scholarly journals Bedside Pulse Oximeters with a Clinical Algorithm Make Economic Sense in the Intensive Care Unit

1996 ◽  
Vol 3 (1) ◽  
pp. 47-51
Author(s):  
David J Leasa ◽  
Jacqueline M Walker
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pulse Oximeter ◽  
Cost Savings ◽  
Clinical Algorithm ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Before And After ◽  
The Mean ◽  
Pulse Oximeters

OBJECTIVE:To determine the effect on arterial blood gas (ABG) and hospital resource use by introducing a strategy of using bedside oximeters with a clinical algorithm, based on the argument that bedside pulse oximeters make economic sense in the intensive care unit (ICU) if safe patient oxygenation can be ensured at a lower cost than that of existing monitoring options.DESIGN:A before and after design was used to examine the consequences of a pulse oximeter at each bedside in the ICU along with a pulse oximeter clinical algorithm (POCA) describing use for titrating oxygen therapy and for performing ABG analysis.SETTING:A 19-bed multidisciplinary ICU with a six-bed extended ICU (EICU) available to function as a 'step-down' facility.PATIENTS:All patients admitted to the ICU/EICU over two 12-month periods were included.RESULTS:The strategy yielded a 31% reduction in the mean number of ABGs per patient after POCA (20.0±26.1 versus 13.8±16.7, mean ± SD; P<0.001) as well as a potential annual cost savings of $32,831.CONCLUSIONS:Bedside oximeters within the ICU, when used with explicit guidelines, reduce ABG use and result in hospital cost savings.

Coronary Care in a General Hospital

1971 ◽  
Vol 16 (3) ◽  
pp. 173-182 ◽  
Author(s):  
Gavin Shaw ◽  
Bernard Groden ◽  
Evelyn Hastings
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
General Hospital ◽  
First Year ◽  
Duration Of Stay ◽  
Before And After ◽  
The Mean ◽  
Coronary Care ◽  
Made In

The establishment, staffing and structure and observations made in the first year of the existence of coronary care in an intensive care unit in a general hospital are recorded. Two hundred and twenty eight patients were admitted during the year in whom the diagnosis of myocardial infarction was confirmed. There were 29 deaths in the unit and 14 deaths occurred in the wards of the hospital after discharge from the unit. 49.1 per cent of the patients were admitted within 4 hours of the onset of symptoms and the mean duration of stay in the unit was 86.5 hours. The type of arrhythmia detected in the unit, and the treatment given to the patients both before and after admission to the intensive care unit are described.

scholarly journals Be cautious during the interpretation of arterial blood gas analysis performed outside the intensive care unit

2020 ◽  
Author(s):  
Lukasz Krzych ◽  
Olga Wojnarowicz ◽  
Paweł Ignacy ◽  
Julia Dorniak
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Point Of Care ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Acid Base Balance ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
The Impact

Introduction. Reliable results of an arterial blood gas (ABG) analysis are crucial for the implementation of appropriate diagnostics and therapy. We aimed to investigate the differences (Δ) between ABG parameters obtained from point-of-care testing (POCT) and central laboratory (CL) measurements, taking into account the turnaround time (TAT). Materials and methods. A number of 208 paired samples were collected from 54 intensive care unit (ICU) patients. Analyses were performed using Siemens RAPIDPoint 500 Blood Gas System on the samples just after blood retrieval at the ICU and after delivery to the CL. Results. The median TAT was 56 minutes (IQR 39-74). Differences were found for all ABG parameters. Median Δs for acid-base balance ere: ΔpH=0.006 (IQR –0.0070–0.0195), ΔBEef=–0.9 (IQR –2.0–0.4) and HCO3–act=–1.05 (IQR –2.25–0.35). For ventilatory parameters they were: ΔpO2=–8.3 mmHg (IQR –20.9–0.8) and ΔpCO2=–2.2 mmHg (IQR –4.2––0.4). For electrolytes balance the differences were: ΔNa+=1.55 mM/L (IQR 0.10–2.85), ΔK+=–0.120 mM/L (IQR –0.295–0.135) and ΔCl–=1.0 mM/L (IQR –1.0–3.0). Although the Δs might have caused misdiagnosis in 51 samples, Bland-Altman analysis revealed that only for pO2 the difference was of clinical significance (mean: –10.1 mmHg, ±1.96SD –58.5; +38.3). There was an important correlation between TAT and ΔpH (R=0.45, p<0.01) with the safest time delay for proper assessment being less than 39 minutes. Conclusions. Differences between POCT and CL results in ABG analysis may be clinically important and cause misdiagnosis, especially for pO2. POCT should be advised for ABG analysis due to the impact of TAT, which seems to be the most important for the analysis of pH.

