Heart & Lung最新文献

Background: Backup behavior-when clinicians help each other via verbal assistance or task completion in their roles-is essential for effective teamwork in the intensive care unit (ICU) but is not well understood. Exploring how interprofessional team members provide backup may guide future interventions.

Objective: To examine who, how often, why, and under what circumstances ICU clinicians provide backup in mechanical ventilation care.

Methods: Using a convergence, triangulation mixed methods design in 2 medical ICUs (2017-2019), we collected qualitative data (observation, shadowing, interviews) to understand how ICU teams provide backup; and patient-shift level surveys of ICU nurses, physicians, and respiratory therapists, to identify whom clinicians contacted for help that shift. We analyzed and compared these data to gain insight into the frequency, and circumstances surrounding ICU clinicians' requests for and receipt of backup when providing mechanical ventilation care.

Results: Backup behavior was common. Interprofessional backup (e.g. nurse to respiratory therapist) related to specific patient care tasks. Intraprofessional backup (e.g. nurse to nurse) involved team members 'checking in' to assist their colleague. Most (57%) survey respondents reported at least one interprofessional contact on day and night shifts, and approximately 25% reported at least one intraprofessional backup contact. We identified distinct backup behavior patterns on day and night shifts.

Conclusions: While backup behavior was common, interprofessional backup focused on care aligning with professional roles whereas intraprofessional backup entailed checking-in with team members. Examining how to enhance interprofessional backup through trainings or interventions may improve how teams work and patient care.

Background: Sepsis is a critical condition associated with high mortality rates that necessitates effective fluid resuscitation. Crystalloids are widely utilized; however, human albumin solutions have been attributed potential oncotic and anti-inflammatory benefits. Given the ongoing debate and the absence of definitive empirical evidence, expert opinions provide valuable insights into the contextual and practical aspects of fluid management.

Objectives: This review synthesizes expert opinions on the utilization of albumin compared to crystalloids in critically ill sepsis patients, emphasizing the contextual and practical considerations rather than drawing conclusions about clinical efficacy.

Methods: Following the Joanna Briggs Institute (JBI) guidelines for systematic reviews of text and opinions, databases and registries were searched from 2015 to 2024. Two reviewers independently screened sources. Data extraction was conducted by one reviewer and verified by another reviewer. Of 1,917 sources, 38 met the inclusion criteria. Findings were synthesized narratively.

Results: Expert consensus emphasizes crystalloids as the preferred first-line fluid for sepsis due to their safety, cost-effectiveness, and availability. Albumin is conditionally recommended in specific scenarios such as severe hypoalbuminemia, high vasopressor requirements, or volume-sensitive conditions. While theoretical benefits of albumin, including enhanced volume expansion and reduced fluid overload, are recognized, evidence for consistent clinical outcomes remains limited. Experts underscore the importance of individualized management tailored to patient-specific factors and dynamic monitoring, aligning with guideline recommendations that advise against routine albumin use.

Conclusions: This review highlights the contextual and practical aspects of fluid management in sepsis, underscoring the predominance of crystalloids as the initial choice. Expert insights suggest that albumin may have a supplementary role in specific clinical scenarios. These findings provide a refined understanding of current practice and serve as a foundation for informed decision-making and future research.

Trial registry: PROSPERO; Registration Number: CRD42024580521; URL: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=580521.

Background: The Naples prognostic score (NPS), a novel nutritional and inflammatory index, holds great promise for predicting the prognosis of heart failure (HF), but research on its association with HF outcomes is limited.

Objective: To analyze the relationship between the NPS and the incidence rate and long-term prognosis of HF.

Methods: Participants from the National Health and Nutrition Examination Survey (NHANES) data were allocated into three groups (group 0 (the NPS=0), group 1-2 (the NPS=1-2), and group 3-4 (the NPS=3-4)) based on the NPS level. Regression analysis was conducted to examine the relationship between the NPS and HF prevalence, and ROC curve analysis was employed to determine the prediction accuracy. The Cox proportional hazards model and Kaplan-Meier survival curves analyzed mortality risk, with subgroup and sensitivity analyses for model stability.

