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EMERGENCY AND INTENSIVE CRITICAL CARE (121 journals)                     

Showing 1 - 124 of 124 Journals sorted alphabetically
AACN Advanced Critical Care     Full-text available via subscription   (Followers: 36)
Academic Emergency Medicine     Hybrid Journal   (Followers: 100)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acute and Critical Care     Open Access   (Followers: 10)
Acute Cardiac Care     Hybrid Journal   (Followers: 12)
Acute Medicine     Full-text available via subscription   (Followers: 7)
Advances in Emergency Medicine     Open Access   (Followers: 21)
Advances in Neonatal Care     Hybrid Journal   (Followers: 45)
African Journal of Anaesthesia and Intensive Care     Full-text available via subscription   (Followers: 8)
African Journal of Emergency Medicine     Open Access   (Followers: 6)
AINS - Anasthesiologie - Intensivmedizin - Notfallmedizin - Schmerztherapie     Hybrid Journal   (Followers: 5)
American Journal of Emergency Medicine     Hybrid Journal   (Followers: 57)
Annals of Emergency Medicine     Hybrid Journal   (Followers: 149)
Annals of Intensive Care     Open Access   (Followers: 39)
Annals of the American Thoracic Society     Full-text available via subscription   (Followers: 15)
Archives of Academic Emergency Medicine     Open Access   (Followers: 6)
Archives of Trauma Research     Open Access   (Followers: 5)
ASAIO Journal     Hybrid Journal   (Followers: 2)
Australasian Journal of Paramedicine     Open Access   (Followers: 9)
Australian Critical Care     Full-text available via subscription   (Followers: 21)
Bangladesh Critical Care Journal     Open Access   (Followers: 1)
BMC Emergency Medicine     Open Access   (Followers: 29)
BMJ Quality & Safety     Hybrid Journal   (Followers: 66)
Burns Open     Open Access   (Followers: 1)
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine     Hybrid Journal   (Followers: 2)
Case Reports in Acute Medicine     Open Access   (Followers: 4)
Case Reports in Critical Care     Open Access   (Followers: 14)
Case Reports in Emergency Medicine     Open Access   (Followers: 23)
Chronic Wound Care Management and Research     Open Access   (Followers: 9)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 28)
Clinical Intensive Care     Hybrid Journal   (Followers: 6)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 3)
Clinical Risk     Hybrid Journal   (Followers: 5)
Crisis: The Journal of Crisis Intervention and Suicide Prevention     Hybrid Journal   (Followers: 17)
Critical Care     Open Access   (Followers: 78)
Critical Care and Resuscitation     Full-text available via subscription   (Followers: 29)
Critical Care Clinics     Full-text available via subscription   (Followers: 35)
Critical Care Explorations     Open Access   (Followers: 3)
Critical Care Medicine     Hybrid Journal   (Followers: 320)
Critical Care Research and Practice     Open Access   (Followers: 13)
Current Emergency and Hospital Medicine Reports     Hybrid Journal   (Followers: 6)
Current Opinion in Critical Care     Hybrid Journal   (Followers: 74)
Disaster and Emergency Medicine Journal     Open Access   (Followers: 12)
Egyptian Journal of Critical Care Medicine     Open Access   (Followers: 2)
EMC - Urgenze     Full-text available via subscription  
Emergency Care Journal     Open Access   (Followers: 8)
Emergency Medicine (Medicina neotložnyh sostoânij)     Open Access  
Emergency Medicine Australasia     Hybrid Journal   (Followers: 18)
Emergency Medicine Clinics of North America     Full-text available via subscription   (Followers: 19)
Emergency Medicine International     Open Access   (Followers: 8)
Emergency Medicine Journal     Hybrid Journal   (Followers: 56)
Emergency Medicine News     Full-text available via subscription   (Followers: 7)
Emergency Nurse     Full-text available via subscription   (Followers: 16)
Enfermería Intensiva (English ed.)     Full-text available via subscription   (Followers: 1)
European Burn Journal     Open Access   (Followers: 9)
European Journal of Emergency Medicine     Hybrid Journal   (Followers: 25)
Frontiers in Emergency Medicine     Open Access   (Followers: 8)
Global Journal of Transfusion Medicine     Open Access   (Followers: 1)
Hong Kong Journal of Emergency Medicine     Full-text available via subscription   (Followers: 5)
Indian Journal of Burns     Open Access   (Followers: 3)
Injury     Hybrid Journal   (Followers: 21)
Intensive Care Medicine     Hybrid Journal   (Followers: 87)
Intensive Care Medicine Experimental     Open Access   (Followers: 2)
Intensivmedizin up2date     Hybrid Journal   (Followers: 4)
International Journal of Critical Illness and Injury Science     Open Access   (Followers: 1)
International Journal of Emergency Medicine     Open Access   (Followers: 9)
International Journal of Emergency Mental Health and Human Resilience     Open Access   (Followers: 2)
International Paramedic Practice     Full-text available via subscription   (Followers: 17)
Iranian Journal of Emergency Medicine     Open Access  
Irish Journal of Paramedicine     Open Access   (Followers: 3)
Journal Européen des Urgences et de Réanimation     Hybrid Journal   (Followers: 1)
Journal of Acute Care Physical Therapy     Hybrid Journal   (Followers: 4)
Journal of Cardiac Critical Care TSS     Open Access   (Followers: 1)
Journal Of Cardiovascular Emergencies     Open Access  
Journal of Concussion     Open Access  
Journal of Critical Care     Hybrid Journal   (Followers: 51)
Journal of Critical Care Medicine     Open Access   (Followers: 18)
Journal of Education and Teaching in Emergency Medicine     Open Access   (Followers: 1)
Journal of Emergencies, Trauma and Shock     Open Access   (Followers: 13)
Journal of Emergency Medical Services     Full-text available via subscription   (Followers: 12)
Journal of Emergency Medicine     Hybrid Journal   (Followers: 53)
Journal of Emergency Medicine, Trauma and Acute Care     Open Access   (Followers: 26)
Journal of Emergency Practice and Trauma     Open Access   (Followers: 6)
Journal of Intensive Care     Open Access   (Followers: 9)
Journal of Intensive Care Medicine     Hybrid Journal   (Followers: 23)
Journal of Intensive Medicine     Open Access   (Followers: 1)
Journal of Neuroanaesthesiology and Critical Care     Open Access   (Followers: 4)
Journal of Stroke Medicine     Hybrid Journal   (Followers: 4)
Journal of the American College of Emergency Physicians Open     Open Access   (Followers: 1)
Journal of the Intensive Care Society     Hybrid Journal   (Followers: 5)
Journal of the Royal Army Medical Corps     Hybrid Journal   (Followers: 7)
Journal of Thrombosis and Haemostasis     Hybrid Journal   (Followers: 52)
Journal of Translational Critical Care Medicine     Open Access   (Followers: 2)
Journal of Trauma and Acute Care Surgery, The     Hybrid Journal   (Followers: 36)
La Presse Médicale Open     Open Access  
Médecine de Catastrophe - Urgences Collectives     Hybrid Journal  
Medicina Intensiva     Open Access   (Followers: 3)
Medicina Intensiva (English Edition)     Hybrid Journal   (Followers: 1)
Mediterranean Journal of Emergency Medicine & Acute Care : MedJEM     Open Access  
Notfall + Rettungsmedizin     Hybrid Journal   (Followers: 4)
OA Critical Care     Open Access   (Followers: 3)
OA Emergency Medicine     Open Access   (Followers: 2)
Open Access Emergency Medicine     Open Access   (Followers: 6)
Open Journal of Emergency Medicine     Open Access   (Followers: 2)
Palliative Care : Research and Treatment     Open Access   (Followers: 22)
Palliative Medicine     Hybrid Journal   (Followers: 56)
Prehospital Emergency Care     Hybrid Journal   (Followers: 20)
Regulatory Toxicology and Pharmacology     Hybrid Journal   (Followers: 25)
Research and Opinion in Anesthesia and Intensive Care     Open Access   (Followers: 3)
Resuscitation     Hybrid Journal   (Followers: 59)
Resuscitation Plus     Open Access   (Followers: 2)
Saudi Critical Care Journal     Open Access   (Followers: 2)
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine     Open Access   (Followers: 12)
Seminars in Thrombosis and Hemostasis     Hybrid Journal   (Followers: 28)
Shock : Injury, Inflammation, and Sepsis : Laboratory and Clinical Approaches     Hybrid Journal   (Followers: 12)
Sklifosovsky Journal Emergency Medical Care     Open Access  
The Journal of Trauma Injury Infection and Critical Care     Full-text available via subscription   (Followers: 23)
Therapeutics and Clinical Risk Management     Open Access   (Followers: 1)
Transplant Research and Risk Management     Open Access   (Followers: 1)
Trauma Case Reports     Open Access   (Followers: 1)
Trauma Monthly     Open Access   (Followers: 4)
Visual Journal of Emergency Medicine     Full-text available via subscription   (Followers: 1)
Western Journal of Emergency Medicine     Open Access   (Followers: 11)
 AEM Education and Training : A Global Journal of Emergency Care     Open Access   (Followers: 1)


