Effect of Infusion Set Replacement Intervals on Central Line-Associated Bloodstream Infection in the Intensive Care Unit: Study Protocol of the INSPIRATION Study.

INTRODUCTION: The replacement intervals for infusion sets may differ among healthcare institutions, which may have an impact on the occurrence of central line-associated bloodstream infections (CLABSI). Nevertheless, there exists a limited amount of high-quality evidence available to assist clinicians in determining the most suitable replacement intervals for infusion sets. Therefore, the objective of this trial is to compare the efficacy of 24-h and 96-h replacement intervals for infusion sets on CLABSI among critically ill adults who have central venous access devices. METHODS: This is a multicenter, parallel-group randomized controlled trial that will investigate the effect of infusion set replacement intervals on CLABSI in adult patients admitted to intensive care units (ICUs). The study will enroll 1240 participants who meet the inclusion criteria, which includes being 18 years or older, expected to stay in the ICU for longer than 96 h, and in need of central venous access. Participants will be randomly assigned to either a control group receiving a 96-h replacement interval or a treatment group receiving a 24-h replacement interval. PLANNED OUTCOME: The primary outcome of this trial is the rate of CLABSI within 28 days after randomization. CONCLUSION: This is the first randomized controlled trial to investigate the effects of infusion set replacement at 24-h and 96-h intervals on CLABSI in ICU patients. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT05359601.

Bereaved parents' perceptions of memory making: a qualitative meta-synthesis.

OBJECTIVE: This study aims to investigate the experiences of parents who have experienced bereavement in their efforts to preserve memories of their deceased child. METHODS: Employing a qualitative meta-synthesis approach, this study systematically sought relevant qualitative literature by conducting searches across various electronic databases, including PubMed, Embase, CINAHL, PsycINFO, Web of Science, Cochrane Library, and Wiley, up until July 2023. RESULTS: Nine studies are eligible for inclusion and included in the meta-synthesis. Three overarching categories are identified: (1) Affirming the Significance of Memory Making. (2) Best Practices in Memory Making. (3) Barriers to Effective Memory Making. CONCLUSION: Bereaved parents highly value the act of creating lasting memories, emphasizing its profound significance. While forming these memories, it is imperative to offer family-centered care and honor diverse preferences and needs. It is essential to offer effective support to parents, offering them a range of choices. Furthermore, a more comprehensive examination of memory-making practices is required to better understand their influence on parents' recollections of their deceased child.

Comparison of Different Prediction Models for Unplanned Interruption of Continuous Renal Replacement Treatment: A Systematic Review of Qualitative Analyses.

INTRODUCTION: This study will systematically search and evaluate the prediction models for unplanned interruption of continuous renal replacement treatment (CRRT) and to provide a reference for building a higher quality prediction model for unplanned interruption of CRRT. METHODS: PubMed, Embase, Cochrane Library, CINAHL, China National Knowledge Infrastructure (CNKI), SinoMed, and Wanfang Database were systematically searched for studies on prediction models for unexpected interruption of CRRT. The languages were limited to Chinese and English. The search time limit was from the establishment of the database to June 30, 2023. Two researchers screened the literature and extracted the data independently, and the risk of bias and applicability of the included literature were analyzed using the risk of bias assessment tool for predictive model studies. RESULTS: A total of nine studies were included, and the area under the receiver operating characteristic curve ranged from 0.679 to 0.997. The applicability of the prediction model in seven studies was good and in two studies was poor. CONCLUSION: More attention should be paid to the effectiveness of different risk assessment methods in future construction, so as to obtain better risk prediction models with high accuracy and provide certain reference and basis for formulating relevant prevention strategies.

Study on the Sleep Quality Classification and Influencing Factors of Adult ICU Awake Patients Based on Latent Profile Analysis: A Cross-Sectional Survey.

