Conectar
In non-intubated patients, symptomatic treatment of hypoxaemic respiratory failure is still debated, with different options: (1) standard oxygen therapy (SOT), (2) high-flow nasal cannula oxygen therapy (HFNC) and (3) non-invasive ventilation (NIV). The objective of this study is to compare the effects of HFNC and NIV on lung volumes assessed by CT scan to allow a better understanding of their effectiveness.
The HONIVAH study (High-flow Oxygen therapy and Non-Invasive ventilation on lung Volumes and on upper Airway in Hypoxemic critically ill patients) is an investigator-initiated, prospective, single-centre, physiological, randomised, parallel-group, unblinded trial with an electronic system-based randomisation. Patients with hypoxaemic respiratory failure, defined as the need for SOT flow ≥3 L/min to maintain a pulsed oxygen saturation ≥95%, and a CT scan prescribed by the physician in charge of the patient, will be randomly assigned to the HFNC group or the NIV group. Two inspiratory thoracic CT scans will be performed, one with SOT as part of the routine patient management and a second thoracic CT scan with HFNC or NIV, depending on the allocation group. The primary outcome is the comparison of the relative variation in ‘poorly aerated’ and ‘non-aerated’ lung volumes before and after the intervention between the HFNC group and NIV group, assessed by thoracic CT scan. Secondary outcomes included the variation in tracheal cross-sectional upper airway area, lung volumes, gas exchange and patient comfort.
The study project has been approved by the appropriate ethics committee (Comité de Protection des Personnes Sud-Ouest et Outre-mer 1, France, 2022-A02458-35). Informed consent is required. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences.
ClinicalTrials.gov identifier: NCT05643911.
To measure the outcome of the implementation of a multifaceted educational intervention on the impact of moral distress among critical care nurses.
The complex nature of critical care settings exaggerates different morally distressing situations that require ongoing development of interventions to mitigate the impact of moral distress. Despite the availability of research that has addressed moral distress among nurses in the literature, there is a debate about the effectiveness of the applied interventions in reducing moral distress.
A quasi-experimental pretest-posttest control group study design.
Critical care nurses in two public hospitals in the Emirate of Abu Dhabi, UAE enrolled in a study that extended over 6 months. Hospital A was assigned as an experimental group (n = 76) and received four educational sessions and three booster sessions. Hospital B was assigned as a control group (n = 82) and didn't receive any moral distress-related education. The Measure of Moral Distress for Health Care Professionals questionnaire and the Moral Distress Thermometer were utilised to measure the participants' moral distress frequency, intensity, and composite scores pre- and post-intervention and identify the outcomes.
The multifaceted educational intervention exhibited statistically significant reductions in the experimental group frequency, intensity, and composite moral distress scores post-test. Conversely, moral distress scores were increased among the control group. Moreover, the intervention significantly reduced the number of nurses who intended to leave their positions from 58 nurses to 47 nurses in the experimental group.
The multifaceted educational intervention exerts positive outcomes in reducing moral distress across all the dimensions and improving the nurses' retention.
The intervention provides materials that could enhance the nurses' moral knowledge and skills. It provides different tools, techniques, and strategies to help the nurses address and manage their moral distress.
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