Intensive Care Unit Management Research Articles

An empirical study of using radiology reports and images to improve ICU-mortality prediction.

The predictive Intensive Care Unit (ICU) scoring system plays an important role in ICU management for its capability of predicting important outcomes, especially mortality. There are many scoring systems that have been developed and used in the ICU. These scoring systems are primarily based on the structured clinical data contained in the electronic health record (EHR), which may suffer the loss of the important clinical information contained in the narratives and images. In this work, we build a deep learning based survival prediction model with multi-modality data to predict ICU-mortality. Four sets of features are investigated: (1) physiological measurements of Simplified Acute Physiology Score (SAPS) II, (2) common thorax diseases pre-defined by radiologists, (3) BERT-based text representations, and (4) chest X-ray image features. We use the Medical Information Mart for Intensive Care IV (MIMIC-IV) dataset to evaluate the proposed model. Our model achieves the average C-index of 0.7847 (95% confidence interval, 0.7625-0.8068), which substantially exceeds that of the baseline with SAPS-II features (0.7477 (0.7238-0.7716)). Ablation studies further demonstrate the contributions of pre-defined labels (2.12%), text features (2.68%), and image features (2.96%). Our model achieves a higher average C-index than the traditional machine learning methods under the same feature fusion setting, which suggests that the deep learning methods can outperform the traditional machine learning methods in ICU-mortality prediction. These results highlight the potential of deep learning models with multimodal information to enhance ICU-mortality prediction. We make our work publicly available at https://github.com/bionlplab/mimic-icu-mortality.

Rehabilitation of intubated COVID-19 patients in a Singapore regional hospital with early intensive care unit and sustained post-intensive care unit rehabilitation

BackgroundA proportion of patients with COVID-19 become critically ill, but few studies describe the functional outcomes and rehabilitation process of these patients.ObjectiveTo describe the complications encountered and functional outcomes of critically ill COVID-19 patients requiring intubation and subsequent intensive care unit (ICU) management and rehabilitation.MethodsRetrospective case note review was conducted on all patients requiring intubation and ICU admission and subsequently discharged from our hospital from February 15, 2020 to May 1, 2020. Demographics, preexisting medical conditions, complications encountered in ICU, ICU and General Ward Length of Stay, number of therapy sessions delivered, nutritional data, and functional outcomes on discharge were collected from electronic medical records and entered in a deidentified database.ResultsMost patients developed significant breathlessness affecting post-ICU rehabilitation, a few patients developed ICU associated delirium while no patient developed ICU-associated weakness. All patients survived and could walk 20 m within 12 days post-extubation.ConclusionEarly ICU and sustained post-ICU rehabilitation of critically ill, intubated COVID-19 patients is feasible. Further studies could look into the outcomes of this group of patients, in particular the effect of nutrition and pulmonary training on functional outcomes. We strongly recommend an interdisciplinary rehabilitation team approach in managing critically ill COVID-19 patients.

Airway Management of Critically Ill Pediatric Patients with Suspected or Proven Coronavirus Disease 2019 Infection: An Intensivist Point of View

AbstractAdvanced airway management of critically ill children is crucial for novel coronavirus disease 2019 (COVID-19) management in the pediatric intensive care unit, whether due to shock and hemodynamic collapse or acute respiratory failure. In this article, intubation is challenging due to the particularities of children's physiology and the underlying disease's pathophysiology, especially when an airborne pathogen, like COVID-19, is present. Unfortunately, published recommendations and guidelines for COVID-19 in pediatrics do not address in-depth endotracheal intubation in acutely ill children. We discussed the caveats and pitfalls of intubation in critically ill children.

International Survey on the Use of Arginine Vasopressin in the Postoperative Management of Single Ventricle Patients.

