Australian Critical Care最新文献

{"title":"Disaster preparedness for intensive care units: Priorities to inform crisis standards of care.","authors":"David Sellers, Julia Crilly, Lynda Hughes, Jamie Ranse","doi":"10.1016/j.aucc.2024.101142","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.101142","url":null,"abstract":"<p><strong>Background: </strong>The number of disasters occurring globally is increasing. Natural hazards, changing geopolitical situations, and increasing population densities may lead to an increased likelihood of a surge of patients requiring health care, some of whom might be requiring intensive care-level treatment. There is a dearth of literature on intensive care unit (ICU) practitioner's priorities regarding disaster preparedness and crisis standards of care.</p><p><strong>Objectives: </strong>This study aimed to understand what nurses working in ICUs within Australia prioritise regarding ICU disaster preparedness and the implementation of crisis standards of care.</p><p><strong>Methods: </strong>A modified three-round Delphi design was used for this study. A snowballing recruitment method facilitated the purposive sampling of ICU nurses, starting with members of the Australian College of Critical Care Nurses. Eligible participants were asked to rate statements according to their priorities when addressing disaster preparedness of the Australian ICU in which they work. Statements that achieved the 10 highest scores in the final round were tabulated to indicate the broader areas of disaster preparedness that the respondents considered priorities.</p><p><strong>Results: </strong>A total of 16 participants completed both round two and round three of this Delphi study. Out of 38 statements across six domains, 33 statements achieved consensus. Healthcare practitioner protection, wellbeing, and the management of space populated the top 10 priorities. These priorities included adequate personal protection equipment, services to support healthcare practitioners, and clear communication and debriefing pathways. Another key priority identified was the need for a clear plan on how the ICU footprint will expand to accommodate a surge of patients.</p><p><strong>Conclusion: </strong>Healthcare practitioner wellbeing followed by adequate plans for ICU expansion are key priorities of nursing staff working in ICUs within Australia. Understanding the priorities of those who work in the ICU gives a pragmatic insight into what is required to further develop the disaster preparedness of Australian ICUs.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101142"},"PeriodicalIF":2.6,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786588","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":"Nurses' and physicians' experience of a new algorithm for tapering analgosedation in the paediatric intensive care unit: A focus-group investigation.","authors":"Mette Dokken, Tone Rustøen, Thordis Thomsen, Gunnar K Bentsen, Ingrid Egerod","doi":"10.1016/j.aucc.2024.101141","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.101141","url":null,"abstract":"<p><strong>Aim/objective: </strong>Iatrogenic withdrawal syndrome occurs frequently during the tapering phase of opioids and benzodiazepines in paediatric intensive care units. The aim of this study was to explore physicians' and nurses' experiences in patient care and staff collaboration during the tapering phase using a new \"algorithm for tapering analgosedation\" METHODS: We used a qualitative explorative design with focus groups. The framework method was followed including transcription, familiarisation, coding, developing a framework, applying the framework, charting data into the framework matrix, and interpreting the data. The study was conducted at two paediatric intensive care units at Oslo University Hospital in Norway. Nurses and physicians who had used the new algorithm participated in the study.</p><p><strong>Findings: </strong>Three focus-group interviews were conducted with a total of 15 informants. Three main themes were identified with relevant subthemes: \"Caring for a child in withdrawal\", \"Advantages of the algorithm\", and \"Challenges of the algorithm\". The algorithm positively affected patient care and staff collaboration during tapering. The use of the Withdrawal Assessment Tool-1 integrated in the algorithm required experienced nurses due to the risk of false-positive patient assessments.</p><p><strong>Conclusion: </strong>Nurses and physicians in our study experienced that the new algorithm promoted staff collaboration and positively affected patient care. The use of the Withdrawal Assessment Tool-1 integrated in the algorithm required experienced staff and resources for continuous staff education.