Ana Paula Cezar Machado
Full Text Available Abstract Pediatric patients, especially those admitted to the neonatal intensive care unit (ICU, are highly vulnerable to medication errors. This study aimed to measure the prescription error rate in a university hospital neonatal ICU and to identify susceptible patients, types of errors, and the medicines involved. The variables related to medicines prescribed were compared to the Neofax prescription protocol. The study enrolled 150 newborns and analyzed 489 prescription order forms, with 1,491 medication items, corresponding to 46 drugs. Prescription error rate was 43.5%. Errors were found in dosage, intervals, diluents, and infusion time, distributed across 7 therapeutic classes. Errors were more frequent in preterm newborns. Diluent and dosing were the most frequent sources of errors. The therapeutic classes most involved in errors were antimicrobial agents and drugs that act on the nervous and cardiovascular systems.
Dias, Fernando Suparregui; Rezende, Ederlon Alves de Carvalho; Mendes, Ciro Leite; Silva Jr., João Manoel; Sanches, Joel Lyra
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
Ana Carolina Vieira Costa Fernandes Távora
Full Text Available This study was designed to describe the epidemiology and risk factors for nosocomial infection (NI in a Brazilian neonatal intensive care unit (NICU. This study was a retrospective cohort from January to December, 2003. All neonates admitted to the NICU. Infection surveillance was conducted according to the NNIS, CDC. Chi-square test and logistic regression model were performed for statistical analyses. The study was conducted at a public, tertiary referral NICU of a teaching hospital in the Northeast of Brazil. A total of 948 medical records were reviewed. Overall NI incidence rate was 34%. The main neonatal NI was bloodstream infection (68.1%, with clinical sepsis accounting for 47.2%, and pneumonia was the second most common NI (8.6%. Multivariate analysis identified seven independent risk factors for NIs: birth weight, exposure to parenteral nutrition, percutaneous catheter, central venous catheter or mechanical ventilation, abruptio placentae and mother's sexually transmitted disease (STD. Neonates from mothers with STD or abruptio placentae, those weighing less than 1,500 g at birth or those who used invasive devices were at increased risk for acquiring NI.
Bittencourt, Paulo Lisboa; Terra, Carlos; Parise, Edison Roberto; Farias, Alberto Queiroz; Arroyo, Vincent; Fernandez, Javier; Pereira, Gustavo; Maubouisson, Luiz Marcelo; Andrade, Guilherme Marques; Costa, Fernando Gomes de Barros; Codes, Liana; Andrade, Antônio Ricardo; Matos, Angelo; Torres, André; Couto, Fernanda; Zyngier, Ivan
Survival rates of critically ill patients with liver disease has sharply increased in recent years due to several improvements in the management of decompensated cirrhosis and acute liver failure. This is ascribed to the incorporation of evidence-based strategies from clinical trials aiming to reduce mortality. In order to discuss the cutting-edge evidence regarding critical care of patients with liver disease, a joint single topic conference was recently sponsored by the Brazilian Society of Hepatology in cooperation with the Brazilian Society of Intensive Care Medicine and the Brazilian Association for Organ Transplantation. This paper summarizes the proceedings of the aforementioned meeting and it is intended to guide intensive care physicians, gastroenterologists and hepatologists in the care management of patients with liver disease.
Macintire, D K
To provide optimal care, a veterinarian in a pediatric intensive care situation for a puppy or kitten should be familiar with normal and abnormal vital signs, nursing care and monitoring considerations, and probable diseases. This article is a brief discussion of the pediatric intensive care commonly required to treat puppies or kittens in emergency situations and for canine parvovirus type 2 enteritis.
Full Text Available INTRODUCTION: Central venous catheters (CVC are devices of great importance in health care. The advantages gained from the use of catheters outweigh the complications that might result from their use, among which bloodstream infections (BSI. In spite of its importance, few national studies have addressed this issue. OBJECTIVE: The aim this study was to determine the incidence of BSI in patients with CVC, hospitalized in ICU, as well as the variables associated with this complication. METHODS: Multicentric cohort study carried out at ICUs of three hospitals at Universidade Federal de São Paulo complex. RESULTS: A total of 118 cases of BSI in 11.546 catheters day were observed: 10.22 BSI per 1,000 catheters day. On average, BSI was associated to seven additional days of hospital stay in our study (p < 0.001, with a significant difference between types of catheters. Concerning the place of insertion, there was no statistical difference in BSI rates. CONCLUSION: We concluded that a patient who uses a catheter for longer than 13 days presents a progressive risk for infection of approximately three times higher in relation to a patient who uses the catheter for less than 13 days (p < 0.001. The median duration of catheter use was 14 days among patients with BSI and 9 days in patients without infection (p < 0.001. There was higher prevalence of Gram-negative infections. The risk factors for BSI were utilization of multiple-lumen catheters, duration of catheterization and ICU length of stay.
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
Christiansen, Christian Fynbo; Møller, Morten Hylander; Nielsen, Henrik
AIM OF DATABASE: The aim of this database is to improve the quality of care in Danish intensive care units (ICUs) by monitoring key domains of intensive care and to compare these with predefined standards. STUDY POPULATION: The Danish Intensive Care Database (DID) was established in 2007...
Zeni Carvalho Lamy
Full Text Available Este estudo contextualiza a experiência brasileira na Atenção Humanizada ao Recém-Nascido de Baixo Peso-Método Canguru, resgatando aspectos ligados à origem do Método Canguru na Colômbia e sua utilização em diferentes países. Para sistematizar a experiência partiu-se da leitura de fontes diversas que incluíram artigos, dissertações, teses e textos oficiais produzidos pelo Ministério da Saúde. A análise do processo de implantação da Atenção Humanizada ao Recém-Nascido de Baixo Peso - Método Canguru pelo Ministério da Saúde nos permitiu mapear uma experiência distinta da encontrada em países que adotaram ou discutem o Método Canguru como estratégia de substituição de tecnologia. Por outro lado, a experiência brasileira também é mais ampla do que aquela encontrada nos países desenvolvidos e se configura como estratégia de qualificação do cuidado neonatal.This work describes the start of Kangaroo Care utilization in Colombia, his spread in other countries and how it is applied in Brazil, contextualizing the Brazilian experience in the Humanized Care of Low Weight Newborn - Kangaroo Care (AHRNPB-MC. Our primary source to systemize the experience was the analysis of documents, including official papers produced by the Brazilian health department. The study provided a reflection on the AHRNPB-MC and his use as tool for improvement the Brazilian neonatal care.
Michel Rodrigues Moreira
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.
Bittner, Martin-Immanuel; Donnelly, Maria; van Zanten, Arthur Rh
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 ...
Schnitzler, E J
8.2% of the gross domestic product is spent annually on health care in Argentina, a country of 32 million people. There is 1 medical doctor of every 147,000 beds in a total 3180 hospitals. The infant mortality rate in Argentina is 24.5/1000 live births which is high compared to developed countries. Perinatal causes and congenital anomalies are the main cause of death after the neonatal period, and accidents, cardiac disease, and respiratory tract infections are the main causes of death among children over age 1 year. Argentina has approximately 35 pediatric intensive care units (ICU), but 154 of 244 beds are within or near the capital. Only 2 hospitals have pediatric intensive care fellowship programs, so full time dedicated staff is rare. 250 registered pediatricians dedicated to intensive care are in the Argentine Pediatric Society and the nurse/bed ratio is 1:2-1:3. Moreover, the country has neither postanesthesia recuperation units, burn units, chronic ventilation units, nor approved home assistance programs, and intermediate care is not clearly standardized. These inadequacies have led to a shortage of beds and the caring for of critically ill children in general pediatric or emergency wards in hospitals which lack adequate equipment; patients are often discharged inappropriately to clear bed space. Even so, prehospital and emergency room care tends to be provided without the necessary coordination with the pediatric ICU, and structural conditions regarding electrical self-sufficiency, air conditioning, and circulation are met in only few units. Despite the existence of these adverse conditions for the care of critically ill children, a pediatric organ transplant program developed since 1987 has demonstrated 70% to 100% survival rates for 16l orthotopic liver and 9 heart transplants, respectively. Alternatives to improving intensive care in Argentina include optimizing the response of emergency and critical care delivery systems, categorizing hospitals and
Sabrina da Costa Machado Duarte
Full Text Available Objectives: to identify the errors in daily intensive nursing care and analyze them according to the theory of human error. Method: quantitative, descriptive and exploratory study, undertaken at the Intensive Care Center of a hospital in the Brazilian Sentinel Hospital Network. The participants were 36 professionals from the nursing team. The data were collected through semistructured interviews, observation and lexical analysis in the software ALCESTE(r. Results: human error in nursing care can be related to the approach of the system, through active faults and latent conditions. The active faults are represented by the errors in medication administration and not raising the bedside rails. The latent conditions can be related to the communication difficulties in the multiprofessional team, lack of standards and institutional routines and absence of material resources. Conclusion: the errors identified interfere in nursing care and the clients' recovery and can cause damage. Nevertheless, they are treated as common events inherent in daily practice. The need to acknowledge these events is emphasized, stimulating the safety culture at the institution.
Magid, Tobias; Haase, Nicolai; Andersen, Jakob Steen
This article presents the treatment results of 320 consecutive patients with malignant haematological diagnoses admitted to a tertiary intensive care unit at a Danish University hospital over a six-year period (2005-2010). With reference to international publications, we describe the development...
Boyko, Yuliya; Jennum, Poul; Nikolic, Miki
PURPOSE: To determine if improving intensive care unit (ICU) environment would enhance sleep quality, assessed by polysomnography (PSG), in critically ill mechanically ventilated patients. MATERIALS AND METHODS: Randomized controlled trial, crossover design. The night intervention "quiet routine......" protocol was directed toward improving ICU environment between 10pm and 6am. Noise levels during control and intervention nights were recorded. Patients on mechanical ventilation and able to give consent were eligible for the study. We monitored sleep by PSG.The standard (American Association of Sleep...... Medicine) sleep scoring criteria were insufficient for the assessment of polysomnograms. Modified classification for sleep scoring in critically ill patients, suggested by Watson et al. (Crit Care Med 2013;41:1958-1967), was used. RESULTS: Sound level analysis showed insignificant effect...
Ocorrência de bactérias multiresistentes em um centro de Terapia Intensiva de Hospital brasileiro de emergências Occurrence of multi-resistant bacteria in the Intensive Care unit of a Brazilian hospital of emergencies
Denise de Andrade
same time, increase hospital costs. Given their clinical conditions, which require invasive procedures and antimicrobial treatment, hospitalized patients, especially at the Intensive Care Unit, are particularly susceptible to hospital infection. This study aimed to evaluate the occurrence of multiresistant bacteria in patients hospitalized at the Intensive Care Unit of a Brazilian emergency hospital. METHODS: Our retrospective study was approved by the Ethics Committee and considered the period between October 2003 and September 2004. A database was developed through variable coding and double entry, and Statistical Package for Social Sciences (SPSS software, version 10.0, was used for statistical analysis. RESULTS: Multiresistant bacteria were identified in 68 patients, 47 (69.1% of whom were men, with 55 years as the mean age. All patients were submitted to endotracheal intubation and central venipuncture. The most frequent bacteria were coagulase-negative Staphylococcus sp. (36.4%, followed by Staphylococcus aureus (19%. Cephalosporin was the most frequently used (21.4% antimicrobial agent. CONCLUSIONS: Knowledge on infection occurrence provokes reflections on multiresistance, directs educative actions and favors interventions to prevent and control problem situations.
Egerod, Ingrid; Bergbom, Ingegerd; Lindahl, Berit
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......: Nordic intensive care units. PARTICIPANTS: Patients in Nordic intensive care units. METHODS: We performed a literature search of qualitative studies of the patient experience of intensive care based on Nordic publications in 2000-2013. We searched the following databases: PubMed, CINAHL, Scopus, and Psyc......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...
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...
Zeilani, Ruqayya Sayed Ali
This study explores women's experiences of critical illness in Jordanian intensive care units. A narrative approach was employed to access Jordanian women's stories of their critical illness and to study how these accounts changed during the period following their discharge from intensive care. The study was conducted in two hospitals in a major Jordanian city. A purposive sample of 16 women who had spent at least 48 hours in intensive care was recruited over a period of six months, with each...
Rafael Celestino da Silva
Full Text Available Objective: to propose a conceptual framework for clinical nursing care in intensive care.Method: descriptive and qualitative field research, carried out with 21 nurses from an intensive care unit of a federal public hospital. We conducted semi-structured interviews and thematic and lexical content analysis, supported by Alceste software.Results: the characteristics of clinical intensive care emerge from the specialized knowledge of the interaction, the work context, types of patients and nurses characteristic of the intensive care and care frameworks.Conclusion: the conceptual framework of the clinic's intensive care articulates elements characteristic of the dynamics of this scenario: objective elements regarding technology and attention to equipment and subjective elements related to human interaction, specific of nursing care, countering criticism based on dehumanization.
Huggins, Elizabeth L; Bloom, Sarah L; Stollings, Joanna L; Camp, Mildred; Sevin, Carla M; Jackson, James C
The number of patients surviving critical illness in the United States has increased with advancements in medicine. Post-intensive care syndrome and post-intensive care syndrome-family are terms developed by the Society of Critical Care Medicine in order to address the cognitive, psychological, and physical sequelae emerging in patients and their families after discharge from the intensive care unit. In the United Kingdom and Europe, intensive care unit follow-up clinics have been used to address the complications of post-intensive care syndrome for some time. However, the interprofessional clinic at Vanderbilt University Medical Center is among the first in the United States to address the wide variety of problems experienced by intensive care survivors and to provide patients and their families with care after discharge from the intensive care unit.
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 ...
Blanch, L; Annane, D; Antonelli, M; Chiche, J D; Cuñat, J; Girard, T D; Jiménez, E J; Quintel, M; Ugarte, S; Mancebo, J
Intensive care medical training, whether as a primary specialty or as secondary add-on training, should include key competences to ensure a uniform standard of care, and the number of intensive care physicians needs to increase to keep pace with the growing and anticipated need. The organisation of intensive care in multiple specialty or central units is heterogeneous and evolving, but appropriate early treatment and access to a trained intensivist should be assured at all times, and intensivists should play a pivotal role in ensuring communication and high-quality care across hospital departments. Structures now exist to support clinical research in intensive care medicine, which should become part of routine patient management. However, more translational research is urgently needed to identify areas that show clinical promise and to apply research principles to the real-life clinical setting. Likewise, electronic networks can be used to share expertise and support research. Individuals, physicians and policy makers need to allow for individual choices and priorities in the management of critically ill patients while remaining within the limits of economic reality. Professional scientific societies play a pivotal role in supporting the establishment of a defined minimum level of intensive health care and in ensuring standardised levels of training and patient care by promoting interaction between physicians and policy makers. The perception of intensive care medicine among the general public could be improved by concerted efforts to increase awareness of the services provided and of the successes achieved.
Egerod, Ingrid; Bagger, Christine
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...... 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...
Biarent, D; Otte, F; Fonteyne, C; Khalil, T
Paediatric intensive care is born 40 years ago. It has been shown that admission of critically ill children in intensive care (ICU) where no paediatric intensivists worked increased significantly the mortality and the length of stay. The recognition of Paediatric Intensive Care (PICU) does not exist in Belgium and children are admitted in both adult and paediatric intensive care units. It is mandatory to recognise the PICU specificity and the usefulness of a fellowship in paediatric intensive care. Development of molecular biology and genetics will permit in the near future to understand reversible and irreversible cellular processes of the majority of problems responsible for mortality in critical care and to allow the development of new diagnostic and therapeutic techniques. Rapid development of information will permit the creation of multicenter databases including all PICU's data. The final goal is an intelligent tool for making decision process. Telemedecine is born which permits a virtual consultation of the patient. Technological progress must not impair the wellbeing of the child and its family. The PICU of the future must be "parents admitted". PICU profile is progressively changing, the way of taking care of the critically ill child and its family is also changing and improving. An ethical reflexion among the health care providers' team and a dialogue with parents will blossom.
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.
Mohan, Deepika; Angus, Derek C
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.
Hasin, Tal; Eldor, Roy; Hammerman, Haim
Treatment in the intensive cardiac care unit (ICCU) enables rigorous control of vital parameters such as heart rate, blood pressure, body temperature, oxygen saturation, serum electrolyte levels, urine output and many others. The importance of controlling the metabolic status of the acute cardiac patient and specifically the level of serum glucose was recently put in focus but is still underscored. This review aims to explain the rationale for providing intensive control of serum glucose levels in the ICCU, especially using intensive insulin therapy and summarizes the available clinical evidence suggesting its effectiveness.
Barbosa, Vanessa Maziero
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…
Nagata, E; Brito, ASJ; Matsuo, T
Background: Nosocomial infections (Nls) have become a matter of major concern in neonatal intensive care units (NICUs). The objectives of this study were to determine the incidence rate and the most frequent sites of infection in a Brazilian NICU from January 1999 to March 2000 and to study the risk
Suzana Margareth Lobo
Full Text Available OBJETIVO: Devido aos avanços da medicina e ao envelhecimento da população, a proporção de pacientes em risco de morte após cirurgias está aumentando. Nosso objetivo foi avaliar o desfecho e a epidemiologia de cirurgias não cardíacas em pacientes admitidos em unidade de terapia intensiva. MÉTODOS: Estudo prospectivo, observacional, de coorte, realizado em 21 unidades de terapia intensiva. Um total de 885 pacientes adultos, cirúrgicos, consecutivamente admitidos em unidades de terapia intensiva no período de abril a junho de 2006 foi avaliado e destes, 587 foram incluídos. Os critérios de exclusão foram; trauma, cirurgias cardíacas, neurológicas, ginecológicas, obstétricas e paliativas. Os principais desfechos foram complicações pós-cirúrgicas e mortalidade na unidade de terapia intensiva e 90 dias após a cirurgia. RESULTADOS: Cirurgias de grande porte e de urgência foram realizadas em 66,4% e 31,7%, dos pacientes, respectivamente. A taxa de mortalidade na unidade de terapia intensiva foi de 15%, e 38% dos pacientes tiveram complicações no pós-operatório. A complicação mais comum foi infecção ou sepse (24,7%. Isquemia miocárdica foi diagnosticada em apenas 1,9%. Um total de 94 % dos pacientes que morreram após a cirurgia tinha co-morbidades associadas (3,4 ± 2,2. A principal causa de óbito foi disfunção de múltiplos órgãos (53%. CONCLUSÃO: Sepse é a causa predominante de morbidade em pacientes submetidos a cirurgias não cardíacas. A grande maioria dos óbitos no pós-operatório ocorreu por disfunção de múltiplos órgãos.OBJECTIVES: Due to the dramatic medical breakthroughs and an increasingly ageing population, the proportion of patients who are at risk of dying following surgery is increasing over time. The aim of this study was to evaluate the outcomes and the epidemiology of non-cardiac surgical patients admitted to the intensive care unit. METHODS: A multicenter, prospective, observational
Egerod, Ingrid; Storli, Sissel Lisa; Åkerman, Eva
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...... from a pragmatic practice to an evidence-based domain of inquiry propelled by academically prepared nurses. Several schools of thought were identified in our study: diaries as (i) a therapeutic instrument, (ii) an act of caring, (iii) an expression of empathy, and (iv) a hybrid of the above. Diaries...
Full Text Available Mnemonics are commonly used in medical procedures as cognitive aids to guide clinicians all over the world. The mnemonic ‘FAST HUG’ (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glycemic control was proposed almost ten years ago for patient care in intensive care units and have been commonly used worldwide. Beside this, new mnemonics were also determined for improving routine care of the critically ill patients. But none of this was accepted as much as “FAST HUGS”. In our clinical practice we delivered an another mnemonic as FAST HUGS with ICU (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, Stress ulcer prevention, and Glucose control, Water balance, Investigation and Results, Therapy, Hypo-hyper delirium, Invasive devices, Check the daily infection parameters, Use a checklist for checking some of the key aspects in the general care of intensive care patients. In this review we summarized these mnemonics.
Yun Sil Chang
Full Text Available In the current era of low-birth rate in Korea, it is important to improve our neonatal intensive care and to establish an integrative system including a regional care network adequate for both high-risk pregnancies and highrisk newborn infants. Therefore, official discussion for nation-wide augmentation, proper leveling, networking, and regionalization of neonatal and perinatal care is urgently needed. In this report, I describe the status of neonatal intensive care in Korea, as well as nationwide flow of transfer of high-risk newborn infants and pregnant women, and present a short review of the regionalization of neonatal and perinatal care in the Unites States and Japan. It is necessary not only to increase the number of neonatal intensive care unit (NICU beds, medical resources and manpower, but also to create a strong network system with appropriate leveling of NICUs and regionalization. A systematic approach toward perinatal care, that includes both high-risk pregnancies and newborns with continuous support from the government, is also needed, which can be spearheaded through the establishment of an integrative advisory board to propel systematic care forward.
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.
Salins, Naveen; Deodhar, Jayita; Muckaden, Mary Ann
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. PMID:27076710
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.
Marcello M. Orzalesi
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.
Kumaş, Gülşah; Oztunç, Gürsel; Nazan Alparslan, Z
This study was conducted to gain opinions about euthanasia from nurses who work in intensive care units. The research was planned as a descriptive study and conducted with 186 nurses who worked in intensive care units in a university hospital, a public hospital, and a private not-for-profit hospital in Adana, Turkey, and who agreed to complete a questionnaire. Euthanasia is not legal in Turkey. One third (33.9%) of the nurses supported the legalization of euthanasia, whereas 39.8% did not. In some specific circumstances, 44.1% of the nurses thought that euthanasia was being practiced in our country. The most significant finding was that these Turkish intensive care unit nurses did not overwhelmingly support the legalization of euthanasia. Those who did support it were inclined to agree with passive rather than active euthanasia (P = 0.011).
Orzalesi, Marcello M; Cuttini, Marina
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.
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.
Espersen, Kurt; Antonsen, Kristian; Joensen, Henning
There are documented capacity problems in Danish ICUs. The indications for intensive care have increased in the last decade without any increase in the number of ICU beds. The result is massive pressure on many ICUs and many negative consequences in relation to healthcare, healthcare economics and patient comfort. Possible solutions: 1) an increase in the number of ICU beds, 2) re-organization of Danish ICUs into larger units and 3) creation of "step-down"-units. Intensive care is a costly area in the healthcare system, where there must be distinct guidelines for visitation and use of expensive medicine and advanced technology.
do Nascimento, Keyla Cristiane; Gomes, Antônio Marcos Tosoli; Erdmann, Alacoque Lorenzini
This qualitative study was performed based on the Social Representations Theory, using a structured approach. The objective was to analyze the social representations of intensive care for professionals who work in mobile intensive care units, given the determination of the central nucleus and the peripheral system. This study included the participation of 73 health care professionals from an Emergency Mobile Care Service. Data collection was performed through free association with the inducing term care for people in a life threatening situation, and analyzed using EVOC software. It is observed that a nucleus is structured in knowledge and responsibility, while contrasting elements present lexicons such as agility, care, stress, and humanization. The representational structure revealed by participants in this study refer particularly to the functionality of intensive care, distinguishing itself by the challenges and encouragements provided to anyone working in this area.
Nap, Raoul E.; Andriessen, Maarten P. H. M.; Meessen, Nico E. L.; Albers, Marcel J. I. J.; van der Werf, Tjip S.
Objective: To assess the adequacy of preparedness planning for an influenza pandemic by modeling the pediatric surge capacity of healthcare facility and pediatric intensive care unit (PICU) requirements over time. Governments and Public Health authorities have planned preparedness activities and tra
Keijsers, GJ; Schaufeli, WB; LeBlanc, P; Zwerts, C; Miranda, DR
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
Morris, Linda L; Whitmer, Andrea; McIntosh, Erik
Tracheotomy is a common procedure in intensive care units, and nurses must provide proper care to tracheostomy patients to prevent complications. One of the most important considerations is effective mobilization of secretions, and a suction catheter is the most important tool for that purpose. Each bedside should be equipped with a functional suctioning system, an oxygen source, a manual resuscitation bag, and a complete tracheostomy kit, which should accompany patients wherever they go in the hospital. Complications include infection, tracheomalacia, skin breakdown, and tracheoesophageal fistula. Tracheostomy emergencies include hemorrhage, tube dislodgement and loss of airway, and tube obstruction; such emergencies are managed more effectively when all necessary supplies are readily available at the bedside. This article describes how to provide proper care in the intensive care unit, strategies for preventing complications, and management of tracheostomy emergencies.
Full Text Available The antimicrobial management of patients in the Intensive Care Units are complex. Antimicrobial resistance is an increasing problem. Effective strategies for the prevention of antimicrobial resistance in ICUs have focused on limiting the unnecessary use of antibiotics and increasing compliance with infection control practices. Antibiotic policies have been implemented to modify antibiotic use, including national or regional formulary manipulations, antibiotic restriction forms, care plans, antibiotic cycling and computer assigned antimicrobial therapy. Moreover, infectious diseases consultation is a simple way to limit antibiotic use in ICU units. To improve rational antimicrobial using a multidisiplinary approach is suggested. [Archives Medical Review Journal 2003; 12(4.000: 299-309
Birinder S Paul
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.
Kutlesic, Marija S; Kutlesic, Ranko M; Mostic-Ilic, Tatjana
Magnesium, one of the essential elements in the human body, has numerous favorable effects that offer a variety of possibilities for its use in obstetric anesthesia and intensive care. Administered as a single intravenous bolus dose or a bolus followed by continuous infusion during surgery, magnesium attenuates stress response to endotracheal intubation, and reduces intraoperative anesthetic and postoperative analgesic requirements, while at the same time preserving favorable hemodynamics. Applied as part of an intrathecal or epidural anesthetic mixture, magnesium prolongs the duration of anesthesia and diminishes total postoperative analgesic consumption with no adverse maternal or neonatal effects. In obstetric intensive care, magnesium represents a first-choice medication in the treatment and prevention of eclamptic seizures. If used in recommended doses with close monitoring, magnesium is a safe and effective medication.
Marcello M. Orzalesi; Marina Cuttini
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 ca...
Annalisa; Passariello; Gianluca; Terrin; Maria; Elisabetta; Baldassarre; Mario; De; Curtis; Roberto; Paludetto; Roberto; Berni; Canani
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...
Carlos Augusto Ramos Feijó
Full Text Available JUSTIFICATIVA E OBJETIVOS: Analisar a gravidade de pacientes internados na Unidade de Terapia Intensiva (UTI de um hospital universitário, utilizando o escore APACHE II. MÉTODO: Foi realizado estudo descritivo, retrospectivo, com análise de 300 pacientes admitidos à UTI, no período de março de 2004 a julho de 2005. RESULTADOS: Dos 300 pacientes estudados, 51,7% eram do sexo masculino, com média idade de 54,2 ± 19,57 anos. Houve maior prevalência de pacientes acima de 60 anos (43%. Quanto à procedência, 78% foram provenientes das enfermarias do próprio hospital. De acordo com o sistema acometido, as principais disfunções foram respiratórias e cardiovasculares. A média de permanência na UTI foi de 7,51 ± 8,21 dias. A média geral de APACHE II foi de 16,48 ± 7,67, com significativa diferença entre sobreviventes e falecidos. A mortalidade total na UTI foi de 32,7%, sem diferença significativa entre os pacientes falecidos com menos ou mais de 48 horas. A razão de mortalidade padronizada foi 1,1. CONCLUSÕES: Apesar da gravidade dos pacientes admitidos, a razão de mortalidade padronizada sugere satisfatória qualidade no serviço em apreço.BACKGROUND AND OBJECTIVES: The aim of this study was to analyze the morbidity and the mortality of critically ill patients admitted to the intensive care unit in a teaching hospital, using the APACHE II score. METHODS: Descriptive and retrospective study, with analysis of 300 patients admitted to ICU from March 2004 to July 2005. RESULTS: Of the 300 patients admitted to ICU, 51.7% were men, average 54.2 ± 19.57 years and 78% from the wards of the teaching hospital itself. There was more prevalence of patients aged 60 years or older (43%. The main dysfunctions were from the respiratory and cardiocirculatory systems. Length of stay in ICU was 7.51 ± 8.21 days. The mean of APACHE II was 16.48 ± 7.67, with meaningful difference between survivors and deceased patients. The real mortality rate
Guntupalli, Kalpalatha K.; Wachtel, Sherry; Mallampalli, Antara; Surani, Salim
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. PMID:24701063
Kalpalatha K Guntupalli
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.
Ana Maria Loureiro De Souza Delabary
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.
Jensen, Hanne Irene; Gerritsen, Rik T; Koopmans, Matty
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......-retest reliability showed a median weighted κ of 0.69 (0.53-0.83). Validation showed significant correlation between total scores and key questions. CONCLUSIONS: The questions were assessed as relevant and understandable, providing high face and content validity. Ceiling effects were comparable to similar...
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.
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) (Pmusic (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.
Full Text Available Delirium is characterized by impaired cognition with nonspecific manifestations. In critically ill patients, it may develop secondary to multiple precipitating or predisposing causes. Although it can be a transient and reversible syndrome, its occurrence in Intensive Care Unit (ICU patients may be associated with long-term cognitive dysfunction. This condition is often under-recognized by treating physicians, leading to inappropriate management. For appropriate management of delirium, early identification and risk factor assessment are key factors. Multidisciplinary collaboration and standardized care can enhance the recognition of delirium. Interdisciplinary team working, together with updated guideline implementation, demonstrates proven success in minimizing delirium in the ICU. Moreover, should the use of physical restraint be necessary to prevent harm among mechanically ventilated patients, ethical clinical practice methodology must be employed. This traditional narrative review aims to address the presentation, risk factors, management, and ethical considerations in the management of delirium in ICU settings.
Arumugam, Suresh; El-Menyar, Ayman; Al-Hassani, Ammar; Strandvik, Gustav; Asim, Mohammad; Mekkodithal, Ahammed; Mudali, Insolvisagan; Al-Thani, Hassan
Delirium is characterized by impaired cognition with nonspecific manifestations. In critically ill patients, it may develop secondary to multiple precipitating or predisposing causes. Although it can be a transient and reversible syndrome, its occurrence in Intensive Care Unit (ICU) patients may be associated with long-term cognitive dysfunction. This condition is often under-recognized by treating physicians, leading to inappropriate management. For appropriate management of delirium, early identification and risk factor assessment are key factors. Multidisciplinary collaboration and standardized care can enhance the recognition of delirium. Interdisciplinary team working, together with updated guideline implementation, demonstrates proven success in minimizing delirium in the ICU. Moreover, should the use of physical restraint be necessary to prevent harm among mechanically ventilated patients, ethical clinical practice methodology must be employed. This traditional narrative review aims to address the presentation, risk factors, management, and ethical considerations in the management of delirium in ICU settings.
Rochester, Carolyn L
Critical illness has many devastating sequelae, including profound neuromuscular weakness and psychological and cognitive disturbances that frequently result in long-term functional impairments. Early rehabilitation begun in the intensive care unit (ICU) is emerging as an important strategy both to prevent and to treat ICU-acquired weakness, in an effort to facilitate and improve long-term recovery. Rehabilitation may begin with range of motion and bed mobility exercise, then may progress when the patient is fully alert and able to participate actively to include sitting and posture-based exercise, bed to chair transfers, strength and endurance exercises, and ambulation. Electrical muscle stimulation and inspiratory muscle training are additional techniques that may be employed. Studies conducted to date suggest that such ICU-based rehabilitation is feasible, safe, and effective for carefully selected patients. Further research is needed to identify the optimal patient candidates and procedures and for providing rehabilitation in the ICU.
Hensel, Mario; Böhler, Klaus; Marnitz, Rudolf; Binder, Christian; von Brevern, Michael
We report a case of severe neuroleptic malignant syndrome developing in a 28-year-old female patient following deliberate self-poisoning with atypical antipsychotic drugs and serotonin reuptake inhibitors. Because of an increasing loss of consciousness she was rapidly transferred to an Intensive Care Unit. Following this, she became progressively febrile associated with rhabdomyolysis and life-threatening organ dysfunctions. Due to fast diagnosis and immediate therapy the patient was treated successfully. This article describes etiology, pathophysiology and symptoms of neuroleptic malignant syndrome. In addition therapeutic options are discussed.
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) ...
Rubinos, Clio; Ruland, Sean
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.
Suzana Margareth Lobo
Full Text Available JUSTIFICATIVA E OBJETIVOS: A anemia é uma condição comum em pacientes graves. A transfusão de hemoderivados aumenta de forma significativa o risco de transmissão de agentes infecciosos e afeta o perfil imunológico. O objetivo deste estudo foi avaliar a incidência de anemia e a prática de transfusão de hemácias em UTI brasileiras. MÉTODO: Estudo prospectivo, multicêntrico, realizado em 19 UTI em um período de duas semanas. A presença de anemia, as indicações e a utilização de concentrados de hemácias, foram avaliadas diariamente. As complicações que ocorreram durante a internação na UTI e após a transfusão da primeira unidade de concentrado de hemácias foram registradas. RESULTADOS: Um total de 33% apresentava anemia na admissão na UTI e esta proporção aumentou para 55% no final de sete dias de internação. Um total de 348 unidades de concentrado de hemácias foi transfundido em 86 pacientes (36,5%. A média de suas unidades por paciente foi 4,1 ± 3,3 U. O nível de hemoglobina limiar para a transfusão de CH foi 7,7 ± 1,1 g/dL. Pacientes transfundidos tinham mais disfunções orgânicas avaliadas pelo escore SOFA (7,9 ± 4,6 versus 5,6 ± 3,8, transfundidos versus não transfundidos, p BACKGROUND AND OBJECTIVES: Anemia of critical illness is a multifactorial condition caused by blood loss, frequent phlebotomies and inadequate production of red blood cells (RBC. Controversy surrounds the most appropriate hemoglobin concentration "trigger" for transfusion of RBC. We aimed to evaluate transfusion practices in Brazilian ICUs. METHODS: A prospective study throughout a 2-week period in 19 Brazilian ICUs. Hemoglobin (Hb level, transfusion rate, organ dysfunction assessment and 28-day mortality were evaluated. Primary indication for transfusion and pretransfusion hemoglobin level were collected for each transfusion. RESULTS: Two hundred thirty-one patients with an ICU length of stay longer than 48h were included. An Hb
Mariama Amaral Michels
Full Text Available Rationale and objective: currently, Healthcare-associated Infections (HAIs constitute a serious public health problem. It is estimated that for every ten hospitalized patients, one will have infection after admission, generating high costs resulting from increased length of hospitalization, additional diagnostic and therapeutic interventions. The intensive care unit (ICU, due to its characteristics, is one of the most complex units of the hospital environment, a result of the equipment, the available technology, the severity of inpatients and the invasive procedures the latter are submitted to. The aim of the study was to evaluate the adherence to specifi c HAI prevention measures in invasive ICU procedures. Methods: This study had a quantitative, descriptive and exploratory approach. Among the risk factors for HAIs are the presence of central venous access, indwelling vesical catheter and mechanical ventilation, and, therefore, the indicators were calculated for patients undergoing these invasive procedures, through a questionnaire standardized by the Hospital Infection Control Commission (HICC. Results: For every 1,000 patients, 15 had catheter-related bloodstream infection, 6.85 had urinary tract infection associated with indwelling catheter in the fi rst half of 2010. Conclusion: most HAIs cannot be prevented, for reasons inherent to invasive procedures and the patients. However, their incidence can be reduced and controlled. The implementation of preventive measures based on scientifi c evidence can reduce HAIs signifi cantly and sustainably, resulting in safer health care services and reduced costs. The main means of prevention include the cleaning of hands, use of epidemiological block measures, when necessary, and specifi c care for each infection site. KEYWORDS Nosocomial infection. Intensive care units.
Jensen, Anne-Mette Bæk; Lundstrøm, Kaare E.; Reinholdt, Jes;
Intensive care of infants below one year of age has been centralized in a paediatric intensive care unit (PICU) related to the neonatal intensive care unit (NICU) at Rigshospitalet, the University Hospital in Copenhagen in eastern Denmark (approximately 2.5 million inhabitants) since 2002. The aim...
Madsen, Kristian Rørbaek; Lorentzen, Kristian; Clausen, Niels;
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...
Millar, Ian L
In an emergency, life support can be provided during recompression or hyperbaric oxygen therapy using very basic equipment, provided the equipment is hyperbaric-compatible and the clinicians have appropriate experience. For hyperbaric critical care to be provided safely on a routine basis, however, a great deal of preparation and specific equipment is needed, and relatively few facilities have optimal capabilities at present. The type, size and location of the chamber are very influential factors. Although monoplace chamber critical care is possible, it involves special adaptations and inherent limitations that make it inappropriate for all but specifically experienced teams. A large, purpose-designed chamber co-located with an intensive care unit is ideal. Keeping the critically ill patient on their normal bed significantly improves quality of care where this is possible. The latest hyperbaric ventilators have resolved many of the issues normally associated with hyperbaric ventilation, but at significant cost. Multi-parameter monitoring is relatively simple with advanced portable monitors, or preferably installed units that are of the same type as used elsewhere in the hospital. Whilst end-tidal CO₂ readings are changed by pressure and require interpretation, most other parameters display normally. All normal infusions can be continued, with several examples of syringe drivers and infusion pumps shown to function essentially normally at pressure. Techniques exist for continuous suction drainage and most other aspects of standard critical care. At present, the most complex life support technologies such as haemofiltration, cardiac assist devices and extra-corporeal membrane oxygenation remain incompatible with the hyperbaric environment.
Discussions of conscientious objection (CO) in healthcare often concentrate on objections to interventions that relate to reproduction, such as termination of pregnancy or contraception. Nevertheless, questions of conscience can arise in other areas of medicine. For example, the intensive care unit is a locus of ethically complex and contested decisions. Ethical debate about CO usually concentrates on the issue of whether physicians should be permitted to object to particular courses of treatment; whether CO should be accommodated. In this article, I focus on the question of how clinicians ought to act: should they provide or support a course of action that is contrary to their deeply held moral beliefs? I discuss two secular examples of potential CO in intensive care, and propose that clinicians should adopt a norm of conscientious non-objection (CNO). In the face of divergent values and practice, physicians should set aside their personal moral beliefs and not object to treatment that is legally and professionally accepted and provided by their peers. Although there may be reason to permit conscientious objections in healthcare, conscientious non-objection should be encouraged, taught, and supported.
