Platelet count as a prognostic marker for acute respiratory distress syndrome.

BACKGROUND: This study aimed to evaluate the role of platelet count (PLT) in the prognosis of patients with acute respiratory distress syndrome (ARDS). METHODS: The data were extracted from the Medical Information Mart for Intensive Care database (version 2.2). Patients diagnosed with ARDS according to criteria from Berlin Definition and had the platelet count (PLT) measured within the first day after intensive care unit admission were analyzed. Based on PLT, ARDS patients were divided into four groups: PLT ≤ 100 × 109/L, PLT 101-200 × 109/L, PLT 201-300 × 109/L, and PLT > 300 × 109/L. The primary outcome was 28-day mortality. Survival probabilities were analyzed using Kaplan-Meier. Furthermore, the association between PLT and mortality in ARDS patients was assessed using a univariate and multivariable Cox proportional hazards model. RESULTS: Overall, the final analysis included 3,207 eligible participants with ARDS. According to the Kaplan-Meier curves for 28-day mortality of PLT, PLT ≤ 100 × 109/L was associated with a higher incidence of mortality (P = 0.001), the same trends were observed in the 60-day (P = 0.001) and 90-day mortality (P = 0.001). In the multivariate model adjusted for the potential factors, the adjusted hazard ratio at PLT 101-200 × 109/L group, PLT 201-300 × 109/L, and PLT > 300 × 109/L was 0.681 [95% confidence interval (CI): 0.576-0.805, P < 0.001], 0.733 (95% CI: 0.604-0.889, P = 0.002), and 0.787 (95% CI: 0.624-0.994, P = 0.044) compared to the reference group (PLT ≤ 100 × 109/L), respectively. Similar relationships between the PLT ≤ 100 × 109/L group and 28-day mortality were obtained in most subgroups. CONCLUSION: PLT appeared to be an independent predictor of mortality in critically ill patients with ARDS.

Impact of heat waves on human morbidity and hospital admissions in a city of the western mediterranean area.

PURPOSE: The effect of heat waves on mortality is well known, but current evidence on morbidity is limited. Establishing the consequences of these events in terms of morbidity is important to ensure communities and health systems can adapt to them. METHODS: We thus collected data on total daily emergency hospital admissions, admissions to critical care units, emergency department admissions, and emergency admissions for specific diagnoses to Hospital Universitario de Son Espases from 1 January 2005 to 31 December 2021. A heat wave was defined as a period of ≥ 2 days with a maximum temperature ≥ 35 °C, including a 7 day lag effect (inclusive). We used a quasi-Poisson generalized linear model to estimate relative risks (RRs; 95%CI) for heat wave-related hospital admissions. RESULTS: Results showed statistically significant increases in total emergency admissions (RR 1.06; 95%CI 1 - 1.12), emergency department admissions (RR 1.12; 95%CI 1.07 - 1.18), and admissions for ischemic stroke (RR 1.26; 95%CI 1.02 - 1.54), acute kidney injury (RR 1.67; 95%CI 1.16 - 2.35), and heat stroke (RR 18.73, 95%CI 6.48 - 45.83) during heat waves. CONCLUSION: Heat waves increase hospitalization risk, primarily for thromboembolic and renal diseases and heat strokes.

Single centre observational study evaluating the impact of introducing High Flow Nasal Cannula outside of Paediatric Critical Care Unit.

