American Journal of Critical Care最新文献_第4页

Prone Positioning to Improve Cerebral Oxygenation in Patients With Acute Respiratory Distress Syndrome. 俯卧位改善急性呼吸窘迫综合征患者脑氧合。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-07-01 DOI: 10.4037/ajcc2025879

Yannick Fedun, Boris Campillo-Gimenez, Agathe Delbove, Angélique Goepp, Eddy Lebas, Fanny De Sevin, François Mateos, Julien Huntzinger, Yoann Launey, Florian Reizine

{"title":"Prone Positioning to Improve Cerebral Oxygenation in Patients With Acute Respiratory Distress Syndrome.","authors":"Yannick Fedun, Boris Campillo-Gimenez, Agathe Delbove, Angélique Goepp, Eddy Lebas, Fanny De Sevin, François Mateos, Julien Huntzinger, Yoann Launey, Florian Reizine","doi":"10.4037/ajcc2025879","DOIUrl":"https://doi.org/10.4037/ajcc2025879","url":null,"abstract":"Background: Acute respiratory distress syndrome (ARDS), a common condition among intensive care patients, is characterized by severe hypoxemia that may lead to acute brain injury. Although prone positioning has emerged as a lifesaving strategy in the management of ARDS, its effects on cerebral oxygenation remain insufficiently explored.Objective: To evaluate the evolution of cerebral oxygenation during prone positioning in patients with ARDS.Methods: This prospective, single-center study was done in the intensive care unit of a community hospital. Consecutive patients with moderate or severe ARDS were prospectively enrolled during a 12-month period. Cerebral oxygenation was assessed by near-infrared spectroscopy before and during an 18-hour period of prone positioning. Continuous variables were compared before and during prone positioning using the Wilcoxon signed rank test. Correlations were assessed using the Spearman rank test.Results: Ten patients were included in the study, with 2 patients exiting at hours 6 and 12 after the start of prone positioning because of hemodynamic instability. Evidence of oxygenation improvement during prone positioning was indicated by an increase in regional cerebral oxygen saturation (rSo2) and the ratio of Pao2 to fraction of inspired oxygen (Fio2). The rSo2/Fio2 ratio was significantly increased from hour 3 to 12 (P = .049 at hour 3, P = .02 at hour 8, and P = .02 at hour 12). Also, rSo2 was significantly correlated with oxygen delivery (ρ = 0.811, P < .001) and cardiac index (ρ = 0.463, P < .001).Conclusion: Prone positioning in patients with ARDS seems to be associated with improved cerebral oxygenation based on rSo2/Fio2 ratio.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 4","pages":"277-284"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526047","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

Nurses' Decision-Making and Confidence With Titration of Vasoactive Medication. 护士对血管活性药物滴定的决策与信心。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-07-01 DOI: 10.4037/ajcc2025332

Eugene Waterval, Tara Hunt, Daleen Penoyer

{"title":"Nurses' Decision-Making and Confidence With Titration of Vasoactive Medication.","authors":"Eugene Waterval, Tara Hunt, Daleen Penoyer","doi":"10.4037/ajcc2025332","DOIUrl":"https://doi.org/10.4037/ajcc2025332","url":null,"abstract":"Background: Critical care nurses are responsible for titration of intravenous vasoactive medications. Before the 2017 publication of The Joint Commission standards requiring nurses to titrate medications within specific protocols, nurses mostly titrated medications autonomously according to clinical judgment. Little is known about how nurses make decisions when titrating vasoactive medications. Additional research on this area of nursing practice is needed to optimize patient outcomes.Objectives: To better understand critical care nurses' practices, perceptions, and decision-making processes when titrating vasoactive medications.Methods: The study used a prospective, single-site, convergent mixed-methods, descriptive design. Nurse surveys using the Clinical Decision-Making in Nursing Scale and the Confidence Scale provided data for quantitative analysis. Semistructured interviews provided results for thematic, qualitative analysis.Results: Nurses' scores for decision-making and confidence when titrating vasoactive medications did not differ significantly between demographic groups. Survey saturation was achieved after 10 interviews, resulting in 4 themes: using the protocol, using knowledge and critical thinking, considering patient history, and collaborating professionally.Conclusions: Titration protocols are valued but have limitations based on patients' responses and medical history. Vasoactive medication titration requires a robust knowledge base, experience, and collaboration with physicians and coworkers. Similar confidence levels despite different years of experience may be attributed to a strong unit support system or accelerated experiences during the COVID-19 pandemic, when nurses were exposed to more patients receiving vasoactive medications.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 4","pages":"e24-e31"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526045","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

