Daily Interruption of Sedation with Physical and Occupational Therapy in Mechanically Ventilated Patients

2018 ◽  
pp. 309-316
Author(s):  
Michael Wolfe ◽  
Daniel Saddawi-Konefka
Keyword(s):  
Occupational Therapy ◽  
Functional Status ◽  
Intervention Group ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Icu Patients ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Schweickert et al. studied effects of early physical and occupational therapy in mechanically ventilated patients. 109 mechanically ventilated medical ICU patients (with independent functional status prior to hospitalization) were randomized to receive physical and occupational therapy initiated at time of enrollment (intervention group) vs. physical and occupational therapy ordered at the discretion of the primary team (control group), with both groups receiving daily interruptions of sedation. The primary outcome, independent functional status at time of discharge, was met in 59% of the intervention group vs. 35% of the control group (p = 0.02). Lower rates of ICU and hospital delirium were observed in the intervention group. Hospital length of stay and mortality were unaffected. This study demonstrated that physical and occupational therapy can be safely accomplished in critically ill, mechanically ventilated medical ICU patients, and that early implementation of therapy may improve return to independent functional status at hospital discharge.

scholarly journals Effects of nursing comfort care integrating with the daily Islamic rituals on comfort among mechanically ventilated Muslim patients: A randomized clinical trial

2021 ◽  
Author(s):  
Junaidy Suparman Rustam ◽  
Waraporn Kongsuwan ◽  
Luppana Kitrungrote
Keyword(s):  
Mechanical Ventilation ◽  
Intervention Group ◽  
Public Hospitals ◽  
Control Group ◽  
Comfort Care ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Significant Difference ◽  
Ventilated Patients ◽  
Islamic Rituals

Background & Aim: Most mechanically ventilated patients reported decreasing comfort during their treatments, especially in Muslim patients. Nursing comfort care needs to be addressed by integrating daily Islamic rituals to fulfill the spiritual need and promote holistic comfort of Muslim patients with mechanical ventilation. This study aimed to investigate the effect of nursing comfort care integrating with the daily Islamic rituals on comfort among mechanically ventilated Muslim patients. Methods & Materials: A pretest-postest with control group design was used. Fifty-six participants recruited from intensive care units of three public hospitals in Indonesia were randomly assigned into either the intervention group (n=28) or control group (n=28) by matching technique based on gender, age, and duration using a ventilator. Those in the intervention group received nursing comfort care developed based on Kolcaba’s Theory of Comfort integrating with the daily Islamic rituals, while those in the control group received usual care. Comfort was measured on the first day before receiving the intervention and on the second day after the intervention was completed by using Comfort Questionnaire for Mechanically Ventilated Patients (CQMVP). Results:  Data analysis using an independent t-test found no significant difference between the intervention and control groups at baseline (t = .134, p .894). The mean of comfort score of patients in the intervention group after receiving the intervention was significantly higher than those in the control group (t=6.70, p< .05).  Conclusion:  Nursing comfort care integrated with daily Islamic rituals increased comfort in Muslim patients while receiving mechanical ventilation. Thus, this nursing comfort care program can be recommended to use in practice.

scholarly journals Application of Modified Ventilator Bundle and Its Effect on Weaning and Ventilation Days among Critical Ill Patients

2021 ◽  
Vol 2 (4) ◽  
pp. 9
Author(s):  
Amany S. Eweas ◽  
Sahar Y. Mohammad ◽  
Jehan S. A. Sayyed ◽  
Marwa M. Abd Elbaky ◽  
Magda M. Bayoumi
Keyword(s):  
Statistical Significance ◽  
University Hospital ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Study Group ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilation Support ◽  
Ventilated Patients

Context: Modified ventilator bundle is the group of interventions supported by evidence to prevent ventilator-associated pneumonia and other related complications that commonly occurred in mechanically ventilated patients. Furthermore, it helps in reducing the mortality rates and hospital length of stay. Aim:  The current study aimed to apply a modified ventilator bundle and evaluate its effect on weaning and ventilation days among critically ill patients. Methods: A quasi-experimental research (study/control group) design was utilized. This study was conducted at the following critical care units (surgical, medical, and cardiac care units) affiliated to Bani Suief University Hospital in Bani Suief city, Egypt. A Purposive sample of 100 mechanically ventilated patients was divided into two groups. The study group included patients who received a modified ventilator bundle, while the control group included patients who received routine hospital nursing care. Data collection tools included two tools. The first tool is a patient assessment record, and the second tool is the weaning process assessment checklists using burns wean assessment program score. Results: 68.0% of the study group, compared with only (40.0%) of the control group, had a shorter duration of mechanical ventilation support between (4- 6) days with mean ± SD of 6.1 ± 1.6 and 7.3 ± 1.9, respectively after modified bundle implementation with statistical significance differences (p-value 0.005). The study group of patients obtained higher weaning scores than the control group according to burns weaning scores.   Conclusion: The study group demonstrated higher weaning scores and shorter ventilation support duration than the control group. Developing a simplified and comprehensive training associated with demonstrative booklet, including information about ventilator-associated pneumonia, components of modified ventilator bundle, and its importance for ventilated patients to improve nurses' knowledge and practice. Furthermore, replicating the current study on a larger probability sample from different geographical locations to generalize results.

