Development and Evaluation of The Implementation of a Preceptorship Program for The Novice ICU Nurse Intensive Care Unit -A Secondary Publication

This study focused on the development and evaluation of the implementation of a preceptorship program adapted to ICU practice in the Ab.-T.region to provide preceptors with tools to support novice nurses.This action research was made possible with the involvement of the centers,preceptors,and novice nurses throughout the development and implementation of the program.This approach enabled participants to take ownership of the training content and fully utilize various tools.The program was implemented throughout the CISSS,where this study was subsequently carried out.Several novices mentioned that the program reinforced their sense of security and made them feel more equipped to handle complex care situations.The preceptors said they were better equipped to offer clinical support and novices were better prepared to work in the ICU.It is important to evaluate the development of the novice nurses’skills following their participation in this program and the long-term impact of this preceptorship.

Application of psychological intervention in intensive care unit nursing for patients with severe acute pancreatitis

BACKGROUND Severe acute pancreatitis(SAP)is a familiar critical disease in the intensive care unit(ICU)patients.Nursing staff are important spiritual pillars during the treatment of patients,and in addition to routine nursing,more attention needs be paid to the patient’s psychological changes.AIM To investigate the effects of psychological intervention in ICU patients with SAP.METHODS One hundred ICU patients with SAP were hospitalized in the authors’hospital between 2020 and 2023 were selected,and divided into observation and control groups per the hospitalization order.The control and observation groups received routine nursing and psychological interventions,respectively.Two groups are being compared,using the Self-rating Anxiety Scale(SAS),Self-Determination Scale(SDS),Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱ,and 36-item Short Form Health Survey(SF-36)scores;nursing satisfaction of patients;ICU care duration;length of stay;hospitalization expenses;and the incidence of complications.RESULTS After nursing,the SDS,SAS,and APACHEⅡ scores in the experimental group were significantly lower than in the control group(P<0.05).The SF-36 scores in the observation group were significantly higher than those in the control group(P<0.05).The nursing satisfaction of patients in the experimental group was 94.5%,considerably higher than that of 75.6% in the control group(P<0.05).The ICU care duration,length of stay,and hospitalization expenses in the observation group were significantly lower than those in the control group,and the incidence of complications was lower(P<0.05).CONCLUSION For patients with SAP,the implementation of standardized psychological intervention measures can effectively alleviate adverse psychological conditions.

Increasing role of post-intensive care syndrome in quality of life of intensive care unit survivors

In this editorial we comment on the detrimental consequences that post-intensive care syndrome(PICS)has in the quality of life of intensive care unit(ICU)survivors,highlighting the importance of early onset of multidisciplinary rehabilitation from within the ICU.Although,the syndrome was identified and well described early in 2012,more awareness has been raised on the long-term PICS related health problems by the increased number of coronavirus disease 2019 ICU survivors.It is well outlined that the syndrome affects both the patient and the family and is described as the appearance or worsening of impairment in physical,cognitive,or mental health as consequence of critical illness.PICS was described in order:(1)To raise awareness among clinicians,researchers,even the society;(2)to highlight the need for a multilevel screening of these patients that starts from within the ICU and continues after discharge;(3)to present preventive strategies;and(4)to offer guidelines in terms of rehabilitation.An early multidisci-plinary approach is the key element form minimizing the incidence of PICS and its consequences in health related quality of life of both survivors and their families.

Analysis of the Efficacy of Xuebijing Combined with Antimicrobials in the Treatment of Intensive Care Unit Patients with Severe Pneumonia

Objective:To analyze the therapeutic effect of Xuebijing+antimicrobials in intensive care unit(ICU)patients with severe pneumonia.Methods:60 ICU patients with severe pneumonia from June 2021 to June 2023 were selected and divided by the random number table method,with 30 cases in each group.The observation group received Xuebijing+antimicrobial treatment,while the control group received only antimicrobial treatment.The differences in rehabilitation indexes,test indexes,and inflammation indexes were compared between the two groups.Results:Mechanical ventilation time,fever reduction time,cough relief time,and hospitalization time of the observation group were significantly shorter than those of the control group(P<0.05);C-reactive protein,procalcitonin,and white blood cell count of the observation group were significantly lower than those of the control group(P<0.05);interleukin-6 and tumor necrosis factor-aαof the observation group were significantly lower than those of the control group(P<0.05).Conclusion:The treatment of severe pneumonia patients in ICU with Xuebijing+antibacterial drugs can reduce inflammation,enhance immune function,shorten the pneumonia recovery time,and reduce the adverse reactions of severe pneumonia.