Results: The study included 47,300 individuals (mean age 47.18 years; 51.07% female; 68.86% non-Hispanic white). The HF prevalence was 2.30% (95% CI: 1.66, 3.17). Among 1,581 HF patients, 851 all-cause deaths occurred during a median follow-up of 6.84 years. In groups 3-4, the risk of all-cause, cardiovascular, and cancer mortality was significantly higher (4.18, 4.89, and 16.93, respectively, all p < 0.05) compared to group 0. Furthermore, a significant difference was observed in the association between the NPS and cancer mortality across age subgroups (p < 0.05). In contrast, there was no significant interaction between the NPS and all-cause mortality or cardiovascular mortality in subgroup analyses.

Conclusions: The NPS is a low-cost and easy-to-calculate prognostic score that helps predict the clinical course of patients with HF.

Background: Evidence for a relation between residential greenspace and respiratory health is scarce and controversial.

Objectives: The purpose of this study was to explore the association between residential greenspace and its interaction with particulate matter (PM_2.5) and risk of chronic obstructive pulmonary disease (COPD) and lung function.

Methods: A total of 3,759 adults were recruited from Wenzhou in this study. Lung function measurements included forced expiratory volume in 1 s (FEV1); forced vital capacity (FVC); FEV1/FVC ratio; peak expiratory flow (PEF); forced expiratory flow (FEF) at 25 %, 50 %, and 75 %; and maximal mid-expiratory flow (MMEF). The Normalized Difference Vegetation Index (NDVI) was used to characterize the greenspace.

Results: The mean (SD) age of study participants was 62.8(10.2) years, with 51.8 % female. NDVI was positively associated with risk of COPD (odds ratio [OR]: 1.26, 95 % CI: 1.04-1.54) and inversely with lung function: the βs (95 % CIs) for FEV1; FVC; FEV1/FVC ratio; PEF; FEF25 %, 50 %, and 75 %; and MMEF were -0.09 (-0.12, -0.06); -0.07 (-0.10, -0.04); -1.39 (-2.06, -0.72); -0.66 ( -0.74, -0.57); -0.52 (-0.61, -0.43), -0.22 (-0.28, -0.15), and -0.05 (-0.09, -0.01); and -0.17 (-0.22, -0.12), respectively. In high PM_2.5 areas, NDVI was positively associated with COPD risk (OR: 5.40, 95 % CI: 3.45-8.58) and inversely with FEV1/FVC ratio (β:8.29, 95 % CI:9.82, -6.76) and FVC (β:0.13, 95 %CI:0.21, 0.06), and in low PM_2.5 areas, was positively associated with risk of COPD (OR: 1.75, 95 % CI: 1.12-2.80) and inversely with FEV1/FVC ratio (β:3.45, 95 % CI:4.80, 2.11).

Conclusions: High residential greenspace may be associated with increased risk of COPD and decreased lung function in adults, particularly in areas with high PM_2.5.

Background: Endotracheal intubation and mechanical ventilation comprise common life support interventions for patients in intensive care units (ICUs). Premature or delayed extubation increases the risk of morbidity and mortality. Despite following weaning protocols, 10-20 % of patients fail extubation within 48 h. To improve extubation success, predictors such as the rapid shallow breathing index (RSBI-the ratio of respiratory rate to tidal volume) are needed. The current RSBI value (<105 breaths/min/L) comes from clinically outdated methods and small samples.

Objective: To identify the highest-performing RSBI threshold value associated with extubation success using current weaning protocols in a large sample of medical and surgical ICU patients.

Methods: Using secondary data from hospital records, receiver operating characteristic (ROC) analysis of the RSBI, measured immediately after a spontaneous breathing trial, was conducted for 1313 mechanically ventilated (≥ 48 h and ≤ 21 days) patients at one hospital in Saudi Arabia.

