Impact of COVID-19 on nursing time in intensive care units in Belgium.

INTRODUCTION: The COVID-19 pandemic has had a significant impact on nursing practice in intensive care unit and consequently, on workload. OBJECTIVE: To assess the nurse-patient ratio required by COVID-19 patients and to identify the factors that influence nursing in this context. DESIGN: This study was a retrospective observational study that evaluated the ratio using the Nursing Activities Score (NAS). SETTING: Three Belgian French-speaking hospitals, including five ICUs. Patients included COVID-19 and non-COVID-19 patients. MEASUREMENTS AND MAIN RESULTS: The study included 95 COVID-19 patients and 1604 non-COVID-19 patients (control group) resulting in 905 and 5453 NAS measures, respectively. The NAS was significantly higher among the COVID-19 patients than in the control group (p = <0.0001). In the COVID-19 group, these higher scores were also observed per shift and uniformly across the three hospitals. COVID-19 patients required more time in the activities of monitoring and titration (χ2 = 457.60, p = <0.0001), mobilisation (χ2 = 161.21, p = <0.0001), and hygiene (χ2 = 557.77, p = <0.0001). Factors influencing nursing time measured by NAS in the COVID-19 patients were age <65 years old (p = 0.23), the use of continuous venovenous hemofiltration (p = 0.002), a high APACHE II score (p = 0.006) and patient death (p = 0.002). A COVID-19 diagnosis was independently associated with an increase in nursing time (OR = 4.8, 95% CI:3.6-6.4). CONCLUSIONS: Patients hospitalised in the ICU due to COVID-19 require significantly more nursing time and need an average ratio of almost 1:1.

Cardiogenic shock with resultant multiple organ dysfunction syndrome.

The prognosis for a patient with multiple organ dysfunction syndrome (MODS)-also known as organ dysfunction or organ failure-is grave, and mortality can be high when three or more organ systems fail. This article reviews ongoing abnormalities of organ-specific parameters and a bedside clinical scoring assessment tool to identify the mortality of MODS, focusing on the management of MODS resulting from cardiogenic shock in ICU patients who require support of failing organs to survive.

Nursing Management of Patients Requiring Acute Mechanical Circulatory Support Devices.

TOPIC: The growing use of acute mechanical circulatory support devices to provide hemodynamic support that has accompanied the increasing prevalence of heart failure and cardiogenic shock, despite significant improvement in the treatment of acute myocardial infarction. CLINICAL RELEVANCE: The critical care nurse plays a crucial role in managing patients receiving acute mechanical circulatory support devices and monitoring for potential complications. PURPOSE: To review the anatomical placement and mechanics of each type of device so that nurses can anticipate patients' hemodynamic responses and avoid complications whenever possible, thereby improving patients' clinical outcomes. CONTENT COVERED: Nursing considerations regarding the intra-aortic balloon pump, the TandemHeart, the Impella, and extracorporeal membrane oxygenation.

Percutaneous Biventricular Mechanical Heart Support in Cardiogenic Shock: A Nursing Case Report.

INTRODUCTION: Only a few cases of biventricular cardiogenic shock have been treated with Impella circulatory assist devices in the United States. CLINICAL FINDINGS: A 29-year-old man came to the emergency department because of cough, shortness of breath, fever, and chills. Initial assessment revealed hypotension; an elevated creatinine level of 2.1 mg/dL; and markedly elevated results on liver function tests, with alanine transaminase 5228 IU/L and aspartate aminotransferase 6200 IU/L. The patient's signs and symptoms met criteria for New York Heart Association class IV heart failure and associated poor prognosis for recovery. DIAGNOSIS: Echocardiography revealed dilated cardiomyopathy and biventricular failure with an ejection fraction of 15%. Results of an endomyocardial biopsy confirmed the diagnosis of myocarditis. INTERVENTIONS: After unsuccessful treatment with inotropes, biventricular support was started with an Impella CP device in the left ventricle and an Impella RP device in the pulmonary artery. OUTCOMES: The patient was maintained on support for 8 days and was discharged to home from the hospital after 27 days. Repeat echocardiography 90 days after discharge indicated improvement in ejection fraction to 40%. At follow-up 16 weeks after discharge, all signs and symptoms of heart failure had resolved. The patient has not had any inpatient readmissions to the hospital to date. CONCLUSION: This case presents an opportunity for analysis of care activities and role responsibilities of bedside nurses in caring for this patient. Discussion of this case expands the literature describing nursing activities associated with caring for patients with Impella devices.

