Background: Careful monitoring for patient with hepatocellular carcinoma who receiving trans-arterial chemoembolization in adult intensive care units to reduce complications remains mandatory for nurses. The study aimed to evaluate the effect of implementing a nursing protocol on patients' outcomes undergoing trans-hepatic arterial chemoembolization. Quasi experimental research design was used in this study. Subjects: All adult patients who diagnosis with hepatocellular carcinoma and receiving trans-arterial chemoembolization at the liver intensive care unit and gastroenterology department at Al-Rajhi liver hospital were involved in this study. Two tools were used. Tool one: patient assessment questionnaire and includes 4 parts, tool two: patient outcomes assessment questionnaire. Methods: The nursing protocol on trans-arterial chemoembolization was implemented by the researcher from the day before procedure until discharge, the researcher assess site of insertion, post embolization syndrome after procedure and recorded it. Results: Findings of the present study revealed significant improvement in pain scores as it was 3.77±0.59 in the control group 4 hours after TACE while it was 3.19±0.63 in the Study group, and Mean ± SD was 3.95±0.58 in the control group 6 hours after TACE in comparison to 3.15±0.75 in the study group. Insertion site and ICU stay values of less than p=0.005, p=0.5 and p=0.05 respectively in response to implementing nursing protocol. Conclusion: implementing the nursing protocol on trans-hepatic arterial chemoembolization appear to be effective in terms of reducing incidence and consequences of post procedure complications. Recommendation: Patients and their caregivers need to be apprised of post embolization syndrome symptoms prior to TACE and provided with adequate nursing care for symptom control.

Background: Gastrointestinal (GI) dysfunction is a danger for critically sick patients who receive mechanical breathing. During the course of enteral feeding in the early stages of critical illness, gastric residual volume (GRV) is used as a surrogate metric for GI dysfunction. This study aimed to investigate the effect of high gastric residual volume on critically ill patient outcomes. Design: A prospective, observational research design. Methods: A purposive sample of 60 adult critically ill patients of both sex from the intensive care units )sUCI( at Assiut University Hospital, Egypt were included in the study from August 2020 to April 2021. According to the measurement of gastric residual volume, those patients were not randomly allocated in group 1[the normal limit of gastric residual volume (NGRV) 500]. Five tools were used to collect data included patient's assessment tool, APACHE 11 score, nutritional intervention assessment tool, gastric residual volume assessment tool, and Patient outcomes assessment tools. Results: there was a significant decrease in the Length of ICU stay, duration of mechanical ventilation, and mortality rate in NGRV group than the HGRV group (11.04±4.12 versus 13.91±5.88, 8.43± 4.5 versus 13.02 ±5.04, 30.4% versus 70.3%) respectively. Conclusion: HGRV had an adverse effect on critically ill patients' outcomes such as high ICU mortality, long duration of mechanical ventilation and long ICU stay. Recommendation: Frequent monitoring of gastric residual volume and gastric residual volume protocol and guidelines should be applied in ICU.

Background: The COVID-19 pandemic has a negative effect on critical care nurses' mental health. Aim: This study aimed to assess the level of post-traumatic stress disorder (PTSD) among the critical care nurses caring for patients with COVID 19 and evaluate the stress factors that affect them. Study design and Methods: A descriptive crosssectional study was conducted in the intensive care and emergency units at Assiut University Hospital from the period of August 2020 to November 2020; 118 critical care nurses completed the questionnaire via an online survey. Results: Among the participating nurses (47.5%) were reported moderate level of post-traumatic stress disorder symptoms, and (39.0%) were reported severe level of PTSD symptoms. At P=0.05, there was a positive significant correlation between PTSD and workload, COVID 19 patient death, conflict with physician, lack of competency, and fear of infection among participant nurses (r =.370**, r = .268**, r = 268**, r = .265**, r = r =.272**, r =.277**) respectively. Conclusion: The rate of post-traumatic stress disorder was higher among critical care nurses caring for patients with COVID-19. Recommendations: We recommended further study to investigate the impact of the COVID-19 on mental health of critical care nurses and educate them about PTSD.

Dyspnea and a higher volume of secretions are common complaints among chronic obstructive
pulmonary disease patients. As a result, there is a current tendency to adopt non-pharmacological
approaches to help clear secretions, improve lung function, and relieve dyspnea. So, the aim of this
research was to evaluate the effect of autogenic drainage and acupressure on the respiratory
outcomes of non-invasive mechanically ventilated COPD patients. A quasi-experimental design was
used. Setting: chest and general intensive care units at Assuit University Hospitals. Sixty noninvasive
mechanically ventilated COPD patients recently admitted were included. Data was
collected using two tools: tool I: patient assessment sheet, tool II respiratory outcome assessment
sheet. Results: There was a highly significant reduction in the respiratory rate in study group after
application of autogenic drainage and acupressure at 3rd and 7th day (p<0.001), significance
differences were found regarding PaO2, SaO2 before and after intervention between study and
control groups at 7th day with P. value (0.004, 0.029and 0.005&0.005)respectively. Moreover, there
was highly significance increase in the amount of sputum clearance at 7th day (p<0.001),
improvement with highly significance in dyspnea measures among study group patients 7th day
(p<0.005) after extubation and (p<0.001) before discharge. Conclusion: applying autogenic
drainage and acupressure had statistically significant positive effect on respiratory parameters
outcomes on non invasive mechanically ventilated COPD Recommendations: provide educational
program for nurses about AD and acupressure.

