Patient Care In Intensive Care Unit Research Articles

A Usability Survey of a Quality Improvement Data Visualization Tool among Medical Intensive Care Unit Nurses

Abstract Background Cognitive overload is prevalent among intensive care unit (ICU) clinicians. Data visualization may decrease cognitive load by assisting with data interpretation and task prioritization. We developed the Bundle Board to display real-time data from the electronic medical record (EMR), highlighting opportunities for action in standardized ICU patient care. This study evaluates the practical usability of this data visualization tool among nurses in the ICU. Methods The tool is offered as an application separate from the EMR and was available in the medical ICU for 8 months before we surveyed unit nursing staff. To evaluate usability of the tool, we adapted the Health-Information Technology Usability Scale and included an option to provide open-ended feedback. Survey data were analyzed using quantitative and qualitative methods. Results ICU nurses were invited to participate through email and verbal announcements. Of the potential participants, 38% (N = 47) responded. The survey demonstrated that the tool was perceived as usable. For each subscale, mean scores were as follows: Perceived Ease of Use 4.40, Impact 4.14, User Control 4.07, and Perceived Usefulness 3.61. There were no significant differences between core and contracted nurses or after stratifying by duration of Bundle Board use. Fifteen respondents completed the optional free-text portion of the survey. Qualitative analysis revealed six subthemes focusing on perceived impacts on quality and safety, cognitive burden and workload, and emotional impact of the Bundle Board. Conclusion The Bundle Board demonstrated good usability among ICU nurses, who provided substantive feedback for its improvement. These observations may be generalizable to other comparable interventions. Iterative feedback from end users is vital to developing and implementing a digital health intervention. Our study provides a framework for performing a usability analysis within a specific clinician population and environment.

Assessment of Knowledge, Attitude, and Practice (KAP) Among Nurses on Oral Care for Intensive Care Unit Patients in Riyadh, Saudi Arabia: A Cross-Sectional Study.

Oral care of intensive care unit (ICU) bound individuals is essential for overall health outcomes and to prevent complications. Nurses, who are the primary caregivers, should possess adequate knowledge, attitude, and practice (KAP) in this regard to provide optimal care to these patients. There are no standardized guidelines existing at present in this regard, making the practice of oral care more challenging.There is a diversified representation of nurses who practice in this region of the world and have not been analyzed in the past. This study would like to address this paucity of data. Hence, the aim of the present study was to evaluate the knowledge, attitude, and practice of nurses regarding oral health care in ICU patients along with analyzing any existing hospital-based policies related to oral care. A cross-sectional study was conducted among 230 nurses practicing at ICU of the National Guard Health Affairs (NGHAs) Hospital, King Abdulaziz Medical City, in Riyadh City, Saudi Arabia. Nurses responded to 22 closed-ended questionnaires, which were adopted after content validation and reliability assessment. Descriptive statistics, chi-square analysis, and multinomial logistic regression were carried out using the Statistical Package for the Social Sciences (SPSS, Version 20, 2011; IBM Corp., Armonk, USA). A total of 230 (51.1%) nurses responded. The mean working experience of 12.6 (±7.5) years and ICU experience of 10.6 (±6.7) years were observed. Seventy-four (32.2%) nurses mentioned they received oral care training for ICU patients as part of their degree. A significant variation (p=0.03) in response was observed based on qualification concerning the knowledge of nurses if improper oral care among ICU patients could cause systemic complications. Nurses with less than five years' experience were more likely to provide oral care only once per day compared to nurses with higher experience (>10 years) (OR: 2.97, p=0.00, 95% CI: 2.40-12.2). There were certain knowledge, attitude, and practice-based questions that elicited significant differences in responses based on the qualifications and experience of the nurses. Overall, the nurses did possess fair knowledge and favorable attitudes towards oral care in these patients.

Alert-Grouping: Smart Personalization of Monitoring System Thresholds to Help Healthcare Teams Struggle with Alarm Fatigue in Intensive Care.

