Critical Care Areas Research Articles

The importance of psychological intervention in emergencies for patients with anorexia nervosa

Dear Editor, We consider it appropriate to highlight the importance of early psychological intervention in emergencies for patients with eating disorders. In the contemporary age, characterized by incessant socio-cultural pressures and aesthetic ideals, eating disorders emerge as a complex and critical challenge to mental and physical health in individuals during developmental age. This psychiatric condition can have fatal outcomes. Approximately one-fifth to one-third of adolescent patients with Anorexia Nervosa (AN) require intensive care during the course of the illness. Access to critical care areas in healthcare facilities due to significant emaciation-related organic decompensation is increasing significantly, particularly after the COVID-19 pandemic. [...]

Killip and Kimball classification in the Ultrasound era: Is it time to redefine?

Lung ultrasound is a tool that is increasingly gaining strength in the initial evaluation of the patient in the emergency department and in critical care areas, making it particularly useful for cardiologists. In patients with ST elevation and acute myocardial infarction it has been observed that 25-45% of patients are wrongly classified as Class I in the Killip and Kimball classification after lung ultrasound (subclinical congestion). The clinical relevance of this finding lies in the fact that the greater the number of B lines, the greater short- and long-term the mortality is. An important advantage is that no prolonged time for learning the technique is required. More studies are needed to evaluate the role and importance of subclinical congestion in patients with acute myocardial infarction. Unfortunately, ultrasound is not widely available in developing countries, so the physical examination will continue to play an important role in the initial evaluation of patients with acute myocardial infraction.

Validity and Reliability of Holistic Nursing Competencies and The Patients’s Holistic Needs: A Pilot Study

Aims: This study aimed to identify the validity and reliability of the core competencies of The Holistic Nursing Competency Questionnaire and The Holistic Needs of Patients. Methods: A pilot study with a correlational descriptive design was conducted to measure holistic nursing competency and the fulfillment of holistic patient needs in the ICU room of Dr. H. Soewondo Kendal Hospital. The study included 25 nurses and 30 patients. Holistic nursing competency was measured using a questionnaire, while the fulfillment of holistic patient needs was assessed using an observation sheet. Results: The Holistic Nursing Competency Questionnaire is valid, reliable, and psychometrically robust, but the holistic needs of patients were reduced from 33 items to 29 valid and reliable items. Conclusion: The validity test showed that the questionnaire and observation sheet were valid and reliable for measuring holistic nursing competency and the fulfillment of holistic patient needs. The study highlights the need to improve nurses' holistic competencies and address the challenges in fulfilling the holistic needs of patients, especially in critical care areas.

Controlled Substance Liquid Waste Management Systems As Potential Reservoirs for Nosocomial Infection in a Pediatric Hospital.

The purpose of this study was to determine if controlled substance waste management systems (CSWMS) demonstrate microbial growth, and therefore present a potential infection risk to pediatric hospital patients. Twenty CSWMS, either Smart Sink or Pharma Lock systems, located in patient care areas were sampled. Twelve were located in critical care areas. Cultures were obtained by swabbing the drain grate with a sterile swab. Swabs were then transported to the microbiology lab for culture. Each sample was labeled with the location of the CSWMS and each system was photographed. Of the CSWMS sampled, 50% demonstrated bacterial or fungal growth with a total of 15 microorganisms isolated, including 3 systems with Micrococcus luteus, 2 with Aspergillus species, and 2 with -Bacillus cereus. Nine of the 15 microorganisms isolated were from systems in the pediatric intensive care unit (PICU) followed by 2 microorganisms in the neonatal intensive care unit (NICU). Of the 12 systems sampled in critical care areas, 8 (66%) had positive cultures. Of the 10 systems which demonstrated growth, 9 were Pharma Lock and 1 was Smart Sink. Controlled substance waste management systems harbor potential pathogens and may serve as reservoirs of infectious agents in pediatric hospitals. Microbial growth was identified in more than half of sampled CSWMS located in critical care areas, where the most vulnerable patients are located. Based on this study, a cleaning procedure for CSWMS should be implemented. Further investigation on the relationship between CSWMS and nosocomial infections is warranted.

Epidemiology, clinical profiles, and antimicrobial susceptibility of Elizabethkingia meningoseptica infections: Insights from a tertiary care hospital in Saudi Arabia.

