Intensive Care Unit Experience Research Articles

Ethical Consequences of Technological Mediation on Parental Decision-Making Experiences in the Neonatal Intensive Care Unit.

The neonatal intensive care unit (NICU) is a morally charged space in which parents may be confronted with difficult decisions about the treatment of their newborns, decisions often complicated and created by the increasing use of technologies. This paper adopts a postphenomenological approach to explore the ethical consequences of technological mediation on parental treatment decision-making in the NICU. Semi-structured interviews were conducted with parents of children who received invasive technological support in the NICU to better understand how they made treatment decisions or decisions about specific interventions during their child's hospitalization. The findings suggest that technological mediation-or the various ways in which humans can interact with their world via technologies-contributes to experiences of ambiguity, ambivalence, and alienation in parental decision-making. The ambiguity of invasive NICU technologies can create uncertainty in a decision, which can then lead to internal ambivalence about which decision to make. Ultimately, this ambiguity and ambivalence may lead to alienation from one's child, as parents are disconnected physically and emotionally from the decision and thus their child. Articulating the effects of technological mediation on parental decision-making is a key step in addressing decisional conflict in neonatal intensive care settings and better supporting parents in their decision-making roles.

Aloud real- time reading of intensive care unit diaries: A feasibility study

ObjectivesMemories of frightening/delusional intensive care unit experiences are a major risk factor for subsequent psychiatric morbidity of critical illness survivors; factual memories are protective. Systematically providing factual information during initial memory consolidation could mitigate the emotional character of the formed memories. We explored feasibility and obtained stakeholder feedback of a novel approach to intensive care unit diaries whereby entries were read aloud to the patients right after they were written to facilitate systematic real time orientation and formation of factual memories. Research methodologyProspective interventional pilot study involving reading diary entries aloud. We have also interviewed involved stakeholders for feedback and collected exploratory data on psychiatric symptoms from patients right after the intensive care stay. SettingVarious intensive care units in a single academic center. Main outcome measuresFeasibility was defined as intervention delivery on ≥80% of days following patient recruitment. Content analysis was performed on stakeholder interview responses. Questionnaire data were compared for patients who received real-time reading to the historical cohort who did not. ResultsOverall, 57% (17 of 30) of patients achieved the set feasibility threshold. Following protocol adjustment, we achieved 86% feasibility in the last subset of patients. Patients reported the intervention as comforting and appreciated the reorientation aspect. Nurses overwhelmingly liked the idea; most common concern was not knowing what to write. Some therapists were unsure whether reading entries aloud might overwhelm the patients. There were no significant differences in psychiatric symptoms when compared to the historic cohort. ConclusionWe encountered several implementation obstacles; once these were addressed, we achieved set feasibility target for the last group of patients. Reading diary entries aloud was welcomed by stakeholders. Designing a trial to assess efficacy of the intervention on psychiatric outcomes appears warranted. Implications for Clinical PracticeThere is no recommendation to change current practice as benefits of the intervention are unproven.

Radiology Nursing Saudi Career Development Program: Single Center Experience

The vast variety and complexity of procedures done in vascular interventional radiology necessitates highly specialized and experienced nursing care throughout the procedures. Although no specific qualification is currently required to practice as Vascular Interventional radiology (VIR) nurse in Saudi Arabia, most employers require prior experience in intensive care units, emergency rooms, or post anesthesia care units. Here we report our institutional experience in specialized nursing training in vascular interventional radiology. This proposed program prepares graduate nurses to practice VIR nursing with greater level of competency.

Extracorporeal Membrane Oxygenation and Lebanese Critical Care Nurses' Perceptions: A Qualitative Phenomenological Study.

