Intensive Care Unit Factors Research Articles

Comparison of Nurses’ Workload and Multiple Organ Failure of Patients Hospitalized in the COVID-19 and Non–COVID-19 Intensive Care Units

Background: Measuring nurses’ workload and related factors in intensive care units and reviewing their staffing is very important during COVID-19. This study aims to compare nurses’ workload and multiple organ failure of patients hospitalized during the COVID-19 in intensive care units and non–COVID-19 intensive care units. Materials and Methods: An observational study was conducted with 768 patients hospitalized in intensive care units and Zanjan City (Iran) intensive care units in 2021. The data were collected using the Nursing Activities Score and the Sequential Organ Failure Assessment. Data analysis was performed by independent t-test, Chi-squared (χ2) test, Pearson’s correlation coefficient (r), and Multiple Linear Regression (MLR). The statistical significance level was set at p < 0.05. Results: NAS in non–COVID-19 intensive care units 59.90% (10.03) was significantly higher than that of COVID-19 intensive care units 56.38% (6.67) (p < 0.001). In addition, the SOFA score was higher in the non–COVID-19 intensive care units 6.98 (3.89) than in COVID-19 intensive care units 5.62 (3.98) (p < 0.001). The Nursing Activities Score had a positive and statistically significant relationship with the Sequential Organ Failure Assessment in both units, and this relationship was higher in the COVID-19 intensive care units (r = 0.71). In addition, predictors of NAS were identified as four variables, i.e. consciousness level, SOFA, length of stay, and having an artificial airway (p < 0.05). Conclusions: Non–COVID-19 ICUs had higher NAS and SOFA scores in the study. Further investigation is needed to identify additional workload aspects in intensive care units.

Factors related to futile care and its consequences in intensive care units: A narrative review

Futile care includes not only end-of-life care but any care that cannot cause the patient to survive and be discharged from the hospital or preserve the quality of life is also called futile care. Providing futile care comes with many challenges. Therefore, this review was conducted to assess futile care and its related factors in intensive care units. This study was conducted as a narrative review. The factors related to the perception of futile care included individual and organizational factors. The consequences of futile care on nurses include increasing moral distress, decreasing job satisfaction, high levels of depersonalization of negative caring behavior, and weakening healthcare professionals' morale. According to the findings, nursing officials should reduce unnecessary care in special departments by increasing nurses' knowledge and supporting strategies, and designing effective care programs.

Carbapenem-resistant Enterobacteriaceae infection and associated factors in intensive care unit: a cross-sectional study

Carbapenem-resistant Enterobacteriaceae infection and associated factors in intensive care unit: a cross-sectional study

Occurrences of post-traumatic stress disorder, anxiety, depression, and burnout syndrome in ICU staff workers after two-year of the COVID-19 pandemic: the international PSY-CO in ICU study

PurposeThe present study aimed at assessing the prevalences of post-traumatic stress disorder (PTSD) (main objective), anxiety, depression, and burnout syndrome (BOS) and their associated factors in intensive care unit (ICU) staff workers in the second year of the COVID-19 pandemic.Materials and methodsAn international cross-sectional multicenter ICU-based online survey was carried out among the ICU staff workers in 20 ICUs across 3 continents. ICUs staff workers (both caregivers and non-caregivers) were invited to complete PCL-5, HADS, and MBI questionnaires for assessing PTSD, anxiety, depression, and the different components of BOS, respectively. A personal questionnaire was used to isolate independent associated factors with these disorders.ResultsPCL-5, HADS, and MBI questionnaires were completed by 585, 570, and 539 responders, respectively (525 completed all questionnaires). PTSD was diagnosed in 98/585 responders (16.8%). Changing familial environment, being a non-caregiver staff worker, having not being involved in a COVID-19 patient admission, having not been provided with COVID-19-related information were associated with PTSD. Anxiety was reported in 130/570 responders (22.8%). Working in a public hospital, being a woman, being financially impacted, being a non-clinical healthcare staff member, having no theoretical or practical training on individual preventive measures, and fear of managing COVID-19 patients were associated with anxiety. Depression was reported in 50/570 responders (8.8%). Comorbidity at risk of severe COVID-19, working in a public hospital, looking after a child, being a non-caregiver staff member, having no information, and a request for moving from the unit were associated with depression. Having received no information and no adequate training for COVID-19 patient management were associated with all 3 dimensions of BOS.ConclusionThe present study confirmed that ICU staff workers, whether they treated COVID-19 patients or not, have a substantial prevalence of psychological disorders.

