Australian Critical Care最新文献

{"title":"Six-month outcomes after traumatic brain injury in the Augmented versus Routine Approach to Giving Energy multicentre, double-blind, randomised controlled Trial (TARGET).","authors":"Kym Wittholz, Kate Fetterplace, Lee-Anne Chapple, Emma J Ridley, Mark Finnis, Jeffrey Presneill, Marianne Chapman, Sandra Peake, Rinaldo Bellomo, Amalia Karahalios, Adam M Deane","doi":"10.1016/j.aucc.2024.09.001","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.09.001","url":null,"abstract":"<p><strong>Background: </strong>Critically ill patients with a traumatic brain injury (TBI) may require prolonged intensive care unit (ICU) admission and hence receive greater exposure to hospital enteral nutrition. It is unknown if augmented energy delivery with enteral nutrition during ICU admission impacts quality of life in survivors or gastrointestinal tolerance during nutrition delivery in the ICU.</p><p><strong>Objectives: </strong>The objective of this study was to compare health-related quality of life, using the EuroQol five-dimensions five-level visual analogue scale at 6 months, in survivors who presented with a TBI and received augmented energy (1.5 kcal/ml) to those who received routine energy (1.0 kcal/ml). Secondary objectives were to explore differences in total energy and protein delivery, gastrointestinal tolerance, and mortality between groups.</p><p><strong>Methods: </strong>Secondary analysis of participants admitted with a TBI in the Augmented versus Routine Approach to Giving Energy Trial (TARGET) randomised controlled trial. Data are represented as n (%) or median (interquartile range).</p><p><strong>Results: </strong>Of the 3957 patients in TARGET, 231 (5.8%) were admitted after a TBI (augmented = 124; routine = 107). Patients within TARGET who were admitted with a TBI were relatively young (42 [27, 61] years) and received TARGET enteral nutrition for an extended period (9 [5, 15] days). At 6 months, EuroQol five-dimensions five-level quality-of-life scores were available for 166 TBI survivors (72% of TBI cohort randomised, augmented = 97, routine = 69). There was no evidence of a difference in quality of life (augmented = 70 [52, 90]; routine = 70 [55, 85]; median difference augmented vs routine = 0 [95% confidence interval: -5, 10]). TBI participants assigned to augmented energy received more energy with a similar protein than the routine group. Gastrointestinal tolerance was similar between groups.</p><p><strong>Conclusion: </strong>While patients admitted after a TBI received enteral nutrition for an extended period, an increased exposure to augmented energy did not affect survivors' quality-of-life scores.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101116"},"PeriodicalIF":2.6,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401818","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":"Comparison of different eye care methods to prevent dry eye and corneal ulcer in older critically ill patients: A three-arm randomised clinical trial.","authors":"Mahsa Tebyanian, Ali Darvishpoor Kakhki, Sepehr Feizi","doi":"10.1016/j.aucc.2024.09.005","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.09.005","url":null,"abstract":"<p><strong>Background: </strong>As the population ages, the number of older patient admitted to intensive care units (ICUs) will increase. This age group is at higher risk for developing eye problems because of higher prevalence of dry eye among older people. Inconsistency of early studies' results and less attention to eye care guidelines for older patients in the ICU pose severe consequences such as dry eye and corneal ulcer.</p><p><strong>Objective: </strong>The objective of this study was to investigate the effectiveness of artificial tear gel, polyethylene cover, and conventional eye care methods for preventing dry eye and corneal ulcer in older patients admitted to an ICU.</p><p><strong>Methods: </strong>In this three-arm randomised clinical trial, 99 older ICU patients with Glasgow Coma Scale scores measuring <7 were randomly assigned to one of three treatment groups: (i) participants who received artificial tear gel in one eye and polyethylene cover on the other; (ii) these interventions were applied in the opposite eyes; and (iii) participants who received conventional eye care including antiallergic adhesive to closed eyelids. Development of dry eye and corneal ulcer was assessed based on Schirmer's and the fluorescein tests for 5 days. Repeated measures analysis of variance was used to detect differences between groups.</p><p><strong>Results: </strong>The mean age of the participants was 70.91 (±9.47). No statistically significant difference was observed between the groups regarding baseline demographic and disease characteristics. While there was a nonsignificant difference between artificial tear gel and polyethylene cover in reducing dry eye and corneal ulcer, each of these methods could reduce dry eye and corneal ulcer significantly (P < 0.001) compared with conventional eye care.</p><p><strong>Conclusions: </strong>The results revealed that artificial tear gel eye care and polyethylene cover methods were more effective in prevention of dry eye and corneal ulcer than antiallergic adhesive eye care. Nurses can choose an appropriate care method based on clinical conditions, costs, and care burden in older ICU patients.</p><p><strong>Registration: </strong>Iranian Clinical Trial Registry (IRCT20200711048079N1). The first recruitment was conducted in October 2021.