AIM: To evaluate the impact of High Flow Nasal Cannula (HFNC) introduction outside of Paediatric Critical Care Units (PCCU), on PCCU admissions and intubation rates. Secondarily, to identify escalation predictors. METHODS: Retrospective observational study with matched PCCU admissions and intubation rates, 2-years before (Group 1) and 2-years after (Group 2) HFNC introduction outside of PCCU. Within Group 2, we compared those admitted to PCCU (escalation) and those who did not (non-escalation). Observations, change in observations and time to starting HFNC were analysed. RESULTS: Pre- and post-introduction comparison: Of 980 admissions in Group 1, 55 were admitted to PCCU, whereas of 1209 admission in Group 2, there were 85 admissions, P = 0.188. Group 1 had 25 intubations compared to 23 in Group 2, P = 0.309. Over twice as many children had some form of respiratory support in Group 2. Post-introduction: 104 children commenced HFNC, 72% for bronchiolitis. Median age was 4 months in the non-escalation group and 6.5 months in the escalation group, P = 0.663. Thirty-eight children escalated to PCCU: 33 required CPAP/BiPAP, 4 were intubated with 1 remaining on HFNC. Comparisons of age, gender, comorbidities, observations, change in observations and time to starting HFNC showed no significant escalation predictors. CONCLUSIONS: This study identified no statistically significant predictors of escalation. There was an observed increase in PCCU admissions with decreased intubations. The resource implications of this therapy are significant and further studies should examine cost effectiveness of HFNC use outside of PCCU.

Knowledge, practice, and factors associated with electrocardiography interpretation among nurses working in adult emergency and critical care units at selected governmental hospitals in Addis Ababa, Ethiopia, 2023: a cross-sectional study.

BACKGROUND: Electrocardiography (ECG) is a noninvasive diagnostic method used to examine electrical and muscular cardiac activity. It is usually the first-line diagnostic tool for patients with chest pain. Late recognition of electrocardiography abnormalities can cause in-hospital cardiac arrest, further complicate care, increase the cost of health care, and prolong admission. Hence, the objective of this study was to determine the knowledge, practice, and associated factors of nurses regarding the interpretation of electrocardiography. METHODS: A cross-sectional study was carried out on 334 nurses working at randomly selected public hospitals from March 06, 2023, to April 05, 2023. Since our study populations were less than the calculated sample size, all nurses who fulfilled the inclusion criteria were included. The collected data were coded and cleaned using EpiData version 4.2 and analysed using Statistical Package for the Social Sciences (SPSS) version 25. Both bivariate and multivariate logistic regression was run to find an association between dependent and independent variables. Odds ratios (ORs) with 95% confidence levels were used to measure the strength of associations. RESULTS: A total of 334 nurses responded to the survey, yielding a 93% response rate. Only 15.4% and 9% of them had satisfactory knowledge and good practice, respectively. Nurses who had 2-4 years of experience in the current unit were 3.13 times more likely (AOR = 3.13 (1.23, 7.92) to have sufficient knowledge. Nurses working in cardiac care units were 3.45 times more likely to have good practices than those working in intensive care units (AOR = 3.45 (1.02, 13.73)). CONCLUSION: The study revealed that educational qualifications, in-service training, and current working units were significantly associated with nurses' knowledge and practice of electrocardiography interpretation. The concerned body must provide continuous on-the-job training related to ECG interpretation to all nurses working in adult emergency and critical care unit.

A mixed-method study to develop and evaluate a structured therapeutic communication module on psychological distress and perceived needs among caregivers of critically ill patients in Critical Care Units.

AIMS AND OBJECTIVES: To develop and evaluate the effectiveness of a structured therapeutic communication module on psychological distress and perceived needs among caregivers of critically ill patients. BACKGROUND: Caregivers of critically ill patients experience intense psychological distress, and their needs often go unexpressed or unidentified. Structured therapeutic communication enables nurses to explore and fulfill these needs. METHOD: A mixed-method study was conducted among 30 caregivers of critically ill patients. During phase one, a qualitative interview was conducted, and a structured therapeutic communication module was developed based on Hildegard Peplau's Interpersonal Relations Theory. In the second phase, one group pre-test and post-test design was adopted. The Hospital Anxiety and Depression Scale (HADS) and a Semi-structured interview schedule were used to assess psychological distress and perceived needs, respectively. RESULTS: Half of (50 %) the caregivers reported a high level of anxiety before intervention, with a mean of 11.30 (SD: 4.0), and 66.7 % of them had a high level of depression, with a mean of 12.03 (SD: 0.08). There was a statistically significant difference in anxiety (CI: 0.451-2.016) and depression (CI: 0.261-1.538) before and after the intervention. The qualitative analysis revealed unmet needs perceived by caregivers. CONCLUSION: Using a structured therapeutic communication module helps nurses to alleviate the psychological distress experienced by caregivers of CCU patients. RELEVANCE TO CLINICAL PRACTICE: Nurses need to be sensitive to the unexpressed needs of caregivers of critically ill patients. The structured therapeutic communication modules can be integrated into routine nursing care practice to ensure family-centered care.

