Enfermeria intensiva最新文献

{"title":"Medication reconciliation in critically ill patients: Digital innovation for patient safety","authors":"María Martín Cerezuela BPharm, Luis Pérez de Amezaga Tomás BPharm, Jesús Ruiz Ramos BPharm, PhD, Ana de Lorenzo Pinto BPharm, PhD, Esther Domingo Chiva BPharm, PhD, Marta Valera Rubio BPharm, Irene Aquerreta González BPharm, PhD, Carla Bastida Fernández BPharm, PhD, Laura Doménech Moral BPharm, PhD, Amaia Egüés Lugea BPharm, PhD, Miguel Ángel Amor García BPharm, PhD, Tatiana Betancor García BPharm, Sara Cobo Sacristán BPharm, Marta Albanell Fernández BPharm, Sara Ortiz Pérez BPharm, Fernando Becerril Moreno BPharm, PhD","doi":"10.1016/j.enfie.2026.500615","DOIUrl":"10.1016/j.enfie.2026.500615","url":null,"abstract":"","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"37 3","pages":"Article 500615"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474909","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":"Post-intensive care syndrome in cardiac patients: Cognitive, psychological, and functional implications — A cross-sectional study","authors":"Anastasios Tzenalis PhD, MSc, RN,&nbsp;Efrosini Petropoulou MSc, RN,&nbsp;George Kipourgos PhD(c), MSc, RN,&nbsp;Evangelia Andreopoulou MSc, RN,&nbsp;Angeliki Gkotsi PhD(c), MSc, RN,&nbsp;Eleni Albani PhD, MSc, RN","doi":"10.1016/j.enfie.2026.500602","DOIUrl":"10.1016/j.enfie.2026.500602","url":null,"abstract":"<div><h3>Introduction</h3><div>Post-intensive care syndrome (PICS) involves cognitive, psychological, and physical impairments after ICU hospitalization. While extensively studied in general ICU populations, its impact on cardiac patients remains underexplored.</div></div><div><h3>Objectives</h3><div>This study examined the prevalence and severity of PICS-related symptoms among cardiac patients 2–4 weeks after ICU discharge and explored correlations with selected demographic and clinical factors.</div></div><div><h3>Method</h3><div>A cross-sectional correlational study was conducted with 100 post-ICU cardiac patients, assessed 2–4 weeks after ICU discharge, at a Critical Care Recovery Center (May–June 2024). Data were collected using a structured questionnaire and the Greek-adapted Healthy Aging Brain Care Monitor–Self Report (HABC-M SR). Non-parametric tests and Spearman correlations were applied (<em>p</em> &lt; 0.05).</div></div><div><h3>Results</h3><div>Clinically relevant PICS symptoms were identified in 68% of participants. The mean total HABC-M SR score was 41.4 ± 23.9, indicating moderate to severe symptom burden. Functional and psychological impairments were more prominent than cognitive deficits. Greater symptom burden correlated with older age, lower educational level, and male sex.</div></div><div><h3>Discussion</h3><div>PICS significantly influences the recovery of cardiac patients, affecting their physical, cognitive, and emotional well-being. Early identification of vulnerable groups is essential.</div></div><div><h3>Conclusions</h3><div>Post-intensive care syndrome was highly prevalent among cardiac patients within the first month following ICU discharge, with functional and psychological impairments more pronounced than cognitive deficits. Older age, lower educational level, and male sex were correlated with greater symptom burden across PICS domains. These findings highlight the multidimensional impact of PICS in cardiac populations and underscore the need for early, structured screening and multidisciplinary follow-up during early recovery to support functional recovery and psychological well-being.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"37 3","pages":"Article 500602"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581768","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":"Nursing workload in critical care unit during admission and discharge: A prospective study","authors":"M. Dolores Gonzalez-Baz RN, MSN, PhD,&nbsp;Raquel López-Sánchez RN, MSN, PhD,&nbsp;M. Ángeles Palma-Ramírez RN, MSN,&nbsp;Raquel Ribón-Liberal RN, MSN,&nbsp;Elena Moreno-Ortega RN, MSN,&nbsp;Angeles Ponce-Figuereo RN,&nbsp;Ana García-Pozo RN, MSN, PhD,&nbsp;M. Nieves Moro-Tejedor RN, MSN, PhD","doi":"10.1016/j.enfie.2026.500608","DOIUrl":"10.1016/j.enfie.2026.500608","url":null,"abstract":"<div><h3>Introduction</h3><div>Higher nursing workload (NW) is associated with a negative impact on patient-focused clinical outcomes in critical care units. Adjusting the nursing staffing to the individualized care needs of critically ill patients’ using a validated scale could constitute an efficient care management strategy in these settings.