BACKGROUND: Percutaneous coronary intervention has been the main percutaneous method of myocardial revascularization used in all clinical scenarios, but patients undergoing these procedures may experience negative physio...BACKGROUND: Percutaneous coronary intervention has been the main percutaneous method of myocardial revascularization used in all clinical scenarios, but patients undergoing these procedures may experience negative physiological and psychological changes. OBJECTIVE: To identify the physiological and psychological changes experienced by patients undergoing percutaneous coronary intervention. METHODS: This integrative review was carried out through a search for primary studies included in the PubMed, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), LILACS (Latin America and the Caribbean Literature on Health Sciences), and Embase databases in February 2023. No publication time frame was delimited, and articles in English, Portuguese, and Spanish were considered. RESULTS: Of the 889 studies initially identified in the search, 20 made up the final sample. The majority (n = 13) of the included studies predominantly assessed psychological changes after percutaneous coronary intervention, with follow-up periods ranging from 6 months to 1 year. A few studies (n = 6) explored physiological changes among patients undergoing percutaneous coronary intervention, and 1 study investigated the prevalence of depression and anxiety in patients with coronary heart disease in 24 European countries. The main psychological changes found after percutaneous coronary intervention were increased anxiety and depression. Anxiety and depression levels were reduced at long-term follow-up. Physiological changes included fatigue, shortness of breath, and chest discomfort. CONCLUSION: The results of this review show an urgent need for health care professionals to better assess patients' psychological state and employ strategies aimed at providing comprehensive care.
BACKGROUND: Catheter-associated urinary tract infections are among the most prevalent and costly types of hospital-acquired infections. During the COVID-19 pandemic, growing numbers of critical care patients required ind...BACKGROUND: Catheter-associated urinary tract infections are among the most prevalent and costly types of hospital-acquired infections. During the COVID-19 pandemic, growing numbers of critical care patients required indwelling urinary catheters, leading to higher infection rates. LOCAL PROBLEM: A critical care unit saw a 7-fold increase in the rate of catheter-associated urinary tract infection during the COVID-19 pandemic. A review of procedures showed that the current standard of care for preventing such infections was inadequate. In particular, patients who could not have indwelling urinary catheters promptly removed risked a potential false-positive diagnosis of catheter-associated urinary tract infection due to clinicians' use of long-term catheters to obtain urine specimens for microbiological evaluation. METHODS: A literature review was performed to gather evidence on best practices for urine specimen collection in the critical care unit. An interprofessional task force including frontline nurses advocated implementation of a pilot project in 2 critical care units involving exchange of catheters before obtaining urine specimens for microbiological evaluation in any patient who had an indwelling catheter in place for more than 24 hours. RESULTS: Implementation of the new protocol resulted in a major reduction in the diagnosis of catheter-associated urinary tract infection, with no incidents occurring for 2 consecutive quarters. Based on these results, the new evidence-based workflow was incorporated as the standard of care for all adult inpatients. CONCLUSION: Catheter exchange before collection of urine specimens in patients requiring urine culture evaluation can improve accuracy of diagnosis of catheter-associated urinary tract infection and promote antibiotic stewardship.
BACKGROUND: Critically ill patients may have pressure injuries upon admission, increasing the need for nursing care and resources. LOCAL PROBLEM: An increase in pressure injuries during the COVID-19 pandemic required imp...BACKGROUND: Critically ill patients may have pressure injuries upon admission, increasing the need for nursing care and resources. LOCAL PROBLEM: An increase in pressure injuries during the COVID-19 pandemic required implementation of 2-nurse skin assessments for pressure injury identification and prevention. METHODS: A quality improvement initiative incorporating tele-intensive care unit (tele-ICU) nurses and wound, ostomy, and continence nurses using camera technology in collaboration with bedside intensive care unit nurses was conducted in 3 intensive care units within a multi-institutional health care system from 2021 through 2023. Sites included an academic medical center and 2 community hospitals. The team implemented the following bundle: (1) tele-ICU nurses provided second skin assessments, (2) tele-ICU and bedside intensive care unit nurses reviewed pressure injury prevention measures on admission, and (3) tele-ICU nurses documented pressure injuries. Customized daily dashboards and automated reporting were implemented. Crude data descriptive analysis and segmented regression analysis were used. RESULTS: For 4723 admissions, 2-nurse skin assessment compliance increased from 46.9% during the 9-month preimplementation period to 80.8% during the 18-month postimplementation period, showing that compliance increased by 72.3%. Overall, 1153 pressure injuries were identified on intensive care unit admission or transfer, a mean of 20.6 per month before implementation and 64.1 per month after implementation. In the segmented regression analysis, the number of pressure injuries identified as present on admission significantly increased after implementation (P = .02). CONCLUSION: Integrating tele-ICU nurses, bedside intensive care unit nurses, and wound, ostomy, and continence nurses with camera technology increased compliance with 2-nurse assessments, leading to identification of present-on-admission pressure injuries, prompt treatment, and preventive interventions.