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101141"},"PeriodicalIF":2.6,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786671","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":"Digital health interventions to improve recovery for intensive care unit survivors: A systematic review.","authors":"Nina Leggett, Yasmine Ali Abdelhamid, Adam M Deane, Kate Emery, Evelyn Hutcheon, Thomas C Rollinson, Annabel Preston, Sophie Witherspoon, Cindy Zhang, Mark Merolli, Kimberley J Haines","doi":"10.1016/j.aucc.2024.101134","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.101134","url":null,"abstract":"<p><strong>Objective: </strong>Recovery models of care for intensive care unit (ICU) survivors are limited by availability, accessibility, and efficacy. Digital health interventions represent an alternative mode of service delivery. The primary aim of this systematic review was to describe implementation factors (Reach, Effectiveness, Adoption, Implementation, and Maintenance) for digital health interventions for ICU survivors. The secondary aim was to describe any effect on patient-reported health outcomes.</p><p><strong>Data sources: </strong>A systematic search of Medical Literature Analysis and Retrieval System Online (MEDLINE), Excertpa Medica Database (EMBASE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Systematic Reviews (CENTRAL) databases was undertaken in March 2023.</p><p><strong>Study selection: </strong>Two independent reviewers screened abstracts and full texts against eligibility criteria. Studies of adult survivors with any post-ICU discharge care, delivered via a digital mode, were included. Studies were excluded if published before 1990 or not in English.</p><p><strong>Data extraction: </strong>Quantitative data were extracted using predefined data fields. Risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool 2.0. Implementation factors were reported according to the Reach, Effectiveness, Adoption, Implementation and Maintenance framework.</p><p><strong>Data synthesis: </strong>A total of 6482 studies were screened. Ten studies, with 686 participants, were included. Implementation factors were reported in all studies. Acceptability (reported in six studies) was high, with high satisfaction and usability scores, defined a priori by investigators. Eight studies reported intervention adherence rates between 46% and 100%. Nine studies report final outcome measurement retention rates up to 12 months, between 52% and 100%. Five studies included the primary outcome as the difference in a patient-reported health outcome. Appraisal of efficacy and digital health literacy was limited due to substantial methodological variation and a lack of reporting in included studies. There was some risk of bias in 50% of studies.</p><p><strong>Conclusions: </strong>Digital health interventions can be successfully implemented for critical care survivors and have varying intervention adherence and retention rate success. To broaden reach, future research should include cultural diversity and investigate digital health access, literacy, and cost-effectiveness. INTERNATIONAL PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS REGISTRATION: CRD42022348252.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101134"},"PeriodicalIF":2.6,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683509","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":"Barriers and facilitators in implementing intra-abdominal pressure measurement by nurses in paediatric intensive care units: A qualitative study.","authors":"ZhiRu Li, FangYan Lu, Li Dong, YanHong Dai, RuiJie Bao, JingYun Wu, YuXin Rao, HuaFen Wang","doi":"10.1016/j.aucc.2024.101136","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.101136","url":null,"abstract":"<p><strong>Background: </strong>Intra-abdominal hypertension has been proven to be an independent risk factor for death in critically ill patients. Accurate monitoring of intra-abdominal pressure is of great significance for early identification and timely intervention of intra-abdominal hypertension to prevent further progression to abdominal compartment syndrome. Paediatric critical care nurses play an important role in constant observation and recognition of subtle and dynamic changes in intra-abdominal pressure of critically ill children.</p><p><strong>Objectives: </strong>The objective of this study was to explore paediatric critical care nurses's views on the barriers and facilitators in clinical practice of intra-abdominal pressure measurement.