Nursing in Critical Care最新文献

{"title":"Nurses' perceptions of the layout and environment of the paediatric intensive care unit in terms of sleep promotion.","authors":"Tomas Slåtten Nenningsland, Hanne Birgit Alfheim, Babak Asadi-Azarbaijani, Janet Mattsson, Gitte Mikkelsen, Elisabeth Holm Hansen","doi":"10.1111/nicc.70016","DOIUrl":"10.1111/nicc.70016","url":null,"abstract":"<p><strong>Background: </strong>Noise and light are frequently cited as major factors contributing to sleep disturbance. The paediatric intensive care unit (PICU) layout may increase environmental stimuli and limit nurses' control over the environmental disturbances that patients encounter.</p><p><strong>Aim: </strong>This study aims to describe nurses' perceptions regarding the layout of the PICU and its potential impact on environmental disturbances and patients' sleep. Additionally, it seeks to investigate the extent to which unit layout impacts environmental disturbances across Scandinavian countries.</p><p><strong>Study design: </strong>A comparative cross-sectional study was conducted using an online questionnaire in three PICUs in three large university hospitals in Norway, Sweden and Denmark.</p><p><strong>Results: </strong>Out of the 79 study participants, 63% did not agree that their PICU layout was conducive to their patients sleeping well. While 52% reported having control over the light at nighttime, 55% felt that they were unable to control noise levels during the night. Monitors and alarms were rated as the highest contributing factors limiting control over noise. Compared to the Danish nurses, the Norwegian nurses were five times less likely to agree that the unit layout supported a normal sleep-wake cycle.</p><p><strong>Conclusion: </strong>The Scandinavian nurses perceived the PICU layouts as inadequate for promoting control over the environment and patients' sleep. The Norwegian PICU layout, with larger multibed units, was perceived as inferior in promoting sleep and controlling noise and light compared with the Swedish and Danish PICUs.</p><p><strong>Relevance to clinical practice: </strong>This study provides valuable insights to nurses regarding the specific factors influencing noise and light in the PICU, enabling nurses to take appropriate measures to improve sleep by gaining control over the patient's environment. Additionally, the results of this study can inform future renovations or modifications of multibed units, with the aim of preventing the layout from restricting nurses' control over the noise and light levels experienced by patients.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70016"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774747","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":"Association of atrial fibrillation with rapid ventricular response and hospital mortality in intensive care unit: A retrospective cohort study.","authors":"Yu-Xiang Long, Xiao-Min Ma, Yi-Wen Ren, Di-Yu Cui, Yue-Hui Yin","doi":"10.1111/nicc.70027","DOIUrl":"10.1111/nicc.70027","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) with rapid ventricular response (RVR) is a prevalent condition among critically ill patients, frequently contributing to haemodynamic instability. However, the association between AF with RVR and hospital mortality in critically ill patients remains inconclusive.</p><p><strong>Aim: </strong>To investigate the associations between AF with RVR and hospital mortality in patients admitted to the intensive care unit (ICU).</p><p><strong>Study design: </strong>This study included patients from the MIMIC-IV database who experienced episodes of atrial fibrillation (AF) during their ICU stay. AF with RVR was defined as a heart rate (HR) >110 beats/min (bpm) during an episode of AF and was further classified into three categories: mild (111-130 bpm), moderate (131-150 bpm) and severe (>150 bpm) RVR. Multivariable adjusted logistic regression models and restricted cubic spline analyses were used to estimate odds ratios and 95% CIs and to explore linear and non-linear relationships of RVR and mortality, respectively.</p><p><strong>Results: </strong>A total of 7027 eligible patients with AF were identified, and AF with RVR occurred in 5274 patients (75.1%). Patients with RVR had a significantly higher hospital mortality compared to those without (23.8% vs. 15.8%, adjusted OR, 1.32; 95% CI (1.13-1.54), p < .001). The adjusted ORs in mild, moderate and severe RVR were 1.11 (0.93-1.33), 1.25 (1.05-1.49) and 1.87 (1.54-2.27) for hospital mortality (p for trend <.001), respectively. Restricted cubic spline analyses showed a non-linear relationship of RVR with hospital mortality (p < .001). Additionally, hospital mortality decreased linearly with the reduction in 1-h HR following moderate and severe RVR.