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Sample records for brazilian intensive care

  1. Hemodynamic monitoring in the intensive care unit: a Brazilian perspective

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    Dias, Fernando Suparregui; Rezende, Ederlon Alves de Carvalho; Mendes, Ciro Leite; Silva Jr., João Manoel; Sanches, Joel Lyra

    2014-01-01

    Objective In Brazil, there are no data on the preferences of intensivists regarding hemodynamic monitoring methods. The present study aimed to identify the methods used by national intensivists, the hemodynamic variables they consider important, the regional differences, the reasons for choosing a particular method, and the use of protocols and continued training. Methods National intensivists were invited to answer an electronic questionnaire during three intensive care events and later, through the Associação de Medicina Intensiva Brasileira portal, between March and October 2009. Demographic data and aspects related to the respondent preferences regarding hemodynamic monitoring were researched. Results In total, 211 professionals answered the questionnaire. Private hospitals showed higher availability of resources for hemodynamic monitoring than did public institutions. The pulmonary artery catheter was considered the most trusted by 56.9% of the respondents, followed by echocardiograms, at 22.3%. Cardiac output was considered the most important variable. Other variables also considered relevant were mixed/central venous oxygen saturation, pulmonary artery occlusion pressure, and right ventricular end-diastolic volume. Echocardiography was the most used method (64.5%), followed by pulmonary artery catheter (49.3%). Only half of respondents used treatment protocols, and 25% worked in continuing education programs in hemodynamic monitoring. Conclusion Hemodynamic monitoring has a greater availability in intensive care units of private institutions in Brazil. Echocardiography was the most used monitoring method, but the pulmonary artery catheter remains the most reliable. The implementation of treatment protocols and continuing education programs in hemodynamic monitoring in Brazil is still insufficient. PMID:25607264

  2. I Brazilian guidelines for respiratory physiotherapy in pediatric and neonatal intensive care units.

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    Johnston, Cíntia; Zanetti, Nathalia Mendonça; Comaru, Talitha; Ribeiro, Simone Nascimento Dos Santos; Andrade, Lívia Barboza de; Santos, Suzi Laine Longo Dos

    2012-06-01

    Developing guidelines for the role of the physiotherapist in neonatal and pediatric intensive care units is essential because these professionals are responsible for the rehabilitation of critically ill patients. Rehabilitation includes the evaluation and prevention of functional kinetic alterations, application of treatment interventions (respiratory and/or motor physiotherapy), control and application of medical gases, care of mechanical ventilation, weaning and extubation, tracheal gas insufflation, inflation/deflation of the endotracheal cuff protocol, and surfactant application, aiming to allow patients to have a full recovery and return to their functional activities. In this article, we present guidelines that are intended to guide the physiotherapist in some of the prevention/treatment interventions in respiratory therapy (airway clearance, lung expansion, position in bed, airway suction, drug inhalation, and cough assist), which help in the rehabilitation process of newborns and children in intensive care units during mechanical ventilation and up to 12 hours following extubation. PMID:23917758

  3. Perfil de fisioterapeutas brasileiros que atuam em unidades de terapia intensiva A profile of Brazilian physical therapists in intensive care units

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    Emilia Nozawa

    2008-01-01

    Full Text Available Este estudo visou investigar o perfil dos fisioterapeutas que atuam nas unidades de terapia intensiva (UTIs no Brasil, focalizando a direção do serviço, técnicas fisioterapêuticas empregadas e nível de autonomia em relação à ventilação mecânica invasiva e não-invasiva. Questionários foram enviados aos chefes dos serviços de fisioterapia de 1.192 hospitais registrados na Associação Médica de Terapia Intensiva, com retorno de 461 (39% UTIs. Em 88% destas, os serviços são chefiados por fisioterapeutas; em 78%, compostos por até oito fisioterapeutas; 44,4% dos fisioterapeutas trabalham em regime de 30 horas semanais e 46,1% têm contrato de trabalho. Há assistência fisioterapêutica durante 24 horas em 33,6% das UTIs; 88% delas mantêm assistência nos finais de semana. Quanto às técnicas fisioterapêuticas, todos realizam mobilização, posicionamento e aspiração; 91,5% atuam na ventilação não-invasiva, sendo que 43% trabalham com total autonomia. Em relação à ventilação mecânica invasiva, 80% realizam extubação; 79,2% realizam regulagem e desmame do ventilador; entretanto, só 22% têm total autonomia (78% necessitam de protocolo ou opinião da equipe médica. Os fisioterapeutas brasileiros atuam, em sua maioria, em instituições privadas e assistenciais, cujos serviços são chefiados por fisioterapeutas. Têm relativa autonomia quanto às técnicas fisioterapêuticas e o manuseio da ventilação mecânica não-invasiva mas, no caso da invasiva, atuam sob diretiva da equipe médica.The purpose of this study was to outline a profile of physical therapists who work in intensive care units (ICU in Brazil, focusing on service management, techniques used, and the degree of therapists' autonomy regarding invasive and non-invasive mechanical ventilation. Questionnaires were sent to the heads of physical therapy (PT services of 1,192 hospitals registered at the Brazilian Intensive Care Medicine Association and 461

  4. Preventing catheter-associated infections in the Pediatric Intensive Care Unit: impact of an educational program surveying policies for insertion and care of central venous catheters in a Brazilian teaching hospital

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    Marcelo Luiz Abramczyk

    2011-12-01

    Full Text Available Objectives: To determine the impact of an educational program on the prevention of central venous catheter-related infections in a Brazilian Pediatric Intensive Care Unit. Patients and Methods: All patients admitted to the unit between February 2004 and May 2005 were included in the cohort study in a longitudinal assessment. An educational program was developed based on the Centers for Disease Control and Prevention recommendations for prevention of catheter-associated infections and was adapted to local conditions and resources after an initial observational phase. Incidence of catheter-associated infections was measured by means of on-site surveillance. Results: One hundred eighteen nosocomial infections occurred in 253 patients (46.6 infections per 100 admissions and in 2,954 patient-days (39.9 infections per 1,000 patient-days. The incidence-density of catheter infections was 31.1 episodes per 1.000 venous central catheter-days before interventions, and 16.5 episodes per 1,000 venous central catheter-days afterwards (relative risk 0.53 [95% CI 0.28-1.01]. Corresponding rates for exit-site catheter infections were 8.0 and 2.5 episodes per 1,000 venous central catheter-days [0.32 (0.07-1.49], and the rates for bloodstream infections were 23.1 and 13.9 episodes per 1,000 venous central catheter-days, before and after interventions [0.61 (0.32-1.14]. Conclusion: A prevention strategy targeted at the insertion and maintenance of vascular access can decrease rates of vascular-access infections in pediatric intensive care unit.

  5. Intensive Care, Intense Conflict: A Balanced Approach.

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    Paquette, Erin Talati; Kolaitis, Irini N

    2015-01-01

    Caring for a child in a pediatric intensive care unit is emotionally and physically challenging and often leads to conflict. Skilled mediators may not always be available to aid in conflict resolution. Careproviders at all levels of training are responsible for managing difficult conversations with families and can often prevent escalation of conflict. Bioethics mediators have acknowledged the important contribution of mediation training in improving clinicians' skills in conflict management. Familiarizing careproviders with basic mediation techniques is an important step towards preventing escalation of conflict. While training in effective communication is crucial, a sense of fairness and justice that may only come with the introduction of a skilled, neutral third party is equally important. For intense conflict, we advocate for early recognition, comfort, and preparedness through training of clinicians in de-escalation and optimal communication, along with the use of more formally trained third-party mediators, as required. PMID:26752393

  6. Relationship between antibiotic consumption, oropharyngeal colonization, and ventilator-associated pneumonia by Staphylococcus aureus in an intensive care unit of a Brazilian teaching hospital

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    Michel Rodrigues Moreira

    2012-02-01

    Full Text Available INTRODUCTION: his study evaluated the consumption of major classes of antibiotics, the colonization of the oropharynx of patients on mechanical ventilation, and the risk of ventilator-associated pneumonia (VAP caused by Staphylococcus aureus in an intensive care unit for adults. METHODS: A case-control study was carried out using colonized patients (cases by oxacillin-resistant S. aureus (ORSA and (controls oxacillin-sensitive S. aureus (OSSA from May 2009 to August 2010. The occurrence of VAP by S. aureus was also evaluated in the same period. Antibiotic consumption was expressed as the number of defined daily doses (DDD/1,000 patient-days for glycopeptides, carbapenems, and extended-spectrum cephalosporins. RESULTS: Three hundred forty-six (56.1% patients underwent mechanical ventilation with a frequency of oropharyngeal colonization of 36.4%, corresponding to 63.5% for ORSA and 36.5% for OSSA. The risk of illness for this organism was significant (p60 years, previous antibiotic therapy, and previous use of carbapenems were statistically significant by multivariate analysis. CONCLUSIONS: There was a significant relationship between the colonization of the oropharyngeal mucosa and the risk of VAP by both phenotypes. The use of glycopeptides was related to colonization by ORSA.

  7. Intensive care of conjoined twins.

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    Kobylarz, Krzysztof

    2014-01-01

    Conjoined twinning is one of the most uncommon congenital anomalies. Maintenance in an intensive care setting during this time allows for close monitoring, stabilisation, and nutritional supplementation of the infants as necessary to optimise preoperative growth and development. The birth of conjoined twins is a very difficult and dramatic moment for parents. It is also a very difficult situation for the team of physicians, nurses and other required hospital staff to carry out treatment and care of these specific developmental anomalies. The diagnostics and treatment in this extraordinary situation requires close cooperation of the multidisciplinary medical team, which includes their personal experience and medical knowledge, with a team of intensive care unit nurses. This report presents the rules in cease of conjoined twins during their intensive care unit stay with special reference to the proceedings before and after complete separation. PMID:24858974

  8. Contracting for intensive care services.

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    Dorman, S

    1996-01-01

    Purchasers will increasingly expect clinical services in the NHS internal market to provide objective measures of their benefits and cost effectiveness in order to maintain or develop current funding levels. There is limited scientific evidence to demonstrate the clinical effectiveness of intensive care services in terms of mortality/morbidity. Intensive care is a high-cost service and studies of cost-effectiveness need to take account of case-mix variations, differences in admission and discharge policies, and other differences between units. Decisions over development or rationalisation of intensive care services should be based on proper outcome studies of well defined patient groups. The purchasing function itself requires development in order to support effective contracting. PMID:9873335

  9. How is intensive care reimbursed?

    DEFF Research Database (Denmark)

    Bittner, Martin-Immanuel; Donnelly, Maria; van Zanten, Arthur Rh;

    2013-01-01

    of them originating from a DRG system, the high degree of complexity found, and the difficulties faced in several countries when collecting the data for this collaborative work. This review has been designed to help the intensivist clinician and researcher to understanding neighbouring countries......Reimbursement schemes in intensive care are more complex than in other areas of healthcare, due to special procedures and high care needs. Knowledge regarding the principles of functioning in other countries can lead to increased understanding and awareness of potential for improvement. This can...... be achieved through mutual exchange of solutions found in other countries. In this review, experts from eight European countries explain their respective intensive care unit reimbursement schemes. Important conclusions include the apparent differences in the countries' reimbursement schemes---despite all...

  10. Peri-operative intensive care.

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    Walsh, Sandra A; Peters, Mark J

    2015-10-01

    All good intensive care requires attention to detail of the routine elements of care. These include staffing and monitoring, drug prescription and administration, feeding and fluid balance, analgesia and sedation, organ support and reducing the risk of healthcare-associated infection. Doing this well requires an understanding of the relevant physiology and an awareness of the limited evidence base. Detailed protocols and implementation checklist are valuable in ensuring that these minimum standards are met. However, peri-operative care is not all predictable and amenable to protocolization. This is especially true following separation of conjoined twins. Despite the sophisticated imaging and multi-disciplinary planning that precede elective separation, the acute physiological changes in each twin cannot always be predicted reliably. In this article, we review briefly each element of peri-operative care and how this might vary in conjoined twins. PMID:26382268

  11. Handling during neonatal intensive care.

    OpenAIRE

    Murdoch, D R; Darlow, B A

    1984-01-01

    The handling received by very low birthweight newborns undergoing intensive care in the first few days of life and the effects of this were studied. Infants were handled an average of 4.3 hours (18%) of the total 24 hour observation time and received a mean 234 handling procedures. Parental handling contributed 35% of the total time but was usually benign except in that it could interfere with the infant's rest. Many procedures were associated with undesirable consequences. Endotracheal sucti...

  12. Pediatric Palliative Care in the Intensive Care Unit.

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    Madden, Kevin; Wolfe, Joanne; Collura, Christopher

    2015-09-01

    The chronicity of illness that afflicts children in Pediatric Palliative Care and the medical technology that has improved their lifespan and quality of life make prognostication extremely difficult. The uncertainty of prognostication and the available medical technologies make both the neonatal intensive care unit and the pediatric intensive care unit locations where many children will receive Pediatric Palliative Care. Health care providers in the neonatal intensive care unit and pediatric intensive care unit should integrate fundamental Pediatric Palliative Care principles into their everyday practice. PMID:26333755

  13. Intensive Care in Critical Access Hospitals

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    Freeman, Victoria A.; Walsh, Joan; Rudolf, Matthew; Slifkin, Rebecca T.; Skinner, Asheley Cockrell

    2007-01-01

    Context: Although critical access hospitals (CAHs) have limitations on number of acute care beds and average length of stay, some of them provide intensive care unit (ICU) services. Purpose: To describe the facilities, equipment, and staffing used by CAHs for intensive care, the types of patients receiving ICU care, and the perceived impact of…

  14. Oral care in Brazilian bone marrow transplant centers

    OpenAIRE

    Fernanda de Paula Eduardo; Letícia Mello Bezinelli; Nelson Hamerschlak; Claudia Toledo Andrade; Leonardo Raul Morelli; Luciana Corrêa

    2011-01-01

    BACKGROUND: Oral care is a fundamental procedure for the success of the hematopoietic stem cell transplantation, particularly regarding the control of oral infectious diseases. Information about oral care protocols and the inclusion of dental professionals in transplantation medical staff is poorly known. OBJECTIVE: The aim of this study was to carry out a survey about the protocols of Brazilian dental professionals with regard to oral care of HSCT patients. METHODS: A questionnaire was maile...

  15. The patient experience of intensive care

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Bergbom, Ingegerd; Lindahl, Berit;

    2015-01-01

    BACKGROUND: Sedation practices in the intensive care unit have evolved from deep sedation and paralysis toward lighter sedation and better pain management. The new paradigm of sedation has enabled early mobilization and optimized mechanical ventilator weaning. Intensive care units in the Nordic c...... state, where they face the choice of life or death. Caring nurses and family members play an important role in assisting the patient to transition back to life.......BACKGROUND: Sedation practices in the intensive care unit have evolved from deep sedation and paralysis toward lighter sedation and better pain management. The new paradigm of sedation has enabled early mobilization and optimized mechanical ventilator weaning. Intensive care units in the Nordic...... countries have been particularly close to goals of lighter or no sedation and a more humane approach to intensive care. OBJECTIVES: The aim of our study was to systematically review and reinterpret newer Nordic studies of the patient experience of intensive care to obtain a contemporary description of human...

  16. Organizing Safe Transitions from Intensive Care

    OpenAIRE

    Marie Häggström; Britt Bäckström

    2014-01-01

    Background. Organizing and performing patient transfers in the continuum of care is part of the work of nurses and other staff of a multiprofessional healthcare team. An understanding of discharge practices is needed in order to ultimate patients’ transfers from high technological intensive care units (ICU) to general wards. Aim. To describe, as experienced by intensive care and general ward staff, what strategies could be used when organizing patient’s care before, during, and after transfer...

  17. Intensive Care Management in Pediatric Burn Patients

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    Ayşe Ebru Sakallıoğlu Abalı

    2011-07-01

    Full Text Available Burn injury is still a leading cause of morbidity and mortality in children. This article aimed to review the current principles of management from initial assessment to early management and intensive care for pediatric burn patients. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 62-9

  18. Current physiotherapy approaches in intensive care units

    OpenAIRE

    Yurdalan, S. Ufuk

    2011-01-01

    Physiotherapy is a part of the multidisciplinary treatment in different intensive care units. Respiratory, cardiovascular and neuromusculoskeletal- focused physiotherapy programmes and prevention of the respiratory, neuromuscular complications which may be possible, developing the exercise capacity related to inspiratory muscle function in critically patients internalized and postoperative cases in intensive care unit are clinical targets. It is known that physiotherapy initiated early is rel...

  19. Intensive care patient diaries in Scandinavia

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Storli, Sissel Lisa; Åkerman, Eva

    2011-01-01

    Critical illness and intensive care therapy are often followed by psychological problems such as nightmares, hallucinations, delusions, anxiety, depression, and symptoms of posttraumatic stress. Intensive care patient diaries have been kept by nurses and the patients' family since the early 1990s...

  20. [Quality management in intensive care medicine].

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    Martin, J; Braun, J-P

    2014-02-01

    Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to external quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system. PMID:24493011

  1. Oral care in Brazilian bone marrow transplant centers

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    Fernanda de Paula Eduardo

    2011-02-01

    Full Text Available BACKGROUND: Oral care is a fundamental procedure for the success of the hematopoietic stem cell transplantation, particularly regarding the control of oral infectious diseases. Information about oral care protocols and the inclusion of dental professionals in transplantation medical staff is poorly known. OBJECTIVE: The aim of this study was to carry out a survey about the protocols of Brazilian dental professionals with regard to oral care of HSCT patients. METHODS: A questionnaire was mailed to 36 Brazilian transplant centers with questions about basic oral care protocols, the indication of specific mouthwashes, antibiotic therapy regimens, laser therapy, and treatment of oral mucositis and graft-versus-host disease. All the respondent centers (n = 12 have dentists as members of the HSCT medical staff. RESULTS: The majority indicate non-alcoholic chlorhexidine (n = 9; 75.0% and sodium bicarbonate (n = 5; 41.7% as routine mouthwashes. Laser therapy was frequently indicated (n= 9; 75.0%, mainly in the prevention of oral mucositis and in oral pain control. In the post-transplant period, antibiotic therapy was only indicated for invasive dental treatments (n= 8; 66.7%. Several treatments for graft-versus-host disease were mentioned without a trend towards establishing a standard protocol. CONCLUSION: Basic oral care constitutes regular assessment in the routine treatment of hematopoietic stem cell transplantation patients in Brazilian centers.

  2. Nosocomial Infections in Neonatal Intensive Care Units

    OpenAIRE

    Ioanna Paulopoulou; Christina Nanou

    2013-01-01

    Neonates, especially prematures, requiring care in Intensive Care Unit are a highly vulnerable population group at increased risk for nosocomial infections. In recent decades become one of the leading causes of morbidity and mortality in the Neonatal Intensive Care Unit. Aim: Highlighting the severity of nosocomial infections for hospitalized infants and the imprinting of risk factors that affects their development. Material-Methods: Searched for studies published in international scientific ...

  3. Patients' experiences of intensive care diaries

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Bagger, Christine

    2010-01-01

    had a triangulated approach and group dynamics were described as the focus group was used to explore agreement and disagreement among the participants. Little is known about the content of intensive care diaries and their usefulness and meaning for the patients. The participants in our study agreed......The aim of the study was to explore patients' experiences and perceptions of receiving intensive care diaries. A focus group and intensive care diaries for four former ICU patients were analysed to understand what works and what needs further development for patients who receive a diary. The study...

  4. Interdisciplinary communication in the intensive care unit

    OpenAIRE

    Reader, Tom W; Flin, R; Mearns, Kathryn; Cuthbertson, Brian H

    2007-01-01

    Background. Patient safety research has shown poor communication among intensive care unit (ICU) nurses and doctors to be a common causal factor underlying critical incidents in intensive care. This study examines whether ICU doctors and nurses have a shared perception of interdisciplinary communication in the UK ICU. Methods. Cross-sectional survey of ICU nurses and doctors in four UK hospitals using a previously established measure of ICU interdisciplinary collaboration. Results. A sample o...

  5. Hyperglycemia in the Intensive Care Unit

    OpenAIRE

    Rainer Lenhardt; Ozan Akca

    2014-01-01

    Hyperglycemia is frequently encountered in the intensive care unit. In this disease, after severe injury and during diabetes mellitus homeostasis is impaired; hyperglycemia, hypoglycemia and glycemic variability may ensue. These three states have been shown to independently increase mortality and morbidity. Patients with diabetics admitted to the intensive care unit tolerate higher blood glucose values without increase of mortality. Stress hyperglycemia may occur in patients with or without d...

  6. Thought outside the box: intensive care unit freakonomics and decision making in the intensive care unit.

    Science.gov (United States)

    Mohan, Deepika; Angus, Derek C

    2010-10-01

    Despite concerted efforts to improve the quality of care provided in the intensive care unit, inconsistency continues to characterize physician decision making. The resulting variations in care compromise outcomes and impose unnecessary decisional regret on clinicians and patients alike. Critical care is not the only arena where decisions fail to conform to the dictates of logic. Behavioral psychology uses scientific methods to analyze the influence of social, cognitive, and emotional factors on decisions. The overarching hypothesis underlying this "thought outside the box" is that the application of behavioral psychology to physician decision making in the intensive care unit will demonstrate the existence of cognitive biases associated with classic intensive care unit decisions; provide insight into novel strategies to train intensive care unit clinicians to better use data; and improve the quality of decision making in the intensive care unit as characterized by more consistent, patient-centered decisions with reduced decisional regret and work-related stress experienced by physicians. PMID:21164408

  7. Monitoring in the Intensive Care

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    Eric Kipnis

    2012-01-01

    Full Text Available In critical care, the monitoring is essential to the daily care of ICU patients, as the optimization of patient’s hemodynamic, ventilation, temperature, nutrition, and metabolism is the key to improve patients' survival. Indeed, the decisive endpoint is the supply of oxygen to tissues according to their metabolic needs in order to fuel mitochondrial respiration and, therefore, life. In this sense, both oxygenation and perfusion must be monitored in the implementation of any resuscitation strategy. The emerging concept has been the enhancement of macrocirculation through sequential optimization of heart function and then judging the adequacy of perfusion/oxygenation on specific parameters in a strategy which was aptly coined “goal directed therapy.” On the other hand, the maintenance of normal temperature is critical and should be regularly monitored. Regarding respiratory monitoring of ventilated ICU patients, it includes serial assessment of gas exchange, of respiratory system mechanics, and of patients' readiness for liberation from invasive positive pressure ventilation. Also, the monitoring of nutritional and metabolic care should allow controlling nutrients delivery, adequation between energy needs and delivery, and blood glucose. The present paper will describe the physiological basis, interpretation of, and clinical use of the major endpoints of perfusion/oxygenation adequacy and of temperature, respiratory, nutritional, and metabolic monitorings.

  8. Frequency of candidemias in a tertiary care intensive care unit

    International Nuclear Information System (INIS)

    Objective: To determine the frequency of fungal infections in intensive care unit (ICU) of Military Hospital, Rawalpindi, a tertiary care health facility. Study Design: Cross sectional study. Place and Duration of Study: Intensive Care Department of Military Hospital Rawalpindi from 01 Jan 2012 to 30 Jun 2012. Methodology: A total of 89 patients were screened with stay of more than 5 days in intensive care unit. Thirty cases were enrolled in the study for investigation of fungal infections that had fever even after 05 days of being on broad spectrum antibiotics. Culture was done on blood, urine and catheter tip samples as per clinical condition of a patient. Results: Candida infection was found in 23.4% of study cases. The mean age of study patients was 41.2 +- 20.0 years while 63.4% were female patients as compared to 36.7% males. Conclusion: Fungal infections especially candidemias are quite frequent in the intensive care units. (author)

  9. Teamwork in the Neonatal Intensive Care Unit

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    Barbosa, Vanessa Maziero

    2013-01-01

    Medical and technological advances in neonatology have prompted the initiation and expansion of developmentally supportive services for newborns and have incorporated rehabilitation professionals into the neonatal intensive care unit (NICU) multidisciplinary team. Availability of therapists specialized in the care of neonates, the roles of…

  10. Benefitting From Monitorization in Intensive Care Unit

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    Mois Bahar

    2011-12-01

    Full Text Available The most essential matter about following a patient in intensive care unit is a fine and correct monitorization. While benefitting from monitorization is the main objective of every intensive care physician, it should be discussed how successful we are when we do not take monitorization as a subject of interest sufficiently. This physicians who are both performing medical care and education has a very important role regarding the matter: To question and confirm the correctness of the parameters that are being followed and to use this data for choosing the treatment type. The vital parameters that are found necessary to be followed usually do not present us the sufficient utility. For purpose, implementing monitorization in a way of whole perspective including Examining, Questioning, Reading (Observing, Repeating, Recalling will maintain to receive consequences for the benefit of the patient. (Journal of the Turkish Society Intensive Care 2011; 9: 110-5

  11. Distributive Justice and Attitudes of Intensive Care Physicians towards Distribution of Intensive Care Beds in Turkey

    OpenAIRE

    Akpınar A et al.

    2013-01-01

    Objective: To assess intensive care physicians’ attitudes about the importance of various factors in decisions to use intensive care in Turkey according to distributive justice. Methods: The study was conducted between 2004 and 2006 in two medical congresses in Turkey and via e-mail. A-self-administered questionnaire was presented to the intensive care physicians and they asked to make admission/discharge decisions for 13 cases, and to ascribe importance to 20...

  12. Identification and characteristics of patients with palliative care needs in Brazilian primary care

    OpenAIRE

    Marcucci, Fernando C. I.; Cabrera, Marcos A. S.; Perilla, Anamaria Baquero; Brun, Marilia Maroneze; de Barros, Eder Marcos L.; Martins, Vanessa M.; Rosenberg, John P.; Yates, Patsy

    2016-01-01

    Background The Brazilian healthcare system offers universal coverage but lacks information about how patients with PC needs are serviced by its primary care program, Estratégia Saúde da Família (ESF). Methods Cross-sectional study in community settings. Patients in ESF program were screened using a Palliative Care Screening Tool (PCST). Included patients were assessed with Karnofsky Performance Scale (KPS), Edmonton Symptom Assessment System (ESAS) and Palliative Care Outcome Scale (POS). Res...

  13. [Refusal of care in the intensive care: how makes decision?].

    OpenAIRE

    Borel, Marie; Veber, Benoit; Villette-Baron, Karen; Hariri, S.; Dureuil, Bertrand; Hervé, Christian

    2009-01-01

    It is not a question of going towards a systematic admission in intensive care of any patient proposed, but to make sure that so if there is a refusal, it is carried out according to a step ethically acceptable.

  14. Organizing Safe Transitions from Intensive Care

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    Marie Häggström

    2014-01-01

    Full Text Available Background. Organizing and performing patient transfers in the continuum of care is part of the work of nurses and other staff of a multiprofessional healthcare team. An understanding of discharge practices is needed in order to ultimate patients’ transfers from high technological intensive care units (ICU to general wards. Aim. To describe, as experienced by intensive care and general ward staff, what strategies could be used when organizing patient’s care before, during, and after transfer from intensive care. Method. Interviews of 15 participants were conducted, audio-taped, transcribed verbatim, and analyzed using qualitative content analysis. Results. The results showed that the categories secure, encourage, and collaborate are strategies used in the three phases of the ICU transitional care process. The main category; a safe, interactive rehabilitation process, illustrated how all strategies were characterized by an intention to create and maintain safety during the process. A three-way interaction was described: between staff and patient/families, between team members and involved units, and between patient/family and environment. Discussion/Conclusions. The findings highlight that ICU transitional care implies critical care rehabilitation. Discharge procedures need to be safe and structured and involve collaboration, encouraging support, optimal timing, early mobilization, and a multidiscipline approach.

  15. Intensive Care Unit death and factors influencing family satisfaction of Intensive Care Unit care

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    Naveen Salins

    2016-01-01

    Full Text Available Introduction: Family satisfaction of Intensive Care Unit (FS-ICU care is believed to be associated with ICU survival and ICU outcomes. A review of literature was done to determine factors influencing FS-ICU care in ICU deaths. Results: Factors that positively influenced FS-ICU care were (a communication: Honesty, accuracy, active listening, emphatic statements, consistency, and clarity; (b family support: Respect, compassion, courtesy, considering family needs and wishes, and emotional and spiritual support; (c family meetings: Meaningful explanation and frequency of meetings; (d decision-making: Shared decision-making; (e end of life care support: Support during foregoing life-sustaining interventions and staggered withdrawal of life support; (f ICU environment: Flexibility of visiting hours and safe hospital environment; and (g other factors: Control of pain and physical symptoms, palliative care consultation, and family-centered care. Factors that negatively influenced FS-ICU care were (a communication: Incomplete information and unable to interpret information provided; (b family support: Lack of emotional and spiritual support; (c family meetings: Conflicts and short family meetings; (d end of life care support: Resuscitation at end of life, mechanical ventilation on day of death, ICU death of an elderly, prolonged use of life-sustaining treatment, and unfamiliar technology; and (e ICU environment: Restrictive visitation policies and families denied access to see the dying loved ones. Conclusion: Families of the patients admitted to ICU value respect, compassion, empathy, communication, involvement in decision-making, pain and symptom relief, avoiding futile medical interventions, and dignified end of life care.

  16. Ethical issues in neonatal intensive care

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    Marcello M. Orzalesi

    2011-01-01

    Full Text Available Recent progress in neonatal care have significantly improved the prognosis and chances of survival of critically ill or extremely preterm neonates and have modified the limits of viability. However, in some circumstances, when the child's death can only be briefly postponed at the price of severe suffering, or when survival is associated with severe disabilities and an intolerable life for the child and his/her parents, the application of the full armamentarium of modern neonatal intensive care may not be appropriate. In such circumstances the limitation of intensive treatments (withholding or withdrawing and shift towards palliative care, can represent a more humane and reasonable alternative. This article examines and discusses the ethical principles underlying such difficult decisions, the most frequent situations in which these decisions may be considered, the role of parents in the decisional process, and the opinions and behaviours of neonatologists of several European neonatal intensive units as reported by the EURONIC study.

  17. Hyperglycemia in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Rainer Lenhardt

    2014-12-01

    Full Text Available Hyperglycemia is frequently encountered in the intensive care unit. In this disease, after severe injury and during diabetes mellitus homeostasis is impaired; hyperglycemia, hypoglycemia and glycemic variability may ensue. These three states have been shown to independently increase mortality and morbidity. Patients with diabetics admitted to the intensive care unit tolerate higher blood glucose values without increase of mortality. Stress hyperglycemia may occur in patients with or without diabetes and has a strong association with increased mortality in the intensive care unit patients. Insulin is the drug of choice to treat hyperglycemia in the intensive care unit. In patients with moderate hyperglycemia a basal–bolus insulin concept can be used. Close glucose monitoring is of paramount importance throughout the intensive care unit stay of the patient. In the guidelines for glycemic control based on meta-analyses it was shown that a tight glycemic control does not have a significant mortality advantage over conventional treatment. Given the controversy about optimal blood glucose goals in the intensive care unit setting, it seems reasonable to target a blood glucose level around 140 mg/dL to avoid episodes of hypoglycemia and minimize glycemic variability. The closed loop system with continuous glucose monitoring and algorithm based insulin application by an infusion pump is a promising new concept with the potential to further reduce mortality and morbidity due to hyperglycemia, hypoglycemia and glycemic variability. The goal of this review was to give a brief overview about pathophysiology of hyperglycemia and to summarize current guidelines for glycemic control in critically ill patients.

  18. Medicare Managed Care Spillovers and Treatment Intensity.

    Science.gov (United States)

    Callison, Kevin

    2016-07-01

    Evidence suggests that the share of Medicare managed care enrollees in a region affects the costs of treating traditional fee-for-service (FFS) Medicare beneficiaries; however, little is known about the mechanisms through which these 'spillover effects' operate. This paper examines the relationship between Medicare managed care penetration and treatment intensity for FFS enrollees hospitalized with a primary diagnosis of AMI. I find that increased Medicare managed care penetration is associated with a reduction in both the costs and the treatment intensity of FFS AMI patients. Specifically, as Medicare managed care penetration increases, FFS AMI patients are less likely to receive surgical reperfusion and mechanical ventilation and to experience an overall reduction in the number of inpatient procedures. Copyright © 2015 John Wiley & Sons, Ltd. PMID:25960418

  19. Factors Affecting Intensive Care Units Nursing Workload

    OpenAIRE

    Mohammadkarim BAHADORI; RAVANGARD, Ramin; Raadabadi, Mehdi; Mosavi, Seyed Masod; Gholami Fesharaki, Mohammad; Mehrabian, Fardin

    2014-01-01

    Background: The nursing workload has a close and strong association with the quality of services provided for the patients. Therefore, paying careful attention to the factors affecting nursing workload, especially those working in the intensive care units (ICUs), is very important. Objectives: This study aimed to determine the factors affecting nursing workload in the ICUs of the hospitals affiliated to Tehran University of Medical Sciences. Materials and Methods: This was a cross-sectional a...

  20. Nosocomial Infections in Neonatal Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Ioanna Paulopoulou

    2013-10-01

    Full Text Available Neonates, especially prematures, requiring care in Intensive Care Unit are a highly vulnerable population group at increased risk for nosocomial infections. In recent decades become one of the leading causes of morbidity and mortality in the Neonatal Intensive Care Unit. Aim: Highlighting the severity of nosocomial infections for hospitalized infants and the imprinting of risk factors that affects their development. Material-Methods: Searched for studies published in international scientific journals during the period 2004-2013. As a main tool of retraction of bibliography was used the internet. Specific web sites and library databases: PubMed, Cinahl and Google scholar with key-words: "prevent nosocomial infections", "infection control", "neonatal care", "nursing care prematurity", "neonates nosocomial infections", "neonatal intensive care unit" (NICU. Methodology was applied thematic content analysis, which provides a careful reading of the material and recording the recurring risk factors Neonatal Neonatal Unit. Results: All researchers agree that nosocomial infections of hospitalized infants are a result of interaction of intrinsic and extrinsic factors risk. The intrinsic factors predisposing to infection is the immaturity of the immune system, the barriers of the skin and mucous membranes. Furthermore, multiple external factors contribute to the development of infection, such as low birth weight, underlying disease, broad-spectrum antibiotics, prolonged hospitalization, invasive techniques, parenteral nutrition, numerical insufficiency of staff, and poor compliance with medical professionals on hand hygiene. In recent years, the use of protocols and guidelines for each intervention in newborns has dramatically reduce the incidence of nosocomial infections. Conclusions: Nosocomial infections constitute serious threat to the population of the Neonatal Intensive Care Unit. Surveillance of infections and the use of protocols will help control

  1. Performance and burnout in intensive care units

    NARCIS (Netherlands)

    Keijsers, G.J.; Schaufeli, W.B.; LeBlanc, P.; Zwerts, C.; Miranda, D.R.

    1995-01-01

    The relationship between three different performance measures and burnout was explored in 20 Dutch Intensive Care Units (ICUs). Burnout (i.e. emotional exhaustion and depersonalization) proved to be significantly related to nurses' perceptions of performance as well as to objectively assessed unit p

  2. Predictive data mining in intensive care

    OpenAIRE

    Guiza Grandas, Fabian; Fierens, Daan; Ramon, Jan; Blockeel, Hendrik; Meyfroidt, Geert; Bruynooghe, Maurice; Van den Berghe , Greet

    2006-01-01

    In this paper we describe an application of data mining methods for different prediction tasks in an intensive care unit. Some of the challenging aspects of performing data mining in this domain are highlighted. The applied methods result in models with good performances within medical standards that can be valuable in assisting medical decision making.

  3. Caring with difficulty: Brazilian nurses' experiences of gynaecological surgery care.

    OpenAIRE

    Vargens, O; Berterö, Carina

    2010-01-01

    This study was made by a qualitative approach based on symbolic interactionism and grounded theory. The subject was defined as what mutilation means for nurses who take care of women submitted to gynaecological surgery. The aim was to identify the interaction relationship of nurses as female with the phenomenon of mutilation in gynaecological surgeries and how it affects their relationship with female patients in this situation. Data were obtained by interviews with 16 nurses who work in gyna...

  4. Negotiating natural death in intensive care.

    Science.gov (United States)

    Seymour, J E

    2000-10-01

    Recent empirical evidence of barriers to palliative care in acute hospital settings shows that dying patients may receive invasive medical treatments immediately before death, in spite of evidence of their poor prognosis being available to clinicians. The difficulties of ascertaining treatment preferences, predicting the trajectory of dying in critically ill people, and assessing the degree to which further interventions are futile are well documented. Further, enduring ethical complexities attending end of life care mean that the process of withdrawing or withholding medical care is associated with significant problems for clinical staff. Specific difficulties attend the legitimation of treatment withdrawal, the perceived differences between 'killing' and 'letting die' and the cultural constraints which attend the orchestration of 'natural' death in situations where human agency is often required before death can follow dying. This paper draws on ethnographic research to examine the way in which these problems are resolved during medical work within intensive care. Building on insights from the literature, an analysis of observational case study data is presented which suggests that the negotiation of natural death in intensive care hinges upon four strategies. These, which form a framework with which to interpret social interaction between physicians during end of life decision-making in intensive care, are as follows: firstly, the establishment of a 'technical' definition of dying--informed by results of investigations and monitoring equipment--over and above 'bodily' dying informed by clinical experience. Secondly, the alignment of the trajectories of technical and bodily dying to ensure that the events of non-treatment have no perceived causative link to death. Thirdly, the balancing of medical action with non-action, allowing a diffusion of responsibility for death to the patient's body; and lastly, the incorporation of patient's companions and nursing staff

  5. Sedation in neurological intensive care unit

    Directory of Open Access Journals (Sweden)

    Birinder S Paul

    2013-01-01

    Full Text Available Analgesia and sedation has been widely used in intensive care units where iatrogenic discomfort often complicates patient management. In neurological patients maximal comfort without diminishing patient responsiveness is desirable. In these patients successful management of sedation and analgesia incorporates a patient based approach that includes detection and management of predisposing and causative factors, including delirium, monitoring using sedation scales, proper medication selection, emphasis on analgesia based drugs and incorporation of protocols or algorithms. So, to optimize care clinician should be familiar with the pharmacokinetic and pharmacodynamic variables that can affect the safety and efficacy of analgesics and sedatives.

  6. Intensive care for the adult population in Ireland: a multicentre study of intensive care population demographics

    OpenAIRE

    ,

    2008-01-01

    Introduction This prospective observational study was conducted to describe the nature of the intensive care population across Ireland, identify adherence to international benchmarks of practice, and describe patient outcomes in critically ill patients. Methods A prospective observational multicentre study of demographics and organ failure incidence was carried out over a 10-week period in 2006 across the intensive care units (ICUs) of 14 hospitals in both the Republic and Northern Ireland. R...

  7. Understanding the dimensions of intensive care: transpersonal caring and complexity theories.

    Science.gov (United States)

    do Nascimento, Keyla Cristiane; Erdmann, Alacoque Lorenzini

    2009-01-01

    This is a descriptive, interpretive and qualitative study carried out at the ICU of a Brazilian teaching hospital. It aimed to understand the dimensions of human caring experienced by health care professionals, clients and their family members at an ICU, based on human caring complexity. The Transpersonal Caring and Complexity theories support theory and data analysis. The following dimensions of care emerged from the themes analyzed according to Ricoeur: self-care, care as an individual value, professional vs. informal care, care as supportive relationship, affective care, humanized care, care as act/attitude, care practice; educative care, dialogical relationship, care coupled to technology, loving care, interactive care, non-care, care ambience, the essence of life and profession, and meaning/purpose of care. We believe in care that encompasses several dimensions presented here, based on the relationship with the other, on the empathetic, sensitive, affectionate, creative, dynamic and understanding being in the totality of the human being. PMID:19551275

  8. Diarrhea in neonatal intensive care unit

    Institute of Scientific and Technical Information of China (English)

    Annalisa; Passariello; Gianluca; Terrin; Maria; Elisabetta; Baldassarre; Mario; De; Curtis; Roberto; Paludetto; Roberto; Berni; Canani

    2010-01-01

    AIM:To investigate the frequency,etiology,and current management strategies for diarrhea in newborn.METHODS:Retrospective,nationwide study involving 5801 subjects observed in neonatal intensive care units during 3 years.The main anamnesis and demographic characteristics,etiology and characteristics of diarrhea,nutritional and therapeutic management,clinical outcomes were evaluated.RESULTS:Thirty-nine cases of diarrhea(36 acute,3 chronic) were identified.The occurrence rate of diarrhea was 6.72 per 1000 hosp...

  9. Managing malaria in the intensive care unit

    OpenAIRE

    Marks, M; Gupta-Wright, A.; Doherty, JF; Singer, M; Walker, D.

    2014-01-01

    The number of people travelling to malaria-endemic countries continues to increase, and malaria remains the commonest cause of serious imported infection in non-endemic areas. Severe malaria, mostly caused by Plasmodium falciparum, often requires intensive care unit (ICU) admission and can be complicated by cerebral malaria, respiratory distress, acute kidney injury, bleeding complications, and co-infection. The mortality from imported malaria remains significant. This article reviews the man...

  10. Hospital infections in neonatal intensive care units

    OpenAIRE

    Đurišić Jasna; Marković-Denić Ljiljana N.; Ilić Slobodanka; Ramadani Ruždi

    2005-01-01

    Introduction Sick newborn babies in the neonatal intensive care units (NICU) are al increased risk for hospital-acquired infections (HI). The aim of our study was to determine the incidence and localization of neonatal hospital infections in NICU. Material and methods A prospective, six-month study was carried out in a NICU. All patients hospitalized in NICU longer then 48 hours were examined according to their basic descriptive-epidemiological characteristics and the incidence of all hospita...

  11. Performance and burnout in intensive care units

    OpenAIRE

    Keijsers, G.J.; Schaufeli, W.B.; LeBlanc, P; Zwerts, C.; Miranda, D.R.

    1995-01-01

    The relationship between three different performance measures and burnout was explored in 20 Dutch Intensive Care Units (ICUs). Burnout (i.e. emotional exhaustion and depersonalization) proved to be significantly related to nurses' perceptions of performance as well as to objectively assessed unit performance. Subjective performance measures relate negatively to burnout levels of nurses, whereas an objective performance measure relates positively to burnout. Furthermore, subjectively assessed...

  12. Music Inside an Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Ana Maria Loureiro De Souza Delabary

    2004-07-01

    Full Text Available This paper reports on the music therapy work performed in the intensive care unit of a university hospital. Clinical practice is inserted with in the hospital psychology department and acts jointly with some of the other health departments in the same hospital. The text presents the employed methodology, techniques, and repertoire, along with some considerations, comments, and observations on the practical side of the treatment. Music therapy imposes itself as a valuable element for the health area and becomes particularly meaningful as a part of the hospital's humanization program which is being developed in the institution. Striving for care quality, all the while it helps integrating all involved personnel interacting with the patients, music can be a powerful stimulus for the improvement of health care, particularly in the reception and support of the difficult situations terminal patients are faced with.

  13. Burnout in the intensive care unit professionals

    Directory of Open Access Journals (Sweden)

    Kalpalatha K Guntupalli

    2014-01-01

    Full Text Available Background: Professional burnout has been widely explored in health care. We conducted this study in our hospital intensive care unit (ICU in United States to explore the burnout among nurses and respiratory therapists (RT. Materials and Methods: A survey consisting of two parts was used to assess burnout. Part 1 addressed the demographic information and work hours. Part 2 addressed the Maslach Burnout Inventory-Human Service Survey. Results: The analysis included 213 total subjects; Nurses 151 (71% and RT 62 (29%. On the emotional exhaustion (EE scale, 54% scored "Moderate" to "High" and 40% scored "Moderate" to "High" on the depersonalization (DP scale. Notably 40.6% scored "Low" on personal accomplishment (PA scale. Conclusion: High level of EE, DP and lower PAs were seen among two groups of health care providers in the ICUs.

  14. How is mechanical ventilation employed in a pediatric intensive care unit in Brazil?

    OpenAIRE

    Dafne Cardoso Bourguignon da Silva; Audrey Rie Ogawa Shibata; Farias, Julio A; Eduardo Juan Troster

    2009-01-01

    OBJECTIVE: to investigate the relationship between mechanical ventilation and mortality and the practice of mechanical ventilation applied in children admitted to a high-complexity pediatric intensive care unit in the city of São Paulo, Brazil. DESIGN: Prospective cohort study of all consecutive patients admitted to a Brazilian high-complexity PICU who were placed on mechanical ventilation for 24 hours or more, between October 1st, 2005 and March 31st, 2006. RESULTS: Of the 241 patients admit...

  15. Role of music in intensive care medicine.

    Science.gov (United States)

    Trappe, Hans-Joachim

    2012-01-01

    The role of music in intensive care medicine is still unclear. However, it is well known that music may not only improve quality of life but also effect changes in heart rate (HR) and heart rate variability (HRV). Reactions to music are considered subjective, but studies suggest that cardio/cerebrovascular variables are influenced under different circumstances. It has been shown that cerebral flow was significantly lower when listening to "Va pensioero" from Verdi's "Nabucco" (70.4+3.3 cm/s) compared to "Libiam nei lieti calici" from Verdi's "La Traviata" (70.2+3.1 cm/s) (Pflow in Beethoven's Ninth Symphony during rest (67.6+3.3 cm/s) or music (69.4+3.1 cm/s). It was reported that relaxing music plays an important role in intensive care medicine. Music significantly decreases the level of anxiety for patients in a preoperative setting (STAI-X-1 score 34) to a greater extent even than orally administered midazolam (STAI-X-1 score 36) (Pmusic group (STAI-X-1 score 30) compared to midazolam (STAI-X-1 score 34) (Pmusic a useful alternative to midazolam. In addition, there is sufficient practical evidence of stress reduction suggesting that a proposed regimen of listening to music while resting in bed after open-heart surgery is important in clinical use. After 30 min of bed rest, there was a significant difference in cortisol levels between the music (484.4 mmol/l) and the non-music group (618.8 mmol/l) (Pmusic produces significantly better correlations between cardiovascular and respiratory signals in contrast to uniform emphasis (Pmusic and meditation music, whereas heavy metal music or techno are not only ineffective but possibly dangerous and can lead to stress and/or life-threatening arrhythmias, particularly in intensive care medicine patients. PMID:22624099

  16. Breastfeeding support in neonatal intensive care

    DEFF Research Database (Denmark)

    Maastrup, Ragnhild; Bojesen, Susanne Norby; Kronborg, Hanne; Hallström, Inger

    2012-01-01

    Background: The incidence of breastfeeding of preterm infants is affected by the support provided at the hospital and in the neonatal intensive care unit (NICU). However, policies and guidelines promoting breastfeeding vary both nationally and internationally. Objectives: The aim of this survey was...... to describe breastfeeding support in Danish NICUs, where approximately 98% of mothers initiate lactation. Methods: A national survey of all 19 Danish NICUs was conducted in 2009. Four NICUs were at designated Baby-Friendly hospitals, and 5 had a lactation consultant. In all NICUs, it was possible for...... some parents to stay overnight; 2 units had short restrictions on parents' presence. Five NICUs had integrated postpartum care for mothers. Breastfeeding policies, written guidelines, and systematic breastfeeding training for the staff were common in most NICUs. Seventeen NICUs recommended starting...

  17. Ethical issues in neonatal intensive care units.

    Science.gov (United States)

    Liu, Jing; Chen, Xin-Xin; Wang, Xin-Ling

    2016-07-01

    On one hand, advances in neonatal care and rescue technology allow for the healthy survival or prolonged survival time of critically ill newborns who, in the past, would have been non-viable. On the other hand, many of the surviving critically ill infants have serious long-term disabilities. If an infant eventually cannot survive or is likely to suffer severe disability after surviving, ethical issues in the treatment process are inevitable, and this problem arises not only in developed countries but is also becoming increasingly prominent in developing countries. In addition, ethical concerns cannot be avoided in medical research. This review article introduces basic ethical guidelines that should be followed in clinical practice, including respecting the autonomy of the parents, giving priority to the best interests of the infant, the principle of doing no harm, and consent and the right to be informed. Furthermore, the major ethical concerns in neonatal intensive care units (NICUs) in China are briefly introduced. PMID:26382713

  18. Dermatology in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Uwe Wollina

    2012-10-01

    Full Text Available Introduction: The intensive care unit (ICU represents a special environment for patients. We analyzed patients in the ICU/ high care unit (HCU with respect to dermatology counselling and skin problems.Setting: Academic Teaching Hospital over a 10 month period.Methods: The total number of patients of the ICU was 1,208 with a mean stay of 4.1 days. In the HCU the mean stay was 16 days. Diagnosis leading to admission were analyzed. All files of dermatological counselling were evaluated in detail.Results: Fifty-five patients with dermatologic problems were identified: 19 women and 26 males. The age ranged from 22 to 90 years of life (mean ± standard deviation: 67.2 ± 17.4 years. The total number of consultations were 85. The range of repeated dermatological consultation ranged from two to ten. The major reasons were skin and soft tissue infections, adverse drug reactions, chronic wounds including pressure sores and skin irritation or dermatitis. Pre-existing skin conditions may complicate the treatment and care during ICU/HCU stay.Conclusion: A tight collaboration between of the medical staff of ICU/HCU and dermatology department will ensure a rapid diagnosis and treatment of various skin conditions in the ICU, without increasing the costs significantly. Interdisciplinary education of nursing staff contributes to improved skin care in the ICU/HCU and helps to prevent acute skin failure.

  19. Neurologic Complications in the Intensive Care Unit.

    Science.gov (United States)

    Rubinos, Clio; Ruland, Sean

    2016-06-01

    Complications involving the central and peripheral nervous system are frequently encountered in critically ill patients. All components of the neuraxis can be involved including the brain, spinal cord, peripheral nerves, neuromuscular junction, and muscles. Neurologic complications adversely impact outcome and length of stay. These complications can be related to underlying critical illness, pre-existing comorbid conditions, and commonly used and life-saving procedures and medications. Familiarity with the myriad neurologic complications that occur in the intensive care unit can facilitate their timely recognition and treatment. Additionally, awareness of treatment-related neurologic complications may inform decision-making, mitigate risk, and improve outcomes. PMID:27098953

  20. Role of music in intensive care medicine

    OpenAIRE

    Trappe, Hans-Joachim

    2012-01-01

    The role of music in intensive care medicine is still unclear. However, it is well known that music may not only improve quality of life but also effect changes in heart rate (HR) and heart rate variability (HRV). Reactions to music are considered subjective, but studies suggest that cardio/cerebrovascular variables are influenced under different circumstances. It has been shown that cerebral flow was significantly lower when listening to “Va pensioero” from Verdi's “Nabucco” (70.4+3.3 cm/s) ...

  1. A alta prevalência de prescrições de medicamentos off-label e não licenciados em unidade de terapia intensiva pediátrica brasileira High prevalence of off-label and unlicensed drug prescribing in a Brazilian intensive care unit

    Directory of Open Access Journals (Sweden)

    Lilian de Abreu Ferreira

    2012-02-01

    Full Text Available OBJETIVO: Descrever o uso e determinar a prevalência de medicamentos de uso off-label enão licenciados em prescrições na unidade de terapia intensiva pediátrica de um hospital no sudeste do Brasil. MÉTODOS: Estudo transversal envolvendo os pacientes internados na unidade de terapia intensiva pediátrica durante o período de maio de 2008 a janeiro de 2009. A classificação quanto aos critérios de aprovação da Agência de Vigilância Sanitária (Anvisa foi baseada em seu bulário eletrônico e no Dicionário de Especialidades Farmacêuticas e as análises realizadas no software R. RESULTADOS: Foram analisados 1.054 itens de prescrição de 73 pacientes. O gênero feminino foi o mais frequente (52% e a idade dos pacientes variou de zero a 16 anos. Observou-se que 23,4% dos medicamentos foram prescritos de modo off-label, 12,6% não licenciados e 1,4% foram classificados em ambas as razões; 86% receberam ao menos um item de uso off-label e 67% ao menos um item de uso não licenciado. Os grupos terapêuticos mais prescritos foram os antibacterianos de uso sistêmico, os analgésicos, psicolépticos e antiasmáticos. CONCLUSÃO: Os resultados do presente trabalho confirmam a alta prevalência do uso off-label e não licenciados dos medicamentos em unidade de terapia intensiva pediátrica.OBJECTIVE: To describe the use and determine the prevalence of off-label and unlicensed drug use prescribing in a pediatric intensive care unit in a Southeastern Brazilian hospital METHODS: Cross-sectional study of inpatients in a pediatric intensive care unit from May 2008 through January 2009. The classification according to the Brazilian regulatory agency (Agência de Vigilância Sanitária - Anvisa approval criteria was based on the Anvisa electronic package insert list, Pharmaceuticals Dictionary, and the analysis was conducted through R software. RESULTS: We analysed 1,054 prescription items for 73 patients. Females predominated (52%, and the

  2. Analysis of the energy intensity evolution in the Brazilian industrial sector. 1995 to 2005

    Energy Technology Data Exchange (ETDEWEB)

    Andrade Silva, Fabiano Ionta; Guerra, Sinclair Mallet Guy [CECS/UFABC, Rua Catequeses, 242 - 10a., 09090-400 Santo Andre, SP (Brazil)

    2009-12-15

    This study developed a method to evaluate the evolution of energy intensity in the Brazilian industrial sector from 1995 to 2004. In order to do so, it was necessary to obtain six different measures (indicators) of the sector energy intensity. Considering the concept of energy intensity as the ratio between energy consumption and the level of economic activity, two measures were used for the energy consumption: a thermal (physical) and an economic one. For the level of economic activity, three measures were used: value of production, value of delivered goods and added value. In the Brazilian industrial sector, most of these indicators have behaved in a similar way. In a disaggregated way, energy intensity indicators show a unified direction of its evolution. However, a more elaborate study on the consumption profile of the Brazilian industrial sector and its economical activities indicates the presence of important deviations concerning the annual rate of change in energy intensity. Besides, there is no evident relation between these deviations and the composition of the different indicators of energy intensity. (author)

  3. Withholding or withdrawing therapy in intensive care units

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Ammentorp, Jette; Erlandsen, Mogens; Ording, Helle

    2011-01-01

    The purpose of the study was to determine the views of intensive care nurses, intensivists, and primary physicians regarding collaboration and other aspects of withholding and withdrawing therapy in the intensive care unit (ICU).......The purpose of the study was to determine the views of intensive care nurses, intensivists, and primary physicians regarding collaboration and other aspects of withholding and withdrawing therapy in the intensive care unit (ICU)....

  4. The expansion of intensive agriculture and ranching in Brazilian Amazonia

    Science.gov (United States)

    Walker, Robert; DeFries, Ruth; del Carmen Vera-Diaz, Maria; Shimabukuro, Yosio; Venturieri, Adriano

    Agriculture in Amazonia has often provoked controversy, given the tremendous ecological value of the region's environment. First with ranching, and now with the soybean boom, tractors and cattle have marched across lands that for millennia supported only closed moist forest, resident ecosystems, and dispersed indigenous peoples. The present chapter considers this expansion, focusing on the Brazilian portion of the basin. Its premise is that effective Amazonian policy must be grounded on an understanding of the region's agriculture. The chapter pursues its objectives by first addressing the development initiatives that created the preconditions for Amazonia's current agricultural economy. The region is remote and has therefore required sustained government intervention to release its potential. The policy discussion is followed by descriptions of cattle ranching and soy farming. For each, market settings and trajectories of expansion are presented. Although these sectoral descriptions are data rich, they do not provide a conceptual framework for analyzing the environmental impacts of evolving market conditions. To accomplish this, the chapter invokes the classical land use model of von Thünen to explain Amazonian land cover dynamics in relation to soy-cattle linkages. It addresses these dynamics with remote sensing data from Mato Grosso, Pará, and Rondônia, and then discusses scenarios of agricultural advances on the forest. Conclusions follow, considering possible policy responses to deforestation, and the social context of agricultural intensification, with special attention to the issues of land tenure security and distributional equity.

  5. Families' experiences of intensive care unit quality of care

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Gerritsen, Rik T; Koopmans, Matty;

    2015-01-01

    PURPOSE: The purpose of the study is to adapt and provide preliminary validation for questionnaires evaluating families' experiences of quality of care for critically ill patients in the intensive care unit (ICU). MATERIALS AND METHODS: This study took place in 2 European ICUs. Based on literature...... and qualitative interviews, we adapted 2 previously validated North American questionnaires: "Family Satisfaction with the ICU" and "Quality of Dying and Death." Family members were asked to assess relevance and understandability of each question. Validation also included test-retest reliability and construct...... validity. RESULTS: A total of 110 family members participated. Response rate was 87%. For all questions, a median of 97% (94%-99%) was assessed as relevant, and a median of 98% (97%-100%), as understandable. Median ceiling effect was 41% (30%-47%). There was a median of 0% missing data (0%-1%). Test...