Results: The sample of 61.5 % medical and 38.5 % surgical patients included 65 % males with a mean age of 53 years and an extubation failure rate of 12 %. Ideal RSBI threshold values differed by medical and surgical samples. For each sample, the area under the ROC curve approximated 0.5 for the RSBI, and multivariable logistic regression identified a unique set of physiologic parameters to predict successful extubation.

Conclusion: The RSBI alone demonstrated low diagnostic performance for predicting successful extubation using current weaning protocols. However, results suggest needed updates for RSBI threshold values in current weaning protocols to optimize RSBI use with other predictors for extubation success.

Background: Disease management programs for heart failure (HF) often include various strategies such as medication management and lifestyle modifications, and are known to improve clinical outcomes.

Objectives: To evaluate the effectiveness of an individualized patient education program (IPEP) specifically designed for patients with reduced ejection fraction (HFrEF) on clinical outcomes.

Methods: In our prospective interventional study involving 164 patients, participants were divided into control (CG) and intervention (IG) groups. The IG received the IPEP facilitated by the academic pharmacist, while both the IG and the CG continued to receive standard care from the healthcare team without any differences in the care provided. Self-care practices, medication adherence, quality of life, and clinical outcomes were assessed at both the 6th and 12th months. Statistical analysis included Chi-square tests, Kaplan-Meier survival plots, and Multivariable Cox proportional regression analysis. Data analysis was conducted using JAMOVI and R software.

Results: The demographic and clinical characteristics of sample population were largely homogeneous in both the groups. The unadjusted 1-year rehospitalization (RH) rate was significantly lower in the IG at 33 % compared to 48 % in the CG, with a hazard ratio of 0.55 (95 % CI: 0.34-0.90, p = 0.018). Kaplan-Meier survival analysis depicts a higher RH rate for HFrEF participants over time, with a significant difference observed between CG and IG (log-rank P = 0.017). Notable disparities in self-care practices emerged & at the 6th and 12th-month assessments medication adherence & QoL were significantly improved in the IG (p ≤ 0.001).

Conclusion: IPEP led by an academic pharmacist resulted in improved self-care practices, enhanced quality of life, and reduced one-year rehospitalization rates.

Background: Clinical practice guidelines for acute coronary syndrome recommend an interval between electrocardiogram (ECG) and balloon of <60 min in patients attending the emergency department (ED) of a hospital with primary angioplasty capacity. Compliance with this can be complex, especially in atypical presentations.

Objective: To assess the effectiveness of specific training for ED triage nurses in reducing ECG-balloon time in STEMI.

Methods: Quasi-experimental study with a pre-test-post-test design. In June 2021, a training intervention was implemented in the diagnosis of STEMI in the ED. The EDUCAMI program included complex presentations, emphasising disparities in women and elderly people. A historical sample was compared with a post-intervention sample. All patients consecutively activated as code STEMI in the ED were included, excluding those activated out-of-hospital. The main variable was ECG-balloon time, which was compared according to sex and age.

Results: The final sample consisted of 447 patients distributed into historical sample (n = 327) and post-test groups (n = 120). A reduction from 88 (65-133) to 60 (50-116) minutes in ECG-balloon time was observed in the post-test group together with a shorter hospital stay of 5 (3-8) vs 4 (3-5.5) days (p= 0.013). When comparing according to sex and age, a decrease in ECG-balloon time (p < 0.001) was observed in men and patients under 65 years of age (p < 0.001).

Conclusions: The training intervention proved effective, reducing the ECG-balloon time by 32 %. EDUCAMI reduces the time in men and young people, however, the bias persists in women and those over 65 years of age.

Background: During the COVID-19 pandemic, intensive care units (ICUs) experienced a surge in patients with viral pneumonia, often leading to acute respiratory failure. A global rise in ICU superinfections was observed; however, it remains unclear whether the extensive use of broad-spectrum antibiotics, corticosteroids, and immunosuppressants contributed to this rise.

Objectives: We aim to identify clinical factors associated with these superinfections while analyzing epidemiologic patterns of superinfections in two different periods.

