Australian Critical Care最新文献

{"title":"Determining the needs of relatives of patients with a COVID-19 diagnosis in the intensive care unit","authors":"Hasan Şeren Msc, RN ,&nbsp;Gülay Altun Uğraş PhD, RN ,&nbsp;Tuğba Çam Yanik MSc, PhD, RN","doi":"10.1016/j.aucc.2024.06.008","DOIUrl":"10.1016/j.aucc.2024.06.008","url":null,"abstract":"<div><h3>Background</h3><div>The precautions taken in the intensive care unit (ICU) during the COVID-19 pandemic have caused a change in the needs of relatives of patients.</div></div><div><h3>Objective</h3><div>This research was conducted to determine the needs of relatives of ICU patients diagnosed with COVID-19.</div></div><div><h3>Methods</h3><div>The sample of this cross-sectional study consisted of 68 relatives of patients treated with COVID-19 in the ICU. Data were collected with a “Patient Relatives Information Form”, a “Factors Affecting the Needs of the Relatives of Patients in the Intensive Care Unit Form”, and the Critical Care Family Needs Inventory (CCFNI). A multivariate and univariate general linear model was used to determine the factors affecting the CCFNI total and subscale scores. Higher CCFNI scores are indicative of higher family need.</div></div><div><h3>Results</h3><div>The assurance (3.5 ± 0.4), information (3.4 ± 0.5), proximity (3.0 ± 0.6), comfort (2.8 ± 0.6), and support (2.7 ± 0.5) dimensions were important needs of relatives of patients hospitalised in the ICU. There was a weak negative correlation between participants' ages and CCFNI scores (<em>p</em> = 0.041). According to the univariate general linear model, significant difference was found between the total CCFNI scores (<em>p</em> = 0.032; 95% confidence interval [CI]: 2.68–3.03), based on multivariate general linear model proximity scores (<em>p</em> = 0.000; 95% CI: 2.49–2.91), and support scores (<em>p</em> = 0.029; 95% CI: 2.26–2.68) and the effect of ICU visit restrictions on relatives’ anxiety. Additionally, based on the multivariate general linear model, significant difference was found between the assurance scores and the presence of people who provided support to avoid disruption of responsibilities at home (<em>p</em> = 0.025; 95% CI: 3.30–3.54) and between the proximity scores and the expectations of intensive care nurses (<em>p</em> = 0.028; 95% CI: 2.83–3.59).</div></div><div><h3>Conclusion</h3><div>This study showed that relatives of ICU patients had high levels of needs. Relatives had high needs for assurance and information, whereas their needs for comfort and support were low. As the age of patients’ relatives increased, their levels of needs decreased. Relatives of the patients who received support to help with their obligations at home had increased assurance needs, and those who had anxiety about the ICU visit restrictions had increased proximity and support needs.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101085"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762448","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":"Expression of Concern: Comparison of different eye care methods to prevent dry eye and corneal ulcer in older critically ill patients: A randomised controlled trial.","authors":"","doi":"10.1016/j.aucc.2024.101140","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.101140","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"101140"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980572","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":"How is work–family conflict linked to nurse-assessed patient safety among intensive care unit nurses? A serial multiple mediation analysis","authors":"Qianqian Yang RN, PhD ,&nbsp;Linlin Yang RN, MN ,&nbsp;Chunling Yang RN, MN ,&nbsp;Xia Wu RN, MN ,&nbsp;Zhen Xu RN, MN ,&nbsp;Xiaobing Wang MBBS, MN","doi":"10.1016/j.aucc.2024.03.008","DOIUrl":"10.1016/j.aucc.2024.03.008","url":null,"abstract":"<div><h3>Aim</h3><div><span>The aim of this study was to test whether rumination and negative affectivity mediate the relationship between work–family conflict and nurse-assessed patient safety among </span>intensive care unit nurses.