Crit Care Nurs Clin North Am
· 2025 Jun · PMID 40382090
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Infusion of fluids and medications through an intravenous smart pump (IVSP) is widely used for inpatient care in the United States yet carries high risk of error, especially for critically ill patients. This review artic...Infusion of fluids and medications through an intravenous smart pump (IVSP) is widely used for inpatient care in the United States yet carries high risk of error, especially for critically ill patients. This review article aims to provide critical care nurses understanding of the current IVSP technology available focusing primarily on large volume IVSPs used most in the United States. Discussion focuses on the types of technology and their history in practice along with common causes of error and challenges for nursing workflow.
Crit Care Nurs Clin North Am
· 2025 Jun · PMID 40382089
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Approximately 6000 intensive care units in the United States have Extracorporeal Membrane Oxygenation (ECMO) programs that are crucial for supporting critically ill patients with cardiogenic shock or respiratory failure....Approximately 6000 intensive care units in the United States have Extracorporeal Membrane Oxygenation (ECMO) programs that are crucial for supporting critically ill patients with cardiogenic shock or respiratory failure. ECMO is a lifesaving technique that oxygenates blood outside the body, providing critical time for other treatments to take effect. There are two main types of ECMO: veno-venous ECMO, which supports lung function, and veno-arterial ECMO, which supports both lung function and cardiac output. Despite advancements in technology, the success of ECMO relies heavily on skilled specialists who require extensive training and effective teamwork.
Lozano VM, Denny DL, Owens RA
… +9 more, Sandhu S, Fakir MH, Molani M, Labuhn M, Vetsch C, Tavakolian K, Hanson D, Jean KL, Tavakolian P
Crit Care Nurs Clin North Am
· 2025 Jun · PMID 40382088
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Pressure injuries, also known as pressure ulcers, pose a serious health care concern for patients undergoing lengthy surgeries due to prolonged immobility while under anesthesia. The occurrence of pressure injuries can b...Pressure injuries, also known as pressure ulcers, pose a serious health care concern for patients undergoing lengthy surgeries due to prolonged immobility while under anesthesia. The occurrence of pressure injuries can be costly and adversely impact patient outcomes, leading to increased morbidity, extended hospital stays, and a reduced quality of life. One preventative approach is to use engineered support surfaces designed to redistribute pressure, thereby reducing the risk of tissue damage. This study aimed to compare the effectiveness of 3 different support surfaces to redistribute pressure: standard surgical foam, gel overlay, and an active, small-cell alternating-pressure air mattress.
Crit Care Nurs Clin North Am
· 2025 Jun · PMID 40382087
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After identifying challenges with existing tools and structures aimed at reducing hospital-acquired pressure injuries in the intensive care unit, we employed new technology in the form of a wearable sensor to provide vis...After identifying challenges with existing tools and structures aimed at reducing hospital-acquired pressure injuries in the intensive care unit, we employed new technology in the form of a wearable sensor to provide visual cues and promote the proper turning of patients. This discussion will cover the device, the development of inclusion and exclusion criteria, the application of the wearable sensor, and the overall success achieved after implementation, which resulted in a 54% reduction in hospital-acquired pressure injuries across a 120 bed critical care service line.
Crit Care Nurs Clin North Am
· 2025 Jun · PMID 40382086
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Nursing engineering is an emerging interdisciplinary applied science that combines clinical nursing expertise with engineering innovations to enhance the quality and efficiency of health care. This field improves the des...Nursing engineering is an emerging interdisciplinary applied science that combines clinical nursing expertise with engineering innovations to enhance the quality and efficiency of health care. This field improves the design, assessment, and implementation of health care technologies by fostering collaboration between nurses and engineers. This partnership ensures that technologies align with clinical requirements and improve patient outcomes. In critical care, by addressing essential issues such as workflow enhancement, identifying customized care solutions, and implementing secure, user-centered technologies, nursing engineering will become increasingly crucial in integrating clinical practice with technological advancements.
Crit Care Nurs Clin North Am
· 2025 Jun · PMID 40382085
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Burnout is a pervasive issue in nursing, influenced by factors like patient acuity, nurse-to-patient ratios, and the working environment. Alarm fatigue occurs when high rates of clinical alarms lead to desensitization am...Burnout is a pervasive issue in nursing, influenced by factors like patient acuity, nurse-to-patient ratios, and the working environment. Alarm fatigue occurs when high rates of clinical alarms lead to desensitization among staff, creating unsafe patient conditions. Nearly all critical care nurses involved in this study reported high levels of burnout, particularly in the Emotional Exhaustion and Depersonalization domains. These nurses also experienced moderately high levels of alarm fatigue. A majority of nurses indicated that alarm fatigue significantly contributed to their burnout. More research is needed to clarify the relationship between alarm fatigue and burnout.
