Medicina intensiva最新文献

Objective: To investigate the association of a dead space ventilation index, namely ventilatory ratio (VR), with subsequent development of severe late acute kidney injury (AKI).

Design: Multicenter retrospective study. Secondary analysis of individual patient-level data from seven ARDS Network and PETAL Network randomized controlled trials.

Setting: Critically ill patients with ARDS.

Patients: We compared patients who developed severe AKI (stage II or III) more than two days but no longer than seven days following ARDS onset ("severe late AKI" group) with patients who did not develop severe late AKI ("no severe late AKI" group).

Interventions: None.

Main variables of interest: VR, severe late AKI.

Results: Of 3007 patients with ARDS included in the study, 376 (12.5%) developed severe late AKI. Baseline VR was independently associated with severe late AKI development [odds ratio (OR) 1.712, CI 1.096-2.674, p = 0.018)]. An adjusted linear mixed effects model revealed that trajectory of VR was higher in patients who developed severe late AKI than those who did not (estimate = 0.23, p < 0.001). Adjusted latent class mixed modeling identified two distinct trajectories of VR evolution over time, class 1 with lower trajectory over time, and class 2 with higher trajectory, which was independently associated with an increased risk of severe late AKI (OR 2.55, 95% CI 1.02-6.41, p = 0.046) compared to class 1.

Conclusions: In ARDS, baseline value of VR was independently associated with severe late AKI, while its trajectory was significantly higher in patients who developed severe late AKI than those who did not.

Objective: To evaluate the effects of music therapy and virtual reality on physiological parameters, pain and anxiety levels in critically ill patients undergoing nursing interventions in the intensive care unit.

Design: Randomized controlled trail.

Setting: The study was conducted in the adult intensive care unit of a tertiary care hospital in Turkey.

Patients: A total of 90 intensive care unit patients were enrolled and randomly assigned to one of three groups: Music Therapy (n = 30), Virtual Reality (n = 30), and control group receiving standard nursing care (n = 30). Inclusion criteria included adult patients with stable vital signs and the ability to provide informed consent. Patients with hearing or vision impairments, cognitive disorders, or under sedation were excluded.

Interventions: The music therapy group received music therapy using calming instrumental tracks through headphones for 20 min during nursing interventions. The virtual reality group experienced relaxing nature scenes using a virtual reality headset for the same duration. The control group received no additional interventions beyond routine care.

Main variables of interest: Physiological parameters (heart rate, blood pressure, respiratory rate, oxygen saturation), pain and anxiety levels (using validated intensive care unit scales) measured pre- and post-intervention.

Results: Both music therapy and virtual reality groups showed statistically significant improvements in physiological parameters and anxiety levels compared to the control group (p < 0.05). Music therapy was more effective in reducing anxiety scores, with a mean reduction of 5.6 ± 1.2 points on the State Anxiety Inventory, and improving oxygen saturation levels, with a mean increase of 2.1 ± 0.5% compared to virtual reality. In contrast, the virtual reality group demonstrated greater reductions in perceived pain levels, with a mean decrease of 4.8 ± 1.1 points measured using the Visual Analog Scale, compared to music therapy (4.1 ± 1.3). Pulse rate, respiratory rate, and blood pressure values improved in both intervention groups post-intervention, while minimal changes were observed in the control group. No adverse effects were reported during or after interventions.

Conclusions: The study demonstrates that both music therapy and virtual reality are effective non-pharmacological interventions for reducing anxiety and stabilizing physiological parameters in ICU patients during nursing procedures. Music therapy may be preferred when the goal is anxiety reduction and oxygenation improvement, whereas virtual reality may be more suitable for managing procedural pain. Integrating such interventions into routine intensive care unit nursing practice can enhance patient comfort and psychological well-being during critical care.