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Background Physical restraints (PRs) are frequently used in adult critical care units to protect staff and prevent self-harm, despite the fact that they represent significant safety risks. Restraint complications may have an impact on the patient’s long- and short-term outcomes. This integrative review aimed to meticulously evaluate existing evidence pertaining to physical restraint practices in adult critical care settings. The review was specifically geared towards examining the prevalence of PR, identifying influential factors, elucidating the role of nurses in PR implementation, exploring nurses’ experiences in caring for patients under restraint, and scrutinizing the complications associated with PR application Method This integrative review included the studies published between January 2009 and December 2019 and the literature search was conducted in July 2020. The databases searched included EBSCOhost, Ovid, ProQuest, PubMed, Wiley Online Library, SCOPUS, and ScienceDirect. The keywords included in the search were restraint, critical care, intensive care, ICU, mechanical ventilation, intubation, nursing, and experience. A checklist based on the CASP checklist and the JBI Critical Appraisal Tool was used to assess the methodological quality. Results The findings were evaluated and summarized into seven key topics after twenty-one publications were found to be evaluated. i) High prevalence of PR application in adult critical care unit; ii) determinants of PR applications; iii) types of PR in adult critical care units; iv) decision maker of PR; v) moral and ethical dilemma in PR application; vi) awareness and guidelines for PR applications; vii) common complications and use of sedation, analgesics, antipsychotic drugs in PR application. Conclusion The number of days PR is used is related to the risk of an adverse event. In order to standardize nursing practice, ICU nurses require greater training on the ideas of PR use. Evidence-based recommendations will assist critical care nurses in making the best judgments possible concerning the use of PR.

Road traffic collisions are the commonest cause of traumatic brain injury (TBI). Patients with brain injury may present with a wide range of symptoms depending on nature and types of injury. Generally, severity of TBI can be classified into mild, moderate and severe based on Glasgow Coma Scale (GCS). This scoring system objectively describes the extent of impaired consciousness. Score of 8 or below indicates severe TBI and will require admission to intensive care and mechanical ventilation. These patients experience significant metabolic changes as a result of excessive production of endogenous catabolic hormones following the injury. Nutritional requirements among these patients differ based on severity of trauma and phase of illness. Timely initiation of feed and addressing individualised nutritional needs can prevent malnutrition. Apart from that, nutrition plays a very important role in neuronal recovery and directly affects neuronal plasticity thus the prognosis. Early involvement of nutritional support as a part of comprehensive care is the key to recovery and better outcome. The aim of this review is to provide an overview of the current evidence-based nutrition therapy for patients with TBI in critical care settings. The review covers the energy and nutrient requirements, enteral and parenteral nutrition, and challenges associated with it.

Objective: Enhanced recovery after surgery (ERAS) encompasses aspects from preoperative, intraoperative and postoperative care to reduce postoperative complications and length of stay. It has been implemented intraoperatively by the Department of Anaesthesia, Hospital Sungai Buloh, for oesophagectomy and gastrectomy since February 2017. The main objective of this study was to compare the postoperative length of stay in the intensive care unit or recovery room before and following implementation of the ERAS protocol on intraoperative haemodynamic stability in oesophagectomy and gastrectomy. Secondary objectives included comparing the overall postoperative length of stay in hospital and assessing whether application of the ERAS protocol affected serum lactate levels taken within 48 hours after operation. Methods: Data from patients who underwent oesophagectomy or gastrectomy between 2016 and 2018 was traced using the electronic Hospital Information System (eHIS). Results: 161 records were analysed (52 operations without ERAS and 109 with ERAS implementation). 94 patients were admitted to ICU whereas 67 patients were observed in recovery room postoperatively. Length of stay in ICU was significantly different between the non-ERAS and ERAS groups (mean 98.7 hours vs 42.3 hours respectively; p=0.012). Overall hospital stay was longer in the non-ERAS group (mean 21.1 days vs. 16.2 days; p<0.001). A higher percentage of patients in the ERAS group suffered acute kidney injury (14.1% vs 4.3%). There was no significant difference in recovery room stay (2.7 hours vs. 3.5 hours, p=0.328) or postoperative serum lactate levels (p=0.324). Conclusion: This study showed a reduction in postoperative length of stay in ICU and overall hospital stay for patients who underwent major upper gastrointestinal surgery with ERAS implementation despite having a higher risk of developing AKI. Length of stay in recovery room and postoperative serum lactate concentration were not different between the two groups. [ABSTRACT FROM AUTHOR]

