Nursing in Critical Care最新文献

{"title":"What influences interruption of continuous renal replacement therapy in intensive care unit patients: A review with meta-analysis on outcome variables.","authors":"Xia Xiaomei, Chong Yuliang, Qiao Jianhong, Paulo Moreira, Xue Xiujuan","doi":"10.1111/nicc.13179","DOIUrl":"10.1111/nicc.13179","url":null,"abstract":"<p><strong>Background: </strong>Evidence suggests that 8%-10% of ICU patients receive renal replacement therapy. However, there is a high rate of unplanned CRRT interruption, ranging between 17% and 74%. Studies on unplanned interruption of CRRT mainly focused on the retrospective investigation of related risk factors and conclusions have been diverse.</p><p><strong>Aim: </strong>This article aims to clarify the main influencing factors related to unplanned interruption of continuous renal replacement therapy (CRRT) in adult patients in intensive care units (ICUs).</p><p><strong>Study design: </strong>A literature review and meta-analysis were undertaken. Following the application of the Newcastle-Ottawa Scale (NOS), a total of 15 articles were included in a total of 2132 patients who underwent 3690 CRRT procedures and 2181 unplanned interruption times. The methodological guideline of a scoping review was applied for the evidence synthesis while applying the meta-analysis quantitative methodological guideline to identify and clarify main influencing factors related to unplanned interruption of CRRT. The reporting Prisma Protocol was followed.</p><p><strong>Results: </strong>Longer filter life and prothrombin activation time, higher red blood cell count, greater transmembrane pressure, faster blood flow rate, intermittent saline irrigation, lower creatinine level, low prothrombin activity and pre-dilution are factors identified to potentially affect unplanned CRRT in ICU patients.</p><p><strong>Conclusions: </strong>Available evidence suggests four clinical challenges associated with unplanned CRRT interruption, namely: (a) effects of red blood cell count, filter life, cross-mode pressure, blood flow velocity, prothrombin activity and activated partial thrombin time on unplanned interruption; (b) influence of dilution mode on unplanned interruption; (c) influence of intermittent saline irrigation on unplanned interruption; (d) influence of Scr level on unplanned interruption.</p><p><strong>Relevance to clinical practice: </strong>The potential to increase the ability to better manage unplanned CRRT in ICUs has been identified in this article and constitutes a relevant potential health care management contribution that can be implemented by nurses.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13179"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12051084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480264","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":"ICU nurses' perceptions of patients with co-morbid mental health disorders: An integrative review.","authors":"Angela Teece, John Baker","doi":"10.1111/nicc.70022","DOIUrl":"10.1111/nicc.70022","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of patients with a mental health (MH) disorder in intensive care units (ICU) is roughly twice that of other secondary care areas. This patient group can struggle to access the health care system because of stigma. Nurses' perceptions of MH patients in the Emergency Department have been studied and were associated with avoidance, misconceptions and perceived lack of skills to manage this patient group; however, it was unclear if similar issues were present amongst ICU nurses.</p><p><strong>Aim: </strong>This review aimed to explore how nurses perceive ICU patients with a co-morbid MH disorder.</p><p><strong>Study design: </strong>An integrative review was undertaken in March 2024 using CINAHL, Medline, Embase and PsychInfo to synthesize empirical and theoretical evidence from a range of different research approaches. A five-step approach (problem identification, literature search, data evaluation using the Mixed Methods Appraisal tool, data analysis and presentation) was followed. Papers were included if they focused on nurses' perceptions of adult ICU patients with a co-morbid MH disorder. Totally, 620 studies were identified following duplicate removal.</p><p><strong>Results: </strong>Eight studies were selected for inclusion. Four themes were identified: (1) 'Those types of patient', (2) Patients with MH disorders are all violent and aggressive, (3) 'They' don't belong in ICU and (4) 'They' need someone with special skills. The themes explored issues of preconceptions, stigma and 'othering'.</p><p><strong>Conclusions: </strong>There was a paucity of research on this topic, and it was limited in geographical area. The findings suggest that stigma, misconceptions, a lack of support and a perceived lack of skills might lead nurses to deliver suboptimal care to this vulnerable patient group.</p><p><strong>Relevance to clinical practice: </strong>Stigma against patients with MH disorders could lead ICU nurses to reduce their engagement with them, impacting negatively on the provision of holistic care. Education and ongoing support are required to reduce misconceptions and bias and increase nurses' confidence when managing patients with co-morbid MH disorders.