In Intensive Care Units (ICUs), patients are monitored using various devices that generate alerts when specific metrics, such as heart rate and oxygen saturation, exceed predetermined thresholds. However, these alerts can be inaccurate and lead to alert fatigue, resulting in errors and inaccurate diagnoses. We propose Alert grouping, a "Smart Personalization of Monitoring System Thresholds to Help Healthcare Teams Struggle Alarm Fatigue in Intensive Care" model. The alert grouping looks at patients at the individual and cluster levels, and healthcare-related constraints to assist medical and nursing teams in setting personalized alert thresholds of vital parameters. By simulating the function of ICU patient bed devices, we demonstrate that the proposed alert grouping model effectively reduces the number of alarms overall, improving the alert system's validity and reducing alarm fatigue. Implementing this personalized alert model in ICUs boosts medical and nursing teams' confidence in the alert system, leading to better care for ICU patients by significantly reducing alarm fatigue, thereby improving the quality of care for ICU patients.

Perawatan Spiritual Pasien Di Ruang Intensive Care Unit: Narrative Review

Nursing services worldwide today strive to incorporate a holistic approach, where individuals are regarded as complete beings encompassing biological, psychological, social, cultural, and spiritual dimensions. Within the context of intensive care units (ICUs), spiritual care is recognized as a fundamental element that can foster hope, provide a sense of life's purpose, and alleviate anxiety in patients. This research aimed to gain insight into the provision of spiritual care for ICU patients and utilized a narrative review methodology. Searches were conducted in clinical databases such as Scopus and ProQuest, using keywords like "intensive care unit AND patients AND psychiatric care AND spirituality." The selected articles adhered to inclusion criteria, pertained to the subject matter, and were published within the last seven years (2016-2022). In total, 11 articles were included as primary references in this study. The findings of this research reveal that ICUs offer three categories of spiritual services to patients: tailored spiritual services that address individual needs, spiritual support provided by the patient's family, and spiritual support delivered by healthcare professionals. This study underscores the multiple facets of spiritual care that benefit ICU patients, encompassing the recognition and response to their spiritual needs, the assistance of family members, and the support provided by the medical team. All of these components contribute positively to the recovery of ICU patients and meet their spiritual requirements.

Oral health care in adult intensive care units: A national point prevalence study.

The importance of good oral hygiene for patients in Intensive Care Units (ICUs) is well recognized, however, the most effective way to achieve good oral care in the ICU is unclear. This study aimed to provide a national picture of oral care practices in adult ICUs in the United Kingdom (UK) to identify areas for improvement. A national one-day point prevalence study was undertaken in adult ICUs in the UK in the period from 30th September to 14th October 2021. Data were collected on all patients in the ICU on the date of data collection. Using a validated electronic data collection form, anonymised data were collected on methods and frequency of oral care provided, and the use of oral care protocols within the ICU. Data were analysed using descriptive analysis. Data from 195 patients in 15 ICUs in England, Wales and Northern Ireland were collected. Written oral care protocols were available for use in the care of 65% (n = 127) of patients. 73% (n = 142) of patients received oral care within the 24-h period. Oral care methods included toothbrushing 41% (n = 79), foam sticks 3% (n = 5), moisturizing the oral cavity 10% (n = 19) and mouth rinse with chlorhexidine 3% (n = 5) and other oral care methods not specified 12% (n = 23). 44% (n = 85) of patients had an oral assessment within the 24-h period and variable assessment methods were used. There is large variability in oral care provision and methods for intubated ICU patients and a lack of consensus was revealed in the study. Oral assessment is conducted less frequently using multiple tools. Optimal oral care standards and further research into oral care provision is pivotal to address this important patient-relevant practice. Oral care is a fundamental part of care for ICU patients, however, there is a large degree of variability, and oral care is often not based upon oral assessment. The use of an oral care protocol and oral assessments would help to improve patient care, ease of use for staff and provide a tailored oral care plan for patients, improving efficiency and preventing wasted resources.