Feasıbılıty of Transcutaneous Method for Carbon Dıoxıde Monıtorıng in an Intensive Care Unıt

2022 ◽  
Vol 18 ◽  
Author(s):  
Nazlıhan Boyacı ◽  
Sariyya Mammadova ◽  
Nurgül Naurizbay ◽  
Merve Güleryüz ◽  
Kamil İnci ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Partial Pressure ◽  
Blood Gas ◽  
Peripheral Oxygen Saturation ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Randomized Controlled Studies ◽  
Significant Difference

Background: Transcutaneous partial pressure of carbon dioxide (PtCO2) monitorization provides a continuous and non-invasive measurement of partial pressure of carbon dioxide (pCO2). In addition, peripheral oxygen saturation (SpO2) can also be measured and followed by this method. However, data regarding the correlation between PtCO2 and arterial pCO2 (PaCO2) measurements acquired from peripheric arterial blood gas is controversial. Objective: We aimed to determine the reliability of PtCO2 with PaCO2 based on its advantages, like non-invasiveness and continuous applicability. Methods: Thirty-five adult patients with hypercapnic respiratory failure admitted to our tertiary medical intensive care unit (ICU) were included. Then we compared PtCO2 and PaCO2 and both SpO2 measurements simultaneously. Thirty measurements from the deltoid zone and 26 measurements from the cheek zone were applied. Results: PtCO2 could not be measured from the deltoid region in 5 (14%) patients. SpO2 and pulse rate could not be detected at 8 (26.7%) of the deltoid zone measurements. Correlation coefficients between PtCO2 and PaCO2 from deltoid and the cheek region were r: 0,915 and r: 0,946 (p = 0,0001). In comparison with the Bland-Altman test, difference in deltoid measurements was -1,38 ± 1,18 mmHg (p = 0.252) and in cheek measurements it was -5,12 ± 0,92 mmHg (p = 0,0001). There was no statistically significant difference between SpO2 measurements in each region. Conclusion: Our results suggest that PtCO2 and SpO2 measurements from the deltoid region are reliable compared to the arterial blood gas analysis in hypercapnic ICU patients. More randomized controlled studies investigating the effects of different measurement areas, hemodynamic parameters, and hemoglobin levels are needed.

scholarly journals Reducing inappropriate arterial blood gas testing in a level III intensive care unit: a before-and-after observational study

2020 ◽  
Vol 22 (4) ◽  
pp. 370-377
Author(s):  
Oliver M Walsh ◽  
◽  
Katelyn Davis ◽  
Jonathan Gatward ◽  
◽  
...  
Keyword(s):  
Intensive Care ◽  
Clinical Guideline ◽  
Ventilatory Support ◽  
Clinical Indication ◽  
Blood Gas ◽  
Stable Patient ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Before And After ◽  
Mortality Ratio