Rationing nursing care and organizational factors in intensive care units.

Rationing nursing care is a term that applies to various aspects of the required patient care that are omitted or their performance is delayed. This study aimed to identify the extent of rationing of nursing care in intensive care units (ICUs) in different types of hospitals and determine the relationship between rationing of nursing care and hospital and staff characteristics. This quantitative, cross-sectional, multicenter study was performed. The sample comprised 226 nurses working in ICUs in a North-East part of Poland. The Polish version of the PRINCA questionnaire methods was applied. The survey was conducted between 15 January and 31 May 2023. There were statistically significant differences between rationing of nursing care in university/provincial hospitals and district hospitals t = 6.92 p<0.001. In provincial and university hospitals, nursing care is often omitted, leading to a lower perceived quality of nursing care (t = -3.0 p = 0.003). This is further compounded by the fact that nursing care is more likely to be rationed in units with a larger number of beds. The level of rationing of nursing care was significantly correlated with the perceived work quality and job satisfaction in both types of hospitals. The most frequently omitted aspects of nursing care included providing emotional support (university/provincial 1.27 vs. district 0.89), patient and family education (1.11 vs. 0.74), communication with external entities (1.11 vs. 0.84), and observing safe patient-handling practices (1.01 vs. 0.99). The type of hospital and organizational factors influence the rationing of nursing care. Improvements in working conditions can improve nursing care quality in ICUs.

Irisflorentin promotes bacterial phagocytosis and inhibits inflammatory responses in macrophages during bacterial infection

Bacterial infection remains a big concern in the patients of ICU, which is the main cause of life-threatening organ dysfunction, or even sepsis. The poor control of bacterial infection caused by antibiotic resistance, etc. or the overwhelming immune response are the most important patho genic factors in intensive care unit (ICU) patients. As main pathogens, antibiotic-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), impose serious challenges during sepsis and require alternative therapeutic options. Irisflorentin (IFL) is one of the major bioactive compounds isolated from the roots of Belamcanda chinensis (Shegan). In this study, IFL could suppress inflammatory response induced by MRSA or a synthetic mimic of bacterial lipoprotein (Pam3CSK4). IFL treatment enhanced the ability of macrophages to phagocytose bacteria likely through up-regulating the expression of phagocytic receptors SR-A1 and FcγR2a. Furthermore, IFL inhibited Pam3CSK4-induced production of pro-inflammatory cytokines, including IL-6 and TNF-α in Raw 264.7 cells, mouse primary macrophages or dendritic cells. IFL treatment also inhibited heat-killed MRSA-induced secretion of IL-6 and TNF-α in mouse bone marrow-derived macrophages. Moreover, IFL attenuated M1 polarization of macrophages as indicated by the down-regulated expression of its polarization markers CD86 and iNOS. Mechanistically, IFL markedly decreased the Pam3CSK4-induced activation of ERK, JNK or p38 MAPK pathways in macrophages. Taken together, IFL may serve as a promising compound for the therapy of bacterial infection, particularly those caused by antibiotic-resistant bacteria, such as MRSA.

