Nursing in Critical Care最新文献

{"title":"Knowledge, attitudes and practices of ICU nurses regarding postextubation dysphagia in tracheal intubation patients in 25 hospitals in China: A multicentre cross-sectional survey.","authors":"Yanmin Zheng, Nianqi Cui, Ruiqin Sha, Wenfan Yu, Yapeng Tan, Xueyan Guan, Yaruo Huang, Rui Hu, Zexi Huang, Ying Tian","doi":"10.1111/nicc.13280","DOIUrl":"10.1111/nicc.13280","url":null,"abstract":"<p><strong>Background: </strong>Postextubation dysphagia is common in the ICU, with varying incidence rates. However, few studies have focused on ICU nurses' knowledge, attitudes and practices regarding postextubation dysphagia, as well as the various influencing factors.</p><p><strong>Aims: </strong>To investigate ICU nurses' knowledge, attitudes and practices regarding postextubation dysphagia and provide suggestions for improvement.</p><p><strong>Study design: </strong>This was a multicentre cross-sectional survey. Data were collected using a validated questionnaire to assess knowledge, attitudes and practices regarding postextubation dysphagia.</p><p><strong>Results: </strong>A total of 510 valid questionnaires were analysed. The median scores with interquartile ranges for knowledge, attitudes and practices regarding postextubation dysphagia were 8 (7, 9), 8 (7, 9) and 4.9 (3.8, 6.2), respectively. Multivariate analysis revealed that knowledge scores were significantly influenced by education level, ICU experience and managerial role (p < .05). Nurses with a bachelor's degree (OR = 3.636; 95% CI: 1.587-8.33) or a master's degree and above (OR = 7.742; 95% CI: 1.968-30.465) demonstrated higher knowledge scores than those with a postsecondary diploma. Nurses in managerial roles had higher scores (OR = 1.924; 95% CI: 1.053-3.515). Attitude (OR = 1.616; 95% CI: 1.092-2.39) and practice scores (OR = 4.079; 95% CI: 2.692-6.182) were significantly impacted by targeted PED training (p < .05). The correlation analysis revealed a weak but significant correlation only between knowledge and attitudes (τb = 0.196, p < .001).</p><p><strong>Conclusion: </strong>Education level, ICU experience, managerial role and targeted PED training may enhance knowledge, attitudes or practices individually but do not lead to cohesive improvement across all three areas. Relying on knowledge alone is far from sufficient to drive behavioural change, indicating the need for comprehensive interventions to bridge these gaps.</p><p><strong>Relevance to clinical practice: </strong>To bridge this gap, comprehensive interventions beyond standard training are essential. These may include applying an implementation science strategy to ensure that ICU nurses' enhanced knowledge and positive attitudes are consistently translated into clinical practice.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 2","pages":"e13280"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11876486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544431","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 relationship between post-traumatic stress disorder and sleep quality in intensive care unit professionals.","authors":"Sevinç Mersin, Özlem İbrahimoğlu, Muhammet Emin Naldan, Ali Arslanoğlu","doi":"10.1111/nicc.13276","DOIUrl":"10.1111/nicc.13276","url":null,"abstract":"<p><strong>Background: </strong>Intensive care units (ICUs) have impact on physical and mental health not only for patients but also for health professionals. Post-traumatic stress disorder that may occur in ICU professionals may negatively affect the treatment and care process by affecting their sleep quality.</p><p><strong>Aim: </strong>This study aims to evaluate the relationship between post-traumatic stress disorder and sleep quality in intensive care unit professionals.</p><p><strong>Study design: </strong>The cross-sectional study conducted with 341 (nurses, physicians and others) professionals working in the ICUs in Turkey. Data were collected with a socio-demographic form, Posttraumatic Stress Disorder-Short Scale (PTSD-SS) and Richard-Campbell Sleep Questionnaire (RCSQ).</p><p><strong>Results: </strong>The mean PTSD-SS and RCSQ scale scores of the participants were 15.37 ± 6.72 (min: 0, max: 35) and 46.61 ± 22.46 (min: 0, max: 100). When the cutoff points of the scores obtained from PTSD-SS was examined, 12.9% (n = 33) of ICU nurses, 11.3% (n = 6) of the physicians and 3.4% (n = 1) of the other health professionals had post-traumatic stress disorder symptoms, and it was determined that the prevalence of PTSD in all ICU professionals was 12% (n = 40). In addition, there was a statistically significant negative weak correlation between PTSD-SS and RCSQ (r = -0.207) (p < .05).</p><p><strong>Conclusions: </strong>The results of this study show that increasing the level of PTSD causes sleep quality to deteriorate. Therefore, evaluation and recognition of PTSD symptoms in ICU professionals and interventions to be important in maintaining sleep quality. Additionally, the results of this study can be used in planning to improve the mental health of ICU nurses. Therefore, greater support for ICU nurses to prevent PTSD is recommended.