Background: Arterial blood gas (ABG) analysis is the most frequently performed test in intensive care units (ICUs), often without a specific clinical indication. This is costly and contributes to iatrogenic anaemia. Objectives: To reduce the number of ABG tests performed and the proportion that are inappropriate. Design, setting and participants: The indications for ABG analysis were surveyed at a 58-bed level III ICU during fortnightly periods before and after a multifaceted educational intervention which included the introduction of a clinical guideline. The number of ABG tests performed during the period July–December 2017 was compared with that for the period July–December 2018. Tests were predefined as inappropriate if performed at regular time intervals, at change of shift, concurrently with other blood tests or after a treatment was ceased on a stable patient or after ventilatory support or oxygen delivery was decreased in an otherwise stable patient. The study was enrolled on the Quality Improvement Projects Register and ethics approval was waived by the local ethics committee. Results: There was a 31.3% bed-day adjusted decrease in number of ABG tests performed (33 005 v 22 408; P < 0.001), representing an annual saving of A$770 000 and 100 litres of blood. The proportion of inappropriate ABG tests decreased by 47.3% (54.2% v 28.6%; P < 0.001) and the number of inappropriate ABG tests per bed-day decreased by 71% (2.8 v 0.8; P < 0.001). Patient outcomes before and after the intervention did not differ (standardised mortality ratio, 0.65 v 0.63; P = 0.22). Conclusion: Staff education and implementation of a clinical guideline resulted in substantial decreases in the number of ABG tests performed and the proportion of inappropriate ABG tests.

scholarly journals Role of Arterial Blood Gas (ABG) as a valuable assessment tool of disease severity in SARS-CoV-2 patients

2021 ◽  
Author(s):  
Jyot Amrita
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Disease Severity ◽  
Negative Correlation ◽  
Assessment Tool ◽  
Ionized Calcium ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood

Summary   Background: COVID-19 is caused by a novel coronavirus, named severe acute respiratory syndrome coronavirus2 (SARS-CoV-2). The foremost predominant complication of SARS-CoV-2 is arterial hypoxemia thereby disturbing lung compliance, requiring mechanical ventilation. The aim of the current research study is to analyze role of ABG as a valuable assessment tool of disease severity in SARS-CoV-2 patients. Methods: 170 arterial blood samples were collected from patients admitted in Intensive Care Unit (ICU) of Sri Guru Ram Das Charitable Hospital, Amritsar. They were analyzed for arterial blood gas using ABG analyzer. Parameters of ABG such as pH, pCo2, HCO3, O2 saturation, ionized calcium (iCa) and calculated ionized calcium (at pH 7.4) was calculated for all the samples. Results: Continuous variables were described as medians with interquartile ranges (IQRs) and categorical variables as percentages and frequencies. Spearman correlation test was done for calculation of correlation between pH and other ABG parameters. Analysis of arterial blood gas revealed significant negative correlation (p<0.05) between pH and pCO2 and significant positive correlation (p<0.05) between pH and HCO3 and between pH and delta ionized calcium. Low levels (98.2%) of ionized calcium were observed while monitoring the ABG findings though weak negative correlation (p<0.05) was observed between pH and iCa. Conclusion: Our study suggests that ABG analysis acts as a momentous indicator for critically ill patients admitted in Intensive Care Unit (ICU). Estimation of iCa in this critical care setting acts as a distinctive biochemical feature of SARS-CoV-2 disease, as an initial assessment tool, for hypocalcemia. Keywords:  Arterial Blood Gas, SARS-CoV-2, Ionized Calcium, Hypocalcemia

Practice guideline for arterial blood gas measurement in the intensive care unit decreases numbers and increases appropriateness of tests

1997 ◽  
Vol 25 (8) ◽  
pp. 1308-1313 ◽  
Author(s):  
Chad S. Pilon ◽  
Mary Leathley ◽  
Rennie London ◽  
Shelley McLean ◽  
P. Terry Phang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Practice Guideline ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Gas Measurement

scholarly journals Safe Transitions Pathway for Postcraniotomy Neurological Surgery Patients: High-Value Care That Bypasses the Intensive Care Unit

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Jacob S Young ◽  
Andrew Kai-Hong Chan ◽  
Jennifer Viner ◽  
Sujatha Sankaran ◽  
Alvin Y Chan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Transitional Care ◽  
Cost Savings ◽  
Clinical Information ◽  
Fiscal Year ◽  
Net Revenue ◽  
The Mean ◽  
Neuroscience Intensive Care Unit ◽  
Neurological Surgery

