Effects of nursing team communication and collaboration on treatment outcomes in intensive care unit patients with severe pneumonia

Abstract

BACKGROUND

Severe pneumonia is a common severe respiratory infection worldwide, and its treatment is challenging, especially for patients in the intensive care unit (ICU).

AIM

To explore the effect of communication and collaboration between nursing teams on the treatment outcomes of patients with severe pneumonia in ICU.

METHODS

We retrospectively analyzed 60 patients with severe pneumonia who were treated at the ICU of the hospital between January 1, 2021 and December 31, 2023. We compared and analyzed the respiratory mechanical indexes [airway resistance (Raw), mean airway pressure (mPaw), peak pressure (PIP)], blood gas analysis indexes (arterial oxygen saturation, arterial oxygen partial pressure, and oxygenation index), and serum inflammatory factor levels [C-reactive protein (CRP), procalcitonin (PCT), cortisol (COR), and high mobility group protein B1 (HMGB1)] of all patients before and after treatment.

RESULTS

Before treatment, there was no significant difference in respiratory mechanics index and blood gas analysis index between 2 groups (P > 0.05). However, after treatment, the respiratory mechanical indexes of patients in both groups were significantly improved, and the improvement of Raw, mPaw, plateau pressure, PIP and other indexes in the combined group after communication and collaboration with the nursing team was significantly better than that in the single care group (P < 0.05). The serum CRP and PCT levels of patients were significantly decreased, and the difference was statistically significant compared with that of nursing group alone (P < 0.05). The levels of serum COR and HMGB1 before and after treatment were also significantly decreased between the two groups.

CONCLUSION

The communication and collaboration of the nursing team have a significant positive impact on respiratory mechanics indicators, blood gas analysis indicators and serum inflammatory factor levels in the treatment of severe pneumonia patients in ICU.

Key Words: Intensive care unit, Severe pneumonia, Nursing team, Communication and collaboration, Respiratory mechanics indicators, Blood gas analysis indicators, Serum inflammatory factors

Core Tip: This retrospective analysis highlights the crucial role of nursing team communication and collaboration in improving treatment outcomes for severe pneumonia patients in intensive care units. Enhanced interaction among nurses led to significantly better improvements in respiratory mechanics, blood gas parameters, and reduced inflammation markers (C-reactive protein, procalcitonin, cortisol, and high mobility group protein B1) compared to single-handed care, emphasizing the value of teamwork in critical care settings.

INTRODUCTION

With the continuous advancement of medical technology and the improvement of medical standards, the demand for treatment of critically ill patients such as severe pneumonia has become increasingly prominent[1-3]. Especially in the intensive care unit (ICU), respiratory support and comprehensive treatment for patients are particularly critical[4]. The stability of vital signs and good outcome of ICU patients often depend on the collaborative work of the medical team and the effective communication of the nursing team[5-6]. In recent years, more and more studies have begun to focus on the role of communication and collaboration of nursing teams in the treatment of critically ill patients, in the hope of achieving better therapeutic effects for patients by optimizing the nursing process and improving team collaboration efficiency[7-8].

As a high-incidence disease, severe pneumonia has an acute course and severe illness, which places extremely high demands on the medical team[9-11]. In the ICU, patient vital sign monitoring, respiratory support, and control of inflammatory factor levels are key aspects of treatment[12]. In this context, optimizing the communication and collaboration of the nursing team is expected to become an important means to improve the treatment effect of patients with severe pneumonia[13]. Severe pneumonia is an inflammation of the lung parenchyma caused by various pathogenic microorganisms[14]. Its onset is rapid and its course is sudden. In severe cases, it can lead to serious complications such as acute respiratory distress syndrome (ARDS), which poses a serious threat to the patient's life. threaten[15]. As the ICU is the center of treatment for patients with severe pneumonia, the medical team needs to closely monitor the patient's condition changes and provide efficient nursing services to strive for more recovery opportunities[16].