Similar Journals
Journal Cover
Critical Care Research and Practice
Journal Prestige (SJR): 0.499
Citation Impact (citeScore): 1
Number of Followers: 13  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2090-1305 - ISSN (Online) 2090-1313
Published by Hindawi Homepage  [340 journals]
  • Prevalence and Mortality Rates of Acute Kidney Injury among Critically Ill
           Patients: A Retrospective Study

    • Abstract: Acute kidney injury (AKI) poses a significant challenge in critically ill patients. To determine the prevalence, risk factors, and mortality rate of AKI among nonsurgical critically ill patients in Jordan University Hospital, we conducted a retrospective study using a consecutive sampling method, including 457 nonsurgical critically ill patients admitted to the medical intensive care unit (MICU) from January to June 2021. The mean age was 63.8 ± 18 years, with 196 (42.8%) developing AKI during their stay in the MICU. Among AKI nonsurgical patients, pulmonary diseases (n = 52; 34.5%) emerged as the primary cause for admission, exhibiting the highest prevalence, followed by sepsis (n = 40; 20.4%). Furthermore, we found that older age (adjusted OR (AOR): 1.04; 95% confidence interval (CI): 1.04–1.06; ), preadmission use of diuretics (AOR: 2.12; 95% CI: 1.06–4.25; ), use of ventilators (2.19; 95% CI: 1.12–2.29; ), and vasopressor use during MICU stay (AOR: 4.25; 95% CI: 2.1308.47; ) were observed to have higher mortality rates. Prior utilization of statins before admission exhibited a significant association with reduced mortality rate (AOR: 0.42; 95% CI: 0.2–0.85; ). Finally, AKI was associated with a higher mortality rate during MICU stay (AOR: 2.44; 95% CI: 1.07–5.56; ). The prevalence of AKI among nonsurgical patients during MICU stay is higher than what has been reported previously in the literature, which highlights the nuanced importance of identifying more factors contributing to AKI in developing countries, and hence providing preventive measures and adhering to global strategies are recommended.
      PubDate: Thu, 16 Nov 2023 10:20:00 +000
  • Barriers to Safe Oxygen Therapy and the Effect of the Training on the
           Knowledge and Performance of ICU Nurses

    • Abstract: Introduction. Proper oxygen therapy is crucial in hospitals, particularly intensive care units, to ensure safety and accuracy. The role of nurses during oxygen therapy is vital, as their knowledge and correct performance significantly impact patients’ clinical conditions. A study was carried out to examine the knowledge and performance of nurses regarding safe oxygen therapy. The study aimed to identify the obstacles hindering safe oxygen therapy and assess the impact of training on the knowledge and performance of intensive care nurses. Methods. This study was conducted among the ICU nurses at Shahid Rahnemoun Teaching Hospital in Yazd, Iran. The study method is a sequential combination of descriptive, qualitative, and educational phases. The first stage involved examining the knowledge and performance of 80 ICU nurses in oxygen therapy. The study employed content analysis to elaborate on participants’ perspectives on safe oxygen therapy challenges and potential solutions. The third phase involved a two-group study with pre- and post-tests to examine the effect of training on ICU nurses’ knowledge and performance in oxygen therapy. Results. The study found that intervention and control groups had low average scores in knowledge, performance, and total score of oxygen therapy before the study, with no significant difference. There was a significant difference between intervention and control groups one and three months after the intervention in the areas of knowledge (after-1 month 24.41 vs. 20.29, 95% CI [3.144–5.098], after-3 month 22.13 vs. 20.24, 95% CI [0.729–3.053]), performance (after-1 month 21.54 vs. 18.05, 95% CI [2.898–4.073], after-3 month 19.74 vs. 18.63, 95% CI [0.400–1.824]), and total score of oxygen therapy (after-1 month 45.95 vs. 38.34, 95% CI [6.288–8.925], after-3 month 41.87 vs. 38.87, 95% CI [1.394–4.613]). Conclusion. The study’s findings revealed that nurses in ICUs lack the appropriate knowledge and performance in oxygen therapy. A lack of knowledge and correct practice, insufficient monitoring of oxygen therapy, and defects in hospital equipment are contributing factors. The training was found to improve the knowledge and performance of nurses significantly. Consistent training at shorter intervals is suggested for nurses to keep their knowledge current.
      PubDate: Thu, 09 Nov 2023 10:20:00 +000
  • The Effect of Listening to Holy Quran Recital on Pain and Length of Stay
           Post-CABG: A Randomized Control Trial

