Nursing Activities Score and Acute Kidney Injury

Nursing workload assessment in an intensive care unit: A retrospective observational study using the Nursing Activities Score

BACKGROUND

Nursing Activities Score (NAS) is a promising tool for calculating the nursing workload in intensive care units (ICU). However, data on intensive care nursing activities in Portugal are practically non-existent.

AIM

To assess the nursing workload in a Portuguese ICU using the NAS.

STUDY DESIGN

Retrospective cohort study developed throughout the analysis of the electronic health record database from 56 adult patients admitted to a six-bed Portuguese ICU between 1 June-31 August 2020. The nursing workload was assessed by the Portuguese version of the NAS. The study was approved by the Hospital Council Board and Ethics Committee. The study report followed the STROBE guidelines.

RESULTS

The average occupancy rate was 73.55% (±16.60%). The average nursing workload per participant was 67.52 (±10.91) points. There was a correlation between the occupancy rate and the nursing workload. In 35.78% of the days, the nursing workload was higher than the available human resources, overloading nurse staffing/team.

CONCLUSIONS

The nursing workload reported follows the trend of the international studies and the results reinforce the importance of adjusting the nursing staffing to the complexity of nursing care in this ICU. This study highlighted periods of nursing workload that could compromise patient safety.

RELEVANCE TO CLINICAL PRACTICE

This was one of the first studies carried out with the NAS after its cross-cultural adaptation and validation for the Portuguese population. The nursing workload at the patient level was higher in the first 24 h of ICU stays. Because of the 'administrative and management activities' related to the 'patient discharge procedures', the last 24 h of ICU stays also presented high levels of nursing workload. The implementation of a nurse-to-patient ratio of 1:1 may contribute to safer nurse staffing and to improve patient safety in this Tertiary (level 3) ICU.

Factors associated with acute kidney injury in patients undergoing extracorporeal membrane oxygenation: retrospective cohort

OBJECTIVE

To identify factors associated with acute kidney injury in patients undergoing extracorporeal membrane oxygenation.

METHOD

Retrospective cohort study conducted in an adult Intensive Care Unit with patients undergoing extracorporeal membrane oxygenation from 2012 to 2021. The research used the Kidney Disease Improving Global Outcomes as criteria for definition and classification of acute kidney injury. A multiple logistic regression model was developed to analyze the associated factors.

RESULTS

The sample was composed of 122 individuals, of these, 98 developed acute kidney injury (80.3%). In multiple regression, the associated factors found were vasopressin use, Nursing Activities Score, and glomerular filtration rate.

CONCLUSION

The use of vasopressin, the Nursing Activities Score, and the glomerular filtration rate were considered as factors related to the development of acute kidney injury in patients undergoing extracorporeal membrane oxygenation.

Prevalence and factors associated with acute kidney injury in patients in intensive care units

OBJECTIVES

to identify the prevalence and factors associated with the development of acute kidney injury in critically ill patients.

METHODS

a cross-sectional study, conducted from June 2018 to August 2019. The Kidney Disease Improving Global Outcomes was used to classify acute kidney injury. A significant value was set at p<0.05.

RESULTS

a total of 212 patients were included, of whom 35.8% evolved into an acute kidney injury. Patients with acute kidney injury had hypertension, higher levels on severity scores and a higher baseline creatinine rate> 1.5 mg/dL, also, when applied logistic regression, were 7 times more likely to develop acute kidney injury, Odds Ratio 7.018. More than half (56.6%) of the patients with acute kidney injury died. Moreover, 26.7% of these patients developed pressure sore.

CONCLUSIONS

the prevalence of kidney injury was high (35.8%). The patients who developed it had a higher severity, mortality, and pressure sore index.

Fluid Overload and Risk of Mortality in Critically Ill Patients

BACKGROUND

Fluid overload (FO) is a condition present in critical care units, and it is associated with clinical complications and worse outcomes for severe patients.

OBJECTIVE

The aim of this study was to verify if FO is a risk factor for mortality in critically ill patients.

METHODS

Retrospective study performed in a Brazilian intensive care unit, from January to March 2016, with patients older than 18 years and hospitalized for more than 24 hours. Demographic and clinical data, as well as fluid balance and overload, were analyzed to verify the risk factors for mortality. A logistic regression model was elaborated, and significance was set at P < .05.

RESULTS

There were 158 patients included, of which only 13 (8.2%) presented FO. Mortality was verified in individuals 30 (18.9%), of whom only 7 (23.3%) developed FO, which was lower in survivors 6 (4.9%), P = .001. In the simple regression model, the FO was significant (odds ratio [OR], 6.23; 95% confidence interval [CI], 2.04-19.53), P = .001. However, in the multiple regression model, there were significant findings only for mechanical ventilation (OR, 5.86; 95% CI, 2.10-18.12, P = .001), acute kidney injury (OR, 4.05; 95% CI, 1.53-11; P = .001), and noradrenaline (OR, 3.85; 95% CI, 1.01-9.51; P = .041); FO was not significant (OR, 3.68; 95% CI, 0.91-15.55; P = .069).

CONCLUSION

Fluid overload is higher in patients who died. Therefore, it was not considered a risk factor for mortality.

Sepsis-induced acute kidney injury: kidney protection effects by antioxidants

ABSTRACT Objective: To evaluate the antioxidant action of N-acetylcysteine and diosmin-hesperidin in an experimental model of sepsis-induced acute kidney injury in rats. Methods: The study used 20 Wistar adult male rats divided into the following groups: control (laparotomy with no induction of abdominal sepsis), sepsis (experimental model of sepsis with cecal ligation and puncture), N-acetylcysteine + sepsis and diosmin-hesperidin + sepsis. The evaluation contemplated physiological parameters (temperature, glycemia, and average blood pressure), kidney function (creatinine clearance), oxidative stress (urinary peroxides) and kidney histology. Results: The animals submitted to cecal ligation and puncture (sepsis) presented lower body temperature, lower average blood pressure, reduced creatinine clearance and increased urinary hydrogen peroxide levels. Treatment with diosmin-hesperidin improved kidney function and led to a reduction in the excretion of oxidative metabolites. Conclusion: The present study highlighted the protective antioxidant action of diosmin-hesperidin in the experimental model of sepsis-induced acute kidney injury.