An overview of mechanical ventilation in the intensive care unit

Constructing a Nomogram Model to Estimate the Risk of Ventilator-Associated Pneumonia for Elderly Patients in the Intensive Care Unit

BACKGROUND

Ventilator-associated pneumonia (VAP) causes heavy losses in terms of finances, hospitalization, and death for elderly patients in the intensive care unit (ICU); however, the risk is difficult to evaluate due to a lack of reliable assessment tools. We aimed to create and validate a nomogram to estimate VAP risk to provide early intervention for high-risk patients.

METHODS

Between January 2016 and March 2021, 293 patients from a tertiary hospital in China were retrospectively reviewed as a training set. Another 84 patients were enrolled for model validation from April 2021 to February 2022. Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analysis were employed to select predictors, and a nomogram model was constructed. The calibration, discrimination, and clinical utility of the nomogram were verified. Finally, a web-based online scoring system was created to make the model more practical.

RESULTS

The predictors were hypoproteinemia, long-term combined antibiotic use, intubation time, length of mechanical ventilation, and tracheotomy/intubation. The area under the curve (AUC) was 0.937 and 0.925 in the training and validation dataset, respectively, suggesting the model exhibited effective discrimination. The calibration curve demonstrated high consistency with the observed result and the estimated values. Decision curve analysis (DCA) demonstrated that the nomogram was clinically applicable.

CONCLUSIONS

We have created a novel nomogram model that can be utilized to anticipate VAP risk in elderly ICU patients, which is helpful for healthcare professionals to detect patients at high risk early and adopt protective interventions.

Measuring the intensive care experience of intensive care unit patients: A cross-sectional study in western China

BACKGROUND

The negative experiences of intensive care unit (ICU) patients seriously affect their quality of life and survival outcomes. Thus, it is of great significance to evaluate the monitoring experience of ICU patients for the clinical improvement of their experiences and promote interventions.

OBJECTIVES

The objective of this study was to investigate patients' experiences of ICU and to understand the sources of patient experience and influencing factors.

METHODS

From November 2021 to September 2022, a cross-sectional survey was conducted with 600 inpatients from four grade A-III hospitals in western China. Data were collected using the Chinese version of the Intensive Care Experience Questionnaire.

RESULTS

585 valid questionnaires were collected, the response rate was 97.5%. ICU patients in western China scored below-the-average for their intensive care experience. Family monthly income, occupation types, medical payment method, type of ICU, ICU admission plan, ICU admission times, mechanical ventilation use, fertility status, analgesia, sedation, and Acute Physiology and Chronic Health Evaluation II scores are important factors influencing ICU patients' intensive care experience.

CONCLUSIONS

Medical staff need to pay attention to patient experience, improve the awareness of patient stressors and influencing factors, design nursing programs conducive to patient-positive experience, and promote interventions to further improve the long-term prognosis of patients. The results of this study can also be used as a set of nursing-sensitive indicators for evaluating nursing structure, process, and outcomes.

Determining respiratory rate using measured expiratory time constant: A prospective observational study

PURPOSE

Potential negative implications associated with high respiratory rate (RR) are intrinsic positive end-expiratory pressure (PEEPi) generation, cardiovascular depression and possibly ventilator induced lung injury. Despite these negative consequences, optimal RR remains largely unknown. We hypothesized that without consideration of dynamics of lung emptying (i.e., the expiratory time constant [RC_EXP]) clinician settings of RR may exceed the frequency needed for optimal lung emptying.

MATERIALS AND METHODS

This prospective multicenter observational study measured RC_EXP in 56 intensive care patients receiving pressure-controlled ventilation. We compared set RR to the one predicted with RC_EXP (RR_P). Also, the subgroup of patients with prolonged RC_EXP was analyzed.

RESULTS

Overall, the absolute mean difference between the set RR and RR_P was 2.8 bpm (95% CI: 2.3-3.2). Twenty-nine (52%) patients had prolonged RC_EXP (>0.8 s), mean difference between set RR and RR_P of 3.1 bpm (95% CI: 2.3-3.8; p < 0.0001) and significantly higher PEEPi compared to those with RC_EXP ≤ 0.8 s: 4.4 (95% CI: 3.6-5.2) versus 1.5 (95% CI: 0.9-2.0) cmH₂O respectively, p < 0.0001.

CONCLUSIONS

Use of RR_P based on measured RC_EXP revealed that the clinician-set RR exceeded that predicted by RC_EXP in the majority of patients. Measuring RC_EXP appears to be a useful variable for adjusting the RR during mandatory mechanical ventilation.

Factors influencing nurses' behavioral intention toward caring for COVID-19 patients on mechanical ventilation: A cross-sectional study

OBJECTIVES

To investigate nurses' behavioral intention toward caring for COVID-19 patients on mechanical ventilation, as well as the factors affecting their intention.

BACKGROUND

COVID-19 patients undergoing mechanical ventilation have many care needs and pose more challenges for nurses, which might adversely affect nurses' intention toward caring behavior.