Predictors of Nurses' Practice of Eye Care for Patients in Intensive Care Units.

Taking care of patients' eyes is an important nursing skill. Nurses must be capable of providing a standard assessment of the eye and vision as well as necessary care such as eye cleaning. Intensive care unit (ICU) nurses typically focus on life-threatening issues while giving little attention to other serious issues. The purpose of this study was to assess predictors of nurses' practice of eye care for patients in ICUs in the West Bank. A cross-sectional study was conducted with all ICU nurses from West Bank hospitals. The researchers developed a self-administered questionnaire to collect data. One hundred and fifty-two nurses participated in this study. The findings revealed that the mean age of nurses was 31.2 (SD = 7.5) years. The analysis revealed that only 0.7% had a good knowledge level, 7.2% had a fair knowledge level, and 25.7% had a good practice level of eye care for patients in an ICU. Knowledge of patients' eye care in the ICU, as well as an eye care protocol or policy for unconscious patients, was found to be significant predictors of practice (p < .001). The study confirmed that the nurses had poor knowledge and inadequate practice of eye care for patients in the ICU. Also, the study confirmed that a nurse's knowledge of patients' eye care in the ICU and an eye care protocol or policy for unconscious patients were significant predictors of practice.

Validation of "the patient evaluation of emotional care during hospitalisation" questionnaire in intensive care unit patients.

To validate the "Patient Evaluation of Emotional Care During Hospitalization" (PEECH) questionnaire, which assesses hospitalised patients' emotional experiences, in patients admitted to the intensive care unit (ICU). Prospective study. The PEECH consists of three sections and four sub-scales: "level of security", "level of knowing", "level of personal value", and "level of connection". The questionnaire was completed by 253 hospitalised patients. Expert judgement was used to analyse the content validity and factor analysis was performed to confirm construct validity. Cronbach's alpha was used to measure the internal consistency of the four sub-scales. In the confirmatory factor analysis of the four sub-scales, the weights of all questions were found to be significant (>1). The internal consistency of the PEECH questionnaire was 0.86 (Cronbach's alpha) and the homogeneity index was high (>0.50). The PEECH questionnaire is a valid and reliable tool to evaluate the perception of emotional care in ICU patients. The information gathered can help provide more comprehensive care for patients in the ICU and in other hospitalised patients.

Readiness to care and factors influencing readiness to care for patients in the intensive care units among novice nurses

Problem consideredNurses are the heart and soul of any healthcare institution. A skilled, qualified nurse with the readiness to care for patients in critical care setting is the dire need for today's world. MethodsA cross-sectional descriptive survey was conducted among novice nurses working in the selected tertiary care hospitals to assess the readiness to care for patients in the intensive care unit (ICU) and the factors influencing readiness to care. The sample were selected using purposive sampling technique. ResultsThe majority 157 (52.4%) had moderate readiness, 143 (47.6%) novice nurses had high readiness to care for patients in ICUs. The top six factors expressed by the participants were: knowledge of the fundamental subjects 292(97.3%), continuing nursing education 278(92.7%), feedback by peers and superiors 283(94.3%), internal motivation 277(93.3%), communication skills 277(92.3%), and proper documentation of care given 278(92.7%). There was a statistically significant association between readiness to care and gender (χ2 = 9.060; p = .011), area of work (χ2 = 10.009; p = .040), duration of clinical exposure in ICUs during the course of study (χ2 = 18.301; p = .011), duration of clinical experience during final year of training (χ2 = 10.315; p = .016), specific ICU related training (χ2 = 6.511; p = .011), and duration of induction programme (χ2 = 50.23; p= <.001) ConclusionThe novice nurses had moderate readiness to practice in ICUs. The nursing educational sector and the nursing service sector can devise certain structures which can help increase the readiness of novice nurses to work in ICUs by focusing on the factors identified.

Study on the Efficacy and Safety of Oral Care in ICU Patients Based on Meta-Analysis.

