Nursing in Critical Care最新文献

{"title":"Non-pharmacological interventions to support the cognitive rehabilitation of patients admitted to the intensive care unit: An umbrella review.","authors":"Anna Holm, Linette Thorn, Anette Bjerregaard Alrø, Helene Korvenius Nedergaard, Hanne Irene Jensen, Pia Dreyer","doi":"10.1111/nicc.13190","DOIUrl":"10.1111/nicc.13190","url":null,"abstract":"<p><strong>Background: </strong>Critically ill patients experience cognitive impairment throughout their intensive care unit trajectory, in the acute phase and the long-term alike. Cognitive impairment may negatively impact patients' quality of life and rehabilitation outcomes.</p><p><strong>Aim: </strong>To provide an overall examination of literature concerning non-pharmacological interventions that can enhance cognitive functioning in critically ill patients or facilitate their rehabilitation pathway during and after their intensive care unit stay.</p><p><strong>Study design: </strong>This study was conducted as an umbrella review. A systematic search was conducted in CINAHL, Embase, PubMed and PsychINFO, including all types of peer-reviewed research syntheses published between 2008 and 2023. Eligible studies had to describe interventions capable of improving adult patients' cognitive functioning or supporting their cognitive rehabilitation process throughout the intensive care unit trajectory. All eligible research syntheses were screened systematically; those included were critically appraised.</p><p><strong>Result: </strong>Based on 13 research syntheses, this review summarizes rehabilitative interventions that may be delivered during different phases of critical illness and recovery, in relation to content, delivery and timing. Interventions were: (1) cognitive activities and training, (2) mobilization and physical exercises, (3) emotional, psychological and social support and (4) information.</p><p><strong>Conclusion: </strong>Due to limited evidence, no definitive conclusion can be drawn about which type of intervention is most supportive or effective. Additionally, no recommendations can be made about the optimal timing for intervention delivery.</p><p><strong>Relevance to clinical practice: </strong>Clinicians involved in developing and implementing cognitive rehabilitation measures should consider designing individualized, multicomponent interventions with a focus on content, delivery and timing.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13190"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583650","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":"Delirium prevalence, interventions and barriers in intensive care units in German-speaking countries: A retrospective cross-sectional secondary analysis.","authors":"Matthias Thomas Exl, Sibylle Fischbacher, Heidi Lindroth, Keibun Liu, Magdalena Hoffmann, Marie-Madlen Jeitziner, Peter Nydahl, Rebecca von Haken, Lars Krüger, Florian Schimböck","doi":"10.1111/nicc.70041","DOIUrl":"https://doi.org/10.1111/nicc.70041","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of delirium in intensive care units (ICUs) is high and has a major impact on patient outcomes.</p><p><strong>Aim: </strong>To describe delirium assessment instruments, prevalence, interventions and barriers in delirium management in adult and paediatric ICUs; and to explore the association between delirium prevalence and reported interventions and barriers at unit level.</p><p><strong>Study design: </strong>A secondary analysis of the cross-sectional World Delirium Awareness Day Delirium Survey on 15 March 2023. This was a prospective study to assess the one-day point delirium prevalence, practices and quality improvement efforts across healthcare systems. Data was analysed descriptively and using multiple linear regression.</p><p><strong>Results: </strong>Data of 1612 assessments in 123 ICUs from three German-speaking countries were analysed. The most frequently used delirium assessment instrument was the Intensive Care Delirium Screening Checklist (43.9%, n = 54). The prevalence of delirium at 8 AM was 18.6% and at 8 PM 20.4% from the 94 ICUs included in the regression analyses. Prevalence for adult and paediatric and mixed ICUs are comparable. Main reported over all unit-level interventions were 'pain management' (95.9%, n = 118), 'mobilization' (94.3%, n = 116) and 'verbal re-orientation' (84.6%, n = 104). Main reported over all unit-level barriers were 'shortage of staff' (53.7%, n = 66) and 'patients who are difficult to assess' (44.7%, n = 55). Interventions such as 'avoidance of bladder tubes/catheters' in all ICUs, 'use of ear plugs and/or sleep glasses' in adult ICUs and 'mobilization' in paediatric and mixed ICUs were associated with reduced delirium prevalence. Across all ICUs, as well as in both adult and paediatric ICUs, 'lack of appropriate scores for delirium assessment' was identified as a significant barrier.</p><p><strong>Conclusions: </strong>One fifth of assessed ICU patients suffer from delirium. Several reported unit-level interventions and barriers may have an impact on delirium prevalence, suggesting an approach for future studies and clinical practice.