To investigate the incidence rate, clinical characteristics across different age groups, antimicrobial susceptibility, and outcomes of Elizabethkingia meningoseptica (E. meningoseptica) infections. A retrospective analysis was carried out to include 66 cases with confirmed E. meningoseptica cultures from sterile samples between January 2014 and June 2022 at King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia. A total of 66 cases were identified, with an incidence rate of 0.3 per 1000 admissions. Most cases were hospital-acquired (80.3%), primarily in critical care areas. All patients had underlying diseases, with respiratory (40.9%) and cardiovascular (39.4%) diseases being the most common. Minocycline showed the highest susceptibility (96.0%), followed by trimethoprim/sulfamethoxazole (77.0%), whereas tobramycin and colistin were fully resistant. The in-hospital mortality rate was 34.8%, whereas the 28-day mortality rate was 22.7%. Clinical characteristics across age groups showed a higher prevalence of cardiovascular disease in pediatrics than in adults, whereas exposure to mechanical ventilation, immunosuppressive therapy, previous infection, anemia, and in-hospital mortality were reported more frequently in adults (p<0.05). Our study provides valuable insights into E. meningoseptica infection in Saudi Arabia, emphasizing the importance of robust infection control measures. Incidence and mortality rates align with global trends. Variations in clinical characteristics across age groups highlight the importance of tailored treatments based on patient demographics and underlying comorbidities.

Experiences of the Parents of Children Admitted to PICU.

A pediatric intensive care unit (PICU) is a highly technological and fast-paced setting in a hospital. To explore the experiences of the parents in the critical care area of a selected tertiary care facility. In a qualitative study, we interviewed 10 purposively selected parents of the children admitted to PICU using a pre-validated in-depth interview schedule. All parents, whose children were admitted to PICU for more than 5 days, who understood Hindi or English and were willing to participate in the study, were enrolled in the study. Parents of critically ill children having readmission to PICU or prolonged stay of more than 15 days and not accompanied by parents were excluded. Parents had unmet needs, such as the need for information, counseling and education from the healthcare team (HCT) members, having trusting relationship with the HCT, and expecting receiving orientation of the routines and the protocols of PICU, and empathy from the various levels of PICU team. The majority of subjects expressed the desire to talk to a dedicated person for their queries. The parents had multiple feelings of distress, hopelessness, helplessness, guilt, and the fear of losing the child and used various coping strategies. Parents of critically ill children in the PICU have unmet needs. Healthcare team members should take initiative in relieving parental distress and improving their coping abilities. Kichu S, Joshi P, Bhandari S, Lodha R, Jaykrishnan K. Experiences of the Parents of Children Admitted to PICU. Indian J Crit Care Med 2024;28(7):696-701.

Impact of specialized renal technologists on optimizing delivery of continuous kidney replacement therapy in critical care areas a retrospective study.

Continuous renal replacement therapy (CKRT) is delivered to some of the most critically ill patients in hospitals. This therapy is expensive and requires coordination of multidisciplinary teams to ensure the prescribed dose is delivered. With increased demands on the critical care nursing staff and increased complexities of patients admitted to critical care units, we evaluated the role of specialized renal technologists in ensuring the prescribed dose is delivered. Therefore, the aim of this study is to investigate the impact of supporting intensive care unit nurses with specialized renal technologists on optimizing efficiency of CKRT sessions in the United Arab Emirates. This is a retrospective study that compared critically ill patients on CKRT overseen by specialized renal technologists versus who are non-covered in the year 2021. A total of 331 sessions on 158 patients were included in the study. The mean filter life was longer in specialized renal technologists-covered patients compared to the non-covered group (66 vs. 59 h, p = 0.019). After adjustment by multiple regression analysis for risk factors (i.e., age, gender, mechanical ventilation, sepsis, mean arterial pressure, vasopressors, and SOFA) that may affect CKRT machines' filter life, presence of a specialized renal technologists resulted in significantly longer filter life (co-efficient 0.129; CI 95% 1.080, 11.970; p-value: 0.019). Our study suggests that specialized renal technologists play a vital role in prolonging CKRT machine's filter life span and optimizing CKRT machine's efficiency. Further research should focus on other potential benefits of having specialized renal technologists performing CKRT sessions, and to confirm the finding of this study. Additionally, a cost-benefit analysis could be conducted to determine the economic impact of having specialized teams performing CKRT.