  6. Benefits of High-Intensity Intensive Care Unit Physician Staffing under the Affordable Care Act

    Directory of Open Access Journals (Sweden)

    Sachin Logani

    2011-01-01

    Full Text Available The Affordable Care Act signed into law by President Obama, with its value-based purchasing program, is designed to link payment to quality processes and outcomes. Treatment of critically ill patients represents nearly 1% of the gross domestic product and 25% of a typical hospital budget. Data suggest that high-intensity staffing patterns in the intensive care unit (ICU are associated with cost savings and improved outcomes. We evaluate the literature investigating the cost-effectiveness and clinical outcomes of high-intensity ICU physician staffing as recommended by The Leapfrog Group (a consortium of companies that purchase health care for their employees and identify ways to overcome barriers to nationwide implementation of these standards. Hospitals that have implemented the Leapfrog initiative have demonstrated reductions in mortality and length of stay and increased cost savings. High-intensity staffing models appear to be an immediate cost-effective way for hospitals to meet the challenges of health care reform.

  7. Distributive Justice and Attitudes of Intensive Care Physicians towards Distribution of Intensive Care Beds in Turkey

    Directory of Open Access Journals (Sweden)

    Akpınar A et al.

    2013-06-01

    Full Text Available Objective: To assess intensive care physicians’ attitudes about the importance of various factors in decisions to use intensive care in Turkey according to distributive justice. Methods: The study was conducted between 2004 and 2006 in two medical congresses in Turkey and via e-mail. A-self-administered questionnaire was presented to the intensive care physicians and they asked to make admission/discharge decisions for 13 cases, and to ascribe importance to 20 criteria. The relationship between characteristics of physicians and their decisions was analyzed by chi-square test and p<0.05 was accepted significant. Results: A total of 228 physician participated to the study. Eighty-three percent of physicians were contributing the admission /discharge decision-making process, 76% were making triage decisions because of resource scarcity. Most (69% of the physicians state that they would accept the case who has a living will regarding treatment refusal and 46% made the same decision for the patient in persistent vegetative state, the later rate is higher than the lung cancer patients. The leading discharge decisions were made for the postoperative patient with aortic aneurism (41% and the child with brain death (40%. Physicians mostly ascribed importance to medical criteria, then to the cost of the treatment to the family and to the public. Criteria which may cause discrimination were also regarded by some. Physicians’ characteristics affected their answers. Conclusion: We conclude that patient’s autonomy could be disregarded in intensive care, risky solutions and unacceptable criteria could be used when resource scarcity increases, and biased decisions could be made in intensive care.

  8. Factors influencing nursing care in a surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Raj John

    2006-01-01

    Full Text Available Context: The total time spent in nursing care depends on the type of patient and the patient′s condition. We analysed factors that influenced the time spent in nursing a patient. Aims : To analyse the factors in a patient′s condition that influenced time spent in nursing a patient. Materials and Methods: This study was performed in the Surgical Intensive Care Unit of a tertiary referral centre, over a period of one month. The total time spent on a patient in nursing care for the first 24 hours of admission, was recorded. This time was divided into time for routine nursing care, time for interventions, time for monitoring and time for administering medications. Statistical analysis used: A backward stepwise linear regression analysis using the age, sex, diagnosis, type of admission and ventilatory status as variables, was done. Results: Patients admitted after elective surgery required less time (852.4 ± 234.1 minutes, than those admitted after either emergency surgery (1069.5 ± 187.3 minutes, or directly from the ward or the emergency room (1253.7 ± 42.1 minutes. Patients who were ventilated required more time (1111.5 ± 132.5 minutes, than those brought on a T-piece (732.2 ± 134.8 minutes or extubated (639.5 ± 155.6 minutes. The regression analysis showed that only the type of admission and the ventilatory status significantly affected the time. Conclusions : This study showed that the type of admission and ventilatory status significantly influenced the time spent in nursing care. This will help optimal utilization of nursing resources.

  9. NOSOCOMIAL ACINETOBACTER INFECTIONS IN INTENSIVE CARE UNIT

    Directory of Open Access Journals (Sweden)

    Nwadike V. Ugochukwu

    2013-01-01

    Full Text Available Acinetobacter plays an important role in the infection of patients admitted to hospitals. Acinetobacter are free living gram-negative coccobacilli that emerge as significant nosocomial pathogens in the hospital setting and are responsible for intermittent outbreaks in the Intensive Care Unit. The aim of this study was to determine the prevalence of Acinetobacter in patients admitted into the Intensive Care Unit and determine their role in infections in the ICU. A total of one hundred patients were recruited for the study, catheter specimen urine, tracheal aspirate and blood culture were collected aseptically from the patients. The specimens were cultured on blood and MacConkey and the organisms identified using Microbact 12E (0xoid. The Plasmid analysis was done using the TENS miniprep method. Fourteen (14% of the 100 patients recruited into the study, developed Acinetobacter infection. Acinetobacter spp constituted 9% of the total number of isolates. Twelve (86% of the isolates were recovered from tracheal aspirate, 1(7% from urine and 1(7% from blood. All of the isolates harbor plasmids of varying molecular sizes. Ten of the fourteen Acinetobacter were isolated at about the same period of time in the ICU with 6(42.7% having plasmid size in the 23.1kb band and all showed similar pattern revealing that the isolates exhibit some relatedness. The clonal nature of the isolates suggest that strict infection control practices must be adopted in ICU, also an antibiotic policy must be developed for the ICU to prevent abuse of antibiotics that may lead to selection of resistant bacteria.

  10. [The list of drugs in the Popular Pharmacy Program and the Brazilian National Pharmaceutical Care Policy].

    Science.gov (United States)

    Yamauti, Sueli Miyuki; Barberato-Filho, Silvio; Lopes, Luciane Cruz

    2015-08-01

    This study aimed to analyze the list of drugs in the Popular Pharmacy Program in Brazil (PFPB) in relation to the country's pharmaceutical care policy. The list of drugs in the PFPB was compared to the Brazilian and international reference lists of essential medicines, the components of pharmaceutical care in Brazilian Unified National Health System (SUS), and drug production by the country's government pharmaceutical laboratories. The PFPB list includes 119 drugs, of which 19.3% and 47.1% were not selected on the Brazilian and international reference lists, respectively; 16.8% are not used in primary care, and 40.3% are not produced by the country's government laboratories. A revision of the PFPB list based on the essential medicines concept (World Health Organization), alignment of pharmaceutical care policies, and production by government laboratories are essential to improve quality of health care, management, training of prescribers, and information for the population. PMID:26375644

  11. Building collaborative teams in neonatal intensive care.

    Science.gov (United States)

    Brodsky, Dara; Gupta, Munish; Quinn, Mary; Smallcomb, Jane; Mao, Wenyang; Koyama, Nina; May, Virginia; Waldo, Karen; Young, Susan; Pursley, DeWayne M

    2013-05-01

    The complex multidisciplinary nature of neonatal intensive care combined with the numerous hand-offs occurring in this shift-based environment, requires efficient and clear communication and collaboration among staff to provide optimal care. However, the skills required to function as a team are not typically assessed, discussed, or even taught on a regular basis among neonatal personnel. We developed a multidisciplinary, small group, interactive workshop based on Team STEPPS to provide staff with formal teamwork skills, and to introduce new team-based practices; 129 (95%) of the eligible 136 staff were trained. We then compared the results of the pretraining survey (completed by 114 (84%) of staff) with the post-training survey (completed by 104 (81%) of participants) 2 years later. We found an improvement in the overall teamwork score from 7.37 to 8.08 (p=job fulfilment (p=<0.0001), believed that their abilities were being utilised properly (p=0.003), and felt more respected (p=0.0037). 90% of staff found the new practice of team meetings to help increase awareness of unit acuity, and 77% of staff noted that they had asked for help or offered assistance because of information shared during these meetings. In addition to summarising the results of our training programme, this paper also provides practical tools that may be of use in developing team training programmes in other neonatal units. PMID:23396854

  12. Oral care practices for patients in Intensive Care Units: A pilot survey

    Directory of Open Access Journals (Sweden)

    Alexandre Franco Miranda

    2016-01-01

    Full Text Available Objective: To assess the level of knowledge and difficulties concerning hospitalized patients regarding preventive oral health measures among professionals working in Intensive Care Units (ICUs. Study Population and Methods: A cross-sectional survey was conducted among 71 health professionals working in the ICU. A self-administered questionnaire was used to determine the methods used, frequency, and attitude toward oral care provided to patients in Brazilian ICUs. The variables were analyzed using descriptive statistics (percentages. A one-sample t-test between proportions was used to assess significant differences between percentages. t-statistics were considered statistically significant for P < 0.05. Bonferroni correction was applied to account for multiple testing. Results: Most participants were nursing professionals (80.3% working 12-h shifts in the ICU (70.4%; about 87.3% and 66.2% reported having knowledge about coated tongue and nosocomial pneumonia, respectively (P < 0.05. Most reported using spatulas, gauze, and toothbrushes (49.3% or only toothbrushes (28.2% with 0.12% chlorhexidine (49.3% to sanitize the oral cavity of ICU patients (P < 0.01. Most professionals felt that adequate time was available to provide oral care to ICU patients and that oral care was a priority for mechanically ventilated patients (80.3% and 83.1%, respectively, P < 0.05. However, most professionals (56.4% reported feeling that the oral cavity was difficult to clean (P < 0.05. Conclusion: The survey results suggest that additional education is necessary to increase awareness among ICU professionals of the association between dental plaque and systemic conditions of patients, to standardize oral care protocols, and to promote the oral health of patients in ICUs.

  13. Intensive Care Unit Infections and Antibiotic Use

    Directory of Open Access Journals (Sweden)

    Ayşegül Yeşilkaya

    2011-07-01

    Full Text Available Burn wound infections is the leading cause of morbidity and mortality in burn trauma patients. Although burn wound is sterile at the beginning, because of risk factors such as prolonged hospital stay, immunesuppression and burn affecting large body surface area, colonisation firstly with Staphylococcus aureus and then Pseudomonas aeruginosa will occur later. Delay in wound closure and treatment with broad-spectrum antibiotic will result wound colonisation with antibiotic-resistant bacteria. To control colonization and to prevent burn wound infection topical antimicrobial dressings are used. The criteria used for the diagnosis of sepsis and wound infections are different in burn victims. Surface swabs from burn wounds must be cultured for the early assestment of infection. Although histopathological examination and quantitative culture of wound tissue biopsy has been known as the gold standard for the verification of invasive burn wound infection, many burn centers cannot do histopathological examination. When the traditional treatment modalities such as debridement of necrotic tissue, cleaning of wound and topical antimicrobial dressing application fails in the management of burn patient, cultures must be taken from possible foci of infection for the early diagnosis. After specimen collection, empirical bactericidal systemic antibiotic treatment should be started promptly. Inappropriate utilization of antibiotics may cause selection of resistant bacteria in the flora of the patient and of the burn unit which facilitates an infection or an outbreak at the end. Infection control in the burn unit includes surveillance cultures, cohort patient care staff, standard isolation precautions, strict hand hygiene compliance and appropariate antibiotic utilization. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 55-61

  14. The determinants of advertising intensity in the Brazilian manufacturing industry: an econometric study

    Directory of Open Access Journals (Sweden)

    Marcelo Resende

    2006-12-01

    Full Text Available The paper econometrically investigates the determinants of advertising intensity in the manufacturing industry of São Paulo, Brazil in 1996 taking as reference an extensive survey carried out by Fundação SEADE. The preliminary investigation indicated a substantial degree of endogeneity in structure and performance variables. The instrumental variables estimation also considered instruments referring to information technology and organizational practices and indicated relevant roles for industrial concentration, barriers to entry, profitability and prevalence of durable goods in explaining advertising intensity. The results lend some support to an informative role of advertising in the Brazilian case.

  15. Micropolitics of the work in the Brazilian Family Health Program: do caretakers also need care?

    OpenAIRE

    Francisco Senna de Oliveira Neto

    2011-01-01

    The space of work micropolitics in the Brazilian Family Health Strategy is a scenario where the protagonism of workers and users of health services takes place. The objective of this article was to recognize and study the diverse, creative, and dynamic potential of how the activities in the Brazilian Family Health Strategy are organized and, mainly, to see the other face of the health care technology: the health of the health workers. This is a qualiquantitative exploratory study, developed b...

  16. Brazilian immigrants’ oral health literacy and participation in oral health care in Canada

    OpenAIRE

    Calvasina, Paola; Lawrence, Herenia P.; Hoffman-Goetz, Laurie; Norman, Cameron D

    2016-01-01

    Background Inadequate functional health literacy is a common problem in immigrant populations. The aim of this study was to investigate the association between oral (dental) health literacy (OHL) and participation in oral health care among Brazilian immigrants in Toronto, Ontario, Canada. Methods The study used a cross-sectional design and a convenience sample of 101 Brazilian immigrants selected through the snowball sampling technique. Data were analyzed using descriptive statistics and logi...

  17. Transfusional profile in different types of intensive care units

    OpenAIRE

    Ilusca Cardoso de Paula; Luciano Cesar Pontes de Azevedo; Luiz Fernando dos Reis Falcão; Bruno Franco Mazza; Melca Maria Oliveira Barros; Flavio Geraldo Rezende Freitas; Flávia Ribeiro Machado

    2014-01-01

    Background and objectives: anemia is a common clinical finding in intensive care units. The red blood cell transfusion is the main form of treatment, despite the associated risks. Thus, we proposed to evaluate the profile of transfusional patients in different intensive care units. Methods: prospective analysis of patients admitted in the intensive care units of a tertiary university hospital with an indication for transfusion of packed red blood cells. Demographic profile and transfusio...

  18. Quality of life before admission to the intensive care unit

    OpenAIRE

    Tereran, Nathalia Perazzo; Zanei, Suely Sueko Viski; Whitaker, Iveth Yamaguchi

    2012-01-01

    Objective To examine the reliability of the SF-36 general health questionnaire when used to evaluate the health status of critically ill patients before admission to intensive care and to measure their health-related quality of life prior to admission and its relation to severity of illness and length of stay in the intensive care unit. Methods Prospective cohort study conducted in the intensive care unit of a public teaching hospital. Over three months, communicative and oriented patients we...

  19. Postoperative Intensive Care Treatment after Esophageal Resection

    Institute of Scientific and Technical Information of China (English)

    DirkL.Stippel; K.TobiasE.Beckurts

    2004-01-01

    The aim of this article is to give a short review of problems associated with the intensive care treatment of patients after esophageal resection. Pulmonary dysfunction, supraventricular tachyarrhythmia, anastomotic leakage and mental disorders are the topics covered. Systemic inflammatory reaction and sepsis is the linking topic between these specific complications. Pulmonary dysfunction having an incidence of up to 40% is the most important complication. Low tidal volume ventilation, pain management including epidural analgesia and early tracheostomy are the mainstay of therapy. Supraventricular tachyarrhythmia is an early indicator of emerging complications. Its symptomatic treatment is standardized using electric cardioversion, beta-blockers and amiodarone. Anastomotic leakage must be suspect in any septic episode.Endoscopy and contrast studies allow for precise diagnosis. Interventional endoscopy is increasingly successful in the therapy of these leakages. Microbiological surveillance and specific antibiotic therapy ensure that a complication does not cause a septic cascade leading to multiorgan failure. The workload on ICU caused by a patient after esophageal resection still exceeds that of most other patients with gastrointestinal surgery.

  20. Pharmacovigilance in Intensive Care Unit - An Overview

    Directory of Open Access Journals (Sweden)

    Bimla Sharma

    2008-01-01

    Full Text Available The drug related complications are on the rise warranting special attention towards patient safety in Intensive Care Unit (ICU setup. Pharmacovigilance is the science about the detection, assessment and prevention of drug related problems. This review is aimed to highlight significant problems arising from medication errors with emphasis on special drugs used in ICU (oxygen, antibiotics, sedatives, analgesics and neuromuscular blocking drugs and their risk reduction strategies in ICU utilizing practice of pharmacovigilance. Human error, lack of communication among various health providers, inadequate knowledge about drugs, failure to follow protocols or recommended guidelines are important causes of drug related problems in ICU. It is imperative that ICU administrators and medical directors of hospitals consider adverse drug events (ADEs as system failures. Pharmacovigilance, an observational science is the need of the hour for patients admitted in ICUs. We need to give more emphasis on prevention rather than treating the potentially fatal complications arising from ADEs. Eternal vigilance is the key. Protocol based management, improvement of medication system, frequent audits, improved communication, good team work, a blame free environ-ment, inclusion of a pharmacist, leadership involvement and use of information technology in the ICU are possible solutions.

  1. New additions to the intensive care armamentarium.

    Science.gov (United States)

    Rice, Todd W; Bernard, Gordon R

    2004-02-01

    Many advances have improved the care of critically ill patients, but only a few have been through the use of pharmaceutical agents. Recently, the US Food and Drug Administration (FDA) approved drotrecogin alfa (activated), or recombinant human activated protein C, for the treatment of patients with a high risk of death from severe sepsis. Drotrecogin alfa (activated) has antiinflammatory, antithrombotic and fibrinolytic properties. When given as a continuous intravenous infusion, recombinant human activated protein C decreases absolute mortality of severely septic patients by 6.1%, resulting in a 19.4% relative reduction in mortality. The absolute reduction in mortality increases to 13% if the population treated is restricted to patients with an APACHE II score greater than 24, as suggested by the FDA. The most frequent and serious side effect is bleeding. Severe bleeds increased from 2% in patients given placebo to 3.5% in patients receiving drotrecogin alfa (activated). The risk of bleeding was only increased during the actual infusion time of the drug, and the bleeding risk returned to placebo levels 24 hours after the infusion was discontinued. Patients treated in the intensive care unit frequently develop anemia, usually severe enough to require at least one transfusion of red blood cells. With the recent discovery of the harmful effects of allogeneic red blood cell transfusions and the increasing shortage of available red blood cell products, emphasis has been placed on minimizing transfusions. Patients who receive exogenous recombinant human erythropoietin maintain higher hemoglobin levels, in spite of requiring fewer transfusions during their stay in the intensive care unit. Recombinant human erythropoietin appears to be effective whether it is given as 300 units/kg of body weight subcutaneously every other day or as 40,000 units subcutaneously every week. Differences in hemoglobin values were not apparent until at least one week of therapy, but they

  2. Pharmacy intervention at an intensive care rehabilitation clinic

    OpenAIRE

    MacTavish, P.; McPeake, J.; Devine, H.; Kinsella, J; Daniel, M; Fenlon, C.; Quasim, T.

    2016-01-01

    Introduction: During an intensive care stay, patients often have their chronic medications withheld for a variety of reasons and new drugs commenced [1]. As patients are often under the care of a number of different medical teams during their admission there is potential for these changes to be inadvertently continued [2]. Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) is a five week rehabilitation programme for patients and their care...

  3. Oral care in patients on mechanical ventilation in intensive care unit: literature review

    OpenAIRE

    Selma Atay; Ukke Karabacak

    2014-01-01

    intensive care patients needs to oral assessment and oral care for avoid complications caused by orafarengeal bacteria. In this literature review, it is aimed to determine the practice over oral hygiene in mechanical ventilator patients in intensive care unit. For the purpose of collecting data, Medline/pub MED and EBSCO HOST databases were searched with the keywords and lsquo;oral hygiene, oral hygiene practice, mouth care, mouth hygiene, intubated, mechanical ventilation, intensive care an...

  4. Healthcare assistants in the children's intensive care unit.

    Science.gov (United States)

    King, Peter; Crawford, Doreen

    2009-02-01

    Recruiting and retaining qualified nurses for children's intensive care units is becoming more difficult because of falling numbers of recruits into the child branch and inadequate educational planning and provision. Meeting the staffing challenge and maintaining the quality of children's intensive care services requires flexible and creative approaches, including considered evolution of the role of healthcare assistants. Evidence from adult services indicates that the addition of healthcare assistants to the intensive care team can benefit patient care. The evolution of the healthcare assistant role to support provision of safe, effective care in the children's intensive care setting requires a comprehensive strategy to ensure that appropriate education, training and supervision are in place. Career development pathways need to be in place and role accountability clearly defined at the different stages of the pathway. Experience in one unit in Glasgow suggests that healthcare assistants make a valuable contribution to the care of critically ill children and young people. PMID:19266786

  5. Inpatient Transfers to the Intensive Care Unit

    Science.gov (United States)

    Young, Michael P; Gooder, Valerie J; McBride, Karen; James, Brent; Fisher, Elliott S

    2003-01-01

    OBJECTIVE To examine if delayed transfer to the intensive care unit (ICU) after physiologic deterioration is associated with increased morbidity and mortality. DESIGN Inception cohort. SETTING Community hospital in Ogden, Utah. PATIENTS Ninety-one consecutive inpatients with noncardiac diagnoses at the time of emergent transfer to the ICU. We determined the time when each patient first met any of 11 pre-specified physiologic criteria. We classified patients as “slow transfer” when patients met a physiologic criterion 4 or more hours before transfer to the ICU. Patients were followed until discharge. INTERVENTIONS None. MEASUREMENTS In-hospital mortality, functional status at hospital discharge, hospital resources. MAIN RESULTS At the time when the first physiologic criterion was met on the ward, slow- and rapid-transfer patients were similar in terms of age, gender, diagnosis, number of days in hospital prior to ICU transfer, prehospital functional status, and APACHE II scores. By the time slow-transfer patients were admitted to the ICU, they had significantly higher APACHE II scores (21.7 vs 16.2; P = .002) and were more likely to die in-hospital (41% vs 11%; relative risk [RR], 3.5; 95% confidence interval [95% CI], 1.4 to 9.5). Slow-transfer patients were less likely to have had their physician notified of deterioration within 2 hours of meeting physiologic criteria (59% vs 31%; P = .001) and less likely to have had a bedside physician evaluation within the first 3 hours after meeting criteria (23% vs 83%; P = .001). CONCLUSIONS Slow transfer to the ICU of physiologically defined high-risk hospitalized patients was associated with increased risk of death. Slow response to physiologic deterioration may explain these findings. PMID:12542581

  6. Repertoire of intensive care unit pneumonia microbiota.

    Directory of Open Access Journals (Sweden)

    Sabri Bousbia

    Full Text Available Despite the considerable number of studies reported to date, the causative agents of pneumonia are not completely identified. We comprehensively applied modern and traditional laboratory diagnostic techniques to identify microbiota in patients who were admitted to or developed pneumonia in intensive care units (ICUs. During a three-year period, we tested the bronchoalveolar lavage (BAL of patients with ventilator-associated pneumonia, community-acquired pneumonia, non-ventilator ICU pneumonia and aspiration pneumonia, and compared the results with those from patients without pneumonia (controls. Samples were tested by amplification of 16S rDNA, 18S rDNA genes followed by cloning and sequencing and by PCR to target specific pathogens. We also included culture, amoeba co-culture, detection of antibodies to selected agents and urinary antigen tests. Based on molecular testing, we identified a wide repertoire of 160 bacterial species of which 73 have not been previously reported in pneumonia. Moreover, we found 37 putative new bacterial phylotypes with a 16S rDNA gene divergence ≥ 98% from known phylotypes. We also identified 24 fungal species of which 6 have not been previously reported in pneumonia and 7 viruses. Patients can present up to 16 different microorganisms in a single BAL (mean ± SD; 3.77 ± 2.93. Some pathogens considered to be typical for ICU pneumonia such as Pseudomonas aeruginosa and Streptococcus species can be detected as commonly in controls as in pneumonia patients which strikingly highlights the existence of a core pulmonary microbiota. Differences in the microbiota of different forms of pneumonia were documented.

  7. Brazilian scientific production on pharmaceutical care from 1990 to 2009

    Directory of Open Access Journals (Sweden)

    Maria Denise Ricetto Funchal-Witzel

    2011-06-01

    Full Text Available Brazilian scientific production on pharmaceutical care was identified based on articles indexed on the Medline, Embase, Lilacs, Web of Science and International Pharmaceutical Abstracts databases. Sixty-three articles published in both national and international journals were retrieved. With regard to authors, 72.3% were from the Southeast and South Regions, and 60.8% were affiliated to public universities. In relation to the type of studies, 85.7% were descriptive, and the most frequently researched fields were community pharmacies, hospitals and primary health care units. Articles were original in 65.1% of cases, updates in 20.6%, and reviews in 7.9%. An increase in publications commenced in 2006. In 31.7% of cases, authors had adopted a bibliographical study design, 28.6% qualitative study, 23.8% intervention, and 15.9% observational study design. The most researched subjects were elderly with chronic diseases. The importance of stimulating the conducting of experimental and qualitative studies, as well as amplifying authorship affiliated with the service area, foreign authors and with research in a wide variety of practice settings were highlighted. Despite the limited quantity of articles, an increase in their number as well as in their scope and quality is expected, so as to create further knowledge that contributes to the recognition of pharmacists' actions by patient healthcare teams.Identificam-se características da produção científica brasileira sobre atenção farmacêutica, a partir de artigos indexados nas bases Medline, Embase, Lilacs, Web of Science e International Pharmaceutical Abstracts. Foram localizados 63 artigos em revistas nacionais e internacionais. Em relação aos autores, 72,3% pertenciam as Regiões Sudeste e Sul e 60,8% estavam vinculados a universidades públicas. Quanto ao tipo de pesquisa, 85,7% foram descritivas, sendo campos mais pesquisados: farmácias comunitárias, hospitais e unidades básicas de sa

  8. Glucose variability is associated with intensive care unit mortality

    NARCIS (Netherlands)

    J. Hermanides; T.M. Vriesendorp; R.J. Bosman; D.F. Zandstra; J.B. Hoekstra; J.H. DeVries

    2010-01-01

    OBJECTIVE: Mounting evidence suggests a role for glucose variability in predicting intensive care unit (ICU) mortality. We investigated the association between glucose variability and intensive care unit and in-hospital deaths across several ranges of mean glucose. DESIGN: Retrospective cohort study

  9. Investigation of Ventilator Associated Pneumoniae in Intensive Care Patients

    OpenAIRE

    Hakan Tağrıkulu,; Dilek Memiş; Nesrin Turan

    2016-01-01

    Objective: Mechanical ventilator associated pneumonia is a serious infection occurred frequently in intensive care units and associated with high mortality. In this study we aimed to investigate the incidence of ventilator associated pneumonia, the duration of mechanical ventilation, length of intensive care unit stay, complication occurrence and mortality rates on patients undergoing mechanical ventilation for more than 48 hours. Material and Method: Two hundred...

  10. Respiratory virology and microbiology in intensive care units

    DEFF Research Database (Denmark)

    Østby, Anne-Cathrine; Gubbels, Sophie; Baake, Gerben;

    2013-01-01

    Our aim was to determine the frequency of 12 common respiratory viruses in patients admitted to intensive care units with respiratory symptoms, evaluate the clinical characteristics and to compare the results to routine microbiological diagnostics. Throat swabs from 122 intensive care-patients >18...

  11. Musculoskeletal problems in intensive care unit patients post discharge

    OpenAIRE

    Devine, H.; MacTavish, P.; Quasim, T.; Kinsella, J; McPeake, J.; Daniel, M

    2016-01-01

    Introduction: The aim of this study was to examine the incidence of musculoskeletal problems (i.e. pain, weakness, decreased joint range of movement) in critical care patients post discharge. Post intensive care syndrome (PICS) is now a widely used term to describe the collection of problems patients develop due to their stay in intensive care. ICU survivors have been found to have a high risk of developing not only psychological problems but physical problems such as Int...

  12. Communication skills and error in the intensive care unit

    OpenAIRE

    Reader, Tom W; Flin, Rhona; Cuthbertson, Brian H

    2007-01-01

    Purpose of review: Poor communication in critical care teams has been frequently shown as a contributing factor to adverse events. There is now a strong emphasis on identifying the communication skills that can contribute to, or protect against, preventable medical errors. This review considers communication research recently conducted in the intensive care unit and other acute domains. Recent findings: Error studies in the intensive care unit have shown good communication to be crucial for e...

  13. [Long-haul intensive care transports by air].

    Science.gov (United States)

    Graf, Jürgen; Seiler, Olivier; Pump, Stefan; Günther, Marion; Albrecht, Roland

    2013-03-01

    The need for inter-hospital transports over long distances aboard air ambulances or airlines has increased in recent years, both in the civil as well as the military sector. More often severely ill intensive care patients with multiple organ failure and appropriate supportive care (e.g. mechanical ventilation, catecholamines, dialysis, cardiac assist devices) are transported by air. Despite the fact that long-haul intensive care transports by air ambulance and airlines via Patient Transport Compartment (PTC) are considered established modes of transport they always provide a number of challenges. Both modes of transport have distinct logistical and medical advantages and disadvantages. These-as well as the principal risks of an air-bound long-haul intensive care transport -have to be included in the risk assessment and selection of means of transport. Very often long-haul intensive care transports are a combination of air ambulance and scheduled airlines utilizing the PTC. PMID:23504461

  14. Guideline for stress ulcer prophylaxis in the intensive care unit

    DEFF Research Database (Denmark)

    Madsen, Kristian Rørbaek; Lorentzen, Kristian; Clausen, Niels; Oberg, Emilie; Kirkegaard, Peter Roy Casparij; Maymann-Holler, Nana; Møller, Morten Hylander

    2014-01-01

    Stress ulcer prophylaxis (SUP) is commonly used in the intensive care unit (ICU), and is recommended in the Surviving Sepsis Campaign guidelines 2012. The present guideline from the Danish Society of Intensive Care Medicine and the Danish Society of Anesthesiology and Intensive Care Medicine sums...... critically ill patients in the ICU outside the context of randomized controlled trials (GRADE 1C). No robust evidence supports recommendations for subpopulations in the ICU such as septic, burn, trauma, cardiothoracic or enterally fed patients. However, if SUP is considered clinically indicated in individual...

  15. Knowledge sharing behaviour and intensive care nurse innovation: the moderating role of control of care quality

    DEFF Research Database (Denmark)

    Li-Ying, Jason; Paunova, Minna; Egerod, Ingrid

    2016-01-01

    of the questionnaire were used – one designed for nurse employees and the other for the managing nurse(s). An ordinary least squares regression analysis was used to test the hypotheses. Results Different aspects of knowledge sharing affect innovation differently, depending on the strength of the control of care......Aims This study investigates the influence of intensive care unit nurses’ knowledge sharing behaviour on nurse innovation, given different conditions of care quality control. Background Health-care organisations face an increasing pressure to innovate while controlling care quality. We have little...... insight on how the control of care quality interacts with the knowledge sharing behaviour of intensive care nurses to affect their innovative behaviours. Methods We developed a multi-source survey study of more than 200 intensive care nurses at 22 intensive care units of 17 Danish hospitals. Two versions...

  16. [Asthma in the intensive care unit].

    Science.gov (United States)

    Bautista Bautista, Edgar Gildardo

    2009-01-01

    All asthma patients are at risk of suffering an asthma attack in the course of their life, which can eventually be fatal. Hospitalizations and attention at critical care services are a fundamental aspect of patient care in asthma, which invests a significant percentage of economic contributions to society as a whole does, therefore it is particularly important establish plans for prevention, treatment education and rationalization in the primary care level to stabilize the disease and reduce exacerbations. The severity of exacerbations can range from mild to crisis fatal or potentially fatal asthma; there is a fundamental link between mortality and inadequate assessment of the severity of the patient, which results in inadequate treatment for their condition. PMID:20873061

  17. Family reintegration of children and adolescents in foster care in Brazilian municipalities with different population sizes

    Directory of Open Access Journals (Sweden)

    Andrea M. Iannelli

    2015-01-01

    Full Text Available The scope of this article is to present and analyze data from Brazilian foster care services for children / adolescents from the perspective of family reintegration. It also seeks to support the implementation of public policies in order to provide effective reintegration in accordance with the differing local contexts. It uses data from 1,157 municipalities that have foster care services. The methodology takes into account the data collection of 2,624 Brazilian centers and 36,929 children and adolescents in care. The growing number of children/adolescents in care is in line with the increase in population size: 8.4 per small city; 60 per large city and 602.4 per metropolis. With respect to care residence in a different municipality there are varying indices: 12.4% in metropolises and 33.6% in small cities, revealing the absence of centers close to family units in the smaller communities. Regarding the activities promoted together with families, it was seen that there are still units that do not perform any activities, which runs contrary to Brazilian law. It is clear that policies for the child/adolescent in foster care centers need to consider the capacity of the municipality in accordance with population size to implement support actions for families to assist in family reintegration.

  18. The Concept of Ethics in the Intensive Care

    Directory of Open Access Journals (Sweden)

    Kutay Alpir

    2010-12-01

    Full Text Available The concept of ethics in the intensive care unit has developed in the last 50 years along with the advancements and regulations in this area of medicine. Especially by the use of life-supportive equipment in the intensive care units and the resulting elongation in the terminal stage of life has led to newly described clinical conditions. These conditions include vegetative state, brain death, dissociated heart death. The current trend aiming to provide the best health care facilities with optimal costs resulted with regulations. The conflicts in the patient-physician relations resulting from these regulations has resolved to some extent by the studies of intensive care unit ethics. The major ethical topics in the intensive care are the usage of autonomy right, the selection of patients to be admitted to the intensive care unit and the limitation of the treatment. The patient selection is optimized by triage and allocation, the limitation of the treatment is done by the means of withdrawal and withhold, and the usage of autonomy right is tried to be solved by proxy, living will and ethics committee regulations. The ethical regulations have found partial solutions to the conflicts. For the ultimate solution much work about the subject has to be done. (Journal of the Turkish Society of Intensive Care 2010; 8: 77-84

  19. Cost-analysis of neonatal intensive and special care.

    Science.gov (United States)

    Tudehope, D I; Lee, W; Harris, F; Addison, C

    1989-04-01

    In the present economic climate and with increasing expenditure on neonatal intensive care, there has been a demand for economic evaluation and justification of neonatal intensive care programmes. This study assesses the inhospital costs of neonatal intensive care. Fixed and variable costs were calculated for services and uses of an Intensive/Special Care Nursery for the year 1985 and corrected to 1987 Australian dollar equivalents. Establishing a new neonatal intensive care unit of 43 costs in an existing hospital with available floor space including operating costs for a year were estimated in Australian dollars for 1987 at $6,408,000. Daily costs per baby for each were $1282 ventilator, $481 intensive, $293 transitional and $287 recovery, respectively. The cost per survivor managed in the Intensive/Special Care Nursery in 1985 showed the expected inverse relationship to birthweight being $2400 for greater than 2500 g, $4050 for 2000-2500 g, $9200 for 1500-1999 g, $23,900 for 1000-1499 g and $63,450 for less than 1000 g. Further analysis for extremely low birthweight infants managed in 1986 and 1987 demonstrated costs per survivor of $128,400 for infants less than 800 g birthweight and $43,950 for those 800-999 g. This methodology might serve as a basis for further accounting and cost-evaluation exercises. PMID:2735885

  20. Reducing medication errors in the neonatal intensive care unit

    OpenAIRE

    Simpson, J.; Lynch, R; Grant, J; Alroomi, L

    2004-01-01

    Background: Medication errors are common in the neonatal intensive care unit (NICU). Various strategies to reduce errors have been described in adult and paediatric patients but there are few published data on their effect in the NICU.

  1. Infants in a neonatal intensive care unit: parental response

    OpenAIRE

    Carter, J; Mulder, R; Bartram, A; Darlow, B

    2005-01-01

    Objective: To compare the psychosocial functioning of the parents (mother and father) of infants admitted to a neonatal intensive care unit (NICU) with the parents of infants born at term and not admitted to the NICU.

  2. Paediatric oncology and intensive care treatments: changing trends

    OpenAIRE

    Keengwe, I.; Stansfield, F.; EDEN, O; Nelhans, N.; Dearlove, O.; Sharples, A.

    1999-01-01

    OBJECTIVES—To review the outcome of patients with childhood malignancy requiring intensive care treatment and to assess whether there is any secular trend for improved outcome.
DESIGN—Retrospective chart reviews of 74 consecutive admissions to a paediatric intensive care unit from a regional paediatric oncology centre between 1990 and 1997. During the same period there were 6419 admissions to the oncology unit, 814 of whom were new cases.
RESULTS—The overall survival a...

  3. Pathophysiology of intensive care unit-acquired anemia

    OpenAIRE

    Fink, Mitchell P.

    2004-01-01

    The formation of red blood cells (RBCs) in the bone marrow is regulated by erythropoietin in response to a cascade of events. Anemia in the intensive care unit can be caused by a host of factors. Patients in the intensive care unit may have decreased RBC production and a blunted response to erythropoietin. Administration of recombinant human erythropoietin may stimulate erythropoiesis, increase hematocrit levels and hemoglobin concentration, and reduce the need for RBC transfusions.

  4. Developing a team performance framework for the intensive care unit

    OpenAIRE

    Reader, Tom W; Flin, Rhona; Mearns, Kathryn; Cuthbertson, Brian H

    2009-01-01

    Objective: There is a growing literature on the relationship between teamwork and patient outcomes in intensive care, providing new insights into the skills required for effective team performance. The purpose of this review is to consolidate the most robust findings from this research into an intensive care unit (ICU) team performance framework. Data Sources: Studies investigating teamwork within the ICU using PubMed, Science Direct, and Web of Knowledge databases. Study Selection: Studies i...

  5. Nutrition in the intensive care unit

    OpenAIRE

    Weissman, Charles

    1999-01-01

    Nutritional support has become a routine part of the care of the critically ill patient. It is an adjunctive therapy, the main goal of which is to attenuate the development of malnutrition, yet the effectiveness of nutritional support is often thwarted by an underlying hostile metabolic milieu. This requires that these metabolic changes be taken into consideration when designing nutritional regimens for such patients. There is also a need to conduct large, multi-center studies to acquire more...

  6. [Specialized neurological neurosurgical intensive care medicine].

    Science.gov (United States)

    Kuramatsu, J B; Huttner, H B; Schwab, S

    2016-06-01

    In Germany dedicated neurological-neurosurgical critical care (NCC) is the fastest growing specialty and one of the five big disciplines integrated within the German critical care society (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin; DIVI). High-quality investigations based on resilient evidence have underlined the need for technical advances, timely optimization of therapeutic procedures, and multidisciplinary team-work to treat those critically ill patients. This evolution has repeatedly raised questions, whether NCC-units should be run independently or better be incorporated within multidisciplinary critical care units, whether treatment variations exist that impact clinical outcome, and whether nowadays NCC-units can operate cost-efficiently? Stroke is the most frequent disease entity treated on NCC-units, one of the most common causes of death in Germany leading to a great socio-economic burden due to long-term disabled patients. The main aim of NCC employs surveillance of structural and functional integrity of the central nervous system as well as the avoidance of secondary brain damage. However, clinical evaluation of these severely injured commonly sedated and mechanically ventilated patients is challenging and highlights the importance of neuromonitoring to detect secondary damaging mechanisms. This multimodal strategy not only requires medical expertise but also enforces the need for specialized teams consisting of qualified nurses, technical assistants and medical therapists. The present article reviews most recent data and tries to answer the aforementioned questions. PMID:27206707

  7. Clinical risk assessment in intensive care unit

    Directory of Open Access Journals (Sweden)

    Saeed Asefzadeh

    2013-01-01

    Full Text Available Background: Clinical risk management focuses on improving the quality and safety of health care services by identifying the circumstances and opportunities that put patients at risk of harm and acting to prevent or control those risks. The goal of this study is to identify and assess the failure modes in the ICU of Qazvin′s Social Security Hospital (Razi Hospital through Failure Mode and Effect Analysis (FMEA. Methods: This was a qualitative-quantitative research by Focus Discussion Group (FDG performed in Qazvin Province, Iran during 2011. The study population included all individuals and owners who are familiar with the process in ICU. Sampling method was purposeful and the FDG group members were selected by the researcher. The research instrument was standard worksheet that has been used by several researchers. Data was analyzed by FMEA technique. Results: Forty eight clinical errors and failure modes identified, results showed that the highest risk probability number (RPN was in respiratory care "Ventilator′s alarm malfunction (no alarm" with the score 288, and the lowest was in gastrointestinal "not washing the NG-Tube" with the score 8. Conclusions: Many of the identified errors can be prevented by group members. Clinical risk assessment and management is the key to delivery of effective health care.

  8. Intensive care unit-acquired weakness in the burn population.

    Science.gov (United States)

    Cubitt, Jonathan J; Davies, Menna; Lye, George; Evans, Janine; Combellack, Tom; Dickson, William; Nguyen, Dai Q

    2016-05-01

    Intensive care unit-acquired weakness is an evolving problem in the burn population. As patients are surviving injuries that previously would have been fatal, the focus of treatment is shifting from survival to long-term outcome. The rehabilitation of burn patients can be challenging; however, a certain subgroup of patients have worse outcomes than others. These patients may suffer from intensive care unit-acquired weakness, and their treatment, physiotherapy and expectations need to be adjusted accordingly. This study investigates the condition of intensive care unit-acquired weakness in our burn centre. We conducted a retrospective analysis of all the admissions to our burn centre between 2008 and 2012 and identified 22 patients who suffered from intensive care unit-acquired weakness. These patients were significantly younger with significantly larger burns than those without intensive care unit-acquired weakness. The known risk factors for intensive care unit-acquired weakness are commonplace in the burn population. The recovery of these patients is significantly affected by their weakness. PMID:26975787

  9. Supporting families of dying patients in the intensive care units.

    Science.gov (United States)

    Heidari, Mohammad Reza; Norouzadeh, Reza

    2014-01-01

    Family support in the intensive care units is a challenge for nurses who take care of dying patients. This article aimed to determine the Iranian nurses' experience of supporting families in end-of-life care. Using grounded theory methodology, 23 critical care nurses were interviewed. The theme of family support was extracted and divided into 5 categories: death with dignity; facilitate visitation; value orientation; preparing; and distress. With implementation of family support approaches, family-centered care plans will be realized in the standard framework. PMID:25099985

  10. Mothers of Pre-Term Infants in Neonate Intensive Care

    Science.gov (United States)

    MacDonald, Margaret

    2007-01-01

    In this study, eight mothers of pre-term infants under the care of nursing staff and neonatologists in the Neonatal Intensive Care Unit (NICU) of Children's Hospital in Vancouver, British Columbia, were observed and interviewed about their birth experience and their images of themselves as mothers during their stay. Patterns and themes in the…

  11. Coping with Poor Prognosis in the Pediatric Intensive Care Unit.

    Science.gov (United States)

    Waller, David A.; And Others

    1979-01-01

    The intensive care pediatrician who prophesies to parents that their child's illness is irreversible may encounter denial and hostility. Four cases are reported in which parents rejected their child's hopeless prognosis, counterprophesied miraculous cures, resolved to obtain exorcism, criticized the care, or accused nurses of neglect. Journal…

  12. Physical Therapy Intervention in the Neonatal Intensive Care Unit

    Science.gov (United States)

    Byrne, Eilish; Garber, June

    2013-01-01

    This article presents the elements of the Intervention section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy interventions presented in this path are evidence-based and the suggested timing of these interventions is primarily based on practice knowledge from expert…

  13. [The organization of a post-intensive care rehabilitation unit].

    Science.gov (United States)

    Barnay, Claire; Luauté, Jacques; Tell, Laurence

    2015-01-01

    When a patient is admitted to a post-intensive care rehabilitation unit, the functional outcome is the main objective of the care. The motivation of the team relies on strong cohesion between professionals. Personalised support provides a heightened observation of the patient's progress. Listening and sharing favour a relationship of trust between the patient, the team and the families. PMID:26365639

  14. [The difficulties of staff retention in neonatal intensive care units].

    Science.gov (United States)

    Deparis, Corinne

    2015-01-01

    Neonatal intensive care units attract nurses due to the technical and highly specific nature of the work. However, there is a high turnover in these departments. Work-related distress and the lack of team cohesion are the two main causes of this problem. Support from the health care manager is essential in this context. PMID:26183101

  15. Inadequate follow-up after tracheostomy and intensive care

    DEFF Research Database (Denmark)

    Mondrup, Frederik; Skjelsager, Karen; Madsen, Kristian Rørbæk

    2012-01-01

    When patients are transferred from intensive care units (ICUs) to general wards with a tracheostomy in situ, there is a risk of suboptimal care and increased morbidity. The aim of this study was to elucidate the management of patients with a tracheostomy in situ at discharge from the ICU to the...

  16. Micropolitics of the work in the Brazilian Family Health Program: do caretakers also need care?

    Directory of Open Access Journals (Sweden)

    Francisco Senna de Oliveira Neto

    2011-12-01

    Full Text Available The space of work micropolitics in the Brazilian Family Health Strategy is a scenario where the protagonism of workers and users of health services takes place. The objective of this article was to recognize and study the diverse, creative, and dynamic potential of how the activities in the Brazilian Family Health Strategy are organized and, mainly, to see the other face of the health care technology: the health of the health workers. This is a qualiquantitative exploratory study, developed by the application of instruments for the evaluation of life quality and occupational history, supported by the observation and evaluation of the daily work in a Brazilian Family Health Strategy unit in the town of Jerônimo Monteiro, state of Espírito Santo, in Brazil. The results show that, when targeting his/her own health, the health worker is more concerned about health problems and disorders already installed, neglecting the preventive aspects. Signs of organic and psychic suffering were considered as caused by work overload and by precariousness of links and work conditions. The study also showed that reflections on occupational health in the Brazilian Family Health Strategy also need to be carried out and that health prevention and promotion need to be explored by health workers. It is also important to review the path of the Brazilian Family Health Strategy under the perspective of health workers, aiming at the construction of a humanized work environment. 

  17. Nursing staff requirements for neonatal intensive care.

    OpenAIRE

    Williams, S.; Whelan, A; Weindling, A M; Cooke, R W

    1993-01-01

    A study to estimate the number of nursing staff required for neonatal nursing was undertaken. Certain nursing tasks, such as transporting any infant, caring for the dying infant, and looking after the very unstable infant required continuous attention by one nurse (5.5 whole time equivalent (wte) nurses for each cot). The stable ventilated infant required 10.5 nursing hours each day-that is, 2.4 wte/cot. Infants with intravenous infusions, but not ventilated, required only slightly less nursi...

  18. Nursing workload in a trauma intensive care unit

    OpenAIRE

    Luana Loppi Goulart; Roberta Nazário Aoki; Camila Fernanda Lourençon Vegian; Edinêis de Brito Guirardello

    2014-01-01

    Severely injured patients with multiple and conflicting injuries present themselves to nursing professionals at critical care units faced with care management challenges. The goal of the present study is to evaluate nursing workload and verify the correlation between workload and the APACHE II severity index. It is a descriptive study, conducted in the Trauma Intensive Care Unit of a teaching hospital. We used the Nursing Activities Score and APACHE II as instruments. The sample comprised 32 ...

  19. Environmental Design for Patient Families in Intensive Care Units

    OpenAIRE

    Rashid, Mahbub

    2010-01-01

    The purpose of this paper is to define the role of environmental design in improving family integration with patient care in Intensive Care Units (ICUs). It argues that it is necessary to understand family needs, experience and behavioral responses in ICUs to develop effective models for family integration. With its two components—the “healing culture” promoting effective relationships between caregivers and care seekers, and the “environmental design” supporting the healing culture—a “healin...

  20. Intensive care nurses′ opinions and practice for oral care of mechanically ventilated patients

    Directory of Open Access Journals (Sweden)

    Mohsen Adib-Hajbaghery

    2013-01-01

    Full Text Available Context: Oral care is an essential aspect of critical care nursing. However, no study has been published on oral care practice of Iranian and Asian nurses. The majority of published studies were conducted in western and European countries. Aims: This study aimed to evaluate the nurses′ opinions and practice about oral care in patients under mechanical ventilation. Settings and Design: A cross-sectional study was conducted on 130 intensive care nurses from 6 intensive care units in the university hospitals of Iran. Materials and Methods: A questionnaire was used to gather the data and charts of 45 patients were evaluated. Statistical analysis: Descriptive statistical analysis are presented. Results: Oral care obtained the 7 th rank in prority and a mean score of 5.7 on a scale of 1-10. More than 21% of subjects did not perform oral care in their usual duties. High load of writing tasks and personnel shortages were the major barriers to oral care. Only 20% of the patients′ charts contained a report on oral care. Conclusions: Nurses did not consider oral care in intensive care patients as a high priority. This result highlights the need to continue education programs on oral care for improving the knowledge and attitude of intensive care nurses with respect to oral care.

  1. Intensive Care in India: The Indian Intensive Care Case Mix and Practice Patterns Study

    Science.gov (United States)

    Divatia, Jigeeshu V.; Amin, Pravin R.; Ramakrishnan, Nagarajan; Kapadia, Farhad N.; Todi, Subhash; Sahu, Samir; Govil, Deepak; Chawla, Rajesh; Kulkarni, Atul P.; Samavedam, Srinivas; Jani, Charu K.; Rungta, Narendra; Samaddar, Devi Prasad; Mehta, Sujata; Venkataraman, Ramesh; Hegde, Ashit; Bande, BD; Dhanuka, Sanjay; Singh, Virendra; Tewari, Reshma; Zirpe, Kapil; Sathe, Prachee

    2016-01-01

    Aims: To obtain information on organizational aspects, case mix and practices in Indian Intensive Care Units (ICUs). Patients and Methods: An observational, 4-day point prevalence study was performed between 2010 and 2011 in 4209 patients from 124 ICUs. ICU and patient characteristics, and interventions were recorded for 24 h of the study day, and outcomes till 30 days after the study day. Data were analyzed for 4038 adult patients from 120 ICUs. Results: On the study day, mean age, Acute Physiology and Chronic Health Evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores were 54.1 ± 17.1 years, 17.4 ± 9.2 and 3.8 ± 3.6, respectively. About 46.4% patients had ≥1 organ failure. Nearly, 37% and 22.2% patients received mechanical ventilation (MV) and vasopressors or inotropes, respectively. Nearly, 12.2% patients developed an infection in the ICU. About 28.3% patients had severe sepsis or septic shock (SvSpSS) during their ICU stay. About 60.7% patients without infection received antibiotics. There were 546 deaths and 183 terminal discharges (TDs) from ICU (including left against medical advice or discharged on request), with ICU mortality 729/4038 (18.1%). In 1627 patients admitted within 24 h of the study day, the standardized mortality ratio was 0.67. The APACHE II and SOFA scores, public hospital ICUs, medical ICUs, inadequately equipped ICUs, medical admission, self-paying patient, presence of SvSpSS, acute respiratory failure or cancer, need for a fluid bolus, and MV were independent predictors of mortality. Conclusions: The high proportion of TDs and the association of public hospitals, self-paying patients, and inadequately equipped hospitals with mortality has important implications for critical care in India.

  2. Organ donation from intensive care units in England and Wales: two year confidential audit of deaths in intensive care.

    OpenAIRE

    Gore, S M; Cable, D. J.; Holland, A.J.

    1992-01-01

    OBJECTIVES--Quantify possible increases in cadaveric organ donation from intensive care units; identify major sources of regional variation. DESIGN--Confidential audit of all deaths in intensive care units in England in 1989 and 1990 and in Wales in 1990. SETTING--15 regional and special health authorities in England; Wales. PATIENTS--24,023 audited deaths in England; 682 in Wales. MAIN OUTCOME MEASURES--Solid organ and corneal donor rates per 100 deaths; solid organ donor rate per 100 confir...

  3. Intensive care unit telemedicine: review and consensus recommendations.

    Science.gov (United States)

    Cummings, Joseph; Krsek, Cathleen; Vermoch, Kathy; Matuszewski, Karl

    2007-01-01

    Intensive care unit telemedicine involves nurses and physicians located at a remote command center providing care to patients in multiple, scattered intensive care units via computer and telecommunication technology. The command center is equipped with a workstation that has multiple monitors displaying real-time patient vital signs, a complete electronic medical record, a clinical decision support tool, a high-resolution radiographic image viewer, and teleconferencing for every patient and intensive care unit room. In addition to communication functions, the video system can be used to view parameters on ventilator screens, infusion pumps, and other bedside equipment, as well as to visually assess patient conditions. The intensivist can conduct virtual rounds, communicate with on-site caregivers, and be alerted to important patient conditions automatically via software-monitored parameters. This article reviews the technology's background, status, significance, clinical literature, financial effect, implementation issues, and future developments. Recommendations from a University HealthSystem Consortium task force are also presented. PMID:17656728

  4. Avoidable causes on the waiting list for admissions to intensive care units

    Directory of Open Access Journals (Sweden)

    Guido Luis Gomes Otto

    2016-01-01

    Full Text Available Objective: to evaluate occurrence of avoidable-mortality causes on the waiting list of patients at the intensive care units. Methods: one thousand, two hundred and twelve enrollments of patients from all age groups were analyzed and classified according to the Brazilian Health System for causes of avoidable mortality. Descriptive statistics for simple, relative and mean frequency rates were employed for the comparative analysis of the variables. Results: cases of non-communicable diseases, among the avoidable-mortality causes, occupied more than 80.0% of intensive care unit´s beds. Hospitalizations comprised illnesses of the circulatory and respiratory apparatus, especially in patients over 40 years old, together with the external causes and consequences of pregnancy and puerperium with mortality rates within the 15-39 age group. Conclusion: the high proportion of patients with diseases from avoidable causes on the waiting list for intensive care units hospitalization suggest that improvements in the programs involved with the prevention of diseases, especially non-communicable diseases, are needed.

  5. Synoptic patterns of atmospheric circulation associated with intense precipitation events over the Brazilian Amazon

    Science.gov (United States)

    Santos, Eliane Barbosa; Lucio, Paulo Sérgio; Santos e Silva, Cláudio Moisés

    2015-12-01

    The objective of this study is to characterize the atmospheric patterns associated with the occurrence of intense precipitation events (IPE) in different sub-regions of the Brazilian Amazon. Intense rainfall cases over six sub-regions were selected from a precipitation data set for the period from 1983 to 2012. The composition technique was used to characterize the prevailing atmospheric patterns for the occurrence of IPE. In the south of the Amazon, the composition fields showed a favorable configuration for the formation of the South Atlantic Convergence Zone (SACZ). Along the coast, the intense precipitation events must be associated with mesoscale systems, such as squall lines. In the northwest, they are apparently associated with the Intertropical Convergence Zone (ITCZ) and/or local convection. The results reveal the complexity of the synoptic environment associated with the formation and development of weather systems that produce heavy rainfall in the Amazon Basin. Several factors can interfere as conditions in large-scale, local conditions and thermodynamic factors.

  6. Direct and indirect nursing care time in an Intensive Care Unit1

    OpenAIRE

    Luciana Emi Kakushi; Yolanda Dora Martinez Évora

    2014-01-01

    OBJECTIVE: to identify the direct and indirect nursing care time in an Intensive Care Unit. METHOD: a descriptive/exploratory study conducted at a private hospital. The Nursing Activities Score classification system was used to estimate the direct care time, and electronic health records were used to estimate the indirect care time. The data were collected from March to June 2011. RESULTS: the findings indicate that the average nursing care time was 29.5 hours, consisting of 27.4 hou...

  7. Arterial pulmonary hypertension in noncardiac intensive care unit

    OpenAIRE

    Tsapenko, Mykola

    2008-01-01

    Mykola V Tsapenko1,5, Arseniy V Tsapenko2, Thomas BO Comfere3,5, Girish K Mour1,5, Sunil V Mankad4, Ognjen Gajic1,51Division of Pulmonary and Critical Care Medicine; 3Division of Critical Care Medicine; 4Division of Cardiovascular Diseases, Mayo Epidemiology and Translational Research in Intensive Care (M.E.T.R.I.C), Mayo Clinic, Rochester, MN, USA; 2Division of Pulmonary and Critical Care Medicine, Brown University, Miriam Hospital, Providence, RI, USAAbstract: Pulmonary artery pressure elev...

  8. Integrating primary care and public health: learning from the Brazilian way

    OpenAIRE

    Harris, Matthew

    2012-01-01

    After a long history of vertical programming, specialisation and disintegration, general practitioners are now being urged to take on wider commissioning and public health responsibilities. The support structures are not in place, and integration of primary care with good public health practice is new territory. Innovation can be found in unlikely places. The Brazilian government has a 20-year history of a nationwide, integrated, comprehensive, community health programme that seamlessly bridg...

  9. (Dis) connections between management and care in a surgical intensive care unit

    OpenAIRE

    Borges, Maria Cristina Leite Araujo; Silva, Lucilane Maria Sales da

    2013-01-01

    Objective: The objective was to understand the perception of the nursing team on the (dis)connections between management actions and care performed by nurses in a surgical intensive care unit. Method: Exploratory research with qualitative approach carried out in a surgical intensive care unit of a hospital in the public net of Fortaleza-CE, Brazil. Data was collected between March and July 2011, through semi-structured interviews and systematic observations, with 20 nursing ...

