessing the lens of truth 重症监护的观察研究：利用真相的透镜。

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-10-27 DOI: 10.1016/j.iccn.2025.104259

Karin Plummer , Ann Bonner , Melissa J Bloomer

引用次数: 0

Endotracheal tube cuff modifications for VAP prevention: Bridging evidence and clinical practice – Letter on Li S et al. 气管内套管袖带改良预防VAP：连接证据与临床实践- Li S等人评论。

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-10-27 DOI: 10.1016/j.iccn.2025.104269

Rongyi Xu, Deyi Pan, Lisong Chen

引用次数: 0

Omega-3 fatty acids in critical care nutrition: Balancing promise and pragmatism Omega-3脂肪酸在重症监护营养：平衡承诺和实用主义。

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-10-27 DOI: 10.1016/j.iccn.2025.104264

Antonios Katsounas , Georgios Papathanakos , Despoina Koulenti

引用次数: 0

Effect of ultrashort-acting β-blocker on the mortality of patients with sepsis or septic shock: A systematic review and trial sequential meta-analysis of randomized controlled trials 超短效β受体阻滞剂对脓毒症或脓毒性休克患者死亡率的影响：随机对照试验的系统回顾和试验序贯荟萃分析。

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-10-26 DOI: 10.1016/j.iccn.2025.104265

Po-Yu Huang , Ting-Hui Liu , Jheng-Yan Wu , Ya-Wen Tsai , Wan-Hsuan Hsu , Min-Hsiang Chuang , Hung-Jen Tang , Chih-Cheng Lai

Background

Adrenergic responses, particularly tachycardia, play a role in sepsis-related complications. Ultrashort-acting β-blockers have been evaluated in randomized controlled trials (RCTs) for their impact on sepsis outcomes, but conflicting results have been reported. This systematic review and meta-analysis aim to provide an updated perspective on the impact of ultrashort-acting β-blockers on the clinical outcomes of sepsis.

Methods

A comprehensive search of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and ClinicalTrials.gov was conducted from inception to January 12, 2024. RCTs investigating the clinical effects and safety of ultrashort-acting β-blockers in sepsis or septic shock were included. Meta-analyses were performed using random-effects models, and trial sequential analysis (TSA) was conducted to evaluate the reliability of cumulative evidence. The primary outcome was 28-day mortality rate.

Results

A total of 2253 patients involved in 27 RCTs were included. Ultrashort-acting β-blockers significantly reduced the 28-day mortality rate (31.6% versus 48.4%; risk ratio [RR] 0.66; 95% CI 0.56–0.78). TSA provided robust evidence for the 28-day and in-hospital mortality benefit. The survival benefit remains evident in subgroups of patients with septic tachycardia (RR, 0.66; 95% CI, 0.47–0.93), septic cardiomyopathy (RR, 0.61; 95% CI, 0.44–0.83), Chinese populations (RR, 0.64; 95% CI, 0.54–0.76), and those treated with esmolol (RR, 0.64; 95% CI, 0.56–0.73). For patients with septic shock, only those with tachycardia demonstrated a statistically significant difference in mortality rates (RR, 0.70; 95% CI, 0.55–0.88).

Conclusions

Adjuvant ultrashort-acting β-blocker therapy demonstrated potential benefits in improving survival for patients with sepsis or septic shock.

Implications for clinical practice

This study highlights the potential benefits of adjuvant ultrashort-acting β-blocker therapy for the treatment of sepsis or septic shock in terms of enhanced survival and other clinical advantages, including reduced heart rate and cardiovascular biomarkers. Furthermore, such therapy did not appear to impair cardiac function and hemodynamic stability.

背景：肾上腺素能反应，特别是心动过速，在脓毒症相关并发症中起作用。超短效β受体阻滞剂在随机对照试验（rct）中被评估对败血症结果的影响，但报道了相互矛盾的结果。本系统综述和荟萃分析旨在为超短效β受体阻滞剂对败血症临床结局的影响提供最新视角。方法：综合检索PubMed、Embase、Cochrane图书馆、中国国家知识基础设施和ClinicalTrials.gov网站，检索时间自成立至2024年1月12日。研究超短效β受体阻滞剂在脓毒症或感染性休克中的临床效果和安全性的随机对照试验。采用随机效应模型进行meta分析，并采用试验序列分析（TSA）评估累积证据的可靠性。主要终点为28天死亡率。结果：27项rct共纳入2253例患者。超短效β受体阻滞剂显著降低28天死亡率（31.6% vs 48.4%；风险比[RR] 0.66; 95% CI 0.56-0.78）。TSA为28天和住院死亡率的降低提供了强有力的证据。在脓毒性心动过速（RR, 0.66; 95% CI, 0.47-0.93）、脓毒性心肌病（RR, 0.61; 95% CI, 0.44-0.83）、中国人群（RR, 0.64; 95% CI, 0.54-0.76）和接受艾司洛尔治疗的患者（RR, 0.64; 95% CI, 0.56-0.73）的亚组中，生存获益仍然明显。对于感染性休克患者，只有心动过速患者的死亡率有统计学差异（RR, 0.70; 95% CI, 0.55-0.88）。结论：辅助超短效β受体阻滞剂治疗在提高脓毒症或感染性休克患者的生存率方面具有潜在的益处。临床实践意义：本研究强调了辅助超短效β受体阻滞剂治疗败血症或感染性休克的潜在益处，包括提高生存率和其他临床优势，包括降低心率和心血管生物标志物。此外，这种治疗似乎不会损害心功能和血流动力学稳定性。

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引用次数: 0

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全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Intensive and Critical Care Nursing

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