Full Text Available Introduction: Central venous catheters (CVC are part of daily clinical practice, regarding treatment of critically ill patients in the Intensive Care Unit (ICU. Infections associated with CVC, are a serious cause of morbidity and mortality, thus making as a demanding need the adoption of clinical protocols for the care in ICU. Aim: The aim of this review was to explore the nursing care to prevent CVC’s infections in ICU. Method and material: The methodology followed included reviews and research studies. The studies were carried out during the period 2000-2014 and were drawn from foreign electronic databases (Pubmed, Medline, Cochrane and Greek (Iatrotek, on the nursing care of CVC, in the ICU to prevent infections. Results: The literature review showed that the right choice of dressings on the point of entry, the antiseptic treatment solution, the time for replacement infusion sets, the flushing of central venous catheter, the hand disinfection and finally the training of nursing staff, are the key points to prevent CVC’s infections in ICU. Conclusions: Education and compliance of nurses regarding the instructions of CVC's care, are the gold standard in the prevention of infections.
... neonatal nurse practitioner: someone with additional training in neonatology care Other people who may help care for ... intensive care who heads up the medical team neonatology fellows, medical residents, and medical students: all pursuing ...
Weis, Janne; Zoffmann, Vibeke; Egerod, Ingrid
AIMS AND OBJECTIVES: To evaluate and adjust systematic implementation of guided family-centred care in a neonatal intensive care unit. BACKGROUND: Family-centred care is valued in neonatal intensive care units internationally, but innovative strategies are needed to realise the principles. Guided...
Rozeboom, Nathan; Parenteau, Kathy; Carratturo, Daniel
Each year between 10 000 and 12 000 spinal cord injuries occur in the United States. Once injured, many of these patients will receive a portion of their care in an intensive care unit (ICU), where their treatment will begin. Harborview Medical Center in Seattle, Washington, provides comprehensive care to approximately 60 to 70 cervical spinal cord injuries each year. Because of many factors such as hemodynamic instability, pulmonary complications, and risk of infection, patients with cervical spinal cord injuries can spend up to 2 or more weeks in the ICU before they transfer to a rehabilitation unit. To achieve optimal outcomes, it is imperative that members of the interdisciplinary team work together in a consistent, goal-oriented, collaborative manner. This team includes physicians, nurses, respiratory therapists, physical and occupational therapists, speech pathologists, dieticians, and rehabilitation psychologists. An individual plan is developed for each patient and rehabilitation starts in the ICU as soon as the patient is medically stable. This article will highlight the management strategies used in the neuroscience ICU at Harborview Medical Center and will include a case study as an example of the typical experience for our patients with high cervical cord injury.
Avaliação da efetividade e segurança do protocolo de infusão de insulina de Yale para o controle glicêmico intensivo Assessment of effectiveness and safety of Yale insulin infusion protocol in a brazilian medical and surgical Intensive Care Unit
José Roberto Carvalho Diener
Full Text Available JUSTIFICATIVA E OBJETIVOS: O controle glicêmico intensivo ocupa lugar de destaque no manuseio dos pacientes críticos. O objetivo desde estudo foi avaliar a efetividade e a segurança do protocolo de insulinoterapia por via venosa de Yale nos pacientes críticos internados em unidade de terapia intensiva geral em hospital comunitário. MÉTODO: Foi realizado um estudo retrospectivo e comparativo entre 2 coortes de pacientes críticos, antes e após a implantação do controle glicêmico intensivo. Os desfechos de interesse do estudo foram glicemia média durante o tratamento, tempo para atingir a faixa alvo de 80 a 140 mg/dL, percentual de glicemia dentro desta faixa e incidência de hipoglicemia. RESULTADOS: Foram estudados 112 pacientes, divididos em dois grupos. Sessenta pacientes constituíram o grupo controle (GC e 52 o grupo protocolo (GP. A glicemia média no GP foi de 131,2 ± 14,7 mg/dL versus 181,7 ± 36,1 mg/dL no GC. Os pacientes no GP alcançaram a faixa alvo mais rápido [mediana 7h (4 - 10h versus mediana 96h (46 - 278h] no GC. O percentual de glicemia dentro da faixa-alvo foi de 65% no GP e de 32% no GC. Não houve diferença estatística significativa na incidência de hipoglicemia grave; 4 pacientes no GP versus 2 pacientes no GC. CONCLUSÕES: O protocolo de insulinoterapia por via venosa contínua de Yale, mostrou-se efetivo e seguro para o manuseio do controle glicêmico em unidade de terapia intensiva que atende pacientes clínicos e cirúrgicos.BACKGROUND AND OBJECTIVES: Actually tight glycemic control is a major concern in critical care. The objective of this study was to evaluate effectiveness and safety of Yale insulin infusion protocol in a Brazilian medical and surgical intensive care unit. METHODS: Retrospective, before-after cohort study. Selected end-points were mean blood glucose levels, time-to-reach target range of 80 - 140 mg/dL, and percent of blood glucose in target range and hypoglycemia incidence. RESULTS
Daniela Couto Carvalho Barra
Full Text Available OBJECTIVE To analyze the usability of Computerized Nursing Process (CNP from the ICNP® 1.0 in Intensive Care Units in accordance with the criteria established by the standards of the International Organization for Standardization and the Brazilian Association of Technical Standards of systems. METHOD This is a before-and-after semi-experimental quantitative study, with a sample of 34 participants (nurses, professors and systems programmers, carried out in three Intensive Care Units. RESULTS The evaluated criteria (use, content and interface showed that CNP has usability criteria, as it integrates a logical data structure, clinical assessment, diagnostics and nursing interventions. CONCLUSION The CNP is a source of information and knowledge that provide nurses with new ways of learning in intensive care, for it is a place that provides complete, comprehensive, and detailed content, supported by current and relevant data and scientific research information for Nursing practices.
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.
Jensen, Hanne Irene; Gerritsen, Rik T; Koopmans, Matty;
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...
Chuang, Chien-Huai; Tseng, Pei-Chi; Lin, Chun-Yu; Lin, Kuan-Han; Chen, Yen-Yuan
Abstract Background: Burnout has been described as a prolonged response to chronic emotional and interpersonal stress on the job that is often the result of a period of expending excessive effort at work while having too little recovery time. Healthcare workers who work in a stressful medical environment, especially in an intensive care unit (ICU), may be particularly susceptible to burnout. In healthcare workers, burnout may affect their well-being and the quality of professional care they provide and can, therefore, be detrimental to patient safety. The objectives of this study were: to determine the prevalence of burnout in the ICU setting; and to identify factors associated with burnout in ICU professionals. Methods: The original articles for observational studies were retrieved from PubMed, MEDLINE, and Web of Science in June 2016 using the following MeSH terms: “burnout” and “intensive care unit”. Articles that were published in English between January 1996 and June 2016 were eligible for inclusion. Two reviewers evaluated the abstracts identified using our search criteria prior to full text review. To be included in the final analysis, studies were required to have employed an observational study design and examined the associations between any risk factors and burnout in the ICU setting. Results: Overall, 203 full text articles were identified in the electronic databases after the exclusion of duplicate articles. After the initial review, 25 studies fulfilled the inclusion criteria. The prevalence of burnout in ICU professionals in the included studies ranged from 6% to 47%. The following factors were reported to be associated with burnout: age, sex, marital status, personality traits, work experience in an ICU, work environment, workload and shift work, ethical issues, and end-of-life decision-making. Conclusions: The impact of the identified factors on burnout remains poorly understood. Nevertheless, this review presents important information
Mª Teresa Martín Alonso
Full Text Available The care plan we expose is a general one applicable to all the children who are admitted in the unit, no matter what pathology they present/display, their physiopathological situation or their age. We present the common nursing actions which are applied to all the patients at the time of their admittance. The factor related to the studied problems is the hospitalization and what it has associate, from separation of the parents and rupture familiar ties, up to immobilization, the use of bloody devices and the generally hostile and stranger background.The protocol is based on the NANDA, the nursing outcomes classification NOC and the nursing intervention classification NIC. It is part of the nursing process and promotes systematized, humanistic and effective care, focuses on the child and his parents.We have selected the most relevant problems, ordered according to the deficits in the different selfcare requirements of Dorotea E. Orem. Each problem has its definition, the outcomes we pretend to reach with our care and the interventions to get the outcomes (these two last topics have the corresponding codification. In them all the most important factor is hospitalization in a unit of intensive care and the separation of the child from his habitual environment.
Nouira, Kaouther; Trabelsi, Abdelwahed
We address in the present paper a medical monitoring system designed as a multi-agent based approach. Our system includes mainly numerous agents that act as correlated multi-agent sub-systems at the three layers of the whole monitoring infrastructure, to avoid non informative alarms and send effective alarms at time. The intelligence in the proposed monitoring system is provided by the use of time series technology. In fact, the capability of continuous learning of time series from the physiological variables allows the design of a system that monitors patients in real-time. Such system is a contrast to the classical threshold-based monitoring system actually present in the Intensive Care Units (ICUs) which causes a huge number of irrelevant alarms.
Ana Paula Marcon
Full Text Available We made an epidemiological case-control study to examine risk factors for the development of diarrhea in the intensive care unit (ICU of a public hospital in Santo André, SP, from January to October 2002. Forty-nine patients with diarrhea (cases and 49 patients without diarrhea (controls, matched for age and gender, were included in the study. A stool culture and enzyme immunoassays for Clostridium difficile toxins A and B were performed on fecal specimens from diarrhea patients. Fourteen of them presented positive cultures for Pseudomonas aeruginosa and 22 patients presented positive ELISA for Clostridium diffícile. Nosocomial diarrhea was associated with several factors, including use of antibiotics (P=0.001, use of ceftriaxone (P=0.001, presence of infection (P=0.010 and length of hospital stay (P=0.0001.
Carbajal, R; Lenclen, R; Paupe, A; Blanc, P; Hoenn, E; Couderc, S
Jargon, the specialized vocabulary and idioms, is frequently used by people of the same work or profession. The neonatal intensive care unit (NICU) makes no exception to this. As a matter of fact, NICU is one place where jargon is constantly developing in parallel with the evolution of techniques and treatments. The use of jargon within the NICU is very practical for those who work in these units. However, this jargon is frequently used by neonatologists in medical reports or other kinds of communication with unspecialized physicians. Even if part of the specialized vocabulary can be decoded by physicians not working in the NICU, they do not always know the exact place that these techniques or treatments have in the management of their patients. The aim of this article is to describe the most frequent jargon terms used in the French NICU and to give up-to-date information on the importance of the techniques or treatments that they describe.
Zaragoza, Rafael; Ramírez, Paula; López-Pueyo, María Jesús
Nosocomial infections (NI) still have a high incidence in intensive care units (ICUs), and are becoming one of the most important problems in these units. It is well known that these infections are a major cause of morbidity and mortality in critically ill patients, and are associated with increases in the length of stay and excessive hospital costs. Based on the data from the ENVIN-UCI study, the rates and aetiology of the main nosocomial infections have been described, and include ventilator-associated pneumonia, urinary tract infection, and both primary and catheter related bloodstream infections, as well as the incidence of multidrug-resistant bacteria. A literature review on the impact of different nosocomial infections in critically ill patients is also presented. Infection control programs such as zero bacteraemia and pneumonia have been also analysed, and show a significant decrease in NI rates in ICUs.
van Diepen, Sean; Sligl, Wendy I; Washam, Jeffrey B; Gilchrist, Ian C; Arora, Rakesh C; Katz, Jason N
Over the past half century, coronary care units have expanded from specialized ischemia arrhythmia monitoring units into intensive care units (ICUs) for acutely ill and medically complex patients with a primary cardiac diagnosis. Patients admitted to contemporary coronary intensive care units (CICUs) are at risk for common and preventable critical care complications, yet many CICUs have not adopted standard-of-care prevention protocols and practices from general ICUs. In this article, we (1) review evidence-based interventions and care bundles that reduce the incidence of ventilator-associated pneumonia, excess sedation during mechanical ventilation, central line infections, stress ulcers, malnutrition, delirium, and medication errors and (2) recommend pragmatic adaptations for common conditions in critically ill patients with cardiac disease, and (3) provide example order sets and practical CICU protocol implementation strategies.
Nwadike V. Ugochukwu
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.
The book on radiological diagnostics within intensive care covers the following chapters: Fundamentals: radiological techniques and radiation protection; the thorax of intensive care patients; intensive care patients after thorax surgery; acute abdomen problems of intensive care patients; intensive care patients after abdominal surgery; the thorax of pediatric intensive care patients; acute abdomen problems of pediatric intensive care patients.
Pisani, Margaret A; Friese, Randall S; Gehlbach, Brian K; Schwab, Richard J; Weinhouse, Gerald L; Jones, Shirley F
Sleep is an important physiologic process, and lack of sleep is associated with a host of adverse outcomes. Basic and clinical research has documented the important role circadian rhythm plays in biologic function. Critical illness is a time of extreme vulnerability for patients, and the important role sleep may play in recovery for intensive care unit (ICU) patients is just beginning to be explored. This concise clinical review focuses on the current state of research examining sleep in critical illness. We discuss sleep and circadian rhythm abnormalities that occur in ICU patients and the challenges to measuring alterations in circadian rhythm in critical illness and review methods to measure sleep in the ICU, including polysomnography, actigraphy, and questionnaires. We discuss data on the impact of potentially modifiable disruptors to patient sleep, such as noise, light, and patient care activities, and report on potential methods to improve sleep in the setting of critical illness. Finally, we review the latest literature on sleep disturbances that persist or develop after critical illness.
Robinson, A. (Weston Park Hospital, Sheffield (UK)); Dellagrammaticas, H.D. (Sheffield Univ. (UK))
Radiological investigations have become accepted as an important part of the range of facilities required to support severely ill newborn babies. Since the infants are so small, many of the examinations are virtually ''whole-body'' irradiations and it was thought that the total doses received might be appreciable. A group of such babies admitted to the Neonatal Intensive Care Unit in Sheffield over a six-month period have been studied. X-ray exposure factors used for each examination have been noted and total skin, gonad and bone marrow doses calculated, supplemented by measurements on phantoms. It is concluded that in most cases doses received are of the same order as those received over the same period from natural background radiation and probably less than those received from prenatal obstetric radiography, so that the additional risks from the diagnostic exposure are small. The highest doses are received in CT scans and barium examinations and it is recommended that the need for these should be carefully considered.
Brodsky, Dara; Gupta, Munish; Quinn, Mary; Smallcomb, Jane; Mao, Wenyang; Koyama, Nina; May, Virginia; Waldo, Karen; Young, Susan; Pursley, DeWayne M
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=showing that staff had greater 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.
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.
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.
Yamauti, Sueli Miyuki; Barberato-Filho, Silvio; Lopes, Luciane Cruz
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.
Srikanth Ram Mohan
Full Text Available Acute undifferentiated fever (AUF is common in tropical regions of the developing world, its specific etiology is often unknown. It’s common causes include malaria, dengue fever, enteric fever, leptospirosis, rickettsial infection. AUF is defined as fever without any localised source of infection, of 14 days or less in duration. The objective of the study was to focus on identifying the causes of AUF in patients admitted to Intensive care units & to determine importance of clinical examination in identifying the cause. It was a prospective study done in our Medical college Hospital at Kolar, Karnataka between 1-11-2010 to 30-11-2011. Cases presenting to hospital aged >18 years with complaints of Fever & admitted in Intensive care units were included in study. A total of 558 cases were enrolled. The clinical findings were noted and subsequent Investigations required were asked for. The study compromised of approximately equal number of Male & Female patients & age varied from 18 – 100 years. There was a clear seasonal variation – More no of cases were admitted between April & November. Majority presented with Fever of Short duration (1-3 days. Certain well defined syndromes were identified like: Fever with Thrombocytopenia – the most common of all the syndromes. Fever with Myalgia & Arthralgia, Fever with Hepatorenal dysfunction, Fever with Encephalopathy, Fever with Pulmonary - Renal dysfunction and Fever with Multiorgan dysfunction (MODS. Out of 558 cases AUF was noted in 339 cases (60.86%. An etiological diagnosis could be made for 218 cases (39.06%. Leptospirosis was the commonest cause with 72 cases (12.9%. The no of cases with Dengue were 48(8.6%, Malaria –25 (4.4%, Viral fever –35 (6.2%, Mixed infections – 12 (2.1%, Pulmonary Tuberculosis -25 ( 4.4% and one case of Rickettsial Infection. MODS was the most common presentation in AUF patients, seen in 108 cases (31.8% and 40 cases expired. A study of AUF
Full Text Available BACKGROUND Knowledge of the incidence of ventilator-associated pneumonia (VAP and its associated risk factors is imperative for the development and use of more effective preventive measures. METHODOLOGY We conducted a prospective cohort study over a period of 12 months to determine the incidence and the risk factors for development of VAP in critically ill adult patients admitted in intensive care units (ICUs in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, we included 150 patients, on mechanical ventilation for more than 48 hours. VAP was diagnosed according to the current diagnostic criteria. RESULTS The study cohort comprised of 150 patients of various cases of cerebrovascular accident, poisoning, neurological disorders, sepsis and others. VAP was diagnosed when a score of ≥6 was obtained in the clinical pulmonary infection scoring system having six variables and a maximum score of 12. The mean age of the patients was 40 years. Of the 150 patients, 28 patients developed VAP during the ICU stay. The incidence of VAP in our study was 18.8%. The risk factor in our study was decrease in the PaO2/FiO2 ratio, duration of mechanical ventilation, impaired consciousness, tracheostomy, re-intubation, emergency intubation, nasogastric tube, emergency intubation and intravenous sedatives were found to be the specific risk factors for early onset VAP, while tracheostomy and re-intubation were the independent predictors of late-onset VAP, The most predominant organisms in our study was Pseudomonas (39.2%. CONCLUSIONS Knowledge of these risk factors may be useful in implementing simple and effective preventive measures. Precaution during emergency intubation, minimizing the occurrence of reintubation, avoidance of tracheostomy as far as possible, and minimization of sedation. The ICU clinicians should be aware of the risk factors for VAP, which could prove useful in identifying patients at high risk for VAP, and modifying patient care to
Conner, J M; Nelson, E C
Health care systems today are complex, technically proficient, competitive, and market-driven. One outcome of this environment is the recent phenomenon in the health care field of "consumerism." Strong emphasis is placed on customer service, with organized efforts to understand, measure, and meet the needs of customers served. The purpose of this article is to describe the current understanding and measurement of parent needs and expectations with neonatal intensive care services from the time the expectant parents enter the health care system for the birth through the discharge process and follow-up care. Through literature review, 11 dimensions of care were identified as important to parents whose infants received neonatal intensive care: assurance, caring, communication, consistent information, education, environment, follow-up care, pain management, participation, proximity, and support. Five parent satisfaction questionnaires-the Parent Feedback Questionnaire, Neonatal Index of Parent Satisfaction, Inpatient Parent Satisfaction-Children's Hospital Minneapolis, Picker Institute-Inpatient Neonatal Intensive Care Unit Survey, and the Neonatal Intensive Care Unit-Parent Satisfaction Form-are critically reviewed for their ability to measure parent satisfaction within the framework of the neonatal care delivery process. An immense gap was found in our understanding about what matters most and when to parents going through the neonatal intensive care experience. Additional research is required to develop comprehensive parent satisfaction surveys that measure parent perceptions of neonatal care within the framework of the care delivery process.
Alexandre Franco Miranda
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.
Jeejeebhoy, Khursheed N
Patients in the intensive care unit (ICU) are unable to nourish themselves orally. In addition, critical illness increases nutrient requirements as well as alters metabolism. Typically, ICU patients rapidly become malnourished unless they are provided with involuntary feeding either through a tube inserted into the GI tract, called enteral nutrition (EN), or directly into the bloodstream, called parenteral nutrition (PN). Between the 1960s and the 1980s, PN was the modality of choice and the premise was that if some is good, more is better, which led to overfeeding regimens called hyperalimentation. Later, the dangers of overfeeding, hyperglycemia, fatty liver, and increased sepsis associated with PN became recognized. In contrast, EN was not associated with these risks and it gradually became the modality of choice in the ICU. However, ICU patients in whom the gastrointestinal tract was nonfunctional (i.e., gut failure) required PN to avoid malnutrition. In addition, EN was shown, on average, to not meet nutrient requirements, and underfeeding was recognized to increase complications because of malnutrition. Hence, the balanced perspective has been reached of using EN when possible but avoiding underfeeding by supplementing with PN when required. This new role for PN is currently being debated and studied. In addition, the relative merits and needs for protein, carbohydrates, lipids, and micronutrients are areas of study.
Singhi, Sunit; Deep, Akash
Candidemia and disseminated candidiasis are major causes of morbidity and mortality in hospitalized patients especially in the intensive care units (ICU). The incidence of invasive candidasis is on a steady rise because of increasing use of multiple antibiotics and invasive procedures carried out in the ICUs. Worldwide there is a shifting trend from C. albicans towards non albicans species, with an associated increase in mortality and antifungal resistance. In the ICU a predisposed host in one who is on broad spectrum antibiotics, parenteral nutrition, and central venous catheters. There are no pathognomonic signs or symptoms. The clinical clues are: unexplained fever or signs of severe sepsis or septic shock while on antibiotics, multiple, non-tender, nodular erythematous cutaneous lesions. The spectrum of infection with candida species range from superficial candidiasis of the skin and mucosa to more serious life threatening infections. Treatment of candidiasis involves removal of the most likely source of infection and drug therapy to speed up the clearance of infection. Amphotericin B remains the initial drug of first choice in hemodynamically unstable critically ill children in the wake of increasing resistance to azoles. Evaluation of newer antifungal agents and precise role of prophylactic therapy in ICU patients is needed.
Morrow, Lee E; Gogineni, Vijaya; Malesker, Mark A
Probiotics are living microorganisms that, when ingested in adequate amounts, provide benefits to the host. The benefits include either a shortened duration of infections or decreased susceptibility to pathogens. Proposed mechanisms of beneficial effects include improving gastrointestinal barrier function, modification of the gut flora by inducing host cell antimicrobial peptides and/or local release of probiotic antimicrobial factors, competition for epithelial adherence, and immunomodulation. With increasing intensive care unit (ICU) antibacterial resistance rates and fewer new antibiotics in the research pipeline, focus has been shifted to non-antibiotic approaches for the prevention and treatment of nosocomial infections. Probiotics offer promise to ICU patients for the prevention of antibiotic-associated diarrhea, Clostridium difficile infections, multiple organ dysfunction syndrome, and ventilator-associated pneumonia. Our current understanding of probiotics is confounded by inconsistency in probiotic strains studied, optimal dosages, study durations, and suboptimal sample sizes. Although probiotics are generally safe in the critically ill, adverse event monitoring must be rigorous in these vulnerable patients. Delineation of clinical differences of various effective probiotic strains, their mechanisms of action, and optimal dosing regimens will better establish the role of probiotics in various disorders. However, probiotic research will likely be hindered in the future given a recent ruling by the U.S. Food and Drug Administration.
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.
Sadek, Ahmed-Ramadan; Damian, Maxwell; Eynon, C Andy
The neurosciences intensive care unit provides specialized medical and nursing care to both the neurosurgical and neurological patient. This second of two articles describes the role it plays in the management of patients with neurological conditions.
Marx, G; Reinhart, K
A recent survey conducted by the Competence Network Sepsis (SepNet) revealed that severe sepsis and/or septic shock occurs in 75000 inhabitants (110 per 100,000) and sepsis occurs in 79000 inhabitants (116 per 100,000) in Germany annually. The prevalence of urosepsis in this survey was 7%. Early diagnosis of sepsis prior to the onset of clinical deterioration is of particular interest because this would increase the possibility of early and specific treatment, which in turn is the major determining factor of mortality in septic patients. Treatment of urosepsis consists of source control, early antimicrobial therapy as well as supportive and adjunctive therapy. For supportive therapy, adequate volume loading is the most important step in the treatment of patients with urosepsis in order to restore and maintain oxygen transport and tissue oxygenation. Therefore, supportive treatment should focus on adequate volume resuscitation and appropriate use of inotropes/vasopressors. The PROWESS study is the first investigation demonstrating the decrease in mortality in patients with sepsis following administration of activated protein C (APC). Thus, administration of APC to patients with two-organ failure or an APACHE II score > or =25 within the first 24 h after the first sepsis-induced organ failure is a part of adjunctive therapy. Additionally, current data support low-dose hydrocortisone therapy in patients with vasopressor-dependent severe septic shock. Time to initiation of therapy is crucial for surviving sepsis. Implementing new medical evidence in this context into daily clinical intensive care remains a major hurdle.
Rompaey, B. van; Schuurmans, M.J.; Shortridge-Baggett, L.M.; Truijen, S.; Bossaert, L.
Delirium has been a recognised syndrome in the intensive care unit for some years. This systematic review reports risk factors for delirium studied in the intensive care unit. Four predisposing and 21 precipitating factors, including nine laboratory blood values and seven items relating to the use o
Østby, Anne-Cathrine; Gubbels, Sophie; Baake, Gerben
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...
Demirkiran, O; Dikmen, Y; Utku, T; Urkmez, S
We aimed to determine the morbidity and mortality among obstetric patients admitted to the intensive care unit. In this study, we analyzed retrospectively all obstetric admissions to a multi-disciplinary intensive care unit over a five-year period. Obstetric patients were identified from 4733 consecutive intensive care unit admissions. Maternal age, gestation of newborns, mode of delivery, presence of coexisting medical problems, duration of stay, admission diagnosis, specific intensive care interventions (mechanical ventilation, continuous veno-venous hemofiltration, central venous catheterization, and arterial cannulation), outcome, maternal mortality, and acute physiology and chronic health evaluation (APACHE) II score were recorded. Obstetric patients (n=125) represented 2.64% of all intensive care unit admissions and 0.89% of all deliveries during the five-year period. The overall mortality of those admitted to the intensive care unit was 10.4%. Maternal age and gestation of newborns were similar in survivors and non-survivors. There were significant differences in length of stay and APACHE II score between survivors and non-survivors P intensive care unit admission was preeclampsia/eclampsia (73.6%) followed by post-partum hemorrhage (11.2%). Intensive care specialists should be familiar with these complications of pregnancy and should work closely with obstetricians.
This article addresses some of the practical aspects of auditing in the intensive care setting by comparing two audit tools. An overview of each tool is provided together with a description of how it was used. Recommendations for auditing in intensive care are given.
Helder, O.K.; Verweij, J.C.M.; Staa, A.L. van
To explore parents' and nurses' experiences with the transition of infants from the neonatal intensive care unit to a special care nursery. Qualitative explorative study in two phases. Level IIID neonatal intensive care unit in a university hospital and special care nurseries (level II) in five comm
Pires, Maria Raquel Gomes Maia; Gottems, Leila Bernarda Donato; Vasconcelos Filho, José Eurico; Silva, Kênia Lara; Gamarski, Ricardo
The present article describes the development of the initial version of the Brazilian Care Management Information System for the Home Care Network (SI GESCAD). This system was created to enhance comprehensive care, care coordination and the continuity of care provided to the patients, family and caretakers of the Home Care (HC) program. We also present a reflection on the contributions, limitations and possibilities of the SI GESCAD within the scope of the Home Care Network of the Brazilian Unified Health System (RAS-AD). This was a study on technology production based on a multi-method protocol. It discussed software engineering and human-computer interaction (HCI) based on user-centered design, as well as evolutionary and interactive software process (prototyping and spiral). A functional prototype of the GESCAD was finalized, which allowed for the management of HC to take into consideration the patient's social context, family and caretakers. The system also proved to help in the management of activities of daily living (ADLs), clinical care and the monitoring of variables associated with type 2 HC. The SI GESCAD allowed for a more horizontal work process for HC teams at the RAS-AD/SUS level of care, with positive repercussions on care coordination and continuity of care.
de Souza, Sônia Regina Oliveira e Silva; da Silva, Cláudia Aparecida; de Mello, Ursula Magliano; Ferreira, Carolina Neris
Our aim is to describe the clients'perception related to to the admission in the Intensive Care. We have developed a descriptive study based on a qualitative approach in the intensive care in a university hospital in RJ, from May, 2003 to May, 2004. Thirty-two clients participated in this study just after hospital discharge. Data collection was possible through a questionaire. We consider that the clients showed some kind of satisfaction related to nursing intensive care, and the problem that really annoys them is the physical and ambiental stressors. The study shows questions that need a continuous discussion considering the stress, once it is a part of the activities and the atmosphere of intensive care and it also detaches the relavence of a work using indicatives of subjective quality in the intensive care.
Madsen, Kristian Rørbæk; Guldager, Henrik; Rewers, Mikael;
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...
Maria Denise Ricetto Funchal-Witzel
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
Background Medication administration errors in patient care have been shown to be frequent and serious. Such errors are particularly prevalent in highly technical specialties such as the intensive care unit (ICU). In Ethiopia, the prevalence of medication administration errors in the ICU is not studied. Objective To assess medication administration errors in the intensive care unit of Jimma University Specialized Hospital (JUSH), Southwest Ethiopia. Methods Prospective observation based cross...
After intensive care and before classic neurological rehabilitation is possible, patients in an altered state of consciousness are cared for at early stages in so-called coma awakening units. The care involves, on the one hand, the complex support of the patient's awakening from coma as a neurological and existential process, and on the other, support for their families.
Wlody, Ginger Schafer
This article describes organizational ethics issues involved in nursing management of an intensive care unit. The intensive care team and medical center management have the dual responsibility to create an ethical environment in which to provide optimum patient care. Addressing organizational ethics is key to creating that ethical environment in the intensive care unit. During the past 15-20 yrs, increasing costs in health care, competitive markets, the effect of high technology, and global business changes have set the stage for business and healthcare organizational conflicts that affect the ethical environment. Studies show that critical care nurses experience moral distress and are affected by the ethical climate of both the intensive care unit and the larger organization. Thus, nursing moral distress may result in problems related to recruitment and retention of staff. Other issues with organizational ethics ramifications that may occur in the intensive care unit include patient safety issues (including those related to disruptive behavior), intensive care unit leadership style, research ethics, allocation of resources, triage, and other economic issues. Current organizational ethics conflicts are discussed, a professional practice model is described, and multidisciplinary recommendations are put forth.
Puntillo, Kathleen A; Max, Adeline; Timsit, Jean-Francois;
RATIONALE: Intensive care unit (ICU) patients undergo several diagnostic and therapeutic procedures every day. The prevalence, intensity, and risk factors of pain related to these procedures are not well known. OBJECTIVES: To assess self-reported procedural pain intensity versus baseline pain, ex...
Chollet-Rivier, M; Chioléro, R L
Taking in charge severely ill patients in the intensive care environment to manage complex procedures is a performance requiring highly specific knowledge. Close collaboration between anaesthetists and intensive care specialists is likely to improve the safety and quality of medical care. Three forms of anaesthetic care should be considered in clinical practice: sedation and analgesia; monitored anaesthetic care; and general anaesthesia or conduction block anaesthesia. Even in the field of sedation and analgesia, the anaesthesiologist can offer expertise on new anaesthetic techniques like: the most recent concepts of balanced anaesthesia in terms of pharmacokinetics and dynamics, favouring the use of short-acting agents and of sedative-opioid combinations. New modes of administration and monitoring intravenous anaesthesia have been developed, with potential application in the intensive care unit. These include the use of target-controlled administration of intravenous drugs, and of electroencephalographic signals to monitor the level of sedation.
da Silva, Rafael Celestino; Ferreira, Márcia de Assunção; Apostolidis, Thémistoklis; Brandão, Marcos Antônio Gomes
Objective: to propose a conceptual framework for clinical nursing care in intensive care. Method: descriptive and qualitative field research, carried out with 21 nurses from an intensive care unit of a federal public hospital. We conducted semi-structured interviews and thematic and lexical content analysis, supported by Alceste software. Results: the characteristics of clinical intensive care emerge from the specialized knowledge of the interaction, the work context, types of patients and nurses characteristic of the intensive care and care frameworks. Conclusion: the conceptual framework of the clinic's intensive care articulates elements characteristic of the dynamics of this scenario: objective elements regarding technology and attention to equipment and subjective elements related to human interaction, specific of nursing care, countering criticism based on dehumanization. PMID:26487133
van Lieshout, E.J.
The Mobile Intensive Care Unit (MICU) is a combination of i) a team of critical care nurse, physician and ambulance driver, ii) a MICU-trolley (i.e. equipped with cardiovascular monitor, mechanical ventilator, syringe pumps etc. indispensable for safe transport and iii) an Intensive Care ambulance.
Li-Ying, Jason; Paunova, Minna; Egerod, Ingrid
quality within the unit. Conclusions The increasing pressures to implement the control of care quality and innovate may be conflicting, unless handled properly. Implications for nursing management Process control at intensive care units should be loosened, when personal interaction between intensive care...
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
The aim of this study is to retrospectively evaluate the obstetric cases who referred to intensive care unit, and define the frequency, cause and clinic outcomes of the patients. Demographic data, causes of reference, interventions in the intensive care and the outcomes of 15 obstetric cases in the pregnancy and postpartum period, whose referred to Gaziosmanpasa University Hospital Intensive Care Unit between 2007 and 2013 were included and retrospectively evaluated. The frequency of patients who referred from another center to our intensive care unit was 10 (%66.6. The mean age of the patients was 28.80 +/- 5.74. The mean hospital stay time was 3.20 +/- 2.51. The most cause to refer into intensive care unit was postpartum hemorrhage. One of the cases was resulted in death. The mortality ratio was found as %6.7. In conclusion, the frequent cause of intensive care requirement of the obstetric cases were obstetric bleeding and uncontrolled hypertension. The maternal morbidity and mortality will be substantially decreased with advanced treatment modalities and maternal care before pregnancy. [J Contemp Med 2014; 4(1.000: 14-17
Iannelli, Andrea M; Assis, Simone Gonçalves; Pinto, Liana Wernersbach; Pinto, Liana Wenersbach
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.
Sakaguchi, Hideya; Yamashita, Satoshi; Hirano, Teruyuki; Nakajima, Makoto; Kimura, En; Maeda, Yasushi; Uchino, Makoto
The purpose of this report was to investigate predictive factors that necessitate intensive care in myasthenic crisis (MC). We retrospectively reviewed MC patients at our institution and compared ICU and ward management groups. Higher MG-ADL scale scores, non-ocular initial symptoms, infection-triggered findings, and higher MGFA classification were observed more frequently in the ICU group. In patients with these prognostic factors, better outcomes may be obtained with early institution of intensive care.
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...
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.
Sprung, Charles L.; Baras, Mario; Iapichino, Gaetano; Kesecioglu, Jozef; Lippert, Anne; Hargreaves, Chris; Pezzi, Angelo; Pirracchio, Romain; Edbrooke, David L.; Pesenti, Antonio; Bakker, Jan; Gurman, Gabriel; Cohen, Simon L.; Wiis, Joergen; Payen, Didier; Artigas, Antonio
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 decisio
Santos, Eliane Barbosa; Lucio, Paulo Sérgio; Santos e Silva, Cláudio Moisés
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.
Infections are an important complication in the treatment of critical ill patients in Intensive Care Units (ICUs) and are associated with increased mortality, morbidity and health care costs. Selective Decontamination of the Digestive Tract (SDD) and Selective Oropharyngeal Decontamination (SOD) are
Krag, Morten Brøgger; Perner, A; Wetterslev, J;
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...
Byrne, Eilish; Garber, June
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…
Full Text Available Cerebral vasospasm is the prolonged, intense constriction of the larger conducting arteries in the subarachnoid space which are initially surrounded by subarachnoid clot. Significant narrowing develops gradually over the first few days after the aneurysmal rupture. The spasm usually is maximal in about a week′s time following haemorrhage. Vasospasm is the one of the leading causes of death after the aneurysmal rupture along with the effect of the initial haemorrhage and latter rebleeding. The purpose of this article is to outline the importance in early diagnosis and aggressive treatment of this otherwise challenging clinical entity.
Ramon Pereira Souza
Full Text Available Introduction: Football 5-a-side is a sport played by blind athletes that takes part in the Paralympic Games since 2004. The Brazilian national team is currently considered the best team in the world in this sport. Objective: To analyze the variations of intensity of effort (average per position and group average made by blind athletes of the Brazilian football 5-a-side national team during six matches simulations. Methods: The sample on this research is the intentional type, made with eight blind male players, ages ranging from 21 to 30 years old (23.8 ± 3.3, all of them part of the Brazilian Football 5-a-side National team, which played in the 2012 Paralympics Games in England. In was evaluated the VO2máx and the heart rate during six simulations of official matches. Results: The intensity of effort of the blind athletes of the Brazilian Football 5-a-side National Team is intermittent and remains 52.5 % of the total time of a match (50 minutes with an intensity of effort between the zone 2 (between threshold ventilation and respiratory compensation point and the zone 3 (above the respiratory compensation point averaging 89.8 % of the HR max. Conclusion: The intensity of effort is greater than the Football of 11 and, that in the Futsal players.
Penrod, Joan D.; Pronovost, Peter J.; Livote, Elayne E.; Puntillo, Kathleen A.; Walker, Amy S.; Wallenstein, Sylvan; Mercado, Alice F.; Swoboda, Sandra M.; Ilaoa, Debra; Thompson, David A.; Nelson, Judith E.
Objectives High-quality care for intensive care unit patients and families includes palliative care. To promote performance improvement, the Agency for Healthcare Research and Quality’s National Quality Measures Clearinghouse identified nine evidence-based processes of intensive care unit palliative care (Care and Communication Bundle) that are measured through review of medical record documentation. We conducted this study to examine how frequently the Care and Communication Bundle processes were performed in diverse intensive care units and to understand patient factors that are associated with such performance. Design Prospective, multisite, observational study of performance of key intensive care unit palliative care processes. Settings A surgical intensive care unit and a medical intensive care unit in two different large academic health centers and a medical-surgical intensive care unit in a medium-sized community hospital. Patients Consecutive adult patients with length of intensive care unit stay ≥5 days. Interventions None. Measurements and Main Results Between November 2007 and December 2009, we measured performance by specified day after intensive care unit admission on nine care process measures: identify medical decision-maker, advance directive and resuscitation preference, distribute family information leaflet, assess and manage pain, offer social work and spiritual support, and conduct interdisciplinary family meeting. Multivariable regression analysis was used to determine predictors of performance of five care processes. We enrolled 518 (94.9%) patients and 336 (83.6%) family members. Performances on pain assessment and management measures were high. In contrast, interdisciplinary family meetings were documented for <20% of patients by intensive care unit day 5. Performance on other measures ranged from 8% to 43%, with substantial variation across and within sites. Chronic comorbidity burden and site were the most consistent predictors of care
Vishal B Shete
Results: A total of 26 Acinetobacter septicemia cases were identified by blood culture. Acb complex strains predominated. Institutional birth and preterm birth were identified as the most frequent significant risk factors. 11.3% mortality rate was recorded. Acb complex strains exhibited a multi-drug resistant pattern. No carbapenem resistance was observed. Conclusion: Acinetobacter should be added to the list of organisms causing severe nosocomial infection in neonatal intensive care units. Continuous bacteriological surveillance, implementation of infection control policies, careful disinfection of intensive care equipment, and rational antibiotic use are required for control of such infections.