</p><p><strong>Relevance to clinical practice: </strong>It is important and necessary to prevent the development of PTSD in ICU nurses and to reduce its negative impact on sleep quality.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 2","pages":"e13276"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11867011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517235","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":"Breaking bad news: Comparing the perception of the role, barriers and experiences of neonatal intensive care and well-baby nursery nurses.","authors":"Lilach Haim-Eli, Julie Benbenishty, Anna C Kienski Woloski Wruble","doi":"10.1111/nicc.13119","DOIUrl":"10.1111/nicc.13119","url":null,"abstract":"<p><strong>Background: </strong>Nurses accompany patients throughout the breaking bad news process.</p><p><strong>Aim: </strong>The aim of the research was to compare neonatal intensive care unit (NICU) nurses and well-baby nursery (WBN) nurses on their role, barriers and experiences in breaking bad news to parents/relatives during hospitalization.</p><p><strong>Study design: </strong>A cross-sectional comparative study.</p><p><strong>Results: </strong>Two medical centres in Israel were employed. A 39-item questionnaire was distributed with 140 nurses participating in the study. STROBE Checklist was used. A total of 140 nurses participated in this study. There was no significant overall difference (p ≤ .45) between NICU and WBN nurses in their perception of their role in breaking bad news. Differences were found in barriers to the role which included a lack of information, lack of time and communication issues. No differences were found in the nurses' experiences in breaking bad news. NICU and WBN nurses reported that they received no support (n = 40, 58.8%; n = 45, 64.3%, respectively). No breaking bad news specialty team existed in either unit (NICU: n = 64, 91.4%; n = 60, 87.0%).</p><p><strong>Conclusions: </strong>Nurses in the WBN and NICU are involved in breaking bad news. The role of the nurse has not been fully acknowledged making it difficult to perform. Nurses' experiences in breaking bad news were varied. Nurses facing challenges should be provided guidance and support. This needs to be implemented.</p><p><strong>Relevance to clinical practice: </strong>The role played by nurses in breaking bad news has not been fully acknowledged making it difficult to perform. Nurses need to receive formal training and support in order to improve this practice.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13119"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861625","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":"How to master point-of-care ultrasound as an advanced paediatric nurse practitioner in critical care.","authors":"Jennifer Elizabeth Norton, Andras Husz, Zoltan Gyorgyi","doi":"10.1111/nicc.70019","DOIUrl":"https://doi.org/10.1111/nicc.70019","url":null,"abstract":"<p><p>Point-of-care ultrasound (POCUS) offers diagnostic insights, safety enhancements and increased procedural success in neonatal and paediatric care. However, POCUS use among Advanced Nurse Practitioners (ANPs) in the United Kingdom is limited. This study outlines a roadmap for ANPs to develop POCUS competence in Paediatric Critical Care (PCC), improving diagnostic efficiency, management and procedural success. POCUS integration in paediatric ANP roles enhances patient care. A structured training pathway and supportive team environment are crucial for skill acquisition. ANPs can potentially participate in POCUS-related quality improvement and research projects as well. ANPs are well positioned to deliver POCUS skilfully, and its integration into clinical practice can lead to improved patient outcomes and enhanced health care delivery.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 2","pages":"e70019"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665277","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":"Effect of frozen saline and menthol gum on thirst level after abdominal surgery: A mixed-methods study.","authors":"Bahar Aslan, Meral Özkan","doi":"10.1111/nicc.13288","DOIUrl":"10.1111/nicc.13288","url":null,"abstract":"<p><strong>Background: </strong>Thirst is rarely studied in practice. Even though this condition is experienced intensively in surgical patients, it is still not listed in the nursing diagnoses classification and there is no standard for quenching thirst.</p><p><strong>Aim: </strong>The study was conducted to determine effect of frozen saline and menthol gum on thirst level after abdominal surgery.</p><p><strong>Study design: </strong>This mixed-methods study was conducted between March 2020 and July 2021. A power analysis determined the inclusion of 159 patients. Quantitative data were collected using the Patient Information Form, FOUR Score, Safe Protocol for Early Postoperative Thirst Management, and Numerical Rating Scale. The qualitative stage involved a descriptive study design, with four open-ended questions informed by the literature. After gathering quantitative data, patients were interviewed by phone, and the qualitative data were analysed using thematic analysis.