Critical Care Nursing Quarterly最新文献

{"title":"Metabolic Profiles of Critical Care Patients to Confirm Sepsis and Further Understand the Metabolic Phenotype of Sepsis.","authors":"Julie-Kathryn Graham, Anova Westcott, Shawn Smith, Emlyn Mann, Ray Daniels, Molly Quillin-McEwan, Angel Bahena, Dwight Bello, Christina Kelley","doi":"10.1097/CNQ.0000000000000540","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000540","url":null,"abstract":"<p><p>Sepsis remains a major concern in health care globally. Despite decades of research, incidence is on the rise, and mortality remains high. Costs are staggering. Additionally, the outdated sepsis bundle established based on SIRS, remains the standard by which providers are held accountable. It is now accepted that organ dysfunction in sepsis is secondary to cellular metabolic dysregulation. Technology for metabolic monitoring should be explored for improved, early recognition of sepsis. We sought to investigate the underlying metabolic profile of patients with sepsis, to determine the value of continuous metabolic monitoring technology. The investigators partnered with industry, to trial noninvasive monitoring of the cellular metabolite carbon dioxide, under a prospective, observational design. During the 6-month trial, the investigators collected data from the electronic medical record of patients using the technology, to determine the specific metabolic differences between patients with and without sepsis. The investigators found serum carbon dioxide (paCO2) was significantly lower in patients with sepsis, and, low paCO2 had a significant inverse relationship to serum lactate. This finding supports the notion that paCO2 is low in sepsis secondary to metabolic dysregulation and not hyperventilation, which had historically explained low paCO2 under the SIRS model. Metabolic monitoring is available, easy to apply and manage, and contributes valuable information in the detection of sepsis. Further research should be done to understand trends in serum CO2 and its relationship to the development of sepsis. This study also provides important further support for the emerging understanding of the dysregulated host response in sepsis.</p>","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"48 1","pages":"8-14"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Earplugs and Eye Masks on the Melatonin and Cortisol Levels of Patients Hospitalized in Cardiac Critical Care Units.","authors":"Saeideh I Noroziani, Maryam Esmaeili, Mohammad A Cheraghi","doi":"10.1097/CNQ.0000000000000531","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000531","url":null,"abstract":"<p><p>To determine the effectiveness of using earplugs and eye masks on the melatonin and cortisol levels of patients hospitalized in cardiac critical care units (CCUs). The research population of this study included all patients with acute coronary syndrome hospitalized in the CCU of Shahid Rajaei Hospital affiliated with to Alborz University of Medical Sciences. A total of 60 patients were selected by the available sampling method based on the inclusion criteria and then were divided into 2 control and intervention groups by block randomization method with blocks of 4 (n = 30 in the intervention group, and n = 30 in the control group). Patients in the intervention groups used blindfolds and earmuffs during the night sleep for 3 nights, but patients in the control group received the routine care. Cortisol and melatonin levels of both groups were measured at 8 am, using the urine samples. The findings of the 2 groups were compared and statistically analyzed by SPSS software version 16. The findings showed no significant difference between the 2 groups in terms of demographic characteristics and clinical variables. The intervention had no effect on the cortisol level of patients in the intervention group (P = .24). After the intervention, a statistically significant difference was observed between the control and intervention groups in terms of the melatonin level in the nocturnal urine (P ≤ .001). A statistically significant difference was also observed between the 2 groups in terms of the time taken for patients to fall asleep (P ≤ .001) and the number of times waking up at night (P ≤ .001). The use of earplugs and eye masks had no impact on the level of cortisol hormone, but it affected the level of melatonin hormone and the sleep quality of patients hospitalized in the CCU.</p>","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"48 1","pages":"59-65"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute-on-Chronic Inflammation and Patients' Risk for Renal Support in Critically Ill Patients.","authors":"Julie-Kathryn Graham, Molly Quillin-Mcewan, Christina Kelley","doi":"10.1097/CNQ.0000000000000536","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000536","url":null,"abstract":"<p><p>Hypertension (HTN) and heart failure (HF) can chronically activate the renin-angiotensin-aldosterone system, a mechanism designed to maintain hemodynamic stability by reabsorption of water and electrolytes. Additionally, this system activates the sympathetic nervous system to increase vagal tone. When these patients face acute illness requiring hospitalization, the acute stressor or pathogen also activates the sympathetic nervous system. The combination of activation of both systems puts patients at increased risk of organ failure, specifically renal failure. With early recognition of renal insult, organ damage can be reversed. C-reactive protein (CRP) and D-dimer are commonly used to measure acute inflammation. These biomarkers can alert critical care nurses to excessive inflammation in patients with underlying HTN and HF, enabling nurses to make informed decisions to intervene at the earliest sign of renal failure. This retrospective study of adult SARS-CoV-2 patients in an intensive care unit setting sought to examine the relationship of CRP, D-dimer, and the need for eventual renal support in patients with HF and HTN. Of the sample (n + 189), mean age was 62 (SD = 14.0), and most (70.9%) were male. Thirty-nine patients (20.6%) required renal support. Of the cases requiring renal support, 21 (53.8%) had a history of prior renal disease (P < 0.001, r = 0.351). History of HTN was significantly correlated with requirement for renal support (P = 0.010, r = 0.187). D-dimer (P = 0.038, η = 1.0) and CRP (P = 0.018, η = 0.924) were also significant. Survival was significantly worse in the renal support group (P < 0.001, r = -0.310). D-dimer and CRP were correlated with more severe illness and need for renal support. Study findings have implications for future validation research of chronic inflammation and risk for renal support during acute severe illness.