Management of patients with single ventricle physiology after surgical palliation is challenging. Arginine vasopressin has gained popularity in recent years as a non-catecholamine vasoactive medication due to its unique properties. However, data regarding its use in the pediatric population is limited. Therefore, we designed a survey to explore whether and how clinicians use this medication in intensive care units for the postoperative management of single ventricle patients. This international survey aimed to assess usage, practices, and concepts related to arginine vasopressin in pediatric intensive care units worldwide. Directors of pediatric intensive care units who are members of the following international professional societies: European Society of Pediatric Neonatal Intensive Care, Association for European Pediatric and Congenital Cardiology, and Pediatric Cardiac Intensive Care Society were invited to participate in this survey. Of the 62 intensive care unit directors who responded, nearly half use arginine vasopressin in the postoperative management of neonatal single ventricle patients, and 90% also use the drug in subsequent surgical palliation. The primary indications are vasoplegia, hemodynamic instability, and refractory shock, although it is still considered a second-line medication. Conceptual benefits include improved hemodynamics and end-organ perfusion and decreased incidence of low cardiac output syndrome. Those practitioners who do not use arginine vasopressin cite lack of availability, fear of potential adverse effects, unclear indication for use, and lack of evidence suggesting improved outcomes. Both users and non-users described increased myocardial afterload and extreme vasoconstriction as potential disadvantages of the medication. Despite the lack of conclusive data demonstrating enhanced clinical outcomes, our study found arginine vasopressin is used widely in the care of infants and children with single ventricle physiology after the first stage and subsequent palliative surgeries. While many intensive care units use this medication, few had protocols, offering an area for further growth and development.

Risk Factors for Complications Following Lateral Skull Base Surgery and the Utility of ICU Monitoring.

To examine the role of intensive care unit (ICU) management following lateral skull base surgery for vestibular schwannoma and identify risk factors for complications warranting admission to the ICU. Retrospective review. Tertiary referral center. Two hundred consecutive patients undergoing lateral skull base surgery for vestibular schwannomas. Lateral skull base approach for resection of vestibular schwannoma and postoperative monitoring. Patients were grouped if they sustained an ICU complication, a non-ICU complication, or no complication. Analysis was performed to determine patient or treatment factors that may be associated with ICU complications. Multivariate and three-way analysis of variance compared groups, and multivariate logistic regression determined adjusted odds ratios (aOR) for analyzed factors. Seventeen of 200 patients sustained ICU complications (8.5%), most commonly hypertensive urgency (n = 15). Forty-six (23%) sustained non-ICU complications, and 137 (68.5%) had no complications. When controlling for age, sex, obesity, and other comorbidities, only hypertension (aOR 5.43, 95% confidence interval (CI) 1.35-21.73, p = 0.017) and tumor volume (aOR 3.29, 95% CI 1.09-9.96, p = 0.035) were independently associated with increased risk of ICU complications. The necessity of intensive care following lateral skull base surgery is rare, with the primary ICU complication being hypertensive urgency. Preoperative hypertension and large tumor volume (>4500 mm3) were independently associated with increased risk for ICU complications. These findings may allow for risk stratification of patients appropriate for admission to stepdown units following resection of vestibular schwannomas. Further prospective, multi-center, randomized studies are necessary to validate these findings before systematic changes to current postoperative care practices.

Une hypokaliémie symptomatique induite par une consommation excessive de Coca-Cola zéro®

IntroductionCoca-Cola zero® is a caffeinated soft drink involved in cardiovascular risk factors, but did you know that it can be responsible for serious metabolic disorder? Case reportA 54-years-old patient presents a progressive asthenia with tetraparesis and neuropathic pain in upper and lower limbs. Laboratory tests showed severe hypokalemia (1.26mmol/L) with electrocardiographics signs, associated to an uncompensated metabolic alkalosis, rhabdomyolysis (CPK: 80 N). The management in intensive care unit allowed normalization of metabolic disorders without relapse when stopping supplements and she recovered motor deficit. Neuropathic pain persists and the electromyogram concluded to a length-dependent axonal sensitive polyneuropathy. The etiological assessment eliminated renal or extra-renal causes. She admitted a 2–5 liters per day Coca-Cola zero® potomania for more than ten years. DiscussionFew cases of symptomatic hypokalemia alcalosis due to excessive consumption of Coca-Cola® are described and various mechanisms have been implicated, linked to the components: caffeine, fructose, glucose. We report the first case severe hypokalemia-induced tetraparesis related to Coca-Cola zero®, sugar-free soda but containing sweeteners: this raises the question of the main toxicity of caffeine and the role of additives. ConclusionSymptomatic severe hypokalemic alkalosis induced by excessive consumption of Coca-Cola normal or zero® is an exclusion diagnosis that clinicians have to awred because of the complications which could be serious while the disorders could be reversible after supplementation and stopping intoxication. Additional research is needed on food components which can cause serious metabolic disorders in order to sensitize population with the danger of industrial junk food.