</div></div><div><h3>Background</h3><div>Most intensive care unit nurses experience work–family conflicts that jeopardise patient safety. Although prior studies have explored the effect of work–family conflict on patient safety, few have investigated whether work–family conflict is associated with patient safety through rumination and negative affectivity among intensive care unit nurses.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Methods</h3><div>This study included 209 intensive care unit nurses from five general hospitals. The Work–Family Conflict Scale, the Ruminative Response Scale, the Positive and Negative Affect Schedule-Negative Affectivity, and three items indicating nurses’ perception of overall patient safety were used to gather data. Associations between work–family conflict, rumination, negative affectivity, and nurse-assessed patient safety were assessed using correlation and serial multiple mediation analysis.</div></div><div><h3>Results</h3><div>Work–family conflict, rumination, negative affectivity, and nurse-assessed patient safety were significantly correlated (<em>p</em> &lt; 0.01). Work–family conflict can have not only a direct negative impact on the nurse-assessed patient safety (effect = −0.0234; standard error [SE] = 0.0116; 95% confidence interval [CI]: lower limit [LL] = −0.0464, upper limit [UL] = −0.0005) but also an indirect impact on nurse-assessed patient safety through three paths: the independent mediating role of rumination (effect = −0.0118; SE = 0.0063; 95% CI: LL = −0.0251, UL = −0.0006), the independent mediating role of negative affectivity (effect = −0.0055; SE = 0.0039; 95% CI: LL = −0.0153, UL = −0.0001), and the chain-mediating role of rumination and negative affectivity (effect = −0.0078; SE = 0.0031; 95% CI: LL = −0.0152, UL = −0.0027).</div></div><div><h3>Conclusion</h3><div>Our findings indicated that work–family conflict could influence nurse-assessed patient safety through increasing rumination and negative affectivity among intensive care unit nurses. Based on the results, interventions aimed at decreasing work–family conflict would be beneficial for intensive care unit nurses’ emotional stability and patient safety.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101053"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141032061","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":"Physicians' decision making when weaning patients from mechanical ventilation: A qualitative content analysis","authors":"Catarina Tingsvik RN, CCRN, PhD ,&nbsp;Maria Henricson RN, CCRN, PhD ,&nbsp;Fredrik Hammarskjöld MD, PhD ,&nbsp;Jan Mårtensson RN, PhD","doi":"10.1016/j.aucc.2024.06.015","DOIUrl":"10.1016/j.aucc.2024.06.015","url":null,"abstract":"<div><h3>Background</h3><div>Weaning from mechanical ventilation is a complex and central intensive care process. This complexity indicates that the challenges of weaning must be explored from different perspectives. Furthermore, physicians' experiences and the factors influencing their decision-making regarding weaning are unclear.</div></div><div><h3>Objectives</h3><div>This study aimed to explore and describe the factors influencing physicians' decision-making when weaning patients from invasive mechanical ventilation in Swedish intensive care units (ICUs).</div></div><div><h3>Methods</h3><div>This qualitative study used an exploratory and descriptive design with qualitative content analysis. Sixteen physicians from five ICUs across Sweden were purposively included and interviewed regarding their weaning experiences.</div></div><div><h3>Findings</h3><div>The physicians expressed that prioritising the patient's well-being was evident, and there was agreement that both the physical and mental condition of the patient had a substantial impact on decision-making. Furthermore, there was a lack of agreement on whether patients should be involved in the weaning process and how their resources, needs, and wishes should be included in decision-making. In addition, there were factors not directly linked to the patient but which still influenced decision-making, such as the available resources and teamwork. Sometimes, it was difficult to point out the basis for decisions; in that decisions were made by gut feeling, intuition, or clinical experience.