Australian Critical Care最新文献

{"title":"Prevalence and complications of agitation between intensive care unit admission and tracheal extubation in adult cardiac surgery patients: A single-centre observational study","authors":"Meredith Heily RN, MEd ,&nbsp;Marie Gerdtz RN, PhD ,&nbsp;Rebecca J. Jarden RN, PhD ,&nbsp;Celene Y.L. Yap BPharm, PhD ,&nbsp;Rinaldo Bellomo AO MBBS, PhD, FRACP, FCICM","doi":"10.1016/j.aucc.2025.101293","DOIUrl":"10.1016/j.aucc.2025.101293","url":null,"abstract":"<div><h3>Background</h3><div>Some patients admitted to the intensive care unit (ICU) after adult cardiac surgery develop agitation prior to tracheal extubation. The prevalence and consequences of such agitation remain unknown.</div></div><div><h3>Objectives</h3><div>The objectives were to study the prevalence and complications of agitation that occurs between ICU admission and prior to tracheal extubation.</div></div><div><h3>Methods</h3><div>A single-centre observational study was conducted from March 2021 to December 2023. Data were retrieved from the medical records of all adult patients with sedation ceased for tracheal extubation &lt; 24 hours after ICU admission. Agitation prior to tracheal extubation was defined as a Richmond Agitation-Sedation Scale score ≥+2. Comparisons were made between agitated and nonagitated groups. All variables underwent descriptive analysis. For time-to-event outcomes, Cox regression was performed, while dichotomous outcomes were analysed using logistic regression.</div></div><div><h3>Results</h3><div>Seven hundred patient records were analysed. Agitation was identified in 204 (29%) patients. Patients with agitation had prolonged mechanical ventilation (mean: 25.7 hours, standard deviation [SD]: 41.1) compared to non-agitated patients (mean: 11.6 hours, SD: 15.6, hazard ratio: 0.50, 95% confidence interval [CI]: 0.42–0.59), and prolonged ICU stay (72.9 hours, SD: 66.1 compared to nonagitated patients (52.4 hours, SD: 60.7, hazard ratio: 0.68, 95% CI: 0.58–0.80). Sixty-four (31.4%) patients with agitation were referred to specialist pain services compared to 92 (18.5%) nonagitated patients (odds ratio [OR]: 2.00, 95% CI: 1.38–2.91). Delirium in the ICU developed in 48 (23.5%) patients with agitation, compared to 61 (12.3%) nonagitated patients (OR: 2.19, 95% CI: 1.44–3.34). After transfer to the ward, 70 (34.5%) patients with agitation and 114 (23%) nonagitated patients were diagnosed with delirium (OR: 0.57, 95% CI: 0.40–0.82).</div></div><div><h3>Conclusion</h3><div>Patients frequently developed agitation before extubation. All patients received mechanical ventilation, but the duration was prolonged in agitated patients, who also stayed in the ICU for longer, received more specialist pain services, and had a higher likelihood of delirium.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 5","pages":"Article 101293"},"PeriodicalIF":2.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144597035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-evaluating structural equation modelling in nursing research: Insights from compassion fatigue and empowerment in Chinese intensive care units","authors":"Mana Egawa ,&nbsp;Souichi Oka PhD ,&nbsp;Yoshiyasu Takefuji PhD","doi":"10.1016/j.aucc.2025.101292","DOIUrl":"10.1016/j.aucc.2025.101292","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 5","pages":"Article 101292"},"PeriodicalIF":2.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144597036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acid–base imbalances in critically ill obstetric patients: A multicentre retrospective cohort study","authors":"José Rojas-Suarez MSc ,&nbsp;Iveth Vanegas MD ,&nbsp;Oscar Lavalle MD ,&nbsp;Miguel Aguilar-Schotborgh MD ,&nbsp;Amilkar Almanza-Hurtado MD ,&nbsp;Diana Borre-Naranjo MD ,&nbsp;Francisco Camargo MD ,&nbsp;Yasaira Pajaro-Cantillo MD ,&nbsp;Carmelo Dueñas-Castell MD","doi":"10.1016/j.aucc.2025.101297","DOIUrl":"10.1016/j.aucc.2025.101297","url":null,"abstract":"<div><h3>Background</h3><div>Acid–base imbalances are critical indicators of clinical outcomes in intensive care settings, yet their specific impact on critically ill pregnant obstetric patients remains underexplored. This lack of knowledge is particularly concerning given the potential for severe outcomes in this vulnerable population.</div></div><div><h3>Aim/objective</h3><div>The aim of this study was to assess acid–base abnormalities and their association with severe outcomes, including mortality.