Factors Affecting Nurses Performance Working in Intensive Care Units at Tertiary Care Hospitals Peshawar

Specialized nurses play a significant role in the capacity of standard health care across the globe. Many factors in intensive care units (ICUs) are present that could waste nurses’ time and energy. Objectives: To determine the factors affecting job performance of nursing staff working in Peshawar, Khyber Pakhtunkhwa, Pakistan. Methods: In this Descriptive Cross-sectional study, total of 325 nurses were selected through census sampling working in ICUs of five tertiary care hospitals Peshawar from May, 2021 to September 2021. The data collected by using adapted research instrument which had two parts: 1-demographic data, 2-nursing performance factors/obstacles. The data were analyzed with the descriptive and inferential statistics by using SPSS version-22. Results: The most common factors were: delay in getting medications from pharmacy (71.79%), improper patient’s beds space in ICUs (69.55%), distraction caused by the family’ members (62.82%) and insufficient space to sit down and do paper-work (57.69%). In the field of technology shortage of equipment’s (52.56%) and using equipment’s in poor condition (41.7%) were the most frequent obstacles. Gender, age and specialization in ICU is associated with factors that affect the performance of ICU nurses. Conclusions: Many obstacles such as delay in getting medication from pharmacy and having to use equipment in poor condition can be managed by simple interventions such as implementation of centralized pharmacy system as well as biomedical engineering system. Furthermore, management of policies and enhancing teamwork are needed to reduce obstacles such as inadequate information from physicians and disorganized unit.

Obstetrics mortality and associated factors in intensive care unit of Addis Ababa public hospital in, 2020/21: A hospital based case control study

BackgroundIn low-income nations like Ethiopia, the rate of obstetric death in intensive care units is significant. The indications of admission are Preeclampsia/Eclampsia, postpartum hemorrhage, and puerperal sepsis but, patient outcomes subsequent to intensive care unit admission are sparse. The aim of this study is to assess factors associated with obstetrics mortality in Intensive Care unit. MethodsA hospital based unmatched case control study was conducted on obstetrics patients admitted to Addis Ababa Public hospital's intensive care unit from October 2018 to November 2020. Multivariable logistic regression analysis was done; Odds Ratio and Confidence Interval (OR and 95% CI) were computed using SPSS version 26. P value < 0.05 was taken as statistically significant. ResultObstetrics mortality in intensive care unit was high and accounts 27% from the total intensive care unit admission. Severe pre-eclampsia AOR: 6.33; 95% CI: 2.25–17.79, puerperal sepsis AOR: 4.51; 95% CI: 1.68–12.15, age ≥35 years AOR: 4.09; 95% CI: 1.42–11.77, absence of antenatal care: AOR: 3.74; 95% CI: 1.03–13.5, maternal coexisting diseases AOR: 5.2; 95% CI: 2.22–12.16, and severely decrease of consciousness at admission AOR: 3.78; 95% CI: 1.21–11.79 were significantly associated with obstetrics mortality in Addis Ababa Public Hospitals intensive care unit. Conclusionand Recommendation: Maternal age ≥35 years, loss of antenatal care, puerperal sepsis, severe pre-eclampsia, pre-existing medical comorbidities and severe decrease level of consciousness during ICU admission were the most significant factors associated with obstetrics mortality. It is recommended that all pregnant women should have antenatal care so that preeclampsia and maternal comorbidities will be early diagnosed and treated.

Septic shock: incidence, mortality and hospital readmission rates in French intensive care units from 2014 to 2018

IntroductionSeptic shock is responsible for high morbidity and mortality rates and its incidence is increasing worldwide. Its evolution over the last few years and the leverage points for action to improve associated outcomes remain unclear. Our aim was to determine trends in the incidence and mortality of septic shock and associated risk factors in intensive care unit (ICU) patients and readmission rates after hospital discharge. MethodsWe performed a retrospective cohort study using data from the French national hospitalisation database, including adult patients with septic shock from 2014 to 2018. Primary outcomes were the incidence of septic shock and the hospital mortality rate at 30, 90 and 365 days. Secondary outcomes were all-cause hospital readmission. ResultsSeptic shock was identified in 187,587 ICU stays. The age- and sex-adjusted incidence rate of septic shock per 100 ICU admissions increased from 6.5% to 6.8% (P < .001); age- and sex-adjusted hospital mortality rates decreased from 47.3% to 44.5% (P < .001). The hospital readmission rate at 365 days was 65.0%. Older age, higher Charlson score, occurrence of organ failure and previous hospitalisation were associated with increased risk of mortality. Identification of a specific microorganism and a time between hospitalisation and ICU admission of less than one day were associated with a decreased risk of death. ConclusionsOur study revealed an increase in the incidence of septic shock and a decrease in mortality rates. Pathogen identification and rapid admission to the ICU were associated with better outcomes. The rate of hospital readmission increased, raising questions about the discharge criteria for these patients.