</p><p><strong>Conclusions: </strong>AF with moderate and severe RVR was associated with increased hospital mortality in critically ill patients, and acute HR reduction following moderate and severe RVR may be beneficial in reducing hospital mortality.</p><p><strong>Relevance to clinical practice: </strong>This study emphasized the importance of individual management of AF patients in the ICU according to the severity of RVR and provided an approximate range of RVR to guide risk stratification.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70027"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781332","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":"Prone position applied to COVID-19 patients: Systematic review-meta-analysis.","authors":"Derya Tülüce, Emine Kaplan Serin, Ebru Yıldız Karadeniz","doi":"10.1111/nicc.13185","DOIUrl":"10.1111/nicc.13185","url":null,"abstract":"<p><strong>Background: </strong>Position change and interventions to increase lung capacity should be considered in mechanically ventilated patients. The most effective of these is the prone position.</p><p><strong>Aim: </strong>This systematic review and meta-analysis aimed to determine the effects of the prone position on respiratory parameters and outcomes and to guide nurses working in the intensive care unit.</p><p><strong>Study design and methods: </strong>This systematic review-meta-analysis was conducted in accordance with the Preferred Reporting in Systematic Reviews and Meta-Analyses guideline. ScienceDirect, CINAHL, Academic Search Complete (EBSCOhost), MEDLINE, EMBASE, Web of Science, Cochrane and PubMed databases were searched between January 2022 and January 2023 to access studies related to prone position in COVID-19 patients.</p><p><strong>Results: </strong>Twenty-three studies were included. This meta-analysis shows that a prone position is feasible and can achieve improvements in gas exchange. Prone position increases PaO₂/FiO₂ in the majority of patients followed with a diagnosis of COVID-19 and severe hypoxemic.</p><p><strong>Conclusions: </strong>The study has shown that the prone position is effective in improving patients' respiratory function and oxygenation.</p><p><strong>Relevance to clinical practice: </strong>The results presented in this article support the notion that the prone position can be an effective strategy in the clinical management of COVID-19 patients.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13185"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395072","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":"Nursing care during management of recurrent pheochromocytoma: A case study.","authors":"Minmin Chen, Yaoning Zhuang, Zhicheng Weng, Jingjing Zhuang, Liangying Chen","doi":"10.1111/nicc.13165","DOIUrl":"10.1111/nicc.13165","url":null,"abstract":"<p><p>Pheochromocytoma can occur in patients with multiple endocrine neoplasia type 2, placing them at increased risk of tumour recurrence after surgical resection. Therefore, management of pheochromocytoma in these patients is a clinical challenge. We aim to present and discuss the nursing management of patient with recurrent pheochromocytoma. Case studies. We reviewed and retrieved the necessary information from the medical records. A 34-year-old female with a history of medullary thyroid carcinoma and pheochromocytoma complicated by cardiomyopathy, who had undergone surgical resections 6 years ago, presented with abdominal pain for 1 day and was diagnosed with recurrent bilateral pheochromocytoma, hypertensive crisis, acute heart failure, and acute renal failure. Eight hours after hospital admission, she experienced sudden cardiac arrest and received cardiopulmonary resuscitations. She was then supported under extracorporeal membrane oxygenation and continuous renal replacement therapy (CRRT). The adrenal tumour was successfully treated with absolute ethanol ablation followed by gelatin sponge particle embolization, a management approach which has not been reported previously. She had a satisfactory recovery. A comprehensive nursing management approach, including prone ventilation; safe transportation; close cardiopulmonary monitoring; pre-, intra- and post-procedure care; individualized early rehabilitation; and psychological supports, should be applied to improve the prognoses in patients with similar medical conditions. Bilateral adrenal pheochromocytoma can be managed by absolute ethanol ablation followed by gelatin sponge particle embolization. Comprehensive nursing management, including a team effort regarding patient positioning, transportation, close monitoring, early rehabilitation and psychological support, should be provided during the peri-procedure period.