Acute and Critical Care

Review Article

Nursing
Promoting patient safety in critically ill patients: nursing interventions in surveillance and prevention of ocular injuries: Anabela Carvalho Raposo, Maria Candida Durao, Maria do Rosário Pinto, Helga Rafael Henriques, Joana Ferreira Teixeira; Received November 19, 2023 Accepted November 16, 2024 Published online February 12, 2025; DOI: https://doi.org/10.4266/acc.005014 [Epub ahead of print]

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Abstract PDF: Corneal surface injuries occur frequently (59.4%) in critically ill patients, and the average time for their appearance is eight days. Such injuries are primarily related to dry eye, which increases the risk of exposure injury in patients admitted to intensive care units. This can result in a severe ulcer or perforation that results in partial to total loss of vision, decreasing the quality of the patient's life. This is a sensitive nursing care area requiring further investigation. Thus, this review aims to analyse nursing interventions that aim to prevent ocular surface injuries. An integrative literature review was carried out from May to August 2023 in the Medline, CINAHL, Scopus, Web of Science, and PubMed databases using the Whittemore and Knafl methodology. Inclusion and exclusion criteria were subsequently applied to assess the results. After verifying result eligibility, seven documents were identified for data extraction and analysis. The results suggest the importance of recognizing risk factors for ocular injuries in critically ill patients, surveillance as a nursing competency, adequate ocular hygiene and effective lubrication, and managing environmental conditions to prevent corneal injuries. Implementing surveillance and intervention protocols for critically ill patients at risk of corneal injuries requires specialised training for critical care nurses. Specifically, environmental management, including temperature and humidity control, is highlighted as an area that merits further research.

Original Articles

Epidemiology
Red blood cell transfusion for critically ill patients admitted through the emergency department in South Korea: Tae Sung Kim, Yongil Cho, Hyuk Joong Choi, Joonbum Park, Wonhee Kim, Chiwon Ahn, Joon Young Kim; Acute Crit Care. 2024;39(4):517-525. Published online November 5, 2024; DOI: https://doi.org/10.4266/acc.2024.00577

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Abstract PDF: Background
Red blood cells (RBCs) are a limited resource, and the adverse effects of transfusion must be considered. Multiple randomized controlled trials on transfusion thresholds have been conducted, leading to the establishment of a restrictive transfusion strategy. This study aimed to investigate the status of RBC transfusions in critically ill patients.
Methods
This cohort study was conducted at five university hospitals in South Korea. From December 18, 2022, to November 30, 2023, 307 nontraumatic, anemic patients admitted to intensive care units through the emergency departments were enrolled. We determined whether patients received RBC transfusion, transfusion triggers, and the clinical results.
Results
Of the 154 patients who received RBC transfusions, 71 (46.1%) had a hemoglobin level of 7 or higher. Triggers other than hemoglobin level included increased lactate levels in 75 patients (48.7%), tachycardia in 47 patients (30.5%), and hypotension in 46 patients (29.9%). The 28-day mortality rate was not significantly reduced in the group that received transfusions compared to the non-transfusion group (21.4% vs. 26.8%, P=0.288). There was no difference in the intensive care unit and hospital length of stay or the proportion of survival to discharge between the two groups. The prognosis showed the same pattern in various subgroups.
Conclusions
Despite the large number of RBC transfusions used in contradiction to the restrictive strategy, there was no notable difference in the prognosis of critically ill patients. To minimize unnecessary RBC transfusions, the promotion of transfusion guidelines and research on transfusion criteria that reflect individual patient conditions are required.

Clinical Significance of Postoperative Prealbumin and Albumin Levels in Critically Ill Patients who Underwent Emergency Surgery for Acute Peritonitis: Seung Hwan Lee, Ji Young Jang, Jae Gil Lee; Korean J Crit Care Med. 2013;28(4):247-254.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.247

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Abstract PDF

BACKGROUND
Many studies have shown that serum albumin and prealbumin levels correlate with patient outcomes in critically ill patients. The purpose of this study was to evaluate the clinical significance of prealbumin and albumin levels in patients in the intensive care unit (ICU) after emergency surgery for acute peritonitis.
METHODS
We examined serum albumin and prealbumin as markers for the prediction of patient outcome in 51 patients admitted to the ICU after emergency surgery from January to December in 2012. Biochemical parameters were measured postoperatively. Serum albumin and prealbumin levels were compared between survivors and non-survivors. Patients were also divided according to the occurrence of shock and pulmonary complications (shock group vs. non-shock group, pulmonary complications group vs. non-pulmonary complications group), and outcome analysis was performed for age, American Society of Anesthesiologists (ASA) score, length of ICU stay (IS), length of hospital stay (HS), mechanical ventilation, and APACHE II score. Serum albumin and prealbumin levels were evaluated for any correlation with complications and mortality.
RESULTS
In patients with shock, prealbumin and albumin were significantly decreased (p = 0.047, p = 0.036). Additionally, albumin was significantly decreased in patients with pulmonary complications. Neither albumin nor prealbumin, however, showed a correlation with mortality. Prealbumin showed a correlation with serum albumin, CRP level, and HS (r = 0.511, p < 0.001; r = -0.438, p = 0.002; and r = -0.45, p = 0.001, respectively). Albumin showed a correlation with HS, IS, and APACHE II score (r = -0.404, p = 0.003; r = -0.424, p = 0.002; and r = -0.40, p = 0.006, respectively).
CONCLUSIONS
The initial prealbumin level measured upon admission to the ICU after gastrointestinal emergency surgery can be useful predictor of shock. The initial albumin level was significantly low in patients with shock and pulmonary complications. However, neither prealbumin nor albumin showed a correlation with mortality. Our study also showed that albumin and prealbumin levels are affected by other factors, such as massive hydration and severe inflammation, as reported in previous studies.