The training of nursing staff to deliver extracorporeal membrane oxygenation in Lebanon has recently attracted attention. It is important to comprehend the background of nurses who take on this new duty. The main objectives of this study were to (1) explore the experiences of intensive care unit nursing staff who work with extracorporeal membrane oxygenation, (2) identify the psychological and physiological challenges experienced by intensive care unit nurses while managing patients with extracorporeal membrane oxygenation, and (3) determine the roles assumed by intensive care unit nurses while managing patients utilizing extracorporeal membrane oxygenation. A qualitative phenomenological design utilizing semistructured interviews utilizing a purposive sampling of 15 intensive care unit nurses using extracorporeal membrane oxygenation devices. Interviews were audio recorded, verbatim transcribed, and thematically analyzed. Three themes emerged, namely (1) nurses' role in extracorporeal membrane oxygenation, (2) skills and training, and (3) challenges faced by extracorporeal membrane oxygenation nurses. This study demonstrates that nurses play a crucial role in providing extracorporeal membrane oxygenation patient care, placing them under significant occupational stress due to the intensive care unit's routine workload and the demands of extracorporeal membrane oxygenation. Additionally, role confusion brought on by a lack of professional practice norms and emotional exhaustion made occupational pressure worse.

The Impact of Short Intensive Care Rotation on Residents' Experience in the COVID-19 Pandemic: A Mixed-Methods Study.

To assess the impact and utility of an intensive care unit (ICU) rotation during the coronavirus disease 2019 (COVID-19) pandemic and the need for mandatory ICU rotations in training for all clinical specialties. A mixed methods study was conducted from January to September 2021 at the Aga Khan University Hospital, including resident doctors who rotated through COVID ICU between May and September 2020. An online survey was undertaken, followed by two focused group discussions (FGDs). Fifty-nine complete responses out of a total of 86 were analyzed. Around 42.3% (n = 25) of doctors belonged to medicine/allied specialties and 57.6% (n = 34) had previous ICU experience. Both groups, with and without prior ICU experience, found the rotation equally challenging (82.3% (n = 28) versus 84% (n = 21), P = .776) and gained similar practical skills (35.3% (n = 12) versus 16% (n = 4), P = .072), however, those with experience gained significantly more knowledge (58.5% (n = 20) versus 32% (n = 8), P = .047). On opinion regarding mandatory ICU rotation, the majority agreed to have a mandatory rotation (82% (n = 28) versus 72% (n = 18), P = .421)) with an optimal duration of 1 to 2 months. The FGDs found that all residents encouraged the idea of mandatory training in ICU which must be tailored to their training specialty and suggested extending the duration beyond 1 week to ensure learning. COVID ICU rotation was a good avenue for learning and the idea of mandatory ICU training was supported. Mandating ICU rotation might theoretically enhance response to emergencies. More research is needed to understand for feasible incorporation of ICU training in the curriculum.

The Optimal Time for Initiating Probiotics for Preterm and Very-Low-Birth-Weight Infants: A 10-Year Experience in a Single Neonatal Intensive Care Unit.

The starting time for probiotic supplementation in preterm infants after birth varies widely. This study aimed to investigate the optimal time for initiating probiotics to reduce adverse outcomes in preterm or very low birth weight (VLBW) infants. Medical records of preterm infants born at a gestational age (GA) of <32 weeks or VLBW infants in 2011-2020 were reviewed respectively. The infants who received Saccharomyces boulardii probiotics within 7 days of birth were grouped into an early introduction (EI) group, and those who received supplemented probiotics after 7 days of birth were part of the late introduction (LI) group. Clinical characteristics were compared between the two groups and analyzed statistically. A total of 370 infants were included. The mean GA (29.1 weeks vs. 31.2 weeks, p<0.001) and birth weight (1,235.9 g vs. 1491.4 g, p<0.001) were lower in the LI group (n=223) than in the EI group. The multivariate analysis indicated that factors affecting the LI of probiotics were GA at birth (odds ratio [OR], 1.52; p<0.001) and the enteral nutrition start day (OR, 1.47; p<0.001). The late probiotic introduction was associated with a risk of late-onset sepsis (OR, 2.85; p=0.020), delayed full enteral nutrition (OR, 5.44; p<0.001), and extrauterine growth restriction (OR, 1.67; p=0.033) on multivariate analyses after adjusting for GA. Early supplementation of probiotics within a week after birth may reduce adverse outcomes among preterm or VLBW infants.

Early period intensive care follow-up after liver transplantation in children: a single center experience.

Liver transplantation (LT) is a well-established, life-saving treatment for children with irreversible acute and chronic liver failure (LF). We aimed to evaluate the factors associated with morbidity and mortality in the early period of LT in children by reviewing our pediatric intensive care unit (PICU) experience. We reviewed children`s medical records followed in the PICU after LT between May 2015-August 2021, including demographic parameters, indications for LT, operative variables, respiratory and circulatory support requirements, LT-related complications and survival. During this period, 40 pediatric patients who underwent LT were evaluated. LT was performed in 35 (87.5%) cases of chronic liver disease and 5 (12.5%) cases of acute liver failure. Twenty-four patients had chronic liver failure due to cholestatic liver disease. The patients` Pediatric Risk of Mortality (PRISM) III score was 18.82±SD (2-58) at PICU admission. 1-year survival was 87.5%, and overall survival was 85%. Younger age, low body weight, preoperative pediatric end-stage liver disease (PELD), and model for end-stage liver disease (MELD) values of 20 and higher were important risk factors for unfavorable outcomes after living donor liver transplantation (LDLT). These risk factors are both associated with technically more challenging vascular and bile duct reconstruction and higher complication rates, and increased mortality during the early period after LT. The early period of optimum PICU management in pediatric LT recipients is crucial for successful outcomes, which is also related to the patients` characteristics, disease severity scores, and surgical procedures.

The influence of repeated pain exposure on morning salivary cortisol in term and preterm neonates.

Introduction: Because neonates in the intensive care units (ICU) experience recurrent stress due to painful medical procedures, they are at risk of dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis. Aim of the study: To evaluate the influence of repeated pain exposure on morning salivary cortisol (SC) in newborns admitted to the ICU. The neonates were divided into 3 groups: term (370/7-416/7 weeks), moderate to late preterm (320/7-366/7 weeks), and very preterm (< 320/7 weeks). The hospital stay was prospectively monitored for the number of the most common medical procedures. At least 2 saliva samples for morning SC were collected after completion of 35 weeks of postmenstrual age (PMA) in preterm infants and before discharge in term neonates. The results of SC were compared with the reference intervals for healthy term newborns. The study group consisted of 57 patients: 21 term, 17 moderate to late preterm, and 19 very preterm neonates. Very preterm neonates obtained the highest values of mean morning SC in comparison to moderate to late preterm and term infants (3.83 [1.67-8.81] ng/ml vs. 2.44 [1.94-4.38] ng/ml vs. 2.15 [1.5-5.25] ng/ml, p=0.45). The relationship between mean morning SC and the number of invasive blood samplings was found only in term newborns (Rs=-0.44, p<0.05). 46% of all SC measurements in very preterm, 47% in moderate to late preterm, and 46% in term infants were within the reference intervals for healthy newborns. High exposure to painful procedures seems to dampen the morning SC in term, but not in preterm infants.

Stress, postpartum depression, and anxiety in mothers of neonates admitted in the NICU: A cross-sectional hospital-based study.

Mothers of neonates admitted to a neonatal intensive care unit (NICU) experience heightened distress, anxiety, depression, and trauma symptoms. Despite their prevalence, these conditions are generally neither recognized nor treated due to the constraints of time and concerns about the social acceptability of screening. To study stress, postpartum depression, and anxiety in mothers of neonates admitted to the NICU. One hundred forty consecutive mothers having preterm and low birth weight neonates in the NICU were taken for the study as cases and an equal number of mothers of full-term neonates matched for age and socioeconomic status (SES), were recruited as controls with their informed consent. Subjects were assessed with the Acute Stress Disorder Scale (ASDS), Post-Traumatic Stress Disorder (PTSD) Symptom Scale (PSS), Edinburgh Postnatal Depression Scale (EPDS), and Perinatal Anxiety Screening Scale (PASS). Mothers of preterm neonates in NICU had significantly higher scores on the ASDS, PSS, EPDS, and PASS compared to controls. There was a significant association of ASDS and PSS scores with younger age, higher education, middle SES, joint family, urban residence, unplanned pregnancy, and male child. There was a significant association of the EPDS scores with lower SES, low education, unemployment, and male child. There was a significant association of the PASS scores with younger age, lower SES, and cesarean section. Mothers of preterm neonates admitted to the NICU compared to controls have significantly higher levels of stress, anxiety, and depression.

Perception and Attitude towards Passive Euthanasia among Doctors in a Tertiary Care Hospital in Northeast India: A Cross-sectional Study

Introduction: The medical fraternity now has more control over the processes of life and death due to advances in medical technology and equipment. Euthanasia has been debated around the world for more than half a century and it continues to raise important questions in medical ethics, moral theology, civil rights and liberty. Physicians’ attitudes to life and death emerge to relate their end-of-life decision-making, although usually carried out at the request of ailing person. Physicians’ contemplation on euthanasia is a vital building block in the path towards any change, in the euthanasia situation in a country. Aim: To determine perception and attitude towards passive euthanasia among doctors in Regional Institute of Medical Sciences, Manipur, India and to evaluate the association between attitude and variables favourable to passive euthanasia. Materials and Methods: A cross-sectional survey in the Regional Institute of Medical Sciences (tertiary care hospital), Manipur, India, between October 2018 and September 2020, in Northeast was carried out among 673 doctors. A selfadministered questionnaire was designed and approved by three specialists with expertise in palliative care and medical ethics. The questionnaire had a total of 46 questions in English language, of which 15 questions were on socio-demographic profile, 13 were attitude questions and 18 were questions on perception towards passive euthanasia. Attitude questions were scored using 5-point Likert scale from strongly disagree (-2) to strongly agree (+2). Total attitude score ranges from -26 to +26. Score above zero was considered to have positive attitude and vice-versa. There was no scoring to determine perception towards euthanasia. The questionnaires were given to the doctors and postgraduate trainees of clinical and non clinical specialities in a tertiary care hospital in North Eastern India during their work hours. Data were summarised using descriptive statistics. Chi-square test was used to assess factors favouring attitudes toward passive euthanasia. Results: Age of the respondents ranged from 24 years to 63 years, with a mean age of 37.1±10.7 years and mean duration of experience was eight years. Out of 577 respondents, 368 (63.8%) were postgraduate trainees and 209 (36.2%) were doctors. Majority (463, 80.2%) of the respondents had positive attitude, 97 (16.9%) had negative attitude and 17 (2.9%) had neutral attitude. Total 543 (94.1%) respondents agreed that declaration from patient/family members must be obtained before the act of passive euthanasia. Also, the quality of life as viewed by the patient himself (452, 78.3%) and humanitarian basis (372, 64.4%) were the important factors in influencing decision making regarding passive euthanasia on a terminally ill patient. There was no significant association between sex, religion, specialisation, Intensive Care Unit (ICU) experience and attitude towards passive euthanasia. Conclusion: Majority of the respondents had positive attitude towards passive euthanasia in the face of intractable suffering and terminal illness. Hastened death looks easier to the patients and family because of physical suffering and financial burdens they are subjected to. The doctors got request for euthanasia by the patients and relatives which reflects the public awareness on euthanasia.

Long-term health-related quality of life and independence among older survivors of serious injury.

Little is known about the recovery experiences of older trauma intensive care unit (TICU) survivors and the relationship between geriatric trauma care and long-term functional ability and health-related quality of life (HRQOL). We conducted a prospective cohort study of 218 patients (age, ≥65 years) admitted to a Level 1 regional trauma center TICU before versus after implementation of a geriatric care bundle with protocolized geriatrics consultations (Geri-T). Survivors or their proxies were interviewed approximately 1 year after hospitalization. Outcomes included the Katz Index of Independence in Activities of Daily Living (ADLs), Lawton Instrumental Activities of Daily Living (IADLs), and EQ-5D-5L HRQOL survey. Two investigator-developed questions regarding recovery experiences were included. Differences in outcomes among survivors admitted before versus after Geri-T were analyzed using multivariable linear regression. Responses to questions about recovery experiences were qualitatively assessed using content analysis. We reached 67% (146/218) of hospital survivors or their proxies across both groups; 126 patients were still alive and completed the survey. Mean age was 76 (SD, 8), 36% were female, and 90% were independent with ADLs preinjury. At follow-up, independence with ADLs was 76% and IADLs was 63%. The mean EQ-5D-5L index score was 0.78 (SD, 0.18). Most patients (65%) reported having not returned to preinjury functional status. Neither functional ability or HRQOL differed significantly among patients admitted before versus after Geri-T. Content analysis of open-ended questions revealed themes of activity limitations, persistent pain, and cognitive dysfunction. Nearly one-fifth of TICU survivors experienced loss of ADL function 1 year after injury, and most reported having not returned to preinjury functional status. Nonetheless, patient-reported HRQOL was comparable to age-adjusted norms. Geri-T was not associated with differences in HRQOL or functional ability. Survivors reported persistent difficulty with activities beyond those of daily living, pain, and cognition. Prognostic and Epidemiologic, Level III.

1000: WHICH SURGICAL INTENSIVE CARE UNIT SYSTEM IS BENEFICIAL FOR CRITICALLY ILL PATIENTS, CLOSED OR OPEN?

Introduction: Despite reports that the closed intensive care unit (ICU) system improves clinical outcomes, it has not been widely applied for various reasons. And few studies have been conducted on “surgical” ICU systems. This study aimed to propose a better ICU system for critically ill patients by comparing the experience of open surgical ICU (OSICU) and closed surgical ICU (CSICU) systems in the same institution. Methods: Our institution converted the ICU system from “open” to “closed” in February 2021, and enrolled patients were classified into the open OSICU and the CSICU groups at that time from March 2019 to February 2022. Results: This study included 751 patients categorized into the OSICU group (n=191) and the CSICU group (n=560). The mean age was 67 years in the OSICU group and 72 years in the CSICU group (P< 0.05). The score for acute physiology and chronic health evaluation II (APACHE II) was 21.8±7.65 in the CSICU group, which was higher than 17.4±7.97 in the OSICU group (P< 0.05). The sequential organ failure assessment (SOFA) score was 2.0±2.29 in the OSICU group and 4.1±3.06 in the CSICU group (P< 0.05). The overall mortality rate was 2.1% and 2.0% in the OSICU and CSICU groups, respectively (P=0.912). However, after correction for bias by logistic regression analysis for all-cause mortality, the odds ratio of the CSICU group was 0.089 (95% CI: 0.014–0.568, P< 0.05). Administration of fluid and albumin on day 1 of ICU admission was higher in the CSICU group (P< 0.05). Norepinephrine was used in 233 (41.6%) of the CSICU group and 11 (5.8%) of the OSICU group (P< 0.05). Vasopressin was used only in the CSICU group. Fentanyl and remifentanil for analgesics and dexmedetomidine for sedation were used more frequently in the CSICU group (P< 0.05). Conclusions: Despite considering various factors of increased patient severity, a SCICU system is more beneficial for critically ill patients. After conversion to the CSICU system, the surgeon’s burden of postoperative management of critically ill patients would be reduced, and he or she would be able to perform more operations on severe cases with older age and higher APACHE II or SOFA scores. Based on these studies, we propose that the CSICU system be applied worldwide.