Francisco Senna de Oliveira Neto
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.
Flávio Benevett Fligenspan
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.
Full Text Available Introduction. The TISS-28 scale, which may be used for nursing staff scheduling in ICU, does not reflect the complete scope of nursing resulting from varied cultural and organizational conditions of individual systems of health care. Aim. The objective of the study was an attempt to provide an answer to the question what scope of nursing care provided by Polish nurses in ICU does the TISS-28 scale reflect? Material and Methods. The methods of working time measurement were used in the study. For the needs of the study, 252 hours of continuous observation (day-long observation and 3.697 time-schedule measurements were carried out. Results. The total nursing time was 4125.79 min. (68.76 hours, that is, 60.15% of the total working time of Polish nurses during the period analyzed. Based on the median test, the difference was observed on the level of χ2=16945.8, P<0.001 between the nurses’ workload resulting from performance of activities qualified into the TISS-28 scale and load resulting from performance of interventions within the scopes of care not considered in this scale in Polish ICUs. Conclusions. The original version of the TISS-28 scale does not fully reflect the workload among Polish nurses employed in ICUs.
Latour, Jos M.; van Goudoever, Johannes B.; Duivenvoorden, Hugo J.; van Dam, Nicolette A. M.; Dullaart, Eugenie; Albers, Marcel J. I. J.; Verlaat, Carin W. M.; van Vught, Elise M.; van Heerde, Marc; Hazelzet, Jan A.
To identify parental perceptions on pediatric intensive care-related satisfaction items within the framework of developing a Dutch pediatric intensive care unit (PICU) satisfaction instrument. Prospective cohort study in tertiary PICUs at seven university medical centers in The Netherlands. Parents
J.M. Latour (Jos); J.B. van Goudoever (Hans); H.J. Duivenvoorden (Hugo); N.A.M. van Dam (Nicolette); E. Dullaart (Eugenie); M.J.I.J. Albers (Marcel); C.W.M. Verlaat (Carin); E.M. van Vught (Elise); M. van Heerde (Marc); J.A. Hazelzet (Jan)
textabstractAbstract: PURPOSE: To identify parental perceptions on pediatric intensive care-related satisfaction items within the framework of developing a Dutch pediatric intensive care unit (PICU) satisfaction instrument. METHODS: Prospective cohort study in tertiary PICUs at seven university med
Ramezani, Tahereh; Hadian Shirazi, Zahra; Sabet Sarvestani, Raheleh; Moattari, Marzieh
Background: The concept of family- centered care in neonatal intensive care unit has changed drastically in protracted years and has been used in various contexts differently. Since we require clarity in our understanding, we aimed to analyze this concept. Methods: This study was done on the basis of developmental approach of Rodgers’s concept analysis. We reviewed the existing literature in Science direct, PubMed, Google Scholar, Scopus, and Iran Medex databases from 1980 to 2012. The keywords were family-centered care, family-oriented care, and neonatal intensive care unit. After all, 59 out of 244 English and Persian articles and books (more than 20%) were selected. Results: The attributes of family-centered care in neonatal intensive care unit were recognized as care taking of family (assessment of family and its needs, providing family needs), equal family participation (participation in care planning, decision making, and providing care from routine to special ones), collaboration (inter-professional collaboration with family, family involvement in regulating and implementing care plans), regarding family’s respect and dignity (importance of families’ differences, recognizing families’ tendencies), and knowledge transformation (information sharing between healthcare workers and family, complete information sharing according to family learning style). Besides, the recognized antecedents were professional and management-organizational factors. Finally, the consequences included benefits related to neonate, family, and organization. Conclusion: The findings revealed that family centered-care was a comprehensive and holistic caring approach in neonatal intensive care. Therefore, it is highly recommended to change the current care approach and philosophy and provide facilities for conducting family-centered care in neonatal intensive care unit. PMID:25349870
Karthik Nagesh, N; Razak, Abdul
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.
de Menezes, Fernanda Souza; Leite, Heitor Pons; Fernandez, Juliana; Benzecry, Silvana Gomes; de Carvalho, Werther Brunow
The aims of this study were to estimate the occurrence of hypophosphatemia and to identify potential risk factors and outcome measures associated with this disturbance in children admitted to a pediatric intensive care unit. Data concerning 42 children admitted consecutively to 1 pediatric intensive care unit over a 1-year period were examined. Serum phosphorus levels were measured on the third day of admission, where levels below 3.8 mg/dL were considered indicative of hypophosphatemia. Hypophosphatemia was found in 32 children (76%), and there was a significant association between this disturbance and malnutrition (P = .04). Of the potential risk factors such as sepsis, diuretic/steroid therapy, starvation (over 3 days), and Pediatric Index of Mortality, none discriminated for hypophosphatemia. There were no associations between hypophosphatemia and mortality, length of stay in the pediatric intensive care unit, or time on mechanical lung ventilation. Hypophosphatemia was a common finding in critically ill children and was associated with malnutrition.
Deshpande, Girish; Rao, Shripada; Patole, Sanjay
Survival of extremely preterm and critically ill neonates has improved significantly over the last few decades following advances in neonatal intensive care. These include antenatal glucocorticoids, surfactant, continuous positive airway pressure support, advanced gentle modes of ventilation and inhaled nitric oxide. Probiotic supplementation is a recent significant milestone in the history of neonatal intensive care. Very few, if any, interventions match the ability of probiotics to significantly reduce the risk of death and definite necrotising enterocolitis while facilitating enteral feeds in high-risk preterm neonates. Probiotics also have a potential to benefit neonates with surgical conditions with significant gastrointestinal morbidity. Current evidence for the benefits of probiotic supplementation for neonates in an intensive care unit is reviewed. The mechanisms for the benefits of probiotics in this population are discussed, and guidelines for clinicians are provided in the context of the regulatory framework in Australia.
Maestri, Eleine; do Nascimento, Eliane Regina Pereira; Bertoncello, Kátia Cilene Godinho; de Jesus Martins, Josiane
This qualitative study was performed at the adult Intensive Care Unit (ICU) of a public hospital in Southern Brazil with the objective to evaluate the implemented welcoming strategies. Participants included 13 patients and 23 relatives. Data collection was performed from July to October 2008, utilizing semi-structured interviews. All interviews were recorded. Data analysis was performed using the Collective Subject Discourse. The collected information yielded two discourses: the family recognized the welcoming strategies and the patients found the ICU team to be considerate. By including the family as a client of nursing care, relatives felt safe and confident. Results show that by committing to the responsibility of making changes in heath care practices, nurses experience a novel outlook towards ICU care, focused on human beings and associating the welcoming to the health care model that promotes the objectivity of care.
Full Text Available Ventilator associated pneumonia (VAP is the most common nosocomial infection in Intensive Care Unit. One major factor causing VAP is the aspiration of oral colonization because of poor oral care practices. We feel the role of simple measure like oral care is neglected, despite the ample evidence of it being instrumental in preventing VAP.
Ten Have, Elsbeth Cornelia Maria; Nap, Raoul Ernesto
Purpose: Insights regarding the results of interdisciplinary communication about patient care are limited. We explored the perceptions of intensivists, junior physicians, and nurses about patient care directly after the interdisciplinary rounds (IDRs) in the intensive care unit (ICU) to determine mu
Fuly, Patrícia Dos Santos Claro; Leite, Joséte Luzia; Lima, Suzinara Beatriz Soares
This study is a research that has as objective analyze the bibliographical production about the Systematization of Nursing Care in order to discuss concepts associated to the subject. Were analyzed books and national articles published in the database of the Virtual Library in Health, Medline, Lilacs and Scielo, in the period of January of 2000 to January of 2008. Were analyzed 11 articles, having been identified three distinct kind of thought to define concepts associated to Systematization of Nursing Care. Such fact aims for the difficulty of theoretical and pratical articulation, evidenced by the conflicts existing in the literature.
Ilusca Cardoso de Paula
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.
Intensive care medicine and palliative care medicine were considered for a long time to be contrasting concepts in therapy. While intensive care medicine is directed towards prolonging life and tries to stabilize disordered body functions, palliative care medicine is focused upon the relief of disturbances to help patients in the face of death. Today both views have become congruent. Palliative aspects are equally important in curative therapy. In the course of illness or in respect of the patient's will, the aim of therapy may change from curative to palliative. Two examples are presented to illustrate the ethical challenges in this process. They follow from the medical indication, attention to the patient's will, different opinions in the team, truth at the bedside and from what must be done in the process of withdrawing therapy.
Alexandre Rodrigues da Silva
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.
Plantinga, Nienke L; Wittekamp, Bastiaan H J; van Duijn, Pleun J; Bonten, Marc J M
Antibiotic resistance is a global and increasing problem that is not counterbalanced by the development of new therapeutic agents. The prevalence of antibiotic resistance is especially high in intensive care units with frequently reported outbreaks of multidrug-resistant organisms. In addition to classical infection prevention protocols and surveillance programs, counterintuitive interventions, such as selective decontamination with antibiotics and antibiotic rotation have been applied and investigated to control the emergence of antibiotic resistance. This review provides an overview of selective oropharyngeal and digestive tract decontamination, decolonization of methicillin-resistant Staphylococcus aureus and antibiotic rotation as strategies to modulate antibiotic resistance in the intensive care unit.
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
Full Text Available The cost of Intensive Care Units has the greatest impact on overall medical costs and the overall cost for the health of a country and an increasing number of studies from around the world presenting the quantification of these costs. Aim: Review of the Economic Analysis of the Cost of Intensive Care Units. Method: Search was made in the SCOPUS, MEDLINE and CINAHL databases using the key-words “Intensive Care Units (ICU”, “Cost”, “Cost Analysis”, “Health Care Costs”, “Health Resources”, “ICU resources”. The study was based on articles published in English from 2000 to 2011 investigating the Economic Analysis of the Cost of Intensive Care Units. Results: The cost of ICU is a significant percentage of gross domestic product in developed countries. Most cost analysis studies that relate to plans that include the study of staff costs, duration of stay in the ICU, the clinical situations of hospitalized patients, engineering support, medications and diagnostic tests costing scales and in relation to the diagnostic criteria. Conclusions: most studies conclude that the remuneration of staff, particularly nurses, in the ICU is the largest cost of ICU, while for the duration of stay in the ICU results are conflicting. The analysis on the cost-effectiveness of ICU can help to better apply these findings to the therapeutic context of ICU.
Erstad, Brian L; Jordan, Ché J; Thomas, Michael C
Compilations of key articles and guidelines in a particular clinical practice area are useful not only to clinicians who practice in that area, but to all clinicians. We compiled pertinent articles and guidelines pertaining to drug therapy in the intensive care unit setting from the perspective of an actively practicing critical care pharmacist. This document also may serve to stimulate other experienced clinicians to undertake a similar endeavor in their practice areas.
Introduction Competence of nurses is a complex combination of knowledge, function, skills, attitudes, and values. Delivering care for patients in the Intensive Cardiac Care Unit (ICCU) requires nurses’ competences. This study aimed to explain nurses’ competence in the ICCU. Methods This was a qualitative study in which purposive sampling with maximum variation was used. Data were collected through semi-structured interviews with 23 participants during 2012–2013. Interviews were recorded, tran...
Cascade, P N; Kazerooni, E A
Timely performance and accurate interpretation of portable chest radiographs in the ICU setting are fundamental components of quality care. Teamwork between intensive care clinicians and radiologists is necessary to assure that the appropriate studies, of high technical quality, are obtained. By working together to integrate available clinical information with systematic comprehensive analysis of images, accurate diagnoses can be made, optimal treatment instituted, and successful outcomes optimized.
Maria Licele do Nascimento
Full Text Available Objective: tounderstand the social care networks of children discharged from Neonatal Intensive Care Unit. Methods: qualitative study conducted in the home of six families of seven children. In data collection, authors used the triangulation of techniques with thematic content analysis. Results: family composition is nuclear, social networks are formed by the support of family, leisure and spiritual ties, by school and hospital institutions. The families reported the challenges of caring for a premature baby, and the main care demands were respiratory, motor and cognitive. The non-effective communication between professionals and family showed negative impact on hospitalization and home care. Conclusion:social care networks for children discharged from the Neonatal Intensive Care unit proved to be disjointed and health care for children and family proved to be fragmented.
Müller, M M; Hackl, W; Griesmacher, A
After successful centralization of laboratory analyses since more than 30 years, advances in biosensors, microprocessors, measurement of undiluted whole blood and miniaturization of laboratory analyzers are leading nowadays more and more to a re-decentralization in the laboratory medicine. Point-of-care-testing (POCT), which is defined as any laboratory test performed outside central or decentralized laboratories, is becoming more and more popular. The theoretical advantages of POCT are faster turn-around-times (TAT), more rapid medical decisions, avoidance of sample identification and sample transport problems and the need of only small specimen volumes. These advantages are frequently mentioned, but are not associated with a clear clinical benefit. The disadvantages of POCT such as incorrect handling and/or maintenance of the analyzers by nontrained clinical staff, inadequate or even absent calibrations and/or quality controls, lack of cost-effectiveness because of an increased number of analyzers and more expensive reagents, insufficient documentation and difficult comparability of the obtained POCT-results with routine laboratory results, are strongly evident. According to the authors' opinion the decision for the establishing of POCT has only to be made in a close co-operation between physicians and laboratorians in order to vouch for necessity and high quality of the analyses. Taking the local situation into consideration (24-h-central laboratory, etc.) the spectrum of parameters measured by means of POCT should be rigorously restricted to the vital functions. Such analytes should be: hemoglobin or hematocrit, activated whole blood clotting time, blood gases, sodium, potassium, ionized calcium, glucose, creatinine, ammonia and lactate.
Arts, DGT; Bosman, RJ; de Jonge, E; Joore, JCA; de Keizer, NF
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)
van de Leur, JP; van der Schans, CP; Loef, BG; Deelman, BG; Geertzen, JHB; Zwaveling, JH
Introduction A stay in the intensive care unit (ICU), although potentially life-saving, may cause considerable discomfort to patients. However, retrospective assessment of discomfort is difficult because recollection of stressful events may be impaired by sedation and severe illness during the ICU s
Bonten, MJM; Kullberg, BJ; Girbes, ARJ; Hoepelman, IM; Hustinx, W; van der Meer, JWM; Speelman, P; Stobberingh, EE; Verbrugh, HA; Verhoef, J; Zwaveling, JH
Selective digestive decontamination (SDD) is the most extensively studied method for the prevention of infection in patients in intensive care units (ICUs). Despite 27 prospective randomized studies and six meta-analyses, routine use of SDD is still controversial. In this review, we summarize the av
Mook, W.N. van; Grave, W.S. De; Gorter, S.L.; Zwaveling, J.H.; Schuwirth, L.W.; Vleuten, C.P.M. van der
The Competency-Based Training program in Intensive Care Medicine in Europe identified 12 competency domains. Professionalism was given a prominence equal to technical ability. However, little information pertaining to fellows' views on professionalism is available. A nationwide qualitative study was
Andersen, J H; Boesen, Hans Christian Toft; Olsen, Karsten Skovgaard
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...
Pauw, B.E. de
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
Plantinga, Nienke L.; Wittekamp, Bastiaan H J; Van Duijn, Pleun J.; Bonten, Marc J M
Antibiotic resistance is a global and increasing problem that is not counterbalanced by the development of new therapeutic agents. The prevalence of antibiotic resistance is especially high in intensive care units with frequently reported outbreaks of multidrug-resistant organisms. In addition to cl
Millar, K. J.; Thiagarajan, R. R.; Laussen, P. C.
In recent years, it has been our practice to treat persistent hypotension in the cardiac intensive care unit with glucocorticoids. We undertook a retrospective review in an attempt to identify predictors of a hemodynamic response to steroids and of survival in these patients. Patients who had receiv
Rogowski, JA; Horbar, JD; Plsek, PE; Baker, LS; Deterding, J; Edwards, WH; Hocker, J; Kantak, AD; Lewallen, P; Lewis, W; Lewit, E; McCarroll, CJ; Mujsce, D; Payne, NR; Shiono, P; Soll, RF; Leahy, K
Objective. To make measurable improvements in the quality and cost of neonatal intensive care using a multidisciplinary collaborative quality improvement model. Design. Interventional study. Data on treatment costs were collected for infants with birth weight 501 to 1500 g for the period of January
Reis Miranda, D; Citerio, G; Perner, A
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...
van den Hoogen, A.
Neonatal infections are an important cause of morbidity in neonatal intensive care units (NICUs). Prematurity or very low birth weight is an important predisposing factor for neonatal infection. In addition, preterm infants have a compromized immune system and they often require invasive procedures
van der Elst, Kim C M; Veringa, Anette; Zijlstra, Jan G; Beishuizen, Albertus; Klont, Rob; Brummelhuis-Visser, Petra; Uges, Donald R A; Touw, Daan J; Kosterink, Jos G W; van der Werf, Tjip S; Alffenaar, Jan-Willem C
In critically ill patients, drug exposure may be influenced by altered drug distribution and clearance. Earlier studies showed that the variability in caspofungin exposure was high in Intensive Care Unit (ICU) patients. The primary objective of this study was to determine if the standard dose of cas
Li, Y.; Albayrak, A.; Goossens, R.H.M.; Xiao, D.; Jakimowicz, J.J.
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 ba
Le Blanc, Pascale M.; Schaufeli, Wilmar B.; Salanova, Marisa; Llorens, Susana; Nap, Raoul E.
P>Aim. This paper is a report of an investigation of whether intensive care nurses' efficacy beliefs predict future collaborative practice, and to test the potential mediating role of team commitment in this relationship. Background. Recent empirical studies in the field of work and organizational p
XIE Guo-hao; FANG Xiang-ming
@@ Delirium is an acute and fluctuating change in mental status, with inattention and altered levels of consciousness. It is a common comorbidity in intensive care units (ICU), resulting in delayed withdrawal of mechanical ventilation, prolonged length of stay in ICU, increased ICU mortality and impaired long-term cognitive function of the survivors.
Manjiri P Dighe
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.
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
Fernanda Umpierre Bueno
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.
Sprung, Charles L; Artigas, Antonio; Kesecioglu, Jozef
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...... for intensive care unit admission. INTERVENTIONS:: Admission or rejection to intensive care unit. MEASUREMENTS AND MAIN RESULTS:: Demographic, clinical, hospital, physiologic variables, and 28-day mortality were obtained on consecutive patients. There were 8,472 triages in 6,796 patients, 5,602 (82%) were...... 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...
Full Text Available 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 twenty patients were included in the study. Demographic data at the time of the admission to intensive care unit (age, sex, height, weight and body mass index, intensive care admission diagnosis and systemic diseases were all recorded. The clinical pulmonary infection score was used for ventilator associated pneumonia diagnosis. Antibiotic usage, duration of stay in intensive care unit, duration of mechanical ventilation stay and mortality were all recorded. Results: Ventilator-associated pneumonia was detected in 51.36% (n=113 of the 220 patients. Clinical pulmonary infection score was found as 8.04±1.03 in patients with ventilator-associated pneumonia and 1.75±1.88 in non- ventilatorassociated pneumonia patients (p=0.001. Higher age was detected in ventilator-associated pneumonia group (58±12.79 years and 51.37±15.87 years, p=0.001. Also hypertension and diabetes mellitus were observed more frequently (p=0.001. Development of enteral nutrition in patients with ventilator-associated pneumonia were significantly higher than those of parenterally fed patients (enteral: by 36.4% and 25.5% p=0.006; parenteral: 25% and 19.1%, p=0.042. The length of stay in intensive care unit (12.38±5.81 and 10.79±5.91 days, p=0.045, duration of mechanical ventilation (9.67±4.84 days and 6.7±3.87 days, p=0.001 and mortality rates (24.5% and 15.5% p=0.019 were significantly higher in the ventilator-associated pneumonia group. Conclusion: Ventilator-associated pneumonia increases the duration of
Saul Martins Paiva
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.
Selim, Bernardo J; Ramar, Kannan; Surani, Salim
The steady growing prevalence of critically ill obese patients is posing diagnostic and management challenges across medical and surgical intensive care units. The impact of obesity in the critically ill patients may vary by type of critical illness, obesity severity (obesity distribution) and obesity-associated co-morbidities. Based on pathophysiological changes associated with obesity, predominately in pulmonary reserve and cardiac function, critically ill obese patients may be at higher risk for acute cardiovascular, pulmonary and renal complications in comparison to non-obese patients. Obesity also represents a dilemma in the management of other critical care areas such as invasive mechanical ventilation, mechanical ventilation liberation, hemodynamic monitoring and pharmacokinetics dose adjustments. However, despite higher morbidity associated with obesity in the intensive care unit (ICU), a paradoxical lower ICU mortality ("obesity paradox") is demonstrated in comparison to non-obese ICU patients. This review article will focus on the unique pathophysiology, challenges in management, and outcomes associated with obesity in the ICU.
Santos, Luciano Marques; Pereira, Monick Piton; dos Santos, Leandro Feliciano Nery; de Santana, Rosana Castelo Branco
This study aimed to analyze the process of pain identification in premature by the professional staff of the Neonatal Intensive Care Unit of a public hospital in the interior of Bahia, Brazil. This is a quantitative descriptive exploratory study that was made through a form applied to twenty-four health professional of a Neonatal Intensive Care Unit. The data were analyzed in the Statistical Package for Social Sciences. The results showed 100% of professionals believed that newborns feel pain, 83.3% knew the pain as the fifth vital sign to be evaluated; 54,8% did not know the pain assessment scales; 70.8% did not use scales and highlighted behavioral and physiological signs of the newborn as signs suggestive of pain. Thus, it is important that professionals understand the pain as a complex phenomenon that demands early intervention, ensuring the excellence of care.
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
Intensive care medicine has made great contributions to the immense success of modern curative medicine. However, emotional care and empathy for the patient and his family seem to be sparse. There is an assumed constraint to objectivity and efficiency, as well as a massive economic pressure which transfers the physician into an agent of the disease instead of a trustee of the ill human being. The physician struggles against the disease and feels the death of his patient as his personal defeat. However, in futile situations the intensivist must learn to let go. He is responsible for futile overtreatment as well as for successful treatment. Today, in futile situations in the intensive care unit (ICU), it is possible to change the goal from curative treatment to palliative care. This is a consequent further development from critical care medicine. In end-of-life situations in the intensive care unit, emotional care and empathy are mandatory using intensive dialogues with the family. Despite great workload stress enough time for such conversation should be taken, because the physician will generously be repaid by the way he sees his medical activity. The maintenance of a culture of empathy within the intensive care team is a major task for the leader. In this manner, the ICU will become and remain a place for living humanity.
Okumura, Lucas Miyake; da Silva, Daniella Matsubara; Comarella, Larissa
Abstract Objective: Clinical Pharmacy Services (CPS) are considered standard of care and is endorsed by the Joint Commission International, the American Academy of Pediatrics, and the American College of Clinical Pharmacy. In Brazil, single experiences have been discreetly arising and the importance of these services to children and adolescents care has led to interesting results, but certainly are under reported. This short report aims to discuss the effect of implementing a bedside CPS at a Brazilian Pediatric Intensive Care Unit (PICU). Methods: This is a cross-sectional study conducted in a 12 bed PICU community hospital, from Campo Largo/Brazil. Subjects with<18 years old admitted to PICU were included for descriptive analysis if received a CPS intervention. Results: Of 53 patients accompanied, we detected 141 preventable drug-related problems (DRPs) which were solved within clinicians (89% acceptance of all interventions). The most common interventions performed to improve drug therapy included: preventing incompatible intravenous solutions (21%) and a composite of inadequate doses (17% due to low, high and non-optimized doses). Among the top ten medications associated with DRPs, five were antimicrobials. By analyzing the correlation between DRPs and PICU length of stay, we found that 74% of all variations on length of stay were associated with the number of DRPs. Conclusions: Adverse drug reactions due to avoidable DRPs can be prevented by CPS in a multifaceted collaboration with other health care professionals, who should attempt to use active and evidence-based strategies to reduce morbidity related to medications. PMID:27578187
Nouwen, Marinus J.; Klijn, Francina A. M.; van den Broek, Brigitte T. A.; Slooter, Arjen J. C.
Purpose: The aim of this study was to review literature exploring the emotional consequences of delirium and delusional memories in intensive care unit patients. Methods: A systematic review was performed using PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and PsychINFO.
Kett, D.H.; Azoulay, E.; Echeverria, P.M.; Vincent, J.L.; Pickkers, P.
OBJECTIVES: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the I
Martinez, Elizabeth A; Donelan, Karen; Henneman, Justin P; Berenholtz, Sean M; Miralles, Paola D; Krug, Allison E; Iezzoni, Lisa I; Charnin, Jonathan E; Pronovost, Peter J
Despite important progress in measuring the safety of health care delivery in a variety of health care settings, a comprehensive set of metrics for benchmarking is still lacking, especially for patient outcomes. Even in high-risk settings where similar procedures are performed daily, such as hospital intensive care units (ICUs), these measures largely do not exist. Yet we cannot compare safety or quality across institutions or regions, nor can we track whether safety is improving over time. To a large extent, ICU outcome measures deemed valid, important, and preventable by clinicians are unavailable, and abstracting clinical data from the medical record is excessively burdensome. Even if a set of outcomes garnered consensus, ensuring adequate risk adjustment to facilitate fair comparisons across institutions presents another challenge. This study reports on a consensus process to build 5 outcome measures for broad use to evaluate the quality of ICU care and inform quality improvement efforts.
Full Text Available Background Prolonged hospitalization in the intensive care unit (ICU can impose long-term psychological effects on patients. One of the most significant psychological effects from prolonged hospitalization is delirium. Objectives The aim of this study was to assess the effect of prolonged hospitalization of patients and subsequent delirium in the intensive care unit. Patients and Methods This conventional content analysis study was conducted in the General Intensive Care Unit of the Shariati Hospital of Tehran University of Medical Sciences, from the beginning of 2013 to 2014. All prolonged hospitalized patients and their families were eligible participants. From the 34 eligible patients and 63 family members, the final numbers of actual patients and family members were 9 and 16, respectively. Several semi-structured interviews were conducted face-to-face with patients and their families in a private room and data were gathered. Results Two main themes from two different perspectives emerged, 'patients' perspectives' (experiences during ICU hospitalization and 'family members' perspectives' (supportive-communicational experiences. The main results of this study focused on delirium, Patients' findings were described as pleasant and unpleasant, factual and delusional experiences. Conclusions Family members are valuable components in the therapeutic process of delirium. Effective use of family members in the delirium caring process can be considered to be one of the key non-medical nursing components in the therapeutic process.
Sprung, Charles L; Baras, Mario; Iapichino, Gaetano
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 dec......:: The initial refusal score and final triage score provide objective data for rejecting patients that will die even if admitted to the intensive care unit and survive if refused intensive care unit admission.......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...
Full Text Available Abstract Background Questions about the existence of supplier-induced demand emerge repeatedly in discussions about governing Swiss health care. This study therefore aimed to evaluate the interrelationship between structural factors of supply and the volume of services that are provided by primary care physicians in Switzerland. Methods The study was designed as a cross-sectional investigation, based on the complete claims data from all Swiss health care insurers for the year 2004, which covered information from 6087 primary care physicians and 4.7 million patients. Utilization-based health service areas were constructed and used as spatial units to analyze effects of density of supply. Hierarchical linear models were applied to analyze the data. Results The data showed that, within a service area, a higher density of primary care physicians was associated with higher mortality rates and specialist density but not with treatment intensity in primary care. Higher specialist density was weakly associated with higher mortality rates and with higher treatment intensity density of primary care physicians. Annual physician-level data indicate a disproportionate increase of supplied services irrespective of the size of the number of patients treated during the same year and, even in high volume practices, no rationing but a paradoxical inducement of consultations occurred. The results provide empirical evidence that higher densities of primary care physicians, specialists and the availability of out-patient hospital clinics in a given area are associated with higher volume of supplied services per patient in primary care practices. Analyses stratified by language regions showed differences that emphasize the effect of the cantonal based (fragmented governance of Swiss health care. Conclusion The study shows high volumes in Swiss primary care and provides evidence that the volume of supply is not driven by medical needs alone. Effects related to the
Pallás-Alonso, Carmen R; Losacco, Valentina; Maraschini, Alice
To compare, in a large representative sample of European neonatal intensive care units, the policies and practices regarding parental involvement and holding babies in the kangaroo care position as well as differences in the tasks mothers and fathers are allowed to carry out....
Twohig, Bridget; Manasia, Anthony; Bassily-Marcus, Adel; Oropello, John; Gayton, Matthew; Gaffney, Christine; Kohli-Seth, Roopa
The experience of critical care is stressful for both patients and their families. This is especially true when patients are not able to make their own care decisions. This article details the creation of a Family Experience Survey in a surgical intensive care unit (SICU) to capture and improve overall experience. Kolcaba's "Enhanced Comfort Theory" provided the theoretical basis for question formation, specifically in regards to the four aspects of comfort: "physical," "psycho-spiritual," "sociocultural" and "environmental." Survey results were analyzed in real-time to identify and implement interventions needed for issues raised. Overall, there was a high level of satisfaction reported especially with quality of care provided to patients, communication and availability of nurses and doctors, explanations from staff, inclusion in decision making, the needs of patients being met, quality of care provided to patients and cleanliness of the unit. It was noted that 'N/A' was indicated for cultural needs and spiritual needs, a chaplain now rounds on all patients daily to ensure these services are more consistently offered. In addition, protocols for doctor communication with families, palliative care consults, daily bleach cleaning of high touch areas in patient rooms and nurse-led progressive mobility have been implemented. Enhanced comfort theory enabled the opportunity to identify and provide a more 'broad' approach to care for patients and families.
Nedel, Wagner Luis; da Silveira, Fernando
Different research designs have various advantages and limitations inherent to their main characteristics. Knowledge of the proper use of each design is of great importance to understanding the applicability of research findings to clinical epidemiology. In intensive care, a hierarchical classification of designs can often be misleading if the characteristics of the design in this context are not understood. One must therefore be alert to common problems in randomized clinical trials and systematic reviews/meta-analyses that address clinical issues related to the care of the critically ill patient. PMID:27737421
Nørgaard, Betty; Johannessen, Helle; Fenger-Grøn, Jesper
BACKGROUND: In neonatal intensive care units (NICUs) health care professionals typically give most of their attention to the infants and the mothers while many fathers feel uncertain and have an unmet need for support and guidance. This paper describes and discusses participatory action research...... of the father friendly NICU. CONCLUSIONS: This paper contributed new knowledge of how PAR can be used to ensure that participants engaged in the field are involved in the entire process; consequently, this will ensure that the changes are feasible and sustainable....
Adams-Chapman, Ira; Stoll, Barbara J
Nosocomial infections are responsible for significant morbidity and late mortality among neonatal intensive care unit patients. The number of neonatal patients at risk for acquiring nosocomial infections is increasing because of the improved survival of very low birthweight infants and their need for invasive monitoring and supportive care. Effective strategies to prevent nosocomial infection must include continuous monitoring and surveillance of infection rates and distribution of pathogens; strategic nursery design and staffing; emphasis on handwashing compliance; minimizing central venous catheter use and contamination, and prudent use of antimicrobial agents. Educational programs and feedback to nursery personnel improve compliance with infection control programs.
The field of critical care has changed markedly in recent years to accommodate a growing population of chronically critically ill patients. New administrative structures have evolved to include divisions, departments, and sections devoted exclusively to the practice of critical care medicine. On an individual level, the ability to manage complex multisystem critical illnesses and to introduce invasive monitoring devices defines the intensivist. On a systems level, critical care services managed by an intensivist-led multidisciplinary team are now recognized by their ability to efficiently utilize hospital resources and improve patient outcomes. Due to the numerous cost and quality issues related to the delivery of critical care medicine, intensive care unit physician staffing (IPS) has become a charged subject in recent years. Although the federal government has played a large role in regulating best practices by physicians, other third parties have entered the arena. Perhaps the most influential of these has been The Leapfrog Group, a consortium representing 130 employers and 65 Fortune 500 companies that purchase health care for their employees. This group has proposed specific regulatory guidelines for IPS that are purported to result in substantial cost containment and improved quality of care. This narrative review examines the impact of The Leapfrog Group's recommendations on critical care delivery in the United States.
Nilsson, Karen; Berner, Susanne; Hertz, Iben
-care. Several studies have investigated psychological consequences. Additionally, the meaning of dreams and follow-up care been explored. It may therefore seem appropriate to further investigate patients individual experiences in order to search for a deeper understanding of the dimensions that influence...... and critical interpretation and discussion. RESULTS. The preliminary findings indicate that there are three categories of lived experiences of intensive care. CONCLUSIONS. This clinical nursing research provides new basic knowledge useful in the efforts to enhance patient psychological processing after...
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
Adriana Janzantte Ducci
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.
Mazutti, Sandra Regina Gonzaga; Nascimento, Andréia de Fátima; Fumis, Renata Rego Lins
Objective To estimate the incidence of limitations to Advanced Life Support in critically ill patients admitted to an intensive care unit with integrated palliative care. Methods This retrospective cohort study included patients in the palliative care program of the intensive care unit of Hospital Paulistano over 18 years of age from May 1, 2011, to January 31, 2014. The limitations to Advanced Life Support that were analyzed included do-not-resuscitate orders, mechanical ventilation, dialysis and vasoactive drugs. Central tendency measures were calculated for quantitative variables. The chi-squared test was used to compare the characteristics of patients with or without limits to Advanced Life Support, and the Wilcoxon test was used to compare length of stay after Advanced Life Support. Confidence intervals reflecting p ≤ 0.05 were considered for statistical significance. Results A total of 3,487 patients were admitted to the intensive care unit, of whom 342 were included in the palliative care program. It was observed that after entering the palliative care program, it took a median of 2 (1 - 4) days for death to occur in the intensive care unit and 4 (2 - 11) days for hospital death to occur. Many of the limitations to Advanced Life Support (42.7%) took place on the first day of hospitalization. Cardiopulmonary resuscitation (96.8%) and ventilatory support (73.6%) were the most adopted limitations. Conclusion The contribution of palliative care integrated into the intensive care unit was important for the practice of orthothanasia, i.e., the non-extension of the life of a critically ill patient by artificial means. PMID:27626949
Full Text Available The primary aim of managing patients with acute brain injury in the intensive care unit is to minimise secondary injury by maintaining cerebral perfusion and oxygenation. The mechanisms of secondary injury are frequently triggered by secondary insults, which may be subtle and remain undetected by the usual systemic physiological monitoring. Continuous monitoring of the central nervous system in the intensive care unit can serve two functions. Firstly it will help early detection of these secondary cerebral insults so that appropriate interventions can be instituted. Secondly, it can help to monitor therapeutic interventions and provide online feedback. This review focuses on the monitoring of intracranial pressure, blood flow to the brain (Transcranial Doppler, cerebral oxygenation using the methods of jugular bulb oximetry, near infrared spectroscopy and implantable sensors, and the monitoring of function using electrophysiological techniques.
Bequette, B Wayne
Intensive care unit (ICU) blood glucose control algorithms were reviewed and analyzed in the context of linear systems theory and classical feedback control algorithms. Closed-loop performance was illustrated by applying the algorithms in simulation studies using an in silico model of an ICU patient. Steady-state and dynamic input-output analysis was used to provide insight about controller design and potential closed-loop performance. The proportional-integral-derivative, columnar insulin dosing (CID, Glucommander-like), and glucose regulation for intensive care patients (GRIP) algorithms were shown to have similar features and performance. The CID strategy is a time-varying proportional-only controller (no integral action), whereas the GRIP algorithm is a nonlinear controller with integral action. A minor modification to the GRIP algorithm was suggested to improve the closed-loop performance. Recommendations were made to guide control theorists on important ICU control topics worthy of further study.
Helen Katharine Christofel
Full Text Available Objective: to analyze the noise level in adult intensive care unit. Methods: a quantitative study, in which the sound levels of the intensive care unit have been assessed by means of a decibel meter. Results: comparing the groups, there was a reduction in noise levels in both periods studied, but only in the afternoon there was a statistically significant difference (p<0.05. The health professionals pointed out that the unit had moderate noise, coming mainly from equipment and professionals. Conclusion: adjusting the ventilator alarms contributed to the reduction of noise levels in the unit, and there was the perception that it is a moderate noise environment, although the noise levels in decibels observed were above the recommended values.
Nilsson, Krister; Ekström-Jodal, Barbro; Meretoja, Olli
The initiation and development of pediatric anesthesia and intensive care have much in common in the Scandinavian countries. The five countries had to initiate close relations and cooperation in all medical disciplines. The pediatric anesthesia subspecialty took its first steps after the Second...... World War. Relations for training and exchange of experiences between Scandinavian countries with centers in Europe and the USA were a prerequisite for development. Specialized pediatric practice was not a full-time position until during the 1950s, when the first pediatric anesthesia positions were...... 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...
Full Text Available Centralization of intensive care units (ICUs is a concept that has been around for several decades and the OECD countries have led the way in adopting this in their operations. Singapore Hospital was built in 1981, before the concept of centralization of ICUs took off. The hospital's ICUs were never centralized and were spread out across eight different blocks with the specialization they were associated with. Coupled with the acquisitions of the new concept of centralization and its benefits, the hospital recognizes the importance of having a centralized ICU to better handle major disasters. Using simulation models, this paper attempts to study the feasibility of centralization of ICUs in Singapore Hospital, subject to space constraints. The results will prove helpful to those who consider reengineering the intensive care process in hospitals.