    • Abstract: Background. Nearly, 75% of patients post-CABG complain of moderate to severe pain during their hospital stay. Nonpharmacological interventions have been investigated; however, the effect of Holy Quran recital post-CABG is still not well studied, especially in developing Islamic countries. Objective. To investigate the effect of listening to the Holy Quran recital on pain and length of stay post-CABG. Methods. This was a randomized control trial on 132 patients recruited from four hospitals in Amman, Jordan. The intervention group listened to the Holy Quran recited for 10 minutes twice daily while the control group received the usual care. Data were analyzed using paired and independent samples t-tests. Results. Paired t-test testing showed that there was a significant reduction in the pain level, (M [SD], 6.82 [2.27] vs. 4.65 [2.18], t = 23.65,  
      PubDate: Mon, 06 Nov 2023 09:20:00 +000
  • Direct Discharge from the Critical Care Resuscitation Unit: Results from a
           Longitudinal Assessment

    • Abstract: Background. The critical care resuscitation unit (CCRU) facilitates interhospital transfer (IHT) of critically ill patients for immediate interventions. Due to these patients’ acuity, it is uncommon for patients to be directly discharged home from this unit, but it does happen on occasion. Since there is no literature regarding outcomes of patients being discharged from a resuscitation unit, our study investigated these patients’ outcome at greater than 12 months after being discharged directly from the CCRU. Methods. We performed a retrospective cohort study of all adult patients directly discharged from the CCRU between January 01, 2017, and December 31, 2020. The primary outcome was number of ED visits or hospitalizations within 6 months. Secondary outcomes were number of ED visits or hospitalizations within 6, 12, and>12 months from CCRU discharge. Results. We analyzed 145 patients’ records. Mean age was 56 (standard deviation [SD] ± 19), with a majority being male (72%) and Caucasian (58%). The most common discharge destination was home (139 patients, 96% of total subjects) versus hospice (2%) or nursing facilities (2%). Most patients (55%) did not have any hospital revisits within the first 6 months of discharge, while 31% had 1-2 revisits, and 14% had ≥3 revisits. The most common discharge diagnoses were soft tissue infection (16.5%), aortic dissection (14%), and stroke (11%). Factors which were associated with a greater likelihood of any return hospital visit within 6 months receiving mechanical ventilation during CCRU stay (coefficient −2.23, 95% CI 0.01–0.87, ), while high hemoglobin on CCRU discharge was associated with no ED revisit (coeff. 0.42, 95% CI 1.15–2.06, ).Conclusions. Most patients who were discharged from the CCRU did not require any hospital revisits in the first 6 months. Requiring mechanical ventilation and having soft tissue infection were associated with high unplanned hospital revisits following discharge. Further research is needed to validate these findings.
      PubDate: Mon, 30 Oct 2023 08:20:00 +000
  • Comfort and Coordination among Interprofessional Care Providers Involved
           in Intubations in the Pediatric Intensive Care Unit

    • Abstract: Background. Successful execution of invasive procedures in acute care settings, including tracheal intubation, requires careful coordination of an interprofessional team. The stress inherent to the intensive care unit (ICU) environment may threaten the optimal communication and planning necessary for the safe execution of this complex procedure. The objective of this study is to characterize the perceptions of interprofessional team members surrounding tracheal intubations in the pediatric ICU (PICU). Methods. This is a single-center survey-based study of staff involved in the intubation of pediatric patients admitted to a tertiary level academic PICU. Physicians, nurses, and respiratory therapists (RT) involved in tracheal intubations were queried via standardized, discipline-specific electronic surveys regarding their involvement in procedural planning and overall awareness of and comfort with the intubation plan. Qualitative variables were assessed by both Likert scales and free-text comments that were grouped and analyzed thematically. Results. One hundred and eleven intubation encounters were included during the study time period, of which 93 (84%) had survey responses from at least 2 professional teams. Among those included in the analysis, the survey was completed 244 times by members of the PICU teams including 86 responses from physicians, 76 from nurses, and 82 from RTs. Survey response rates were>80% from each provider team. There were significant differences in interprofessional team comfort with nurses feeling less well informed and comfortable with the intubation plan and process compared to physicians and RTs ( 
      PubDate: Wed, 04 Oct 2023 12:50:00 +000
  • The Impact of Positive Fluid Balance on Sepsis Subtypes: A Causal
           Inference Study

    • Abstract: Introduction. Sepsis, the leading cause of death in hospitalized patients globally, was investigated in this study, examining the varying effects of positive fluid balance on sepsis subtypes through causal inference. Methods. In this study, data from the eICU database were utilized, extracting 35 features from sepsis patients. Fluid balance during ICU stay was the treatment, and ICU mortality was the primary outcome. Data preprocessing ensured linear assumptions for logistic regression. Binarized positive fluid balance with mortality was examined using DoWhy’s logistic regression, while continuous data were analyzed with random forest T-learner. ATE served as the primary metric. Results. Results revealed that septic patients with higher fluid balance had worse mortality outcomes, with an ATE of 0.042 (95% CI: (0.034, 0.047)) using logistic regression and an ATE of 0.0340 (95% CI: (0.028–0.040)) using T-learner. In the pulmonary sepsis subtype, higher mortality was associated with increased fluid balance, showing an ATE of 0.047 (95% CI: (0.037, 0.055)) using logistic regression and an ATE of 0.28 (95% CI: (0.22, 0.34)) with T-learner. Conversely, urinary sepsis patients had improved mortality with higher fluid balance, presenting an ATE of −0.135 (95% CI: (−0.024, −0.0035)) using logistic regression and an ATE of −0.28 (95% CI: (−0.34, −0.22)) with T-learner. Conclusion. Our research implies that fluid balance impact on ICU mortality differs among sepsis subtypes. Positive fluid balance raises mortality in sepsis and pulmonary sepsis but may protect against urinary sepsis. Further trials are needed to confirm these findings.
      PubDate: Tue, 03 Oct 2023 08:50:00 +000
  • Rate of Change of Rapid Shallow Breathing Index and Extubation Outcome in
           Mechanically Ventilated Patients

