AACN clinical issues in critical care nursing最新文献_第2页

Dynamic arterial elastance for predicting mean arterial pressure responsiveness after fluid challenge in spontaneously breathing septic patients: A protocol for prospective observational study 动态动脉弹性预测脓毒症患者在液体刺激后的平均动脉压反应:一项前瞻性观察研究方案

AACN clinical issues in critical care nursing Pub Date : 2023-05-22 DOI: 10.54205/ccc.v31.260187

Subundit Injampa, Punchika Luetrakool, S. Morakul, T. Petnak

{"title":"Dynamic arterial elastance for predicting mean arterial pressure responsiveness after fluid challenge in spontaneously breathing septic patients: A protocol for prospective observational study","authors":"Subundit Injampa, Punchika Luetrakool, S. Morakul, T. Petnak","doi":"10.54205/ccc.v31.260187","DOIUrl":"https://doi.org/10.54205/ccc.v31.260187","url":null,"abstract":"Background: Fluid resuscitation is essential for patients with sepsis and septic shock; however, the response of blood pressure to fluids is still challenging. Dynamic arterial elastance (Eadyn), defined as the ratio between pulse pressure variation (PPV) and stroke volume variation (SVV), is one of the parameters that has been proposed to predict mean arterial pressure (MAP) response to fluid administration. PPV and SVV are obtained from the heart-lung interaction concepts, in which spontaneous breathing is an important limitation. In this study, we evaluate the accuracy (sensitivity and specificity) of Eadyn in predicting the MAP response after fluid administration in predicted fluid responsive, spontaneously breathing septic patients.\u0000\u0000Methods: Spontaneously breathing patients with sepsis or septic shock and acute circulatory failure who were predicted to be fluid responders by the passive leg raising test or the mini-fluid challenge test were enrolled. PPV, SVV, Eadyn and the other hemodynamic parameters were measured by an arterial catheter connected to FloTracTM sensor integrated with the HemoSphereTM platform before and after a fluid challenge. Patients were classified according to the increase in MAP after fluid administration into 2 groups: MAP-responders (MAP increase ≥ 10%) and MAP-nonresponders (MAP increase < 10%). \u0000\u0000Hypothesis: In predicted fluid responders and spontaneously breathing septic patients, Eadyn should have predicted blood responsiveness. \u0000\u0000Ethics and dissemination: The Ramathibodi Human Research Ethics Committee has approved the trial. The findings plan to be presented in peer-reviewed publications and conferences in critical care medicine.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"194 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73198351","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}

引用次数: 0

Effect of early post-extubation high-flow nasal cannula versus conventional low-flow oxygen therapy on reintubation in postoperative patients from prolonged general anesthesia at surgical ICU: A randomized clinical trial (Protocol) 早期拔管后高流量鼻插管与常规低流量氧疗对外科ICU长时间全麻术后患者再插管的影响:一项随机临床试验(方案)

AACN clinical issues in critical care nursing Pub Date : 2023-05-09 DOI: 10.54205/ccc.v31.260850

Sirichai Phetuthairung, S. Kongsayreepong

{"title":"Effect of early post-extubation high-flow nasal cannula versus conventional low-flow oxygen therapy on reintubation in postoperative patients from prolonged general anesthesia at surgical ICU: A randomized clinical trial (Protocol)","authors":"Sirichai Phetuthairung, S. Kongsayreepong","doi":"10.54205/ccc.v31.260850","DOIUrl":"https://doi.org/10.54205/ccc.v31.260850","url":null,"abstract":"Background: The main concerns following general anesthesia, especially if it lasts longer than 4 hours, are postoperative pulmonary complications, including hypoxemia, lung atelectasis, and acute respiratory failure requiring reintubation. To avoid these complications, postoperative extubation with respiratory support is crucial. The high-flow nasal cannula (HFNC) increases end-expiratory lung volume and reduces the work of breathing to improve oxygenation by delivering a flow-dependent positive airway pressure. The advantages of using HFNC to prevent reintubation have been demonstrated in patients undergoing cardiothoracic surgery. Our target population's information is still deficient, and our trial is set up to uncover this proof.\u0000Objectives: To evaluate the effect of high-flow nasal cannula (HFNC) versus low-flow nasal cannula on the reintubation rate and clinical outcomes in the early post-extubation adult who has prolonged general anesthesia for non-cardiothoracic and non-neuro surgery that requires surgical ICU admission.\u0000Methods: In this study, 260 patients with an intermediate to high risk of postoperative pulmonary complications following non-cardiothoracic surgery and non-neurosurgery that required general anesthesia for longer than 4 hours were randomly assigned to receive either a high-flow nasal cannula (HFNC) or a low-flow nasal cannula after extubation. The primary outcome indicator is the reintubation rate within 72 hours of tracheal extubation. Postoperative pulmonary complications, the length of stay in the ICU and hospital, and mortality are considered secondary outcome measures.\u0000Conclusions: This study is an investigator-initiated randomized controlled trial powered to test the hypothesis that early application of a high-flow nasal cannula probably reduces the reintubation rate in patients in SICUs with prolonged durations of general anesthesia.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90499994","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}