Nurses' alarm fatigue, influencing factors, and its relationship with burnout in the critical care units: A cross-sectional study.

BACKGROUND: Excessive number of alarms and false and nonactionable alarms may lead to alarm fatigue. Alarm fatigue could easily contribute to burnout. Burnout may reduce nurses' sensitivity to alarms, thus affecting patients' safety due to insufficient response to the alarms. However, no study has examined nurses' alarm fatigue in Ghana. OBJECTIVES: The objective of this study was to investigate the level of alarm fatigue and its associated factors, as well as determine its relationship with burnout among nurses working in the critical care units of hospitals in Ghana. METHODS: The cross-sectional study was conducted in critical care units of five hospitals in Ghana from November 2021 to January 2022. A total of 364 nurses were recruited and completed the questionnaire. Alarm fatigue was assessed by the alarm fatigue questionnaire, which was originally developed in Chinese and was translated into English using a standard protocol. Burnout was assessed using the Maslach Burnout Inventory. RESULTS: The overall alarm fatigue score was 76.43 ± 27.80 out of 124. Longer years working at the critical care unit (B = -2.50, 95% confidence interval [CI]: -4.62, -0.37) and having policies related to alarm management (B = -10.77, 95% CI: -3.50, -18.04) were associated with a decreased risk of alarm fatigue, while working in neonatal intensive care unit (B = 16.35, 95% CI: 2.48, 30.21) and postanesthesia care unit (B = 15.16; 95% CI: 0.32, 30.01), and having anxiety and stress (B = 8.15, 95% CI: 1.30, 15.00) were associated with an increased risk of alarm fatigue. In addition, alarm fatigue was positively associated with emotional exhaustion (r = 0.52, P < 0.001) and depersonalisation (r = 0.43, P < 0.001) but not personal accomplishment (r = -0.09, P = 0.100). CONCLUSION: Critical care nurses in Ghana experienced higher levels of alarm fatigue, which is affected by multiple factors. There is a significant link between nurses' alarm fatigue and burnout. Our findings provide important guidance for future intervention programs to improve critical care nurses' alarm fatigue by introducing policies on alarm management and improving nurses' psychological health, with a special focus on nurses with shorter working years and working in neonatal intensive care unit and postanesthesia care unit.

Smart care for dealing with nurses' alarm fatigue in the intensive care unit.

BACKGROUND: Alarm fatigue is a condition in which a person experiences sensory overload or desensitization in exposure to frequent non-actionable alarms. Nurses are the main users of alarms in health care and their behaviors for alarm management influence the occurrence of alarm fatigue. OBJECTIVES: This qualitative research aimed to explore strategies used by nurses in dealing with nurses' alarm fatigue in the intensive care unit (ICU). DESIGN: Qualitative research was carried out. Eighteen nurses working in ICUs were selected purposefully and were invited to take part in individual semi-structured interviews. Collected data were analyzed using content analysis for developing categories and subcategories. SETTING: Twelve ICUs in ten hospitals in four urban areas of Iran. RESULTS: The research's main category was "smart care" consisting of two categories of "technologic actions" and "non-technologic actions." Also, six subcategories were developed: "identifying the cause and taking timely actions", "personalized alarm settings", "reducing the number of unnecessary alarms", "effective teamwork", "improving the physical environment and ward arrangement", and "self-calmness". CONCLUSION: Smart care by nurses included a set of active and proactive interventions developed through thinking and reflection and the use of information, skills, and experiences in order to manage exposure to alarm fatigue. Strategies used by nurses to prevent alarm fatigue can reduce the physical and psychological burden caused by frequent exposure to alarms in the ICU and consequently can have direct impacts on the quality and safety of nursing care. CLINICAL RELEVANCE: Nurses in the healthcare process often experience alarm fatigue that is influenced by the cultural-contextual aspect of care and the care environment. Smart care in terms of technologic and non-technologic actions helps with the prevention of alarm fatigue.