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13165"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401825","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 associated with Intensive care nurses' use of non-pharmacological methods of pain management: A multinomial logistic regression analysis.","authors":"Ayşe Gül Parlak, Yeliz Akkuş","doi":"10.1111/nicc.70039","DOIUrl":"https://doi.org/10.1111/nicc.70039","url":null,"abstract":"<p><strong>Background: </strong>Although there are numerous studies in the literature on the roles, methods used and attitudes of nurses in pain management, the factors related to the use of non-pharmacological methods (NPMs) are not well-documented.</p><p><strong>Aim: </strong>This research aims to determine the factors related to the use of NPMs by intensive care nurses in Turkey.</p><p><strong>Study design: </strong>This descriptive and cross-sectional study was conducted with the participation of 385 intensive care unit nurses. Data were collected by using the 'Sociodemographic Data Form', 'Non-Pharmacological Methods Form' and 'Pain Beliefs Questionnaire' (PBQ) between January-December 2022. Multiple multinomial logistic regression analysis was used to identify factors associated with non-pharmacological methods. Pain management was categorized as pharmacological, non-pharmacological and both. The use of pharmacological methods (PMs) was taken as the reference category. The STROBE checklist was adhered to in this study.</p><p><strong>Results: </strong>It was found that in pain management in the ICU, 33% used pharmacological methods, and 62.1% used both methods. The most frequent barriers experienced in the use of NPMs were 'heavy workload' (82.9%), 'inadequate time' (82.9%) and 'patients being unstable' (69.6%). Receiving pain management training increased the nurses' use of NPMs by 237% compared to pharmacological methods (RRR = 2.377, 95% CI = 1.200-4.707; p = .013). Regarding the barriers to the use of NPMs, 'the lower priority of NPMs compared to emergency practices (RRR=0.333, 95% CI=0.191-0.579; p=.000) and Deficiency in resources (materials and equipment)' (RRR = 0.454, 95% CI = 0.244-0.846; p = .013) decreased the use of NPMs. The Psychological Beliefs subscale of the PBQ increased the use of NPMs (RRR = 2.094, 95% CI = 1.152-3.803; p = .015).</p><p><strong>Conclusion: </strong>Nurses should be provided with training on non-pharmacological methods as well as pharmacological methods in pain management, barriers to the use of non-pharmacological methods should be eliminated and psychological beliefs regarding pain should also be addressed.</p><p><strong>Relevance to clinical practice: </strong>There is a need to solve the problems of lack of education, legal barriers and lack of resources in increasing the use of non-pharmacological pain methods by nurses in intensive care units.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70039"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047452","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 association of early passive mobilization with intracranial pressure in the adult intensive care unit: A prospective, cohort study.","authors":"Ahmet Oğuzhan Küçük, Neslihan Hatınoğlu, Umut Apaydin, Turgay Altunalan, Mehtap Pehlivanlar Küçük","doi":"10.1111/nicc.13197","DOIUrl":"10.1111/nicc.13197","url":null,"abstract":"<p><strong>Background: </strong>Early mobilization are key components of the ABCDEF Care Bundle and critical treatments to reduce acquired muscle weakness, delirium and prolonged intensive care unit (ICU) stay.</p><p><strong>Aim: </strong>This study aimed to determine whether routine early mobilization related to intracranial pressure in intensive care patients on mechanical ventilation, using optic nerve sheath diameter measurement (ONSD).</p><p><strong>Study design: </strong>This study was planned as a prospective, cohort study in the third-step adult ICU of a faculty hospital. The study included only patients who were intubated and followed up on a mechanical ventilator and were clinically stable. Passive range of motion (PROM) exercises were performed daily by the physiotherapists as part of routine care from the day of hospitalization. ONSD was assessed before, during and 10 min after PROM exercises.</p><p><strong>Results: </strong>The study included 20 eligible patients out of the 142 who were evaluated upon admission to the ICU. The median age of the patients was 65 years, and nine (45%) of them were female. The analyses showed that there was no statistically significant change in ONSD during and at the end of the PROM (ONSD right eye p:.621, Partial η²: 0.025, ONSD left eye p:.935, Partial η²: 0.004). Similarly, there was no statistically significant change in haemodynamic parameters in during and at the end of the PROM (Heart beat p:.849, Partial η²: 0.009, Systolic Pressure p:.435, Partial η²: 0.043, Diastolic Pressure p:.128, Partial η²:0.103, Saturation p:.103, Partial η²: 0.113 and Respiratory rate p:.071, Partial η²:0.130).