Critical Care Research and Practice
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Submission to final decision129 days
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CiteScore2.600
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dCROX and ROX Indices Predict Clinical Outcomes in Patients with COVID-19 Pneumonia Treated with High-Flow Nasal Cannula Oxygen Therapy

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Critical Care Research and Practice publishes articles related to anesthesiology, perioperative and critical care medicine, and the integration of intraoperative management in preparation for postoperative critical care management.

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Chief Editor, Dr Thomas J. Esposito, works in the Division of Trauma Surgical Critical Care and Burns at Loyola University Stritch School of Medicine, USA.

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Research Article

The Association of the Pulmonary Artery Pulsatility Index and Right Ventricular Function after Cardiac Surgery

Background. The pulmonary artery pulsatility index (PAPi) has been shown to correlate with right ventricular (RV) failure in patients with cardiac disease. However, the association of PAPi with right ventricular function following cardiac surgery is not yet established. Methods. PAPi and other hemodynamic variables were obtained postoperatively for 959 adult patients undergoing cardiac surgery. The association of post-bypass right ventricular function and other clinical factors to PAPi was evaluated using linear regression. A propensity-score matched cohort for PAPi ≥ 2.00 was used to assess the association of PAPi with postoperative outcomes. Results. 156 patients (16.3%) had post-bypass right ventricular dysfunction defined by visualization on transesophageal echocardiography. There was no difference in postoperative PAPi based on right ventricular function (2.12 vs. 2.00, ). In our matched cohort (n = 636), PAPi < 2.00 was associated with increased incidence of acute kidney injury (23.0% vs 13.2%, ) and ventilator time (6.0 hours vs 5.6 hours, ) but not with 30-day mortality or intensive care unit length of stay. Conclusion. In a general cohort of patients undergoing cardiac surgery, postoperative PAPi was not associated with postcardiopulmonary bypass right ventricular dysfunction. A postoperative PAPi < 2 may be associated with acute kidney injury.

Research Article

Plasma KL-6 as a Potential Biomarker for Bronchopulmonary Dysplasia in Preterm Infants

Background. KL-6 is a biomarker of interstitial lung injury and increases during repair. Aim. Our aim was to determine the predictive value of plasma KL-6 for the development of bronchopulmonary dysplasia (BPD) in preterm infants. Methods. Ninety-five extremely preterm infants (EPIs), born at <28 gestational age (GA), were divided into two main BPD groups as follows: the moderate/severe and the no/mild group. KL-6 was analyzed on days 7 and 14. Binary logistic regression analyses and ROC curve analyses were performed. Results. Infants <26 + 0 weeks’ GA have higher mean KL-6 than infants >25 + 6 weeks’ GA on 7 and 14 days (335 vs. 286 U/ml and 378 vs. 260 U/ml; and 0.018, respectively). In the binary regression model at KL-6 day 7, three of the prognostic factors remained significant—mechanical ventilation OR: 10.38 (95% CI: 3.57–30.14), PDA OR: 6.39 (95% CI: 0.87–46.74), and KL-6 OR: 4.98 (95% CI: 1.54–16.08). The AUC was 0.86 with a sensitivity and specificity of 79% at a cutoff value ≥0.34. In the binary regression model at KL-6 day 14, six of the prognostic factors were significant—PDA OR: 23.34 (95% CI: 2.14–254.24), KL-6 OR: 13.59 (95% CI: 3.19–57.96), GA OR: 4.58 (95% CI: 1.16–18.06), mechanical ventilation OR: 4.45 (95% CI: 1.23–16.16), antenatal steroids OR: 0.19 (95% CI: 0.04–0.95), and gender (female OR: 0.30 (95% CI 0.08–1.12)). The AUC was 0.91, and the sensitivity and accuracy for a cutoff ≥0.37 were 89% and 85%, respectively. Conclusion. KL-6 could be a useful screening biomarker for early detection of infants at increased risk for developing BPD.

Research Article

Application of a New Type of Protective Sputum Suction Device in Clinic against Cross-Infection between Medical Staff and Patients

Objective. To explore the clinical application of a new type of protective sputum suction device (PSSD) in patients with tracheotomy or tracheal intubation and to evaluate the protective effect of PSSD against cross-infection between medical staffs and patients. Methods. A novel PSSD was designed which can assist closed sputum suction operation without disconnecting the ventilator. 32 patients with tracheotomy were included to study the protective effect and safety of this device. Patients’ vital signs including heart rate, respiratory rate, mean arterial pressure, and blood oxygen saturation were recorded to compare the influence of open suction and closed suction (performed with this novel device). To verify the antisplash effect of this device on airway secretions, bacterial samples were collected from the hands of the suction operators and the environment near the endotracheal tube orifice before and after the two suction processes. In addition, the satisfaction of the two suction methods was compared through the questionnaire of suction staff. Finally, with the assistance of this device, an attempt was made to complete the bronchoscopy without weaning of ventilator. Results. Compared with open sputum suction, closed sputum suction has a smaller decrease in patients’ blood oxygen saturation (), and no significant differences in other vital signs. Compared with open sputum suction, bacteria from the hands of suction staffs and the surrounding environment of the endotracheal tube were barely detected in closed suction. A questionnaire survey of sputum suction nurses suggested that the satisfaction with use and protective effect of the closed suction were better than open suction. In addition, bronchoscopy can be successfully completed with the assistance of this device, which is not possible for other breathing tubes. Conclusion. This closed sputum suction device has little effect on the oxygen saturation of patients but has excellent protective effects for medical staff against cross-infection. It has a unique advantage that can assist in completing the fiberoptic bronchoscopy with continuous ventilator-assisted breathing.