  10. Current status of neonatal intensive care in India.

    Science.gov (United States)

    Karthik Nagesh, N; Razak, Abdul

    2016-05-01

    Globally, newborn health is now considered as high-level national priority. The current neonatal and infant mortality rate in India is 29 per 1000 live births and 42 per 1000 live births, respectively. The last decade has seen a tremendous growth of neonatal intensive care in India. The proliferation of neonatal intensive care units, as also the infusion of newer technologies with availability of well-trained medical and nursing manpower, has led to good survival and intact outcomes. There is good care available for neonates whose parents can afford the high-end healthcare, but unfortunately, there is a deep divide and the poor rural population is still underserved with lack of even basic newborn care in few areas! There is increasing disparity where the 'well to do' and the 'increasingly affordable middle class' is able to get the most advanced care for their sick neonates. The underserved urban poor and those in rural areas still contribute to the overall high neonatal morbidity and mortality in India. The recent government initiative, the India Newborn Action Plan, is the step in the right direction to bridge this gap. A strong public-private partnership and prioritisation is needed to achieve this goal. This review highlights the current situation of neonatal intensive care in India with a suggested plan for the way forward to achieve better neonatal care. PMID:26944066

  11. Perceptions of Appropriateness of Care Among European and Israeli Intensive Care Unit Nurses and Physicians

    NARCIS (Netherlands)

    Piers, Ruth D.; Azoulay, Elie; Ricou, Bara; Ganz, Freda DeKeyser; Decruyenaere, Johan; Max, Adeline; Michalsen, Andrej; Maia, Paulo Azevedo; Owczuk, Radoslaw; Rubulotta, Francesca; Depuydt, Pieter; Meert, Anne-Pascale; Reyners, Anna K.; Aquilina, Andrew; Bekaert, Maarten; Van den Noortgate, Nele J.; Schrauwen, Wim J.; Benoit, Dominique D.

    2011-01-01

    Context Clinicians in intensive care units (ICUs) who perceive the care they provide as inappropriate experience moral distress and are at risk for burnout. This situation may jeopardize patient quality of care and increase staff turnover. Objective To determine the prevalence of perceived inappropr

  12. The Brazilian exports of labor-intensive goods in the 2000s: An analysis using the Constant Market Share Method

    Directory of Open Access Journals (Sweden)

    Flávio Benevett Fligenspan

    2015-01-01

    Full Text Available This paper aims at analyzing international trade in labor-intensive sectors in the 2000s, with a special reference to the Brazilian case. Therefore, we use the constant market share analysis to compare several countries’ export performance. It was observed that Asian countries emerged strengthened from this period. Brazil had a mediocre performance, losing market-share in global markets. Moreover, competition from Asian economies and even from the small Central American countries, such as Guatemala and El Salvador, has undermined the penetration of Brazilian exports in its major trade partners, which are North America and South America.

  13. Oral care in patients on mechanical ventilation in intensive care unit: literature review

    Directory of Open Access Journals (Sweden)

    Selma Atay

    2014-06-01

    Full Text Available intensive care patients needs to oral assessment and oral care for avoid complications caused by orafarengeal bacteria. In this literature review, it is aimed to determine the practice over oral hygiene in mechanical ventilator patients in intensive care unit. For the purpose of collecting data, Medline/pub MED and EBSCO HOST databases were searched with the keywords and lsquo;oral hygiene, oral hygiene practice, mouth care, mouth hygiene, intubated, mechanical ventilation, intensive care and critical care and rdquo; between the years of 2000- 2012. Inclusion criteria for the studies were being performed in adult intensive care unit patients on mechanical ventilation, published in peer-reviewed journals in English between the years of 2000-2012, included oral care practice and presence of a nurse among researchers. A total of 304 articles were identified. Six descriptive evaluation studies, three randomised controlled trials, four literature reviews, three meta-Analysis randomized clinical trials, one qualitative study and one semi-experimental study total 18 papers met all of the inclusion criteria. Oral care is emphasized as an infection control practice for the prevention of Ventilator-Associated Pneumonia (VAP. In conclusion, we mention that oral care is an important nursing practice to prevent VAP development in intensive care unit patients; however, there is no standard oral evaluation tool and no clarity on oral care practice frequency, appropriate solution and appropriate material. It can be recommended that the study projects on oral care in intensive care patients to have high proof level and be experimental, and longitudinal. [Int J Res Med Sci 2014; 2(3.000: 822-829

  14. The Living, Dynamic and Complex Environment Care in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Marli Terezinha Stein Backes

    2015-06-01

    Full Text Available OBJECTIVE: to understand the meaning of the Adult Intensive Care Unit environment of care, experienced by professionals working in this unit, managers, patients, families and professional support services, as well as build a theoretical model about the Adult Intensive Care Unit environment of care.METHOD: Grounded Theory, both for the collection and for data analysis. Based on theoretical sampling, we carried out 39 in-depth interviews semi-structured from three different Adult Intensive Care Units.RESULTS: built up the so-called substantive theory "Sustaining life in the complex environment of care in the Intensive Care Unit". It was bounded by eight categories: "caring and continuously monitoring the patient" and "using appropriate and differentiated technology" (causal conditions; "Providing a suitable environment" and "having relatives with concern" (context; "Mediating facilities and difficulties" (intervenienting conditions; "Organizing the environment and managing the dynamics of the unit" (strategy and "finding it difficult to accept and deal with death" (consequences.CONCLUSION: confirmed the thesis that "the care environment in the Intensive Care Unit is a living environment, dynamic and complex that sustains the life of her hospitalized patients".

  15. Transfusional profile in different types of intensive care units

    Directory of Open Access Journals (Sweden)

    Ilusca Cardoso de Paula

    2014-06-01

    Full Text Available Background and objectives: anemia is a common clinical finding in intensive care units. The red blood cell transfusion is the main form of treatment, despite the associated risks. Thus, we proposed to evaluate the profile of transfusional patients in different intensive care units. Methods: prospective analysis of patients admitted in the intensive care units of a tertiary university hospital with an indication for transfusion of packed red blood cells. Demographic profile and transfusional profile were collected, a univariate analysis was done, and the results were considered significant at p = 0.05. Results: 408 transfusions were analyzed in 71 patients. The mean hemoglobin concentration on admission was 9.7 ± 2.3 g/dL and the pre-transfusional concentration was 6.9 ± 1.1 g/dL. The main indications for transfusion were hemoglobin concentration (49% and active bleeding (32%. The median number of units transfused per episode was 2 (1-2 and the median storage time was 14 (7-21 days. The number of patients transfused with hemoglobin levels greater than 7 g/dL and the number of bags transfused per episode were significantly different among intensive care units. Patients who received three or more transfusions had longer mechanical ventilation time and intensive care unit stay and higher mortality after 60 days. There was an association of mortality with disease severity but not with transfusional characteristics. Conclusions: the practice of blood products transfusion was partially in agreement with the guidelines recommended, although there are differences in behavior between the different profiles of intensive care units. Transfused patients evolved with unfavorable outcomes. Despite the scarcity of blood in blood banks, the mean storage time of the bags was high.

  16. Neonatal intensive care unit lighting: update and recommendations.

    Science.gov (United States)

    Rodríguez, Roberto G; Pattini, Andrea E

    2016-08-01

    Achieving adequate lighting in neonatal intensive care units is a major challenge: in addition to the usual considerations of visual performance, cost, energy and aesthetics, there appear different biological needs of patients, health care providers and family members. Communicational aspects of light, its role as a facilitator of the visual function of doctors and nurses, and its effects on the newborn infant physiology and development were addressed in order to review the effects of light (natural and artificial) within neonatal care with a focus on development. The role of light in regulating the newborn infant circadian cycle in particular and the therapeutic use of light in general were also reviewed. For each aspect, practical recommendations were specified for a proper well-lit environment in neonatal intensive care units. PMID:27399015

  17. Measuring technical efficiency of output quality in intensive care units.

    Science.gov (United States)

    Junoy, J P

    1997-01-01

    Presents some examples of the implications derived from imposing the objective of maximizing social welfare, subject to limited resources, on ethical care patients management in respect of quality performance of health services. Conventional knowledge of health economics points out that critically ill patients are responsible for increased use of technological resources and that they receive a high proportion of health care resources. Attempts to answer, from the point of view of microeconomics, the question: how do we measure comparative efficiency in the management of intensive care units? Analyses this question through data from an international empirical study using micro-economic measures of productive efficiency in public services (data envelopment analysis). Results show a 28.8 per cent level of technical inefficiency processing data from 25 intensive care units in the USA. PMID:10169231

  18. Respiratory syncytial virus rhinosinusitis in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    Alexandre Rodrigues da Silva

    2007-02-01

    Full Text Available This study reported a case of rhinosinusitis for Respiratory Syncytial Virus in Intensive Care Unit patient. The settings were Intensive Care Unit at Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. One female HIV-infected patient with respiratory failure and circulatory shock due to splenic and renal abscesses, who developed rhinosinusitis caused by RSV and bacteria. Respiratory viruses can play a pathogenic role in airways infection allowing secondary bacterial overgrowth.

  19. [Do not resuscitate orders in the intensive care setting].

    Science.gov (United States)

    Kleiren, P; Sohawon, S; Noordally, S O

    2010-01-01

    Even if Belgium (2002), The Netherlands (2002) and Luxemburg (2009) are the first three countries in the world to have legalized active euthanasia, there still is not a law on the do not resuscitate concept (NTBR or DNR). Nevertheless, numerous royal decrees and some consensus as well as advice given by the Belgian Medical Council, hold as jurisprudence. These rules remain amenable to change so as to suite the daily practice in intensive care units. This article describes the actual Belgian legal environment surrounding the intensive care specialist when he has to take such decisions. PMID:20687449

  20. Implementation of an electronic logbook for intensive care units.

    OpenAIRE

    Wallace, Carrie J.; Stansfield, Dennis; Gibb Ellis, Kathryn A.; Clemmer, Terry P.

    2002-01-01

    Logbooks of patients treated in acute care units are commonly maintained; the data may be used to justify resource use, analyze patient outcomes, and encourage clinical research. We report herein the conversion of a paper-based logbook to an electronic logbook in three hospital intensive care units. The major difference between the paper logbook and electronic logbook data was the addition of clinician-entered data to the electronic logbook. Despite extensive computerization of patient inform...

  1. Symptomatic and asymptomatic candidiasis in a pediatric intensive care unit

    OpenAIRE

    Arslankoylu Ali Ertug; Kuyucu Necdet; Yilmaz Berna; Erdogan Semra

    2011-01-01

    Abstract Introduction This study aimed to examine the incidence, epidemiology, and clinical characteristics of symptomatic and asymptomatic candidiasis in a pediatric intensive care unit (PICU), and to determine the risk factors associated with symptomatic candidiasis. Methods This retrospective study included 67 patients from a 7-bed PICU in a tertiary care hospital that had Candida-positive cultures between April 2007 and July 2009. Demographic and clinical characteristics of the patients, ...

  2. Hospital-acquired pneumonia in intensive care patients

    OpenAIRE

    Hyllienmark, Petra

    2013-01-01

    The present thesis describes the incidence and risk factors for pneumonia and especially ventilator-associated pneumonia (VAP) among Intensive Care Unit (ICU) patients. Bacteria in samples from the lower respiratory tract of patients receiving mechanical ventilation are reported, including the duration of treatment prior to the first occurrence of different pathogens. The frequency of VAP using Swedish criteria (Swedish Intensive Registry, SIR) was compared with the VAP rate me...

  3. Is there a role of palliative care in the neonatal intensive care unit in India?

    Directory of Open Access Journals (Sweden)

    Manjiri P Dighe

    2011-01-01

    Full Text Available Recent advances in medical care have improved the survival of newborn babies born with various problems. Despite this death in the neonatal intensive care unit (NICU is an inevitable reality. For babies who are not going to "get better," the health care team still has a duty to alleviate the physical suffering of the baby and to support the family. Palliative care is a multidisciplinary approach to relieve the physical, psycho social, and spiritual suffering of patients and their families. Palliative care provision in the Indian NICU settings is almost nonexistent at present. In this paper we attempt to "build a case" for palliative care in the Indian NICU setting.

  4. Oral Care during Pregnancy: Attitudes of Brazilian Public Health Professionals

    Directory of Open Access Journals (Sweden)

    Saul Martins Paiva

    2012-09-01

    Full Text Available There is little information about health professionals’ behavior regarding oral health care during pregnancy. We evaluated attitudes of obstetricians/gynecologists, nurses, and dentists working at a public community service towards pregnant women’s oral health. Health professionals responded to a self-applied questionnaire. Cluster analysis identified two clusters of respondents; Chi-square, Student’s t test, and logistic regression were used to compare the two clusters in terms of the independent variables. Respondents were categorized into cluster 1 ‘less favorable’ (n = 159 and cluster 2 ‘more favorable’ (n = 124 attitudes. Professionals that had attended a residency or specialization program (OR = 2.08, 95% CI = 1.15–3.77, p = 0.016 and worked exclusively at the public service (OR = 2.15, 95% CI = 1.10–4.20, p = 0.025 presented more favorable attitudes. Obstetricians/gynecologists (OR = 0.22, 95% CI = 0.09–0.54, p = 0.001 and nurses (OR = 0.50, 95% CI = 0.29–0.86, p = 0.013 showed less favorable attitudes than dentists. Health care providers’ attitudes regarding pregnant women’s oral health were related to their occupation, qualification, and dedication to the public service.

  5. Integrating primary care and public health: learning from the Brazilian way.

    Science.gov (United States)

    Harris, Matthew

    2012-01-01

    After a long history of vertical programming, specialisation and disintegration, general practitioners are now being urged to take on wider commissioning and public health responsibilities. The support structures are not in place, and integration of primary care with good public health practice is new territory. Innovation can be found in unlikely places. The Brazilian government has a 20-year history of a nationwide, integrated, comprehensive, community health programme that seamlessly bridges two important interfaces - between the community and primary care, and between primary care and public health. Some elements of this approach could be translated into the UK and would likely bring about improved clinical care, cost savings, improved understanding of local epidemiological variations and therefore commissioning. Understanding this approach is the first step to a new way of integrated commissioning, spanning and not reinforcing traditional clinical domains. PMID:26265950

  6. Nursing in the Pediatric Intensive Care Unit, Nursing 205.

    Science.gov (United States)

    Varton, Deborah M.

    A description is provided of a course, "Nursing in the Pediatric Intensive Care Unit," offered for senior-level baccalaureate degree nursing students. The first section provides information on the place of the course within the curriculum, the allotment of class time, and target student populations. The next section looks at course content in…

  7. Sleep in the Intensive Care Unit measured by polysomnography

    DEFF Research Database (Denmark)

    Andersen, J H; Boesen, Hans Christian Toft; Olsen, Karsten Skovgaard

    2013-01-01

    Sleep deprivation has deleterious effects on most organ systems. Patients in the Intensive care unit (ICU) report sleep deprivation as the second worst experience during their stay only superseded by pain. The aim of the review is to provide the clinician with knowledge of the optimal sleep...

  8. Training in data definitions improves quality of intensive care data

    NARCIS (Netherlands)

    Arts, DGT; Bosman, RJ; de Jonge, E; Joore, JCA; de Keizer, NF

    2003-01-01

    Background Our aim was to assess the contribution of training in data definitions and data extraction guidelines to improving quality of data for use in intensive care scoring systems such as the Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS)

  9. Noise Pollution in Intensive Care Units and Emergency Wards

    Directory of Open Access Journals (Sweden)

    Gholamreza Khademi

    2011-03-01

    Conclusion:  The average levels of noise in intensive care units and also emergency wards were  more than the standard levels and as it is known these wards have vital roles in treatment procedures, so more attention is needed in this area.

  10. Increasing fungal infections in the intensive care unit

    NARCIS (Netherlands)

    Pauw, B.E. de

    2006-01-01

    BACKGROUND: Yeasts and molds now rank among the most common pathogens in intensive care units. Whereas the incidence of Candida infections peaked in the late 1970s, aspergillosis is still increasing. METHOD: Review of the pertinent English-language literature. RESULTS: Most factors promoting an inva

  11. The development of pediatric anesthesia and intensive care in Scandinavia

    DEFF Research Database (Denmark)

    Nilsson, Krister; Ekström-Jodal, Barbro; Meretoja, Olli;

    2015-01-01

    created. Scandinavian anesthesia developed slowly. In contrast, Scandinavia pioneered both adult and certainly pediatric intensive care. The pioneers were heavily involved in the teaching and training of anesthetists and nurses. This was necessary to manage the rapidly increasing work. The polio epidemics...

  12. Use of selective digestive tract decontamination in European intensive cares

    DEFF Research Database (Denmark)

    Reis Miranda, D; Citerio, G; Perner, A; Dimopoulos, G; Torres, A; Hoes, A; Beale, R; De Smet, A M; Kesecioglu, J

    2015-01-01

    BACKGROUND: Several studies have shown that the use of selective digestive tract decontamination (SDD) reduces mortality. However, fear for increasing multi drug resistance might prevent wide acceptance. A survey was performed among the units registered in the European Registry for Intensive Care...

  13. Evolução e característica de lactantes com bronquiolite viral aguda submetidos à ventilação mecânica em uma unidade de terapia intensiva pediátrica brasileira Outcome and characteristics of infants with acute viral bronchiolitis submitted to mechanical ventilation in a Brazilian pediatric intensive care

    Directory of Open Access Journals (Sweden)

    Fernanda Umpierre Bueno

    2009-06-01

    bronquiolite viral aguda.OBJECTIVE: To describe the characteristics and the outcome of infants with acute viral bronchiolitis submitted to mechanical ventilation. METHODS: We performed a retrospective study enrolling all infants (less than 12 months old admitted with the diagnosis of acute viral bronchiolitis and submitted to mechanical ventilation in an university affiliated Brazilian pediatric intensive care unit between March, 2004 and September, 2006 (3 consecutives winters. The mechanical ventilation parameters' employed on 1st, 2nd, 3rd, 7th day and before extubation were evaluated as well as the evolution (mortality rate, presence of acute respiratory distress syndrome and the prevalence of complications. The groups were compared using the Student t test, the Mann-Whitney U test and the Chi-square test. RESULTS: Fifty-nine infants were included (3.8 ± 2.7 months old, 59% male, with 9.0 ± 9.4 days on mechanical ventilation. Prior mechanical ventilation, non invasive ventilation was instituted in 71% of children. Anemia was observed in 78% of the sample. In 51 infants (86.5% the lower airway obstructive pattern was maintained up to tracheal extubation with a nil mortality and low prevalence of pneumothorax (7.8%. Acute respiratory distress syndrome occurred in 8 infants (13.5%, with higher mortality and a higher prevalence of pneumothorax (62.5%. CONCLUSIONS: The declining mortality in acute viral bronchiolitis is observed even in non developed regions, involving children with high rates of anemia and premature labor. The low mortality is associated with the maintenance of the lower airway obstructive pattern during the period on mechanical ventilation. The development of acute respiratory distress syndrome is associated with increased mortality and higher prevalence of complications, representing the actual challenge in the management of children with severe acute viral bronchiolitis.

  14. Brazilian recommendations of mechanical ventilation 2013. Part I

    OpenAIRE

    Barbas, Carmen Sílvia Valente; Ísola, Alexandre Marini; Farias, Augusto Manoel de Carvalho; Cavalcanti, Alexandre Biasi; Gama, Ana Maria Casati; Duarte, Antonio Carlos Magalhães; Vianna, Arthur; Serpa, Ary; Bravim, Bruno de Arruda; Pinheiro, Bruno do Valle; Mazza, Bruno Franco; Carvalho, Carlos Roberto Ribeiro; Toufen, Carlos; David, Cid Marcos Nascimento; Taniguchi, Corine

    2014-01-01

    Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented b...

  15. Brazilian recommendations of mechanical ventilation 2013. Part 2

    OpenAIRE

    Barbas, Carmen Sílvia Valente; Ísola, Alexandre Marini; Farias, Augusto Manoel de Carvalho; Cavalcanti, Alexandre Biasi; Gama, Ana Maria Casati; Duarte, Antonio Carlos Magalhães; Vianna, Arthur; Serpa Neto, Ary; Bravim, Bruno de Arruda; Pinheiro, Bruno do Valle; Mazza, Bruno Franco; Carvalho, Carlos Roberto Ribeiro; Toufen Júnior, Carlos; David, Cid Marcos Nascimento; Taniguchi, Corine

    2014-01-01

    Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented b...

  16. Stress ulcer prophylaxis in the intensive care unit

    DEFF Research Database (Denmark)

    Krag, Morten Brøgger; Perner, A; Wetterslev, J;

    2013-01-01

    Stress ulcer prophylaxis (SUP) is regarded as standard of care in the intensive care unit (ICU). However, recent randomized, clinical trials (RCTs) and meta-analyses have questioned the rationale and level of evidence for this recommendation. The aim of the present systematic review was to evaluate...... Grading of Recommendations Assessment, Development, and Evaluation, and risk of random errors in cumulative meta-analyses was assessed with trial sequential analysis. A total of 57 studies were included in the review. The literature on SUP in the ICU includes limited trial data and methodological weak...... intervention?; (4) Do intensive care patients benefit from SUP with proton pump inhibitors as compared with other SUP interventions? Systematic reviews of possible interventions and well-powered observational studies and RCTs are needed....

  17. Review of noise in neonatal intensive care units - regional analysis

    Energy Technology Data Exchange (ETDEWEB)

    Alvarez Abril, A [National Technological University, Regional Bioengineering Institute, Mendoza (Argentina); Terron, A; Boschi, C [National Technological University, Regional Bioengineering Institute, Mendoza (Argentina); Gomez, M [National Technological University, La Rioja (Argentina)

    2007-11-15

    This work is about the problem of noise in neonatal incubators and in the environment in the neonatal intensive care units. Its main objective is to analyse the impact of noise in hospitals of Mendoza and La Rioja. Methodology: The measures were taken in different moments in front of higher or lower severity level in the working environment. It is shown that noise produces severe damages and changes in the behaviour and the psychological status of the new born babies. Results: The noise recorded inside the incubators and the neonatal intensive care units together have many components but the noise of motors, opening and closing of access gates have been considered the most important ones. Values above 60 db and and up to 120 db in some cases were recorded, so the need to train the health staff in order to manage the new born babies, the equipment and the instruments associated with them very carefully is revealed.

  18. Geriatric patient profile in the cardiovascular surgery intensive care unit

    International Nuclear Information System (INIS)

    Objectives: To determine hospitalization durations and mortalities of elderly in the Cardiovascular Surgery Intensive Care Unit. Methods: The retrospective study was conducted in a Cardiovascular Surgery Intensive Care Unit in Turkey and comprised patient records from January 1 to December 31, 2011. Computerized epicrisis reports of 255, who had undergone a cardiac surgery were collected. The patients were grouped according to their ages, Group I aged 65-74 and Group II aged 75 and older. European society for Cardiac Operative Risk Evaluation scores of the two groups were compared using SPSS 17. Results: Overall, there were 80 (31.37%) females and 175 (68.62%) males. There were 138 (54.1%) patients in Group I and 117 (45.9%) in Group II. Regarding their hospitalization reasons, it was determined that 70 (27.5%) patients in Group I and 79 (30.9%) patients in Group II were treated with the diagnosis of coronary artery disease. The average hospitalization duration of patients in the intensive care unit was determined to be 11.57+-10.40 days. Regarding the EuroSCORE score intervals of patients, 132 (51.8%)had 3-5 and 225 (88.2%) patients were transferred to the Cardiovascular Surgery and then all of them were discharged; 5 (4.1%) had a mortal course; and 11 (7.7%) were transferred to the anaesthesia intensive care unit Conclusions: The general mortality rates are very low in the Cardiovascular Surgery Intensive Care Unit and the patients have a good prognosis. (author)

  19. Guidelines for Percutaneous Dilatational Tracheostomy (PDT) from the Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM)

    DEFF Research Database (Denmark)

    Madsen, Kristian Rørbæk; Guldager, Henrik; Rewers, Mikael;

    2011-01-01

    Percutaneous dilatational tracheostomy is a common procedure in intensive care. This guideline from the Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM) describes indications and contraindications, timing, complications...... compared to surgical tracheostomy, anaesthesia and technique, decannulation strategy, as well as training and education....

  20. Perceptions of the appropriateness of care in California adult intensive care units

    OpenAIRE

    Anstey, Matthew H; Adams, John L.; McGlynn, Elizabeth A

    2015-01-01

    Introduction Increased demand for expensive intensive care unit (ICU) services may contribute to rising health-care costs. A focus on appropriate use may offer a clinically meaningful way of finding the balance. We aimed to determine the extent and characteristics of perceived inappropriate treatment among ICU doctors and nurses, defined as an imbalance between the amount or intensity of treatments being provided and the patient’s expected prognosis or wishes. Methods This was a cross-section...

  1. The distinct role of palliative care in the surgical intensive care unit.

    Science.gov (United States)

    Schulz, Valerie; Novick, Richard J

    2013-12-01

    Palliative care is expanding its role into the surgical intensive care units (SICU). Embedding palliative philosophies of care into SICUs has considerable potential to improve the quality of care, especially in complex patient care scenarios. This article will explore palliative care, identifying patients/families who benefit from palliative care services, how palliative care complements SICU care, and opportunities to integrate palliative care into the SICU. Palliative care enhances the SICU team's ability to recognize pain and distress; establish the patient's wishes, beliefs, and values and their impact on decision making; develop flexible communication strategies; conduct family meetings and establish goals of care; provide family support during the dying process; help resolve team conflicts; and establish reasonable goals for life support and resuscitation. Educational opportunities to improve end-of-life management skills are outlined. It is necessary to appreciate how traditional palliative and surgical cultures may influence the integration of palliative care into the SICU. Palliative care can provide a significant, "value added" contribution to the care of seriously ill SICU patients. PMID:24071600

  2. Unusual ionospheric effects observed during the intense 28 October 2003 solar flare in the Brazilian sector

    Directory of Open Access Journals (Sweden)

    Y. Sahai

    2008-01-01

    Full Text Available The 28 October 2003 solar flare (X-ray Class X17.2 was one of the most intense solar flares observed in the recent past. In the present investigation we show the unusual ionospheric effects observed in the Brazilian sector during this solar flare, using both the ionospheric sounding observations obtained at the UNIVAP stations: Palmas (7–10.2° S, 48.2° W, dip lat. 5.5° S and Sao Jose dos Campos (23.2° S, 45.9° W, dip lat. 17.6° S, Brazil; and ground-based global positioning system (GPS data obtained at the "Instituto Brasileiro de Geografia e Estatística" (IBGE stations: Imperatriz (5.5° S, 47.5° W, dip lat. 2.9° S, Brasilia (15.9° S, 47.9° W, dip lat. 11.7° S, Presidente Prudente (22.3° S, 51.4° W, dip lat. 14.9° S, and Porto Alegre (30.1° S, 51.1° W, dip lat. 20.7° S, Brazil; on two consecutive days, viz., 27 (without solar flare and 28 (with solar flare October 2003. It should be mentioned that the vertical total electron content (VTEC from the GPS observations obtained during the solar flare showed an unusual simultaneous increase in the VTEC values at about 11:00 UT at all four stations associated with the solar flare EUV enhancements and lasted for about 3 h. However, no ionograms were obtained at any of the two UNIVAP stations for a period of about 1 h between about 11:00 to 12:00 UT. Before 11:00 UT (from about 10:45 UT and after 12:00 UT (to about 16:00 UT, the ionograms were only partial, with the low frequency end missing. During this intense solar flare, hard X-rays (1 to 10 A, as observed by the GOES 12 satellite, were ejected by the Sun during a long period (several hours, with peak radiation at about 11:10 UT. These hard X-ray radiations can penetrate further into the ionosphere, causing an increase in ionization in the lower part of ionosphere (D-region. In this way, the lack of ionograms or partial ionograms, which indicates no echoes or partial echoes of the transmitted digital ionosonde signals, are

  3. [Financing in Brazilian health care system: a recent retrospective and dentistry approach].

    Science.gov (United States)

    Nóbrega, Carolina Bezerra Cavalcanti; Hoffmann, Rosana Helena Schllitler; Pereira, Antonio Carlos; Meneghim, Marcelo de Castro

    2010-06-01

    The guided policies designed to modify the health care system occurred in three stages: the first occurred at the end of the military regimen with the implantation of the Integrated Actions of Health (AIS); the second came with the implantation of the Unified and Decentralized Health System (SUDS) in 1987; and the third was the promulgation of the Constitution in 1988, when the Brazilian Unified Health System (SUS), an organizational structure based on principles of citizenship and social justice, was then created. With the creation of SUS, there was the need for defining objectives and strategic lines of direction for the decentralization process, concerning responsibility aspects, relations among managers, and criteria of transference from federal to state and municipal levels. Thus, the objective of this study was to accomplish a recent retrospective of the budgetary plan aimed at health care, with an approach on dental care. Data collected from the Ministry of Health (DATASUS) between 1998 and 2005 were used in this retrospective study. In conclusion, a positive situation was observed for transferred annual values, suggesting that the reorganization and financial structure of the Brazilian health system is starting to work. PMID:20640338

  4. Management of Acute Myeloid Leukemia in the Intensive Care Setting.

    Science.gov (United States)

    Cowan, Andrew J; Altemeier, William A; Johnston, Christine; Gernsheimer, Terry; Becker, Pamela S

    2015-10-01

    Patients with acute myeloid leukemia (AML) who are newly diagnosed or relapsed and those who are receiving cytotoxic chemotherapy are predisposed to conditions such as sepsis due to bacterial and fungal infections, coagulopathies, hemorrhage, metabolic abnormalities, and respiratory and renal failure. These conditions are common reasons for patients with AML to be managed in the intensive care unit (ICU). For patients with AML in the ICU, providers need to be aware of common problems and how to manage them. Understanding the pathophysiology of complications and the recent advances in risk stratification as well as newer therapy for AML are relevant to the critical care provider. PMID:24756309

  5. Produção científica brasileira de enfermagem em terapia intensiva de 1995 a 2004 Producción científica brasileña de enfermería en cuidados intensivos de 1995 al 2004 Brazilian researches on intensive care unit from 1995 to 2004

    Directory of Open Access Journals (Sweden)

    Adriana Janzantte Ducci

    2007-06-01

    ón científica brasileña en la UCI es aún incipiente, manteniéndose estable en las últimas dos décadas.OBJECTIVE: To investigate nursing research in critical care in Brazil from 1995 to 2004. METHODS: Selected articles from ten Brazilian scientific journals were analyzed regarding frequency of publication, authorship, research methodology, topic, and study population. RESULTS: Among 3464 published articles, only 97 (2.8% were related to critical care. A great part of these studies (38.1% was conducted by Master's or Doctoral graduate students. Almost a half of the studies (49.5% used qualitative design. Main topics studied consisted of the professional performance of worker involved on care (23.7% and emotional aspects of nursing care (21.6%. Iatrogenic occurrences also emerge as an important topic. Nursing team was a common sample (50.0% of the studies. CONCLUSION: Nursing research in critical care in Brazil although incipient remains stable in the last two decades.

  6. Status of neonatal intensive care units in India.

    Directory of Open Access Journals (Sweden)

    Fernandez A

    1993-04-01

    Full Text Available Neonatal mortality in India accounts for 50% of infant mortality, which has declined to 84/1000 live births. There is no prenatal care for over 50% of pregnant women, and over 80% deliver at home in unsafe and unsanitary conditions. Those women who do deliver in health facilities are unable to receive intensive neonatal care when necessary. Level I and Level II neonatal care is unavailable in most health facilities in India, and in most developing countries. There is a need in India for Level III care units also. The establishment of neonatal intensive care units (NICUs in India and developing countries would require space and location, finances, equipment, staff, protocols of care, and infection control measures. Neonatal mortality could be reduced by initially adding NICUs at a few key hospitals. The recommendation is for 30 NICU beds per million population. Each bed would require 50 square feet per cradle and proper climate control. Funds would have to be diverted from adult care. The largest expenses would be in equipment purchase, maintenance, and repair. Trained technicians would be required to operate and monitor the sophisticated ventilators and incubators. The nurse-patient ratio should be 1:1 and 1:2 for other infants. Training mothers to work in the NICUs would help ease the problems of trained nursing staff shortages. Protocols need not be highly technical; they could include the substitution of radiant warmers and room heaters for expensive incubators, the provision of breast milk, and the reduction of invasive procedures such as venipuncture and intubation. Nocosomial infections should be reduced by vacuum cleaning and wet mopping with a disinfectant twice a day, changing disinfectants periodically, maintaining mops to avoid infection, decontamination of linen, daily changing of tubing, and cleaning and sterilizing oxygen hoods and resuscitation equipment, and maintaining an iatrogenic infection record book, which could be used to

  7. The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: Intensive care benefit for the elderly

    DEFF Research Database (Denmark)

    Sprung, Charles L; Artigas, Antonio; Kesecioglu, Jozef;

    2012-01-01

    RATIONALE:: Life and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly. OBJECTIVE:: To determine the effect of intensive care unit triage decisions on...... mortality and intensive care unit benefit, specifically for elderly patients. DESIGN:: Prospective, observational study of triage decisions from September 2003 until March 2005. SETTING:: Eleven intensive care units in seven European countries. PATIENTS:: All patients >18 yrs with an explicit request for...... accepted to the intensive care unit, 1,194 (18%) rejected; 3,795 (49%) were =65 yrs. Refusal rate increased with increasing patient age (18-44: 11%; 45-64: 15%; 65-74: 18%; 75-84: 23%; >84: 36%). Mortality was higher for older patients (18-44: 11%; 45-64: 21%; 65-74: 29%; 75-84: 37%; >84: 48%). Differences...

  8. Methicillin resistant Staphylococcus aureus (MRSA) in the intensive care unit

    OpenAIRE

    Haddadin, A; Fappiano, S; Lipsett, P

    2002-01-01

    Methicillin resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen that causes severe morbidity and mortality worldwide. MRSA strains are endemic in many American and European hospitals and account for 29%–35% of all clinical isolates. Recent studies have documented the increased costs associated with MRSA infection, as well as the importance of colonisation pressure. Surveillance strategies have been proposed especially in high risk areas such as the intensive care unit. Pneum...

  9. Human-centered environment design in intensive care unit

    OpenAIRE

    Li, Y.; Albayrak, A.; Goossens, R.H.M.; D. Xiao; Jakimowicz, J.J.

    2013-01-01

    Because of high risk and instability of the patients in Intensive care unit(ICU), the design of ICU is very difficult. ICU design, auxiliary building design, lighting design, noise control and other aspects can also enhance its management. In this paper, we compare ICU design in China and Holland based on related standards. We also premeditate the indoor environment from planning perspective, analyze patients, their families, medical staff and space requirement to conduct research in ICU desi...

  10. Predictors of physical restraint use in Canadian intensive care units

    OpenAIRE

    Luk, Elena; Sneyers, Barbara; Rose, Louise; Perreault, Marc M; Williamson, David R; Mehta, Sangeeta; Cook, Deborah J; Lapinsky, Stephanie C; Burry, Lisa

    2014-01-01

    Introduction Physical restraint (PR) use in the intensive care unit (ICU) has been associated with higher rates of self-extubation and prolonged ICU length of stay. Our objectives were to describe patterns and predictors of PR use. Methods We conducted a secondary analysis of a prospective observational study of analgosedation, antipsychotic, neuromuscular blocker, and PR practices in 51 Canadian ICUs. Data were collected prospectively for all mechanically ventilated adults admitted during a ...

  11. Causes Of Microbial Carriers During Admission To Intensive Care Unit

    OpenAIRE

    Panagiotopoulou, Efthymia; Nteves, Ioannis; Kadda, Olga; Kapadohos, Theodore; Vasilopoulos, Georgios; Marvaki, Christina

    2016-01-01

    Introduction: The recording of microbial agent upon patients admission in the Intensive Care Unit (ICU) can be useful for the prevention and reduction of dispersion, forecasting new colonization or infection respectively bacteria and guide empirical antimicrobial therapy. Aim: The aim of the present study was to investigate the factors associated with microbial colonization of patients admitting to ICU. Material and Method: The studied sample consisted of 72 patients admitted to the I...

  12. The importance of parents in the neonatal intensive care units

    OpenAIRE

    Hercília Guimarães

    2015-01-01

    The premature birth and the hospitalization in a neonatal intensive care unit (NICU) are potential risk factors for the development and behavior of the newborn, as has been shown in recent studies. Premature birth of an infant is a distressing event for the family. Several feelings are experienced by parents during hospitalization of their baby in the NICU. Feelings of guilt, rejection, stress and anxiety are common. Also the attachment processes have the potential to be disrupted or delayed ...

  13. Physiotherapy practices in Intensive Care Units across Maharashtra

    OpenAIRE

    Ujwal Lakshman Yeole; Ankita Ramesh Chand; Nandi, Biplab B.; Pravin P Gawali; Adkitte, Roshan G.

    2015-01-01

    Purpose: To find out the current physiotherapy practices in Intensive Care Unit (ICU) across Maharashtra. Materials and Methods: Study design was exploratory cross-sectional survey. Questionnaires were sent to the physiotherapists working in hospitals across Maharashtra state, India. Four weeks for completion of questionnaire was given in an attempt to ensure good response rates. Result: Of 200, 73 questionnaires were received representing a 36% response rate. The study revealed that 76% of t...

  14. Eye injury treatment in intensive care unit patients

    OpenAIRE

    L. K. Moshetova; S. A. Kochergin; A. S. Kochergin

    2015-01-01

    Aim. To describe eye injuries in intensive care unit (ICU) patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes) with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative...

  15. Intensive Care Unit Acquired Weakness: Under or Overdiagnosed?

    OpenAIRE

    Morgado, S; Moura, S.

    2010-01-01

    Intensive care unit-acquired weakness (ICU-AW) is recognized as an important and common clinical problem, associated with an increased morbidity in critical ill patients. This muscle weakness has been described in a wide range of clinical settings and therefore, has many different terminologies such as “critical illness myopathy – CIM”, “critical illness polyneuropathy - CIP”, “acute quadriplegic myopathy”, among others. Nowadays, these designations are considered somewhat restric...

  16. Maternal Psychological Problems Associated with Neonatal Intensive Care Admission

    OpenAIRE

    Ziya Yurdakul; Ipek Akman; M. Kemal Kuşçu; Aytul Karabekiroglu; Gulsum Yaylalı; Figen Demir; Eren Özek

    2009-01-01

    Background. Mothers of infants admitted to a neonatal intensive care unit (NICU) are believed to have heightened distress. The purpose of this paper was to determine depression and anxiety symptoms and attachment style in NICU mothers. Methods. The NICU group consisted of mothers whose infants were admitted to the NICU and the control group consisted of mothers of healthy term infants. The psychosocial assessments were done at the first month. Results. The mean Edinburgh Postpartum ...

  17. Incidence of intravenous drug incompatibilities in intensive care units

    Czech Academy of Sciences Publication Activity Database

    Machotka, O.; Maňák, J.; Kuběna, Aleš Antonín; Vlček, J.

    2015-01-01

    Roč. 159, č. 4 (2015), s. 652-656. ISSN 1213-8118 Institutional support: RVO:67985556 Keywords : medical error * graph theory * graph coloring * drug administration * drug incompatibilities * applied combinatorics * decision theory * medical * medication safety * intensive care units Subject RIV: FN - Epidemiology, Contagious Diseases ; Clinical Immunology Impact factor: 1.200, year: 2014 http://library.utia.cas.cz/separaty/2014/E/kubena-0437509.pdf

  18. What Does Change with Nutrition Team in Intensive Care Unit?

    OpenAIRE

    Ahmet Fatih Yılmaz; Ertuğrul Kılıç; Sema Gürsel; Nazlı Tiryaki

    2016-01-01

    Intrroduction: Clinical nutrition is the nutrition support therapy provided to patients under medical supervision at the hospital or home setting. It is a multidisciplinary task performed under the control of the physician, dietician, pharmacist and nurse. In this study, the changes in the patient admission statistics to the general intensive care unit (GICU), the exitus ratios, decubitus ulcer formation rates, albumin use rates, duration of the hospital stay, Acute Physiology and Chronic Hea...

  19. Renal replacement therapy in the intensive care unit

    OpenAIRE

    Pannu, Neesh; Gibney, RT Noel

    2005-01-01

    Acute renal failure is a common complication in the intensive care unit (ICU). Over the last 25 years, there have been significant technological advances in the delivery of renal replacement therapy, particularly as it pertains to the critically ill patient population. Despite these advances, acute renal failure in critically ill patients continues to carry a poor prognosis. In this article, we review the current literature about timing and initiation of renal replacement therapy in the ICU a...

  20. Non-invasive respiratory monitoring in paediatric intensive care unit.

    OpenAIRE

    Nadkarni U; Shah A; Deshmukh C

    2000-01-01

    Monitoring respiratory function is important in a Paediatrics Intensive Care Unit (PICU), as majority of patients have cardio-respiratory problems. Non-invasive monitoring is convenient, accurate, and has minimal complications. Along with clinical monitoring, oxygen saturation using pulse oximetry, transcutaneous oxygenation (PtcO2) and transcutaneous PCO2 (PtcCO2) using transcutaneous monitors and end-tidal CO2 using capnography are important and routine measurements done in most PICUs. Cons...

  1. Clinical review: Airway hygiene in the intensive care unit

    OpenAIRE

    Jelic, Sanja; Cunningham, Jennifer A; Factor, Phillip

    2008-01-01

    Maintenance of airway secretion clearance, or airway hygiene, is important for the preservation of airway patency and the prevention of respiratory tract infection. Impaired airway clearance often prompts admission to the intensive care unit (ICU) and can be a cause and/or contributor to acute respiratory failure. Physical methods to augment airway clearance are often used in the ICU but few are substantiated by clinical data. This review focuses on the impact of oral hygiene, tracheal suctio...

  2. Epidemiology of Acute Kidney Injury in the Intensive Care Unit

    OpenAIRE

    James Case; Supriya Khan; Raeesa Khalid; Akram Khan

    2013-01-01

    The incidence of acute kidney injury (AKI) in the intensive care unit (ICU) has increased during the past decade due to increased acuity as well as increased recognition. Early epidemiology studies were confounded by erratic definitions of AKI until recent consensus guidelines (RIFLE and AKIN) standardized its definition. This paper discusses the incidence of AKI in the ICU with focuses on specific patient populations. The overall incidence of AKI in ICU patients ranges from 20% to 50% with l...

  3. Prevalence of Hospital Acquired Infections in Anesthesiology Intensive Care Unit

    OpenAIRE

    ÇELİK, İlhami; İNCİ, Nuran; Denk, Affan; SEVİM, Erol; YAŞAR, Demet; YAŞAR, M. Akif

    2005-01-01

    Objectives: To determine the prevalence of infections, predominant organisms and their resistance pattern. Materials and Methods: Prospective cohort study. All patients over 16 years old were occupying an intensive care unit bed over a 24-hour period. All patients admitted to the unit were evaluated on a daily basis for nosocomial infections in compliance with National Nosocomial Infections Surveillance System (NNISS) methodology. Infection site definitions were in agreement with Center fo...

  4. Post-traumatic pulmonary embolism in the intensive care unit

    OpenAIRE

    Mabrouk Bahloul; Anis Chaari; Hassen Dammak; Fatma Medhioub; Leila Abid; Hichem Ksibi; Sondes Haddar; Hatem Kallel; Hedi Chelly; Chokri Ben Hamida; Mounir Bouaziz

    2011-01-01

    Objective: To determine the predictive factors, clinical manifestations, and the outcome of patients with post-traumatic pulmonary embolism (PE) admitted in the intensive care unit (ICU). Methods: During a four-year prospective study, a medical committee of six ICU physicians prospectively examined all available data for each trauma patient in order to classify patients according to the level of clinical suspicion of pulmonary thromboembolism. During the study period, all trauma patients ...

  5. Bedside Neonatal Intensive Care Unit Surgery- Myth or Reality!

    OpenAIRE

    Shandip Kumar Sinha; Sujoy Neogi

    2013-01-01

    Neonatal transport is associated with complications, more so in sick and unstable neonates who need immediate emergency surgery. To circumvent these problems, surgery in Neonatal intensive care unit (NICU) is proposed for these neonates. This article reviews the literature regarding feasibility of this novel concept and based on the generated evidence, suggest the NICU planners to always include infrastructure for this. Also neonatal surgical team can be developed that could be transported.

  6. Nutritional support of children in the intensive care unit.

    OpenAIRE

    Seashore, J. H.

    1984-01-01

    Nutritional support is an integral and essential part of the management of 5-10 percent of hospitalized children. Children in the intensive care unit are particularly likely to develop malnutrition because of the nature and duration of their illness, and their inability to eat by mouth. This article reviews the physiology of starvation and the development of malnutrition in children. A method of estimating the nutritional requirements of children is presented. The techniques of nutritional su...

  7. Grid data mining for outcome prediction in intensive care medicine

    OpenAIRE

    Santos, Manuel Filipe; Wesley, Mathew; Portela, Filipe

    2011-01-01

    This paper introduces a distributed data mining approach suited to grid computing environments based on a supervised learning classifier system. Specific Classifier and Majority Voting methods for Distributed Data Mining (DDM) are explored and compared with the Centralized Data Mining (CDM) approach. Experimental tests were conducted considering a real world data set from the intensive care medicine in order to predict the outcome of the patients. The results demonstrate that the performance ...

  8. Costing of consumables: use in an intensive care unit.

    Science.gov (United States)

    Mann, S A

    1999-08-01

    In 1991, the Intensive Care Unit (ICU) at Middlemore Hospital manually costed the treatment and care of asthmatic patients. This was long-winded and labour-intensive, but provided hard data to support anecdotal beliefs that intensive care patients are more expensive than was currently believed or accepted. It is a known problem that funder and provider organizations see a huge disparity on the funding issue. With additional accurate information on the actual cost of individual patients, which can be grouped into disease categories, funding applications can be backed with accurate, up-to-date quantitative data. After a long preparation time, we are now costing individual patient stays in the ICU. Each individual resource was established, costed and entered into an MS ACCESS computerized database. Schedules have been prepared for updating prices, as these change. The final report available gives a detailed list of resource use within certain categories. Some items proved to be impractical to cost on an individual patient basis, and these have been grouped together, costed, and divided by the number of patient days for the last year, and assigned to each individual patient as an hourly unit cost. Believed to be a world-first, this information now forms the basis for variance reporting and pricing. PMID:10786509

  9. Performance of Primary Dental Care Services: An Ecological Study in a Large Brazilian City

    Directory of Open Access Journals (Sweden)

    Rita Sibele Souza Esteves

    2013-01-01

    Full Text Available This study explored the association between area-level primary dental care performance and area-level demographics, dental treatment need, and health care service indicators. An ecological cross-sectional study was performed in Belo Horizonte, Brazil, in 2010. The 142 primary health care (PHC units were grouped based on the following variables: access to individual dental treatment, frequency of dental emergencies, and frequency of individual preventive procedures. The independent variables analyzed were demographic variables, dental treatment need, and health care service indicators. The data were obtained from the information systems of the Brazilian Ministry of Health and the city of Belo Horizonte. We explored the associations between membership in a specific PHC cluster type and the independent variables using multinomial logistic regression with a significance level of 5%. Variables such as the high/very high vulnerability of population, rate of completed treatment, and rate of referrals of users to secondary care were independently associated with the clusters (P<0.05. The performance of primary dental care services was associated with patient demographics, dental treatment need, and referrals. The results of this study have implications for the planning of public policies.

  10. Courts and health care rationing: the case of the Brazilian Federal Supreme Court.

    Science.gov (United States)

    Wang, Daniel W L

    2013-01-01

    The recognition that access to health care is a constitutional right in Brazil has resulted in a situation in which citizens denied treatments by the public health care system have brought lawsuits against health authorities, claiming that their right to health was violated. This litigation forces the courts to decide between a patient-centred and a population-centred approach to public health - a choice that forces the courts to assess health care rationing decisions. This article analyses the judgments of the Brazilian Federal Supreme Court in right to health cases, arguing that the Court's recent decisions have been contrary to their long-standing stance against rationing. In 2009, the Court organized a public hearing to discuss this topic with civil society and established criteria to determine when rationing would be legal. However, I argue that these criteria for health care rationing do not adequately address the most difficult health care distribution dilemmas. They force the health care system to keep their rationing criteria implicit and make population-centred concerns secondary to individual-centred ones. PMID:23040509

  11. [Prevalence of home care and associated factors in the Brazilian elderly population].

    Science.gov (United States)

    Wachs, Louriele Soares; Nunes, Bruno Pereira; Soares, Mariangela Uhlmann; Facchini, Luiz Augusto; Thumé, Elaine

    2016-03-01

    The aim of this study was to evaluate the prevalence of home care for the Brazilian elderly population and associated factors, using a cross-sectional design with a sample of individuals 60 years or older living in the urban areas of 100 municipalities located in 23 states. A Poisson regression model was used for crude and adjusted analyses. A total of 6,624 elderly individuals were interviewed, and prevalence of home care was 11.7%. After adjustment, higher home care rates were associated with female gender, older old age, lower schooling and purchasing power, diagnosis of chronic illness, history of falls, previous hospitalization, and medical consultation in the previous three months. The results highlight more extensive use of home care by the most vulnerable elderly. This finding suggests a contribution from home care to the promotion of healthcare equity in Brazil, especially due to the expansion of the Family Health Strategy. The results can support the organization of the work process for primary care professionals and managers. PMID:27027455

  12. Establishment of Pediatric Cardiac Intensive Care Advanced Practice Provider Services.

    Science.gov (United States)

    Gilliland, Jill; Donnellan, Amy; Justice, Lindsey; Moake, Lindy; Mauney, Jennifer; Steadman, Page; Drajpuch, David; Tucker, Dawn; Storey, Jean; Roth, Stephen J; Koch, Josh; Checchia, Paul; Cooper, David S; Staveski, Sandra L

    2016-01-01

    The addition of advanced practice providers (APPs; nurse practitioners and physician assistants) to a pediatric cardiac intensive care unit (PCICU) team is a health care innovation that addresses medical provider shortages while allowing PCICUs to deliver high-quality, cost-effective patient care. APPs, through their consistent clinical presence, effective communication, and facilitation of interdisciplinary collaboration, provide a sustainable solution for the highly specialized needs of PCICU patients. In addition, APPs provide leadership, patient and staff education, facilitate implementation of evidence-based practice and quality improvement initiatives, and the performance of clinical research in the PCICU. This article reviews mechanisms for developing, implementing, and sustaining advance practice services in PCICUs. PMID:26714997

  13. Postpartum depression on the neonatal intensive care unit: current perspectives

    Directory of Open Access Journals (Sweden)

    Tahirkheli NN

    2014-11-01

    Full Text Available Noor N Tahirkheli,1 Amanda S Cherry,1 Alayna P Tackett,2 Mary Anne McCaffree,3 Stephen R Gillaspy11Section of General and Community Pediatrics, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; 2Department of Psychology, Oklahoma State University, Stillwater, OK, USA; 3Section of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USAAbstract: As the most common complication of childbirth affecting 10%–15% of women, postpartum depression (PPD goes vastly undetected and untreated, inflicting long-term consequences on both mother and child. Studies consistently show that mothers of infants in the neonatal intensive care unit (NICU experience PPD at higher rates with more elevated symptomatology than mothers of healthy infants. Although there has been increased awareness regarding the overall prevalence of PPD and recognition of the need for health care providers to address this health issue, there has not been adequate attention to PPD in the context of the NICU. This review will focus on an overview of PPD and psychological morbidities, the prevalence of PPD in mothers of infants admitted to NICU, associated risk factors, potential PPD screening measures, promising intervention programs, the role of NICU health care providers in addressing PPD in the NICU, and suggested future research directions.Keywords: neonatal intensive care unit, postpartum depression, mothers

  14. Trends in elderly psychiatric admissions to the Brazilian public health care system

    Directory of Open Access Journals (Sweden)

    Pedro L. Ritter

    2016-01-01

    Full Text Available Objective: To evaluate trends in psychiatric bed occupancy by elderly inpatients in the Brazilian public health care system between 2000 and 2010 and to determine the leading psychiatric diagnosis for hospital admissions. Methods: Data from all 895,476 elderly psychiatric admissions recorded in the Brazilian Public Health Care Database (DATASUS between January 2000 and February 2010 were analyzed. Polynomial regression models with estimated curve models were used to determine the trends. The number of inpatient days was calculated for the overall psychiatric admissions and according to specific diagnoses. Results: A moderate decreasing trend (p < 0.001 in the number of inpatient days was observed in all geriatric psychiatric admissions (R2 = 0.768 and in admissions for organic mental disorders (R2 = 0.823, disorders due to psychoactive substance use (R2 = 0.767, schizophrenia (R2 = 0.680, and other diagnoses (R2 = 0.770, but not for mood disorders (R2 = 0.472. Most admissions (60 to 65% were due to schizophrenia. Conclusion: There was a decreasing trend in inpatient days for elderly psychiatric patients between 2000 and 2010. The highest bed occupancy was due to schizophrenia, schizotypal, and delusional disorders.

  15. [Legislation on primary care in Brazilian Unified National Health System: document analysis].

    Science.gov (United States)

    Domingos, Carolina Milena; Nunes, Elisabete de Fátima Polo de Almeida; Carvalho, Brígida Gimenez; Mendonça, Fernanda de Freitas

    2016-03-01

    A reflection on Brazil's legislation for primary care helps understand the way health policy is implemented in the country. This study focuses on the legal provisions aimed at strengthening primary care, drawing on an analysis of documents from the Ministry of Health's priority actions, programs, and strategies. A total of 224 provisions were identified, in two groups of documents, so-called instituting provisions and complementary provisions. The former include the principles and guidelines of the Brazilian Unified National Health System (SUS) and also involve the expansion of actions. Financing was a quantitatively central theme, especially in the complementary provisions. The analysis led to reflection on the extent to which these strategies can induce linkage between health system managers and civil society in building a political project resulting in improvements and meeting the population's health needs. PMID:27027459

  16. Innovation in Pediatric Cardiac Intensive Care: An Exponential Convergence Toward Transformation of Care.

    Science.gov (United States)

    Maher, Kevin O; Chang, Anthony C; Shin, Andrew; Hunt, Juliette; Wong, Hector R

    2015-10-01

    The word innovation is derived from the Latin noun innovatus, meaning renewal or change. Although companies such as Google and Apple are nearly synonymous with innovation, virtually all sectors in our current lives are imbued with yearn for innovation. This has led to organizational focus on innovative strategies as well as recruitment of chief innovation officers and teams in a myriad of organizations. At times, however, the word innovation seems like an overused cliché, as there are now more than 5,000 books in print with the word "innovation" in the title. More recently, innovation has garnered significant attention in health care. The future of health care is expected to innovate on a large scale in order to deliver sustained value for an overall transformative care. To date, there are no published reports on the state of the art in innovation in pediatric health care and in particular, pediatric cardiac intensive care. This report will address the issue of innovation in pediatric medicine with relevance to cardiac intensive care and delineate possible future directions and strategies in pediatric cardiac intensive care. PMID:26467873

  17. Paediatric admissions and outcome in a general intensive care unit

    Directory of Open Access Journals (Sweden)

    Embu Henry

    2011-01-01

    Full Text Available Background: It is believed that intensive care greatly improves the prognosis for critically ill children and that critically ill children admitted to a dedicated Paediatric Intensive Care Unit (PICU do better than those admitted to a general intensive care unit (ICU. Methods: A retrospective study of all paediatric (< 16 years admissions to our general ICU from January 1994 to December 2007. Results: Out of a total of 1364 admissions, 302 (22.1% were in the paediatric age group. Their age ranged from a few hours old to 15 years with a mean of 4.9 ± 2.5 years. The male: female ratio was 1.5:1. Postoperative admissions made up 51.7% of the admissions while trauma and burn made up 31.6% of admissions. Medical cases on the other hand constituted 11.6% of admissions. Of the 302 children admitted to the ICU, 193 were transferred from the ICU to other wards or in some cases other hospitals while 109 patients died giving a mortality rate of 36.1%. Mortality was significantly high in post-surgical paediatric patients and in patients with burn and tetanus. The length of stay (LOS in the ICU ranged from less than one day to 56 days with a mean of 5.5 days. Conclusion: We found an increasing rate of paediatric admissions to our general ICU over the years. We also found a high mortality rate among paediatric patients admitted to our ICU. The poor outcome in paediatric patients managed in our ICU appears to be a reflection of the inadequacy of facilities. Better equipping our ICUs and improved man-power development would improve the outcome for our critically ill children. Hospitals in our region should also begin to look into the feasibility of establishing PICUs in order to further improve the standard of critical care for our children.