scholarly journals Tracheostomy Practice in Mechanically Ventilated Patients With SARS-CoV-2 Induced Acute Respiratory Distress Syndrome: a Single-center Retrospective Study With Focus on Tracheomalacia

2021 ◽  
Author(s):  
Marcello Guarnieri ◽  
Patrizia Andreoni ◽  
Hedwige Gay ◽  
Riccardo Giudici ◽  
Maurizio Bottiroli ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Invasive Mechanical Ventilation ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Single Center ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Factors Associated ◽  
Ventilated Patients

Abstract Background: The SARS-CoV-2 pandemic increased the number of patients needing invasive mechanical ventilation, either through an endotracheal tube or through a tracheostomy. Tracheomalacia is a rare, but potentially severe complication of mechanical ventilation, which can significantly complicate the weaning process. Aim of this study was to describe the strategies of airway management in mechanically ventilated patients with respiratory failure due to SARS-CoV-2, the incidence of severe tracheomalacia, and investigate the factors associated with its occurrence.Methods. Retrospective, single-center study performed in an Italian teaching hospital. All adult patients admitted to the Intensive Care Unit (ICU) between February 24 and June 30, 2020, treated with invasive mechanical ventilation for respiratory failure caused by SARS-CoV-2 were included. Clinical data were collected on the day of ICU admission, while information regarding airway management was collected daily.Results. A total of 151 patients were included in the study. On admission, ARDS severity was mild in 21%, moderate in 62%, and severe in 17% of the cases, with an overall mortality of 39.7%. A tracheostomy was performed in 73 (48.3%) patients: open surgical technique in 54 patients (74%) and percutaneous Ciaglia technique in 19 patients (26%). Patients in whom a tracheostomy was performed had, compared to the other patients, a longer duration of mechanical ventilation and longer ICU and hospital length of stay. Tracheomalacia was diagnosed in 8 (5%) patients. The factors associated with tracheomalacia were female sex, obesity, and tracheostomy.Conclusions. In our population, approximately 50% of patients with ARDS due to SARS-CoV-2 were tracheostomized. Tracheostomized patients had a longer ICU and hospital length of stay. Five percent of our population was diagnosed with tracheomalacia. This percentage is 10 times higher than what is reported in available literature and the underlying mechanisms are not fully understood.

scholarly journals THE EFFECT OF GASTRIC GAS EMPTYING ON THE RESIDUAL GASTRIC VOLUME IN MECHANICALLY-VENTILATED INTENSIVE CARE UNIT PATIENTS FED THROUGH NASOGASTRIC TUBES: A RANDOMIZED, SINGLE-BLIND, CLINICAL TRIAL

2018 ◽  
Vol 11 (9) ◽  
pp. 492
Author(s):  
Ali Mohammadpour ◽  
Mousa Sajadi ◽  
Somayyeh Maghami ◽  
Hossein Soltani
Keyword(s):  
Clinical Trial ◽  
Gastric Volume ◽  
Control Group ◽  
Case Group ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Residual Gastric Volume ◽  
Nasogastric Tubes ◽  
Single Blind ◽  
Ventilated Patients

Objective: Increased gastric residual volume is a complication of enteral nutrition intolerance that leads to gastrointestinal complications such as nausea, vomiting, and aspiration pneumonia. The present study was conducted to determine the effect of gastric gas emptying on the residual gastric volume in mechanically-ventilated patients fed through nasogastric tubes.Methods: This randomized, single-blind, clinical trial was conducted on two groups of patients in the intensive care unit (ICU) of Kamyab Hospital of Mashhad. A total of 64 patients were randomly divided into a case and a control group. In the case group, the gastric gases accumulated through the nasogastric tube were emptied by applying palm pressure on the epigastric region. The control group did not undergo this intervention but received the routine care provided in the ward. Data were collected using a demographic questionnaire and a form containing records of the patients’ residual gastric volume and disease-related information. The residual gastric volume was measured and compared in the two groups before and after the intervention. Data were analyzed in SPSS-19 using the Chi-square test, the independent t-test, and the repeated measures ANOVA at the significance level of 5%.Results: The residual gastric volume did not differ significantly between the two groups before the intervention (p=0.14); after the intervention; however, a significant reduction was observed in the case group compared to the controls (p=0.007).Conclusion: Gastric gas emptying helps reduce the residual gastric volume in mechanically-ventilated patients fed through nasogastric tubes. Further studies are recommended to further ensure the benefits of this method.

