Beyond the GCS: an integrative review of new tools for neurological assessment in the intensive care unit for adult patients

The Glasgow Coma Scale (GCS) is a widely used clinical tool for assessing impaired consciousness, but concerns arise when applied to intubated patients or those receiving analgesics, sedatives, and paralytics because verbal scores are not evaluable. Furthermore, the GCS does not differentiate the neurological status of the patient once intubated, resulting in poor reliability in neurological assessment, and clinical indicators that may reflect the severity of the coma are not included in the GCS. This study explores alternative tools for neurological assessment in Intensive Care Units (ICUs) when GCS is impractical. Conducting an integrative review of studies from 2018 to 2022, we identified seven relevant papers. Results indicate the FOUR score as a promising GCS alternative, particularly in cases where the GCS is unavailable. Automated pupillometry also demonstrated the potential for monitoring neurologically impaired ICU patients. These tools, independent of verbal responses and applicable to sedated patients, offer improved accuracy in assessing consciousness. The study emphasizes the importance of adopting such alternatives, and addressing GCS limitations, and highlights the need for further research and implementation to enhance patient care in ICU settings

‘INEFFECTIVE SPONTANEOUS VENTILATION (00033)’ NURSING DIAGNOSIS: A REVISION STUDY.

Background: Spontaneous ventilation, essential for human life, is addressed by the nursing diagnosis “Ineffective Spontaneous Ventilation” which requires strong scientific support. Aim: This revision study aimed to elevate this nursing diagnosis to a higher level of evidence by clarifying its definition, clinical indicators, and differentiation from other diagnoses. The diagnosis is crucial for identifying patients with compromised breathing who may require respiratory support. Methods: Researchers searched the PubMed medical literature database for studies (2006-2021) on the "Ineffective Spontaneous Ventilation" diagnosis. Results: The search identified 45 studies, but after applying pre-defined criteria, only 10 articles were included in the final analysis. These articles mainly focused on the accuracy of defining characteristics for the diagnosis. Despite limitations of individual defining characteristics, Impaired Spontaneous Ventilation remains a valuable nursing diagnosis for patients with respiratory issues. Utilizing clusters of these characteristics and considering the specific context can significantly enhance the accuracy of ISV diagnosis. Conclusion: The findings unequivocally corroborate the definition of Impaired Spontaneous Ventilation, with eight out of ten articles providing validation. Moreover, the analysis proposes additional defining characteristics, namely dyspnea and cyanosis, to further refine the diagnosis. The clinical applicability of Impaired Spontaneous Ventilation extends to a wide range of patient populations and conditions. It serves as a critical marker for premature infants grappling with respiratory and cardiac challenges, trauma victims battling life-threatening injuries, and patients relying on mechanical ventilation in intensive care settings

How to communicate with families living in complete isolation

The global emergency caused by the SARS-CoV-2 pandemic has suddenly changed how we communicate with families in all the CoViD19 care settings, on account of the need to maintain complete social isolation. Far-reaching mental suffering manifests itself in widespread anxiety. Health workers are isolated from their families, and must manage the consequences of this isolation just like the patients under their care. Patients and their families perceive not only the clinical results but also the personal attitudes, closeness and psychological support from the care teams. This perception of genuine participation by the health worker in the course of the treatment is especially important when a patient dies, and may influence the whole process of grief

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake