Australian Critical Care最新文献

{"title":"The development of a family-led novel intervention for delirium prevention and management in the adult intensive care unit: A co-design qualitative study","authors":"Gideon U. Johnson RN, MSN ,&nbsp;Amanda Towell-Barnard RN, PhD ,&nbsp;Christopher McLean RN, PhD ,&nbsp;Beverley Ewens RN, PhD","doi":"10.1016/j.aucc.2024.07.076","DOIUrl":"10.1016/j.aucc.2024.07.076","url":null,"abstract":"<div><h3>Aim</h3><div>The aim of this study was to codesign a Family Members’ Voice Reorientation Intervention (FAMVR) for delirium prevention and management in critically ill adult patients through collaborative process with previous patients, families, and clinical staff.</div></div><div><h3>Background</h3><div>Delirium is a common consequence of intensive care admission, and there is limited evidence to support family-led interventions to prevent or minimise delirium in intensive care. People with lived experience of intensive care are seldom involved in codesigning delirium prevention and management interventions despite the identified benefits of their involvement in delirium care.</div></div><div><h3>Design</h3><div>Codesign qualitative study.</div></div><div><h3>Methods</h3><div>The process of co-designing was undertaken using the four stages of the Double Diamond model. Participants included people with lived experience of the intensive care unit, family members, and intensive care clinicians. The codesign approach was utilised, and data were gathered from a series of focus groups and individual interviews. Data were digitally recorded, transcribed verbatim, and analysed using thematic analysis.</div></div><div><h3>Findings</h3><div>Of the 26 people who indicated their interest in participating, 12 (46%) completed the first and second stages, and nine (35%) completed the third and fourth stages of the Family Members’ Voice Reorientation Intervention development. All participant groups were represented in the fourth stage: patients (n = 4), family members (n = 1), nurses (n = 2), and medical staff (n = 2). Four themes were identified: message content, wording, reactions, and tone, all of which informed the prototype of the intervention and its associated domains.</div></div><div><h3>Conclusion</h3><div>A codesign approach was important for developing a delirium management intervention. This process enabled participants to provide their feedback in the context of their unique experiences, which in turn enhanced the authenticity and appropriateness of this unique intervention.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101088"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918024","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":"Nurses’ perceptions of patient pain, delirium, and sedation assessments in the intensive care unit: A qualitative study","authors":"Anu Correya RN, MScNurs ,&nbsp;Helen Rawson RN, PhD ,&nbsp;Cherene Ockerby BA (Hons) ,&nbsp;Alison M. Hutchinson RN, PhD","doi":"10.1016/j.aucc.2024.05.013","DOIUrl":"10.1016/j.aucc.2024.05.013","url":null,"abstract":"<div><h3>Background</h3><div>Pain, delirium, and sedation should be assessed routinely using validated assessment scales. Inappropriately managed pain, delirium, and sedation in critically ill patients can have serious consequences regarding mortality, morbidity, and increased healthcare costs. Despite the benefits of a bundled approach to pain, delirium, and sedation assessments, few studies have explored nurses' perceptions of using validated scales for such assessments. Furthermore, no studies have examined nurses’ perceptions of undertaking these assessments as a bundled approach.</div></div><div><h3>Objectives</h3><div>The objective of this study was to explore nurses’ knowledge, perceptions, attitudes, and experiences regarding the use of validated pain, delirium, and sedation assessment tools as a bundled approach in the intensive care unit (ICU).</div></div><div><h3>Methods</h3><div>A qualitative exploratory descriptive design was adopted. We conducted four focus groups and 10 individual interviews with 23 nurses from a 26-bed adult ICU at an Australian metropolitan tertiary teaching hospital. Data were analysed using thematic analysis techniques.</div></div><div><h3>Findings</h3><div>Four themes were identified: (i) factors impacting nurses' ability to undertake pain, delirium, and sedation assessments in the ICU; (ii) use, misuse, and nonuse of tools and use of alternative strategies to assess pain, delirium, and sedation; (iii) implementing assessment tools; and (iv) consequences of suboptimal pain, delirium, and sedation assessments. A gap was found in nurses’ use of validated scales to assess pain, delirium, and sedation as a bundled approach, and they were not familiar with using a bundled approach to assessment.</div></div><div><h3>Conclusion</h3><div>The practice gap could be addressed using a carefully planned implementation strategy. Strategies could include a policy and protocol for assessing pain, delirium, and sedation in the ICU, engagement of change champions to facilitate uptake of the strategy, reminder and feedback systems, further in-service education, and ongoing workplace training for nurses.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101076"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499625","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":"Nutrition intake, muscle thickness, and recovery outcomes for critically ill patients requiring non-invasive forms of respiratory support: A prospective observational study","authors":"Elizabeth Viner Smith BND (Hons) ,&nbsp;Matthew J. Summers BSc, MDiet ,&nbsp;Imogen Asser BHlthMedSc ,&nbsp;Rhea Louis BMedSc (Hons) ,&nbsp;Kylie Lange BSc Ma&CompSci (Hons) ,&nbsp;Emma J. Ridley BNutrDiet, PhD ,&nbsp;Lee-anne S. Chapple BMedSc, MNutrDiet, PhD","doi":"10.1016/j.aucc.2024.07.078","DOIUrl":"10.1016/j.aucc.2024.07.078","url":null,"abstract":"<div><h3>Background</h3><div>Use of high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) in the intensive care unit (ICU) is increasing, yet reporting of nutrition intake, muscle thickness, or recovery outcomes in this population is limited.</div></div><div><h3>Objective</h3><div>The objective of this study was to quantify muscle thickness, nutrition intake, and functional recovery outcomes for patients receiving HFNC/NIV within the ICU.</div></div><div><h3>Methods</h3><div>A single-centre, prospective, observational study in adult ICU patients recruited within 48 hrs of commencing HFNC/NIV. Change in quadriceps muscle layer thickness using ultrasound (primary outcome) and 24 hr nutrition intake from study inclusion to day 7 (D7), functional capacity (Barthel Index), and quality of life (EuroQol five-dimension five-level utility index) at D90 were assessed. Data are <em>n</em> (%), mean ± standard deviation or median [interquartile range], are compared using paired sample t-test, and a <em>P</em> value of &lt;0.05 was considered significant.</div></div><div><h3>Results</h3><div>Primary outcome data were available for <em>n</em> = 28/42: 64 ± 13 y, 61% male, body mass index: 29.1 ± 9.0 kg/m², and Acute Physiology and Chronic Health Evaluation II score: 17 ± 5. Quadriceps muscle layer thickness reduced from 2.41 ± 0.87 to 2.12 ± 0.73 cm; mean difference: −0.29 cm (95% confidence interval: -0.44, −0.13). Nutrition intake increased from study inclusion to D7: 1735 ± 1283 to 5448 ± 2858 kJ and 17.4 ± 16.6 to 60.9 ± 36.8g protein. Barthel Index was 87 ± 20 at baseline and 91 ± 15 at D90 (out of 100). Quality of life was impaired at D90: 0.64 ± 0.23 (health = 1.0).</div></div><div><h3>Conclusion</h3><div>Critically ill patients receiving HFNC/NIV experienced muscle loss and impaired quality of life.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101097"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037746","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":"Effect of different mouthwashes on ventilator-related outcomes and mortality in intensive care unit patients: A network meta-analysis","authors":"Qianqian He BSc(Nurs) ,&nbsp;Zengjin Peng MSc(Nurs) ,&nbsp;Caiyun He RN ,&nbsp;Chao Zhang BSc(Nurs) ,&nbsp;Rong Hu BSc(Nurs)","doi":"10.1016/j.aucc.2024.06.014","DOIUrl":"10.1016/j.aucc.2024.06.014","url":null,"abstract":"<div><h3>Background</h3><div>Ventilator-associated pneumonia is a common and life-threatening complication in intensive care unit (ICU) patients. Maintaining oral hygiene is crucial for reducing ventilator-associated pneumonia incidence. Various mouthwash solutions are used for oral care in ICU settings, but their comparative effectiveness remains unclear. This study aims to systematically evaluate and compare the efficacy and safety of commonly used mouthwashes for oral care in mechanically ventilated ICU patients.</div></div><div><h3>Methods</h3><div>We searched PubMed, Web of Science, Embase, and Cochrane Library for randomised controlled trials (RCTs) comparing saline, chlorhexidine, sodium bicarbonate, oxidising agents, herbal extracts, and povidone-iodine for oral care in ventilated ICU patients. Outcomes included ventilator-associated pneumonia incidence, ICU mortality, duration of ventilation, and <em>Escherichia coli</em> fixed value. A network meta-analysis (NMA) was conducted to synthesise direct and indirect evidence. This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols, 2023120028.</div></div><div><h3>Results</h3><div>FourteenRCTs with 1644 participants were included. Oxidising agents showed a trend towards reducing the incidence of VAP compared to the control group (risk ratio: 0.24, 95% confidence interval: 0.05–1.10). Administration of saline was associated with a notable reduction in ICU mortality (risk ratio: 0.18, 95% confidence interval: 0.04–0.88) versus no mouthwash. No significant differences were observed in the duration of mechanical ventilation between chlorhexidine, povidone-iodine, and the control group.