</p><p><strong>Relevance to clinical practice: </strong>In clinical practice, unit-level 'avoidance of bladder tubes/catheters', 'use of ear plugs and/or sleep glasses' and 'mobilization' may be used as delirium prevention and treatment interventions.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70041"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052153","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 relationship between positive end-expiratory pressure (PEEP) and intra-abdominal pressure (IAP) in mechanically ventilated patients: A prospective observational study.","authors":"Mohammed M Al-Jabri, Ghada H Ahmed, Mostafa M A Ali, Omar Abdelwahab, Sherif Mohamed, Ghada S K Mahran","doi":"10.1111/nicc.13181","DOIUrl":"10.1111/nicc.13181","url":null,"abstract":"<p><strong>Background: </strong>Positive end-expiratory pressure is a crucial mechanical breathing parameter. Intra-abdominal hypertension is well defined as a sustained increase in the intra-abdominal pressure ≥12 mmHg. There are still controversies about mechanical ventilation's effect and use of positive end-expiratory pressure on intra-abdominal pressure.</p><p><strong>Aim: </strong>We aimed to delineate the relationship between positive end-expiratory pressure and intra-abdominal pressure in mechanically ventilated patients admitted to the intensive care units of a large tertiary hospital in Upper Egypt.</p><p><strong>Study design: </strong>This study was a prospective observational study. The study was conducted at a university hospital from October 2023 to February 2024. The enrolled adult patients were allocated into two groups based on their positive end-expiratory pressure: group I, low pressure (<8 cm H₂O) and group II, high pressure (8-10 cm H₂O).</p><p><strong>Results: </strong>A total of 120 patients were enrolled, 60 patients in each group. The most commonly encountered diagnoses were pneumonia (32/120, 26.7%) and acute respiratory distress syndrome (ARDS) (31/120, 25.8%), respectively. There was a significant difference between the intra-abdominal pressure mean values of the two patient groups, 18.9 ± 3.3 versus 24.4 ± 5.9 mmHg in the group of low versus high pressure (correlation value of .454, p < .001), respectively. There were highly significant correlations between intra-abdominal pressure categories and the patient groups (correlation value of .495, p < .001). There were 24 (40%) versus 0 (0%) patients of high pressure versus low pressure within the category IV group of intra-abdominal hypertension (>25 mmHg).</p><p><strong>Conclusions: </strong>We observed a significant relationship between positive end-expiratory pressure and intra-abdominal pressure in mechanically ventilated patients. The patient group with high pressure had higher mean values compared with the group with low pressure. The study highlights the importance of closely monitoring intra-abdominal pressure in mechanically ventilated patients who receive positive end-expiratory pressure. Further studies are warranted.</p><p><strong>Relevance to clinical practice: </strong>The relationship between positive end-expiratory pressure and intra-abdominal pressure is an essential issue in daily critical care nursing clinical practice. Considering the occurrence of multiple organ dysfunction as a result of a non-detected increase in intra-abdominal pressure, critical care nurses should pay attention to measuring this pressure to maintain intra-abdominal pressures that are safe for mechanically ventilated and critically ill intensive care unit patients, thereby preventing these undue effects.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13181"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373479","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":"Strategies for Providing Research Information to Participants in Multicentre Adult Critical Care Studies: A Survey of Chief Investigators.","authors":"Eleanor Reeves, Keith Couper","doi":"10.1111/nicc.70058","DOIUrl":"https://doi.org/10.1111/nicc.70058","url":null,"abstract":"<p><p>The recruitment of participants in adult critical care studies is often challenging. We surveyed chief investigators of UK multicentre adult critical care studies in this cross-sectional survey to evaluate what strategies they used to provide study information to potential participants. Of 61 eligible responses, we received completed surveys from 35 investigators (response rate 57%). Most chief investigators reported using a written participant information sheet (n = 34, 97%), but the uptake of alternative strategies was limited to 9 studies (26%). Only 6 studies (17%) utilized digital methods. Most chief investigators (63%) reported that they planned to adopt alternative strategies in their next study. RELEVANCE TO CLINICAL PRACTICE: This cross-sectional online survey study explores the strategies currently used by chief investigators for providing research information in critical care and explores how likely chief investigators are to adopt alternative strategies.