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70022"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755647","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":"Patient follow-up after discharge from the paediatric intensive care unit: A scoping review.","authors":"Delphine Micaëlli, Jérôme Naudin, Stéphane Dauger, Michaël Levy, Sébastien Kerever","doi":"10.1111/nicc.13187","DOIUrl":"10.1111/nicc.13187","url":null,"abstract":"<p><strong>Background: </strong>Most children admitted to a paediatric intensive care unit (PICU) now survive because of improvements in care. Many studies have identified the psychological, functional, cognitive and social impact of PICU admission on a child and their family. However, expert recommendations on follow-up are lacking.</p><p><strong>Aim: </strong>To identify the strategies of clinical follow-up after PICU discharge performed from 2001 to 2021.</p><p><strong>Study design: </strong>This scoping review was undertaken between January and April 2021 using three databases: PubMed, EMBASE and CINAHL. The search strategy consisted of a combination of keywords, including PICU, post-PICU discharge and follow-up in articles published between 2001 and 2021. The results are reported according to PRISMA-ScR guidelines.</p><p><strong>Results: </strong>Six-hundred and fifty-two articles were identified and 68 were analysed. Median age was 4.5 years and the two main reasons for PICU admission were cardiorespiratory failure and sepsis. Median length of PICU stay was 8 days. Most follow-up was carried out by research units (88%), while 6% of studies reported follow-up by a multidisciplinary PICU team. The most common follow-up schedule included an assessment at PICU discharge, and then at 3, 6 and 12 months. Follow-up for >1 year was reported in 20% of studies. One third of studies focused on follow-up quality of life and neurological outcomes. Parental emotional impact was assessed in 7% of studies.</p><p><strong>Conclusion: </strong>Follow-up after PICU discharge was highly heterogeneous regarding timing, health care professionals involved and assessment methods. There is an urgent need for standardization and coordination of PICU follow-up because of the increasing number of patients impacted by a PICU stay.</p><p><strong>Relevance to clinical practice: </strong>Although most patients admitted to a paediatric intensive care unit (PICU) now survive; they may develop paediatric post-intensive care syndrome (PICS-P). To our knowledge, there are currently no clinical guidelines regarding follow-up after PICU discharge. This review summarizes current approaches to follow-up after PICU discharge, including how it is carried out, who is involved and what the main aims of assessment are.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13187"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480250","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 mediating role of work-life balance on the relationship between emotional intelligence and job satisfaction among Lebanese critical care nurses.","authors":"Ali Hemade, Mohamad Baqer Khashab, Charbel Houwayek, Souheil Hallit, Feten Fekih-Romdhane, Mirna Fawaz","doi":"10.1111/nicc.13239","DOIUrl":"10.1111/nicc.13239","url":null,"abstract":"<p><strong>Background: </strong>In healthcare settings, particularly in intensive care units, nurses face significant stress due to the high demands of their job. This stress can impact their job satisfaction, mental health, and overall quality of life. Emotional intelligence has been identified as a crucial factor that can mitigate workplace stress and enhance job satisfaction. Moreover, work-life balance is increasingly recognized as a critical factor influencing job satisfaction in the nursing profession.</p><p><strong>Aim: </strong>Our study aims at understanding the mediating effect of work-life balance between emotional intelligence and job satisfaction in Lebanese nurses working in the Intensive Care Unit.</p><p><strong>Study design: </strong>This study has a cross-sectional design.</p><p><strong>Methods: </strong>Nurses working in intensive care units of one hospital (n = 100) were asked to fill an online questionnaire which included the Wong and Law Emotional Intelligence Scale, Work-Life Balance Self-Assessment Scale, and Job Satisfaction Scale.</p><p><strong>Results: </strong>Work Interference with Personal Life and Personal Life Interference with Work acted as significant mediators between emotional intelligence and job satisfaction. Specifically, the direct role of emotional intelligence on job satisfaction was found to be significant, with work interference with personal life (β = .02, SE = .01, p = .001) and personal life interference with work (β = .02, SE = .01, p = .002) showing significant indirect roles. Higher emotional intelligence was directly and significantly associated with more job satisfaction (p < .01).</p><p><strong>Conclusions: </strong>The study underscores the potential benefits of emotional intelligence training and work-life balance promotion in enhancing nurses' job satisfaction.