Våga Astrid, Busch Michael, Karlsen Tom Erik, Nilsen Odd Bjarte, Søreide Eldar
Department of Anaesthesia, Division of Acute Care Medicine, Stavanger University Hospital, 4068 Stavanger, Norway.
Resuscitation. 2008 Jan;76(1):25-30. doi: 10.1016/j.resuscitation.2007.07.008. Epub 2007 Aug 20.
Therapeutic hypothermia (TH) has become an integrated part of neurointensive care. Still, little data exists on the actual experience with cooling patients in the ICU from the intensive care nurse (ICN) perspective. The purpose of this survey was to evaluate important nursing aspects with different cooling methods and devices in ICU use.
The ICNs used a four-point rating scale (1=worst, 4=best possible) to evaluate (a) ease of application, (b) visual patient monitoring, (c) work load, (d) hygiene and (e) noise level with four cooling methods used in our ICU. Our simple, initial method of towels soaked in iced water spread over the torso was compared to three commercial cooling methods used; (1) Coolgard 3000 (Alsius, Irvine, USA), (2) Thermowrap (MTRE, Yavne, Israel) and (3) Artic Sun (Medivance, Louisville, USA).
There were significant differences in how the ICNs rated the nursing aspects of the different cooling methods. Ice-water soaked towels over the torso scored high with respect to ease of application and noise level. For work-load, all the three commercial devices scored significantly better than ice-water soaked towels (P<0.05). Only the Coolgard 3000 system scored significantly better than ice-water soaked towels for visual patient monitoring (P<0.001). For hygienic aspects, Artic Sun and Coolgard scored significantly higher than the others (P<0.05). Overall, the ICNs involved felt they had a general good understanding of TH but were only partly prepared in terms of training and knowledge of protocols and complications when TH was introduced in our ICU. The majority felt the new cooling protocol was acceptable.
We identified significant differences in the rating of key nursing aspects of the different cooling methods. More studies on implementation of new cooling methods and devices seem warranted.
治疗性低温已成为神经重症监护的一个组成部分。然而，从重症监护护士（ICN）的角度来看，关于在重症监护病房（ICU）为患者降温的实际经验的数据仍然很少。本次调查的目的是评估ICU中使用的不同降温方法和设备在护理方面的重要情况。
ICN使用四点评分量表（1 = 最差，4 = 最好）来评估（a）应用的难易程度、（b）对患者的可视监测、（c）工作量、（d）卫生状况和（e）使用我们ICU中四种降温方法时的噪音水平。我们将简单的初始方法——用浸泡在冰水中的毛巾覆盖躯干，与使用的三种商业降温方法进行了比较；（1）Coolgard 3000（美国艾尔修斯公司，尔湾）、（2）Thermowrap（以色列MTRE公司，亚夫内）和（3）Artic Sun（美国Medivance公司，路易斯维尔）。
ICN对不同降温方法在护理方面的评分存在显著差异。用浸泡在冰水中的毛巾覆盖躯干在应用的难易程度和噪音水平方面得分较高。在工作量方面，所有三种商业设备的得分均显著高于浸泡在冰水中的毛巾（P < 0.05）。只有Coolgard 3000系统在对患者的可视监测方面得分显著高于浸泡在冰水中的毛巾（P < 0.001）。在卫生方面，Artic Sun和Coolgard的得分显著高于其他方法（P < 0.05）。总体而言，参与调查的ICN感觉他们对治疗性低温有大致良好的理解，但在我们ICU引入治疗性低温时，在培训以及对方案和并发症的知识方面只是部分有所准备。大多数人认为新的降温方案是可以接受的。
我们发现不同降温方法在关键护理方面的评分存在显著差异。似乎有必要对新的降温方法和设备的实施进行更多研究。