Critical care nurses' role in the decision-making process of withdrawal of life-sustaining treatment: A qualitative systematic review.

AIM: To synthesise the qualitative evidence regarding the role of critical care nurses in the decision-making process of withdrawing life-sustaining treatment in critically ill adults. DESIGN: Qualitative systematic review. REVIEW METHODS: This qualitative systematic review employed the guidelines of Bettany-Saltikov and McSherry. The review was reported according to the ENTREQ checklist. Pairs of authors independently assessed eligibility, appraised methodological quality and extracted data. Data were synthesised using thematic synthesis. DATA SOURCES: CINAHL, MEDLINE and EMBASE were searched for studies published between January 2001 and November 2021. RESULTS: Twenty-three studies were included. Three analytical themes were synthesised: performing ethical decision-making to safeguard patients' needs rights, and wishes; tailoring a supporting role to guide the family's decision-making process; and taking on the role of the middleman by performing coordination. CONCLUSION: The role of the critical care nurses in the decision-making process in withdrawal of life-sustaining treatment requires experience and the development of the clinical perspective of critical care nurses. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Enhanced knowledge of the decision-making process of withdrawing life-sustaining treatment can prepare critical care nurses to be more equipped to master this role and enhance their ability to handle the emotional and moral stress associated with this part of the critical care unit. IMPACT: The literature reveals the complex and challenging role of critical care nurses during the decision-making process of withdrawing life-sustaining treatment. Critical care nurses perform ethical decision-making to safeguard patients' concerns, guide the family's decision-making process and take on the role of the middleman. The findings have implications for critical nurses working in critical care units in hospitals and for educators and students in training in critical care nursing. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was included.

Predicting Receipt and Types of Occupational Therapy Services for Patients with Arousal Deficits in the Neuro Critical Care Unit.

Occupational therapy has been identified as a required service in the neuro critical care unit (NCCU), however who receives occupational therapy services and what services they receive are not well understood. We sought to determine if arousal deficits impacted patients' likelihood to receive an occupational therapy evaluation or specific types of occupational therapy interventions in the NCCU. When compared to patients without arousal deficits, patients who were experiencing agitation or light sedation, but not deep sedation, were more likely to receive occupational therapy interventions in the therapeutic activities category. Arousal deficits were not associated with receipt of occupational therapy services or occupational therapy interventions in the self-care or therapeutic exercise categories. Determining predictors of occupational therapy services will help ensure the timely delivery of services by improving the allocation of resources and identifying potential gaps in care.

A Nationwide Survey on the Practice of End-of-life Care Issues in Critical Care Units in India.

Background: End-of-life (EOL) care is the care of terminally ill patients who are nearing their end. It includes important components like palliative care, supportive care, hospice care, patient's right to choose, and choice of medical intervention, including continuation of routine medical interventions. The aim of this survey was to assess the practices of EOL care in various critical care units in India. Methods: The participants included clinicians involved in EOL care of patients with advanced diseases in different hospital across India. We sent blast emails and posted links on social media for inviting participants to take the survey. Study data were collected and managed by using Google Forms. The collected information was automatically entered into a spread sheet and stored in a secure database. Results: In total, 91 clinicians took the survey. The years of experience, practice area, and setting had significant effect on the palliative care, terminal strategy, and prognostication in terminally ill patients (p < 0.05). Statistical analysis was done using software STATA. Descriptive statistics were performed, and results were presented as number (percentage). Conclusion: The years of work experience, the practice area, and the practice setting have a strong impact on EOL care management of terminally ill patients. There are a lot of gaps in providing EOL care for these patients. Many reforms are needed in the Indian health care system to make EOL care better. How to cite this article: Kapoor I, Prabhakar H, Mahajan C, Zirpe KG, Tripathy S, Wanchoo J, et al. A Nationwide Survey on the Practice of End-of-life Care Issues in Critical Care Units in India. Indian J Crit Care Med 2023;27(5):305-314.