  18. Reflecting on healthcare and self-care in the Intensive Care Unit: our story

    Directory of Open Access Journals (Sweden)

    Allan Peterkin

    2014-12-01

    Full Text Available Health care professionals working in Intensive Care Units (ICUs are exposed to high levels of stress-provoking stimuli. Some may unconsciously employ negative coping skill s which may contribute to burnout and negatively affect patient care. We chose to explore ways of facilitating and encouraging self-reflective practice in an effort to increase empathic traits and enhance communication. A narrative medicine series, which included six sessions that were focused on different narrative approaches, was organized for staff of an academic teaching hospital. Totally, 132 interdisciplinary ICU staff attended the sessions. They were generally open to exploring the selected approaches and discussing their reflections within the interdisciplinary environment. The narrative medicine series provided tools for health care professionals to enhance self-reflective skills utilizing a team-based learning approach. The anticipated outcomes were improved self-care, increased empathy and communication skills, enhanced team functioning, which all contribute to better patient care at the bedside.

  19. End of life in the neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Helena Moura

    2011-01-01

    Full Text Available PURPOSE: Death at the beginning of life is tragic but not uncommon in neonatal intensive care units. In Portugal, few studies have examined the circumstances surrounding the final moments of neonates. We evaluated the care given to neonates and their families in terminal situations and the changes that had occurred one decade later. DESIGN AND METHODS: We analyzed 256 charts in a retrospective chart review of neonatal deaths between two periods (1992-1995 and 2002-2005 in a level III neonatal intensive care unit. RESULTS: Our results show differences in the care of dying infants between the two periods. The analysis of the 2002-2005 cohort four years revealed more withholding and withdrawing of therapeutic activities and more effective pain and distress relief; however, on the final day of life, 95.7% of the infants received invasive ventilatory support, 76.3% received antibiotics, 58.1% received inotropics, and 25.8% received no opioid or sedative administration. The 2002-2005 cohort had more spiritual advisor solicitation, a higher number of relatives with permission to freely visit and more clinical meetings with neonatologists. Interventions by parents, healthcare providers and ethics committees during decision-making were not documented in any of the charts. Only eight written orders regarding therapeutic limitations and the adoption of palliative care were documented; seven (87.5% were from the 2002-2005 cohort. Parental presence during death was more frequent in the latter four years (2002-2005 cohort, but only 21.5% of the parents wanted to be present at that moment. CONCLUSION: Despite an increase in the withholding and withdrawing of therapeutic activities and improvements in pain management and family support, many neonates still receive curative and aggressive practices at the end of life.

  20. Structure and Function: Planning a New Intensive Care Unit to Optimize Patient Care

    Directory of Open Access Journals (Sweden)

    Jozef Kesecioğlu

    2014-08-01

    Full Text Available To survey the recent medical literature reporting effects of intensive care unit (ICU design on patients’ and family members’ well-being, safety and functionality. Features of ICU design linked to the needs of patients and their family are single-rooms, privacy, quiet surrounding, exposure to daylight, views of nature, prevention of infection, a family area and open visiting hours. Other features such as safety, working procedures, ergonomics and logistics have a direct impact on the patient care and the nursing and medical personnel. An organization structured on the needs of the patient and their family is mandatory in designing a new intensive care. The main aims in the design of a new department should be patient centered care, safety, functionality, innovation and a future-proof concept.

  1. The Use of Modafinil in the Intensive Care Unit.

    Science.gov (United States)

    Gajewski, Michal; Weinhouse, Gerald

    2016-02-01

    As patients recover from their critical illness, the focus of intensive care unit (ICU) care becomes rehabilitation. Fatigue, excessive daytime somnolence (EDS), and depression can delay their recovery and potentially worsen outcomes. Psychostimulants, particularly modafinil (Provigil), have been shown to alleviate some of these symptoms in various patient populations, and as clinical trials are underway exploring this novel use of the drug, we present a case series of 3 patients in our institution's Thoracic Surgery Intensive Care Unit. Our 3 patients were chosen as a result of their fatigue, EDS, and/or depression, which prolonged their ICU stay and precluded them from participating in physical therapy, an integral component of the rehabilitative process. The patients were given 200 mg of modafinil each morning to increase patient wakefulness, encourage their participation, and enable a more restful sleep during the night. Although the drug was undoubtedly not the sole reason why our patients became more active, the temporal relationship between starting the drug and our patients' clinical improvement makes it likely that it contributed. Based on our observations with these patients, the known effects of modafinil, its safety profile, and the published experiences of others, we believe that modafinil has potential benefits when utilized in some critically ill patients and that the consequences of delayed patient recovery and a prolonged ICU stay may outweigh the risks of potential modafinil side effects. PMID:25716122

  2. Primary nursing in Intensive Care Unit: measuring nurses' attitudes

    Directory of Open Access Journals (Sweden)

    Zetta, S.

    2010-07-01

    Full Text Available Intensive Care Units have been identified as having advantages for the use of primary nursing. Nursing staff play an important role οn the successful implementation of primary nursing. It is important to know in advance of the implementation plan the attitudes and opinions of the nurses. Such knowledge would adequately inform the management and enable them to use the right approaches to achieve successful implementation. Aim and Method The current study is a non-experimental, cross-sectional descriptive research design aiming to identify nurses’ attitudes towards primary nursing. The study was conducted in an 8-beded Intensive Care Unit (ICU part of a University Hospital in Scotland. The sample consisted of all 38 registered and enrolled nurse working at the unit at the time. Results Results indicated that nurses were aware and identified benefits and shortcomings of primary nursing which have been seen in the primary care literature. Nurses’ attitudes towards implementation of primary nursing were positive and appeared to agree with the positive impact of primary nursing to the patients either in term of patient satisfaction or patient autonomy. Conclusions Primary nursing advocates a shift away from the traditional system of hierarchical task allocation. Nurses are willing to change and want to learn more in order to improve patients’ outcomes.

  3. Physical outcome measure for critical care patients following intensive care discharge

    OpenAIRE

    Devine, H.; MacTavish, P.; Quasim, T.; Kinsella, J; Daniel, M; McPeake, J.

    2016-01-01

    Introduction: The aim of this study was to evaluate the most suitable physical outcome measures to be used with critical care patients following discharge. ICU survivors experience physical problems such as reduced exercise capacity and intensive care acquired weakness. NICE guideline ‘Rehabilitation after critical illness’ (1) recommends the use of outcome measures however does not provide any specific guidance. A recent Cochrane review noted wide variability in measures...

  4. The core characteristics and nursing care activities in psychiatric intensive care units in Sweden

    OpenAIRE

    Salzmann-Erikson, Martin; Lützén, Kim; Ivarsson, Ann-Britt; Eriksson, Henrik

    2008-01-01

    Internationally, research on psychiatric intensive care units (PICUs) commonly reportsresults from demographic studies such as criteria for admission, need for involuntary treatment, andthe occurrence of violent behaviour. A few international studies describe the caring aspect of thePICUs based specifically on caregivers’ experiences. The concept of PICU in Sweden is not clearlydefined. The aim of this study is to describe the core characteristics of a PICU in Sweden and todescribe the ...

  5. [Managed care. Its impact on health care in the USA, especially on anesthesia and intensive care].

    Science.gov (United States)

    Bauer, M; Bach, A

    1998-06-01

    Managed care, i.e., the integration of health insurance and delivery of care under the direction of one organization, is gaining importance in the USA health market. The initial effects consisted of a decrease in insurance premiums, a very attractive feature for employers. Managed care promises to contain expenditures for health care. Given the shrinking public resources in Germany, managed care seems attractive for the German health system, too. In this review the development of managed care, the principal elements, forms of organisation and practical tools are outlined. The regulation of the delivery of care by means of controlling and financial incentives threatens the autonomy of physicians: the physician must act as a "double agent", caring for the interest for the individual patient and being restricted by the contract with the managed care organisation. Cost containment by managed care was achieved by reducing the fees for physicians and hospitals (and partly by restricting care for patients). Only a fraction of this cost reduction was handed over to the enrollee or employer, and most of the money was returned with profit to the shareholders of the managed care organisations. The preeminent role of primary care physicians as gatekeepers of the health network led to a reduced demand for specialist services in general and for university hospitals and anesthesiologists in particular. The paradigm of managed care, i.e., to guide the patient and the care giver through the health care system in order to achieve cost-effective and high quality care, seems very attractive. The stress on cost minimization by any means in the daily practice of managed care makes it doubtful if managed care should be an option for the German health system, in particular because there are a number of restrictions on it in German law. PMID:9676303

  6. Acinetobacter baumannii Infection in the Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    AMK AL Jarousha

    2008-09-01

    Full Text Available Background: To perform a prospective case control study of blood stream infection to determine the infection rate of Acine­tobac­ter baumannii and the risk factors associated with mortality."nMethods:   From February 2004 to January 2005, 579 consecutive episodes of blood stream infection were obtained at two neo­na­tal intensive care units Al Nasser and Al Shifa hospitals in Gaza City. Forty (6.9% isolates of A. baumannii were ob­tained from the neonates under 28 d. Most of the isolates (92% were from hospitalized patients in the intensive care units."nResults: Community acquired infection was 8%.  Sixty three percent of the patients were males. The isolates of A. bauman­nii were resistant to commonly used antibiotics while being sensitive to meropenem (92.5%, imipenem (90%, chloram­pheni­col (80%, ciprofloxacin (75%, gentamicin (57.5%, ceftriaxone (50%, amikacin (37.5%, cefuroxime and ce­fo­taxime (35%. Over all crude mortality rate was 20% with much higher crude mortality among patients with noso­co­mial infec­tion.  Based on logistic regression, the following factors were statistically significant: weight < 1500g, age < 7 d, mean of hospitalization equal 20 days, antibiotic use, and mechanical ventilation, when compared to the control group (P< 0.05."nConclusion:  Infection rate of nosocomial blood stream infection was considerable and alarming in neonatal intensive care unit infants and associated with a significant excess length of NICU stay and a significant economic burden.  

  7. Noise Pollution in Intensive Care Units and Emergency Wards

    Directory of Open Access Journals (Sweden)

    Gholamreza Khademi

    2011-03-01

    Full Text Available Introduction: The improvement of technology has increased noise levels in hospital Wards to higher than international standard levels (35-45 dB. Higher noise levels than the maximum level result in patient’s instability and dissatisfaction. Moreover, it will have serious negative effects on the staff’s health and the quality of their services. The purpose of this survey is to analyze the level of noise in intensive care units and emergency wards of the Imam Reza Teaching Hospital, Mashhad. Procedure: This research was carried out in November 2009 during morning shifts between 7:30 to 12:00. Noise levels were measured 10 times at 30-minute intervals in the nursing stations of 10 wards of the emergency, the intensive care units, and the Nephrology and Kidney Transplant Departments of Imam Reza University Hospital, Mashhad. The noise level in the nursing stations was tested for both the maximum level (Lmax and the equalizing level (Leq. The research was based on the comparison of equalizing levels (Leq because maximum levels were unstable. Results: In our survey the average level (Leq in all wards was much higher than the standard level. The maximum level (Lmax in most wards was 85-86 dB and just in one measurement in the Internal ICU reached 94 dB. The average level of Leq in all wards was 60.2 dB. In emergency units, it was 62.2 dB, but it was not time related. The highest average level (Leq was measured at 11:30 AM and the peak was measured in the Nephrology nursing station. Conclusion:  The average levels of noise in intensive care units and also emergency wards were  more than the standard levels and as it is known these wards have vital roles in treatment procedures, so more attention is needed in this area.

  8. Implementation of an electronic logbook for intensive care units.

    Science.gov (United States)

    Wallace, Carrie J.; Stansfield, Dennis; Gibb Ellis, Kathryn A.; Clemmer, Terry P.

    2002-01-01

    Logbooks of patients treated in acute care units are commonly maintained; the data may be used to justify resource use, analyze patient outcomes, and encourage clinical research. We report herein the conversion of a paper-based logbook to an electronic logbook in three hospital intensive care units. The major difference between the paper logbook and electronic logbook data was the addition of clinician-entered data to the electronic logbook. Despite extensive computerization of patient information extant in the participating units, there was considerable reluctance to replace the paper-based logbook. The project's success can be attributed to the use of feedback from the clinical users in the development and implementation process to create accessible, high quality data. These data provide clinicians with the capability to monitor trends in a variety of patient groups. Advantages of the electronic logbook include more efficient data access, higher data quality and increased ability to conduct quality improvement and clinical research activities. PMID:12463943

  9. Urinary catheter related nosocomial infections in paediatric intensive care unit.

    Directory of Open Access Journals (Sweden)

    Tullu M

    1998-04-01

    Full Text Available The present prospective study was carried out in the Paediatric Intensive Care Unit (PICU of a tertiary care teaching hospital in Mumbai. The objective was to determine the incidence, risk factors, mortality and organisms responsible for urinary catheter related infections (UCRI. Colonization and/or bacteriuria was labelled as urinary catheter related infection (UCRI. Forty-four patients with 51 urinary catheters were studied. Incidence of UCRI was 47.06%. Age, female sex and immunocompromised status did not increase the risk of UCRI. Duration of catheter in-situ and duration of stay in the PICU were associated with higher risk of UCRI. The mortality was not increased by UCRI. Commonest organism isolated in UCRI was E. coli, which had maximum susceptibility to nitrofurantoin and amikacin.

  10. End-of-life decisions in the intensive care unit

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene

    2012-01-01

    Background When making end-of-life decisions in intensive care units, the different staff groups have different roles in the decision-making process and may not always assess the situation identically. Practice recommendations for withholding or withdrawing therapy state that decisions should...... and guidelines, can improve both interdisciplinary collaboration and patient care. Methods A multi-method approach was used, including five sub-projects: Subproject 1. Hospital record review: The review included all patients who had either died in two regional ICUs in 2008, or were discharged with treatment...... primary physicians were conducted in two ICUs. Subproject 3. Questionnaire survey: A questionnaire regarding different aspects of end-of-life practices was developed based on literature and the interviews. After pilot testing the questionnaire, it was used in a survey among nurses (495) and intensivists...

  11. End-of-life care in the intensive care unit: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine.

    Science.gov (United States)

    Myburgh, John; Abillama, Fayez; Chiumello, Davide; Dobb, Geoff; Jacobe, Stephen; Kleinpell, Ruth; Koh, Younsuk; Martin, Claudio; Michalsen, Andej; Pelosi, Paolo; Torra, Lluis Blanch; Vincent, Jean-Louis; Yeager, Susan; Zimmerman, Janice

    2016-08-01

    End-of-life care in the intensive care unit (ICU) was identified as an objective in a series of Task Forces developed by the World Federation of Societies of Intensive and Critical Care Medicine Council in 2014. The objective was to develop a generic statement about current knowledge and to identify challenges relevant to the global community that may inform regional and local initiatives. An updated summary of published statements on end-of-life care in the ICU from national Societies is presented, highlighting commonalities and differences within and between international regions. The complexity of end-of-life care in the ICU, particularly relating to withholding and withdrawing life-sustaining treatment while ensuring the alleviation of suffering, within different ethical and cultural environments is recognized. Although no single statement can therefore be regarded as a criterion standard applicable to all countries and societies, the World Federation of Societies of Intensive and Critical Care Medicine endorses and encourages the role of Member Societies to lead the debate regarding end-of-life care in the ICU within each country and to take a leading role in developing national guidelines and recommendations within each country. PMID:27288625

  12. Intermittent Demand Forecasting in a Tertiary Pediatric Intensive Care Unit.

    Science.gov (United States)

    Cheng, Chen-Yang; Chiang, Kuo-Liang; Chen, Meng-Yin

    2016-10-01

    Forecasts of the demand for medical supplies both directly and indirectly affect the operating costs and the quality of the care provided by health care institutions. Specifically, overestimating demand induces an inventory surplus, whereas underestimating demand possibly compromises patient safety. Uncertainty in forecasting the consumption of medical supplies generates intermittent demand events. The intermittent demand patterns for medical supplies are generally classified as lumpy, erratic, smooth, and slow-moving demand. This study was conducted with the purpose of advancing a tertiary pediatric intensive care unit's efforts to achieve a high level of accuracy in its forecasting of the demand for medical supplies. On this point, several demand forecasting methods were compared in terms of the forecast accuracy of each. The results confirm that applying Croston's method combined with a single exponential smoothing method yields the most accurate results for forecasting lumpy, erratic, and slow-moving demand, whereas the Simple Moving Average (SMA) method is the most suitable for forecasting smooth demand. In addition, when the classification of demand consumption patterns were combined with the demand forecasting models, the forecasting errors were minimized, indicating that this classification framework can play a role in improving patient safety and reducing inventory management costs in health care institutions. PMID:27562485

  13. Nurses Empathy and Family Needs in the Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Sima Moghaddasian

    2013-08-01

    Full Text Available Introduction: The patients’ families in intensive care units (ICUs experience excessive stress which may disrupt their performance in daily life. Empathy is basic to the nursing role and has been found to be associated with improved patient outcomes and greater satisfaction with care in patient and his/her family. However, few studies have investigated the nursing empathy with ICU patients. This study aimed to assess nursing empathy and its relationship with the needs, from the perspective of families of patients in ICU.Methods: In this cross-sectional study, 418 subjects were selected among families of patients admitted to ICUs in Tabriz, Iran, by convenience sampling, from May to August 2012. Data were collected through Barrett-Lennard Relationship inventory (BLRI empathy scale and Critical Care Family Needs Intervention (CCFNI inventories and were analyzed using descriptive and inferential statistical tests. Results: Findings showed that most of the nurses had high level of empathy to the patients (38.8%. There was also statistically significant relationship between nurses’ empathy and needs of patients’ families (p < 0.001. Conclusion: In this study we found that by increasing the nurse’s empathy skills, we would be able to improve providing family needs. Through empathic communication, nurses can encourage family members to participate in planning for the care of their patients. However, further studies are necessary to confirm the results.

  14. The Extensometer. Potential applications in anaesthesia and intensive care.

    Science.gov (United States)

    Brimacombe, J R; MacFie, A G; McCrirrick, A

    1991-09-01

    The Extensometer is a new device capable of continuous accurate measurement of length over convex surfaces with a rapid response rate. This makes it a powerful research tool and a useful clinical instrument, particularly in the field of respiratory monitoring. This paper describes the principles behind the device. The linearity of its response was demonstrated in laboratory tests and its ability to quantify abdominal and chest wall movement was assessed in anaesthetised patients. Potential applications in the field of ventilatory pattern analysis and respiratory monitoring in anaesthesia and intensive care are discussed. PMID:1928678

  15. Pneumothorax in intensive-care patients: Ranking of tangential views

    International Nuclear Information System (INIS)

    In 55 intensive-care patients an additional tangential view of the chest was taken to demonstrate or exclude a pneumothorax in patients with sudden deterioration of gas exchange and negative ap-chest x-ray, if there was a suspicion of pneumothorax or a confirmed small pneumothorax in the ap-view. In 14 of 42 cases (33.3%) with negative or suspected ap-chest x-ray the tangential view revealed a pneumothorax. 6 of these 14 pneumothoraces were under tension. In 7 out of 11 patients (63.6%) with small pneumothorax, the tangential view showed additionally a tensionpneumothorax. (orig.)

  16. X-ray diagnosis of pneumothorax in intensive care units

    International Nuclear Information System (INIS)

    Pneumothorax is the most severe manifestation of pulmonary barotrauma which occurs in mechanical ventilation. Diagnosis of pneumothorax in intensive care radiology is of particular difficulty. Chest radiographs in supine position show a variety of signs which may be helpful but are not conclusive. There are different techniques for verification of ventrally located pneumothorax. 450 tangential radiographs of the hemithorax in question are most conclusive for demonstration of extrapulmonary air located inside the pleural cavity. This 450 technique is easy to carry out without changing the patients position. (orig.)

  17. Non-invasive respiratory monitoring in paediatric intensive care unit.

    Directory of Open Access Journals (Sweden)

    Nadkarni U

    2000-04-01

    Full Text Available Monitoring respiratory function is important in a Paediatrics Intensive Care Unit (PICU, as majority of patients have cardio-respiratory problems. Non-invasive monitoring is convenient, accurate, and has minimal complications. Along with clinical monitoring, oxygen saturation using pulse oximetry, transcutaneous oxygenation (PtcO2 and transcutaneous PCO2 (PtcCO2 using transcutaneous monitors and end-tidal CO2 using capnography are important and routine measurements done in most PICUs. Considering the financial and maintenance constraints pulse oximetry with end tidal CO2 monitoring can be considered as most feasible.

  18. Intraocular infections in the neonatal intensive care unit

    OpenAIRE

    Sisk RA; Berrocal AM; Aziz HA; Flynn HW Jr; Murray TG; Dubovy SR; Hess D; Johnson RA; Hartley K; Diaz-Barbosa M

    2012-01-01

    Hassan A Aziz1, Audina M Berrocal1,2, Robert A Sisk1, Kristin Hartley1, Magaly Diaz-Barbosa2, Rose A Johnson2, Ditte Hess1, Sander R Dubovy1, Timothy G Murray1, Harry W Flynn Jr11Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 2Jackson Memorial Hospital, Miami, FL, USABackground: The purpose of this study was to report on the incidence and treatment outcomes of endogenous endophthalmitis among newborns in the neonatal intensive care uni...

  19. Stress ulcer prophylaxis in the intensive care unit

    DEFF Research Database (Denmark)

    Krag, M; Perner, A; Wetterslev, J;

    2015-01-01

    BACKGROUND: Stress ulcer prophylaxis (SUP) may decrease the incidence of gastrointestinal bleeding in patients in the intensive care unit (ICU), but the risk of infection may be increased. In this study, we aimed to describe SUP practices in adult ICUs. We hypothesised that patient selection...... adverse effects. Fisher's exact test was used to assess differences between groups. RESULTS: Ninety-seven adult ICUs in 11 countries participated (eight European). All but one ICU used SUP, and 64% (62/97) reported having a guideline for the use of SUP. Proton pump inhibitors were the most common SUP...

  20. Radiation control in the intensive care unit for high intensity iridium-192 brain implants

    International Nuclear Information System (INIS)

    A bedside lead cubicle was designed to minimize the radiation exposure of intensive care unit staff during routine interstitial brain irradiation by removable, high intensity iridium-192. The cubicle shields the patient without restricting intensive care routines. The design specifications were confirmed by exposure measurements around the shield with an implanted anthropomorphic phantom simulating the patient situation. The cubicle reduces the exposure rate around an implant patient by as much as 90%, with the exposure level not exceeding 0.1 mR/hour/mg of radium-equivalent 192Ir. Evaluation of data accumulated for the past 3 years has shown that the exposure levels of individual attending nurses are 0.12 to 0.36 mR/mg of radium-equivalent 192Ir per 12-hour shift. The corresponding range for entire nursing teams varies between 0.18 and 0.26. A radiation control index (exposure per mg of radium-equivalent 192Ir per nurse-hour) is thus defined for individual nurses and nursing teams; this index is a significant guide to the planning of nurse rotations for brain implant patients with various 192Ir loads. The bedside shield reduces exposure from 192Ir implants by a factor of about 20, as expected, and the exposure from the lower energy radioisotope iodine-125 is barely detectable

  1. Supporting the scholar role in intensive care nursing.

    Science.gov (United States)

    Melles, M; Freudenthal, A; de Ridder, H

    2012-01-01

    This study investigates how future informatics applications can support and challenge intensive care nurses (ICU nurses) to grow and learn continuously. To this end a research-and-design tool is introduced which is based on a model of the nursing process that starts from the idea that a nurse fulfills three different roles: the role of practitioner (using information immediately to base actions upon), the role of scholar (using information later on to learn from) and the role of human (coping with stress and dealing with emotions). In this paper the focus is on the scholar role. Twenty-eight intensive care staff members from six different hospitals were asked to recount an imposing experience from the perspective of each role. Regarding the scholar role, the participants mentioned 77 learning strategies they adopt for individual as well as organizational learning. Individual learning concerned reflection on former patient cases, reflection on current patient cases to anticipate a change in the patient's condition and reflection on personal behavior and decisions. Organizational learning concerned reflection on former patient cases. Examples of specific strategies were formal team evaluations focused on procedure and understanding the perspective of team members, being present at autopsies, and giving feedback on the nursing skills of colleagues. Based on these strategies design implications are defined for future nursing informatics applications, which will be presented. PMID:22317164

  2. Cognitive Workload of Computerized Nursing Process in Intensive Care Units.

    Science.gov (United States)

    Dal Sasso, Grace Marcon; Barra, Daniela Couto Carvalho

    2015-08-01

    The aim of this work was to measure the cognitive workload to complete printed nursing process versus computerized nursing process from International Classification Practice of Nursing in intensive care units. It is a quantitative, before-and-after quasi-experimental design, with a sample of 30 participants. Workload was assessed using National Aeronautics and Space Administration Task-Load Index. Six cognitive categories were measured. The "temporal demand" was the largest contributor to the cognitive workload, and the role of the nursing process in the "performance" category has excelled that of computerized nursing process. It was concluded that computerized nursing process contributes to lower cognitive workload of nurses for being a support system for decision making based on the International Classification Practice of Nursing. The computerized nursing process as a logical structure of the data, information, diagnoses, interventions and results become a reliable option for health improvement of healthcare, because it can enhance nurse safe decision making, with the intent to reduce damage and adverse events to patients in intensive care. PMID:26061562

  3. Clinical Predictors of Intensive Care Unit Admission for Asthmatic Children

    Directory of Open Access Journals (Sweden)

    Mohammad Hasan Kargar Maher

    2015-07-01

    Full Text Available IntroductionChildren with severe asthma attack are a challenging group of patients who could be difficult to treat and leading to significant morbidity and mortality. Asthma attack severity is qualitatively estimated as mild, moderate and severe attacks and respiratory failure based on conditions such as respiration status, feeling of dyspnea, and the degree of unconsciousness. part of which are subjective rather than objective. We investigated clinical findings as predictors of severe attack and probable requirement for Pediatric Intensive Care Unit (PICU admission.Materials and MethodsIn a cross sectional and analytical study 120 patients with asthma attack were enrolled from April 2010 to April 2014 (80 admitted in the ward and 40 in pediatric intensive care unit. Predictors of PICU admission were investigated regarding to initial heart rate(HR, respiratory rate (RR, Arterial Oxygen Saturation(SaO2 and PaCo2 and clinically evident cyanosis.ResultsInitial heart rate(p-value=0.02, respiratory rate (p-value=0.03, Arterial Oxygen Saturation(p-value=0.02 and PaCo2(p-value=0.03 and clinically evident cyanosis were significantly different in two groups(Ward admitted and PICU admittedConclusion There was a significant correlation between initial vital sign and blood gas analysis suggesting usefulness of these factors as predictors of severe asthma attack and subsequent clinical course.

  4. Iatrogenia em Medicina Intensiva Iatrogenic in Intensive Care Medicine

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    Rafael Canineu

    2006-03-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Define-se iatrogenia ou afecções iatrogênicas como decorrentes da intervenção médica, correta ou não e justificada ou não, da qual resultam conseqüências prejudiciais ao paciente. Os cuidados em Medicina Intensiva apresentam desafios substanciais com relação à segurança do paciente. O objetivo deste artigo foi apresentar uma breve revisão da literatura sobre a iatrogenia em seus conceitos e termos básicos e suas taxas de prevalência em Medicina Intensiva. CONTEÚDO: A Medicina Intensiva fornece subsídios que melhoram a morbidade e a mortalidade, mas que também se associam a riscos significativos de eventos adversos e erros graves; as iatrogenias podem ser diminuídos com monitoração adequada ou podem ser rotuladas como agravante esperado, idiopatia e se perpetuarem no anonimato CONCLUSÕES: É fundamental reconhecer a necessidade do constante aprendizado, reciclagem e consciência da susceptibilidade ao erro; neste contexto, o respeito pelo ser humano deve nortear a conduta profissional.BACKGROUND AND OBJECTIVES: Iatrogenic conditions was due of the medical, correctly intervention or not, justified or not, which harmful consequences to the patient. The cares in Intensive Care Medicine present substantial challenges with relation to the security of the patient. The objective of this article is to make one brief revision of literature on the iatrogenic in its concepts and basic terms and its taxes prevalence in Intensive Care Medicine. CONTENTS: Intensive Care Medicine supplies subsidies that improve the morbidity and mortality, but that also the significant risks of adverse events and serious errors associate. The Iatrogenic can be minimized with the adequate monitorization or can be friction as waited aggravation, idiopathic and if to perpetuate in the anonymity. CONCLUSIONS: It is basic to recognize the necessity of the constant learning and recycling and conscience of the susceptibilities to the

  5. The Eldicus prospective, observational study of triage decision making in European intensive care units: Part I-European Intensive Care Admission Triage Scores (EICATS)

    DEFF Research Database (Denmark)

    Sprung, Charles L; Baras, Mario; Iapichino, Gaetano;

    2012-01-01

    OBJECTIVE:: Life and death triage decisions are made daily by intensive care unit physicians. Scoring systems have been developed for prognosticating intensive care unit mortality but none for intensive care unit triage. The objective of this study was to develop an intensive care unit triage...... decision rule based on 28-day mortality rates of admitted and refused patients. DESIGN:: Prospective, observational study of triage decisions from September 2003 until March 2005. SETTING:: Eleven intensive care units in seven European countries. PATIENTS:: All patients >18 yrs with a request for intensive...... score. Cutoff values for 99.5% specificity were determined. Of 6796 patients, 5602 were admitted and 1194 rejected. The initial refusal score included age, diagnosis, systolic blood pressure, pulse, respirations, creatinine, bilirubin, PaO2, bicarbonate, albumin, use of vasopressors, Glasgow Coma Scale...

  6. Different Nursing Care Methods for Prevention of Keratopathy Among Intensive Care Unit Patients

    Science.gov (United States)

    Kalhori, Reza Pourmirza; Ehsani, Sohrab; Daneshgar, Farid; Ashtarian, Hossein; Rezaei, Mansour

    2016-01-01

    Background: Patients with reduced consciousness level suffer from eye protection disorder and Keratopathy. This study was conducted to compare effect of three eye care techniques in prevention of keratopathy in the patients hospitalized in intensive care unit of Kermanshah. Methods: This clinical trial was conducted in 2013 with sample size of 96 persons in three random groups. Routine care included washing of eyes with normal saline and three eye care methods were conducted with poly ethylene cover, liposic ointment, and artificial tear drop randomly on one eye of each sample and a comparison was made with the opposite eye as the control. Eyes were controlled for 5 days in terms of keratopathy. Data collection instrument was keratopathy severity index. Data statistical analysis was performed with SPSS-16 software and chi-squared test, Fisher’s exact test, ANOVA and Kruskal–Wallis one-way analysis of variance. Findings: The use of poly ethylene cover (0.59±0.665) was significantly more effective in prevention of keratopathy than other methods (P=0.001). There was no statistically significant difference between two care interventions of liposic ointment and artificial tear drop (P=0.844) but the results indicated the more effective liposic ointment (1.13±0.751) than the artificial tear drop (1.59±0.875) in prevention of corneal abrasion (Phospitalized in intensive care unit.

  7. Difficulties in access and estimates of public beds in intensive care units in the state of Rio de Janeiro

    Science.gov (United States)

    Goldwasser, Rosane Sonia; Lobo, Maria Stella de Castro; de Arruda, Edilson Fernandes; Angelo, Simone Aldrey; Silva, José Roberto Lapa e; de Salles, André Assis; David, Cid Marcos

    2016-01-01

    ABSTRACT OBJECTIVE To estimate the required number of public beds for adults in intensive care units in the state of Rio de Janeiro to meet the existing demand and compare results with recommendations by the Brazilian Ministry of Health. METHODS The study uses a hybrid model combining time series and queuing theory to predict the demand and estimate the number of required beds. Four patient flow scenarios were considered according to bed requests, percentage of abandonments and average length of stay in intensive care unit beds. The results were plotted against Ministry of Health parameters. Data were obtained from the State Regulation Center from 2010 to 2011. RESULTS There were 33,101 medical requests for 268 regulated intensive care unit beds in Rio de Janeiro. With an average length of stay in regulated ICUs of 11.3 days, there would be a need for 595 active beds to ensure system stability and 628 beds to ensure a maximum waiting time of six hours. Deducting current abandonment rates due to clinical improvement (25.8%), these figures fall to 441 and 417. With an average length of stay of 6.5 days, the number of required beds would be 342 and 366, respectively; deducting abandonment rates, 254 and 275. The Brazilian Ministry of Health establishes a parameter of 118 to 353 beds. Although the number of regulated beds is within the recommended range, an increase in beds of 122.0% is required to guarantee system stability and of 134.0% for a maximum waiting time of six hours. CONCLUSIONS Adequate bed estimation must consider reasons for limited timely access and patient flow management in a scenario that associates prioritization of requests with the lowest average length of stay. PMID:27191155

  8. Vitamin D deficiency at pediatric intensive care admission

    Directory of Open Access Journals (Sweden)

    Corsino Rey

    2014-04-01

    Full Text Available OBJECTIVE: to assess whether 25hydroxivitaminD or 25(OHvitD deficiency has a high prevalence at pediatric intensive care unit (PICU admission, and whether it is associated with increased prediction of mortality risk scores. METHOD: prospective observational study comparing 25(OHvitD levels measured in 156 patients during the 12 hours after critical care admission with the 25(OHvitD levels of 289 healthy children. 25(OHvitD levels were also compared between PICU patients with pediatric risk of mortality III (PRISM III or pediatric index of mortality 2 (PIM 2 > p75 [(group A; n = 33 vs. the others (group B; n = 123]. Vitamin D deficiency was defined as < 20 ng/mL levels. RESULTS: median (p25-p75 25(OHvitD level was 26.0 ng/mL (19.2-35.8 in PICU patients vs. 30.5 ng/mL (23.2-38.6 in healthy children (p = 0.007. The prevalence of 25(OHvitD < 20 ng/mL was 29.5% (95% CI: 22.0-37.0 vs. 15.6% (95% CI: 12.2-20.0 (p = 0.01. Pediatric intensive care patients presented an odds ratio (OR for hypovitaminosis D of 2.26 (CI 95%: 1.41-3.61. 25(OHvitD levels were 25.4 ng/mL (CI 95%: 15.5-36.0 in group A vs. 26.6 ng/mL (CI 95%: 19.3-35.5 in group B (p = 0.800. CONCLUSIONS: hypovitaminosis D incidence was high in PICU patients. Hypovitaminosis D was not associated with higher prediction of risk mortality scores.

  9. Models for intensive care training. A European perspective.

    Science.gov (United States)

    Bion, Julian; Rothen, Hans U

    2014-02-01

    The diversity of European culture is reflected in its healthcare training programs. In intensive care medicine (ICM), the differences in national training programs were so marked that it was unlikely that they could produce specialists of equivalent skills. The Competency-Based Training in Intensive Care Medicine in Europe (CoBaTrICE) program was established in 2003 as a Europe-based worldwide collaboration of national training organizations to create core competencies for ICM using consensus methodologies to establish common ground. The group's professional and research ethos created a social identity that facilitated change. The program was easily adaptable to different training structures and incorporated the voice of patients and relatives. The CoBaTrICE program has now been adopted by 15 European countries, with another 12 countries planning to adopt the training program, and is currently available in nine languages, including English. ICM is now recognized as a primary specialty in Spain, Switzerland, and the UK. There are still wide variations in structures and processes of training in ICM across Europe, although there has been agreement on a set of common program standards. The combination of a common "product specification" for an intensivist, combined with persisting variation in the educational context in which competencies are delivered, provides a rich source of research inquiry. Pedagogic research in ICM could usefully focus on the interplay between educational interventions, healthcare systems and delivery, and patient outcomes, such as including whether competency-based program are associated with lower error rates, whether communication skills training is associated with greater patient and family satisfaction, how multisource feedback might best be used to improve reflective learning and teamworking, or whether increasing the proportion of specialists trained in acute care in the hospital at weekends results in better patient outcomes. PMID

  10. Nurses' experiences of futile care at intensive care units: a phenomenological study.

    Science.gov (United States)

    Yekefallah, Leili; Ashktorab, Tahereh; Manoochehri, Houman; Hamid, Alavi Majd

    2015-01-01

    The concept and meaning of futile care depends on the existing culture, values, religion, beliefs, medical achievements and emotional status of a country. We aimed to define the concept of futile care in the viewpoints of nurses working in intensive care units (ICUs). In this phenomenological study, the experiences of 25 nurses were explored in 11 teaching hospitals affiliated to Social Security Organization in Ghazvin province in the northwest of Iran. Personal interviews and observations were used for data collection. All interviews were recorded as well as transcribed and codes, subthemes and themes were extracted using Van Manen's analysis method. Initially, 191 codes were extracted. During data analysis and comparison, the codes were reduced to 178. Ultimately, 9 sub-themes and four themes emerged: uselessness, waste of resources, torment, and aspects of futility.Nurses defined futile care as "useless, ineffective care giving with wastage of resources and torment of both patients and nurses having nursing and medical aspects" As nurses play a key role in managing futile care, being aware of their experiences in this regard could be the initial operational step for providing useful care as well as educational programs in ICUs. Moreover, the results of this study could help nursing managers adopt supportive approaches to reduce the amount of futile care which could in turn resolve some of the complications nurses face at these wards such as burnout, ethical conflicts, and leave. PMID:25946928

  11. The bulldozer and the ballet dancer: aspects of nurses' caring approaches in acute psychiatric intensive care.

    Science.gov (United States)

    Björkdahl, A; Palmstierna, T; Hansebo, G

    2010-08-01

    Demanding conditions in acute psychiatric wards inhibit provision of safe, therapeutic care and leave nurses torn between humanistic ideals and the harsh reality of their daily work. The aim of this study was to describe nurses' caring approaches within this context. Data were collected from interviews with nurses working in acute psychiatric intensive care. Data were analysed using qualitative analysis, based on interpretive description. Results revealed a caring-approach continuum on which two approaches formed the main themes: the bulldozer and the ballet dancer. The bulldozer approach functioned as a shield of power that protected the ward from chaos. The ballet dancer approach functioned as a means of initiating relationships with patients. When examining the data from a theoretical perspective of caring and uncaring encounters in nursing, the ballet dancer approach was consistent with a caring approach, while the bulldozer approach was more complex and somewhat aligned with uncaring approaches. Conclusions drawn from the study are that although the bulldozer approach involves a risk for uncaring and harming actions, it also brings a potential for caring. This potential needs to be further explored and nurses should be encouraged to reflect on how they integrate paternalistic nursing styles with person-centred care. PMID:20633078

  12. Central nervous system infections in the intensive care unit

    Directory of Open Access Journals (Sweden)

    B. Vengamma

    2014-04-01

    Full Text Available Neurological infections constitute an uncommon, but important aetiological cause requiring admission to an intensive care unit (ICU. In addition, health-care associated neurological infections may develop in critically ill patients admitted to an ICU for other indications. Central nervous system infections can develop as complications in ICU patients including post-operative neurosurgical patients. While bacterial infections are the most common cause, mycobacterial and fungal infections are also frequently encountered. Delay in institution of specific treatment is considered to be the single most important poor prognostic factor. Empirical antibiotic therapy must be initiated while awaiting specific culture and sensitivity results. Choice of empirical antimicrobial therapy should take into consideration the most likely pathogens involved, locally prevalent drug-resistance patterns, underlying predisposing, co-morbid conditions, and other factors, such as age, immune status. Further, the antibiotic should adequately penetrate the blood-brain and blood- cerebrospinal fluid barriers. The presence of a focal collection of pus warrants immediate surgical drainage. Following strict aseptic precautions during surgery, hand-hygiene and care of catheters, devices constitute important preventive measures. A high index of clinical suspicion and aggressive efforts at identification of aetiological cause and early institution of specific treatment in patients with neurological infections can be life saving.

  13. [Treatment in the Intensive Care Unit: continue or withdraw?].

    Science.gov (United States)

    Savelkoul, Claudia; de Graeff, Nienke; Kompanje, Erwin J O; Tjan, Dave H T

    2016-01-01

    End-of-life decision-making in the Intensive Care Unit is a common and complex process. The step-by-step process of decision-making leading to withdrawal of life-sustaining treatment is illustrated in this paper by a clinical case. A variety of factors influences the decision to adjust the initial curative treatment policy towards withdrawal of life-sustaining therapy and the pursuit of comfort care. For a smooth decision-making process, it is necessary to make a prognosis and obtain consensus amongst the healthcare team. Withdrawal of life-sustaining treatment is ultimately a medical decision and a consensual decision should be reached by all medical staff and nurses, and preferably also by the patient and family. Timely involvement of a legal representative of the patient is essential for an uncomplicated decision-making process. Advance care planning and advance directives provide opportunities for patients to express their preferences beforehand. It is important to realise that end-of-life decisions are significantly influenced by personal and cultural values. PMID:27050494

  14. Let Them In: Family Presence during Intensive Care Unit Procedures.

    Science.gov (United States)

    Beesley, Sarah J; Hopkins, Ramona O; Francis, Leslie; Chapman, Diane; Johnson, Joclynn; Johnson, Nathanael; Brown, Samuel M

    2016-07-01

    Families have for decades advocated for full access to intensive care units (ICUs) and meaningful partnership with clinicians, resulting in gradual improvements in family access and collaboration with ICU clinicians. Despite such advances, family members in adult ICUs are still commonly asked to leave the patient's room during invasive bedside procedures, regardless of whether the patient would prefer family to be present. Physicians may be resistant to having family members at the bedside due to concerns about trainee education, medicolegal implications, possible effects on the technical quality of procedures due to distractions, and procedural sterility. Limited evidence from parallel settings does not support these concerns. Family presence during ICU procedures, when the patient and family member both desire it, fulfills the mandates of patient-centered care. We anticipate that such inclusion will increase family engagement, improve patient and family satisfaction, and may, on the basis of studies of open visitation, pediatric ICU experience, and family presence during cardiopulmonary resuscitation, decrease psychological distress in patients and family members. We believe these goals can be achieved without compromising the quality of patient care, increasing provider burden significantly, or increasing risks of litigation. In this article, we weigh current evidence, consider historical objections to family presence at ICU procedures, and report our clinical experience with the practice. An outline for implementing family procedural presence in the ICU is also presented. PMID:27104301

  15. Perfil dos pacientes com lúpus eritematoso sistêmico, internados na unidade de terapia intensiva de um hospital universitário de Fortaleza Characteristics of patients with systemic lupus erythematosus admitted to the intensive care unit in a brazilian teaching hospital

    Directory of Open Access Journals (Sweden)

    Denison de Oliveira Couto

    2008-09-01

    metabólico faleceram significativamente mais. CONCLUSÃO: A despeito da gravidade à admissão na unidade de terapia intensiva, inferida pelo APACHE II e as disfunções agudas, a evolução dos pacientes analisados sugere susceptibilidade às medidas terapêuticas.OBJECTIVES: Due to the high incidence in our service, we did object on this study describe the features and outcome of patients with systemic lupus erythematosus (SLE admitted to the intensive care unit of Walter Cantídio University Hospital METHODS: Patients were restrospectively characterized according to demography parameters, time of diagnosis of SLE, organ dysfunction and laboratorial parameters at admission, supportive therapies during their stay, length of stay in the hospital before admission, length of stay in the unit, readmission to the unit and outcome. We also evaluated Systemic Lupus Erythematosus Disease Activity (SLEDAI score, Acute Physiology and Chronic Health Evaluation II (APACHE II score, expected mortality and standardized mortality ratio. RESULTS: From November 2003 to October 2006, 1,052 patients were admitted to the intensive care unit. Fifty patients had SLE and were included in this retrospective study. Of the 50 patients with SLE admitted to the ICU, 88.2% were female. The mean age was 30.3 ± 12.8 years. The median time of diagnosis of SLE was 67 months. The most common organ dysfunctions were renal (70.6%, cardiovascular (61.8%, respiratory (55.9% and neurological (55.9%. The main reasons for admission to the ICU were respiratory (38.2%, cardiologic (29.4% and neurological (29.4% dysfunctions. Among the intensive care therapies, 44.1% of the patients needed blood products, 41.2% vasopressor agents and 35.3% mechanical ventilation, 23.5% dialysis. The mean SLEDAI score was 15.0 ± 12.2. The mean APACHE II score was 19.3 ± 6.8, with a predicted mortality rate of 37.6%. The actual mortality rate in ICU was 29.4%, with 8.8% before 48 hours. The standardized mortality ratio was 0

  16. Ambivalent implications of health care information systems: a study in the Brazilian public health care system

    Directory of Open Access Journals (Sweden)

    João Porto de Albuquerque

    2011-01-01

    Full Text Available This article evaluates social implications of the "SIGA" Health Care Information System (HIS in a public health care organization in the city of São Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors.

  17. [The integrality of care and communicative actions in the cross-discipline practice in intensive care].

    Science.gov (United States)

    Pirolo, Sueli Moreira; Ferraz, Clarice Aparecida; Gomes, Romeu

    2011-12-01

    Cross-disciplinary work in health is an important element to deliver comprehensive health care actions. The present study analyzed cross-disciplinary actions in intensive care according to Habermas. This case study was performed using a qualitative approach. The empiric material capture was collected by observing the setting and using semi-structured interviews with health workers. The information was analyzed using the meaning interpretation technique. The analysis revealed two thematic lines: individual instrumental care in view of the clinical inconstancy, and the collective care fragmented by functions. This result weakens the worker/worker and the worker/patient interactions and compromises the association between health actions. As it does not favor communicative actions, it becomes fragile and the strategic/instrumental action is evinced. PMID:22241198

  18. The importance of parents in the neonatal intensive care units

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    Hercília Guimarães

    2015-10-01

    Full Text Available The premature birth and the hospitalization in a neonatal intensive care unit (NICU are potential risk factors for the development and behavior of the newborn, as has been shown in recent studies. Premature birth of an infant is a distressing event for the family. Several feelings are experienced by parents during hospitalization of their baby in the NICU. Feelings of guilt, rejection, stress and anxiety are common. Also the attachment processes have the potential to be disrupted or delayed as a result of the initial separation of the premature newborn and the mother after the admission to the NICU. Added to these difficulties, there is the distortion of infant’s “ideal image”, created by the family, in contrast with the real image of the preterm. This relationship-based family-centered approach, the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP, promotes the idea that infants and their families are collaborators in developing an individualized program to maximize physical, mental, and emotional growth and health and to improve long-term outcomes for the high risk newborns. The presence of parents in NICUs and their involvement caring their babies, in a family centered care philosophy, is vital to improve the outcome of their infants and the relationships within each family. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy, Michele Mussap (Genoa, Italy, Antonio Del Vecchio (Bari, Italy, Bo Sun (Shanghai, China, Dorret I. Boomsma (Amsterdam, the Netherlands, Gavino Faa (Cagliari, Italy, Antonio Giordano (Philadelphia, USA

  19. Confronting youth gangs in the intensive care unit.

    Science.gov (United States)

    Akiyama, Cliff

    2015-01-01

    Youth gang violence has continued its upward trend nationwide. It was once thought that gangs convened only in selected areas, which left churches, schools, and hospitals as "neutral" territory. Unfortunately, this is a fallacy. The results of gang violence pour into hospitals and into intensive care units regularly. The media portrays California as having a gang violence problem; however, throughout the United States, gang violence has risen more than 35% in the past year. Youth gang violence continues to rise dramatically with more and more of our youth deciding to join gangs each day. Sadly, every state has gangs, and the problem is getting much worse in areas that would never have thought about gangs a year ago. These "new generation" of gang members is younger, much more violent, and staying in the gang longer. Gangs are not just an urban problem. Gang activity is a suburban and rural problem too. There are more than 25 500 gangs in the United States, with a total gang membership of 850 000. Ninety-four percent of gang members are male and 6% are female. The ethnic composition nationwide includes 47% Latino, 31% African American, 13% White, 7% Asian, and 2% "mixed," according to the Office of Juvenile Justice and Delinquency Prevention of the U.S. Department of Justice. As a result of the ongoing proliferation of youth street gangs in our communities, it is imperative that critical care nurses and others involved with the direct care become educated about how to identify gang members, their activities, and understand their motivations. Such education and knowledge will help provide solutions to families and the youth themselves, help eradicate the problem of gang violence, and keep health care professionals safe. PMID:25463004

  20. The influence of care interventions on the continuity of sleep of intensive care unit patients

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    Fernanda Luiza Hamze

    2015-10-01

    Full Text Available Objective: to identify care interventions, performed by the health team, and their influence on the continuity of sleep of patients hospitalized in the Intensive Care Unit.Method: descriptive study with a sample of 12 patients. A filming technique was used for the data collection. The awakenings from sleep were measured using the actigraphy method. The analysis of the data was descriptive, processed using the Statistical Package for the Social Sciences software.Results: 529 care interventions were identified, grouped into 28 different types, of which 12 (42.8% caused awakening from sleep for the patients. A mean of 44.1 interventions/patient/day was observed, with 1.8 interventions/patient/hour. The administration of oral medicine and food were the interventions that caused higher frequencies of awakenings in the patients.Conclusion: it was identified that the health care interventions can harm the sleep of ICU patients. It is recommended that health professionals rethink the planning of interventions according to the individual demand of the patients, with the diversification of schedules and introduction of new practices to improve the quality of sleep of Intensive Care Unit patients.

  1. Terminalidade e cuidados paliativos na unidade de terapia intensiva End of life and palliative care in intensive care unit

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    Rachel Duarte Moritz

    2008-12-01

    pacientes são submetidos a grande estresse e tensão sendo desejável que lhes sejam disponíveis programas de educação continuados sobre cuidados paliativos.The objective of this review was to evaluate current knowledge regarding terminal illness and palliative care in the intensive care unit, to identify the major challenges involved and propose a research agenda on these issues The Brazilian Critical Care Association organized a specific forum on terminally ill patients, to which were invited experienced and skilled professionals on critical care. These professionals were divided in three groups: communication in the intensive care unit, the decision making process when faced with a terminally ill patient and palliative actions and care in the intensive care unit. Data and bibliographic references were stored in a restricted website. During a twelve hour meeting and following a modified Delphi methodology, the groups prepared the final document. Consensual definition regarding terminality was reached. Good communication was considered the cornerstone to define the best treatment for a terminally ill patient. Accordingly some communication barriers were described that should be avoided as well as some approaches that should be pursued. Criteria for palliative care and palliative action in the intensive care unit were defined. Acceptance of death as a natural event as well as respect for the patient's autonomy and the nonmaleficence principles were stressed. A recommendation was made to withdraw the futile treatment that prolongs the dying process and to elected analgesia and measures that alleviate suffering in terminally ill patients. To deliver palliative care to terminally ill patients and their relatives some principles and guides should be followed, respecting individual necessities and beliefs. The intensive care unit staff involved with the treatment of terminally ill patients is subject to stress and tension. Availability of a continuous education program on

  2. Hypomagnesaemia in paediatric population in an intensive care unit.

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    Deshmukh C

    2000-07-01

    Full Text Available AIMS: To determine incidence and risk factors for hypomagnesaemia in children admitted in Paediatric Intensive Care Unit, (PICU. SUBJECTS AND METHODS: Prospective study was carried out on 80 children admitted in PICU. The patients were clinically assessed for nutritional status, neurological status on Glasgow coma scale, congestive cardiac failure, etc. and relevant biochemical parameters including serum and red cell magnesium levels were done. 25 patients of the same age group admitted in general ward who were not in critical state were included as a control group. RESULTS: 70% of PICU patients had hypomagnesaemia, which was more common in patients on aminoglycosides and diuretics. CONCLUSION: In view of complications of magnesium depletion and benign nature of appropriate magnesium therapy critically ill children should have their magnesium level monitored.

  3. Modes of death in neonatal intensive care units.

    LENUS (Irish Health Repository)

    Finan, E

    2006-04-01

    With the ever-increasing availability of aggressive medical treatment and technical support, neonatologists are offered an increasing ability to prolong life. While "end-of-life" decisions within NICUs have been studied internationally, there is limited data available for Ireland. Through the auspices of the Irish Faculty of Paediatrics 2002 Neonatal Mortality Ouestionnaire, decisions made around the time of death in Irish Neonatal Intensive Care Units were examined. The overall response rate to the questionnaire was 96% (n=25). One hundred and eighty seven deaths were reported for 2002. Information pertaining to the mode of death was available in 53% of cases. Seventy seven percent of those paediatricians who answered this question, reported either withdrawing or withholding treatment in babies thought to have a hopeless outcome, with the greatest proportion of these deaths occurring in premature infants (n=30) and babies with congenital defects (n=40).

  4. Difficult airway management from Emergency Department till Intensive Care Unit

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    Debasis Pradhan

    2015-01-01

    Full Text Available We report a case of "can ventilate but can′t intubate" situation which was successfully managed in the Emergency Department and Intensive Care Unit by the use of ProSeal laryngeal mask airway and Frova Intubating Introducer as bridging rescue devices. Use of appropriate technique while strictly following the difficult airway algorithm is the mainstay of airway management in unanticipated difficult airway situations. Although the multiple airway devices were used but each step took not more than 2 min and "don′t struggle, skip to the next step principle" was followed. With the availability of many advanced airway management tools, the intensivists should have a training and experience along with preparedness in order to perform such lifesaving airway managements.

  5. Heart rate dynamics preceding hemorrhage in the intensive care unit.

    Science.gov (United States)

    Moss, Travis J; Clark, Matthew T; Lake, Douglas E; Moorman, J Randall; Calland, J Forrest

    2015-01-01

    Occult hemorrhage in surgical/trauma intensive care unit (STICU) patients is common and may lead to circulatory collapse. Continuous electrocardiography (ECG) monitoring may allow for early identification and treatment, and could improve outcomes. We studied 4,259 consecutive admissions to the STICU at the University of Virginia Health System. We collected ECG waveform data captured by bedside monitors and calculated linear and non-linear measures of the RR interbeat intervals. We tested the hypothesis that a transfusion requirement of 3 or more PRBC transfusions in a 24 hour period is preceded by dynamical changes in these heart rate measures and performed logistic regression modeling. We identified 308 hemorrhage events. A multivariate model including heart rate, standard deviation of the RR intervals, detrended fluctuation analysis, and local dynamics density had a C-statistic of 0.62. Earlier detection of hemorrhage might improve outcomes by allowing earlier resuscitation in STICU patients. PMID:26342251

  6. Clinical review: Airway hygiene in the intensive care unit

    Science.gov (United States)

    Jelic, Sanja; Cunningham, Jennifer A; Factor, Phillip

    2008-01-01

    Maintenance of airway secretion clearance, or airway hygiene, is important for the preservation of airway patency and the prevention of respiratory tract infection. Impaired airway clearance often prompts admission to the intensive care unit (ICU) and can be a cause and/or contributor to acute respiratory failure. Physical methods to augment airway clearance are often used in the ICU but few are substantiated by clinical data. This review focuses on the impact of oral hygiene, tracheal suctioning, bronchoscopy, mucus-controlling agents, and kinetic therapy on the incidence of hospital-acquired respiratory infections, length of stay in the hospital and the ICU, and mortality in critically ill patients. Available data are distilled into recommendations for the maintenance of airway hygiene in ICU patients. PMID:18423061

  7. Intensive care medicine and organ donation: exploring the last frontiers?

    Science.gov (United States)

    Escudero, D; Otero, J

    2015-01-01

    The main, universal problem for transplantation is organ scarcity. The gap between offer and demand grows wider every year and causes many patients in waiting list to die. In Spain, 90% of transplants are done with organs taken from patients deceased in brain death but this has a limited potential. In order to diminish organ shortage, alternative strategies such as donations from living donors, expanded criteria donors or donation after circulatory death, have been developed. Nevertheless, these types of donors also have their limitations and so are not able to satisfy current organ demand. It is necessary to reduce family denial and to raise donation in brain death thus generalizing, among other strategies, non-therapeutic elective ventilation. As intensive care doctors, cornerstone to the national donation programme, we must consolidate our commitment with society and organ transplantation. We must contribute with the values proper to our specialization and try to reach self-sufficiency by rising organ obtainment. PMID:25841298

  8. Supporting Neonatal Intensive Care Unit Parents Through Social Media.

    Science.gov (United States)

    Dzubaty, Dolores R

    2016-01-01

    Parents of infants in the neonatal intensive care unit may often find themselves seeking healthcare information from online and social media sources. Social media applications are available to healthcare consumers and their families, as well as healthcare providers, in a variety of formats. Information that parents gather on their own, and information that is explained by providers, is then used when parents make healthcare decisions regarding their infants. Parents also seek support from peers and family while making healthcare decisions. The combination of knowledge obtained and social support given may empower the parent to feel more confident in their decision making. Healthcare professionals can guide parents to credible resources. The exchange of information between providers and parents can occur using a variety of communication methods. Misperceptions can be corrected, support given, open sharing of information occurs, and parent empowerment may result. PMID:27465452

  9. Functional systemic approach to the resuscitation and intensive care

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    Sadchikov D.V.

    2014-09-01

    Full Text Available Functional systemic approach to the resuscitation and intensive care may be considered as a direct correlation between analysis and synthesis, induction and deduction, and, in general, between the formal and dialectical categories. The realization of this system should be started with the interaction and formation of the final beneficial result. Therefore the experience assessment on the basis of functional systematic approach will enable us to formulate more precisely the subject and methods of resuscitation from the philosophical point of view taking into consideration the interaction of the human life integrity with death phenomenon as fixed in ontogenesis and will allow to methodically justify the distinguishing of functional systems and standard processes both in sanogenesis and thanatogenesis.