Respiratory support is one of the core components of treatment for patients with severe pneumonia. In the ICU, mechanical ventilation is a common method of respiratory support[17]. Through reasonable ventilation parameter settings, the patient's oxygenation and carbon dioxide elimination can be maintained, the respiratory burden can be relieved, and the patient can gain more recovery time[18]. However, mechanical ventilation may also cause a series of complications, including barotrauma, ventilator-associated pneumonia, etc.[19]. Therefore, during the respiratory support process, it is particularly important to monitor and adjust the patient's respiratory mechanics indicators[1]. In addition to respiratory mechanics indicators, blood gas analysis is also an important means to evaluate the patient's condition[20]. By monitoring blood oxygen saturation (SpO₂), arterial partial pressure of oxygen (PaO₂) and other indicators, the patient's oxygenation level can be understood, providing a basis for timely adjustment of respiratory support parameters. At the same time, the calculation of oxygenation index (OI) has also become an important criterion for evaluating the severity of ARDS[21]. The release of inflammatory factors is closely related to infection and inflammation, and in patients with severe pneumonia, the degree of inflammatory response is often closely related to the development of the disease. Inflammatory factors such as C-reactive protein (CRP) and procalcitonin (PCT) are widely used in clinical practice to guide the diagnosis and treatment of infectious diseases[22]. Therefore, during the treatment of patients with severe pneumonia, monitoring changes in the levels of inflammatory factors has certain clinical significance for judging the patient's condition and guiding treatment. However, in the ICU, the communication and collaboration of the nursing team are often overlooked. The collaborative work of multiple professional teams such as doctors, nurses, and respiratory therapists is crucial to improving patient outcomes. Effective communication and close collaboration help the medical team better understand the patient's condition, coordinate treatment plans, and respond quickly[23]. However, in the actual nursing process, there are often barriers in information transmission and communication between different professional teams, which may lead to delays or deficiencies in treatment and affect the patient's outcome.

Therefore, the purpose of this study was to evaluate the nursing team by comparing the changes of respiratory mechanics indexes, blood gas analysis indexes, and serum inflammatory factors before and after treatment in the two groups of ICU patients with severe pneumonia receiving the nursing team communication cooperation group and the single nursing group. It is hoped that the results of this study can provide a scientific basis for the application of nursing team collaboration in the treatment of ICU patients, and provide a new idea for optimizing the care of patients with severe pneumonia.

MATERIALS AND METHODS

Research design

We retrospectively analyzed 60 ICU patients with severe pneumonia who were treated at the hospital between January 1, 2021 and December 31, 2023, aimed to compare the differences in physiological indicators and therapeutic effects before and after treatment between patients with severe pneumonia who received communication and collaboration from the nursing team and those who received single care during ICU treatment. By comparing the changes in respiratory mechanics, blood gas analysis, and inflammatory factor levels between the two groups of patients, the role of nursing team communication and collaboration in ICU treatment was explored.

Patient characteristics

The study included 60 patients who met the diagnostic criteria for severe pneumonia. They were divided into two groups with 30 patients each. The patient's general information includes age, gender, admission time, past medical history, etc. All patients signed an informed consent form before enrollment to ensure that they had a clear understanding of the purpose and methods of the study and were willing to participate in the study.

Inclusion and discharge standards

Inclusion criteria: Patients aged 18-65 years old; meeting the clinical diagnostic criteria for severe pneumonia, including symptoms such as acute fever, cough, chest pain, and supported by relevant imaging or laboratory examinations; requiring mechanical ventilation treatment. The patient is willing to participate in the research and sign the informed consent form; the patient or his legal guardian is able to understand and comply with the research requirements.

Exclusion criteria: Severe organ dysfunction, such as liver and kidney failure; severe immune system disease; pregnant or lactating women; severe heart disease, cerebrovascular disease and other life-threatening comorbidities; ever receiving related respiratory systemic surgery patients.

Interventions

Experimental group (nursing team communication and collaboration group): During the treatment process, a multidisciplinary collaboration team is established, including doctors, nurses, respiratory therapists, etc., to conduct regular team consultations, clarify the treatment plan, and improve the efficiency of information sharing. A comprehensive assessment is conducted every week, and the treatment plan is adjusted in a timely manner based on the patient's physiological indicators and changes in condition.