</div></div><div><h3>Objective</h3><div>Assessing NW within 24 h of admission and discharge using the Nursing Activities Score (NAS) in 4 adult critical care units.</div></div><div><h3>Methodology</h3><div>Prospective, observational, single-center study.</div></div><div><h3>Population</h3><div>Patients admitted to the critical care units of a high-complexity hospital from October 2022 to February 2023. Descriptive analysis, Student's t-test, ANOVA, and multiple linear regression were performed using SPSS® v26.</div></div><div><h3>Results</h3><div>A total of 236 patients were included, of which 143 (60.9%) were male and the mean age was 61.30 (15.79). The reason for admission was medical in 151 (64.3%) cases, unplanned in 184 (78.3%) cases, APACHE II 17.09 (7.31), Charlson index of 5 [3−8], number of devices 4 [3−6], invasive ventilation 97 (41.1%), length of stay 5 [3−10] days, on admission ratio 1:2 in 203 (86.0%) and care level 3 in 236 (100.0%), on discharge with ratio 1:2 in 232 (98.3%) and care level 2 in 195 (82.6%). The mean NAS 24 h on admission was 59.46 (5.19) and on discharge was 51.13 (7.55). The variables that predicted the 24-h NAS on admission were the unit (<em>P</em> = .001), number of devices (<em>P</em> &lt; .001), and APACHE IIs (<em>P</em> &lt; .001); while those predicting 24-h NAS at discharge were unit (<em>P</em> &lt; .001), mortality (<em>P</em> &lt; .001), care level (<em>P</em> &lt; .001), number of devices (<em>P</em> = .011), and length of ICU stay (<em>P</em> = .037).</div></div><div><h3>Conclusions</h3><div>NW was high, both at admission and discharge, exceeding the 1:2 ratio. Higher rates were found in the afternoon shift. The variables that predict NW on admission are the unit, number of devices and severity of illness, and on discharge, also mortality, level of care, and length of ICU stay.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"37 3","pages":"Article 500608"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280443","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":"Nursing care planning in a patient with severe acute respiratory distress syndrome treated with venovenous extracorporeal membrane oxygenation: A case report","authors":"José Ángel Zamora-Soler RN, MSM,&nbsp;Segundo Jiménez-García RN, MSM, PhD,&nbsp;Vanesa Maturana Ibáñez MD, MSc,&nbsp;Julio Armas Castro MD, MSc,&nbsp;María Flores Vizcaya-Moreno RN, BScAN, PhD","doi":"10.1016/j.enfie.2026.500609","DOIUrl":"10.1016/j.enfie.2026.500609","url":null,"abstract":"<div><h3>Assessment</h3><div>Acute respiratory distress syndrome (ARDS) is a severe form of acute respiratory failure characterized by severe hypoxemia, reduced lung compliance, and bilateral pulmonary opacities not fully explained by cardiogenic causes. We report a case of severe refractory ARDS in the immediate postoperative period following urgent abdominal surgery in a patient with extreme obesity, focusing on nursing assessment and care planning during venovenous extracorporeal membrane oxygenation (VV-ECMO) support. A 47-year-old woman (BMI 71.11 kg/m²) developed severe ARDS (PaO₂/FiO₂ 60 mmHg) after aspiration during anesthetic induction, refractory to advanced ventilatory strategies (PEEP 15 cm H₂O and prone positioning), and underwent jugulo-jugular VV-ECMO cannulation. The clinical course was favorable, with decannulation on day 5, extubation on day 11, and ICU discharge on day 13 without relevant respiratory sequelae.</div></div><div><h3>Diagnoses</h3><div>Seven NANDA-I nursing diagnoses were prioritized: impaired gas exchange (00030), impaired spontaneous ventilation (00033), risk for infection (00004), risk for impaired skin integrity (00047), risk for impaired physical mobility (00324), acute pain (00132), and obesity (00232).</div></div><div><h3>Planning</h3><div>NOC outcomes and NIC interventions were established, and baseline outcome scores (RO) were recorded using a Likert scale. An AREA clinical reasoning network was developed to analyze diagnostic interconnections and support prioritization.