</p><p><strong>Relevance to clinical practice: </strong>Pending future longitudinal studies, findings cautiously imply that targeting work-life balance could help foster the positive connection between emotional intelligence and Job Satisfaction among nurses. Accordingly, healthcare administrators should prioritize policies that promote flexible scheduling, sufficient staffing levels, and mental health resources, which are essential for maintaining a balance between professional obligations Job Satisfaction and personal life.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13239"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985444","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":"Investigating key factors of feeding intolerance in sepsis: A scoping review.","authors":"Yijing Ling, Xufeng Chen, Yujia Gu, O Mensah Solomon, Gaimei Wang, Yehong Wei","doi":"10.1111/nicc.70038","DOIUrl":"10.1111/nicc.70038","url":null,"abstract":"<p><strong>Background: </strong>At present, domestic and international research on the current status of feeding intolerance in septicemia patients only stops at the study of influencing factors; however, due to the specificity of the disease, the influencing factors are numerous and controversial.</p><p><strong>Aims: </strong>To systematically analyse the studies related to the occurrence of feeding intolerance in patients with sepsis, to find out the influencing factors of feeding intolerance in these patients and to provide a reference for nursing staff to develop relevant interventions.</p><p><strong>Study design: </strong>The study employed Arksey and O'Malley's methodology to carry out a scoping review. We conducted a systematic search, using the scoping review as a framework, for relevant Chinese and English literature on factors influencing feeding intolerance in patients with sepsis in China Knowledge Network, Wanfang, CINAHL, Pubmed, Web of Science and Google Scholar, covering a time frame from construction to 1 September 2024. We identified research questions, completed literature screening and quality assessment, extracted data and summarized and analysed the data.</p><p><strong>Results: </strong>The review included a total of 13 papers. Factors influencing feeding intolerance in septicemia patients included patient factors, disease factors, biochemical indicators, feeding determinants, clinical treatment and drug effects.</p><p><strong>Conclusions: </strong>Factors affecting feeding intolerance in patients with sepsis are multifaceted. We should develop individualized care plans based on relevant risk factors to improve feeding tolerance and shorten hospital stays in patients with sepsis.</p><p><strong>Relevance to clinical practice: </strong>In order to improve the ability of ICU nurses to identify the risk factors of feeding intolerance in patients with sepsis, it is recommended to conduct systematic training on the pathophysiology of sepsis, influencing factors of feeding intolerance and intervention measures and assist nurses to implement appropriate intervention measures.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70038"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052693","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":"Risk factors for enteral nutrition feeding intolerance in stroke patients: A scoping review.","authors":"Owusu Mensah Solomon, Yujia Gu, Yehong Wei","doi":"10.1111/nicc.13183","DOIUrl":"10.1111/nicc.13183","url":null,"abstract":"<p><strong>Background: </strong>Feeding intolerance is a common issue in stroke patients who are receiving enteral nutrition, and it has a substantial effect on their recovery and rehabilitation. Understanding the various factors of feeding intolerance in this patient population is vital for improving care and outcomes.</p><p><strong>Aim: </strong>This review aims to map the existing literature on enteral nutrition in stroke patients, identifying key themes, gaps and areas for future research.</p><p><strong>Study design: </strong>This review was conducted as a scoping review following the PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist to ensure comprehensive coverage and methodological rigour. We conducted a scoping review by searching databases such as PubMed, CINAHL, Scopus, Web of Science, CNKI and WangFang from 1 January 2000 to 31 January 2024. We aimed to locate research about issues with enteral nutrition feeding in stroke patients. We collected data on the patient's characteristics, medical status, therapies, feeding protocols and nursing care. A total of 25 articles met the inclusion criteria and were included in the review.</p><p><strong>Results: </strong>Twenty-two influencing factors were identified and categorized into patient factors (5), disease factors (8), treatment factors (2), feeding management factors (5) and nursing factors (2). Notably, age, intra-abdominal pressure, serum albumin levels, APACHE-II scores and central venous pressure (CVP) were among the most commonly reported.</p><p><strong>Conclusions: </strong>This scoping introduction uniquely focuses on stroke patients receiving enteral nutrition, explaining specific influencing factors for feeding intolerance.</p><p><strong>Relevance to clinical practice: </strong>Health care professionals must identify and manage risk factors for enteral nutrition feeding intolerance. Ongoing professional development and specialized training on the significance of enteral feeding in stroke rehabilitation can improve patient care and outcomes.