Velloso, Isabela; Ceci, Christine; Alves, Marilia
In this paper, we make explicit the changing configurations of power relations that currently characterize the Brazilian Emergency Care System (SAMU) team in Belo Horizonte, Brazil. The SAMU is a recent innovation in Brazilian healthcare service delivery. A qualitative case study methodology was used to explore SAMU's current organizational arrangements, specifically the power relations that have developed and that demonstrate internal team struggles over space and defense of particular occupational interests. The argument advanced in this paper is that these professionals are developing their work in conditions of exposure, that is, they are always being observed by someone, and that such observational exposure provides the conditions whereby everyday emergency care practices are enacted such that practice is shaped by, as well as shapes, particular, yet recognizable power relationships. Data were collected through the observation of the SAMU's work processes and through semi-structured interviews. Research materials were analyzed using discourse analysis. In the emergency care process of work, visibility is actually embedded in the disciplinary context and can thus be analyzed as a technique applied to produce disciplined individuals through the simple mechanisms elaborated by Foucault such as hierarchical surveillance, normalizing judgment, and the examination.
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...
Sidhu, H.; Heasley, R. N.; Patterson, C C; Halliday, H L; Thompson, W.
OBJECTIVE--To compare the mortality in babies refused admission to a regional perinatal centre with that in babies accepted for intensive care in the centre. DESIGN--Retrospective study with group comparison. SETTING--Based at the Royal Maternity Hospital, Belfast, with follow up of patients in all obstetric units in Northern Ireland. PATIENTS--Requests for transfer of 675 babies to the regional perinatal centre (prenatally and postnatally) were made from hospitals in Northern Ireland between...
de Jesus, Fábio Santos; Paim, Daniel de Macedo; Brito, Juliana de Oliveira; Barros, Idiel de Araujo; Nogueira, Thiago Barbosa; Martinez, Bruno Prata; Pires, Thiago Queiroz
Objective To evaluate the variation in mobility during hospitalization in an intensive care unit and its association with hospital mortality. Methods This prospective study was conducted in an intensive care unit. The inclusion criteria included patients admitted with an independence score of ≥ 4 for both bed-chair transfer and locomotion, with the score based on the Functional Independence Measure. Patients with cardiac arrest and/or those who died during hospitalization were excluded. To measure the loss of mobility, the value obtained at discharge was calculated and subtracted from the value obtained on admission, which was then divided by the admission score and recorded as a percentage. Results The comparison of these two variables indicated that the loss of mobility during hospitalization was 14.3% (p < 0.001). Loss of mobility was greater in patients hospitalized for more than 48 hours in the intensive care unit (p < 0.02) and in patients who used vasopressor drugs (p = 0.041). However, the comparison between subjects aged 60 years or older and those younger than 60 years indicated no significant differences in the loss of mobility (p = 0.332), reason for hospitalization (p = 0.265), SAPS 3 score (p = 0.224), use of mechanical ventilation (p = 0.117), or hospital mortality (p = 0.063). Conclusion There was loss of mobility during hospitalization in the intensive care unit. This loss was greater in patients who were hospitalized for more than 48 hours and in those who used vasopressors; however, the causal and prognostic factors associated with this decline need to be elucidated. PMID:27410406
Cies, Jeffrey J; Chopra, Arun
We evaluated whether procalcitonin (PCT) might aid diagnosing serious bacterial infections in a general pediatric intensive care unit population. Two-hundred and one patients accounted for 332 PCT samples. A PCT ≥1.45 ng/mL had a positive predictive value of 30%, a negative predictive value of 93% and a sensitivity of 72% and a specificity of 75%. These data suggest PCT can assist in identifying patients without serious bacterial infections and limit antimicrobial use.
Saintrain, Suzanne Vieira; de Oliveira, Juliana Gomes Ramalho; Saintrain, Maria Vieira de Lima; Bruno, Zenilda Vieira; Borges, Juliana Lima Nogueira; Daher, Elizabeth De Francesco; da Silva Jr, Geraldo Bezerra
Objective To identify factors associated with maternal death in patients admitted to an intensive care unit. Methods A cross-sectional study was conducted in a maternal intensive care unit. All medical records of patients admitted from January 2012 to December 2014 were reviewed. Pregnant and puerperal women were included; those with diagnoses of hydatidiform mole, ectopic pregnancy, or anembryonic pregnancy were excluded, as were patients admitted for non-obstetrical reasons. Death and hospital discharge were the outcomes subjected to comparative analysis. Results A total of 373 patients aged 13 to 45 years were included. The causes for admission to the intensive care unit were hypertensive disorders of pregnancy, followed by heart disease, respiratory failure, and sepsis; complications included acute kidney injury (24.1%), hypotension (15.5%), bleeding (10.2%), and sepsis (6.7%). A total of 28 patients died (7.5%). Causes of death were hemorrhagic shock, multiple organ failure, respiratory failure, and sepsis. The independent risk factors associated with death were acute kidney injury (odds ratio [OR] = 6.77), hypotension (OR = 15.08), and respiratory failure (OR = 3.65). Conclusion The frequency of deaths was low. Acute kidney injury, hypotension, and respiratory insufficiency were independent risk factors for maternal death. PMID:28099637
Goss, Linda K; Coty, Mary-Beth; Myers, John A
Oral care is recognized as an essential component of care for critically ill patients and nursing documentation provides evidence of this process. This study examined the practice and frequency of oral care among mechanically ventilated and nonventilated patients. A retrospective record review was conducted of patients admitted to an intensive care unit (ICU) between July 1, 2007 and December 31, 2007. Data were analyzed using bivariate and multivariate analyses to determine the variables related to patients receiving oral care. Frequency of oral care documentation was found to be performed, on average, every 3.17 to 3.51 hr with a range of 1 to 8 hr suggesting inconsistencies in nursing practice. This study found that although oral care is a Center for Disease Control and Prevention (CDC) recommendation for the prevention of hospital-associated infections like ventilator-associated pneumonia (VAP), indication of documentation of the specifics are lacking in the patients' medical record.
Goh, A Y; Lum, L C; Chan, P W
Paediatric intensive care in Malaysia is a developing subspecialty with an increasing number of specialists with a paediatric background being involved in the care of critically ill children. A part prospective and part retrospective review of 118 consecutive non-neonatal ventilated patients in University Hospital, Kuala Lumpur was carried out from 1 June 1995 to 31 December 1996 to study the clinical epidemiology and outcome in our paediatric intensive case unit (PICU). The mean age of the patients was 33.9 +/- 6.0 months (median 16 months). The main mode of admission was emergency (96.6 per cent) with an overall mortality rate of 42 per cent (50/118). The mean paediatric risk of mortality (PRISM) score was 20 +/- 0.98 SEM, with 53 per cent of patients having a score of over 30 per cent. Multiorgan dysfunction (MODS) was identified in 71 per cent of patients. Admission efficiency (mortality risk > 1 per cent) was 97 per cent. Standardized mortality rate using PRISM was an acceptable 1.06. The main diagnostic categories were respiratory (32 per cent), neurology (22 per cent), haematology-oncology (18 per cent); the aetiology of dysfunction was mainly infective. Non-survivors were older (29.5 vs. 13.8 months, p < 0.0001), had more severe illness (mean PRISM score 30 vs. 14, p < 0.0001), were more likely to develop MODS (96 vs. 53 per cent, p < 0.0001) and required more intervention and monitoring. Paediatric intensive care in Malaysia differs widely from that in developed countries in patient characteristics, severity of illness, and care modalities provided.
Wang, Daniel W L
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.
Gillett, G R
There are widely acknowledged ethical issues in enrolling unconscious patients in research trials, particularly in intensive care unit (ICU) settings. An analysis of those issues shows that, by and large, patients are better served in units where research is actively taking place for several reasons: i) they do not fall prey to therapeutic prejudices without clear evidential support, ii) they get a chance of accessing new and potentially beneficial treatments, iii) a climate of careful monitoring of patients and their clinical progress is necessary for good clinical research and affects the care of all patients and iv) even those not in the treatment arm of a trial of a new intervention must receive best current standard care (according to international evidence-based treatment guidelines). Given that we have discovered a number of 'best practice' regimens of care that do not optimise outcomes in ICU settings, it is of great benefit to all patients (including those participating in research) that we are constantly updating and evaluating what we do. Therefore, the practice of ICU-based clinical research on patients, many of whom cannot give prospective informed consent, ticks all the ethical boxes and ought to be encouraged in our health system. It is very important that the evaluation of protocols for ICU research should not overlook obvious (albeit probabilistic) benefits to patients and the acceptability of responsible clinicians entering patients into well-designed trials, even though the ICU setting does not and cannot conform to typical informed consent procedures and requirements.
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.
Mykola V Tsapenko
Full Text Available 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 elevation complicates the course of many complex disorders treated in a noncardiac intensive care unit. Acute pulmonary hypertension, however, remains underdiagnosed and its treatment frequently begins only after serious complications have developed. Significant pathophysiologic differences between acute and chronic pulmonary hypertension make current classification and treatment recommendations for chronic pulmonary hypertension barely applicable to acute pulmonary hypertension. In order to clarify the terminology of acute pulmonary hypertension and distinguish it from chronic pulmonary hypertension, we provide a classification of acute pulmonary hypertension according to underlying pathophysiologic mechanisms, clinical features, natural history, and response to treatment. Based on available data, therapy of acute arterial pulmonary hypertension should generally be aimed at acutely relieving right ventricular (RV pressure overload and preventing RV dysfunction. Cases of severe acute pulmonary hypertension complicated by RV failure and systemic arterial hypotension are real clinical challenges requiring tight hemodynamic monitoring and aggressive treatment including combinations of pulmonary vasodilators, inotropic agents and systemic arterial vasoconstrictors. The choice of vasopressor and inotropes in patients with acute pulmonary hypertension should take into consideration their effects on vascular resistance and cardiac output when used alone or in
Domingos, Carolina Milena; Nunes, Elisabete de Fátima Polo de Almeida; Carvalho, Brígida Gimenez; Mendonça, Fernanda de Freitas
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.
Gajewski, Michal; Weinhouse, Gerald
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.
Clermont, G; Angus, D C
In recent years, several factors have led to increasing focus on the meaning of appropriateness of care and clinical performance in the intensive care unit (ICU). The emergence of new and expensive treatment modalities, a deeper reflection on what constitutes a desirable outcome, increasing financial pressure from cost containment efforts, and new attitudes regarding end-of-life decisions are reshaping the delivery of intensive care worldwide. This quest for a measure of ICU performance has led to the development of severity adjustment systems that will allow standardised comparisons of outcome and resource use across ICUs. These systems, for many years used only in the research setting, have evolved to become sophisticated, computer-based decision-support tools, in some instances commercially developed, and capable of predicting a diverse set of outcomes. Their application has broadened to include ICU performance assessment, individual patient decision-making, and pre- and post-hoc risk stratification in randomised trials. In this paper, we review the popular scoring systems currently in use; design issues in the development and evaluation of new scoring systems; current applications of scoring systems; and future directions.
The provision of quality end-of-life care is essential when a neonate is dying. End-of-life care delivered in a neonatal intensive care unit (NICU) must consider the needs of both the newborn and their family. The purpose of this paper is to demonstrate how comfort theory and its associated taxonomic structure can be used as a conceptual framework for nurses and midwives providing end-of-life care to neonates and their families. Comfort theory and its taxonomic structure are presented and issues related to end-of-life care in the NICU are highlighted. A case study is used to illustrate the application of comfort theory and issues related to implementation are discussed. The delivery of end-of-life care in the NICU can be improved through the application of comfort.
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.
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.
Malouf-Todaro, Nabia; Barker, James; Jupiter, Daniel; Tipton, Phyllis Hart; Peace, Jane
Ventilator-associated pneumonia is a hospital-acquired infection that may develop in patients 48 hours after mechanical ventilation. The project goal was to determine whether a ventilator-associated pneumonia care bundle checklist embedded into an existing electronic health record would increase completeness of nursing documentation in an intensive care unit setting. With the embedded checklist, there were significant improvements in nursing documentation and a decreased incidence of ventilator-associated pneumonia.
Bianca Gonçalves de Carrasco Bassi
Full Text Available In the 2000’s, supported by governmental investments in the Family Health Strategy, reflections onthe subject of Primary Health Care (PHC began to arise, which in Brazil was called Basic Health Care. As partof the research in the Primary Health Care matter, an analysis on the occupational therapy work in this contextwas carried out. This article seeks to present a discussion map of the category about its intervention in the areabased in two national Journals of Occupational Therapy and the main local forum of discussion, the Brazilian Congress of Occupational Therapy. Articles with this thematic published between 2000 and 2011, as well as thescientific knowledge presented in the last seven congresses (1999-2011 were searched. Twenty-one full articleson this theme published in specialized Periodicals during this period were selected. The investigation showed thatmost articles related to the assistance of the occupational therapist to disabled people in Primary Health Care,mainly results of research and education studies carried out by universities from the State of Sao Paulo. Withrespect to the papers presented in the congresses, from a total of 3755, 191 (5% scientific congress presentationsconcerned Primary Health Care. Results showed an increase in the discussions on this theme during the studyperiod. It was possible to conclude that more importance has been given to this theme and more comprehensiveresearches are needed to support knowledge improvement in this field.
Agarwal, Banwari; Walecka, Agnieszka; Shaw, Steve; Davenport, Andrew
Hypophosphatemia is well recognized in the intensive care setting, associated with refeeding and continuous forms of renal replacement therapy (CCRT). However, it is unclear as to when and how to administer intravenous phosphate supplementation in the general intensive care setting. There have been recent concerns regarding phosphate administration and development of acute kidney injury. We therefore audited our practice of parenteral phosphate administration. We prospectively audited parenteral phosphate administration (20 mmol) in 58 adult patients in a general intensive care unit in a University tertiary referral center. Fifty-eight patients were audited; mean age 57.2 ± 2.0 years, 70.7% male. The median duration of the infusion was 310 min (228-417), and 50% of the patients were on CRRT. 63.8% of patients were hypophosphatemic (phosphate infusion, and serum phosphate increased from 0.79 ± 0.02 to 1.07 ± 0.03 mmol/L, P 1.45 mmol/L). There was no correlation between the change in serum phosphate and the pre-infusion phosphate. Although there were no significant changes in serum urea, creatinine or other electrolytes, arterial ionized calcium fell from 1.15 ± 0.01 to 1.13 ± 0.01 mmol/L, P phosphate did not appear to adversely affect renal function and corrected hypophosphatemia in 67.7% of cases, we found that around 33% of patients who were given parenteral phosphate were not hypophosphatemic, and that the fall in ionized calcium raises the possibility of the formation of calcium-phosphate complexes and potential for soft tissue calcium deposition.
AMK AL Jarousha
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.
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.
Karanikola, Maria N K; Papathanassoglou, Elizabeth D E; Mpouzika, Meropi; Lemonidou, Chrysoula
Burnout symptoms in Greek intensive care unit (ICU) nurses have not been explored adequately. The aim of this descriptive, correlational study was to investigate the prevalence and intensity of burnout symptoms in Greek ICU nursing personnel and any potential associations with professional satisfaction, as well as with demographic, educational, and vocational characteristics. Findings showed that the overall burnout level reported by Greek ICU nursing personnel was at a moderate to high degree. The most pronounced symptom of burnout was depersonalization, whereas emotional exhaustion was found to be a strong predictor of job satisfaction. This is a factor connected with the nurses' intention to quit the job. It appears that work factors have a more powerful influence over the development of burnout in comparison to personality traits.
De Gaudio, Raffaele; Selmi, Valentina; Chelazzi, Cosimo
Patients admitted to cardiac intensive care units are at high risk for infections, particularly nosocomial pneumonia, pacemaker's pocket and sternotomic wound infections. These complications delay recovery, prolong hospitalization, time on mechanical ventilation, and increase mortality. Both behavioral and pharmacological measures are needed to prevent and control infections in these patients, as well as specific antibiotic treatment and nutritional support. In infected critically ill patients, pathophysiological alterations modify distribution and clearance of antibiotics, and hypercatabolic state leads to malnutrition and immune paralysis, which both contribute to increased infectious risk and worsened outcome. A deep understanding of antibacterial agents pharmacology in the critically ill is essential in order to treat severe infections; moreover, it is necessary to know routes of administration and composition of artificial nutrition solutions. The aim of this review is to define main and specific aspects of antibiotic therapy and nutritional support in cardiac critical care patients in light of recent literature data.
Alfredo Darío Espinosa Brito
Full Text Available Conception, organization, and development of Intensive Care Medicine is one of the greatest contribution that medical care services brought to the professional practice of doctors and paramedic personnel in the second part of the 20th centrury. In our country, since the 70’s years, this field was incorporated in our National Health System to the daily work of our professionals as to the patients expectations, in an almost an imperceptible way. Twenty polemical questions were asked to an expert, about several current dilemmas in this field. The questions and the answes are only a motivation for new debates in medical services, in medical education activities and in research.
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.
Full Text Available Severe ovarian hyperstimulation syndrome (OHSS is characterized by increased capillary permeability and fluid retention in the third space. It is generally a complication of assisted reproduction therapy (ART with exogenous gonadotropins, but cases with natural onset of OHSS have been reported. The massive extravascular exudation can cause tense ascites, pleural and pericardial effusion, hypovolemic shock, oliguria, electrolyte imbalance (hyponatremia and hyperkalemia, and hemoconcentration, with a tendency for hypercoagulability and risk of life-threatening thromboembolic complications. The patient can rarely develop multi-organ failure (adult respiratory distress syndrome, renal failure and death. With increasing use of ART, this syndrome may be seen more frequently in the intensive care unit (ICU, requiring multidisciplinary care. We report the management of two cases of severe OHSS, which required admission to the ICU in our hospital.
Pereira, E A C; Madder, H; Millo, J; Kearns, C F
The authors describe a novel 4-month clinical placement in neurosciences intensive care medicine (NICM) undertaken in the first specialty registrar (ST1) year of neurosurgical training as part of a clinical neurosciences themed training year. Neurosurgery is unique among British surgical specialties in having pioneered themed early years in run-through training to replace basic surgical training in general surgical specialties as part of Modernising Medical Careers. After describing events leading to the new neurosurgical training, the knowledge, skills and attitudes acquired in NICM are highlighted alongside discussion of logistic aspects and future directions from an inaugural experience.
Uglitskikh, A K; Kon', I Ia; Ostreĭkov, I F; Shilina, N M; Smirnov, V F
The paper deals with the nutritional status of infants in intensive care units (ICU). It shows nutritional trends in 269 children aged 1 month to 15 years, treated in the ICU of a Tushino children's city hospital, Moscow, for brain injury, abdominal surgical diseases, and severe pneumonia. The paper evaluates the physical development of children in the ICU, shows the trends in weight-height, somatometric, laboratory parameters, and balance study data. The values of protein losses and nitrogen balance in children in the postaggression period and their relationship to age and feeding mode (enteral, parenteral-enteral) are shown.
Sadchikov, D V; Marshalov, D V
The study covered 235 obstetric patients having varying blood loss (1.8 to 55.7%) at labor. Their constitutional, history, clinical, functional, and biochemical data were studied, which allowed the authors to develop a strategic and tactic line of prediction of the development of massive blood loss at labor. The algorithm of preventive intensive care, developed on the basis of predictive criteria, was found to significantly improve the results of treatment and to reduce the frequency and severity of obstetric hemorrhagic complications.
Nogueira, Vera Maria Ribeiro; Dal Prá, Keli Regina; Fermiano, Sabrina
This article presents the results of a study in Brazilian municipalities along the border with the other Southern Cone Common Market (MERCOSUR) countries, identifying health care patterns and showing ethical and political diversity in the guarantee and use of the right to health care, characterizing demands on (and responses by) local health systems. The main variable was whether non-Brazilians had access to Brazilian health services. Data were collected using forms in municipalities with more than 10 thousand inhabitants, field diaries, meetings, and interviews. The definition of the right to health care varied greatly, indicating lack of common ethical and political principles and weak institutionality, with incapacity to absorb the demand by non-Brazilian patients. Agreements between the respective Federal governments of MERCOSUR countries had failed to reach the local level and were ignored by local health services managers and professionals. The foreign population remains uncertain about receiving care. In Brazil, the lack of uniform standards of care lead to ad hoc personal decisions by health services managers and professionals, thus hindering integrated action.
Cheng, Chen-Yang; Chiang, Kuo-Liang; Chen, Meng-Yin
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.
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.
Bambi, Stefano; Lucchini, Alberto; Solaro, Massimo; Lumini, Enrico; Rasero, Laura
Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units. Over the past 15 years, the model of medical and nursing care changed from being exclusively oriented to the diagnosis and treatment of acute illness, to the achievement of outcomes by preventing iatrogenic complications (Hospital Acquired Conditions). Nursing Sensitive Outcomes show as nursing is directly involved in the development and prevention of these complications. Many of these complications, including falls from the bed, use of restraints, urinary catheter associated urinary infections and intravascular catheter related sepsis, are related to basic nursing care. Ten years ago in critical care, a school of thought called get back to the basics, was started for the prevention of errors and risks associated with nursing. Most of these nursing practices involve hygiene and mobilization. On the basis of these reflections, Kathleen Vollman developed a model of nursing care in critical care area, defined Interventional Patient Hygiene (IPH). The IPH model provides a proactive plan of nursing interventions to strengthen the patients' through the Evidence-Based Nursing Care. The components of the model include interventions of oral hygiene, mobilization, dressing changes, urinary catheter care, management of incontinence and bed bath, hand hygiene and skin antisepsis. The implementation of IPH model follows the steps of Deming cycle, and requires a deep reflection on the priorities of nursing care in ICU, as well as the effective teaching of the importance of the basic nursing to new generations of nurses.
Because geographic variation in medical care utilization is jointly determined by both supply and demand, it is difficult to empirically estimate whether capacity itself has a causal impact on utilization in health care. In this paper, I exploit short-term variation in Neonatal Intensive Care Unit (NICU) capacity that is unlikely to be correlated with unobserved demand determinants. I find that available NICU beds have little to no effect on NICU utilization for the sickest infants, but do increase utilization for those in the range of birth weights where admission decisions are likely to be more discretionary.
Lucas Miyake Okumura
Full Text Available Abstract Objective: Clinical Pharmacy Services (CPS are considered standard of care and is endorsed by the Joint Commission International, the American Academy of Pediatrics, and the American College of Clinical Pharmacy. In Brazil, single experiences have been discreetly arising and the importance of these services to children and adolescents care has led to interesting results, but certainly are under reported. This short report aims to discuss the effect of implementing a bedside CPS at a Brazilian Pediatric Intensive Care Unit (PICU. Methods: This is a cross-sectional study conducted in a 12 bed PICU community hospital, from Campo Largo/Brazil. Subjects with<18 years old admitted to PICU were included for descriptive analysis if received a CPS intervention. Results: Of 53 patients accompanied, we detected 141 preventable drug-related problems (DRPs which were solved within clinicians (89% acceptance of all interventions. The most common interventions performed to improve drug therapy included: preventing incompatible intravenous solutions (21% and a composite of inadequate doses (17% due to low, high and non-optimized doses. Among the top ten medications associated with DRPs, five were antimicrobials. By analyzing the correlation between DRPs and PICU length of stay, we found that 74% of all variations on length of stay were associated with the number of DRPs. Conclusions: Adverse drug reactions due to avoidable DRPs can be prevented by CPS in a multifaceted collaboration with other health care professionals, who should attempt to use active and evidence-based strategies to reduce morbidity related to medications.
Paunova, Minna; Li-Ying, Jason; Egerod, Ingrid Eugenie
This study investigates the influence of nurse knowledge sharing behavior on nurse innovation, given different conditions of control of care quality within the intensive care unit (ICU). After conducting a number of interviews and a pilot study, we carried out a multi-source survey study of more...... than 200 nurses employed in 22 ICUs at 17 Danish hospitals. Overall, we find that knowledge sharing among individual ICU nurses has a positive impact on their innovation. Meanwhile, strong control of care quality makes this positive impact less effective. However, different aspects of knowledge sharing...... affect innovation differently, depending on the strength as well as type of control of care quality within the unit. Healthcare organizations face an increasing pressure to innovate while controlling and accounting for care quality. This study demonstrates that the increasing pressures to implement...
Sadek, Ahmed-Ramadan; Eynon, C Andy
The creation of neurosciences intensive care units was born out of the awareness that a group of neurological and neurosurgical patients required specialized intensive medical and nursing care. This first of two articles describes the role of neurosciences intensive care in the management of trauma and neurosurgical conditions.
Luna, Jesus; Dikaiakos, Marios; Marazakis, Manolis; Kyprianou, Theodoros
Modern e-Health systems require advanced computing and storage capabilities, leading to the adoption of technologies like the grid and giving birth to novel health grid systems. In particular, intensive care medicine uses this paradigm when facing a high flow of data coming from intensive care unit's (ICU) inpatients just like demonstrated by the ICGrid system prototyped by the University of Cyprus. Unfortunately, moving an ICU patient's data from the traditionally isolated hospital's computing facilities to data grids via public networks (i.e., the Internet) makes it imperative to establish an integral and standardized security solution to avoid common attacks on the data and metadata being managed. Particular emphasis must be put on the patient's personal data, the protection of which is required by legislations in many countries of the European Union and the world in general. In this paper, we extend our previous research with the following contributions: 1) a mandatory access control model to protect patient's metadata; 2) a major security revision to our previously proposed privacy protocol by contributing with a "quality of security" quantitative metric to improve fragmented data's assurance; and finally, 3) a set of early results to demonstrate that our protocol not only improves a patient personal data's security and privacy but also achieves a performance comparable with existing approaches.
Hecker, Matthias; Mayer, Konstantin
Malnutrition of critically ill patients is a widespread phenomenon in intensive care units (ICUs) worldwide. Lipid emulsions (LEs) are able to provide sufficient caloric support and essential fatty acids to correct the energy deficit and improve outcome. Furthermore, components of LEs might impact cell and organ function in an ICU setting. All currently available LEs for parenteral use are effective in providing energy and possess a good safety profile. Nevertheless, soybean oil-based LEs have been associated with an elevated risk of adverse outcomes, possibly due to their high content of omega-6 fatty acids. More newly developed emulsions partially replace soybean oil with medium-chain triglycerides, fish oil or olive oil in various combinations to reduce its negative effects on immune function and inflammation. The majority of experimental studies and smaller clinical trials provide initial evidence for a beneficial impact of these modern LEs on critically ill patients. However, large, well-designed clinical trials are needed to evaluate which LE offers the greatest advantages concerning clinical outcome. Lipid emulsions (LEs) are a powerful source of energy that can help to adjust the caloric deficit of intensive care unit (ICU) patients. LEs possess various biological activities, but their subsequent impact on critically ill patients awaits further investigations.
Figueiredo Dias, Paulo; Ferreira, Alcina Azevedo; Xerinda, Sandra Margarida; Lima Alves, Carlos; Sarmento, António Carlos; dos Santos, Lurdes Campos
Background. This study aims to describe the characteristics of tuberculosis (TB) patients requiring intensive care and to determine the in-hospital mortality and the associated predictive factors. Methods. Retrospective cohort study of all TB patients admitted to the ICU of the Infectious Diseases Department of Centro Hospitalar de São João (Porto, Portugal) between January 2007 and July 2014. Comorbid diagnoses, clinical features, radiological and laboratory investigations, and outcomes were reviewed. Univariate analysis was performed to identify risk factors for death. Results. We included 39 patients: median age was 52.0 years and 74.4% were male. Twenty-one patients (53.8%) died during hospital stay (15 in the ICU). The diagnosis of isolated pulmonary TB, a positive smear for acid-fast-bacilli and a positive PCR for Mycobacterium tuberculosis in patients of pulmonary disease, severe sepsis/septic shock, acute renal failure and Multiple Organ Dysfunction Syndrome on admission, the need for mechanical ventilation or vasopressor support, hospital acquired infection, use of adjunctive corticotherapy, smoking, and alcohol abuse were significantly associated with mortality (p < 0.05). Conclusion. This cohort of TB patients requiring intensive care presented a high mortality rate. Most risk factors for mortality were related to organ failure, but others could be attributed to delay in the diagnostic and therapeutic approach, important targets for intervention. PMID:28250986
Mohammad Hasan Kargar Maher
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.
Full Text Available Introduction: Noise pollution in hospital wards can arise from a wide range of sources including medical devices, air-conditioning systems and conversations among the staffs. Noise in intensive care units (ICUs can disrupt patients’ sleep pattern and may have a negative impact on cognitive performance. Material and methods: In this review article, we searched through PubMed and Google Scholar, using [noise and (ICU or “intensive care unit”] as keyword to find studies related to noise pollution in ICUs. In total, 250 studies were found among which 35 articles were included. Results: The majority of the reviewed studies showed that noise pollution levels were higher in ICUs than the level recommend by The United States Environmental Protection Agency and World Health Organization. Noise pollution was mostly caused by human activity and operating equipments in ICUs and other hospital wards. Conclusion: As the results indicated, identifying, monitoring and controlling noise sources, as well as educating the hospital staffs about the negative effects of noise on patients’ health, can be highly effective in reducing noise pollution.
Wiedermann, Christian J
Ethical standards in the context of scientific publications are increasingly gaining attention. A narrative review of the literature concerning publication ethics was conducted as found in PubMed, Google Scholar, relevant news articles, position papers, websites and other sources. The Committee on Publication Ethics has produced guidelines and schedules for the handling of problem situations that have been adopted by professional journals and publishers worldwide as guidelines to authors. The defined requirements go beyond the disclosure of conflicts of interest or the prior registration of clinical trials. Recommendations to authors, editors and publishers of journals and research institutions were formulated with regard to issues of authorship, double publications, plagiarism, and conflicts of interest, with special attention being paid to unethical research behavior and data falsification. This narrative review focusses on ethical publishing in intensive care medicine. As scientific misconduct with data falsification damage patients and society, especially if fraudulent studies are considered important or favor certain therapies and downplay their side effects, it is important to ensure that only studies are published that have been carried out with highest integrity according to predefined criteria. For that also the peer review process has to be conducted in accordance with the highest possible scientific standards and making use of available modern information technology. The review provides the current state of recommendations that are considered to be most relevant particularly in the field of intensive care medicine.
Wiedermann, Christian J
Ethical standards in the context of scientific publications are increasingly gaining attention. A narrative review of the literature concerning publication ethics was conducted as found in PubMed, Google Scholar, relevant news articles, position papers, websites and other sources. The Committee on Publication Ethics has produced guidelines and schedules for the handling of problem situations that have been adopted by professional journals and publishers worldwide as guidelines to authors. The defined requirements go beyond the disclosure of conflicts of interest or the prior registration of clinical trials. Recommendations to authors, editors and publishers of journals and research institutions were formulated with regard to issues of authorship, double publications, plagiarism, and conflicts of interest, with special attention being paid to unethical research behavior and data falsification. This narrative review focusses on ethical publishing in intensive care medicine. As scientific misconduct with data falsification damage patients and society, especially if fraudulent studies are considered important or favor certain therapies and downplay their side effects, it is important to ensure that only studies are published that have been carried out with highest integrity according to predefined criteria. For that also the peer review process has to be conducted in accordance with the highest possible scientific standards and making use of available modern information technology. The review provides the current state of recommendations that are considered to be most relevant particularly in the field of intensive care medicine. PMID:27652208
Bétry, Cécile; Disse, Emmanuel; Chambrier, Cécile; Barnoud, Didier; Gelas, Patrick; Baubet, Sandrine; Laville, Martine; Pelascini, Elise; Robert, Maud
Severe nutrition complications after bariatric surgery remain poorly described. The aim of this case series was to identify specific factors associated with nutrition complications after bariatric surgery and to characterize their nutrition disorders. We retrospectively reviewed all people referred to the clinical nutrition intensive care unit of our university hospital after bariatric surgery from January 2013 to June 2015. Twelve persons who required artificial nutrition supplies (ie, enteral nutrition or parenteral nutrition) were identified. Seven persons underwent a "one-anastomosis gastric bypass" (OAGB) or "mini gastric bypass," 2 underwent a Roux-en-Y gastric bypass, 2 had a sleeve gastrectomy, and 1 had an adjustable gastric band. This case series suggests that OAGB could overexpose subjects to severe nutrition complications requiring intensive nutrition care and therefore cannot be considered a "mini" bariatric surgery. Even if OAGB is often considered a simplified surgical technique, it obviously requires as the other standard bariatric procedures a close follow-up by experimented teams aware of its specific complications.
J.M. Latour (Jos)
textabstractThe aim of this thesis – the EMPATHIC studies – was to develop and implement validated parent satisfaction questionnaires for pediatric and neonatal intensive care units. Part I presents the general introduction, which justifies the construction, validation, and utilization of parent sat
Souza, Paola Nóbrega; de Miranda, Erique José Peixoto; Cruz, Ronaldo; Forte, Daniel Neves
Objective To describe the characteristics of patients with HIV/AIDS and to compare the therapeutic interventions and end-of-life care before and after evaluation by the palliative care team. Methods This retrospective cohort study included all patients with HIV/AIDS admitted to the intensive care unit of the Instituto de Infectologia Emílio Ribas who were evaluated by a palliative care team between January 2006 and December 2012. Results Of the 109 patients evaluated, 89% acquired opportunistic infections, 70% had CD4 counts lower than 100 cells/mm3, and only 19% adhered to treatment. The overall mortality rate was 88%. Among patients predicted with a terminally ill (68%), the use of highly active antiretroviral therapy decreased from 50.0% to 23.1% (p = 0.02), the use of antibiotics decreased from 100% to 63.6% (p < 0.001), the use of vasoactive drugs decreased from 62.1% to 37.8% (p = 0.009), the use of renal replacement therapy decreased from 34.8% to 23.0% (p < 0.0001), and the number of blood product transfusions decreased from 74.2% to 19.7% (p < 0.0001). Meetings with the family were held in 48 cases, and 23% of the terminally ill patients were discharged from the intensive care unit. Conclusion Palliative care was required in patients with severe illnesses and high mortality. The number of potentially inappropriate interventions in terminally ill patients monitored by the palliative care team significantly decreased, and 26% of the patients were discharged from the intensive care unit. PMID:27737420
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
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
Denison de Oliveira Couto
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
Belli, M A
The purpose of the study was to examine the experiences, feelings and expectation of mothers of high risk newborns. The population was a group of 20 mothers of high risk newborns of three hospitals in the City of São Paulo. Interview with the mothers was the method of data collection containing opened and structured questions. It was verified that most of the mothers had none or only a little interaction with the newborn after delivery; the eye contact was the most referred during the staying of the newborn in the Intensive Care Unity; all of them demonstrated interest in participating in the care of the newborn and expressed the need of information concerning to the health status of the newborn, the Intensive Care Unity environment and the hospital team. Several were the feelings expressed and the motives that indicated the needs of the mothers.
Full Text Available Purpose: To determine the demographic characteristics of the newborns with respiratory difficulties, frequency of neonatal disease, analyze of the prognostic factors and effectiveness of treatment who were hospitalized in neonatal intensive care unit (NICU. Methods: In this study, file records of the newborns who were hospitalized in NICU of Meram Medical School were analyzed retrospectively. Results: Of the 771 newborns, 225 who admitted due to respiratory distress in 2008 and of the 692 newborns, 282 who admitted due to respiratory distress in 2009. Mean birth weight was 1954±972 gr in 2008, and 2140±1009 gr in 2009. Mean pregnancy weeks were 32,4±5,0 in 2008 and 33,4±4,9 in 2009. Diagnosis of patients were sepsis (77,8%, respiratory distress syndrome (RDS (40,4%, pneumothorax (20,9%, patent ductus arteriosus (PDA (12,4%, meconium aspiration syndrome (MAS (6,2%, intraventricular hemorrhage (IVH (5,3%, pneumonia (3,6%, retinopathy of prematurely (ROP (3,1%, bronchopulmonary dysplasia (BPD (2,7% and transient tachypne of newborn (TTN (2,2% in 2008. In 2009, percentage of the diagnosis was 69,5% sepsis, 33,3% RDS, 17,0% PDA, 16,0% pneumothorax, 10,3% pneumonia, 8,2% IVH, 6% TTN, 5,3% BPD, 3,2% MAS and 3,2% ROP. 33.7% of the patients were died in 2009 and 43,6% of them in 2008. Conclusion: The newborns with respiratory distress who admitted to the hospital must be evaluated according to the pregnancy week, way of birth and accompanying problems during first examination and convenient transportation of the ones who need to be cared in advanced center where an intensive care support can be applied to decrease mortality and morbidity of newborns distress. [Cukurova Med J 2012; 37(2.000: 90-97
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.
Beesley, Sarah J; Hopkins, Ramona O; Francis, Leslie; Chapman, Diane; Johnson, Joclynn; Johnson, Nathanael; Brown, Samuel M
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.
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.
Zwerdling, Ted; Hamann, Kevin C; Kon, Alexander A
Compassionate home extubation for pediatric patients is a topic that seldom appears in the literature and is of unknown clinical importance. However, standards in pediatric intensive care unit (PICU) and among pediatric critical care physicians regarding end-of-life decisions are changing, including where and when patient extubation occurs. The authors' hospice recently consulted on an infant with spinal muscular atrophy in the PICU requiring mechanical ventilation, for whom further life-sustaining care was deemed futile. In consultation with the family, nursing staff, physicians, and the ethics committee, and following protocol guidelines, arrangements were made for this infant and his parents to be transported home. Once comfortable with his family, a small amount of lorazepam was given and the endotracheal tube removed. The infant died quietly about 20 minutes later. This case prompted the authors to review the current state of published articles covering this topic, suggest a protocol for implementing home extubation, realize imposed barriers, and discuss potential solutions. A well-developed plan for home extubation procedures may improve interactions with PICU and hospice services and at the same time provide additional choices for parents and patients wishing to maximize end-of-life quality outside the hospital setting.