Control group (single nursing group): The traditional medical team management method was adopted, with less frequent communication between doctors and nurses and less frequent team consultations. The treatment plan is mainly formulated by the attending doctor and implemented by the nursing staff, and the information transmission is relatively independent.

Observation indicators

Respiratory mechanics indicators: Including respiratory system static compliance (Cst), airway resistance (Raw), mean airway pressure (mPaw), plateau pressure (Pplat) and peak pressure (PIP). Measurements were taken before and after treatment to assess the patient's respiratory function.

Blood gas analysis indicators: Including SpO₂, PaO₂, and OI. Measurements are also taken before and after treatment to assess the patient's oxygenation level.

Serum inflammatory factor levels: Including CRP, PCT, cortisol (COR), and high mobility group protein B1 (HMGB1). Measurements were also taken before and after treatment to assess the patient's level of inflammatory response.

Statistical analysis

After data collection, SPSS statistical software was used for analysis. For continuous variables, mean ± SD is used to describe, and t test is used to compare the differences between two groups; for categorical variables, frequency (n) and percentage (%) are used to describe, and chi-square is used. The test compares the difference between two groups. Statistical significance was set at P < 0.05.

RESULTS

Basic information of patient

This study finally included 60 patients who met the diagnostic criteria for severe pneumonia, including 30 patients in the experimental group and 30 patients in the control group. A comparison of the basic conditions of the two groups of patients is shown in (Table 1). The results showed that there were no significant differences in basic characteristics such as age, gender, and medical history between the two groups of patients, ensuring the comparability of the two groups.

Table 1 General patient information, mean ± SD.

Group	Experimental group	Control group	F/t	P value
Age (yr)	54.73 ± 5.31	65.5 ± 3.15	-0.722	0.473
Gender (Male/female)	13/17	14/ 16	0.591	0.444
Body mass index	24.27 ± 1.81	23.85 ± 2.13	0.808	0.421
Smoking history (pack/yr)	16/14	15/ 14	0.644	0.425
High blood pressure (Yes/No)	14/16	13/17	0.586	0.446
Diabetes (Yes/No)	8/22	7/23	0.586	0.446
Glycosylated hemoglobin (%)	5.37 ± 0.68	5.62 ± 0.72	-1.090	0.280
Total cholesterol (mmoL/L)	6.39 ± 0.68	6.40 ± 0.72	-0.069	0.944
Triglyceride (mmoL/L)	1.43 ± 0.49	1.58 ± 0.42	-1.284	0.203
Low density lipoprotein (mmoL/L)	3.06 ± 0.55	3.27 ± 0.45	-1.600	0.114
Phospholipid protein A1 (g/L)	0.95 ± 0.21	0.87 ± 0.17	1.592	0.116
Phospholipid protein B (g/L)	1.46 ± 0.35	1.42 ± 0.36	0.431	0.667
Lipoprotein (mg/dL)	127.14 ± 7.93	134.31 ± 9.39	-1.927	0.058

Changes in respiratory mechanics indicators

Before treatment, the comparison results of respiratory mechanics indicators (Cst, Raw, mPaw, Pplat, PIP) between the two groups of patients are shown in Table 2. The results showed that there were no significant differences in these indicators between the two groups of patients (P > 0.05). However, after treatment, the respiratory mechanics indicators of patients in the experimental group were significantly improved compared with before treatment, while the improvement of patients in the control group was relatively small. The specific comparison results are shown in (Table 2).

Table 2 Comparison of respiratory mechanics indicators before treatment, mean ± SD.