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70058"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063238","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":"Analysis of the Prevalence of Missed Nursing Care Using Three Workload Assessment Methods: A Nationwide Cross-Sectional Study Among Intensive Care Nurses.","authors":"Anaëlle Caillet, Jérôme E Dauvergne, Laurent Poiroux, Pierre-Yves Blanchard, Arnaud Bruyneel","doi":"10.1111/nicc.70055","DOIUrl":"https://doi.org/10.1111/nicc.70055","url":null,"abstract":"<p><strong>Background: </strong>Increased workload is associated with a higher prevalence of missed nursing care.</p><p><strong>Aim: </strong>Describe the prevalence of missed care in intensive care units (ICUs) and identify the workload scale most strongly associated with this prevalence.</p><p><strong>Study design: </strong>A cross-sectional survey was combined with a longitudinal study conducted in 2024, between 15 January and 15 April, in France to assess the workload. A total of 1271 nurses working in 61 ICUs completed the questionnaire one time per shift.</p><p><strong>Results: </strong>A total of 72.3% of nurses reported at least one missed care. The Nursing Activities Score provided the strongest association with the prevalence of missed care compared to patient-to-nurse ratio and the Practice Environment Scale of the Nursing Work Index.</p><p><strong>Conclusion: </strong>The prevalence of missed care and nursing workload was high. Nurses tended to focus on direct patient care.</p><p><strong>Relevance to clinical practice: </strong>Continuously assessing the prevalence of missed care can be a valuable tool for managing workload in ICUs.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70055"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095578","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":"Knowledge, attitude and practice related to intra-abdominal pressure measurement among intensive care unit nurses and determinant factors: A regional multicentre cross-sectional study.","authors":"Qingqing Sheng, Lihua Chen, Yufeng Tan, Shuqin Zhang, Yao Huang, Tingting He, Xinning Wang, Liting Zeng","doi":"10.1111/nicc.70035","DOIUrl":"https://doi.org/10.1111/nicc.70035","url":null,"abstract":"<p><strong>Background: </strong>Intra-abdominal hypertension is a common serious complication in critically ill patients. Intra-abdominal pressure (IAP) measurement is the only reliable method of detecting and managing IAP. Various factors influence the knowledge, attitude and practice of IAP measurement.</p><p><strong>Aim: </strong>To assess the knowledge, attitude and practice of IAP measurement among ICU nurses and to identify the factors affecting the knowledge, attitude and practice.</p><p><strong>Study design: </strong>A multi-centre cross-sectional survey was conducted in 38 hospitals in Guangdong province, China, from March to June 2024.</p><p><strong>Results: </strong>A total of 1254 valid questionnaires were collected. The median scores of knowledge were 8.0, with an interquartile range of 7.0-8.0. The median scores of attitude were 23.0, with an interquartile range of 21.0-25.0. The median scores of practice were 41.0, with an interquartile range of 36.0-45.0. There was a positive and significant relationship between knowledge, attitude and practice. Multiple linear regression analysis indicated that ICU type (95%CI = -0.469 to -0.163, p = .000), education level (95%CI = 0.024-0.332, p = .024), monthly income (95%CI = 0.054-0.227, p = .002), attitude (95%CI = 0.038-0.090, p = .000) and practice (95%CI = 0.033-0.055, p = .000) independently affected the knowledge; age (95%CI = 0.068-0.815, p = .021), clinical instructor (95%CI = 0.145-0.822, p = .005), head nurse (95%CI = 0.006-1.409, p = .048), knowledge (95%CI = 0.174-0.411, p = .000) and practice (95%CI = 0.077-0.123, p = .000) independently affected the attitude; and age (95%CI = -0.956 to -0.031, p = .036), knowledge (95%CI = 0.871-1.416, p = .000) and attitude (95%CI = 0.446-0.702, p = .000) independently affected the practice.</p><p><strong>Conclusions: </strong>Although the knowledge, attitude and practice of IAP measurement among ICU nurses are acceptable, there is still room for improvement in knowledge and practice. Nursing managers should strengthen management, provide more learning resources and training to meet nurses' needs about IAP measurement, so as to further improve the early recognition and management of increased IAP.</p><p><strong>Relevance to clinical practice: </strong>The data highlight the knowledge, attitude and practice and determinant factors of IAP measurement among ICU nurses and will help to make management protocols in the future. Nursing educators and administrators are recommended to provide guidance, training and support to further improve knowledge and practice of IAP measurement among the ICU nurses.