</div></div><div><h3>Conclusion</h3><div>Physicians' decision-making regarding weaning was a dynamic process influenced by several factors. These factors were related to the patient's condition and the structure for weaning. Increased understanding of weaning from the physicians' and ICU teams’ perspectives may improve the weaning process by broadening the knowledge about the aspects influencing the decision-making.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101096"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of point-of-care ultrasound during cardiac arrest in the intensive care unit: A cross-sectional survey","authors":"David A. West MD, MPH, GCertClinUS ,&nbsp;Caroline Killick MBBS, FRACP, FCICM, LLM ,&nbsp;Daryl Jones BSc(Hons), MBBS, MD, PhD, FRACP, FCICM","doi":"10.1016/j.aucc.2024.04.003","DOIUrl":"10.1016/j.aucc.2024.04.003","url":null,"abstract":"<div><h3>Background</h3><div>There is growing interest in the use of point-of-care ultrasound during cardiac arrest, but few studies document its use in the intensive care unit.</div></div><div><h3>Objective</h3><div>We hypothesised this may reflect a low prevalence of use of point-of-care ultrasound during cardiac arrest or negative attitudes towards its use. We aimed to determine the self-reported prevalence, attitudes towards, and barriers to use of point-of-care ultrasound during cardiac arrest in the intensive care unit.</div></div><div><h3>Methods</h3><div>We conducted a web-based survey over 3 months (08/08/2022–06/11/2022), of intensive care unit consultants and registrars in Victoria, Australia. Descriptive and mixed-methods analyses of Likert-type and free-text answers were performed.</div></div><div><h3>Results</h3><div>The response rate was 91/398 (22.8%), split evenly between consultants and registrars. There was a broad range of clinical and ultrasound experience. Only 22.4% (22/91) of respondents reported using point-of-care ultrasound 75–100% of the time during their management of cardiac arrest. Respondents rated the value they place in point-of-care ultrasound during cardiac arrest 3 (interquartile range: 3–4) and that of a “skilled operator” 4 ((interquartile range; 4–5) on a 5-point scale. Free-text analysis suggested exclusion of “tamponade” (40/80 [50%] comments) as the most valuable use-case and “skill” as a personal barrier (20/73 [27.4%] comments). Personal and departmental barriers were not rated highly, although registrars perceived “lack of a structured training program” as a barrier. Respondents were equivocal in the value they gave point-of-care ultrasound during cardiac arrest but saw greater value when conducted by a skilled operator.</div></div><div><h3>Conclusions</h3><div>Point-of-care ultrasound was reported to be infrequently used in cardiac arrest, mostly due to self-perceived skill and lack of a structured training program.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101058"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155747","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 influence of anxiety and depression on critical care nurses’ performance: A multicenter correlational study","authors":"Sameer A. Alkubati RN, PhD ,&nbsp;Salman H. Alsaqri RN, PhD ,&nbsp;Gamil G. Alrubaiee RN, PhD ,&nbsp;Mokhtar A. Almoliky RN, PhD ,&nbsp;Talal Al-Qalah RN, PhD ,&nbsp;Eddieson Pasay-an RN, PhD ,&nbsp;Habib Almeaibed RN, AG-ACNP, PhD ,&nbsp;Shimmaa M. Elsayed RN, PhD","doi":"10.1016/j.aucc.2024.04.008","DOIUrl":"10.1016/j.aucc.2024.04.008","url":null,"abstract":"<div><h3>Background</h3><div>Anxiety and depression among critical care nurses (CCNs) negatively affect performance because of association with clinical medical errors, ineffective communication, absenteeism from work, and burnout.</div></div><div><h3>Objectives</h3><div>The aim of this study was to investigate the prevalence of anxiety and depression and their associated factors as well as their impact on the CCNs’ performance in Hail city, Saudi Arabia.</div></div><div><h3>Methods</h3><div>A cross-sectional correlational study was conducted among 262 CCNs from April to June 2023.