Intensive and Critical Care Nursing最新文献_第2页

Accuracy of indices of inferior vena cava in predicting fluid responsiveness in patients with shock: A systematic review and meta-analysis

IF 4.9 2区医学

Intensive and Critical Care Nursing Pub Date : 2025-04-08 DOI: 10.1016/j.iccn.2025.104015

Yang Wenwen , Xu Ping , Dong Yue , Lu Xuan

{"title":"Accuracy of indices of inferior vena cava in predicting fluid responsiveness in patients with shock: A systematic review and meta-analysis","authors":"Yang Wenwen , Xu Ping , Dong Yue , Lu Xuan","doi":"10.1016/j.iccn.2025.104015","DOIUrl":"10.1016/j.iccn.2025.104015","url":null,"abstract":"<div><h3>Objectives</h3><div>To synthesise quantitative research findings on the accuracy of inferior vena cava (IVC) indices in judging fluid responsiveness (FR) in patients with shock.</div></div><div><h3>Methods</h3><div>A total of nine electronic databases were searched from inception to April 8, 2024. The risk of bias of the included studies was evaluated by Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. A <em>meta</em>-analysis of the values of external validations of the model was performed by Stata 16.0. Pooled estimates were calculated according to the true positive, false positive, false negative, true negative, sensitivity, and specificity using random-effects models. Meta-regression was adopted to investigate between-study heterogeneity, and funnel plots were tested for publication bias.</div></div><div><h3>Results</h3><div>Twenty-nine studies were included in the <em>meta</em>-analysis (1833 patients). For FR, the sensitivity was 0.82 (95 %CI, 0.75–0.87), specificity was 0.82 (95 % CI, 0.77–0.87), positive likelihood ratio was 4.58 (95 %CI, 3.48–6.03), negative likelihood ratio was 0.22 (95 %CI, 0.16–0.31), diagnostic odds ratio was 20.65 (95 %CI, 12.84–33.14), and the area under the summary receiver operating characteristic curve was 0.89 (95 % CI, 0.86–0.91). All studies had a low or moderate risk of bias in terms of methodological quality. There was heterogeneity among the included studies (sensitivity: <em>I</em><sup>2</sup> = 83.04 %, <em>P</em> < 0.001, specificity: <em>I</em><sup>2</sup> = 78.78 %, <em>P</em> < 0.001), and bivariate <em>meta</em>-regression analysis showed that fluid infusion ingredient, reference standards and thresholds, and type of measurement (invasive or non-invasive) were sources of literature heterogeneity.</div></div><div><h3>Conclusion</h3><div>The IVC indices moderately predicted the incidence of FR in patients with shock. However, significant heterogeneity was evident among the included studies. Studies of high methodological quality in specific subgroups of shock are needed to evaluate the efficacy of IVC indices as predictors of FR.</div></div><div><h3>Implications for Clinical Practice</h3><div>Monitoring of the inferior vena cava (IVC) by ultrasonography has been shown to have a clinical value in terms of volume reactivity, with the potential to provide non-invasive and effective guidance.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"89 ","pages":"Article 104015"},"PeriodicalIF":4.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Knowledge, attitudes and practices of multiprofessional clinicians towards assisted dying in ICU: A scoping review

IF 4.9 2区医学

Intensive and Critical Care Nursing Pub Date : 2025-04-04 DOI: 10.1016/j.iccn.2025.104014

Luke Costello , Brigitta Fazzini

{"title":"Knowledge, attitudes and practices of multiprofessional clinicians towards assisted dying in ICU: A scoping review","authors":"Luke Costello , Brigitta Fazzini","doi":"10.1016/j.iccn.2025.104014","DOIUrl":"10.1016/j.iccn.2025.104014","url":null,"abstract":"<div><h3>Background</h3><div>Care of the dying is at the forefront in intensive care unit (ICU); however there is persistent debate surrounding clinicians’ interventions to aid the dying process and make this more bearable and compassionate for patients. Since the expansion of assisted dying internationally, it is unclear how common this occurs within critical care. This work aims to evaluate the knowledge, attitudes and international practices of ICU clinicians about assisted dying.</div></div><div><h3>Methods</h3><div>Systematic literature search of PubMed, Embase and CINAHL including articles discussing the knowledge or attitudes towards and/or practices of assisted dying in ICU. The preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines were followed. Records were included from 2002 as the year when assisted dying was first legalised in Belgium and by healthcare professionals. A qualitative data synthesis approach was used.</div></div><div><h3>Results</h3><div>17 studies were eligible and included in the qualitative analysis. Knowledge of assisted dying was rarely assessed directly in the data, though self-reported knowledge was low apart from in one Canadian survey of ICU physicians. Abilities to define modalities of assisted dying were low across all studies where it was measured. Attitudes were highly variable, ranging from 23.6% to 76.5% in support of assisted dying, though clinicians’ answers were inconsistent within and between studies. Actual practices of assisted dying in ICU were rarely measured or discussed, despite evidence of assisted dying in Canada and The Netherlands. Outside of legal pathways, there is also evidence of covert interventions either via non-framework approaches where it is otherwise legal or in countries where there is no supportive legislation.</div></div><div><h3>Conclusion</h3><div>ICU clinicians have heterogeneous knowledge and attitudes towards assisted dying, and overall familiarity remains low. The relevance of assisted dying to the ICU setting remains controversial, and its incidence is unclear.</div></div><div><h3>Implications for clinical practice</h3><div>Evaluating the attitudes and experiences of ICU clinicians about assisted dying is important to gain insight about clinical practices.</div><div>This holistic viewpoint is key to develop management strategies focused on humanisation of care for patients and families while understanding how to support multidisciplinary clinicians in critical care so they can provide safe and respectful interventions.</div><div>The identification of its incidence in legal and illegal frameworks and knowledge gaps is key when developing further research and planning tailored interventions.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"89 ","pages":"Article 104014"},"PeriodicalIF":4.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Do we still need central venous pressure monitoring in the ICU? Yes!