Objective: To explore the potential category characteristics of sleep quality in conscious adult patients in the intensive care unit (ICU) and to analyze the differences in characteristics of different categories of conscious adult patients in the ICU. Methods: From 5/4/2023 to 30/6/2023, we selected ICU patients of a Class iii Grade A hospital in Wuhan as subjects by simple random sampling. The general information questionnaire, Acute Physiology and Chronic Health Evaluation II, Numerical Rating Scale (NRS)/Critical Care Pain Observation Tool (CPOT) and Richards-Campbell Sleep Questionnaire (RCSQ) were used for investigation. To analyze the latent profile of sleep quality characteristics of adult ICU awake patients and to identify the influencing factors of the latent profile through univariate analysis and logistic regression analysis. Results: A total of 298 awake ICU patients were investigated. There were three potential profiles of sleep quality characteristics, namely "low sleep quality" type (16.31%), "medium sleep quality" type (52.11%), and "high sleep quality" type (31.57%). Logistic regression analysis showed that age (36-60), disease type admitted to ICU, oxygen administration method, CPOT or NRS score, postoperative or not, use of analgesic drugs or not, and use of sleep-promoting drugs or not were the factors affecting the sleep quality of adult ICU awake patients (P < 0.05). Conclusion: The sleep quality of adult ICU awake patients has obvious classification characteristics. Health professionals can carry out individualized interventions according to the influencing factors of different potential profiles to improve the sleep quality of adult ICU awake patients.

Efficacy and Safety of a Low-Flow Extracorporeal Carbon Dioxide Removal System in Acute Respiratory Failure, a Pilot Study in China.

BACKGROUND: Low-flow extracorporeal carbon dioxide removal (LF-ECCO2R) has the potential to play an important role in the management of adults with acute respiratory failure. However, it has never been tested in China. The study aimed at exploring the safety and efficacy on LF-ECCO2R for acute respiratory failure in a Chinese tertiary intensive care unit (ICU). MATERIALS AND METHODS: We performed a retrospective case note review of patients admitted to our tertiary regional ICU and commenced on LF-ECCO2R from June 2020 to September 2021. The LF-ECCO2R device we used was ProLUNG® system (Estor S.p.A., Milan, Italy). The device employed a nonporous poly-4-methyl-1-pentene membrane lung with a surface area of 1.81 m2 and run at an extracorporeal blood flow between 100 and 450 mL/min. Demographic and physiologic data (including ventilation parameters and arterial blood gases) as well as the outcome of LF-ECCO2R treatment were recorded. RESULTS: A total of 12 cases were included. A statistically significant reduction in respiratory rate, driving pressure, PaCO2, and blood lactate was observed. In addition, there was a statistically significant improvement in pH and PaO2/FiO2. Six out of 12 patients (50%) were discharged alive from ICU. Three complications related to LF-ECCO2R were reported, none resulting in serious adverse outcomes. CONCLUSION: Our clinical series indicated that LF-ECCO2R seemed to be safely applied in patients with acute respiratory failure. The efficacy of CO2 removal as well as the improved respiratory parameters was also observed. However, large-scale randomized clinical trials are needed to confirm the effects.

A transition programme to enhance ICU new graduate nurses' professional identity and intention to remain employed: A pre- and postevaluation.

AIMS: To investigate the effect of a transition programme including cognitive-behaviour-based preceptorship intervention on ICU new graduate nurses' (NGNs)' professional identity and their intention to remain employed. DESIGN: One-arm pre- and post-test design followed the TREND Statement. METHODS: NGNs' professional identity and intention to remain employed were measured at baseline (T1), postintervention (1 month, T2) and 6-month follow-up (T3). RESULTS: Fifty-three NGNs completed the programme, and their professional identity score significantly increased postintervention [from 111.5 (SD = 16.72) at T1 to 114.2 (SD = 9.12) at T2, p < 0.05], but decreased at T3 [105.8 (SD = 9.44) compared with T1 and T2, p < 0.05]. There was no significant difference in ICU NGNs' intention of remain employed outcomes at three time points (p > 0.05). The transition programme was effective to improve ICU NGNs' professional identity immediately after the intervention, but the increment did not maintain at the 6-month follow-up.

Nurses' experiences of providing care to patients with COVID-19 in the ICU in Wuhan: a descriptive phenomenological research.

