AACN clinical issues in critical care nursing最新文献

{"title":"Treatment of adults with severe dengue patients in Thailand","authors":"C. Sivakorn, Marcus J. Schultz, D. Mabey, Samuel Clark, A. Wongsa, N. Srisawat","doi":"10.54205/ccc.v30.255725","DOIUrl":"https://doi.org/10.54205/ccc.v30.255725","url":null,"abstract":"Key measures for improving the survival rate in dengue shock patients are an early and appropriate diagnosis and treatment together with close monitoring by early provision of appropriate types, rates, objectives, and limits (TROLs) of fluid therapies, especially in the critical phase of the disease. The hemodynamic assessments to guide fluid resuscitation should mainly rely on clinical signs, hematocrit along with non-invasive monitoring tools. These concepts aim to maintain adequate oxygen delivery to the vital organs, to prevent a prolonged shock stage and subsequent organ failures. Diagnosis and treatment for poor tissue perfusion should be initiated as early as possible from the onset of the cytokine cascade-induced plasma leakage and disruption of the glycocalyx layer of the vascular endothelial cells.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83194989","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":"Comparison of ultrasound assessment for diaphragmatic workload during spontaneous breathing trial between automatic tube compensation and pressure support ventilation: Study protocol","authors":"Nutarpa Kulkanokwan, S. Morakul, Chawika Pisitsak, P. Theerawit","doi":"10.54205/ccc.v30.255057","DOIUrl":"https://doi.org/10.54205/ccc.v30.255057","url":null,"abstract":"Background: The process of weaning from mechanical ventilation is crucial. Less demanding spontaneous breathing trials (SBT) can be done by either automatic tube compensation (ATC) or pressure support ventilation (PSV) to decrease inspiratory effort by endotracheal tube resistance compensation. This study aimed to assess the patient’s effort, by diaphragm ultrasonography with ATC compared to PSV during SBT.\u0000\u0000Methods: Patients who have been on mechanical ventilation for more than 48 hours and meet the weaning requirements are given 30 minutes for ATC and 30 minutes for PSV in this randomized control experiment. The diaphragm workload difference, as assessed by diaphragm thickness fraction, was the primary outcome. The sensitivity and specificity of ultrasound-measured diaphragmatic muscle activity measures in predicting ventilator weaning and effective extubation were secondary outcomes.\u0000\u0000Hypothesis: Intubated patients should be (1) weaning with lower effort SBT mode (2) predicted weaning success with more accurately parameters\u0000\u0000Ethics and dissemination: Ramathibodi Human Research Ethics Committee has approved the trial. The findings plan to summitted in peer-reviewed publications and conferences in critical care medicine or anesthesiology.\u0000\u0000Trial registration number: TCTR20210317004","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86048458","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":"Terlipressin for refractory septic shock: a study protocol of a single center, placebo-controlled double-blind phase III RCT (The TERESEP study).","authors":"Thipdhorn Aritajati, Chawanee Chayakul, S. Tongyoo","doi":"10.54205/ccc.v30.254966","DOIUrl":"https://doi.org/10.54205/ccc.v30.254966","url":null,"abstract":"Introduction: In septic shock, vasopressin is a standard treatment that increases blood pressure by vasopressin receptor activation. Vasopressin can reduce catecholamine dose requirement and reduce cardiac arrhythmia in septic shock. Terlipressin is specific vasopressin 1 receptor that may replace vasopressin for septic shock treatment.The TERESEP trial evaluates the benefit of terlipressin add-on catecholamine versus catecholamine only treatment for septic shock.\u0000\u0000Methods and analysis: This single-center randomized controlled clinical trial is enrolling hospitalized intensive care patients with septic shock with norepinephrine doses of more than 0.2 microgram/kilogram/min or norepinephrine combine with epinephrine. Patient randomized for terlipressin combined with catecholamine or placebo combined with catecholamine. The primary endpoint is successful of shock treatment within 6 hours define as the rate of mean arterial blood pressure more than 65 mmHg achievement with catecholamine requirement dose less than 0.2 mcg/kg/min. The secondary outcomes include mean blood pressure, 28 days mortality, hospital mortality, intensive care unit range of stay, rate of urine output achievement, lactate clearance, accumulative catecholamine dose, cardiac arrhythmia, 28 days alive without any organ support. The main analysis will use intension to treat approach.