    • Abstract: Background. Rapid shallow breathing index (RSBI) has been widely used as a predictor of extubation outcome in mechanically ventilated patients. We hypothesize that the rate of change of RSBI between the beginning and end of a 120-minute spontaneous breathing trial (SBT) could be a better predictor of extubation outcome than a single RSBI measured at the end of SBT in mechanically ventilated patients. Methodology. In this prospective observational study, we enrolled 193 patients who met the inclusion criteria, of whom 33 patients were unable to tolerate a 120-minute SBT and were excluded from the study. The study population consisted of 160 patients, categorized into three subgroups: patients with normal lung (no reported history of respiratory diseases), patients with airway disease, and patients with parenchymal disease who completed 120 minutes of SBT on low levels of pressure support ventilation. RSBI was obtained from the ventilator display at the 5th and the 120th minutes of SBT. The rate of change of RSBI (RSBI 5–120) was calculated as (RSBI 2-RSBI 1)/RSBI 1 × 100. Receiver-operating characteristic (ROC) curves were plotted for RSBI 5–120 and RSBI 120 in all patients and among the three subgroups (normal group, airway group, and parenchymal group) to compare the superiority of their best thresholds in predicting extubation failure. Results. The RSBI 5–120 threshold for extubation failure in the entire patient group was 23% with an overall accuracy of 88% (AUC = 0.933, sensitivity = 91%, and specificity = 86%) and the threshold of RSBI 120 for extubation failure in the entire patient group was 70 breaths/min/L with an overall accuracy of 82% (AUC = 0.899, sensitivity = 85%, and specificity = 81%). In patients in the normal lung group, the threshold of RSBI 5–120 was 22%, with an overall accuracy of 89% (AUC = 0.892, sensitivity = 87.5%, and specificity = 90%), and the RSBI 120 threshold was 70 breaths/min/L, with an overall accuracy of 89% (AUC = 0.956, sensitivity = 88%, and specificity = 90%). The RSBI 5–120 threshold in patients with airway disease was 25% with an accuracy of 86% (AUC = 0.892, sensitivity = 85%, and specificity = 86%) and the threshold of RSBI 120 was 73 breaths/min/L with an accuracy of 83% (AUC = 0.874, sensitivity = 85%, and specificity = 82%). In patients in the parenchymal disease group, the threshold of RSBI 5–120 was 24%, with an accuracy of 90% (AUC = 0.966, sensitivity = 92%, and specificity = 89%) and RSBI 120 threshold was 71 breaths/min/L, which was 88% accurate (AUC = 0.893, sensitivity = 85%, and specificity = 89%). Conclusion. The rate of change of RSBI between the 5th and 120th minutes was moderately more accurate than the single value of RSBI measured at the 120th minute in predicting extubation outcome.
      PubDate: Tue, 26 Sep 2023 10:05:00 +000
  • Impact of Chronic Kidney Disease on Clinical Outcomes during
           Hospitalization and Five-Year Follow-Up after Coronary Artery Bypass

    • Abstract: Background. Chronic kidney disease (CKD) is often associated with multiple comorbidities including diabetes mellitus, and each has its own complications and impact after cardiac surgery including coronary revascularization. The objective of this work was to study the impact of CKD on clinical outcomes after coronary artery bypass grafting (CABG) and to compare outcomes in patients with different grades of renal functions. We retrospectively reviewed all patients who underwent CABG from January 2016 to August 2020 at our tertiary care hospital using electronic medical records. Results. The study included 410 patients with a median age of 60 years, and 28.6% of them had CKD and hospital mortality of 2.7%. About 71.4% of the patients had GFR > 60 mL/min per 1.73 m2, 18.1% had early CKD (GFR 30–60), 2.7% had late CKD (GFR 
      PubDate: Tue, 26 Sep 2023 06:35:00 +000
  • Value of Diaphragm Ultrasonography for Extubation: A Single-Blinded
           Randomized Clinical Trial

    • Abstract: Introduction. Daily evaluation of mechanically ventilated (MV) patients is essential for successful extubation. Proper withdrawal prevents complications and reduces the cost of hospitalization in the intensive care unit (ICU). Diaphragm ultrasonography (DUS) has emerged as a potential instrument for determining whether a patient is ready to be extubated. This study compared the efficacy rate of extubation using a standard withdrawal protocol and DUS in patients with MV. Methods. A randomized, parallel, single-blind, controlled study was conducted on ICU patients undergoing MV. Patients were randomly assigned to either the control (conventional weaning protocol) group or intervention (DUS-guided weaning) group in a 1 : 1 ratio. The primary outcome measure was the rate of reintubation and hospital mortality. Results. Forty patients were randomized to the trial. The mean age of the sample was 70 years, representing an older population. The extubation success rate was 90% in both groups. There was no reintubation in the first 48 hours and only two reintubations in both groups between the second and seventh days. The hospital mortality risk in patients with acute kidney injury was positively correlated with age and the need for hemodialysis. Discussion. This study demonstrates the usefulness of DUS measurement protocols for withdrawing MV. The rate of reintubation was low for both cessation methods. As a parameter, the diaphragm thickness fraction comprehensively evaluates the diaphragm function. The results demonstrate that DUS has the potential to serve as a noninvasive tool for guiding extubation decisions. In conclusion, using DUS in patients with respiratory failure revealed no difference in reintubation rates or mortality compared with the conventional method. Future research should concentrate on larger, multicentered, randomized trials employing a multimodal strategy that combines diaphragmatic parameters with traditional clinical withdrawal indices.
      PubDate: Tue, 19 Sep 2023 10:35:00 +000
  • Fungal Infections Are Not Associated with Increased Mortality in COVID-19
           Patients Admitted to Intensive Care Unit (ICU)

    • Abstract: Introduction. Fungal infection is a cause of increased morbidity and mortality in intensive care patients. Critically unwell patients are at increased risk of developing invasive fungal infections. COVID-19 patients in the intensive care unit (ICU) may be at a particularly high risk. The primary aim of this study was to establish the incidence of secondary fungal infections in patients admitted to the ICU with COVID-19. Secondary aims were to investigate factors that may contribute to an increased risk of fungal infections and to calculate the mortality between fungal and nonfungal groups. Methods. We undertook a retrospective observational study in a tertiary ICU in Wales, United Kingdom. 174 patients admitted with COVID-19 infection from March 2020 until May 2021 were included. Data were collected through a retrospective review of patient’s clinical notes and microbiology investigation results obtained from the online clinical portal. Results. 81/174 (47%) COVID-19 patients developed fungal infections, 93% of which were Candida species, including Candida albicans (88%), and 6% had an Aspergillus infection. Age and smoking history did not appear to be contributing factors. The nonfungal group had a significantly higher body mass index (33 ± 8 vs. 31 ± 7, ). The ICU length of stay (23 (1–116) vs. 8 (1–60), ), hospital length of stay (30 (3–183) vs. 15 (1–174) ± 7, ), steroid days (10 (1–116) vs. 4 (0–28), ), and ventilation days (18 (0–120) vs. 2 (0–55), ) were significantly higher in the fungal group. The mortality rate in both groups was similar (51% vs. 52%). The Kaplan–Meier survival analysis showed that the fungal group survived more than the nonfungal group (log rank (Mantel–Cox), ).Conclusion. Secondary fungal infections are common in COVID-19 patients admitted to the ICU. Longer treatment with corticosteroids, increased length of hospital and ICU stay, and greater length of mechanical ventilation significantly increase the risk of fungal infections. Fungal infection, however, was not associated with an increase in mortality.
      PubDate: Sat, 09 Sep 2023 06:35:00 +000
  • Early Tracheostomy May Reduce the Length of Hospital Stay