scholarly journals A Implementation of Antibiotic Prophylaxis Program for Cesarean Section at Thai Nguyen National Hospital

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Nguyen Thi Thu Thuy ◽  
Nguyem Thanh Hai ◽  
Nguyem Xuan Bach ◽  
Hoang Thi Thu Huong ◽  
Nguyem Chi Cuong ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Antibiotic Prophylaxis ◽  
Intervention Group ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Viet Nam ◽  
National Hospital ◽  
Ministry Of Health

This study aims to evaluate the effectiveness of the use of antibiotic prophylaxis in cesarean section at Thai Nguyen National Hospital as a first pilot activity of a surgical prophylaxis program. In the study, a randomized controlled trial was designed with two groups: intervention group and control group. Patients characteristics and effectiveness of prophylactic antibiotics for caesarean section were compared. The study results show that the patients’ ages ranged from 18 to 44 years; most of the patients had ASA score of 1; and mean hospital length of stay was statistically significant between the two groups (p<0.05). Regarding the indication of caesarean section, the reason of genital tract abnormalities accounted for the highest proportion. The percentage of the patients switching from prophylactic antibiotic regimens to therapeutic antibiotics in the intervention group was 2%. There was no patient with superficial and/or deep incisional surgical site infections in both groups. The difference in mean number of injections in the two groups was statistically significant (p<0.05). The average cost of antibiotics for each patient in the intervention group and control group were 267.720 VND and 543.871 VND, respectively. The study concludes that the effectiveness of antibiotics prophylaxis for caesarean section: 99% of the patients were without wound infection; hospital length of stay in the intervention group was shorter than the control group; and using prophylactic antibiotics was not only more economical but could also reduce the workload of medical staff, costs of antibiotics and medical supplies. Keywords  Antibiotics prophylaxis, caesarean section, Thai Nguyen National Hospital. References [1] Viet Nam Ministry of Health, National guideline on prevention of surgical site infection, issued with Decision No. 3671/QD-BYT, September 27, 2012 of Viet Nam Ministry of Health, Ha Noi, 2012 (in Vietnamese).[2] Viet Nam Ministry of Health, National guideline on antibiotics use, issued with Decision No.708/QD-BYT, March 2, 2015 of Viet Nam Ministry of Health, Ha Noi, 2015 (in Vietnamese).[3] D.W. Bratzler, K.M. Olsen, et al., Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery, American Journal of Health-System Pharmacy 70 (2013) 195 – 283. https://doi.org/10.2146/ajhp120568.[4] R.F. Lamont, J.D. Sobel, et al., Current debate on the use of antibiotic prophylaxis for caesarean section, BJOG: An International Journal of Obstetrics & Gynaecology 118 (2011) 193-201. https://doi.org/10.1111/j.14710528.2010.02729.x.[5] T.V. Khai, Infection rate of surgical incisions and associated factors on women after cesarean section at Dong Nai General Hospital, Scientific Research Project of Dong Nai Hospital, 2015 (in Vietnamese).[6] N.H. Tuan, Study on the use of cefazolin to prevent infection after cesarean section or uterine fibroids surgery at the Institute of maternal and neonatal protection, Master’s thesis, Hanoi University of Pharmacy, 2002 (in Vietnamese).[7] F.M. Smaill, R.M. Grivell, Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section, Cochrane Database Syst Rev 10 (2014) CD007482. https://doi.org/10.1002/14651858.cd007482.pub3.    

scholarly journals Effectiveness of Communication Board on Level of Satisfaction Over Communication among Mechanically Venitlated Patients

2020 ◽  
Vol 5 (9) ◽  
pp. 311-316
Author(s):  
Dr. Metilda ◽  
Dr. A. Jaganath
Keyword(s):  
Mechanical Ventilation ◽  
Control Group ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Level Of Satisfaction ◽  
Significant Difference ◽  
Group 15 ◽  
Experimental Group ◽  
Ventilated Patients ◽  
Communication Board

Mechanical ventilation is widely used to treat patients with critical conditions. This treatment is usually applied for difficulty in breathing. The use of mechanical ventilation devices has unique benefits to the patient. However, it can also cause various problems. Reduction in communication rank as one of the most negative experiences in mechanically ventilated patients. Effective communication with ventilator-based patients is essential. Nursing management of a mechanically ventilated patient is challenging on many levels, requiring a wealth of high technical skills. The Patient Communications Board improves communication, maintains information and creates a comfortable, attractive setting for patient, family and health care workers. The research methodology used for the study is a Quasi experimental approach, post-test only design with a comparison group to assess the effect of the communication board on the level of satisfaction over communication among clients on mechanical ventilator. The sample was selected by purposive sampling technique and included 30 (experimental group-15, control group-15), mechanically ventilated patients in PESIMR hospital, Kuppam. The control group patients were provided with routine communication methods, while the experimental group were communicated with communication board. The level of satisfaction on communication was assessed by a 15items rating scale. Data was analysed using both the descriptive and inferential statistics. There was a significant difference in the level of satisfaction on communication among the patients who were communicated using communication board compared to the routine method of communication. The communication board had significantly improved the communication pattern and increased the satisfaction among the patients who are mechanically ventilated.

