Intensive Care Patients Research Articles

Use of different debriefing methods after in situ simulation with intensive care unit nurses.

The debriefing phase is the simulation phase where performance improves and learning occurs. This study examined the effects of the learning conversation (LC)-based, 3D (defusing, discovering and deepening) model-based and unstructured debriefing methods on satisfaction and debriefing experience after in-situ simulation among intensive care unit (ICU) nurses. In this randomized controlled experimental study, three debriefing methods were compared, according to which 119 ICU nurses were divided into the following groups: LC group (n = 38), 3D group (n = 40) and control group (n = 41). In- situ simulation was performed with an intensive care patient scenario. p < .05 was considered statistically significant. The total Debriefing Experience Scale-Experience with Debriefing part scores were 89.76 ± 8.10 in the LC group, 88.90 ± 8.70 in the 3D group and 88.29 ± 7.28 in the control group. No significant difference was found in debriefing experience and satisfaction between the groups (p > .05), but a significant difference was observed in the LC group. The groups showed a homogeneous distribution regarding participant characteristics. Debriefing experience and satisfaction do not differ between the methods. Implementation of the simulation in the ICU in - situ with ICU nurses is beneficial in obtaining a fidelity experience. Performing the debriefing application after simulation in line with the model supports the International Nursing Association for Clinical Simulation and Learning (INACSL) debriefing standards.

Validity and Reliability of the Turkish Version of the Postextubation Dysphagia Screening Tool.

Background and Purpose: Patients who have been intubated ≥48 hours are at risk of dysphagia. Evaluation of swallowing before starting oral feeding after extubation is necessary to prevent aspiration and the problems caused by aspiration. The Postextubation Dysphagia Screening tool is a validated and reliable tool used to evaluate extubation-induced dysphagia. This study was conducted to evaluate the validity and reliability of the Postextubation Dysphagia Screening Tool for the Turkish population. Methods: The study had a methodological design and was carried out with 50 patients followed in the intensive care unit of a public hospital. The study was carried out in four stages: (1) language validity, (2) content validity, (3) establishing interrater reliability by agreement with two observers (intensive care nurse and intensivist), and (4) establishing sensitivity and specificity with the intensive care nurse and intensivist. Results: The overall content validity index was 0.91, indicating content validity. Interrater reliability was established (Cohen's g = 0.93). The prevalence of postextubation dysphagia was 42%, and the sensitivity of the Postextubation Dysphagia Screening Tool was 82% and the specificity was 64%. Implications for Practice: The Turkish version of the Postextubation Dysphagia Screening Tool exhibited good evidence of validity and reliability and was determined important as it can help nurses evaluate postextubation dysphagia in intensive care patients. The use of this tool by a nurse reduces the risk of unsafe oral intake among patients after prolonged intubation. This tool allows accurate assessment of dysphagia and initiation of early and safe oral feeding in critical care patients.

Isoflurane, like sepsis, decreases CYP1A2 liver enzyme activity in intensive care patients: a clinical study and network model.

Liver function of intensive care patients is routinely monitored by static blood pathology. For specific indications, liver specific cytochrome activity may be measured by the commercially available maximum liver function capacity (LiMAx) test via quantification of the cytochrome P450 1A2 (CYP1A2) dependent C-methacetin metabolism. Sedation with the volatile anesthetic isoflurane was suspected to abrogate the correlation of LiMAx test with global liver function. We hypothesized that isoflurane has a CYP1A2-activity and LiMAx test result decreasing effect. In this monocentric, observational clinical study previously liver healthy intensive care patients, scheduled to be changed from propofol to isoflurane sedation, were enrolled. LiMAx testing was done before, during and after termination of isoflurane sedation. The mean LiMAx value decreased during isoflurane sedation. Septic patients (n = 11) exhibited lower LiMAx values compared to non-septic patients (n = 11) at all time points. LiMAx values decreased with isoflurane from 140 ± 82 to 30 ± 34 µg kg-1 h-1 in the septic group and from 253 ± 92 to 147 ± 131 µg kg-1 h-1 in the non-septic group while laboratory markers did not imply significant hepatic impairment. Lactate increased during isoflurane inhalation without clinical consequence. Sepsis and isoflurane have independently demonstrated an effect on reducing the hepatic CYP1A2-activity. A network model was constructed that could explain the mechanism through the influence of isoflurane on hypoxia inducible factor (HIF-1α) by upregulation of the hypoxia-inducible pathway and the downregulation of CYP1A2-activity via the ligand-inducible pathway. Thus, the increased anaerobic metabolism may result in lactate accumulation. The influence of isoflurane sedation on the validated correlation of global liver function with CYP1A2-activity measured by LiMAx testing needs to be investigated in more detail.