"Nurse-The Archer" Fighting Against the Hidden Enemy.

Background and aim: The coronavirus disease-2019 (COVID-19) pandemic is a global threat spreading like a wildfire and taking the world by its storm. It has challenged the healthcare delivery systems and disrupted them in a way no one ever imagined before. We at Apollo Hospitals, Chennai, Tamil Nadu, India received many patients in the COVID critical care unit (CCU) and found a gradual lack of bundle care compliance resulting in an upsurge of central line-associated bloodstream infection (CLABSI) amid the patients. Materials and methods: A qualitative research approach and quasi-experimental research design were selected to assess the knowledge of the 150 frontline COVID CCU nurses regarding the CLABSI bundle and its prevention strategies. Results: This study revealed that 57% [mean (M) = 12.6; standard deviation (SD) = 2.37] of nurses had inadequate knowledge of the CLABSI bundle and its prevention strategies, in the pretest and scored 80% (M = 6.7; SD = 2.28) in the post-test, with "t" = 22.06 at p < 0.00001 after the hands-on training. The percentage of compliance to CLABSI bundle care increased to 83% and thereafter in an increasing trend. This was clearly evident through the reduction in the preventable CLABSI rate among critically ill COVID-19 patients. Conclusion: Nurses are on the frontline in preventing and controlling healthcare-associated infections (HAIs). Fighting with all the visible and invisible challenges, our research focused on hands-on training for frontline warriors to adhere to the CLABSI bundle care which drove us to the reduction in preventable CLABSI rate in our hospital through improved CLABSI bundle compliance. How to cite this article: Premkumar S, Ramanathan Y, Varghese JJ, Morris B, Nambi PS, Ramakrishnan N, et al. "Nurse-The Archer" Fighting Against the Hidden Enemy. Indian J Crit Care Med 2023;27(4):246-253.

Association between in-ICU red blood cells transfusion and 1-year mortality in ICU survivors.

BACKGROUND: Impact of in-ICU transfusion on long-term outcomes remains unknown. The purpose of this study was to assess in critical-care survivors the association between in-ICU red blood cells transfusion and 1-year mortality. METHODS: FROG-ICU, a multicenter European study enrolling all-comers critical care patients was analyzed (n = 1551). Association between red blood cells transfusion administered in intensive care unit and 1-year mortality in critical care survivors was analyzed using an augmented inverse probability of treatment weighting-augmented inverse probability of censoring weighting method to control confounders. RESULTS: Among the 1551 ICU-survivors, 42% received at least one unit of red blood cells while in intensive care unit. Patients in the transfusion group had greater severity scores than those in the no-transfusion group. According to unweighted analysis, 1-year post-critical care mortality was greater in the transfusion group compared to the no-transfusion group (hazard ratio (HR) 1.78, 95% CI 1.45-2.16). Weighted analyses including 40 confounders, showed that transfusion remained associated with a higher risk of long-term mortality (HR 1.21, 95% CI 1.06-1.46). CONCLUSIONS: Our results suggest a high incidence of in-ICU RBC transfusion and that in-ICU transfusion is associated with a higher 1-year mortality among in-ICU survivors. Trial registration ( NCT01367093 ; Registered 6 June 2011).

Using Music for the Prevention of Delirium in Patients After Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial.

OBJECTIVE: The aim was to evaluate the effect of music on preventing delirium after coronary artery bypass grafting, to analyze vital signs and blood gas parameters, and to determine risk factors affecting delirium. DESIGN: A randomized clinical trial. SETTING: A single-center, tertiary hospital. PARTICIPANTS: In total, 200 patients who underwent coronary artery bypass grafting surgery from April 2020 to April 2021. INTERVENTIONS: A one-hour session of new-age music was administered twice a day postoperatively for 7 days using a headphone. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit before and after each session. Vital signs and blood gas parameters were compared to evaluate the effect of music. All assessments were conducted blindly by a different researcher. MEASUREMENTS AND MAIN RESULTS: Twelve participants who were delirium-positive were in the control group, and there were 3 in the case group, which suggested a statistically significant effect of music in preventing delirium (p = 0.016). The mean age of patients was 64.7 ± 7.9 years old in the control group and 62.2 ± 7.5 years old in the case group. There was a significant difference among the control and case groups in terms of the surgery time; surgery time in the control group was significantly lower than in the case group (242.4 ± 42.3 v 261.6 ± 48.9, respectively; p = 0.03 < 0.05). Blood pressure and heart rate in the case group were lower, similar to the respiratory rate and venous blood gas parameters; Blood pressure differences were not statistically significant (p > 0.05); CONCLUSION: Relaxation music, including bird, water, and wind, significantly prevents delirium after coronary artery bypass grafting.

