American Journal of Critical Care最新文献_第10页

Evaluation of Nurse-Driven Management of Hypoglycemia In Critically Ill Patients. 评估重症患者低血糖的护士驱动管理。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-05-01 DOI: 10.4037/ajcc2024320

Anna Robinson, Michelle A Mathiason, Carol Manchester, Mary Fran Tracy

{"title":"Evaluation of Nurse-Driven Management of Hypoglycemia In Critically Ill Patients.","authors":"Anna Robinson, Michelle A Mathiason, Carol Manchester, Mary Fran Tracy","doi":"10.4037/ajcc2024320","DOIUrl":"https://doi.org/10.4037/ajcc2024320","url":null,"abstract":"Background: Intensive care unit (ICU) patients experience hypoglycemia at nearly 4 times the rate seen in non-ICU counterparts. Although inpatient hypoglycemia management relies on nurse-driven protocols, protocol adherence varies between institutions and units.Objective: To compare hypoglycemia management between ICU and non-ICU patients in an institution with high adherence to a hypoglycemia protocol.Methods: This secondary analysis used retrospective medical record data. Cases were ICU patients aged 18 years or older with at least 1 hypoglycemic event (blood glucose level < 70 mg/dL); non-ICU controls were matched by age within 10 years, sex, and comorbidities. Time from initial hypoglycemic blood glucose level to subsequent blood glucose recheck, number of interventions, time to normoglycemia, and number of spontaneous hypoglycemic events were compared between groups.Results: The sample included 140 ICU patients and 280 non-ICU controls. Median time to blood glucose recheck did not differ significantly between groups (19 minutes for both groups). Difference in mean number of interventions before normoglycemia was statistically but not clinically significant (ICU, 1.12; non-ICU, 1.35; P < .001). Eighty-four percent of ICU patients and 86% of non-ICU patients returned to normoglycemia within 1 hour. Median time to normoglycemia was lower in ICU patients than non-ICU patients (21.5 vs 26 minutes; P = .01). About 25% of patients in both groups experienced a spontaneous hypoglycemic event.Conclusion: Adherence to nurse-driven hypoglycemia protocols can be equally effective in ICU and non-ICU patients. Further research is needed to determine protocol adherence barriers and patient characteristics that influence response to hypoglycemia interventions.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 3","pages":"218-225"},"PeriodicalIF":2.7,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140849329","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}

引用次数: 0

Identifying and Mitigating Sound Sources to Enhance Patients' Sleep. 识别和缓解声源，改善患者睡眠。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-05-01 DOI: 10.4037/ajcc2024102

Meredith Padilla

引用次数: 0

Hospital-Based Electrocardiographic Monitoring: The Good, the Not So Good, and Untapped Potential 医院心电监护：优点、缺点和尚未开发的潜力

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-05-01 DOI: 10.4037/ajcc2024484

M. Pelter

引用次数: 0

Early Mobility Index and Patient Outcomes: A Retrospective Study in Multiple Intensive Care Units. 早期活动指数与患者预后：多项重症监护病房回顾性研究

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-05-01 DOI: 10.4037/ajcc2024747

Sarina A Fazio, Irene Cortés-Puch, Jacqueline C Stocking, Amy L Doroy, Hugh Black, Anna Liu, Sandra L Taylor, Jason Y Adams

{"title":"Early Mobility Index and Patient Outcomes: A Retrospective Study in Multiple Intensive Care Units.","authors":"Sarina A Fazio, Irene Cortés-Puch, Jacqueline C Stocking, Amy L Doroy, Hugh Black, Anna Liu, Sandra L Taylor, Jason Y Adams","doi":"10.4037/ajcc2024747","DOIUrl":"https://doi.org/10.4037/ajcc2024747","url":null,"abstract":"Background: Early mobility interventions in intensive care units (ICUs) are safe and improve outcomes in subsets of critically ill adults. However, implementation varies, and the optimal mobility dose remains unclear.Objective: To test for associations between daily dose of out-of-bed mobility and patient outcomes in different ICUs.Methods: In this retrospective cohort study of electronic records from 7 adult ICUs in an academic quarternary hospital, multivariable linear regression was used to examine the effects of out-of-bed events per mobility-eligible day on mechanical ventilation duration and length of ICU and hospital stays.Results: In total, 8609 adults hospitalized in ICUs from 2015 through 2018 were included. Patients were mobilized out of bed on 46.5% of ICU days and were eligible for mobility interventions on a median (IQR) of 2.0 (1-3) of 2.7 (2-9) ICU days. Median (IQR) out-of-bed events per mobility-eligible day were 0.5 (0-1.2) among all patients. For every unit increase in out-of-bed events per mobility-eligible day before extubation, mechanical ventilation duration decreased by 10% (adjusted coefficient [95% CI], -0.10 [-0.18 to -0.01]). Daily mobility increased ICU stays by 4% (adjusted coefficient [95% CI], 0.04 [0.03-0.06]) and decreased hospital stays by 5% (adjusted coefficient [95% CI], -0.05 [-0.07 to -0.03]). Effect sizes differed among ICUs.Conclusions: More daily out-of-bed mobility for ICU patients was associated with shorter mechanical ventilation duration and hospital stays, suggesting a dose-response relationship between daily mobility and patient outcomes. However, relationships differed across ICU subpopulations.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 3","pages":"171-179"},"PeriodicalIF":2.7,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848921","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}

引用次数: 0

Discussion Guide for the Moale Article. 莫尔文章讨论指南

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-05-01 DOI: 10.4037/ajcc2024770