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70035"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991432","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":"Wake Up Call: A Qualitative Study of Nursing and Medical Managers' Perceptions and Support for Nurses' Night Shift Napping in Intensive Care Units.","authors":"Ghada Shalaby Khalaf Mahran, Emran A Abu Aqoulah, Ebtisam Abd Elazeem Saber Seleem, Mervat Abd Elhamed Hawash, Ragaa D M Ahmed","doi":"10.1111/nicc.70056","DOIUrl":"https://doi.org/10.1111/nicc.70056","url":null,"abstract":"<p><strong>Background: </strong>Night shift work in healthcare settings is associated with increased fatigue, decreased alertness and potential risks to patient safety. While nurses napping during night shifts has been proposed as a strategy to mitigate these effects, its implementation remains controversial and understudied from a managerial perspective.</p><p><strong>Aim: </strong>This study aimed to explore nursing and medical managers' perceptions of, and support for nurses' night shift napping policies in intensive care units.</p><p><strong>Study design: </strong>A qualitative descriptive approach was employed from the beginning of March 2024 to the end of October 2024, utilising semi-structured interviews with 40 nursing and medical managers from various intensive care units. Participants were purposively sampled to ensure diversity in experience and department. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.</p><p><strong>Results: </strong>Five main themes emerged: (1) Understanding perceptions of night shift napping, (2) perceptions of the benefits of night shift napping, (3) assessing support for night shift napping, (4) barriers and challenges of applying napping strategies and (5) developing effective implementation strategies to facilitate the successful adoption of napping policies. While most managers acknowledged the potential benefits of night shift napping, they expressed apprehension about its practical implementation, staff coverage concerns and the potential for policy abuse. Supportive managers emphasised the importance of education, structured guidelines and gradual cultural change to successfully integrate napping practices.</p><p><strong>Conclusion: </strong>The findings suggest that while there is growing recognition of the potential benefits of night shift napping, significant barriers to implementation persist. The results can inform the development of evidence-based napping policies and guide strategies to address managerial concerns, ultimately improving night shift working conditions and patient care quality.</p><p><strong>Relevance to clinical practice: </strong>Researching the perceptions and support of nursing and medical managers for night shift napping in ICUs is relevant to clinical practice, as it can provide insights into the potential benefits, challenges and strategies for implementing such policies. These findings may ultimately improve patient safety, staff well-being and quality of care.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70056"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081829","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":"Factors related to resilience and attitudes towards care of the dying among critical care nurses.","authors":"Akiko Kondo, Tomomi Oki, Ann L Eckhardt","doi":"10.1111/nicc.13146","DOIUrl":"10.1111/nicc.13146","url":null,"abstract":"<p><strong>Background: </strong>Many critical care nurses provide care to patients who are injured or ill and are at the end-of-life. Therefore, they are at high risk for developing negative emotional responses due to exposure to patient suffering and death.</p><p><strong>Aim: </strong>To determine the association between attitudes towards care of the dying, resilience, and Sense of Coherence.</p><p><strong>Study design: </strong>A cross-sectional descriptive approach was used. Head nurses at 74 hospitals in Japan were sent a letter about the study; 29 head nurses agreed to send information to the critical care nurses in their hospital. Demographic factors, attitudes towards care of the dying, resilience, and Sense of Coherence were collected using Google Forms. Structural equation modelling was used to analyze the associations among the variables.</p><p><strong>Results: </strong>A total of 229 nurses completed the survey. The average years of clinical experience were 10.5 ± 8.4 years. Factors directly related to positive attitudes towards care of the dying were higher resilience, more years of clinical nursing experience, and having a Master's degree. Sense of Coherence was the strongest predictor of resilience. Other predictors for higher resilience included confidence in nursing skills, social support, and religious beliefs towards death. The main predictor for higher Sense of Coherence was workplace satisfaction.</p><p><strong>Conclusion: </strong>Nurses with higher resilience had more positive attitudes about care of the dying. Individual factors, such as a Sense of Coherence, confidence in caring for patients, and religious beliefs were the most important factors related to resilience.</p><p><strong>Relevance to clinical practice: </strong>It is necessary to support newer nurses especially those with lower educational attainment, to increase workplace satisfaction, Sense of Coherence and resilience. It is necessary to develop educational programs focused on care of dying patients and to evaluate their effect so that critical care nurses have a positive response to caring for dying patients.