    • Abstract: Introduction. There is evidence that prolonged invasive mechanical ventilation has negative consequences for critically ill patients and that performing tracheostomy (TQT) could help to reduce these consequences. The ideal period for performing TQT is still not clear in the literature since few studies have compared clinical aspects between patients undergoing early or late TQT. Objective. To compare the mortality rate, length of stay in the intensive care unit, length of hospital stay, and number of days free of mechanical ventilation in patients undergoing TQT before or after ten days of orotracheal intubation. Methods. A retrospective cohort study carried out by collecting data from patients admitted to an intensive care unit between January 2008 and December 2017. Patients who underwent TQT were divided into an early TQT group (i.e., time to TQT ≤ 10 days) or late TQT (i.e., time to TQT > 10 days) and the clinical outcomes of the two groups were compared. Results. Patients in the early TQT group had a shorter ICU stay than the late TQT group (19 ± 16 vs. 32 ± 22 days, ), a shorter stay in the hospital (42 ± 32 vs. 52 ± 50 days, ), a shorter duration of mechanical ventilation (17 ± 14 vs. 30 ± 18 days, ), and a higher proportion of survivors in the ICU outcome (57% vs. 46%, ).Conclusion. Tracheostomy performed within 10 days of mechanical ventilation provides several benefits to the patient and should be considered by the multidisciplinary team as a part of their clinical practice.
      PubDate: Fri, 18 Aug 2023 06:50:00 +000
  • Change in Antimicrobial Therapy Based on Bronchoalveolar Lavage Data
           Improves Outcomes in ICU Patients with Suspected Pneumonia

    • Abstract: Flexible bronchoscopy (FB) is often performed in critically ill patients with suspected pneumonia. It is assumed that there will be an association with improved outcomes when bronchoalveolar lavage (BAL) data lead to a change in antimicrobial therapy. Methods. This study included a retrospective cohort of intensive care unit (ICU) patients who underwent FB for a diagnosis of suspected pneumonia. The study compared the outcome of patients in whom antimicrobial modification was carried out based on BAL reports versus those in whom it was not carried out. Cases where the procedure could not be completed or had incomplete records were excluded. The FB reports were accessed from the register maintained in the Department of Respiratory Medicine. The demographic details, clinical symptoms, laboratory investigations, and microbiological and radiology reports were recorded. Data on the antmicrobial therapy that the patients received during treatment and the outcome of the treatment were obtained from the case records and noted in the data collection form. Results. Data from a total of 150 patients admitted to the ICU, who underwent FB, were analyzed. The outcomes in the group where antimicrobial modification based on bronchoalveolar lavage (BAL) fluid reports was carried out versus the no-change group were as follows: expired 23, improved 82, unchanged 8 versus expired 12, improved 18, and unchanged 7 (); total duration of ICU stay 13.12 ± 10.61 versus 19.43 ± 13.4 days (); and duration from FB to discharge from ICU 6.33 ± 3.76 days versus 8.46 ± 5.99 (). The median total duration of ICU stay and clinical outcomes were significantly better in the nonintubated patients in whom BAL-directed antimicrobial modification was implemented. Distribution of microorganisms based on BAL reports was as follows: Acinetobacter baumanii 45 (30%), Klebsiella pneumoniae 37 (24.66%), Escherichia coli 9 (6%), and Pseudomonas aeruginosa 9 (6%). Conclusion. A change in antimicrobial therapy based on BAL data was associated with improved outcomes. The commonest bacterial isolate in the BAL fluid was Acinetobacter baumanii.
      PubDate: Mon, 14 Aug 2023 08:05:00 +000
  • Investigating the Utility of the SOFA Score and Creating a Modified SOFA
           Score for Predicting Mortality in the Intensive Care Units in a Tertiary
           Hospital in Jordan

    • Abstract: Background. The utility of the Sequential Organ Failure Assessment (SOFA) score in predicting mortality in the intensive care unit (ICU) has been demonstrated before, but serial testing in various settings is required to validate and improve the score. This study examined the utility of the SOFA score in predicting mortality in Jordanian ICU patients and aimed to find a modified score that required fewer laboratory tests. Methods. A prospective observational study was conducted at Jordan University Hospital (JUH). All adult patients admitted to JUH ICUs between June and December 2020 were included in the study. SOFA scores were measured daily during the whole ICU stay. A modified SOFA score (mSOFA) was constructed from the available laboratory, clinical, and demographic data. The performance of the SOFA, mSOFA, qSOFA, and SIRS in predicting ICU mortality was assessed using the area under the receiver operating characteristic curve (AUROC). Results. 194 patients were followed up. SOFA score (mean ± SD) at admission was significantly higher in non-survivors (7.5 ± 3.9) compared to survivors (2.4 ± 2.2) and performed the best in predicting ICU mortality (AUROC = 0.8756, 95% CI: 0.8117–0.9395) compared to qSOFA (AUROC = 0.746, 95% CI: 0.655–0.836) and SIRS (AUROC = 0.533, 95% CI: 0.425–0.641). The constructed mSOFA included points for the hepatic and CNS SOFA scores, in addition to one point each for the presence of chronic kidney disease or the use of breathing support; it performed as well as the SOFA score in this cohort or better than the SOFA score in a subgroup of patients with heart disease. Conclusion. SOFA score was a good predictor of mortality in a Jordanian ICU population and better than qSOFA, while SIRS could not predict mortality. Furthermore, the proposed mSOFA score which employed fewer laboratory tests could be used after validation from larger studies.
      PubDate: Mon, 07 Aug 2023 09:50:01 +000
  • Early Neuromuscular Electrical Stimulation Preserves Muscle Size and
           Quality and Maintains Systemic Levels of Signaling Mediators of Muscle
           Growth and Inflammation in Patients with Traumatic Brain Injury: A
           Randomized Clinical Trial