Calling Attention to the Practice of Acute and Critical Care Nursing. 呼吁关注急危重症护理实践。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-05-01 DOI: 10.4037/ajcc2025397

Michele C Balas, Kirsten E Hepburn, Martha A Q Curley

引用次数: 0

Maximizing Data Capture for Race and Ethnicity of Children Admitted to Critical Care Units. 最大限度地获取入住重症监护病房的儿童的种族和民族数据。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-05-01 DOI: 10.4037/ajcc2025971

Patricia A Hickey, Jean A Connor, Cheryl Toole, Valerie L Ward

{"title":"Maximizing Data Capture for Race and Ethnicity of Children Admitted to Critical Care Units.","authors":"Patricia A Hickey, Jean A Connor, Cheryl Toole, Valerie L Ward","doi":"10.4037/ajcc2025971","DOIUrl":"https://doi.org/10.4037/ajcc2025971","url":null,"abstract":"Background: Access to complete patient sociodemographic data in a hospital's electronic health record is important for identifying and understanding health inequities and designing interventions to close health care gaps. Through participation in a national safety collaborative, this team identified many patients in intensive care units (ICUs) for whom sociodemographic data (race and ethnicity) were incomplete or missing.Objectives: To describe the processes the team used to understand how sociodemographic data were being ascertained for children admitted to hospital ICUs; demonstrate how interprofessional care teams can collaborate to create solutions for vulnerable patients; and provide steps that can be used at other hospitals to decrease missing sociodemographic data and deliver equitable care.Methods: A plan-do-study-act framework guided this initiative to improve collection of data on the race and ethnicity of ICU patients. Via 4 plan-do-study-act cycles, care vulnerabilities and implemented tests of change were evaluated to achieve the goal of capturing sociodemographic data within 72 hours of patient admission.Results: A new process was developed for patient experience representatives to collect, enter, and track sociodemographic data accurately. Through education and use of a script, documentation rates reached 80% to 100%.Conclusions: Overcoming barriers in the electronic health record and creating new processes supported the collection of sociodemographic data for children admitted to ICUs. Engaging and acknowledging the value of interprofessional teams was important in this successful groundwork to help deliver equitable care.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 3","pages":"167-173"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957275","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

AACN's Healthy Work Environment Standards: Why They Matter. AACN的健康工作环境标准：为什么它们很重要。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-05-01 DOI: 10.4037/ajcc2025277

Meredith Padilla

引用次数: 0

Oral Microbiome Changes During Hospitalization in Older Adults Not Receiving Mechanical Ventilation. 未接受机械通气的老年人住院期间口腔微生物组的变化。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-05-01 DOI: 10.4037/ajcc2025470

Kimberly Paige Rathbun, Mary Lou Sole, Shibu Yooseph, Rui Xie, Annette M Bourgault, Steven Talbert