</p><p><strong>Results: </strong>Patients' thirst level in the frozen saline and menthol gum group was lower than the control group at all time (Cohen's d = .217, 95% confidence interval 5.43 to 6.35; p = 0.000). In the qualitative stage, three main themes emerged: thirst experience, post-application opinions and feelings. After the interventions, patients reported that they felt well intensely.</p><p><strong>Conclusions: </strong>Frozen saline and menthol gum were found to be effective in quenching thirst after abdominal surgery. The patients in the experimental groups expressed their opinions about feeling well after the applications, and the majority of the patients stated that they wanted the application to be repeated.</p><p><strong>Relevance to clinical practice: </strong>Despite several attempts to quench thirst, thirst still remains a significant problem in intensive care units. It is felt more commonly and intensely, especially in surgical intensive care patients. However, it is a symptom that is not taken into consideration enough. For this reason, intensive care nurses need to increase their focus on issues of thirst.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 2","pages":"e13288"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651837","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":"A descriptive investigation of alarm activation in a critical care setting.","authors":"Van Nguyen, Brendan MacDonald, Anthony Cignarella, Charne Miller","doi":"10.1111/nicc.13302","DOIUrl":"10.1111/nicc.13302","url":null,"abstract":"<p><strong>Background: </strong>Alarm fatigue, a phenomenon referring to clinicians being desensitized to the high volume of monitoring alarms, can impact the working environment, clinical care and patient outcomes. Explorations and understandings of alarm fatigue have yet to be a focus of attention in the Australian context.</p><p><strong>Aim: </strong>To describe the prevalence and type of alarms activated in intensive care and cardiac units in a major metropolitan hospital in Victoria, Australia.</p><p><strong>Study design: </strong>This study was a descriptive observation study of patient monitoring data gathered over a 1-month time frame during April 2019. Data from the Philips Healthcare IntelliVue® Patient Monitoring system were extracted. After classifying the alarms into types (clinical or technical) and levels of urgency (lower or higher priority), further descriptive analysis was conducted to quantify the most prevalent alarms.</p><p><strong>Results: </strong>During the study period, a total of 271 414 activated alarms were identified. The majority were clinical alarms (89.1%) compared with technical alarms (10.9%). Clinical alarms tended to be classified as high priority (55.1%); the most common were heart rate (36.7%) and premature ventricular contraction (18.8%). Technical alarms were predominantly electrocardiogram lead disconnection (89%). The frequency of alarms per patient-bed day was highest in the acute cardiac unit (98 alarms) compared with the intensive care unit (67 alarms).</p><p><strong>Conclusion: </strong>Staff education and a culture of individual alarm customization might influence the number of alarms activated in the study settings. Further research is also required to examine alarm fatigue in other Australian critical care settings, and responses to alarms by clinicians, and whether these responses are calibrated to detect clinical deterioration and sentinel events.</p><p><strong>Relevance to clinical practice: </strong>A bundle of interventions should be in place to increase the accuracy of alarm monitoring and to reduce non-actionable alarms in order to reduce the possible impacts on clinicians, patients and their families/visitors.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 2","pages":"e13302"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494573","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":"Nursing staff adherence to guidelines on nutritional management for critically ill patients with cancer: A service evaluation.","authors":"Marie Parsons","doi":"10.1111/nicc.13062","DOIUrl":"10.1111/nicc.13062","url":null,"abstract":"<p><strong>Background: </strong>Critically ill patients with cancer are at high risk of developing malnutrition, negatively affecting their outcome.</p><p><strong>Aim: </strong>To critically analyse nursing staff's adherence to nutrition management guidelines for critically unwell patients with cancer and identify barriers which prevent this. Two areas of nutrition management were evaluated: early initiation (<48 h from admission) of enteral nutrition (EN) and continuation of EN without interruption.</p><p><strong>Study design: </strong>A retrospective data analysis was performed on mechanically ventilated adult patients admitted to a single cancer centre. Data from electronic patient records (EPR) were collected. Health care professionals' (HCP) documentation was analysed, and a nursing staff focus group (n = 5) was undertaken.