Methods: We conducted a retrospective study comparing ICU patients admitted between January 2016 and December 2018 (control group) with those admitted due to hypoxemic respiratory failure from SARS-CoV-2 between September 2020 and February 2022. Clinical characteristics were analyzed after propensity score matching, and a subsequent multivariate analysis was conducted on the COVID-19 population to identify independent risk factors for superinfections.

Results: 1456 patients were identified in the pre-COVID group and 164 in the COVID-19 group. The mean age was similar (64 years), but the pre-COVID-19 group was sicker. After matching, 427 pre-COVID-19 and 163 COVID-19 patients were analyzed. COVID-19 patients experienced higher superinfection rates (42 % vs. 12 %, p < 0.001), were more obese, and had greater exposure to antibiotics and corticosteroids. After multivariate analysis of the COVID-19 population, ICU length of stay (OR=1.09, p = 0.01) and mechanical ventilation (OR=5.05, p = 0.008) were independent risk factors for superinfections.

Conclusion: Increased superinfection rates in COVID-19 patients were linked to mechanical ventilation and prolonged ICU stays, potentially influenced by MDR infections linked to antibiotics and corticosteroids. Further investigations are needed to establish causality.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common respiratory disease that significantly impairs the quality of life of patients. Single exercises can help COPD patients focus on enhancing specific physical abilities, and enable a more precise analysis of the specific effects of single exercises on improving exercise capacity in COPD patients.

Objectives: To evaluate the effectiveness of single exercises in improving the exercise capacity of COPD patients and to conduct an indirect comparison to identify the most efficacious intervention.

Methods: We conducted a comprehensive search for randomized controlled trials in the following databases: PubMed, Web of Science, Scopus, Cochrane Library, Embase, and Chinese National Knowledge Infrastructure, from their inception to July 1, 2024. A network meta-analysis was used. We calculated mean differences and their corresponding 95% confidence intervals to quantify the effect sizes and assess the precision of the estimates.

Results: 65 studies that met the inclusion criteria, encompassing a total sample size of 5,034 participants. The meta-analysis demonstrated that single exercises significantly enhanced the exercise capacity in COPD patients. Upon direct comparison, several exercises showed significant improvements in exercise capacity compare to conventional therapy. Core muscle Elastic band exercise appeared to provide the most substantial benefit in enhancing exercise capacity in COPD patients.

Conclusion: Healthcare providers are encouraged to consider incorporating Core muscle Elastic band exercise into their intervention plans, given its demonstrated efficacy. However, the presence of substantial heterogeneity among the included studies highlights the need for caution in interpreting these results.

Background: Chronic inflammatory airway diseases (CIAD) are well-known risk factors for depression symptoms. There exists a complex interplay between leisure-time physical activity (LTPA) and depressive symptoms. However, the relationship between LTPA duration and depressive symptoms in CIAD patients remains unclear.

Objectives: This study investigated NHANES data from 2007 to 2018 to investigate the relationship between LTPA and depressive symptoms in CIAD patients.

Methods: We collected data from National Health and Nutrition Examination Survey (NHANES) 2007-2018. Weighted logistic regression was employed to analyze the correlation between CIAD and depressive symptoms. Next, CIAD patients with LTPA information, the similar method was also employed to examine the association between LTPA and depressive symptoms. Finally, the dose-response relationship between LTPA duration and depressive symptoms was explored using restricted cubic spline (RCS) plot.

Results: Consistent with previous research findings, patients with CIAD are more prone to experiencing symptoms of depression (P < 0.0001). Compared to CIAD patients without LTPA, patients who engage in LTPA have a lower probability of experiencing depressive symptoms (P < 0.0001). Interestingly, we had discovered that there is an l-shaped relationship between the duration of LTPA and the prevalence of depressive symptoms (non-linear P = 0.001). There is a threshold effect between the duration of LTPA and depressive symptoms. Within12 h/week, the risk of depressive symptoms in CIAD patients decreases with increased duration of LTPA. However, beyond 12 h/week, this association no longer exists.

Conclusion: Our research indicates that CIAD patients can increase the prevalence of depressive symptoms. And LTPA over a period of time is negatively correlated with depressive symptoms, but only up to a total duration of 12 h/week.