Sepsis remains one of the leading causes of mortality in adult critical care, representing a dysregulated host response to infection. Despite advances in therapeutics and supportive care, it continues to account for over 31 million deaths annually. Its unpredictable trajectory and variable physiologic presentations make early recognition and timely intervention crucial to improving outcomes. Early warning systems were initially developed to standardize the recognition of physiologic instability and guide early recognition. The Modified Early Warning Score, National Early Warning Score 2, and Quick Sequential Organ Failure Assessment remain the most frequently used bedside tools for adult deterioration and sepsis.
Caring for patients with respiratory infection induced acute respiratory distress syndrome (ARDS) is a complex task. During the Covid-19 pandemic, patients with ARDS due to Covid-19 overwhelmed the hospitals and traditional care practices were not as effective leading to a high mortality rate. This caused many providers to seek out other less traditional treatments for these patients in order to save lives. Proper patient positioning, ventilation settings, and ventilation delivery changes were some of the areas explored. As the pandemic has resolved, retrospective studies have looked at the effectiveness of these changes with mixed results.
Antimicrobial resistance is a growing threat to human health and especially relevant in critical care settings. Intensive care unit patients are particularly vulnerable to multidrug-resistant organisms (MDROs) because of characteristic immunosuppression, reliance on medical devices, treatment with broad-spectrum antibiotics, and exposure to the hospital environment. Nurses play a critical role in preventing the spread of MDROs by leading coordinated, multimodal interventions including antibiotic and laboratory stewardship, passive and active pathogen surveillance, implementation and de-escalation of isolation precautions, and evidence-based hygiene measures. Collectively, these team-based interventions can foster a culture of safety that protects individual patients and the wider community.
Integrating ethics into clinical practice when caring for critically ill patients with serious infectious diseases (IDs) is challenging due to the complexities of the ethical considerations and multitude of populations at risk for IDs. It is imperative for critical nurses to understand the ethical tenets and integrate these ethical considerations into their clinical practice. Additionally, they should be aware of the resources available in their institution to assist with the care of their patients.
The diagnosis and management of critically ill patients with severe infection is complex. Severe infections in critically ill populations is a leading cause of morbidity and mortality in the United States and includes sepsis, drug resistant infections, opportunistic infections in immunocompromising illness (eg, cancer, human immunodeficiency virus, etc.), community acquired pneumonia (viral and bacterial), ventilator-associated pneumonia, complicated genitourinary infection, and others. The clinical evaluation methods through a comprehensive history collection and physical examination does not yield enough diagnostic data to identify the pathogen(s), control the source of infection, or monitor the progress or deterioration of the patient's condition.
Sepsis remains a leading cause of mortality, accounting for 1 in 5 deaths worldwide. The implementation of the sepsis management bundle has been associated with reduced mortality in sepsis patients. Critical care nurses must play a pivotal role in early sepsis recognition and work collaboratively with the multidisciplinary team to accelerate protocols. Increasing nurse's knowledge, confidence, and clinical reasoning skills as well as assuring nurses work to the full extent of their licensure, is vital to improving patient outcomes, reducing mortality, and optimizing adherence to evidence sepsis management strategies.
Fluid and electrolyte management is a crucial component of care in critically ill patients with severe infections. Patients with sepsis, septic shock, or multiorgan dysfunction syndrome struggle to maintain fluid balance due to increased capillary permeability, inflammation, vasodilation, and organ dysfunction. Inadequate fluid balance can increase complications, morbidity, and mortality. Fluid management is complex because sepsis disrupts vascular permeability, tissue perfusion, and cellular function. Infectious disease care is further challenged by antimicrobial resistance, drug stewardship, and infection control. Skilled nursing, advanced monitoring, and continuous education are essential to optimize outcomes and ensure high-quality management in this vulnerable population.
Infectious diseases have circulated the globe since the dawn of time, and new ones are seen often. Emerging infectious diseases (EIDs) are defined as a newly found or an already known infectious disease that is rapidly increasing in incidence. COVID-19 changed the theoretic risk of this to a reality. Frontline providers, particularly nurses, were at the forefront of caring for those with COVID-19. This article discusses the history of EID, how care is and should be provided to patients with infectious disease, and future work that needs to be done.
Patients and health care organizations alike can benefit from interprofessional teams in the intensive care unit to manage infectious diseases. Interprofessional team frameworks within organizations bring these teams to fruition and have shown positive benefits. These teams not only promote antimicrobial stewardship and recognition of the whole-patient care needs, but also can be a cost-saving way to manage these complex patients. Each team member brings a specific skill set and competencies to create an optimized approach to treating infections with antibiotics and antivirals.
Critically ill patients with fungal meningitis present complex challenges in pain and sedation management due to the need for accurate neurologic assessments, immunosuppression, and high intracranial pressure. This article explores pathophysiology, clinical presentation, and diagnostic strategies for fungal meningitis, with a focus on evidence-based, interdisciplinary approaches to pain and sedation. Emphasis is placed on multimodal analgesia delirium prevention, and critical role of nurses in optimizing outcomes. Ethical considerations and long-term recovery planning are also discussed to support comprehensive care.
Critical care nurses play a crucial role in antimicrobial stewardship (AMS) within the intensive care unit, where their expertise is essential in combating resistance and optimizing therapy. Critical care nurses are at the forefront of patient care, ensuring the appropriate use of antimicrobials to minimize antimicrobial resistance and improve patient outcomes. Critical nurses collaborate with multidisciplinary teams to implement AMS strategies, such as monitoring and documenting antimicrobial use, educating patients and families about the importance of adherence to prescribed therapies, and advocating for the de-escalation of broad-spectrum antibiotic use when appropriate.