Pressure ulcers related to prone positioning: a pandemic amidst a pandemic.

To explore the epidemiology and risk factors associated with the development of pressure ulcers (PUs) in patients receiving prone positioning (PP) ventilatory therapy; to compare the inflammatory status of patients who develop PUs with those who do not; and to describe the experience and useful findings that have allowed us to improve the management of these patients to reduce the incidence of PUs. An observational, descriptive and longitudinal study was conducted, where sociodemographic and laboratory data were collected from patients who were hospitalised and required PP ventilatory therapy in critical care areas (CCA) during the months of May-October 2020. From the total number of patients who required PP during their CCA stay (n=240), 202 (84.2%) developed a PU. The four most frequent areas where a PU appeared were: the head and neck (n=115); the pinna (n=21); the torso (n=21); and the lower limbs (n=21). Patients who developed PU were more frequently males with higher initial levels of creatinine phosphokinase and ferritin. The incidence for each month of follow-up decreased from 8.3% to 5.8%. Regardless of the intervention, a multidisciplinary approach is required to optimise the prevention and treatment of these wounds. While PUs are often the result of other medical conditions or poor health status in general, the vast majority of PUs are avoidable.

Malnutrition: muscle wasting, inflammation, RDW, and their relation with adverse outcomes.

The objective of the study was to explore red cell distribution width (RDW) as a surrogate marker of inflammation, alone and in conjunction with muscle wasting to predict malnutrition-related adverse outcomes. This was a single-center observational study including adult hospitalized patients. Demographic variables, malnutrition criteria, and RDW were captured within 24 hours of hospital admission. Correlation tests and regression models were performed between these variables (RDW and muscle wasting) and adverse outcomes (in-hospital mortality and unplanned transfer to critical care areas (CCA). Five hundred and forty-five patients were included in the final analysis. Muscle wasting showed an independent association with adverse outcomes in every regression model tested. RDW alone showed fair predictive performance for both outcomes' significance and the adjusted model with muscle wasting showed association only for unplanned transfer to CCA. RDW did not improve the prediction of adverse outcomes compared to muscle wasting assessed by physical examination and simple indexes for acute and chronic inflammation. Malnourished patients presented higher RDW values showing a possible metabolic profile (higher inflammation and lower muscle). It is still unknown whether nutrition support can influence RDW value over time as a response marker or if RDW can predict who may benefit the most from nutritional support.

Impact of Povidone Application to Nares in Addition to Chlorhexidine Bath in Critically Ill Patients on Nosocomial Bacteremia and Central Line Blood Stream Infection.

Nosocomial Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia results in a significant increase in morbidity and mortality in hospitalized patients. We aimed to analyze the impact of applying 10% povidone iodine (PI) twice daily to both nares in addition to chlorhexidine (CHG) bathing on nosocomial (MRSA) bacteremia in critically ill patients. A quality improvement study was completed with pre and post-design. The study period was from January 2018 until February 2020 and February 2021 and June 2021. The control period (from January 2018 to May 2019) consisted of CHG bathing alone, and in the intervention period, we added 10% PI to the nares of critically ill patients. Our primary outcome is rates of nosocomial MRSA bacteremia, and our secondary outcome is central line associated blood stream infection (CLABSI) and potential cost savings. There were no significant differences in rates of MRSA bacteremia in critically ill patients. Nosocomial MRSA bacteremia was significantly lower during the intervention period on medical/surgical areas (MSA). CLABSIs were significantly lower during the intervention period in critically ill patients. There were no Staphylococcus aureus CLABSIs in critical care area (CCA)during the intervention period. The intervention showed potential significant cost savings. The application of 10% povidone iodine twice a day in addition to CHG bathing resulted in a significant decrease in CLABSIs in critically ill patients and a reduction in nosocomial MRSA in the non-intervention areas. Further trials are needed to tease out individual patients who will benefit from the intervention.

Bias between capnometry and venous carbon dioxide during initial assessment of pediatric emergency department patients: A video-based study.