Outcomes of rib fractures in the geriatric population: A 5-year retrospective, single-institution, Australian study.

Surgical rib fixation in the general population can decrease morbidity, including length of stay and ventilator days. Elderly rib fractures convey high rates of morbidity and mortality, and it is unclear whether this population benefits from operative management. A single-centre, retrospective study at a Level 1 Australasian trauma centre was conducted. Registry-identified patients aged ≥70 years, admitted to hospital with blunt trauma-induced rib fractures, were included. Outcome measures included demographics, pre-morbid function, acute length of stay, intensive care unit admission, injury characteristics, management and complications. A total of 920 presentations were identified, with 295 meeting the inclusion criteria. Falls accounted for majority (n= 148/295, 50.2%), with a median Injury Severity Score of 10 (inter-quartile range [IQR] 10-14). Severe chest trauma occurred overall in 80% (n= 243/294) and all operative patients (n= 15/15). Conservative management was used in 95% (n= 280/295). Patient-controlled analgesia was common (n= 177/295, 60.0%) and regional techniques increased in the surgical approach (n= 12/15, 80.0%) compared with conservative approach (n= 71/280, 25.4%). Despite longer acute length of stay (12 days, IQR 9-15), operative management resulted in similar complications (26.7% vs. 30.4%) and no deaths. Operative intervention was significantly associated with increased number of fractures (p< 0.001), flail segment (p= 0.001) and higher chest Abbreviated Injury Score (p< 0.001); however, it was not significantly associated with age (p= 0.90), comorbidities (0.91) or anticoagulation (p= 0.51). Surgical management of rib fractures in the elderly was performed without increased complications within this centre's multimodal approach. Standard indications for rib fixation may be applicable in the elderly population, whilst comorbidities, age and anticoagulation use alone may not be adequate reasons to withhold surgical rib fixation.

Comparison of the Efficacy of Metoclopramide Versus Dexamethasone for the Prevention of Postoperative Nausea Vomiting during General Anesthesia

Objective:To evaluate the efficacy of Metoclopramide versus Dexamethasone for prevention of postoperative nausea and vomiting during general anesthesia.&#x0D; Study Design:This is a Randomized control trial (RCT) study.&#x0D; Setting: Study carried out at Department of Anaesthesiology, Surgical Intensive Care Unit and Pain Management, Clinic, Dow University of Health Sciences and Dr. Ruth Pfau Hospital Karachi, from December 2018 to June 2019.&#x0D; Materials and Methods:110 patients undergoing elective surgeries, who fulfilled the inclusion criteria and gave informed consent were included in the study. They were randomly assigned to either group M or group D, with 55 patients in each group. All patients were then administered either intravenous dexamethasone (8mg) in group D or intravenous metoclopramide (10mg) in group M at the time of induction of anesthesia. The main outcome measure was postoperative nausea and vomiting, at the end of 6th hour postoperatively. The SPSS version 21 was applied to the data.&#x0D; Results: Majority of the patients 66 (60%) were of age 35 years or less. Mean age of the patients was 35.09±11.55 years. There were more females than males, with male to female ratio being 1:1.03. Overall, in patients receiving metoclopramide, 12(21.8%) had postoperative nausea and vomiting, while in patients who received dexamethasone, only 4 (7.3%) patients had post-operative nausea and vomiting. When comparing two groups, there was statistically significant (p= 0.02) reduced postoperative nausea/vomiting among those patients who had received intravenous dexamethasone.&#x0D; Conclusion: Intravenous dexamethasone is more effective than Metoclopramide in preventing postoperative nausea and vomiting in patients during general anesthesia.