</div></div><div><h3>Methods</h3><div>We conducted a retrospective multicentre cohort study between 2006 and 2019 across six high-complexity hospitals in Colombia (two obstetric centres and four general hospitals with intensive care units that admit obstetric patients). Arterial blood gas was evaluated for acid–base balance at admission, and its association with clinical outcomes, including maternal death, mechanical ventilation, and vasopressor use, was assessed.</div></div><div><h3>Results</h3><div>The study included 798 patients: 768 survivors and 30 nonsurvivors. Our findings revealed that respiratory alkalosis was the most common imbalance (491/798 [61.5%]). Its presence is linked to better survival rates. Conversely, mixed metabolic and respiratory acidosis significantly increased the risk of mortality (18/768 [2.3%] in survivors vs. 7/30 [23.3%] in nonsurvivors, p &lt; 0.001). After adjusting for confounders, lower potential hydrogen (pH) and bicarbonate (HCO₃) levels were associated with higher in-hospital mortality.</div></div><div><h3>Conclusions</h3><div>Most critically ill obstetric patients presented with baseline respiratory alkalosis, and the inability to maintain it was strongly associated with increased mortality. Further controlled studies are needed to confirm these findings and explore the impact of interventions to sustain respiratory alkalosis on outcomes.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 5","pages":"Article 101297"},"PeriodicalIF":2.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144580698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on Critical care nurses’ responses to clinical scenarios involving cardiopulmonary resuscitation for deceased inpatients without a do not resuscitate order: A cross-sectional study","authors":"Melissa J. Bloomer RN, PhD, FACCCN","doi":"10.1016/j.aucc.2025.101290","DOIUrl":"10.1016/j.aucc.2025.101290","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 5","pages":"Article 101290"},"PeriodicalIF":2.6,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between coping strategies, burnout, bullying, and distress in intensive and progressive care nurses: A single-centre cross-sectional survey","authors":"Leah H. Hackney RN, BN, MHealSc, FNZCCN ,&nbsp;Lois J. Surgenor PhD, DipClinPsych, FNZCCPsych","doi":"10.1016/j.aucc.2025.101288","DOIUrl":"10.1016/j.aucc.2025.101288","url":null,"abstract":"<div><h3>Background</h3><div>Critical care nurses are exposed to challenging work situations and experience high rates of occupational stress and burnout, potentially aggravated by exposure to bullying. Specific coping strategies may alleviate the risk of adverse psychological outcomes such as these.</div></div><div><h3>Aim/objective</h3><div>The aim of this study was to investigate the association between coping strategies, burnout, bullying, and psychological distress.</div></div><div><h3>Methods</h3><div>Intensive/progressive care registered nurses (n = 116) from a single centre completed a cross-sectional survey incorporating (i) demographic and work characteristics and (ii) standardised questionnaires including Coping Orientations to Problems Experienced Inventory (Brief-COPE), Maslach Burnout Inventory, General Health Questionnaire-12, and Negative Acts Questionnaire-Revised. Univariate and linear regression analyses explored the associations between demographic and work characteristics and the questionnaires. Stepwise multiple regression explored the degree to which coping strategies, bullying, and demographic and work variables (independent variables) predicted burnout and psychological distress (dependent variables).</div></div><div><h3>Results</h3><div>Gender (t = 3.34, p = 0.001) was associated with Emotion-Focused Coping, while ethnicity was associated with both Emotion-Focused (<em>ƞ</em>^<em>2</em> = 0<em>.</em>12, p = &lt;0.001) and Problem-Focused coping (<em>ƞ</em>^<em>2</em> = 0<em>.</em>07, p = 0.018). Working in the Progressive Care Unit was associated with higher Emotional Exhaustion (t = 4.74, p = &lt;0.001) and higher Depersonalisation (t = 3.61, p &lt; 0.001) than working in the Intensive Care Unit. Less experienced nurses reported higher Emotional Exhaustion (<em>t</em> = 3.14, p = 0.002), higher Depersonalisation (t = 3.75, p &lt; 0.001), and lower Personal Accomplishment (t = 2.42. p = 0.017). After controlling for associations between independent covariables, the regression analysis showed that all three Brief-COPE scales contributed significantly (<em>F</em> = 9.22–21.71, p &lt; 0.001) to Emotional Exhaustion and Depersonalisation subscales.