Volatile versus propofol sedation after cardiac valve surgery: a single-center prospective randomized controlled trial

BackgroundOptimal intensive care of patients undergoing valve surgery is a complex balancing act between sedation for monitoring and timely postoperative awakening. It remains unclear, if these requirements can be fulfilled by volatile sedations in intensive care medicine in an efficient manner. Therefore, this study aimed to assess the time to extubation and secondary the workload required.MethodsWe conducted a prospective randomized single-center trial at a tertiary university hospital to evaluate the postoperative management of open valve surgery patients. The study was randomized with regard to the use of volatile sedation compared to propofol sedation. Sedation was discontinued 60 min after admission for critical postoperative monitoring.ResultsWe observed a significantly earlier extubation (91 ± 39 min vs. 167 ± 77 min; p < 0.001), eye-opening (86 ± 28 min vs. 151 ± 71 min; p < 0.001) and command compliance (93 ± 38 min vs. 164 ± 75 min; p < 0.001) using volatile sedation, which in turn was associated with a significantly increased workload of a median of 9:56 min (± 4:16 min) set-up time. We did not observe any differences in complications. Cardiopulmonary bypass time did not differ between the groups 101 (IQR 81; 113) versus 112 (IQR 79; 136) minutes p = 0.36.ConclusionsUsing volatile sedation is associated with few minutes additional workload in assembling and enables a significantly accelerated evaluation of vulnerable patient groups. Volatile sedation has considerable advantages and emerges as a safe sedation technique in our vulnerable study population.Trial registration: Clinical trials registration (NCT04958668) was completed on 1 July 2021.

Ayuno corto vs prolongado previo a la realización de traqueostomías en pacientes de terapia intensiva: un estudio retrospectivo

Introduction: International guidelines on aid prior to invasive procedures usually generate longer aid than in intensive care (IT) patients. This fact represents a high risk of malnutrition and, consequently, a worse prognosis. The objective of the present investigation was to analyze the degree of association between the fasting time prior to tracheostomy of patients under mechanical ventilatory assistance (MVA) and the appearance of pneumonia. Methods: Retrospective cohort study that included patients admitted to our IT from 10/01/2018 to 08/31/2022 and with a tracheostomy performed. Two cohorts were defined characterized by fasting ≤3 hours vs. &gt;3 hours. Fisher's exact test and Mann-Whitney test were used for bivariate analysis. A p value &lt;0.05 was shown to be significant. Results: 141 patients were hospitalized with a tracheostomy, 9 were excluded, leaving 132 patients. The cohort with fasting ≤3 hours was made up of 15 patients and the one with fasting &gt;3 hours was made up of 117, the latter presented an average fast of 2.5 hours (IR 2-3), days of AVM prior to the procedure of 13 days (IR 12-18), while the other cohort presented an average fast of 6 hours (IR 5-8), days of AVM prior to the procedure of 12 days (IR 10-14.5). When analyzing the association between the type of fasting and the appearance of pneumonia, an OR of 0.958 (95% CI: 0.32-2.87) was obtained, p value of 0.743. Conclusions: No significant differences were found regarding fasting time and the appearance of pneumonia as referred to in the international literature.