Survey on Sternal Wound Management in the Italian Pediatric Cardiac Intensive Care Units.

(1) Background: a review of the literature found a lack of standardized pediatric guidelines regarding wound management after cardiac surgery. (2) Objective: the aim of the study is to investigate the cardiac surgical wound management in Italian pediatric cardiac intensive care units. (3) Methods: we sent an online questionnaire to the 13 Italian pediatric cardiac intensive care units. (4) Results: ten pediatric cardiac intensive care units (77%) have a protocol for the management of the cardiac surgical wound. The staff members that mainly have the responsibility for the wound management after cardiac surgery are registered nurses and physicians together both in the pediatric cardiac intensive care units (69%), and when a patient is transferred to another ward (62%). Thirty-eight percent of the pediatric cardiac intensive care units have a protocol used to monitor wound infection, and the staff mostly uses a written shift report (54%) to monitor the infection. (5) Discussion: this is the first survey to investigate the management of the wound after cardiac surgery in Italian pediatric cardiac intensive care units. The small sample size and the fact that the centers involved are only Italian cardiac intensive care units are the limits of this study. (6) Conclusions: in the Italian pediatric cardiac intensive care units it emerged that there is a diversity in the treatments adopted and a lack of specific protocols in the management of the pediatric cardiac surgical wound.

What is the role of neurosurgeons in the current management of intracranial aneurysm in France? An analysis of professional practices

Study DesignRetrospective observational survey-based study. IntroductionIn France, intracranial aneurysm (IA) patients are managed by neurosurgeons and by interventional neuroradiologists. The growth of endovascular treatment led us to reflect on the role of neurosurgeons in the management of patients with IA. The present study aimed to highlight the current organization of IA management in France. MethodA 60-question survey was sent to the neurosurgeons in 34 hospitals managing IA patients. Thirty-three questions dealt with standards of care, follow-up procedures and the involvement of the specific specialist. ResultsTwenty-seven centers (79.4%) responded to the survey. A Vascular Multidisciplinary Discussion Team was organized, including both surgeons and neuroradiologists, in 92% of responding centers. There were department protocols in 66% of centers, a local registry in 33% and clinical trials in IA in 60%. Patients with unruptured IA were first seen by a neurosurgeon or by an interventional neuroradiologist, with different practices. For ruptured IA, the neurosurgeons were contacted first in 93% of cases, and were systematically involved in initial intensive care unit management. The patients were hospitalized in the neurosurgery department in 89% of the centers. The neurosurgeons took care of initial follow-up in 85% of the centers, and of lifetime follow-up in 36%. In most centers, radiological monitoring of IA was based on MRI angiography for patients who were embolized or under surveillance, and on CT angiography after microsurgery. ConclusionDespite the growth of endovascular treatments, the present survey and the literature highlight a major role of neurosurgeons in treatment, follow-up and care coordination.

Risk Scoring System of Mortality and Prediction Model of Hospital Stay for Critically Ill Patients Receiving Parenteral Nutrition.

Predicting the clinical progression of intensive care unit (ICU) patients is crucial for survival and prognosis. Therefore, this retrospective study aimed to develop the risk scoring system of mortality and the prediction model of ICU length of stay (LOS) among patients admitted to the ICU. Data from ICU patients aged at least 18 years who received parenteral nutrition support for ≥50% of the daily calorie requirement from February 2014 to January 2018 were collected. In-hospital mortality and log-transformed LOS were analyzed by logistic regression and linear regression, respectively. For calculating risk scores, each coefficient was obtained based on regression model. Of 445 patients, 97 patients died in the ICU; the observed mortality rate was 21.8%. Using logistic regression analysis, APACHE II score (15–29: 1 point, 30 or higher: 2 points), qSOFA score ≥ 2 (2 points), serum albumin level < 3.4 g/dL (1 point), and infectious or respiratory disease (1 point) were incorporated into risk scoring system for mortality; patients with 0, 1, 2–4, and 5–6 points had approximately 10%, 20%, 40%, and 65% risk of death. For LOS, linear regression analysis showed the following prediction equation: log(LOS) = 0.01 × (APACHE II) + 0.04 × (total bilirubin) − 0.09 × (admission diagnosis of gastrointestinal disease or injury, poisoning, or other external cause) + 0.970. Our study provides the mortality risk score and LOS prediction equation. It could help clinicians to identify those at risk and optimize ICU management.