Improving resident experience during the pediatric intensive care unit rotation

BackgroundIt was recognized through rotation evaluations that residents were dissatisfied with their Pediatric Intensive Care Unit (PICU) experience. It is essential to consistently review resident satisfaction and intervene in a timely manner, as resident dissatisfaction may impact well-being. ObjectiveThrough PICU rotation evaluations and confidential discussion with pediatric residents, key drivers of resident dissatisfaction were identified. A multidisciplinary PICU improvement team was formed, interventions were developed, and a key driver diagram was created. Our aim was to have a minimum of 50% of participating residents agree that implemented interventions were beneficial to their PICU experience upon completion of their PICU rotation. Design/MethodsThe key driver diagram focused on 5 areas: expectation of knowledge, structure of rounds, resolution of conflicts, patient load, and nursing experience. Interventions began in April 2020. The improvement team consistently discussed the status of implementation, as well as met formally on a quarterly basis. Resident satisfaction was evaluated and monitored with three tools: intensivist and PICU rotation evaluations during the study period, pre- and post-mock code surveys during the study period, and a post-intervention satisfaction survey following the study period. ResultsThe post-intervention satisfaction survey revealed that ten of the eleven interventions were reported as either occurring regularly or overall beneficial by 55% to 100% of residents, with an average of 80%. 100% of residents reported the following interventions to be beneficial: being exposed to PICU before their formal rotation, participating in bedside teaching, and completing online modules of core PICU topics. Only 27% of residents agreed that the transport nurse routinely took transport calls during rounds, making this the only intervention that did not regularly occur. Pre- and post-mock code surveys revealed that 67% of residents participated in a mock code and 100% of participating residents agreed that the code was beneficial. Resident evaluations of the PICU rotation revealed that overall resident satisfaction with the rotation improved from 78% to 88%. Resident evaluations of attending intensivists revealed that 75% of intensivists had either sustained or improved resident satisfaction. ConclusionThis study demonstrates that timely and successful creation of an improvement team in response to resident dissatisfaction can be beneficial to residents’ rotation experience and well-being.

Evaluation of a course for neonatal fellows on providing psychosocial support to NICU families.

Families in the Neonatal Intensive Care Unit (NICU) experience significant psychological distress. Fellowship training requires education on mental health issues. No standardized program exists. We evaluated the impact of an online course, combining research with family perspectives, on neonatology fellow knowledge and self-efficacy when emotionally supporting NICU families. Fellows from 20 programs completed a course covering: (1) Parent Mental Health, (2) Infant Mental Health, (3) Communication, and (4) Comprehensive Mental Health (e.g., discharge, bereavement) with pre- and post-course knowledge and self-efficacy assessments. Fellows (n=91) completed the course and assessments. Pre-course knowledge was similar by year of training (1st: 66.9%; 2nd: 67.2%; 3rd: 67.4%). Mean knowledge and self-efficacy improved between pre- and post-course assessments regardless of training year or prior education for knowledge (d=1.2) (67.1% vs. 79.4%) and for self-efficacy (d=1.2) (4.7 vs 5.2 on 6-point Likert scale). Fellows who gained more knowledge had higher self-efficacy scores at post-test (r = .37). Current neonatal fellowship training under-educates on mental health. An online course improved fellow knowledge and self-efficacy. Our course may be an exemplar for others creating similar curricula. An online course enriched by patient perspectives is an effective method of disseminating education around mental health.

Factors Influencing Nursing Professionalism on the Nursing Performance in Intensive Care Unit Nurses

Purpose: This study examined the degree of self-leadership, emotional intelligence, nursing professionalism, and nursing performance of intensive care unit (ICU) nurses, and aimed to identify factors influencing nursing performance.Methods: In this descriptive study, the study participants were 121 nurses with over 6 months of experience working at a tertiary general hospital in Seoul. Data were analyzed using descriptive statistics, the independent t-test and one-way analysis of variance, the Scheffé test, Pearson correlation coefficients, and stepwise multiple regression analysis.Results: The average scores for self-leadership, emotional intelligence, nursing professionalism, and nursing performance were 3.66±0.40, 5.06±0.62, 3.59±0.37, and 3.11±0.29, respectively. In this study nursing performance showed statistically significant differences according to gender (t=2.39, p=.018), age (F=20.62, p&lt;.001), marital status (t=-2.94, p=.004), educational background (t=-4.05, p&lt;.001), total experience (F=11.95, p&lt;.001), ICU experience (F=12.44, p&lt;.001), and work department (F=3.33, p=.026). Self-leadership (r=.41, p&lt;.001), emotional intelligence (r=.31, p&lt;.001), and nursing professionalism (r=.24, p=.007) were positively correlated with nursing performance. Factors affecting nursing performance were ICU experience (β=-.42, p&lt;.001), self-leadership (β=.30, p=.001), and emotional intelligence (β=.17, p=.046), with a total explanatory power of approximately 35%.Conclusion: ICU career experience, self-leadership, and emotional intelligence predicted higher nursing performance among ICU nurses.