BACKGROUND: Alcohol use disorder in the United States is increasing. Alcohol is the second most commonly abused drug worldwide, resulting in acute hospitalizations related to alcohol use and alcohol withdrawal syndrome....BACKGROUND: Alcohol use disorder in the United States is increasing. Alcohol is the second most commonly abused drug worldwide, resulting in acute hospitalizations related to alcohol use and alcohol withdrawal syndrome. Management of alcohol withdrawal syndrome relies on screening tools to determine the need for treatment. The most commonly used tool is the Clinical Institute Withdrawal Assessment for Alcohol Scale-Revised (CIWA-Ar), which has not been validated for use in critical care units. OBJECTIVE: To evaluate whether the modified Minnesota Detoxification Scale (mMINDS) is more effective than the CIWA-Ar for evaluating acute withdrawal symptoms in patients in intensive care units. METHODS: This integrative review used the framework of Whittemore and Knafl. The literature was searched for studies related to mMINDS, neurocritical care, and critical care. RESULTS: Nine articles were included in the review. The review revealed 3 outcomes: nurses preferred the mMINDS over the CIWA-Ar, assessments with the mMINDS tool was more accurate for patients with CIWA-Ar scores greater than 10, and patient outcomes were improved with use of the mMINDS. The mMINDS is preferred over the CIWA-Ar for managing alcohol withdrawal syndrome in patients in intensive care units because it is associated with shorter stays, less benzodiazepine use, and a decrease in delirium tremens. CONCLUSION: The findings regarding mMINDS can apply to both critical care and non-critical care settings. The mMINDS is preferred by nurses and results in more positive patient outcomes. The mMINDS is effective and should be used in critical care areas.
BACKGROUND: In critically ill patients, intravenous fluid resuscitation is contentious. Although research has explored intravenous fluids for patients with sepsis or septic shock, evidence guiding fluid choices for traum...BACKGROUND: In critically ill patients, intravenous fluid resuscitation is contentious. Although research has explored intravenous fluids for patients with sepsis or septic shock, evidence guiding fluid choices for trauma patients in intensive care units remains scarce. OBJECTIVE: To summarize current recommendations for intravenous fluid choices for resuscitation and their impact on outcomes in trauma patients in intensive care units. METHODS: The literature was appraised with a scoping review using the Joanna Briggs Institute framework. RESULTS: A search of databases (CINAHL Plus, MEDLINE, Health Source: Nursing/Academic Edition, PubMed, and Scopus) yielded 10 articles examining crystalloid and colloid solutions. In trauma patients, major adverse outcomes (mortality, acute kidney injury, hospital/intensive care unit length of stay) did not significantly differ according to crystalloid solution type except in patients with traumatic brain injury, for whom normal saline was beneficial. Albumin and hypertonic saline as adjuncts to fluid therapy were generally safe except for patients with traumatic brain injury. DISCUSSION: Balanced crystalloid solutions and normal saline can be used interchangeably in trauma patients except those with traumatic brain injury. The use of albumin for first-line resuscitation is questionable due to cost and lack of benefit over other fluids. Hypertonic saline may benefit patients with delayed abdominal closure after exploratory laparotomy. CONCLUSION: In trauma patients, outcomes are not influenced by intravenous fluid type except for those with traumatic brain injury, for whom normal saline is preferred over balanced crystalloid solutions. Hypertonic saline and albumin may be adjunct therapies after considering cost, availability, and individual patient characteristics.