</div></div><div><h3>Conclusions</h3><div>Antimicrobial mouthwashes, especially chlorhexidine, pose potential risks in ICU patients; oxidising solutions demonstrate relative safety. Saline solution emerges as a promising alternative, associated with a significant reduction in mortality rates. However, the need for large, high-quality RCTs remains paramount to substantiate these findings and establish evidence-based oral-care protocols in ICU settings.</div></div><div><h3>Registration</h3><div>This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols, 2023120028.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101095"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047484","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":"Effectiveness, experience, and usability of low-technology augmentative and alternative communication in intensive care: A mixed-methods systematic review","authors":"Hissah A. Alodan OT, MSc ,&nbsp;Anna-Liisa Sutt MSPA, CPSP, PhD ,&nbsp;Rebekah Hill RGN, MSc, MA, PhD ,&nbsp;Joud Alsadhan OT, MSc ,&nbsp;Jane L. Cross Grad Dip Phys, MSc, EdD","doi":"10.1016/j.aucc.2024.04.006","DOIUrl":"10.1016/j.aucc.2024.04.006","url":null,"abstract":"<div><h3>Background</h3><div>Patients in the intensive care unit (ICU) are commonly on mechanical ventilation, either through endotracheal intubation or tracheostomy, which usually leaves them nonverbal. Low-technology augmentative and alternative communication (AAC) strategies are simple and effective ways to enhance communication between patients and their communication partners but are underutilised.</div></div><div><h3>Aim</h3><div>The aim of this study was to systematically review current evidence regarding the effectiveness, experience of use, and usability of low-technology AAC with nonverbal patients and their communication partners in the ICU.</div></div><div><h3>Methods</h3><div>This review included quantitative, qualitative, and mixed-methods studies of adult ICU patients aged 18 or older who were nonverbal due to mechanical ventilation and their communication partners. Studies using low-technology AAC, such as communication boards and pen and paper, were included. Six databases were searched, and the review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A convergent segregated approach was used for data synthesis.</div></div><div><h3>Results</h3><div>Thirty-two studies were included. Low-technology AAC improved patient satisfaction, facilitated communication, and met patients' physical and psychological needs. Communication boards with mixed content (e.g., pictures, words, and letters) were preferred but were used less frequently than unaided strategies due to patients' medical status, tool availability, and staff attitudes. Boards should be user-friendly, tailored, include pen/paper, and introduced preoperation to increase patient's comfort when using them postoperatively.</div></div><div><h3>Conclusion</h3><div>Existing evidence support low-technology AAC's efficacy in meeting patients' needs. Better usability hinges on proper implementation and addressing challenges. Further research is crucial for refining communication-board design, ensuring both user-friendliness and sophistication to cater to ICU patients' diverse needs.</div></div><div><h3>Registration</h3><div>The review protocol was registered in the International Prospective Register of Systematic Reviews, with registration number CRD42022331566.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101061"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312266","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":"The role of critical care nurses in organ and tissue donation: A position statement of the Australian College of Critical Care Nurses","authors":"Melissa J. Bloomer RN, PhD ,&nbsp;Laura A. Brooks RN, MN ,&nbsp;Alysia Coventry RN, MPhil ,&nbsp;Kristen Ranse RN, PhD ,&nbsp;Jessie Rowe RN, Grad Dip Nurs Pract (Paediatric Crit Car) ,&nbsp;Shontelle Thomas RN, Grad Cert Nurs Pract (Paediatric Intens Care)","doi":"10.1016/j.aucc.2024.05.010","DOIUrl":"10.1016/j.aucc.2024.05.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Australian organ and tissue donation rates are low compared to other countries. Acknowledging that donation practices vary across Australia, the Australian College of Critical Care Nurses supported the development of a position statement to explicate critical care nurses’ role in supporting organ and tissue donation. Several Australian peak professional organisations provide guidance to inform and support organ and tissue donation.