</div></div><div><h3>Conclusion</h3><div>The study largely supports previous findings of associations between workforce factors, exposure to bullying, and deleterious effects such as burnout symptoms and psychological distress. After controlling for significant moderating factors, coping responses independently contribute to emotional exhaustion and depersonalisation. Understanding how coping responses are activated or are affected by adverse psychological states and events remains important. While interventions that specifically focus on protective coping responses may be especially helpful in alleviating particular components of burnout, nuances of the relationship require further investigation.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 5","pages":"Article 101288"},"PeriodicalIF":2.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring comfort with the Comfort Questionnaire (CQ)-ICU in critically ill patients during intensive care unit stay: A cross-sectional study","authors":"Ma Dolores Gonzalez-Baz RN, PhD ,&nbsp;Enrique Pacheco del Cerro RN, PhD ,&nbsp;Jesús Ledesma Fajardo RN ,&nbsp;Ma Ara Murillo Perez RN, MSC ,&nbsp;Telmo de la Rubia Gonzalez BS ,&nbsp;Ma Nieves Moro Tejedor RN, PhD","doi":"10.1016/j.aucc.2025.101205","DOIUrl":"10.1016/j.aucc.2025.101205","url":null,"abstract":"<div><h3>Background</h3><div>Stress factors have been studied in critically ill patients; however, there is a paucity of research examining the holistic aspects of comfort in this population.</div></div><div><h3>Objective</h3><div>The aim of this study was to identify the factors influencing the perceived comfort of critically ill patients in the intensive care unit (ICU) and their association with sociodemographic and clinical variables.</div></div><div><h3>Methods</h3><div>An analytical cross-sectional study was conducted with 580 patients admitted to two 1000-bed hospitals in Spain. Participants were interviewed during their ICU stay between 2015 and March 2020. Comfort was measured using the Spanish version of the Comfort Questionnaire (CQ)-ICU with seven factors: Psychological Context, Need for Information, Physical Context, Sociocultural Context, Emotional Support, Spirituality, and Environmental Context. Sociodemographic and clinical variables also collected.</div></div><div><h3>Results</h3><div>The comfort level was 3.18 (0.42). The mean (standard deviation [SD]) CQ-ICU score was 88.96 (11.87). The highest values (SD) were obtained in Sociocultural Context (20.21 (3.03)) and Emotional Support (10.62 (1.91)); scores (SD) were moderate in Psychological Context (16.61 (2.98)) and Spirituality (6.66 (1.93)), whereas the lowest scores (SD) were found in Need for Information (5.44 (2.23)) and Physical Context (17.33 (4.26)) and Environmental Context (12.07 (2.65)). In the logistic regression model with explained variance (62.80%), predictive variables were odds ratio [95% confidence interval]: Religion (p = 0.041) 1.54 [1.018–2.333], Numerical Rating Scale Oral (NRS-O) (p &lt; 0.001) 2.51 [1.662–3.784], Acute Physiology and Chronic Health Evaluation II (APACHE II) (p = 0.041) 1.57 [1.019–2.433], and the number of vascular access catheters (p = 0.003), 1.79 [1.219–2.638].</div></div><div><h3>Conclusion</h3><div>The comfort level was high. Patients with religious beliefs or those cared for with a nurse-to-patient ratio of 1:1 were associated with higher comfort values. Sociocultural support, professionals, and spirituality were factors increasing comfort levels, whereas moderate or severe pain, lack of information, or noise requires bundles to improve comfort. The results show the importance of evaluating individual needs during ICU stay via a holistic approach using a validated instrument that also allows the measurement of the impact of interventions that prevent delirium and post-ICU syndrome. Nonetheless, studies in specific critical care units are recommended to provide further evidence.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 5","pages":"Article 101205"},"PeriodicalIF":2.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case management of a patient with botulism by an intensive care nurse practitioner team","authors":"Katie Kelleway BN, MN NP, NP ,&nbsp;Brett Mace ,&nbsp;Jessica Butler BSc, MN Prereg, MN NP, NP ,&nbsp;Sarah Webb BN, MN NP, NP ,&nbsp;Kelly Harbour BN, MN NP, NP ,&nbsp;Rosalind Elliott RN, PhD","doi":"10.1016/j.aucc.2025.101291","DOIUrl":"10.1016/j.aucc.2025.101291","url":null,"abstract":"<div><h3>Introduction</h3><div>People affected by conditions such as botulism often require complex case management, a core activity of nurse practitioners, in intensive care. This case report, coauthored by the patient, describes exemplary nurse practitioner–led complex case management including weaning from mechanical ventilation of a person affected by botulism.</div></div><div><h3>Methods</h3><div>The case management was person centred and included goal setting and collaborative multidisciplinary team meetings including the patient. Goals were set by the patient in consultation with the nurse practitioner and included timelines for discontinuation of mechanical ventilation.