{"title":"Oral Microbiome Changes During Hospitalization in Older Adults Not Receiving Mechanical Ventilation.","authors":"Kimberly Paige Rathbun, Mary Lou Sole, Shibu Yooseph, Rui Xie, Annette M Bourgault, Steven Talbert","doi":"10.4037/ajcc2025470","DOIUrl":"10.4037/ajcc2025470","url":null,"abstract":"Background: Oral bacteria can be pathogenic and may change during hospitalization, potentially increasing risk for complications for older adults, including residents of skilled nursing facilities (SNFs).Objectives: To compare the oral microbiome at hospital admission by prehospital residence (SNF vs home) in older adults not receiving mechanical ventilation and to assess changes in their oral microbiome during hospitalization.Methods: This prospective, observational study included 46 hospitalized adults (≥65 years old) not receiving mechanical ventilation, enrolled within 72 hours of hospitalization (15 admitted from SNF, 31 from home). Oral health was assessed with the Oral Health Assessment Tool at baseline and days 3, 5, and 7. Genomic DNA was extracted from unstimulated oral saliva specimens for microbiome profiling using 16S ribosomal RNA sequencing. Taxonomic composition, relative abundance, α-diversity (Shannon Index), and β-diversity (Bray-Curtis dissimilarity) of bacterial communities were determined.Results: Most patients were female (70%) and White (74%) or Hispanic (11%). Mean age was 78.7 years. More patients admitted from SNFs than from home had cognitive impairment (P < .001), delirium (P = .01), frailty (P < .001), and comorbidities (P = .04). Patients from SNFs had more oral bacteria associated with oral disease, lower α-diversity (P < .001), and higher β-diversity (P = .01). In the 28 study completers, α-diversity altered over time (P < .001). A significant interaction was found between groups after adjusting for covariates (P < .001).Conclusions: Hospitalized older adults admitted from SNFs experience oral microbial and oral health disparities.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 3","pages":"208-217"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12183789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964795","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}

引用次数: 0

Longitudinal Evaluation of Implementation of AACN's Healthy Work Environment Framework in an Intensive Care Unit. 在重症监护室实施AACN健康工作环境框架的纵向评价。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-05-01 DOI: 10.4037/ajcc2025172

Philip Parker, Heather Pena, Jason Stokes, Jessica Seabrooks, Amanda Ornell, Annie Jaeger, Adam Millard, Robert Stern, Benjamin Edwards, Kelly Kester, Bradi Granger

{"title":"Longitudinal Evaluation of Implementation of AACN's Healthy Work Environment Framework in an Intensive Care Unit.","authors":"Philip Parker, Heather Pena, Jason Stokes, Jessica Seabrooks, Amanda Ornell, Annie Jaeger, Adam Millard, Robert Stern, Benjamin Edwards, Kelly Kester, Bradi Granger","doi":"10.4037/ajcc2025172","DOIUrl":"https://doi.org/10.4037/ajcc2025172","url":null,"abstract":"Background: Bedside nurse turnover in the United States is 22.5%, representing a national challenge that has been attributed to poor work environments. Poor work environments result in decreased nurse satisfaction and retention as well as poor patient outcomes. Healthy work environments have the opposite effects.Objectives: To evaluate the impact of implementation of the American Association of Critical-Care Nurses (AACN) healthy work environment framework in an intensive care unit on work environment scores, turnover, and tenure during a 6-year period.Methods: A prospective, longitudinal design was used to evaluate implementation of the healthy work environment framework in an intensive care unit in a large academic medical facility. Interventions for each of the 6 healthy work environment standards were carried out. The AACN Healthy Work Environment Assessment Tool was used to measure each standard in 2017, 2019, 2021, and 2023.Results: No statistically significant differences were found between cohorts. The score for each healthy work environment standard and the overall score increased significantly from 2017 to 2023. Nurse turnover increased during the COVID-19 pandemic but restabilized within 2 years.Conclusions: Findings from this study suggest that targeted interventions addressing the healthy work environment standards are associated with improved staff satisfaction and reduced turnover. Furthermore, the findings highlight the value of the healthy work environment framework in improving nurse retention.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 3","pages":"183-192"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964793","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

Ethics Is Essential. 道德是必要的。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-05-01 DOI: 10.4037/ajcc2025767

Cindy L Munro, Lakshman Swamy

引用次数: 0

Beginning to Think About Ethical Issues in Critical Care. 开始思考重症监护中的伦理问题。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-05-01 DOI: 10.4037/ajcc2025435

Catherine Green

引用次数: 0

Inflammatory Cardiac Disease in a Young Adult With Syncope. 青壮年晕厥并发炎症性心脏病