Study of the intensive care unit activity scale in the early rehabilitation of patients after direct cardiac surgery

BACKGROUND Direct cardiac surgery often necessitates intensive post-operative care,and the intensive care unit(ICU)activity scale represents a crucial metric in assessing and guiding early rehabilitation efforts to enhance patient recovery.AIM To clarify the clinical application value of the ICU activity scale in the early recovery of patients after cardiac surgery.METHODS One hundred and twenty patients who underwent cardiac surgery between September 2020 and October 2021 were selected and divided into two groups using the random number table method.The observation group was rated using the ICU activity scale and the corresponding graded rehabilitation interventions were conducted based on the ICU activity scale.The control group was assessed in accordance with the routine rehabilitation activities,and the postoperative rehabilitation indexes of the patients in both groups were compared(time of tracheal intubation,time of ICU admission,occurrence of complications,and activity scores before ICU transfer).The two groups were compared according to postoperative rehabilitation indicators(time of tracheal intubation,length of ICU stay,and occurrence of complications)and activity scores before ICU transfer.RESULTS In the observation group,tracheal intubation time lasted for 18.30±3.28 h and ICU admission time was 4.04±0.83 d,which were significantly shorter than the control group(t-values:2.97 and 2.038,respectively,P<0.05).The observation group also had a significantly lower number of complications and adverse events compared to the control group(P<0.05).Before ICU transfer,the observation group(6.7%)had few complications and adverse events than the control group(30.0%),and this difference was statistically significant(P<0.05).Additionally,the activity score was significantly higher in the observation(26.89±0.97)compared to the control groups(22.63±1.12 points)(t-value;-17.83,P<0.05).CONCLUSION Implementation of early goal-directed activities in patients who underwent cardiac surgery using the ICU activity scale can promote the recovery of cardiac function.

Development and validation of a nomogram for predicting in-hospital mortality of intensive care unit patients with liver cirrhosis

BACKGROUND Liver cirrhosis patients admitted to intensive care unit(ICU)have a high mortality rate.AIM To establish and validate a nomogram for predicting in-hospital mortality of ICU patients with liver cirrhosis.METHODS We extracted demographic,etiological,vital sign,laboratory test,comorbidity,complication,treatment,and severity score data of liver cirrhosis patients from the Medical Information Mart for Intensive Care IV(MIMIC-IV)and electronic ICU(eICU)collaborative research database(eICU-CRD).Predictor selection and model building were based on the MIMIC-IV dataset.The variables selected through least absolute shrinkage and selection operator analysis were further screened through multivariate regression analysis to obtain final predictors.The final predictors were included in the multivariate logistic regression model,which was used to construct a nomogram.Finally,we conducted external validation using the eICU-CRD.The area under the receiver operating characteristic curve(AUC),decision curve,and calibration curve were used to assess the efficacy of the models.RESULTS Risk factors,including the mean respiratory rate,mean systolic blood pressure,mean heart rate,white blood cells,international normalized ratio,total bilirubin,age,invasive ventilation,vasopressor use,maximum stage of acute kidney injury,and sequential organ failure assessment score,were included in the multivariate logistic regression.The model achieved AUCs of 0.864 and 0.808 in the MIMIC-IV and eICU-CRD databases,respectively.The calibration curve also confirmed the predictive ability of the model,while the decision curve confirmed its clinical value.CONCLUSION The nomogram has high accuracy in predicting in-hospital mortality.Improving the included predictors may help improve the prognosis of patients.