Grant A Pignatiello

引用次数: 0

Documentation, Data, and Decision-Making. 文件、数据和决策。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-05-01 DOI: 10.4037/ajcc2024617

Cindy L Munro, Lakshman Swamy

引用次数: 0

Cardiac Arrhythmias After Coronary Artery Bypass Graft Surgery. 冠状动脉旁路移植手术后的心律失常。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-05-01 DOI: 10.4037/ajcc2024870

Dillon J Dzikowicz, Sukardi Suba, Mary G Carey

引用次数: 0

Critical Care Nurses' Moral Resilience, Moral Injury, Institutional Betrayal, and Traumatic Stress After COVID-19. 重症监护护士在 COVID-19 之后的道德复原力、道德伤害、制度背叛和创伤压力。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-03-01 DOI: 10.4037/ajcc2024481

Guy M Weissinger, Deborah Swavely, Heidi Holtz, Katherine C Brewer, Mary Alderfer, Lisa Lynn, Angela Yoder, Thomas Adil, Tom Wasser, Danielle Cifra, Cynda Rushton

{"title":"Critical Care Nurses' Moral Resilience, Moral Injury, Institutional Betrayal, and Traumatic Stress After COVID-19.","authors":"Guy M Weissinger, Deborah Swavely, Heidi Holtz, Katherine C Brewer, Mary Alderfer, Lisa Lynn, Angela Yoder, Thomas Adil, Tom Wasser, Danielle Cifra, Cynda Rushton","doi":"10.4037/ajcc2024481","DOIUrl":"10.4037/ajcc2024481","url":null,"abstract":"Background: Traumatic stress and moral injury may contribute to burnout, but their relationship to institutional betrayal and moral resilience is poorly understood, leaving risk and protective factors understudied.Objectives: To examine traumatic stress symptoms, moral injury symptoms, moral resilience, and institutional betrayal experienced by critical care nurses and examine how moral injury and traumatic stress symptoms relate to moral resilience, institutional betrayal, and patient-related burnout.Methods: This cross-sectional study included 121 critical care nurses and used an online survey. Validated instruments were used to measure key variables. Descriptive statistics, regression analyses, and group t tests were used to examine relationships among variables.Results: Of participating nurses, 71.5% reported significant moral injury symptoms and/or traumatic stress. Both moral injury symptoms and traumatic stress were associated with burnout. Regression models showed that institutional betrayal was associated with increased likelihood of traumatic stress and moral injury. Increases in scores on Response to Moral Adversity subscale of moral resilience were associated with a lower likelihood of traumatic stress and moral injury symptoms.Conclusions: Moral resilience, especially response to difficult circumstances, may be protective in critical care environments, but system factors (eg, institutional betrayal) must also be addressed systemically rather than relying on individual-level interventions to address nurses' needs.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 2","pages":"105-114"},"PeriodicalIF":2.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139995265","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}

引用次数: 0

Impact of Virtual Reality Simulation on New Nurses' Assessment of Pediatric Respiratory Distress. 虚拟现实模拟对新护士评估儿科呼吸窘迫的影响。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-03-01 DOI: 10.4037/ajcc2024878

Dana L Raab, Kelly Ely, Keith Israel, Li Lin, Amy Donnellan, Jennifer Saupe, Melissa Klein, Matthew W Zackoff

{"title":"Impact of Virtual Reality Simulation on New Nurses' Assessment of Pediatric Respiratory Distress.","authors":"Dana L Raab, Kelly Ely, Keith Israel, Li Lin, Amy Donnellan, Jennifer Saupe, Melissa Klein, Matthew W Zackoff","doi":"10.4037/ajcc2024878","DOIUrl":"10.4037/ajcc2024878","url":null,"abstract":"Background: Children often experience respiratory illnesses requiring bedside nurses skilled in recognizing respiratory decompensation. Historically, recognizing respiratory distress has relied on teaching during direct patient care. Virtual reality simulation may accelerate such recognition among novice nurses.Objective: To determine whether a virtual reality curriculum improved new nurses' recognition of respiratory distress and impending respiratory failure in pediatric patients based on assessment of physical examination findings and appropriate escalation of care.Methods: New nurses (n = 168) were randomly assigned to complete either an immersive virtual reality curriculum on recognition of respiratory distress (intervention) or the usual orientation curriculum (control). Group differences and changes from 3 months to 6 months after the intervention were examined.Results: Nurses in the intervention group were significantly more likely to correctly recognize impending respiratory failure at both 3 months (23.4% vs 3.0%, P < .001) and 6 months (31.9% vs 2.6%, P < .001), identify respiratory distress without impending respiratory failure at 3 months (57.8% vs 29.6%, P = .002) and 6 months (57.9% vs 17.8%, P < .001), and recognize patients' altered mental status at 3 months (51.4% vs 18.2%, P < .001) and 6 months (46.8% vs 18.4%, P = .006).Conclusions: Implementation of a virtual reality-based training curriculum was associated with improved recognition of pediatric respiratory distress, impending respiratory failure, and altered mental status at 3 and 6 months compared with standard training approaches. Virtual reality may offer a new approach to nurse orientation to enhance training in pediatrics-specific assessment skills.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 2","pages":"115-124"},"PeriodicalIF":2.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139995270","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}

引用次数: 0

Clinical Pearls. 临床珍珠

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-03-01 DOI: 10.4037/ajcc2024539

Rhonda Board

引用次数: 0