</div></div><div><h3>Discussion</h3><div>VV-ECMO is an effective therapy for refractory hypoxemia in severe ARDS when delivered in experienced centers, enabling ultraprotective ventilation and serving as a bridge to recovery. Standardized NANDA–NOC–NIC language supports the organization and evaluation of the care plan in highly complex, critically ill patients, including those with extreme obesity. This case illustrates the role of structured nursing care planning in VV-ECMO patients with extreme obesity.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"37 3","pages":"Article 500609"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371467","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":"Virtual reality to reduce pain and anxiety during the removal of chest drains after cardiac surgery: A randomized controlled trial","authors":"Laia Gascón-Tomás MSc, RN,&nbsp;Sara González-Del Hoyo MSc, RN,&nbsp;Marta Martínez-Orellana MSc, RN,&nbsp;Josep Maria Ramos-Puig MSc, RN,&nbsp;Laura García-López MSc, RN,&nbsp;Silvia Serrano-Jaureguizar MSc, RN,&nbsp;Ariadna Puig-Aragón MSc, RN,&nbsp;Mireia Cigarrán-Mensa MSc,&nbsp;Gemma Via-Clavero PhD, MSc, RN","doi":"10.1016/j.enfie.2026.500614","DOIUrl":"10.1016/j.enfie.2026.500614","url":null,"abstract":"<div><h3>Introduction</h3><div>Removal of chest drains after cardiac surgery is ranked among the most painful procedures in the intensive care units. Virtual reality, as an entertaining, non-pharmacological tool, may help for managing procedural pain and anxiety, although its efficacy in this context remains uncertain.</div></div><div><h3>Objective</h3><div>To assess the efficacy of virtual reality on acute pain and anxiety during chest drain removal and to evaluate patient satisfaction with the intervention.</div></div><div><h3>Methods</h3><div>An open-label, randomized controlled trial was conducted in a cardiac surgery unit in a tertiary-level university hospital with 101 spontaneously breathing post-cardiac surgery patients who were able to communicate. Participants were randomized to undergo virtual reality-guided removal of chest drains (Intervention Group) or to receive usual care without distraction (Control Group). Self-reported pain (Numeric Rating Scale) and state-anxiety scores through the 20-item of the <em>State-Trait Anxiety Inventory-State Scale</em> (STAI-s) were assessed at baseline, 1-minute, and 30-minutes post-procedure. Satisfaction levels and adverse events with the intervention were also monitored.</div></div><div><h3>Results</h3><div>Analysis of 98 patients (48 in the intervention group and 50 in the control group) showed similar baseline characteristics between groups. Two-way ANOVA for repeated measures showed a non-significant effect of the interaction between time-treatment for pain (MD = 0.16; 95%CI: −0.7 to 1.03; <em>F</em>_1,96 = 0.14; <em>p</em> = 0.71) and state-anxiety (MD = −1.83; 95% CI: −4.5 to 0.88; <em>F</em>_1,96 = 1.79; <em>p</em> = 0.18). Patient satisfaction with the virtual reality experience was high with a mean score of 8.3 (SD = 1.9) points.</div></div><div><h3>Discussion</h3><div>The findings suggest that the effect of virtual reality on managing procedural pain and anxiety might be modelled by individual and contextual factors, such as improvements in patient’s clinical situation.</div></div><div><h3>Conclusion</h3><div>Compared with usual care, virtual reality did not significantly reduce pain and anxiety during the removal of chest drains after cardiac surgery, although patients rated the experience with a high level of satisfaction.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"37 3","pages":"Article 500614"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383423","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":"Impact of a simulation-based training program on the acquisition of ultrasound window competencies for the initial assessment of polytrauma patients in advanced prehospital nursing care","authors":"Jose Luis Almenara Abellán MD, PhD,&nbsp;Carolina Lagares Franco PhD,&nbsp;Francisco Bordes Bustamante RN,&nbsp;Manuel Ángel Gracia Romero PhD,&nbsp;Antonio Leopoldo Santisteban Espejo PhD","doi":"10.1016/j.enfie.2026.500604","DOIUrl":"10.1016/j.enfie.2026.500604","url":null,"abstract":"<div><h3>Introduction</h3><div>Point-of-care ultrasound is essential in the initial assessment of polytrauma patients. The E-FAST protocol enables rapid detection of intra-abdominal free fluid, pericardial effusion, and pneumothorax, with particular usefulness in prehospital settings. However, ultrasound training among emergency nursing staff remains limited, especially within Advanced Life Support (ALS) mobile units.