Effect of programmed comprehensive nursing on delirium incidence in intensive care unit children following severe cardiac surgery

BACKGROUND Programmed comprehensive nursing was adopted for intensive care unit(ICU)children following severe cardiac surgery to improve respiratory function and delirium incidence.AIM To explore how programmed comprehensive nursing impacts respiratory func-tion and delirium incidence in ICU children post cardiac surgery.METHODS Between January 2022 and January 2024,180 pediatric patients from the Chil-dren’s Hospital of Nanjing were admitted to the ICU after cardiac surgery and randomly grouped.The control group comprised 90 patients and received routine nursing care.The observation group comprised 90 patients and received program-med comprehensive nursing.Both groups received continuous nursing care until discharge.Their respiratory function,incidence of delirium,and clinical outcomes were compared.The memory state and sleep quality of both groups were com-pared.RESULTS The incidence of delirium was 5.56%in the observation group when admitted to ICU,which was lower than that in the control group(20.00%;P<0.05).The observation group demonstrated higher peak expiratory flow rate,respiratory frequency,deep breathing volume,and tidal volume in the ICU compared with the control group.Additionally,the observation group showed higher sleep depth,sleep latency,night awakening,return to sleep,and sleep quality com-pared with the control group(P<0.05).CONCLUSION Programmed comprehensive nursing in ICU patients following severe cardiac surgery can reduce the impact on respiratory function,improve sleep quality,and alleviate postoperative delirium,showing significant promise for clinical application.

Effects of nursing team communication and collaboration on treatment outcomes in intensive care unit patients with severe pneumonia

BACKGROUND Severe pneumonia is a common severe respiratory infection worldwide,and its treatment is challenging,especially for patients in the intensive care unit(ICU).AIM To explore the effect of communication and collaboration between nursing teams on the treatment outcomes of patients with severe pneumonia in ICU.METHODS We retrospectively analyzed 60 patients with severe pneumonia who were treated at the ICU of the hospital between January 1,2021 and December 31,2023.We compared and analyzed the respiratory mechanical indexes[airway resistance(Raw),mean airway pressure(mPaw),peak pressure(PIP)],blood gas analysis indexes(arterial oxygen saturation,arterial oxygen partial pressure,and oxygenation index),and serum inflammatory factor levels[C-reactive protein(CRP),procalcitonin(PCT),cortisol(COR),and high mobility group protein B1(HMGB1)]of all patients before and after treatment.RESULTS Before treatment,there was no significant difference in respiratory mechanics index and blood gas analysis index between 2 groups(P>0.05).However,after treatment,the respiratory mechanical indexes of patients in both groups were significantly improved,and the improvement of Raw,mPaw,plateau pressure,PIP and other indexes in the combined group after communication and collaboration with the nursing team was significantly better than that in the single care group(P<0.05).The serum CRP and PCT levels of patients were significantly decreased,and the difference was statistically significant compared with that of nursing group alone(P<0.05).The levels of serum COR and HMGB1 before and after treatment were also significantly decreased between the two groups.CONCLUSION The communication and collaboration of the nursing team have a significant positive impact on respiratory mechanics indicators,blood gas analysis indicators and serum inflammatory factor levels in the treatment of severe pneumonia patients in ICU.

Perspectives on non-emergent neonatal intensive care unit to pediatric intensive care unit care transfers in the United States

BACKGROUND There is a substantial population of long-stay patients who non-emergently transfer directly from the neonatal intensive care unit(NICU)to the pediatric intensive care unit(PICU)without an interim discharge home.These infants are often medically complex and have higher mortality relative to NICU or PICUonly admissions.Given an absence of data surrounding practice patterns for nonemergent NICU to PICU transfers,we hypothesized that we would encounter a broad spectrum of current practices and a high proportion of dissatisfaction with current processes.AIM To characterize non-emergent NICU to PICU transfer practices across the United States and query PICU providers’evaluations of their effectiveness.METHODS A cross-sectional survey was drafted,piloted,and sent to one physician representative from each of 115 PICUs across the United States based on membership in the PARK-PICU research consortium and membership in the Children’s Hospital Association.The survey was administered via internet(REDCap).Analysis was performed using STATA,primarily consisting of descriptive statistics,though logistic regressions were run examining the relationship between specific transfer steps,hospital characteristics,and effectiveness of transfer.RESULTS One PICU attending from each of 81 institutions in the United States completed the survey(overall 70%response rate).Over half(52%)indicated their hospital transfers patients without using set clinical criteria,and only 33%indicated that their hospital has a standardized protocol to facilitate non-emergent transfer.Fewer than half of respondents reported that their institution’s nonemergent NICU to PICU transfer practices were effective for clinicians(47%)or patient families(38%).Respondents evaluated their centers’transfers as less effective when they lacked any transfer criteria(P=0.027)or set transfer protocols(P=0.007).Respondents overwhelmingly agreed that having set clinical criteria and standardized protocols for non-emergent transfer were important to the patient-family experience and patient safety.CONCLUSION Most hospitals lacked any clinical criteria or protocols for non-emergent NICU to PICU transfers.More positive perceptions of transfer effectiveness were found among those with set criteria and/or transfer protocols.