The bias of capnometry (ETCO2) and venous carbon dioxide (vpCO2) among pediatric emergency department (PED) patients triaged to critical care areas is unknown. We aimed to explore correlations and bias between ETCO2 and vpCO2¸and identify predictors of bias. This was an observational, video-based, retrospective study comparing ETCO2 and vpCO2. Pediatric patients with simultaneous ETCO2 and vpCO2 data were included. Our primary aim utilized linear regressions to determine correlations and Bland-Altman analysis to assess bias. Our secondary aim utilized multiple regression to identify clinical covariates contributing to bias. Covariates included age, respiratory rate, heart rate, mean arterial blood pressure, capnometry interface, PED diagnosis, and PED disposition. A total of 200 PED patients with ETCO2 and vpCO2 data were included. The median (interquartile range [IQR]) ETCO2, vpCO2, and ΔCO2 in mmHg were 38 (32, 46), 49 (41, 61), and 11 (4, 20), respectively. ETCO2 (r=0.76) and ΔCO2 (r=0.71) were highly correlated with vpCO2. The mean bias between ETCO2 and vpCO2 was -14.1mmHg (95% confidence interval [CI], -41.9 -13.7). The bias between ETCO2 and vpCO2 increased at higher values of each measure. ETCO2 sampling interface was the only independent predictor of vpCO2 in our multivariate analysis. Patients requiring bag-valve mask (BVM) ventilation had the highest median bias between ETCO2 and vpCO2 (29mmHg, IQR 15, 37). ETCO2 and vpCO2 were highly correlated. However, bias increased at higher levels of both ETCO2 and vpCO2. Among PED patients, ETCO2's ability to approximate vpCO2 diminishes with worsening hypercarbic respiratory failure.

Achievement of adequate nutrition contributes to maintaining the skeletal muscle area in patients with sepsis undergoing early mobilization: a retrospective observational study

BackgroundThe onset of muscle loss in critically ill patients, known as intensive care unit-acquired weakness (ICU-AW), worsens their outcomes. Preventing muscle loss, which begins in the early phase of critical illness, is crucial in patient care. Adequate nutrition management may contribute to maintaining muscles; however, its evidence in patients with sepsis is insufficient. This study aimed to analyze the association between energy achievement rate in the first 7-days of critical care and muscle area changes evaluated by computed tomography (CT).MethodsThis was a retrospective observational study. Patients with sepsis admitted to the intensive care (ICU) of a tertiary care hospital in Japan were included. They were divided into three groups according to tertiles of the first 7-day energy achievement rate calculated using administered energy doses and basement energy expenditure. Skeletal muscle area (SMA) and changes in SMA were determined by CT on ICU admission and within days 7–10 of ICU admission. SMA maintenance was defined as SMA change ≥ 100%. Logistic regression analyses were performed to analyze the association of energy achievement rate with SMA changes (primary outcome) and in-hospital 28-day mortality (secondary outcome).ResultsPatients (n = 93) were classified into low, middle, and high groups according to their 7-day energy achievement rate (median rates, 16.8%, 38.8%, and 73.4%, respectively). The CT scans showed that SMA decreased between the CT scans in the low and middle groups, whereas it was maintained in the high group (median changes, -8.5%, -11.7%, and 2.8%, respectively). Univariate and multivariate logistic regression analyses showed that high energy achievement rate was significantly associated with SMA maintenance (reference, middle energy achieved group; univariate, odds ratio [95% confidence interval] 6.23 [2.04–19.10], P = 0.0013; multivariate, odds ratio [95% confidence interval] 5.92 [1.90–18.40], P = 0.0021). There was no significant difference in the association between energy achievement rate and mortality among the three groups.ConclusionsOur study found that a fulfillment of energy achievement in the first 7 days of hospitalization was associated with maintenance of muscle area. Thus, satisfying adequate energy should be considered even in patients with sepsis.