</div></div><div><h3>Objective</h3><div>To evaluate the effect of a brief, structured training program on the acquisition of competencies for obtaining E-FAST windows in ALS mobile units nurses, assessing knowledge, technical skills, scanning sequence, and perceived confidence.</div></div><div><h3>Method</h3><div>A quasi-experimental pre-post intervention study was conducted with nurses with ≥6 months of experience in emergency or prehospital care. The intervention included baseline assessment, a 2-h theoretical module, high-fidelity simulation with Ultrasound Mentor®, and hands-on practice with human models. Final assessment combined a theoretical test, simulator-based practical evaluation, and scanning with a real ultrasound device. Knowledge, execution times, and confidence levels were recorded.</div></div><div><h3>Results</h3><div>Fourteen nurses participated, most without previous ultrasound training (85.7%). Initial confidence was low and improved significantly after the intervention. Theoretical performance increased in 5 of the 6 evaluated items, reaching up to 92.9% accuracy in key content areas. Practical assessment demonstrated an organized scanning sequence and appropriate times for prehospital care (medians of 118 s [IQR 24.5] in advanced simulation and 237 s [IQR 33.3] using a real ultrasound device).</div></div><div><h3>Discussion</h3><div>The program enabled the acquisition of essential skills even in professionals without prior ultrasound experience. The combination of theory, simulation, and hands-on practice facilitated rapid competency transfer and protocol standardization.</div></div><div><h3>Conclusions</h3><div>A brief training program improves ALS mobile units nurses’ competence and confidence in obtaining E-FAST windows, supporting the safe integration of point-of-care ultrasound into prehospital care.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"37 3","pages":"Article 500604"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267570","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 relationship between emotional intelligence and moral sensitivity in critical care nurses","authors":"Ana Sesma-Mendaza MSN,&nbsp;Ana de-Vicente-Lasquibar RN,&nbsp;Maialen Ugalde-Ustárroz RN,&nbsp;Amaya Arboniés-Cabodevilla RN,&nbsp;M. Mar Sarasa-Monreal MSN,&nbsp;Rosana Goñi-Viguria MSN","doi":"10.1016/j.enfie.2026.500612","DOIUrl":"10.1016/j.enfie.2026.500612","url":null,"abstract":"<div><h3>Introduction</h3><div>Emotional intelligence (EI) helps nurses in managing emotions and coping with stressful situations while providing high-quality care. Moral sensitivity (MS) is crucial for identifying moral dilemmas and evaluating different decision-making options.</div></div><div><h3>Objectives</h3><div>To determine the level of emotional intelligence and moral sensitivity amongst nurses working in a critical care unit, and to study the relationship between these factors and sociodemographic data.</div></div><div><h3>Methodology</h3><div>A descriptive, prospective, correlational study was conducted in the critical care area of a tertiary-level university hospital. The Wong and Law Emotional Intelligence Scale (WLEIS) was used to evaluate the nurses' perceived EI. It measures four dimensions: intrapersonal perception, interpersonal perception, emotional assimilation, and emotional regulation. MS was assessed using the MS scale for nursing cares (CuSMCE-23), which measures two factors: nursing values and nursing responses. Sociodemographic data were also collected. Descriptive and inferential statistics were used, with statistical significance set at <em>p</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>Sixty-two nurses participated in the study. The overall EI score was 5.51 (95% CI 5.37–5.64). The MS score was 93.40 (95% CI 90.83–95.96). Significant differences in total EI scores were observed in relation to the presence of dependents (<em>p</em> = 0.010) and working hours (<em>p</em> = 0.012). Concerning MS, a positive correlation was found with age (<em>p</em> = 0.046) and having dependents (<em>p</em> = 0.013). A positive correlation between EI and MS was also found (<em>r</em> = 0.432, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Critical care nurses showed medium-high levels of EI and very high levels of MS. Factors such as age and the presence of dependents were found to influence both EI and MS. Recognizing the relationship between these variables is crucial for clinical practice. Educational programmes and further research are needed to better understand this emerging connection.