</div></div><div><h3>Results</h3><div>Intensive care nurse practitioner case management resulted in a greater sense of continuity of care, successful discontinuation of mechanical ventilation, and satisfaction with care. The patient returned to their previous employment and function.</div></div><div><h3>Conclusions</h3><div>The intensive care nurse practitioner case management included advanced, bespoke, and holistic practice which was coordinated using a structured approach providing clinical leadership and continuity for the patient and their family.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 5","pages":"Article 101291"},"PeriodicalIF":2.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deciding who decides: An interview study exploring the factors affecting emergency department and intensive care unit health professionals’ understanding and application of the law on end-of-life decision-making","authors":"Jayne Hewitt RN, BN, LLB, LLM, PhD ,&nbsp;Katya May RN, PhD ,&nbsp;Nemat Alsaba MBBS, FACEM ,&nbsp;Kerina Denny MBBS, PhD, FCICM ,&nbsp;Colleen Cartwright BSocWk (Hons), MPH, PhD ,&nbsp;Lindy Willmott BCom, LLB(Hons), LLM, PhD ,&nbsp;Ben White LLB (Hons), DPhil ,&nbsp;Andrea P. Marshall RN, PhD","doi":"10.1016/j.aucc.2025.101271","DOIUrl":"10.1016/j.aucc.2025.101271","url":null,"abstract":"<div><h3>Background</h3><div>All health care is underpinned by legal frameworks, including those that regulate who is responsible for healthcare decisions at the end of life. How these frameworks support decision-making in emergency departments (EDs) and intensive care units (ICUs) is underexplored.</div></div><div><h3>Objective</h3><div>The objective of this study was to identify factors that help or hinder healthcare professionals' understanding and application of the law that applies to end-of-life decision-making in the EDs and ICUs in Queensland, Australia.</div></div><div><h3>Methods</h3><div>A descriptive qualitative study based on naturalistic inquiry was undertaken. Participants were healthcare professionals working in the ICUs or EDs of one South East Queensland Hospital and Health Service, responsible for the care of adult patients who had died.</div></div><div><h3>Results</h3><div>Thirteen medical practitioners, 19 registered nurses, and three social workers participated in semistructured interviews. Three themes and eight subthemes were identified in the data. First, the theme <em>the complexity of communication is laid bare at the end of life</em> described the challenges associated with talking about death and dying and the need to reframe conversations where death is inevitable. Next, the theme <em>decision-making has layers</em> highlighted family inclusion in decisions, navigating different perspectives to share decision-making and acknowledging that decision-making is emotionally burdensome. Finally, the theme h<em>ow the law should apply is uncertain</em> described the difficulties in deciding who should decide, knowing when Advance Health Directives can be relied on, and the need to reduce legal risk.</div></div><div><h3>Conclusion</h3><div>Decision-making at the end of life is complex and challenging. Healthcare professionals charged with leading conversations find them challenging and are mindful of the burdens associated with such decisions. The need to work within the legal framework is acknowledged, but applying the law can be difficult.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 5","pages":"Article 101271"},"PeriodicalIF":2.6,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A mixed-method evaluation of the acceptability, appropriateness, and feasibility of using an actionable processes of care checklist for patients with persistent critical illness","authors":"Laura Istanboulian PhD, NP ,&nbsp;Laura Allum MRes ,&nbsp;Anthony J. Gilding HbSc ,&nbsp;Kay Quimson-Yeung MN, RN ,&nbsp;Lisa Burry PhD, PharmD ,&nbsp;Craig Dale PhD, RN ,&nbsp;Ian Fraser MD ,&nbsp;Louise Rose PhD, RN, MBE","doi":"10.1016/j.aucc.2025.101289","DOIUrl":"10.1016/j.aucc.2025.101289","url":null,"abstract":"<div><h3>Background</h3><div>Patients with persistent critical illness have care priorities distinct from those experiencing acute critical illness. We developed a checklist called “Action 11” incorporating actionable priorities of care for these patients.</div></div><div><h3>Objective</h3><div>The objective of this study was to evaluate the acceptability, appropriateness, and feasibility of using the Action 11 checklist.