</p><p><strong>Methods: </strong>A qualitative, open-ended, and exploratory study was conducted in the paediatric intensive care unit of a tertiary hospital in China. Semistructured interviews were conducted with nurses and nursing managers who were involved in the management of intra-abdominal pressure. The interview guide was developed using the Theoretical Domains Framework to explore the barriers and facilitators to intra-abdominal pressure measurement in the paediatric intensive care unit. Data analysis followed the framework approach, drawing on the Theoretical Domains Framework.</p><p><strong>Results: </strong>Fourteen participants (10 nurses and four nursing managers) were interviewed. We identified seven domains related to intra-abdominal pressure measurement mapping to six \"barrier\" domains and four \"facilitator\" domains. The six \"barrier\" domains were knowledge, social influences, behavioural regulation, beliefs about consequences, beliefs about capabilities, and environmental context and resources, and the four \"facilitator\" domains were social influences, beliefs about consequences, environmental context and resources, and social/professional role and identity.</p><p><strong>Conclusions: </strong>The findings confirm the need for interventions to support paediatric critical care nurses in their intra-abdominal pressure measurement practices, with a particular focus on increasing knowledge, improving skills and measurement equipment, promoting nurse-physician interprofessional collaboration, providing a standardised measurement process, and establishing a supportive environment. Using the Theoretical Domains Framework will enhance the design of a targeted intervention, which should facilitate the standardised management of intra-abdominal pressure in the paediatric intensive care unit.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101136"},"PeriodicalIF":2.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648995","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":"Comparing arterial catheterisation by palpation or ultrasound guidance by novice nurses in an adult intensive care unit: A prospective cohort study.","authors":"Manuela León, Daniel N Marco, Marta Cubedo, Cristina González, Ana Guirao, María Del Carmen Cañueto, Laura Salvador, Àlvar Farré, Javier Pérez, Inmaculada Carmona, Pamela-Inés Doti, Sara Fernández, Adrián Téllez, Juan Carlos López-Delgado, Eric Mayor-Vázquez, Laura Almorín, Josep M Nicolás, Pedro Castro","doi":"10.1016/j.aucc.2024.101135","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.101135","url":null,"abstract":"<p><strong>Background: </strong>Arterial catheterisation is a common procedure in intensive care units (ICUs), typically performed using the palpation technique. Ultrasound (US)-guided catheterisation remains underutilised, particularly when performed by nonphysician operators.</p><p><strong>Objective: </strong>The objective of this study was to assess the effectiveness of US-guided arterial catheterisation performed by nurses in critically ill patients.</p><p><strong>Methods: </strong>This prospective cohort study took place in a medical ICU at a tertiary university hospital, comparing outcomes before and after a training program. Critically ill patients requiring arterial catheterisation were included. The study examined the performance and complications associated with two catheterisation techniques used by critical care nurses: palpation (PP) and US-guided. Nurses inexperienced with the US technique completed a brief training program consisting of two 3-h workshops followed by supervised clinical practice before performing the procedure. Collected data included the first-attempt success rate (primary endpoint), overall success rate, procedure time, the number of attempts, the number of cannulas used, complication rate, and catheter durability.</p><p><strong>Results: </strong>The study included 175 patients, with 89 in the PP group and 86 in the US group. Baseline characteristics were similar between groups. The first-attempt success rate was 50% in the PP group and 58% in the US group (p = 0.39, 95% confidence interval -23.4% to +8.3%). No significant differences were observed between groups in terms of failed attempts (21.3% vs. 14%, p = 0.28), procedure time (284 s vs 350 s, p = 0.44), or rates of immediate (haematoma) and late (catheter infection or dysfunction) complications. Catheter durability was also comparable. Although radial artery cannulation was preferred in both groups, femoral and brachial access were more frequently used in the US group (12.9% and 2.9% vs. 17.6% and 14.9%, respectively, p = 0.02).