</p><p><strong>Results: </strong>Sixty-four patient records were included. Early EN was not administered in 67% (n = 43) of cases. The reasons for the three longest interruptions to EN feed were as follows: delays in EN tube insertion, gastric residual volumes (GRVs) less than the recommended feed discontinuation threshold and endotracheal intubation. Four main themes relating to barriers to practice were identified from the focus group data analysis: HCPs' approach towards nutrition management, the patient's physiological condition and stability, multi-disciplinary team (MDT) communication and guidance on nutrition management, and practical issues with patient care.</p><p><strong>Conclusions: </strong>Multi-disciplinary communication difficulties, lack of clear guidelines and inadequate awareness of the importance of nutrition for critically ill patients with cancer were barriers identified preventing optimal nutrition management.</p><p><strong>Relevance to clinical practice: </strong>Nursing education is fundamental to help break down the barriers to practice which prevent critically ill patients from receiving optimal nutrition management.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13062"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11862872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177652","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":"Investigating key factors of feeding intolerance in severe acute pancreatitis: A scoping review.","authors":"Yujia Gu, O Mensah Solomon, Yehong Wei","doi":"10.1111/nicc.13093","DOIUrl":"10.1111/nicc.13093","url":null,"abstract":"<p><strong>Background: </strong>The complexity of severe acute pancreatitis (SAP) and the stress caused by the disease is associated with a high incidence of feeding intolerance. However, the factors influencing feeding incontinence in patients with SAP are diverse.</p><p><strong>Aims: </strong>To systematically analyse relevant studies that investigate the occurrence of feeding intolerance in patients with SAP, identify the relevant factors of feeding intolerance in such patients and provide a reference for nursing staff to develop relevant intervention measures.</p><p><strong>Design and methods: </strong>This scoping review followed the approach proposed by Arksey and O'Malley. Seven electronic databases were searched from their establishment until August 2023. This included research on the factors influencing feeding intolerance in patients with SAP, determining research questions, completing literature screening and quality evaluation, extracting data and summarizing and analysing the data. The PRISMA extension for scoping reviews (PRISMA-ScR) statement has also been included.</p><p><strong>Results: </strong>A total of 23 articles were included. The factors influencing feeding intolerance in patients with SAP included the patient's condition, disease, treatment, feeding management and follow-up care.</p><p><strong>Conclusions: </strong>The factors affecting feeding intolerance in patients with SAP are multifaceted. A personalized nursing care plan should be developed based on relevant risk factors to improve feeding tolerance and comfort in patients with SAP and shorten hospitalization time.</p><p><strong>Relevance to clinical practice: </strong>Intensive care nurses should identify the risk factors for feeding intolerance in patients with SAP and implement appropriate interventions. To identify the risk factors, nurses must be updated with courses and training. Moreover, a systematic feeding intolerance prediction program can help intensive care nurses effectively identify the risk factors for feeding.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13093"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141200410","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":"Lateral kangaroo position for thermal stability of extremely preterm: Non-inferiority randomized controlled trial.","authors":"Lucía Jimenez-Fernández, Ana Serrano-Gutierrez, Patricia Martínez-Pérez, Patricia Melchor-Muñoz, Amalia Fernández-Carvajal, Belén Campos-Martínez, Salvador Piris-Borregas, María Pont-Vilalta, Laura Collados-Gómez","doi":"10.1111/nicc.13102","DOIUrl":"10.1111/nicc.13102","url":null,"abstract":"<p><strong>Background: </strong>Kangaroo care (KC) is an evidence-based best practice that can prevent major health complications in preterm infants. However, there is a lack of evidence on the feasibility and safety of placing extremely preterm infants under 28 weeks gestational age in KC position.</p><p><strong>Aim: </strong>To compare thermal stability 60 min after the first KC session in the lateral versus prone position in extremely preterm infants under 28 weeks gestational age.</p><p><strong>Study design: </strong>This is a single-centre, randomized, non-inferiority, parallel clinical trial. The patients were extremely preterm infants during their first 5 days of life. Infants in the intervention group received KC in the lateral position while those in the control group received KC in the prone position. All infants receiving KC were inside their polyethylene bags but maintained skin-to-skin contact. The primary outcome was the axillary temperature of the infants, and the secondary outcome was the development of intraventricular haemorrhage.