</div></div><div><h3>Aim</h3><div>The aim of this study was to develop a position statement using contemporary Australian research evidence to build upon and complement existing guidance, focussing on the role of critical care nurses in organ and tissue donation in Australian critical care.</div></div><div><h3>Method</h3><div><span>An approach similar to a rapid review was used, providing a streamlined approach to synthesising evidence. A comprehensive search using Medical Subject Headings, keywords, and synonyms was undertaken using Medline and CINAHL Complete via EBSCOhost to identify peer-reviewed Australian research evidence about critical care nurses’ role, obligations, expectations, and </span>scope of practice during organ and tissue donation. Narrative synthesis was used to synthesise the research evidence.</div></div><div><h3>Findings</h3><div>The importance of separating death from organ donation in discussions with family, the timing and the approach to organ donation conversations, and working in collaboration with the DonateLife Donation Specialist Nurses were identified. The importance of understanding family perspectives, caring for families, and collegial support for critical care clinicians were also identified. With the guidance of peak professional organisations, the research evidence was then used to develop practice recommendations for critical care units, leaders, and critical care nurses.</div></div><div><h3>Discussion and conclusion</h3><div>The recommendations explicate the important contribution critical care nurses can make to ensuring timely, sensitive communication, providing high-quality end-of-life care, supporting families irrespective of the donation decision and supporting colleagues from the wider critical care team, thereby optimising the processes related to organ and tissue donation in Australian critical care settings.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101073"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141328064","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":"Exploring critically ill patients’ functional recovery through family partnerships: A descriptive qualitative study","authors":"Julie Cussen MN, BN ,&nbsp;Sasithorn Mukpradab RN, PhD ,&nbsp;Georgia Tobiano RN, PhD ,&nbsp;Kimberley J. Haines BHSc, PhD ,&nbsp;Lauren O’Connor MPhil, BPhty ,&nbsp;Andrea P. Marshall RN, PhD","doi":"10.1016/j.aucc.2024.06.007","DOIUrl":"10.1016/j.aucc.2024.06.007","url":null,"abstract":"<div><h3>Background</h3><div>Early mobilisation interventions play a role in preventing intensive care unit–acquired weakness in critically ill patients and may contribute to improved recovery. Patient-and-family-centred care includes collaborative partnerships between healthcare professionals and families and is a potential strategy to promote early mobilisation in critical care; however, we currently do not know family member preferences for partnering and involvement in early mobilisation interventions.</div></div><div><h3>Objectives</h3><div>The objective of this study was to explore family member perspectives on the acceptability and feasibility of partnering with healthcare professionals in early mobilisation interventions for adult critically ill patients.</div></div><div><h3>Methods</h3><div>A descriptive qualitative design. Semistructured interviews were conducted with family members of adult critically ill patients admitted to an intensive care unit. Data were collected through individual audio-recorded interviews. Interview data were analysed using the six phases of thematic analysis described by Braun and Clark. This study is reported following the Consolidated Criteria for Reporting Qualitative Research guidelines.</div></div><div><h3>Results</h3><div>Most family members of critically ill patients found the idea of partnering with healthcare professionals in early mobilisation interventions acceptable and feasible, although none had ever considered a partnership before. Participants thought their involvement in early mobilisation would have a positive impact on both the patient's and their own wellbeing. Themes uncovered showed that understanding family-member readiness and their need to feel welcome and included in the unfamiliar critical care environment are required before family member and healthcare professional partnerships in early mobilisation interventions can be enacted.</div></div><div><h3>Conclusions</h3><div>Family members found partnering with healthcare professionals in early mobilisation interventions acceptable and feasible to enact, but implementation is influenced by their readiness and sense of belonging.