Palliative Care Consultation in Cardiogenic Shock Requiring Short-Term Mechanical Circulatory Support: A Retrospective Cohort Study.

BACKGROUND: Little is known about palliative care consultation (PCC) for patients with cardiogenic shock requiring short-term mechanical circulatory support (STMCS). OBJECTIVE: To describe the utilization of PCC in this population. DESIGN: Retrospective cohort study in a university medical center intensive care unit (ICU). SETTING/PARTICIPANTS: In total, 195 patients aged >18 years with cardiogenic shock requiring STMCS were included. The cohort was divided into three categories: no PCC, early PCC (within seven days of STMCS), and late PCC (eight or more days after STMCS). Follow-up occurred during the index hospitalization. RESULTS: Mean age was 59.3 ± 13.9 years; 67.9% were men. Mean follow-up period was 33.8 ± 37.7 days. Overall inpatient mortality was 52.3%. Ninety-four patients (48.2%) received PCC; 49 (25.1%) and 45 (23.1%) received early and late PCCs, respectively. STMCS duration, ICU stay after STMCS, and hospital stay after STMCS were significantly shorter in the no PCC group than the early PCC group (4 vs. 12 days, p < 0.001; 11 vs. 19 days, p = 0.004; and 16 vs. 19 days, p = 0.031; respectively). ICU stay after STMCS and hospital stay after STMCS were significantly shorter in the early PCC group than the late PCC group (19 vs. 38 days, p < 0.001; 19 vs. 49 days, p < 0.001; respectively). However, time from initial PCC to discharge was not significantly different between early and late PCC groups (18 vs. 31 days, p = 0.13). CONCLUSIONS: PCC was utilized in almost half of patients with cardiogenic shock requiring STMCS. PCC tends to occur toward the end of life regardless of the duration of STMCS. The optimal PCC timing remained unclear.

Nursing home nurses conceptualize how to care for residents with cardiac vulnerability.

BACKGROUND: With ageing, older people face cardiovascular problems as the major cause of disability and death. Although immediate medical attention is a major factor in determining outcomes of cardiac problems, lack of personnel (i.e. registered nurse, certified nursing assistant and home care aide) in nursing homes without residing doctor limits the awareness of such problems, thus making it difficult to initiate timely and appropriate intervention. AIM: The aim of this study was to conceptualize critical care for nursing home residents with cardiac vulnerability and develop practical knowledge in nursing practice. METHODS: Conventional content analysis was performed on date from interviews with 30 nurses from 10 nursing homes in South Korea between July and November 2010. RESULTS: The analysis revealed three major cardiac problems resulting from residents' cardiac vulnerability: angina, myocardial infarction (MI) and cardiogenic shock. Through content analysis, we extracted 6 themes and 21 subthemes for nurses' conceptualization of critical care for nursing home residents with cardiac vulnerability. In nursing homes without a residing doctor, nurses assessed the physical, functional and cognitive conditions along with the responses and symptoms of residents when emergency situations related to the cardiac problems occurred. Moreover, with a lack of infrastructures of a hospital, nurses provided critical care to the elderly by using personal practice strategies based on their personal experience in facilities along with practical knowledge of nurses while following the management principles of emergencies. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE: We found that nurses conceptualized critical nursing care for cardiac problems at nursing homes, which are different from those of general hospitals. The results of this study will provide basis for the development of care guidelines and educational materials that can be used by novice nurses or nursing students.

Early presentation of very long chain acyl-CoA dehydrogenase deficiency: nursing action resulting in a positive outcome.

A clinical case of very long chain fatty acid acyl-CoA dehydrogenase (VLCAD) deficiency with cardiac manifestation, is presented. A 2-day old newborn, delivered after a normal pregnancy, birth, and immediate post-natal period, was transported from an outside hospital (OSH) with episodic wide complex tachycardia. In this case, the newborn screen returned suggesting VLCAD deficiency, positively redirecting treatment. An overview of VLCAD, one category of inborn error of metabolism (IEM), is presented. Additionally, the importance of newborn screening, the role of genetic testing, and nursing implications to improve outcomes, will also be discussed.