</div></div><div><h3>Methods</h3><div>A convergent mixed-method study was conducted in two units (unit 1 outside critical care; unit 2 inside critical care) of a community hospital in Canada caring for patients with persistent critical illness. The checklist was used daily for 4 weeks and then weekly for 4 weeks. A sample of healthcare providers was recruited to evaluate checklist acceptability, appropriateness, and feasibility using a questionnaire and interviews.</div></div><div><h3>Results</h3><div>We received 52 questionnaires and conducted 14 interviews (August–November 2022). Of the 52 completed questionnaires, 35 (67%), 42 (81%), and 41 (79%) had a score ≥16 for acceptability, appropriateness, and feasibility, respectively. Of a maximum score of 20, the total mean (standard deviation) scores for acceptability, appropriateness, and feasibility were 16.2 (2.9), 16.7 (2.4) and 17 (2.5), respectively. Participants from unit 1 found the checklist more acceptable (mean difference: 1.7, 95% confidence interval: [0.2–3.29]) and feasible (mean difference: 1.46, 95% confidence interval: [0.09–2.84]) to use than those from unit 2. Qualitative descriptions for acceptability (comprehensive, inclusive, straightforward, prevented omissions in care, and promoted professional accountability), appropriateness (suited patient needs and enabled a personalised, consistent, and collaborative approach to care), and feasibility (embedding into existing rounding, tailored to unit processes, and through leadership support) were also positive; however, they did not explain differences in rated acceptability and feasibility between the two units.</div></div><div><h3>Conclusions</h3><div>The Action 11 checklist was perceived as acceptable, appropriate, and feasible to use in units caring for patients with persistent critical illness. A larger-scale evaluation the of the Action 11 checklist exploring its effect on care processes and patient outcomes is recommended.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 5","pages":"Article 101289"},"PeriodicalIF":2.6,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving energy and protein intake via an oral nutrition support pathway in the intensive care unit and beyond: An uncontrolled before and after study","authors":"Alicia N. Wiese BHlthSc (Hons), APD ,&nbsp;Emma Ballard MBiostatistics, PhD, AStat","doi":"10.1016/j.aucc.2025.101273","DOIUrl":"10.1016/j.aucc.2025.101273","url":null,"abstract":"<div><h3>Background</h3><div>Survivors of critical illness face multiple barriers to adequate oral intake. Research suggests these patients are not meeting nutrition requirements, yet no guidelines or published studies exist to improve energy and protein intake post critical illness.</div></div><div><h3>Objectives</h3><div>The aim of our study was to increase energy and protein intake of patients in the intensive care unit (ICU) and beyond onto the post-ICU ward via the implementation of a multidisciplinary, individualised oral nutrition support pathway.</div></div><div><h3>Methods</h3><div>We conducted a prospective single-centre, uncontrolled before-and-after study in a 10-bed ICU comprising 112 patients. Consecutively admitted patients expected to remain in the ICU for ≥48 h were followed up from commencement of oral intake for 15 days. Pre-implementation, patients received standard care, while post-implementation, patients followed the oral nutrition support pathway. This included energy- and protein-dense foods, oral nutrition supplements, and nutrition screening. Adequacy of energy and protein intake was expressed as the percentage of estimated energy requirements (EERs) and percentage of estimated protein requirements (EPRs) met, and the proportion of patients meeting ≥80% of their EERs and EPRs on average were compared pre-implementation and post-implementation.</div></div><div><h3>Results</h3><div>Post-implementation, there was a significant increase in the percentage of EERs and EPRs met with a mean difference between periods of 34% (95% confidence interval: 22–46) for energy and 28% (95% confidence interval: 16–40) for protein. The proportion of patients meeting ≥80% of EERs significantly increased post-implementation (pre: 19.6% vs post: 58.9%, <em>p</em> &lt; 0.001) as did those meeting ≥80% of EPRs (pre: 12.5% vs post: 46.4%, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>A multidisciplinary, individualised oral nutrition support pathway significantly improved energy and protein delivery of critically ill and post–critically ill patients for 15 days from the initiation of oral intake. Further work is required to ascertain the impact of this on clinical outcomes.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 5","pages":"Article 101273"},"PeriodicalIF":2.6,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}