Research Article

Prevalence and Mortality Rates of Acute Kidney Injury among Critically Ill Patients: A Retrospective Study

Acute kidney injury (AKI) poses a significant challenge in critically ill patients. To determine the prevalence, risk factors, and mortality rate of AKI among nonsurgical critically ill patients in Jordan University Hospital, we conducted a retrospective study using a consecutive sampling method, including 457 nonsurgical critically ill patients admitted to the medical intensive care unit (MICU) from January to June 2021. The mean age was 63.8 ± 18 years, with 196 (42.8%) developing AKI during their stay in the MICU. Among AKI nonsurgical patients, pulmonary diseases (n = 52; 34.5%) emerged as the primary cause for admission, exhibiting the highest prevalence, followed by sepsis (n = 40; 20.4%). Furthermore, we found that older age (adjusted OR (AOR): 1.04; 95% confidence interval (CI): 1.04–1.06; ), preadmission use of diuretics (AOR: 2.12; 95% CI: 1.06–4.25; ), use of ventilators (2.19; 95% CI: 1.12–2.29; ), and vasopressor use during MICU stay (AOR: 4.25; 95% CI: 2.1308.47; ) were observed to have higher mortality rates. Prior utilization of statins before admission exhibited a significant association with reduced mortality rate (AOR: 0.42; 95% CI: 0.2–0.85; ). Finally, AKI was associated with a higher mortality rate during MICU stay (AOR: 2.44; 95% CI: 1.07–5.56; ). The prevalence of AKI among nonsurgical patients during MICU stay is higher than what has been reported previously in the literature, which highlights the nuanced importance of identifying more factors contributing to AKI in developing countries, and hence providing preventive measures and adhering to global strategies are recommended.

Research Article

Barriers to Safe Oxygen Therapy and the Effect of the Training on the Knowledge and Performance of ICU Nurses

Introduction. Proper oxygen therapy is crucial in hospitals, particularly intensive care units, to ensure safety and accuracy. The role of nurses during oxygen therapy is vital, as their knowledge and correct performance significantly impact patients’ clinical conditions. A study was carried out to examine the knowledge and performance of nurses regarding safe oxygen therapy. The study aimed to identify the obstacles hindering safe oxygen therapy and assess the impact of training on the knowledge and performance of intensive care nurses. Methods. This study was conducted among the ICU nurses at Shahid Rahnemoun Teaching Hospital in Yazd, Iran. The study method is a sequential combination of descriptive, qualitative, and educational phases. The first stage involved examining the knowledge and performance of 80 ICU nurses in oxygen therapy. The study employed content analysis to elaborate on participants’ perspectives on safe oxygen therapy challenges and potential solutions. The third phase involved a two-group study with pre- and post-tests to examine the effect of training on ICU nurses’ knowledge and performance in oxygen therapy. Results. The study found that intervention and control groups had low average scores in knowledge, performance, and total score of oxygen therapy before the study, with no significant difference. There was a significant difference between intervention and control groups one and three months after the intervention in the areas of knowledge (after-1 month 24.41 vs. 20.29, 95% CI [3.144–5.098], after-3 month 22.13 vs. 20.24, 95% CI [0.729–3.053]), performance (after-1 month 21.54 vs. 18.05, 95% CI [2.898–4.073], after-3 month 19.74 vs. 18.63, 95% CI [0.400–1.824]), and total score of oxygen therapy (after-1 month 45.95 vs. 38.34, 95% CI [6.288–8.925], after-3 month 41.87 vs. 38.87, 95% CI [1.394–4.613]). Conclusion. The study’s findings revealed that nurses in ICUs lack the appropriate knowledge and performance in oxygen therapy. A lack of knowledge and correct practice, insufficient monitoring of oxygen therapy, and defects in hospital equipment are contributing factors. The training was found to improve the knowledge and performance of nurses significantly. Consistent training at shorter intervals is suggested for nurses to keep their knowledge current.

Research Article

The Effect of Listening to Holy Quran Recital on Pain and Length of Stay Post-CABG: A Randomized Control Trial

Background. Nearly, 75% of patients post-CABG complain of moderate to severe pain during their hospital stay. Nonpharmacological interventions have been investigated; however, the effect of Holy Quran recital post-CABG is still not well studied, especially in developing Islamic countries. Objective. To investigate the effect of listening to the Holy Quran recital on pain and length of stay post-CABG. Methods. This was a randomized control trial on 132 patients recruited from four hospitals in Amman, Jordan. The intervention group listened to the Holy Quran recited for 10 minutes twice daily while the control group received the usual care. Data were analyzed using paired and independent samples t-tests. Results. Paired t-test testing showed that there was a significant reduction in the pain level, (M [SD], 6.82 [2.27] vs. 4.65 [2.18], t = 23.65,  < 0.001) for the intervention group. In addition, the intervention group had shorter LoS in the ICU and in the hospital compared to the control group, (M [SD], 5.0 [4.02] vs. 6.58 [4.18], t = −2.1,  < 0.05), (M [SD], 10.15 [9.21] vs. 15.01 [13.14], t = −2.6,  < 0.05), respectively. Conclusions. Listening to the Quran was significantly effective in improving pain intensity among post-CABG patients and shortening their hospital/ICU stay. This trial is registered with NCT05419554.

Critical Care Research and Practice
 Journal metrics
See full report
Acceptance rate20%
Submission to final decision129 days
Acceptance to publication17 days
CiteScore2.600
Journal Citation Indicator0.310
Impact Factor1.7
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