The effectiveness and safety of oral care in Intensive Care Unit (ICU) patients by meta-analysis are explored. According to the research direction of the effectiveness and safety of oral nursing in ICU patients, the corresponding literature studies are retrieved in literature databases and meta-analysis is performed. A total of 17 Chinese and English literature studies are included, and the literature has no obvious publication bias. The experimental results show that the improvement effect of dry mouth and halitosis in the improved group is significantly higher than that in the traditional group, and the dry mouth score, plaque index, and complications such as oral mucosa infection, oral mucosa damage, and halitosis are significantly reduced in the improved group, and the differences are statistically significant (P < 0.05). Improved oral care can significantly improve the symptoms of dry mouth and halitosis in ICU patients, quickly remove dental plaque and effectively reduce the incidence of complications such as halitosis, oral mucosal infection, and oral mucosal damage. Improved oral care is an effective and safe ICU nursing program.

Effect of specific training course for competency in professional oral hygiene care in the intensive care unit: a quasi-experimental study for developing a standardized learning curve

BackgroundThe development of evidence-based training standards can help improve the quality of educational programs for novice intensive care unit (ICU) nurses. This study was conducted to assess the application of a training course on competency development of nurses in relation to oral hygiene care in ICU patients and to develop a checklist for evaluating the competence performance. In addition, to achieve a certain level of oral hygiene competence, as well as to assess the relative importance of predicting factors and learning competency patterns in oral hygiene care, we used standard learning curve.MethodsThis quasi-experimental study with time series design was conducted on newly registered ICU nurses of a teaching hospital affiliated with Tehran University of Medical Sciences, Iran, between 2016 and 2018. In the first phase of this study, we designed a checklist to assess nurses' professional competence in oral hygiene care in three stages: before, during, and after care. Then, in the second phase, the level of competence of nurses in repeated times of oral hygiene care was determined based on checklist items and recorded in the learning curve.ResultsThe greatest increase of oral hygiene care competency due to repetition was observed in the first and fourth times of repetition in comparison to the subsequent and previous steps. In the linear regression model, demographic variables predicted 12–19% of changes related to skill scores in repetitions.ConclusionAccording to the learning curve, newly registered ICU nurses can reach an acceptable competency after 6 repetitions of oral hygiene care.

Nurses’ perceptions on the effects of high nursing workload on patient care in an intensive care unit of a referral hospital in Malawi: a qualitative study

BackgroundThe Malawi health system has taken numerous actions to reduce high nurse workloads, despite this, shortage of nurses especially in critical care settings still persists due to lack of prioritisation of critical care. Therefore, it is important to understand the effects of high nursing workload in Intensive Care Unit (ICU). This study aimed at exploring the perceptions of nurses regarding the effects of high nursing workload on patient care in ICU at Queen Elizabeth Central Hospital.MethodsThis qualitative descriptive study was conducted in a general ICU at Queen Elizabeth Central Hospital in Blantyre, Malawi. A purposive sample of 12 nurses working in the ICU was selected. Participants included full-time nurses working in the ICU. A total of 10 In-depth interviews were conducted to collect data upon which data saturation was reached. A semi-structured interview guide was used for data collection. Data was analysed manually using thematic analysis method by Braun & Clarke.ResultsStudy findings indicated that high nursing workload compromises the delivery of quality nursing care to critically ill patients, compromises patient safety and has negative impact on nurses’ wellbeing.ConclusionThe study findings portray that nurses are aware of the negative effects that high nursing workload has on patient care. The study findings support the need for more ICU nurses in order to reduce nurse workloads and the need for nurse managers and policy makers to develop strategies to manage nurse workloads and its effects on patient care.

Relationships among Demographic, Clinical, and Psychological Factors Associated with Family Caregiver Readiness to Participate in Intensive Care Unit Care.

