Airway management in critically ill patients. From International Studies to Clinical Practice – A summary from an EAMS webinar

Critically ill patients in the intensive care unit (ICU) have a high risk of developing malnutrition, and this is associated with poorer clinical outcomes. In clinical practice, nutrition, including enteral nutrition (EN), is often not prioritized. Resulting from this, risks and safety issues for patients and healthcare professionals can emerge. The aim of this literature review, inspired by the Rapid Review Guidebook by Dobbins, 2017, was to identify risks and safety issues for patient safety in the management of EN in critically ill patients in the ICU. Three databases were used to identify studies between 2009 and 2020. We assessed 3495 studies for eligibility and included 62 in our narrative synthesis. Several risks and problems were identified: No use of clinical assessment or screening nutrition assessment, inadequate tube management, missing energy target, missing a nutritionist, bad hygiene and handling, wrong time management and speed, nutritional interruptions, wrong body position, gastrointestinal complication and infections, missing or not using guidelines, understaffing, and lack of education. Raising awareness of these risks is a central aspect in patient safety in ICU. Clinical experts can use a checklist with 12 identified top risks and the recommendations drawn up to carry out their own risk analysis in clinical practice.

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Good clinical practice for the use of vasopressor and inotropic drugs in critically ill patients: state-of-the-art and expert consensus

Minerva Anestesiologica ◽

10.23736/s0375-9393.20.14866-1 ◽

2021 ◽

Vol 87 (6) ◽

Author(s):

Andrea CARSETTI ◽

Elena BIGNAMI ◽

Andrea CORTEGIANI ◽

Katia DONADELLO ◽

Abele DONATI ◽

...

Keyword(s):

Clinical Practice ◽

Critically Ill ◽

Critically Ill Patients ◽

State Of The Art ◽

Good Clinical Practice ◽

Expert Consensus ◽

Inotropic Drugs

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Music therapy in critical care: indications and guidelines for intervention

Critical Care Nurse ◽

10.4037/ccn1999.19.3.35 ◽

1999 ◽

Vol 19 (3) ◽

pp. 35-41 ◽

Cited By ~ 37

Author(s):

L Chlan ◽

MF Tracy

Keyword(s):

Critical Care ◽

Clinical Practice ◽

Music Therapy ◽

Stress Management ◽

Critically Ill ◽

Critically Ill Patients ◽

Anxiety Reduction ◽

Music Listening ◽

Sense Of Control ◽

Music Selection

Music therapy is an effective intervention for critically ill patients for such purposes as anxiety reduction and stress management. The therapy is readily accepted by patients and is an intervention patients thoroughly enjoy. The MAIT is one resource that nurses caring for critically ill patients can use to implement music therapy in clinical practice. Patients can be given the opportunity to select a musical tape they prefer and to negotiate with the nurse for uninterrupted music-listening periods. Allowing patients control over music selection and providing uninterrupted time for music listening gives the patients an enhanced sense of control in an environment that often controls them.

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Serum Albumin Levels: Who Needs Them?

Annals of Pharmacotherapy ◽

10.1177/1060028020959348 ◽

2020 ◽

pp. 106002802095934 ◽

Cited By ~ 1

Author(s):

Brian L. Erstad

Keyword(s):

Clinical Practice ◽

Serum Albumin ◽

Critically Ill ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Critically Ill Patients ◽

Severity Of Illness ◽

Current Clinical Practice ◽

Albumin Administration ◽

Nutritional Monitoring

Objectives The purpose of this critical narrative review is to discuss common indications for ordering serum albumin levels in adult critically ill patients, evaluate the literature supporting these indications, and provide recommendations for the appropriate ordering of serum albumin levels. Data Sources PubMed (1966 to August 2020), Cochrane Library, and current clinical practice guidelines were used, and bibliographies of retrieved articles were searched for additional articles. Study Selection and Data Extraction Current clinical practice guidelines were the preferred source of recommendations regarding serum albumin levels for guiding albumin administration and for nutritional monitoring. When current comprehensive reviews were available, they served as a baseline information with supplementation by subsequent studies. Data Synthesis Serum albumin is a general marker of severity of illness, and hypoalbuminemia is associated with poor patient outcome, but albumin is an acute phase protein, so levels vacillate in critically ill patients in conjunction with illness fluctuations. The most common reasons for ordering serum albumin levels in intensive care unit (ICU) settings are to guide albumin administration, to estimate free phenytoin or calcium levels, for nutritional monitoring, and for severity-of-illness assessment. Relevance to Patient Care and Clinical Practice Because hypoalbuminemia is common in the ICU setting, inappropriate ordering of serum albumin levels may lead to unnecessary albumin administration or excessive macronutrient administration in nutritional regimens, leading to possible adverse effects and added costs. Conclusions With the exception of the need to order serum albumin levels as a component of selected severity-of-illness scoring systems, there is little evidence or justification for routinely ordering levels in critically ill patients.

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Airway Management in Critically Ill Patients

CHEST Journal ◽

10.1378/chest.07-0624 ◽

2007 ◽

Vol 132 (5) ◽

pp. 1714

Author(s):

Ali Al-Khafaji ◽

Su Min Cho

Keyword(s):

Airway Management ◽

Critically Ill ◽

Critically Ill Patients

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Airway management in critically sick in intensive care

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v22i1.1194 ◽

2020 ◽

Author(s):

S. K. Malhotra ◽

Komal Gandhi

Keyword(s):

Intensive Care ◽

Airway Management ◽

Difficult Airway ◽

Critically Ill ◽

Critically Ill Patients ◽

Operation Theatre ◽

Physiological Reserve ◽

Airway Equipment ◽

One Airway ◽

Airway Devices

In critically ill patients in Intensive Care Unit (ICU), patency of airway and managementof difficult airway are of utmost importance. The incidence of difficult intubation maybe 10% to 22% depending on the various factors in patient as well as availability ofequipment facilities. As compared to the regular surgery in operation theatre, themanagement of airway in critically ill patients is considerably different and morechallenging. The physiological reserve and co-morbidities are more common in criticallyill patients. In ICU, recent techniques of airway management must be considered andpracticed, such as videolaryngoscope (VLS), fiberoptic bronchoscope and supraglotticdevices. The success for airway management would be greater if airway expert, therequired devices and an adequate protocol are available. The outcome of managingairway would be enhanced if best use of available airway devices in a particular hospitalsetup since every instrument may not be available. The standard guidelines for difficultairway and the protocol of individual hospital may reduce the complications; hencemust be followed. The availability of difficult airway cart and capnograph is a must. Theindications and timing of surgical airway must be clear to the airway team. The Trainingcourses for the staff in ICU should be held regularly to apprise them of advancementin airway management. The best use of available airway equipment should be made incritically ill patients. At least, one airway expert must be accessible in ICU at any giventime. Received: 12 Sep 2018Reviewed: 5 Oct 2018Accepted: 10 Oct 2018 Citation: Malhotra SK, Gandhi K. Airway management in critically sick in intensive care. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S21-S28

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