Efficacy and safety of remimazolam-based sedation for intensive care unit patients undergoing upper gastrointestinal endoscopy:a cohort study

BACKGROUND:Remimazolam is a novel ultra-short-acting sedative,but its safety and adverse events(AEs)in high-risk patients in the intensive care unit(ICU)setting remain unknown.METHODS:This was a single-center,retrospective study that compared remimazolam to propofol and midazolam in patients undergoing upper gastrointestinal endoscopy.The primary outcome was the incidence of treatment-related AEs.The secondary outcomes were the time to extubation,the length of ICU stay,and the average cost of sedative per case.RESULTS:Of the 88 patients analyzed,47 were treated with remimazolam(mean dose,7.90±4.84mg),and 41 were treated with propofol(21.19±17.98 mg)or midazolam(3.08±2.17 mg).There was no statistically significant difference in the average duration of the endoscopic procedure(35.89±13.37 min vs.44.51±21.68 min,P=0.133)or the time to extubation(15.00±9.75 h vs.20.59±18.71 h,P=0.211)in the remimazolam group(group I)compared to the propofol or midazolam group(group II).ICU stays(5.40±2.93 d vs.4.63±3.31 d,P=0.072)and treatment-related AEs(48.61%vs.51.38%,P=0.056)were similar between groups.The average cost of sedative per case was significantly lower in the group I than in the group II(RMB 16.07±10.58 yuan vs.RMB 24.37±15.46 yuan,P=0.016).CONCLUSION:Remimazolam-based sedation was noninferior to the classic sedatives and had lower average cost per case,indicating that it may be used as a promising sedative for high-risk patients during endoscopic procedures in the ICU setting.

Mortality of Children in the Intensive Care Unit of the Pediatric University Hospital of Bangui

Background: In sub-Saharan Africa, one in 13 children died before their fifth birthday. Objective: To study mortality among children hospitalized in the intensive care unit of the CHUPB. Methodology: This was a retrospective, descriptive study over a 12-month period. Included were children aged 1 month to 15 years hospitalized in the intensive care unit and who died during the period. The data were entered and analyzed through the Epi Info software. The statistical test used was Pearson’s chi2. Results: The overall mortality rate was 21.49%. The sex ratio was 1.14 and the mean age was 3.17 ± 2.21 years. Children 5 years of age accounted for 78.49% (n = 197) of cases. Deaths were more frequent in January, April and December. The mean time to consultation was 6.91 ± 1.8 days. Fever 78.48% (n = 197), diarrhea/vomiting 35.45% (n = 89) and convulsions 26.29% (n = 66) were the main reasons for consultation. Prior to admission, treatment was administered in 73.38% (n = 184) of children. The main diagnoses of death were: septic shock 29.08% (n = 73), hypovolemic shock post AEG 17.13% (n = 43), severe malaria 10.76% (n = 27) and meningitis 6.38% (n = 16). Death was early in 66.53% (n = 167) of cases. It was influenced by male sex, origin of residence, rural residence, herbal medicine and the occurrence of deaths during the shifts after 16 hours. Conclusion: Mortality in pediatrics remains a concern in our practice. It is related to conditions that are mostly preventable by vaccination, information, education and communication.