What helps or hinders effective end-of-life care in adult intensive care units in Middle Eastern countries? A systematic review

BackgroundAs many patients are spending their last days in critical care units, it is essential that they receive appropriate end-of -life care. However, cultural differences, ethical dilemmas and preference practices can arise in the intensive care settings during the end of life. Limiting therapy for dying patients in intensive care is a new concept with no legal definition and therefore there may be confusion in interpreting the terms ‘no resuscitation’ and ‘comfort care’ among physicians in Middle East. Therefore, the research question is ‘What helps or hinders effective end-of-life care in adult intensive care units in Middle Eastern countries?’MethodsThe authors conducted a comprehensive systematic literature review using five electronic databases. We identified primary studies from Medline, Embase, CINAHL, Psycinfo and Scopus. The team assessed the full-text papers included in the review for quality using the Joanna Briggs Institute checklist (JBI). We completed the literature search on the first of April 2022 and was not limited to a specific period.ResultsWe identified and included nine relevant studies in the review. We identified five main themes as end-of-life care challenges and/or facilitators: organisational structure and management, (mis)understanding of end-of-life care, spirituality and religious practices for the dying, communication about end-of-life care, and the impact of the ICU environment.ConclusionsThis review has reported challenges and facilitators to providing end-of-life care in ICU and made initial recommendations for improving practice. These are certainly not unique to the Middle East but can be found throughout the international literature. However, the cultural context of Middle East and North Africa countries gives these areas of practice special challenges and opportunities. Further observational research is recommended to confirm or modify the results of this review, and with a view to developing and evaluating comprehensive interventions to promote end-of-life care in ICUs in the Middle East.

Epirubicin for the Treatment of Sepsis and Septic Shock (EPOS-1): study protocol for a randomised, placebo-controlled phase IIa dose-escalation trial

IntroductionSepsis remains the major cause of death among hospitalised patients in intensive care. While targeting sepsis-causing pathogens with source control or antimicrobials has had a dramatic impact on morbidity and...

Laser photobiomodulation for chemical stomatitis in intensive care patient: Case report

Chemical stomatitis is a type of traumatic injury caused by contact of chemical substances and drugs with oral tissues, resulting in clinically significant damage. This case reports a 14-year-old male patient with chronic kidney disease on renal replacement therapy (peritoneal dialysis) and using calcium carbonate via oral capsules for treatment. Due to peritoneal dialysis complications, the patient developed bacterial peritonitis, requiring intensive care unit admission and alteration of his dialysis therapy mode to hemodialysis. During the hospitalization period, significant oral lesions developed due to inadequate calcium carbonate administration, interfering with the evolution of the patient’s general health and requiring the assistance of a dental team for diagnosis and treatment. The patient was diagnosed with chemical stomatitis. During the clinical examination, ulcerated, bleeding lesions were observed on the lip, jugal mucous membranes, hard palate, and soft palate. Laser photobiomodulation was used as a treatment associated with a topical corticosteroid. Each region received ten 1 J/point, and 60 J of energy were delivered per day/session. In total, 480 J of energy were delivered with a total irradiation time of 4800 s. The patient reported considerable improvement in pain symptoms after the first laser-photobiomodulation session. After 8 sessions, the patient had improved, and laser photobiomodulation proved effective for treating oral lesions.

Night sleep in intensive care patients: An interpretive phenomenological study

Night sleep in intensive care patients: An interpretive phenomenological study

Effectiveness and safety of a static insulin infusion protocol in intensive care patients at a Vietnam hospital

Effectiveness and safety of a static insulin infusion protocol in intensive care patients at a Vietnam hospital

Evaluation of the effects of physiotherapy on intracranial pressure in intensive care patients by ultrasonographic optic nerve sheats diameter measurement

Evaluation of the effects of physiotherapy on intracranial pressure in intensive care patients by ultrasonographic optic nerve sheats diameter measurement

Prediction of blood transfusion in intensive care patients after surgery

Prediction of blood transfusion in intensive care patients after surgery

Evaluation of the relationship of intra-abdominal hypertension with respiratory mechanics, hemodynamic parameters and mortality in intensive care patients

Evaluation of the relationship of intra-abdominal hypertension with respiratory mechanics, hemodynamic parameters and mortality in intensive care patients

Determination of the relationship between NRS-2002, modified nutric scores and GLIM criteria with mortality used in malnutrition screening in intensive care patients

Determination of the relationship between NRS-2002, modified nutric scores and GLIM criteria with mortality used in malnutrition screening in intensive care patients

Perioperative patient education and nursing management in intensive care patients: A systematic review

Perioperative patient education and nursing management in intensive care patients: A systematic review

Application of a downward tract adherence method in the manual bedside placement of post-pyloric tubes in the intensive care unit.