Physiology of continuous-flow pumps.

The use of mechanical pumps for circulatory support started in the mid-1950s. The evolution of these devices has led to the present-day use of continuous-flow pumps to take over the function of a patient's failing heart. The physiology associated with rotary blood pump use is quite different from normal cardiovascular physiology. Clinicians caring for patients who are supported by rotary blood pumps must have an understanding of the differences in physiology, monitoring methods, and unique complications associated with the use of these pumps.

Percutaneously implanted left ventricular assist device: establishing a program from implant to intensive care unit.

Cardiogenic shock is a critical disease process that claims lives every year. A new device on the market allows 2.5 L of cardiac output through the heart to assist in patient stabilization while attempting treatment options such as percutaneous coronary intervention to open closed coronary arteries.

Kinetic therapy reduces complications and shortens hospital stay in patients with cardiogenic shock - a retrospective analysis.

BACKGROUND: Kinetic therapy (KT) has been shown to reduce complications and to shorten hospital stay in trauma patients. Data in non-surgical patients are inconclusive, and kinetic therapy has not been tested in patients with cardiogenic shock. OBJECTIVE: The present analysis compares KT with standard care in patients with cardiogenic shock. METHODS: A retrospective analysis of 133 patients with cardiogenic shock admitted to 1 academic heart center was performed. Patients with standard care (SC, turning every 2 h by the staff) were compared with kinetic therapy (KT, using oscillating air-flotation beds). MEASUREMENTS AND MAIN RESULTS: 68 patients with KT were compared with 65 patients with SC. Length of ventilator therapy was 11 days in KT and 18 days in SC (p=0.048). The mortality was comparable in both groups. Pneumonia occurred in 14 patients in KT and 39 patients in SC (p<0.001); pressure ulcers were reduced by 50% (p<0.001). Length of ICU stay (21 days in SC and 13 days in KT, p=0.009) and length of hospital stay were reduced in the patients treated with kinetic therapy. CONCLUSION: The use of KT shortens hospital stay and reduces rates of pneumonia and pressure ulcers as compared to SC.

Complications associated with myocardial infarction.

The incidence of complications after acute myocardial infarction (MI) has been estimated to range from 14-95 per cent, with an overall one-month mortality of 30 per cent. Early treatment, as advocated by the National Service Framework for Heart Disease, has brought about some reduction in associated morbidity and mortality after MI. This article reviews the common complications associated with an acute MI, such as cardiogenic shock, pericarditis and heart failure. Nurses who are knowledgeable about potential complications should be able to detect early signs and symptoms, initiate emergency treatment, and prevent profound haemodynamic compromise occurring.

Choque cardiogénico / Cardiogenic shock

Es un sindrome producido por la incapacidad del corazon para funcionar como bomba y mantener un gasto cardiaco (GC) adecuado que cubra las demandas metabólicas del organismo,esto se traduce en un estado de insuficiencia circulatoria aguda con un aporte de oxigeno (DO2) deteriorado e hipoperfusion tisular que conducira a una disfuncion organica progresiva y finalmente a la muerte.(au)

Perianesthesia care of cardiac surgery patients: a CPAN review.

Postoperative nursing management of cardiac surgery patients is considered part of perianesthesia nursing core curriculum by ASPAN. In many hospitals, however, these patients bypass the PACU and are admitted directly to the ICU. For that reason, perianesthesia nurses who do not have cardiothoracic surgical ICU experience need information related to the immediate postoperative routine and nursing care regimen of cardiac surgery patients. Bleeding, cardiac tamponade, low cardiac output syndrome, and dysrhythmias are postoperative complications that are discussed. A brief overview of postoperative nursing management and several "nursing pearls of wisdom" are also presented.

How to respond to shock.

This article describes three common types of shock-hypovolemic, septic, and cardiogenic-and how to recognize and respond appropriately. Shock has many causes, but the underlying disease process is the same, and prompt, aggressive intervention is the key to improved patient outcomes.