</p>","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"48 1","pages":"52-58"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Foreword.","authors":"Scot Nolan","doi":"10.1097/CNQ.0000000000000542","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000542","url":null,"abstract":"","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"48 1","pages":"1"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal Function Markers Predicts Extubation Failure in Critically Ill Patients: A Retrospective Study.","authors":"Rodrigo Cerqueira Borges, Andrey Wirgues Sousa, Flaubert Luíz Rocha, Isadora Salvador Rocco, Vanessa Chaves Barreto Ferreira Lima, Samantha Longhi Simões de Almeida","doi":"10.1097/CNQ.0000000000000534","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000534","url":null,"abstract":"<p><p>Several studies attempt to identify predictors for weaning and extubation from mechanical ventilation (MV) and none have been shown to be particularly accurate. Therefore, the objective of the study was to evaluate whether markers of renal function may be associated with extubation failure. This retrospective study collected data through electronic medical records for 2 consecutive years. The inclusion criteria were: ≥18 years old and requiring invasive MV for a period of ≥48 hours. Extubation failure was determined when subjects needed to return to invasive MV within 48 hours of the tracheal tube withdrawal. Acute kidney injury (AKI) was assessed according to the KDIGO classification. From a total of 167 subjects, 15% evolved with extubation failure. Lower creatinine clearance and higher fluid balance was observed in the extubation failure group compared to the successful extubation group (42 mL/min vs 100 mL/min, P = 0.01 and 739 mL vs - 189 mL, P = 0.01, respectively). Subjects with AKI are 51% more likely to evolve with extubation failures than those with normal renal function (OR = 2.7; 95% CI: 1.6-4.7; P < 0.01). Renal dysfunction was related to the rate of extubation failure. Fluid balance and serum creatinine may be aspects to be considered when making the extubation decision.</p>","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"48 1","pages":"35-42"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Implementing Respiratory Care Unit Ventilator Weaning Assessment Checklist on Weaning and Extubation Outcomes.","authors":"Salwa Hassan Ahmed, Mogedda Mohamed Mehany, Emad Zarief Kamel, Asmaa Aly Mahgoub","doi":"10.1097/CNQ.0000000000000532","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000532","url":null,"abstract":"<p><strong>Background: </strong>Approximately 48% of patients with chronic respiratory disorders experience post-extubation respiratory failure necessitating noninvasive respiratory support or reintubation, which is linked to higher morbidity and mortality. So, it is necessary to determine patients' preparedness for weaning and extubation.</p><p><strong>Objectives: </strong>To examine the effect of implementing respiratory care unit (RCC) ventilator weaning assessment checklist on weaning and extubation outcomes.</p><p><strong>Methods: </strong>Randomized controlled trial, carried out in 70 patients receiving mechanical ventilation from January 2023 to September 2023 at the respiratory intensive care units at Assiut University Hospital, Egypt. Patients were randomly assigned to a study and a usual care group, with 35 patients for each group. The usual care group weaned using the routine method, while the study group weaned using (RCC) ventilator weaning assessment checklist; the 2 groups were compared concerning weaning and extubation outcomes.</p><p><strong>Results: </strong>Compared to the usual care group, the study group's weaning success rate was significantly higher than that of the usual care group (88.6% vs 51.4%; P = .008), and extubation failure rate was significantly lower (17.1% vs 45.7%; P = .010).</p><p><strong>Conclusions: </strong>Using RCC ventilator weaning assessment checklist improving weaning and extubation outcomes.</p>","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"48 1","pages":"23-34"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Tracheostomy Care: Knowledge Among Nurses in Intensive Care Units.","authors":"Moath Abu Ejheisheh, Ahmad Ayed, Basma Salameh, Waed A Salameh, Alaa H Obeyat, Riham H Melhem, Sanaa Alkhatib, Bahaaeddin M Hammad, Mohammed ALBashtawy, Ahmad Batran","doi":"10.1097/CNQ.0000000000000533","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000533","url":null,"abstract":"<p><p>Patients requiring continuous mechanical ventilation benefit from easier airway management through tracheostomy, a standard treatment in critical care. However, gaps in nurses' comprehension of tracheostomy car can lead to complications such as infections and airway blockages. Therefore, understanding nurses' competency in tracheostomy care is essential for enhancing patient outcomes in intensive care units (ICUs). A cross-sectional study was conducted in the southern West Bank of Palestine among 237 nurses working in ICUs to assess their level of knowledge in tracheostomy care. Data were gathered via a structured questionnaire and analyzed using inferential tests and descriptive. Most nurses showed moderate knowledge of tracheostomy care, with significant differences observed based on age, gender, years of experience, and educational level. To significantly improve patient outcomes and safety in ICUs, it is imperative that nurses participate in continuous education and training programs focused on tracheostomy care.