Clinical and Epidemiological Characteristics of Paediatric Patients Diagnosed with COVID-19 in a Tertiary Hospital in Mexico City.

COVID-19 affects the paediatric population less frequently than adults. A retrospective study was performed in a tertiary paediatric hospital in Mexico City in children <18 years of age who were hospitalized with a positive reverse transcription-polymerase chain reaction for SARS-CoV-2. Included in the study were 86 patients with a median age of 10 years old (IQR 2.6-14.3 years), who were classified in three groups: previously healthy, with chronic disease and immunosuppressed patients. The principal signs and symptoms were fever (81%), cough (51%) and headache (35%). A total of 20 patients (23%) required management in the paediatric intensive care unit (PICU) and 17% needed mechanical ventilation for an average of 12.7 days (IQR 2-29 days). There was no statistically significant difference between the three clinical classification groups in those patients admitted to the PICU, most of which were previously healthy patients. The mortality rate was 5% (four patients). Given that the paediatric population is susceptible to infection, potential transmitters and to clinical presentations with variable degrees of severity, it is important to continue reinforcing social distancing measures.

Neonatal Nurse and Midwife Competence Regarding Pain Management in Neonates: A Systematic Review.

Neonates in need of intensive care are often subjected to numerous painful procedures. Despite the growing scientific research, hospitalized neonates continue to experience unrelieved pain. Enhancing the competence of neonatal intensive care nurses is an integral component of effective pain management. The purpose of this article is to identify and synthesize the existing evidence on nurses' and midwives' competence regarding neonatal pain management internationally. The review was guided by Whittemore and Knafl's 5-stage framework, with 8 databases searched in June 2020 including PubMed, CINAHL Complete (via EBSCOhost), MEDLINE (via EBSCOhost), PsycINFO (via Ovid), EMBASE, Scopus, Cochrane Library, and Google Scholar. Reference lists of selected articles were also hand-searched. Studies were reviewed independently for methodology and inclusion and exclusion criteria. The initial search yielded 3037 articles; 19 met the inclusion criteria and were included for analysis: qualitative (n = 5) and quantitative (n = 14). Nurses' and midwives' competence regarding neonatal pain management in the neonatal intensive care unit is discussed in relation to knowledge, attitudes, behaviors, and perceptions of competence by most studies. The barriers to effective neonatal pain management were found to relate to nurses' and midwives' factors, underutilized pain assessment tools, and organizational factors. Potential facilitators to effective neonatal pain management included clear evidence-based guidelines/protocols, adequate training, and the use of appropriate and accurate pain assessment tools. Parent involvement and a team approach to neonatal pain management were also identified. These findings suggest that further research is necessary to address the barriers and promote facilitators to improve neonatal pain management.

Procalcitonin-guided protocol use and impact on intensive care unit and antibiotic management: a pilot study

Objective: To assess the procalcitonin protocol use and its impact on antibiotic therapy management of critically ill patients in the intensive care unit (ICU). Method: An observational descriptive and retrospective study conducted in an adult ICU with 28 beds from the Brazilian Unified Health System (SUS). Results: This present study observed a 78% (90/116) of PCT protocol adherence in the studied ICU. We observed a reduction in days of antibiotic treatment (DOT) going from 14 to 8,5 treatment-day duration (5.49 ± 2.2 days), impacting the overall antibiotic therapy cost for a decrease of 40.91%. Conclusion: The study revealed that PCT use was associated with substantial benefits, reducing hospital costs and days of exposure to antibiotic therapy applied to patients affected by infectious diseases in critical care settings.