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13183"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480251","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":"Missed Intensive Nursing Care Scale: Results From an Italian Validation Study.","authors":"Ilaria de Barbieri, Martina Dato, Lisa Grego, Xiuni Gan, Elisa Daniele, Claudia Casumaro, Mayra Veronese, Matteo Danielis","doi":"10.1111/nicc.70044","DOIUrl":"https://doi.org/10.1111/nicc.70044","url":null,"abstract":"<p><strong>Background: </strong>Unfinished Nursing Care (UNC) refers to essential patient care that is postponed or neglected, significantly impacting outcomes such as increased morbidity, mortality and hospital-acquired infections. In Intensive Care Units (ICUs), the complexity of patient conditions results in higher UNC rates, particularly for basic care interventions. The Missed Intensive Nursing Care Scale (MINCS) assesses the frequency and types of missed care in these settings.</p><p><strong>Aim: </strong>This study aimed to translate, culturally adapt and validate MINCS for use in the Italian ICU context, ensuring its psychometric robustness.</p><p><strong>Study design: </strong>A methodological research for translation, cross-cultural adaptation and validation was conducted in two hospitals in north-eastern Italy, involving general, neurosurgical and cardiothoracic ICUs. The process included translation, back-translation, expert evaluation, pilot testing and psychometric analysis of MINCS-Italy (MINCS-IT) using Cronbach's alpha, Exploratory Factor Analysis (EFA) and Rasch analysis.</p><p><strong>Results: </strong>A total of 135 ICU nurses participated in the study, 76.3% were female, and an average ICU experience of 11.1 years. The final version of MINCS-IT contained 48 items, divided into three sections: demographics, elements of missed nursing care (34 items, α = 0.92), and reasons for missed care (14 items, α = 0.94). EFA revealed a five-factor structure for elements of missed care (53.2% variance explained) and a two-factor structure for reasons (64.9% variance explained). Rasch analysis supported item validity, except for one item (\"Assessing patient nutritional status\"), which showed suboptimal values.</p><p><strong>Conclusions: </strong>The MINCS-IT is a reliable tool for assessing missed nursing care in Italian ICUs, addressing both fundamental and complex patient needs. Its comprehensive approach supports targeted interventions to improve care quality.</p><p><strong>Relevance to clinical practise: </strong>The MINCS-IT enables nurse managers to identify missed care patterns, fostering improvements in nursing practises and patient-family care outcomes, ultimately elevating ICU standards.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70044"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040218","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":"Challenges and peculiarities of nursing activities in intermediate care units compared with internal medicine wards: A prospective study.","authors":"Serena Sibilio, Arian Zaboli, Marta Parodi, Paolo Ferretto, Daniela Milazzo, Monica Trentin, Francesca Stefani, Elisa Mantiero, Francesco Brigo, Massimo Marchetti, Gianni Turcato","doi":"10.1111/nicc.13155","DOIUrl":"10.1111/nicc.13155","url":null,"abstract":"<p><strong>Background: </strong>Intermediate Care Units (IMCs) are specialized facilities located within other departments in many Western countries. They are designed to manage patients with conditions that are not severe enough to require an intensive care unit. IMCs aim to fill the gap between regular wards and intensive care units, necessitating an adequate allocation of nursing resources.</p><p><strong>Aims: </strong>The aims of the study are to (1) evaluate and compare the nursing workload for patients admitted to a regular ward or to an IMC; (2) quantify nursing workload in terms of activities and time spent to perform them; and (3) evaluate which patient characteristics predict nursing work overload.</p><p><strong>Study design and methods: </strong>This is an observational, prospective, single-centre study. We included patients admitted to the Internal Medicine department in a general hospital in Italy, between 1 September and 31 December 2022, either in the regular ward or in the IMC. Clinical characteristics, comorbidity, functionality, frailty, severity and acuity of patients were recorded using validated assessment tools. Nursing activities in the first 3 days of hospitalization were recorded and standardized as activities/5 min/patient/day. An average number of nursing activities/5 min/patient/day exceeding the 85th percentile was considered nursing work overload. Multivariate logistic regression models were conducted to identify patient-related risk factors associated with nursing work overload.</p><p><strong>Results: </strong>We included 333 patients, 55% (183/333) admitted to the IMC and 45% (150/333) to the regular ward. In the IMC, the average nursing activities were 32.4/5 min/patient/day compared with 22.6 in the regular ward. Nursing work overload was found in 6% (9/150) of patients admitted to the regular ward compared with 23% (42/183) in the IMC.