Awareness and practice of airway pressure release ventilation mode in acute respiratory distress syndrome patients among nurses in Saudi Arabia

BackgroundThis study aimed to assess the knowledge and current practice of using the airway pressure release ventilation (APRV) mode with acute respiratory distress syndrome (ARDS) patients and identify barriers to not using this mode of ventilation among nurses who work in critical areas in Saudi Arabia.MethodsBetween December 2022 and April 2023, a cross-sectional online survey was disseminated to nurses working in critical care areas in Saudi Arabia. The characteristics of the respondents were analyzed using descriptive statistics. Percentages and frequencies were used to report categorical variables.ResultsOverall, 1,002 nurses responded to the online survey, of whom 592 (59.1%) were female. Only 248 (24.7%) nurses had ever used APRV mode, whereas only 229 (22.8%) received training on APRV mode. Moreover, 602 (60.0%) nurses did not know whether APRV was utilized in their hospital. Additionally, 658 (65.6%) nurses did not know whether APRV mode was managed using a standard protocol. Prone positioning was the highest recommended intervention by 444 (43.8%) when a conventional MV failed to improve oxygenation in patients with ARDS. 323 (32.2%) respondents stated that the P-high should be set equal to the plateau pressure on a conventional ventilator, while 400 (39.9%) said that the P-low should match PEEP from a conventional ventilator. Almost half of the respondents (446, 44.5%) stated that the T-high should be set between 4 and 6 s, while 415 (41.4%) said that the T-low should be set at 0.4 to 0.8 s. Over half of the nurses (540, 53.9%) thought that the maximum allowed tidal volume during the release phase should be 4–6 ml/kg. Moreover, 475 (47.4%) believed that the maximum allowed P-high setting should be 35 cm H2O. One-third of the responders (329, 32.8%) stated that when weaning patients with ARDS while in APRV mode, the P-high should be reduced gradually to reach a target of 10 cm H2O. However, 444 (44.3%) thought that the T-high should be gradually increased to reach a target of 10 s. Half of the responders (556, 55.5%) felt that the criteria to switch the patient to continuous positive airway pressure (CPAP) were for the patient to have an FiO2 ≤ 0.4, P-high ≤ 10 cm H2O, and T-high ≥ 10 s. Lack of training was the most common barrier to not using APRV by 615 (61.4%).ConclusionThe majority of nurses who work in critical care units have not received sufficient training in APRV mode. A significant discrepancy was observed regarding the clinical application and management of APRV parameters. Inadequate training was the most frequently reported barrier to the use of APRV in patients with ARDS.

Nursing care in pediatric tracheostomized patients: a knowledge challenge for these professionals. Literature review

Introduction: One of the most applied surgical interventions in the critical care area is tracheostomy, which involves the incision and opening of the trachea to insert a plastic cannula between the 2nd and 3rd cartilage ring. This cannula is strategically placed to constantly maintain a free airway. Objective: to conduct a review of the literature on nursing knowledge and care in pediatric tracheostomized patients. Methods: a bibliographic review was carried out according to the guidelines proposed by the PRISMA declaration. The articles were extracted from three renowned databases in the scientific field: Scopus, Web of Science and Google Scholar. “Tracheotomy”, “nursing care”, “postoperative complications” as well as their combinations were used as descriptors in English through the use of the Boolean operators “AND” and “OR”. The terms were chosen as long as they were included in the Medical Subject Headings (MeSH) website. Before analyzing the documents in detail, inclusion and exclusion criteria were established, facilitating the focus on the most relevant works and discarding those that did not align with the research objectives and questions. Results: in the finally selected articles, the close relationship that exists between the level of preparation of nursing staff and their performance in caring for pediatric tracheostomized patients can be seen. Conclusions: the degree of knowledge of the nursing professional about the care of pediatric patients with tracheostomy directly influences the quality of health care that they are able to provide to the patient

Cardiopulmonary resuscitation: knowledge among nurses in selected departments of a teaching hospital, Nepal