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401816","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 diaries-harmful or harmless: A systematic literature review and qualitative data synthesis.","authors":"Matthias Thomas Exl, Lea Lotzer, Teresa Deffner, Marie-Madlen Jeitziner, Peter Nydahl","doi":"10.1016/j.aucc.2024.09.006","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.09.006","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this research was to evaluate the extent of harm for critically ill patients, family members, and healthcare professionals associated with writing and reading intensive care unit (ICU) diaries.</p><p><strong>Review method used: </strong>A systematic literature review and a synthesis of qualitative data were performed. The protocol of this study has been registered in the International prospective register of systematic reviews (CRD42022376393).</p><p><strong>Data sources: </strong>Databases were PubMed, Cochrane Library, CINAHL, PsychNet, and Livivo.</p><p><strong>Review methods: </strong>The search included qualitative and mixed-methods studies related to harm with an ICU diary. Deductive content analysis was used to create abstractions of quotations. Study quality was assessed with the Critical Appraisal Skills Programme.</p><p><strong>Results: </strong>Of 12 827 titles, 27 studies with 476 participants were included. Events involving the patients, family members, and healthcare professionals occurred but did not result in harm. A total of 68 quotations from patients, family members, and healthcare professionals were extracted. Those patients, their families, and healthcare professionals who mentioned intense emotions regarding diaries experienced writing and reading diaries as an emotional journey (patients), a help with tears (families), or a question of emotional distance (healthcare professionals).</p><p><strong>Conclusions: </strong>Writing and reading ICU diaries can be associated with intense emotions, which are natural reactions when coping with a stressful situation. No study reported harm. Based on uncertain qualitative evidence, the benefits of writing and reading ICU diaries as coping strategies outweigh the potential harm. More research is needed.</p><p><strong>Registration of review: </strong>The International prospective register of systematic reviews CRD42022376393.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401817","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":"In-hospital mortality is associated with observation-chart modifications","authors":"Daksh Tyagi,&nbsp;Sheryn Tan,&nbsp;Joshua G. Kovoor,&nbsp;Brandon Stretton,&nbsp;Minh-Son To,&nbsp;Rudy Goh,&nbsp;Christopher D. Ovenden,&nbsp;Yiran Tan,&nbsp;James Malycha,&nbsp;Aashray K. Gupta,&nbsp;Stephen Bacchi","doi":"10.1016/j.aucc.2024.05.002","DOIUrl":"10.1016/j.aucc.2024.05.002","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"37 6","pages":"Pages 837-838"},"PeriodicalIF":2.6,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401820","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":"Gastrointestinal complications from a cardiac surgical perspective","authors":"Rohan Magoon DM,&nbsp;Sunaakshi Puri DM,&nbsp;Anjishnujit Bandyopadhyay DM","doi":"10.1016/j.aucc.2024.08.001","DOIUrl":"10.1016/j.aucc.2024.08.001","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"37 6","pages":"Page 842"},"PeriodicalIF":2.6,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401819","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":"Ultrasound to support neonatal vascular access","authors":"Jessica Ruggiero MD ,&nbsp;Carmen Rodriguez-Perez MD, PhD ,&nbsp;Francesco Maria Risso MD, PhD","doi":"10.1016/j.aucc.2024.06.002","DOIUrl":"10.1016/j.aucc.2024.06.002","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"37 6","pages":"Pages 839-840"},"PeriodicalIF":2.6,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401822","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":"Defining minimum workforce standards for intensive care physiotherapy in Australia and New Zealand: A Dephi study.","authors":"Peter Thomas, Wendy Chaseling, Leanne Marais, Claire Matheson, Michelle Paton, Nelmari Swanepoel","doi":"10.1016/j.aucc.2024.08.005","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.08.005","url":null,"abstract":"<p><strong>Background: </strong>Intensive care staffing guidelines provide recommendations for the safe and effective delivery of health care while recognising professional requirements of the workforce. To guide recommendations for physiotherapy staffing guidelines, profession-specific consultation is needed.</p><p><strong>Objectives: </strong>The objective of this study was to develop consensus-based recommendations for minimum workforce standards for physiotherapy in intensive care.</p><p><strong>Methods: </strong>A Delphi survey process was conducted involving physiotherapists from Australia and New Zealand.</p><p><strong>Results: </strong>The panel consisted of 65 physiotherapists in the first round and 60 in the second round (92% retention). Respondents were from both Australia (49, 76%) and New Zealand (16, 24%) who had been physiotherapists for an average of 18.8 ± 9.0 years and were primarily senior intensive care physiotherapists (44, 68%). Respondents had experience across level 3 (50, 77%), level 2 (18, 28%), and level 1 (5, 8%) adult intensive care units (ICUs), adult high-dependency units (27, 42%), and paediatric intensive care (6, 9%). A total of 42 statements were presented, with 37 reaching consensus after two rounds. After two rounds, consensus was achieved for a minimum staffing ratio in paediatric ICUs of one physiotherapist per six (1:6) beds. For adult ICUs, use of the median value of the participant's responses was supported to establish minimum staffing ratios of 1:8, 1:7, 1:6, and 1:8 for levels 1, 2, and 3 ICUs and high-dependency units, respectively. The requirement for an additional allocation for senior physiotherapist staffing for each ICU level was also established. Statements that also gained consensus included recommendations for access to on-call and weekend services for all ICU settings and the consideration of evening shifts specifically for level 3 and paediatric ICUs.