  10. Intensive-care unit lungs - possibilities to improve the quality

    International Nuclear Information System (INIS)

    X-ray lung diagnosis in an intensive-care unit makes special demands on technique, imaging and on the physician's experience. The quality of image interpretation and evaluation is considerably improved by superimposing the technical data on the X-ray image and by using an antiscatter grid cassette. Proper evaluation of the parameters important for diagnosis is improved by registration of the data on the X-ray film; taking a maximum possible score of 100 as reference value, quality of evaluation is improved from 66.5 points to 71.8 points by data registration on the film itself, whereas the simultaneous use of an antiscatter grid cassette improves the score still further, namely, to 84.3 points. The importance of the clinical condition of the patient, and of the type of breathing chosen, for assessing the chest X-ray, is emphasized. (orig.)

  11. Optimal physicians schedule in an Intensive Care Unit

    Science.gov (United States)

    Hidri, L.; Labidi, M.

    2016-05-01

    In this paper, we consider a case study for the problem of physicians scheduling in an Intensive Care Unit (ICU). The objective is to minimize the total overtime under complex constraints. The considered ICU is composed of three buildings and the physicians are divided accordingly into six teams. The workload is assigned to each team under a set of constraints. The studied problem is composed of two simultaneous phases: composing teams and assigning the workload to each one of them. This constitutes an additional major hardness compared to the two phase's process: composing teams and after that assigning the workload. The physicians schedule in this ICU is used to be done manually each month. In this work, the studied physician scheduling problem is formulated as an integer linear program and solved optimally using state of the art software. The preliminary experimental results show that 50% of the overtime can be saved.

  12. Temporal abstraction for the analysis of intensive care information

    Energy Technology Data Exchange (ETDEWEB)

    Hadad, Alejandro J [Artificial Intelligence Group, Fac. de Ingenieria, University Nac. de Entre Rios, FI-UNER (Argentina); Evin, Diego A [Artificial Intelligence Group, Fac. de Ingenieria, University Nac. de Entre Rios, FI-UNER (Argentina); Drozdowicz, Bartolome [Artificial Intelligence Group, Fac.de Ingenieria, University Nac. de Entre Rios, FI-UNER (Argentina); Chiotti, Omar [Instituto de Desarrollo y Diseno, INGAR-CONICET (Argentina)

    2007-11-15

    This paper proposes a scheme for the analysis of time-stamped series data from multiple monitoring devices of intensive care units, using Temporal Abstraction concepts. This scheme is oriented to obtain a description of the patient state evolution in an unsupervised way. The case of study is based on a dataset clinically classified with Pulmonary Edema. For this dataset a trends based Temporal Abstraction mechanism is proposed, by means of a Behaviours Base of time-stamped series and then used in a classification step. Combining this approach with the introduction of expert knowledge, using Fuzzy Logic, and multivariate analysis by means of Self-Organizing Maps, a states characterization model is obtained. This model is feasible of being extended to different patients groups and states. The proposed scheme allows to obtain intermediate states descriptions through which it is passing the patient and that could be used to anticipate alert situations.

  13. Peripartum Cardiomyopathy in Intensive Care Unit: An Update

    Science.gov (United States)

    Dinic, Vesna; Markovic, Danica; Savic, Nenad; Kutlesic, Marija; Jankovic, Radmilo J.

    2015-01-01

    Peripartum cardiomyopathy (PPCM) is a systolic heart failure that occurs during the last month of pregnancy or within 5 months after delivery. It is an uncommon disease of unknown etiopathogenesis and has a very high rate of maternal mortality. Because of similarity between symptoms of PPCM and physiological discomforts during pregnancy, the early diagnosis of PPCM presents a major challenge. Since hemodynamic changes during PPCM can vitally jeopardize the mother and the fetus, patients with severe forms of PPCM require a multidisciplinary approach in intensive care units. This review summarizes the current state of knowledge about the diagnosis, monitoring, and the treatment of PPCM. Having reviewed the recent researches, it gives insight into the new treatment strategies of this rare disease. PMID:26636086

  14. Target value design: applications to newborn intensive care units.

    Science.gov (United States)

    Rybkowski, Zofia K; Shepley, Mardelle McCuskey; Ballard, H Glenn

    2012-01-01

    There is a need for greater understanding of the health impact of various design elements in neonatal intensive care units (NICUs) as well as cost-benefit information to make informed decisions about the long-term value of design decisions. This is particularly evident when design teams are considering the transition from open-bay NICUs to single-family-room (SFR) units. This paper introduces the guiding principles behind target value design (TVD)-a price-led design methodology that is gaining acceptance in healthcare facility design within the Lean construction methodology. The paper also discusses the role that set-based design plays in TVD and its application to NICUs. PMID:23224803

  15. Temporal abstraction for the analysis of intensive care information

    International Nuclear Information System (INIS)

    This paper proposes a scheme for the analysis of time-stamped series data from multiple monitoring devices of intensive care units, using Temporal Abstraction concepts. This scheme is oriented to obtain a description of the patient state evolution in an unsupervised way. The case of study is based on a dataset clinically classified with Pulmonary Edema. For this dataset a trends based Temporal Abstraction mechanism is proposed, by means of a Behaviours Base of time-stamped series and then used in a classification step. Combining this approach with the introduction of expert knowledge, using Fuzzy Logic, and multivariate analysis by means of Self-Organizing Maps, a states characterization model is obtained. This model is feasible of being extended to different patients groups and states. The proposed scheme allows to obtain intermediate states descriptions through which it is passing the patient and that could be used to anticipate alert situations

  16. Radiation Dose to Newborns in Neonatal Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Mohammad Taghi Bahreyni Toossi

    2012-01-01

    Full Text Available Background: With the increase of X-ray use for medical diagnostic purposes, knowing the given doses is necessary in patients for comparison with reference levels. The concept of reference doses or diagnostic reference levels (DRLs has been developed as a practical aid in the optimization of patient protection in diagnostic radiology.Objectives: To assess the radiation doses to neonates from diagnostic radiography (chest and abdomen. This study has been carried out in the neonatal intensive care unit of a province in Iran.Patients and Methods: Entrance surface dose (ESD was measured directly with thermoluminescent dosimeters (TLDs. The population included 195 neonates admitted for a diagnostic radiography, in eight NICUs of different hospital types.Results: The mean ESD for chest and abdomen examinations were 76.3 µGy and 61.5 µGy, respectively. DRLs for neonate in NICUs of the province were 88 µGy for chest and 98 µGy for abdomen examinations that were slightly higher than other studies. Risk of death due to radiation cancer incidence of abdomens examination was equal to 1.88 × 10 -6 for male and 4.43 × 10 -6 for female. For chest X-ray, it was equal to 2.54 × 10 -6 for male and 1.17 × 10 -5 for female patients.Conclusion: DRLs for neonates in our province were slightly higher than values reported by other studies such as European national diagnostic reference levels and the NRPB reference dose. The main reason was related to using a high mAs and a low kVp applied in most departments and also a low focus film distance (FFD. Probably lack of collimation also affected some exams in the NICUs.Keywords:Intensive Care Units,Neonatal,Radiation Dosimetry

  17. Variability of intensive care admission decisions for the very elderly.

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    Ariane Boumendil

    Full Text Available UNLABELLED: Although increasing numbers of very elderly patients are requiring intensive care, few large sample studies have investigated ICU admission of very elderly patients. Data on pre triage by physicians from other specialities is limited. This observational cohort study aims at examining inter-hospital variability of ICU admission rates and its association with patients' outcomes. All patients over 80 years possibly qualifying for ICU admission who presented to the emergency departments (ED of 15 hospitals in the Paris (France area during a one-year period were prospectively included in the study. Main outcome measures were ICU eligibility, as assessed by the ED and ICU physicians; in-hospital mortality; and vital and functional status 6 months after the ED visit. 2646 patients (median age 86; interquartile range 83-91 were included in the study. 94% of participants completed follow-up (n = 2495. 12.4% (n = 329 of participants were deemed eligible for ICU admission by ED physicians and intensivists. The overall in-hospital and 6-month mortality rates were respectively 27.2% (n = 717 and 50.7% (n = 1264. At six months, 57.5% (n = 1433 of patients had died or had a functional deterioration. Rates of patients deemed eligible for ICU admission ranged from 5.6% to 38.8% across the participating centers, and this variability persisted after adjustment for patients' characteristics. Despite this variability, we found no association between level of ICU eligibility and either in-hospital death or six-month death or functional deterioration. In France, the likelihood that a very elderly person will be admitted to an ICU varies widely from one hospital to another. Influence of intensive care admission on patients' outcome remains unclear. TRIAL REGISTRATION: ClinicalTrials.gov NCT00912600.

  18. Prevalence of Depression and Depression Care for Populations Registered in Primary Care in Two Remote Cities in the Brazilian Amazon

    Science.gov (United States)

    2016-01-01

    Background The prevalence of depression has been widely studied in high-income countries and in large cities of low-income countries; however, little is known about the prevalence and treatment gap of depression in remote areas of the Amazonian region in Brazil. Objectives The objectives of this study are to estimate the prevalence of depression in adults registered with the Family Health Strategy in two remote cities in the Brazilian Amazon and to investigate the proportion of individuals with depression that received mental health care. Methods This is a cross-sectional study of an adult population registered with primary care clinics in the cities of Coari and Tefé, State of Amazon, Brazil. Depression was defined as a score of ≥10 on the Patient Health Questionnaire-9. Depression care was evaluated by asking participants with depression if they received antidepressants and/or had been seen by a health professional at a community mental health center in the three months prior to the interview. Poisson regression was used to examine the unadjusted and adjusted associations between depression and exposure variables. Results The overall prevalence of depression was 19.1% (95% CI: 17.2–21.1), with 22.2% (95% CI: 19.3–25.0) among women and 16.0% (95% CI: 13.4–18.5) among men. The prevalence of depression in Coari and Tefé were 18.3% (CI 95% 15.7–21.0) and 19.9% (95% CI:17.2–22.7), respectively. Being a woman, lacking social support, increasing exposure to stressful life events and having a higher number medical comorbidities were consistently associated with depression. Lower educational attainment and income, tobacco use, and risky alcohol use were also associated with depression in the unadjusted analyses. Only 11.5% of those with depression were receiving antidepressants and/or visited the mental health care facility during the three months prior to the interview. Conclusion Approximately one in five adults in our sample had depression. A high

  19. Intensive care performance: how should we monitor performance in the future?

    NARCIS (Netherlands)

    T.K. Timmers (Tim); M.H.J. Verhofstad (Michiel); K.G.M. Moons (Carl); L.P.H. Leenen (Luke)

    2014-01-01

    textabstractAbstract Intensive care faces economic challenges. Therefore evidence proving both effectiveness and efficiency, i.e. cost-effectiveness, of delivered care is needed. Today, the quality of care is an important issue in the health care debate. How do we measure quality of care, and how ac

  20. Bacterial nosocomial pneumonia in Paediatric Intensive Care Unit.

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    Tullu M

    2000-01-01

    Full Text Available AIMS: To determine the incidence, risk factors, mortality and organisms causing nosocomial pneumonia (NP in intubated patients in Paediatric Intensive Care Unit (PICU. MATERIALS & METHODS: All patients with endotracheal (ET tube with or without mechanical ventilation (MV in a PICU of a tertiary care teaching hospital were included in this prospective study. Clinical parameters and investigations were evaluated in patients who developed nosocomial pneumonia (NP. Colonisation of the ET tube tip was studied by culture and the antibiotic susceptibility pattern of the isolates was determined. RESULTS: Sixty-nine patients had an ET tube inserted and fifty-nine of these underwent MV. ET tube tip colonisation was seen in 70 out of 88 ET tubes inserted. The incidence of NP in patients with ET tube was 27.54% (7.96/100 days of ET intubation. NP developed only in patients undergoing MV. The main risk factors for developing NP were - duration of MV and duration of stay in the PICU. Age, sex, immunocompromised status and altered sensorium did not increase the risk of NP. The mortality in cases with NP was 47. 37%. E. coli and Klebsiella were the commonest organisms isolated from the ET tube tip cultures with maximum susceptibility to amikacin and cefotaxime. CONCLUSIONS: NP developed only in patients undergoing MV. Duration of MV and duration of stay in the PICU increased the risk of developing NP.

  1. Ethics of drug research in the pediatric intensive care unit.

    Science.gov (United States)

    Kleiber, Niina; Tromp, Krista; Mooij, Miriam G; van de Vathorst, Suzanne; Tibboel, Dick; de Wildt, Saskia N

    2015-02-01

    Critical illness and treatment modalities change pharmacokinetics and pharmacodynamics of medications used in critically ill children, in addition to age-related changes in drug disposition and effect. Hence, to ensure effective and safe drug therapy, research in this population is urgently needed. However, conducting research in the vulnerable population of the pediatric intensive care unit (PICU) presents with ethical challenges. This article addresses the main ethical issues specific to drug research in these critically ill children and proposes several solutions. The extraordinary environment of the PICU raises specific challenges to the design and conduct of research. The need for proxy consent of parents (or legal guardians) and the stress-inducing physical environment may threaten informed consent. The informed consent process is challenging because emergency research reduces or even eliminates the time to seek consent. Moreover, parental anxiety may impede adequate understanding and generate misconceptions. Alternative forms of consent have been developed taking into account the unpredictable reality of the acute critical care environment. As with any research in children, the burden and risk should be minimized. Recent developments in sample collection and analysis as well as pharmacokinetic analysis should be considered in the design of studies. Despite the difficulties inherent to drug research in critically ill children, methods are available to conduct ethically sound research resulting in relevant and generalizable data. This should motivate the PICU community to commit to drug research to ultimately provide the right drug at the right dose for every individual child. PMID:25354987

  2. Noise Sources and Levels in Intensive Care Units

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    Emine Kol

    2015-12-01

    Full Text Available Objective: Noise has been an important problem for both patients and healthcare workers at hospitals. The study was aimed at determining noise sources and noise levels intensive care units. Material and Method: Noise level measurements were performed in four weeks between March 01, 2012 and April 01, 2012. Noise measurement was performed using a Extech 407780 sound level meter during 24 hours. At the same time, observation was performed to identify the sound sources and the highest noise sources were noted by researcher. The sound level meter was placed on the wall between two patient beds and the nurses’ station. Results: The sources of the highest noises were the conversation voices coming from the nurses’ station (84.1 dB(A and perfusor alarm (83.2 dB(A. Other sources of noise were the alarm sounds from the pulse oximetry (81.1 dB(A, nebulizator (80.1 dB(A, monitor (78.6 dB(A, ringing phones (77.4 dB(A, infusion pump (76 dB(A and ventilator (75 dB(A. Conclusion: Staff conversations, caring activities and monitor alarm management are controlled by health Professionals. Therefore, it is particularly important in informing nurses about noise control.

  3. The use of dexmedetomidine in intensive care sedation

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    Massimo Antonelli

    2013-05-01

    Full Text Available The goals and recommendations for ICU (Intensive Care Unit patients’ sedation and analgesia should be to have adequately sedated patients who are calm and arousal, so that they can guarantee a proper evaluation and an adequate control of pain. This way, it is also possible to perform their neurological evaluation, preserving intellectual faculties and helping them in actively participating to their care. Dexmedetomidine is a selective alpha-2 receptor agonist, member of theraputical cathegory: “other hypnotics and sedatives” (ATC: N05CM18. Dexmedetomidine is recommended for the sedation of adult ICU patients who need a sedation level not deeper than arousal in response to verbal stimulation (corresponding to Richmond Agitation-Sedation Scale 0 to -3. After the EMA approval, some European government authorities have elaborated HTA on dexmedetomidine, based on clinical evidence derived from Prodex and Midex trials. Dexmedetomidine resulted to be as effective as propofol and midazolam in maintaining the target depth of sedation in ICU patients. The mean duration of mechanical ventilation with dexmedetomidine was numerically shorter than with propofol and significantly shorter than with midazolam. The resulting favourable economic profile of dexmedetomidine supported the clinical use in ICU. Dexmedetomidine seems to provide clinical benefits due to the reduction of mechanical ventilation and ventilator weaning duration. Within the present review, an economic analysis of costs associated to the use of dexmedetomidine was therefore performed also in the Italian care setting. Thus, four different analyses were carried out based on the quantification of the total number of days in ICU, the time spent on mechanical ventilation, the weighted average number of days with mechanical ventilation or not and TISS points (Therapeutic Intervention Scoring System. Despite the incremental cost for drug therapy associated with dexmedetomidine, a reduction of

  4. Quality improvement in radiography in a neonatal intensive care unit

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    Loovere, L.; Boyle, E.M. [Dept. of Pediatrics, McMaster Univ., Hamilton, Ontario (Canada); Blatz, S. [Dept. of Pediactrics, McMaster Children' s Hospital, Hamilton Health Sciences, Hamilton, Ontario (Canada); Bowslaugh, M.; Kereliuk, M. [Dept. of Radiology, Diagnostic Imaging, Hamilton Health Sciences, Hamilton, Ontario (Canada); Paes, B. [Dept. of Pediatrics, McMaster Univ., Hamilton, Ontario (Canada)], E-mail: paes@mcmaster.ca

    2008-10-15

    The primary objective of this study was to ensure that X-rays performed consistently adhere to established technological quality standards and are achieved without compromising patient care while minimizing exposure risks. The secondary objective was to evaluate whether educational sessions targeting areas deemed suboptimal would facilitate improvement. A retrospective, 1-week review of all neonatal X-rays and documentation of clinical information on X-ray requisitions (n = 132) was completed in a tertiary care neonatal intensive care unit (NICU), by a single observer. Standards for X-ray evaluation were defined a priori based on radiographic principles and essential documented medical information for correct interpretation. Targeted areas for improvement were identified and addressed through brief educational sessions and printed pamphlets. The review was repeated after recommendations were implemented. 1 month (n = 93) and 1 year (n = 76) later. Improvements were evident in both the completion of X-ray requisitions and image quality. In particular, there was a statistically significant improvement in requisition legibility (P = 0.019), completeness of the medical history (P < 0.001), reduction in X-ray rotation (P < 0.001), collimation to the specific area of interest (P <0.001), gonadal shielding (P < 0.001), and decrease in monitor leads or artifacts obscuring views (P < 0.001). These improvements were sustained both 1 month and 1 year following the educational sessions. A neonatal X-ray audit is a simple, effective way to evaluate radiographic technique and encourage provision of basic clinical information for diagnostic interpretation by radiologists and neonatologists. As well, structured, collaborative educational sessions between radiology and neonatology staff appear to be a successful and sustainable method to effect overall improvement. (author)

  5. Quality improvement in radiography in a neonatal intensive care unit

    International Nuclear Information System (INIS)

    The primary objective of this study was to ensure that X-rays performed consistently adhere to established technological quality standards and are achieved without compromising patient care while minimizing exposure risks. The secondary objective was to evaluate whether educational sessions targeting areas deemed suboptimal would facilitate improvement. A retrospective, 1-week review of all neonatal X-rays and documentation of clinical information on X-ray requisitions (n = 132) was completed in a tertiary care neonatal intensive care unit (NICU), by a single observer. Standards for X-ray evaluation were defined a priori based on radiographic principles and essential documented medical information for correct interpretation. Targeted areas for improvement were identified and addressed through brief educational sessions and printed pamphlets. The review was repeated after recommendations were implemented. 1 month (n = 93) and 1 year (n = 76) later. Improvements were evident in both the completion of X-ray requisitions and image quality. In particular, there was a statistically significant improvement in requisition legibility (P = 0.019), completeness of the medical history (P < 0.001), reduction in X-ray rotation (P < 0.001), collimation to the specific area of interest (P <0.001), gonadal shielding (P < 0.001), and decrease in monitor leads or artifacts obscuring views (P < 0.001). These improvements were sustained both 1 month and 1 year following the educational sessions. A neonatal X-ray audit is a simple, effective way to evaluate radiographic technique and encourage provision of basic clinical information for diagnostic interpretation by radiologists and neonatologists. As well, structured, collaborative educational sessions between radiology and neonatology staff appear to be a successful and sustainable method to effect overall improvement. (author)

  6. Brazilian public policies for reproductive health: family planning, abortion and prenatal care.

    Science.gov (United States)

    Guilhem, Dirce; Azevedo, Anamaria Ferreira

    2007-08-01

    This study is an ethical reflection on the formulation and application of public policies regarding reproductive health in Brazil. The Integral Assistance Program for Women's Health (PAISM) can be considered advanced for a country in development. Universal access for family planning is foreseen in the Brazilian legislation, but the services do not offer contraceptive methods for the population in a regular and consistent manner. Abortion is restricted by law to two cases: risk to the woman's life and rape. This reality favors the practice of unsafe abortion, which is the third largest cause of maternal death in Brazil. Legal abortion is regulated by the State and the procedure is performed in public health centers. However, there is resistance on the part of professionals to attend these women. Prenatal care is a priority strategy for promoting the quality of life of these women and of future generations. Nonetheless, it is still difficult for these women to access the prenatal care services and to have the required number of consultations. Moreover, managers and health professionals need to be made aware of the importance of implementing the actions indicated by the public policies in the area of sexual and reproductive health, favoring respect for autonomy in a context of personal freedom. PMID:17614992

  7. Sleeping on a problem: the impact of sleep disturbance on intensive care patients - a clinical review

    OpenAIRE

    Delaney, Lori J; van Haren, Frank; Lopez, Violeta

    2015-01-01

    Sleep disturbance is commonly encountered amongst intensive care patients and has significant psychophysiological effects, which protract recovery and increases mortality. Bio-physiological monitoring of intensive care patients reveal alterations in sleep architecture, with reduced sleep quality and continuity. The etiological causes of sleep disturbance are considered to be multifactorial, although environmental stressors namely, noise, light and clinical care interactions have been frequent...

  8. Intraocular infections in the neonatal intensive care unit

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    Sisk RA

    2012-05-01

    Full Text Available Hassan A Aziz1, Audina M Berrocal1,2, Robert A Sisk1, Kristin Hartley1, Magaly Diaz-Barbosa2, Rose A Johnson2, Ditte Hess1, Sander R Dubovy1, Timothy G Murray1, Harry W Flynn Jr11Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 2Jackson Memorial Hospital, Miami, FL, USABackground: The purpose of this study was to report on the incidence and treatment outcomes of endogenous endophthalmitis among newborns in the neonatal intensive care unit (NICU of a single medical center.Methods: This was a noncomparative, retrospective case series of endogenous endophthalmitis among infants at the Jackson Memorial Hospital NICU treated between March 1, 2002 and March 1, 2007.Results: Of 4323 infants admitted to the NICU, seven eyes of six (0.139% infants (two males, four females were diagnosed with endophthalmitis during the study period. Four patients were born prematurely with a mean gestational age of 27.5 weeks and a mean birth weight of 1153 g. Retinopathy of prematurity was reported in two of the six patients. Mean follow-up was 3.5 years. The diagnosis was confirmed by positive cultures or polymerase chain reaction testing at a median age of 34 postnatal days. Positive cultures included Candida albicans (n = 4, Pseudomonas aeruginosa (n = 1, and Herpes simplex type 2 (n = 1. All patients received systemic treatment and five received adjunctive ophthalmic interventions, including intravitreal antibiotics in five eyes of four patients and vitrectomy with pars plana lensectomy in three eyes. One patient underwent primary enucleation and another had delayed evisceration. In the remaining five eyes, there was a normal appearing posterior segment and normal intraocular pressures at last follow-up.Conclusion: Endogenous endophthalmitis is a rare complication in infants in the NICU, but may occur in patients with candidemia, bacteremia, retinopathy of prematurity, and low birth weight. Despite early and

  9. Acinetobacter infections as an emerging threat in intensive care units

    International Nuclear Information System (INIS)

    Nosocomial infections caused by Acinetobacter species (Spp.) is an emerging threat in health care setups especially intensive care units (ICU). The objective of this observational study was to determine the pattern of Acinetobacter infections and its association with length of stay in patients admitted to our medical ICU from January to August 2011. Methods: All patients above 16 years of age with stay of more than 48 hours were checked for any development of new infections not present or incubating at the time of admission. Nosocomial infections were documented in the light of clinical findings and lab results. Data was analysed using statistical software SPSS 15.0. Results: A total of 146 patients had a stay of at least 48 hours; frequency of nosocomial infection was 30.8% out of which 57.8% were Acinetobacter infections. Respiratory system was most commonly involved. Acinetobacter Spp showed high resistance (96.2%) to penicillins, cephalosporins and even extended spectrum antibiotics including carbepenems, quinolones and piperacillin plus tazobactam. Extended drug resistance was seen in 92.3% isolates; while we found high susceptibility to tigecycline (88.5%) and polymyxins (100%). Acinetobacter Spp. infected patients had mean length of stay (LOS) of 12.92 days when compared to patients with other nosocomial infections and no infection with mean LOS of 7.05 days (p=0.05) and 4.86 days (p=0.00) respectively. Conclusions: Acinetobacter Spp infections increase with longer duration of stay in ICU. Emergence of multi-drug and extended-drug resistant Acinetobacter Spp is alarming and overwhelming at this rate for already stretched out health system with its economic and health implications. (author)

  10. Caval filters in intensive care: a retrospective study

    Science.gov (United States)

    Ferraro, F; Di Gennaro, TL; Torino, A; Petruzzi, J; d’Elia, A; Fusco, P; Marfella, R; Lettieri, B

    2014-01-01

    Aim To evaluate the effectiveness of a caval vein filter (CVF) peri-implant monitoring protocol in order to reduce pulmonary embolism (PE) mortality and CVF-related morbidity. Background The reduction in mortality from PE associated with the use of CVF is affected by the risk of increase in morbidity. Therefore, CVF implant is a challenging prophylactic or therapeutic option. Nowadays, we have many different devices whose rational use, by applying a strict peri-implant monitoring protocol, could be safe and effective. Materials and methods We retrospectively studied 62 patients of a general Intensive Care Unit (ICU) scheduled for definitive, temporary, or optional bedside CVF implant. A peri-implant monitoring protocol including a phlebocavography, an echo-Doppler examination, and coagulation tests was adopted. Results In our study, no thromboembolic recurrence was registered. We implanted 48 retrievable and only 20 definitive CVFs. Endothelial adhesion (18%), residual clot (5%), cranial or caudal migration (6%), microbial colonization of the filter in the absence of clinical signs of infection (1%), caval thrombosis (1%), and pneumothorax (1%) were reported. Deep-vein thrombosis (DVT) was reported (8%) as early complication. All patients with DVT had a temporary or optional filter implanted. However, in our cohort, definitive CVFs were reserved only to 32% of patients and they were not associated with DVT as complication. Conclusion CVF significantly reduces iatrogenic PE without affecting mortality. Generally, ICU patients have a transitory thromboembolic risk, and so the temporary CVF has been proved to be a first-line option to our cohort. A careful monitoring may contribute to a satisfactory outcome in order to promote CVF implant as a safe prophylaxis option. PMID:25395837

  11. Impact of clinical pharmacist in an Indian Intensive Care Unit

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    Mohamed Hisham

    2016-01-01

    Full Text Available Background and Objectives: A critically ill patient is treated and reviewed by physicians from different specialties; hence, polypharmacy is a very common. This study was conducted to assess the impact and effectiveness of having a clinical pharmacist in an Indian Intensive Care Unit (ICU. It also evaluates the clinical pharmacist interventions with a focus on optimizing the quality of pharmacotherapy and patient safety. Materials and Methods: The prospective, observational study was carried out in medical and surgical/trauma ICU over a period of 1 year. All detected drug-related problems and interventions were categorized based on the Pharmaceutical Care Network Europe system. Results: During the study period, average monthly census of 1032 patients got treated in the ICUs. A total of 986 pharmaceutical interventions due to drug-related problems were documented, whereof medication errors accounted for 42.6% (n = 420, drug of choice problem 15.4% (n = 152, drug-drug interactions were 15.1% (n = 149, Y-site drug incompatibility was 13.7% (n = 135, drug dosing problems were 4.8% (n = 47, drug duplications reported were 4.6% (n = 45, and adverse drug reactions documented were 3.8% (n = 38. Drug dosing adjustment done by the clinical pharmacist included 140 (11.9% renal dose, 62 (5.2% hepatic dose, 17 (1.4% pediatric dose, and 104 (8.8% insulin dosing modifications. A total of 577 drug and poison information queries were answered by the clinical pharmacist. Conclusion: Clinical pharmacist as a part of multidisciplinary team in our study was associated with a substantially lower rate of adverse drug event caused by medication errors, drug interactions, and drug incompatibilities.

  12. [Intensive care - palliative care. Contradiction or supplement? Considerations on ethical issues and principles in the treatment of dying patients].

    Science.gov (United States)

    Müller-Busch, H C

    2001-12-01

    Over the last five decades the progress in intensive care has extended the limitations of controlling the process of dying and given doctors more influence in determining the time of death. More recently, palliative care has emerged as a new approach in response to the ethical dilemmas of modern medicine, which accepts that dying is a natural process that should not be hastened or delayed through medical interventions. While in Germany in 1999 more than 50 000 people have died in intensive care units, only a small number of 8000 patients have died in palliative care. In comparison to the highly-developed intensive care sector, palliative care is a much neglected area. The public debate following the legalisation of euthanasia in the Netherlands has highlighted concerns in Germany that intensive care has the potential of inappropriately prolonging life and raised expectations about the alternative therapies offered by palliative care. Doctors in intensive care and in palliative care face similar ethical dilemmas, though with a different weighting: the dilemma between professional judgement and patient autonomy, between traditional medical roles and patient self-determination and the dilemma of extending the span of life at the expense of quality of life. The approach of palliative care with its strong focus on alleviating the suffering of the terminally ill, has influenced the ethical debate of dying in intensive care. Although intensive care and palliative care have different aims and priorities, there are common problems of decision-making which could benefit from a shared orientation and interdisciplinary debate. Both the interpretation of a dying parent's will as well as withdrawing or withholding treatment in patients who are unable to decide for themselves should not merely be guided by the debate on active and passive euthanasia, but rather take into account the appropriateness or inappropriateness of medical actions in the specific situation. PMID:11743668

  13. Point-of-care screening for syphilis and HIV in the borderlands: challenges in implementation in the Brazilian Amazon.

    OpenAIRE

    Ruffinen, CZ; Sabidó, M; Díaz-Bermúdez, XP; Lacerda, M.; Mabey, D; Peeling, RW; Benzaken, AS

    2015-01-01

    Background Point-of-care (POC) screening for HIV and syphilis using rapid testing was implemented in indigenous communities in the triple-border area of the Brazilian Amazon. We describe the context of the early introduction of POC screening, explore hindering and enabling factors for POC implementation, and recommend strategies for feasible, viable, and sustainable syphilis and HIV screening interventions. Methods This was a qualitative study based on grounded theory methodology. Data were c...

  14. The Mental Health Care Gap among Children and Adolescents: Data from an Epidemiological Survey from Four Brazilian Regions

    OpenAIRE

    Cristiane S Paula; Isabel A. S. Bordin; Jair de Jesus Mari; Luciane Velasque; Rohde, Luis A.; Evandro S F Coutinho

    2014-01-01

    INTRODUCTION: Worldwide, a minority of disordered children/adolescents receives mental health assistance. In order to improve service access, it is important to investigate factors that influence the process leading to receiving care. Data on frequency and barriers for mental health service use (MHSU) among Brazilian children/adolescents are extremely scarce and are needed to guide public policy. OBJECTIVES: To establish the frequency of MHSU among 6-to-16-year-old with psychiatric disorders ...

  15. Team leadership in the intensive care unit: the perspective of specialists

    OpenAIRE

    Reader, Tom W; Flin, Rhona; Cuthbertson, Brian H

    2011-01-01

    Objectives: To identify the behaviors senior physicians (e.g., specialists, staff attendings) report using to lead multidisciplinary teams in the intensive care unit. Design: Semistructured interviews focusing on team leadership, crisis management, and development of an environment that enable effective team performance in the intensive care unit. Setting: Seven general intensive care units based in National Health Service hospitals in the United Kingdom. Participants: Twenty-five...

  16. [Thrombosis prophylaxis with heparins in intensive care patients].

    Science.gov (United States)

    Greinacher, A; Janssen, D

    2005-03-01

    Venous thromboembolism is a common complication in critically ill patients, resulting in high morbidity and mortality. Most patients treated in intensive care units (ICU) face a high risk of thromboembolic complications. There is a need for well-defined strategies for prevention of thrombosis in ICU patients. Mechanical methods such as compression stockings are frequently used, even though evidence for these measures in ICU patients is limited. Unfractionated heparin (UFH) is still the leading drug for thromboprophylaxis in ICU patients, but pharmacokinetic disadvantages such as low predictability of effect on anticoagulation are relevant, especially in ICU patients. Additionally, there is no sufficient evidence from clinical trials to support subcutaneous or intravenous prophylaxis with UFH. At least equivalent efficacy and safety of subcutaneous low molecular weight heparin (LMWH) compared with subcutaneous UFH have been shown in numerous studies investigating non-ICU high-risk groups. First studies on the use of LMWH in critically ill patients are promising. Some conclusions for safe use of subcutaneous LMWH in ICU patients can be drawn. Intravenous LMWH may be the optimal prophylaxis in most ICU patients, but there is a lack of sufficient data on dosing. Precautions such as monitoring of anticoagulation in patients with renal insufficiency are fundamental if LMWH is given. Further investigations into prevention of venous thromboembolism in ICU patients are urgently needed. PMID:15770559

  17. Major themes for 2012 in cardiovascular anesthesia and intensive care.

    Science.gov (United States)

    Riha, H; Patel, P; Al-Ghofaily, L; Valentine, E; Sophocles, A; Augoustides, J G T

    2013-01-01

    There was major progress through 2012 in cardiovascular anesthesia and intensive care. Although recent meta-analysis has supported prophylactic steroid therapy in adult cardiac surgery, a large Dutch multicenter trial found no outcome advantage with dexamethasone. A second large randomized trial is currently testing the outcome effects of methyprednisolone in this setting. Due to calibration drift, the logistic EuroSCORE has recently been recalibrated. Despite this model revision, EuroSCORE II still overestimates mortality after transcatheter aortic valve implantation. It is likely that a specific perioperative risk model will be developed for this unique patient population. Recent global consensus has prioritized 12 non-surgical interventions that merit further study for reducing mortality after surgery. There is currently a paradigm shift in the conduct of adult aortic arch repair. Recent advances have facilitated aortic arch reconstruction with routine antegrade cerebral perfusion at mild-to-moderate hypothermia. Further integration of hybrid endovascular techniques may allow future aortic arch repair without hypothermia or circulatory arrest. These advances will likely further improve patient outcomes. PMID:23734284

  18. Anemia in Intensive Cardiac Care Unit patients - An underestimated problem.

    Science.gov (United States)

    Uscinska, Ewa; Idzkowska, Ewelina; Sobkowicz, Bozena; Musial, Wlodzimierz J; Tycinska, Agnieszka M

    2015-09-01

    The heterogeneous group of patients admitted to Intensive Cardiac Care Unit (ICCU) as well as nonspecific complaints associated with anemia might be the reason for underdiagnosing or minimization of this problem. Because of this heterogeneity, there are no clear guidelines to follow. It is known that anemia is impairing the outcome. Thus, it is crucial to keep alert in the diagnosis and treatment of anemia, especially in critically ill cardiac patients. The greatest groups of patients admitted to ICCU are those with acute coronary syndromes (ACS), acute decompensated heart failure (ADHF), severe arrhythmias as well as individuals after cardiac operations. However, patients suffering other critical cardiac illnesses quite often become anemic during hospitalization in ICCU. It is because anemia is typed in the clinical features of heavy diseases or may be the consequence of treatment. The current review focuses on the incidence, complex etiology and predictive role of anemia in a diverse group of ICCU patients. It discusses clinical aspects of anemia treatment in particular groups of critically ill cardiac patients because proper treatment increases chances for recovery and improves the outcome in this severe group of patients. PMID:26149915

  19. Eye injury treatment in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    L. K. Moshetova

    2015-03-01

    Full Text Available Aim. To describe eye injuries in intensive care unit (ICU patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative fundus camera, tonometry, cranial CT and MRT, and bacteriological study of conjunctival smears. Results. Modern methods of ophthalmological examination of ICU patients provided correct diagnosis and prediction of wound healing. Eye injury treatment schedule provided maximum possible results in all ICU patients. Hospitalacquired infection results in asymptomatic dissemination of pathogenic microbes on ocular surface. Conclusions. 14-day topical treatment with antimicrobials, steroids, and NSAIDs reduces posttraumatic inflammation caused by mechanical eye injuries in ICU patients. Bacteriological studies of conjunctival smears demonstrate the presence of pathogenic flora in ICU patients. In these patients, the most effective antibacterial agents are third-generation fluoroquinolones. 

  20. Eye injury treatment in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    L. K. Moshetova

    2015-01-01

    Full Text Available Aim. To describe eye injuries in intensive care unit (ICU patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative fundus camera, tonometry, cranial CT and MRT, and bacteriological study of conjunctival smears. Results. Modern methods of ophthalmological examination of ICU patients provided correct diagnosis and prediction of wound healing. Eye injury treatment schedule provided maximum possible results in all ICU patients. Hospitalacquired infection results in asymptomatic dissemination of pathogenic microbes on ocular surface. Conclusions. 14-day topical treatment with antimicrobials, steroids, and NSAIDs reduces posttraumatic inflammation caused by mechanical eye injuries in ICU patients. Bacteriological studies of conjunctival smears demonstrate the presence of pathogenic flora in ICU patients. In these patients, the most effective antibacterial agents are third-generation fluoroquinolones. 

  1. ENVIRONMENTAL HAZARDS AS A CAUSE OF PEDIATRIC INTENSIVE CARE ADMISSION

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    Nasser Ali Haidar

    2014-12-01

    Full Text Available Background: Children are exposed to several environmental hazards with variable effects from mild to severe manifestations leading to death. The aim of this study is to study the pattern of Pediatric Intensive Care Unit (PICU admission due to environmental hazards and its mortality rate. Methods: This is a hospital-based study conducted during a 5 years period in Al-Madinah Al-Munwarah, Saudi Arabia. Results: Out of total PICU admissions, 9% were due to environmental hazards. Bronchial asthma which is triggered mostly by environmental factors, was the most common (35.3% followed by: trauma (27%, poisoning (15.3% and submersion injuries (9.7%. Males were significantly more exposed to environmental hazard than females (χ2= 13, p = 0.021. Statistical analysis showed a significant difference in the frequency of environmental hazards between summer and winter (χ2= 12, p = 0.033. Trauma, poisoning, submersion injuries, stings and bites were more in summer compared to winter. However, bronchial asthma had higher frequency in winter. The Median length of PICU stay ranges from 1.6 – 12.5 days depending on the type of hazard. Overall mortality rate was 8.8% with the highest rate among trauma followed by submersion injury patients with no fatality in drug ingestion or food poisoning. Conclusion: Environmental hazards represent a preventable major health problem with significant mortality and burden in health economics by long PICU stay and its sequel.

  2. Bloodstream Infections in a Neonatal Intensive Care Unit

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    Mehmet Sah Ižpek

    2014-12-01

    Full Text Available Aim: To determine the pattern of bloodstream infections (BSIs and antimicrobial susceptibility of pathogens in a neonatal intensive care unit (NICU.Material and Method: Positive hemoculture of neonates diagnosed with nosocomial sepsis from March 2011 to March 2014 in the NICU of Diyarbakir Maternity and Children%u2019s Hospital, in the southeastern region of Anatolia, Turkey, were retrospectively reviewed. Results: A total of 148 pathogens were isolated in 142 neonates. The most common microorganisms isolated were Klebsiella pneumoniae (40.5% and Acinetobacter baumannii (29.7% which was a result of a hospital outbreak. Multi-drug resistant (MDR strains accounted for 20.0% of K. pneumoniae isolates and 93.2% of A. baumannii isolates. The sepsis-attributable mortality rate was higher in cases infected with MDR strains than in cases infected without MDR strains or Candida spp (24% vs. 9.7%, p=0.032. Discussion: In our unit, BSIs were more often caused by Gram negative bacteria. BSIs caused by MDR strains were associated with a higher rate of sepsis-attributable mortality.

  3. Elective open bedside tracheostomy in the neurosurgical intensive care unit

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    Niran Maharjan

    2015-09-01

    Full Text Available JCMSBackground and Objectives: Tracheostomy is electively performed in critically ill patients requiring prolonged respiratory support. The risk of transporting, the increasing associated cost and operative room schedule are some of the obstacles for wider acceptance of this procedure. The use of rigid selection criteria exclude many patients who would benefit of this approach. The present study was designed to determine the safety of open bedside tracheostomy (OBT as a routine intensive care units (ICU procedure without any selection criteria, considering its peri and postoperative complications.Materials & Methods: Retrospective medical chart review of all patients that underwent elective tracheostomy between June 2014 and January 2015.Results: The study group comprised 52 patients with a mean age of 40.4±15.1 years. The incidence of intra-procedure complications was 5.7% and post-procedure complications was 3.8%.Conclusions: Open bedside tracheostomy seems to be a safe and simple procedure, even when performed by a trained resident under controlled circumstances, and should be considered as an option for ICU patients.JCMS Nepal. 2015;11(1: 9-11

  4. Candida colonization in intensive care unit patients' urine

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    Xisto Sena Passos

    2005-12-01

    Full Text Available The objective of this study was to identify possible predisposing factors for candiduria in intensive care unit (ICU patients from Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Brazil, during one year. Urine samples from 153 ICU patients were obtained by catheterization on admission day and every seven days. Data such as sex, age, antifungal therapy, and variables as antibiotics, underlying diseases or comorbid conditions and stay in the hospital, were collected from patients who had at least one urine culture that yielded > 10³ yeast colonies/ml. Candiduria was recovered in 68 patients and the commonest predisposing factors were antibiotic therapy (100% and indwelling urinary catheter (92.6%. The percentage of Candida spp. isolation increased during the extended periods in which patients remained in the ICU. C. albicans was isolated in 69.1%, and the other species non-albicans as C. glabrata, C. kefyr, C. parapsilosis, C. famata, C. guilliermondii, C. krusei, and C. tropicalis were isolated in lower percentage. The high frequency of candiduria and the possible predisposing factors found in ICU patients show that candiduria surveillance should be performed to help reducing nosocomial infections.

  5. [Invasive aspergillosis on a surgical intensive care unit].

    Science.gov (United States)

    Kujath, P; Klempien, I; Muhl, E; Kämmerer, R

    2000-01-01

    From 1-1-1995 until 1-3-2000 4777 patients were treated in a surgical intensive care unit. 12 patients (10 male/2 female, mean age 58 years) suffered from invasive aspergillosis. One patient had a purulent descending mediastinitis with evidence of Aspergillus fumigatus in the mediastinum and in both pleural cavities. One patient got a right upper lobectomie in cause of an aspergilloma. In 10 patients a broncho-alveolar aspergillosis was proved by at least two cultures from broncho-alveolar lavage (BAL) and biopsies. All our patients had a mean of 12.8 risk factors for systemic mycoses. The patients suffered from following underlying diseases: 3 x carcinoma of the esophagus (chemotherapy + radiation), 2 x ulcerative colitis, 1 x rupture of the aorta with insufficiency of the liver, 1 x acute leucosis and 1 x purulent mediastinitis. The therapy was based on infusion with amphotericin B up to 1.5 mg/kg/day in combination with flucytosine or itraconazole. In 4 patients inhalation of amphotericin B aerosol was applied. After therapeutic failure of amphotericin B-therapy 3 patients got voriconazole according to a study protocol. 10 patients died, 7 of them from their underlying disease. PMID:11291572

  6. Antimicrobial usage in an intensive care unit: a prospective analysis.

    LENUS (Irish Health Repository)

    Conrick-Martin, I

    2012-01-31

    Antimicrobial therapies in the Intensive Care Unit (ICU) need to be appropriate in both their antimicrobial cover and duration. We performed a prospective observational study of admissions to our semi-closed ICU over a three-month period and recorded the indications for antimicrobial therapy, agents used, duration of use, changes in therapy and reasons for changes in therapy. A change in therapy was defined as the initiation or discontinuation of an antimicrobial agent. There were 51 patients admitted during the three-month study period and all received antimicrobial therapy. There were 135 changes in antimicrobial therapy. 89 (66%) were made by the ICU team and 32 (24%) were made by the primary team. Changes were made due to a deterioration or lack of clinical response in 41 (30%) cases, due to the completion of prescribed course in 36 (27%) cases, and in response to a sensitivity result in 25 (19%) cases. Prophylactic antibiotic courses (n=24) were of a duration greater than 24 hours in 15 (63%) instances. In conclusion, the majority of changes in antimicrobial therapy were not culture-based and the duration of surgical prophylaxis was in excess of current recommended guidelines.

  7. Taking care of the newborn dying and their families: Nurses' experiences of neonatal intensive care

    Directory of Open Access Journals (Sweden)

    Fabiane de Amorim Almeida

    2016-06-01

    Full Text Available Objective To understand the experiences of nurses when caring for dying newborns and their families in the NICU; and redeem their perceptions about acting before the death and grieving process. Method A descriptive exploratory study with a qualitative approach, developed with nine nurses at the ICU of a hospital in São Paulo (SP, Brazil. Data was collected through semi-structured interviews and analyzed using the Collective Subject Discourse (CSD. Results Caring for newborns who are dying and their families is very difficult for nurses, due to the intense involvement. They seek strategies to deal with the situation and, before the newborn’s death, despite the suffering, express the feeling of accomplishment. Conclusions Facing death and grief triggers mechanisms that emerge life references, coming across painful issues. Learning to deal with these questions is a daily challenge for nurses of the NICU.

  8. Hand hygiene compliance in the intensive care units of a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Sarit Sharma

    2011-01-01

    Full Text Available Context: Hand hygiene (HH is the most important measure to prevent hospital-acquired infections but the compliance is still low. Aims: To assess the compliance, identify factors influencing compliance and to study the knowledge, attitude and perceptions associated with HH among health care workers (HCW. Settings and Design: Cross-sectional study conducted in 42 bedded Medical (Pulmonary, Medicine and Stroke intensive care units (ICU of a tertiary care hospital. Materials and Methods: HCWs (doctors and nurses were observed during routine patient care by observers posted in each ICU and their HH compliance was noted. Thereafter, questionnaire regarding knowledge, perception and attitudes toward HH was filled by each HCW. Statistical Analysis: Percentages and χ2 test. Results: The overall compliance was 43.2% (394/911 opportunities. It was 68.9% (31/45 in the intensivists, 56.3% (18/32 in attending physicians, 40.0% (28/70 in the postgraduate residents and 41.3% (301/728 in the nurses. Compliance was inversely related to activity index. Compliance for high, medium and low risk of cross-transmission was 38.8% (67/170, 43.8% (175/401 and 44.7% (152/340, respectively. Conclusions: Compliance of the study group is affected by the activity index (number of opportunities they come across per hour and professional status. The HCWs listed less knowledge, lack of motivation, increased workload as some of the factors influencing HH.

  9. [Guidelines for treatment of pneumonia in intensive care units].

    Science.gov (United States)

    Emmi, V

    2005-01-01

    Patients affected by pneumonia can be admitted in Intensive Care Units (ICUs) independently by the setting where the infection has been acquired (community, hospital, long-term care facilities); even more frequently pneumonia can develop in patients already hospitalized in ICU especially in those requiring mechanical ventilation for different reasons. Within the severe community acquired pneumonia requiring admission in ICU, the most frequently responsible micro-organisms are mainly represented by Streptococcus pneumoniae, but also by Legionella and Haemophilus. Pseudomonas aeruginona, anyway, cannot be excluded. The most recent Canadian and American guidelines for treatment of the above mentioned infections suggest the use of a combination therapy with beta-lactams (ceftriaxone, cefotaxime, ampicillin/sulbactam, piperacillin/tazobactam) and a new generation macrolide or respiratory fluoroquinolone. In case of allergy to beta-lactams, the association fluoroquinolone-clindamycin should be preferred. Whenever a Pseudomonas etiology is suspected because of the presence of risk factors such as COPD, cystic fibrosis, bronchiectasis, previous and/or frequent therapies with antibiotics and/or steroids, the same guidelines suggest the use of an anti-pseudomonas beta-lactam (such as piperacillin/tazobactam, carbapenems, cefepime) associated with an anti-pseudomonas fluoroquinolone (high doses ciprofloxacin). An anti-pseudomonas beta-lactam plus an aminoglycoside or aminoglicosyde plus fluoroquinolone can be an alternative. Early onset Hospital Acquired Pneumonia (HAP) and early onset Ventilator Associated Pneumonia (VAP) in patients without risk factors for multi-resistant etiological agents are generally sustained by S. pneumoniae, H. influenzae, methicillin-susceptible Staphylocccus aureus e Gram negative enteric rods. These infections can be treated with one of the following antibiotics: ceftriaxone or fluoroquinolones (moxifloxacin or ciprofloxacin or levofloxacin) or

  10. Caval filters in intensive care: a retrospective study

    Directory of Open Access Journals (Sweden)

    Ferraro F

    2014-11-01

    Full Text Available F Ferraro,1 TL Di Gennaro,1 A Torino,1 J Petruzzi,1 A d’Elia,1 P Fusco,1 R Marfella,2 B Lettieri1 1Department of Anesthesiological, Surgical and Emergency Sciences, 2Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy Aim: To evaluate the effectiveness of a caval vein filter (CVF peri-implant monitoring protocol in order to reduce pulmonary embolism (PE mortality and CVF-related morbidity.Background: The reduction in mortality from PE associated with the use of CVF is affected by the risk of increase in morbidity. Therefore, CVF implant is a challenging prophylactic or therapeutic option. Nowadays, we have many different devices whose rational use, by applying a strict peri-implant monitoring protocol, could be safe and effective.Materials and methods: We retrospectively studied 62 patients of a general Intensive Care Unit (ICU scheduled for definitive, temporary, or optional bedside CVF implant. A peri-implant monitoring protocol including a phlebocavography, an echo-Doppler examination, and coagulation tests was adopted.Results: In our study, no thromboembolic recurrence was registered. We implanted 48 retrievable and only 20 definitive CVFs. Endothelial adhesion (18%, residual clot (5%, cranial or caudal migration (6%, microbial colonization of the filter in the absence of clinical signs of infection (1%, caval thrombosis (1%, and pneumothorax (1% were reported. Deep-vein thrombosis (DVT was reported (8% as early complication. All patients with DVT had a temporary or optional filter implanted. However, in our cohort, definitive CVFs were reserved only to 32% of patients and they were not associated with DVT as complication.Conclusion: CVF significantly reduces iatrogenic PE without affecting mortality. Generally, ICU patients have a transitory thromboembolic risk, and so the temporary CVF has been proved to be a first-line option to our cohort. A careful monitoring may contribute to a satisfactory

  11. Developing a Diary Program to Minimize Patient and Family Post-Intensive Care Syndrome.

    Science.gov (United States)

    Locke, Meaghan; Eccleston, Sarah; Ryan, Claire N; Byrnes, Tiffany J; Mount, Cristin; McCarthy, Mary S

    2016-01-01

    A series of evidence-based interventions beginning with an intensive care unit diary and a patient/family educational pamphlet were implemented to address the long-term consequences of critical illness after discharge from the intensive care unit, bundled as post-intensive care syndrome and post-intensive care syndrome-family. An extensive literature review and nursing observations of the phenomenon highlighted the potential for this project to have a favorable impact on patients, their families, and the health care team. The goal of this article is to explain the education of all stakeholders; the introduction of the diary, video, and educational pamphlet; and the evaluation of the acceptance of these interventions. This process began with an informal evaluation of the educational products and overall perception of the usefulness of the diary by patients, family members, and staff. The efforts described contribute to the evidence base supporting diaries as an adjunct to intensive care. PMID:27153310

  12. Model Point-of-Care Ultrasound Curriculum in an Intensive Care Unit Fellowship Program and Its Impact on Patient Management

    OpenAIRE

    Keith Killu; Victor Coba; Michael Mendez; Subhash Reddy; Tanja Adrzejewski; Yung Huang; Jessica Ede; Mathilda Horst

    2014-01-01

    Objectives. This study was designed to assess the clinical applicability of a Point-of-Care (POC) ultrasound curriculum into an intensive care unit (ICU) fellowship program and its impact on patient care. Methods. A POC ultrasound curriculum for the surgical ICU (SICU) fellowship was designed and implemented in an urban, academic tertiary care center. It included 30 hours of didactics and hands-on training on models. Minimum requirement for each ICU fellow was to perform 25–50 exams on respec...

  13. Withholding or withdrawing therapy in intensive care units: improving interdisciplinary cooperation

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Ammentorp, Jette; Ørding, Helle

    INTRODUCTION. Decisions regarding withholding or withdrawing therapy are common in the intensive care units. The health care professionals involved in the decision-making process do not always assess the situation identically, leading to potential conflicts. Studies have suggested that improving...... (conducted at two hospitals) with participation of primary care physicians, anaesthesiologists (both with and without ICU as their main workplace) and intensive care nurses. A total of 29 participated in the audits. The participants received beforehand three complicated cases (borrowed from other hospitals...... intensive care unit conflicts: the conflicus study. Am J Respir Crit Care Med180:853-860. (2) Halvorsen K, Forde R, Nortvedt P (2009) Value choices and considerations when limiting intensive care treatment: a qualitative study. Acta Anaesthesiol Scand 53:10-17 GRANT ACKNOWLEDGMENT. The study was supported...

  14. Radiation Dose to Newborns in Neonatal Intensive Care Units

    International Nuclear Information System (INIS)

    With the increase of X-ray use for medical diagnostic purposes, knowing the given doses is necessary in patients for comparison with reference levels. The concept of reference doses or diagnostic reference levels has been developed as a practical aid in the optimization of patient protection in diagnostic radiology. To assess the radiation doses to neonates from diagnostic radiography (chest and abdomen). This study has been carried out in the neonatal intensive care unit of a province in Iran. Entrance surface dose was measured directly with thermoluminescent dosimeters. The population included 195 neonates admitted for a diagnostic radiography, in eight NICUs of different hospital types. The mean entrance surface dose for chest and abdomen examinations were 76.3 μGy and 61.5 μGy, respectively. Diagnostic reference levels for neonate in NICUs of the province were 88 μGy for chest and 98 μGy for abdomen examinations that were slightly higher than other studies. Risk of death due to radiation cancer incidence of abdomens examination was equal to 1.88 × 10-6 for male and 4.43 × 10-6 for female. For chest X-ray, it was equal to 2.54 × 10-6 for male and 1.17 × 10-5 for female patients. Diagnostic reference levels for neonates in our province were slightly higher than values reported by other studies such as European national diagnostic reference levels and the NRPB reference dose. The main reason was related to using a high mAs and a low kVp applied in most departments and also a low focus film distance. Probably lack of collimation also affected some exams in the NICUs.

  15. Physiotherapy practices in Intensive Care Units across Maharashtra

    Directory of Open Access Journals (Sweden)

    Ujwal Lakshman Yeole

    2015-01-01

    Full Text Available Purpose: To find out the current physiotherapy practices in Intensive Care Unit (ICU across Maharashtra. Materials and Methods: Study design was exploratory cross-sectional survey. Questionnaires were sent to the physiotherapists working in hospitals across Maharashtra state, India. Four weeks for completion of questionnaire was given in an attempt to ensure good response rates. Result: Of 200, 73 questionnaires were received representing a 36% response rate. The study revealed that 76% of the respondents were bachelors qualified, 15% were masters in physiotherapy with only 4% specialized in cardio-respiratory physiotherapy; 82% had <5 years experience in ICU. Almost 19% had not at all attended any seminars/workshops related to ICU management while 61% attended up to three within last 2 years. The availability of a physiotherapist during the night was affirmed by 63%, 58% responded initiation of physiotherapy to be "always physician referred" and 39% mentioned "physiotherapist initiated." Almost 80% performed chest wall techniques, 86% positioning, 27% postural drainage, 5% manual hyperinflation, 12% application of nebulizer, and 56% bedsores management. Only 5% reported involvement in ventilator setting, 11% had their opinion sought before weaning from ventilator, 29% practiced noninvasive ventilation, 11% were involved in decision-making for extubation and 44% reported involvement in patient family education. Conclusion: The study showed that physiotherapists among the responding ICUs surveyed lack in experience and updated knowledge. Physician reference is necessary to initiate physiotherapy and there exists no established criteria for physiotherapy treatment in ICU. All physiotherapists were routinely involved in chest physiotherapy, mobilization, and positioning.