Acute kidney injury (AKI) in patients with Covid-19 infection is associated with ventilatory management with elevated positive end-expiratory pressure (PEEP)

BackgroundAcute kidney injury (AKI) in Covid-19 patients admitted to the intensive care unit (ICU) is common, and its severity may be associated with unfavorable outcomes. Severe Covid-19 fulfills the diagnostic criteria for acute respiratory distress syndrome (ARDS); however, it is unclear whether there is any relationship between ventilatory management and AKI development in Covid-19 ICU patients.PurposeTo describe the clinical course and outcomes of Covid-19 ICU patients, focusing on ventilatory management and factors associated with AKI development.MethodsSingle-center, retrospective observational study, which assessed AKI incidence in Covid-19 ICU patients divided by positive end expiratory pressure (PEEP) tertiles, with median levels of 9.6 (low), 12.0 (medium), and 14.7 cmH2O (high-PEEP).ResultsOverall mortality was 51.5%. AKI (KDIGO stage 2 or 3) occurred in 38% of 101 patients. Among the AKI patients, 19 (53%) required continuous renal replacement therapy (CRRT). In AKI patients, mortality was significantly higher versus non-AKI (81% vs. 33%, p < 0.0001). The incidence of AKI in low-, medium-, or high-PEEP patients were 16%, 38%, and 59%, respectively (p = 0.002). In a multivariate analysis, high-PEEP patients showed a higher risk of developing AKI than low-PEEP patients (OR = 4.96 [1.1–21.9] 95% CI p < 0.05). ICU mortality rate was higher in high-PEEP patients, compared to medium-PEEP or low-PEEP patients (69% vs. 44% and 42%, respectively; p = 0.057).ConclusionThe use of high PEEP in Covid-19 ICU patients is associated with a fivefold higher risk of AKI, leading to higher mortality. The cause and effect relationship needs further analysis.Graphic abstract

Computed tomography findings of COVID-19 pneumonia in Intensive Care Unit-patients.

Background: In December 2019, a cluster of unknown etiology pneumonia cases occurred in Wuhan, China leading to identification of the responsible pathogen as SARS-coV-2. Since then, the coronavirus disease 2019 (COVID-19) has spread to the entire world. Computed Tomography (CT) is frequently used to assess severity and complications of COVID-19 pneumonia. The purpose of this study is to compare the CT patterns and clinical characteristics in intensive care unit (ICU) and non- ICU patients with COVID-19 pneumonia.Design and Methods: This retrospective study included 218 consecutive patients (136 males; 82 females; mean age 63±15 years) with laboratory-confirmed SARS-coV-2. Patients were categorized in two different groups: (a) ICU patients and (b) non-ICU inpatients. We assessed the type and extent of pulmonary opacities on chest CT exams and recorded the information on comorbidities and laboratory values for all patients.Results: Of the 218 patients, 23 (20 males: 3 females; mean age 60 years) required ICU admission, 195 (118 males: 77 females, mean age 64 years) were admitted to a clinical ward. Compared with non-ICU patients, ICU patients were predominantly males (60% versus 83% p=0.03), had more comorbidities, a positive CRP (p=0.04) and higher LDH values (p=0.008). ICU patients’ chest CT demonstrated higher incidence of consolidation (p=0.03), mixed lesions (p=0.01), bilateral opacities (p<0.01) and overall greater lung involvement by consolidation (p=0.02) and GGO (p=0.001).Conclusions: CT imaging features of ICU patients affected by COVID-19 are significantly different compared with non-ICU patients. Identification of CT features could assist in a stratification of the disease severity and supportive treatment. Significance for public health The major implication of our study is the differences in CT and laboratory findings in COVID-19 patients in ICU and non-ICU settings. Although the prospective impact of these findings was not assessed, recognition of these findings may help physicians anticipate the disease course and triage the patient to early ICU management. Our study highlights the importance of structured and quantitative reporting format where radiologists explicitly describe the specific pattern of pulmonary opacities (such as GGO, consolidation, and mixed) as well as lung areas and the number of lung lobes involved with COVID-19 pneumonia. To

Effectiveness of application of a manual for improvement of alarms management by nurses in Intensive Care Units.