Advancements in critical care medicine result in a growing population of survivors of critical illness. Many intensive care unit (ICU) patients have physical, mental and cognitive sequelae after discharge from the ICU, known as post-intensive care syndrome (PICS). These problems are associated with
Sussmane, Jeffrey B; Torbati, Dan; Gitlow, Howard S
Our goal was to measure the quality of care provided in the Pediatric Intensive Care Unit (PICU) during Therapeutic Apheresis (TA). We described the care as a step by step process. We designed a flow chart to carefully document each step of the process. We then defined each step with a unique clinical indictor (CI) that represented the exact task we felt provided quality care. These CIs were studied and modified for 1 year. We measured our performance in this process by the number of times we accomplished the CI vs. the total number of CIs that were to be performed. The degree of compliance, with these clinical indicators, was analyzed and used as a metric for quality by calculating how close the process is running exactly as planned or "in control." The Apheresis Process was in control (compliance) for 47% of the indicators, as measured in the aggregate for the first observational year. We then applied the theory of Total Quality Management (TQM) through our Design, Measure, Analyze, Improve, and Control (DMAIC) model. We were able to improve the process and bring it into control by increasing the compliance to > 99.74%, in the aggregate, for the third and fourth quarter of the second year. We have implemented TQM to increase compliance, thus control, of a highly complex and multidisciplinary Pediatric Intensive Care therapy. We have shown a reproducible and scalable measure of quality for a complex clinical process in the PICU, without additional capital expenditure.
Loughran, John; Puthawala, Tauqir; Sutton, Brad S; Brown, Lorrel E; Pronovost, Peter J; DeFilippis, Andrew P
Prior to the advent of the coronary care unit (CCU), patients having an acute myocardial infarction (AMI) were managed on the general medicine wards with reported mortality rates of greater than 30%. The first CCUs are believed to be responsible for reducing mortality attributed to AMI by as much as 40%. This drastic improvement can be attributed to both advances in medical technology and in the process of health care delivery. Evolving considerably since the 1960s, the CCU is now more appropriately labeled as a cardiac intensive care unit (CICU) and represents a comprehensive system designed for the care of patients with an array of advanced cardiovascular disease, an entity that reaches far beyond its early association with AMI. Grouping of patients by diagnosis to a common physical space, dedicated teams of health care providers, as well as the development and implementation of evidence-based treatment algorithms have resulted in the delivery of safer, more efficient care, and most importantly better patient outcomes. The CICU serves as a platform for an integrated, team-based patient care delivery system that addresses a broad spectrum of patient needs. Lessons learned from this model can be broadly applied to address the urgent need to improve outcomes and efficiency in a variety of health care settings.
Full Text Available Rostislav Horacek,1 Barbora Krnacova,2 Jan Prasko,2 Klara Latalova2 1Department of Central Intensive Care Unit for Surgery, 2Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, Czech Republic Background: The aim of this study was to examine the impact of somatic illnesses, electrolyte imbalance, red blood cell count, hypotension, and antipsychotic and opioid treatment on the duration of delirium in Central Intensive Care Unit for Surgery.Patients and methods: Patients who were admitted to the Department of Central Intensive Care Unit for Surgery in the University Hospital Olomouc from February 2004 to November 2008 were evaluated using Riker sedation–agitation scale. Their blood pressure, heart rate, respiratory rate, and peripheral blood oxygen saturation were measured continually, and body temperature was monitored once in an hour. The laboratory blood tests including sodium, potassium, chlorides, phosphorus, urea and creatinine, hemoglobin, hematocrit, red and white blood cell count, and C-reactive protein, albumin levels and laboratory markers of renal and liver dysfunction were done every day. All measurements were made at least for ten consecutive days or longer until the delirium resolved.Results: The sample consisted of 140 consecutive delirious patients with a mean age of 68.21±12.07 years. Delirium was diagnosed in 140 of 5,642 patients (2.48% admitted in CICUS in the last 5 years. The median duration of delirium was 48 hours with a range of 12–240 hours. Statistical analysis showed that hyperactive subtype of delirium and treatment with antipsychotics were associated with prolonged delirium duration (hyperactive 76.15±40.53 hours, hypoactive 54.46±28.44 hours, mixed 61.22±37.86 hours; Kruskal–Wallis test: 8.022; P<0.05. The duration of delirium was significantly correlated also with blood potassium levels (Pearson’s r=0.2189, P<0.05, hypotension
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
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.
Full Text Available Necrotizing fasciitis is a rare disease, potentially limb and life-threatening infection of fascia, subcutaneous tissue with occasionally muscular involvement. Necrotizing faciitis is surgical emergency with high morbidity and mortality. Aim: Aim of this study was to analyze presentation, microbiology, surgical, resuscitative management and outcome of this devastating soft tissue infection. Materials and Methods: The medical records of necrotizing fasciitis patients treated in surgical intensive care unit (SICU of our hospital from Jan 1995 to Feb 2005 were reviewed retrospectively. Results: Ninety-four patients with necrotizing fasciitis were treated in the surgical intensive care unit during the review period. Necrotizing fasciitis accounted for 1.15% of total admissions to our SICU. The mean age of our patients was 48.6 years, 75.5% of the cases were male. Diabetes mellitus was the most common comorbid disease (56.4%, 24.5% patients had hypertension, 14.9% patients had coronary artery disease, 9.6% had renal disease and 6.4% cases were obese. History of operation (11.7% was most common predisposing factor in our patients. All patients had leucocytosis at admission to the hospital. Mean duration of symptoms was 3.4 days. Mean number of surgical debridement was 2.1, mean sequential organ failure assessment (SOFA score at admission to SICU was 8.6, 56.38% cases were type 1 necrotizing fasciitis and 43.61% had type 2 infection. Streptococci were most common bacteria isolated (52.1%, commonest regions of the body affected by necrotizing fasciitis were the leg and the foot. Mean intubated days and intensive care unit (ICU stay were 4.8 and 7.6 days respectively. Mean fluid, blood, fresh frozen plasma and platelets concentrate received in first 24 hours were 4.8 liters, 2.0 units, 3.9 units and 1.6 units respectively. Most commonly used antibiotics were tazocin and clindamycin. Common complication was ventricular tachycardia (6.4. 46.8% patients had
Pirolo, Sueli Moreira; Ferraz, Clarice Aparecida; Gomes, Romeu
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.
Weisbord, Steven D; Palevsky, Paul M
Acute renal failure (ARF) is a common complication in critically ill patients, with ARF requiring renal replacement therapy (RRT) developing in approximately 5 to 10% of intensive care unit (ICU) patients. Epidemiological studies have demonstrated that ARF is an independent risk factor for mortality. Interventions to prevent the development of ARF are currently limited to a small number of settings, primarily radiocontrast nephropathy and rhabdomyolysis. There are no effective pharmacological agents for the treatment of established ARF. Renal replacement therapy remains the primary treatment for patients with severe ARF; however, the data guiding selection of modality of RRT and the optimal timing of initiation and dose of therapy are inconclusive. This review focuses on the epidemiology and diagnostic approach to ARF in the ICU and summarizes our current understanding of therapeutic approaches including RRT.
Hidri, L.; Labidi, M.
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.
Rybkowski, Zofia K; Shepley, Mardelle McCuskey; Ballard, H Glenn
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.
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).
Maffessanti, M. [Istituto di Radiologia, Universita di Trieste, Ospedale di Cattinara, I-34 100 Trieste (Italy); Berlot, G. [Istituto di Anestesia e Rianimazione, Universita di Trieste, Ospedale di Cattinara, I-34 100 Trieste (Italy); Bortolotto, P. [Servizio di Radiologia, Ospedale Maggiore, I-34 100 Trieste (Italy)
Chest roentgenology in the intensive care unit is a real challenge for the general radiologist. Beyond the basic disease, the critically ill is at risk for developing specific cardiopulmonary disorders, all presenting as chest opacities, their diagnosis often being impossible if based only on the radiological aspect. To make things harder, their appearance can vary with the subject`s position and the mechanical ventilation. Patients require a continuous monitoring of the vital functions and their mechanical and pharmacological support, for which they are connected to different instruments. The radiologist should know the normal position of these devices, and promptly recognize when they are misplaced or when complications from their insertion occurred. Our aim is to suggest for each of the above-mentioned conditions a guideline of interpretation based not only on the radiological aspect and distribution of the lesions, but also on the physiopathological and clinical grounds. (orig.) With 13 figs., 58 refs.
Krag, M; Perner, A; Wetterslev, J
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...... agent, used in 66% of ICUs (64/97), and H2-receptor antagonists were used 31% (30/97) of the units. Twenty-three different indications for SUP were reported, the most frequent being mechanical ventilation. All patients were prescribed SUP in 26% (25/97) of the ICUs. Adequate enteral feeding was the most...... frequent reason for discontinuing SUP, but 19% (18/97) continued SUP upon ICU discharge. The majority expressed concern about nosocomial pneumonia and Clostridium difficile infection with the use of SUP. CONCLUSIONS: In this international survey, most participating ICUs reported using SUP, primarily proton...
Full Text Available Peripartum cardiomyopathy (PPCM is a systolic heart failure that occurs during the last month of pregnancy or within five months after delivery. It is uncommon disease of unknown ethiopatogenesis and 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 jeopardise the mother and the fetus, patients with severe forms of PPCM require a multidisciplinary approach in intensive care units. This review summarize 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.
Giuffrè, Mario; Bonura, Celestino; Cipolla, Domenico; Mammina, Caterina
Methicillin-resistant Staphylococcus aureus (MRSA) is well known as one of the most frequent etiological agents of healthcare-associated infections. The epidemiology of MRSA is evolving with emergence of community-associated MRSA, the clonal spread of some successful clones, their spillover into healthcare settings and acquisition of antibacterial drug resistances. Neonatal intensive care unit (NICU) patients are at an especially high risk of acquiring colonization and infection by MRSA. Epidemiology of MRSA in NICU can be very complex because outbreaks can overlap endemic circulation and make it difficult to trace transmission routes. Moreover, increasing prevalence of community-associated MRSA can jeopardize epidemiological investigation, screening and effectiveness of control policies. Surveillance, prevention and control strategies and clinical management have been widely studied and are still the subject of scientific debate. More data are needed to determine the most cost-effective approach to MRSA control in NICU in light of the local epidemiology.
Calili, Duygu Kayar; Mutlu, Nevzat Mehmet; Mutlu Titiz, Ayse Pinar; Akcaboy, Zeynep Nur; Aydin, Eda Macit; Turan, Isil Ozkocak
Fahr Syndrome is a rare disease where calcium and other minerals are stored bilaterally and symmetrically in the basal ganglia, cerebellar dentate nucleus and white matter. Fahr Syndrome is associated with various metabolic disorders, mainly parathyroid disorders. The presented case discusses a 64-year old male patient admitted to the intensive care unit of our hospital diagnosed with aspiration pneumonia and urosepsis. The cranial tomography examination to explain his nonspecific neurological symptoms showed bilateral calcifications in the temporal, parietal, frontal, occipital lobes, basal ganglia, cerebellar hemisphere and medulla oblongata posteriorly. His biochemical test results also indicated parathormone-calcium metabolic abnormalities. Fahr Syndrome must be considered for a definitive diagnosis in patients with nonspecific neuropsychiatric symptoms and accompanying calcium metabolism disorders in order to control serious morbidity and complications because of neurological damage.
Ratzer, Mette; Brink, Ole; Knudsen, Linda
Aims: This study aimed to estimate the prevalence of severe Posttraumatic Stress Disorder (PTSD) symptoms and to identify factors associated with PTSD in survivors of intensive care unit (ICU) treatment following traumatic injury. Methods: Fifty-two patients who were admitted to an ICU through...... the emergency ward following traumatic injury were prospectively followed. Information on injury severity and ICU treatment were obtained through medical records. Demographic information and measures of acute stress symptoms, experienced social support, coping style, sense of coherence (SOC) and locus...... of control were assessed within one-month post-accident (T1). At the six months follow-up (T2), PTSD was assessed with the Harvard Trauma Questionnaire (HTQ). Results: In the six months follow-up, 10 respondents (19.2%) had HTQ total scores reaching a level suggestive of PTSD (N = 52), and 11 respondents (21...
João Porto de Albuquerque
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.
Reader, T; Flin, R; Lauche, K; Cuthbertson, B H
In high-risk industries such as aviation, the skills not related directly to technical expertise, but crucial for maintaining safety (e.g. teamwork), have been categorized as non-technical skills. Recently, research in anaesthesia has identified and developed a taxonomy of the non-technical skills requisite for safety in the operating theatre. Although many of the principles related to performance and safety within anaesthesia are relevant to the intensive care unit (ICU), relatively little research has been done to identify the non-technical skills required for safe practice within the ICU. This review focused upon critical incident studies in the ICU, in order to examine whether the contributory factors identified as underlying the critical incidents, were associated with the skill categories (e.g. task management, teamwork, situation awareness and decision making) outlined in the Anaesthetists' Non-technical Skills (ANTS) taxonomy. We found that a large proportion of the contributory factors underlying critical incidents could be attributed to a non-technical skill category outlined in the ANTS taxonomy. This is informative both for future critical incident reporting, and also as an indication that the ANTS taxonomy may provide a good starting point for the development of a non-technical skills taxonomy for intensive care. However, the ICU presents a range of unique challenges to practitioners working within it. It is therefore necessary to conduct further non-technical skills research, using human factors techniques such as root-cause analyses, observation of behaviour, attitudinal surveys, studies of cognition, and structured interviews to develop a better understanding of the non-technical skills important for safety within the ICU. Examples of such research highlight the utility of these techniques.
Martinho, Carina Isabel Ferreira; Rodrigues, Inês Tello Rato Milheiras
Objective The aim of this study was to translate and culturally and linguistically adapt the Ease of Communication Scale and to assess the level of communication difficulties for patients undergoing mechanical ventilation with orotracheal intubation, relating these difficulties to clinical and sociodemographic variables. Methods This study had three stages: (1) cultural and linguistic adaptation of the Ease of Communication Scale; (2) preliminary assessment of its psychometric properties; and (3) observational, descriptive-correlational and cross-sectional study, conducted from March to August 2015, based on the Ease of Communication Scale - after extubation answers and clinical and sociodemographic variables of 31 adult patients who were extubated, clinically stable and admitted to five Portuguese intensive care units. Results Expert analysis showed high agreement on content (100%) and relevance (75%). The pretest scores showed a high acceptability regarding the completion of the instrument and its usefulness. The Ease of Communication Scale showed excellent internal consistency (0.951 Cronbach's alpha). The factor analysis explained approximately 81% of the total variance with two scale components. On average, the patients considered the communication experiences during intubation to be "quite hard" (2.99). No significant correlation was observed between the communication difficulties reported and the studied sociodemographic and clinical variables, except for the clinical variable "number of hours after extubation" (p < 0.05). Conclusion This study translated and adapted the first assessment instrument of communication difficulties for mechanically ventilated patients in intensive care units into European Portuguese. The preliminary scale validation suggested high reliability. Patients undergoing mechanical ventilation reported that communication during intubation was "quite hard", and these communication difficulties apparently existed regardless of the
Albertine, Paul; Borofsky, Samuel; Brown, Derek; Patel, Smita; Lee, Woojin; Caputy, Anthony; Taheri, M Reza
With advancing technology, the sensitivity of computed tomography (CT) for the detection of subdural hematoma (SDH) continues to improve. In some cases, the finding is limited to one or 2 images of the CT examination. At our institution, all patients with an SDH require intensive care unit (ICU) admission, regardless of size. In this report, we tested the hypothesis that patients with a small traumatic SDH on their presenting CT examination do not require the intensive monitoring offered in the ICU and can instead be managed on a hospital unit with a lower level of monitoring. This is a retrospective study of patients evaluated and treated at a level I trauma center for acute traumatic intracranial hemorrhage between 2011 and 2014. The clinical and imaging profile of 87 patients with traumatic SDH were studied. Patients with small isolated traumatic subdural hemorrhage (tSDH) (medical stability during hospitalization, and did not require any neurosurgical intervention. It is our recommendation that patients with isolated tSDH (medical decline (4%) and neurologic decline (4%) but may still benefit from ICU observation. Patients with tSDH greater than 10 cm(3) overall demonstrated poor clinical courses and outcome and would benefit ICU monitoring.
Mikhael, Michel; Cleary, John P; Dhar, Vijay; Chen, Yanjun; Nguyen, Danh V; Chang, Anthony C
Objective The aim of this article is to examine characteristics of birth tourism (BT) neonates admitted to a neonatal intensive care unit (NICU). Methods This was a retrospective review over 3 years; BT cases were identified, and relevant perinatal, medical, social, and financial data were collected and compared with 100 randomly selected non-birth tourism neonates. Results A total of 46 BT neonates were identified. They were more likely to be born to older women (34 vs. 29 years; p < 0.001), via cesarean delivery (72 vs. 48%; p = 0.007), and at a referral facility (80 vs. 32%; p < 0.001). BT group had longer hospital stay (15 vs. 7 days; p = 0.02), more surgical intervention (50 vs. 21%; p < 0.001), and higher hospital charges (median $287,501 vs. $103,105; p = 0.003). One-third of BT neonates were enrolled in public health insurance program and four BT neonates (10%) were placed for adoption. Conclusion Families of BT neonates admitted to the NICU face significant challenges. Larger studies are needed to better define impacts on families, health care system, and society.
Kleiber, Niina; Tromp, Krista; Mooij, Miriam G; van de Vathorst, Suzanne; Tibboel, Dick; de Wildt, Saskia N
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.
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.
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
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: email@example.com
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)
Fraisse, Alain; Le Bel, Stéphane; Mas, Bertrand; Macrae, Duncan
Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. A paediatric cardiac intensive care programme should have patients (preoperative and postoperative) grouped together geographically, and should provide proximity to the operating theatre, catheterization laboratory and radiology department, as well as to the regular ward. Age-appropriate medical equipment must be provided. An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least '150 major procedures per year in children' and must provide a 'specialized paediatric intensive care unit'.
Durrington, Hannah J; Clark, Richard; Greer, Ruari; Martial, Franck P; Blaikley, John; Dark, Paul; Lucas, Robert J; Ray, David W
Intensive care units provide specialised care for critically ill patients around the clock. However, intensive care unit patients have disrupted circadian rhythms. Furthermore, disrupted circadian rhythms are associated with worse outcome. As light is the most powerful 're-setter' of circadian rhythm, we measured light intensity on intensive care unit. Light intensity was low compared to daylight during the 'day'; frequent bright light interruptions occurred over 'night'. These findings are predicted to disrupt circadian rhythms and impair entrainment to external time. Bright lighting during daytime and black out masks at night might help maintain biological rhythms in critically ill patients and improve clinical outcomes.
Danjoux, Nathalie; Hawryluck, Laura; Lawless, Bernard
On January 31, 2007, Ontario's Critical Care Strategy hosted a workshop for healthcare providers examining cultural and religious perspectives on patient care in the intensive care unit (ICU). The workshop provided an opportunity for the Ministry of Health and Long-Term Care (MOHLTC) to engage service providers and discuss important issues regarding cultural and religious perspectives affecting critical care service delivery in Ontario. While a favourable response to the workshop was anticipated, the truly remarkable degree to which the more than 200 front-line healthcare providers, policy developers, religious and cultural leaders, researchers and academics who were in attendance embraced the need for this type of dialogue to take place suggests that discussion around this and other "difficult" issues related to care in a critical care setting is long overdue. Without exception, the depth of interest in being able to provide patient-centred care in its most holistic sense--that is, respecting all aspects of the patients' needs, including cultural and religious--is a top-of-mind issue for many people involved in the healthcare system, whether at the bedside or the planning table. This article provides an overview of that workshop, the reaction to it, and within that context, examines the need for a broad-based, non-judgmental and respectful approach to designing care delivery in the ICU. The article also addresses these complex and challenging issues while recognizing the constant financial and human resource constraints and the growing demand for care that is exerting tremendous pressure on Ontario's limited critical care resources. Finally, the article also explores the healthcare system's readiness and appetite for an informed, intelligent and respectful debate on the many issues that, while often difficult to address, are at the heart of ensuring excellence in critical care delivery.
Amante, Lúcia Nazareth; Rossetto, Annelise Paula; Schneider, Dulcinéia Ghizoni
The purpose of this study was to implement the Nursing Care Systematization--Sistematização da Assistência de Enfermagem (SAE)--with Wanda Aguiar Horta's Theory of Basic Human Necessities and the North American Nursing Diagnosis Association's (NANDA) Nursing Diagnosis as its references. The starting point was the evaluation of the knowledge of the nursing team about the SAE, including their participation in this process. This is a qualitative study, performed in the Intensive Care Unit in a hospital in the city of Brusque, Santa Catarina, from October, 2006 to March, 2007. It was observed that the nursing professionals know little about SAE, but they are greatly interested in learning and developing it in their daily practice. In conclusion, it was possible to execute the healthcare systematization in an easy way, with the use of simple brochures that provided all the necessary information for the qualified development of nursing care.
Mammina, C; Bonura, C; Aleo, A; Calà, C; Caputo, G; Cataldo, M C; Di Benedetto, A; Distefano, S; Fasciana, T; Labisi, M; Sodano, C; Palma, D M; Giammanco, A
In this study 45 isolates of Acinetobacter baumannii identified from patients in intensive care units of three different hospitals and from pressure ulcers in home care patients in Palermo, Italy, during a 3-month period in 2010, were characterized. All isolates were resistant to at least three classes of antibiotics, but susceptible to colistin and tygecycline. Forty isolates were non-susceptible to carbapenems. Eighteen and two isolates, respectively, carried the bla(OXA-23-like) and the bla(OXA-58-like) genes. One strain carried the VIM-4 gene. Six major rep-PCR subtype clusters were defined, including isolates from different hospitals or home care patients. The sequence type/pulsed field gel electrophoresis group ST2/A included 33 isolates, and ST78/B the remaining 12. ST2 clone proved to be predominant, but a frequent involvement of the ST78 clone was evident.
J.G.M. Hofhuis (Jose); P.E. Spronk (Peter); H.F. van Stel (Henk); A.J.P. Schrijvers (Augustinus); J. Bakker (Jan)
textabstractIntroduction: Predicting whether a critically ill patient will survive intensive care treatment remains difficult. The advantages of a validated strategy to identify those patients who will not benefit from intensive care unit (ICU) treatment are evident. Providing critical care treatmen
Browne, Joy V.; Talmi, Ayelet
Infants who begin their lives in intensive care are impacted physically and socioemotionally for many months and years to come. Likewise, stressful experiences of caring for a baby hospitalized in intensive care have an impact on primary caregivers, typically the baby's parents. Infant mental health (IMH) is an expanding, evidence-based field that…
Estressores em Unidade de Terapia Intensiva: versão brasileira do The Environmental Stressor Questionnaire Estresores en Unidad de Terapia Intensiva: versión brasileña del Environmental Stressor Questionnaire Stressors at the Intensive Care Unit: the Brazilian version of The Environmental Stressor Questionnaire
Beatriz Ângelo Rosa
és (r = 0,70, confirmado la validez convergente. La versión brasileña del ESQ se mostró como una herramienta confiable y válida para la evaluación de estresores en UTI.The objective of the present study was to perform the cultural adaptation of The Environmental Stressor Questionnaire - ESQ for the Brazilian Portuguese, as well as to verify its reliability and validity. In order to ensure the equivalence between the original instrument and the Brazilian version, all methodological steps recommended in the literature regarding cultural adaptation were followed. The Brazilian version of the ESQ was applied to 106 ICU patients in two hospitals (public and private in the interior of São Paulo State. Reliability was evaluated in relation to internal consistency and stability (test e retest and the convergent validity was determined by the correlation between ESQ and generic questions about ICU stress. Reliability was satisfactory with Cronbach's Alfa = 0,94 and stability (ICC=0,861; IC95% 0,723; 0,933. ESQ total score displayed strong correlation with the generic questions about stress (r=0,70; p<0,0001, thus confirming the convergent validity. The conclusion was that the ESQ adapted for Brazilian culture is a reliable instrument for evaluation of stressors in the ICU.
Tisnado, Diana M.; Walling, Anne M.; Dy, Sydney M.; Asch, Steven M.; Ettner, Susan L.; Kim, Benjamin; Pantoja, Philip; Schreibeis-Baum, Hannah C.; Lorenz, Karl A.
Abstract Background: Early patient-physician care planning discussions may influence the intensity of end-of-life (EOL) care received by veterans with advanced cancer. Objective: The study objective was to evaluate the association between medical record documentation of patient-physician care planning discussions and intensity of EOL care among veterans with advanced cancer. Methods: This was a retrospective cohort study. Subjects were 665 veteran decedents diagnosed with stage IV colorectal, lung, or pancreatic cancer in 2008, and followed till death or the end of the study period in 2011. We estimated the effect of patient-physician care planning discussions documented within one month of metastatic diagnosis on the intensity of EOL care measured by receipt of acute care, intensive interventions, chemotherapy, and hospice care, using multivariate logistic regression models. Results: Veterans in our study were predominantly male (97.1%), white (74.7%), with an average age at diagnosis of 66.4 years. Approximately 31% received some acute care, 9.3% received some intensive intervention, and 6.5% had a new chemotherapy regimen initiated in the last month of life. Approximately 41% of decedents received no hospice or were admitted within three days of death. Almost half (46.8%) had documentation of a care planning discussion within the first month after diagnosis and those who did were significantly less likely to receive acute care at EOL (OR: 0.67; p=0.025). Documented discussions were not significantly associated with intensive interventions, chemotherapy, or hospice care. Conclusion: Early care planning discussions are associated with lower rates of acute care use at the EOL in a system with already low rates of intensive EOL care. PMID:26186553
Silberstein, Dalia; Litmanovitz, Ita
During hospitalization in the neonatal intensive care unit (NICU), the brain of the preterm infant undergoes a particularly vulnerable and sensitive period of development. Brain development might be negatively influenced by direct injury as well as by complications of prematurity. Over the past few years, stress has come to be increasingly recognized as a potential risk factor. The NICU environment contains numerous stress factors due to maternal deprivation and over-stimulation, such as light, sound and pain, which conflict with the brain's developmental requirements. Developmental care is a caregiving approach that addresses the early developmental needs of the preterm infant as an integral component of quality neonatal care. NIDCAP (Newborn Individualized Developmental Care and Assessment Program) is a comprehensive program that aims to reduce environmental stress, to support the infant's neuro-behavioral maturation and organization, and to promote early parent-infant relationships. The implementation of developmental care based on NIDCAP principles is a gradual, in-depth systems change process, which affects all aspects of care in the NICU. This review describes the theoretical basis of the NIDCAP approach, summarizes the scientific evidence and addresses some of the implications of the transition from a traditional to a developmental care NICU.
Nosocomial Infection in an Intensive Care Unit in a Brazilian University Hospital Infección hospitalaria en unidad de tratamiento intensivo de un hospital universitario brasileño Infecção hospitalar em unidade de tratamento intensivo de um hospital universitário brasileiro
Adriana Cristina de Oliveira
Full Text Available This prospective study aimed to determine the nosocomial infection (NI incidence in an Intensive Care Unit (ICU, its association with clinical characteristics and occurrence sites. It was carried out among 1.886 patients admitted in an ICU of a University Hospital, from August 2005 to January 2008. Data analysis was done using Fisher’s test and Relative Risk (RR. There were 383 NIs (20.3%. The infections were in the urinary tract (n=144; 37.6%, pneumonia (n=98; 25.6%, sepsis (n=58; 15.1%, surgical site (n=54; 14.1% and others (n=29; 7.7%. Hospitalization average was 19.3 days for patients with NI and 20.2 days for those with colonization by resistant microorganisms. The mortality was 39.5% among patients with NI (RR: 4.4; 3.4-5.6. The NI was associated with patients originated from other units of the institution/emergency unit, more than 4 days of hospitalization, community infection, colonized by resistant microorganisms, using invasive procedures and deaths resulting from NI.Este estudio prospectivo tuvo como objetivo determinar la incidencia de infección hospitalaria (IH en una Unidad de Terapia Intensiva (UTI, su asociación con características clínicas del paciente y sitios de ocurrencia. Fueron incluidos 1886 pacientes de la UTI de un hospital universitario, entre agosto de 2005 y enero de 2008. Se utilizó el test exacto de Fisher y Riesgo Relativo. Fueron identificadas 383 (20,3% IH: 144 (37,6% del tracto urinario, 98 (25,6% neumonía, 58 (15,1% sepsis, 54 (14.1% sitio quirúrgico y 29 (7,7% otras infecciones. La permanencia promedio fue 19,3 días para pacientes con IH y 20,2 días para colonizados con microorganismos resistentes. Se registró 39.5% óbitos entre pacientes con IH (RR: 4,4; 3,4-5,6. La IH estuvo asociada a pacientes provenientes de otra unidad de la institución/unidad de emergencia, internación mayor que 4 días, con infección comunitaria, colonizados por microorganismos resistentes, uso de procedimientos
Escudero, D; Valentín, M O; Escalante, J L; Sanmartín, A; Perez-Basterrechea, M; de Gea, J; Martín, M; Velasco, J; Pont, T; Masnou, N; de la Calle, B; Marcelo, B; Lebrón, M; Pérez, J M; Burgos, M; Gimeno, R; Kot, P; Yus, S; Sancho, I; Zabalegui, A; Arroyo, M; Miñambres, E; Elizalde, J; Montejo, J C; Domínguez-Gil, B; Matesanz, R
We conducted a multicentre study of 1844 patients from 42 Spanish intensive care units, and analysed the clinical characteristics of brain death, the use of ancillary testing, and the clinical decisions taken after the diagnosis of brain death. The main cause of brain death was intracerebral haemorrhage (769/1844, 42%), followed by traumatic brain injury (343/1844, 19%) and subarachnoid haemorrhage (257/1844, 14%). The diagnosis of brain death was made rapidly (50% in the first 24 h). Of those patients who went on to die, the Glasgow Coma Scale on admission was ≤ 8/15 in 1146/1261 (91%) of patients with intracerebral haemorrhage, traumatic brain injury or anoxic encephalopathy; the Hunt and Hess Scale was 4-5 in 207/251 (83%) of patients following subarachnoid haemorrhage; and the National Institutes of Health Stroke Scale was ≥ 15 in 114/129 (89%) of patients with strokes. Brain death was diagnosed exclusively by clinical examination in 92/1844 (5%) of cases. Electroencephalography was the most frequently used ancillary test (1303/1752, 70.7%), followed by transcranial Doppler (652/1752, 37%). Organ donation took place in 70% of patients (1291/1844), with medical unsuitability (267/553, 48%) and family refusal (244/553, 13%) the main reasons for loss of potential donors. All life-sustaining measures were withdrawn in 413/553 of non-donors (75%).
Fabian, T C
Empiri c therapy of ventilator-associated pneumonia (VAP) in surgical patients should be based on intensive care unit (ICU)-specific surveillance data, because microbial flora patterns vary widely between geographic regions as well as within hospitals. Surgical ICUs have higher VAP rates than other units. Data from the National Nosocomial Infection Surveillance (NNIS) System report Pseudomonas aeruginosa and Staphylococcus aureus to be the most frequent isolates (each 17.4%). Data from the NNIS documents high resistance patterns in ICUs compared with hospitals at large, as well as unit-specific patterns. VAP risk factors for surgical patients include thoracoabdominal surgery, altered level of consciousness, advanced age, diabetes mellitus, malnutrition, chronic obstructive pulmonary disease, and prior antibiotic administration. Promising prevention strategies include restricting ventilator circuit changes, in-line heat moisture exchange filters, semi-recumbant positioning, and continuous subglottic aspiration. Pharmacodynamics should be considered when choosing antibiotic regimens. Postantibiotic effect and time-dependent versus concentration-dependent killing should be studied in clinical trials. Current guidelines for choosing regimens have been well developed by the American Thoracic Society.
Xisto Sena Passos
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.
Bühler, K E; Land, Tatjana
Previous research into the causes of burnout has mainly been concerned with external triggers, such as onerous work criteria or organizational or social influences. Factors such as individual reactions and personality have largely been ignored as a possible etiology of burnout. In preparation for a long-term study, this general cross-sectional study investigates the relationship between burnout and personality variables. Different personality variables that have a possible impact on burnout were determined in a number of prestudies. The data were gathered from 119 people working in intensive care units. The Maslach Burnout Inventory (MBI) was used as well as certain subscales of the following personality questionnaires: Eysenck Personality Inventory (EPI), Inventory of Aggressivity (IA), Trier Personality Questionnaire (TPQ), Scales of Control (SC), Locus of Control (LC), and the Logo-test (LOGO). The scales of mental health, respectively Psychoprotection, external locus of control, and neuroticism, were confirmed as being statistically relevant concerning burnout. The application and significance of this study for future burnout research are discussed.
Barber Vicki S
Full Text Available Abstract Background Extended follow-up of survivors of ICU treatment has shown many patients suffer long-term physical and psychological consequences that affect their health-related quality of life. The current lack of rigorous longitudinal studies means that the true prevalence of these physical and psychological problems remains undetermined. Methods/Design The ICON (Intensive Care Outcome Network study is a multi-centre, longitudinal study of survivors of critical illness. Patients will be recruited prior to hospital discharge from 20–30 ICUs in the UK and will be assessed at 3, 6, and 12 months following ICU discharge for health-related quality of life as measured by the Short Form-36 (SF-36 and the EuroQoL (EQ-5D; anxiety and depression as measured by the Hospital Anxiety and Depression Scale (HADS; and post traumatic stress disorder (PTSD symptoms as measured by the PTSD Civilian Checklist (PCL-C. Postal questionnaires will be used. Discussion The ICON study will create a valuable UK database detailing the prevalence of physical and psychological morbidity experienced by patients as they recover from critical illness. Knowledge of the prevalence of physical and psychological morbidity in ICU survivors is important because research to generate models of causality, prognosis and treatment effects is dependent on accurate determination of prevalence. The results will also inform economic modelling of the long-term burden of critical illness. Trial Registration ISRCTN69112866
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.
L. K. Moshetova
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.
Berger, Mette M; Revelly, Jean-Pierre; Cayeux, Marie-Christine; Gersbach, Philippe; Chioléro, René L
Hospital malnutrition is an insidious problem which is responsible for many complications. Critically ill patients are frequently hypermetabolic with increased nutritional requirements, and are exposed to the risk of underfeeding. The case report presents the case of a patient which stayed 22 days in the intensive care unit (ICU), and whose nutritional support failed: he ultimately died of surgical and infectious complications. An optimal support includes a early metabolic support provided as glucose-insulin-potassium infusion and antioxidant micronutrients, with an enteral nutrition initiated on days 3 or 4. It is frequently difficult to reach energy targets with exclusive enteral nutrition: if the latter is not reached after 5-6 days of enteral feeding, combination with parenteral nutrition enables worsening of the energy deficit. Transition to oral feeding is another critical event which may expose the patient to underfeeding: prescription of oral supplements and/or maintenance of overnight enteral feeding providing 50-75% of energy requirements helps overcome this period. The case illustrates the importance of monitoring daily and cumulated energy balance.
Nydahl, P; Dubb, R; Filipovic, S; Hermes, C; Jüttner, F; Kaltwasser, A; Klarmann, S; Mende, H; Nessizius, S; Rottensteiner, C
Immobility of patients in intensive care units (ICU) can lead to long-lasting physical and cognitive decline. During the last few years, bundles for rehabilitation were developed, including early mobilization. The German guideline for positioning therapy and mobilization, in general, recommends the development of ICU-specific protocols. The aim of this narrative review is to provide guidance when developing a best practice protocol in one's own field of work. It is recommended to a) implement early mobilization as part of a bundle, including screening and management of patient's awareness, pain, anxiety, stress, delirium and family's presence, b) develop a traffic-light system of specific in- and exclusion criteria in an interprofessional process, c) use checklists to assess risks and preparation of mobilization, d) use the ICU Mobility Scale for targeting and documentation of mobilization, e) use relative safety criteria for hemodynamic and respiratory changes, and Borg Scale for subjective evaluation, f) document and evaluate systematically mobilization levels, barriers, unwanted safety events and other parameters.
Philbin, M Kathleen
This article addresses general principles of designing a quiet neonatal intensive care unit (NICU) and describes basic aspects of room acoustics as these apply to the NICU. Recommended acoustical criteria for walls, background noise, vibration, and reverberation are included as appendices. Crowding in open, multiple-bed NICUs is the major factor in designs that inevitably produce noisy nurseries with limited space for parents. Quiet infant spaces with appropriate sound sources rely on isolation of the infant from facility and operational noise sources (eg, adult work spaces, supply delivery, and travel paths) and extended contact with family members.However, crowding has been an important influence on the clinical practice and social context of neonatology. It allows clinicians to rely on wide visual and auditory access to many patients for monitoring their well-being. It also allows immediate social contact with other adults, both staff and families. Giving up this wide access and relying on other forms of communication in order to provide for increased quiet and privacy for staff, infants, and parents is a challenge for some design teams. Studies of the effects of various nursery designs on infants, parents, clinicians, and the delivery of services are proposed as a means of advancing the field of design.
Dzulfikar D. Lukmanul Hakim
Full Text Available Dengue viral infections affect all age groups and produce a spectrum of clinical illness that ranges from asymptomatic to severe and occasionally fatal disease. Severe dengue characterized by plasma leakage, hemoconcentration, and hemostatic disorder. The aim of this study was to know the characteristic of severe dengue patients admitted to Pediatric Intensive Care Unit (PICU Dr. Hasan Sadikin Hospital Bandung during January 2009 to December 2010. This was a retrospective descriptive study based on the data collected from the medical records. Twenty-one severe dengue cases in two years were admitted 15/21 girls and 6/21 boys, and 5/21 of them died during hospitalization because of dengue shock syndrome (DSS and disseminated intravascular coagulation (DIC. Most of them were 1−5 years old with good nutritional status. Hepatomegaly was found in all cases with mean hematocrit was 38%. In this research, the most manifestation of severe dengue were DSS (15/21, DIC (11/21, encephalopathy (6/21, pleural effusion (5/21, myocarditis (3/21, and acute respiratory distress syndrome (3/21. In conclusions, severe dengue are more common in girls, 1–5 years old, and well-nourished children. The most common clinical manifestation of severe dengue are shock, disseminated intravascular coagulation, and encephalopathy.