Crit Care Nurse
· 2025 Feb · PMID 39889802
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BACKGROUND: In critical care settings during night shift, the number of staff members is reduced and a designated time for structured patient care discussions is often absent. The absence of organized collaboration and s...BACKGROUND: In critical care settings during night shift, the number of staff members is reduced and a designated time for structured patient care discussions is often absent. The absence of organized collaboration and shared decision-making strains professional relationships. LOCAL PROBLEM: In a 21-bed cardiovascular intensive care unit, advanced practice providers were frequently interrupted by night shift nurses to discuss nonurgent clinical matters while engaged in patient care activities. METHODS: This quality improvement project used a preintervention-postintervention design. Surveys were distributed to advanced practice providers and nurses to determine perceptions of communication. All advanced practice providers and nurses working night shift in the cardiovascular intensive care unit were included. Nightly bedside rounds for advanced practice providers and nurses using a goal sheet to improve communication were implemented in the cardiovascular intensive care unit. Preintervention and postintervention scores on survey subscales (perceptions of collaboration, workflow, and communication) were examined with analysis of variance for both groups. RESULTS: Mean scores increased after the intervention for both advanced practice providers and nurses. Scores for perception of collaboration significantly increased for both advanced practice providers and nurses (both P = .01). The score for perception of workflow significantly increased for nurses (P < .001) but not for advanced practice providers. Scores for perception of communication did not significantly change for either group. CONCLUSION: Implementation of bedside rounds using a goal sheet for advanced practice providers and nurses working night shift in the cardiovascular intensive care unit improved perceptions of collaboration and workflow.
Crit Care Nurse
· 2025 Feb · PMID 39889801
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BACKGROUND: Hospital-acquired pressure injuries are a significant patient safety concern. The Centers for Medicare & Medicaid Services tracks hospital-acquired pressure injuries as a patient safety indicator. Health care...BACKGROUND: Hospital-acquired pressure injuries are a significant patient safety concern. The Centers for Medicare & Medicaid Services tracks hospital-acquired pressure injuries as a patient safety indicator. Health care organizations with higher-than-expected rates may incur penalties. LOCAL PROBLEM: The pressure injury prevalence rate in a cardiothoracic intensive care unit was above the National Database of Nursing Quality Indicators benchmark. The current standard of care-use of the Braden scale for pressure injury risk assessment and the SKIN (surface, keep turning, incontinence care, and nutrition) care bundle-may not adequately address the needs of the intensive care unit population. In addition, cardiac patients present a special challenge because of their disease process and the mechanical support devices used to treat patients in cardiogenic shock, which place them at risk for the development of hospital-acquired pressure injuries. METHODS: A performance improvement project was carried out in the cardiothoracic intensive care unit to reduce the prevalence and incidence of hospital-acquired pressure injuries. A preintervention convenience cohort was compared with a postintervention cohort. The intervention consisted of use of the Cubbin-Jackson scale, an intensive care unit-specific risk-assessment tool, with linked interventions to prevent pressure injuries. RESULTS: The preintervention and postintervention cohorts consisted of 102 patients each. The pressure injury prevalence and incidence rates decreased by 67.84% and 36.43%, respectively, from before to after the intervention. CONCLUSION: The use of an intensive care unit-specific risk-assessment tool with linked interventions to prevent pressure injury can help reduce hospital-acquired pressure injuries in an intensive care unit.
