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Patients in intensive care units (ICUs) frequently require mechanical ventilation, with approximately half needing invasive ventilation through an orotracheal tube. For these patients, gastric tube (GT) insertion is routinely performed to administer nutrition and medications or to drain gastric contents. The insertion route (oral or nasal) may affect the incidence of ventilator-associated pneumonia (VAP), a significant ICU care complication. This study aims to compare the impact of oral versus nasal GT insertion on the incidence of VAP in intubated ICU patients.
The SONG trial (NCT 05915663) is a multicentre, open-label, two-period, two-intervention, cluster randomised crossover superiority trial. 16 French ICUs will participate. ICUs will be randomised to periods of nasogastric or orogastric tube placement. The trial includes a practice standardisation period, followed by two 12-month inclusion periods separated by a monitoring and washout period. The primary endpoint is the incidence rate of VAP at day 28, confirmed by three independent physicians. Secondary endpoints include the ease of GT insertion, measured by the number of attempts.
This study received approval from a central ethical review board on 12 April 2024 (CPP Sud-est VI, registration number 23.00943.000175). Patients are included after informed consent or, when not possible, from next of kin. If none are available, the investigator will proceed with emergency inclusion, following French law. When consent is initially obtained from the next of kin or through emergency inclusion, the investigator will seek consent from the patient as soon as possible. Data will be anonymised and patient confidentiality maintained. Results will be published in peer-reviewed journals and presented at scientific meetings.
The objectives of this study were to determine the prevalence of burnout risk and intention-to-leave among intensive care unit (ICU) nurses and analyse the association of these with workload and work environment.
A cross-sectional survey of nurses working in ICUs was conducted in France between 15 January 2024 and 15 April 2024 alongside a longitudinal assessment of workload during the same period.
ICU nurse workload was assessed using the Nursing Activities Score (NAS). The risk of burnout was assessed using the Maslach Burnout Inventory scale and intention-to-leave the hospital was assessed with a binary question. A total of 1271 nurses working in 61 intensive care units completed the questionnaire and 14,134 NAS per patient and 1885 NAS per nurse were included in the study.
The median overall of burnout by hospital site was 64.7% [P25: 53.3–P75: 72.7] for the broad definition and a median of 20.7% [13.3–27.3] of ICU nurses reported an intent-to-leave their job. The median overall NAS score per nurse was 135.9% [121.4–156.9] and the prevalence of NAS scores exceeding 100% per nurse was 73.9% [62.8–80.3]. A significant association was found between nurses working in an ICU with a better work environment and all dimensions of burnout as well as the intention-to-leave the job. A prevalence in the hospital site of NAS scores exceeding 100% per nurse below the median was associated with a lower burnout (OR = 0.69, 95% CI: 0.50–0.88 for broad definition) and intention-to-leave the job (OR = 0.68, 95% CI: 0.50–0.92).
This study found significant associations between burnout and the intention to leave the job for nurses in ICUs, mainly due to a better work environment and, to a lesser extent, a lower workload for nurses.
In an era of nurse shortages and absenteeism, it is crucial for institutions to retain their nursing staff. Our results should encourage hospital managers to take action to improve the ICU work environment and keep ICU workloads manageable to decrease burnout and the intention-to-leave the job among ICU nurses.
This article follows the STROBE guidelines for the reporting of cross-sectional studies.
No patient or public contribution.
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