Coronary artery bypass graft surgery (CABG) is one of the common treatments for cardiac diseases, despite the numerous complications of CABG. The most serious adverse events are bleeding requiring further surgery, cardiac arrhythmias, deep sternal wound infection and death. Aim of the study: This study was carried to examine postoperative complications in patients undergoing CABGs. Research design: this prospective observational study was conducted at CICU in Heart Assuit University Hospital. Methods: Data collected through a period of seven months, from first of August 2019 to the end of January 2020. At this period there were 68 patients admitted to Cardiothoracic department for CABG surgery, while 8 died and 60 patients included to the study. Three tools were used, Tool I: Cardiac surgical patient assessment sheet, Tool II: Predictors of mortality, and Tool III: CABG Complications sheet. Results: Findings of the present study revealed that patients post CABG surgeries in CICU reported several complications included: Atrial fibrillation (26.6%), Ventricular ectopic (8.3%), Ventricular tachycardia (1.6%), Cardiac tamponed (6.6%), while there were (10%) reported pneumonia, and (6.6%) reported atelectasis, about nausea (43.3%) and also (43.3%) reported vomiting complications, there was (20.0%) By acute kidney injury stage I, there was (5%) of patients complain from wound infection. Conclusion: the most complications occurred post CABG operations was Postoperative Atrial fibrillation (POAF), gastrointestinal complications, and acute kidney injury (AKI). Recommendations: Results of the study help in preoperative risk assessment, and understanding complications after CABGs.

Background and objective: Intra-abdominal hypertension (IAH) is a frequent plentiful problem in patients admitted to critical care units. It ranges from a surge incidence of morbidity and mortality to a particular need for nursing health care, so recognition of the occurrence of IAH is a very critical issue for critical care nurses and physician. This study aimed to recognize the effects of various body position with the various head of bed elevation on the intra-abdominal pressure (IAP) in patients with mechanical ventilation. Methods: Design: A non-randomized, prospective observational study was used. Setting: Trauma and general intensive care units at Assuit University Hospitals. Method: In a prospective observational study, during the third day of mechanical ventilation, 60 patients were screened for IAP via a urinary catheter, in two various body positions in three separate degrees of the head of the bed (HOB) elevation (0◦ , 15◦ , and 30◦ ). The position was changed at least 4 hours apart over a 24-h period. Results: In lateral recumbence, IAP measurements were significantly elevated compared to supine position, they were 19.70 ± 3.09 mmHg versus 16.00 ± 3.14 (p < .001), 22.80 ± 3.56 mmHg versus 19.03 ± 2.95 (p < .001), and 26.08 ± 3.59 mmHg versus 21.46 ± 2.90 versus (p < .001) at 0◦ , 15◦ , and 30◦ respectively. The mean of IAP difference was 3.7 ± 3.0 mmHg at 0◦ , 3.8 ± 1.00 mmHg at 15◦ , and 5.5 ± 1.01 mmHg at 30◦ (p < .005). Conclusions: IAP reading is significantly elevated by changing from supine to lateral position especially with HOB elevation and significantly correlated with mortality rate in patients with mechanical ventilation

Background: critically ill patient need a nursing practice that can enhance him to get all benefits of enteral feeding and overlapping the GI complications and maintain the intra-abdominal pressure.Objective: This work aimed to explore the effect of abdominal massage on gastrointestinal complications and intra-abdominal pressure of critical- enteral-feed patients. Methods: A randomized controlled trial was applied on 74 eligibly enteral-fed patients at Trauma and General ICUs. Of these, the trail was completed on sixty patients who distributed randomly to equal intervention and control groups. The manipulation was two times for 15mins of abdominal massage for five days. The effect was measured on enteral feeding complications (GRV, abdominal circumference and distention, vomiting) and intra-abdominal pressure as compared with control group who didn't receive the massage.Results: the GRV difference between the massage group and control group subjects was statistically significant (P<0.001) in the 3rd, 4th, and 5th days indicating higher GRV among control group. The abdominal circumference between the five days was not significantly in the two groups. The difference between the two groups in relation to the distension was statistically significant (p < 0.05) in day 3, 4 and5. None of intervention patients were vomited along the study period (5days) in compared to 5% of control patients without statistical significant. Conclusions: The abdominal massage was significantly effective in lowering GRV, preventing distension and avoiding vomiting. Besides, the abdominal massage maintained the IAP without any statistical significant support. Therefore, it is recommended that this practice can be applied as a caring procedure in the daily ICU care program.

Background: Enhanced recovery after cardiac surgery protocol is an evidence-based interdisciplinary process, which has not previously been systematically applied to cardiac surgery. Objectives: The aim of this study was to evaluate the clinical effectiveness of ERAS protocol compared with routine care on the outcomes of patients undergoing cardiac surgery. Methods: This study was conducted between January 2020 and December 2020. A total of 75 patients who underwent cardiac surgery by one surgical team were evaluated for eligibility. Five patients were excluded after the initial assessment; hence, 70 patients were randomly assigned to the ERAS protocol group and control group. Patients in the ERAS group received all elements of the ERAS protocol while patients in control group receive routine care. Tools: Preoperative assessment tool to form base line data, Intra-operative assessment tool to assess Ischemic time, bypass time, and operation time and postoperative evaluation tool to assess the patients' outcome were used in data collection .Results: The duration of ICU stay and duration of mechanical ventilation were significantly shorter in the ERAS group versus control group3.04 ± 0.74, 2.33 ± 0.8), versus (5.82±0.61, 4.64±2.13), respectively; P < 0.001). Post-operative bleeding and re intubation were less in ERAS group versus control group (10 %, 3.33 %), versus (36.67 %, 16.66 %), respectively; P = 0.03).Conclusions: ERAS protocol reduces the length of ICU and for patients undergoing cardiac surgery.