Rationale: There has been a paradigm shift to partner with family caregivers by actively involving them in the direct care of the patient throughout the critical illness trajectory. Before effectively engaging family members in patient care, clinicians must assess characteristics and circumstances that may affect caregiver readiness to assume a caregiving role in the intensive care unit (ICU). Objectives: To determine how demographic, clinical, and psychological factors are related to characteristics of family caregiver readiness to engage in ICU patient care. Methods: A convenience sample of ICU family caregivers of both adult and pediatric patients in the ICU was recruited for this cross-sectional study. Participants completed the following measures: PROMIS-29 (Patient-Reported Outcomes Measurement and Information System); HADS (Hospital Anxiety and Depression Scale); CaSES (Caregiver Self-Efficacy Scale); Prep Scale (Preparedness for Caregiving Scale); Patient Activation Measure for Caregivers; and FCMFHS (Family Caregiver's Motives for Helping Scale). Data were collected via self-report at a single time point while the caregiver was visiting the critically ill patient in the ICU. Data analysis consisted of descriptive statistics and bivariate correlations. Results: Caregivers (N = 127) were primarily White (82.7%), females (77.2%), with a mean age of 51.8 (standard deviation [SD], 15.6). Most were either spouses (37.8%) or parents (32.3%) of the patient in the ICU. Patients were primarily adult (76.4%) with a mean APACHE (Acute Physiology, Age, Chronic Health Evaluation) III of 45.9 (SD, 22.5). There were significant (P < 0.05) negative correlations between depression, anxiety, and fatigue and all subscales of self-efficacy (resilience r = -0.18 to -0.30; self-maintenance r = -0.44 to -0.63; emotional connectivity r = -0.27 to -0.41; instrumental giving r = -0.34 to -0.46). Caregiver depression was negatively correlated with caregiver activation (r = -0.199) and caregiver preparedness (r = -0.300). Social satisfaction was positively correlated (P < 0.05) with caregiving preparedness, motivation, and all subscales of self-efficacy (preparedness r = 0.19; motivation r = 0.24; resilience r = 0.21; self-maintenance r = 0.49; emotional connectivity r = 0.29; instrumental giving r = 0.36). Conclusions: We found that caregiver symptoms of depression, anxiety, and fatigue are inversely related to caregiver preparation, motivation, and self-efficacy. To develop effective interventions for ICU family caregivers, further research is needed to understand the relationship between caregiver well-being, caregiving readiness, and caregiver involvement in patient care.

Creation of an International Interprofessional Simulation-enhanced Mechanical Ventilation Course.

BackgroundEvidence shows poor adherence to strategies for reducing morbidity and mortality in intensive care unit (ICU) patients receiving mechanical ventilation globally. Best practice management relies on training all members of the interprofessional ICU team, each with complementary roles in patient management.ObjectivesTo develop and evaluate a novel two-phase, train-the-trainer, interprofessional and multicultural “Best Practice Management of the Ventilated ICU Patient” multimodality, simulation-enhanced curriculum for Thai education leaders in critical care.MethodsIn phase 1 (Oregon Health and Science University cohort), two groups of nine ICU nurses and one critical care physician representing experts in critical care and education from a large hospital system in Thailand participated in a weeklong, immersive course consisting of didactic, simulation, and in situ immersive sessions focused on best practice management of mechanically ventilated ICU patients, as well as training in our educational techniques. Outcomes were assessed with pre- and postcourse knowledge assessments and overall course evaluation. In phase 2 (Thai cohort), participants from phase 1 returned to Thailand and implemented a lower fidelity curriculum in two hospitals, using the same pre- and posttest knowledge assessment in 41 participants, before the onset of the coronavirus disease (COVID-19) 6 pandemic.ResultsIn the Oregon Health and Science University cohort, the mean pretest knowledge score was 58.4 ± 13.2%, with a mean improvement to 82.5 ± 11.6% after completion of the course (P , 0.05). The greatest improvements were seen in respiratory physiology and advanced/disease-specific concepts, which demonstrated absolute improvements of 30.4% and 30.6%, respectively (P < 0.05). Participants had a high degree of satisfaction, with 90% rating the course as “excellent” and .90% reporting that the course “greatly improved” their understanding of best practices and comfort in managing mechanical ventilation. The Thai cohort had a mean baseline score of 45.4 ± 15.0% and a mean improvement to 70.3 ± 19.1% after training (P < 0.05). This cohort also saw the greatest improvement in respiratory physiology and advanced/disease-specific concepts, with 26.2% and 26.3% absolute improvements, respectively (P < 0.05).ConclusionA novel, two-phase, interprofessional, multicultural, simulation-enhanced train-the-trainer curriculum was feasible and effective in improving education in best practice management of mechanically ventilated patients and may be a useful model for improving the care of ICU patients across the world.