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13146"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019488","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":"Postoperative Care of a Paediatric Patient With Common Arterial Trunk Associated With Ventricular Septal Defect and Pulmonary Arterial Hypertension: A Rare Case Report.","authors":"Huimin Fu, Li Geng, Jingli Chen, Qin Fan, Qiong Hu, Ping Hu","doi":"10.1111/nicc.70048","DOIUrl":"https://doi.org/10.1111/nicc.70048","url":null,"abstract":"<p><p>Common truncus arteriosus is a rare congenital cardiac malformation. This case was associated with a ventricular septal defect (VSD) and also combined with pulmonary hypertension, which, together with the young age of the child and the fragility of the tissues, demanded a high degree of refinement in surgical operation, making the procedure complex and extremely risky. This case reports the postoperative care experience of a child with a common arterial trunk (CAT) combined with a VSD and pulmonary hypertension. Throughout the postoperative nursing process, blood pressure fluctuations should be closely monitored to prevent postoperative bleeding; cardiac changes and in/out volume should be closely monitored to reduce cardiac oedema and to be alert to cardiac arrhythmia; pulmonary physical therapy and early rehabilitation training should be strengthened to promote the recovery of cardiopulmonary function; stepwise nutritional risk screening interventions should be carried out to ensure the supply of nutrients; and maximised humanistic care should be given to prevent neurological complications. In similar cases, doctors and nurses should pay attention to postoperative hemodynamic monitoring, concern for bleeding risk, and anti-heart failure treatment, etc., to promote the recovery of children through careful treatment and care. RELEVANCE TO CLINICAL PRACTICE: Common truncus arteriosus is a rare congenital cardiac malformation, and the relevant literature is mostly studies on genetics, diagnosis, and therapeutic methods, with less practical nursing experience available for clinical caregivers. This case reports the key points and difficulties of postoperative intensive care nursing, which can help critical care nurses to formulate targeted nursing interventions, thus improving the ability of critical care nurses in caring for this type of disease, and promoting the early recovery of postoperative children.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70048"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045516","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":"Predictive model for the risk of paediatric intensive care utilization in children with medical complexity: A longitudinal retrospective cohort study.","authors":"Bibiana Pérez-Ardanaz, Laura Gutiérrez-Rodríguez, Alberto José Gómez-González, José Miguel Morales-Asencio, Antonio Montero-García, Álvaro León-Campos","doi":"10.1111/nicc.13180","DOIUrl":"10.1111/nicc.13180","url":null,"abstract":"<p><strong>Background: </strong>Children with medical complexity (CMC) are at increased risk of admission in intensive care. Despite improvements in mortality rates, there remains a burden of morbidity, long-term health care needs and hospital readmissions. Beyond clinical factors, socio-demographic determinants could impact utilization of acute services.</p><p><strong>Aim: </strong>To identify risk factors that can differentiate CMC who are admitted to the paediatric intensive care unit (PICU).</p><p><strong>Study design: </strong>A 6-year longitudinal retrospective cohort study evaluated clinical, socio-demographic and health care utilization.</p><p><strong>Results: </strong>A total of 248 CMC were included, with a median age of 13 years (9.75-17.00). Intensive care admission rate was 47.2%. The risk of PICU admission was higher for children undergoing surgical interventions (HR = 1.58, 95% CI 1.34-1.86, p < .001) and those using medical devices (HR = 1.81, 95% CI 1.54-2.13, p < .001). Mother's higher educational level was a protective factor (HR = 0.66, 95% CI 0.55-0.79, p < .001). Multivariable analysis revealed significant associations between risk of admission and the presence of malignancy, comorbidities, home medical devices, surgical procedures and higher health care utilization. Children's age and higher maternal educational level acted as protective factors.</p><p><strong>Conclusion: </strong>Socio-demographic factors should be considered in the provision of care to CMC. Individualized assessments to guide supportive interventions adapted to socio-economic factors may prevent PICU admissions.</p><p><strong>Relevance to clinical practice: </strong>This study highlights the importance of integrating individualized assessments of socio-demographic risk factors, such as maternal educational level, into the clinical practice of paediatric nurses. Moreover, targeted interventions, including educational resources and community support programmes, may optimize care.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13180"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395071","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}