Crit Care Nurs Clin North Am
· 2025 Jun · PMID 40382084
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In this focus group study, we examined the challenges associated with sensory overload resulting from medical technology alarms and alerts experienced by intensive care unit nurses. The prevalence of excessive warnings h...In this focus group study, we examined the challenges associated with sensory overload resulting from medical technology alarms and alerts experienced by intensive care unit nurses. The prevalence of excessive warnings has a detrimental impact on the well-being of critical care nurses. Participants reported a variety of emotional responses to the alarms, predominately negative feelings, such as anger, frustration, stress, and nervousness. Thus, it is imperative to implement strategic measures to address the issue of alarm fatigue and associated noise levels to foster a more conducive work environment, ultimately improving human performance and enhancing workflow for critical care nurses.
Crit Care Nurs Clin North Am
· 2025 Jun · PMID 40382083
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The systematic annotation of crisis alarms reveals a high number of false alarms for both ventricular tachycardia and asystole, which are best identified by inspecting simultaneous multilead electrocardiographs. Among th...The systematic annotation of crisis alarms reveals a high number of false alarms for both ventricular tachycardia and asystole, which are best identified by inspecting simultaneous multilead electrocardiographs. Among the few true crisis alarms, 11 were categorized as ventricular tachycardia, while the remaining 11 were classified as asystole. These false crisis alarms were primarily attributed to artifacts and low QRS voltage. Future research should use artificial intelligence that mimics critical care professionals to identify and evaluate false crisis alarms. This could enhance the algorithms used in physiologic monitors, leading to improved arrhythmia detection and a reduction in false alarms.
Crit Care Nurs Clin North Am
· 2025 Mar · PMID 39890354
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One of the life-threatening adverse effects associated with the use of immune checkpoint inhibitors is β cells destruction resulting in type 1 diabetes. Immune checkpoint inhibitor-induced type 1 diabetes (ICI-T1D) usual...One of the life-threatening adverse effects associated with the use of immune checkpoint inhibitors is β cells destruction resulting in type 1 diabetes. Immune checkpoint inhibitor-induced type 1 diabetes (ICI-T1D) usually has a rapid onset requiring admission to the intensive care unit for the management of diabetic ketoacidosis using an insulin drip protocol. Once stabilized patients with ICI-T1D are started on insulin therapy to mimic usual pancreatic function. Insulin administration may be through multiple daily injections or continuous subcutaneous insulin infusions using an insulin pump. People who develop ICI-T1D will require insulin therapy for life.
Crit Care Nurs Clin North Am
· 2025 Mar · PMID 39890353
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Hypertension is a common comorbid condition among patients with diabetes, occurring in 71% to 80.6% of diabetes patients in the United States, and contributes to the development of cardiovascular disease. Screening for h...Hypertension is a common comorbid condition among patients with diabetes, occurring in 71% to 80.6% of diabetes patients in the United States, and contributes to the development of cardiovascular disease. Screening for hypertension and a multifaceted treatment approach, including lifestyle management, pharmacologic therapy, and blood pressure targets are the key to reducing morbidity and mortality associated with uncontrolled blood pressure. Most patients require more than 1 medication to control their blood pressure, and clinicians should follow published guidelines to select the most appropriate and efficacious blood pressure agents for their patients.
Crit Care Nurs Clin North Am
· 2025 Mar · PMID 39890352
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This article will discuss the current medical nutrition therapy (MNT) recommendations for non-hospitalized people with diabetes based on published standards, general principles for healthy meal planning, common dietary m...This article will discuss the current medical nutrition therapy (MNT) recommendations for non-hospitalized people with diabetes based on published standards, general principles for healthy meal planning, common dietary methods used with people with diabetes, and matching the prandial insulin dose to food(s) consumed. This article will also discuss MNT for hospitalized patients with diabetes including assessing for malnutrition and identifying contributing factors for the development of malnutrition. Common dietary methods used in the hospital setting will be discussed, as well as the current recommendations for managing diabetes in patients on clear liquid diets, enteral nutrition, and parenteral nutrition.
Crit Care Nurs Clin North Am
· 2025 Mar · PMID 39890351
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Hyperglycemia is common in critically ill patients. Due to the complex medical issues of critically ill patients, continuous insulin infusions are often used to treat hyperglycemia in the ICU. This article discusses the...Hyperglycemia is common in critically ill patients. Due to the complex medical issues of critically ill patients, continuous insulin infusions are often used to treat hyperglycemia in the ICU. This article discusses the benefits and risks of continuous insulin infusions, components of insulin infusion protocols, nursing management while administering insulin infusions, and proper transition off an insulin infusion.
Crit Care Nurs Clin North Am
· 2025 Mar · PMID 39890350
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There are an estimated 38 million people in the United States who have diabetes mellitus, both diagnosed and undiagnosed. Chronic complications are generally due to insulin deficiency or insulin resistance, with persiste...There are an estimated 38 million people in the United States who have diabetes mellitus, both diagnosed and undiagnosed. Chronic complications are generally due to insulin deficiency or insulin resistance, with persistent hyperglycemia, dyslipidemia, and other metabolic pathways disorders. They have 2 to 8 times greater risk of cardiovascular (CV) disease including complications from ischemic heart disease, peripheral artery disease, heart failure, and stroke, which can result in death for more than 50% of persons with type 2 diabetes. This article will discuss the latest CV risk reduction guideline recommended for persons with diabetes.