</p><p><strong>Conclusions: </strong>Recommendations for minimum staffing for physiotherapy in intensive care settings were achieved and supported requirements for clinical service delivery, supervision, and training.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300385","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":"Mastering tracheostomy care: Refresher programme for tracheostomy training for nurses: Comparison of two training methods based on hands-on simulation-based training alone versus additional complementary self-directed e-learning.","authors":"Wei Jun Dan Ong, Amit Kansal, Fauziah Jabil, Li-Phing Clarice Wee, Yit Ying Adeline Tan, Ching Yee Tan, Eleanor Dela Peña, Faheem Ahmed Khan","doi":"10.1016/j.aucc.2024.09.004","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.09.004","url":null,"abstract":"<p><strong>Background: </strong>Effective clinical education is essential for managing tracheostomy patients safely and efficiently. Simulation-based training has shown greater efficacy than traditional methods in various clinical settings. Our internal training programme, called the Tracheostomy Refresher Program (TRP) was used to enhance nurses' skills in tracheostomy care.</p><p><strong>Aim/objective: </strong>The aim of this study was to evaluate the impact of the TRP on nurses' self-reported knowledge and confidence and psychomotor skills comparing hands-on simulation-based training alone (TRP-S) with both the simulation-based training and the e-learning component (TRP-S + e).</p><p><strong>Methods: </strong>The study was conducted at a large tertiary hospital in Singapore from February 2022 to October 2022, focussing on the TRP. Participants were divided into two cohorts: those receiving TRP-S and those receiving additional complementary TRP-S + e. All participants completed theory tests and affective questionnaires before and after the training to assess knowledge and attitudes. At the same time, their psychomotor skills were evaluated during the simulation using a standardised checklist. The two cohorts were then compared based on the results of these pretests and post-tests and the psychomotor skills assessment to evaluate the effectiveness of the additional e-learning component.</p><p><strong>Results: </strong>Participants reported significantly enhanced confidence, knowledge, and psychomotor skills in tracheostomy care post training (p < 0.001 for all). The TRP-S + e cohort showed significantly higher knowledge and confidence scores than the TRP-S cohort (p < 0.001 for both).</p><p><strong>Conclusion: </strong>Our study suggests that a TRP incorporating hands-on simulation-based training with or without e-learning significantly improved self-reported knowledge, confidence, and psychomotor skills in tracheostomy care. Future research should explore the optimal duration, engagement strategies, and cost-effectiveness of such educational techniques and whether similar approaches can be applied for other clinical skills.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300387","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 patients' experiences of receiving music therapy sessions during invasive procedures: A qualitative phenomenological study.","authors":"Verónica Saldaña-Ortiz, Esther Martínez-Miguel, Carlos Navarro-García, Isabel Font-Jimenez, José Miguel Mansilla-Domínguez","doi":"10.1016/j.aucc.2024.07.085","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.07.085","url":null,"abstract":"<p><strong>Background: </strong>Excessive noise in intensive care units poses a significant challenge, impacting both patients and staff by elevating stress, disrupting recovery, and impeding effective communication among healthcare professionals. Despite the World Health Organization recommending noise levels below 35 dB, alarms in these units often surpass these limits, contributing to consistently high noise levels.</p><p><strong>Objectives: </strong>The aim of this study is to explore intensive care unit patients' experiences with music therapy sessions during invasive procedures.</p><p><strong>Methods: </strong>This study was conducted using a qualitative hermeneutic phenomenological methodology grounded in Heideggerian philosophy. Interventions were conducted with a music therapist, and 14 in-depth interviews were collected. Reflexive inductive thematic analysis was performed.</p><p><strong>Results/findings: </strong>From the thematic analysis extracted from the 14 personal interviews, three themes were described that represent the bulk of the experiences and emotions of the study participants following the completion of the music therapy sessions. The most noteworthy results are described in the following, organised according to each theme: (i) music therapy against noise, sounds, and light; (ii) music therapy in the face of invasive tests and techniques; and (iii) music therapy as a strategy and tool.</p><p><strong>Conclusions: </strong>Music therapy has significant potential to enhance the quality of life for patients in the intensive care unit. Music therapy can promote relaxation, reduce stress and anxiety, alleviate pain and discomfort, and improve emotional and physical wellbeing during patients' stay and invasive procedures.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300386","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":"Special issue: Challenges and Opportunities for ICU Recovery","authors":"Lee-anne S. Chapple PhD, APD,&nbsp;Peter Kelly","doi":"10.1016/j.aucc.2024.09.003","DOIUrl":"10.1016/j.aucc.2024.09.003","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"37 6","pages":"Pages 835-836"},"PeriodicalIF":2.6,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300390","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}