  16. Fatigue in Family Caregivers of Adult Intensive Care Unit Survivors

    Science.gov (United States)

    Choi, JiYeon; Tate, Judith A.; Hoffman, Leslie A.; Schulz, Richard; Ren, Dianxu; Donahoe, Michael P.; Given, Barbara A.; Sherwood, Paula R.

    2014-01-01

    Context Family caregivers are a vital resource in the recovery of intensive care unit (ICU) survivors. Of concern, the stress associated with this role can negatively affect caregiver health. Fatigue, an important health indicator, has been identified as a predictor of various illnesses, greater use of health services, and early mortality. Examining the impact of fatigue on caregivers’ physical health can assist in identifying critical time points and potential targets for intervention. Objectives To describe self-reported fatigue in caregivers of ICU survivors from patients’ ICU admission to ≤ two weeks, two- and four-months post-ICU discharge. Methods Patient-caregiver pairs were enrolled from a medical ICU. Caregiver fatigue was measured using the Short-Form-36 Health Survey Vitality subscale (SF-36 Vitality). Caregiver psychobehavioral stress responses included depressive symptoms, burden, health risk behaviors, and sleep quality. Patient data included self-reported physical symptoms and disposition (home vs. institution). Results Forty seven patient-caregiver pairs were initially enrolled. Clinically significant fatigue (SF-36 Vitality ≤ 45) was reported by 43% to 53% of caregivers across the time points and these caregivers reported worse scores in measures of depressive symptoms, burden, health risk behaviors and sleep quality, and patients’ symptom burden. In 26 caregivers with data for all time points (55% of the total sample), SF-36 Vitality scores showed trends of improvement when the patient returned home and greater impairment when institutionalization continued. Conclusion In caregivers of ICU survivors, fatigue is common and potentially linked with poor psychobehavioral responses. Worsening fatigue was associated with greater symptom distress and long-term patient institutionalization. PMID:24439845

  17. Bombay experience in intensive respiratory care over 6 years.

    Directory of Open Access Journals (Sweden)

    Kamat S

    1989-07-01

    Full Text Available The experience of the intensive respiratory care in 930 cases treated from 1983 for 4 years and in 404 cases over the next 2 years is reported. The background operational problems are stressed. Those between age 10 and 50 years did significantly better (p less than 0.05. The survival over the first 4 years in IPPR cases was 16.3% and in non IPPR group 71.8%; over the next 2 years, the former group, survival was 32.4 and 36.3%. The survival in asthmatic patients was high (76%. In cases with organophosphorus poisoning (without IPPR, survival was 81% while in IPPR group it was 29%. In 1988, the results in this group were better due to more aggressive management. In autopsy data on 85 cases, infection was not a major feature in those dying within 24 hours. The survival in COPD cases showed significant relation to age (p less than 0.05, initial arterial pO2 below 60 mm (p less than 0.01 and arterial pH below 7.3 (p less than 0.01. In cases with pneumonia (also asthma younger cases did better (p less than 0.05 as also those with pneumonia and initial pO2 above 60 mm (p less than 0.01 and pH above 7.3 (p less than 0.001. When pneumonia was community acquired, survival (64.8% was better than when it was hospital acquired (24%; p less than 0.01. Only the need for IPPR affected survival in trauma group. The major cause of death was infection with Klebsiella, Pseudomonas, Staphylococci and other gram--ve organisms. It is concluded that with proper planning and training, the IRCU does provide a useful mode of treatment in selected patients with respiratory problems.

  18. How is mechanical ventilation employed in a pediatric intensive care unit in Brazil?

    Directory of Open Access Journals (Sweden)

    Dafne Cardoso Bourguignon da Silva

    2009-01-01

    Full Text Available OBJECTIVE: to investigate the relationship between mechanical ventilation and mortality and the practice of mechanical ventilation applied in children admitted to a high-complexity pediatric intensive care unit in the city of São Paulo, Brazil. DESIGN: Prospective cohort study of all consecutive patients admitted to a Brazilian high-complexity PICU who were placed on mechanical ventilation for 24 hours or more, between October 1st, 2005 and March 31st, 2006. RESULTS: Of the 241 patients admitted, 86 (35.7% received mechanical ventilation for 24 hours or more. Of these, 49 met inclusion criteria and were thus eligible to participate in the study. Of the 49 patients studied, 45 had chronic functional status. The median age of participants was 32 months and the median length of mechanical ventilation use was 6.5 days. The major indication for mechanical ventilation was acute respiratory failure, usually associated with severe sepsis / septic shock. Pressure ventilation modes were the standard ones. An overall 10.37% incidence of Acute Respiratory Distress Syndrome was found, in addition to tidal volumes > 8 ml/kg, as well as normo- or hypocapnia. A total of 17 children died. Risk factors for mortality within 28 days of admission were initial inspiratory pressure, pH, PaO2/FiO2 ratio, oxygenation index and also oxygenation index at 48 hours of mechanical ventilation. Initial inspiratory pressure was also a predictor of mechanical ventilation for periods longer than 7 days. CONCLUSION: Of the admitted children, 35.7% received mechanical ventilation for 24 h or more. Pressure ventilation modes were standard. Of the children studied, 91% had chronic functional status. There was a high incidence of Acute Respiratory Distress Syndrome, but a lung-protective strategy was not fully implemented. Inspiratory pressure at the beginning of mechanical ventilation was a predictor of mortality within 28 days and of a longer course of mechanical ventilation.

  19. Inappropriate emergency management of status epilepticus in children contributes to need for intensive care

    OpenAIRE

    Chin, R; Verhulst, L; Neville, B.; Peters, M; Scott, R.

    2004-01-01

    Objectives: To characterise the clinical features, emergency pre-paediatric intensive care (PIC) treatment, and course of status epilepticus (SE) in children admitted to PIC. This may provide insight into reasons for admission to PIC and provide a framework for the development of strategies that decrease the requirement for intensive care.

  20. Neonatal Intensive Care for Low Birthweight Infants: Costs and Effectiveness. Health Technology Case Study 38.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. Office of Technology Assessment.

    After a brief introduction delineating the scope of the case study, chapter 1 summarizes findings and conclusions about the costs and effectiveness of neonatal intensive care in the United States. Chapter 2 inventories the national supply of neonatal intensive care units and describes recent trends in use and costs. Chapter 3 reviews mortality and…

  1. Factors promoting intensive care patients' perception of feeling safe: A systematic review

    NARCIS (Netherlands)

    Wassenaar, A.; Schouten, J.A.; Schoonhoven, L.

    2014-01-01

    BACKGROUND: Feeling safe in the intensive care unit is of great importance while recovering from critical illness. Moreover, feeling unsafe can result in distress. In order to meet the safety needs of intensive care patients as well as to stimulate their recovery and prevent distress, nurses must be

  2. [The Second All-Russian Educational Congress "Anaesthesia and Intensive Care in Obstetrics and Neonatology"].

    Science.gov (United States)

    Pyregov, A V; Burov, A A

    2010-01-01

    The article highlights the most urgent issues of anaesthesia and intensive care in obstetrics presented in the reports of the leading specialists at the 2nd All-Russian Educational Congress "Anaesthesia And Intensive Care In Obstetrics And Neonatology". PMID:21400803

  3. Incidence and preventability of adverse events requiring intensive care admission

    OpenAIRE

    Vlayen, Annemie; Verelst, Sandra; Bekkering, Geertruida E; Schrooten, Ward; Hellings, Johan; Claes, Neree

    2011-01-01

    Rationale, aims and objectives: Adverse events are unintended patient injuries or complications that arise from health care management resulting in death, disability or prolonged hospital stay. Adverse events that require critical care are a considerable financial burden to the health care system, but also their global impact on patients and society is probably underestimated. The objectives of this systematic review were to synthesize the best available evidence regarding the estimates of th...

  4. Circumstances surrounding dying in the paediatric intensive care unit

    Directory of Open Access Journals (Sweden)

    Plötz Frans B

    2006-08-01

    Full Text Available Abstract Background Death is inevitable in the paediatric intensive care unit (PICU. We aimed to describe the circumstances surrounding dying in a PICU. Method The chart records of all patients less than 18 years of age who died at the PICU between January first 2000 and July first 2005 were retrospectively analyzed. Information regarding sex, age, length of stay, admission, diagnosis, and the way a patient died was registered. Post mortem information regarding natural versus unnatural death, autopsy and donation was obtained. Non-survivors were allocated in five groups: do-not-resuscitate (DNR, withholding and/or withdrawal of therapy (W/W, failed cardiopulmonary resuscitation (failed CPR, brain death (BD, and terminal organ failure (TOF. Results During the study period 87 (4.4% of the 1995 admitted patients died. Non-survivors were more often admitted during the day (54% and the week (68%. W/W was found in 27.6%, TOF in 26.4%, BD in 23.0%, failed CPR in 18.4%, and DNR in 4.6%. Forty-three percent died in the first two days, of which BD (40.5% and failed CPR (37.8% were most common. Seventy-five children (86% died due to a natural cause. Autopsy permission was obtained in 19 of 54 patients (35%. The autopsies confirmed the clinical diagnosis in 11 patients, revealed new information in 5 patients, and in 3 patients the autopsy did not provide additional information. Nine patients were medically suitable for organ donation and 24 patients for tissue donation, whereas consent was only obtained in 2 cases in both groups. Conclusion We observed that 43% of the patients died within the first two days of admission due to BD and failed CPR, whereas after 4 days most patients died after W/W. Autopsy remains an useful tool to confirm clinical diagnoses or to provide new information. Only a small percentage of the deceased children is suitable for organ donation.

  5. What Does Change with Nutrition Team in Intensive Care Unit?

    Directory of Open Access Journals (Sweden)

    Ahmet Fatih Yılmaz

    2016-08-01

    Full Text Available Intrroduction: Clinical nutrition is the nutrition support therapy provided to patients under medical supervision at the hospital or home setting. It is a multidisciplinary task performed under the control of the physician, dietician, pharmacist and nurse. In this study, the changes in the patient admission statistics to the general intensive care unit (GICU, the exitus ratios, decubitus ulcer formation rates, albumin use rates, duration of the hospital stay, Acute Physiology and Chronic Health Evaluation (APACHE II scores, rate of usege of parenteral and enteral products, and the change in expenses per patient within the first year of activity of the nutrition team in comparison to the previous year was presented. Material and Method: In this study a 6-bed GICU was used. The patients who was admitted through retrospective file scanning between 1 January 2012 and 31 December 2012 and between 1 January 2013 and 31 December 2013 were compared. Results: The number of the patients admitted to the GICU was 341 in 2012 and 369 in 2013. The number of the patients who died in 2012 was 86 (25.2%, while it was 106 in 2013 (28.7%. In 2012, 122 patients (35.7% had decubitus ulcers, while this number was 92 (24.7% in 2013. Human albumin usage was reduced by 23% for the 100 mL (225 in 2012, 175 in 2013 and by 33% for the 50 mL doses (122 in 2012, 82 in 2013. Duration of stay in the hospital was 6.3±0.9 vs. 5.8±0.9 (days (p=0.06. The mean APACHE II scores were observed to be 24.7±6.9 vs. 30.5±11.4 (p=0.03. When the distribution of product types were analyzed, it was observed that the ratio of parenteral products: enteral products was 2:1 in 2012, however the ratio of enteral products to parenteral products was 2:1 in 2013. The daily expense of a patient decreased from 100 TL to 55 TL. Conclusion: The nutrition team directly influences the clinical process outcomes of patients under treatment in the ICU. It was thought that using appropriate nutritional

  6. Post-traumatic pulmonary embolism in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Mabrouk Bahloul

    2011-01-01

    Full Text Available Objective: To determine the predictive factors, clinical manifestations, and the outcome of patients with post-traumatic pulmonary embolism (PE admitted in the intensive care unit (ICU. Methods: During a four-year prospective study, a medical committee of six ICU physicians prospectively examined all available data for each trauma patient in order to classify patients according to the level of clinical suspicion of pulmonary thromboembolism. During the study period, all trauma patients admitted to our ICU were classified into two groups. The first group included all patients with confirmed PE; the second group included patients without clinical manifestations of PE. The diagnosis of PE was confirmed either by a high-probability ventilation/perfusion (V/Q scan or by a spiral computed tomography (CT scan showing one or more filling defects in the pulmonary artery or its branches. Results: During the study period, 1067 trauma patients were admitted in our ICU. The diagnosis of PE was confirmed in 34 patients (3.2%. The mean delay of development of PE was 11.3 ± 9.3 days. Eight patients (24% developed this complication within five days of ICU admission. On the day of PE diagnosis, the clinical examination showed that 13 patients (38.2% were hypotensive, 23 (67.7% had systemic inflammatory response syndrome (SIRS, three (8.8% had clinical manifestations of deep venous thrombosis (DVT, and 32 (94% had respiratory distress requiring mechanical ventilation. In our study, intravenous unfractionated heparin was used in 32 cases (94% and low molecular weight heparin was used in two cases (4%. The mean ICU stay was 31.6 ± 35.7 days and the mean hospital stay was 32.7 ± 35.3 days. The mortality rate in the ICU was 38.2% and the in-hospital mortality rate was 41%. The multivariate analysis showed that factors associated with poor prognosis in the ICU were the presence of circulatory failure (Shock (Odds ratio (OR = 9.96 and thrombocytopenia (OR = 32

  7. Withdrawal of ventilatory support outside the intensive care unit: guidance for practice

    OpenAIRE

    Laddie, J.; Craig, F; Brierley, J; Kelly, P; Bluebond-Langner, M.

    2014-01-01

    Objective To review the work of one tertiary paediatric palliative care service in facilitating planned withdrawal of ventilatory support outside the intensive care setting, with the purpose of developing local guidance for practice. Methods Retrospective 10-year (2003–2012) case note review of intensive care patients whose parents elected to withdraw ventilation in another setting. Demographic and clinical data revealed common themes and specific incidents relevant to local guideline develop...

  8. Psychosocial factors and prevalence of burnout syndrome among nursing workers in intensive care units

    OpenAIRE

    da Silva, Jorge Luiz Lima; Soares, Rafael da Silva; Costa, Felipe dos Santos; Ramos, Danusa de Souza; Lima, Fabiano Bittencourt; Teixeira, Liliane Reis

    2015-01-01

    Objective To evaluate the prevalence of burnout syndrome among nursing workers in intensive care units and establish associations with psychosocial factors. Methods This descriptive study evaluated 130 professionals, including nurses, nursing technicians, and nursing assistants, who performed their activities in intensive care and coronary care units in 2 large hospitals in the city of Rio de Janeiro, Brazil. Data were collected in 2011 using a self-reported questionnaire. The Maslach Burnout...

  9. Availability of transplantable organs from brain stem dead donors in intensive care units.

    OpenAIRE

    Gore, S M; Taylor, R. M.; Wallwork, J

    1991-01-01

    OBJECTIVE--By audit from January to June 1989 to quantify, separately for hearts, kidneys, liver, lungs and corneas, the possible increases in transplantable organs from brain stem dead potential donors in intensive care units and to compare them with the increases achieved in October-November 1989, during intense, national publicity about transplantation. DESIGN--Prospective audit of all deaths in intensive care units in England from 1 January to 30 June 1989 and subsequent case study of the...

  10. Improved nurse-parent communication in neonatal intensive care unit

    DEFF Research Database (Denmark)

    Weis, Janne; Zoffmann, Vibeke; Egerod, Ingrid

    2014-01-01

    adjustment of nurse adherence to guided family-centred care was conducted by monitoring (1) knowledge, (2) delivery, (3) practice uptake and (4) certification. RESULTS: Implementation was improved by the development of a strategic framework and by adjusting the framework according to the real-life context of...... a busy neonatal care unit. Promoting practice uptake was initially underestimated, but nurse guided family-centred care training was improved by increasing the visibility of the study in the unit, demonstrating intervention progress to the nurses and assuring a sense of ownership among nurse leaders...... and nonguided-family-centred-care-trained nurses. CONCLUSIONS: An adjusted framework for guided family-centred care implementation was successful in overcoming barriers and promoting facilitators. RELEVANCE TO CLINICAL PRACTICE: Insights gained from our pioneering work might help nurses in a similar...

  11. [Intensive care for emerging infectious diseases--Ebola and Dengue].

    Science.gov (United States)

    Ohmagari, Norio

    2016-02-01

    Although significant effort has been made for the development of treatment and prevention of Ebola hemorrhagic fever, one has to keep in mind that basic supportive therapy, including sufficient hydration to the patients, would be a standard of care for Ebola hemorrhagic fever and other antiviral therapy would be an adjunct to this standard of care. Also, effective antiviral drug to dengue virus is not known, and a basic supportive therapy, including fluid therapy, would be a standard of care and prevent serious type of dengue virus infections. Aspirin and other non-steroidal anti-inflammatory drug must not be used, because they promote bleeding and acidosis. PMID:26915248

  12. Challenges encountered by critical care unit managers in the large intensive care units

    Directory of Open Access Journals (Sweden)

    Mokgadi C. Matlakala

    2014-02-01

    Full Text Available Background: Nurses in intensive care units (ICUs are exposed regularly to huge demands interms of fulfilling the many roles that are placed upon them. Unit managers, in particular, are responsible for the efficient management of the units and have the responsibilities of planning, organising, leading and controlling the daily activities in order to facilitate the achievement of the unit objectives.Objectives: The objective of this study was to explore and present the challenges encountered by ICU managers in the management of large ICUs.Method: A qualitative, exploratory and descriptive study was conducted at five hospital ICUs in Gauteng province, South Africa. Data were collected through individual interviews from purposively-selected critical care unit managers, then analysed using the matic coding.Results: Five themes emerged from the data: challenges related to the layout and structure of the unit, human resources provision and staffing, provision of material resources, stressors in the unit and visitors in the ICU.Conclusion: Unit managers in large ICUs face multifaceted challenges which include the demand for efficient and sufficient specialised nurses; lack of or inadequate equipment that goes along with technology in ICU and supplies; and stressors in the ICU that limit the efficiency to plan, organise, lead and control the daily activities in the unit. The challenges identified call for multiple strategies to assist in the efficient management of large ICUs.

  13. Epidemiology and risk factors of healthcare associated infections from intensive care unit of a tertiary care hospital

    OpenAIRE

    Sanjay Melville Masih; Shewtank Goel; Abhishek Singh; Sanjeev Kumar Khichi; Vasundhara; Rakesh Tank

    2016-01-01

    Background: Nosocomial infections (NIs) result in increased morbidity, mortality and length of hospital stay. The Incidence of NIs, their risk factors and the antibiogram patterns vary across and within countries. We assessed the rates, infection sites, pathogens and risk factors of health-care-associated infections in ICU of a tertiary care hospital. Methods: In this retrospective study, all the patients admitted in Intensive Care Unit over a period of 6 months during August 2015 to Janu...

  14. Chicken pox outbreak in the Intensive Care Unit of a tertiary care hospital: Lessons learnt the hard way

    OpenAIRE

    Sarit Sharma; Shruti Sharma; Deepinder Chhina; Chhina, R. S.

    2015-01-01

    Varicella-zoster virus (VZV) causes 2 clinically and epidemiologically distinct forms of diseases. Chickenpox (varicella) is the disease that results from primary infection with the VZV. Herpes zoster (HZ) results from the reactivation of VZV latently infecting the dorsal root ganglia. We are reporting an outbreak of varicella infection among the health care workers (HCWs) in the Intensive Care Unit (ICU) of a tertiary care hospital. We found transmission of varicella among eight HCWs of pulm...

  15. The perception of organ donation among health-care providers in the intensive care units at a tertiary center

    OpenAIRE

    Mohammad Alsultan

    2012-01-01

    The growing demand for organs continues to outpace the supply. The aim of our study was to evaluate the knowledge, attitude and awareness of organ donation procedures among the health-care providers in the Intensive Care Units (ICUs) at a tertiary hospital. This was a questionnaire-based study conducted in December 2011 among the health-care providers at five ICUs in a tertiary teaching hospital in Riyadh, Saudi Arabia. A total of 154 participants completed the questionnaire. Eighty percent o...

  16. Parents’ views on care of their very premature babies in neonatal intensive care units: a qualitative study

    OpenAIRE

    Russell, G. M.; Sawyer, A.; Rabe, H.; Abbott, J; Gyte, G; Duley, L; Ayers, S; Very Preterm Birth Qualitative Collaborative Group, .

    2014-01-01

    Background The admission of a very premature infant to the neonatal intensive care unit (NICU) is often a difficult time for parents. This paper explores parents’ views and experiences of the care for their very premature baby on NICU. Methods Parents were eligible if they had a baby born before 32 weeks gestation and cared for in a NICU, and spoke English well. 32 mothers and 7 fathers were interviewed to explore their experiences of preterm birth. Although parents’ evaluation of c...

  17. Consensus guidelines on analgesia and sedation in dying intensive care unit patients

    Directory of Open Access Journals (Sweden)

    Lemieux-Charles Louise

    2002-08-01

    Full Text Available Abstract Background Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. Methods Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1 Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9; 2 Deputy chief provincial coroners (N = 5; 3 Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12. Results After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. Conclusion Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia.

  18. The mental health care gap among children and adolescents: data from an epidemiological survey from four Brazilian regions.

    Directory of Open Access Journals (Sweden)

    Cristiane S Paula

    Full Text Available INTRODUCTION: Worldwide, a minority of disordered children/adolescents receives mental health assistance. In order to improve service access, it is important to investigate factors that influence the process leading to receiving care. Data on frequency and barriers for mental health service use (MHSU among Brazilian children/adolescents are extremely scarce and are needed to guide public policy. OBJECTIVES: To establish the frequency of MHSU among 6-to-16-year-old with psychiatric disorders from four Brazilian regions; and to identify structural/psychosocial/demographic barriers associated with child/adolescent MHSU. METHODS: Multicenter cross-sectional-study involving four towns from four out of five Brazilian regions. In each town, a representative sample of elementary public school students was randomly selected (sample: 1,721. Child/adolescent MHSU was defined as being seen by a psychologist/psychiatrist/neurologist in the previous 12 months. Standardized instruments measured: (1 children/adolescent characteristics [(1.1 Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL-psychiatric disorders; (1.2 Ten Questions Screen-neurodevelopment problems; (1.3 two subtests of WISC-III-estimated IQ; (1.4 Academic Performance Test-school performance], (2 factors related to mothers/main caregivers (Self-Reporting Questionnaire-anxiety/depression, (3 family (Brazilian Research-Companies-Association's Questionnaire-SES. RESULTS: Only 19.8% of children/adolescents with psychiatric disorder have used mental health services in the previous 12 months. Multiple logistic regression modeling identified five factors associated with lower rates of MHSU (female gender, adequate school performance, mother/main caregiver living with a partner, lower SES, residing in deprived Brazilian regions regardless of the presence of any psychiatric disorders/neurodevelopmental problems. CONCLUSIONS: Only a small proportion of children

  19. Expansion of the ten steps to successful breastfeeding into neonatal intensive care

    DEFF Research Database (Denmark)

    Nyqvist, Kerstin Hedberg; Häggkvist, Anna-Pia; Hansen, Mette Ness;

    2012-01-01

    The World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative: Revised, Updated, and Expanded for Integrated Care (2009) identifies the need for expanding the guidelines originally developed for maternity units to include neonatal intensive care. For this purpose...... goal is to offer these documents to international health care, professional, and other nongovernmental organizations involved in lactation and breastfeeding support for mothers of infants who require special neonatal care....

  20. Frequency of admission in Intensive Care Unit due to road accident

    OpenAIRE

    Vasilios Tziallas; Dimitrios Karagiorgis; Stergios Voutos; Othon Vlachopoulos; Dimitrios Tziallas; Mariana Ntokou

    2011-01-01

    During recent years, it has been noticed a remarkable increase in admission of the young in Intensive Care Unit due to road accident. The aim of the present study was to explore the injuries, the special conditions of admission of young 18-40 years old that were admitted to Intensive Care Unit due to road accident. Method and material: The sample studied consisted of young individuals 18-40 years old that were admitted in the Intensive Care Unit (ICU) of public hospitals in the area of Attica...

  1. Prevalence rates of infection in intensive care units of a tertiary teaching hospital

    OpenAIRE

    Toufen Junior Carlos; Hovnanian André Luiz Dresler; Franca Suelene Aires; Carvalho Carlos Roberto Ribeiro

    2003-01-01

    OBJECTIVE: To determine the prevalence rates of infections among intensive care unit patients, the predominant infecting organisms, and their resistance patterns. To identify the related factors for intensive care unit-acquired infection and mortality rates. DESIGN: A 1-day point-prevalence study. SETTING:A total of 19 intensive care units at the Hospital das Clínicas - University of São Paulo, School of Medicine (HC-FMUSP), a teaching and tertiary hospital, were eligible to participate in th...

  2. Digital luminescence radiography (DLR) for lateral chest radiographs in intensive care units

    International Nuclear Information System (INIS)

    The DLR technique is being used increasingly for clinical diagnosis, particularly in intensive care. Since the installation of a DLR unit, we have carried out more than 20 000 examinations of the chest on patients in intensive care. 12.1% of these were lateral radiographs. In this way, the diagnosis can be made of the extent of a pleural effusion, the presence of a ventral pneumothorax or of atelectasis. Using DLR, these examinations can be carried out at the bedside and have improved the radiological investigation of patients in intensive care. (orig.)

  3. Diagnostic characterization of services providing care to victims of accidents and violence in five Brazilian state capitals

    Directory of Open Access Journals (Sweden)

    Suely Ferreira Deslandes

    2006-06-01

    Full Text Available This article characterizes the services providing care to victims in five Brazilian regions with high violence and accident rates. It analyzes care activities and strategies, the profile of the teams, the conditions of installations, equipment and supplies, integrated care and registration services and the opinion of health managers with respect to the needs and requirements for a better care to the victims. The sample is composed by 103 services: 34 from Recife, 25 from Rio de Janeiro, 18 from Manaus, 18 from Curitiba and 8 from Brasília. The still preliminary results indicate: lower number of services focusing on the elderly; scarce investment in preventive actions; the principal actions carried out are social assistance, ambulatory and hospital care and psychological assistance; patients received from Basic Health Units require attention of the communities and families; need for investment in capacity building programs for professionals; precarious registries, data handled manually. The wording of the National Policy for Reduction of Morbidity and Mortality from Accidents and Violence is not well-known and there is a lack of articulation among and inside sectors and between prehospital and emergency care services. Rehabilitation services are insufficient in all cities.

  4. Neonatal Intensive Care Unit Nurses Working in an Open Ward: Stress and Work Satisfaction.

    Science.gov (United States)

    Lavoie-Tremblay, Mélanie; Feeley, Nancy; Lavigne, Geneviève L; Genest, Christine; Robins, Stéphanie; Fréchette, Julie

    2016-01-01

    There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork. PMID:27455363

  5. Using Technology to Create a More Humanistic Approach to Integrating Palliative Care into the Intensive Care Unit.

    Science.gov (United States)

    Cox, Christopher E; Curtis, J Randall

    2016-02-01

    A decade ago, the major obstacles to integration of palliative care into the intensive care unit (ICU) were the limited number of providers trained in palliative care, an immature evidence base, and a lack of appreciation for the importance of palliative care in the ICU. In 2016, the palliative care workforce has expanded markedly and there is growing appreciation of the benefits of palliative care, whether provided by a generalist (intensivist, nurse, social worker) or palliative care specialist. However, there is evidence that the quality of ICU-based palliative care is often suboptimal. A major barrier to more broadly addressing this quality problem is the lack of scalable ICU-based palliative care models that use technology to deliver efficient, collaborative palliative care in the ICU setting to the right patient at the right time. To address these challenges, we first review strengths and limitations of current care models as the basis for our novel conceptual framework that uses the electronic health record as a platform on which external innovations can be built, including: (1) screening for patients at risk for poor outcomes, (2) integrating patient- and family-reported needs, (3) personalizing care, and (4) directing generalist versus specialist triage algorithms. In the approaches considered, we describe current challenges and propose specific solutions that use technology to improve the quality of the human interaction in a stressful, complex environment. PMID:26599829

  6. Danish Guidelines 2015 for percutaneous Dilatational Tracheostomy in the Intensive Care Unit

    DEFF Research Database (Denmark)

    Madsen, Kristian Rørbæk; Guldager, Henrik; Rewers, Mikael;

    2015-01-01

    Percutaneous dilatational tracheostomy is a common procedure in intensive care. This updated Danish national guideline describes indications, contraindications and complications, and gives recommendations for timing, anaesthesia, and technique, use of fibre bronchoscopy and ultrasound guidance, as...

  7. Percutaneous dilatational tracheostomy without fiber optic bronchoscopy-Evaluation of 80 intensive care units cases

    NARCIS (Netherlands)

    J.A. Calvache (Jose Andrés); R.A. Molina García (Rodrigo); A.L. Trochez (Adolfo); J. Benitez (Javier); L.A. Flga (Lucía Arroyo)

    2013-01-01

    textabstractBackground: The development of percutaneous dilatational tracheostomy techniques (PDT) has facilitated the procedure in Intensive Care Units (ICU). Objective: To describe the early intra and post-operative complications in ICU patients requiring percutaneous dilatational tracheostomy usi

  8. Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us

    OpenAIRE

    Zhang, Yu-Zhi; Singh, Suveer

    2015-01-01

    Antibiotic usage and increasing antimicrobial resistance (AMR) mount significant challenges to patient safety and management of the critically ill on intensive care units (ICU). Antibiotic stewardship programmes (ASPs) aim to optimise appropriate antibiotic treatment whilst minimising antibiotic resistance. Different models of ASP in intensive care setting, include “standard” control of antibiotic prescribing such as “de-escalation strategies”through to interventional approaches utilising bio...

  9. PATIENT DATA MANAGEMENT SYSTEM IN INTENSIVE CARE UNIT (ICU) USING LABVIEW

    OpenAIRE

    Amritjot Kaur*, Shimi S. L

    2016-01-01

    This paper proposes a new system that takes the benefits of data flow technology. Its objective is to collect the data from monitoring system in the intensive care unit (ICU) and store that data for further analysis. Then it will be available for medical personnel to analyze data and take the suitable medication for patients. In fact, the monitoring system in intensive care unit provides a large amount of data quickly and continuously. Most units operate with a very limited storage capacity w...

  10. Evaluation of Guidelines for the Use of Telemetry in the Non–Intensive-Care Setting

    OpenAIRE

    Estrada, Carlos A.; Rosman, Howard S.; Prasad, Niraj K; Battilana, Guido; Alexander, Myrna; Held, Arthur C; Young, Mark J.

    2000-01-01

    To determine if the American College of Cardiology (ACC) cardiac monitoring guidelines accurately stratify patients according to their risks for developing clinically significant arrhythmias in non–intensive-care settings, we conducted a prospective cohort study of 2,240 consecutive patients admitted to a non–intensive-care telemetry unit over 7 months. Sixty-one percent of patients were assigned to ACC class I (telemetry indicated in most patients), 38% to class II (telemetry indicated in so...

  11. How to compare adequacy of algorithms to control blood glucose in the intensive care unit?

    OpenAIRE

    Van den Berghe , Greet

    2004-01-01

    Vogelzang et al. retrospectively assessed a derivative marker of blood glucose control over time in the intensive care unit (ICU), "the hyperglycemic index" (HGI), in relation to outcome. The HGI predicted mortality better than other indices of blood glucose control that do not take the duration of hyperglycemia into account. This provided further support to the concept of maintaining normoglycemia with insulin throughout intensive care in order to improve outcome. The HGI was also proposed a...

  12. Physical Function and Mental Health in Trauma Intensive Care Patients: A 2-Year Cohort Study

    OpenAIRE

    Aitken, L.M.; Macfarlane, B.; Chaboyer, W; Schuetz, M.; Joyce, C.; Barnett, A.G.

    2015-01-01

    OBJECTIVES:: This study was designed to examine changes in function over time after injury and to identify factors associated with long-term recovery that may be amenable to change through intervention. DESIGN:: Prospective cohort study. SETTING:: Intensive care in a tertiary hospital in Queensland, Australia. PATIENTS:: Adult (n = 123) admitted to intensive care for treatment of injury. INTERVENTIONS:: Data were collected prior to hospital discharge and 1, 6, 12, and 24 months post injury. D...

  13. Practice patterns of physiotherapists in neonatal intensive care units: A national survey

    OpenAIRE

    Chokshi, Tejas; Alaparthi, Gopala Krishna; Krishnan, Shyam; Vaishali, K; Zulfeequer, C.P.

    2013-01-01

    Objective: To determine practice pattern of physiotherapists in the neonatal intensive care units (ICUs) in India with regards to cardiopulmonary and neuromuscular physiotherapy. Materials and Methods: A cross-sectional survey was conducted across India, in which 285 questionnaires were sent via e-mail to physiotherapists working in neonatal intensive care units. Results: A total of 139 completed questionnaires were returned with a response rate of 48.7%, with a majority of responses from Kar...

  14. In Our Intensive Care Unit the Experience of the Checklist Use to Prevent Ventilator Associated Pneumonia

    OpenAIRE

    Semiha Solak Grassie; Sümeyra Çetin Gevrek; Dilber Kumral

    2016-01-01

    Objective: Intensive care units are high risk units for serious infections like ventilator associated pneumonia. Preventing ventilator associated pneumonia is one of the most important infection control practice in intensive care units. In this study, it was aimed to investigate the effect of the ventilator associated pneumonia prevention checklist use in decreasing ventilator associated pneumonia rates. Material and Method: This study was performed in the int...

  15. Evaluation of functional independence after discharge from the intensive care unit

    OpenAIRE

    Curzel, Juliane; Forgiarini Junior, Luiz Alberto; Rieder, Marcelo de Mello

    2013-01-01

    Objective 1) To evaluate the functional independence measures immediately after discharge from an intensive care unit and to compare these values with the FIMs 30 days after that period. 2) To evaluate the possible associated risk factors. Methods The present investigation was a prospective cohort study that included individuals who were discharged from the intensive care unit and underwent physiotherapy in the unit. Functional independence was evaluated using the functional independence meas...

  16. Intensive Care Nurses’ Knowledge of Radiation Safety and Their Behaviors Towards Portable Radiological Examinations

    OpenAIRE

    Dianati, Mansoor; Zaheri, Azita; TALARI, Hamid reza; Deris, Fateme; Rezaei, Sara

    2014-01-01

    Background: Radiological examinations for patients who are hospitalized at intensive care units are usually performed using portable radiography devices. However they may require knowledge and safety precautions of nurses. Objectives: The aim of the study was to investigate ICU nurses’ knowledge of radiation safety and their behaviors towards portable radiological examinations. Materials and Methods: In total, 44 intensive care nurses were recruited for this cross-sectional descriptive study ...

  17. Psychosocial factors and mental work load: a reality perceived by nurses in intensive care units1

    OpenAIRE

    Paula Ceballos-Vásquez; Gladys Rolo-González; Estefanía Hérnandez-Fernaud; Dolores Díaz-Cabrera; Tatiana Paravic-Klijn; Mónica Burgos-Moreno

    2015-01-01

    OBJECTIVE: To analyse the perception of psychosocial factors and mental workload of nurses who work in intensive care units. It is hypothesised that nurses in these units could perceive psychosocial risks, manifesting in a high mental work load. The psychosocial dimension related to the position's cognitive demands is hypothesised to mostly explain mental work load. METHOD: Quantitative study, with a descriptive, cross-sectional, and comparative design. A total of 91% of the intensive care un...

  18. Simple radio-isotopic method for the detection of bronchial inhalation during intensive care

    Energy Technology Data Exchange (ETDEWEB)

    Venot, J.; Veyriras, E.; Vandroux, J.C.; Bournaud, E.; Gastinne, H.; Beck, C.

    1984-08-01

    The high incidence of pneumopathy in intensive care units might be due to the pulmonary aspiration of gastric juice following gastro-oesophageal reflux. The paper describes a radio-isotopic method using material easy to install at the patient's bedside. This technique demonstrated aspiration of gastric juice in the lungs of 8 of 25 intensive care patients investigated. Such a method might be useful later to demonstrate that silent bronchial aspirations of gastric juice are responsible for pulmonary complications.

  19. Maternal experiences with premature children in a neonatal intensive care unit

    OpenAIRE

    Raphael Colares de Sá; Lêda Maria da Frota Pinheiro Costa; Fabiane Elpídio de Sá

    2012-01-01

    Objective: Understand the maternal experience with premature children in neonatal intensive care unit. Methods: This is a qualitative and descriptive study. A questionnaire was used with semi-structured interview type, analyzed by the technique of content analysis and discussed, using the theoretical framework. The sample consisted of 11 mothers who accompanied their babies every day in the Neonatal Intensive Care Unit. Results: After discourse analysis emerged the following categories: exper...

  20. Early Rehabilitation in the Intensive Care Unit: Preventing Physical and Mental Health Impairments

    OpenAIRE

    Parker, Ann; Sricharoenchai, Thiti; Needham, Dale M.

    2013-01-01

    Survivors of critical illness often experience new or worsening impairments in physical, cognitive and/or mental health, referred to as post-intensive care syndrome (PICS). Such impairments can be long-lasting and negatively impact survivors’ quality of life. Early rehabilitation in the intensive care unit (ICU), while patients remain on life-support therapies, may reduce the complications associated with PICS. This article addresses evidence-based rehabilitation interventions to reduce the p...

  1. Intensive Care Unit–Acquired Weakness: Implications for Physical Therapist Management

    OpenAIRE

    Nordon-Craft, Amy; Moss, Marc; Quan, Dianna; Schenkman, Margaret

    2012-01-01

    Patients admitted to the intensive care unit (ICU) can develop a condition referred to as “ICU-acquired weakness.” This condition is characterized by profound weakness that is greater than might be expected to result from prolonged bed rest. Intensive care unit–acquired weakness often is accompanied by dysfunction of multiple organ systems. Individuals with ICU-acquired weakness typically have significant activity limitations, often requiring physical assistance for even the...

  2. Classification of pain and its treatment at an intensive care rehabilitation clinic

    OpenAIRE

    MacTavish, P.; McPeake, J.; Devine, H.; Kinsella, J; Daniel, M; Quasim, T.

    2016-01-01

    Introduction Treatment in an Intensive Care Unit (ICU) often necessitates uncomfortable and painful procedures for patients throughout their admission. There is growing evidence to suggest that chronic pain is becoming increasingly recognised as a long term problem for patients following an ICU admission [1]. Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) is a five week rehabilitation programme for patients and their caregivers after ...

  3. Gender differences in psychological morbidity and treatment in intensive care survivors - a cohort study

    OpenAIRE

    Schandl, Anna; Bottai, Matteo; Hellgren, Elisabeth; Sundin, Örjan; Sackey, Peter

    2012-01-01

    Introduction Many hospitals have initiated follow-up to facilitate rehabilitation after critical illness and intensive care, although the efficacy of such an intervention is uncertain. Studies in trauma research indicate significant differences in psychological reactions to traumatic events between men and women. Our aim, in a quasi-experimental design, was to compare psychological morbidity and treatment effects between men and women enrolled in a multidisciplinary intensive care unit (ICU) ...

  4. Sedation and memories of patients subjected to mechanical ventilation in an intensive care unit

    OpenAIRE

    Jaquilene Barreto da Costa; Sonia Silva Marcon; Claudia Rejane Lima de Macedo; Amaury Cesar Jorge; Péricles Almeida Delfino Duarte

    2014-01-01

    Objective To investigate the relationship between sedation and the memories reported by patients subjected to mechanical ventilation following discharge from the intensive care unit. Methods This prospective, observational, cohort study was conducted with individuals subjected to mechanical ventilation who remained in the intensive care unit for more than 24 hours. Clinical statistics and sedation records were extracted from the participants' clinical records; the data relative to the partici...

  5. Investigating risk factors for psychological morbidity three months after intensive care: a prospective cohort study

    OpenAIRE

    Wade, Dorothy M; Howell, David C; Weinman, John A; Hardy, Rebecca J; Mythen, Michael G.; Brewin, Chris R; Borja-Boluda, Susana; Matejowsky, Claire F; Raine, Rosalind A

    2012-01-01

    Introduction There is growing evidence of poor mental health and quality of life among survivors of intensive care. However, it is not yet clear to what extent the trauma of life-threatening illness, associated drugs and treatments, or patients' psychological reactions during intensive care contribute to poor psychosocial outcomes. Our aim was to investigate the relative contributions of a broader set of risk factors and outcomes than had previously been considered in a single study. Methods ...

  6. Are We Being Informed Correctly During the Patient Transfer to the Intensive Care Units?

    OpenAIRE

    Münire Babayiğit; Zehra Baykal Tutal; Necla Dereli; Handan Güleç; Mustafa Alparslan Babayiğit; Eyüp Horasanlı

    2016-01-01

    Objective: We aimed to demonstrate to what extent do the right information in patients’ inter-hospital transfers due to the intensive care indications Material and Method: In this study, 38 patients who applied to our general intensive care unit (ICU) from the other hospitals were included. The demographic data of patients, declarations before ICU admission and diagnosis after admission, the reason and accuracy of the transfer, the overall stay time and the treatments in ICU were recorded....

  7. Enteral nutrition practices in the intensive care unit: Understanding of nursing practices and perspectives

    OpenAIRE

    Babita Gupta; Pramendra Agrawal; Soni, Kapil D; Vikas Yadav; Roshni Dhakal; Shally Khurana; M C Misra

    2012-01-01

    Background: Adequate nutritional support is important for the comprehensive management of patients in intensive care units (ICUs). Aim: The study was aimed to survey prevalent enteral nutrition practices in the trauma intensive care unit, nurses′ perception, and their knowledge of enteral feeding. Study Design: The study was conducted in the ICU of a level 1 trauma center, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India. The study design used an audit. Materials...

  8. Characterisation of sleep in intensive care using 24-hour polysomnography: an observational study

    OpenAIRE

    Elliott, Rosalind; McKinley, Sharon; Cistulli, Peter; Fien, Mary

    2013-01-01

    Introduction Many intensive care patients experience sleep disruption potentially related to noise, light and treatment interventions. The purpose of this study was to characterise, in terms of quantity and quality, the sleep of intensive care patients, taking into account the impact of environmental factors. Methods This observational study was conducted in the adult ICU of a tertiary referral hospital in Australia, enrolling 57 patients. Polysomnography (PSG) was performed over a 24-hour pe...

  9. Relationship between oxidative and occupational stress and aging in nurses of an intensive care unit

    OpenAIRE

    Casado, Ángela; Castellanos, Alberto; López-Fernández, M. Encarnación; Ruíz, Rocío; García Aroca, Concha; Noriega, Federico

    2008-01-01

    Stressful conditions lead to formation of excessive reactive oxygen species (ROS) and cause oxidative stress and aging. The aim of this study was to determine superoxide dismutase (SOD) and catalase (CAT) activity, and malondialdehyde (MDA) levels in nurses of a hospital intensive care unit according to demographic and occupational parameters, and to analyse the relationship with aging. Thirty-two nurses working in an intensive care unit and 35 aged-matched healthy individuals of both sexes a...

  10. Study protocol: Intensive care anxiety and emotional recovery (Icare) - A prospective study

    OpenAIRE

    Castillo, M.; Aitken, L. M.; Cooke, M. L.

    2013-01-01

    Background Survivors of intensive care units (ICUs) commonly present with symptoms of anxiety, depression and post-traumatic stress disorder (PTSD) during recovery. A number of factors have been identified as predictors of these adverse emotional outcomes, but the role of state anxiety during critical illness in the development of these emotional problems remains unknown. Purpose The Intensive Care Anxiety and Emotional Recovery (ICARe) study protocol proposes the development of a s...

  11. Retrospective analysis of the intoxication cases followed in an intensive care unit

    OpenAIRE

    Taş, Nilay; Yağan, Özgür; YANCAR DEMİR, Esra; MUTLU, Tuğçe; ENGİNYURT, Özgür

    2015-01-01

    Intoxications occur accidentally or due to suicide attempts and some cases are evaluated in Intensive Care Unit (ICU). In this study, we aimed to evaluate the patients older than 18 years old who were admitted to our second level intensive care unit from emergency department between 2010-2013. All the patients with prediagnosis of poisoning who were admitted to ICU were evaluated with respect to their demographic properties, etiology of poisoning, substance that exposured, Glasgow Coma Scale ...

  12. Evaluation of hospital infections developing in intensive care unit during a decade and review of literature

    OpenAIRE

    Adnan Tüfek; Recep Tekin; Tuba Dal; Orhan Tokgöz; Erdal Doğan; Gönül Ölmez Kavak; Salih Hoşoğlu

    2012-01-01

    Objectives: Hospital acquired infections (HAI) are majorhealth problem in intensive care units. We aimed to determinethe nosocomial infection rate, distribution of HAI andthe distribution of microorganisms isolated from nosocomialinfections and their antibiotic resistance profiles in hospitalizedpatients in intensive care unit.Materials and methods: A total 222 patients with a diagnosisof hospital-acquired infection hospitalized between January2003 and June 2012 at Dicle University Medical Fa...

  13. Evaluation of Suicide and Intoxication Cases Admitted to our Newly Opened Intensive Care Unit

    OpenAIRE

    Nalan Muhammedoğlu; Gökçen Başaranoğlu; Yaşar Gökhan Gül; Mehmet Toptaş; Sevim Baltalı; Bengü Özütürk

    2014-01-01

    Aim: The aim of this study was to evaluate the suicide and intoxication cases between April 2011 and April 2013. Methods: We retrospectively analyzed hospital records of patients who were admitted to our intensive care unit due to suicide and intoxication. The age, sex, intoxication causes, laboratory analyses, treatment refusal rates, and the prognosis were evaluated. Results: A total of 308 patients (105 males, 203 females) were admitted to the intensive care unit. The mean age of t...

  14. Family members' lived experience in the intensive care unit: a phemenological study.

    LENUS (Irish Health Repository)

    McKiernan, Margaret

    2012-01-31

    AIM: To describe the lived experience of family members of patients in the intensive care unit. BACKGROUND: Admission of a critically ill relative to an intensive care unit causes anxiety and stress to family members. Nursing care is initially focused on maintaining the physiological stability of the patient and less on the needs and concerns of family members. Understanding how families make sense of this experience may help nurses focus on the delivery of family centred care. METHODOLOGY: A phenomenological method was used to describe the lived experiences of family members of patients in an intensive care unit. In-depth interviews were conducted with six family members and analysed using qualitative thematic analysis. RESULTS: Four main themes emerged from the data: the need to know, making sense of it all, being there with them and caring and support. Family members needed honest information about the patient\\'s progress and outcome to make the situation more bearable for them. Making sense of the situation was a continuous process which involved tracking and evaluating care given. Being with their relative sustained their family bond and was a way to demonstrate love and support. Caring reassurance provided by the nurses enabled a sense of security. Support was needed by family members to assist them in coping. CONCLUSION: The research provided an insight into how family members viewed the impact of the admission and how they subsequently found ways of dealing with the situation. RELEVANCE TO CLINICAL PRACTICE: Using a holistic approach to nursing assessment and care delivery in intensive care necessitates that nurses interact with and care for family members of patients. Development of a philosophy of family centred care is necessary, with formal assessment of families to take place soon after admission and an appropriate plan of care drawn up at this time.

  15. Nurse care assesment at the end of life in intensive critical units

    Directory of Open Access Journals (Sweden)

    Mª Cristina Pascual Fernández

    2013-11-01

    Full Text Available To die nowadays is not the critical instant of our existence in occidental societies. Technological and scientific advances in health sciences have not been developed equally company and humanization in care. Nurses play an important and responsible role at end of life care, to provide patients and their families comfort cares in dying process. The main objective was to describe and analyze the professionals’ cares in Intensive Care Unit at the end of life process. An observational study was developed and 472 surveys to critical care nurses of six high complexity hospitals of Madrid Community were made. The questionnaire on the evaluation from the cares to the children that die in Pediatrics Intensive Care was applied. We have obtained that nurses said that most of the families remained with their patient in the moment of the death and needed support and empathy from the staff. As a conclusion we could say that the cares to the patients in Intensive Care Unit should be improved.

  16. Children's Post-Traumatic Stress and the Role of Memory Following Admission to Intensive Care: A Review

    Science.gov (United States)

    Dow, Belinda; Kenardy, Justin; Long, Deborah; Le Brocque, Robyne

    2012-01-01

    Although our understanding of children's psychological outcomes following intensive care lags significantly behind advances in medicine, there is a growing awareness that intensive care admission impacts children beyond the boundaries of physical well-being. Intensive care presents a variety of disease-related, treatment-related, and…

  17. Nurses' experiences of caring for critically ill, non-sedated, mechanically ventilated patients in the Intensive Care Unit

    DEFF Research Database (Denmark)

    Laerkner, Eva; Egerod, Ingrid; Hansen, Helle Ploug

    2015-01-01

    closeness. CONCLUSION: Despite the complexity of care, nurses preferred to care for more awake rather than sedated patients and appreciated caring for just one patient at a time. The importance of close collaboration between nurses and doctors to ensure patient comfort during mechanical ventilation was......OBJECTIVE: The objective was to explore nurses' experiences of caring for non-sedated, critically ill patients requiring mechanical ventilation. DESIGN AND SETTING: The study had a qualitative explorative design and was based on 13 months of fieldwork in two intensive care units in Denmark where a...... protocol of no sedation is implemented. Data were generated during participant observation in practice and by interviews with 16 nurses. Data were analysed using thematic interpretive description. FINDINGS: An overall theme emerged: "Demanding, yet rewarding". The demanding aspects of caring for more awake...

  18. Role-based support for intensive care nursing: A designer's perspective

    NARCIS (Netherlands)

    Melles, M.

    2011-01-01

    Design goals and design directions are formulated for the (digital) support of non-technical nursing tasks and skills in the intensive care unit (ICU), such as organizing work, evaluating care, coping with stress and dealing with poor team dynamics. A conceptual framework for ICU nursing was develop

  19. Health Risk Behaviors in Family Caregivers During Patients’ Stay in Intensive Care Units: A Pilot Analysis

    Science.gov (United States)

    Choi, JiYeon; Hoffman, Leslie A.; Schulz, Richard; Ren, Dianxu; Donahoe, Michael P.; Given, Barbara; Sherwood, Paula R.

    2014-01-01

    Background Studies of family caregivers of the critically ill have mainly focused on the psychological impact of the patients’ stay in the intensive care unit and related stress. Despite known associations between stress and physical health, limited attention has been paid to the need to promote and maintain physical health in these caregivers. Objective To explore how family caregivers’ health risk behaviors are associated with patients’ preexisting care needs and the caregivers’ depressive symptoms and burden. Methods During the intensive-care-unit stay of critically ill patients (who required mechanical ventilation for ≥4 days), 50 family caregivers were surveyed to determine the caregivers’ depressive symptoms, burden, and health risk behaviors. Data were also collected on patients’ care needs before admission to the intensive care unit. Results One or more health risk behaviors were reported by 94% of family caregivers. More than 90% of caregivers reported depressive symptoms above the score indicating risk for clinical depression. A high level of burden was reported by 36% of caregivers. More health risk behaviors were associated with higher scores of depressive symptoms and burden (P<.001 for both). Caregivers’ responses did not differ according to patients’ preexisting care needs. Conclusion Health risk behaviors of family caregivers are associated with greater perceptions of burden and/or depressive symptoms but not with patients’ care needs before admission to the intensive care unit. PMID:23283087

  20. Physical Therapy Observation and Assessment in the Neonatal Intensive Care Unit

    Science.gov (United States)

    Byrne, Eilish; Campbell, Suzann K.

    2013-01-01

    This article presents the elements of the Observation and Assessment section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy assessments presented in this path are evidence-based and the suggested timing of these assessments is primarily based on practice knowledge from expert…

  1. Patients with diabetes in the intensive care unit; not served by treatment, yet protected?

    NARCIS (Netherlands)

    S.E. Siegelaar; J.H. Devries; J.B. Hoekstra

    2010-01-01

    Diabetes is associated with severe complications and decreased life expectancy. However, in the previous issue of Critical Care, Vincent and colleagues report no difference in mortality between patients with insulin-treated diabetes and patients without diabetes in the intensive care unit ( ICU), de

  2. Predictors of quality of life of people receiving intensive community-based care

    NARCIS (Netherlands)

    Emmerink, P.M.J.; Roeg, Diana

    2015-01-01

    Purpose Intensive community-based care (ICBC) is a home-treatment approach aiming to support people ‘living in the community’ with severe psychiatric and addiction problems. Although subjective quality of life (SQOL) is an increasingly important outcome measure in health care, little is known on ICB

  3. Determinants of procedural pain intensity in the intensive care unit. The Europain® study

    DEFF Research Database (Denmark)

    Puntillo, Kathleen A; Max, Adeline; Timsit, Jean-Francois;

    2014-01-01

    192 ICUs in 28 countries. MEASUREMENTS AND MAIN RESULTS: Pain intensity on a 0-10 numeric rating scale increased significantly from baseline pain during all procedures (P < 0.001). Chest tube removal, wound drain removal, and arterial line insertion were the three most painful procedures, with median...... distress; intensity of the worst pain on the same day, before the procedure; and procedure not performed by a nurse. A significant ICU effect was observed, with no visible effect of country because of its absorption by the ICU effect. Some of the risk factors became nonsignificant when each procedure was...

  4. Implementing New Practices: An Empirical Study of Organizational Learning in Hospital Intensive Care Units

    OpenAIRE

    Tucker, Anita L; Nembhard, Ingrid M.; Amy C. Edmondson

    2007-01-01

    This paper contributes to research on organizational learning by investigating specific learning activities undertaken by improvement project teams in hospital intensive care units and proposing an integrative model to explain implementation success. Organizational learning is important in this context because medical knowledge changes constantly and hospital care units must learn new practices if they are to provide high-quality care. To develop a model of factors affecting improvement proje...

  5. Hemodynamic Assessment and Monitoring in the Intensive Care Unit: an Overview

    OpenAIRE

    Adler, Adam C.; Ramakant Sharma; Thomas Higgins; McGee, William T

    2014-01-01

    The goal of hemodynamic monitoring in intensive care is to assess the adequacy of perfusion, specifically with regard to maintaining sufficient perfusion pressures and oxygen delivery. Precise volume management of peri-operative and critical care patients is crucial as under or over resuscitation is associated with adverse outcomes. Hemodynamic monitoring allows care to be individualized based on specific patient response to therapy and can provide early warning of impending perfusion deficit...

  6. Impact of a continuous education program on the quality of assistance offered by intensive care physiotherapy

    OpenAIRE

    Pinto, Walkyria Araújo Macedo; Rossetti, Heloisa Baccaro; Araújo, Abigail; Spósito Júnior, José Jonas; Salomão, Hellen; Mattos, Simone Siqueira; Rabelo, Melina Vieira; Machado, Flávia Ribeiro

    2014-01-01

    Objective To evaluate the role of quality indicators and adverse events registering in the quality assessment of intensive care physiotherapy and to evaluate the impact of implementing protocolized care and professional training in the quality improvement process. Methods A prospective before-after study was designed to assess 15 indicators of the quality of care. Baseline compliance and adverse events were collected before and after the implementation of treatment protocols and staff trainin...

  7. Bench-to-bedside review: Dealing with increased intensive care unit staff turnover: a leadership challenge

    OpenAIRE

    Laporta, Denny P; Burns, Judy; Doig, Chip J

    2005-01-01

    Critical care leaders frequently must face challenging situations requiring specific leadership and management skills for which they are, not uncommonly, poorly prepared. Such a fictitious scenario was discussed at a Canadian interdisciplinary critical care leadership meeting, whereby increasing intensive care unit (ICU) staff turnover had led to problems with staff recruitment. Participants discussed and proposed solutions to the scenario in a structured format. The results of the discussion...

  8. Incidence of Bacterial Isolates from Blood Culture in the Neonatal Intensive Care Unit of Tertiary Care Hospital

    Directory of Open Access Journals (Sweden)

    Afif Ahmed

    2012-12-01

    Full Text Available Background - Even with advancement in the care provided for patients in Neonatal Intensive Care Units (NICU and wide spread use of antibiotics, sepsis remains an important cause of high mortality and morbidity. This study was done to determine the Incidence of bacterial isolates. Objective - We aimed to investigate bacterial pathogens causing neonatal sepsis in the neonatal intensive care unit of Hamad Medical Corporation, Doha, Qatar. Materials and methods - Descriptive and retrospective study between August 2006 and June 2008, Neonatal Intensive Care Unit of Hamad Medical Corporation in Doha, Qatar. All neonates with culture-proven sepsis admitted to Neonatal Intensive Care Unit during study period. Results - Out of 2,851 blood culture sent to the laboratory 302 were positive. These cultures were obtained from 176 neonates resulting in sepsis incidence rates of 6.4 cases per 1,000 live births and case-fatality rates of 17%. Gram positive cocci, fungi, and gram negative bacilli made up 66%, 17.8%, and 16.2% of isolates respectively. Conclusion - Gram positive cocci are the major causes of neonatal sepsis in Doha. The high incidence rates of fungal sepsis are associated with increased mortality risk. Good infection control practice together with sensible antibiotic use and on-going surveillance would result in proper neonatal sepsis management, decrease in associated morbidity and mortality.