Citations

Citations to this article as recorded by

Perioperative risk factors for in-hospital mortality after emergency gastrointestinal surgery
Jin Young Lee, Seung Hwan Lee, Myung Jae Jung, Jae Gil Lee
Medicine.2016; 95(35): e4530. CrossRef

Healthcare Professional's Knowledge, Perception and Performance on Early Enteral Nutrition for Critically Ill Patients: Sun Hee Yun, Sun Jung Kim, Eui Geum Oh; Korean J Crit Care Med. 2012;27(1):36-44.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.36

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Abstract PDF

BACKGROUND
Proper nutritional supplement is one of the fundamental management domains for critical ill patients. While it shows positive effect on processing and prognosis of critical ill patients, early enteral nutrition is overlooked. This study explored healthcare professional's level of knowledge perception and performance on early enteral nutrition for critically ill patients. Data was collected from a convenient sample of 319 registered doctors, nurses and nutritionists in ICU at seven university hospitals.
METHODS
A cross-sectional survey design was used. The participants were assessed by questionnaires, specifically designed for the study and verified for the content validity by professional reviewers related with critical ill patients.
RESULTS
While the level of the perception of early enteral nutrition is high, the level of knowledge and performance are relatively low. The nurses showed a statistically significant difference on the level of knowledge, by their educational backgrounds and clinical experiences. Regarding the hospital support system, the doctors showed a significant difference on the level of perception and performance, while the nurses only showed that difference on the level of performance. It was shown that with higher the level of knowledge regarding the early enteral nutrition, the higher the level of performance. Further, the higher the level of perception, the higher the level of performance was observed. The hospital support system and the perception of the healthcare professionals are two most influential factors to affect the performance of the healthcare professionals related with the early enteral nutrition for the critically ill patients.
CONCLUSION
To perform the proper early enteral nutrition, the hospital support system and the level of the healthcare professionals' perception, are two most important factors. Therefore, the efforts to build the hospital support system along with the educational provisions are needed.

Citations

Citations to this article as recorded by

Effects of a video-based enteral nutrition education program using QR codes for intensive care unit nurses: a quasi-experimental study
Won Kee Seo, Hyunjung Kim
Journal of Korean Biological Nursing Science.2024; 26(1): 16. CrossRef
Critical Care Nurses’ Perceptions of Enteral Nutrition: A Descriptive Cross-Sectional Study
Khaled Mohammed Al-Sayaghi, Talal Ali Hussein Saad Alqalah, Sameer Abdulmalik Alkubati, Gamil Ghaleb Alrubaiee, Sultan Abdulwadoud Alshoabi, Masouda Hassan Atrous, Farida Khalil Ibrahim Mohamed, Kamal Dahan Alsultan, Awadia Greeballah Suliman, Moawia Bush
The Open Nursing Journal.2022;[Epub] CrossRef
Factors Influencing the Occurrence of Diarrhea in Patients Admitted to Intensive Care Units
Hanna Lee, Rhayun Song
Journal of Korean Academy of Fundamentals of Nursing.2019; 26(4): 221. CrossRef
Critical Care Nurses’ Perception, Knowledge, and Practices of Enteral Nutrition
Hyunjung Kim, Eunjin Soun
Journal of Korean Academy of Fundamentals of Nursing.2016; 23(4): 383. CrossRef
Nutritional Assessment of ICU Inpatients with Tube Feeding
Yu-Jin Kim, Jung-Sook Seo
Journal of the Korean Dietetic Association.2015; 21(1): 11. CrossRef
Nutritional Support, Gastric Residual Volume and Nutritional Status during Enteral Nutrition in Intensive Care Unit Patients
Minju Lee, Jiyeon Kang
Korean Journal of Adult Nursing.2014; 26(6): 621. CrossRef

Energy Deficiency Aggravates Clinical Outcomes of Critically Ill Patients: Hye Kyung Chung, Song Mi Lee, Jae Hoon Lee, Cheung Soo Shin; Korean J Crit Care Med. 2005;20(1):49-53.

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Abstract PDF: BACKGROUND
Adequate nutrition support reduces infectious complications, mortality and length of hospitalizationin intensive care unit. However, there are multi factors like frequent null per os (NPO) due to examination, intolerance to tube feeding, complication of TPN (total parenteral nutrition) and ineffective recognition by medical staff. The purpose of this study is to identify detrimental effects of cumulative energy deficiency in critically ill patients.
METHODS
The patients who were received tube feeding or total parenteral nutrition for more than 5 days were investigated. Daily and cumulative energy deficiency was tabulated until oral intake was achieved or until they discharged or died. Patients were divided into two groups, severe energy deficient group (>10, 000 kcal) or mild energy deficient group (<5, 000 kcal). Then we compared clinical outcomes between two groups. RESULTS: Total 150 patients were studied. 48 (32%) patients were severe energy deficient group and 42 (28%) patients were mild energy deficient group. Mortality and nosocomial infection were significantly higher in severe energy deficient group than in mild group. Hospital day and ICU day were significantly higher in severe energy deficient group than in mild group. CONCLUSIONS: Severe energy deficiency was very common in critically ill patients and it deteriorated the clinical outcomes such as mortality, nosocomial infection, hospital day and ICU day.

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