Evaluation of air quality in intensive care units and its relationship with sick building syndrome in nurses

Introduction: Indoor air quality can lead to health problems such as Sick Building Syndrome among nurses who spend many hours in intensive care units.The aim of this study was to determine the relationship between Sick Building Syndrome in nurses and indoor air quality of intensive care units in educational hospitals in Rasht.&#x0D; Materials and Methods: This cross-sectional analytical study was performed on 144 nurses in intensive care units who were randomly selected by quota random sampling. Some of the physical and chemical factors affecting indoor air quality including volatile organic compounds (Ethyl benzene, Xylene, Toluene), carbon monoxide, dust, temperature, humidity, brightness, noise,and airflow velocity were measured by calibrated equipment and symptoms of building syndrome were assessed by the MM040EA questionnaire.&#x0D; Results: The chemical factors were lower; temperature, humidity and noise were higher and brightness was lower than the recommended minimum. However, no statistically significant relationship was observed between indoor air quality and Sick Building Syndrome.&#x0D; Conclusion: Although the measured physical and chemical factors in intensive care units were often at the occupational limits. The studied nurses reported poor physical conditions in their workplaces. Identifying and controlling occupational hazards in intensive care units can improve nursing performance by increasing job satisfaction.

Impact of sound levels on physiological and consciousness state of cardiovascular patients.

Patients treated in intensive care units (ICUs) experience life-threatening medical conditions but some external factors in ICUs do not help or even adversely affect and complicate their evolution. Among others, such factors include noise pollution due to alarms and medical clinical equipment, as well as the activities of the health care personnel themselves. This study aimed to evaluate the influence of elevated sound levels on physiological variables and the consciousness state of patients treated in a cardiovascular area in an ICU. A longitudinal study with several observations was carried out during 1 month in the cardiovascular area of an ICU of a third-level hospital in southern Spain. Sound levels were monitored in different work shifts and patients' physiological data and consciousness status were recorded. Generalized additive mixed models (GAMMs) were developed to detect the variability of the sound levels together with the vital parameters of the patients in the ICU. Thirty-eight patients were included. The mean sound level was 54.09 dBA. The GAMM sound levels analysis showed a significant increase in sound levels from 4:30 p.m. to 8:00 p.m. (1.83 dBA; P < .001) and 8:00 p.m. to 11:30 p.m. (3.06 dBA; P < .001). An increase in heart rate (3.66 bpm; P < .001), respiratory rate (2.62 rpm; P < .001) and the Glasgow Coma Scale (0.50 units; P=.002) was detected during the 4:30 p.m.-8:30 p.m. Elevated sound levels in cardiovascular ICUs seem to influence positively the physiological and consciousness status of patients. Given the importance of the findings for patient safety, future intervention studies are recommended. The finding of this study could translate into structural changes in ICU facilities, as well as the development of clinical practice guidelines that influence the behaviour of health care professionals.

Acute Kidney Injury and Associated Factors in Intensive Care Units at a Tertiary Hospital in Northern Tanzania.

Background:Acute kidney injury (AKI) is a recognized complication in critically ill patients. The epidemiology of AKI varies worldwide, depending on the diagnostic criteria used and the setting. The International Society of Nephrology has called for a reduction in preventable deaths from AKI to zero by the year 2025. It is suspected that the majority of AKI cases are in limited-resource countries, but the true burden of AKI in these settings remains unknown.Objective:We aimed to determine, using standardized KDIGO (Kidney Disease Improving Global Outcomes) criteria, the prevalence of AKI, associated factors, and clinical characteristics of adult (≥18 years) patients admitted to intensive care units (ICUs) at a tertiary hospital in Tanzania.Design:Prospective observational study from November 2017 to May 2018.Methods:In all, 320 patients admitted to medical and surgical ICUs were consecutively enrolled. Baseline, clinical, and laboratory data were collected on admission and during their ICU stay. Serum creatinine and urine output were measured, and KDIGO criteria were used to determine AKI status.Results:More than half (55.3%) of ICU patients were diagnosed with AKI. Of these, 80% were diagnosed within 24 hours of admission. Acute kidney injury stage 3 accounted for 35% of patients with AKI. Patients with AKI were older, more likely to have cardiovascular comorbidities, and with higher baseline serum levels of creatinine, potassium, universal vital assessment admission scores, and total white cell count ≥12. Sepsis (odds ratio [OR] = 3.81; confidence interval [CI] = 1.21-11.99), diabetes (OR = 2.54; CI = 1.24-5.17), and use of vasopressors (OR = 3.78; CI = 1.36-10.54) were independently associated with AKI in multivariable logistic regression. Less than one-third of those who needed dialysis received it. There was 100% mortality in those who needed dialysis but did not receive (n = 19).Limitations:Being based at a referral center, the findings do not represent the true burden of AKI in the community.Conclusion:The prevalence of AKI was very high in ICUs in Northern Tanzania. The majority of patients presented with AKI and were severely ill, suggesting late presentation, underscoring the importance of prioritizing prevention and early intervention. Further studies should explore locally suitable AKI risk scores that could be used to identify high-risk patients in the community health centers from where patients are referred.

Assessment of Clinical Characteristics and Mortality-Associated Factors in COVID-19 Critical Cases in Kuwait

Objective: The objective of this study was to assess the clinical characteristics and identify mortality risk factors in intensive care unit (ICU)-admitted COVID-19 patients. Methods: We recruited and analyzed SARS-CoV-2-infected adult patients (age ≥18 years) who were admitted to the ICU at Jaber Al-Ahmad Al Sabah Hospital, Kuwait, between March 1, 2020, and April 30, 2020. The risk factors associated with in-hospital mortality were assessed using multiple regression analysis. Results: We recruited a total of 103 ICU patients in this retrospective cohort. The median age of the patients was 53 years and the fatality rate was 45.6%; majority (85.5%) were males and 37% patients had more than 2 comorbidities. Preexisting hypertension, moderate/severe acute respiratory distress syndrome, lymphocyte count <0.5 × 10⁹, serum albumin <22 g/L, procalcitonin >0.2 ng/mL, D-dimer >1,200 ng/mL, and the need for continuous renal replacement therapy were significantly associated with mortality. Conclusion: This study describes the clinical characteristics and risk factors for mortality among ICU patients with CO­VID-19. Early identification of risk factors for mortality might help improve outcomes.

Investigating the Frequency of Pressure Ulcers and Their Effective Factors in Intensive Care Units

Background: For patients with prolonged bed rest and immobilization because of motor or consciousness disorders, many factors may contribute to the development of pressure ulcers. To this end, the present study aimed to investigate the frequency of pressure ulcers and the factors affecting the development of this condition in intensive care units (ICUs). Methods: In this descriptive cross-sectional study, the case files and records of patients hospitalized between March 2017 and March 2018 entered the study using the census method. The necessary information including age, gender, location of pressure ulcers, number of ulcers on each part of the body, length of stay in ICU, and underlying diseases was extracted from the files and recorded in the data checklist. In the end, the extracted data were analyzed with SPSS 25. Results: Of the 781 patients studied, 71 (9.1%) had pressure ulcers, of whom 34 were men and 37 were women. A statistically significant difference was found between men and women in terms of the incidence of pressure ulcer (p = 0.0013). The most common sites of pressure ulcers were buttock with 34 cases (47.9%) and sacrum with 21 cases (29.6%). Conclusion: Old age and prolonged stay in ICU are important determinants of the development of pressure ulcers.

Colistin-induced nephrotoxicity and risk factors in intensive care unit: estimating from the routine laboratory findings

Objective: In this study we aimed to evaluate the patients treated with colistin in an intensive care unit (ICU) and risk factors emergence of acute renal failure (ARF) after colistine treatment.&#x0D; Materials and Methods: Patients treated with colistine in the ICU between June 2016 and September 2018 were reviewed in this retrospective study. The 37 patients who were received colistine more than 3 days due to detection of Acinetobacter baumannii in culture of tracheal aspirate specimen were included in this study. Sociodemographic and clinical data and also biochemical parameters, glomerular filtration rates (GFR), APACHE-II, RIFLE and AKIN scores were examined. Patients were divided into two groups as ARF-developing and non-ARF-developing. Follow - up parameters were compared between these two groups.&#x0D; Results: The patient group consisted of 26 males and 11 females. The mean age of the patients was 61.0 ± 19.33 years and %45 of the patients developed ARF. Mean APACHE-II score was 20.7±5.6. Mean age was significantly older in ARF patients. Onset day of colistine was significantly lower in patients with ARF. Significant relationships were found with the creatinine, albumin, AST, ALT and BUN parameters between ARF.&#x0D; Conclusion: Older age and early initiation of colistin treatment in the ICU should be considered to be risky for ARF development. Before colistin treatment BUN, creatinine, CRP, albumin and AST levels should be considered to be risky for ARF development. After colistin treatment ALT, BUN, creatinine, urine output, platelet, AST, arterial blood gas base excess levels, urine pH, and protein amount in urine should be followed carefully.

Prevalence and Related Risk Factors of Low Back Pain among Nurses Working in Intensive Care Units

Studies have shown that low back pain is a common health problem among hospital nurses especially those working in Intensive Care Units. However, prevalence and the related risk factors in intensive care units needs to be widely investigated. The aims: of this study were to identify prevalence of low back pain and determine its related risk factors among nurses working in Intensive Care Units. Subjects: A purposive sample of all nurses who worked in intensive care units and meet the inclusion criteria. Setting: The study was conducted at four intensive care units of Menoufia University hospital. Tools of the study: Two tools were utilized for data collection as follow; Tool I: Interviewing questionnaire and Tool II: Observational checklist. Results: The prevalence of low back pain among studied nurses was 85%. The most important and preventable risk factors for low back pain among studied nurses were higher body mass index, more average working hours/day, not enough working space, lower compliance of nurses with proper body mechanics and range of motion exercises during work. Conclusion: prevalence of low back pain among nurses working in intensive care units was high. There were multi interrlatrelatede risk factors for low back pain among studied nurses: work, patients and personnel related factors. Recommendations: Periodic and continuous in-services training for nurses working in intensive care units on preventing and coping strategies for low back pain should be implemented.

Epidemiology of painful procedures in premature and influencing factors in intensive care unit

Objective To report epidemiological data on neonatal pain collected from a geographically defined region, and analyze its influencing factors. Methods We prospectively collected data on all painful procedures from the first 3 days of admission from 106 premature by using self-made questionnaire. Results One hundred and six premature infants experienced 8 167 first-attempt procedures during the first 3 days of admission, 26 painful procedures per premature per day.The top seven were respectively plaster removal 1 661(20.3%), nasal aspiration 1 416(17.3%), blood sugar testing 982(12.0%), foil removal 833(10.2%), intravenous cannula 806(9.9%), removal of intravenous line 803(9.8%), arterial puncture 696(8.5%); 640(7.8%)supplemental attempts were performed.Arterial puncture 274(42.8%)and intravenous cannula 235(36.7%)were the top two painful procedures easily failed.Non-invasive ventilation, mechanical ventilation, neonatal respiratory distress syndrome and low weight were the risk factors of painful procedures. Conclusion In neonatal intensive care unit, large number of painful procedures are performed in the first 3 days of admission.Healthcare providers should develop individualized measures to promote the management of premature pain. Key words: Premature; Procedural pain; Pain; Analgesia; Neonatal intensive care unit

Expression changes of autophagy-related proteins in AKI patients treated with CRRT and their effects on prognosis of adult and elderly patients

BackgroundSepsis is one of the common death factors in intensive care unit, which refers to the systemic inflammatory response syndrome caused by infection. It has many complications such as acute renal injury, shock, multiple organ dysfunction, and failure. The mortality of acute renal injury is the highest among the complications, which is a serious threat to the safety of patients and affects the quality of life. This study aimed to observe the changes in autophagy-related protein expressions in patients with acute kidney injury (AKI) after continuous renal replacement therapy (CRRT) and their impacts on prognosis.Methods207 AKI patients visiting the Emergency Department of The First People’s Hospital of Xuzhou from January 2014 to February 2018 were recruited and treated with CRRT. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was applied to detect the expression of autophagy-related genes, including light chain 3 type II (LC3-II), autophagy-related 5 (Atg-5) and Beclin-1, in the monocytes of the patient’s peripheral blood before and after treatment. The levels of inflammatory mediators interleukin (IL)-1β and IL-6 were determined via enzyme-linked immunosorbent assay before and after treatment. The patient’s serum creatinine (Scr) level before and after treatment was measured using a full-automatic biochemistry analyser. Moreover, the treatment effect was graded after CRRT, and the relationship between the prognosis of patients and the autophagy-related proteins was observed.ResultsThe Scr levels in the patients were significantly decreased after treatment with CRRT. Before treatment, the IL-1β and IL-6 blood levels were high in the patients, while the amounts were significantly reduced after CRTT. The expressions of LC3-II, Atg-5 and Beclin-1 in the monocytes of patients after treatment were significantly decreased compared with those before treatment. Compared with those in survived patients, the expression of autophagy-related proteins was significantly elevated in in patients died after one to three weeks after the treatment. IL-1β, IL-6, LC3-II and Beclin-1, but not Atg-5 values were significantly correlated with Scr.ConclusionThe expression of LC3-II, Atg-5 and Beclin-1 in the monocytes of patients may change prominently after treatment with CRRT, so they are expected to be regarded as new prognostic indicators for AKI patients.

Nature of nursing errors and their contributing factors in intensive care units.

Errors tend to be multifactorial and so learning from nurses' experiences with them would be a powerful tool toward promoting patient safety. To identify the nature of nursing errors and their contributing factors in intensive care units (ICUs). A semi-structured interview with 112 critical care nurses to elicit the reports about their encountered errors followed by a content analysis. A total of 300 errors were reported. Most of them (94·3%) were classified in more than one error category, e.g. 'lack of intervention', 'lack of attentiveness' and 'documentation errors': these were the most frequently involved error categories. Approximately 40% of reported errors contributed to significant harm or death of the involved patients, with system-related factors being involved in 84·3% of them. More errors occur during the evening shift than the night and morning shifts (42·7% versus 28·7% and 16·7%, respectively). There is a statistically significant relation (p≤0·001) between error disclosure to a nursing supervisor and its impact on the patient. Nurses are more likely to report their errors when they feel safe and when the reporting system is not burdensome, although an internationally standardized language to define and analyse nursing errors is needed. Improving the health care system, particularly the managerial and environmental aspects, might reduce nursing errors in ICUs in terms of their incidence and seriousness. Targeting error-liable times in the ICU, such as mid-evening and mid-night shifts, along with improved supervision and adequate staff reallocation, might tackle the incidence and seriousness of nursing errors. Development of individualized nursing interventions for patients with low health literacy and patients in isolation might create more meaningful dialogue for ICU health care safety.

Light and noise: Environmental factors in intensive care units

Light and noise: Environmental factors in intensive care units