Incidence, Severity and Clinical Factors Associated with Hypotension in Patients Admitted to an Intensive Care Unit: A Prospective Observational Study.

The majority of patients admitted to the intensive care unit (ICU) experience severe hypotension which is associated with increased morbidity and mortality. At present, prospective studies examining the incidence and severity of hypotension using continuous waveforms are missing. This study is a prospective observational cohort study in a mixed surgical and non-surgical ICU population. All patients over 18 years were included and continuous arterial pressure waveforms data were collected. Mean arterial pressure (MAP) below 65 mmHg for at least 10 s was defined as hypotension and a MAP below 45 mmHg as severe hypotension. The primary outcome was the incidence of hypotension. Secondary outcomes were the severity of hypotension expressed in time-weighted average (TWA), factors associated with hypotension, the number and duration of hypotensive events. 499 patients were included. The incidence of hypotension (MAP &lt; 65 mmHg) was 75% (376 out of 499) and 9% (46 out of 499) experienced severe hypotension. Median TWA was 0.3 mmHg [0-1.0]. Associated clinical factors were age, male sex, BMI and cardiogenic shock. There were 5 (1-12) events per patients with a median of 52 min (5-170). In a mixed surgical and non-surgical ICU population the incidence of hypotension is remarkably high.

Abstract 13952: Incidence of In-Hospital Cardiac Arrest and Associated In-Hospital Mortality in Pediatric Critically Ill Patients With Cardiac Disease Significantly Decreased Over Time: Results From a Systematic Review and Meta-Analysis

Introduction: Studies evaluating trends in the incidence and mortality for in-hospital cardiac arrest (IHCA) in children with cardiac disease admitted to the intensive care unit (ICU) are rare. Additionally, there is limited information on factors associated with IHCA and mortality. Hypothesis: We hypothesized that the incidence of IHCA and the mortality rate in cardiac children admitted to the ICU has significantly decreased over time. Methods: We conducted a systematic review of PubMed, Web of Science, EMBASE, and CINAHL from inception to Sept 2021. Random effects meta-analysis was used to compute pooled-proportions and pooled-ORs. Meta-regression adjusted for type of study (registry vs cohort) and diagnostic category (surgical vs general cardiac) was used to evaluate trends in incidence and mortality. Results: Of the 2,574 studies identified, 25 were included in the systematic review (126,087 patients), 18 in the meta-analysis. Five percent (95% CI: 4-7%) of ICU children experienced IHCA and 35% (95% CI: 27-44%) did not achieve ROSC. In centers with ECMO, 21% (95% CI: 15-28%) underwent ECPR. The pooled in-hospital mortality was 54% (95% CI: 47-62%). Both incidence of IHCA and in-hospital mortality decreased significantly in the last 20 y (p&lt;0.001, Figure 1, and p=0.020, respectively), while the proportion of patients achieving ROSC did not change (p=0.572). Neonatal age, prematurity, comorbidities, univentricular physiology, arrhythmias, pre-arrest mechanical ventilation, ECMO, and higher surgical complexity increased IHCA and mortality odds. Conclusions: A significant proportion (5%) of cardiac children in the ICU experience IHCA. Decreasing trends in IHCA and in-hospital mortality suggests that education on preventive measures and post-arrest care have been effective. However, unchanged proportion of patients not achieving ROSC illustrates the crucial need for developing resuscitation strategies specific to children with cardiac disease.