Marta Luján Hernández
Full Text Available Fundament: The infections nosocomiales constitute an important problem of health, for what is of supreme importance to identify the epidemic situation of this. Objective: Describe the behaviour of the infections nosocomiales in the Unit of Intensive Cares. Methods: I Study descriptive retrospective carried out in the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ of Cienfuegos during the years 1997-2002. The following variables were included: hospital expenditures, cases infected by months and years, localizations, germs, deaths and procedures of more risk (ventilation mechanics, deep veined catheters and vesical catheters. Results: We check stabilization in the global rates, the cases you find inside the predicted parameters, the main localization was the breathing one with a percentage stocking of 42 in the seven investigated years, while the germ of more circulation was the Acynetobacter with an average of 27,1%. The rates of mortality associated to infection stayed low and the lethality suffered a on decreased in the studied period, however the pneumonias associated to the ventilation mechanics stayed high with an average of 24, 6 for every 1000 patient days and to the closing of the 2002 the service you will find in the area of security of the endemic channel.K
Tilden, S J; Watkins, S; Tong, T K; Jeevanandam, M
Few data are available on energy requirements of mechanically ventilated, critically ill children. We measured the resting energy expenditure in 18 mechanically ventilated patients between ages 2 and 18 years, using indirect calorimetry. All patients had fractional inspired oxygen concentration less than 0.6, no spontaneous respirations, hemodynamic stability, and no fever or active infection, and were receiving 5% dextrose. All subjects were hypermetabolic, since the measured resting energy expenditure divided by the predicted basal energy expenditure from the Harris-Benedict equations was 1.48 +/- 0.09 (mean +/- SEM). The energy requirements calculated using "injury factors" and "activity factors" adapted for adults is 1.62 times basal energy expenditure. The injury factor for the pediatric multiple trauma patients should be 1.25 compared with 1.35 in adults. In these pediatric intensive care patients 33% +/- 8% of the energy is derived from carbohydrates, 53% +/- 8% from fat, and 14% +/- 2% from protein oxidation. In individual critically ill pediatric patients, energy requirements should be estimated by measuring their resting energy expenditure whenever possible and adding 5% for their activity. In the absence of the actual measurement of resting energy expenditure, the recommended energy requirement is 1.5 times basal energy expenditure. In this acute phase of injury, the daily nitrogen requirement is 250 mg per kilogram of body weight.
Franck, Linda S; Naughton, Ita; Winter, Ira
The purposes of this prospective repeated measures study were to: (a) describe the occurrence of withdrawal symptoms with the use of a standardised protocol to slowly taper opioids and benzodiazepines; and (b) to test the predictive validity of an opioid and benzodiazepine withdrawal assessment scoring tool in critically ill infants and young children after prolonged opioid and benzodiazepine therapy. Fifteen children (6 weeks-28 months of age) with complex congenital heart disease and/or respiratory failure who received opioids and benzodiazepines for 4 days or greater were evaluated for withdrawal symptoms using a standardized assessment tool. Thirteen children showed moderate to severe withdrawal symptoms a median 3 days after commencement of tapering. Symptom intensity was not related to prior opioid or benzodiazepine exposure, extracorporeal membrane oxygenation (ECMO) therapy or length of tapering. Children who received fentanyl in addition to morphine more often exhibited signs of withdrawal. This study demonstrated that significant withdrawal symptoms occur in critically ill children even with the use of a standardised assessment tool and tapering management protocol. The predictive validity and utility of the Opioid and Benzodiazepine Withdrawal Score (OBWS) was adequate for clinical use, but areas for further improvement of the tool were identified. Problems with the clinical withdrawal prevention and management guidelines were also identified. More research is needed to establish the optimal methods for prevention and management of iatrogenic opioid and benzodiazepine withdrawal in paediatric critical care.
Mehmet Sah Ipek
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.
Miranda,Erique José Peixoto de; Stancato,Kátia
In this study we discuss about risks to health of intensive care unity staff and suggest a proposal of integral approach of health. Literature review, from 1997 to 2007, at Bireme database about health education, intensive care unity, nursing and occupational health, regardless of design of study. All studies show that the environment of intensive care unity is unhealthy, which is also due to habits and attitudes of ICU health professionals. An approach to health education would be beneficial...
Advancements in critical care medicine result in a growing population of survivors of critical illness. Many intensive care unit (ICU) patients have physical, mental and cognitive sequelae after discharge from the ICU, known as post-intensive care syndrome (PICS). These problems are associated with long-lasting restrictions in daily functioning and reduced health-related quality of life (QoL), and can also negatively affect family members (PICS-F). The nature of these restrictions require int...
Bringsvor, Heidi B; Bentsen, Signe Berit; Berland, Astrid
This study explored the sources of knowledge that intensive care nurses used in their daily nursing practice. It used a qualitative design based on four focus group interviews with 20 intensive care nurses, from four intensive care units in Norway. Data were analysed using systematic text condensation. The following condensed meaning units were identified: research, theoretical knowledge, experiential knowledge, work place culture, clinical expertise and patient participation. This study illustrates the complexity and variety of the knowledge bases of intensive care nurses. Despite some variation in nurses' familiarity with research literature, nursing interventions found by research to be useful were given priority, and research affected daily practice through changes in guidelines and procedures.
D.Cur. The goal of this research was to generate and describe a support approach for the advanced practitioner in psychiatric nursing to utilize for the neonatal intensive care nurse, working in a neonatal intensive care unit, in order to promote, to maintain and to restore mental health as integral part of health. Many changes occurred in the health care industry during the twentieth century. In South Africa, health care and social services that have developed, are grossly inefficient and...
Steinmetz, O K; Meakins, J L
The traditional approach to the care of the gastrointestinal tract in the intensive care unit has been one of neglect. However, recent evidence has linked enteric flora to the generation of clinical sepsis in the absence of other infectious foci. The role of the bowel as an efficient barrier to the invasion of its own flora is addressed in this paper. A variety of insults disrupt the integrity of the barrier function of the gut, allowing the entry of bowel organisms or endotoxins, or both, into the portal and systemic circulatory systems. In animal and early clinical studies, a number of interventions, aimed at altering the enteric flora and enhancing the bowel's barrier function, have been shown to modulate the host's resistance to different insults and may even improve clinical outcome. Such interventions include maintenance of enteral feeding, glutamine supplementation of hyperalimentation solutions and selective bacterial decontamination of the bowel.
Fabiane de Amorim Almeida
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.
Nosocomial pneumonia is a major cause of morbidity and mortality in hospitalized patients. The risk is especially high in the neonatal intensive care unit (NICU) particularly in infants with mechanically assisted ventilation. During the 5-year period of the study, 160 infants with problems including prematurity (60.6%), respiratory distress (55.6%) and birth asphyxia (45.0%) were admitted to the NICU. One hundred and thirty-three infants (83.1%) received mechanical ventilation. Nosocomial pneumonia was found in 65 infants (40.6%) or 88.3 cases per 1,000 ventilator-days. Low birth weight, prematurity, respiratory distress and hyperbilirubinemia were found more significantly in the pneumonia group. They underwent more manipulations such as the placement of an umbilical catheter and orogastric tube. Infants with pneumonia received mechanical ventilation at a higher percentage and for a longer period than those without pneumonia (96.9% vs 73.7%, odds ratio = 11.2, p = 0.000) with a mean duration of 11.7 and 3.5 days respectively (p = 0.000). The etiologic organisms recovered from hemoculture were Acinetobacter calcoaceticus var. anitratus 44.0 per cent, Enterobacter spp. 16.0 per cent, Klebsiella pneumoniae 16.0 per cent, coagulase-negative staphylococci 12.0 per cent. There was no concordance of the bacteriologic results in endotracheal aspirate culture and hemoculture in each infant. Leukocytosis and granulocytosis as well as blood gas values could not differentiate the presence of pneumonia. The mean hospital stay for the infants with pneumonia was longer (23.0 days vs 6.4 days, p = 0.000). Nosocomial pneumonia did not only prolong hospital stay but also contributed to mortality. Twenty-seven (41.5%) of the infants with pneumonia died, compared with 46 (48.4%) of the other group without pneumonia (p = 0.422). The risk of nosocomial pneumonia can be reduced by using infection control measures, including meticulous hand washing and gloving during respiratory
Amâncio, Frederico Figueiredo; Heringer, Tiago Pires; de Oliveira, Cristina da Cunha Hueb Barata; Fassy, Liliane Boaventura; de Carvalho, Frederico Bruzzi; Oliveira, Daniela Pagliari; de Oliveira, Claudio Dornas; Botoni, Fernando Otoni; Magalhães, Fernanda do Carmo; Lambertucci, José Roberto; Carneiro, Mariângela
The purpose of our study was to describe the clinical profile of dengue-infected patients admitted to Brazilian intensive care units (ICU) and evaluate factors associated with death. A longitudinal, multicenter case series study was conducted with laboratory-confirmed dengue patients admitted to nine Brazilian ICUs situated in Minas Gerais state, southeastern Brazil from January 1, 2008, to December 31, 2013. Demographic, clinical and laboratory data; disease severity scores; and mortality were evaluated. A total of 97 patients were studied. The in-ICU and in-hospital mortality rates were 18.6% and 19.6%, respectively. Patients classified as having severe dengue according to current World Health Organization classifications showed an increased risk of death in a univariate analysis. Nonsurvivors were older, exhibited lower serum albumin concentrations and higher total leukocyte counts and serum creatinine levels. Other risk factors (vomiting, lethargy/restlessness, dyspnea/respiratory distress) were also associated with death in a univariate analysis. Multivariate analysis indicated that in-hospital mortality was significantly associated with Acute Physiology and Chronic Health Evaluation II and the Sequential Organ Failure Assessment score. The ICU and in-hospital mortality observed in this study were higher than values reported in similar studies. An increased frequency of ICU admission due to severe organ dysfunction, higher severity indices and scarcity of ICU beds may partially explain the higher mortality. PMID:26090676
Horacek, Rostislav; Krnacova, Barbora; Prasko, Jan; Latalova, Klara
Background The aim of this study was to examine the impact of somatic illnesses, electrolyte imbalance, red blood cell count, hypotension, and antipsychotic and opioid treatment on the duration of delirium in Central Intensive Care Unit for Surgery. Patients and methods Patients who were admitted to the Department of Central Intensive Care Unit for Surgery in the University Hospital Olomouc from February 2004 to November 2008 were evaluated using Riker sedation–agitation scale. Their blood pressure, heart rate, respiratory rate, and peripheral blood oxygen saturation were measured continually, and body temperature was monitored once in an hour. The laboratory blood tests including sodium, potassium, chlorides, phosphorus, urea and creatinine, hemoglobin, hematocrit, red and white blood cell count, and C-reactive protein, albumin levels and laboratory markers of renal and liver dysfunction were done every day. All measurements were made at least for ten consecutive days or longer until the delirium resolved. Results The sample consisted of 140 consecutive delirious patients with a mean age of 68.21±12.07 years. Delirium was diagnosed in 140 of 5,642 patients (2.48%) admitted in CICUS in the last 5 years. The median duration of delirium was 48 hours with a range of 12–240 hours. Statistical analysis showed that hyperactive subtype of delirium and treatment with antipsychotics were associated with prolonged delirium duration (hyperactive 76.15±40.53 hours, hypoactive 54.46±28.44 hours, mixed 61.22±37.86 hours; Kruskal–Wallis test: 8.022; Ppiracetam 46.96±18.42 hours; Kruskal–Wallis test: 17.39, P<0.0005), and history of alcohol abuse (with a history of abuse 73.63±45.20 hours, without a history of abuse 59.54±30.61 hours; Mann–Whitney U=1,840; P<0.05). One patient had suffered from complicated postoperative hypostatic pneumonia and died due to respiratory failure (patient with hypoactive subtype). According to the backward stepwise multiple regression
Hewitt, Krissi M; Mannino, Frank L; Gonzalez, Antonio; Chase, John H; Caporaso, J Gregory; Knight, Rob; Kelley, Scott T
Infants in Neonatal Intensive Care Units (NICUs) are particularly susceptible to opportunistic infection. Infected infants have high mortality rates, and survivors often suffer life-long neurological disorders. The causes of many NICU infections go undiagnosed, and there is debate as to the importance of inanimate hospital environments (IHEs) in the spread of infections. We used culture-independent next-generation sequencing to survey bacterial diversity in two San Diego NICUs and to track the sources of microbes in these environments. Thirty IHE samples were collected from two Level-Three NICU facilities. We extracted DNA from these samples and amplified the bacterial small subunit (16S) ribosomal RNA gene sequence using 'universal' barcoded primers. The purified PCR products were pooled into a single reaction for pyrosequencing, and the data were analyzed using QIIME. On average, we detected 93+/-39 (mean +/- standard deviation) bacterial genera per sample in NICU IHEs. Many of the bacterial genera included known opportunistic pathogens, and many were skin-associated (e.g., Propionibacterium). In one NICU, we also detected fecal coliform bacteria (Enterobacteriales) in a high proportion of the surface samples. Comparison of these NICU-derived sequences to previously published high-throughput 16S rRNA amplicon studies of other indoor environments (offices, restrooms and healthcare facilities), as well as human- and soil-associated environments, found the majority of the NICU samples to be similar to typical building surface and air samples, with the notable exception of the IHEs which were dominated by Enterobacteriaceae. Our findings provide evidence that NICU IHEs harbor a high diversity of human-associated bacteria and demonstrate the potential utility of molecular methods for identifying and tracking bacterial diversity in NICUs.
Krissi M Hewitt
Full Text Available Infants in Neonatal Intensive Care Units (NICUs are particularly susceptible to opportunistic infection. Infected infants have high mortality rates, and survivors often suffer life-long neurological disorders. The causes of many NICU infections go undiagnosed, and there is debate as to the importance of inanimate hospital environments (IHEs in the spread of infections. We used culture-independent next-generation sequencing to survey bacterial diversity in two San Diego NICUs and to track the sources of microbes in these environments. Thirty IHE samples were collected from two Level-Three NICU facilities. We extracted DNA from these samples and amplified the bacterial small subunit (16S ribosomal RNA gene sequence using 'universal' barcoded primers. The purified PCR products were pooled into a single reaction for pyrosequencing, and the data were analyzed using QIIME. On average, we detected 93+/-39 (mean +/- standard deviation bacterial genera per sample in NICU IHEs. Many of the bacterial genera included known opportunistic pathogens, and many were skin-associated (e.g., Propionibacterium. In one NICU, we also detected fecal coliform bacteria (Enterobacteriales in a high proportion of the surface samples. Comparison of these NICU-derived sequences to previously published high-throughput 16S rRNA amplicon studies of other indoor environments (offices, restrooms and healthcare facilities, as well as human- and soil-associated environments, found the majority of the NICU samples to be similar to typical building surface and air samples, with the notable exception of the IHEs which were dominated by Enterobacteriaceae. Our findings provide evidence that NICU IHEs harbor a high diversity of human-associated bacteria and demonstrate the potential utility of molecular methods for identifying and tracking bacterial diversity in NICUs.
Ujwal Lakshman Yeole
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.
van der Elst, Kim C M; Veringa, Anette; Zijlstra, Jan G; Beishuizen, Albertus; Klont, Rob; Brummelhuis-Visser, Petra; Uges, Donald R A; Touw, Daan J; Kosterink, Jos G W; van der Werf, Tjip S; Alffenaar, Jan-Willem C
In critically ill patients, drug exposure may be influenced by altered drug distribution and clearance. Earlier studies showed that the variability in caspofungin exposure was high in intensive care unit (ICU) patients. The primary objective of this study was to determine if the standard dose of caspofungin resulted in adequate exposure in critically ill patients. A multicenter prospective study in ICU patients with (suspected) invasive candidiasis was conducted in the Netherlands from November 2013 to October 2015. Patients received standard caspofungin treatment, and the exposure was determined on day 3 of treatment. An area under the concentration-time curve from 0 to 24 h (AUC0-24) of 98 mg · h/liter was considered adequate exposure. In case of low exposure (i.e., caspofungin dose was increased and the exposure reevaluated. Twenty patients were included in the study, of whom 5 had a positive blood culture. The median caspofungin AUC0-24 at day 3 was 78 mg · h/liter (interquartile range [IQR], 69 to 97 mg · h/liter). A low AUC0-24 (caspofungin dose in mg/kg/day (P = 0.011). The median AUC0-24 with a caspofungin dose of 1 mg/kg was estimated using a pharmacokinetic model and was 114.9 mg · h/liter (IQR, 103.2 to 143.5 mg · h/liter). In conclusion, the caspofungin exposure in ICU patients in this study was low compared with that in healthy volunteers and other (non)critically ill patients, most likely due to a larger volume of distribution. A weight-based dose regimen is probably more suitable for patients with substantially altered drug distribution. (This study has been registered at ClinicalTrials.gov under registration no. NCT01994096.).
Castellanos-Ortega, A; Rothen, H U; Franco, N; Rayo, L A; Martín-Loeches, I; Ramírez, P; Cuñat de la Hoz, J
The medical training model is currently immersed in a process of change. The new paradigm is intended to be more effective, more integrated within the healthcare system, and strongly oriented towards the direct application of knowledge to clinical practice. Compared with the established training system based on certification of the completion of a series or rotations and stays in certain healthcare units, the new model proposes a more structured training process based on the gradual acquisition of specific competences, in which residents must play an active role in designing their own training program. Training based on competences guarantees more transparent, updated and homogeneous learning of objective quality, and which can be homologated internationally. The tutors play a key role as the main directors of the process, and institutional commitment to their work is crucial. In this context, tutors should receive time and specific formation to allow the evaluation of training as the cornerstone of the new model. New forms of objective summative and training evaluation should be introduced to guarantee that the predefined competences and skills are effectively acquired. The free movement of specialists within Europe is very desirable and implies that training quality must be high and amenable to homologation among the different countries. The Competency Based training in Intensive Care Medicine in Europe program is our main reference for achieving this goal. Scientific societies in turn must impulse and facilitate all those initiatives destined to improve healthcare quality and therefore specialist training. They have the mission of designing strategies and processes that favor training, accreditation and advisory activities with the government authorities.
Hwang, David Y; Yagoda, Daniel; Perrey, Hilary M; Tehan, Tara M; Guanci, Mary; Ananian, Lillian; Currier, Paul F; Cobb, J Perren; Rosand, Jonathan
Many prior nursing studies regarding family members specifically of neuroscience intensive care unit (neuro-ICU) patients have focused on identifying their primary needs. A concept related to identifying these needs and assessing whether they have been met is determining whether families explicitly report satisfaction with the care that both they and their loved ones have received. The objective of this study was to explore family satisfaction with care in an academic neuro-ICU and compare results with concurrent data from the same hospital's medical ICU (MICU). Over 38 days, we administered the Family Satisfaction-ICU instrument to neuro-ICU and MICU patients' families at the time of ICU discharge. Those whose loved ones passed away during ICU admission were excluded. When asked about the respect and compassion that they received from staff, 76.3% (95% CI [66.5, 86.1]) of neuro-ICU families were completely satisfied, as opposed to 92.7% in the MICU (95% CI [84.4, 101.0], p = .04). Respondents were less likely to be completely satisfied with the courtesy of staff if they reported participation in zero formal family meeting. Less than 60% of neuro-ICU families were completely satisfied by (1) frequency of physician communication, (2) inclusion and (3) support during decision making, and (4) control over the care of their loved ones. Parents of patients were more likely than other relatives to feel very included and supported in the decision-making process. Future studies may focus on evaluating strategies for neuro-ICU nurses and physicians to provide better decision-making support and to implement more frequent family meetings even for those patients who may not seem medically or socially complicated to the team. Determining satisfaction with care for those families whose loved ones passed away during their neuro-ICU admission is another potential avenue for future investigation.
Nazlı Gamze Bülbül
Full Text Available Neuroleptic malignant syndrome (NMS is a rare but life-threatening clinical manifestation induced by neuroleptic medication. Although NMS is regarded as a psychiatric diagnosis, its treatment requires a systematic approach and thus intensive care follow-up. In this paper, we report nine cases with NMS followed up in our Neurology Intensive Care Unit over the last three years.
Bech, A.; Blans, M.; Raaijmakers, M.; Mulkens, C.; Telting, D.; Boer, H. de
BACKGROUND: Hypophosphatemia occurs in about 25% of patients admitted to the intensive care unit. To date, a safe and validated phosphate replacement protocol is not available. OBJECTIVE: To evaluate an individualized phosphate replacement regimen. DESIGN: Fifty consecutive intensive care unit patie
S.J.G.M. Ahlers (Sabine)
textabstractIntensive care patients are subject to many factors that may influence the patients’ state of comfort or distress. Pain is the main cause of distress experienced by many adult intensive care patients, which can be caused by different factors like underlying disease, prolonged immobility
During admission to an intensive care unit (ICU), many critically ill patients develop generalized muscle weakness, a condition called intensive care unit-acquired weakness (ICU-AW). ICU-AW can be caused by muscle problems, peripheral nerve problems or a combination of both. As the name of the condi
Iapichino, G; Mistraletti, G; Corbella, D; Bassi, G; Borotto, E; Miranda, DR; Morabito, A
Objective. Patients admitted to the intensive care unit greatly differ in severity and intensity of care. We devised a system for selecting high-risk patients that reduces bias by excluding low-risk patients and patients with an early death irrespective of the treatment. Design: A posteriori analysi
Марина Александровна Макарова
Full Text Available In spite of success in treatment and diagnostics attained last years the problem of an acute pneumonia remains actual, this fact is caused by the growing rate of prolonged clinical course and unfavorable clinical outcomes. The growth of antibiotic resistance of microflora is a substantial problem. In addition even the most vigorous modern antibacterial preparations are not effective without an adequate surgical sanitation of the nidus of infection.The aim of the work is to improve the therapy of destructive pneumonia in children that need an intensive care.Methods. 12 patients 9 month – 12 years old who underwent the treatment of heavy community-acquired pneumonia were under observation. There was carried out an X-ray examination at admission and in dynamics, microbiological examination of lavages from the respiratory tract, pleural exudate and blood, determination of laboratory indexes of intoxication (by Kalf-Kalif, Dashtayants, Lubimova and the level of the middle molecules. The statistical analysis was done using the program package "Microsoft Excel" and "StatSoft 6".Results. In the course of microbiological examination it was demonstrated the prevalence of gram-negative flora and its associations with gram-positive one, the purely gram-positive flora was detected only in 25 % of children. So there was proved an inefficiency of antibiotics that effect mainly on the gram-positive microorganisms. In addition the cephalosporins of the third generation were found insufficiently effective. Such preparations as carbapenems or protected penicillins were chosen in vitro and according to its clinical efficiency. Plasmapheresis and bronchoscopy are useful in the complex therapy. Thoracoscopy must be carried out if the conservative treatment is not effectiveConclusions. At present the gram-negative flora and its associations with gram-positive one prevails in etiological structure of the heavy community-acquired pneumonias that must be taken into
Ahmet Fatih Yılmaz
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
Plötz Frans B
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.
Full Text Available Consensus regarding optimal burns intensive care (BICU patient management is lacking. This study aimed to assess whether ventilation strategies, cardiovascular support and sedation in BICU patients have changed over time, and whether this affects outcome. A retrospective observational study comparing two 12-patient BICU cohorts (2005/06 and 2010/11 was undertaken. Demographic and admission characteristics, ventilation parameters, sedation, fluid resuscitation, cardiovascular support and outcome (length of stay, mortality data were collected from patient notes. Data was analysed using T-tests, Fisher's exact and Mann-Whitney U tests. In our study cohort groups were equivalent in demographic and admission parameters. There were equal ventilator-free days in the two cohorts 10 ± 12.7 vs. 13.3 ± 12.2 ventilator free days; P = 0.447. The 2005/06 cohort were mechanically ventilated more often than in 2010/11 cohort (568 ventilator days/1000 patient BICU days vs. 206 ventilator days/1000 patient BICU days; P = 0.001. The 2005/06 cohort were ventilated less commonly in tracheostomy group/endotracheal tube spontaneous (17.8% vs. 26%; P = 0.001 and volume-controlled modes (34.4% vs. 40.8%; P = 0.001. Patients in 2010/11 cohort were more heavily sedated (P = 0.001 with more long-acting sedative drug use (P = 0.001 than the 2005/06 cohort, fluid administration was equivalent. Patient outcome did not vary. Inhalational injury patients were ventilated in volume-controlled (44.5% vs. 28.1%; P = 0.001 and pressure-controlled modes (18.2% vs. 9.5%; P = 0.001 more frequently than those without. Outcome did not vary. This study showed there has been shift away from mechanical ventilation, with increased use of tracheostomy/tracheal tube airway spontaneous ventilation. Inhalation injury patients require more ventilatory support though patient outcomes do not differ. Prospective trials are required to establish which strategies confer benefit.
Castro Maria A
Full Text Available Abstract Background In addition to mortality, Health Related Quality of Life (HRQOL has increasingly been claimed as an important outcome variable. The aim of this study was to assess HRQOL and independence in activities of daily living (ADL six months after discharge from an Intensive Care Unit (ICU, and to study its determinants. Methods All post-operative adult patients admitted to a surgical ICU between October 2004 and July 2005, were eligible for the study. The following variables were recorded on admission: age, gender, American Society of Anesthesiologists physical status (ASA-PS, type and magnitude of surgical procedure, ICU and hospital length of stay (LOS, mortality and Simplified Acute Physiology Score II (SAPS II. Six months after discharge, a Short Form-36 questionnaire (SF-36 and a questionnaire to assess dependency in ADL were sent to all survivors. Descriptive statistics was used to summarize data. Patient groups were compared using non-parametric tests. A logistic regression analysis was performed to identify covariate effects of each variable on dependency in personal and instrumental ADL, and for the change-in-health question of SF-36. Results Out of 333 hospital survivors, 226 completed the questionnaires. Fifty-nine percent reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients with greater co-morbidities (ASA-PS III/IV, had lower SF-36 scores in all domains and were more frequently dependent in instrumental and personal ADL. Logistic regression showed that SAPS II was associated with changes in general level of health (OR 1.06, 95%CI, 1.01 – 1.11, p = 0,016. Six months after ICU discharge, 60% and 34% of patients, respectively, were dependent in at least one activity in instrumental ADL (ADLI and personal ADL (ADLP. ASA-PS (OR 3.00, 95%CI 1.31 – 6.87, p = 0.009 and age (OR 2.36, 95%CI, 1.04 – 5.34, p = 0.04 were associated with dependency in
Raheja, J. L.; Dhiraj; Gopinath, D.; Chaudhary, Ankit
In the old age, few people need special care if they are suffering from specific diseases as they can get stroke while they are in normal life routine. Also patients of any age, who are not able to walk, need to be taken care of personally but for this, either they have to be in hospital or someone like nurse should be with them for better care. This is costly in terms of money and man power. A person is needed for 24x7 care of these people. To help in this aspect we purposes a vision based s...
Objective: To assess the impact of early introduction of enteral nutrition therapy in reducing morbidity and mortality in pediatric intensive care unit.Methods: Search in the literature of the last 10 years, in English and the target population of individuals aged 1 month to 18 years admitted to pediatric intensive care units in the databases PubMed, Lilacs and Embase using the keywords: Critical Care, Nutritional Support and Nutrition Disorders or Malnutrition.Results: Despite advances in th...
Erstad, Brian L; Martin, Steven J; Brophy, Gretchen M; Haas, Curtis E; Jacobi, Judith; Welage, Lynda S; Thomas, Michael C
Compilations of key articles and guidelines in a particular clinical practice area are useful not only to clinicians who practice in that area, but to all clinicians. We compiled pertinent articles and guidelines pertaining to drug therapy in the intensive care setting from the perspective of actively practicing critical care pharmacists. This document differs from the original 2002 version in that a broader assembly of intensive care practitioners was involved in the compilation.
Erstad, Brian L; Brophy, Gretchen M; Martin, Steven J; Haas, Curtis E; Devlin, John W; Welage, Lynda S; Dager, William E
Compilations of key articles and guidelines in a particular clinical practice area are useful not only to clinicians who practice in that area, but also to all clinicians. We compiled pertinent articles and guidelines pertaining to drug therapy in the intensive care setting from the perspective of experienced critical care pharmacists. A broad assembly of practitioners with expertise in various areas of intensive care unit pharmacology were involved in the compilation of this update.
Laddie, Joanna; Craig, Finella; Brierley, Joe; Kelly, Paula; Bluebond-Langner, Myra
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...
Currie, Erin R; Christian, Becky J; Hinds, Pamela S; Perna, Samuel J; Robinson, Cheryl; Day, Sara; Meneses, Karen
This descriptive qualitative study explored parent experiences related to their infant's neonatal intensive care unit (NICU) hospitalization, end-of-life care, and palliative care consultation. "Life and death in the NICU environment" emerged as the primary theme with the following categories: ups and downs of parenting in the NICU, decision-making challenges in the NICU, and parent support. Parents encountered challenges with areas for improvement for end-of-life and palliative care in the NICU. Further research is necessary to understand barriers with integrating palliative care and curative care in the NICU, and how NICU care affects bereavement and coping outcomes after infant death.
Thiéry, Guillaume; Kovacević, Pedja; Straus, Slavenka; Vidovic, Jadranka; Iglica, Amer; Festic, Emir; Gajic, Ognjen
Intensive care medicine is a relatively new specialty, which was created in the 1950's, after invent of mechanical ventilation, which allowed caring for critically ill patients who otherwise would have died. First created for treating mechanically ventilated patients, ICUs extended their scope and care to all patients with life threatening conditions. Over the years, intensive care medicine developed further and became a truly multidisciplinary speciality, encompassing patients from various fields of medicine and involving specialists from a range of base specialties, with additional (subspecialty) training in intensive care medicine. In Bosnia and Herzegovina, the founding of the society of intensive care medicine in 2006, the introduction of non invasive ventilation in 2007, and opening of a multidisciplinary ICUs in Banja Luka and Sarajevo heralded a new age of intensive care medicine. The number of admissions, high severity scores and needs for mechanical ventilation during the first several months in the medical ICU in Banja Luka confirmed the need of these kinds of units in the country. In spite of still suboptimal personnel training, creation of ICUs in Bosnia and Herzegovina may serve as example for other developing countries in the region. However, in order to achieve modern ICU standards and follow European trends toward harmonisation of medicine, Bosnia and Herzegovina needs to take up this challenge by recognizing intensive care medicine as a distinctive specialty, by implementing a specific training program and by setting up multidisciplinary ICUs in acute care hospitals.
Full Text Available The increasing prevalence of chronic diseases throughout the world is an undeniable phenomenon; 395,000 deaths occurred in Iran in 2014 and about 76% of them were related to chronic diseases.1 Cancer is one of the chronic diseases that are progressing rapidly. In Iran, cancer is known as the third cause of death. Adult morbidity rate of cancer in different regions of Iran is estimated 48-112 cases per million people among the females and 51-144 cases per million people among the males.2 Also, mortality rate related to cancer was about 53500 people in 2014.3 In fact, 13% of all deaths related to chronic diseases are caused by cancer1 and the majority of cancer patients expire in the intensive care units (ICU, whereas bed occupancy of ICUs is in crises, being about 100% in Iran. For each ICU bed, 4 people are applicants. In this situation, firstly, a number of patients do not have access to the ICU beds, and secondly, because of the need to ICU beds, the admitted patients in ICU wards are discharged earlier than the standard time for each disease. According to the head of the Intensive Care association, the shortage of ICU beds is about ten thousand in Iran, whereas setting up each ICU bed requires a high cost.4 In the current condition, due to the high cost and shortage of nurses in Iran, setting up of ICU beds is a challenge for the health system. WHO introduced home-based palliative care to improve the quality of life, quality of care, quality of death and patient satisfaction; decrease burnout in staffing and mortality in hospitals; reduce the cost, accept end of life as live days; neither accelerate death nor prolong life; consider all dimensions of human; help the patients to be active until the time of death; help the patient’s family to cope with the disease and loss of patient; and release the beds in hospitals.5 Although hospital beds are considered for healing the patients not a hospice for them, the majority of cancer patients die in
Askenazi, D J; Heung, Michael; Connor, Michael J; Basu, Rajit K; Cerdá, Jorge; Doi, Kent; Koyner, Jay L; Bihorac, Azra; Golestaneh, Ladan; Vijayan, Anitha; Okusa, Mark D; Faubel, Sarah
As advances in Critical Care Medicine continue, critically ill patients are surviving despite the severity of their illness. The incidence of acute kidney injury (AKI) has increased, and its impact on clinical outcomes as well as medical expenditures has been established. The role, indications and technological advancements of renal replacement therapy (RRT) have evolved, allowing more effective therapies with less complications. With these changes, Critical Care Nephrology has become an established specialty, and ongoing collaborations between critical care physicians and nephrologist have improved education of multi-disciplinary team members and patient care in the ICU. Multidisciplinary programs to support these changes have been stablished in some hospitals to maximize the delivery of care, while other programs have continue to struggle in their ability to acquire the necessary resources to maximize outcomes, educate their staff, and develop quality initiatives to evaluate and drive improvements. Clearly, the role of the nephrologist in the ICU has evolved, and varies widely among institutions. This special article will provide insights that will hopefully optimize the role of the nephrologist as the leader of the acute care nephrology program, as clinician for critically ill patients, and as teacher for all members of the health care team.
Jensen, Hanne Irene; Gerritsen, Rik T.; Koopmans, Matty; Zijlstra, Jan G.; Curtis, Jared Randall; Ording, Helle
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 a
Mokgadi C. Matlakala
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.
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.
AWARD NUMBER: W81XWH-13-2-0011 TITLE: The Phase of Illness Paradigm: A Checklist Centric Model to Improve Patient Care in the Burn Intensive...2016 4. TITLE AND SUBTITLE “The Phase of Illness Paradigm: A Checklist Centric Model to 5a. CONTRACT NUMBER Improve Patient Care in the Burn...shared mental model of patient care amongst clinicians in the BICU and thus enhance distributed cognition (Hutchins 2000) and assist the work of the
Roberto NardI; Vincenzo Arienti; Carlo Nozzoli; Antonino Mazzone
IntroductionThe extreme variability of clinical severity in medical admitted patients is diluted in a “average” standard of care, that may be stronger than the real needs for someone, but clearly inadequate, sometimes even dangerous, for other ones, critically ill.DiscussionThe model of a differentiated intensity of hospital care can be defined as the organizational model structured to areas/sectors dedicated to patients with homogeneous needs of care. The intermediate care unit (“High depend...
Full Text Available Critical care patients benefit from the attention of nursing personnel with a high competence level. The aim of the study was to describe and evaluate the self-assessed basic competence of intensive care unit nurses and related factors. A cross-sectional survey design was used. A basic competence scale (Intensive and Critical Care Nursing Competence Scale version 1, Likert scale 1–5, 1 = poor and 5 = excellent was employed among Finnish intensive care unit nurses (n=431. Intensive care unit nurses’ self-assessed basic competence was good (mean 4.19, SD 0.40. The attitude and value base of basic competence was excellent whereas experience base was the poorest compared to the knowledge base and skill base of intensive and critical care nursing. The strongest factor explaining nurses’ basic competence was their experience of autonomy in nursing care (F value 60.85, β 0.11, SE 0.01, and P≤0.0001. Clinical competence was self-rated as good. Nurses gave their highest competence self-ratings for ICU patient care according to the principles of nursing care. The ICU nurses also self-rated their professional competence as good. Collaboration was self-rated as the best competence. In basic and continuing education and professional self-development discussions it is meaningful to consider and find solutions for how to improve nurses’ experienced autonomy in nursing.
Møller, A M; Pedersen, T; Villebro, N
with > 50 pack-years history. Smokers admitted to intensive care with > 50 pack-years history had a higher incidence of chronic lung disease (p consumption (p ....01). The mortality rate was 37% in smokers with > 50 pack-years history and 24% in nonsmokers (odds ratio = 2.02, p = 0.08). We conclude long-term tobacco smoking (> 50 pack-years) carries a higher risk of postoperative admission to intensive care, and there seems to be a dose relationship between the amount...... of tobacco consumed and the risk of postoperative intensive care admission....
Campbell Deborah Y
Full Text Available Abstract Background To determine whether a computerized clinical documentation system (CDS: 1 decreased time spent charting and increased time spent in patient care; 2 decreased medication errors; 3 improved clinical decision making; 4 improved quality of documentation; and/or 5 improved shift to shift nursing continuity. Methods Before and after implementation of CDS, a time study involving nursing care, medication delivery, and normalization of serum calcium and potassium values was performed. In addition, an evaluation of completeness of documentation and a clinician survey of shift to shift reporting were also completed. This was a modified one group, pretest-posttest design. Results With the CDS there was: improved legibility and completeness of documentation, data with better accessibility and accuracy, no change in time spent in direct patient care or charting by nursing staff. Incidental observations from the study included improved management functions of our nurse manager; improved JCAHO documentation compliance; timely access to clinical data (labs, vitals, etc; a decrease in time and resource use for audits; improved reimbursement because of the ability to reconstruct lost charts; limited human data entry by automatic data logging; eliminated costs of printing forms. CDS cost was reasonable. Conclusions When compared to a paper chart, the CDS provided a more legible, compete, and accessible patient record without affecting time spent in direct patient care. The availability of the CDS improved shift to shift reporting. Other observations showed that the CDS improved management capabilities; helped physicians deliver care; improved reimbursement; limited data entry errors; and reduced costs.
G S Umamaheswara Rao
Full Text Available Trauma to the cervical spine may have devastating consequences. Timely interventions are essential to prevent avoidable neurological deterioration. In the initial stabilization of patients with acute cervical spine injuries, physiological disturbances, especially those involving cardiac and respiratory function require careful attention. Early surgery, which facilitates rapid mobi-lization of the patient, is fraught with important management considerations in the intraopoerative period and the subsequent critical care. Airway management poses a crucial challenge at this stage. Those patients who survive the injury with quadriplegia or quadriparesis may present themselves for incidental surgical procedures. Chronic systemic manifestations in these patients require attention in providing anaesthesia and postoperative care at this stage. The current review provides an insight into the physiological disturbances and the management issues in both acute and chronic phases of traumatic cervical spine injury.
Elliott, Malcolm; Worrall-Carter, Linda; Page, Karen
ICU readmissions are a commonly used quality measure but despite decades of research, these adverse events continue to occur. Of particular concern is that readmitted patients have much worse prognoses than those not readmitted. In recent years new clinical service roles have evolved to assist ward staff with the care of acutely ill patients, such as those discharged from ICU. Given the recent emergence of these service roles, a review of contemporary ICU readmission studies was warranted to determine their impact on this adverse event. Reviewed studies indicated the incidence of readmissions and outcomes of these patients have changed little in recent years. Few studies mentioned whether clinical service roles existed to support ward staff caring for patients recently discharged from ICU. Future research needs to focus on identifying modifiable factors in care processes to reduce the incidence and outcomes of this adverse event and to determine how clinical service roles can best help prevent its occurrence.