Background & Aims: The effect of provision of full feeding or permissive underfeeding on mortality in mechanically ventilated critically ill patients in the intensive care unit (ICU) is still controversial. This study investigated the relationship of energy and protein intakes with 60-day mortality, and the extent to which ICU length of stay and nutritional risk status influenced this relationship., Methods: This is a prospective observational study conducted among critically ill patients aged ≥18 years, intubated and mechanically ventilated within 48 h of ICU admission and stayed in the ICU for at least 72 h. Information on baseline characteristics and nutritional risk status (the modified Nutrition Risk in Critically ill [NUTRIC] score) was collected on day 1. Nutritional intake was recorded daily until death, discharge, or until the twelfth evaluable days. Mortality status was assessed on day 60 based on the patient's hospital record. Patients were divided into 3 groups a) received <2/3 of prescribed energy and protein (both <2/3), b) received ≥2/3 of prescribed energy and protein (both ≥2/3) and c) either energy or protein received were ≥2/3 of prescribed (either ≥2/3). The relationship between the three groups with 60-day mortality was examined by using logistic regression with adjustment for potential confounders. Sensitivity analysis was performed to examine the influence of ICU length of stay (≥7 days) and nutritional risk status., Results: Data were collected from 154 mechanically ventilated patients (age, 51.3 ± 15.7 years; body mass index, 26.5 ± 6.7 kg/m 2 ; 54% male). The mean modified NUTRIC score was 5.7 ± 1.9, with 56% of the patients at high nutritional risk. The patients received 64.5 ± 21.6% of the amount of energy and 56.4 ± 20.6% of the amount of protein prescribed. Provision of energy and protein at ≥2/3 compared with <2/3 of the prescribed amounts was associated with a trend towards increased 60-day mortality (Adjusted odds ratio [Adj OR] 2.23; 95% confidence interval [CI], 0.92-5.38; p = 0.074). No difference in mortality status was found between energy and protein provision at either ≥2/3 compared with <2/3 of the prescribed amounts (Adj OR 1.61, 95% CI, 0.58-4.45; p = 0.357). Nutritional risk status, not ICU length of stay, influenced the relationship between nutritional adequacy and 60-day mortality., Conclusions: Energy and protein adequacy of ≥2/3 of the prescribed amounts were associated with a trend towards increased 60-day mortality among mechanically ventilated critically ill patients. However, neither energy nor protein adequacy alone at ≥ or <2/3 adequacy affect 60-day mortality. Increased mortality was associated with provision of energy and protein at ≥2/3 of the prescribed amounts, which only affected patients with low nutritional risk., (Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Nutrition support is an integral part of care among critically ill patients. However, critically ill patients are commonly underfed, leading to consequences such as increased length of hospital and intensive care unit stay, time on mechanical ventilation, infectious complications, and mortality. Nevertheless, the prevalence of underfeeding has not resolved since the first description of this problem more than 15 years ago. This may be due to the traditional conservative feeding approaches. A novel feeding protocol (the Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol in Critically Ill Patients [PEP uP] protocol) was proposed and proven to improve feeding adequacy significantly. However, some of the components in the protocol are controversial and subject to debate. This article is a review of the supporting evidences and some of the controversy associated with each component of the PEP uP protocol., (© 2015 American Society for Parenteral and Enteral Nutrition.)