Temperature Profile and Adverse Outcomes After Discharge From the Intensive Care Unit

Nursing care complexity as a predictor of adverse events in patients transferred from ICU to hospital ward after general surgery

OBJECTIVES

Predicting the likelihood of adverse events following discharge from the intensive care unit (ICU) can contribute to improving the quality of surgical care. This study aimed to evaluate the impact of nursing care complexity as a predictor of adverse event development in general surgery patients transferred from the ICU to the hospital ward.

METHODS

A prospective observational study was conducted with 100 patients in the ICU and general surgical inpatient unit of a training and research hospital in Istanbul, Turkey. The Nursing Care Complexity tool was used by ICU and hospital ward nurses to measure nursing complexity.

RESULTS

A total of 65 adverse events developed in 51 patients during hospital ward hospitalization after discharge from the ICU. Nursing care complexity evaluations by the ICU nurses predicted overall and some specific adverse events, while hospital ward nurses' evaluations predicted ICU readmission and some follow-up abnormalities such as patients' blood pressure, pulse rate, and laboratory results.

CONCLUSION

The results of the current study validate that nursing care complexity can serve as a valuable tool for predicting the risk of adverse events and ICU readmission following discharge from the ICU.

IMPLICATIONS FOR CLINICAL PRACTICE

The use of the Nursing Care complexity tool by the ICU and even hospital ward nurses after ICU discharge may have a significant impact on patient outcomes and contribute to the recognition of nursing efforts.

Circadian Rhythmicity of Vital Signs at Intensive Care Unit Discharge and Outcome of Traumatic Brain Injury

BACKGROUND

Physiological functions with circadian rhythmicity are often disrupted during illness.

OBJECTIVE

To assess the utility of circadian rhythmicity of vital signs in predicting outcome of traumatic brain injury (TBI).

METHODS

A retrospective single-center cohort study of adult intensive care unit (ICU) patients with largely isolated TBI to explore the relationship between the circadian rhythmicity of vital signs during the last 24 hours before ICU discharge and clinical markers of TBI severity and score on the Glasgow Outcome Scale 6 months after injury (GOS-6).

RESULTS

The 130 study participants had a median age of 39.0 years (IQR, 23.0-59.0 years), a median Glasgow Coma Scale score at the scene of 8.0 (IQR, 3.0-13.0), and a median Rotterdam score on computed tomography of the head of 3 (IQR, 3-3), with 105 patients (80.8%) surviving to hospital discharge. Rhythmicity was present for heart rate (30.8% of patients), systolic blood pressure (26.2%), diastolic blood pressure (20.0%), and body temperature (26.9%). Independent predictors of a dichotomized GOS-6 ≥4 were the Rotterdam score (odds ratio [OR], 0.38 [95% CI, 0.18-0.81]; P = .01), Glasgow Coma Scale score at the scene (OR, 1.22 [95% CI, 1.05-1.41]; P = .008), age (OR, 0.95 [95% CI, 0.92-0.98]; P = .003), oxygen saturation <90% in the first 24 hours (OR, 0.19 [95% CI, 0.05-0.73]; P = .02), serum sodium level <130 mmol/L (OR, 0.20 [95% CI, 0.05-0.70]; P = .01), and active intracranial pressure management (OR, 0.16 [95% CI, 0.04-0.62]; P = .008), but not rhythmicity of any vital sign.

CONCLUSION

Circadian rhythmicity of vital signs at ICU discharge is not predictive of GOS-6 in patients with TBI.