Introduction: Cardiopulmonary Resuscitation (CPR) is considered a core emergency skill in which all health care professionals must be proficient. If early basic life support CPR is instantiated, the survival rate is improved. This study aims to assess the knowledge regarding CPR among nurses. Method: A descriptive cross-sectional study design was adopted among 150 nurses in critical care area of Patan Hospital Lalitpur Nepal, from January to April 2023. Researcher developed self-administered structured questionnaire was used for data collection. Statistical Package for Social Sciences (SPSS) version 20 was used for statistical analysis. Ethical approval was taken from the Institutional Review Committee of Patan Academy of Health Sciences. Result: Study revealed that majority 143(95.3%) of the respondents had knowledge regarding meaning of sudden cardiac death. Same as 137(91.3%) knew the indication of CPR and most of the respondents 140(93.3%) knew the carotid pulse should be checked before starting CPR. More than half 131(87.3%) had knowledge regarding ratio of chest compression. We found more than half respondents 83(55.3%) knew the best time to switch. Nearly half of the respondents 61(40%) knew the component of high-quality CPR whereas minority of the respondents; 20(13.3%) knew the algorithm of adult cardiac arrest. Conclusion: Majority of the respondents had knowledge regarding meaning, indication, site of pulse taking, and ratio of chest compression. Whereas more than fifty percent respondents had knowledge regarding, best time to switch, nearly half of respondents knew the components of CPR. Minority of respondents aware the algorithm of adult cardiac arrest.

Registered nurses' knowledge and interpretation of ECG rhythms: A cross-sectional study.

Electrocardiographic (ECG) monitoring and recording are seen as the most commonly used non-invasive diagnostic tool to identify cardiac arrhythmia and myocardial damage in the clinical setting. There is an expectation that critical care nurses are ideally trained to interpret abnormalities and morphology in the ECG more proficiently than nurses from general ward areas. However, the ability to interpret and recognise ECG abnormalities is dependent on which critical care area nurses are currently working in and their level of experience. The aim of this study was to investigate registered nurses' knowledge in being able to identify and interpret select electrocardiographic rhythms. This was a cross-sectional study that evaluated registered nurses' knowledge of electrocardiogram rhythm identification and interpretation. A convenience sample of 105 registered nurses currently enrolled in a 2-year Master's programme leading to critical care specialism and advanced practice nurse award were recruited. A 20-item multiple choice questionnaire that provided examples of electrocardiogram rhythm (n=14) abnormalities and rhythm abnormalities caused by electrolyte disturbances (n=6) RESULTS: The study included registered nurses from critical care and general ward areas. The overall results were poor with only 55% of questions answered correctly. Coronary care nurses scored the highest in identifying ECG rhythms (12/20 ± 1.58; p < .001). When ECG abnormalities associated with electrolyte imbalances were analysed, both groups were unable to identify the effects of hypokalaemia and hypomagnesaemia effectively (p = .748). Length of time as a registered nurse (r = -0.304, p = .002) and length of time in current work environment were weakly correlated (r = -0.328, p = .001). Having a critical care background showed a positive relationship with nursing knowledge of ECG rhythm identification (r = 0.614, p < .001). The results of this study demonstrate that nurses have a poor knowledge of ECG rhythm identification and interpretation, a consistent finding from other work. A possible solution is a revamp of education and training associated with ECG recognition and morphology. Monitoring and assessing ECG morphology provide important details about cardio-electroconductive stability, especially with fluctuations in serum electrolyte levels seen in critical illness or trauma. For this, critical nurses must improve their proficiency through education/training or internal quality improvement activities in detecting abnormalities associated with ECG changes beyond those most easily recognizable rhythms such as atrial fibrillation or ventricular tachycardia.

Measuring Critical Thinking Ability of Respiratory Therapists Working in Critical Areas in King Abdullah Specialized Children’s Hospital, King Abdulaziz City, Riyadh, Saudi Arabia

Aim: The aim of this study was to assess the critical thinking ability of respiratory therapists working in critical care areas from King Abdullah Specialized Children Hospital (KASCH), Riyadh, Kingdom of Saudi Arabia.&#x0D; Methods: The study's design was cross-sectional. Prior to the start of the research, the protocol was reviewed and given the approval by King Abdullah International Medical Research Center in Saudi Arabia. The study was conducted in Riyadh, Saudi Arabia, at the King Abdullah Specialized Children's Hospital (KASCH). The research included all the 45 respiratory therapy ICU staff members. The critical thinking skills of the respiratory therapy staff were evaluated using the Watson Glaser Critical Thinking Appraisal (WGCTA) short form. The evaluation consisted of a total of 40 questions broken down into five distinct categories: assumptions, arguments, deductions, inferences, and information interpretation. Excel was used to enter the acquired data before it was exported to the Statistical Package for Social Sciences (SPSS) (version 22).&#x0D; Results: The results showed that most RTs (77.42%) were male and (22.58%) were female. Regarding educational level, it shows that (87.09%) had bachelor's degree. Additionally, it shows that majority (58.06%) had 3-6 years of experience. Nearly two thirds (64.52%) of RTs aged between 26 to 30 years. The critical thinking skills level among respiratory therapists in the screened hospital was average.&#x0D; Conclusion: This study revealed no correlation between respiratory therapists' critical thinking abilities and age, gender, experience, or education.&#x0D; Recommendations: ICU respiratory therapists should continuously improve their critical thinking skills. This research will help managers and supervisors understand respiratory therapists' critical thinking and build programs to improve staff skills and prepare them to manage ICU situations. The study also recommends conducting further studies to accurately measure the staff's critical thinking skills. These recommendations aim to foster a culture of critical thinking and contribute to informed decision-making within the organization.