引用次数: 0

Cerebral oximetry and autoregulation monitoring in shock patients 休克患者脑血氧测定和自身调节监测

AACN clinical issues in critical care nursing Pub Date : 2023-04-27 DOI: 10.54205/ccc.v31.260918

Jirapat Lohpratana, T. Viarasilpa

{"title":"Cerebral oximetry and autoregulation monitoring in shock patients","authors":"Jirapat Lohpratana, T. Viarasilpa","doi":"10.54205/ccc.v31.260918","DOIUrl":"https://doi.org/10.54205/ccc.v31.260918","url":null,"abstract":"Background: Data on regional cerebral oxygen saturation (rSO2) and cerebral autoregulation monitoring in shock patients are limited. This study aimed to find the optimal range of rSO2 and cerebral oximetry index (COx), an autoregulation index correlated with adequate tissue perfusion determined by standard clinical and laboratory assessment.\u0000\u0000Method: We plan to monitor cerebral oximetry using near-infrared spectroscopy in shock patients admitted to the medical intensive care unit (MICU) at Siriraj Hospital. The rSO2 are continuously recorded for 72 hours [48] after admission or 24 hours after cessation of vasopressor infusion. The COx is calculated from the correlation coefficient between rSO2 and MAP. Data on patient demographics, treatments, physiologic parameters, and outcomes are recorded. The primary objective is to identify the optimal rSO2 and COx correlated with adequate tissue perfusion assessed by the current standard method. Adequate tissue perfusion as is defined as MAP ≥65 mmHg and two of the following criteria: urine ≥0.5 ml/kg/hour, capillary refill time ≤3 seconds, improvement in consciousness, lactate reduction ≥10% in 1 hour, serum lactate <2 mmol/L, or central venous oxygen saturation (ScVO2) ≥70%. Since the optimal values of rSO2 and COx in shock patients are unknown, we are unable to perform the sample size calculation. Thus, for this study, we plan to collect data on rSO2 and COx in 30 patients.\u0000\u0000Hypothesis: We hypothesize that the values of rSO2 and COx are different between patients with adequate and inadequate tissue perfusion.\u0000\u0000Ethics statement: The study was reviewed and approved by the Human Research Protection Unit of Siriraj Hospital, Mahidol University (certificate of approval no. si 410/2022).","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"115 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77694970","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}

引用次数: 0

Prevention of contrast-associated acute kidney injury in critically-ill and high-risk preoperative patient: Protocol for a systematic review and network meta-analysis 危重患者和高危术前患者对比剂相关急性肾损伤的预防:系统评价和网络荟萃分析方案

AACN clinical issues in critical care nursing Pub Date : 2023-03-29 DOI: 10.54205/ccc.v31.259642

Woraphon Choatwongwachira, Sidaporn Louisirirotchanakul, Kaweesak Chittawatararat, C. Ruengorn, K. Trongtrakul, Srisuluk Kacha