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
Krag, Mette; Perner, Anders; Møller, Morten H
PURPOSE OF REVIEW: Stress ulcer prophylaxis (SUP) is considered standard of care in the majority of critically ill patients in the ICU. In this review, we will present the current evidence for the use of SUP in ICU patients, including data on the prevalence of gastrointestinal bleeding and the ba......PURPOSE OF REVIEW: Stress ulcer prophylaxis (SUP) is considered standard of care in the majority of critically ill patients in the ICU. In this review, we will present the current evidence for the use of SUP in ICU patients, including data on the prevalence of gastrointestinal bleeding...
Full Text Available Background and Objective: Caring is the core of nursing however, different individules have different perceptions of it. Continuous assessment and measurement of caring behaviors results in the identification of their problems. The careful planning of interventions and problem solving will improve care. The aim of this study was to identify nurses' perception of caring behaviors in the intensive care units. Materials and Method: In this descriptive-analytic study, 140 nurses were selected from intensive care units of hospitals affiliated to Lorestan University of Medical Sciences, Iran, using the census method in 2012. The data collection tool was the Caring Behaviors Inventory for Elders (CBI-E. This questionnaire consisted of two parts including demographic information and 28 items related to care. Face and content validity of the Persian version of the questionnaire were provided by professionals, and after deletion of 4 items a 24-item questionnaire was provided. Cronbach's alpha coefficient was calculated to assess reliability (&alpha = 0.71. Data were analyzed using SPSS software version 18 and descriptive-analytic statistics (Kruskal-Wallis test and Mann-Whitney test. Results: Based on the findings, nurses paid more attention to the physical–technical aspects (95.71 ± 12.76 of care in comparison to its psychosocial aspects (75.41 ± 27.91. Nurses had the highest score in care behavior of "timely performance of medical procedures and medication administration". Conclusion: Since nurses paid more attention to the technical aspects of care than its psychosocial aspects, by providing nurses with a correct perception of care, patients can be provided with needs-based care. This will increase patient satisfaction with nursing care, and indirectly result in the positive attitude of patients and society toward the nursing profession and its services. Moreover, nursing education officials can use these results to assist nurses in meeting
Howe, D C
The objectives of this study were to identify factors associated with decisions concerning triage and admission to the intensive care unit and to describe the outcome of patients referred to intensive care unit for admission. The study was a single-centre, prospective, observational study. It was performed in the general intensive care unit of a tertiary regional hospital, over the period of February to June 2009. The patients were non-elective, acute medical in-patients. For 100 patients referred, only 36 were admitted to the intensive care unit. The remaining 64 were declined admission: nine were declined admission because they were assessed as too sick to benefit, 41 were declined admission because they were assessed as too well to benefit and 14 were deemed to potentially benefit from intensive care unit admission but were not admitted ('triage'). Patients most likely to receive triage decisions were medical in-patients who had expressed wishes about end-of-life care, who were functionally limited with co-morbid conditions affecting their performance status. Patients referred by Resident Medical Officers were also more likely to receive a triage decision. Age, gender Aboriginal and Torres Strait Islander status, diagnostic category and reason for referral did not impact on admission or triage decisions. Bed status in intensive care unit at the time of referral affected neither admission nor triage decisions. Hospital mortality in patients deemed too well to benefit from intensive care unit was 7.3%, suggesting that all patients referred for consideration of admission to intensive care unit should be classified as 'high risk'.
Leandro Barbosa de Pinho
Full Text Available This study seeks to present an updated discussion concerning psychiatric care in Brazil. It is based upon a historical review of psychiatric knowledge and practices within the Brazilian context and knowledge about the phenomenon of madness. It discusses the appearance of modern medical science as an area of knowledge designed for the treatment and comprehension of mental suffering. It also presents a discussion on psychiatric reform, stressing how it is a movement that seeks to redefine the significance of knowledge and practices about the phenomenon of madness, by concentrating on the application of such knowledge and practices in the psychiatric hospital. This paper concludes with a brief critical reflection on prevailing mental healthcare in Brazil, singling out the potential and the difficulties faced within the scope of health policies and the day-to-day working life of professionals of the area.O presente estudo pretende fazer uma discussão atualizada acerca da assistência psiquiátrica no Brasil, tendo como base um resgate histórico dos saberes e práticas psiquiátricas no contexto brasileiro e a apropriação do fenômeno da loucura. Discute o surgimento da ciência médica moderna e da psiquiatria como área do conhecimento designada ao tratamento e à compreensão do sofrimento mental. Também apresenta discussões acerca da reforma psiquiátrica, ressaltandoa como um movimento que vem ao encontro da ressignificação de saberes e práticas de intervenção referentes ao fenômeno da loucura, a partir da concentração desses saberes e práticas no hospital psiquiátrico. No final, realiza uma breve reflexão crítica sobre a assistência em saúde mental no país na atualidade, constatando potencialidades e dificuldades enfrentadas no âmbito das políticas de saúde e do cotidiano do processo de trabalho dos profissionais da área.
Doyle, J J; Casciano, J P; Arikian, S R; Mauskopf, J; Paul, J E
We applied an activity-based costing methodology to determine the full cost of intensive care service at a community hospital, a university hospital and a health maintenance organisation (HMO)-affiliated hospital. A total of 5 patient care units were analysed: the intensive care unit (ICU) and surgical ICU (SICU) at the university setting, the ICU at the community setting, and the SICU and cardiac care unit at the HMO setting. The selection of the different ICU types was based on the types of critical care units that were found in each setting (e.g. the HMO did not have an ICU). Institution-specific cost data and clinical management parameters were collected through surveys and site visits from the 3 respective organisation types. The analysis revealed a marked increase in patient-minute cost associated with mechanical ventilation. Higher costs associated with prolonged neuromuscular blockade have important economic implications with respect to selection of an appropriate neuromuscular blocking agent.
Kim, Yu Jung; Kim, Mi-Jung; Cho, Young-Jae; Park, Jong Sun; Kim, Jin Won; Chang, Hyun; Lee, Jeong-Ok; Lee, Keun-Wook; Kim, Jee Hyun; Yoon, Ho Il; Bang, Soo-Mee; Lee, Jae Ho; Lee, Choon-Taek; Lee, Jong Seok
Critical care for advanced lung cancer patients is still controversial, and the appropriate method for the selection of patients who may benefit from intensive care unit (ICU) care is not clearly defined. We retrospectively reviewed the medical records of stage IIIB-IV lung cancer patients admitted to the medical ICU of a university hospital in Korea between 2003 and 2011. Of 95 patients, 64 (67%) had Eastern Cooperative Oncology Group (ECOG) performance status (PS)≥2, and 79 (84%) had non-small-cell lung cancer. In total, 28 patients (30%) were newly diagnosed or were receiving first-line treatment, and 22 (23%) were refractory or bedridden. Mechanical ventilation was required in 85 patients (90%), and ICU mortality and hospital mortality were 57 and 78%, respectively. According to a multivariate analysis, a PaO2/FiO2 ratiocare. Oncologists should try to discuss palliative care and end-of-life issues in advance to avoid futile care.
J.A. Calvache (Jose Andrés); R.A. Molina García (Rodrigo); A.L. Trochez (Adolfo); J. Benitez (Javier); L.A. Flga (Lucía Arroyo)
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
Oostdijk, E.A.; Smet, A.M. de; Kesecioglu, J.; Bonten, M.J.; Hoeven, J.G. van der; Pickkers, P.; Sturm, P.D.; Voss, A.
OBJECTIVES: Prevalences of cephalosporin-resistant Enterobacteriaceae are increasing globally, especially in intensive care units (ICUs). The effect of selective digestive tract decontamination (SDD) on the eradication of cephalosporin-resistant Enterobacteriaceae from the intestinal tract is unknow
Oostdijk, Evelien A. N.; de Smet, Anne Marie G. A.; Kesecioglu, Jozef; Bonten, Marc J. M.
Prevalences of cephalosporin-resistant Enterobacteriaceae are increasing globally, especially in intensive care units (ICUs). The effect of selective digestive tract decontamination (SDD) on the eradication of cephalosporin-resistant Enterobacteriaceae from the intestinal tract is unknown. We quanti
Madsen, Kristian Rørbæk; Guldager, Henrik; Rewers, Mikael;
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...
Daiane Silva Resende
Full Text Available INTRODUCTION: Catheter-associated bloodstream infection (CA-BSI is the most common nosocomial infection in neonatal intensive care units. There is evidence that care bundles to reduce CA-BSI are effective in the adult literature. The aim of this study was to reduce CA-BSI in a Brazilian neonatal intensive care unit by means of a care bundle including few strategies or procedures of prevention and control of these infections. METHODS: An intervention designed to reduce CA-BSI with five evidence-based procedures was conducted. RESULTS: A total of sixty-seven (26.7% CA-BSIs were observed. There were 46 (32% episodes of culture-proven sepsis in group preintervention (24.1 per 1,000 catheter days [CVC days]. Neonates in the group after implementation of the intervention had 21 (19.6% episodes of CA-BSI (14.9 per 1,000 CVC days. The incidence of CA-BSI decreased significantly after the intervention from the group preintervention and postintervention (32% to 19.6%, 24.1 per 1,000 CVC days to 14.9 per 1,000 CVC days, p=0.04. In the multiple logistic regression analysis, the use of more than 3 antibiotics and length of stay >8 days were independent risk factors for BSI. CONCLUSIONS: A stepwise introduction of evidence-based intervention and intensive and continuous education of all healthcare workers are effective in reducing CA-BSI.
Suely Ferreira Deslandes
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.
Toufen Junior Carlos
Full Text Available 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 the study. PATIENTS: All patients over 16 years old occupying an intensive care unit bed over a 24-hour period. The 19 intensive care unit s provided 126 patient case reports. MAIN OUTCOME MEASURES: Rates of infection, antimicrobial use, microbiological isolates resistance patterns, potential related factors for intensive care unit-acquired infection, and death rates. RESULTS: A total of 126 patients were studied. Eighty-seven patients (69% received antimicrobials on the day of study, 72 (57% for treatment, and 15 (12% for prophylaxis. Community-acquired infection occurred in 15 patients (20.8%, non- intensive care unit nosocomial infection in 24 (33.3%, and intensive care unit-acquired infection in 22 patients (30.6%. Eleven patients (15.3% had no defined type. The most frequently reported infections were respiratory (58.5%. The most frequently isolated bacteria were Enterobacteriaceae (33.8%, Pseudomonas aeruginosa (26.4%, and Staphylococcus aureus (16.9%; [100% resistant to methicillin]. Multivariate regression analysis revealed 3 risk factors for intensive care unit-acquired infection: age > 60 years (p = 0.007, use of a nasogastric tube (p = 0.017, and postoperative status (p = 0.017. At the end of 4 weeks, overall mortality was 28.8%. Patients with infection had a mortality rate of 34.7%. There was no difference between mortality rates for infected and noninfected patients (p=0.088. CONCLUSION: The rate of nosocomial infection is high in intensive care
Settle, Peggy Doyle
Nurses working in a newborn intensive care unit report that treatment decision disagreements for infants in their care may lead to ethical dilemmas involving all health-care providers. Applying Rest's Four-Component Model of Moral Action as the theoretical framework, this study examined the responses of 224 newborn intensive care unit nurses to the Nurses Ethical Involvement Survey. The three most frequent actions selected were as follows: talking with other nurses, talking with doctors, and requesting a team meeting. The multiple regression analysis indicates that newborn intensive care unit nurses with greater concern for the ethical aspects of clinical practice (p = .001) and an increased perception of their ability to influence ethical decision making (p = .018) were more likely to display Nurse Activism. Future research is necessary to identify other factors leading to and inhibiting Nurse Activism as these findings explained just 8.5% of the variance.
Özden, Dilek; Karagözoğlu, Şerife; Yildirim, Gülay
Suffering repeated experiences of moral distress in intensive care units due to applications of futility reflects on nurses' patient care negatively, increases their burnout, and reduces their job satisfaction. This study was carried out to investigate the levels of job satisfaction and exhaustion suffered by intensive care nurses and the relationship between them through the futility dimension of the issue. The study included 138 intensive care nurses. The data were obtained with the futility questionnaire developed by the researchers, Maslach Burnout Inventory and Minnesota Satisfaction Questionnaire. It was determined that nurses who agreed to the proposition that the application of futility demoralizes health-care professionals had low levels of job satisfaction but high levels of depersonalization. It was determined that nurses had moderate levels of job satisfaction, emotional exhaustion, and personal achievements but high levels of sensitivity. Nurses' job satisfaction and sensitivities are positively affected when they consider that futility does not contradict the purposes of medicine.
Jensen, Hanne Irene
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...... withheld or withdrawn (264 patients). The basic characteristics of the patients who were discharged from the units with full therapy were also collected (1401 patients). Subproject 2. Interviews: Mono-professional focus-group interviews with 11 nurses and 10 intensivists, and individual interviews with 8...... (135) from 10 ICUs in the Region of Southern Denmark. Additionally the survey included primary physicians (146) from two regional ICUs. Subproject 4. Audit: Three interdisciplinary audits with the participation of 8 primary care physicians, 9 intensivists, and 12 nurses were conducted. Form and profit...
Full Text Available Anthony T Gerlach, Claire V Murphy The Ohio State University Medical Center, Ohio State University, Columbus, OH, USA Abstract: Dexmedetomidine is an α-2 agonist that produces sedation and analgesia without compromising the respiratory drive. Use of dexmedetomidine as a sedative in the critically ill is associated with fewer opioid requirements compared with propofol and a similar time at goal sedation compared with benzodiazepines. Dexmedetomidine may produce negative hemodynamic effects including lower mean heart rates and potentially more bradycardia than other sedatives used in the critically ill. Recent studies have demonstrated that dexmedetomidine is safe at higher dosages, but more studies are needed to determine whether the efficacy of dexmedetomidine is dose dependent. In addition, further research is required to define dexmedetomidine's role in the care of delirious critically ill patients, as many, but not all, studies have indicated favorable outcomes. Keywords: dexmedetomidine, sedation, critical care
Full Text Available OBJECTIVE: Cardiac operations with cardiopulmonary bypass can be associated with postoperative lung dysfunction. The present study investigates the incidence of postoperative hypoxia after cardiac surgery, its relationship with the length of intensive care unit stay, and the role of body mass index in determining postoperative hypoxia and intensive care unit length of stay. DESIGN: Single-center, retrospective study. SETTING: University Hospital. Patients. Adult patients (N = 5,023 who underwent cardiac surgery with CPB. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: According to the body mass index, patients were attributed to six classes, and obesity was defined as a body mass index >30. POH was defined as a PaO2/FiO2 ratio <200 at the arrival in the intensive care unit. Postoperative hypoxia was detected in 1,536 patients (30.6%. Obesity was an independent risk factor for postoperative hypoxia (odds ratio 2.4, 95% confidence interval 2.05-2.78, P = 0.001 and postoperative hypoxia was a determinant of intensive care unit length of stay. There is a significant inverse correlation between body mass index and PaO2/FiO2 ratio, with the risk of postoperative hypoxia increasing by 1.7 folds per each incremental body mass index class. The relationship between body mass index and intensive care unit length of stay is U-shaped, with longer intensive care unit stay in underweight patients and moderate-morbid obese patients. CONCLUSIONS: Obese patients are at higher risk for postoperative hypoxia, but this leads to a prolonged intensive care unit stay only for moderate-morbid obese patients. Obese patients are partially protected against the deleterious effects of hemodilution and transfusions. Underweight patients present the "paradox" of a better lung gas exchange but a longer intensive care unit stay. This is probably due to a higher severity of their cardiac disease.
Parker, Ann; Sricharoenchai, Thiti; Needham, Dale M.
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...
Ng, Vivian K S; Lo, T K; Tsang, H H; Lau, W L; Leung, W C
OBJECTIVES. To review the characteristics of a series of obstetric patients admitted to the intensive care unit in a regional hospital in 2006-2010, to compare them with those of a similar series reported from the same hospital in 1989-1995 and a series reported from another regional hospital in 1998-2007. DESIGN. Retrospective case series. SETTING. A regional hospital in Hong Kong. PATIENTS. Obstetric patients admitted to the Intensive Care Unit of Kwong Wah Hospital from 1 January 2006 to 31 December 2010. RESULTS. From 2006 to 2010, there were 67 such patients admitted to the intensive care unit (0.23% of total maternities and 2.34% of total intensive care unit admission), which was a higher incidence than reported in two other local studies. As in the latter studies, the majority were admitted postpartum (n=65, 97%), with postpartum haemorrhage (n=39, 58%) being the commonest cause followed by pre-eclampsia/eclampsia (n=17, 25%). In the current study, significantly more patients had had elective caesarean sections for placenta praevia but fewer had had a hysterectomy. The duration of intensive care unit stay was shorter (mean, 1.8 days) with fewer invasive procedures performed than in the two previous studies, but maternal and neonatal mortality was similar (3% and 6%, respectively). CONCLUSION. Postpartum haemorrhage and pregnancy-induced hypertension were still the most common reasons for intensive care unit admission. There was an increasing trend of intensive care unit admissions following elective caesarean section for placenta praevia and for early aggressive intervention of pre-eclampsia. Maternal mortality remained low but had not decreased. The intensive care unit admission rate by itself might not be a helpful indicator of obstetric performance.
Kalhan, S C; Wilson-Costello, D
Contemporary clinical practice for the care of the prematurely born babies has markedly improved their rates of survival so that most of these babies are expected to grow up to live a healthy functional life. Since the clinical follow-up is of short duration (years), only limited data are available to relate non-communicable diseases in adult life to events and interventions in the neonatal period. The major events that could have a programming effect include: (1) intrauterine growth restriction; (2) interruption of pregnancy with change in redox and reactive oxygen species (ROS) injury; (3) nutritional and pharmacological protocols for clinical care; and (4) nutritional care in the first 2 years resulting in accelerated weight gain. The available data are discussed in the context of perturbations in one carbon (methyl transfer) metabolism and its possible programming effects. Although direct evidence for genomic methylation is not available, clinical and experimental data on impact of redox and ROS, of low protein intake, excess methionine load and vitamin A, on methyl transfers are reviewed. The consequences of antenatal and postnatal administration of glucocorticoids are presented. Analysis of the correlates of insulin sensitivity at older age, suggests that premature birth is the major contributor, and is compounded by gain in weight during infancy. We speculate that premature interruption of pregnancy and neonatal interventions by affecting one carbon metabolism may cause programming effects on the immature baby. These can be additive to the effects of intrauterine environment (growth restriction) and are compounded by accelerated growth in early infancy.
Intensive care remains an area of high acuity and high mortality across the globe. With a rapidly aging population, the disease burden requiring intensive care is growing. The cost of critical care also is rising with new technology becoming available rapidly. We present the all-cause mortality results of 5 years database established in a restructured, large public hospital in Singapore, looking at all three types of Intensive Care Units present in our hospital. These include medical, surgical, and coronary care units.
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.
Full Text Available Introduction. Nurses often experience work-related stress. High stress can negatively affect job satisfaction and lead to emotional exhaustion with risk of burnout. Aim. To analyse possible differences in biological stress markers, psychosocial working conditions, health, and well-being between nurses working in two different departments. Methods. Stress was evaluated in nurses working in a neonatal intensive care unit (NICU (n=33 and nurses working in a child and adolescent psychiatry inpatient ward (CAP (n=14 using salivary cortisol and HbA1c. Salivary cortisol was measured three times a day on two consecutive days during two one-week periods, seven weeks apart (= 12 samples/person. Psychosocial working conditions, health, and well-being were measured once. Results. NICU nurses had better social support and more self-determination. CAP nurses had a lower salivary cortisol quotient, poorer general health, and higher client-related burnout scores. Conclusion. When comparing these nurses with existing norm data for Sweden, as a group their scores reflect less work-related stress than Swedes overall. However, the comparison between NICU and CAP nurses indicates a less healthy work situation for CAP nurses. Relevance to Clinical Practice. Healthcare managers need to acknowledge the less healthy work situation CAP nurses experience in order to provide optimal support and promote good health.
Mª Cristina Pascual Fernández
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.
Dow, Belinda; Kenardy, Justin; Long, Deborah; Le Brocque, Robyne
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…
Garry, D A; McKechnie, S R; Culliford, D J; Ezra, M; Garry, P S; Loveland, R C; Sharma, V V; Walden, A P; Keating, L M
We examined the current incidence, type, severity and preventability of iatrogenic events associated with intensive care unit admission in five hospitals in England. All unplanned adult admissions to intensive care units were prospectively reviewed over a continuous six-week period. In the week before admission, 76/280 patients (27%) experienced 104 iatrogenic events. The majority of iatrogenic events were categorised as medical (37%), drug (17%) or nursing events (17%). Seventy-seven per cent of the events were considered preventable and 80% caused or contributed to admission. Eleven events were thought to have contributed to a patient's death. The mean (SD) age of patients who had an event was greater (63 (21) years) than those who had not (57 (19) years, p = 0.023), and they had a longer median (IQR [range]) intensive care stay, 4 (1-8 [0-29]) days vs 3 (1-5 [0-20]) days, respectively, p = 0.043.
Ayuela Azcárate, J M; Clau-Terré, F; Vicho Pereira, R; Guerrero de Mier, M; Carrillo López, A; Ochagavia, A; López Pérez, J M; Trenado Alvarez, J; Pérez, L; Llompart-Pou, J A; González de Molina, F J; Fojón, S; Rodríguez Salgado, A; Martínez Díaz, M C; Royo Villa, C; Romero Bermejo, F J; Ruíz Bailén, M; Arroyo Díez, M; Argueso García, M; Fernández Fernández, J L
Ultrasound has become an essential tool in assisting critically ill patients. His knowledge, use and instruction requires a statement by scientific societies involved in its development and implementation. Our aim are to determine the use of the technique in intensive care medicine, clinical situations where its application is recommended, levels of knowledge, associated responsibility and learning process also implement the ultrasound technique as a common tool in all intensive care units, similar to the rest of european countries. The SEMICYUC's Working Group Cardiac Intensive Care and CPR establishes after literature review and scientific evidence, a consensus document which sets out the requirements for accreditation in ultrasound applied to the critically ill patient and how to acquire the necessary skills. Training and learning requires a structured process within the specialty. The SEMICYUC must agree to disclose this document, build relationships with other scientific societies and give legal cover through accreditation of the training units, training courses and different levels of training.
Latour, Jos M.; van Goudoever, Johannes B.; Duivenvoorden, Hugo J.; Albers, Marcel J. I. J.; van Dam, Nicolette A. M.; Dullaart, Eugenie; van Heerde, Marc; de Neef, Marjorie; Verlaat, Carin W. M.; van Vught, Elise M.; Hazelzet, Jan A.
Objective: To explore similarities and differences in perceptions on pediatric intensive care practices between parents and staff by using data from two studies. Design: A two-round Delphi method among nurses and physicians followed by an empiric survey among parents. Settings: Pediatric intensive c
Villanueva-Baldonado, Analiza; Barrett-Sheridan, Shirley E
This article describes one institution's intention to implement a financial management business plan for a neurosurgical intensive care unit in a level I trauma center. The financial objective of this proposed business plan includes a service increase in the patient population requiring critical care in a way that will help control costs.
Emmerink, P.M.J.; Roeg, Diana
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
Hoogewerf, M; ter Horst, H. J.; Groen, H.; Nieuwenhuis, T; Bos, A.F.; van Dijk, M W G
OBJECTIVE: To determine the prevalence of oral feeding problems in neonatal intensive care unit (NICU) graduates at 1 to 2 years, and to identify clinical risk factors during NICU admission. STUDY DESIGN: Observational cohort study of 378 children, who received level III/IV NICU care for 4 days or m
Birsan, Sandrine; Rodriguez, Marie-Pierre; Brissaud, Olivier
The psychologist within a neonatal and paediatric intensive care unit intervenes in accordance with the condition of the patient and those at whom their services are aimed. The psychological practice in this particular context comprises certain specificities. As the child nears the end of life the psychologist must find his place within the unit and adapt his care to the needs expressed.
Aardema, H.; Arends, J. P.; de Smet, A. M. G. A.; Zijlstra, J. G.
Background: The occurrence of highly resistant microorganisms (HRMOs) is a major threat to critical care patients, leading to worse outcomes, need for isolation measures, and demand for second-line or rescue antibiotics. The aim of this study was to quantify the burden of HRMOs in an intensive care
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
Byrne, Eilish; Campbell, Suzann K.
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…
J.M. Latour (Jos); J.A. Hazelzet (Jan); H.J. Duivenvoorden (Hugo); J.B. van Goudoever (Hans)
textabstractOBJECTIVE: To identify satisfaction with neonatal intensive care as viewed by parents and healthcare professionals and to explore similarities and differences between parents and healthcare professionals. STUDY DESIGN: A 3-round Delphi method to identify neonatal care issues (round 1) a
Laerkner, Eva; Egerod, Ingrid; Hansen, Helle Ploug
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...... 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...
‘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.
Heloisa Amaral Gaspar
Full Text Available Echocardiography is a key tool for hemodynamic assessment in Intensive Care Units (ICU. Focused echocardiography performed by nonspecialist physicians has a limited scope, and the most relevant parameters assessed by focused echocardiography in Pediatric ICU are left ventricular systolic function, fluid responsiveness, cardiac tamponade and pulmonary hypertension. Proper ability building of pediatric emergency care physicians and intensivists to perform focused echocardiography is feasible and provides improved care of severely ill children and thus should be encouraged.
Leovic, Michael P; Robbins, Hailey N; Foley, Michael R; Starikov, Roman S
Management of the critically ill pregnant patient presents a clinical dilemma in which there are sparse objective data to determine the optimal setting for provision of high-quality care to these patients. This clinical scenario will continue to present a challenge for providers as the chronic illness and comorbid conditions continue to become more commonly encountered in the obstetric population. Various care models exist across a broad spectrum of facilities that are characterized by differing levels of resources; however, no studies have identified which model provides the highest level of care and patient safety while maintaining a reasonable degree of cost-effectiveness. The health care needs of the critically ill obstetric patient calls for clinicians to move beyond the traditional definition of the intensive care unit and develop a well-rounded, quickly responsive, and communicative interdisciplinary team that can provide high-quality, unique, and versatile care that best meets the needs of each particular patient. We propose a model in which a virtual intensive care unit team composed of preselected specialists from multiple disciplines (maternal-fetal medicine, neonatology, obstetric anesthesiology, cardiology, pulmonology, etc) participate in the provision of individualized, precontemplated care that is readily adapted to the specific patient's clinical needs, regardless of setting. With this team-based approach, an environment of trust and familiarity is fostered among team members and well thought-out patient care plans are developed through routine prebrief discussions regarding individual clinical care for parturients anticipated to required critical care services. Incorporating debriefings between team members following these intricate cases will allow for the continued evolution of care as the medical needs of this patient population change as well.
Full Text Available OBJECTIVE: To analyse the prevalent microorganisms and their antimicrobial resistance among intensive care unit patients in a tertiary care centre in New Delhi. METHODS: A retrospective study of all consecutive blood cultures from various intensive care unit patients in the hospital during four years (January 2008 to December 2011. Antibiotic consumption data in the intensive care units were also analysed during the same period. RESULTS: Out of the total 22,491 blood cultures processed, 2846 samples were positive and 3771 microorganisms were isolated. The blood culture positivity was estimated as 12.7% of which 67.5% were monomicrobial and 32.5% polymicrobial infections. Gram negative bacilli, Gram positive cocci, and fungi were isolated in 49%, 33%, and 18% cases, respectively. Coagulase negative staphylococcus was the commonest single isolate followed by Candida spp. A drastic shift in the distribution of Candida spp. towards nonalbicans along with high resistance to azole group of antifungals suggest echinocandins for the empiric therapy of candidemia. High penicillin resistance in Gram positive isolates suggest vancomycin, linezolid and tigecycline as the options for empiric therapy, whereas tigecycline and colistin are the only options remaining for highly resistant Gram negative isolates. Aminoglycosides were observed to have better sensitivity and reduced usage when compared with cephalosporins and ß-lactam + ß-lactam inhibitor combinations. CONCLUSIONS: High frequencies of multidrug resistant organisms were observed in intensive care units which is a warning as to use the only few effective antimicrobials wisely to reduce selective pressure on sensitive strains.
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
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...
Wåhlin, Ingrid; Ek, Anna-Christina; Idvall, Ewa
Experiences of critically ill patients are an important aspect of the quality of care in intensive care units. If next of kin and staff try to empower the patient, this is probably performed in accordance with their beliefs about what patients experience as empowering. As intensive care patients often have difficulties communicating, staff and next of kin need to interpret their wishes, but there is limited knowledge about how correct picture next of kin and staff have of the intensive care patient's experiences. The aim of this study was to compare intensive care patients' experiences of empowerment with next of kin and staff beliefs. Interviews with 11 intensive care patients, 12 next of kin and 12 staff were conducted and analysed using a content analysis method. The findings showed that the main content is quite similar between patient experiences, next of kin beliefs and staff beliefs, but a number of important differences were identified. Some of these differences were regarding how joy of life and the will to fight were generated, the character of relationships, teamwork, humour, hope and spiritual experiences. Staff and next of kin seemed to regard the patient as more unconscious than the patient him/herself did.
Tastan, Sevinc; Iyigun, Emine; Ayhan, Hatice; Kılıckaya, Oguz; Yılmaz, Ali Abbas; Kurt, Ercan
To evaluate the quality of care that is provided in intensive care units, needs and satisfaction of the patient relatives must also be considered. The aim of the study is to test the Turkish version of the Family Satisfaction in the Intensive Care Unit (FS-ICU-24) Survey, which was developed by Heyland et al. This study was planned and applied as a methodological study. Survey was conducted in the intensive care units of a military education and research hospital and a medical faculty hospital, department of anaesthesia and reanimation in the capital city Ankara of Turkey. Sample of the survey was composed of 120 participants. Cronbach's alpha value for the FS-ICU-24 general internal consistency in this study was calculated as 0.95 for total scale. In this study, the Turkish version of the FS-ICU-24 was found to be reliable and valid with Turkish population.
Comi, Richard J
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.
Hartmann, Michael; Knoth, Holger; Schulz, Diane; Knoth, Sven; Meier-Hellmann, Andreas
The purpose of this analysis of health economic studies in the field of intensive and critical care was to investigate whether any relationship could be established between type of sponsorship and (1) type of economic analysis, (2) health technology assessed, (3) sensitivity analysis performed, (4) publication status, and (5) qualitative cost assessment. Using the terms critical care or intensive care, all health economics publications in the field of critical and intensive care were identified in the Health Economic Evaluations Database (HEED, Version 1995-2001) on the basis of sponsorship and comparative studies. This search yielded a total of 42 eligible articles. Their evaluations were prepared independently by 2 investigators on the basis of specific criteria. When evaluators disagreed, a third investigator provided a deciding evaluation. There was no statistically demonstrable relationship between types of sponsorship and sensitivity analysis performed, publication status, types of economic analysis, or qualitative cost assessment.
Anirban Hom Choudhuri
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.
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.
Senanayake, H; Dias, T; Jayawardena, A
Maternal mortality reviews are used globally to assess the quality of health-care services. With the decline in the number of maternal deaths, it has become difficult to derive meaningful conclusions that could have an impact on quality of care using maternal mortality data. The emphasis has recently shifted to severe acute maternal morbidity (SAMM), as an adjunct to maternal mortality reviews. Due to its heterogeneity, there are difficulties in recognising SAMM. The problem of identifying SAMM accurately is the main issue in investigating them. However, admission to an intensive care unit (ICU) provides an unambiguous, management-based inclusion criterion for a SAMM. ICU data are available across health-care settings prospectively and retrospectively, making them a tool that could be studied readily. However, admission to the ICU depends on many factors, such as accessibility and the availability of high-dependency units, which will reduce the need for ICU admission. Thresholds for admission vary widely and are generally higher in facilities that handle a heavier workload. In addition, not all women with SAMM receive intensive care. However, women at the severe end of the spectrum of severe morbidity will almost invariably receive intensive care. Notwithstanding these limitations, the epidemiology of intensive care admissions in pregnancy will provide valuable data about women with severe morbidity. The overall rate of obstetric ICU admission varies from 0.04% to 4.54%.
Barth, Angélica Adam; Weigel, Bruna Dorfey; Dummer, Claus Dieter; Machado, Kelly Campara; Tisott, Taís Montagner
Objective To identify and stratify the main stressors for the relatives of patients admitted to the adult intensive care unit of a teaching hospital. Methods Cross-sectional descriptive study conducted with relatives of patients admitted to an intensive care unit from April to October 2014. The following materials were used: a questionnaire containing identification information and demographic data of the relatives, clinical data of the patients, and 25 stressors adapted from the Intensive Care Unit Environmental Stressor Scale. The degree of stress caused by each factor was determined on a scale of values from 1 to 4. The stressors were ranked based on the average score obtained. Results The main cause of admission to the intensive care unit was clinical in 36 (52.2%) cases. The main stressors were the patient being in a state of coma (3.15 ± 1.23), the patient being unable to speak (3.15 ± 1.20), and the reason for admission (3.00 ± 1.27). After removing the 27 (39.1%) coma patients from the analysis, the main stressors for the relatives were the reason for admission (2.75 ± 1.354), seeing the patient in the intensive care unit (2.51 ± 1.227), and the patient being unable to speak (2.50 ± 1.269). Conclusion Difficulties in communication and in the relationship with the patient admitted to the intensive care unit were identified as the main stressors by their relatives, with the state of coma being predominant. By contrast, the environment, work routines, and relationship between the relatives and intensive care unit team had the least impact as stressors. PMID:27737424
Johnson, Rebecca; Wirpsa, M Jeanne; Boyken, Lara; Sakumoto, Matthew; Handzo, George; Kho, Abel; Emanuel, Linda
Chaplaincy care is different for every patient; a growing challenge is to ensure that electronic health records function to support personalized care. While ICU health care teams have advanced clinical practice guidelines to identify and integrate relevant aspects of the patient's story into whole person care, recommendations for documentation are rare. This qualitative study of over 400 free-text EHR notes offers unique insight into current use of free-text documentation in ICU by six chaplains integrated into the healthcare team. Our research provides insight into the phenomena chaplains record in the electronic record. Content analysis shows recurrent report of patient and family practices, beliefs, coping mechanisms, concerns, emotional resources and needs, family and faith support, medical decision making and medical communications. These findings are important for health care team discussions of factors deemed essential to whole person care in ICUs, and, by extension have the potential to support the development of EHR designs that aim to advance personalized care.
Garg, Sunil Kumar
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.
Sunil Kumar Garg
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.
Full Text Available BACKGROUND: Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors. Recent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the different interventions that might be covered by the program, including neonatal intensive care. The purpose of this study was to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico. METHODS AND FINDINGS: A cost-effectiveness analysis was conducted using a decision analytic model of health and economic outcomes following preterm birth. Model parameters governing health outcomes were estimated from Mexican vital registration and hospital discharge databases, supplemented with meta-analyses and systematic reviews from the published literature. Costs were estimated on the basis of data provided by the Ministry of Health in Mexico and World Health Organization price lists, supplemented with published studies from other countries as needed. The model estimated changes in clinical outcomes, life expectancy, disability-free life expectancy, lifetime costs, disability-adjusted life years (DALYs, and incremental cost-effectiveness ratios (ICERs for neonatal intensive care compared to no intensive care. Uncertainty around the results was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. In the base-case analysis, neonatal intensive care for infants born at 24-26, 27-29, and 30-33 weeks gestational age prolonged life expectancy by 28, 43, and 34 years and averted 9, 15, and 12 DALYs, at incremental costs per infant of US$11,400, US$9,500, and US$3,000, respectively, compared to an alternative of no intensive care. The ICERs of neonatal intensive care at 24-26, 27-29, and 30-33 weeks were US$1,200, US$650, and US$240, per DALY averted, respectively. The findings were robust to variation in parameter values over wide ranges in
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
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
Full Text Available [english] 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 interestingConclusion: 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.
Hossfeld, B; Rohowsky, B; Rödig, E; Lampl, L
Due to the changed task spectrum of the German Federal Armed Forces with participation in international deployments for UN and NATO the concept of Aeromedical Evacuation (MedEvac) gained a new quality for the Air Force as well as for the Medical Corps. The transport of mostly severely injured or critically ill patients requires both, medical equipment which has to be permanently adapted to the national standard, and qualified intensive-care-personnel. At present, the aircrafts used for such deployments are four C-160 Transall, one CL-601 Challenger and two Airbus A310, which, if necessary, can be equipped with one or more intensive-care "patient transportation units" (PTU). Contrary to the two other aircrafts, the CL-601 Challenger is only equipped for the intensive-care transport of one individual patient. The PTU corresponds to the technical equipment of the intensive care unit of a level-1-trauma centre and ensures an intensive-care therapy on highest level also during longer transportation. The work with this equipment, the characteristics of the long-distance air transport and the special situation of the military deployment causes special demands on the qualifications of the assigned personnel. Primarily planned for the repatriation of injured or ill soldiers, in the mean time, this concept is also essential for the medevac of civilian victims after mass casualties worldwide.
Medical dominance is a recurring theme in sociological analyses of healthcare work. One example of a theoretical framework by which the medical profession is said to dominate other healthcare occupations is Turner's (1995: 138) enumeration of the modes of subordination, limitation and exclusion. As Elston (1991) has noted, however, such frameworks tend to be rather speculative and there is not a great deal of evidence on how these strategies are exercised, for example, at a micro-level. There is also a tendency to portray healthcare occupations as monolithic entities, without acknowledging differences within healthcare occupations, and the relationships between them, which can arise in different clinical locales. Through a micro-level analysis of the practice of intensive care, using ethnographic data collected on three intensive care units (ICUs) in England, this paper proposes a hitherto unidentified strategy -incorporation- for medical dominance at a micro-level. Paradoxically, an enhanced position for both intensive care medicine and intensive care nursing arises, relative to proximal healthcare groups. The argument of this paper is that within the ICU an occupational boundary (doctor-nurse) is obscured, while an organisational boundary which differentiates the ICU from the wider hospital is reinforced. Overall, the power relationship between medicine and nursing in intensive care is not 'zero-sum': the influence of both groups in the wider hospital is increased by this strategy of incorporation.