At present, there are few studies on the technical requirements of manual bedside placement of post-pyloric tube in Intensive Care Unit patients. To investigate the application value of downward tract adherence method in the manual bedside placement of jejunal tubes. In the downward group, 160 patients underwent manual bedside placement of jejunal tubes by a downward tract adherence method. In the conventional group, 144 patients were treated with conventional gas injection during the placement. The success rate, average time, and adverse reactions of the placement in the two groups were investigated and compared. The success rate of the placement in the downward group was significantly higher (95% vs. 75%, P< 0.001) and the average time for the successful placement was shortened (23 ± 5.91 min vs. 26 ± 5.49 min, P= 0.025) than that in the conventional group. No treatment-related adverse reactions occurred in either group, and there were also no significant differences in vital sign changes. The use of the downward tract adherence method in the manual bedside placement of postpyloric tubes for the intensive care patients at the bedside has a higher success rate, effectivity and safety.

Dynamic delirium – Nursing intervention to reduce delirium in patients critically Ill, a randomized control trial

ObjectiveTo determine the effectiveness of a nursing intervention based on the Dynamic Symptom Model (DSM) and scientific evidence versus daily care in reducing the incidence and duration of delirium in intensive care patients. MethodWe designed the intervention named “DyDel” (By Dynamic Delirium) based on the theoretical approach of the DSM and from scientific evidence. A double-masked clinical trial of parallel groups was developed to test DyDel, with 213 patients older than 18 admitted to the intensive care unit (ICU) randomized to the study groups. The intervention group received DyDel each shift from day 0 until discharged from the ICU, while the control group received daily care in the ICU. At the same time, all participants were followed to measure primary (incidence and duration of delirium) and secondary outcomes (level of sedation and pain, days of mechanical ventilation, stay in ICU, and physical restriction). ResultsOverall, the study population were older than 60 years (60.3 ± 15.2 years), the male gender (59.6 %), and the diagnosis of acute myocardial infarction (73.7 %) were predominant. Comparing groups of study, the incidence of delirium was lower in the intervention group (5.6 %) than in the control group (14.8 %) (p = 0.037). The intervention group had lower days with delirium (0.07 ± 0.308) than the control group (0.34 ± 1.28) (p = 0.016), lower pain intensity (p = 0.002) and lower days of physical restraints (p = 0.06). ConclusionNon-pharmacological care, like the DyDel intervention, includes the family and focuses on the different patient's needs, which can help to reduce the incidence and duration of delirium in patients admitted to adult ICUs. Implications for Clinical PracticeDyDel was non-pharmacological and included the family. The DyDel's activities were focused on physiological, psychological, spiritual, and social needs and the experience and trajectory of delirium. The nurse can give humanized care in the ICU by applying DyDel.

Robot-assisted mobilisation in the intensive care unit: does it offer relief to mobilising specialists? A qualitative longitudinal study at a German university hospital

BackgroundImmobility among intensive care patients can result in significant impairments. Reasons for this issue include a lack of specialised staff and equipment, as well as safety concerns associated with transferring patients to a therapy device. Nevertheless, early mobilisation is recognised as beneficial for improving patient outcomes. This study explores the perspectives of healthcare professionals on the use of a robotic system for patient mobilisation and identifies related stress and relief factors.MethodThis qualitative longitudinal study was conducted at a German university hospital, where 29 interviews were conducted with nurses at three different data collection points. The data were analysed using qualitative content analysis in accordance with Mayring.FindingsThe utilisation of the VEMOTION® robotic system generally did not lead to any physical discomfort. However, the adoption of this technology presented certain challenges. Non-routine users initially experienced psychological strain, primarily due to the extensive preparation required and the need to integrate the system into established routines. Additionally, structural factors, such as nurse-to-patient ratios and the layout of the care facilities, were identified as significant determinants affecting both the practicality of mobilisation and associated stress levels.ConclusionsRobotic systems like VEMOTION® can alleviate the physical workload of nurses. Successful integration and psychological adaptation depend on familiarity and routine use of the technology. Addressing structural and staffing factors is crucial for optimising robotic assistance in patient care. Further research should delve into these dynamics and explore the broader implications of technology adoption in healthcare.Trial registration: clinicaltrials.org TRN: NCT05071248, Date: 2021/10/21 URL: https://clinicaltrials.gov/ct2/show/NCT05071248

Assessment of Colistin Heteroresistance among Multidrug-Resistant Klebsiella pneumoniae Isolated from Intensive Care Patients in Europe.