</p>","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"48 1","pages":"43-51"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alpha-Gal Syndrome: A Growing Health Care Concern.","authors":"Trevor J Silbernagel, Zackery T Bullard","doi":"10.1097/CNQ.0000000000000539","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000539","url":null,"abstract":"<p><p>Alpha-gal syndrome is a serious, potentially life-threatening allergic reaction to mammalian products that has been linked to the lone star tick. Early recognition and management of alpha-gal syndrome is key for desirable patient outcomes and informed nursing care can make all the difference. The purpose of this article is to provide background information regarding alpha-gal syndrome, review common sources of potential reaction triggers including food and medications, and discuss strategies to detect and avoid allergic reactions from occurring.</p>","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"48 1","pages":"2-7"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the Roles of Critical Care Nurses: Tool Development, Psychometric Properties, and Nurses' Perceptions.","authors":"Mohammad Bani Younis","doi":"10.1097/CNQ.0000000000000535","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000535","url":null,"abstract":"<p><p>Critical care nursing is considered one of the most challenging and demanding fields in nursing. Critical care nurses work in high-stress environments, tending to patients who are experiencing acute illness and necessitate intensive care. Nurses play a crucial role in providing nursing care for critically ill patients, encompassing duties such as assessment, administration of medications, ventilator management, diligent monitoring, and responding to life-saving situations. Despite the significance of their contributions, there are limited assessment tools used to assess critical care nurses' perceptions about their roles and responsibilities in intensive care units (ICU). The main aim of this study was to develop a tool to assess the critical care nurses' knowledge, awareness, and perception of their roles and responsibilities in the critical care units. The researcher developed the Critical Care Nurses' Roles and Responsibilities Assessment Tool. Subsequently, the tool underwent content validity assessment by five nursing experts, resulting in a final tool with 17 Likert-scale items. The scores ranged from 17 to 85, with intervals indicating varying levels of awareness. To assess the nurses' perception of the roles and responsibilities identified in the tool, a study was conducted on 120 registered nurses working in the ICU units across 9 governmental hospitals in Jordan. Data were collected through an online questionnaire covering demographical data and the roles and responsibilities of critical care nurses in the ICU. The collected data were subjected to quantitative analysis using appropriate statistical methods. Regarding the results among the experts, the content validity index (CVI) of the tool was 0.93. Among the participants, Cronbach alpha was measured to assess the reliability and internal consistency of the tool and the result was 0.912. Regarding the nurses' perception, a small percentage of participants, specifically (9%), demonstrated a moderate level of agreement with the roles and responsibilities mentioned in the tool (mean of scores = 40 - 63). Conversely, a substantial majority of participants (91%), exhibited a high level of agreement (mean of scores = 64 - 85). In conclusion, the results of this study revealed a powerful and reliable tool that has earned widespread acclaim among experts and participants alike.</p>","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"48 1","pages":"15-22"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Patients Suffering Acute Traumatic Brain Injuries.","authors":"Anna Jarrett, Alan F Jarrett, Ethan R Estes","doi":"10.1097/CNQ.0000000000000537","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000537","url":null,"abstract":"<p><p>The objective of this literature review was to examine and summarize knowledge of best practices for the management of patients suffering traumatic brain injury based on studies using a variety of practices to improve outcomes published 2018 - 2021. From a clinical perspective, when a patient suffers an acute traumatic brain injury, providers and clinicians ask themselves and each other, \"What else could we do? What could we have tried to improve the outcome with this patient?\" Astute clinicians spend ample time reviewing contemporary studies to improve their patients' outcomes. This project aimed not to find all studies about a specific treatment, but to review all studies about a topic to evaluate the studies for rigor and results to improve bedside patient care in times of crisis. A quality assessment model was used in four domains: design, bias, synthesis, and dissemination with a Quality Assessment Score assigned for each of the four domains. Ten studies met the rigor of the quality assessment evaluation. The highest ranked studies indicate a common theme of prevention of extension of injury.</p>","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"48 1","pages":"66-78"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}