\u0000\u0000Ethic and dissemination: The Ethics Committee has approved this study of Siriraj hospital, Mahidol University (COA No. SI 049/2020). The trial result will be disseminated through the presentation at medical publication. Authorship will consider and grant using the policy of Mahidol University.\u0000\u0000Trial registrations: ClinicalTrials.govNCT04339868. Registered on April 9,2020.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"126 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83441571","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 success of non-ABO-identical convalescent plasma transfusion in coronavirus disease 2019 (COVID-19) related acute respiratory distress syndrome (CARDS): a case-report","authors":"R. Bhurayanontachai, Pisud Siripaitoon, Narongdet Kositpantawong, S. Chusri","doi":"10.54205/ccc.v30.254752","DOIUrl":"https://doi.org/10.54205/ccc.v30.254752","url":null,"abstract":"Coronavirus disease 2019 (COVID-19) is pandemic with substantial fatality without specific treatment. Convalescent plasma is used to treat infectious diseases including severe acute respiratory syndrome coronavirus 1 and Middle East respiratory syndrome coronavirus infection, because of the effect of direct neutralizing and suppression of viremia, and immunomodulation effect. Although several anti-cytokine agents were suggested to improve outcomes of the patient, the unavailability of drugs will be a major problem for accessing. We reported the experience of convalescent plasma transfusion for COVID-19 related acute respiratory distress syndrome (CARDS), who refractory to standard treatment and clinically improvement after convalescent plasma transfusion, despite unidentical blood group.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83940125","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":"Nocturnal dexmedetomidine for prevention of delirium in critically ill surgical patients: a randomized control trial protocol","authors":"Raksakul Kuanha, Thanus Teeratitayang-gool, Annop Piriyapassom, Nuanprae Kitisin, Napat Thikom, O. Chaiwat","doi":"10.54205/ccc.v30.254777","DOIUrl":"https://doi.org/10.54205/ccc.v30.254777","url":null,"abstract":"Background: Nocturnal or postoperative dexmedetomidine has been shown to reduce the incidence of delirium in critically ill surgical patients without an increase in any complications. However, it is not clear whether dexmedetomidine has preventive effect against delirium in the patients with high risk of postoperative delirium (POD) since no previous studies have clearly emphasized high-risk surgical patients.\u0000\u0000Method: In this single-center, double-blind, randomized controlled trial, we randomize 114 high risk POD patients defined by developed predictive scores and admitted to surgical intensive care units (SICUs) into 2 groups: nocturnal dexmedetomidine (9 pm – 6 am) and placebo. The outcomes were incidence of POD, delirium-free days, secondary delirium-related complications and concerned complications including hypotension and bradycardia. Other treatments apart from intervention are standardized. Intention to treat analysis is used to analyze all data.\u0000\u0000Hypothesis: We hypothesize that nocturnal dexmedetomidine giving to high-risk POD patients admitted to SICUs postoperatively would (1) reduce incidence of POD (2) improve delirium-free days (3) reduce secondary delirium-related complications (4) show no difference in hypotension and bradycardia between groups.\u0000\u0000Ethics and dissemination: The trial receives ethic approval from Siriraj Institutional Review Board. We plan to disseminate the results in peer-reviewed critical care medicine or anesthesiology-related journals, conferences nationally and internationally.\u0000\u0000Trial registration: TCTR20210217001","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84124026","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":"Role of loco-regional anesthesia for non-intubated video-assisted thoracoscopic surgery: A tertiary care hospital in northern Thailand","authors":"Tanyong Pipanmekaporn, P. Leurcharusmee, A. Samerchua, S. Lorsomradee, S. Boonsri, Krit Panjasawatwong, S. Siwachat","doi":"10.54205/ccc.v29i.253960","DOIUrl":"https://doi.org/10.54205/ccc.v29i.253960","url":null,"abstract":"Background: A few studies have focused on the role of regional anesthesia for non-intubated thoracoscopic surgery (NIVATS) in Thailand. The purpose of the present study was to review the feasibility and safety of loco-regional anesthesia for NIVATS in a tertiary care hospital.\u0000\u0000Methods: All patients undergoing scheduled NIVATS under loco-regional anesthesia including thoracic epidural analgesia (TEA), intercostal nerve block (ICNB), thoracic paravertebral block, and local wound infiltration from 2018 to 2021 were assessed by a retrospective chart review. Sedation was performed with propofol infusion and bispectral index monitoring. Primary outcomes were the feasibility of surgery and safety related to loco-regional anesthesia techniques.