Psychological distress among the family members of Intensive Care Unit (ICU) patients: A scoping review.

AIMS AND OBJECTIVES: To map research-based psychological distress among the family members with patients in the intensive care unit (ICU). BACKGROUND: Having a loved one in the ICU is a stressful experience, which may cause psychological distress for family members. Depression, anxiety and stress are the common forms of psychological distress associated with ICU patient's family members. Directly or indirectly, psychological distress may have behavioural or physiological impacts on the family members and ICU patient's recovery. DESIGN: The study was based on the five-stage methodological framework by Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19) and were guided by the PRISMA-ScR Checklist. METHODS: A comprehensive and systematic search was performed in five electronic databases, namely the Scopus, Web of Sciences, CINAHL® Complete @EBSCOhost, ScienceDirect and MEDLINE. Reference lists from the screened full-text articles were reviewed. RESULTS: From a total of 1252 literature screened, 22 studies published between 2010-2019 were included in the review. From those articles, four key themes were identified: (a) Prevalence of psychological distress; (b) Factors affecting family members; (c) Symptoms of psychological distress; and (d) Impact of psychological distress. CONCLUSIONS: Family members with a critically ill patient in ICU show high levels of anxiety, depression and stress. They had moderate to major symptoms of psychological distress that negatively impacted both the patient and family members. RELEVANCE TO CLINICAL PRACTICE: The review contributed further insights on psychological distress among ICU patient's family members and proposed psychological interventions that could positively impact the family well-being and improve the patients' recovery.

Ethical conflict among critical care nurses during the COVID-19 pandemic.

BACKGROUND: Ethical conflict is a problem with negative consequences, which can compromise the quality and ethical standards of the nursing profession and it is a source of stress for health care practitioners', especially for nurses. OBJECTIVES: The main aim of this study was to analyze Spanish critical care nurses' level of exposure to ethical conflict and its association with sociodemographic, occupational, and COVID-19-related variables. Research Design, Participants, and Research context: This was a quantitative cross-sectional descriptive study conducted among 117 nurses working in critical care units. Data collection tools were sociodemographic, occupational, and COVID-19-related questionnaires and previously validated Spanish version of Ethical Conflict in Nursing Questionnaire-Critical Care Version. ETHICAL CONSIDERATIONS: We obtained permission from the Ethics Committee and participants' informed consent. FINDINGS: Data indicates a moderate level of exposure to ethical conflicts. The most frequent ethical conflicts were related to situations about "treatment and clinical procedures." The most intensity of ethical conflicts was related to situations about "treatment and clinical procedures" and "dynamics of the service and working environment." No statistical significance was identified between the socio-demographic variables and level of exposure to ethical conflicts. However, for critical care nurses working in ICU, nurses with perceived worked stress had a higher level of exposure to ethical conflicts. Likewise, critical care nurses whose family/friends were infected with COVID-19 had a higher level of exposure. CONCLUSIONS: Critical care nurses experience a moderate level of exposure to ethical conflicts which is consistent with the results of previous studies. A deeper understanding of ethical conflicts in conflictive situations allows recognition of the situations that occur in everyday clinical practice, identification of the ethical conflicts, and facilitation of the nurses working in the challenging clinical situation.

Experiences and mediating factors in nurses' responses to electronic device alarms: A phenomenological study.