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101084"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898933","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 systematic review of the comparative effects of sound and music interventions for intensive care unit patients’ outcomes","authors":"Elizabeth Papathanassoglou RN, PhD ,&nbsp;Usha Pant RN, MN ,&nbsp;Shaista Meghani RN, PhD ,&nbsp;Neelam Saleem Punjani RN, PhD ,&nbsp;Yuluan Wang MSc Rehabilitation Science, MLT, CCW ,&nbsp;Tiffany Brulotte MTA, MA ,&nbsp;Krooti Vyas RN, BScN (Hons) ,&nbsp;Liz Dennett MLIS ,&nbsp;Lucinda Johnston MTA, MLIS ,&nbsp;Demetrios James Kutsogiannis MD, PhD ,&nbsp;Stephanie Plamondon MD FRCPC ,&nbsp;Michael Frishkopf PhD","doi":"10.1016/j.aucc.2024.101148","DOIUrl":"10.1016/j.aucc.2024.101148","url":null,"abstract":"<div><h3>Background</h3><div>Despite syntheses of evidence showing efficacy of music intervention for improving psychological and physiological outcomes in critically ill patients, interventions that include nonmusic sounds have not been addressed in reviews of evidence. It is unclear if nonmusic sounds in the intensive care unit (ICU) can confer benefits similar to those of music.</div></div><div><h3>Objective</h3><div>The aim of this study was to summarise and contrast available evidence on the effect of music and nonmusic sound interventions for the physiological and psychological outcomes of ICU patients based on the results of randomised controlled trials.</div></div><div><h3>Methods</h3><div>This systematic review was directed by a protocol based on the Methodological Expectations of Cochrane Intervention Reviews. Quality of studies was assessed with the Cochrane risk of bias assessment tool. Searches were performed in the following databases: MEDLINE, Embase, APA PsycInfo, CINAHL Plus with Full Text, Academic Search Complete, RILM Abstracts of Music Literature, Web of Science, and Scopus.</div></div><div><h3>Results</h3><div>We identified 59 articles meeting the inclusion criteria, 37 involving music and 22 involving nonmusic sound interventions, with one study comparing music and sound. The identified studies were representative of a general ICU population, regardless of patients’ ability to communicate. Our review demonstrated that both slow-tempo music and sound interventions can significantly (i) decrease pain; (ii) improve sleep; (iii) regulate cortisol levels; (iv) reduce sedative and analgesic need; and (v) reduce stress/anxiety and improve relaxation when compared with standard care and noise reduction. Moreover, compared to nonmusic sound interventions, there is more evidence that music interventions have an effect on stress biomarkers, vital signs, and haemodynamic measures.</div></div><div><h3>Conclusion</h3><div>These results raise the possibility that different auditory interventions may have varying degrees of effectiveness for specific patient outcomes in the ICU. More investigation is needed to clarify if nonmusic sound interventions may be equivalent or not to music interventions for the management of discrete symptoms in ICU patients.</div></div><div><h3>Registration of reviews</h3><div>The protocol was registered on Open Science Framework in November 6 2023 (<span><span>https://doi.org/10.17605/OSF.IO/45F6E</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101148"},"PeriodicalIF":2.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900295","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":"An interprofessional multicomponent intervention to improve end-of-life care in intensive care: A before-and-after study","authors":"Tania Lovell RN, MPH/HM ,&nbsp;Marion Mitchell RN, PhD ,&nbsp;Madeleine Powell RN, MPH/HM ,&nbsp;Petra Strube RN, MN ,&nbsp;Angela Tonge BSW, Grad Cert Hlth Studies (Loss & Grief) ,&nbsp;Kylie O’Neill RN, MN ,&nbsp;Elspeth Dunstan RN, MN ,&nbsp;Amity Bonnin-Trickett RN, Grad Cert (Critical Care) ,&nbsp;Elizabeth Miller B BEH SC (Hons Psych) ,&nbsp;Adam Suliman MB ,&nbsp;Tamara Ownsworth PhD ,&nbsp;Kristen Ranse RN, PhD","doi":"10.1016/j.aucc.2024.101147","DOIUrl":"10.1016/j.aucc.2024.101147","url":null,"abstract":"<div><h3>Background</h3><div>The provision of end-of-life care (EOLC) is an ongoing component of practice in intensive care units (ICUs). Interdisciplinary, multicomponent interventions may enhance the quality of EOLC for patients and the experience of family members and ICU clinicians during this period.</div></div><div><h3>Objectives</h3><div>This study aimed to assess the impact of a multicomponent intervention on EOLC practices in the ICU and family members' and clinicians’ perceptions of EOLC.</div></div><div><h3>Methods</h3><div>A before-and-after interventional study design was used. Interventions comprising of EOLC guidelines, environmental and memory-making resources, EOLC education day for nurses, web-based resources, and changes to EOLC documentation processes were implemented in a 30-bed adult tertiary ICU from September 2020 onwards. Data collection included electronic health record audits of care provided post initiation of EOLC and family and clinician surveys. Open-ended survey questions were analysed using content analysis. Data from before and after the intervention were compared using the Chi-squared test for categorical variables, unpaired two-sample t-tests for normally distributed continuous measurements, and Mann–Whitney U tests for non-normally distributed data.