Heteroresistance (HR) to colistin is especially concerning in settings where multi-drug-resistant (MDR) K. pneumoniae are prevalent and empiric use of colistin might lead to treatment failures. This study aimed to assess the frequency of occurrence of colistin HR (CHR) among (MDR) K. pneumoniae (n = 676) isolated from patients hospitalized in 13 intensive care units (ICUs) in six European countries in a clinical trial assessing the impact of decolonization strategies. All isolates were whole-genome-sequenced and studied for in vitro colistin susceptibility. The majority were colistin-susceptible (CS) (n = 597, MIC ≤ 2 µg/mL), and 79 were fully colistin-resistant (CR) (MIC > 2 µg/mL). A total of 288 CS isolates were randomly selected for population analysis profiling (PAP) to assess CHR prevalence. CHR was detected in 108/288 CS K. pneumoniae. No significant association was found between the occurrence of CHR and country, MIC-value, K-antigen type, and O-antigen type. Overall, 92% (617/671) of the K. pneumoniae were MDR with high prevalence among CS (91%, 539/592) and CR (98.7%, 78/79) isolates. In contrast, the proportion of carbapenemase-producing K. pneumoniae (CP-Kpn) was higher among CR (72.2%, 57/79) than CS isolates (29.3%, 174/594). The proportions of MDR and CP-Kpn were similar among CHR (MDR: 85%, 91/107; CP-Kpn: 29.9%, 32/107) and selected CS isolates (MDR: 84.7%, 244/288; CP-Kpn: 28.1%, 80/285). WGS analysis of PAP isolates showed diverse insertion elements in mgrB or even among technical replicates underscoring the stochasticity of the CHR phenotype. CHR isolates showed high sequence type (ST) diversity (Simpson's diversity index, SDI: 0.97, in 52 of the 85 STs tested). CR (SDI: 0.85) isolates were highly associated with specific STs (ST101, ST147, ST258/ST512, p ≤ 0.003). The widespread nature of CHR among MDR K. pneumoniae in our study urge the development of rapid HR detection methods to inform on the need for combination regimens.

Inter-rater reliability in the assessment of consciousness in patients receiving palliative care in intensive care: A prospective cross sectional observational study.

The Glasgow Coma Scale (GCS) is one of the methods that has validity for evaluating the consciousness levels of patients in the literature and is accepted by health authorities. The purpose of this study was to evaluate the inter-rater reliability of GCS in intensive care patients receiving palliative care. A prospective cross sectional observational study. The study was conducted in a general intensive care unit with 20 beds with patients receiving palliative care. In the unit, 18 nurses worked in two shifts, day and night. Each patient's primary palliative care nurse and two additional researchers were given one minute to independently record the patient's GCS total and subscale scores. All observations were completed within 5 min as there could be significant changes in the patient's GCS score during observations. A total of 258 assessments were completed. For the GCS total scoring, a moderate agreement was found between palliative care nurses and the first researcher-observer (49.0%) and also between palliative care nurses and the second researcher-observer (47.7%). In addition, there was a substantial agreement between the first and second researchers (78.9%) and also between all observers (61.5%) (all p = .001). Although there was a near-perfect agreement between the two researcher-observers, we found only moderate agreement among all observers (palliative care nurses and two researcher-observers) in the evaluation of GCS total and subscale scores. We found that lack of knowledge and training on the standardized use of GCS is still a problem for palliative and intensive care units. Because of the diversity of patients requiring GCS assessment in palliative care units, refresher training programs and hands-on workshops on consciousness assessment should be organized regularly for more experienced nurses.