{"title":"Prevention of contrast-associated acute kidney injury in critically-ill and high-risk preoperative patient: Protocol for a systematic review and network meta-analysis","authors":"Woraphon Choatwongwachira, Sidaporn Louisirirotchanakul, Kaweesak Chittawatararat, C. Ruengorn, K. Trongtrakul, Srisuluk Kacha","doi":"10.54205/ccc.v31.259642","DOIUrl":"https://doi.org/10.54205/ccc.v31.259642","url":null,"abstract":"Introduction: There is limited information of the contrast-associated acute kidney (CA-AKI) prevention in critically-ill patients. Applying the evidence for CA-AKI prevention from non-critically-ill to critically-ill patients could potentially invalidate the data. Therefore, we find it necessary to assess the benefits of preventive strategy by summarizing existing evidence from clinical trials in this systematic review and network meta‐analysis (NMA).\u0000\u0000Methods and analysis: We will search electronic databases, including PubMed, Embase, and Scopus from their inception dates with no language restrictions. Both randomized trials and non-randomized studies using validated measurement tools that investigated the benefits of pharmacological interventions among patients who undergo contrast enhanced computed tomography (CECT). The primary outcome is the incidence of CA-AKI in medical and surgical critically-ill patients who undergo CECT after receiving medication. The risk of bias assessment and analysis of the strength of the evidence will be performed independently by a pair of reviewers. A two-step approach of traditional pairwise and NMA will be performed. Based on a random-effects model, standardized weighted mean differences and ORs with corresponding 95% CIs will be pooled as effect estimates for the continuous and categorical endpoints, respectively. Statistical and methodological heterogeneities will be assessed. Preplanned subgroup analyses and univariate meta-regression will be conducted to quantify the potential sources of heterogeneity. Evidence-based synthesis will be based on the magnitudes of effect size, evidence certainty and the surface under the cumulative ranking curve values.\u0000\u0000 \u0000Ethics: Ethical approval is not required because this study is based on existing published data.\u0000\u0000 PROSPERO registration number: CRD42022328974","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83629669","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}

引用次数: 0

The relationship of lung recruitability assessment by recruitment to inflation ratio, electrical impedance tomography, and lung ultrasound: The research protocol 肺活量与肺活量比值、电阻抗断层扫描和肺超声评价肺活量的关系:研究方案

AACN clinical issues in critical care nursing Pub Date : 2023-02-26 DOI: 10.54205/ccc.v31.260228

Kridsanai Gulapa, Y. Sutherasan, Detajin Junhasavasdikul, P. Theerawit

{"title":"The relationship of lung recruitability assessment by recruitment to inflation ratio, electrical impedance tomography, and lung ultrasound: The research protocol","authors":"Kridsanai Gulapa, Y. Sutherasan, Detajin Junhasavasdikul, P. Theerawit","doi":"10.54205/ccc.v31.260228","DOIUrl":"https://doi.org/10.54205/ccc.v31.260228","url":null,"abstract":"Background: Recently, the recruitment-to-inflation ratio (R/I ratio) from the single-breath technique has been proposed for identifying lung recruitability in acute respiratory distress syndrome (ARDS). This technique is based on measuring end-expiratory lung volume (EELV). Also, electrical impedance tomography (EIT) can estimate the EELV, providing the potential role of EIT in measuring the R/I ratio. In addition, the lung ultrasound was proved to identify lung recruitment. However, a study validating those techniques has not been conducted.\u0000\u0000Methods: We plan to conduct a single-center prospective physiological study on moderate to severe ARDS patients. The R/I ratio by single-breath technique and EIT will be collected before the recruitment maneuver. If the patient has no airway opening pressure (AOP), PEEP of 8 cmH2O will be set as PEEPlow. The PEEPhigh defines as initially set at +10 cmH2O from the PEEPlow. However, if the patients have AOP presence, AOP +10 cmH2O will be set as PEEPhigh The lung ultrasound score (LUS) will be performed at PEEPhigh and PEEPlow during the single-breath technique. Variables that will be used to analyze the relationship are recruited volume (Vrec), R/I ratio, and LUS.\u0000\u0000Hypothesis: We hypothesize that there are associations between the R/I ratio by both techniques and lung ultrasound score (LUS).\u0000\u0000Ethics: The study protocol has been approved by the ethics committee of the faculty of medicine, Ramathibodi Hospital, Mahidol University (COA.MURA2021/433).","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"62 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83970100","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}

引用次数: 0

High-protein delivery in mechanically ventilated patients: A study protocol for a randomized trial 机械通气患者的高蛋白输送:一项随机试验的研究方案

AACN clinical issues in critical care nursing Pub Date : 2023-02-14 DOI: 10.54205/ccc.v31.255072