</p><p><strong>Conclusions: </strong>Arterial catheterisation using US guidance, performed by nurses with limited prior experience after a brief training course, demonstrated similar performance and complications rates compared to the traditional PP technique in a medical ICU setting.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101135"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640317","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":"Intensive care unit nurses' experiences of nursing concerns, activities, and documentation on patient deterioration: A focus-group study.","authors":"Mihui Kim, Yesol Kim, Mona Choi","doi":"10.1016/j.aucc.2024.09.011","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.09.011","url":null,"abstract":"<p><strong>Background: </strong>Although prognosis prediction models using nursing documentation have good predictive performance, the experiences of intensive care unit nurses related to nursing activities and documentation when a patient's condition deteriorates are yet to be explored.</p><p><strong>Objective: </strong>The aim of this study was to explore nurses' experiences of nursing activities and documentation in intensive care units when a patient's condition deteriorates.</p><p><strong>Methods: </strong>This was a descriptive qualitative study using focus-group interviews with intensive care unit nurses in tertiary or university-affiliated hospitals. In total, 19 registered nurses with at least 1 year of clinical experience in the adult intensive care unit were recruited using a purposive sampling method. Five focus-group interviews were conducted, and the data were analysed through a qualitative content analysis.</p><p><strong>Results: </strong>Intensive care unit nurses' experiences with patient deterioration were classified into four main categories-perceived patient deterioration; endeavours to verify nurses' concerns; nursing activities to improve a patient's condition; and optimising documentation practices-which comprised 12 subcategories. Intensive care unit nurses recognise patient deterioration through nursing activities and documentation, and the two processes influence each other. However, nursing activities related to nurses' concerns were mainly handed over verbally rather than documented due to the inflexibility of the available standardised forms and the potential uncertainty of those concerns.</p><p><strong>Conclusions: </strong>The findings reveal how intensive care unit nurses perceive, intervene, and document the condition of a deteriorating patient. Nurses' concerns may be the first sign of a patient's deteriorating condition and are therefore crucial for minimising patient risk. Therefore, efforts to systematically document nurses' concerns may contribute to improving patient outcomes.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101126"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645148","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":"Blood pressure management in acute spinal cord injury: A retrospective study of acute intensive care management of traumatic spinal cord injury in two New South Wales referral centres.","authors":"Tessa Garside, Ralph Stanford, Oliver Flower, Trent Li, Edward Dababneh, Naomi Hammond, Frances Bass, James Middleton, Jonathan Tang, Jonathan Ball, Anthony Delaney","doi":"10.1016/j.aucc.2024.09.016","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.09.016","url":null,"abstract":"<p><strong>Background: </strong>International guidelines recommend maintenance of mean arterial pressure (MAP) > 85 mmHg to defend spinal cord perfusion pressure after acute traumatic spinal cord injury (SCI). Variation in practice has been demonstrated in the emergency department blood pressure management of SCI in New South Wales (NSW). It is unknown whether this variation exists in the phase of intensive care management of acute SCI.</p><p><strong>Objectives: </strong>The objective of this study was to describe and compare current blood pressure management in the intensive care unit (ICU) of patients with acute traumatic SCI in two SCI referral centres in NSW.</p><p><strong>Methods: </strong>Patients with acute traumatic SCI admitted to two SCI referral centres, Unit A and Unit B during 2018-2019 in NSW, were included. Data were summarised using descriptive statistics.