Evaluating the impact of personalized rehabilitation nursing intervention on postoperative recovery of respiratory function among thoracic surgery intensive care unit patients: A protocol for systematic review and meta-analysis.

Background:Exercise tolerance and lung function can be improved by pulmonary rehabilitation. As a result, it may lower thoracic surgery intensive care unit (ICU) patients’ postoperative problems and death. Enhanced recovery after surgery has advanced significantly in the perioperative care of thoracic surgery ICU patients in recent years, and it now plays an essential role in improving ICU patients’ postoperative prognosis. Appropriate tailored rehabilitation nursing intervention is required to promote the postoperative recovery of respiratory function in thoracic surgery ICU patients. This study aims to look at the influence of tailored rehabilitation nurse intervention on postoperative respiratory function recovery in thoracic surgery ICU patients.Methods:To find relevant papers, a comprehensive search of electronic databases will be conducted, including three English databases (PubMed, EMBASE, and the Cochrane Library) and two Chinese databases (Chinese National Knowledge Infrastructure and WanFang). Only research that has been published in either English or Chinese will be considered. The retrieval period will run from November 2021 to November 2021. We will look at randomized controlled trials (RCTs) studies that looked at the effect of a customized rehabilitation nursing intervention on the recovery of respiratory function in thoracic surgery ICU patients after surgery. Two writers will review the literature, retrieve study data, and assess the included studies’ quality. Any disagreements will be settled via consensus. RevMan 5.3 will be used to do the meta-analysis.Results:This research will offer high-quality data on the influence of customized rehabilitation nurse intervention on postoperative respiratory function recovery in thoracic surgery ICU patients.Conclusion:This study will look at whether a targeted rehabilitation nurse intervention might help thoracic surgery ICU patients recover their respiratory function more quickly after surgery.Ethics and dissemination:There will be no need for ethical approval.Registration number:December 12, 2021.osf.io/9rdu2/ (https://osf.io/9rdu2/).

Nurse-nurse collaboration and performance among nurses in intensive care units.

An essential element for offering high-quality care in the intensive care units (ICUs) is the intraprofessional collaboration among nurses, which facilitates the exchange of knowledge and information and hence improves performance. More research is needed to understand the relationship between the nurse-nurse collaboration and job performance in the ICUs due to the multidimensionality of both concepts, the complexity of the ICU environment, and the lack of studies. To examine the relationship between nurse-nurse collaboration and self-perceived nurse performance among Jordanian nurses in ICUs. Descriptive, correlational cross-sectional design was used. Data were collected through an online survey including the demographic questionnaire, the nurse-nurse collaboration scale, and six-dimensions scale for nursing performance. In total, 155 critical care nurses participated (response rate = 46.97%). Self-perceived job performance was significantly associated with gender (t=-3.189, P=.002), age (r=-0.301, P < .01), workplace (F=28.20, P=.001), the type of ICU (F=17.70, P=.001), and the number of assigned patients (r=0.407, P < .01). Among all nurse-nurse collaboration subscales, only the conflict management subscale was an independent significant predictor of self-perceived nursing performance (t=3.06, B=3.066, P=.003). Effective conflict management is associated with better nurse performance, which could ultimately improve patient care in ICUs. Conflict resolution is an important dimension of optimal nurse-nurse collaboration and has an important effect on nursing performance. Nurses and nurse managers in ICUs need to attend workshops and training programs in conflict management.

