AACN clinical issues in critical care nursing最新文献

{"title":"Geo–economic variations in care for invasively ventilated patients: The potential benefits of closed–loop ventilation in resource–limited settings","authors":"Marcus J. Schultz, Kaouther Saihi, Rajyabardhan Pattnaik, Gentle S. Shrestha, Laura A. Buiteman–Kruizinga","doi":"10.54205/ccc.v31.264920","DOIUrl":"https://doi.org/10.54205/ccc.v31.264920","url":null,"abstract":"Lung–protective ventilation for invasively ventilated patients mimics normal breathing in which a low tidal volume is delivered at a specific respiratory rate with a limited inspiratory pressure on top of a sufficient level of positive end–expiratory pressure. It has been thoroughly demonstrated that despite being an expensive procedure, invasive ventilation when applied in a lung-protective way has a strong potential to improve the outcome of critically ill patients. However, implementing lung–protective ventilation has several challenges, including the fact that it can be quite time–consuming. One way to facilitate the use of lung–protective ventilation is to automate the settings involved with this strategy with closed–loop ventilation. In this review, we compare the epidemiology, ventilator management, and outcomes in critically ill ICU patients between middle–income countries and high–income countries and focus on the potentials and risks of closed–loop ventilation in middle–income countries.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"138 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136233366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of sepsis protocol in inpatient departments triggered by Ramathibodi Early Warning Score (REWS) on treatment processes","authors":"Yuda Sutherasan, Somruetai Matupumanon, Detajin Junhasavasdikul, Pongdhep Theerawit","doi":"10.54205/ccc.v31.263852","DOIUrl":"https://doi.org/10.54205/ccc.v31.263852","url":null,"abstract":"Background: Sepsis needs to be more focused on the effect of patient management at the ward level. We aimed to evaluate the effect of implementing the sepsis protocol triggered by the Ramathibodi Early Warning Score (REWS) on treatment processes in inpatients with new-onset sepsis. Methods: We conducted a prospective observational study among adult medical patients admitted to the general wards. A 25-month pre-protocol period was assigned as a control, and a 14-month protocol period was allocated to a protocol group. An inpatient sepsis protocol comprised a nurse-initiated sepsis protocol with REWS ≥2 plus suspected infection, prompt antibiotic, lactate measurement, and fluid resuscitation. Primary outcomes were the achievement of sepsis treatment processes, including the resuscitation and management bundle, namely: 1) the percentage of patients who were taken for the initial laboratory workup for sepsis, especially lactate and blood culture taking before antibiotics; 2) the percentage of patients who received appropriate antibiotics; 3) the percentage of patients who received optimal fluid resuscitation and management; 4) the percentage of patients who performed inferior vena cava ultrasound; 5) the percentage of patients who received steroid and vasopressor drugs; 6) \"time-to-antibiotic,\" the duration from diagnosis of sepsis to receiving antibiotic treatment; 7) \"time-to-optimal intravenous fluid management;\" 8) \"time-to-transfer to ICU. Results: 282 patients were evaluated (141 pre-implementation, 141 post-implementation); 94.7% of patients with sepsis had REWS ≥2. More patients in the protocol period had a lactate measurement and fluid management (89 [63.1%] vs. 44 patients [31.2%], p<0.001 and (50 [35.4%] vs. 22 patients [15.6%], p<0.001, respectively). More patients in the protocol period received antibiotics within 1 hour than in the pre-protocol period (80 [56.7%] vs. 53 patients [37.6%], p=0.001). The time to antibiotic treatment (mean, SD) in the protocol period was shorter than that in the pre-protocol period (81.7 [77.86] vs. 138.22 [145.17], p=0.007). The length of the intensive care unit (ICU) stay was shorter in the protocol period (8 d [3, 16.5] vs. 10 d [5, 20.5], p=0.011). The two groups did not differ in in-hospital mortality, length of hospital stay, or time-to-transfer to the ICU. Conclusions: Implementing an in-hospital sepsis protocol was associated with significant improvement in sepsis treatment processes, namely lactate measurement, starting antibiotic treatment within 1 hour, fluid management, and a shorter length of ICU stay.