Abstract INTRODUCTION High-value medical care is described as excellent outcomes, high patient satisfaction, and efficient costs. Neurosurgical care can be expensive for the hospital, as substantial costs are accrued during the operation and throughout the postoperative stay. At our institution, we implemented a “safe transitions pathway” where select patients would go to the transitional care unit (TCU) rather than the neuroscience intensive care unit (ICU) following a craniotomy. METHODS Patients who were enrolled during the fiscal year (FY) 2018 were included in the study. The electronic medical record was reviewed for clinical information and the hospital bill was reviewed for financial information. Nurses and patients were given a satisfaction survey to assess their respective impression of the hospital stay and recovery pathway RESULTS No patients who proceeded to the TCU post operatively were upgraded to ICU level of care overnight. There were no deaths in the STP patients and no patient required a return to the operating room during their hospitalization. There was a trend towards less 30-day readmissions in the STP patients than the standard pathway patients (1.2% vs 5.1%, P = .058). The mean number of ICU days saved per case was 1.20. The average post-procedure LOS was reduced by 0.25 d for STP patients. Actual FY18 direct cost savings from 94 patients who went through the Safe Transitions Pathway was $422 128. CONCLUSION Length of stay, direct charges, total costs, and ICU days were significantly decreased while net revenue was significantly increased by the adoption of a STP. There were no substantial complications or adverse patient outcomes.

Effectiveness of Breast Massage on Expression of Breast Milk among Mothers of Neonates admitted in Neonatal Intensive Care Unit

2016 ◽  
Vol 8 (1) ◽  
pp. 21-24 ◽  
Author(s):  
Lekha Viswanath ◽  
A Divya ◽  
Anju Philip
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Breast Milk ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Pain Scale ◽  
Breast Milk Expression ◽  
Breast Milk Production ◽  
Before And After ◽  
The Mean

ABSTRACT Massaging the breast may help a postnatal mother to improve breast milk production, alleviate breast engorgement and facilitate breast milk expression. The purpose of the present study was to identify the effect of breast massage on breast milk expression in terms of volume of breast milk expressed, pain during breast milk expression and experience of breast milk expression among mothers of neonates admitted in neonatal intensive care unit (NICU). Materials and methods The quasi-experimental study was conducted among 30 postnatal mothers whose babies were admitted in NICU, selected as a sample of convenience. The design used was time series research design. After the pretest, breast massage was taught to the mothers by the investigator. Breast massage was performed for 10 minutes prior to each expression. The practice of breast massage and breast milk expression is observed by the investigator using a checklist during the next expression. Volume of breast milk expressed and pain during breast milk expression were assessed three times before and after the intervention using a standardized measuring cup and numerical pain scale respectively. The experience of breast milk expression was assessed before and after intervention using breast milk expression experience measure. Analysis was done using mean, frequency, percentage and paired t-test. Major findings The results show that the mean pretest volume of milk expressed in milliliters was 7.33 ± 4.86, which increased to 15.56 ± 8.38 (t = 4.22, p = 0.001) after the intervention. The mean pretest pain score was 7.50 ± 1.42 which decreased to 5.01 ± 1.37 (t = 11.73, p = 0.001) after the intervention. The experience of breast milk expression in post-test 37.6 ± 3.88 was significantly higher than pretest 28.4 ± 4.73 (t = 11.25, p = 0.001). Conclusion The study findings conclude that the breast massage is effective in increasing the volume of expressed breast milk, reducing the pain during breast milk expression and improving the experience of breast milk expression. How to cite this article Divya A, Viswanath L, Philip A. Effectiveness of Breast Massage on Expression of Breast Milk among Mothers of Neonates Admitted in Neonatal Intensive Care Unit. J South Asian Feder Obst Gynae 2016;8(1):21-24.

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