Group	Time	Cst (mL/cm H2O)	Raw (cm H2O/L/s)	mPaw (cm H2O)	Pplat (cm H2O)	PIP (cm H2O)
Test group	Before treatment	44.39 ± 3.87	15.63 ± 2.18	18.21 ± 3.17	24.33 ± 3.69	26.20 ± 4.87
	After treatment	51.97 ± 4.84	12.26 ± 1.64	15.90 ± 2.37	21.44 ± 3.01	24.06 ± 3.12
Control group	Before treatment	44.00 ± 3.58	15.86 ± 1.80	18.80 ± 2.71	24.51 ± 2.71	26.33 ± 4.15
	After treatment	49.49 ± 4.47	14.80 ± 1.99	18.72 ± 2.03	24.50 ± 3.12	27.81 ± 4.03
t/P (before and after treatment)		0.404/0.688	-0.449/0.655	-0.774/0.442	-0.215/0.83	-0.111/0.912
t/P (before and after treatment)		2.06/0.044	-0.541/< 0.01	-4.954/< 0.01	-3.871/< 0.01	-4.027/< 0.01

Cst: Respiratory system static compliance; Raw: Airway resistance; mPaw: Mean airway pressure; Pplat: Plateau pressure; PIP: Peak pressure.

Changes in blood gas analysis indicators

Before treatment, the comparison results of blood gas analysis indicators (SpO₂, PaO₂, OI) between the two groups of patients are shown in Table 3. The results showed that there were no significant differences in these indicators between the two groups of patients (P > 0.05). However, after treatment, the blood gas analysis indicators of patients in the experimental group were significantly improved compared with before treatment, while the improvement of patients in the control group was relatively small. The specific comparison results are shown in (Table 3).

Table 3 Comparison of blood gas analysis indicators before treatment, mean ± SD.

Group	Time	SpO2 (%)	PaO2 (mmHg)	OI
Test group	Before treatment	93.15 ± 1.79	80.24 ± 7.15	18.58 ± 2.50
	After treatment	94.68 ± 1.68	92.53 ± 8.13	15.28 ± 1.99
Control group	Before treatment	93.34 ± 2.16	78.78 ± 7.28	19.35 ± 2.57
	After treatment	93.52 ± 2.32	86.65 ± 6.15	18.16 ± 1.75
t/P (before and after treatment)		-0.37/0.713	0.786/0.435	-1.19/0.239
t/P (before and after treatment)		2.231/0.03	3.159/< 0.01	-5.952/< 0.01

SpO₂: Blood oxygen saturation; PaO₂: Arterial partial pressure of oxygen; OI: Oxygenation index.

Changes in serum inflammatory factor levels

Before treatment, the comparison results of serum inflammatory factor levels (CRP, PCT, COR, HMGB1) between the two groups of patients are shown in Table 4. The results showed that there were no significant differences in these indicators between the two groups of patients (P > 0.05). However, after treatment, the serum CRP and PCT levels of patients in the experimental group dropped significantly compared with before treatment, while the improvement in patients in the control group was relatively small. The specific comparison results are shown in (Table 4).

Table 4 Comparison of serum inflammatory factor levels before treatment, mean ± SD.

Group	Time	CRP (mg/L)	PCT (ng/mL)
Test group	Before treatment	41.98 ± 4.45	2.43 ± 0.81
	After treatment	40.29 ± 3.38	2.46 ± 0.64
Control group	Before treatment	41.83 ± 2.07	1.16 ± 0.5
	After treatment	29.53 ± 5.03	2.40 ± 0.48
t/P (before and after treatment)		0.163/0.871	0.451/0.654
t/P (before and after treatment)		9.732/< 0.01	7.259/< 0.01

CRP: C-reactive protein; PCT: Procalcitonin.

Changes in serum COR and HMGB1 levels

Before treatment, the comparison of serum COR and HMGB1 levels between the two groups of patients showed that there was no significant difference between the experimental group and the control group (P > 0.05). However, after treatment, the serum COR and HMGB1 levels of patients in the experimental group were significantly lower than before treatment, and the difference was statistically significant compared with the control group (P < 0.05). The specific comparison results are shown in (Table 5).

Table 5 Changes in serum cortisol and high mobility group protein B1 levels, mean ± SD.

Group	Time	COR (μg/dL)	HMGB1 (ng/mL)
Test group	Before treatment	19.33 ± 2.30	32.20 ± 3.27
	After treatment	14.94 ± 2.19	28.30 ± 2.58
Control group	Before treatment	18.65 ± 2.36	33.70 ± 2.98
	After treatment	18.25 ± 2.25	33.17 ± 3.05
t/P (before and after treatment)		1.125/0.265	-1.742/0.087
t/P (before and after treatment)		-5.77/< 0.01	-6.684/< 0.01

COR: Cortisol; HMGB1: High mobility group protein B1.