Browning, Annette M
Critical care nurses are often faced with working with families during the end-of-life care of a loved one. Often there is indecisiveness in family members of critically ill patients when faced with making these difficult decisions. The purpose of this manuscript is to describe origins of indecisiveness in family members of critically ill patients who are faced with end-of-life care decisions. Strategies to empower family members during this crucial time are also discussed.
Chang, Beverly; Lorenzo, Javier; Macario, Alex
As health care costs threaten the economic stability of American society, increasing pressures to focus on value-based health care have led to the development of protocols for fast-track cardiac surgery and for delirium management. Critical care services can be led by anesthesiologists with the goal of improving ICU outcomes and at the same time decreasing the rising cost of ICU medicine.
Verbiest, Sarah; McClain, Erin; Stuebe, Alison; Menard, M Kathryn
Objectives Our pilot study aimed to build knowledge of the postpartum health needs of mothers with infants in a newborn intensive care unit (NICU). Methods Between May 2008 and December 2009, a Certified Nurse Midwife was available during workday hours to provide health care services to mothers visiting their infants in the NICU at a large tertiary care center. Results A total of 424 health service encounters were recorded. Maternal requests for services covered a wide variety of needs, with primary care being the most common. Key health concerns included blood pressure monitoring, colds, coughs, sore throats, insomnia and migraines. Mothers also expressed a need for mental health assessment and support, obstetric care, treatment for sexually transmitted infections, tobacco cessation, breastfeeding assistance, postpartum visits, and provision of contraception. Conclusions Our study suggests that mothers with babies in the NICU have a host of health needs. We also found that women were receptive to receiving health services in a critical care pediatric setting. Intensive care nurseries could feasibly partner with in-patient mother-baby units and/or on-site obstetric clinics to increase access to health care for the mothers of the high-risk newborns in their units. Modifications should be made within health care systems that serve high-risk infants to better address the many needs of the mother/baby dyad in the postpartum period.
Full Text Available IntroductionThe extreme variability of clinical severity in medical admitted patients is diluted in a “average” standard of care, that may be stronger than the real needs for someone, but clearly inadequate, sometimes even dangerous, for other ones, critically ill.DiscussionThe model of a differentiated intensity of hospital care can be defined as the organizational model structured to areas/sectors dedicated to patients with homogeneous needs of care. The intermediate care unit (“High dependency units”, “sub-intensive care areas” – “high care units” are particularly suitable for patients who have a lower risk compared to patients treated in intensive care, but liable to develop complications and needing a close monitoring much more than the “standard”, “routine” care. The implementation of the a new organizational model must be careful and consider the possible enlargement errors that can be made. The analysis of the context is necessary for assess prerequisites, excluding the elements opposed to the success of the proposed model (i.e.: wards congestion and overcrowding, with a consequential with increased risk of adverse events. Before implementing and admitting patients in new “models”, we have to define the epidemiological population characteristics, their level of complexity/criticality/instability and the current assessment tools.ConclusionsAny new proposal of hospital management change has, as first obligation, to explicit the basic visions and primary goals for “the added value” resulting to the patient and the whole organization, with the evidence of an “health technology assessment” approach, for the professional hospital overall governance. But without the presumption, or worse, the apodictic assertion, to proclaim the implementation of structures with “differentiated intensity of hospital care” organizations that are not.
Sim, S K; Lim, S L; Lee, H K; Liew, D; Wong, A
Intensive care for severe head injury patients is very important in the prevention and treatment of secondary brain injury. However, in a resources constraint environment and limited availability of Intensive Care Unit (ICU) beds in the hospitals, not all severe head injury patients will receive ICU care. This prospective study is aimed to evaluate the outcome of severe head injured patients who received ICU and general ward care in Sarawak General Hospital (SGH) over a 6-month period. A total of thirty five severe head injury patients were admitted. Twenty three patients (65.7%) were ventilated in general ward whereas twelve patients (34.3%) were ventilated in ICU. Overall one month mortality in this study was 25.7%. Patients who received ICU care had a lower one month mortality than those who received general ward care (16.7% vs 30.4%), although it was not statistically different. Multivariate analysis revealed only GCS on admission (OR 0.731; 95% CI 0.460 to 0.877; P=0.042) as the independent predictive factor for one month mortality in this study.
Pinto, Márcia; Entringer, Aline Piovezan; Steffen, Ricardo; Trajman, Anete
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.
Pinto, Márcia; Entringer, Aline Piovezan; Steffen, Ricardo; Trajman, Anete
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. PMID:26785963
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.
Prier Lindvig, Katrine; Søgaard Teisner, Ane; Kjeldsen, Jens
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 current available data we developed an algorithm, to determine if a patient is candidate to intensive care if needed, based on three scoring systems: premorbid Child-Pugh Score, Model of End stage Liver Disease score and the liver specific Sequential Organ Failure Assessment score. CONCLUSION...
Birtan, D; Arslantas, M K; Dincer, P C; Altun, G T; Bilgili, B; Ucar, F B; Bozoklar, C A; Ayanoglu, H O
In this study, we examined the correspondence between intensive care unit physicians and the relatives of potential brain-dead donors regarding the decision to donate or the reasons for refusing organ donation. A total of 12 consecutive cases of potential brain-dead patients treated in intensive care units of Marmara University Pendik Education and Research Hospital in 2013 were evaluated. For each of the cases, the Potential Donor Questionnaire, and Family Notification, Brain Death Criteria Fulfilment and Organ Donation Conversation Questionnaires were used to collect the required data. Statistically, descriptive analyses were performed. We concluded that honestly, regularly, and sufficiently informed relatives of the potential brain-dead donor more readily donate organs, with a positive contribution from the intensive care physician.
Sérgio H. Loss
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.
Joilda Silva Nery
Full Text Available Social determinants can affect the transmission of leprosy and its progression to disease. Not much is known about the effectiveness of welfare and primary health care policies on the reduction of leprosy occurrence. The aim of this study is to evaluate the impact of the Brazilian cash transfer (Bolsa Família Program-BFP and primary health care (Family Health Program-FHP programs on new case detection rate of leprosy.We conducted the study with a mixed ecological design, a combination of an ecological multiple-group and time-trend design in the period 2004-2011 with the Brazilian municipalities as unit of analysis. The main independent variables were the BFP and FHP coverage at the municipal level and the outcome was new case detection rate of leprosy. Leprosy new cases, BFP and FHP coverage, population and other relevant socio-demographic covariates were obtained from national databases. We used fixed-effects negative binomial models for panel data adjusted for relevant socio-demographic covariates. A total of 1,358 municipalities were included in the analysis. In the studied period, while the municipal coverage of BFP and FHP increased, the new case detection rate of leprosy decreased. Leprosy new case detection rate was significantly reduced in municipalities with consolidated BFP coverage (Risk Ratio 0.79; 95% CI =0.74-0.83 and significantly increased in municipalities with FHP coverage in the medium (72-95% (Risk Ratio 1.05; 95% CI =1.02-1.09 and higher coverage tertiles (>95% (Risk Ratio 1.12; 95% CI =1.08-1.17.At the same time the Family Health Program had been effective in increasing the new case detection rate of leprosy in Brazil, the Bolsa Família Program was associated with a reduction of the new case detection rate of leprosy that we propose reflects a reduction in leprosy incidence.
Full Text Available ABSTRACT OBJECTIVE: The identification of parental needs in Neonatal Intensive Care Units is essential to design and implement family-centered care. This article aims to validate the Neonatal Intensive Care Units Family Needs Inventory for the Portuguese population, and to propose a Short Form. METHODS: A linguistic adaptation of the Neonatal Intensive Care Units Family Needs Inventory, a self-report scale with 56-items, was performed. The instrument was administered to 211 parents of infants hospitalized in all level III Neonatal Intensive Care Units in the North of Portugal, 15-22 days after admission (July of 2013-June of 2014. The number of items needed to achieve reliability close to 0.8 was calculated using by the Spearman-Brown formula. The global goodness of fit of the scale was evaluated using the comparative fit index. Construct validity was assessed through association of each dimension score with socio-demographic and obstetric characteristics. RESULTS: Exploratory factor analysis revealed two dimensions, one focused on parents' needs and another on the infant's needs. To compose the Short Form Inventory, items with ceiling effect were eliminated and 22 items were submitted to confirmatory analysis, which supported the existence of two dimensions (CFI = 0.925. The Short Form showed a high degree of reliability (alpha ≥ 0.76. Less educated and older parents more frequently attributed a significantly higher importance to parent-centered needs, while parents of multiples revealed a tendency to value infant-centered needs. CONCLUSIONS: The Short Form of the Neonatal Intensive Care Units Family Needs Inventory is a brief, simple, and valid instrument with a high degree of reliability. Further studies are needed to explore associations with practices of family-centered care.
Nyqvist, Kerstin Hedberg; Häggkvist, Anna-Pia; Hansen, Mette Ness
; and for external assessment to decide whether neonatal intensive/intermediate care units meet the conditions required to be designated as Baby-Friendly. The documents will be finalized after consultation with the World Health Organization/United Nations Children's Fund, and the goal is to offer these documents......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......-discharge care. The goal of the expert group is to create a final document, the Baby Friendly Hospital Initiative for Neonatal Units, including standards and criteria for each of the 3 Guiding Principles, Ten Steps, and the Code; to develop tools for self-appraisal and monitoring compliance with the guidelines...
de Mul, Marleen; Alons, Peter; van der Velde, Peter; Konings, Ilse; Bakker, Jan; Hazelzet, Jan
There are relatively few institutions that have developed clinical data warehouses, containing patient data from the point of care. Because of the various care practices, data types and definitions, and the perceived incompleteness of clinical information systems, the development of a clinical data warehouse is a challenge. In order to deal with managerial and clinical information needs, as well as educational and research aims that are important in the setting of a university hospital, Erasmus Medical Center Rotterdam, The Netherlands, developed a data warehouse incrementally. In this paper we report on the in-house development of an integral part of the data warehouse specifically for the intensive care units (ICU-DWH). It was modeled using Atos Origin Metadata Frame method. The paper describes the methodology, the development process and the content of the ICU-DWH, and discusses the need for (clinical) data warehouses in intensive care.
Full Text Available 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 partnership between clinical microbiologists and intensive care specialists, which is essential for this model of patient care have been emphasized. The article includes discussions on a variety of common clinical-microbiological problems faced in the ICUs such as ventilator-associated pneumonia, blood stream infections, skin and soft tissue infection, UTI, infection control, besides antibiotic management.
Hopkins, Ramona O; Mitchell, Lorie; Thomsen, George E; Schafer, Michele; Link, Maggie; Brown, Samuel M
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.
Papadimos, Thomas J; Maldonado, Yasdet; Tripathi, Ravi S; Kothari, Deven S; Rosenberg, Andrew L
The population of the earth is aging, and as medical techniques, pharmaceuticals, and devices push the boundaries of human physiological capabilities, more humans will go on to live longer. However, this prolonged existence may involve incapacities, particularly at the end-of-life, and especially in the intensive care unit. This arena involves not only patients and families, but also care givers. It involves topics from economics to existentialism, and surgery to spiritualism. It requires education, communication, acceptance of diversity, and an ultimate acquiescence to the inevitable. Here, we present a comprehensive overview of issues in the care of patients at the end-of-life stage that may cause physicians and other healthcare providers, medical, ethical, social, and philosophical concerns in the intensive care unit. PMID:22229139
Gomes Marília B
Full Text Available Abstract Background To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated. Methods This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years ( Results Overall, 18.4% patients had HbA1c levels Conclusions A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.
Latour, Jos M.; van Goudoever, Johannes B.; Duivenvoorden, Hugo J.; Albers, Marcel J. I. J.; van Dam, Nicolette A. M.; Dullaart, Eugenie; van Heerde, Marc; de Neef, Marjorie; Verlaat, Carin W. M.; van Vught, Elise M.; Hazelzet, Jan A.
To construct and test the reliability and validity of the EMpowerment of PArents in THe Intensive Care (EMPATHIC) questionnaire measuring parent satisfaction in the pediatric intensive care unit (PICU). Structured development and psychometric testing of a parent satisfaction-with-care instrument wit
Kollind, M; Wickbom, F; Wilkman, E
%) of patients, arterial pulse wave analysis in 11/171 (7%), and echocardiography in 50/171 (29%). CONCLUSION: In this survey, Ringer's solution and noradrenaline were the most common first-line treatments in shock. The use of starches and dopamine were rare. Almost all patients were monitored with invasive......BACKGROUND: Shock is common in intensive care units, and treatment includes fluids, vasopressor and/or inotropic drugs, guided by hemodynamic monitoring. The aim of this study was to identify current practice for treatment of shock in Scandinavian intensive care units. METHODS: Seven-day inception...
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-
Grom, I-U; Vagts, D A; Kampa, U; Pfeiffer, G; Schreiber-Winzig, L; Wiese, C H R
The accompaniment of people in the face of death offers insights into dimensions which are mostly not seen in ordinary life. These insights also exist in intensive care in German hospitals and are highly relevant in medical decision making. End-of-life decisions in particular often determine medical, cultural and spiritual aspects concerning medical treatment and therapeutic targets and if necessary new therapy targets. The following article especially illuminates cultural aspects and their characteristics in patients at the end of life in the intensive care unit.
Mang, H; Bauer, M
Since the G-DRG system was introduced in Germany in 2004, attempts have been made to model medical services performed in the intensive care units on a performance-oriented system by capitation. Based on this background the InEK, the institution which is responsible for design and development of the G-DRG system, has implemented several new issues into the version for 2007 which will be presented in this article. On the one hand the changes concerning the coding rules of diagnosis and procedures will be described and on the other hand important topics, such as "multimodal intensive care" or "complex treatment of patients with severe infections by multi-resistant pathogens", will be focused on. Furthermore, some new developments concerning the global functions ("complex procedures", "complex intensive treatment") as well as the changes in the coding rule for the demographic factor "mechanical ventilation" will be discussed. Finally, the regulations for additional remuneration are updated. In general, the attempts of the InEK to improve the G-DRG mapping for intensive care medicine are welcome and constructive. The regulations provided seem to be beneficial, but at the same time complicating the instructions. Hence, standardisation of intensive care medicine via diagnosis-related-groups still remains inadequate and therefore unsatisfactory in 2007.
Iedema, Rick; Sorensen, Ros; Braithwaite, Jeffrey; Turnbull, Elizabeth
This article addresses how professionals working in an intensive care unit in Australia speak about dying, with particular reference to the contradictions and complexities that characterize their work in this setting. The article reflects on the incommensurabilities in these clinicians' talk, and the consequences of this for how different professionals work together and care for extremely ill patients. Examples are drawn from talk recorded during ward rounds and focus groups. The article argues that intensive care units are settings where being reflexive about one's work and assumptions is especially difficult because it involves negotiating decisions and taking moral responsibility for decisions affecting very sick patients. These decisions and responsibilities put into sharp relief the 'wicked problems and tragic choices' of end-of-life existence and of intensive care in specific. This article shows some of the complex ways in which specific clinicians' discourse absorbs and manifests these tensions and responsibilities. The article concludes that these kinds of complexities are unlikely to be resolved with reference to formal knowledge or in-principle conviction, and that a new interactive basis needs to be found where clinicians can rehearse alternative ways of speaking with which to approach each other, the dying, and their families.
Krefft, Maciej; Zamaro-Michalska, Aleksandra; Zabołotny, Wojciech M.; Zaworski, Wojciech; Grzanka, Antoni; Łazowski, Tomasz; Tavola, Mario; Siewiera, Jacek; Mikaszewska-Sokolewicz, Małgorzata
This paper presents a recording system optimized for long term measurement of bed headrest elevation angle in the Intensive Care Unit. The continuous monitoring of this parameter allows to find the correlation between the patient's position in bed and the risk of the Ventilator Associated Pneumonia (VAP), a very serious problem in therapy of critically ill patients. Recorder might be be an important tool to evaluate the "care bundles" - sets of preventive procedures recommended for treatment of patients in the ICU.
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 ICBC clients’ SQOL. Methods Clients of three ICBC teams (N = 523) participated in the study. Upon intake, clients filled out a SQOL measure and indicated whether they had a good friend, partner, and c...
Rosana Alameda Varela
Full Text Available Nosocomial infection is one of the most common causes of adverse events and complications related to health care. Development of nosocomial infection is associated with an increase in hospital stay and mortality and an overall increase in health care costs. Knowing the incidence of nosocomial infection is an effective way of controlling and preventing it. Identifying the relationship between nursing workload and nosocomial infections in critical care may be helpful to adjust the staff to the real requirements of the intensive care unit and may help reducing costs. The aim of the present study is to analyze the influence of nursing workload in the development of nosocomial infections in patients admitted to an intensive care unit. A longitudinal correlational research will be performed. The sample will be comprised of the patients admitted in the intensive care unit of the Hospital Universitario Fundación Alcorcón.Data regarding sociodemographical variables, ventilador-associated pneumonia, intravascular catheter location and duration, urinary catheter type and duration, and all pertinent cultures will be obtained from the medical records. Nursing Activities Score scale will be used to assess daily nursing workload in the unit. The number of patients admitted daily, as well as the number of nursing professionals working in each shift will also be taken into account.
Walker, Lynne J
Parents of infants in the neonatal intensive care unit (NICU) experience one of the most stressful events of their lives. At times, they are unable to participate fully, if at all, in the care of their infant. Parents in the NICU have a need to participate in the care of their infant to attain the parental role. Parental reading to infants in the NICU is an intervention that can connect the parent and infant and offers a way for parents to participate in caregiving. This intervention may have many benefits and may positively affect the parent-infant relationship.
Mark, B A; Hagenmueller, A C
Nurse executives are experiencing severe pressures to create systems of care delivery that provide services in more cost-conscious ways. Before care systems can be restructured, a systematic assessment of the work and the environment of the nursing unit must take place. This study found significant differences among nine intensive care units regarding both the nature of their work and their environments. These differences provided information that can be used in staffing decisions, nurse/physician interaction, and staff nurse and managerial recruitment.
Ávila, Christiane Wahast; Riegel, Barbara; Pokorski, Simoni Chiarelli; Camey, Suzi; Silveira, Luana Claudia Jacoby; Rabelo-Silva, Eneida Rejane
Objective. To adapt and evaluate the psychometric properties of the Brazilian version of the SCHFI v 6.2. Methods. With the approval of the original author, we conducted a complete cross-cultural adaptation of the instrument (translation, synthesis, back translation, synthesis of back translation, expert committee review, and pretesting). The adapted version was named Brazilian version of the self-care of heart failure index v 6.2. The psychometric properties assessed were face validity and content validity (by expert committee review), construct validity (convergent validity and confirmatory factor analysis), and reliability. Results. Face validity and content validity were indicative of semantic, idiomatic, experimental, and conceptual equivalence. Convergent validity was demonstrated by a significant though moderate correlation (r = −0.51) on comparison with equivalent question scores of the previously validated Brazilian European heart failure self-care behavior scale. Confirmatory factor analysis supported the original three-factor model as having the best fit, although similar results were obtained for inadequate fit indices. The reliability of the instrument, as expressed by Cronbach's alpha, was 0.40, 0.82, and 0.93 for the self-care maintenance, self-care management, and self-care confidence scales, respectively. Conclusion. The SCHFI v 6.2 was successfully adapted for use in Brazil. Nevertheless, further studies should be carried out to improve its psychometric properties. PMID:24163765
Visser, Idse H. E.; Hazelzet, Jan A.; Albers, Marcel J. I. J.; Verlaat, Carin W. M.; Hogenbirk, Karin; van Woensel, Job B.; van Heerde, Marc; van Waardenburg, Dick A.; Jansen, Nicolaas J. G.; Steyerberg, Ewout W.
To validate paediatric index of mortality (PIM) and pediatric risk of mortality (PRISM) models within the overall population as well as in specific subgroups in pediatric intensive care units (PICUs). Variants of PIM and PRISM prediction models were compared with respect to calibration (agreement be
Afsarian, Mohammad H; Badali, Hamid; Boekhout, Teun; Shokohi, Tahereh; Katiraee, Farzad
Burn intensive care unit patients are specifically exposed to deep-seated nosocomial infections caused by Candida albicans. Superficial carriage of C. albicans is a potential source of infection and dissemination, and typing methods could be useful to trace the different isolates. Multilocus sequenc
Noritomi, Danilo Teixeira; Chierego, Marialuisa; Byl, Bauduin; Menestrina, Nicola; Carollo, Tiziana; Struelens, Marc; Vincent, Jean-Louis
The performance of hand disinfection by staff in a 31-bed department of intensive care was monitored. During 32 hours of observation, 727 opportunities for hand disinfection were observed, and the compliance rate was 27.9%. The level of work experience was not correlated with hand disinfection compliance rates.
Full Text Available Text treats parent's experiences and perceives and the significant of their newborn premature infants in the neonatal intensive care unit in the Ljubljana maternity hospital. Aim of health promotion, the significance of health education in health education counselling are presented. The purpose of this study was to introduction parent' s experiences and make an implementation in nursing practice. The advantage is represent by performing health education counselling for parents in intensive care unit permanently. Perceives of parents during living their newborn infant in neonatal intensive care unit are present on five concepts: perceive parents themselves, perceive their infant, perceive the staff and the intensive care setting and perceive their home setting. Results are showing statistic important differences between mothers and fathers at the time of deliver and at the time charging infant home. A questionare was used for collecting data. Process of development instrument is represent. Descriptive statistics and T-test was used for quantitative data analysed. Using method of internal consistent Chronbach alpha tested reliability of scales and mean differences in time are graf protrayed by 95% confident intervals. Results show statistical significant differences on all five concepts of parent's experiences. Methodological findings and reseaarch limitations are also present. Authoress positive evaluates the effect of health education counselling program and find out its positive effect on parent's critical thinking and contributes to quality assurance nursing.
Verhagen, A. A. Eduard; Dorscheidt, Jozef H. H. M.; Engels, Bernadette; Hubben, Joep H.; Sauer, Pieter J.
Objective: To clarify the practice of end-of-life decision making in severely ill newborns. Design: Retrospective descriptive study with face-to-face interviews. Setting: The 10 neonatal intensive care units in the Netherlands from October 2005 to September 2006. Patients: All 367 newborn infants wh
J.M. Latour (Jos); J.A. Hazelzet (Jan); H.J. Duivenvoorden (Hugo); J.B. van Goudoever (Hans)
textabstractPurpose: The aims of the study were (1) to identify parental satisfaction items through the opinions of pediatric intensive care unit (PICU) nurses and physicians, (2) to reach consensus on the identified items, and (3) to apply factor analysis to evaluate the items and domains toward a
Reese, Sara M; Thompson, Meredyth; Price, Connie S; Young, Heather L
Nosocomial respiratory infections cause significant morbidity and mortality, especially among the extremely susceptible neonatal population. Human rhinovirus C is a common viral respiratory illness that causes significant complications in children rhinovirus C in a level II-III neonatal intensive care unit in an urban public safety net hospital.
Boogaard, M.H.W.A. van den; Peters, S.A.; Hoeven, J.G. van der; Dagnelie, P.C.; Leffers, P.; Pickkers, P.; Schoonhoven, L.J.
INTRODUCTION: Predictive models, such as acute physiology and chronic health evaluation II (APACHE-II), are widely used in intensive care units (ICUs) to estimate mortality. Although the presence of delirium is associated with a higher mortality in ICU patients, delirium is not part of the APACHE-II
TIAN, ZM; MIRANDA, DR
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
van den Bemt, PMLA; Fijn, R; van der Voort, PHJ; Gossen, AA; Egberts, TCG; Brouwers, JRBJ
Objective., The study aimed to identify both the frequency and the determinants of drug administration errors in the intensive care unit. Design: Administration errors were detected by using the disguised-observation technique (observation of medication administrations by nurses, without revealing t
V. Hira (Vishal); M. Sluijter (Marcel); W.H.F. Goessens (Wil); A. Ott (Alewijn); R. de Groot (Ronald); P.W.M. Hermans (Peter); R.F. Kornelisse (René)
textabstractCoagulase-negative staphylococci (CoNS) are a major cause of sepsis in neonatal intensive care units (NICU) worldwide. Infecting strains of these commensal bacteria may originate from NICU personnel. Therefore, we studied the characteristics of CoNS isolates from NICU personnel and compa
Hira, V.; Sluijter, M.; Goessens, W.H.F.; Ott, A.; Groot, R. de; Hermans, P.W.M.; Kornelisse, R.F.
Coagulase-negative staphylococci (CoNS) are a major cause of sepsis in neonatal intensive care units (NICU) worldwide. Infecting strains of these commensal bacteria may originate from NICU personnel. Therefore, we studied the characteristics of CoNS isolates from NICU personnel and compared them to
Moreira, Ana Sofia Linhares; Afonso, Maria da Graça Alves; Dinis, Mónica Ribeiro dos Santos Alves; dos Santos, Maria Cristina Granja Teixeira
Objective To identify and evaluate the correct positioning of the most commonly used medical devices as visualized in thoracic radiograms of patients in the intensive care unit of our center. Methods A literature search was conducted for the criteria used to evaluate the correct positioning of medical devices on thoracic radiograms. All the thoracic radiograms performed in the intensive care unit of our center over an 18-month period were analyzed. All admissions in which at least one thoracic radiogram was performed in the intensive care unit and in which at least one medical device was identifiable in the thoracic radiogram were included. One radiogram per admission was selected for analysis. The radiograms were evaluated by an independent observer. Results Out of the 2,312 thoracic radiograms analyzed, 568 were included in this study. Several medical devices were identified, including monitoring leads, endotracheal and tracheostomy tubes, central venous catheters, pacemakers and prosthetic cardiac valves. Of the central venous catheters that were identified, 33.6% of the subclavian and 23.8% of the jugular were malpositioned. Of the endotracheal tubes, 19.9% were malpositioned, while all the tracheostomy tubes were correctly positioned. Conclusion Malpositioning of central venous catheters and endotracheal tubes is frequently identified in radiograms of patients in an intensive care unit. This is relevant because malpositioned devices may be related to adverse events. In future studies, an association between malpositioning and adverse events should be investigated. PMID:27737432
ter Maaten, JC; van Schijndel, RJM; Heimans, JJ; Schreuder, WO
Status epilepticus (SE) is a serious disease, associated with a high morbidity and mortality, particularly if refractory to initial therapy. We describe the clinical manifestations and outcome in ten cases with refractory SE admitted to our medical intensive care unit. Three of these selected group
M-A.C.J. de Letter
textabstractPatients with neuromuscular disorders encountered on the ICU can be divided into two main categories. One category has been admitted to the intensive care unit (ICU) due to an underlying neuromuscular disorder, mainly the Guillam Barre Syndrome ( GBS) and myasthenia gravis. The other cat
Iapichino, Gaetano; Corbella, Davide; Minelli, Cosetta; Mills, Gary H.; Artigas, Antonio; Edbooke, David L.; Pezzi, Angelo; Kesecioglu, Jozef; Patroniti, Nicol; Baras, Mario; Sprung, Charles L.
To identify factors influencing triage decisions and investigate whether admission to the intensive care unit (ICU) could reduce mortality compared with treatment on the ward. A multicentre cohort study in 11 university hospitals from seven countries, evaluating triage decisions and outcomes of pati
Olsen, Anne L; Reinholdt, Jes; Jensen, Anders Mørup
and 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...
Phipps, Marcy; Bush, Jeffrey A; Buhrow, Dianne; Tittle, Mary B; Singh, Deepak; Harcombe, Julianne; Riddle, Evanthia
Ileus development has been associated with a wide range of complications among hospitalized patients, ranging from increased patient pain and discomfort to malnutrition, aspiration, delayed rehabilitation, and sepsis. This article examines factors that appeared to correlate with an increase in ileus development among patients in a trauma/surgical intensive care unit, with the goal of preventing the condition through nursing practice changes.
Objectives: This study was done to determine the effect of malnutrition on mortality in Pediatric Intensive Care Unit (PICU) and on the pediatric risk of mortality (PRISM) scoring. Subjects and Methods: This was a prospective study done over 1 year. There were total 400 patients (1 month 14 years), who were divided into cases with weight for age
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).
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
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.
Waele, J. De; Lipman, J.; Sakr, Y.; Marshall, J.C.; Vanhems, P.; Barrera Groba, C.; Leone, M.; Vincent, J.L.; Pickkers, P.
BACKGROUND: Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point preva
Foghsgaard, Signe; Gazi, Dunia; Bach, Karen;
OBJECTIVE: Respiratory failure is a major complication after cardiac surgery. The purpose was to evaluate the impact of minimally invasive aortic valve replacement (mini AVR) on the occurrence of left lower lobe atelectasis (LLLA) in the cardiac intensive care unit (ICU). PATIENTS AND METHODS: 98...
Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF).
Schnell, David; Azoulay, Elie; Benoit, Dominique; Clouzeau, Benjamin; Demaret, Pierre; Ducassou, Stéphane; Frange, Pierre; Lafaurie, Matthieu; Legrand, Matthieu; Meert, Anne-Pascale; Mokart, Djamel; Naudin, Jérôme; Pene, Frédéric; Rabbat, Antoine; Raffoux, Emmanuel; Ribaud, Patricia; Richard, Jean-Christophe; Vincent, François; Zahar, Jean-Ralph; Darmon, Michael
Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis.
van Dommelen, P.; Mohangoo, A. D.; Verkerk, P. H.; van der Ploeg, C. P. B.; van Straaten, H. L. M.
Aim: To assess which infants' characteristics and specialized procedures are risk indicators for unilateral or bilateral hearing loss (HL) and to evaluate whether these risk indicators are associated with variation in prevalence of HL between Neonatal Intensive Care Units (NICUs). Methods: For 2002-
Miranda, D. Reis; Citerio, G.; Perner, A.; Dimopoulos, G.; Torres, A.; Hoes, A.; Beale, R.; De Smet, A. M.; Kesecioglu, J.
Background. Several studies have shown that the use of selective digestive tract decontamination (SDD) reduces mortality. However, fear for increasing multidrug resistance might prevent wide acceptance. A survey was performed among the units registered in the European Registry for Intensive Care (ER
Oostdijk, Evelien A. N.; Smits, Loek; de Smet, Anne Marie G. A.; Leverstein-van Hall, Maurine A.; Kesecioglu, Jozef; Bonten, Marc J. M.
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
Miranda, D. Reis; Citerio, G.; Perner, A.; Dimopoulos, G.; Torres, A.; Hoes, A.; Beale, R.; De Smet, A. M.; Kesecioglu, J.
Background. Several studies have shown that the use of selective digestive tract decontamination (SDD) reduces mortality. However, fear for increasing multidrug resistance might prevent wide acceptance. A survey was performed among the units registered in the European Registry for Intensive Care (ER
Ramsing, Benedicte Grenness Utke; Arpi, Magnus; Andersen, Erik Arthur;
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...
Brødsgaard, Anne; Larsen, Palle; Weis, Janne
REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify how parents of premature infants in neonatal intensive care units (NICUs) and nurses perceive their partnership.The review questions are: how do parents of premature infants and nurses perceive their partnership during hospita...
Hutchinson, Sharon W.; Spillet, Marydee A.; Cronin, Mary
Limited literature exists which examines how parents of infants hospitalized in the Neonatal Intensive Care Unit (NICU) transition from their infant's NICU hospital stay to home. This study examines the question, "What are the experiences of parents during their infant's transition from the NICU to home?" Grounded theory methods served as the…
Kittler, Phyllis M.; Brooks, Patricia J.; Rossi, Vanessa; Karmel, Bernard Z.; Gardner, Judith M.; Flory, Michael J.
Neonatal intensive-care unit (NICU) graduates, a group at risk for attention problems and attention-deficit hyperactivity disorder, performed an intradimensional shift card sort at 34, 42, 51, and 60 months to assess executive function and to examine effects of individual risk factors. In the "silly" game, children sorted cards…
Mannien J; Beaumont MTA; Geubbels ELPE; Wille JC; Boer AS de; deelnemers aan het PREZIES-project; Kwaliteitsinstituut voor de; CIE
In the period from July 1997 to December 2000, 19 hospitals collected data on 3,921 patients in the Intensive Care Unit (ICU) for 41,744 ICU patient-days. Of these patients 1,065 had developed 1,673 infections, including 684 with pneumonia, 354 with sepsis, 353 with urinary tract infections and 282
Geubbels ELPE; Mintjes-de Groot AJ; Boer AS de; Berg JMJ van den; CIE
De resultaten van het eerste jaar van gestandaardiseerde surveillance voor infecties op de Intensive Care (IC) in het PREZIES-project worden beschreven. De surveillance werd geimplementeerd in 22 ziekenhuizen, waarvan er 10 gegevens instuurden die verwerkt zijn in deze rapportage. Voorlopige ref
Kemper, P.F.; Bruijne, M. de; Dyck, C. van; So, K.L.; Tangkau, P.; Wagner, C.
Achtergrond: Er is een toenemende bewustwording dat onbedoelde zorg gerelateerde schade in de gezondheidszorg vaker voortvloeit uit problemen met niet-technische vaardigheden, dan door een gebrek in technische, of klinische, vaardigheden. Dit is vooral van belang in de Intensive Care (IC), waar comp
Kemper, P.F.; Bruijne, M. de; Dyck, C. van; So, R.L.; Tangkau, P.; Wagner, C.
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
van den Hoogen, A; Krediet, TG; Uiterwaal, CSPM; Bolenius, JFGA; Gerards, LJ; Fleer, A
Nosocomial sepsis remains an important cause of morbidity in neonatal intensive care units. Central venous catheters (CVCs) and parenteral nutrition (TPN) are major risk factors. In-line filters in the intravenous (IV) administration sets prevent the infusion of particles, which may reduce infectiou
A. Kröner; E. van Iperen; J. Horn; J.M. Binnekade; P.E. Spronk; J. Stoker; M.J. Schultz
Background. The clinical value of postoperative chest radiographs (CXRs) for surgical intensive care unit (ICU) patients is largely unknown. In the present study, we determined the diagnostic and therapeutic efficacy of postoperative CXRs for different surgical subgroups and related their efficacy t
Zwart, J.J.; Dupuis, J.R.O.; Richters, A.; Öry, F.; Roosmalen, J. van
Purpose: As part of a larger nationwide enquiry into severe maternal morbidity, our aim was to assess the incidence and possible risk factors of obstetric intensive care unit (ICU) admission in the Netherlands. Methods: In a 2-year nationwide prospective population-based cohort study, all ICU admiss
Delvaux, B.; Ryckwaert, Y.; Boven, van R.M.; Kock, M.; Capdevila, X.
SEDATION in the intensive care unit should be minimized to reduce the duration of mechanical ventilation and its related complications.1 The drug regimen would ideally allow rapid awakening, to perform neurologic and respiratory evaluation on a daily basis.2,3 In this context, remifentanil, with its
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.
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
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
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
M. van der Schaaf; A. Beelen; D.A. Dongelmans; M.B. Vroom; F. Nollet
Objective: To examine restrictions in daily functioning from a rehabilitation perspective in patients one year after discharge front the intensive care unit, and to identify prognostic factors for functional status. Design: Cross-sectional design. Patients: Consecutive patients who were admitted to
Ten Have, Elsbeth C. M.; Hagedoorn, Mariet; Holman, Nicole D.; Nap, Raoul E.; Sanderman, Robbert; Tulleken, Jaap E.
Purpose: Interdisciplinary rounds (IDRs) in the intensive care unit (ICU) are increasingly recommended to support quality improvement, but uncertainty exists about assessing the quality of IDRs. We developed, tested, and applied an instrument to assess the quality of IDRs in ICUs. Materials and Meth
Ho Jun Yi; Je Hoon Jeong; Eun-Sun Jin; Il Young Shin; Hyung Sik Hwang; Seung-Myung Moon
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.
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.
KHUENLBRADY, KS; REITSTATTER, B; SCHLAGER, A; SCHREITHOFER, D; LUGER, T; SEYR, M; MUTZ, N; AGOSTON, S
This study was performed to determine the optimum dose of pancuronium (n = 30) and pipecuronium (n = 30) under continuous sedation and analgesia in the intensive care unit (ICU). This was an open clinical investigation in 60 critically ill patients with head injury, multiple trauma (in some complica
Cremer, Olaf Lodewijk
The main goal of neurosurgical intensive care in comatose patients with head injuries is to prevent secondary neuronal damage resulting from ischemia and tissue hypoxia. In his thesis, Olaf Cremer critically examines the rationale and risk-to-benefit ratio of aggressive manipulation of blood pressur
Calder, P.C.; Jensen, G.L.; Koletzko, B.V.; Singer, P.; Wanten, G.J.A.
BACKGROUND: Energy deficit is a common and serious problem in intensive care units and is associated with increased rates of complications, length of stay, and mortality. Parenteral nutrition (PN), either alone or in combination with enteral nutrition, can improve nutrient delivery to critically ill
Nosocomial sepsis is a major cause of morbidity in the neonatal intensive care unit (NICU), with coagulase-negative staphylococci (CONS) generally reported to be the most frequent causative micro-organisms. There is substantial evidence for the association between CONS sepsis and indwelling intravas
Rolls, Kaye Denise; Hansen, Margaret; Jackson, Debra; Elliott, Doug
Social media platforms can create virtual communities, enabling healthcare professionals to network with a broad range of colleagues and facilitate knowledge exchange. In 2003, an Australian state health department established an intensive care mailing list to address the professional isolation experienced by senior intensive care nurses. This article describes the social network created within this virtual community by examining how the membership profile evolved from 2003 to 2009. A retrospective descriptive design was used. The data source was a deidentified member database. Since 2003, 1340 healthcare professionals subscribed to the virtual community with 78% of these (n = 1042) still members at the end of 2009. The membership profile has evolved from a single-state nurse-specific network to an Australia-wide multidisciplinary and multiorganizational intensive care network. The uptake and retention of membership by intensive care clinicians indicated that they appeared to value involvement in this virtual community. For healthcare organizations, a virtual community may be a communications option for minimizing professional and organizational barriers and promoting knowledge flow. Further research is, however, required to demonstrate a link between these broader social networks, enabling the exchange of knowledge and improved patient outcomes.
Full Text Available 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.