Clinical and biochemical predictors of intensive care unit admission among patients with diabetic ketoacidosis

BACKGROUND Diabetic ketoacidosis(DKA)contributes to 94%of diabetes-related hospital admissions,and its incidence is rising.Due to the complexity of its management and the need for rigorous monitoring,many DKA patients are managed in the intensive care unit(ICU).However,studies comparing DKA patients managed in ICU to non-ICU settings show an increase in healthcare costs without significantly affecting patient outcomes.It is,therefore,essential to identify suitable candidates for ICU care in DKA patients.AIM To evaluate factors that predict the requirement for ICU care in DKA patients.METHODS This retrospective study included consecutive patients with index DKA episodes who presented to the emergency department of four general hospitals of Hamad Medical Corporation,Doha,Qatar,between January 2015 and March 2021.All adult patients(>14 years)fulfilling the American Diabetes Association criteria for DKA diagnosis were included.RESULTS We included 922 patients with DKA in the final analysis,of which 229(25%)were managed in the ICU.Compared to non-ICU patients,patients admitted to ICU were older[mean(SD)age of 40.4±13.7 years vs 34.5±14.6 years;P<0.001],had a higher body mass index[median(IQR)of 24.6(21.5-28.4)kg/m2 vs 23.7(20.3-27.9)kg/m2;P<0.030],had T2DM(61.6%)and were predominantly males(69%vs 31%;P<0.020).ICU patients had a higher white blood cell count[median(IQR)of 15.1(10.2-21.2)×103/uL vs 11.2(7.9-15.7)×103/uL,P<0.001],urea[median(IQR)of 6.5(4.6-10.3)mmol/L vs 5.6(4.0-8.0)mmol/L;P<0.001],creatinine[median(IQR)of 99(75-144)mmol/L vs 82(63-144)mmol/L;P<0.001],C-reactive protein[median(IQR)of 27(9-83)mg/L vs 14(5-33)mg/L;P<0.001]and anion gap[median(IQR)of 24.0(19.2-29.0)mEq/L vs 22(17-27)mEq/L;P<0.001];while a lower venous pH[mean(SD)of 7.10±0.15 vs 7.20±0.13;P<0.001]and bicarbonate level[mean(SD)of 9.2±4.1 mmol/L vs 11.6±4.3 mmol/L;P<0.001]at admission than those not requiring ICU management of DKA(P<0.001).Patients in the ICU group had a longer LOS[median(IQR)of 4.2(2.7-7.1)d vs 2.0(1.0-3.9)d;P<0.001]and DKA duration[median(IQR)of 24(13-37)h vs 15(19-24)h,P<0.001]than those not requiring ICU admission.In the multivariate logistic regression analysis model,age,Asian ethnicity,concurrent coronavirus disease 2019(COVID-19)infection,DKA severity,DKA trigger,and NSTEMI were the main predicting factors for ICU admission.CONCLUSION In the largest tertiary center in Qatar,25%of all DKA patients required ICU admission.Older age,T2DM,newly onset DM,an infectious trigger of DKA,moderate-severe DKA,concurrent NSTEMI,and COVID-19 infection are some factors that predict ICU requirement in a DKA patient.

Mechanical ventilation and outcomes in COVID-19 patients admitted to intensive care unit in a low-resources setting: A retrospective study

Objective:To describe the strategies and outcomes of mechanical ventilation in a poorly equipped facility.Methods:This retrospective descriptive study included patients with COVID-19 who were admitted to the intensive care unit(ICU)and mechanically ventilated between September 1,2020,and May 31,2021.Data were collected from medical records and databases.Results:54 Patients aged(62.9±13.3)years were included.Among these cases,79.6%had at least one comorbidity.On admission,all patients had hypoxia.The median peripheral oxygen saturation in room air was 76%(61%,83%).Non-invasive ventilation(NIV)was performed in 75.9%of the patients,and invasive mechanical ventilation(IMV)in 68.5%.IMV was performed on patients due to severe coma(8.1%),failure of standard oxygen therapy(27.0%),and failure of NIV(64.9%).An arterial blood gas test was performed in 14.8%of the patients.NIV failed in 90.2%of cases and succeeded in 9.8%.IMV was successful in 5.4%of cases,vs.94.6%of mortality.The overall mortality rate of patients on ventilation in the ICU was 88.9%.The causes of death included severe respiratory distress syndrome(85.2%),multiple organ failure(14.8%),and pulmonary embolism(13.0%).Conclusions:The ventilation management of COVID-19 patients in the ICU with NIV and IMV in a scarce resource setting is associated with a high mortality rate.Shortcomings are identified in ventilation strategies,protocols,and monitoring.Required improvements were also proposed.