Objective.To evaluate the effects of application of a manual on the improvement of alarms management in Intensive Care Units (ICU).Methods.This quasi-experimental study evaluated the effectiveness of the introduction into of a manual for alarm management and control in the ICU of a hospital in southeastern Iran. The intervention was a 4-hour workshop was on topics related to the adverse effects of alarms, standardization of ECG, oxygen saturation and blood pressure monitoring systems, and the use of ventilators and infusion pumps. Data were collected thorough 200 hours of observation of 60 ICU nurses (100 hours’ pre-intervention and 100 hours’ post-intervention). Response time, type of response, customization of alarm settings for each patient, the person responding to an alarm, and the cause of the alarm were analyzed. Alarms were classified into three types: false, true and technical.Results.The results showed a statistically significant difference between the pre- and post-intervention frequency of alarm types, frequency of monitoring parameters, customized monitoring settings for patients, and individuals who responded to alarms. The percentage of effective interventions was significantly higher for all parameters after the intervention (46.9%) than before the intervention (38.9%).Conclusion.The employment of a manual for management of alarms from electronic equipment in ICUs can increase the frequency of appropriate responses to alarms in these units.

Neonate Apnea Nursing Care in Neonatal Intensive Care Unit

Apnea is a common occurrence in sick neonates, characterized as a cessation of breathing those results inpathological changes in heart rate and oxygen saturation. In the neonatal age, apnea is the most commonform of breathing disorder. A neonate with apnea must be admitted to a special ward known as a neonatalintensive care unit (NICU) (1)The study aims to study nurse’s knowledge regarding nursing management of apnea in neonate and to detectassociation between nurse’s knowledge of apnea in neonate and nurses demographic data.A descriptive hospital based is carried out at neonatal intensive care unit at Bint Al-Huda teaching hospitaland Al-Musawi pediatric hospital, the study period from 3 January 2021 and 15 Abril 2021. Total coverage(50) nurses were participated in the study to achieve the objective of the study the researcher has establishedthe constructed questionnaire which consists of two parts (1) sociodemographic data for nurses 4 items,(2) knowledge of nurses about apnea in neonate that consist of 17- items. Data were coded &amp; analyzed byelectronic was sent to the nurses participants in the study through social media after taking the approval ofDhi Qar health directorate to research in hospitals covered by the study and statistical tables and pie chartswere construct from the data using a statistical package for social sciences (SPSS) program version 20 andexcel.Results: The finding of the present study suggested that assessment of nurses’ Knowledge about nursingmanagement for apnea in neonate. The level of knowledge (16% good, (48 % )fair,(36%) poor knowledge,because their relative sufficiency (76%) were under cutoff point(4), there is a significant association betweennurses’ knowledge about nursing management and demographic data such (age –level of education and levelof experience) in neonatal intensive care unit by P value &lt; 0.05. The study indicated to provide Nursingmanagement of apnea in neonates’ educational program for nurses, including updating booklets, pamphlets,and boosters to help nurses improve their awareness of apnea in neonates.

Current Perspectives on the Assessment and Management of Pain in the Intensive Care Unit.

Critical illness is often painful, both from the underlying source of illness, as well as necessary procedures performed for the monitoring and care of these patients. Pain is often under-recognized in the critically ill, especially among those who cannot self-report, so accurate assessment and management continue to be major consideration in their care. Pain management in the intensive care unit (ICU) is an evolving practice, with a focus on accurate and frequent pain assessment, and targeted pharmacologic and non-pharmacologic treatment methods to maximize analgesia and minimize sedation. In this review, we will evaluate several validated methods of pain assessment in the ICU and present management options. We will review the evidence-based recommendations put forth by the largest critical care societies and several high-quality studies related to both the in-hospital approach to pain, as well as the short- and long-term consequences of untreated pain in ICU patients. We conclude with future directions.

RAND appropriateness panel to determine the applicability of UK guidelines on the management of acute respiratory distress syndrome (ARDS) and other strategies in the context of the COVID-19 pandemic

BackgroundCOVID-19 has become the most common cause of acute respiratory distress syndrome (ARDS) worldwide. Features of the pathophysiology and clinical presentation partially distinguish it from ‘classical’ ARDS. A Research and...