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"37 3","pages":"Article 500612"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564237","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":"Hyperpolypharmacy in intensive care: Medicines interactions between centrally acting drugs","authors":"Ana Paula Possebon Carda,&nbsp;Adriana Inocenti Miasso PhD,&nbsp;Assis do Carmo Pereira Júnior PhD,&nbsp;Carlos Renato Tirapelli PhD","doi":"10.1016/j.enfie.2026.500616","DOIUrl":"10.1016/j.enfie.2026.500616","url":null,"abstract":"<div><h3>Introduction</h3><div>The prescription of multiple drugs increases the likelihood of drug interactions, making the use of drugs in intensive care unit patients challenging.</div></div><div><h3>Aim</h3><div>To analyze the occurrence of hyperpolypharmacy and potential drug interactions between centrally-acting drugs and drugs from other pharmacological classes on the first and last day of admission to an intensive care unit.</div></div><div><h3>Methods</h3><div>Descriptive study with patients in a hospital in the state of São Paulo, Brazil. The study included patients of both sexes over the age of 18. The patients included had been in the ICU for three days or more, had multiple diagnoses and were taking centrally-acting drugs. Data was collected using the Philips Tasy health management software, that provides information on age, gender, marital status, outcome, polypharmacy, hyperpolypharmacy and results of laboratory blood tests. Data was also collected on prescribed medication. Micromedex® software was used to analyze the occurrence of potential drug interactions and a logistic regression model was used to analyze the data.</div></div><div><h3>Results</h3><div>A higher risk of death was identified in patients aged 40–59 years (OR = 7.36; <em>P</em> = .010; CI 1.39–38.80) and in those taking cardiovascular medications that interact with other medications (OR = 4.41; <em>P</em> = .007; CI 1.48–13.08). Severe drug interactions were associated with regular documentation (OR = 3.54; <em>P</em> = .014; CI 1.32–9.46) and an unspecified time of onset (OR = 27.76; <em>P</em> &lt; .001; CI 7.53–102.2). Moderate drug interactions were associated with the time of onset: a nonspecific onset increased the incidence by 13.13 times (<em>P</em> &lt; .001; CI 3.24–53.17), while a delayed onset increased this probability by 24.85 times (<em>P</em> &lt; .001; CI 5.32–115.9).</div></div><div><h3>Conclusion</h3><div>The results reveal the need to invest in educational strategies to reduce drug interactions in the intensive care unit, with a view to identifying potential drug interactions at an early stage.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"37 3","pages":"Article 500616"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551829","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":"Pistoning in continuous renal extracorporeal replacement therapy catheters: Longitudinal descriptive study","authors":"Josefa Valls-Matarín PhD, MSN, RN,&nbsp;Belén Machuca-Ayuso MSN, RN,&nbsp;Roser Jané-Navarro MSN, RN,&nbsp;Francisco Javier González de Molina y Ortiz PhD, MS, MD","doi":"10.1016/j.enfie.2026.500611","DOIUrl":"10.1016/j.enfie.2026.500611","url":null,"abstract":"<div><h3>Introduction</h3><div>Pistoning is defined as the back-and-forth movement of the catheter at the insertion site.</div></div><div><h3>Objective</h3><div>To determine the frequency of pistoning in continuous renal replacement therapy catheters (CRRTC) and its relationship with intravascular thrombosis and catheter dysfunction.</div></div><div><h3>Method</h3><div>A longitudinal descriptive study (March 2023–June 2024) was conducted in two intensive care units. Patients with CRRTC inserted in these units were included.Body mass index (BMI), insertion site, dwell time, and reason for removal were recorded. At each dressing change, pistoning, dysfunction, day of onset, suture fixation status (SFS), hematoma, and line traction were assessed. After catheter removal, ultrasound was performed to determine intravascular thrombosis. Descriptive statistics and bivariate analysis using chi-square or Fisher’s exact test and t-Student test were applied, with significance set at p ≤ 0,05.