Care Measures and Health Outcomes in a Pediatric Intensive Care Unit in Brazil

Introduction: In low- and middle-income countries, including Brazil, conditions that favor mortality in the PICU remain significant. Compared to developed countries, there is a shortage of skilled human resources, lower availability of technological resources, greater difficulty of access and a higher incidence of infections, including both those acquired prior to admission and those resulting from treatment and hospitalization (i.e., healthcare-associated infections (HAIs)). HAIs in the PICU include ventilator-associated pneumonia and catheter-related bloodstream infections. Actions for the prevention of HAIs can minimize the occurrence of negative outcomes. Materials and Methods: This is an epidemiological study comparing admissions at the PICU of a high-complexity hospital in South Brazil over two three-year periods: 2012-2014 (before the measures were adopted) and 2015-2017 (after the measures). The care measures were adopted mainly at the beginning of 2015 and consisted of expansion of physical therapy care, adoption of care protocols, acquisition of new materials and equipment (transparent dressings for central catheters, high-tech mechanical ventilators and multiparametric monitors) and multidisciplinary team training. The frequency of the outcomes mortality, length of PICU stay, diagnosis of catheter-related bloodstream infection, need for and duration of ventilatory support and diagnosis of ventilator-associated pneumonia were compared between the two trienniums using logistic regression with adjustment for age in months and need of vasoactive drugs. Results: A total of 1140 admissions were analyzed (470 in the first triennium and 670 in the second), representing an increase in the admission rate of 42.6% after the adoption of the measures. After adjustments, significant reductions in the frequency of mortality (adjusted OR [adjOR] = 0.54;CI 95%: 0.34 - 0.84), length of PICU stay > 7 days (adjOR = 0.75;CI 95%: 0.57 - 0.97) and duration of ventilatory support > 7 days (adjOR = 0.54;CI 95%: 0.39 - 0.74) were observed. Conclusion: The results indicate the benefits of care measures for children admitted to the PICU in terms of a reduction in adverse events and expansion of access.

Microbiological and Antibiotic Susceptibility Patterns in Cardiothoracic and Vascular Intensive Care Unit of a Tertiary Level Hospital in Nepal

Background: Sepsis has been one of the most important conditions for morbidity and mortality of Intensive care unit (ICU) patients. Antibiotics remain one of the major combating factors for it. Indiscriminate antimicrobial usage and poor prescription practices have contributed to the development of multidrug resistant (MDR) organisms. Therefore, the current study was designed to evaluate the spectrum, and susceptibility patterns of pathogens isolated from patients admitted to our Cardiothoracic and Vascular Intensive care unit. Materials and Methods: The study was conducted in Cardiothoracic and Vascular ICU of a tertiary care teaching hospital from February 2019 to March 2021. Samples (blood, urine, wound swab, tracheal aspirate, and central venous catheter tip) for culture were taken from all the patients in Sepsis admitted in Cardiothoracic and Vascular ICU above 18 years of age during the study period. The culture reports (microbiological profile and their susceptibility pattern) were collected and data collection of all enrolled patients was done. Results: Out of the total 128 samples studied 75 (58.5%) were culture positive. The predominant organisms isolated were Gram negative organisms (Klebsiella, Pseudomonas, Acinetobacter, followed by E. coli). The highest prevalence of microbial growth was found in tracheal aspirate (46.8%), followed by blood (21.8%). Antibiotic susceptibility results showed the highest sensitivity of those common pathogens towards higher antibiotics only (especially Polymyxin B and Colistin). Conclusion: The emergence of multidrug resistant organisms and lesser availability of a higher group of antibiotics is a major concern. So there is a need for regular hospital based antibiograms, strict infection control programs, and implementation of antimicrobial stewardship programmes for guiding clinicians in choosing appropriate therapy and preventing the surge of multidrug resistant organisms.