Comment on article "Correlation between ultrasonography and thorax portable radiography in patients with COVID-19"

Point-of-care ultrasound is an emerging tool in critical care areas. In the study we are discussing, the ultrasonographic findings are compared and contrasted with the radiographic ones in patients with COVID-19.

Reducing the rate of central line-associated bloodstream infections; a quality improvement project

BackgroundThe burden of central line-associated bloodstream infections is significant and has negative implications for healthcare, increasing morbidity and mortality risks, increasing inpatient hospital stays, and increasing the cost of hospitalization. Efforts to reduce the incidence of central line-associated bloodstream infections have utilized quality improvement projects that implement, measure, and monitor outcomes. However, variations in location, healthcare organization, patient risks, and practice gaps are key to the success of interventions and approaches. This study aims to evaluate interventions of a quality improvement project on the reduction of central line-associated bloodstream infection rates at a university teaching hospital.MethodsThis was a retrospective review of a quality improvement project that was implemented using the Plan-Do-Study-Act quality improvement cycle. Active surveillance of processes and outcomes was performed in the critical care areas; compliance to central line care bundles, and central line-associated bloodstream infections. Interrupted time series was used to analyze trends pre and post-intervention and regression modeling to estimate data segments preceding and succeeding the interventions.ResultsThere were 350 central line insertions, 3912 catheter days, and 20 central line-associated bloodstream infection events during the intervention period. Compliance with central line care bundles was at 94%. There was a trend in the reduction of central line-associated bloodstream infections by 18% that did not reach statistical significance (p = 0.252).ConclusionsImprovement projects to reduce central line-associated bloodstream infections face challenges and complexities associated with implementing interventions in real-world healthcare settings. There is a great need to continuously monitor, evaluate, readjust, and adapt interventions to achieve desired results, sustain improvements in patient outcomes, and investigate reasons for non-adherence as keys to achieving desired outcomes.

12-Leads Electrocardiogram Interpretation Competency among Nurses working in Critical Care Areas at Dow University Hospital, Karachi

OBJECTIVE: To assess the 12-lead Electrocardiograph (ECG) interpretation competency level of nurses working in the critical care units of Dow University Hospital, Karachi. METHODOLOGY: The descriptive cross-sectional design study was conducted from October to December 2019. The purposive sampling technique was used to include the participants. The study sample constitutes 120 registered nurses from the critical care units of Dow University Hospital (DUH), including the intensive care unit (ICU), coronary care unit (CCU), and emergency department(ED). Full-time Registered nurses with more than one year of professional experience and currently working in critical care units of Dow University Hospital were included, and those with post-basic-cardiology specialization were excluded. Data were collected through a 12-item validated study questionnaire and analyzed through descriptive statistics using SPSS version 21.0. RESULTS: Most of the participants, 84 (70.0%) in this study, were male, and 46(38.3%) of the nurses have completed Post RN-BS Nursing (post-diploma two years undergraduate nursing degree program) as the highest professional qualification. This study determined ECG interpretation competence as a score of ≥ 9 out of 12. The findings of this study revealed that 38(31.66%) nurses scored ≥ 9, whereas 82 (69.34%) nurses scored eight or less. CONCLUSION: The study found that most nurses performing their duties in critical hospital areas have suboptimal ECG interpretation competency levels. A relatively higher level of competency was found among nurses working in CCU. KEYWORDS: Nurse, Interpretation, competency level, Electrocardiogram, Tertiary care hospital