METHODS

A cross-sectional study was conducted by using simple random sampling to recruit 598 nurses from five tertiary hospitals in Sichuan Province, China. The participants responded to an online questionnaire that included questions on demographic characteristics; the Attitude, Subjective Norms, and Behavioral Intention of Nurses toward Mechanically Ventilated Patients (ASIMP) questionnaire; the Nursing Professional Identity Scale (NPIS); and the Compassion Fatigue-Short Scale (CF-Short Scale). ANOVA, Spearman correlation analysis, and multiple linear regression were performed to analyze the data.

RESULTS

The mean total behavioral intention score was 179.46 (± 14.83) out of a total score of 189.00, which represented a high level of intention toward caring for patients on mechanical ventilation. Multiple linear regression revealed that subjective norms (β = 0.390, P<0.001), perceived behavioral control (β = 0.149, P<0.001), professional identity (β = 0.101, P = 0.009), and compassion fatigue (β = 0.088 P = 0.024) were significant predictors of nurses' behavioral intention.

CONCLUSIONS

Most nurses have a positive behavioral intention to care for COVID-19 patients undergoing mechanical ventilation. The findings in this study provide some insight for developing effective and tailored strategies to promote nurses' behavioral intention toward caring for ventilated patients under the pandemic situation.

GlasVent-The Rapidly Deployable Emergency Ventilator

As a result of the novel Coronavirus disease (COVID-19) outbreak, a surge is witnessed in the demand for mechanical ventilators needed for treating affected patients. With the rapidly virus spreading around the globe, the shortage of ventilators becomes a global challenge and numerus efforts are followed. While industry mobilizes toward producing medical grade equipment, a number of low-cost and less complex emergency ventilators have been developed, mainly through academic and open-source channels, with a hope to meet any temporary needs gap until medical grade ventilator provision becomes sufficient. Herein, the design and implementation of one such emergency ventilator called GlasVent is presented, which an automated version of manual resuscitator device, commonly known as big valve mask or artificial manual breathing unit bag and widely used prior to initiating the mechanical ventilation. GlasVent uses 3D printed mechanical parts, widely available materials and off-the-shelf electronic and sensing devices which can be fast assembled. Furthermore, it requires minimal training and can be operated manually by hands or legs, thus meeting the emergency requirements even in the low-resource settings or regions with less developed healthcare systems. Post-COVID-19, such ventilators can potentially find use in clinical care of a wider variety of patients with injury, pulmonary noncommunicable diseases, and severe asthma etc.

COVID-19 disease: invasive ventilation

This article focuses on the critical care nurse's role in the management of patients with COVID-19 who require invasive ventilation in order to improve outcomes and prevent complications. The nature of COVID-19 is such that many patients deteriorate rapidly and for members of this group requiring intubation and invasive ventilation, different approaches to airway management and ventilatory support are required. In order to reduce the risk of complications and an overview of invasive ventilation, including commonly used modes, potential complications, nursing care, weaning and extubation are all described. COVID-19 presents several challenges as the disease progresses, hypoxemia may worsen, and the patient can develop Acute Respiratory Distress Syndrome. Therefore, additional treatment strategies including the use of the prone position and the use of nitric oxide and prostacyclin nebulisers have been included. The strategies presented in this article are relevant to both critical care nurses and those re-deployed to intensive care units where nurses will inevitably be involved in the management of patients requiring invasive ventilation. Weaning these patients off invasive ventilation is multi-factorial and may be short or long term. A multi-disciplinary weaning plan, the principles, stages/phases, and speed of weaning with expected parameters prior extubation are explained. Planned and unplanned extubation with the serious complications of the latter as the patient may not be ready and may require emergency re-intubation resulting in setbacks should be avoided.

Incidence, Risk Factors, and Outcomes of Ventilator-Associated Pneumonia in Traumatic Brain Injury: A Meta-analysis

Ventilator-associated pneumonia (VAP) is one of the most severe complications in patients with traumatic brain injury (TBI) and is considered a risk factor for poor outcomes. However, the incidence of VAP among patients with TBI reported in studies varies widely. What is more, the risk factors and outcomes of VAP are controversial. This study estimates the incidence, risk factors, and outcomes of VAP in patients with TBI and provides evidence for prevention and treatment. PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched from the earliest records to May 2018. Data involving the incidence, risk factors, and outcomes were extracted for meta-analysis. The results showed that the incidence of VAP was 36% (95% confidence interval (CI) 31-41%); risk factors analyses showed that smoking [odds ratio (OR) 2.13; 95% CI 1.16-3.92], tracheostomy (OR 9.55; 95% CI 3.24-28.17), blood transfusion on admission (OR 2.54; 95% CI 1.24-5.18), barbiturate infusion (OR 3.52; 95% CI 1.68-7.40), injury severity score (OR 4.65; 95% CI 1.96-7.34), and head abbreviated injury scale (OR 2.99; 95% CI 1.66-5.37) were related to the occurrence of VAP. When patients developed VAP, mechanical ventilation time (OR 5.45; 95% CI 3.78-7.12), ICU length of stay (OR 6.85; 95% CI 4.90-8.79), and hospital length of stay (OR 10.92; 95% CI 9.12-12.72) were significantly increased. However, VAP was not associated with an increased risk of mortality (OR 1.28; 95% CI 0.74-2.21). VAP is common in patients with TBI. It is affected by a series of factors and has a poor prognosis.