Crit Care Nurs Clin North Am
· 2025 Mar · PMID 39890349
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There is an estimated 350,000 persons wearing an insulin pump and 2.4 million wearing a continuous glucose monitor (CGM) sensor in the United States. The last few decades have ushered in advancements with the integration...There is an estimated 350,000 persons wearing an insulin pump and 2.4 million wearing a continuous glucose monitor (CGM) sensor in the United States. The last few decades have ushered in advancements with the integration of insulin delivery and continuous glucose evaluations which offer a more precise tight insulin delivery and glycemic control. However, when hospital admissions are necessary, most desire to continue to wear their devices. The last several decades and during the pandemic, many agencies such as the Joint Commission, FDA, and diabetes organizations have generated position statements and guidelines to allow the most optimal diabetes treatment, even when hospitalized.
Crit Care Nurs Clin North Am
· 2025 Mar · PMID 39890348
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The prevalence of pediatric diabetes continues to rise in the United States and worldwide. There are various forms of pediatric diabetes including type 1, type 2, and maturity onset diabetes of youth. The treatment depen...The prevalence of pediatric diabetes continues to rise in the United States and worldwide. There are various forms of pediatric diabetes including type 1, type 2, and maturity onset diabetes of youth. The treatment depends on each unique type of diabetes and must be taken into consideration for patients based on presentation and clinical setting. There is limited literature supporting the use of noninsulin medications to manage pediatric diabetes in an inpatient setting. This article focuses on noninsulin medication management of children and adolescents presenting with hyperglycemia in acute care settings, both critically and noncritically ill.
Crit Care Nurs Clin North Am
· 2025 Mar · PMID 39890347
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Diabetic ketoacidosis (DKA) and euglycemic DKA are both diabetes-related emergencies. Individuals with DKA can experience extremely elevated hyperglycemia exceeding 250 mg/dL. Although DKA is more frequently observed in...Diabetic ketoacidosis (DKA) and euglycemic DKA are both diabetes-related emergencies. Individuals with DKA can experience extremely elevated hyperglycemia exceeding 250 mg/dL. Although DKA is more frequently observed in people with type 1 diabetes (T1DM), euglycemic DKA, which is characterized by mildly elevated or nearly normal blood glucose at levels below 200 mg/dL, has recently been linked to the use of SGLT-2 inhibitors generally used for type 2 diabetes mellitus (T2DM). Without the substantial hyperglycemia associated with DKA, euglycemic DKA may be clinically overlooked. The pathophysiology, precipitating factors, clinical presentations, treatments, and evaluations of euglycemic DKA and DKA are reviewed.
Crit Care Nurs Clin North Am
· 2025 Mar · PMID 39890346
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Diabetes self-management education and support (DSME/S) creates the pillars necessary for a person with diabetes (PWD) to build self-confidence in how to manage a diagnosis of diabetes. Health care organizations should r...Diabetes self-management education and support (DSME/S) creates the pillars necessary for a person with diabetes (PWD) to build self-confidence in how to manage a diagnosis of diabetes. Health care organizations should remain flexible and adaptable to seeking new methods in providing patient education particularly a PWD. As diabetes diagnosis continues to grow along with different diabetes tools and technology, health care organizations should consider embracing change by implementing the use DSME/S, developing a diabetes management inpatient team, and acquiring Certified Diabetes Care and Education Specialists.
Crit Care Nurs Clin North Am
· 2025 Mar · PMID 39890345
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Publisher ↗
Perioperative evaluation and management of diabetes mellitus is vital to minimize adverse complications before, during, and after surgery. It requires a multidisciplinary approach including the surgery team, anesthesia,...Perioperative evaluation and management of diabetes mellitus is vital to minimize adverse complications before, during, and after surgery. It requires a multidisciplinary approach including the surgery team, anesthesia, endocrinology or internal medicine, and other specialties as needed. This article will discuss the effects of surgery and anesthesia on blood glucose, preoperative evaluation of the person with diabetes, glycemic targets for surgery, adjustment of diabetes medications the day before surgery, in the preoperative, intraoperative, and postoperative areas, management of blood glucose in the preoperative, intraoperative, and postoperative periods, and management of hypoglycemia.
Crit Care Nurs Clin North Am
· 2025 Mar · PMID 39890344
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Dysglycemia increases morbidity and mortality in hospitalized patients. Insulin is recommended to manage blood glucose levels greater than or equal to 180 mg/dL. Establishing comprehensive protocols for dysglycemia manag...Dysglycemia increases morbidity and mortality in hospitalized patients. Insulin is recommended to manage blood glucose levels greater than or equal to 180 mg/dL. Establishing comprehensive protocols for dysglycemia management in all departments ensures consistent, evidence-based patient care. Basal, prandial, and correction dosing are the best methods for insulin administration. For patients on total parenteral nutrition (TPN) with hyperglycemia, add regular human insulin to the TPN. Corticosteroids can cause hyperglycemia and can be managed with neutral protamine hagedorn insulin. Pay special attention to the resumption of the patient's diet and oral medications during transitions of care and before discharge.