</p><p><strong>Conclusion: </strong>This study suggests that daily extremity physiotherapy exercises can be safely applied without causing increased intracranial pressure or haemodynamic instability in intensive care patients followed up on mechanical ventilation, including patients with vasopressor therapy.</p><p><strong>Relevance to clinical practice: </strong>Early mobilization, including PROM, is considered safe in terms of intracranial pressure for intubated patients in the ICU.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13197"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512662","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":"Effects of Anxiety Focused Nursing Interventions on Anxiety, Cognitive Function and Delirium in Neurocritical Patients: A Non-Randomized Controlled Design.","authors":"Seo-Young Jang, Myung Kyung Lee","doi":"10.1111/nicc.70062","DOIUrl":"10.1111/nicc.70062","url":null,"abstract":"<p><strong>Background: </strong>Anxiety and cognitive dysfunction are common concerns in neurological intensive care units (ICUs) and are associated with adverse outcomes, including delirium. Addressing these issues effectively is crucial for improving patient outcomes and quality of care.</p><p><strong>Aim: </strong>To develop an anxiety-focused nursing intervention programme and investigate the effects of this programme on anxiety levels, cognitive function and the incidence of delirium among patients in a neurological ICU.</p><p><strong>Study design: </strong>A non-randomized controlled design was employed.</p><p><strong>Method: </strong>The outcome variables of experimental and control groups were compared. Sixty patients in a 1235-bed tertiary general hospital ICU in South Korea were assigned to the experimental (n = 30) or control group (n = 30), which were administered the anxiety nursing intervention and standard care, respectively. Anxiety and cognitive function were measured before and after the intervention, while the incidence of delirium was monitored throughout the study period.</p><p><strong>Results: </strong>The results showed that the experimental group exhibited significantly lower anxiety levels (t = 6.83, p < 0.001) and improved cognitive function (t = 2.56, p = 0.013) compared to that of the control group. Additionally, the incidence of delirium in the experimental group was significantly reduced (χ² = 11.28, p = 0.001) post-intervention.</p><p><strong>Conclusions: </strong>The anxiety nursing intervention programme effectively reduces anxiety, improves cognitive function and decreases the incidence of delirium in patients with neurocritical conditions.</p><p><strong>Relevance to clinical practice: </strong>These findings highlight the essential role of comprehensive nursing interventions in addressing the psychological and cognitive needs of patients with neurocritical conditions. Training nurses to implement the developed protocol is vital to improve patient outcomes in neurological intensive care settings.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70062"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112648","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":"Is the Professional Nurse Advocate Essential in Improving the Retention of Critical Care Nurses?","authors":"Jessica Pountney, Sheera Sutherland, Katy Powell","doi":"10.1111/nicc.70067","DOIUrl":"https://doi.org/10.1111/nicc.70067","url":null,"abstract":"","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70067"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144157","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":"Interventions to Support Psychological Health Outcomes for Children and Families Experiencing Paediatric Intensive Care Unit (PICU) Admission: A Scoping Review.","authors":"Grace Scott, Leigh M Dunn, Belinda Dow, Justin Kenardy, Alexandra C De Young, Debbie A Long","doi":"10.1111/nicc.70057","DOIUrl":"10.1111/nicc.70057","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Admission to a Paediatric Intensive Care Unit (PICU) can be a traumatic experience for children and their families. Most children admitted to a PICU will survive; however, a significant proportion of children and their parents will experience serious psychosocial difficulties before, during and after PICU admission. There remains a knowledge gap concerning effective interventions for preventing or reducing adverse psychological outcomes for children and their caregivers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;This study aimed to identify and describe the types and characteristics of psychosocial interventions for the prevention, early detection and/or treatment of adverse psychological outcomes in children and/or their families before, during and after experiencing PICU admission and to identify gaps in the current literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;A scoping review