Development and Evaluation of a Web-Based Application for Trauma Nursing Documentation in Thailand: A Feasibility Study.

BACKGROUND: Electronic nursing documentation has advantages for monitoring and improving the quality of trauma nursing documentation. However, electronic nursing documentation has rarely been implemented in Thailand. OBJECTIVES: This study aimed to assess the feasibility and nursing satisfaction of a web-based trauma nursing documentation application. METHODS: A descriptive cross-sectional survey design was used to assess the feasibility and nursing satisfaction with a web-based trauma nursing documentation application. The application was based on literature review, Advanced Trauma Life Support principles, and the North American Nursing Diagnosis Association. The survey was administered to trauma and emergency department registered nurses in a hospital in Thailand from November 2021 to January 2022. Patient data were also extracted from the web application system for analysis. RESULTS: A total of 59 nurses piloted the web-based application on 79 trauma patients. Of 59 nurses, 45 (76.3%) were female, 44 (74.6%) had worked in the emergency department for more than 5 years, and 49 (83.1%) had no prior experience with using web-based applications. The nurses were satisfied with the application (M = 3.51, SD = 0.62), and they suggested that it was feasible to apply in practice (M = 3.46, SD = 0.79). CONCLUSION: These preliminary data demonstrate that implementing a web-based application for trauma nursing documentation in the emergency department is feasible and satisfactory to nurses.

Extracorporeal cardiopulmonary resuscitation in a woman with twin pregnancy.

INTRODUCTION: Maternal cardiac arrest is a rare condition. Cardiopulmonary resuscitation (CPR) in pregnancy is different from that in other populations due to physiological changes in patients. Extracorporeal cardiopulmonary resuscitation (ECPR) is recommended in patients having cardiac arrest with potentially reversible etiologies. However, data regarding ECPR in pregnancy are limited. CASE SUMMARY: A 24-year-old woman with a 33-week twin pregnancy developed witnessed cardiac arrest in an antenatal clinic. She underwent perimortem cesarean delivery (PMCD) and ECPR, but uterine atony with massive bleeding occurred. Emergency hysterectomy and massive blood transfusion were performed in the emergency department and the patient was transferred to the intensive care unit after hemodynamics was stable. CONCLUSION: Cardiac arrest in pregnancy is a complex condition. Several aspects of management have not been evaluated. Prospective studies for improving the outcomes are needed.

High-flow nasal oxygen cannula vs. noninvasive mechanical ventilation to prevent reintubation in sepsis: a randomized controlled trial.

BACKGROUND: High-flow nasal oxygen cannula (HFNC) and noninvasive mechanical ventilation (NIV) can prevent reintubation in critically ill patients. However, their efficacy in post-extubated sepsis patients remains unclear. The objective of this study was to compare the efficacy of HFNC vs. NIV to prevent reintubation in post-extubated sepsis patients. METHODS: We conducted a single-centre, prospective, open-labelled, randomised controlled trial at the medical intensive care unit of Siriraj Hospital, Mahidol University, Bangkok, Thailand. Sepsis patients who had been intubated, recovered, and passed the spontaneous breathing trial were enrolled and randomly assigned in a 1:1 ratio to receive either HFNC or NIV support immediately after extubation. The primary outcome was rate of reintubation at 72 h after extubation. RESULTS: Between 1st October 2017 and 31st October 2019, 222 patients were enrolled and 112 were assigned to the HFNC group and 110 to the NIV group. Both groups were well matched in baseline characteristics. The median [IQR] age of the HFNC group was 66 [50-77] vs. 65.5 [54-77] years in the NIV group. The most common causes of intubation at admission were shock-related respiratory failure (57.1% vs. 55.5%) and acute hypoxic respiratory failure (34.8% vs. 40.9%) in the HFNC and NIV groups, respectively. The duration of mechanical ventilation before extubation was 5 [3-8] days in the HFNC group vs. 5 [3-9] days in the NIV group. There was no statistically significant difference in the primary outcome: 20/112 (17.9%) in the HFNC group required reintubation at 72 h compared to 20/110 (18.2%) in the NIV group [relative risk (RR) 0.99: 95% confidence interval (CI) (0.70-1.39); P = 0.95]. The 28-day mortality was not different: 8/112 (7.1%) with HFNC vs. 10/110 (9.1%) with NIV (RR 0.88: 95% CI (0.57-1.37); P = 0.59). CONCLUSIONS: Among sepsis patients, there was no difference between HFNC and NIV in the prevention of reintubation at 72 h after extubation. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT03246893; Registered 11 August 2017; https://clinicaltrials.gov/ct2/show/NCT03246893?term=surat+tongyoo&draw=2&rank=3.