    • Abstract: Objective. To investigate the effects of an early neuromuscular electrical stimulation (NMES) protocol on muscle quality and size as well as signaling mediators of muscle growth and systemic inflammation in patients with traumatic brain injury (TBI). Design. Two-arm, single-blinded, parallel-group, randomized, controlled trial with a blinded assessment. Setting. Trauma intensive care unit at a university hospital. Participants. Forty consecutive patients on mechanical ventilation (MV) secondary to TBI were prospectively recruited within the first 24 hours following admission. Interventions. The intervention group (NMES; n = 20) received a daily session of NMES on the rectus femoris muscle for five consecutive days (55 min/each session). The control group (n = 20) received usual care. Main Outcome Measures. Muscle echogenicity and thickness were evaluated by ultrasonography. A daily blood sample was collected to assess circulating levels of insulin-like growth factor I (IGF-I), inflammatory cytokines, and matrix metalloproteinases (MMP). Results. Both groups were similar at baseline. A smaller change in muscle echogenicity and thickness (difference between Day 1 and Day 7) was found in the control group compared to the NMES group (29.9 ± 2.1 vs. 3.0 ± 1.2, ; −0.79 ± 0.12 vs. −0.01 ± 0.06, , respectively). Circulating levels of IGF-I, pro-inflammatory cytokines (IFN-y), and MMP were similar between groups. Conclusion. An early NMES protocol can preserve muscle size and quality and maintain systemic levels of signaling mediators of muscle growth and inflammation in patients with TBI. This trial is registered with under number RBR-2db.
      PubDate: Wed, 26 Jul 2023 11:35:00 +000
  • Developing a Preliminary Clinical Prediction Model for Prognosis of
           Pneumonia Complicated with Heart Failure Based on Metagenomic Sequencing

    • Abstract: Background. The predictive factors of prognosis in patients with pneumonia complicated with heart failure (HF) have not been fully investigated yet, especially with the use of next-generation sequencing (NGS) of metagenome. Methods. Patients diagnosed with pneumonia complicated with HF were collected and divided into control group and NGS group. Univariate and multivariate logistic regression and LASSO regression analysis were conducted to screen the predictive factors for the prognosis, followed by nomogram construction, ROC curve plot, and internal validation. Data analysis was conducted in SPSS and R software. Results. The NGS of metagenome detected more microbial species. Univariate and multivariate logistic regression and LASSO regression analysis revealed that Enterococcus (χ2 = 7.449,  = 0.006), Hb (Wals = 6.289,  = 0.012), and ProBNP (Wals = 4.037,  = 0.045) were screened out as potential predictive factors for the prognosis. Nomogram was constructed with these 3 parameters, and the performance of nomogram was checked in ROC curves (AUC = 0.772). The specificity and sensitivity of this model were calculated as 0.579 and 0.851, respectively, with the threshold of 0.630 in ROC curve. Further internal verification indicated that the predictive value of our constructed model was efficient. Conclusion. This study developed a preliminary clinical prediction model for the prognosis of pneumonia complicated with HF based on NGS of metagenome. More objects will be collected and tested to improve the predictive model in the near future.
      PubDate: Tue, 18 Jul 2023 07:05:01 +000
  • A Systematic Review and Meta-Analysis of Randomized Controlled Trials on
           Supine vs. Nonsupine Endotracheal Intubation

    • Abstract: Background. This systematic review and meta-analysis of randomized controlled trials (RCTs) was performed to compare the safety and efficacy of supine vs. nonsupine positions during intubation. Methods. Based on the literature from inception to October 2020, 13 studies with nonemergent intubation in supine and nonsupine positions were chosen using PRISMA and MOOSE protocols. Pooled estimates were calculated using random-effects models with 95% confidence interval (CI). The primary outcome was a successful intubation, attempt, and duration of intubation. The secondary outcome was adverse events (trauma and hypoxia). Bias was evaluated qualitatively, by visual analysis, and quantitatively through the Egger test. Results. The final analysis included 13 clinical trials with 1,916 patients. The pooled success rates in the supine vs. lateral positions were 99.21% and 98.82%. The supine vs. semierect positions were 99.21% and 98.82%. The 1st attempt success rate in the supine vs. lateral position was 85.35% and 88.56% compared to 91.38% and 90.76% for the supine vs. semierect position. The rate of total adverse events in the supine position was 3.73% vs. 6.74% in the lateral position, and the rate of total adverse events in the supine position was 0.44% vs. 0.93% in semierect position. Low to substantial heterogeneity was noted in our analysis. Discussion. There is no significant difference between total successful intubations and success from 1st intubation attempt between supine and nonsupine positions. However, there are slightly higher rates of adverse events in nonsupine position. Addition of more recent studies on supine vs. nonsupine intubations would improve this study. Given these findings, it is important to develop more studies regarding different intubation positions and techniques with the aim of improving efficacy and decreasing adverse outcomes. Other. This review is not registered in a public database. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
      PubDate: Thu, 06 Jul 2023 11:50:00 +000
  • Extracorporeal Membrane Oxygenation to Support COVID-19 Patients: A
           Propensity-Matched Cohort Study

    • Abstract: Background. In patients with severe respiratory failure from COVID-19, extracorporeal membrane oxygenation (ECMO) treatment can facilitate lung-protective ventilation and may improve outcome and survival if conventional therapy fails to assure adequate oxygenation and ventilation. We aimed to perform a confirmatory propensity-matched cohort study comparing the impact of ECMO and maximum invasive mechanical ventilation alone (MVA) on mortality and complications in severe COVID-19 pneumonia. Materials and Methods. All 295 consecutive adult patients with confirmed COVID-19 pneumonia admitted to the intensive care unit (ICU) from March 13th, 2020, to July 31st, 2021 were included. At admission, all patients were classified into 3 categories: (1) full code including the initiation of ECMO therapy (AAA code), (2) full code excluding ECMO (AA code), and (3) do-not-intubate (A code). For the 271 non-ECMO patients, match eligibility was determined for all patients with the AAA code treated with MVA. Propensity score matching was performed using a logistic regression model including the following variables: gender, P/F ratio, SOFA score at admission, and date of ICU admission. The primary endpoint was ICU mortality. Results. A total of 24 ECMO patients were propensity matched to an equal number of MVA patients. ICU mortality was significantly higher in the ECMO arm (45.8%) compared with the MVA cohort (16.67%) (OR 4.23 (1.11, 16.17); ). Three-month mortality was 50% with ECMO compared to 16.67% after MVA (OR 5.91 (1.55, 22.58); ). Applied peak inspiratory pressures (33.42 ± 8.52 vs. 24.74 ± 4.86 mmHg; ) and maximal PEEP levels (14.47 ± 3.22 vs. 13.52 ± 3.86 mmHg; ) were higher with MVA. ICU length of stay (LOS) and hospital LOS were comparable in both groups. Conclusion. ECMO therapy may be associated with an up to a three-fold increase in ICU mortality and 3-month mortality compared to MVA despite the facilitation of lung-protective ventilation settings in mechanically ventilated COVID-19 patients. We cannot confirm the positive results of the first propensity-matched cohort study on this topic. This trial is registered with NCT05158816.
      PubDate: Mon, 12 Jun 2023 06:20:01 +000
  • MRI and the Critical Care Patient: Clinical, Operational, and Financial