OBJECTIVES: This phenomenological study aimed to examine intensive care unit (ICU) nurses' experiences of caring for patients with COVID-19, and understand better their everyday experiences of patient' management in the ICU. DESIGN: A descriptive phenomenological research design was used. Individual interviews were conducted. The data were transcribed verbatim and analysed using Colaizzi's seven-step framework. SETTING: An ICU with 16 beds in a tertiary hospital in Wuhan, China. PARTICIPANTS: Nurses who had more than 1 year of experience and had provided care to patients with COVID-19 in ICU for more than 1 week were identified as participants. A total of 13 nurses were interviewed. RESULTS: An analysis of these significant statements yielded four distinct stages of feelings, thereby revealing the essence of this phenomenon. Worry about being infected and infecting family members was present across in all four stages. The themes associated with the four stages were as follows: initial contradictory feelings, quick adaption to the 'new working environment' in the first 1-2 weeks in the ICU, desperation after adaption, holding on and survive. CONCLUSIONS: The nurses reported distinct experiences of providing care to patients with COVID-19 in ICUs. Interventions, such as providing information about the disease, simulation training, emotional support and follow-up care, are needed to help nurses manage patients with COVID-19 and maintain nurses' health.

Facile synthesis of N-halamine-labeled silica-polyacrylamide multilayer core-shell nanoparticles for antibacterial ability.

Silica-polymer antimicrobial composites with a core-shell nanostructure are often prepared through a polymeric process. However, it is difficult to control the polymerization degree of the polymers to give a uniform size distribution. In this article, we present a facile approach to produce antimicrobial silica@polyacrylamide (SiO2@PAM) core-shell nanoparticles, which were synthesized via an electrostatic self-assembly method using acyclic N-halamine polymeric polyacrylamide. The morphologies and structures of these as-prepared nanoparticles were characterized by different techniques. And their antibacterial performance against both Gram-positive bacteria and Gram-negative bacteria was also evaluated. Based on the preliminary results, these core-shell nanosized spheres were made of an outer polymer shell which decorated the inner SiO2 core, showing the encapsulation of silica nanoparticles with PAM polymers. After chlorination, the resultant nanosized particles displayed a powerful and stable bactericidal capability toward both of the two model bacterial species. Bactericidal assessment further suggested a coordinated effect of the well-known antibacterial performance of N-halamines and the flocculation of PAM on the antibacterial behavior. The in vitro cytotoxicity of the prepared nanoparticles with varying concentrations was studied using mouse fibroblast cells (L929). The CCK-8 assay revealed that the SiO2@PAM composites possessed a non-cytotoxic and favorable response to the seeded cells in vitro. These results indicate the suitability of the SiO2@PAM composite particles for controlling biocidal activity, demonstrating their potential applications in deactivating bacteria or even disease control.

Enhancing in vitro bioactivity and in vivo osteogenesis of organic-inorganic nanofibrous biocomposites with novel bioceramics.

Fabricating bioactive nanofibrous scaffolds from biodegradable polymers to mimic native tissue is an important approach in repairing bony defects. Silk fibroin (SF) may contribute to bone regeneration because of its excellent mechanical properties, slow degradability, and low osteoconductivity. A combination of bioceramic-polymer materials is generally used to provide an improved osteoconductive environment for bone healing. This study attempts developing for the first time an electrospun SF-based biocomposite system by introducing new bioceramics based on mesoporous bioactive glass/hydroxyapatite nanocomposite (MGHA). The addition of MGHA into the SF matrix could regulate the physicochemical properties and surface hydrophilicity, but induce weakened tensile properties as compared to pure SF. The excellent apatite-formation ability of a MGHA-introduced nanocomposite also improved the bioactivity of the composite. The biphasic composite increasingly degraded in PBS or enzyme solution in vitro compared with pure SF. In vivo evaluation of bone formation confirmed that SF/MGHA is more advantageous in bone reconstruction than the SF group for cranial bone defects. These results indicate the suitability of the SF/MGHA composite system in bone defects, demonstrating its potential application in bone tissue regeneration.