</div></div><div><h3>Findings</h3><div>A reduction in documented observations and medications and an increased removal of invasive devices unrelated to EOLC were observed post the intervention. The mean overall satisfaction of family members improved from 4.5 to 5 (out of 5); however, this was not statistically significant. Statistically significant improvements in clinicians' perception of overall quality of EOLC (mean difference = 0.28, 95% confidence interval: 0.18, 0.37; t₂₈₂ = 5.8, P &lt; 0.01) were found. Although statistically significant improvements were evident in all subscales measured, clinicians’ work stress related to EOLC and support for staff, patients, and their families were identified as needing further improvement.</div></div><div><h3>Conclusions</h3><div>The development and implementation of a multicomponent interdisciplinary intervention successfully improved EOLC quality, as measured by chart audit and family and clinician perceptions. Continuing interdisciplinary collaboration is needed to drive further change to continue to support high-quality EOLC for patients, families, and clinicians in the ICU.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101147"},"PeriodicalIF":2.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847981","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 clinical utility of shock index in hospitalised patients requiring activation of the rapid response team","authors":"Hasan M. Al-Dorzi MD ,&nbsp;Yasser A. AlRumih MBBS ,&nbsp;Mohammed Alqahtani MBBS ,&nbsp;Mutaz H. Althobaiti MBBS ,&nbsp;Thamer T. Alanazi MD ,&nbsp;Kenana Owaidah MBBS ,&nbsp;Saud N. Alotaibi MBBS ,&nbsp;Monirah Alnasser MBBS, MPH ,&nbsp;Abdulaziz M. Abdulaal MBBS ,&nbsp;Turki Z. Al Harbi MBBS ,&nbsp;Ahmad O. AlBalbisi MBBS ,&nbsp;Saad Al-Qahtani MD ,&nbsp;Yaseen M. Arabi MD, FCCP, FCCM, ATSF","doi":"10.1016/j.aucc.2024.101150","DOIUrl":"10.1016/j.aucc.2024.101150","url":null,"abstract":"<div><h3>Background</h3><div>The systolic shock index (SSI) is used to direct management and predict outcomes, but its utility in patients requiring rapid response team (RRT) activation is unclear.</div></div><div><h3>Objectives</h3><div>We explored whether SSI can predict the outcomes of ward patients experiencing clinical deterioration and compared its performance with other parameters.</div></div><div><h3>Methods</h3><div>This retrospective study included adult patients in medical/surgical wards who required RRT activation. We calculated SSI (heart rate/systolic blood pressure [BP]), diastolic shock index (DSI, heart rate/diastolic BP), modified shock index (heart rate/mean BP), and quick Sequential Organ Failure Assessment (qSOFA) score at activation. We categorised patients into two groups (SSI: ≥1.0 and &lt;1.0). We performed univariate and multivariable logistic regression analyses to evaluate the association of SSI with intensive care unit (ICU) admission, vasopressor therapy, and in-hospital mortality. The covariates included demographics, comorbidities, and reasons for RRT activation.</div></div><div><h3>Results</h3><div>Among the 837 study patients, 297 (35.5%) had an SSI ≥1.0. On univariate analysis, SSI was associated with vasopressor therapy (odds ratio [OR]: 2.04, 95% confidence interval [CI]: 1.40–2.99) but not ICU admission or in-hospital mortality. On multivariable logistic regression analysis, an SSI ≥1.0 was associated with ICU admission (adjusted OR: 1.55, 95% CI: 1.05–2.28), vasopressor therapy (adjusted OR: 3.05, 95% CI: 1.86–5.00), and in-hospital mortality (adjusted OR: 2.18, 95% CI: 1.42–3.33). A systolic BP &lt;90 mmHg, mean BP &lt; 65 mmHg, and qSOFA score ≥2 were associated with these outcomes in univariate and multivariable regression analyses (adjusted ORs close to those of SSI). Separate receiver operating characteristic curve analysis found that SSI, diastolic shock index, and modified shock index poorly discriminated between survivors and nonsurvivors (area under the curve: &lt;0.60 for all).</div></div><div><h3>Conclusions</h3><div>In ward patients experiencing clinical deterioration, an SSI ≥1.0 was associated with adverse outcomes but did not perform better than systolic and mean BP and qSOFA. This limits its standalone clinical utility in these patients.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101150"},"PeriodicalIF":2.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848128","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}