Risk Factors of Eye Complications in Patients Treated in the Intensive Care Unit.

In critically ill patients, normal eye protection mechanisms, such as tear production, blinking, and keeping the eye closed, are impaired. In addition, many other factors related to patients’ severe condition and treatment contribute to ocular surface disease. Reducing risk factors and proper eye care can have a significant impact on incidences of eye complications and patient quality of life after discharge from the intensive care unit (ICU). The aim of the study was to determine risk factors for ocular complication, especially those related to nursing care. The study was conducted in the ICU of a university hospital. Methods for estimating and analyzing medical records were used. The patient’s evaluation sheet covering 12 categories of risk factors for eye complications was worked out. The study group included 76 patients (34 patients with injuries and 42 without injuries). The Shapiro–Wilk test, the Spearman’s rank correlation test, the Mann–Whitney U test and the Friedman’s ANOVA test were used. The level of significance was set at α = 0.05. The most important risk factors for eye complications in the study group were: lagophthalmos (p < 0.001), sedation (p < 0.01), use of some cardiological drugs and antibiotics (p < 0.01), mechanical ventilation (p < 0.05), use of an open suctioning system (p < 0.01), presence of injuries (p < 0.01) including craniofacial trauma (p < 0.001), high level of care intensity (p < 0.01), failure to follow eye care protocol (p < 0.001), length of hospitalization at the ICU (p < 0.001), and the frequency of ophthalmological consultations (p < 0.001). There was no correlation between the incidence of these complications and the age and gender of the patients. The exposure of critically ill patients to eye complications was high. It is necessary to disseminate protocols and guidelines for eye care in ICU patients to reduce the risk factors.

The use of predefined scales and scores with eye-tracking devices for symptom identification in critically ill nonverbal patients.

Eye tracking (ET) may be a novel tool to enable nonverbal communication. We hypothesized that ET could be used successfully by intensive care unit (ICU) patients with artificial airways to express their levels of pain and mood, quality of life, and self-esteem with predefined scales and scores. Prospective, monocentric, observational study, including patients with an endotracheal tube or tracheostomy tube and a history of mechanical ventilation for more than 48 hours without delirium, and inadequate nonverbal communication skills. The ICU patients' pain was assessed with a numeric rating scale, their mood was tested with a smiley analog scale. Quality of life and self-esteem were measured with the European quality of life-5 dimensions-5 levels-score and the visual analog self-esteem scale. A total of 75 patients with a mean age of 58.3 years were included. Main diagnoses for ICU admission were major trauma (45.3%), nonabdominal sepsis (22.6%), and acute abdomen (13.3%). Patients showed moderate levels of pain and sadness with a median of 4 (interquartile range, 3-5.5) on the numeric rating scale and a median of 4 (interquartile range, 3-4) on the smiley analog scale. The general health status on the European quality of life-5 dimensions-5 levels-score was rated as poor. Reporting on the visual analog self-esteem scale, most of the included patients felt trapped (90.7%) and not confident (72%), were frustrated (64%) or did not feel understood (56%). However, despite their severe illness, many patients classified themselves as intelligent (30.6%), not mixed up (38.6%), outgoing (38.6%), and optimistic (44%). Eye tracking enables symptom identification in critically ill voiceless patients with impaired communication options. The results of our study may provide guidance for improvement measures in the care of voiceless ICU patients. We believe that ET is useful for symptom identification and therefore may be capable of improving patient-medical team interaction and patient satisfaction. Diagnostic Test or Criteria, Level III.

Impact of an interdisciplinary nutrition support team (NST) on the clinical outcome of critically ill patients. A pre/post NST intervention study.