\u0000\u0000Results: Twenty-three patients were included. The average age was 43 (26-59) years. The two most common regional anesthesia techniques in this study were TEA and ICNB. The most common surgical procedure was wedge resection (13 patients, 56.5%) followed by pleurectomy (5 patients, 21.7%). The overall median technical feasible scores were 3 (2-3). Intraoperative hypotension (62.5% for TEA vs 20% for ICNB) and urinary retention (25% for TEA vs 0 for ICNB) were found. Among four patients with severe cough, three patients received intrathoracic vagal block and one patient required general anesthesia due to severe hypoxemia. Patients with ICNB had a higher degree of incisional pain and a higher amount of postoperative morphine consumption. \u0000\u0000Conclusion: NIVATS under loco-regional anesthesia could be a feasible and safe technique. A further study is recommended to compare the efficacy and safety of TEA and ICNB for NIVATS.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78675123","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 incidence of postoperative cardiac arrest and pre-resuscitation factors associated with post- cardiopulmonary resuscitation mortality: a single-center study in Thailand","authors":"C. Chomchoey, Thammasak Thawitsri","doi":"10.54205/ccc.v29i.251488","DOIUrl":"https://doi.org/10.54205/ccc.v29i.251488","url":null,"abstract":"Background: The author aimed to determine the incidence of in-hospital postoperative cardiac arrest requiring cardiopulmonary resuscitation (CPR), postoperative CPR mortality and pre-resuscitation factors associated with post CPR mortality.\u0000\u0000Method: A retrospective cohort study was conducted at King Chulalongkorn Memorial Hospital in Thailand from September 2018 through August 2020. A total of 34,590 adult patients underwent surgical procedures under anesthesia were recruited by electronic data recorded review. A subset of patients with postoperative CPR was collected for demographic data, comorbidities, ASA classification, operative time, functional class, types of surgery, postoperative complications, the number of deaths and survival, and SOS score at 4 hours preceding cardiac arrest.\u0000\u0000Results: A total of 34,590 adult surgical patients were recruited. In-hospital postoperative cardiac arrest incidence was 12 patients per 10,000 surgeries and predominated in emergency operation (28 per 10,000 surgeries; P< 0.0001). Risk ratio of emergency operation resulted in postoperative CPR was 3.15 (95% CI 1.72-5.77; P<0.001). Postoperative cardiac arrest patients aged 64.07 ± 16.58. The BMI was 23.46 ± 5.83. Mostly they were in ASA category 3 (44.2%). Everyone had general anesthetic procedures. The most common comorbidity was hypertension. In-hospital postoperative CPR mortality was 62.8%. Factors possibly predisposed to it were functional class < 4 METS, colorectal surgery and SOS score at 4 hours prior to cardiac arrest of at least 8.\u0000\u0000Conclusion:  Incidence of in-hospital postoperative cardiac arrest and mortality after CPR in the study tended to be lower than that of previous studies. Emergency operations predisposed to cardiac arrest. SOS score was possibly valuable as a prognostication tool, ICU triage, as well as, a part of the early warning score to prevent the overwhelming crisis. Surveillance for patient’s deterioration, effective rapid response system, and comprehensive preoperative rehabilitation should be emphasized.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81531845","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":"Extracorporeal membrane oxygenation (ECMO) for COVID-19 patients","authors":"S. Tongyoo, S. Kongsayreepong","doi":"10.54205/ccc.v29i.252413","DOIUrl":"https://doi.org/10.54205/ccc.v29i.252413","url":null,"abstract":"During the current outbreak of coronavirus disease 2019 (COVID-19), Extracorporeal Membrane Oxygenation (ECMO) support could be considered as the rescue treatment from life threatening condition among severe COVID-19 patients who did not respond to mechanical ventilation. We propose that veno-venous ECMO should be considered if patient has persistence PaO2:FiO2 ratio lower than 100 mmHg after appropriate mechanical ventilator adjustment, muscle relaxant and prone position. During ECMO support, treatment against cytokine storm, including non-selective immune suppression with systemic steroid, or selective interleukin-6 inhibition and Janus Kinase inhibition should be considered. Heparin infusion is still the recommended anticoagulant to maintain activated partial thromboplastin time (APTT) ratio range 1.5-2.0. The overall hospital mortality was comparable with respiratory failure patients, requiring ECMO support from other causes, which was reported about 37-50%. The decision to initiate ECMO could be depended on the individual hospital capacity and treatment availability.