Crit Care Nurse
· 2025 Feb · PMID 39889800
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BACKGROUND: Prolonged intubation has been associated with unfavorable outcomes after cardiac surgery. A standardized approach is needed to ensure prompt extubation and shorten intensive care unit stays. LOCAL PROBLEM: Th...BACKGROUND: Prolonged intubation has been associated with unfavorable outcomes after cardiac surgery. A standardized approach is needed to ensure prompt extubation and shorten intensive care unit stays. LOCAL PROBLEM: This quality improvement project was designed to evaluate the impact of a fast-track extubation protocol on time to extubation and intensive care unit length of stay. METHODS: The intervention group consisted of 26 adult cardiac surgery patients who underwent the fast-track extubation protocol. A Mann-Whitney test was used to compare time to extubation and intensive care unit length of stay in this group with those of a pair-matched control group of patients from the previous year who did not undergo the fast-track extubation protocol. INTERVENTIONS: An evidence-based literature review was used to develop a fast-track extubation protocol involving extubation in less than 6 hours. An educational activity was created to improve intensive care unit staff members' knowledge of the fast-track extubation protocol, and its effectiveness was measured by a posttest score of 80%. RESULTS: The percentage of patients with extubation times of less than 6 hours was significantly higher in the fast-track extubation protocol group than in the pair-matched control group (U = 179, P = .003). The mean intensive care unit stay decreased from 2.92 days in the control group to 1.85 days in the fast-track extubation protocol group. CONCLUSION: Implementing a fast-track extubation protocol for adult cardiac surgery patients shortened time to extubation and intensive care unit stay, expediting and improving recovery processes in the intensive care unit.
Crit Care Nurse
· 2025 Feb · PMID 39889799
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BACKGROUND: For patients receiving extracorporeal membrane oxygenation, early mobility decreases mechanical ventilation time, delirium incidence, and length of intensive care unit stay and improves physical functioning....BACKGROUND: For patients receiving extracorporeal membrane oxygenation, early mobility decreases mechanical ventilation time, delirium incidence, and length of intensive care unit stay and improves physical functioning. Individual centers use institutional guidelines to develop ambulation protocols. Local Problem A quality improvement initiative was used to evaluate an ambulation protocol for adult intensive care unit patients receiving extracorporeal membrane oxygenation. METHODS: Adult patients receiving extracorporeal membrane oxygenation who walked according to the protocol were compared with a historical control group of patients who walked without the protocol. Data analysis included descriptive statistics and independent t tests. Outcomes included adverse safety events, number of patients and ambulation sessions, standing and ambulation time, and distance. RESULTS: From January to March 2021, 13 of 46 patients receiving extracorporeal membrane oxygenation (28%) walked according to the protocol. In the control group, 14 of 147 patients (10%) walked in 2019; 21 of 144 patients (15%) walked in 2020. Some characteristics of the control group (hospitalized before the COVID-19 pandemic) differed from those of the protocol group (hospitalized during the pandemic). Mean number of ambulation sessions was not significantly different between groups (protocol group, 10; control group, 9). Differences in mean standing time (protocol group, 121.23 minutes; control group, 210.80 minutes), ambulation time (protocol group, 11.77 minutes; control group, 198.70 minutes), and ambulation distance were not significant. CONCLUSIONS: Standing time, ambulation time, and distance were not significantly different between the groups. The extracorporeal membrane oxygenation ambulation protocol demonstrated clinical significance by increasing the number of patients walking.
Crit Care Nurse
· 2025 Feb · PMID 39889797
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INTRODUCTION: Prone ventilation is a standard treatment for acute respiratory distress syndrome, and its clinical benefits are well established. However, implementing prone positioning safely and effectively is challengi...INTRODUCTION: Prone ventilation is a standard treatment for acute respiratory distress syndrome, and its clinical benefits are well established. However, implementing prone positioning safely and effectively is challenging in patients who are pregnant, have intra-abdominal hypertension, or are in other high-risk groups. CLINICAL FINDINGS AND DIAGNOSIS: A patient in the third trimester of pregnancy (28 weeks and 6 days of gestation) developed a body temperature of 39 °C and severe respiratory distress. She was transferred to the intensive care unit, received noninvasive ventilation, and ultimately underwent endotracheal intubation. Because her oxygenation index remained below 100, she received a diagnosis of severe acute respiratory distress syndrome. INTERVENTIONS: The patient was safely placed in the prone position with a swim ring while receiving venovenous extracorporeal membrane oxygenation. During this period, her intra-abdominal pressure did not increase significantly. OUTCOMES: The fetus was delivered by cesarean birth, and the patient was transferred to the general ward after extubation. CONCLUSION: This case report describes the use of prone positioning in a pregnant patient. The report offers critical care nurses insights into the clinical management of patients who are pregnant or have intra-abdominal hypertension.