</p><p><strong>Results: </strong>Ninety-eight patients were included, with 91 patients having been prescribed a blood pressure target, 81 (83%) having required vasopressors, and 18 (18%) of these having been documented to have complications associated with vasopressor use. The average prescribed MAP target was 78 (interquartile range [IQR]: 10) mmHg in Unit A and 76 (IQR: 12) mmHg in Unit B. Median durations of prescribed target were 120 (IQR: 72) hours and 120 (IQR: 120) hours in Unit A and Unit B, respectively. The average MAP over the first 7 d was 88 (standard deviation: 9.5) mmHg in Unit A and 85 (standard deviation: 7.5) mmHg in Unit B. Sixty-three patients (64%) had a documented systolic blood pressure <90 mmHg in the first 24 h. Median ICU length of stay (LOS) was 9.7 (IQR: 11) d in Unit A and 6 (IQR: 6.6) d in Unit B. Median hospital LOS was 27 (IQR: 56.2) d in Unit B and 34.7 (IQR: 32.3) d in Unit B. ICU LOS was longer in patients who had a MAP target than in those who did not.</p><p><strong>Conclusions: </strong>Current blood pressure management in acute SCI in NSW involves ICU admission and blood pressure support with vasopressors; however, prescribed blood pressure targets are not in line with international guidelines.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101131"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645146","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":"Does intracranial pressure vary based on external ventricular drainage? A real-world clinical observation study.","authors":"Dohee Kwon, Lindsay Riskey, Abdulkadir Kamal, Brittany R Doyle, Brennen Louthen, Jade L Marshall, Samir D Ruxmohan, Amber Salter, DaiWai M Olson","doi":"10.1016/j.aucc.2024.101138","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.101138","url":null,"abstract":"<p><strong>Background: </strong>External ventricular drains (EVDs) are placed in patients with increased intracranial pressure (ICP) to serve as a cerebrospinal fluid (CSF) pressure flow diverter and ICP monitor. EVD management practice among institutions and practitioners varies greatly, with little evidence supporting ideal ICP recording and CSF drainage practice.</p><p><strong>Objective: </strong>This study's aim is to determine variations in ICP across 21 min before and after CSF drainage.</p><p><strong>Methods: </strong>Thirty adult patients with EVDs were consented for a real-world observational study. As per the institution guidelines, each patient's drain was levelled to the tragus and zeroed. The EVD was then clamped for 10 min, opened to drain for 1 min, and clamped again for another 10 min. ICPs were then recorded immediately, at 30 s, 1 min, 5 min, and 10 min after drain clamp. Each patient was eligible for up to 10 separate observation events, limited to one observation per shift.</p><p><strong>Results: </strong>We observed 226 independent drain-clamping events among 30 participants. The most common indication for EVD placement was to monitor and treat a mass-occupying lesion (n = 28). The patients had a mean age of 54.8 (15.9) years, including 12 (41%) females and 17 (59%) males. Fifty-one percent of CSF was characterised as clear, followed by serosanguinous, serous, and sanguineous characterisations. One minute of CSF drainage decreased ICP from 10.30 to 9.20, an average of 1.1 mmHg lower (p < 0.05).</p><p><strong>Conclusion: </strong>The ICP measurement practice is not standardised among clinicians. ICP variations ranged from negative numbers to well above the normal range, whereas no clinical changes in patient exam were seen. Drainage of CSF decreases ICPs momentarily, and the effects of drainage do not last long. Further studies are needed to evaluate the safest approach to EVD management and ICP recording practice.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101138"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645147","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":"Prophylactic dressings for preventing sacral pressure injuries in adult intensive care unit patients: A randomised feasibility trial.","authors":"Sharon Latimer, Wendy Chaboyer, Rachel M Walker, Lukman Thalib, Jodie L Deakin, Brigid M Gillespie","doi":"10.1016/j.aucc.2024.101133","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.101133","url":null,"abstract":"<p><strong>Background: </strong>Prophylactic dressings are used to prevent sacral pressure injuries (PIs) in intensive care unit (ICU) patients. Bedside clinicians are responsible for selecting these dressings despite the lack of comparative evidence.</p><p><strong>Objectives: </strong>The objective of this study was to assess the feasibility of undertaking a larger multisite comparative effectiveness trial of two prophylactic sacral dressings in adult ICU patients.