</div></div><div><h3>Results</h3><div>A total of 63 catheters were analysed. Pistoning occurred in 42.9% (n = 27;) and dysfunction in 31.8% (n = 20), at median 3 [P₂₅ = 2–P₇₅ = 9] and 3.5 [P₂₅ = 1.5–P₇₅ = 6.5] days respectively. Intravascular thrombosis was identified in 26.1% (n = 12). Incorrect SFS was observed in 59.3% of catheter with <em>pistoning</em> (CWP) compared with 11.1% of catheter without <em>pistoning</em>(CWoP) (p &lt; 0.001). CWP remained in place for 11 days (8.5) and CWoP for 7.3 days (3.9) (p = 0.02). Patients with dysfunction had a BMI of 34.5 kg/m² (SD = 10.3) compared with 29.8 kg/m² (SD = 4.6) in those without dysfunction (p = 0.03). No significant differences were found between pistoning and thrombosis (p = 0.30) or between pistoning and dysfunction (p = 0.06).</div></div><div><h3>Discussion</h3><div>Pistoning was frequent and was mainly associated with defective SFS and longer dwell time. Obesity was identified as a factor associated with catheter dysfunction.</div></div><div><h3>Conclusions</h3><div>Nearly half of CRRT catheters present pistoning, associated with inadequate fixation and longer dwell time. Catheter dysfunction is more frequent in patients with obesity.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"37 3","pages":"Article 500611"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383469","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":"Mapping transitional care models after ICU discharge for ECMO survivors: A scoping review","authors":"Paulo Costa RN, MSc ,&nbsp;Amélia Ferreira RN, PhD ,&nbsp;Roberto Roncon-Albuquerque MD, PhD","doi":"10.1016/j.enfie.2026.500598","DOIUrl":"10.1016/j.enfie.2026.500598","url":null,"abstract":"<div><h3>Introduction</h3><div>ECMO survivors frequently develop post-intensive-care syndrome (PICS) with cognitive, psychological, and functional sequelae. Transitional care seeks to bridge ICU discharge and community recovery but remains variably structured, timed, and evaluated.</div></div><div><h3>Objectives and methodology</h3><div>To map transitional care models for ECMO survivors after ICU discharge, describing what is implemented, when (timing), and which outcomes are measured. Scoping review (JBI), reported per PRISMA-ScR. Databases: MEDLINE/PubMed, B-On, Web of Science (January 2015–June 2025). Grey literature: Google Scholar, OpenGrey, ELSO, OSF, ClinicalTrials.gov. Keywords and MeSH terms used: Extracorporeal Membrane Oxygenation [MeSH], Aftercare [MeSH], post-intensive care syndrome [MeSH], Critical Care [MeSH], Transitional Care [MeSH]. Eligibility: adults (≥18) on VV/VA ECMO with post-ICU data; excluded intra-operative ECMO &lt; 24 h and studies without extractable ECMO-specific outcomes.</div></div><div><h3>Results</h3><div>Search retrieved 4101 studies, screening identified 740 records; 41 were included; 699 were excluded (duplicates; non-ECMO or intra-operative ECMO; no transitional intervention; no ECMO-specific outcomes). Seven domains were identified: structured follow-up pathways (<em>n</em> = 12); multidisciplinary interventions (<em>n</em> = 10); psychological/PICS support (<em>n</em> = 7); functional rehabilitation (<em>n</em> = 6); educational/organizational training (<em>n</em> = 5); telemonitoring/digital follow-up (<em>n</em> = 3); palliative/survivorship models (<em>n</em> = 2). Follow-up timings: pre-discharge; ∼1 month; 3–6 months; ≥12 months. Common outcomes: HRQoL, functional status (e.g., 6MWT/ADL), return to work, psychological symptoms (e.g., anxiety/depression/PTSD), readmissions/complications. Designs were predominantly observational/qualitative; trials with comparators were infrequent.</div></div><div><h3>Discussion</h3><div>Emerging concepts—ECMO survivorship, digital follow-up pathways—are not yet indexed in MeSH. Heterogeneity in structures, timing, and instruments limits comparability. Limitations include reliance on descriptive designs, variable reporting, and potential overlap across reviews.</div></div><div><h3>Conclusions</h3><div>This scoping review identified seven domains of transitional care for ECMO survivors after ICU discharge. However, the implementation of these domains and the outcome measures used to evaluate them were heterogeneous and inconsistently reported across studies, highlighting the need for more robust, outcome-focused research.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"37 2","pages":"Article 500598"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847761","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}