AIM: This study aims to explore the experiences and mediating factors of nurses' responses to electronic device alarms in critical care units (CCUs). BACKGROUND: Alarm fatigue occasionally has adverse consequences for patient safety. METHODS: This qualitative study was designed and analysed following Giorgi's descriptive phenomenological approach. Seventeen nurses were theoretically sampled, reaching information saturation. Semistructured interviews were used to collect the data. RESULTS: Three central themes explained nurses' experiences: general perceptions about alarms (basic equipment of the CCU), strategies to reduce false alarms (training in the configuration of monitors, customization of the alarms to fit he patient's condition. teamwork and taking advantage of the development of technology) and key elements of the response to alarms (information about patient's condition, nurses' clinical experience, type of CCU, 'cry-wolf' phenomenon and nurse/patient ratio). CONCLUSIONS: To reduce false alarms, nurses need further postgraduate training, training on monitors and customizing alarms to fit the patient's health status. The complex process of deciding to respond to an alarm includes environmental, professional variables and patient status. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should ensure that nurses have sufficient experience and training in the CCU, improve the nurse/patient ratio, promote teamwork and ensure that the devices are the latest generation.

Occurrence and characteristics of pain after ICU discharge: A longitudinal study.

BACKGROUND: Pain is a serious problem for intensive care unit (ICU) patients, but we are lacking data on pain at the hospital ward after ICU discharge. AIMS AND OBJECTIVES: To describe pain intensity, -interference with function and -location in patients up to 1 year after ICU discharge. To identify demographic and clinical variables and their association with worst pain intensity and pain interference. DESIGN: A longitudinal descriptive secondary analysis of a randomized controlled trial on nurse-led follow-up consultations on post-traumatic stress and sense of coherence after ICU discharge. METHODS: Pain intensity, -interference, and -location were measured using Brief Pain Inventory at the hospital ward and 3, 6, and 12 months after ICU discharge. For associations, data were analysed using multivariate linear mixed models for repeated measures. RESULTS: Of 523 included patients, 68% reported worst pain intensity score above 0 (no pain) at the ward. Estimated means for worst pain intensity and -interference (from 0 to 10) after ICU discharge were 5.5 [CI 4.6-6.5] and 4.5 [CI 3.7-5.3], and decreased to 3.8 [CI 2.8-4.8] (P ≤ .001) and 2.9 [CI 2.1-3.7] after 12 months (P ≤ .001). Most common pain locations were abdomen (43%), lower lumbar back (28%), and shoulder/forearm (22%). At 12 months, post-traumatic stress (PTS) symptoms ≥25 (scale 10-70), female gender, shorter ICU stay, and more traumatic ICU memories were significantly associated with higher worst pain intensity. PTS symptoms ≥25, female gender, more traumatic ICU memories, younger age, and not having an internal medical diagnosis were significantly associated with higher pain interference. CONCLUSIONS: Early after ICU discharge pain was present in 68% of patients. Thereafter, pain intensity and -interference declined, but pain intensity was still at a moderate level at 12 months. Health professionals should be aware of patients' pain and identify potentially vulnerable patients. IMPLICATION FOR PRACTICE: Longitudinal assessment of factors associated with pain early after ICU discharge and the following year is a first step that could improve follow-up focus and contribute to reduced development of chronic pain.

Comparison of Effect of Non-invasive Ventilation Delivered by Helmet vs Face Mask in Patients with COVID-19 Infection: A Randomized Control Study.