How to achieve self-growth as an intern nursing student in Intensive Care Unit: A qualitative study

AimsTo explore the clinical experiences of the intern nursing students who did their internship in the Intensive Care Unit (ICU) at least two months. The key point is to investigate how nursing students achieved self-development in ICUs. MethodsUsing qualitative study based on the grounded theory, we enrolled 15 intern nursing students from November 2021 to April 2022 in a Grade A hospital in Hunan Province, China. ResultsThis study developed an explanatory theoretical framework of the interns’ experience in ICUs, which was described as a comprehensive growth process for ICU interns. In this process, the intern nursing students often go through three stages: pressure period, adjustment period and growth period. Self-regulation and social interaction play a key role to help them get over the negative experiences they experienced in the stress period and achieve personal development. ConclusionClinical nursing educators could make appropriate interventions based on the characteristics of students at different intership stages in ICUs. The target training of intern nursing students should focus on their theoretical knowledge, emotion regulation, communication skills and personality optimization. In addition, clinical tutors should be trained regularly to prepare well for their important roles.

COVID-19 Pandemic Experiences in Pediatric Intensive Care Unit: An Iranian Referral Hospital-Based Study.

In late February 2020, after we had informed about the presence of some cases of COVID-19 in Iran and its rapid spread throughout the country, we decided to make the necessary arrangements for patients with critical conditions in Pediatric Intensive Care Unit (PICU) at Children's Medical Center. There are a little data on critically ill children with COVID-19 infection with ICU requirements. The aim of this study was to describe clinical characteristics, laboratory parameters, treatment, and outcomes of the pediatrics population infected by SARS-CoV-2 admitted to PICU. This study was performed between February 2020 and May 2020 in the COVID PICU of the Children's Medical Center Hospital in Tehran, Iran. Patients were evaluated in terms of demographic categories, primary symptoms and signs at presentation, underlying disease, SARS-CoV-2 RT-PCR test result, laboratory findings at PICU admission, chest X-ray (CXR) and lung CT findings, and treatment. Moreover, the need to noninvasive ventilation (NIV) or mechanical ventilation, the length of hospital stay in the PICU, and outcomes were assessed. In total, 99 patients were admitted to COVID PICU, 42.4% (42 patients) were males, and 66 patients had positive SARS-CoV-2 real-time reverse transcriptase-polymerase chain reaction (RT-PCR). There was no statistically significant difference in the frequency of clinical signs and symptoms (except for fever) among patients with positive SARS-CoV-2 RT-PCR and negative ones. Among all admitted patients, the presence of underlying diseases was noticed in 81 (82%) patients. Of 99 patients, 34 patients were treated with NIV during their admission. Furthermore, 35 patients were intubated and treated with mechanical ventilation. Unfortunately, 11 out of 35 mechanically ventilated patients (31%) passed away. No laboratory and radiological findings in children infected with COVID-19 were diagnostic in cases with COVID-19 admitted to PICU. There are higher risks of severe COVID-19, PICU admission, and mortality in children with comorbidities.

Nursing students' experience during their practicum in an intensive care unit: A qualitative meta-synthesis.

BackgroundClinical practicum provides nursing students with more opportunities to learn their professional knowledge and develop basic nursing skills. Intensive care unit (ICU) is often used as one of the clinical practicum departments for nursing students. Due to the characteristic fast-paced working environments, high acuity of patient care, and technical complexities of an ICU, nursing students are more susceptible to experiencing stress and lack of confidence in these settings, which hinders their professionalization and affects patient care.ObjectiveThe study aimed to summarize and evaluate the nursing students' experience in an ICU during their practicum and to provide a supportive ICU clinical practicum environment for them. One of the main objectives was to increase the ICU specialty nurse reserve and improve nursing care in the ICU.MethodsThe following databases were searched for related qualitative publications in Chinese and English by systematic searches across January 2022, including the nursing students' experience in ICU during their practicum: PubMed, Cochrane Library, Web of Science, and so on. The qualitative meta-synthesis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Two reviewers independently selected these studies and carefully evaluated the quality of each study. Meta-synthesis was then used to summarize the results.ResultsEleven sub-themes and 3 themes were revealed in 9 studies: challenges of clinical practicum in the ICU, the expectation of support from multiple sources, and the importance and necessity of practicum in the ICU.ConclusionPerforming one's practicum in ICU was considered by the nursing students in this review as a beneficial practicum despite the challenges involved. The appropriate guidance and monitoring should be given by hospital managers and college educators.