</p><p><strong>Methods: </strong>Using a two-arm pilot randomised feasibility trial design, we randomly allocated adult ICU patients to the Mepilex® Border Sacrum dressing or Allevyn™ Life Sacrum dressing plus usual PI prevention care. Our primary study outcomes were study eligibility, recruitment, retention, intervention fidelity, and missing data criteria. Participants were followed up for up to 14 days or a study endpoint: new sacral PI, ICU discharge, death, prone positioning, urine/faecal incontinence, or withdrawal. Daily clinical data were collected including a deidentified sacral photograph, sacral visual skin assessment, dressing failure rates (rolled edges, adhesion loss), and dressing-related harm (e.g., blisters). The blinded outcome assessor used these data to determine the presence of a new sacral PI.</p><p><strong>Results: </strong>From January to September 2023, 1069 ICU patients were screened; 77 (7.2%) were eligible, and 68 (88.3%) were recruited. Half of our feasibility criteria were met. One participant (1.5%) developed a sacral PI. Throughout the study, half (n = 54; 49.5%) of the dressing changes were due to dressing failure (rolled edges: n = 43; 79.5%, adhesion failure: n = 11; 20.5%).</p><p><strong>Conclusions: </strong>Several prophylactic sacral dressings are available; however, comparative effective evidence between brands relative to performance, benefits, and harms is lacking. Following minor study criteria modifications, we found that a larger multisite comparative trial is feasible. Sacral prophylactic dressing failure and dressing-related harms are care quality and patient safety issues requiring further investigation regarding performance, harm, and costs.</p><p><strong>Trial registration: </strong>Australian and New Zealand Clinical Trial Registration number: ACTRN12622000793718 and World Health Organization Universal Trial number: U1111-1278-6055.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101133"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645149","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":"The usefulness of a 28-item Therapeutic Intervention Scoring System (TISS-28) in critically ill obstetric patients to detect multiorgan dysfunction: A prospective cohort study.","authors":"Jose Rojas-Suarez, Jeniffer González-Hernández, Diana Borre-Naranjo, Alejandra Vergara-Schotborgh, Laura Saavedra-Valencia, Carmelo Dueñas-Castell, Jose Santacruz-Arias, Wendy Pollock","doi":"10.1016/j.aucc.2024.101137","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.101137","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the effectiveness of the 28-item Therapeutic Intervention Scoring System (TISS-28) in detecting multiorgan dysfunction (MOD) among critically ill obstetric patients and compared its predictive potential to other severity models, such as Sequential Organ Failure Assessment (SOFA) and Mortality Probability Model II (MPM II).</p><p><strong>Methods: </strong>A prospective multicentre cohort study was conducted including obstetric patients, pregnant and up to 42 days postpartum, admitted to the intensive care units of two referral hospitals in Colombia. A total of 93 patients were recruited between March 2016 and February 2017 and from September 2019 to November 2019. Scores from the MPM II, SOFA, and TISS-28 were calculated within the first 24 h post-intensive care unit admission. The primary outcome was to evaluate the effectiveness of TISS-28 in predicting MOD, as defined by the World Health Organization near-miss criteria. We compared the TISS-28 with SOFA and MPM II scores in identifying MOD using the positive predictive value, negative predictive value, and the area under the receiver operating characteristic curve.</p><p><strong>Results: </strong>Data from 93 patients were analysed, of whom 22 developed MOD. Hypertensive disorders were the predominant diagnosis (n = 62; 66.7%). Patients with sepsis exhibited the highest TISS-28 score, indicating more intensive therapeutic interventions. The areas under the receiver operating characteristic curve for TISS-28, SOFA, and MPM II were 0.83 (95% confidence interval: 0.73-0.92), 0.66 (0.51-0.80), and 0.59 (0.43-0.74), respectively (p = 0.001). The cut-off value of a TISS-28 score ≥21 was associated with an increased likelihood of MOD (sensitivity: 83.2%, specificity: 71.2%), a positive predictive value of 47.3%, and a negative predictive value) of 93.2%.</p><p><strong>Conclusions: </strong>TISS-28 demonstrated robust performance in identifying MOD among obstetric patients compared to other severity indexes. The TISS-28 score complements physiology-derived severity scores by reflecting the level of care required, making it a valuable tool in risk stratification and resource allocation for critically ill obstetric patients.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101137"},"PeriodicalIF":2.6,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640319","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}