Causative bacteria of ventilator-associated pneumonia in intensive care unit in Bahrain:Prevalence and antibiotics susceptibility pattern

BACKGROUND Ventilator-associated pneumonia(VAP)is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that.It is the most common infection encountered among intubated patients.VAP incidence showed wide variability between countries.AIM To define the VAP incidence in the intensive care unit(ICU)in the central gove-rnment hospital in Bahrain and review the risk factors and the predominant bacterial pathogens with their antimicrobial susceptibility pattern.METHODS The research was a prospective cross-sectional observational study over six months from November 2019 to June 2020.It included adult and adolescent patients(>14 years old)admitted to the ICU and required intubation and mechanical ventilation.VAP was diagnosed when it occurred after 48 h after endotracheal intubation using the clinical pulmonary infection score,which considers the clinical,laboratory,microbiological,and radiographic evidence.RESULTS The total number of adult patients admitted to the ICU who required intubation and mechanical ventilation during the study period was 155.Forty-six patients developed VAP during their ICU stay(29.7%).The calculated VAP rate was 22.14 events per 1000 ventilator days during the study period,with a mean age of 52 years±20.Most VAP cases had late-onset VAP with a mean number of ICU days before the development of VAP of 9.96±6.55.Gram-negative contributed to most VAP cases in our unit,with multidrug-resistant Acinetobacter being the most identified pathogen.CONCLUSION The reported VAP rate in our ICU was relatively high compared to the international benchmark,which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle.

Application of Flipped Classroom Combined with PBL Teaching Method in the Teaching of Respiratory Intensive Care Unit Nursing

Objective:The aim is to investigate the application effect of flipped classroom combined with problem-based learning(PBL)teaching method in the teaching of respiratory intensive care unit nursing.Methods:100 fresh nursing students who were interned in the respiratory intensive care unit of our hospital from June 2020 to May 2022 were selected and randomly divided into 50 students in the control group and 50 students in the experimental group.The students in the control group were taught by PBL teaching method,and the students in the experimental group were taught by flipped classroom combined with PBL teaching method.After the completion of the teaching,the teachers combined the performance of the two groups of students,and scored them comprehensively in terms of their professional theoretical knowledge,clinical operation skills,independent learning ability,and teamwork ability,and carried out a survey of the experimental group’s students in terms of their satisfaction with the understanding of theoretical knowledge,clinical operation,independent learning ability,teamwork ability,and other dimensions.Results:There was no statistical significance in the specialized theoretical knowledge scores of the two groups of students(P>0.05).The scores of clinical operation,independent learning ability,and teamwork ability of the two groups of students were statistically significant(P<0.05),and all the scores of the students in the experimental group were higher than that of the control group.More than 90%of the students believed that the flipped classroom combined with PBL teaching method could assist in the comprehension of theoretical knowledge,improve the clinical operation skills,enhance the ability of independent learning and teamwork;there were 92%of the students supported the use of flipped classroom combined with PBL teaching in respiratory intensive care unit nursing teaching.Conclusion:In the teaching of respiratory intensive care unit nursing,the use of flipped classroom combined with PBL teaching method can improve the learning effect of students,and has certain value in teaching.

Critical care practice in India:Results of the intensive care unit need assessment survey(ININ2018)

BACKGROUND A diverse country like India may have variable intensive care units(ICUs)practices at state and city levels.AIM To gain insight into clinical services and processes of care in ICUs in India,this would help plan for potential educational and quality improvement interventions.METHODS The Indian ICU needs assessment research group of diverse-skilled individuals was formed.A pan-India survey"Indian National ICU Needs"assessment(ININ 2018-I)was designed on google forms and deployed from July 23rd-August 25th,2018.The survey was sent to select distribution lists of ICU providers from all 29 states and 7 union territories(UTs).In addition to emails and phone calls,social medial applications-WhatsApp™,Facebook™and LinkedIn™were used to remind and motivate providers.By completing and submitting the survey,providers gave their consent for research purposes.This study was deemed eligible for category-2 Institutional Review Board exempt status.RESULTS There were total 134 adult/adult-pediatrics ICU responses from 24(83%out of 29)states,and two(28%out of 7)UTs in 61 cities.They had median(IQR)16(10-25)beds and most,were mixed medical-surgical,111(83%),with 108(81%)being adult-only ICUs.Representative responders were young,median(IQR),38(32-44)years age and majority,n=108(81%)were males.The consultants were,n=101(75%).A total of 77(57%)reported to have 24 h in-house intensivist.A total of 68(51%)ICUs reported to have either 2:1 or 2≥:1 patient:nurse ratio.More than 80%of the ICUs were open,and mixed type.Protocols followed regularly by the ICUs included sepsis care,ventilator-associated pneumonia(83%each);nutrition(82%),deep vein thrombosis prophylaxis(87%),stress ulcer prophylaxis(88%)and glycemic control(92%).Digital infrastructure was found to be poor,with only 46%of the ICUs reporting high-speed internet availability.CONCLUSION In this large,national,semi-structured,need-assessment survey,the need for improved manpower including;in-house intensivists,and decreasing patient-tonurse ratios was evident.Sepsis was the most common diagnosis and quality and research initiatives to decrease sepsis mortality and ICU length of stay could be prioritized.Additionally,subsequent surveys can focus on digital infrastructure for standardized care and efficient resource utilization and enhancing compliance with existing protocols.