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135616864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical points of hemoperfusion in the intensive care unit","authors":"Karjbundid Surasit","doi":"10.54205/ccc.v31.263679","DOIUrl":"https://doi.org/10.54205/ccc.v31.263679","url":null,"abstract":"In cases of critical illness, some patients may experience adverse outcomes due to the excessive release of mediators or exposure to various toxins. These conditions can potentially lead to multi-organ failure and, ultimately, death. Hemoperfusion has emerged as an increasingly utilized method for blood purification, involving the removal of solutes by binding them to adsorbent materials. Currently, this technique is being employed in intensive care units to effectively clear many of the mediators and improve these critical conditions. Hemoperfusion has demonstrated promising results in various conditions, including sepsis, severe Acute Respiratory Distress Syndrome (ARDS), acute liver failure, and severe Coronavirus Disease 2019 (COVID-19). Nonetheless, ongoing trials investigating various hemoperfusion techniques have yielded mixed results, necessitating further confirmation through additional studies. Drawing upon my clinical experience and existing evidence, I advocate for a more personalized approach to initiating hemoperfusion therapy. I recommend evaluating each case individually and tailoring the treatment to optimize outcomes.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135993078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Near-InfraRed Spectroscopy (NIRS) during Vascular Occlusion Test (VOT) for predicting an increase in oxygen consumption after fluid challenge in circulatory shock patients","authors":"Kritsiri Cheerasiri, Sahawat Thertchanakun, S. Morakul, Pongdhep Theeravit, W. Mongkolpun","doi":"10.54205/ccc.v31.259970","DOIUrl":"https://doi.org/10.54205/ccc.v31.259970","url":null,"abstract":"Background: The goal of fluid challenge (FC) is to increase cardiac output (CO) and oxygen delivery (DO2) (known as fluid responders) to correct tissue hypoxia. To optimize fluid administration, fluid challenge (FC) during dependence of oxygen consumption on oxygen delivery (VO2/DO2 dependency) would correct tissue hypoxia confirmed by an increase of oxygen consumption (VO2) and oxygen delivery (DO2) after FC (known as VO2 responders) and get more benefit from a reduction in tissue hypoxia. Markers of anaerobic metabolisms, such as blood lactate concentration or the ratio of venous-arterial CO2 tension difference (P(cv-a)CO2) over arterial-to-venous oxygen content difference (C(a-cv)O2), can predict VO2 responders but still have several limitations. Therefore, near-infrared spectroscopy (NIRS) has been developed to evaluate tissue perfusion, presented as tissue oxygen saturation (StO2), at the bedside. Combining StO2 with the vascular occlusive test (VOT) and introducing a short period of forearm ischemia is a non-invasive technique to examine microvascular alterations at the bedside. However, a study validating the ability of these variables to predict VO2 response has not been conducted. \u0000\u0000Methods: We plan to conduct a single-center prospective study on circulatory failure patients. The cardiac index (CI), oxygen delivery (DO2), oxygen consumption (VO2), arterial lactate, central venous oxygen saturation (ScvO2), ratio of venous-arterial carbon dioxide tension to arterial-to-central venous oxygen content difference (P(cv-a)CO2/ C(a-cv)O2), and tissue oxygen saturation measured by near-infrared spectroscopy (NIRS) probe during vascular occlusion test variables (NIRS-VOT variables) will be collected before and after the fluid challenge. \u0000\u0000Hypothesis: We hypothesize that markers of reactive hyperemia by NIRs will predict an increase in VO2 after FC in patients with circulatory shock. \u0000\u0000Ethics: The study protocol has been approved by the ethics committee of the faculty of medicine, Ramathibodi Hospital, Mahidol University (COA. MURA2022/80).","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77405702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right ventricular failure due to acute pulmonary embolism associated with Graves’ disease: A case report","authors":"Tanya Tanyalakmara, S. Tongyoo","doi":"10.54205/ccc.v31.263457","DOIUrl":"https://doi.org/10.54205/ccc.v31.263457","url":null,"abstract":"Background\u0000 Graves' disease is a prevalent endocrine disorder characterized by diverse clinical manifestations affecting multiple organs, exhibiting varying degrees of severity. Cardiovascular system involvement is one of the most common manifestations, which include palpitation, tachycardia, cardiomyopathy, atrial fibrillation, pulmonary hypertension, or heart failure. Additionally, excessive thyroid hormone can lead to a hypercoagulable state, increasing the risk of venous thrombosis. However, thrombotic