was conducted through PsycINFO, PubMed, CINAHL and Scopus. English-language peer-reviewed and grey literature were searched from the earliest available records to July 2024. Key search domains included interventions and efficacy, feasibility, measurement instruments and psychological outcome variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 3137 studies initially identified through database searching, 10 were included for full review. The findings from included articles describe nine universal interventions that include information provision and psychoeducational approaches, and one targeted psychotherapeutic intervention. There exists a significant paucity of targeted and clinical interventions for those patients and families at high risk of poor psychological outcomes. The Creating Opportunities for Parent Empowerment (COPE) programme emerged as a notable intervention, demonstrating reductions in parental stress, improved emotional coping and increased parental engagement in their child's care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The existing literature examining the efficacy and effectiveness of psychosocial interventions to prevent or treat poor psychological outcomes before, during and after PICU admission is limited. Although a diverse range of interventions has been explored, notable discrepancies have emerged between these interventions and the actual needs and preferences of children and their families. Challenges related to standardisation and intervention type, setting, timing, scope and target must be carefully addressed in future research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Relevance to clinical practice: &lt;/strong&gt;This review highlights the need for targeted and clinical evidence-based psychosocial interventions in PICUs to address psychosocial outcomes including posttraumatic stress symptoms (PTSS) and posttraumatic stress disorder (PTSD) in children and families. Critical care nurses are uniquely positioned to identify early signs of psychological distress and should advocate for and actively participate in the development and delivery of tailored intervention","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70057"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152796","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":"Complicated placement of a nasogastric tube in the gastric mucosa: A case report and literature review.","authors":"Yiqi Zhang, Yuzhi Gao, Linyan Zeng, Juan Hu, Xia Zheng","doi":"10.1111/nicc.13178","DOIUrl":"10.1111/nicc.13178","url":null,"abstract":"<p><p>Nasogastric tubes (NGTs) are commonly used in the intensive care unit (ICU) and are often inserted blindly at the bedside. Previous studies have highlighted various complications associated with NGT misplacement, including epistaxis, pneumothorax and even fatal perforations. To reduce the incidence of complications, guidelines recommend confirming the correct position of the NGT through radiography, pH testing, end-expiratory carbon dioxide monitoring, ultrasonography, etc. Herein, we present the case of a 78-year-old man who experienced sudden dyspnoea, was brought to the ICU and subsequently developed gastrointestinal bleeding following improper NGT placement. In this patient, air was rapidly injected down the NGT while auscultating for a 'whooshing sound' over the epigastrium. However, the correct position of the NGT was eventually confirmed by X-ray. Urgent upper gastrointestinal endoscopy revealed an oesophagogastric submucosal tunnelling of the NGT. This case emphasizes that auscultation may be unreliable and no longer encouraged. Additionally, various verification methods may not detect such rare complications related to NGT placement, making it necessary to focus on the emerging clinical manifestations following NGT insertion. Moreover, gaining further insight into the history of gastrointestinal diseases in patients may be beneficial. RELEVANCE TO CLINICAL PRACTICE: This case underscores the importance of noting resistance during a blind nasogastric tube (NGT) insertion in the intensive care unit (ICU). Additionally, the 'whooshing testing' for tube placement verification is not recommended. Although radiographic confirmation remains the gold standard, it may not effectively identify rare complications. Furthermore, emerging clinical signs (such as the abnormal nature of the gastrointestinal decompression drainage fluid, hypotension and anaemia) after insertion may suggest NGT misalignment. Finally, in urgent ICU settings, the patient's history of gastrointestinal disease should not be overlooked, as it can lead to complications such as gastrointestinal bleeding.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13178"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401824","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}