Family Care Centre Model Could Decrease Anxiety Level among Family Members of Patients Who Have Been Undergoing in the Intensive Care Unit (ICU)

Critical illness/critical condition from any diseases and life-threatening event are the trigger factors of anxiety among family members of patients who are being cared in the intensive care unit. The anxiety is felt by patient’s family members who undergoes in ICU. It is generally triggered by uncertain patient’s conditions, room conditions, strict visiting time and cost factors. Unfortunately some nurses often fail to give attention to the family in such phenomenon and more focus to the physical patient condition. In that regard, giving attention to the family members of patients who are undergoing hospitalization in the ICU is very important and should be done by nurses by applying the Family Care Center (FCC) model. This study aims to determine the effect of the application of the model of family care center to decrease the anxiety level of family members. The results will be very useful to improve the quality of nursing care, especially in applying the model of the FCC as efforts to redeem any anxiety issues among family members. The method was used to quasi-experimental design with pre and post-test by using the control group. The total of 48 family members of patients who are undergoing hospitalization in the intensive care unit in Dr. Hasan Sadikin Hospital is willing to be used as samples in this study. It was obtained by purposive sampling technique. Data were collected by the Hamilton Anxiety Rating Scale (HARS) and analyzed by univariate analysis using mean and standard deviation, then in the bivariate analysis using paired t-test test and Independent t-test. The results showed that there was significant application of the FCC to decrease family member’s anxiety level in ICU. The conlusion of this study is: FCC can be implemented to reduce anxiety level of family members of patients who are undergoing in the intensive care unit. According to the results, this study suggested to the nurses who are working in the intensive care unit to apply FCC model in reducing anxiety level of families members so that they can use the constructive mechanisms to decrease their anxiety.

Prognostic Factors for Acute Heart Failure (AHF) in the Cardiology Intensive Care Unit (ICU) of the University Hospital Point G (UH Pt G)

Background and Aim: The absence of data in our context motivates this study aiming to determine the frequency of AHF at the ICU, assess the in-hospital evolution of the disease and to find out poor prognosis.Material and Methods: It was an observational and descriptive study covering the time from January 1, 2014 to March 30, 2017 involving all inpatient records in ICU. From January 2014 to December 2017, collected data included those on socio-demographic, history of diseases and physical examination, and some labor dataincluding Pro BNP, serum creatinine, blood ionogram,?cardiac enzymes and blood count. Also data electrocardiography, echocardiography and in-hospital evolution were collected. Statistical Analysis:Statistical analysis was performed using SPSS (IBM Inc) version 18. Results: AHF occured in 47.36% with a mean age of 58.74 ± 18.407 and extremes of 17 and 90 years, women representing 53.1% (sex ratio Male:Female = 0.88). Hypertension and diabetes were the predominant cardiovascular risk factors with respectively 67.4% and 18.4%. At admission?44%, 37.7% and 17.9% of patients were respectively hypertensive,?normotensive and hypotensive. The clinical expression was mainly global heart failure with 42.6% followed by left heart failure and right heart failure with respectively 37% and 20.4%. The coronary syndromes (all forms) was the first cause of ICA with 34% of cases followed by pulmonary embolism and hypertension with respectively 25.3% and 24.1%. Mean hospital stay was 5.61 ± 3.527 days (1 to 25 days). Complications were recorded in 18.5% of patients with cardiogenic shock in half of all cases. In multi-variate analysis, only hypotension at admission was shown to be the independent factor of poor prognosis with p = 0.016 and OR = 4.453 (1.322 - 14.996). Conclusion: As a common manifestation heart failure can be rapidly fatal in presence of collapsus or hypotension at admission. These factors should be accurately managed to reduce mortality, which remains high in our context.