events, particularly deep vein thrombosis, cerebral venous thrombosis, or pulmonary embolism, are rare complications of Graves’ disease. \u0000\u0000Case presentation \u0000 In this report, we present the case of a 53 years old woman who presented with progressively worsening dyspnea, orthopnea, paroxysmal nocturnal dyspnea, bilateral leg edema, and jaundice for 2 weeks. She had also reported a weight loss of 4 kilograms within 3 months. Upon admission to our hospital, she initially received a diagnosis of congestive heart failure with atrial fibrillation and thyrotoxicosis. Following diuretic therapy, the patient developed hypotension and severe hypoxemia. Subsequent investigation revealed acute right ventricular failure due to an acute sub-segmental pulmonary embolism, which was confirmed by computed tomography of the pulmonary artery. The patient's condition improved after resuscitation involving intravenous fluid administration to increase right ventricular preload, intravenous vasopressor infusion to elevate systemic blood pressure, management of severe thyrotoxicosis, and intravenous administration of heparin. \u0000\u0000Conclusion \u0000 Graves’ disease, accompanied by hemodynamic disturbances due to acute right ventricular failure, necessitates admission to the intensive care unit for resuscitation and close monitoring. Although acute pulmonary embolism is an uncommon condition associated with Graves’ disease, it should be considered, particularly in patients who develop acute right ventricular failure.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90448259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetic ketoacidosis induced Takotsubo cardiomyopathy: A case report","authors":"Napassorn Teeratakulpisarn, S. Tongyoo, Saranthorn Purngcharoenkul","doi":"10.54205/ccc.v31.262640","DOIUrl":"https://doi.org/10.54205/ccc.v31.262640","url":null,"abstract":"Takotsubo cardiomyopathy (TC) is a syndrome of transient regional wall motion abnormalities of the left ventricle causing an apical ballooning pattern. This condition can be triggered by intense emotional or physical stress. In the past, many case reports showed cases of diabetic ketoacidosis induced Takotsubo cardiomyopathy who presented with initial ST segment elevation ECG at the present to the hospital simultaneously with the ongoing stress. In this paper, we report a case of Takotsubo cardiomyopathy whose ST segment changed 2 days after the resolution of diabetic ketoacidosis.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80584235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Restrictive fluid management and early fluid de-escalation versus usual care in critically ill patients: A feasibility trial protocol for the REDUCE randomized clinical trial","authors":"Ukrit Prajantasen, T. Naorungroj","doi":"10.54205/ccc.v31.260808","DOIUrl":"https://doi.org/10.54205/ccc.v31.260808","url":null,"abstract":"Background: Fluid therapy is an essential therapeutic intervention for critically\u0000ill patients. Both fluid overload and hypovolemia are associated with poor outcomes. However, the fluid strategy in intensive care units is still controversial,\u0000and there is no consensus on using the fluid strategy in patients with circulatory\u0000shock.\u0000\u0000Objectives: To compare the efficacy of protocol-based fluid-restrictive management versus standard care in critically ill patients with circulatory shock.\u0000\u0000Methods: This is a single-center, feasibility-based, randomized, controlled trial\u0000in critically ill patients with circulatory shock receiving either fluid resuscitation\u0000or vasopressors in two medical ICUs at Siriraj Hospital. Eligible patients will be\u0000randomly allocated in a 1:1 ratio and placed in the restrictive fluid strategy (intervention) group or standard care (control) group. The primary outcome is accumulative fluid balance 72 hours after enrollment.\u0000\u0000Conclusions: This study will evaluate the efficacy and safety of a protocol-based\u0000fluid restrictive strategy in critically ill patients who have circulatory shock and are\u0000receiving fluid resuscitation or vasopressors.