Background and aims: We compared the effectiveness of non-invasive ventilation (NIV) provided by helmet mask vs face mask in patients with COVID-19. Methods and materials: Between March and May 2021, a single-center, prospective, open-label randomized controlled research was undertaken. Sixty patients were randomly assigned to one of two groups based on the NIV delivery interface. In group I (n = 30) helmet mask was used and in group II (n = 30) face mask was used for delivery of NIV. The proportion of patients in each group who required endotracheal intubation was the primary outcome. The duration of NIV, length of stay in the intensive care unit (ICU), hospital mortality, ratio of partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2), respiratory rate, patient comfort, and complications were all documented as secondary outcomes. Results: In both groups, demographics, clinical characteristics, and treatment received were comparable. Around 10% of patients in the helmet mask group were intubated, while 43.3% of patients in the face mask group were intubated (p = 0.004). The two groups demonstrated similar hemodynamic patterns. The use of a helmet mask, on the other hand, resulted in enhanced oxygenation (263.57 ± 31.562 vs 209.33 ± 20.531, p = 0.00), higher patient satisfaction (p = 0.001), a lower risk of complications, and a shorter NIV and ICU stay (p = 0.001) (4.53 ± 0.776 vs 7.60 ± 1.354, p = 0.00 and 6.37 ± 0.556 vs 11.57 ± 2.161, p = 0.00). Conclusion: Helmet mask could be a reliable interface for delivery of NIV in COVID-19 and results in a lower rate of endotracheal intubation, better oxygenation with greater patient comfort and shorter ICU stay as compared to face mask used for NIV. How to cite this article: Saxena A, Nazir N, Pandey R, Gupta S. Comparison of Effect of Non-invasive Ventilation Delivered by Helmet vs Face Mask in Patients with COVID-19 Infection: A Randomized Control Study. Indian J Crit Care Med 2022;26(3):282-287.

Asthma-related emergency department (ED) visits and post-ED visit hospital and critical care admissions, National Hospital Ambulatory Medical Care Survey, 2010-2015.

Background: Exacerbation of asthma symptoms increases the likelihood of emergency department (ED) visits and hospitalizations. Because the ED is an important healthcare resource for immediate asthma care with acute exacerbations, we identify those populations most likely to seek ED treatment for asthma and describe the asthma burden for post-ED visit hospitalizations and critical care units.Methods: We examined the characteristics of asthma-related ED visits and hospital admissions and assessed the association between them using multivariable logistic regression models by analyzing data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) during 2010-2015.Results: Of all ED visits, 1.32% were asthma-related; of all ED visits that resulted in hospitalization, 1.12% were asthma-related and, of all ED visits that resulted in admission to a critical care unit, 1.20% were asthma related. The percentages of asthma-related ED visits and post-ED hospitalizations (H) were greater among children (adjusted prevalence ratio: ED: 2.28 [1.96.29-2.65]; H: 8.75 [5.93-12.92]) than among adults and greater for blacks (ED: (2.26 [1.97-2.60]; H: 3.25 [2.07-5.12]) and Hispanics (ED: (1.74 [1.47-2.08]; H: 2.424 [1.46-4.00]) than for whites. The percentage of ED visits was also greater for those covered by Medicaid or the Children's Health Insurance Program (CHIP) than by private insurance.Conclusions: Both asthma-related ED visits and post-ED hospitalizations were greater for children, blacks, and Hispanics. ED visits were also greater for Medicaid/CHIP. These findings might help prompt future studies on identifying additional potential risk factors for frequent ED visits among disproportionally affected subpopulations.

Does heavy mental workload affect moral sensitivity among critical care unit nursing professionals? a cross-sectional study.

BACKGROUND: Moral sensitivity creates the basic attitude in providing effective ethical care to patients. Heavy mental workload is a major concern of critical care nursing professionals, which could adversely affect nursing staff and patients. The present study aimed to investigate the effects of mental workload and some demographic variables on the moral sensitivity of critical care nursing professionals. METHODS: This cross-sectional, descriptive-correlational study was performed on 181 nursing professionals working in the critical care units of Shahid Rajaei Cardiovascular Medical and Research Center in Tehran, Iran. Data were collected using a demographic questionnaire, the moral sensitivity questionnaire, and the NASA-task load index to assess mental workload. Data analysis was performed in SPSS version 22 using descriptive statistics, independent t-test, Pearson's correlation-coefficient, and regression analysis. RESULTS: The results of regression analysis yielded no statistical significant relationship between heavy mental workload and moral sensitivity of the critical care nursing professionals, while clinical experience had a positive, significant association with moral sensitivity. CONCLUSIONS: Although care nursing professionals experience a heavy mental workload in critical care units, it does not decrease their moral sensitivity. In addition, experienced nurses have higher moral sensitivity and lower mental workload. Therefore, it seems that nursing managers should pay special attention to the importance of employing experienced nurses along with younger nurses.