</div></div><div><h3>Results</h3><div>The mean scores of anxiety and depression were significantly higher among male and Saudi CCNs than among their counterparts (p &lt; 0.05). CCNs caring for patients in a ratio of 1:5 or more had significantly higher anxiety scores than those with lower nurse-to-patient ratios (p = 0.004). CCNs who were working night shifts had significantly higher mean scores of anxiety (p = 0.005) and lower mean scores of performance (p = 0.041) than their counterparts. Borderline anxiety and depression were prevalent among 43.1% and 38.5% of CCNs, respectively. In contrast, abnormal anxiety and depression were prevalent among 8.8% and 5.7% of CCNs, respectively. CCNs’ mental, general, and total performance showed a significant negative correlation with both anxiety ([r = −0.247, p &lt;0.001], [r = −0.183, p = 0.003], and [r = −0.172, p = 0.005], respectively) and depression (r = −0.287, p &lt;0.001), (r = −0.207, p &lt;0.001), and (r = −0.180, p = 0.003), respectively.</div></div><div><h3>Conclusions</h3><div>Anxiety and depression levels are significantly higher among male, Saudi CCNs, higher nurse-to-patient ratios, those who work night shifts than among their counterparts. Less than half of CCNs experience borderline anxiety and/or depression that had significantly negative correlation with their performance. Anxiety and depression in shift nurses may be treated by reducing workload, causes of stress during night shifts, and giving practical coping mechanisms for typical nurse job pressures.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101064"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155842","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":"“How to navigate this new area”: Intensive care clinicians’ perceptions of voluntary assisted dying in the intensive care unit: A multisite exploratory study","authors":"Melissa J. Bloomer RN, PhD ,&nbsp;Kylie O'Neill RN, MN ,&nbsp;Jayne Hewitt RN, PhD ,&nbsp;Andrew Wheaton MNursStud, MBioeth, RN ,&nbsp;Margaret O'Connor BTheol, DN, RN ,&nbsp;Ann Bonner RN, PhD","doi":"10.1016/j.aucc.2024.05.007","DOIUrl":"10.1016/j.aucc.2024.05.007","url":null,"abstract":"<div><h3>Background</h3><div>There is growing momentum worldwide for assisted dying. In Australia, voluntary assisted dying may occur in any setting, including an intensive care unit (ICU). As the subject of much debate worldwide, exploring ICU clinicians’ perceptions of assisted dying is essential.</div></div><div><h3>Aim</h3><div>The aim of this study was to explore clinicians’ perceptions of and preparedness for voluntary assisted dying in the ICU.</div></div><div><h3>Method</h3><div>An exploratory qualitative descriptive design using individual interviews was used. Medical, nursing, and allied health clinicians from three ICUs were recruited. Interviews were conducted between Nov 2022 and Jan 2023, with a hypothetical scenario about voluntary assisted dying used to prompt discussion. Interviews were recorded, professionally transcribed, and analysed using inductive content analysis.</div></div><div><h3>Findings</h3><div>ICU registered nurses (n = 20), physicians (n = 2), and allied health clinicians (n = 4) participated with interviews lasting 18–45 min (mean: 28 min). Analysis revealed four themes: (i) <em>purpose of ICU</em> reflected that ICU care was not all about saving lives, yet recognising dying and changing priorities was challenging; (ii) <em>dying in the ICU is complex</em> due to difficulties in talking about dying, accepting death as the outcome and evaluating care efficacy; (iii) <em>voluntary assisted dying is a lot of grey</em> because of perceived clinical and ethicolegal challenges; and finally, (iv) r<em>especting choice</em> was about respecting patients' values, beliefs, and autonomy, as well as clinicians’ beliefs and right to exercise autonomy through conscientious objection.</div></div><div><h3>Conclusion</h3><div>Dying and death are inevitable, and views and perspectives about assisted dying will continue to evolve. Respecting patient choice is at the core of assisted dying, but respecting clinicians’ perspectives and choice is equally important. With voluntary assisted dying now legal in all Australian states, ensuring ICU team and individual clinician preparedness through access to education, resources, and specialist support services is key to raising awareness and easing uncertainty about deaths through voluntary assisted dying.