</p><p><strong>Conclusion: </strong>There is a significantly higher demand for nursing care among patients in the IMC, with higher daily average of nursing activities.</p><p><strong>Relevance to clinical practice: </strong>The allocation of nursing resources within the IMC should be greater than in the regular ward because of higher workload.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13155"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300299","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":"Cortrak feeding tube safety: Criteria for interpreting lung misplacement.","authors":"Stephen J Taylor, Paul White","doi":"10.1111/nicc.70040","DOIUrl":"https://doi.org/10.1111/nicc.70040","url":null,"abstract":"<p><strong>Background: </strong>Pneumothorax occurs in 0.52% of blind tube placements, with 97% occurring in-procedure. Post-procedure pH or x-ray checks cannot prevent these, but CO₂ checks or guided tube placement can. Cortrak guided tube placement is widespread, but manufacturer guidance to interpret lung placement is subjective.</p><p><strong>Aim: </strong>Develop objective criteria to differentiate lung from oesophageal tube placement from measurements and patterns in Cortrak traces.</p><p><strong>Study design: </strong>Paired comparison of lung and oesophageal Cortrak traces using a retrospective analysis of prospectively collected data in critically ill patients.</p><p><strong>Results: </strong>From 126 paired traces, lung position, versus oesophageal, was indicated by deviation from the sagittal midline further from the receiver and by a greater angle and distance. No lung trace moved deep to shallow and returned to the midline then turned left compared with 99.2% of oesophageal traces; 56.3% of traces had some degree of artefact caused by receiver misalignment and required interpretation to account for this.</p><p><strong>Conclusions: </strong>Differences in trace measurements give early warning of lung placement, and absence of an oesophageal pattern is definitive. Manufacturer guidance describing Cortrak trace is subjective, lacking advice on how to interpret or correct for artefacts. This could fail to prompt a 'lung warning' and/or lead to unnecessary withdrawal of oesophageal placements; both risk trauma.</p><p><strong>Relevance to clinical practice: </strong>The objective criteria developed enable detection of lung placement. If regulatory authorities mandate their use in independently accredited training, Cortrak would be a safe method to confirm tube position.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70040"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081659","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":"Impact of Nurse-Driven Analgesia and Sedation Protocols on Medication Exposure and Withdrawal in Critically Ill Children: A Systematic Review.","authors":"Laura Schianchi, Julia Harris","doi":"10.1111/nicc.70051","DOIUrl":"10.1111/nicc.70051","url":null,"abstract":"<p><strong>Background: </strong>The administration of analgesia and sedation is essential for patients admitted to the paediatric intensive care unit (PICU). However, over-sedation can cause side effects, including iatrogenic withdrawal syndrome (IWS). The use of nurse-led analgesia and sedation protocols may improve patient outcomes.</p><p><strong>Aim: </strong>The primary aim of this systematic review was to determine whether the use of such protocols can reduce opioid and benzodiazepine doses. Secondary outcome measures included documentation of pain and sedation scores, incidence of IWS, duration of mechanical ventilation (MV) and PICU/hospital length of stay (LOS).</p><p><strong>Study design: </strong>A systematic review of the literature was conducted, searching several databases, including CINAHL, MEDLINE, Academic Search Complete and Cochrane Library. Pertinent articles were selected according to pre-determined eligibility criteria. The internal validity of included studies was assessed using validated critical appraisal tools for quantitative research from the Cochrane Library. Narrative synthesis was utilised for data analysis due to the heterogeneity of study characteristics.</p><p><strong>Results: </strong>Nurse-led protocolised sedation significantly reduced the administered doses of benzodiazepines and the incidence of IWS. Moreover, the use of protocols significantly improved the documentation of pain and sedation scores across included studies. No significant difference in opioid use, duration of MV, and PICU/hospital LOS has been found. However, sub-group analyses for duration of MV and PICU/hospital LOS showed positive results in older children and those post-cardiac surgery.</p><p><strong>Conclusions: </strong>Nurse-driven analgesia and sedation protocols can reduce over-sedation and IWS in critically ill children. Further studies should explore the use of protocols in patient sub-groups where positive results have been reported.</p><p><strong>Relevance to clinical practice: </strong>Nurse-led analgesia and sedation protocols in PICU can improve outcomes and reduce costs. Effective implementation requires training and audits to boost nurses' confidence and autonomy.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70051"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175764","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}