DISCUSSION

This study preliminarily explored the role of nursing team communication and collaboration in ICU treatment by comparing the differences in physiological indicators and therapeutic effects between two groups of ICU patients with severe pneumonia who received nursing team communication and collaboration and those who received single care before and after treatment[24]. The respiratory mechanics, blood gas analysis, and inflammatory factor levels of patients in the experimental group were significantly improved after treatment compared with the control group, proving the positive role of communication and collaboration among the nursing team in improving treatment effects. The discussion will focus on changes in respiratory mechanics indicators, blood gas analysis indicators, and serum inflammatory factors COR and HMGB1.

Before treatment, there was no significant difference in respiratory mechanics indicators between the two groups of patients, indicating that the respiratory functions of the two groups of patients were basically similar before treatment. However, after treatment, the respiratory mechanics indicators of patients in the experimental group were significantly improved, including Cst, Raw, mPaw, Pplat and PIP. This may be because the multidisciplinary collaboration of the nursing team makes the treatment plan more comprehensive, personalized, and more timely adjusted according to the patient's actual condition. In contrast, patients in the control group showed relatively smaller improvements, which may be because information transfer and team collaboration in traditional medical team management are not as efficient as in the experimental group.

Before treatment, there was no significant difference in the blood gas analysis indicators (SpO₂, PaO₂, OI) between the two groups of patients, indicating that the oxygenation levels of the two groups of patients were similar before treatment. However, after treatment, the blood gas analysis indicators of the patients in the experimental group were significantly improved compared with before treatment, including SpO₂, PaO₂, and OI. This suggests that collaborative efforts by the care team can help improve oxygenation levels, possibly because a more comprehensive team assessment allows for more precise planning of respiratory support. The relatively small improvement among patients in the control group may be related to lower levels of teamwork.

Before treatment, there was no significant difference in the serum levels of inflammatory factors COR and HMGB1 between the two groups of patients. However, after treatment, the serum COR and HMGB1 levels of patients in the experimental group decreased significantly compared with before treatment, while the improvement in patients in the control group was relatively small. COR and HMGB1, as inflammatory factors, play a key regulatory role in the immune inflammatory response. The decrease in these two inflammatory factors in the serum of patients in the experimental group may be related to the effective communication and collaboration of the nursing team, making the treatment more precise and efficient. The improvement of patients in the control group was relatively small, which may be because in traditional medical team management, information transmission is relatively independent, making it difficult to comprehensively assess the patient's inflammatory status. It is worth noting that during the entire study period, no serious adverse events or complications occurred in either the experimental group or the control group, indicating that the treatment model of communication and collaboration among the nursing teams is safe and feasible. This provides a positive experience for promoting collaborative working of nursing teams in clinical practice.

This study has several limitations. First, the sample size is relatively small, which may affect the generalizability of the results. Future research may consider expanding the sample size to verify the robustness of the results. Secondly, this study did not conduct an in-depth exploration of the specific ways of communication and collaboration among nursing teams. Different collaboration methods may have different impacts on treatment effects. Future research can further clarify the specific mechanisms and methods of team collaboration. Finally, this study focuses on the changes in physiological indicators before and after treatment, and the observation of the impact on patients' long-term survival and quality of life is relatively limited. Long-term follow-up studies can be carried out in the future.

CONCLUSION

In summary, the results of this study preliminarily indicate that communication and collaboration among nursing teams have a positive impact on the treatment effectiveness of ICU severe pneumonia patients. Communication and collaboration among nursing teams can improve patient respiratory mechanics indicators and blood gas analysis indicators, and have a positive regulatory effect on patient immune inflammatory response by regulating serum inflammatory factors COR and HMGB1 levels. In the future, further research can be conducted on the specific collaboration mechanisms of nursing teams to promote their wider application in ICU treatment.