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101070"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intubation of critically ill patients: A pilot study of minute-by-minute physiological changes within an Australian tertiary intensive care unit","authors":"Zhen Ti Yong MBBS, BPharm ,&nbsp;Akinori Maeda MD ,&nbsp;Fumitaka Yanase MD, PhD ,&nbsp;Ary Serpa Neto MD, MSc, PhD ,&nbsp;Rinaldo Bellomo MD, PhD, MBBS","doi":"10.1016/j.aucc.2024.06.001","DOIUrl":"10.1016/j.aucc.2024.06.001","url":null,"abstract":"<div><h3>Background</h3><div><span><span>There are no published minute-by-minute physiological assessment data for endotracheal intubation (ETT) performed in the </span>intensive care unit (ICU). The majority of physiological data is available from Europe and North America where </span>etomidate<span> is the induction agent administered most commonly.</span></div></div><div><h3>Aims</h3><div>The aim of this study was to describe the feasibility of obtaining minute-by-minute physiological and medication data surrounding ETT in an Australian tertiary ICU and to assess its associated outcomes.</div></div><div><h3>Methods</h3><div>We performed a single-centre feasibility observational study. We obtained minute-by-minute data on physiological variables and medications for 15 min before and 30 min after ETT. We assessed feasibility as enrolled to screened patient ratio and completeness of data collection in enrolled patients. Severe hypotension (systolic blood pressure &lt; 65 mmHg) and severe hypoxaemia (pulse oximetry saturation &lt; 80%) were the secondary clinical outcomes.</div></div><div><h3>Results</h3><div><span>We screened 43 patients and studied 30 patients. The median age was 58.5 (interquartile range: 49–70) years, and 18 (60%) were male. Near-complete (97%) physiological and medication data were obtained in all patients at all times. Overall, 15 (50%) ETTs occurred after hours (17:30–08:00) and 90% were by video laryngoscopy with a 90% first-pass success rate. Prophylactic vasopressors were used in 50% of ETTs. </span>Fentanyl<span> was used in all except one ETT at a median dose of 2.5 mcg/kg. Propofol<span> (63%) or midazolam (50%) were used as adjuncts at low dose. Rocuronium<span> was used in all but one patient. There were no episodes of severe hypotension and only one episode of short-lived severe hypoxaemia.</span></span></span></div></div><div><h3>Conclusion</h3><div>Minute-by-minute recording of ETT-associated physiological changes in the ICU was feasible but only fully available in two-thirds of the screened patients. ETT was based on fentanyl induction, low-dose adjunctive sedation, and frequent prophylactic vasopressor therapy and was associated with no severe hypotension and a single short-lived episode of severe hypoxaemia.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101078"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535936","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":"‘White lies and safety nets’: The perceptions of nurses on the use of early warning systems and the development of higher-order thinking skills","authors":"Deb Massey RN, PhD ,&nbsp;Tracy Flenady RN, PhD ,&nbsp;Amy-Louise Byrne RN, PhD ,&nbsp;Justine Connor RN, MPhil ,&nbsp;Danielle Le Lagadec RN, PhD","doi":"10.1016/j.aucc.2024.04.007","DOIUrl":"10.1016/j.aucc.2024.04.007","url":null,"abstract":"<div><h3>Background</h3><div>Algorithmic tools such as early warning systems (EWSs) have been embedded into clinical practice globally to facilitate the early recognition of patient deterioration and to guide the escalation of care. Concerns have been raised that the mandated use of these EWS tools may impact the development of nurses' higher-order thinking. However, the relationship between EWS tools and the development of higher-order thinking is poorly understood.</div></div><div><h3>Objectives</h3><div>This paper provides the qualitative results of a larger study that sought to explore the impact of EWS tools on the development of nurses' higher-order thinking. The objective of this component of the study was to ascertain the thoughts and perceptions of nurses on the use of EWSs and how this related to the development of higher-order thinking skills.