  9. Ethical Issues Recognized by Critical Care Nurses in the Intensive Care Units of a Tertiary Hospital during Two Separate Periods

    OpenAIRE

    Park, Dong Won; Moon, Jae Young; Ku, Eun Yong; Kim, Sun Jong; Koo, Young-Mo; Kim, Ock-Joo; Lee, Soon Haeng; Jo, Min-Woo; Lim, Chae-Man; Armstrong, John David; Koh, Younsuck

    2015-01-01

    This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2...

  10. The Obstacles against Nurse-Family Communication in Family-Centered Care in Neonatal Intensive Care Unit: a Qualitative Study

    OpenAIRE

    Zahra Hadian Shirazi; Farkhondeh Sharif; Mahnaz Rakhshan; Narjes Pishva; Faezeh Jahanpour

    2015-01-01

    Introduction: Communication is one of the key principles in Family-Centered Care (FCC). Studies have shown some drawbacks in communication between families and nurses. Therefore, the present study aimed to recognize the obstacles against nurse-family communication in FCC in Neonatal Intensive Care Unit (NICU). Methods: This qualitative study was conducted on 8 staff nurses in 2 NICUs affiliated to Shiraz University of Medical Sciences selected through purposive sampling. The data were collect...

  11. Providing support to doctors working in intensive care

    LENUS (Irish Health Repository)

    Murphy, JFA

    2012-05-01

    ‘Jading’ is a process of exhaustion in which apathy and cynicism replace the drive to be responsive and caring. ‘Burnout’ a term first coined in the psychology literature in 1974 was based on Graham Greene’s novel ‘A Burnt-Out Case1. It is the umbrella description for disengagement in the workplace setting characterised by withdrawal, denial and inefficiency. There is an alienation from the pressures of work. Marshall and Kasman2 defined it as ‘the loss of motivation for creative thought’. It is the opposite of engagement which is associated with energy and optimism. People who experience all 3 symptoms- emotional exhaustion, negative attitude towards patients, reduced sense of personal accomplishment- have the greatest degree of burnout. It doesn’t get better by being ignored. These processes have serious consequences for the individual involved and the hospital that they work in. The doctor underperforms and the Unit becomes dysfunctional There is decreased quality of care, increased absenteeism, and high staff turnover. There is an inability to make decisions and a failure to set priorities.

  12. Six-month survival and quality of life of intensive care patients with acute kidney injury

    OpenAIRE

    Nisula, Sara; Vaara, Suvi T; Kaukonen, Kirsi-Maija; Reinikainen, Matti; Koivisto, Simo-Pekka; Inkinen, Outi; Poukkanen, Meri; Tiainen, Pekka; Pettilä, Ville; Korhonen, Anna-Maija

    2013-01-01

    Introduction Acute kidney injury (AKI) has high incidence among the critically ill and associates with dismal outcome. Not only the long-term survival, but also the quality of life (QOL) of patients with AKI is relevant due to substantial burden of care regarding these patients. We aimed to study the long-term outcome and QOL of patients with AKI treated in intensive care units. Methods We conducted a predefined six-month follow-up of adult intensive care unit (ICU) patients from the prospect...

  13. Predictors of postoperative pulmonary complications after liver resection: Results from a tertiary care intensive care unit

    Directory of Open Access Journals (Sweden)

    Anirban Hom Choudhuri

    2014-01-01

    Full Text Available Background: Postoperative pulmonary complication (PPC is a serious complication after liver surgery and is a major cause of mortality and morbidity in the intensive care unit (ICU. Therefore, the early identification of risk factors of PPCs may help to reduce the adverse outcomes. Objective: The aim of this retrospective study was to determine the predictors of PPCs in patients undergoing hepatic resection. Design: Retrospective, observational. Methods: The patients admitted after hepatic resection in the gastrosurgical ICU of our institute between October 2009 and June 2013 was identified. The ICU charts were retrieved from the database to identify patients who developed PPCs. A comparison of risk factors was made between the patients who developed PPC (PPC group against the patients who did not (no-PPC group. Results: Of 117 patients with hepatic resection, 28 patients developed PPCs. Among these, pneumonia accounted for 12 (42.8% followed by atelectasis in 8 (28.5% and pleural effusion in 3 (10.7%. Among the patients developing PPCs, 16 patients were over a 70-year-old (57.1%, 21 patients were smokers (75% and 8 patients (28.5% had chronic obstructive pulmonary disease (COPD. The requirement for blood transfusion and duration of mechanical ventilation were greater in the patients developing PPC (2000 ± 340 vs. 1000 ± 210 ml; 10 ± 4.5 vs. 3 ± 1.3 days. Conclusion: Old age, chronic smoking, COPD, increased blood product transfusion, increased duration of mechanical ventilation and increased length of ICU stay increased the relative risk of PPC, presence of diabetes and occurrence of surgical complications (leak, dehiscence, etc. were independent predictive variables for the development of PPC.

  14. Quality of life and persisting symptoms in intensive care unit survivors: implications for care after discharge

    Directory of Open Access Journals (Sweden)

    Dorsett Joanna

    2009-08-01

    Full Text Available Abstract Background We assessed the quality of life of ICU survivors using SF-36 at 4 months after ICU discharge and investigated any correlation of PCS and MCS with age, illness severity and hospital or ICU length of stay. We examined the relationship between these variables, persisting physical and psychological symptoms and the perceived benefit of individual patients of follow-up. Findings For one year, adult patients admitted for multiple organ or advanced respiratory support for greater than 48 hours to a 16-bedded teaching hospital general intensive care unit were identified. Those surviving to discharge were sent a questionnaire at 4 months following ICU discharge assessing quality of life and persisting symptoms. Demographic, length of stay and illness severity data were recorded. Higher or lower scores were divided at the median value. A two-tailed Students t-test assuming equal variances was used for normally-distributed data and Mann-Whitney tests for non-parametric data. 87 of 175 questionnaires were returned (50%, but only 65 had sufficient data giving a final response rate of 37%. Elderly patients had increased MCS as compared with younger patients. The PCS was inversely related to hospital LOS. There was a significant correlation between the presence of psychological and physical symptoms and desire for follow-up. Conclusion Younger age and prolonged hospital stay are associated with lower mental or physical quality of life and may be targets for rehabilitation. Patients with persisting symptoms at 4 months view follow-up as beneficial and a simple screening questionnaire may identify those likely to attend outpatient services.

  15. Training in Family-Focused Developmental Care: Bridging the Gap between Traditional and Family-Centered Care in a Neonatal Intensive Care Unit.

    Science.gov (United States)

    Walburn, Kathleen S.; Balsillie, Lois J.; Heermann, Judith A.

    1997-01-01

    An educational program developed to prepare health professionals in a neonatal intensive care unit to initiate family-focused developmental care (FFDC) is described. The program was designed to support families with preterm infants. Findings suggest that the program was cost-efficient, prepared nurses to efficiently initiate FFDC, and improved…

  16. Midwives and obstetric nurses in the Brazilian Unified Health System and Primary Health Care: for a systemic and progressive incorporation

    Directory of Open Access Journals (Sweden)

    Armando Henrique Norman

    2015-03-01

    Full Text Available The objective of this paper is to present a proposal for a gradual and systemic incorporation of midwives and obstetric nurses into the Brazilian Unified Health System (SUS and Primary Health Care (PHC. The proposal was born from contact with the British experience, based on midwives, which is briefly described. In Brazil, these professionals would progressively take over the prenatal, delivery and postpartum care for pregnant women of usual risk in a region, in partnership with the PHC teams. This creates a specific niche for practicing, monitoring and evaluating the pregnancy care, based on the specific life cycle continued care with the user closely linked to the PHC team. There are technical and institutional conditions favorable to the development of this type of proposal, but there is a need to overcome the political obstacles. Its realization is a powerful strategy to reduce the high rates of obstetric violence, especially the significant cesarean rates in Brazil, contributing to humanization of childbirth in the SUS.

  17. Glucose control in the intensive care unit: a roller coaster ride or a swinging pendulum?

    Science.gov (United States)

    Comi, Richard J

    2009-06-01

    Many studies of tight control of blood glucose in critically ill patients are associated with poor outcomes. However, randomized studies of tight glucose control in patients admitted to coronary care or surgical intensive care units showed a reduction in mortality rates; supported by recommendations from professional organizations, many intensive care units implemented protocols for tight glucose control. More recent studies in medical intensive care units did not confirm the benefits of tight control, however, and the most recent study suggests that tight control increases mortality rates. Furthermore, tight control significantly increases episodes of hypoglycemia. The sum of the recent literature suggests that a degree of glucose control lies between the extremes of the adverse outcomes related to poor glucose control and those related to overly aggressive glucose control. PMID:19487715

  18. Sleeping on a problem: the impact of sleep disturbance on intensive care patients - a clinical review.

    Science.gov (United States)

    Delaney, Lori J; Van Haren, Frank; Lopez, Violeta

    2015-01-01

    Sleep disturbance is commonly encountered amongst intensive care patients and has significant psychophysiological effects, which protract recovery and increases mortality. Bio-physiological monitoring of intensive care patients reveal alterations in sleep architecture, with reduced sleep quality and continuity. The etiological causes of sleep disturbance are considered to be multifactorial, although environmental stressors namely, noise, light and clinical care interactions have been frequently cited in both subjective and objective studies. As a result, interventions are targeted towards modifiable factors to ameliorate their impact. This paper reviews normal sleep physiology and the impact that sleep disturbance has on patient psychophysiological recovery, and the contribution that the clinical environment has on intensive care patients' sleep. PMID:25852963

  19. Communication and Culture in the Surgical Intensive Care Unit: Boundary Production and the Improvement of Patient Care.

    Science.gov (United States)

    Conn, Lesley Gotlib; Haas, Barbara; Cuthbertson, Brian H; Amaral, Andre C; Coburn, Natalie; Nathens, Avery B

    2016-06-01

    This ethnography explores communication around critically ill surgical patients in three surgical intensive care units (ICUs) in Canada. A boundary framework is used to articulate how surgeons', intensivists', and nurses' communication practices shape and are shaped by their respective disciplinary perspectives and experiences. Through 50 hours of observations and 43 interviews, these health care providers are found to engage in seven communication behaviors that either mitigate or magnify three contested symbolic boundaries: expertise, patient ownership, and decisional authority. Where these boundaries are successfully mitigated, experiences of collaborative, high-quality patient care are produced; by contrast, boundary magnification produces conflict and perceptions of unsafe patient care. Findings reveal that high quality and safe patient care are produced through complex social and cultural interactions among surgeons, intensivists, and nurses that are also expressions of knowledge and power. This enhances our understanding of why current quality improvement efforts targeting communication may be ineffective. PMID:26481945

  20. [A limited role for telemedicine on the Dutch intensive care].

    Science.gov (United States)

    Girbes, Armand R J; Vroom, Margreeth B

    2014-01-01

    The use of telecommunication and information technology has evolved rapidly in many areas. However, it has not kept pace for the organisation of medicine. It can be expected that e-Health will revolutionise the landscape of medicine in the coming years. Due to a shortage of intensivists, with the 24/7 availability of an intensivist in less than 30% of ICUs, tele-ICU care has been introduced in the U.S. with proven beneficial effects on patient outcome and economics. This cannot be compared with the Dutch situation where there are short distances between hospitals, ubiquitous, excellent infrastructure for patient transport and a sufficient number of intensivists. Furthermore, an ICU is not only characterised by its own means in terms of human resources and equipment, but also by the 24/7 availability of other (critical) medical specialities in the hospital. The contribution of tele-ICU is therefore limited in the Netherlands but might play a role for second opinions and consultation for highly specialized expertise. PMID:25534269

  1. Evolving paradigm of illnesses presented to medical Intensive Care Unit in body builders: Cases from tertiary care center

    OpenAIRE

    Sunil Kumar Garg

    2015-01-01

    Bodybuilding is the use of progressive resistance exercise to control and develop one′s musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects.

  2. Evolving paradigm of illnesses presented to medical Intensive Care Unit in body builders: Cases from tertiary care center.

    Science.gov (United States)

    Garg, Sunil Kumar

    2015-04-01

    Bodybuilding is the use of progressive resistance exercise to control and develop one's musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects. PMID:25878431

  3. Evolving paradigm of illnesses presented to medical Intensive Care Unit in body builders: Cases from tertiary care center

    Directory of Open Access Journals (Sweden)

    Sunil Kumar Garg

    2015-01-01

    Full Text Available Bodybuilding is the use of progressive resistance exercise to control and develop one′s musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects.

  4. Cost analysis of nucleic acid amplification for diagnosing pulmonary tuberculosis, within the context of the Brazilian Unified Health Care System

    Directory of Open Access Journals (Sweden)

    Márcia Pinto

    2015-12-01

    Full Text Available ABSTRACT We estimated the costs of a molecular test for Mycobacterium tuberculosis and resistance to rifampin (Xpert MTB/RIF and of smear microscopy, within the Brazilian Sistema Único de Saúde (SUS, Unified Health Care System. In SUS laboratories in the cities of Rio de Janeiro and Manaus, we performed activity-based costing and micro-costing. The mean unit costs for Xpert MTB/RIF and smear microscopy were R$35.57 and R$14.16, respectively. The major cost drivers for Xpert MTB/RIF and smear microscopy were consumables/reagents and staff, respectively. These results might facilitate future cost-effectiveness studies and inform the decision-making process regarding the expansion of Xpert MTB/RIF use in Brazil.

  5. Voluntary peer review as innovative tool for quality improvement in the intensive care unit – a retrospective descriptive cohort study in German intensive care units

    Science.gov (United States)

    Kumpf, Oliver; Bloos, Frank; Bause, Hanswerner; Brinkmann, Alexander; Deja, Maria; Marx, Gernot; Kaltwasser, Arnold; Dubb, Rolf; Muhl, Elke; Greim, Clemens-A.; Weiler, Norbert; Chop, Ines; Jonitz, Günther; Schaefer, Henning; Felsenstein, Matthias; Liebeskind, Ursula; Leffmann, Carsten; Jungbluth, Annemarie; Waydhas, Christian; Pronovost, Peter; Spies, Claudia; Braun, Jan-Peter

    2014-01-01

    Introduction: Quality improvement and safety in intensive care are rapidly evolving topics. However, there is no gold standard for assessing quality improvement in intensive care medicine yet. In 2007 a pilot project in German intensive care units (ICUs) started using voluntary peer reviews as an innovative tool for quality assessment and improvement. We describe the method of voluntary peer review and assessed its feasibility by evaluating anonymized peer review reports and analysed the thematic clusters highlighted in these reports. Methods: Retrospective data analysis from 22 anonymous reports of peer reviews. All ICUs – representing over 300 patient beds – had undergone voluntary peer review. Data were retrieved from reports of peers of the review teams and representatives of visited ICUs. Data were analysed with regard to number of topics addressed and results of assessment questionnaires. Reports of strengths, weaknesses, opportunities and threats (SWOT reports) of these ICUs are presented. Results: External assessment of structure, process and outcome indicators revealed high percentages of adherence to predefined quality goals. In the SWOT reports 11 main thematic clusters were identified representative for common ICUs. 58.1% of mentioned topics covered personnel issues, team and communication issues as well as organisation and treatment standards. The most mentioned weaknesses were observed in the issues documentation/reporting, hygiene and ethics. We identified several unique patterns regarding quality in the ICU of which long-term personnel problems und lack of good reporting methods were most interesting Conclusion: Voluntary peer review could be established as a feasible and valuable tool for quality improvement. Peer reports addressed common areas of interest in intensive care medicine in more detail compared to other methods like measurement of quality indicators. PMID:25587245

  6. A study of the impact of long-term tobacco smoking on postoperative intensive care admission

    DEFF Research Database (Denmark)

    Møller, A M; Pedersen, T; Villebro, N;

    2003-01-01

    Smoking is a risk factor for intra-operative pulmonary complications and a wide range of postoperative pulmonary, cardiovascular, infection and wound-related complications. These may all lead to unplanned postoperative intensive care admission. We tested the hypothesis that smokers have an increa......Smoking is a risk factor for intra-operative pulmonary complications and a wide range of postoperative pulmonary, cardiovascular, infection and wound-related complications. These may all lead to unplanned postoperative intensive care admission. We tested the hypothesis that smokers have...... an increased incidence of postoperative intensive care admission and more postoperative complications than nonsmokers in a general and orthopaedic surgical population. The following information was assessed in 6026 surgical patients: age, sex and smoking status (pack-years), history of heart and lung disease......, American Society of Anesthesiologists (ASA) physical classification, intensive care admission and postoperative complications. Two thousand five hundred and twenty-six (46%) were smokers but for 620 patients (10.3%) smoking status was not confirmed. Postoperative intensive care admission was required...

  7. Short-and long-term health implications of surgical intensive care in the elderly

    Directory of Open Access Journals (Sweden)

    Stefan Utzolino

    2010-12-01

    Full Text Available Background: Treatment of elderly patients on intensive care units is an increasing challenge all over the world. Objectives: To evaluate short- term survival and long-term quality of life im-plications of intensive care for the elderly. Methods: Retrospective analysis of 314 patients 75 years of age or more requiring over 48 hours of intensive care. Results: In multivariate analy-sis, significant risk factors for mortality were chronic renal impairment (OR for survival .30, p < 0.001 and chronic obstructive pulmonary disease (OR 0.48, p = 0.003, pneumonia (OR for non-surviving 3.01, p < 0.001, or thrombosis (OR 1.89, p = 0.003; sepsis was not (OR 1.96, p = 0.055. Therapeutic measures associated with mortality were ventilator therapy > 24 h (OR 4.5, hemodialysis (OR 6.8, and vasopressor therapy (OR 2.5, p < 0.001 for each. A health survey questionnaire in an up to 60-month follow-up of 28 patients revealed considerably lower physi-cal subscores of our patients compared to the general elderly population. Conclusions: Elderly patients benefit from intensive care in terms of survival. Complications are frequent, as are severe consequences for long-term quality of life. Short-term mortality in elderly intensive care patients correlates most closely to pre- existing disease, not age.

  8. Comparison of a nurse initiated insulin infusion protocol for intensive insulin therapy between adult surgical trauma, medical and coronary care intensive care patients

    Directory of Open Access Journals (Sweden)

    Kuper Philip J

    2007-08-01

    Full Text Available Abstract Background Sustained hyperglycemia is a known risk factor for adverse outcomes in critically ill patients. The specific aim was to determine if a nurse initiated insulin infusion protocol (IIP was effective in maintaining blood glucose values (BG within a target goal of 100–150 mg/dL across different intensive care units (ICUs and to describe glycemic control during the 48 hours after protocol discontinuation. Methods A descriptive, retrospective review of 366 patients having 28,192 blood glucose values in three intensive care units, Surgical Trauma Intensive Care Unit (STICU, Medical (MICU and Coronary Care Unit (CCU in a quaternary care hospital was conducted. Patients were > 15 years of age, admitted to STICU (n = 162, MICU (n = 110 or CCU (n = 94 over 8 months; October 2003-June 2004 and who had an initial blood glucose level > 150 mg/dL. We summarized the effectiveness and safety of a nurse initiated IIP, and compared these endpoints among STICU, MICU and CCU patients. Results The median blood glucose values (mg/dL at initiation of insulin infusion protocol were lower in STICU (188; IQR, 162–217 than in MICU, (201; IQR, 170–268 and CCU (227; IQR, 178–313; p p = 0.27. Hypoglycemia (BG p = 0.85. Protocol violations were uncommon in all three ICUs. Mean blood glucose 48 hours following IIP discontinuation was significantly different for each population: 142 mg/dL in STICU, 167 mg/dL in MICU, and 160 mg/dL in CCU (p Conclusion The safety and effectiveness of nurse initiated IIP was similar across different ICUs in our hospital. Marked variability in glucose control after the protocol discontinuation suggests the need for further research regarding glucose control in patients transitioning out of the ICU.

  9. Nosocomial infection in a Danish Neonatal Intensive Care Unit: a prospective study

    DEFF Research Database (Denmark)

    Olsen, Anne L; Reinholdt, Jes; Jensen, Anders Mørup;

    2009-01-01

    AIM: The aim of this study was to estimate the incidence and identify independent risk factors for nosocomial infections in a Danish Neonatal Intensive Care Unit and to compare these findings with international results. METHODS: The study was performed prospectively from January 1, 2005 to December...... 31, 2005 in the Neonatal Intensive Care Unit at Rigshospitalet, Copenhagen. Specific criteria for blood stream infection and respiratory tract infection adapted for neonates in our ward were worked out. RESULTS: Six hundred and eighty-three patients were included. The overall incidence of nosocomial...... respiratory tract infection, and central venous catheter and parenteral nutrition risk factors for first time blood stream infection. CONCLUSION: This first prospective study of nosocomial infection in a Danish Neonatal Intensive Care Unit found an overall incidence of 8.8/1000 hospital days, which is low or...

  10. Prediction of chronic critical illness in a general intensive care unit

    Directory of Open Access Journals (Sweden)

    Sérgio H. Loss

    2013-06-01

    Full Text Available OBJECTIVE: To assess the incidence, costs, and mortality associated with chronic critical illness (CCI, and to identify clinical predictors of CCI in a general intensive care unit. METHODS: This was a prospective observational cohort study. All patients receiving supportive treatment for over 20 days were considered chronically critically ill and eligible for the study. After applying the exclusion criteria, 453 patients were analyzed. RESULTS: There was an 11% incidence of CCI. Total length of hospital stay, costs, and mortality were significantly higher among patients with CCI. Mechanical ventilation, sepsis, Glasgow score < 15, inadequate calorie intake, and higher body mass index were independent predictors for cci in the multivariate logistic regression model. CONCLUSIONS: CCI affects a distinctive population in intensive care units with higher mortality, costs, and prolonged hospitalization. Factors identifiable at the time of admission or during the first week in the intensive care unit can be used to predict CCI.

  11. Diagnosis of the thorax in the intensive-care ward: Digital radiography

    International Nuclear Information System (INIS)

    Only few reports have been published so far on the clinical use of digital luminescence radiography (DLR). We report on 3.000 X-ray examinations of the thorax in the intensive-care ward performed by us since a suitable system (Philips PCR) had been installed in December 1987. The following advantages must be pointed out in respect of using DLR in thoracic diagnosis in the intensive-care ward: No faulty exposures; the thorax can be X-rayed with the patient recumbent in bed, with lateral take; the image brightness is maintained at a constant level by histogram selection; electronic image processing and storage. Hence, DLR entails considerable improvement in X-ray diagnosis of intensive-care patients. (orig.)

  12. A new mobile X-ray generator for the application in the intensive care department

    International Nuclear Information System (INIS)

    This report introduces a new, mobile radiologic unit, the MOBILETT which has been used in the X-ray department of the Chirurgische Universitaetsklinik at Erlangen since November 1981. This system is a compact, highly mobile X-ray unit whose technical specifications (high-frequency generator with a performance of up to 30 kW, high input power of up to 400 mA and shortest exposure time down from 3 ms with a total weight of only 230 kg) show that this instrument has been designed particularly for the application in intensive care departments. The study reports about the application of this system in the intensive care department, about its handling and operation as well as its adaptation to any intensive care patient. (orig.)

  13. Opinion Piece: honouring the wishes of a dying patient: from intensive care to home with palliative care.

    Science.gov (United States)

    Campbell, Lynette

    2013-10-01

    Due to the severity of illness, death is not uncommon in intensive care units (ICU). Unfortunately, a major percentage of deaths in ICU are patients diagnosed with a terminal disease. Initiating discussions on the transition from curative care to palliative care can be stressful for doctors, patients and families. The challenge for doctors, is to maintain open communication and shared-decision making with patients and family members at this very sensitive time. This can be challenging due to the culture of ICU which focuses on saving lives rather than palliation. Facilitating discussions for terminally ill patients in ICU may enhance their end-of-life care and assist patients to die in an environment of their choice such as their home. PMID:24299256

  14. Posttraumatic stress syndrome associated with stays in the intensive care unit: importance of nurses' involvement.

    Science.gov (United States)

    Warlan, Heather; Howland, Lois

    2015-06-01

    More patients in the intensive care unit are surviving their critical illnesses because of advances in medical care. This change in survival has led to an increased awareness of the emotional consequences of being critically ill. Posttraumatic stress disorder has been identified in approximately 9% to 27% of critically ill patients compared with 7% of the general US population. Risk factors such as treatment with mechanical ventilation, sedation, delusional memories, and agitation are associated with development of posttraumatic stress disorder in patients in the intensive care unit. Individuals with posttraumatic stress disorder are more likely to experience negative physical and psychiatric health outcomes and a lower quality of life than are patients without the disorder. Early identification and treatment of patients experiencing these signs and symptoms may reduce these physical and psychological comorbid conditions. Through careful monitoring of medications, early mobilization, sleep promotion, and pain management, nurses may be able to reduce signs and symptoms of posttraumatic stress disorder. PMID:26033100

  15. Knowing the occasion of a peaceful death in intensive care units in Thailand.

    Science.gov (United States)

    Kongsuwan, Waraporn; Locsin, Rozzano C; Schoenhofer, Savina O

    2011-03-01

    The purpose of this study was to describe how nurses know the occasion of a peaceful death. The data were generated from individual in-depth interviews with ten nurses who practised in adult intensive care units in the southern region of Thailand. Using a content analysis method, four processes of knowing the occasion of a peaceful death were isolated. They were visual knowing, technological knowing, intuitive knowing, and relational knowing.The clinical implications of these processes provide opportunities for nurses to practise the best end-of-life care during a critical time in a patient's life.This study also strengthens cross-cultural nursing during end-of-life care in high-technology settings, such as the intensive care unit. PMID:21352432

  16. Implementing a Mobility Program to Minimize Post-Intensive Care Syndrome.

    Science.gov (United States)

    Hopkins, Ramona O; Mitchell, Lorie; Thomsen, George E; Schafer, Michele; Link, Maggie; Brown, Samuel M

    2016-01-01

    Immobility in the intensive care unit (ICU) is associated with neuromuscular weakness, post-intensive care syndrome, functional limitations, and high costs. Early mobility-based rehabilitation in the ICU is feasible and safe. Mobility-based rehabilitation varied widely across 5 ICUs in 1 health care system, suggesting a need for continuous training and evaluation to maintain a strong mobility-based rehabilitation program. Early mobility-based rehabilitation shortens ICU and hospital stays, reduces delirium, and increases muscle strength and the ability to ambulate. Long-term effects include increased ability for self-care, faster return to independent functioning, improved physical function, and reduced hospital readmission and death. Factors that influence early mobility-based rehabilitation include having an interdisciplinary team; strong unit leadership; access to physical, occupational, and respiratory therapists; a culture focused on patient safety and quality improvement; a champion of early mobility; and a focus on measuring performance and outcomes. PMID:27153308

  17. Use of analgesic agents for invasive medical procedures in pediatric and neonatal intensive care units.

    Science.gov (United States)

    Bauchner, H; May, A; Coates, E

    1992-10-01

    The purpose of this study was to assess the use of analgesic agents for invasive medical procedures in pediatric and neonatal intensive care units. The directors of 38 pediatric units and 31 neonatal units reported that analgesics were infrequently used for intravenous cannulation (10%), suprapubic bladder aspiration (8%), urethral catheterization (2%), or venipuncture (2%). Analgesics were used significantly more regularly in pediatric than in neonatal intensive care units for arterial line placement, bone marrow aspiration, central line placement, chest tube insertion, paracentesis, and lumbar puncture. PMID:1403404

  18. The prevalence of vitamin D deficiency in intensive care unit and its influence on prognosis

    Institute of Scientific and Technical Information of China (English)

    胡杰妤

    2013-01-01

    Objective To investigate the prevalence of vitamin D deficiency in medical intensive care unit (ICU) and its relationship with severity of disease and prognosis.Methods A prospective study was performed to evaluate vitamin D status in 216 patients admitted to the medical intensive care unit.The incidence of hypovitaminosis D was observed.Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) score,days kept in ICU and on ventilator,main laboratory findings,and mortality rate were compared among patients with different serum 25-hydroxyvi-

  19. Impact of intensive care on renal function before graft harvest: results of a monocentric study

    OpenAIRE

    Blasco, Valéry; Leone, Marc; Bouvenot, Julien; Geissler, Alain; Albanèse, Jacques; Martin, Claude

    2007-01-01

    Background The aim of life-support measures in brain-dead donors is to preserve the functional value of their organs. In renal transplantation, serum creatinine level is one of the criteria for graft harvest. The aim of this study was to assess the impact of intensive care on donor renal function through two criteria: preharvesting serum creatinine level above 120 μmol/L and the elevation of serum creatinine level above 20% between intensive care unit (ICU) admission and graft harvest. Method...

  20. Allocation of patients with liver cirrhosis and organ failure to intensive care

    DEFF Research Database (Denmark)

    Prier Lindvig, Katrine; Søgaard Teisner, Ane; Kjeldsen, Jens;

    2015-01-01

    AIM: To propose an allocation system of patients with liver cirrhosis to intensive care unit (ICU), and developed a decision tool for clinical practice. METHODS: A systematic review of the literature was performed in PubMed, MEDLINE and EMBASE databases. The search includes studies on hospitalized...... patients with cirrhosis and organ failure, or acute on chronic liver failure and/or intensive care therapy. RESULTS: The initial search identified 660 potentially relevant articles. Ultimately, five articles were selected; two cohort studies and three reviews were found eligible. The literature on this...

  1. Imaging in intensive care medicine. Techniques, indications, diagnostic signs. Pt. 1

    International Nuclear Information System (INIS)

    The intensive care medicine also profits from the rapid progress made in the field of diagnostic radiology: The modern techniques available today permit to come to a conclusive diagnosis much faster than before, provided that the doctors keep abreast with the chances and restraints of the diagnostic imaging methods applicable in intensive care medicine. This contribution presents a topical survey of the potentials of the various imaging methods, taking as a starting point the essential clinical approaches and indications as well as problems involved. The diagnostic signs are discussed, together with recommended diagnostic procedures. (orig./CB)

  2. [The problem of intensive care of premature and newborn infants (author's transl)].

    Science.gov (United States)

    Esser, K J; Hörnchen, H; Mischke, W

    1981-01-01

    Today there is a controversy about the demand for the preservation of human life at any price. Special difficult problems result from intensive care of premature and newborn infants. The clinical criterions of cerebral death are different to those of adults, special investigations are restricted in their application. Often you cannot be sure of the prognosis in spite of knowing the diagnosis. Should the competent parents decide with us about the renunciation of a -- further -- intensive care? It is necessary to value all available factors to take the right decision. The paper wants to inform about some important criterions and stimulate the discussion. PMID:7193775

  3. Antidepressant or Antipsychotic Overdose in the Intensive Care Unit - Identification of Patients at Risk

    DEFF Research Database (Denmark)

    Borg, Linda; Julkunen, Anna; Madsen, Kristian Rørbaek;

    2016-01-01

    adverse signs at hospital admission that turned out to need intensive care treatment. The effect of the antidepressants overdose risk assessment (ADORA) system was evaluated in patients with antidepressant as well as antipsychotic overdose. Our hypothesis was that patients with low ADORA do not need...... obvious need of intensive care. Of the 157 patients included, 12 patients (8%) developed events during the ICU stay. Only 3 patients received intubation, vasoactive drugs and/or dialysis. None developed ventricular dysrhythmias. There were no fatalities. All the patients with low-risk assessment by ADORA...

  4. [Parental roles and needs in neonatal intensive care: a review of Portuguese guidelines].

    Science.gov (United States)

    Amorim, Mariana; Alves, Elisabete; Barros, Henrique; Silva, Susana

    2016-08-01

    The scope of this article is to analyze the parental roles and needs included in Neonatal Intensive Care Unit guidelines. Thematic content analysis was conducted of 33 guidelines (28 consensuses and 5 documents directed to parents) freely available on the Portuguese Pediatrics Society website in August 2014. These documents deal mainly with information needs, child care activities performed by the parents and the respective responsibilities in decision making with respect to the health of children. Furthermore, parental and family characteristics were mentioned as risk factors for prematurity and perinatal diseases. The psychosocial consequences of parenthood experienced in Neonatal Intensive Care Units, as well as the adequacy of their environmental characteristics to parental needs, were less frequently touched upon. Issues related to the safety and comfort, confidence of parents in healthcare and social support were rarely touched upon. The results reflect sociocultural norms associated with intensive parenting, which is exclusively child centered, highly emotional and performed under the guidance of health professionals. The important aspect is to issue and disseminate guidelines that foster the integration of family-centered care in the dynamics of Neonatal Intensive Care Units. PMID:27557031

  5. Frequency and Outcome of Meningitis in Pediatric Intensive Care Unit of Pakistan.

    Science.gov (United States)

    Jawaid, Amna; Bano, Surriya; Haque, Anwar Ul; Arif, Khubaib

    2016-08-01

    Meningitis is a leading cause of morbidity and mortality worldwide in intensive care settings. The aim of this study was to assess the frequency and outcome in children with meningitis through a retrospective chart review done in pediatric intensive care unit of a tertiary care hospital from January 2000 to December 2014. During these 14 years, 64 patients were admitted with meningitis in pediatric intensive care unit. Out of 64, 36 were diagnosed with pyogenic meningitis, 18 patients with viral meningitis, and 10 with tuberculous meningitis. Most complications were observed in the initial 48 hours. Most common presentation was altered level of consciouness in 50 (78.1%), seizure in 38 (59.4%), and shock in 23 (35.9%) patients. Ventilatory support was required in 30 (46.9%) patients and inotropic support in 26 (40.6%). During stay in pediatric intensive care unit, there was 7.8% mortality. Although meningitis was an infrequent cause of hospitalization at the study centre, but it was an important infectious cause of mortality and morbidity in pediatric age group and associated with high neurological sequelae. PMID:27539773

  6. Tromboelastography: variability and relation to conventional coagulation test in non-bleeding intensive care unit patients

    OpenAIRE

    Halset, Jørgen Holli; Hanssen, Simon Wøhlert; Espinosa, Aurora; Klepstad, Pål

    2015-01-01

    Background: Intensive care unit (ICU) patients usually have abnormal biochemical and hematological laboratory test results as a consequence of organ dysfunction and underlying disease. Thromboelastography (TEG®) is a point-of-care laboratory analysis that gives an overview of several aspects of the coagulation process. In order to be able to perform a clinical interpretation of abnormal TEG® results the expected values from non-bleeding ICU patients should be known. The aim of thi...

  7. Educational Needs of Nurses in Intensive Care Unit for Poisoned Patients

    OpenAIRE

    Dadpour B; Soltani Gh; Peivandi Yazdi A; Zirak N; AR Sedaghat; Sabzevari AR; Eftekharzadeh Mashhadi S; Ariayee N; Amini Sh

    2013-01-01

    Objectives: Poisoned patients are at risk of impaired ventilation in many situations. The purpose of this descriptive study was to investigate the impact of educational workshops on nurses' knowledge, confidence, and attitude in taking care of poisoned patients. Materials and Methods: This descriptive study was performed on 60 nursing staff in the intensive care unit (ICU) for poisoned patients in Imam Reza (p) hospital, Mashhad, Iran. Data was gathered by a researcher-designed questionnaire....

  8. A threat to the understanding of oneself: Intensive care patients' experiences of dependency

    OpenAIRE

    Delmar, Charlotte; Lykkegaard, Kristina

    2013-01-01

    This study examines the meaning of dependency on care as experienced by intensive care patients. Literature on the subject is sparse, but research from nonintensive settings shows that dependency is often experienced negatively. The study is based on in-depth qualitative semistructured interviews with three former patients characterized as narratives. The analysis is inspired by a phenomenological hermeneutical method. The study has found that dependency is experienced as difficult and that t...

  9. Clinical microbiology in the intensive care unit: Strategic and operational characteristics

    OpenAIRE

    Bhattacharya S; Mondal A.

    2010-01-01

    Infection is a major cause of morbidity and mortality among patients admitted in intensive care units (ICUs). The application of the principles and the practice of Clinical Microbiology for ICU patients can significantly improve clinical outcome. The present article is aimed at summarising the strategic and operational characteristics of this unique field where medical microbiology attempts to venture into the domain of direct clinical care of critically ill patients. The close and strategic ...

  10. Imported falciparum malaria among adults requiring intensive care: analysis of the literature.

    OpenAIRE

    Marks, M; Armstrong, M.; Walker, D.; Doherty, T.

    2014-01-01

    BACKGROUND Malaria is the most important imported tropical disease. Infection with Plasmodium falciparum is responsible for most of the morbidity and mortality. There are differences in both the epidemiology of imported malaria and in the facilities available to treat travellers with severe malaria between different parts of the world. There are limited data to guide clinicians caring for adults with imported malaria in an intensive care unit (ICU). Available data from the English-speaking li...

  11. Management of nurse shortage and its impact on pathogen dissemination in the intensive care unit.

    OpenAIRE

    Jordi Ferrer; Pierre-Yves Boelle; Jérôme Salomon; Katiuska Miliani; François L’Hériteau; Pascal Astagneau; Laura Temime

    2014-01-01

    Introduction: Studies provide evidence that reduced nurse staffing resources are associated to an increase in health care-associated infections in intensive care units, but tools to assess the contribution of the mechanisms driving these relations are still lacking. We present an agent-based model of pathogen spread that can be used to evaluate the impact on nosocomial risk of alternative management decisions adopted to deal with transitory nurse shortage. Materials and methods: We constru...

  12. Healthcare Providers’ Perceptions of Breastfeeding Peer Counselors in the Neonatal Intensive Care Unit

    OpenAIRE

    Rossman, Beverly; Engstrom, Janet L.; Meier, Paula P.

    2012-01-01

    In this qualitative descriptive study we examined the perceptions of 17 neonatal intensive care unit (NICU) healthcare providers (nurses, neonatologists, lactation consultants, and dietitians) about the role of breastfeeding peer counselors who were mothers of former NICU infants and who provided primary lactation care in the NICU. Findings revealed that the healthcare providers respected the peer counselors’ lactation expertise and identified three critical elements that contributed to the e...

  13. Transfusion-related acute lung injury management in a pediatric intensive care unit

    OpenAIRE

    Dotis, J.; Stabouli, S.; Violaki, A; Vogiatzi, L; Mitroudi, M; Oikonomou, M.; Athanassiou-Metaxa, M; Kotsiou, M

    2011-01-01

    Transfusion-related acute lung injury (TRALI) constitutes a life threatening complication of blood transfusion. In severe TRALI cases supportive care with mechanical ventilation in intensive care unit is needed. We present two severe TRALI cases caused by leukocyte depleted, ABO compatible, packed red blood cell transfusions, coming from multiparous women donors. In the first case diagnosis was based on clinical findings and established by the identification of leukocyte antibodies in donor's...

  14. Clinical Benefits, Costs, and Cost-Effectiveness of Neonatal Intensive Care in Mexico

    OpenAIRE

    Jochen Profit; Diana Lee; Zupancic, John A.; LuAnn Papile; Cristina Gutierrez; Sue J Goldie; Eduardo Gonzalez-Pier; Joshua A Salomon

    2010-01-01

    Editors' Summary Background Most pregnancies last about 40 weeks but increasing numbers of babies are being born preterm, before they reach 37 weeks of gestation (the period during which a baby develops in its mother). In developed countries and some middle-income countries such as Mexico, improvements in the care of newborn babies (neonatal intensive care) mean that more preterm babies survive now than in the past. Nevertheless, preterm birth is still a major cause of infant death worldwide ...

  15. Patients with diabetes in the intensive care unit; not served by treatment, yet protected?

    OpenAIRE

    Siegelaar, S.E.; DeVries, J. H.; Hoekstra, J.B.

    2010-01-01

    Diabetes is associated with severe complications and decreased life expectancy. However, in the previous issue of Critical Care, Vincent and colleagues report no difference in mortality between patients with insulin-treated diabetes and patients without diabetes in the intensive care unit ( ICU), despite larger severity of illness in the diabetes group at admission. This study contributes to the growing evidence that diabetes in itself is not a risk factor for ICU mortality, although the mech...

  16. Intensive care nurses’ encounters with multicultural families in Norway: An exploratory study

    OpenAIRE

    Høye, Sevald; Severinsson, Elisabeth

    2008-01-01

    The aim of this study was to explore nurses’ perceptions of their encounters with multicultural families in intensive care units in Norwegian hospitals. Immigrants from non-Western countries make up 6.1% of the population in Norway. When a person suffers an acute and critical illness the person's family may experience crises. Nurses’ previous experiences of caring for culturally diverse patients and families is challenging due to linguistic differences, and contextual factors. Family members ...

  17. Cystatin C at Admission in the Intensive Care Unit Predicts Mortality among Elderly Patients

    OpenAIRE

    Dalboni, Maria Aparecida; Beraldo, Daniel de Oliveira; Quinto, Beata Marie Redublo; Blaya, Rosângela; Narciso, Roberto; Oliveira, Moacir; Monte, Júlio César Martins; Durão, Marcelino de Souza; Cendoroglo, Miguel; Pavão, Oscar Fernando; Batista, Marcelo Costa

    2013-01-01

    Introduction. Cystatin C has been used in the critical care setting to evaluate renal function. Nevertheless, it has also been found to correlate with mortality, but it is not clear whether this association is due to acute kidney injury (AKI) or to other mechanism. Objective. To evaluate whether serum cystatin C at intensive care unit (ICU) entry predicts AKI and mortality in elderly patients. Materials and Methods. It was a prospective study of ICU elderly patients without AKI at admission. ...

  18. Epidemiology of acute kidney injury in Hungarian intensive care units: a multicenter, prospective, observational study

    OpenAIRE

    Bencsik Gabor; Marjanek Zsuzsanna; Gartner Bela; Kocsi Szilvia; Paloczi Balazs; Antek Csaba (1967-) (aneszteziológus); Medve Laszlo; Kanizsai Peter; Gondos Tibor

    2011-01-01

    Abstract Background Despite the substantial progress in the quality of critical care, the incidence and mortality of acute kidney injury (AKI) continues to rise during hospital admissions. We conducted a national, multicenter, prospective, epidemiological survey to evaluate the importance of AKI in intensive care units (ICUs) in Hungary. The objectives of this study were to determine the incidence of AKI in ICU patients; to characterize the differences in aetiology, illness severity and clini...

  19. An observation of impact of neurological consultations in intensive care patients: Case series of 23 patients

    OpenAIRE

    Kanwalpreet Sodhi; Rupinder Singh Bhatia; Siddhartha Garg; Anupam Shrivastava

    2013-01-01

    Objective: The objective of the present study was to assess the impact of neurological consultation and intervention upon patient outcome in intensive care unit (ICU). Settings: A retrospective observational study was conducted in the 24-bedded multispecialty ICU of a 350 bedded tertiary care hospital over 8 months period, from January 2011 to August 2011. Critically, ill-patients with varied neurological symptomatology affecting the course of illness and ICU discharge were included. Neurolog...

  20. Characteristics of physical activity programs in the Brazilian primary health care system

    OpenAIRE

    Grace Angélica de Oliveira Gomes; Eduardo Kokubun; Grégore Iven Mieke; Luiz Roberto Ramos; Michael Pratt; Diana C. Parra; Eduardo Simões; Florindo, Alex A; Mario Bracco; Danielle Cruz; Deborah Malta; Felipe Lobelo; Hallal, Pedro C.

    2014-01-01

    The aim of this study was to describe the characteristics of programs that promote physical activity in the public primary care system by region of Brazil, subject to the presence or absence of multidisciplinary primary care teams (NASF). We conducted a cross sectional and population-based telephone survey of the health unit coordinators from 1,251 health care units. Coordinators were asked about the presence and characteristics of physical activity programs. Four out of ten health units repo...

  1. Regional anesthesia for management of acute pain in the intensive care unit

    OpenAIRE

    Pinto, Mario; Dagal, Armagan; O’Donnell, Brendan; Stogicza, Agnes; Chiu, Sheila; Edwards, William Thomas

    2015-01-01

    Pain is a major problem for Intensive Care Unit (ICU) patients. Despite numerous improvements it is estimated that as many as 70% of the patients experience moderate-to-severe postoperative pain during their stay in the ICU. Effective pain management means not only decreasing pain intensity, but also reducing the opioids’ side effects. Minimizing nausea, vomiting, urinary retention, and sedation may indeed facilitate patient recovery and it is likely to shorten the ICU and hospital stay. Adeq...

  2. The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies

    OpenAIRE

    Gusmao-Flores, Dimitri; Salluh, Jorge Ibrain Figueira; Chalhub, Ricardo Ávila; Lucas C Quarantini

    2012-01-01

    Introduction Delirium is a frequent form of acute brain dysfunction in critically ill patients, and several detection tools for it have been developed for use in the Intensive Care Unit (ICU). The objective of this study is to evaluate the current evidence on the accuracy of the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) for the diagnosis of delirium in critically ill patients. Methods A systematic review was condu...

  3. Conceptions of US and Brazilian Early Childhood Care and Education: A Historical and Comparative Analysis

    Science.gov (United States)

    Freitas, Lia B. L.; Shelton, Terri L.; Tudge, Jonathan R. H.

    2008-01-01

    Children's first years of life are fundamental for healthy development. Appropriate care and education in the early years are far more useful than dealing with later problems, and in both the United States and Brazil scholars and public-policy makers have argued that the goal should be an integrated system of care and education. Using a…

  4. Preventing intensive care unit delirium: a patient-centered approach to reducing sleep disruption.

    Science.gov (United States)

    Stuck, Amy; Clark, Mary Jo; Connelly, Cynthia D

    2011-01-01

    Delirium in the intensive care unit is a disorder with multifactorial causes and is associated with poor outcomes. Sleep-wake disturbance is a common experience for patients with delirium. Care processes that disrupt sleep can lead to sleep deprivation, contributing to delirium. Patient-centered care is a concept that considers what is best for each individual. How can clinicians use a patient-centered approach to alter processes to decrease patient disruptions and improve sleep and rest? Could timing of blood draws and soothing music work to promote sleep? PMID:21983504

  5. Vigilant watching over: mothers' actions to safeguard their premature babies in the newborn intensive care nursery.

    Science.gov (United States)

    Hurst, I

    2001-12-01

    The critical ethnography described in this article explored how a diverse group of 12 mothers describe and interpret their experience of having a hospitalized premature baby, including the mothers' actions in a newborn intensive care unit (NICU) and conditions affecting their descriptions, interpretations, and actions throughout 448 hours of participant observation. A central feature of their experience encompassed a repertoire of actions to vigilantly watch over their babies in the NICU. The results of this study suggest that health care providers often interpreted mothers' actions differently than intended, which creates barriers to achieving family-centered care in the NICU. PMID:11785577

  6. [Care provided by nursing students in a neonatal intensive care unit from the mother's point of view].

    Science.gov (United States)

    Pacheco, S T; do Valle, E R; Simões, S M

    2001-01-01

    The objective of the present study is to investigate the perspective of mothers regarding the care given by academics of nursing to their newborn in a neonatal intensive therapy unit. This is a qualitative research based on a phenomenological approach which has as its philosophical framework the thought of Martin Heidegger expressed in his book Being and Time. The data used in the investigation were interviews given by ten mothers who had their newborns in a neonatal intensive therapy unit of a university hospital in the city of Rio de Janeiro. The interpretation of the data collected revealed that mothers viewed the nursing academics as solicitous beings regarding the care given to their newborns. They also acknowledged that these students were engaged in the assistance given and concerned with what was being done and to whom it was being done. PMID:12098862

  7. Hemodynamic Assessment and Monitoring in the Intensive Care Unit: an Overview

    Directory of Open Access Journals (Sweden)

    Adam C. Adler

    2014-08-01

    Full Text Available The goal of hemodynamic monitoring in intensive care is to assess the adequacy of perfusion, specifically with regard to maintaining sufficient perfusion pressures and oxygen delivery. Precise volume management of peri-operative and critical care patients is crucial as under or over resuscitation is associated with adverse outcomes. Hemodynamic monitoring allows care to be individualized based on specific patient response to therapy and can provide early warning of impending perfusion deficits or instability. Physiologic monitoring aids determination of appropriate therapy. Methods for obtaining accurate and continuous measurements in the critically ill patient have evolved from surgical and anesthetic techniques dating back more than a century. These techniques transitioned from the operating room to early intensive care units as necessitated by the polio epidemics of the 1950s. The advantages of cohorting critically ill patients led to specialized intensive care and later cardiac care units. Telemetry developed to monitor astronauts and miniaturization of electronics made possible by substituting transistors for vacuum tubes helped create the first generation of intensive care monitors in the 1960s. Transcutaneous oxygen sensors, end-tidal measurement of carbon dioxide, and pulse oximetry took monitoring to a new level by the 1980s. Monitors became more sophisticated and capable of calculating derived variables such as oxygen delivery and consumption as computer processing became routine. These data sets were useful to clinicians using fluids and vasoactive agents primarily to manipulate oxygen delivery in hemodynamically unstable patients. Recently, simply monitoring vascular pressures has given way to dynamic monitoring where physiologic changes with respiration can be used to derive additional parameters such as pulse pressure variation (PPV and stroke volume variation (SVV. Today’s clinician has a wealth of information available at the

  8. Nurse Practitioners: Knowledge, Skills, and Leadership for the End-of-Life Conversation in Intensive Care.

    Science.gov (United States)

    McRee, Laura; Reed, Pamela G

    2016-01-01

    An impending policy change in Medicare will provide reimbursement for the end-of-life conversation. The rise in numbers of older adults who face serious illness coupled with advances in healthcare technology are increasing the need for providers to address end of life issues in the acute care setting. Doctoral-level nurse practitioners who specialize in acute care of older adults are poised to be leaders and facilitators of this conversation in a particularly challenging context-the intensive care unit. The focus of this article is the new end-of-life policy in relation to the particular contributions that adult gerontology acute care nurse practitioners offer in the acute care setting. PMID:26660780

  9. Positive and negative emotional responses to workrelated trauma of intensive care nurses in private health care facilities

    OpenAIRE

    Lizelle Van der Vyver; Diane Elkonin

    2011-01-01

    Intensive care nursing is a stressful occupation and nurses are continually subjected to both primary and secondary trauma. Responses may be positive in the form of compassion satisfaction, or negative in the form of compassion fatigue. However, nurses tend to deny the negative impact of secondary trauma which leads to the silencing response and subsequent burnout. This article explores and describes the presence of these emotions and the relationships between them. A quantitative approach wi...

  10. Protocolized eye care prevents corneal complications in ventilated patients in a medical intensive care unit

    Directory of Open Access Journals (Sweden)

    Mohammad Feroz Azfar

    2013-01-01

    Full Text Available Background: Eye care is an essential component in the management of critically ill patients. Standardized eye care can prevent corneal complications in ventilated patients. Objective: This study was designed to compare old and new practices of corneal care for reduction in corneal complications in ventilated patients. Methods: This study was done in three phases each of six month duration. Phase 1 was the ongoing practice of eye care in the unit. Before the start of phase 2, a new protocol was made for eye care. Corneal complications were observed in terms of haziness, dryness, and ulceration. All nursing staffs were educated and made compliant with the new protocol. In phase 2, a follow-up audit was done to check the effectiveness and compliance to protocol. In phase 3, a follow-up audit was started 3 months after phase 2. Results: In phase 1, total ventilated patients were 40 with 240 ventilator days. The corneal dryness rate was 40 per 1000 ventilator days while the haziness and ulceration rate was 16 per 1000 ventilator days each. In the second phase 2, total ventilated patients were 53 making 561 ventilator days. The rate of corneal haziness and dryness was 3.52 and 1.78 per 1000 ventilator days, respectively, with no case of corneal ulceration. In phase 3, the number of ventilated patients was 91 with 1114 ventilator days. The corneal dryness rate was 2.69 while the haziness and ulceration rate was 1.79 each. Conclusion: Protocolized eye care can reduce the risk of corneal complications in ventilated patients.

  11. Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis

    OpenAIRE

    Sean M Bagshaw; Webb, Steve AR; Delaney, Anthony; George, Carol; Pilcher, David; Hart, Graeme K; Bellomo, Rinaldo

    2009-01-01

    Introduction Older age is associated with higher prevalence of chronic illness and functional impairment, contributing to an increased rate of hospitalization and admission to intensive care. The primary objective was to evaluate the rate, characteristics and outcomes of very old (age ≥ 80 years) patients admitted to intensive care units (ICUs). Methods Retrospective analysis of prospectively collected data from the Australian New Zealand Intensive Care Society Adult Patient Database. Data we...

  12. Virtual Visitation in the Neonatal Intensive Care: Experience with the Use of Internet and Telemedicine in a Tertiary Neonatal Unit

    OpenAIRE

    Yeo, CL; Ho, Selina KY; Khong, KC; Lau, YY

    2011-01-01

    Introduction: Globally about 8% to 10% of newborns require neonatal intensive care (NICU) care. Families face emotional and financial difficulties when their sick newborns are hospitalized for prolonged periods in a NICU.

  13. Crew resource management training in the intensive care unit: a multisite controlled before-after study.

    NARCIS (Netherlands)

    Kemper, P.F.; Bruijne, M. de; Dyck, C. van; So, R.L.; Tangkau, P.; Wagner, C.

    2016-01-01

    Introduction There is a growing awareness today that adverse events in the intensive care unit (ICU) are more often caused by problems related to non-technical skills than by a lack of technical, or clinical, expertise. Team training, such as crew resource management (CRM), aims to improve these non

  14. Biochemical markers in the surgical intensive care : Identifying critically ill surgical patients with complications

    NARCIS (Netherlands)

    Z.C. Meyer (Zainna)

    2015-01-01

    markdownabstract__Abstract__ Introductie Patiënten die postoperatief op de intensive care (IC) worden opgenomen hebben een hogere kans op het ontwikkelen van complicaties. Het is belangrijk om deze complicaties vroegtijdig te kunnen identificeren bij de kritiek zieke chirurgische patiënten op de IC

  15. Primary immunodeficiency investigation in patients during and after hospitalization in a pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Erica Suavinho

    2014-03-01

    Full Text Available Objective: To analyze whether the patients with severe infections, admitted in the Pediatric Intensive Care Unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia, underwent the active screening for primary immunodeficiencies (PID. Methods: Retrospective study that assessed the data records of patients with any severe infections admitted in the Pediatric Intensive Care Unit, covering a period from January 2011 to January 2012, in order to confirm if they performed an initial investigation for PID with blood count and immunoglobulin dosage. Results: In the studied period, 53 children were hospitalized with severe infections in the Pediatric Intensive Care Unit, and only in seven (13.2% the initial investigation of PID was performed. Among these patients, 3/7 (42.8% showed quantitative alterations in immunoglobulin G (IgG levels, 1/7 (14.3% had the diagnosis of cyclic neutropenia, and 1/7 (14.3% presented thrombocytopenia and a final diagnosis of Wiskott-Aldrich syndrome. Therefore, the PID diagnosis was confirmed in 5/7 (71.4% of the patients. Conclusions: The investigation of PID in patients with severe infections has not been routinely performed in the Pediatric Intensive Care Unit. Our findings suggest the necessity of performing PID investigation in this group of patients.

  16. Survey of Oxygen Delivery Practices in UK Paediatric Intensive Care Units

    Science.gov (United States)

    Peters, Mark J.

    2016-01-01

    Purpose. Administration of supplemental oxygen is common in paediatric intensive care. We explored the current practice of oxygen administration using a case vignette in paediatric intensive care units (PICU) in the united kingdom. Methods. We conducted an online survey of Paediatric Intensive Care Society members in the UK. The survey outlined a clinical scenario followed by questions on oxygenation targets for 5 common diagnoses seen in critically ill children. Results. Fifty-three paediatric intensive care unit members from 10 institutions completed the survey. In a child with moderate ventilatory requirements, 21 respondents (42%) did not follow arterial partial pressure of oxygen (PaO2) targets. In acute respiratory distress syndrome, cardiac arrest, and sepsis, there was a trend to aim for lower PaO2 as the fraction of inspired oxygen (FiO2) increased. Conversely, in traumatic brain injury and pulmonary hypertension, respondents aimed for normal PaO2 even as the FiO2 increased. Conclusions. In this sample of clinicians PaO2 targets were not commonly used. Clinicians target lower PaO2 as FiO2 increases in acute respiratory distress syndrome, cardiac arrest, and sepsis whilst targeting normal range irrespective of FiO2 in traumatic brain injury and pulmonary hypertension.

  17. Should euthanasia be legal? : An international survey of neonatal intensive care units staff

    NARCIS (Netherlands)

    Cuttini, M.; Casotto, V.; Kaminski, M.; Beaufort, I.D. de; Berbik, I.; Hansen, G.; Kollee, L.A.A.; Kucinskas, A.; Lenoir, S.; Levin, A.V.; Orzalesi, M.; Persson, J.; Rebagliato, M.; Reid, M.; Saracci, R.