</p><p><strong>Results: </strong>Seventy infants were randomized (35 per group). The mean gestational age was 26 ⁺¹(1⁺¹) in both groups. In the first KC session, the infant temperature at 60 minutes was 36.79°C (0.43) in lateral KC position, and 36.78°C (0.38) in prone KC position (p = .022). In lateral KC position, 7.69% (2) of the children who, according to the cranial ultrasound performed before the first session, had no haemorrhage presented with intraventricular haemorrhage after the first session. In prone KC position, new haemorrhages appeared after the first session in 29.17% (7) (p = .08).</p><p><strong>Conclusions: </strong>The lateral KC position is an alternative to the conventional prone KC position and maintains normothermia in infants under 28 weeks gestational age.</p><p><strong>Relevance to clinical practice: </strong>Extremely preterm infants are candidates for KC. Lateral KC position is an evidence-based best practice that can be applied to preterm infants under 28 weeks GA. This evidence is particularly useful in performing umbilical catheterization on these patients.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13102"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288909","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 unplanned treatment interruption during CRRT in ICU patients under CVVH (pre + post dilution) or CVVHDF (post-dilution) mode: A retrospective cohort study.","authors":"Yanting Zhang, Jing Ma, Anlong Zheng, Jing Ming, Yuting Huang, Chong Cheng, Xinbo Ding, Meng Xiao, Pu Zhang","doi":"10.1111/nicc.70025","DOIUrl":"https://doi.org/10.1111/nicc.70025","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Continuous renal replacement therapy (CRRT) often becomes prematurely interrupted before the planned dose is reached for various reasons. This not only hampers therapeutic efficacy but also escalates blood loss for patients, thereby increasing the nursing workload and patient costs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To assess the incidence and filter lifespan of unplanned interruptions in ICU patients undergoing CRRT, continuous veno-venous hemofiltration (CVVH) (pre + post dilution) mode was compared with continuous veno-venous haemodiafiltration (CVVHDF) (post dilution) mode.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;We conducted a retrospective study involving 256 patients: 75 in the CVVH group and 181 in the CVVHDF group. Outcomes such as filter lifespan, unplanned treatment interruptions and catheter complications were compared across the three anticoagulation methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A greater proportion of unplanned interruptions was observed in the CVVHDF group. Specifically, filter coagulation led to more frequent interruptions in CVVHDF (p &lt; .05). With citrate anticoagulation, the filters in the CVVH group lasted significantly longer (p = .025). However, under low-molecular-weight heparin or no anticoagulation, filter survival rates were statistically similar between the groups (p &gt; .05). Anticoagulation method (95% CI 1.163-44.95, p = .034), venous pressure (95% CI 0.001-0.004, p = .027) and total serum calcium (95% CI -0.936 to -0.042, p = .033) affect the incidence rate of unplanned treatment interruptions in CVVH (pre- and post-dilution) (p &lt; .05). Venous pressure (95% CI 0.001-0.002, p &lt; .001) and BMI (95% CI -0.936 to -0.042, p = .033) affect the incidence rate of unplanned treatment interruptions in CVVHDF (post-dilution) (p &lt; .05). The adjusted results indicate that PT (HR = 1.09, 95% CI 1.011-1.176, p = .025), venous pressure (HR = 1.013, 95% CI 1.004-1.022, p = .003) and blood flow rate (HR = 1.028, 95% CI 1.002-1.054, p = .034) are potential risk factors for filter lifespan in CVVH (pre- and post-dilution). Venous pressure (HR = 1.005, 95% CI 1.003-1.007, p &lt; .001) is a potential risk factor for filter lifespan in CVVHDF (post-dilution).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Using the CVVH mode with citrate anticoagulation significantly prolongs CRRT filter life and reduces unplanned treatment interruptions. Further prospective, randomised controlled studies are needed to confirm these findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Relevance to clinical practice: &lt;/strong&gt;Exploring the reasons for unplanned treatment interruptions in ICU patients undergoing CRRT under common modes is crucial, serving as an important measure to ensure the quality of treatment. Nurses are the main implementers throughout the entire CRRT process. Understanding the risk factors for unplanned treatment interruptions and filter lifespan can help reduce the economic burden on patients, decrease the workload of medical staff and contribute","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 2","pages":"e70025"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694336","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}