</div></div><div><h3>Methods</h3><div>A mixed-method, concurrent study design was used to explore the concept of the development of nurses' higher-order thinking in the context of EWS tools. The qualitative responses from a Qualtrics survey were thematically analysed and presented.</div></div><div><h3>Findings</h3><div>Two major themes were uncovered: <em>White Lies</em> and <em>Safety Nets</em>. Our analysis of the data suggested that some nurses amend their documentation practice to accommodate the EWS’s escalation process, uncovering a view that the tool did not account for clinical reasoning. Parallel to this, some nurses found that these systems supported clinical decision-making and helped to build confidence, thus acting as a safety net for their practice.</div></div><div><h3>Conclusion</h3><div>Reliance on EWSs can both hinder and/or support the development of higher-order thinking. Early warning systems are useful tools in ensuring patient safety but should be used in conjunction with nurses' higher-order thinking.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101062"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285315","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":"Flexible fibreoptic bronchoscopy is beneficial in children on extracorporeal membrane oxygenation support","authors":"Pravin Babhalgaonkar MBBS ,&nbsp;Gareth Forster FRACP ,&nbsp;Ian B. Masters FRACP ,&nbsp;Emma Haisz RN ,&nbsp;Adrian Mattke FCICM ,&nbsp;Sarfaraz Rahiman FCICM","doi":"10.1016/j.aucc.2024.05.008","DOIUrl":"10.1016/j.aucc.2024.05.008","url":null,"abstract":"<div><h3>Background</h3><div>Flexible fibreoptic bronchoscopy<span><span> (FFB) has the potential to enhance diagnostic capabilities and improve pulmonary function in children on </span>extracorporeal membrane oxygenation (ECMO).</span></div></div><div><h3>Objectives</h3><div>The objective of this study was to evaluate the benefits (clinical, radiological, and microbiological) of FFB and assess associated complications in children on ECMO.</div></div><div><h3>Methods</h3><div>We conducted a single-centre retrospective observational cohort study in a tertiary paediatric intensive care unit. All FFB episodes performed during the study period on children aged 0–18 years on ECMO were included.</div></div><div><h3>Results</h3><div>Out of the 155 children who received ECMO, 36 (23%) underwent a total of 92 episodes of FFB. FFB provided anatomical and pathological information in 53% (19/36) of cases and proved beneficial in clearing the airways in 62% (54/87) of the episodes.</div><div><span>Overall, patients exhibited transient increases in ECMO and mechanical ventilation<span> support 1 h post FFB in 14% (13/92) and 9.7% (9/92) episodes, respectively. At 6 h, the mean fraction of inspired oxygen on the mechanical ventilator was lower (0.46 [±0.21] vs 0.53 [±0.21] </span></span><em>p</em><span> &lt; 0.01), with no change in mean airway pressure. Similarly, compared to pre-FFB, the fraction of inspired oxygen on the mechanical ventilator on ECMO was lower at 6 h and 24 h (0.65 [±0.25] vs 0.71 [±0.23] </span><em>p</em> &lt; 0.01 and 0.006, respectively), with no significant change in the sweep gas flow and ECMO flow.</div><div>The radiological imaging indicated improved or stable findings in 91% (83/91) of FFB episodes. FFB contributed to the identification of new and previously unknown microbiological information in 75% (27/36) of the patients. The incidence of major complications was 7.6%. Minor self-resolving bleeding occurred in 25% (23/92) episodes, and major bleeding occurred in two episodes, with a total of 10 episodes needing blood product transfusion.</div></div><div><h3>Conclusions</h3><div>FFB is a valuable adjunct in managing children with severe respiratory failure on ECMO, offering clinical benefits with a low rate of major complications. Further studies should aim to develop a consensus approach encompassing criteria and clinical management around FFB in patients on ECMO.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101071"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499624","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}