Sumawadee Boonyasurak, P. Promsin

{"title":"High-protein delivery in mechanically ventilated patients: A study protocol for a randomized trial","authors":"Sumawadee Boonyasurak, P. Promsin","doi":"10.54205/ccc.v31.255072","DOIUrl":"https://doi.org/10.54205/ccc.v31.255072","url":null,"abstract":"Background: Critically ill patients are at risk of malnutrition; thus, optimal nutrition delivery is a key treatment for better outcomes. Inadequate energy and protein intake increase rate of hospital-acquired infection, duration of mechanical ventilation and mortality. However, there is no clear consensus regarding optimal protein dose in mechanically ventilated patients. In this study, we aim to compare between the effect of high and usual protein delivery on clinical outcomes in this patient group. \u0000Methods: This is a single-centered, open-labelled, parallel-group, randomized controlled study conducting in medical, surgical and trauma intensive care units (ICU) at a tertiary university hospital in Bangkok, Thailand. We plan to enroll 240 adult mechanically ventilated patients who are expected to require ventilator support for at least 3 days. The intervention group will be prescribed high protein dose (at least 1.5 g/kg/day) throughout ICU stay since day 4 until a maximum of 28 days, whereas the control group will be prescribed usual protein dose (1-1.3 g/kg/day). Nutrition is provided by enteral or parenteral route or both. The primary outcome is ventilator-free days at 28 days. The main secondary outcomes include the temporal change in muscle mass and SOFA score, rate of nosocomial infection and 28-day mortality.\u0000Conclusion: The robust evidence whether delivering high protein in critically ill patients improves outcome is lacking. This randomized trial will examine the consequence of high protein delivery in ICU population.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86850480","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}

引用次数: 0

Clinical characteristics and outcomes of extracorporeal membrane oxygenation used in a non-cardiac surgical intensive care unit: Siriraj experiences and literature review 体外膜氧合用于非心脏外科重症监护病房的临床特点和结果:Siriraj经验和文献综述

AACN clinical issues in critical care nursing Pub Date : 2023-01-20 DOI: 10.54205/ccc.v31.259819

Annop Piriyapatsom, S. Kongsayreepong, O. Chaiwat

{"title":"Clinical characteristics and outcomes of extracorporeal membrane oxygenation used in a non-cardiac surgical intensive care unit: Siriraj experiences and literature review","authors":"Annop Piriyapatsom, S. Kongsayreepong, O. Chaiwat","doi":"10.54205/ccc.v31.259819","DOIUrl":"https://doi.org/10.54205/ccc.v31.259819","url":null,"abstract":"Background: Extracorporeal membrane oxygenation (ECMO) has substantially increased in frequency of use over the past decades. Occasionally, patients who require ECMO support are admitted to an ICU rather than medical or cardiac ICU, where physicians may be not familiar with the process of how to care for ECMO patients. The aims of this case series were to explore the utilization of ECMO support in a non-cardiac general surgical ICU (SICU) in terms of indications, ECMO-related complications and clinical outcomes. \u0000\u0000Methods: Adult patients admitted to the SICU from January 2014 to June 2021 who received ECMO support were included. Demographic data, data regarding ECMO utilization and clinical outcomes were described. Current evidence and updated literature were also researched and reviewed. \u0000\u0000Results: A total of 18 patients were admitted to the SICU and received ECMO support, but four died within four hours of SICU admission. The most common reason for ECMO support was extracorporeal cardiopulmonary resuscitation (ECPR) (9 cases, 50.0%), followed by cardiac and/or respiratory support. The majority of patients received venoarterial ECMO support (15 cases, 83.3%). Unfractionated heparin was used in 10 cases (71.4%) and the anticoagulant effect was monitored with aPTT, which was maintained at a lower range (30–50 seconds). There was no thromboembolic event, and four patients (28.6%) developed major bleeding. The overall hospital mortality was as high as 77.8%. \u0000\u0000Conclusion: There was a small volume of cases receiving ECMO support in the SICU. ECPR was the most common reason for ECMO support in these patients. Overall, the hospital mortality was 77.8%. To improve outcomes in these patients, appropriate patient selection, well-organized protocols, and a multidisciplinary approach are mandatory.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73424585","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}

引用次数: 0

An importance of respiratory drive and effort during mechanical ventilation 机械通气过程中呼吸动力和努力的重要性

AACN clinical issues in critical care nursing Pub Date : 2023-01-13 DOI: 10.54205/ccc.v31.259350

P. Theerawit, Phruet Soipetkasem

引用次数: 0

Energy expenditure in critically ill patient 危重病人的能量消耗

AACN clinical issues in critical care nursing Pub Date : 2022-11-02 DOI: 10.54205/ccc.v30.259272

K. Chittawatanarat

引用次数: 0

A brief of critical care education in Cambodia 柬埔寨重症监护教育简介

AACN clinical issues in critical care nursing Pub Date : 2022-10-19 DOI: 10.54205/ccc.v30.258836

S. Krouch, Meng Chhuoy, Samith Sourn, Pathy Ngeth, Khemry Soeur, Saphy So, No Ku, Sokhak Tan, Nareth Chhor

引用次数: 0