IF 4.9 2区医学

Intensive and Critical Care Nursing Pub Date : 2025-03-29 DOI: 10.1016/j.iccn.2025.103990

Antonio Pesenti , Michael R. Pinsky

引用次数: 0

Family auditory stimulation: A promising family-centered care strategy for preventing ICU delirium

IF 4.9 2区医学

Intensive and Critical Care Nursing Pub Date : 2025-03-29 DOI: 10.1016/j.iccn.2025.104016

Mu-Hsing Ho, Hye Ri Choi

引用次数: 0

Beyond the ICU: Long-term psychological effect of patient restraints

IF 4.9 2区医学

Intensive and Critical Care Nursing Pub Date : 2025-03-29 DOI: 10.1016/j.iccn.2025.103993

Shelly Ashkenazy , Julie Benbenishty

引用次数: 0

The value of social media for intensive care practice

IF 4.9 2区医学

Intensive and Critical Care Nursing Pub Date : 2025-03-28 DOI: 10.1016/j.iccn.2025.104019

Antonija Petosic , Kjetil Sunde , Hilde Wøien

引用次数: 0

What is appropriate ICU care?

IF 4.9 2区医学

Intensive and Critical Care Nursing Pub Date : 2025-03-28 DOI: 10.1016/j.iccn.2025.104018

Marieke Zegers, Gijs Hesselink

引用次数: 0

Advancing Impella Utilization in cardiogenic shock and high-risk percutaneous coronary interventions: Optimizing patient outcomes through evidence-based strategies and comprehensive training

IF 4.9 2区医学

Intensive and Critical Care Nursing Pub Date : 2025-03-28 DOI: 10.1016/j.iccn.2025.104023

Fung Ming Lau , Mu-Hsing Ho , Wai Chi Polly Li

引用次数: 0

Understanding adherence and deviations in potassium replacement protocols: A mixed method study

IF 4.9 2区医学

Intensive and Critical Care Nursing Pub Date : 2025-03-24 DOI: 10.1016/j.iccn.2025.104013

Kylie O’Neill , Jason Meyer , Elizabeth Manias , Gordon Laurie , Stewart Mealing , Kellie Sosnowski , Belinda Badman , Melissa J. Bloomer

{"title":"Understanding adherence and deviations in potassium replacement protocols: A mixed method study","authors":"Kylie O’Neill , Jason Meyer , Elizabeth Manias , Gordon Laurie , Stewart Mealing , Kellie Sosnowski , Belinda Badman , Melissa J. Bloomer","doi":"10.1016/j.iccn.2025.104013","DOIUrl":"10.1016/j.iccn.2025.104013","url":null,"abstract":"<div><h3>Background</h3><div>Potassium replacement protocols are commonly used in ICUs to standardise replacement and minimise harm. Yet, there is variability in potassium replacement practices.</div></div><div><h3>Aims</h3><div>(i) To examine relationships between potassium levels, potassium administration, and the potassium replacement protocol; and (ii) to explore factors influencing potassium replacement decision-making.</div></div><div><h3>Methods</h3><div>An exploratory mixed methods approach using retrospective audit and interviews was undertaken. Clinical data from two ICUs were extracted about potassium results, potassium administration and other related data from the first 72 h of ICU admission, for all patients admitted between January 2015 and December 2022. Critical care nurses were interviewed between January and March 2024, with interviews professionally transcribed and analysed using inductive content analysis.</div></div><div><h3>Results</h3><div>From the sample of N = 10,613 patients, n = 132,507 potassium results were analysed. Potassium replacement was indicated for 39.7 % (n = 52,592) of potassium results. When replacement was indicated, potassium was administered within 2 h in 59.9 % (n = 31,508) of cases. Interviews with critical care nurses (n = 21) lasted 5–28 min (mean 12 min). Interview participants indicated that potassium replacement decisions were influenced by the patient’s history and current condition, and colleague consultation. There was little concern over potential risks associated with potassium replacement. Greater clarity around the purpose and compulsoriness of potassium replacement protocols was desired.</div></div><div><h3>Conclusion</h3><div>These findings offer valuable insights into the intricacies of protocolised potassium replacement adherence and deviations across two ICU settings. Autonomy and interprofessional collaboration emerged as a key factor, with nurses exercising decision-making ability underpinned by patient specific considerations, assessment, and clinical judgement.</div></div><div><h3>Implications for clinical practice</h3><div>When protocols are used to guide potassium replacement and other electrolytes, clear guidance as to the compulsoriness of the protocol is needed. Alternately, with safety a priority, when and how clinicians may use their clinical judgement and discretion in potassium replacement must also be explicit.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"88 ","pages":"Article 104013"},"PeriodicalIF":4.9,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Factors influencing high-flow nasal cannula success in acute hypoxemic respiratory failure – Letter on Zevallos-Villegas et al.

IF 4.9 2区医学

Intensive and Critical Care Nursing Pub Date : 2025-03-21 DOI: 10.1016/j.iccn.2025.104008

Yan Fang , Wen-Li Wu , Li-Fen Hu , Xiao-Xiao Luo , Xian-Rong Shi

引用次数: 0