    • Abstract: Neuroimaging in conjunction with a neurologic examination has become a valuable resource for today’s intensive care unit (ICU) physicians. Imaging provides critical information during the assessment and ongoing neuromonitoring of patients for toxic-metabolic or structural injury of the brain. A patient’s condition can change rapidly, and interventions may require imaging. When making this determination, the benefit must be weighed against possible risks associated with intrahospital transport. The patient’s condition is assessed to decide if they are stable enough to leave the ICU for an extended period. Intrahospital transport risks include adverse events related to the physical nature of the transport, the change in the environment, or relocating equipment used to monitor the patient. Adverse events can be categorized as minor (e.g., clinical decompensation) or major (e.g., requiring immediate intervention) and may occur in preparation or during transport. Regardless of the type of event experienced, any intervention during transport impacts the patient and may lead to delayed treatment and disruption of critical care. This review summarizes the commentary on the current literature on the associated risks and provides insight into the costs as well as provider experiences. Approximately, one-third of patients who are transported from the ICU to an imaging suite may experience an adverse event. This creates an additional risk for extending a patient’s stay in the ICU. The delay in obtaining imaging can negatively impact the patient’s treatment plan and affect long-term outcomes as increased disability or mortality. Disruption of ICU therapy can decrease respiratory function after the patient returns from transport. Because of the complex care team needed for patient transport, the staff time alone can cost $200 or more. New technologies and advancements are needed to reduce patient risk and improve safety.
      PubDate: Tue, 06 Jun 2023 11:20:00 +000
  • Critical Care Nurses’ Adherence to Ethical Codes and Its Association
           with Spiritual Well-Being and Moral Sensitivity

    • Abstract: Background. Adherence to ethical codes is a major pillar of nursing care that is affected by various factors. Identifying these factors can lead to better ethical performance. The present study was conducted to determine critical care nurses’ adherence to ethical codes and its association with spiritual well-being (SWB) and moral sensitivity (MS). Methods. In this descriptive-correlational study, data were collected using the moral sensitivity questionnaire (MSQ) by Lützén et al., Paloutzian and Ellison’s spiritual well-being scale (SWBS), and the adherence to ethical codes questionnaire. The study was conducted on 298 nurses working in critical care units of hospitals affiliated with Shiraz University of Medical Sciences in southern Iran in 2019. This study was examined and approved by the Ethics Committee of Shiraz University of Medical Sciences. Results. The majority of the participants were female (76.2%) and single (60.1%), with a mean age of 30.69 ± 5.74 years. The mean scores of adherence to ethical codes, SWB, and MS were 64.06 (good), 91.94 (moderate), and 134.08 (moderate), respectively. Adherence to ethical codes had a positive correlation with the total score of SWB (,r = 0.25) and MS (,r = 0.27). A positive correlation was also observed between MS and SWB (,r = 0.41). Meanwhile, MS (β = 0.21) had a greater effect than SWB (β = 0.157) on adherence to ethical codes. Conclusion. Critical care nurses showed a good adherence to ethical codes. MS and SWB also positively affected their adherence to ethical codes. Nursing managers can use these findings to devise plans for the promotion of MS and SWB in nurses and thus help improve their ethical performance.
      PubDate: Mon, 08 May 2023 14:05:00 +000
  • In-ICU Outcomes of Critically Ill Patients in a Reference Cameroonian
           Intensive Care Unit: A Retrospective Cohort Study

    • Abstract: Introduction. Mortality rate amongst critically ill patients admitted to the intensive care unit (ICU) is disproportionately high in sub-Saharan African countries such as Cameroon. Identifying factors associated with higher in-ICU mortality guides more aggressive resuscitative measures to curb mortality, but the dearth of data on predictors of in-ICU mortality precludes this action. We aimed to determine predictors of in-ICU mortality in a major referral ICU in Cameroon. Methodology. This was a retrospective cohort study of all patients admitted to the ICU of Douala Laquintinie Hospital from 1st of March 2021 to 28th February 2022. We performed a multivariable analysis of sociodemographic, vital signs on admission, and other clinical and laboratory variables of patients discharged alive and dead from the ICU to control for confounding factors. Significance level was set at .Results. Overall, the in-ICU mortality rate was 59.4% out of 662 ICU admissions. Factors independently associated with in-ICU mortality were deep coma (aOR = 0.48 (0.23–0.96), 95% CI, ), and hypernatremia (>145 meq/L) (aOR = 0.39 (0.17–0.84) 95% CI, ).Conclusion. The in-ICU mortality rate in this major referral Cameroonian ICU is high. Six in 10 patients admitted to the ICU die. Patients were more likely to die if admitted with deep coma and high sodium levels in the blood.
      PubDate: Mon, 08 May 2023 13:35:01 +000
  • Impact of Quality Improvement Bundle on Compliance with Resuscitation
           Guidelines during In-Hospital Cardiac Arrest in Children

    • Abstract: Introduction. Various quality improvement (QI) interventions have been individually assessed for the quality of cardiopulmonary resuscitation (CPR). We aimed to assess the QI bundle (hands-on training and debriefing) for the quality of CPR in our children’s hospital. We hypothesized that the QI bundle improves the quality of CPR in hospitalized children. Methods. We initiated a QI bundle (hands-on training and debriefing) in August 2017. We conducted a before-after analysis comparing the CPR quality during July 2013–May 2017 (before) and January 2018–December 2020 (after). We collected data from the critical events logbook on CPR duration, chest compressions (CC) rate, ventilation rate (VR), the timing of first dose of epinephrine, blood pressure (BP), end-tidal CO2 (EtCO2), and vital signs monitoring during CPR. We performed univariate analysis and presented data as the median interquartile range (IQR) and in percentage as appropriate. Results. We compared data from 58 CPR events versus 41 CPR events before and after QI bundle implementation, respectively. The median (IQR) CPR duration for the pre- and post-QI bundle was 5 (1–13) minutes and 3 minutes (1.25–10), and the timing of the first dose of epinephrine was 2 (1-2) minutes and 2 minutes (1–5), respectively. We observed an improvement in compliance with the CC rate (100–120 per minute) from 72% events before versus 100% events after QI bundle implementation (). Similarly, there was a decrease in CC interruptions and hyperventilation rates from 100% to 50% () and 100% vs. 63% () events before vs. after QI bundle implementation, respectively. We also observed improvement in BP monitoring from 36% before versus 60% after QI bundle ().Conclusion. Our QI bundle (hands-on training and debriefing) was associated with improved compliance with high-quality CPR in children.
      PubDate: Thu, 09 Mar 2023 07:50:00 +000
  • Mechanical Power in Prone Position Intubated Patients with
           COVID-19-Related ARDS: A Cohort Study

    • Abstract: Background. Respiratory monitoring of mechanical ventilation (MV) is relevant and challenging in COVID-19. Mechanical power (MP) is a novel and promising monitoring tool in acute distress respiratory syndrome (ARDS), representing the amount of energy transferred from the ventilator to the patient. It encompasses several setting parameters and patient-dependent variables that could cause lung injury. MP can therefore be an additional tool in the assessment of these patients. Objective. This study aims to evaluate respiratory monitoring through MP and its relationship with mortality in patients with COVID-19-related ARDS (CARDS) under mechanical ventilation (MV) and prone position (PP) strategies. Methods. Retrospective, unicentric, and cohort studies. We included patients with CARDS under invasive MV and PP strategies. Information regarding MP, ventilation, and gas exchange was collected at 3 moments: (1) prior to the first PP, (2) during the first PP, and (3) during the last PP. We tested the relationship between MP and VR with in-hospital mortality. Results. We included 91 patients. There was a statistically significant difference in MP measurements between survivors and nonsurvivors only in the last prone position (). This is due to the significant increase in MP measurements in nonsurvivors (difference from the baseline: 3.63 J/min; 95% CI: 0.31 to 6.94), which was not observed in the group that survived (difference from the baseline: 0.02 J/min; 95% CI: −2.66 to 2.70). In multivariate analysis, MP () was associated with hospital death when corrected for confounder variables (SAPS 3 score, mechanical ventilation time, age, and number of prone sessions). Conclusions. MP is an independent predictor of mortality in PP patients with CARDS.
      PubDate: Wed, 01 Mar 2023 14:50:01 +000
  • Occurrence, Risk Factors, and Outcomes of Pulmonary Barotrauma in
           Critically Ill COVID-19 Patients: A Retrospective Cohort Study

    • Abstract: Objective. Pulmonary barotrauma has been frequently observed in patients with COVID-19 who present with acute hypoxemic respiratory failure. This study evaluated the prevalence, risk factors, and outcomes of barotrauma in patients with COVID-19 requiring ICU admission. Methods. This retrospective cohort study included patients with confirmed COVID-19 who were admitted to an adult ICU between March and December 2020. We compared patients who had barotrauma with those who did not. A multivariable logistic regression analysis was performed to determine the predictors of barotrauma and hospital mortality. Results. Of 481 patients in the study cohort, 49 (10.2%, 95% confidence interval: 7.6–13.2%) developed barotrauma on a median of 4 days after ICU admission. Barotrauma manifested as pneumothorax (N = 21), pneumomediastinum (N = 25), and subcutaneous emphysema (N = 25) with frequent overlap. Chronic comorbidities and inflammatory markers were similar in both patient groups. Barotrauma occurred in 4/132 patients (3.0%) who received noninvasive ventilation without intubation, and in 43/280 patients (15.4%) who received invasive mechanical ventilation. Invasive mechanical ventilation was the only risk factor for barotrauma (odds ratio: 14.558, 95% confidence interval: 1.833–115.601). Patients with barotrauma had higher hospital mortality (69.4% versus 37.0%; ) and longer duration of mechanical ventilation and ICU stay. Barotrauma was an independent predictor of hospital mortality (odds ratio: 2.784, 95% confidence interval: 1.310–5.918). Conclusions. Barotrauma was common in critical COVID-19, with invasive mechanical ventilation being the most prominent risk factor. Barotrauma was associated with poorer clinical outcomes and was an independent predictor of hospital mortality.
      PubDate: Wed, 22 Feb 2023 08:05:00 +000
  • Knowledge Regarding Mechanical Ventilation and Practice of Ventilatory
           Care among Nurses Working in Intensive Care Units in Selected Governmental
           Hospitals in Addis Ababa, Ethiopia: A Descriptive Cross-Sectional Study

    • Abstract: Introduction. Mechanical ventilation (MV) is a backbone and major supportive modality in intensive care units (ICUs) even though it has side effects and complications. Knowledge of nurses about mechanical ventilators and good practice of nursing care for the ventilated patient plays a crucial role in improving the effectiveness of mechanical ventilation, preventing harm, and optimizing the patient outcome. This study intended to assess the knowledge regarding MV and the practice of ventilator care among nurses working in the ICU. Method. A descriptive cross-sectional study design was conducted. All nurses working in the intensive care unit of selected governmental hospitals were included in the study. The data were collected from March 1 to 30, 2021 with structured and pretested self-administered questionnaires. The collected data were evaluated with SPSS version 26 software. The variables, which have an independent association with poor outcomes, were identified based on OR, with 95% CI and a value less than 0.05. Results. Of 146 nurses who participated in the study, 51.4% were males. About 71.4% had a BSc in nursing and 57.5% of them had training related to MV. More than half (51.4%) of nurses had poor knowledge regarding MV and the majority (58.9%) of them had poor practice in ventilatory care. The educational level (AOR, 5.1; 95% CI, 1.190–22.002) was positively associated with knowledge. Likewise, the educational level (AOR 5.0 (1.011–24.971)) and work experience (AOR 4.543 (1.430–14.435)) were positively associated with the practice of nurses. Conclusions. Knowledge regarding mechanical ventilators and the practice of ventilatory care among nurses in the selected public hospitals was poor. The educational levels were found statistically associated with both the knowledge and practice of nurses. To improve nursing care offered for MV patients, upgrading the educational level of intensive care nurses plays a vital role.
      PubDate: Mon, 13 Feb 2023 11:20:00 +000
  • Association of Lower Antispike Antibody Levels with Mortality in ICU
           Patients with COVID-19 Disease

    • Abstract: Background. Though vaccines have been reported as highly efficacious in preventing severe COVID-19 disease, there is emerging data of severe infections, albeit a small number, in vaccinated individuals. We have conducted a retrospective observational study to assess the clinical characteristics, immunological response, and disease outcomes among the vaccinated and unvaccinated patients admitted to the ICU with severe COVID-19 disease. Methods. Study Design and Participants. We conducted a retrospective observational study in COVID ICU of a tertiary care hospital. Data were collected from the month of 1 April 2021 to 31 November 2021. All adult patients admitted to the ICU having severe COVID-19 disease were included in the study. Data were collected from the medical records database which included demographics, a clinical course in the ICU, laboratory and radiological parameters, and disease outcomes. In a subset of patients, cell-mediated immunity and S1S2-neutralising antibody assessment was done. Results. A total of 419 patients with severe COVID-19 were included in the study. Of the 419 patients, 90 (21.5%) were vaccinated, and 329 (78.5%) were unvaccinated. There was a significantly higher mortality in unvaccinated severe COVID 19 patients as compared to vaccinated severe COVID patients (46.2% vs 34.4%; ). The neutralizing antibody titre was significantly higher in survivors as compared to nonsurvivors (2139.8, SE ± 713.3 vs 471, SE ± 154.4); .Conclusion. Our study suggests the association of lower neutralizing antibody levels with mortality in ICU patients admitted with COVID-19 breakthrough infections.
      PubDate: Tue, 31 Jan 2023 12:35:00 +000
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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