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75971767","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":"Mechanical ventilator support and prone positioning in COVID-19 related pneumonia","authors":"R. Bhurayanontachai","doi":"10.54205/ccc.v29i.251359","DOIUrl":"https://doi.org/10.54205/ccc.v29i.251359","url":null,"abstract":"COVID-19 is currently a global pandemic that cause high morbidity and mortality, particularly in the critical cases. The common presentation is among the common respiratory symptoms and could be deteriorated to multiple organ failure. From the previous epidemiologic study, approximate 15% of cases developed pneumonia and 5% required intensive care admission. The optimal respiratory care including oxygen support are the key for hypoxic respiratory failure from severe COVID-19. Several devices have been practically suggested for respiratory symptoms included high flow nasal cannula (HFNC), non-invasive positive pressure ventilator (NIV) via either common facial mask or helmet. However, some patients did not improve with those devices, that become more respiratory distress and eventually required intubation and mechanical ventilator support. In this brief review, the author will pay attention on the mechanical ventilator support and prone positioning for COVID-19 pneumonia.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85958467","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 adjunctive corticosteroid therapy on outcomes in pulmonary tuberculosis patients with acute respiratory failure: a cohort study","authors":"T. Viarasilpa, S. Tongyoo, C. Permpikul","doi":"10.54205/ccc.v29i.253581","DOIUrl":"https://doi.org/10.54205/ccc.v29i.253581","url":null,"abstract":"Background:  Tuberculosis (TB) remains an important and evolving health problem worldwide. Acute respiratory failure, the most severe form of pulmonary tuberculosis, is associated with a high mortality rate. Adjunctive corticosteroid therapy has been reported as an effective treatment in extrapulmonary TB. The aim of this study was to investigate the effect of adjunctive corticosteroid therapy on outcomes in pulmonary tuberculosis patients with acute respiratory failure.\u0000\u0000Methods: This retrospective cohort study enrolled newly diagnosed pulmonary tuberculosis patients with acute respiratory failure who were admitted to Siriraj Hospital (Bangkok, Thailand) during January 2011 to December 2013. Patients that received corticosteroid as an adjunctive treatment for pulmonary TB were assigned to the steroid group. The control group consisted of patients that did not receive corticosteroid. Collected data included age, gender, body mass index (BMI), Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, sequential organ failure assessment (SOFA) scores, vital signs, PaO2/FiO2 ratio, chest X-ray abnormality pattern, and TB treatment strategies, including antituberculosis agents and adjunct corticosteroid treatment. The primary outcome was hospital mortality rate. The secondary outcomes were hospital length of stay and duration of mechanical ventilation.\u0000\u0000Results: Thirty-eight patients were included. There were 18 patients in the steroid group and 20 in the control group. No significant difference was observed between groups for age, gender, BMI, APACHE II score, vital signs, or PaO2/FiO2 ratio. Patients in the steroid group had a significantly higher mean SOFA score than controls (5.7±4.5 vs. 3.3±2.6, respectively; p=0.046). Almost all patients in this study (97.1%) had positive culture for M. tuberculosis from sputum. The mean corticosteroid dose was equivalent to hydrocortisone 329.7±146.0 mg/day. Patients in the steroid group had higher hospital mortality than control group patients, but the difference did not achieve statistical significance (66.7% vs. 45.0%, respectively; p=0.21). Adjunctive corticosteroid therapy did not significantly reduce hospital length of stay or duration of mechanical ventilation when compared between the steroid and control groups (12.0±13.3 vs. 14.6±19.3 days, respectively; p=0.636 and 7.2±10.6 vs. 8.0±8.3 days, respectively; p=0.801).\u0000\u0000Conclusion: Adjunctive corticosteroid therapy had no significant positive effect on outcomes in pulmonary tuberculosis patients with acute respiratory failure.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"82 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76046248","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}