Intensive care unit (ICU) patients are at particular risk for malnutrition with major impact for outcome and prognosis. Nutrition support teams (NST) have been proposed to improve nutrition care in ICU patients. To assess the effectiveness of an interdisciplinary NST on anthropometry and clinical outcome of ICU patients. Before NST implementation, we assessed 120 patients (before NST group; SAPS II score 44±16), afterwards 60 patients (after NST group), of whom 29 received NST guidance (after NST+group; SAPS II 65±19) and 31 not (after NST - group; SAPS II, 54±16). The primary outcome parameter was length of stay in the hospital (hospital-LOS). Severity of disease was assessed by the APACHE II score and the nutritional risk (NUTRIC) score. NST intervention resulted in a more pronounced improvement of disease severity (APACHE II, from 27±8 to 18±6, p<0.001; NUTRIC, from 7±2 to 4±2, p<0.001) compared to no NST intervention (APACHE II from 24±7 to 21±7, p<0.05; NUTRIC from 6±2 to 5±2, p<0.01). The mean hospital-LOS was not reduced, neither in the NST intervention group nor in the control group without NST intervention. NST intervention failed to improve nutritional status or mortality compared to no NST intervention. In our study the NST intervention had a positive effect on disease severity, but failed to improve mortality, hospital-LOS or nutritional status in ICU patients, likely because of a large patient heterogeneity. ClinicalTrials.gov (NCT02200874).

Hospital Dentistry for Intensive Care Unit Patients: A Comprehensive Review.

This study aimed to review the oral hygiene status, oral care guidelines, and outcomes of oral care in intensive care unit (ICU) patients from a dental perspective for effective oral care. A literature search using the keywords “Hospital dentistry” OR “Oral care” OR “Intensive care unit” OR “Hospital inpatient” OR “Hospitalization” OR “Emergency service” AND “Oral health” OR “Oral hygiene” OR “Dental plaque” was conducted in PubMed, Medline, and Google Scholar to identify publications reporting on the oral care of the patients admitted to ICUs. A total of 17,400 articles were initially identified. Of these, 58 were selected and classified into three categories for critical review. Seven of these studies evaluated the oral status of ICU patients, and most of the studies indicated that ICU patients had poor oral hygiene or required active dental treatment. Thirty-three of these studies evaluated oral care methods for ICU patients, and in general, oral care methods using chlorhexidine as adjuncts along with tooth brushing were recommended. However, there were insufficient studies to evaluate oral hygiene through effective assessment tools from a dental perspective. In 36 studies on the outcomes of oral care in ICU patients, interventions by dental professionals showed effective results in preventing hospital-acquired infection. This review highlights the importance of establishing guidelines for the evaluation of oral status in ICU patients and summarizes data that may be useful for future studies. Further studies on maintaining good oral hygiene among ICU patients are needed.

Lung Ultrasound-Guided Fluid Management versus Standard Care in Surgical ICU Patients: A Randomised Controlled Trial.

The value of lung ultrasound (LU) in assessing extravascular lung water (EVLW) was demonstrated by comparing LU with gold-standard methods for EVLW assessment. However, few studies have analysed the value of B-Line score (BLS) in guiding fluid management during critical illness. The purpose of this trial was to evaluate if a BLS-guided fluid management strategy could improve fluid balance and short-term mortality in surgical intensive care unit (ICU) patients. We conducted a randomised, controlled trial within the ICUs of two university hospitals. Critically ill patients were randomised upon ICU admission in a 1:1 ratio to BLS-guided fluid management (active group) or standard care (control group). In the active group, BLS was monitored daily until ICU discharge or day 28 (whichever came first). On the basis of BLS, different targets for daily fluid balance were set with the aim of avoiding or correcting moderate/severe EVLW increase. The primary outcome was 28-day mortality. Over 24 months, 166 ICU patients were enrolled in the trial and included in the final analysis. Trial results showed that daily BLS monitoring did not lead to a different cumulative fluid balance in surgical ICU patients as compared to standard care. Consecutively, no difference in 28-day mortality between groups was found (10.5% vs. 15.6%, p = 0.34). However, at least 400 patients would have been necessary for conclusive results.