Physical and Occupational Therapy in the ICU

2014 ◽  
Author(s):  
William D Schweickert ◽  
John P Kress
Keyword(s):  
Occupational Therapy ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Respiratory Therapists ◽  
Underlying Illness ◽  
Time Periods ◽  
Icu Delirium ◽  
Therapy Team ◽  
Icu Acquired Weakness ◽  
Ventilated Patients

Mechanically ventilated patients in the ICU are commonly immobilized for prolonged time periods due to factors that include the underlying illness, encephalopathy, or sedation. In this setting, severe ICU-acquired weakness is common and may represent both a cause and consequence of immobilization. Physical and occupational therapy is feasible in ICU patients, even very early during mechanical ventilation. This intervention requires a coordinated effort between physicians, nurses, respiratory therapists, and the physical/occupational therapy team. Early physical and occupational therapy can lead to improved strength and functional status, reduced ventilator days and length of stay, and fewer days of ICU delirium.

scholarly journals Effects of ABCDE Bundle Implementation on Reduction of Delirium among Mechanically Ventilated Patients at Damietta Hospital, Egypt

2021 ◽  
pp. 1-14
Author(s):  
Khalil NS ◽  
El-Kady EM ◽  
Abdel-kader FA ◽  
EL-shafey MM
Keyword(s):  
Mechanical Ventilation ◽  
Prolonged Mechanical Ventilation ◽  
Hospital Length Of Stay ◽  
P Value ◽  
Post Intervention ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Early Exercise ◽  
Abcde Bundle ◽  
Ventilated Patients

Background: One of the principal complications in intensive care unit particularly those connected to mechanical ventilation is delirium. Delirium. It is associated with increased mortality, prolonged mechanical ventilation, and prolonged hospital length of stay (LOS). The ABCDE is a bundle intervention that stands for awakening, breathing coordination, delirium monitoring/management, and early exercise/mobility bundle that has been proposed as a multi-component intervention to reduce the incidence of delirium. Aim of the study: This study aimed to evaluate the effect of implementing the ABCDE bundle on the reduction of delirium among mechanically ventilated patients at Damietta hospital. Material and Methods: A quasi-experimental pre/post-intervention design was used to conduct this study. A purposive sample of 65 adult male and female mechanically ventilated patients aged between 18 and 60 years was recruited. Sedation and Delirium instruments measures were utilized in data collection. Result: significant differences were found in delirium scores among the studied patients (x2= 52.52; p-value=0.001). So, the mechanically ventilated patients who exposed to the implementation of the ABCDE bundle were experienced fewer delirium signs than before the ABCDE bundle implementation. Conclusion: Based on the findings of the current study, it can be concluded ABCDE bundle implementation reduced the occurrence of delirium among mechanically ventilated patients. Recommendations: ABCDE bundle should be recommended on mechanically ventilated patients. Keywords: ABCDE bundle; Mechanically Ventilated Patients; Critically Ill Patients

Efficacy and Safety of a Paired Sedation and Ventilator Weaning Protocol for Mechanically Ventilated Patients in Intensive Care

2018 ◽  
pp. 27-32
Author(s):  
Jeffery Katz ◽  
Steve Greenberg
Keyword(s):  
Intensive Care ◽  
Intervention Group ◽  
Ventilator Weaning ◽  
Control Group ◽  
Mechanical Ventilator ◽  
Efficacy And Safety ◽  
Icu Patients ◽  
Mechanically Ventilated ◽  
Improved Outcomes ◽  
Spontaneous Breathing Trials

The chapter entitled examines the efficacy of pairing daily sedation awakening trials (SAT) with daily spontaneous breathing trials (SBT) in intensive care unit (ICU) patients on a mechanical ventilator. Three-hundred thirty-six ICU patients requiring mechanical ventilation for > 12 hours and eligible for a ventilator weaning trial were included. The authors compared the number of ventilator-free days in patients who received an SBT alone versus an SAT + SBT. Patients in the intervention group (SAT + SBT) spent a mean of 3.1 more days liberated from the ventilator when compared to the control group. Medical ICU patients undergoing paired SAT + SBT may experience improved outcomes versus those with SBT alone.

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