    2004-01-01

    OBJECTIVE: To present the views of a representative sample of neonatal doctors and nurses in 10 European countries on the moral acceptability of active euthanasia and its legal regulation. DESIGN: A total of 142 neonatal intensive care units were recruited by census (in the Netherlands, Sweden, Hung

  18. Initial fluid resuscitation of patients with septic shock in the intensive care unit

    DEFF Research Database (Denmark)

    Carlsen, Sarah; Perner, A

    2011-01-01

    Fluid is the mainstay of resuscitation of patients with septic shock, but the optimal composition and volume are unknown. Our aim was to evaluate the current initial fluid resuscitation practice in patients with septic shock in the intensive care unit (ICU) and patient characteristics and outcome...

  19. Prevention of acute kidney injury and protection of renal function in the intensive care unit

    NARCIS (Netherlands)

    Joannidis, Michael; Druml, Wilfred; Forni, Lui G.; Groeneveld, A. B. Johan; Honore, Patrick; Oudemans-van Straaten, Heleen M.; Ronco, Claudio; Schetz, Marie R. C.; Woittiez, Arend Jan

    2010-01-01

    Acute renal failure on the intensive care unit is associated with significant mortality and morbidity. To determine recommendations for the prevention of acute kidney injury (AKI), focusing on the role of potential preventative maneuvers including volume expansion, diuretics, use of inotropes, vasop

  20. QUALITY-OF-LIFE AFTER INTENSIVE-CARE WITH THE SICKNESS IMPACT PROFILE

    NARCIS (Netherlands)

    TIAN, ZM; MIRANDA, DR

    1995-01-01

    Objectives: a) to validate the structure of the Sickness Impact Profile scale (SIP) when applied to intensive care patients after discharge from the hospital; b) to explore the influence of age upon the various components of quality of life. Design: Prospective study. Setting: Patients admitted to 3

  1. Under a watchful eye...: New Medication and Monitoring of Sedation and Analgesia in Pediatric Intensive Care

    NARCIS (Netherlands)

    S.A. Prins (Sandra)

    2005-01-01

    textabstractErnstig zieke kinderen op een kinder-intensive care (IC) afdeling, krijgen regelmatig kalmerende middelen (sedativa) en pijnstillers (analgetica) toegediend om discomfort, onrust en pijn te voorkomen. Om bijwerkingen van deze middelen te voorkomen en om er voor te zorgen dat ze goed hun

  2. Colistin resistance in gram-negative bacteria during prophylactic topical colistin use in intensive care units

    NARCIS (Netherlands)

    Oostdijk, Evelien A. N.; Smits, Loek; de Smet, Anne Marie G. A.; Leverstein-van Hall, Maurine A.; Kesecioglu, Jozef; Bonten, Marc J. M.

    2013-01-01

    Topical use of colistin as part of selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) has been associated with improved patient outcome in intensive care units (ICU), yet little is known about the risks of colistin resistance. We quantified effects of selecti

  3. Evaluation of vitamin D level in patients from neurosurgical intensive care unit

    Institute of Scientific and Technical Information of China (English)

    Ho Jun Yi; Je Hoon Jeong; Eun-Sun Jin; Il Young Shin; Hyung Sik Hwang; Seung-Myung Moon

    2013-01-01

    Vitamin D plays an important role in maintaining normal bone metabolism. Recent studies have suggested that vitamin D influences many other physiological processes, including muscle function, cardiovascular homeostasis, nerve function, and immune response. Furthermore, accumulated evidence suggests that vitamin D also mediates the immune system response to infection. Critical neurosurgical patients have higher infection and mortality rates. To correlate vitamin D deficiency to the immunological status of neurosurgical intensive care unit patients, we detected serum vitamin D level in 15 patients with clinically suspected infection and 10 patients with confirmed infection. Serum level of 25-hydroxyvitamin D, the primary circulating form of vitamin D, was significantly decreased in patients with suspected or confirmed infection after a 2-week neurosurgical intensive care unit hospitalization, while serum level of 1,25-dihydroxyvitamin D, the active form of vitamin D, was significantly decreased in patients after a 4-week neurosurgical intensive care unit hospitalization. These findings suggest that vitamin D deficiency is linked to the immunological status of neurosurgical intensive care unit patients and vitamin D supplementation can improve patient's immunological status.

  4. Factors Affecting Code Status in a University Hospital Intensive Care Unit

    Science.gov (United States)

    Van Scoy, Lauren Jodi; Sherman, Michael

    2013-01-01

    The authors collected data on diagnosis, hospital course, and end-of-life preparedness in patients who died in the intensive care unit (ICU) with "full code" status (defined as receiving cardiopulmonary resuscitation), compared with those who didn't. Differences were analyzed using binary and stepwise logistic regression. They found…

  5. Extensive Variability in Vasoactive Agent Therapy: A Nationwide Survey in Chinese Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Xian-Bo Pei

    2015-01-01

    Conclusions: Vasoactive agent use for treatment of shock is inconsistent according to self-report by Chinese intensive care physicians; however, the variation in use depends upon the form of shock being treated and the type of hospital; thus, corresponding educational programs about vasoactive agent use for shock management should be considered.

  6. Renal replacement therapy in adult and pediatric intensive care : Recommendations by an expert panel from the French Intensive Care Society (SRLF) with the French Society of Anesthesia Intensive Care (SFAR) French Group for Pediatric Intensive Care Emergencies (GFRUP) the French Dialysis Society (SFD).

    Science.gov (United States)

    Vinsonneau, Christophe; Allain-Launay, Emma; Blayau, Clarisse; Darmon, Michael; Ducheyron, Damien; Gaillot, Theophile; Honore, Patrick M; Javouhey, Etienne; Krummel, Thierry; Lahoche, Annie; Letacon, Serge; Legrand, Matthieu; Monchi, Mehran; Ridel, Christophe; Robert, René; Schortgen, Frederique; Souweine, Bertrand; Vaillant, Patrick; Velly, Lionel; Osman, David; Van Vong, Ly

    2015-12-01

    Acute renal failure (ARF) in critically ill patients is currently very frequent and requires renal replacement therapy (RRT) in many patients. During the last 15 years, several studies have considered important issues regarding the use of RRT in ARF, like the time to initiate the therapy, the dialysis dose, the types of catheter, the choice of technique, and anticoagulation. However, despite an abundant literature, conflicting results do not provide evidence on RRT implementation. We present herein recommendations for the use of RRT in adult and pediatric intensive care developed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of French Intensive Care Society (SRLF), with the participation of the French Society of Anesthesia and Intensive Care (SFAR), the French Group for Pediatric Intensive Care and Emergencies (GFRUP), and the French Dialysis Society (SFD). The recommendations cover 4 fields: criteria for RRT initiation, technical aspects (access routes, membranes, anticoagulation, reverse osmosis water), practical aspects (choice of the method, peritoneal dialysis, dialysis dose, adjustments), and safety (procedures and training, dialysis catheter management, extracorporeal circuit set-up). These recommendations have been designed on a practical point of view to provide guidance for intensivists in their daily practice. PMID:26714808

  7. Intensive care diaries reduce new onset post traumatic stress disorder following critical illness

    DEFF Research Database (Denmark)

    Jones, Christina; Bäckman, Carl; Capuzzo, Maurizia;

    2010-01-01

    Patients recovering from critical illness have been shown to be at risk of developing Post Traumatic Stress disorder (PTSD). This study was to evaluate whether a prospectively collected diary of a patient's intensive care unit (ICU) stay when used during convalescence following critical illness...

  8. First outbreak with MRSA in a danish neonatal intensive care unit

    DEFF Research Database (Denmark)

    Ramsing, Benedicte Grenness Utke; Arpi, Magnus; Andersen, Erik Arthur;

    2013-01-01

    The purpose of the study was to describe demographic and clinical characteristics and outbreak handling of a large methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a neonatal intensive care unit (NICU) in Denmark June 25(th)-August 8(th) 2008, and to identify risk factors for MRSA...

  9. Chicken pox outbreak in the Intensive Care Unit of a tertiary care hospital: Lessons learnt the hard way

    Directory of Open Access Journals (Sweden)

    Sarit Sharma

    2015-01-01

    Full Text Available Varicella-zoster virus (VZV causes 2 clinically and epidemiologically distinct forms of diseases. Chickenpox (varicella is the disease that results from primary infection with the VZV. Herpes zoster (HZ results from the reactivation of VZV latently infecting the dorsal root ganglia. We are reporting an outbreak of varicella infection among the health care workers (HCWs in the Intensive Care Unit (ICU of a tertiary care hospital. We found transmission of varicella among eight HCWs of pulmonary ICU. They had a history of contact with a patient having HZ infection. Investigation of the outbreak was conducted as per guidelines. Better dissemination of information on disease transmission, isolation of infected patients inside the hospital, and adequate protection (including vaccination for susceptible employees are important to prevent such outbreaks.

  10. Chicken pox outbreak in the Intensive Care Unit of a tertiary care hospital: Lessons learnt the hard way.

    Science.gov (United States)

    Sarit, Sharma; Shruti, Sharma; Deepinder, Chhina; Chhina, R S

    2015-12-01

    Varicella-zoster virus (VZV) causes 2 clinically and epidemiologically distinct forms of diseases. Chickenpox (varicella) is the disease that results from primary infection with the VZV. Herpes zoster (HZ) results from the reactivation of VZV latently infecting the dorsal root ganglia. We are reporting an outbreak of varicella infection among the health care workers (HCWs) in the Intensive Care Unit (ICU) of a tertiary care hospital. We found transmission of varicella among eight HCWs of pulmonary ICU. They had a history of contact with a patient having HZ infection. Investigation of the outbreak was conducted as per guidelines. Better dissemination of information on disease transmission, isolation of infected patients inside the hospital, and adequate protection (including vaccination) for susceptible employees are important to prevent such outbreaks. PMID:26816447

  11. [Equivalent continuous noise level in neonatal intensive care unit associated to burnout syndrome].

    Science.gov (United States)

    Garrido Galindo, A P; Camargo Caicedo, Y; Vélez-Pereira, A M

    2015-01-01

    Noise levels in neonatal intensive care units allow the appearance of symptoms associated with burnout such as stress, irritability, fatigue and emotional instability on health care personnel. The aim of this study was to evaluate the equivalent continuous noise levels in the neonatal intensive care unit and compare the results with noise levels associated with the occurrence of burnout syndrome on the care team. Continuous sampling was conducted for 20 days using a type I sound level meter on the unit. The maximum, the ninetieth percentile and the equivalent continuous noise level (Leq) values were recorded. Noise level is reported in the range of 51.4-77.6 decibels A (dBA) with an average of 64 dBA, 100.6 dBA maximum, and average background noise from 57.9 dBA. Noise levels exceed the standards suggested for neonatal intensive care units, are close to maximum values referred for noise exposure in the occupational standards and to noise levels associated with the onset of burnout; thus allowing to infer the probability of occurrence of high levels of noise present in the unit on the development of burnout in caregivers. PMID:26187519

  12. Patients’ narratives of lived experiences of intensive care during after-care

    DEFF Research Database (Denmark)

    Nilsson, Karen; Berner, Susanne; Hertz, Iben;

    2013-01-01

    -up dialoguepieces in the puzzle of recovery. World Crit Care Nursing 2011; 8(2):75. [(journal article - abstract) ISSN: 1748–6254]. 3. 4th EfCCNa & FSAIO Congress Copenhagen 2011 http://www.efccna.org/index.php?option=com_content&view=article&id=88&Itemid=96. 4. Storli SL, Lind R. The meaning of follow...

  13. The Bariatric Patient in the Intensive Care Unit: Pitfalls and Management.

    Science.gov (United States)

    Pompilio, Carlos E; Pelosi, Paolo; Castro, Melina G

    2016-09-01

    The increasing number of bariatric/metabolic operations as important alternatives for the treatment of obesity and type 2 diabetes brought several concerns about the intensive care of patients undergoing those procedures. Intensive Care Unit admission criteria are needed in order to better allocate resources and avoid unnecessary interventions. Furthermore, well-established protocols, helpful in many clinical situations, are not directly applicable to obese patients. Indeed, difficult airway management, mechanical ventilation, fluid therapy protocols, prophylaxis, and treatment of venous thromboembolic events have unique aspects that should be taken into consideration. Finally, new data related to planning nutrition therapy of the critically obese have been highlighted and deserve consideration. In this review, we provide an outline of recent studies related to those important aspects of the care of the bariatric/metabolic patients in critical conditions. PMID:27464648

  14. An epidemiological study of Haemophilus influenzae at a Brazilian day care center

    Directory of Open Access Journals (Sweden)

    M.E. Bonifácio da Silva

    2001-10-01

    Full Text Available Day care centers are a relatively new phenomenon in Brazil that bring together large numbers of young children susceptible to contagious diseases. Haemophilus influenzae (Hi is an important infection in the age range of those attending day care centers. In the present study, the carriage rate of Haemophilus influenzae was identified in 38 day care attendees age 6 to 37 months, and 23 staff members, at a day care center in Ribeirão Preto-São Paulo, in 1997. To identify the carriers, two nasopharyngeal swabs were collected; one in July and one in December. The rate of H. influenzae carriers among the children was 77%. Only 2 of 23 staff members (9% had Hi. Among the children, there were 58 isolates in the two sampling periods; 6 of the Hi were serotype b, 1 was serotype e, and 48 isolates were non-typeable. Two were identified as H. parainfluenzae. One adult had a non-typeable Hi and 1 had H. paraphrohaemolyticus. Three of the 6 children with type B had received a conjugate vaccine against H. influenzae type b, but they still carried this bacterium in the nasopharynx (50%. Forty ribotype patterns were found among the isolates, showing a high exchange rate of nontypeable H. influenzae carriers. The results indicate that, because of the high and changing biotype of Hi carriage, day care centers should be carefully monitored as potential point source of HI disease in the community.

  15. Antidepressant or Antipsychotic Overdose in the Intensive Care Unit - Identification of Patients at Risk.

    Science.gov (United States)

    Borg, Linda; Julkunen, Anna; Rørbaek Madsen, Kristian; Strøm, Thomas; Toft, Palle

    2016-07-01

    It is often advised that patients who have ingested an overdose of antidepressants (AD) or antipsychotics (AP) are monitored with continuous ECG for minimum of 12-24 hr. These patients are often observed in an ICU. Our aim was to identify the number of patients with AD and/or AP overdose without adverse signs at hospital admission that turned out to need intensive care treatment. The effect of the antidepressants overdose risk assessment (ADORA) system was evaluated in patients with antidepressant as well as antipsychotic overdose. Our hypothesis was that patients with low ADORA do not need intensive care treatment. This retrospective study was conducted in adult patients admitted to the ICU at Odense University Hospital after an overdose with AP and/or AD between 1 January 2009 and 1 September 2014. Patients with predefined adverse signs in the emergency department were excluded due to obvious need of intensive care. Of the 157 patients included, 12 patients (8%) developed events during the ICU stay. Only 3 patients received intubation, vasoactive drugs and/or dialysis. None developed ventricular dysrhythmias. There were no fatalities. All the patients with low-risk assessment by ADORA within the first 6 hr did not develop events within the first 24 hr after hospital admission. The vast majority of patients with AD and/or AP overdose and no adverse signs at admission did not require intensive care treatment. Low-risk ADORA identified patients with antidepressant as well as antipsychotic overdose who would not require initial intensive care treatment. This is the first time the ADORA system has been evaluated in patients with antidepressant as well as antipsychotic overdose. PMID:26663682

  16. Catheter-Related Bloodstream Infections (CR-BSI) in Geriatric Patients in Intensive Care Units.

    Science.gov (United States)

    Chernecky, Cynthia; Macklin, Denise; Blackburn, Paul

    2015-01-01

    Catheter-related bloodstream infections (CR-BSIs) are bloodstream infections that, through specific laboratory testing, identify the intravascular catheter as the source of the bloodstream infection. By 2015, the rate of elderly patients 80 years of age and older admitted to the intensive care unit (ICU) will represent 1 in 4 admissions. Approximately 80 000 CR-BSIs occur in ICUs annually, potentially resulting in as many as 56 000 CR-BSIs occurring in the geriatric ICU patient, with 20% of these cases resulting in death. To minimize the occurrence of CR-BSIs in these patients, specific knowledge about the geriatric patient will have to be factored into the ICU health care professional's practice, including the development of a vascular access plan, which includes selection of the correct device and proper insertion of that device along with an evidence-based care and maintenance program. Intensive care unit health care professionals may be at a loss when it comes to navigating the vast array of vascular access medical devices available today. The Healthcare and Technology Synergy framework can assist the ICU health care professional to logically review each vascular access device and select those devices that best meet patient needs. PMID:26039650

  17. Biparentally deserted offspring are viable in a species with intense sexual conflict over care.

    Science.gov (United States)

    Pogány, Ákos; Kosztolányi, András; Miklósi, Ádám; Komdeur, Jan; Székely, Tamás

    2015-07-01

    Desertion of clutch (or brood) by both parents often leads to breeding failure, since in vast majority of birds care by at least one parent is required for any young to fledge. Recent works in a highly polygamous passerine bird, the Eurasian penduline tit (Remiz pendulinus), suggest that biparental clutch desertion is due to intense sexual conflict over care. However, an alternative yet untested hypothesis for biparental desertion is low offspring viability so that the parents abandon the offspring that have poor prospect for survival. Here we test the latter hypothesis in a common garden experiment by comparing the viability of deserted and cared for eggs. We show that embryonic development does not differ between deserted and cared for eggs. Therefore, sexual conflict over care remains the best supported hypothesis for biparental clutch desertion in penduline tits. Our work points out that conflict over care is a potential - yet rarely considered - cause of biparental nest desertion, and a strong alternative for the traditional explanations of low offspring viability, human disturbance or deteriorating ambient environment. Apart from a handful of species, the intensity of sexual conflict has not been quantified, and we call for further studies to consider sexual conflict as a cause of nest desertion. PMID:25934135

  18. [The well-being of the newborn infant in neonatal intensive care].

    Science.gov (United States)

    Ancora, G

    2010-06-01

    Patients referred to Neonatal Intensive Care Units are particularly vulnerable because they are in a critical or sensitive period of development. When physicians were first able to really save preemies 40 years ago, not much thought was given to their brain development. The babies we care for are so early that the brain cells are still migrating to where they will finally rest in developed brain. We are shaped, to an extent, by our environment. In early life, the environment takes on a particularly important role. So treatments may over-stimulate areas of the brain with unknown consequences. For this reason minimally invasive treatments together with attention to the environment will favour a care developmentally appropriate for pre-term babies. Use of nasalCPAP, early rescue surfactant, synchronized mechanical ventilation, together with temperature, light and noise control could help to obtain these results. Pain control, music therapy, massage, kangaroo care and a family centred care are essential to optimize results obtained from the intensive care. PMID:21090074

  19. Frequency and clinical manifestations of post-poliomyelitis syndrome in a brazilian tertiary care center

    Directory of Open Access Journals (Sweden)

    Abrahão Augusto Juviniano Quadros

    2012-08-01

    Full Text Available OBJECTIVE: To determine the frequency and clinical manifestations of patients with post-poliomyelitis syndrome (PPS in a Brazilian division of neuromuscular disorders. METHODS: A total of 167 patients with prior history of paralytic poliomyelitis was investigated for PPS, based on international diagnostic criteria. Other variables analyzed were: gender, race, age at poliomyelitis infection, age at PPS onset, and PPS symptoms. RESULTS: One hundred and twenty-nine patients presented PPS, corresponding to 77.2% of the studied population. 62.8% were women and 37.2% were men. Mean age of patients with PPS at onset of PPS symptoms was 39.9±9.69 years. Their main clinical manifestations were: new weakness in the previously affected limbs (69% and in the apparently not affected limbs (31%; joint pain (79.8%; fatigue (77.5%; muscle pain (76%; and cold intolerance (69.8%. CONCLUSIONS: Most patients of our sample presented PPS. In Brazil, PPS frequency and clinical features are quite similar to those of other countries.

  20. Body Composition (Sarcopenia) in Obese Patients: Implications for Care in the Intensive Care Unit

    OpenAIRE

    Gallagher, Dympna; DeLegge, Mark

    2011-01-01

    The study of body composition is a rapidly evolving science. In today’s environment, there is a great deal of interest in assessing body composition, especially in the obese subject, as a guide to clinical and nutrition interventions. There are some strikingly different compartments of body composition between the obese and the lean patient. We do have the ability to measure body composition accurately, although these techniques can be labor intensive and expensive. The recognition of patient...

  1. Management of diabetes mellitus and associated cardiovascular risk factors in Brazil – the Brazilian study on the practice of diabetes care

    OpenAIRE

    Braga, Juarez R.; Avezum, Alvaro; Ferreira, Sandra RG; Forti, Adriana

    2013-01-01

    Background The Brazilian Study on the Practice of Diabetes Care main objective was to provide an epidemiological profile of individuals with type 1 and 2 diabetes mellitus (DM) in Brazil, concerning therapy and adherence to international guidelines in the medical practice. Methods This observational, cross-sectional, multicenter study collected and analyzed data from individuals with type 1 and 2 DM attending public or private clinics in Brazil. Each investigator included the first 10 patient...

  2. Evaluation of practices in mental health care in the Brazilian Northeast.

    Science.gov (United States)

    Carvalho, Maria Aparecida Alves Sobreira; Ximenes, Verônica Morais

    2016-01-01

    This study presents a qualitative evaluation of mental health services, having as a goal to understand in what measure the care practices of a community mental health service in Fortaleza, Ceará (Brazil), have an impact in the strengthening of people diagnosed with mental disorders. Interviews were made mediated by self-photography, a focus group, and in-depth interviews, organizing the contents in categories obtained by the critical hermeneutics method. The results indicate that those care practices promote strengthening processes, because care is not limited in its activities, and is respectful of the existential territory supporting the expressions of pain, of discontent, of the possibility of being and, wishing for different things, and are distanced from the ideology of submission and resignation. PMID:26697903

  3. Warning systems in a computerized nursing process for Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Daniela Couto Carvalho Barra

    2014-02-01

    Full Text Available A hybrid study combining technological production and methodological research aiming to establish associations between the data and information that are part of a Computerized Nursing Process according to the ICNP® Version 1.0, indicators of patient safety and quality of care. Based on the guidelines of the Agency for Healthcare Research and Quality and the American Association of Critical Care Nurses for the expansion of warning systems, five warning systems were developed: potential for iatrogenic pneumothorax, potential for care-related infections, potential for suture dehiscence in patients after abdominal or pelvic surgery, potential for loss of vascular access, and potential for endotracheal extubation. The warning systems are a continuous computerized resource of essential situations that promote patient safety and enable the construction of a way to stimulate clinical reasoning and support clinical decision making of nurses in intensive care.

  4. A comparative cost analysis of polytrauma and neurosurgery Intensive Care Units at an apex trauma care facility in India

    Science.gov (United States)

    Kumar, Parmeshwar; Jithesh, V.; Gupta, Shakti Kumar

    2016-01-01

    Context: Although Intensive Care Units (ICUs) only account for 10% of the hospital beds, they consume nearly 22% of the hospital resources. Few definitive costing studies have been conducted in Indian settings that would help determine appropriate resource allocation. Aim: The aim of this study was to evaluate and compare the cost of intensive care delivery between multispecialty and neurosurgery ICUs at an apex trauma care facility in India. Materials and Methods: The study was conducted in a polytrauma and neurosurgery ICU at a 203-bedded Level IV trauma care facility in New Delhi, India, from May 1, 2012 to June 30, 2012. The study was cross-sectional, retrospective, and record-based. Traditional costing was used to arrive at the cost for both direct and indirect cost estimates. The cost centers included in the study were building cost, equipment cost, human resources, materials and supplies, clinical and nonclinical support services, engineering maintenance cost, and biomedical waste management. Statistical Analysis: Statistical analysis was performed by Fisher's two tailed t-test. Results: Total cost/bed/day for the multispecialty ICU was Rs. 14,976.9/- and for the neurosurgery ICU, it was Rs. 14,306.7/-, workforce constituting nearly half of the expenditure in both ICUs. The cost center wise and overall difference in the cost among the ICUs were statistically significant. Conclusions: Quantification of expenditure in running an ICU in a trauma center would assist health-care decision makers in better allocation of resources. Although multispecialty ICUs are more cost-effective, other factors will also play a role in defining the kind of ICU that needs to be designed.

  5. Prediktor Stres Keluarga Akibat Anggota Keluarganya Dirawat di General Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Zahara Farhan

    2014-09-01

    Full Text Available Hospitalization of family member in intensive care can be a trigger of stress in the family. Several factors which could create a stressful situation in a family are changes of environment, rules in the ward, changes of family emotional status, changes of family member roles, changes of daily activities, changes in financial situation and health care workers' attitude when giving information on patient’s health status. This study was a cross-sectional study. The number of subjects included in this study were 60 representing families whose member was hospitalized in the General Intensive Care Unit (GICU of Dr. Hasan Sadikin General Hospital (RSHS Bandung during the period of March to May 2012. The sampling technique used was purposive sampling. The instrument used to measure the stress predictors was developed based on theoretical review and modification of family inventory live events standard instrument. Meanwhile, the instrument used for measuring the family stress was the Depression Anxiety Stress Scale 42. Data were analyzed using chi-square test and logistic regression. The results of this study showed environmental changes, rules in the ward, emotional status changes and daily activity changes significantly corelated with stress (p value 0.01, 0.04 and 0.03, respectively. In conclusion, none of the 6 family predictors dominantly predicts stress. Nurses are expected to do early detection on psychological family problems in intensive care unit and optimize supportive-educative treatment in the form of counseling for family members.

  6. Intensive care nurses' encounters with multicultural families in Norway: an exploratory study.

    Science.gov (United States)

    Høye, Sevald; Severinsson, Elisabeth

    2008-12-01

    The aim of this study was to explore nurses' perceptions of their encounters with multicultural families in intensive care units in Norwegian hospitals. Immigrants from non-Western countries make up 6.1% of the population in Norway. When a person suffers an acute and critical illness the person's family may experience crises. Nurses' previous experiences of caring for culturally diverse patients and families is challenging due to linguistic differences, and contextual factors. Family members should be near their critically ill spouse to reduce the impact from a frightening environment. The study had a descriptive exploratory qualitative design with a retrospective focus. Three multistage focus groups consisting of 16 nurses were set up in intensive care units. The data were analysed by interpretive content analysis. The theme 'Cultural diversity and workplace stressors' emerged. This theme was characterised by four categories: 'impact on work patterns'; 'communication challenges'; 'responses to crises' and 'professional status and gender issues'. In conclusion, nurses' perception of their encounters with multicultural families in intensive care units seem to be ambiguous with challenges in interaction, and the nurses' stressors emanating from linguistic, cultural and ethnic differentness. To diminish cultural diversity the nurses strive for increased knowledge of different cultures and religions. PMID:18468898

  7. Giving information to family members of patients in the intensive care unit: Iranian nurses’ ethical approaches

    Science.gov (United States)

    Farahani, Mansoureh A; Gaeeni, Mina; Mohammadi, Nooreddin; Seyedfatemi, Naima

    2014-01-01

    Receiving information related to patients hospitalized in the intensive care unit is among the most important needs of the family members of such patients. When health care professionals should decide whether to be honest or to give hope, giving information becomes an ethical challenge We conducted a research to study the ethical approaches of Iranian nurses to giving information to the family members of patients in the intensive care units. This research was conducted in the intensive care units of three teaching hospitals in Iran. It employed a qualitative approach involving semi-structured and in-depth interviews with a purposive sample of 12 nurses to identify the ethical approaches to giving information to family members of the intensive care unit patients. A conventional content analysis of the data produced two categories and five subcategories. The two categories were as follows: a) informational support, and b) emotional support. Informational support had 2 subcategories consisting of being honest in giving information, and providing complete and understandable information. Emotional support in giving information had 3 sub-categories consisting of gradual revelation, empathy and assurance. Findings of the study indicated that ethical approaches to giving information can be in the form of either informational support or emotional support, based on patients’ conditions and prognoses, their families’ emotional state, the necessity of providing a calm atmosphere in the ICU and the hospital, and other patients and their families’ peace. Findings of the present study can be used as a basis for further studies and for offering ethical guidelines in giving information to the families of patients hospitalized in the ICU. PMID:25512830

  8. Giving information to family members of patients in the intensive care unit: Iranian nurses' ethical approaches.

    Science.gov (United States)

    Farahani, Mansoureh A; Gaeeni, Mina; Mohammadi, Nooreddin; Seyedfatemi, Naima

    2014-01-01

    Receiving information related to patients hospitalized in the intensive care unit is among the most important needs of the family members of such patients. When health care professionals should decide whether to be honest or to give hope, giving information becomes an ethical challenge We conducted a research to study the ethical approaches of Iranian nurses to giving information to the family members of patients in the intensive care units. This research was conducted in the intensive care units of three teaching hospitals in Iran. It employed a qualitative approach involving semi-structured and in-depth interviews with a purposive sample of 12 nurses to identify the ethical approaches to giving information to family members of the intensive care unit patients. A conventional content analysis of the data produced two categories and five subcategories. The two categories were as follows: a) informational support, and b) emotional support. Informational support had 2 subcategories consisting of being honest in giving information, and providing complete and understandable information. Emotional support in giving information had 3 sub-categories consisting of gradual revelation, empathy and assurance. Findings of the study indicated that ethical approaches to giving information can be in the form of either informational support or emotional support, based on patients' conditions and prognoses, their families' emotional state, the necessity of providing a calm atmosphere in the ICU and the hospital, and other patients and their families' peace. Findings of the present study can be used as a basis for further studies and for offering ethical guidelines in giving information to the families of patients hospitalized in the ICU. PMID:25512830

  9. Characteristics of physical activity programs in the Brazilian primary health care system

    Directory of Open Access Journals (Sweden)

    Grace Angélica de Oliveira Gomes

    2014-10-01

    Full Text Available The aim of this study was to describe the characteristics of programs that promote physical activity in the public primary care system by region of Brazil, subject to the presence or absence of multidisciplinary primary care teams (NASF. We conducted a cross sectional and population-based telephone survey of the health unit coordinators from 1,251 health care units. Coordinators were asked about the presence and characteristics of physical activity programs. Four out of ten health units reported having a physical activity intervention program, the most common involving walking groups. Most of the activities were performed in the morning, once or twice a week, and in sessions of 30 minutes or more. Physical education professionals were primarily responsible for directing the activities. Interventions occurred in the health unit itself or in adjacent community spaces. In general, these characteristics were similar between units with or without NASF, but varied substantially across regions. These findings will guide future physical activity policies and programs within primary care in Brazil.

  10. Characteristics of physical activity programs in the Brazilian primary health care system.

    Science.gov (United States)

    Gomes, Grace Angélica de Oliveira; Kokubun, Eduardo; Mieke, Grégore Iven; Ramos, Luiz Roberto; Pratt, Michael; Parra, Diana C; Simões, Eduardo; Florindo, Alex A; Bracco, Mario; Cruz, Danielle; Malta, Deborah; Lobelo, Felipe; Hallal, Pedro C

    2014-10-01

    The aim of this study was to describe the characteristics of programs that promote physical activity in the public primary care system by region of Brazil, subject to the presence or absence of multidisciplinary primary care teams (NASF). We conducted a cross sectional and population-based telephone survey of the health unit coordinators from 1,251 health care units. Coordinators were asked about the presence and characteristics of physical activity programs. Four out of ten health units reported having a physical activity intervention program, the most common involving walking groups. Most of the activities were performed in the morning, once or twice a week, and in sessions of 30 minutes or more. Physical education professionals were primarily responsible for directing the activities. Interventions occurred in the health unit itself or in adjacent community spaces. In general, these characteristics were similar between units with or without NASF, but varied substantially across regions. These findings will guide future physical activity policies and programs within primary care in Brazil. PMID:25388318

  11. Reviewing the effects of an educational program about sepsis care on knowledge, attitude, and practice of nurses in intensive care units

    OpenAIRE

    Yousefi, Hojatollah; Nahidian, Malihe; Sabouhi, Fakhri

    2012-01-01

    Background: The most common complication of hospitalization in intensive care units (ICUs) is infections caused by health care. Although sepsis results in a small percentage of infections, it has a high mortality rate. Intensive care nurses play a critical role in the prevention, early detection, and beginning of therapeutic interventions in patients with sepsis. This study aimed to review the effects of an educational program on knowledge, attitude, and practice of ICU nurses in Shariati Hos...

  12. [Learning from failure - implications for respiratory and intensive care medicine: a conceptual review].

    Science.gov (United States)

    Kabitz, H-J

    2013-08-01

    The clinical, social and economical impact of failure in medicine [i. e., adverse health care events (AHCE)] is overwhelming. Respiratory and intensive care medicine are strongly relevant to AHCE, particularly in cases associated with respiratory failure, mechanical ventilation and pharmacotherapy. In spite of the obvious necessity to learn from AHCE, its realisation in health-care organisations is still rare. This conceptual review therefore aims to (i) clarify the most relevant terminology, (ii) identify obstacles related to this health-care topic, and (iii) present possible strategies for solving the problems, thereby enabling respiratory and intensive care medicine to systematically and effectively learn from failure. A review of the literature (effective as of June 2013) derived from the electronic databases Medline via PubMed, EMBASE, ERIC and Google Scholar identified the following relevant obstacles (ii): a so-called blame culture associated with concealing failure, missing system analyses (vs. individual breakdown), and (economically) misdirected incentives. Possible strategies to overcome these obstacles (iii) include acknowledging the importance of leadership, a safe environment, open reporting, an effective feedback culture, and detection (e. g., trigger-tools), analysis and discussion (e. g., double loop learning) of failure. The underlying reasons for the occurrence of AHCE are based on structural, organisational and human shortcomings, and affect all categories of caregivers. Approaches to solving the problem should therefore focus primarily on the entire system, rather than on the individual alone. PMID:23846430

  13. Domestic dogs in a fragmented landscape in the Brazilian Atlantic Forest: abundance, habitat use and caring by owners.

    Science.gov (United States)

    Torres, P C; Prado, P I

    2010-11-01

    This study aimed at estimating the population size and attitudes of residents towards caring for domestic dogs, through questionnaire surveys, as well as the frequency of these animals in different habitats (anthropic and forest patch), using scent stations. The study was conducted in a severely fragmented area of the Brazilian Atlantic Forest. A large number of unrestricted dogs was recorded, averaging 6.2 ind/km². These dogs have owners and are regularly fed. Dog records decreased from the anthropogenic matrix to the forest patch edge, which suggests that dogs act as an edge effect on forest patches. Encounters between domestic dog and wild animals can still be frequent in severely fragmented landscapes, mainly at the forest edges. However the fact that most dogs have an owner and are more frequent in the anthropic habitat suggests that their putative effects are less severe than expected for a carnivore of such abundance, but the reinforcement of responsible ownership is needed to further ameliorate such effects. PMID:21180903

  14. High Burden of Palliative Needs among Older Intensive Care Unit Survivors Transferred to Post–Acute Care Facilities. A Single-Center Study

    OpenAIRE

    Baldwin, Matthew R.; Wunsch, Hannah; Reyfman, Paul A.; Narain, Wazim R.; Blinderman, Craig D.; Schluger, Neil W; Reid, M Cary; Maurer, Mathew S.; Goldstein, Nathan; Lederer, David J; Bach, Peter

    2013-01-01

    Rationale: Adults with chronic critical illness (tracheostomy after ≥ 10 d of mechanical ventilation) have a high burden of palliative needs, but little is known about the actual use and potential need of palliative care services for the larger population of older intensive care unit (ICU) survivors discharged to post–acute care facilities.

  15. Investigating the European perspective of neonatal point-of-care echocardiography in the neonatal intensive care unit-a pilot study

    NARCIS (Netherlands)

    Roehr, C. C.; te Pas, A. B.; Dold, Simone K.; Breindahl, M.; Blennow, M.; Ruediger, M.; Gupta, Samir

    2013-01-01

    Point-of-care functional neonatal echocardiography (fnECHO) is increasingly used to assess haemodynamic status or patency of the ductus arteriosus (PDA). In Australasia, 90 % of neonatal intensive care units (NICUs) practice point-of-care fnECHO. The Australian Society of Ultrasound Medicine offers

  16. Acute kidney injury on admission to the intensive care unit: where to go from here?

    OpenAIRE

    Ostermann, Marlies

    2008-01-01

    Acute kidney injury (AKI) is a common problem, especially in critically ill patients. In Critical Care, Kolhe and colleagues report that 6.3% of 276,731 patients in 170 intensive care units (ICUs) in the UK had evidence of severe AKI within the first 24 hours of admission to ICU. ICU and hospital mortality as well as length of stay in hospital were significantly increased. In light of this serious burden on individuals and the health system in general, the following commentary discusses the c...

  17. Facilitation of parenting the premature infant within the newborn intensive care unit.

    Science.gov (United States)

    Lawhon, Gretchen

    2002-06-01

    A challenge facing neonatal health care providers is to combine technological intensive care for preterm infants with a sensitive and individualized approach facilitating neurobehavioral development while supporting parents in their roles as primary advocates and long-term caregivers. This exploratory study evaluated an individualized nursing intervention based on underlying assumptions of both infant and parent competence. The intervention enhanced parents' ability to appraise their infant's behavior critically and respond in a supportive manner. Study findings provide valuable information on the implications of an individualized nursing intervention both for further research and clinical practice. PMID:12083296

  18. PO02 - Clinical profile of children admitted to a paediatric intensive care unit due to acute clinical deterioration

    DEFF Research Database (Denmark)

    Jensen, Claus Sixtus; Aagaard, Hanne; Olesen, Hanne Vebert;

    2016-01-01

    Theme: Intensive care Background: There has been an increased number of critically ill patients admitted to paediatric departments. Only a few studies have described the various causes of unplanned admission to paediatric intensive care units (PICU) due to clinical deterioration. However, an...... critical ill children in paediatric wards....

  19. The Development and Evaluation of Delirium Assessment and Nursing Care Decision-Making Assistant Mobile Application for Intensive Care Unit.

    Science.gov (United States)

    Yang, Fangyu; Ji, Meihua; Ding, Shu; Wu, Ying; Chang, Polun; Lin, Chiawei; Yang, Xin

    2016-01-01

    Delirium is a common complication among patients in ICU settings. Although it has been repeatedly confirmed that Confusion Assessment Model for Intensive Care Unit (CAM-ICU), one of the most commonly used ICU delirium assessment tool, is highly accurate in validation studies, it's sensitivity and specificity is relatively low during routine practice among bedside nurses. The aim of this study is to develop a mobile application (app) to detect delirium and to test its reliability and validity both by research nurses and among ICU bedside nurses. The app was programmed with Java and installed on a mobile device with Android system. After completion of reliability and validity testing, the app will be integrated into the existing Hospital Information System in order to automatically retrieve essential information for risk factor identification and formulation of care plan accordingly to prevent or manage ICU delirium. PMID:27332299

  20. The History of Care of Premature Infants: From Neonate Intensive Care to Special Care Baby Unit (SCBU).

    Science.gov (United States)

    Douret, L.; And Others

    1994-01-01

    Outlines the history of and reviews the literature on the care of premature infants. Focuses on the medicalization of birth; early neonatology; the effect of advances in medicine on the survival and safety of neonates; and the importance of early mother-neonate interactions. (BC)

  1. The role of memories on health-related quality of life after intensive care unit care: an unforgettable controversy?

    OpenAIRE

    Orvelius, Lotti

    2016-01-01

    Lotti Orwelius,1-4 Armando Teixeira-Pinto,2,5 Cristina Lobo,2 Altamiro Costa-Pereira,1,2 Cristina Granja,1,2,6,7 1Department of Health Information and Decision Sciences, Faculty of Medicine of Porto, Porto, Portugal; 2CINTESIS – Centre for Research in Health Technologies and Health Systems, Faculty of Medicine of Porto, Porto, Portugal; 3Department of Intensive Care, Linköping University, County Council of Östergötland, Linköping, Sweden; 4Departm...

  2. The role of memories on health-related quality of life after intensive care unit care: an unforgettable controversy?

    OpenAIRE

    Orwelius L; Teixeira-Pinto A; Lobo C; Costa-Pereira A; Granja C.

    2016-01-01

    Lotti Orwelius,1-4 Armando Teixeira-Pinto,2,5 Cristina Lobo,2 Altamiro Costa-Pereira,1,2 Cristina Granja,1,2,6,7 1Department of Health Information and Decision Sciences, Faculty of Medicine of Porto, Porto, Portugal; 2CINTESIS – Centre for Research in Health Technologies and Health Systems, Faculty of Medicine of Porto, Porto, Portugal; 3Department of Intensive Care, Linköping University, County Council of Östergötland, Linköping, Sweden; 4Department of Clinical and ...

  3. Mead Johnson Critical Care Symposium for the Practising Surgeon. 4. Abdominal crisis in the intensive care unit.

    Science.gov (United States)

    Gregor, P; Prodger, J D

    1988-09-01

    Abdominal crises are common in critically ill patients who are admitted to the intensive care unit for problems unrelated to the abdomen. General surgeons may be asked to assess these patients for such reasons as pain, distension, possible sepsis, radiologic or laboratory abnormalities. Since many of the diagnostic signs and symptoms of acute abdomen are blunted or absent in critically ill patients who may be comatose or have been given analgesics or steroids, frequent thorough physical examination and close cooperation with the service admitting the patient are necessary to ensure early diagnosis and aggressive treatment of the abdominal crisis. PMID:3046730

  4. Cerrando la brecha entre los cuidados paliativos y los cuidados intensivos Bringing the GAP between palliative care and intensive care

    Directory of Open Access Journals (Sweden)

    María Gálvez González

    2010-09-01

    Full Text Available El envejecimiento de la población ha traído consigo un cambio en el tipo de enfermedades subyacentes que padecen los usuarios de los servicios sanitarios, y ha elevado sustancialmente la tasa de mortalidad de los servicios de medicina intensiva de los países desarrollados. Esta circunstancia ha incentivado la inclusión de herramientas típicas de la medicina paliativa (centrada en el confort del paciente en las unidades de cuidados intensivos (centradas en la curación. La inclusión de estas herramientas no está resultando tarea fácil, puesto que al imperativo tecnológico dominante en este tipo de unidades, se le suman los condicionamientos sociales y culturales de la época moderna. En este artículo se presenta la perspectiva fenomenológica de la muerte en la unidad de cuidados intensivos, vista por una enfermera con experiencia en el campo de la medicina paliativa. En su narración se entrecruzan las creencias, vivencias y sentimientos que estas dos disciplinas han suscitado en la informante.The ageing of the population has introduced a change in the type of underlying diseases of the clients of the health services, and has increased substantially the mortality rate in the units of intensive care in the developed countries. This event has increased the need of including tools and specific care of palliative medicine (cantered in providing patient comfort in the intensive care units (which were aimed to heal. The incorporation of these tools is not turning out to be an easy as this area has been very technological, and now a days has to take into account the modern, cultural and social changes. This article presents the phenomenological perspective of death in the intensive care units, as seen by a nurse with experience in palliative care. In her story we can see the beliefs, feelings and experiences that these two disciplines have awoken in this informer.

  5. Practical measurements of radiation dose in a neonatal intensive care unit

    Energy Technology Data Exchange (ETDEWEB)

    Smans, K.; Vanhavere, F.; Bosmans, H.

    2006-07-01

    The EURATOM directive 97/43 and the Belgian Royal Decree of July 20, 2001 impose today the application of the ALARA principle in medical practices. Priority should be given to paediatric examinations, especially for X-ray examinations undertaken in neonatal intensive care units. Within this framework, a dose study was started to assess the patient doses in one neonatal intensive care unit for the most common examinations. Direct measurement of radiation dose was done using highly sensitive thermoluminescent dosemeters (TLDs). The ESD was on average 66 {mu}Gy. Also DAP-measurements were performed. For RX-thorax an average DAP-value of 1,27 cGy.cm{sub w}as calculated. (Author)

  6. The nurse’s visibility in intensive care units: perceptions of workers

    Directory of Open Access Journals (Sweden)

    Liza Amaral Frota

    2015-09-01

    Full Text Available We aimed to understand health worker’s perceptions about the nurse’s visibility who works at an intensive care unit. An exploratory descriptive and qualitative research conducted in a large size hospital in the South of Brazil. Participants were physicians, physiotherapists, secretaries and cleaning workers from intensive care units. Data were collected through semi-structured interview and submitted to content analysis, thematic modality. The nurse’s visibility is recognized by articulation in assistive process, subsidized by scientific knowledge and management capability. The lack of institutional support and work overload were pointed by other professionals as limits. The great responsibility given to nurses and overload are unfavorable factors to visibility, yet, scientific knowledge linked to their actions, gives them visibility, credibility, trust and respect from the team.

  7. A numerical model of an intensive care ventilator-humidifier system.

    Science.gov (United States)

    Drew, T; Vardy, A; Tarnow-Mordi, W; Lerski, R

    1996-04-01

    Current intensive care ventilator-humidifier systems neither monitor nor adequately control inspired gas humidity. Problems of low delivered humidity and condensation within ventilator circuitry are commonly encountered. To help to address these problems, a numerical model of a complete ventilator-humidifier-patient intensive care system has been developed. The model, based on a finite difference technique, can predict pressures, flow-rates, temperatures and relative humidities at discrete points throughout the system. A comparison of numerical predictions and measurements in a real system is reported. A strong qualitative agreement is demonstrated in all cases studied, and a good quantitative agreement is obtained in most cases. It is concluded that such models could be used to assess methods of controlling ventilator-humidifier systems to prevent the occurrence of condensation. Similar models could be developed for other medical gas delivery systems. PMID:8718951

  8. [Patients, physicians and nursing personnel in intensive care units : Psychological and psychotherapeutic interventions].

    Science.gov (United States)

    Meraner, V; Sperner-Unterweger, B

    2016-03-01

    During intensive care treatment patients suffer from various forms of stress. Certain psychological and psychotherapeutic interventions (e. g. cognitive behavior therapy, hypnotherapy and psychoeducation) can provide relief. Even patients with a severely reduced ability to communicate can benefit from an early psychological intervention as supportive treatment. The aim of these interventions is to reduce psychological impairments and burdens, provide strategies for coping with physical handicaps or necessary treatment and avoid long-term negative psychological impacts. Organizational and institutional constraints as well as emotional stress are a specific challenge for intensive care personnel. In order to guarantee an efficient collaboration within an interdisciplinary team it is vital to follow clearly defined methods of communication exchange, such as daily ward rounds, regular multidisciplinary meetings and team or case-focused supervision. Properly functioning teamwork increases job satisfaction and is the key to an optimal therapy for the patients. PMID:26927678

  9. 3D web based learning of medical equipment employed in intensive care units.

    Science.gov (United States)

    Cetin, Aydın

    2012-02-01

    In this paper, both synchronous and asynchronous web based learning of 3D medical equipment models used in hospital intensive care unit have been described over the moodle course management system. 3D medical equipment models were designed with 3ds Max 2008, then converted to ASE format and added interactivity displayed with Viewpoint-Enliven. 3D models embedded in a web page in html format with dynamic interactivity-rotating, panning and zooming by dragging a mouse over images-and descriptive information is embedded to 3D model by using xml format. A pilot test course having 15 h was applied to technicians who is responsible for intensive care unit at Medical Devices Repairing and Maintenance Center (TABOM) of Turkish High Specialized Hospital. PMID:20703738

  10. Radiation exposure during chest X-ray examinations in a premature intensive care unit: phantom studies

    Energy Technology Data Exchange (ETDEWEB)

    Duetting, T.; Foerste, B.; Darge, K.; Troeger, J. [Heidelberg Univ. (Germany). Dept. of Paediatric Radiology; Knoch, T. [Heidelberg Univ. (Germany). Central Radiation Protection

    1999-03-01

    Background. There are few reports on the radiation dose received by infants, their family and radiographers exposed to scatter radiation in a premature baby intensive care unit. Objective. To evaluate the degree of radiation exposure from diagnostic X-ray examinations with mobile X-ray machines in a premature intensive care unit. Materials and methods. The radiation exposure of an adjacent newborn, the radiographer and other persons in the room was simulated using phantoms during X-ray examination of the chest using vertical and horizontal beams. Results. Most of the measured doses were below the registration limit of the measuring apparatus and had to be extrapolated by multiple exposures. Without exception, the maximal doses were significantly lower than the permitted limit for persons not professionally exposed to X-rays. Conclusions. Recommendations to avoid unnecessary radiation exposure are given. (orig.) With 2 figs., 3 tabs., 10 refs.

  11. Brain lesions in eclampsia: A series of 39 cases admitted in an Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Y Brouh

    2016-01-01

    Full Text Available The aim of this study was to identify the encephalic lesions in the eclampsia occurrences. Within a period of 18 months, computed tomography (CT of the brain was performed in all patients admitted in intensive care for eclampsia. These CTs were analyzed and intracerebral lesions were identified. Thirty-nine patients were included. We noted 10 cases of ischemic stroke, 9 cases of cerebral edema, and 3 cases of hemorrhagic stroke and subarachnoid hemorrhage. The CT scan came back to normal in 20 eclamptic patients. Overall, delays in obstetric and intensive care and time of completion of the CT were long. CT has allowed highlighting in patients with eclampsia varied intracerebral lesions. The early performance of the CT is therefore essential for a better support of patients.

  12. Part 2, Conflict management. Managing low-to-mid intensity conflict in the health care setting.

    Science.gov (United States)

    Aschenbrener, C A; Siders, C T

    1999-01-01

    Physician executives face low to mid-level intensity conflicts, day-to-day issues and problems associated with pressures and changes in the health care environment. Such conflicts can be sorted on the basis of relationship, duration, and intensity. The authors apply the five major modes of conflict management--competition, avoidance, compromise, accommodation, and collaboration--to specific scenarios taken from their work in health care and suggest guidelines for managing conflicts with peers, supervisees, and authority figures. Thorough preparation and a portfolio of skills build flexibility through the conflict management process. In part 1 of this article series, the authors presented the conflict management checklist, a diagnostic tool for assessing conflict in organizations. PMID:10558283

  13. Cluster of Candida parapsilosis primary bloodstream infection in a neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Silva Carmem Lúcia P. da

    2001-01-01

    Full Text Available Candida parapsilosis is an increasingly important bloodstream pathogen in neonatal intensive care units (NICU. We investigated a cluster of bloodstream infections in a NICU to determine whether nosocomial transmission occurred. During a 3-day period, 3 premature infants hospitalized in the same unit presented with sepsis caused by C. parapsilosis. Electrophoretic karyotype of the organisms was performed by using pulsed field gel electrophoresis in a countour-clamped homogeneous electric field system. The isolate from 1 newborn could not be typed, and the isolates from the remaining 2 infants had identical patterns. All 3 cases are described. We conclude that nosocomial transmission of C. parapsilosis occurred and that neonates under intensive care may represent a risk group for this pathogen.

  14. Implementation of sepsis algorithm by nurses in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Paula Pedroso Peninck

    2012-04-01

    Full Text Available Sepsis is defined as a clinical syndrome consisting of a systemic inflammatory response associated to an infection, which may determine malfunction or failure of multiple organs. This research aims to verify the application of implementation of sepsis algorithm by nurses in the Intensive Care Unit and create an operational nursing assistance guide. This is an exploratory, descriptive study with quantitative approach. A data collection instrument based on relevant literature was elaborated, assessed, corrected and validated. The sample consisted of 20 intensive care unit nurses. We obtained satisfactory evaluations on nurses’ performance, but some issues did not reach 50% accuracy. We emphasize the importance of greater numbers of nurses getting acquainted and correctly applying the sepsis algorithm. Based on the above, an operational septic patient nursing assistance guide was created, based on the difficulties that arose vis-à-vis the variables applied in research and relevant literature.

  15. Retrospective Study of the Survival of Patients who Underwent Cardiopulmonary Resuscitation in an Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Moreira Daniel Martins

    2002-01-01

    Full Text Available OBJECTIVE: To evaluate clinical and evolutive characteristics of patients admitted in an intensive care unit after cardiopulmonary resuscitation, identifying prognostic survival factors.METHODS: A retrospective study of 136 patients admitted between 1995 and 1999 to an intensive care unit, evaluating clinical conditions, mechanisms and causes of cardiopulmonary arrest, and their relation to hospital mortality.RESULTS: A 76% mortality rate independent of age and sex was observed. Asystole was the most frequent mechanism of death, and seen in isolation pulmonary arrest was the least frequent. Cardiac failure, need for mechanical ventilation, cirrhosis and previous stroke were clinically significant (p<0.01 death factors.CONCLUSION: Prognostic factors supplement the doctor's decision as to whether or not a patient will benefit from cardiopulmonary resuscitation.

  16. Radiation exposure during chest X-ray examinations in a premature intensive care unit: phantom studies

    International Nuclear Information System (INIS)

    Background. There are few reports on the radiation dose received by infants, their family and radiographers exposed to scatter radiation in a premature baby intensive care unit. Objective. To evaluate the degree of radiation exposure from diagnostic X-ray examinations with mobile X-ray machines in a premature intensive care unit. Materials and methods. The radiation exposure of an adjacent newborn, the radiographer and other persons in the room was simulated using phantoms during X-ray examination of the chest using vertical and horizontal beams. Results. Most of the measured doses were below the registration limit of the measuring apparatus and had to be extrapolated by multiple exposures. Without exception, the maximal doses were significantly lower than the permitted limit for persons not professionally exposed to X-rays. Conclusions. Recommendations to avoid unnecessary radiation exposure are given. (orig.)

  17. Scorpion envenoming caused by Tityus cf. silvestris evolving with severe muscle spasms in the Brazilian Amazon.

    Science.gov (United States)

    Monteiro, Wuelton Marcelo; de Oliveira, Sâmella Silva; Pivoto, Guilherme; Alves, Eliane Campos; de Almeida Gonçalves Sachett, Jacqueline; Alexandre, Cleber Nunes; Fé, Nelson Ferreira; Barbosa Guerra, Maria das Graças Vale; da Silva, Iran Mendonça; Tavares, Antonio Magela; Ferreira, Luiz Carlos de Lima; Lacerda, Marcus Vinícius Guimarães

    2016-09-01

    Scorpion stings are a public health problem in the Brazilian Amazon. However, detailed clinical characterization with the proper animal identification is scarce. Here we report a confirmed case of envenoming by Tityus cf. silvestris in the Brazilian Amazon. The case evolved with generalized muscle spasms and was treated with antivenom and supportive therapy, requiring intensive care unit admission. The patient evolved favourably and was discharged after 9 days of hospitalization. PMID:27368713

  18. Exposure to Phthalates in Neonatal Intensive Care Unit Infants: Urinary Concentrations of Monoesters and Oxidative Metabolites

    OpenAIRE

    Weuve, Jennifer; Brisa N. Sánchez; Calafat, Antonia M.; Schettler, Ted; Green, Ronald A; Hu, Howard; Hauser, Russ

    2006-01-01

    Objective We previously demonstrated that among 54 infants in neonatal intensive care units, exposure to polyvinyl chloride plastic medical devices containing the plasticizer di(2-ethylhexyl) phthalate (DEHP) is associated with urinary concentrations of mono(2-ethylhexyl) phthalate (MEHP), a DEHP metabolite. In this follow-up report, we studied the neonates’ exposure to DEHP-containing devices in relation to urinary concentrations of two other DEHP metabolites, and to urinary concentrations o...

  19. Validation of the Simplified Acute Physiology Score 3 Scoring System in a Korean Intensive Care Unit

    OpenAIRE

    Lim, So Yeon; Ham, Cho Rom; Park, So Young; Kim, Suhyun; Park, Maeng Real; Jeon, Kyeongman; Um, Sang-Won; Chung, Man Pyo; Kim, Hojoong; Kwon, O Jung; Suh, Gee Young

    2010-01-01

    Purpose The Simplified Acute Physiology Score (SAPS) 3 was recently proposed to reflect contemporary changes in intensive care practices. SAPS 3 features customized equations for the prediction of mortality in different geographic regions. However, the usefulness of SAPS 3 and its customized equation (Australasia SAPS 3) have never been externally validated in Korea. This study was designed to validate SAPS 3 and Australasia SAPS 3 for mortality prediction in Korea. Materials and Methods A re...

  20. Biochemical markers in the surgical intensive care: Identifying critically ill surgical patients with complications

    OpenAIRE

    Meyer, Zainna

    2015-01-01

    markdownabstract__Abstract__ Introductie Patiënten die postoperatief op de intensive care (IC) worden opgenomen hebben een hogere kans op het ontwikkelen van complicaties. Het is belangrijk om deze complicaties vroegtijdig te kunnen identificeren bij de kritiek zieke chirurgische patiënten op de IC om tijdig adequate therapie te kunnen starten. Hierom bestudeerden wij de klinische voorspellende waarde van dagelijks gebruikte biomarkers C-reactief proteïne CRP), lactaat, procalcitonine (PCT) e...