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"95 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80604308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive end-expiratory pressure in acute respiratory distress syndrome; where have we been, where are we going?","authors":"Sara Salah Yusuf Radhi, R. C Freebairn, Y. Chiew, J. Chase, M. Cove","doi":"10.54205/ccc.v31.262904","DOIUrl":"https://doi.org/10.54205/ccc.v31.262904","url":null,"abstract":"ARDS is a heterogenous syndrome with a high mortality rate and limited therapeutic strategies. PEEP is routinely applied to these patients as a part of a protective lung ventilation strategy because getting it right helps optimize respiratory system compliance and improve oxygenation. However, if the PEEP is too low or too high, it may cause harm. Large clinical trials, focusing on patients with ARDS, have generally compared strategies designed to deliver low PEEP with those designed to deliver higher PEEP. No superior strategy has emerged, perhaps because these studies did not stratify patients based on their likely response to high or low PEEP. Nevertheless, the best strategy to identify optimal PEEP remains controversial, despite many large studies over the past 50 years. In the modern era of personalized medicine, perhaps our PEEP strategy should not be high PEEP or low PEEP but individualized PEEP. In this manuscript, we review the physiological effects of PEEP and the various methods studied and available to determine optimal PEEP at the bedside, providing a guide for physicians who regularly manage mechanically ventilated patients and highlighting new avenues for research.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"101 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80819847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rational use of corticosteroid treatment in the early phase of severe COVID-19","authors":"R. Ratanarat, Anutr Thitayanapong","doi":"10.54205/ccc.v31.259411","DOIUrl":"https://doi.org/10.54205/ccc.v31.259411","url":null,"abstract":"Mechanisms of hypoxemia in COVID-19 pneumonia include pulmonary inflammation, alveolar collapse, atelectasis, and pulmonary intravascular coagulopathy due to a hyperinflammatory response to SARS-CoV-2 infection. Systemic corticosteroids are widely applied as a standard treatment for hospitalized COVID-19 patients after several studies have shown favorable outcomes. However, the standard dosing and tailoring of corticosteroids in COVID-19 patients have not been established. Differences in dosing and timing of corticosteroid use may affect the outcome of COVID-19 patients. Inappropriate use of corticosteroids can lead to less benefit and potentially harmful adverse events. Dexamethasone is the most widely used corticosteroid as a result of the positive outcome from the RECOVERY study and its high anti-inflammatory potency. Although several studies have shown the benefit of higher dose corticosteroids in severe COVID-19 patients, serious adverse events associated with the use of corticosteroids, such as superimposed bacterial and/or fungal infections, have also been observed. Therefore, in this article, we reviewed current evidence of corticosteroid usage in COVID-19 patients and suggested a strategy for tailoring corticosteroid usage according to the clinical severity and risk of the patients.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78414234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The accuracy of the new non-invasive intra-abdominal pressure measurement by physical examination and ultrasound to diagnose intra-abdominal hypertension: The research protocol","authors":"Chompoonut Achavanuntakul, Paweenuch Bootjeamjai, Pongpol Sirilaksanamanon","doi":"10.54205/ccc.v31.261440","DOIUrl":"https://doi.org/10.54205/ccc.v31.261440","url":null,"abstract":"Background: Twenty-five percent of critically ill patients in the intensive care unit have intra-abdominal hypertension, which causes high morbidity and mortality. The gold standard non-invasive method for measuring intra-abdominal pressure to diagnose intra-abdominal hypertension is intravesical pressure measurement. Unfortunately, the standard method has several limitations. The aim of this study is to invent a new, non-invasive method to diagnose intra-abdominal hypertension.\u0000\u0000Methods: This is a cross-sectional study to determine the accuracy of the new non-invasive intra-abdominal pressure measurement by physical examination and ultrasound to diagnose intra-abdominal hypertension compared to the intravesical pressure measurement.\u0000\u0000Hypothesis: We hypothesize that physical examination and ultrasound can be used to diagnose intra-abdominal hypertension and the ratio of maximal anteroposterior to transverse abdominal diameter minus fat thickness and intra-abdominal pressure has a correlation.\u0000\u0000Ethics and dissemination: The study received ethical approval from the Institutional Review Board of Faculty of Medicine, Chulalongkorn University. We plan to disseminate the results in peer-reviewed journals related to critical care medicine or surgery and at national or international conferences.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90576962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}