Practised sedation in mechanically ventilated patients: A survey of nurses’ perceptions

2020 ◽  
Vol 40 (2) ◽  
pp. 105-112
Author(s):  
Vivian Nystrøm ◽  
Brita Fosser Olsen ◽  
Idunn Brekke
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Infusion ◽  
Assessment Tool ◽  
Scoring Systems ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Mechanically Ventilated ◽  
Nurses Perceptions ◽  
Light Sedation

Recent clinical practice guidelines recommend analgosedation in intensive care unit patients, where the patients' pain first is relieved, followed by sedatives only on indication. The aims of the present study was to examine sedation practice today, to evaluate the degree to which there is a difference in sedation practice between units, and to investigate the associations between nurses' demographic characteristics and their perception of sedation practice. A cross sectional survey was conducted to the nurses in three intensive care units in Norway. The results indicated that light sedation was implemented in the three intensive care unit studied. Continuous infusion of propofol and dexmedetomidine were used most frequently, and continuous infusion of midazolam was used occasionally. However, the sedation practices varied significantly between the units. Subjective scoring systems, physician's prescriptions, and prescription follow-up were reported to be most frequently used as guidelines and directives, and Richmond Agitation–Sedation Scale was reported to be the most frequently used sedation assessment tool.

scholarly journals Adverse Drug Events in Intensive Care Units: A Cross-Sectional Study of Prevalence and Risk Factors

2011 ◽  
Vol 20 (6) ◽  
pp. e131-e140 ◽  
Author(s):  
Simon Seynaeve ◽  
Walter Verbrugghe ◽  
Brigitte Claes ◽  
Dirk Vandenplas ◽  
Dirk Reyntiens ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Drug Events ◽  
Severity Of Illness ◽  
Scoring Systems ◽  
Data Management System ◽  
Nursing Workload ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
The Impact

Background Adverse drug events are considered determinants of patient safety and quality of care. Objective To assess the characteristics of adverse drug events in patients admitted to an intensive care unit and determine the impact of severity of illness and nursing workload on the prevalence of the events. Methods A cross-sectional survey based on retrospective analysis of a high-quality patient data management system for a university-based intensive care unit was used. The prevalence of adverse drug events was measured by using a validated global trigger tool adapted for the critical care environment. Severity was determined by using a validated algorithm. Disease severity and nursing workload were assessed by using validated scoring systems. An investigator blinded to the study and a panel of experts assessed putative serious adverse drug events for each drug taken. Characteristics of patients with and without adverse drug events were compared by using univariate and stepwise multivariate logistic regression. Results During 175 of 1009 intensive care unit days screened, 230 adverse drug events occurred in 79 patients. The most common events were hypoglycemia, prolonged activated partial thromboplastin time, and hypokalemia. Of the adverse events, 96% were classified as causing temporary harm and 4% as causing complications. Both mean severity of disease and nursing workload were significantly higher on days when 1 or more adverse drug events occurred. Conclusion Adverse drug events were common in intensive care unit patients and were associated with illness severity and nursing workload.

scholarly journals Current Physical Therapy Practice in the Intensive Care Unit in Saudi Arabia: A Multicentre Cross-Sectional Survey

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Mazen Alqahtani ◽  
Faizan Kashoo ◽  
Msaad Alzhrani ◽  
Fuzail Ahmad ◽  
Mohammed K. Seyam ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Saudi Arabia ◽  
Intensive Care ◽  
Physical Therapy ◽  
Research Literature ◽  
Current Status ◽  
Current Standard ◽  
Positive Health ◽  
Cross Sectional Survey ◽  
Cross Sectional

Background. Early mobilisation of patients in the intensive care unit (ICU) is associated with positive health benefits. Research literature lacks insight into the current status of ICU physical therapy (PT) practice in the Kingdom of Saudi Arabia. Aim. To determine the current standard of ICU PT practice, attitude, and barriers. Methods. A questionnaire was e-mailed to physiotherapists (PTs) working in the hospital. The questions pertained to experience, qualification, barriers, and most frequently encountered case scenarios in the ICU. Results. The response rate was 28.1% (124/442). Frequent cases referred to the PTs were traumatic paraplegia (n = 111, 89%) and stroke (n = 102, 82.3%) as compared to congestive heart failure (n = 20, 16.1%) and pulmonary infections (n = 7, 5.6%). The preferred treatment of choice among PTs was chest physiotherapy (n = 102, 82.2%) and positioning (n = 73, 58.8%), whereas functional electrical stimulation (n = 12, 9.6%) was least preferred irrespective of the condition. Perceived barriers in the ICU PT management were of low confidence in managing cases (n = 89, 71.7%) followed by inadequate training (n = 53, 42.7%), and the least quoted barrier was a communication gap between the critical care team members (n = 8, 6.4%). Conclusion. PTs reported significant variation in the choice of treatment for different clinical cases inside ICU. The main barriers in the ICU setting were low confidence and inadequate training.

scholarly journals Cerebrospinal Fluid Penetration and Pharmacokinetics of Vancomycin Administered by Continuous Infusion to Mechanically Ventilated Patients in an Intensive Care Unit

2000 ◽  
Vol 44 (5) ◽  
pp. 1356-1358 ◽  
Author(s):  
Jacques Albanèse ◽  
Marc Léone ◽  
Bernard Bruguerolle ◽  
Marie-Laure Ayem ◽  
Bruno Lacarelle ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cerebrospinal Fluid ◽  
Intensive Care ◽  
Continuous Infusion ◽  
The Other ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Csf Penetration ◽  
Group Serum ◽  
Ventilated Patients

ABSTRACT Cerebrospinal fluid (CSF) penetration and the pharmacokinetics of vancomycin were studied after continuous infusion (50 to 60 mg/kg of body weight/day after a loading dose of 15 mg/kg) in 13 mechanically ventilated patients hospitalized in an intensive care unit. Seven patients were treated for a sensitive bacterial meningitis and the other six patients, who had a severe concomitant neurologic disease with intracranial hypertension, were treated for various infections. Vancomycin CSF penetration was significantly higher (P< 0.05) in the meningitis group (serum/CSF ratio, 48%) than in the other group (serum/CSF ratio, 18%). Vancomycin pharmacokinetic parameters did not differ from those obtained with conventional dosing. No adverse effect was observed, in particular with regard to renal function.

Continuous infusion ketamine as analgesia or sedation in mechanically ventilated adults in the intensive care unit: a scoping review

2021 ◽  
Author(s):  
Nicholas David Richards ◽  
Simon Howell ◽  
Mark Bellamy ◽  
Ruben Mujica-Mota
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Infusion ◽  
Scoping Review ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Flow Diagram ◽  
Mechanically Ventilated ◽  
Scoping Reviews ◽  
Review Protocol

Abstract IntroductionMechanical ventilation (MV) is a common and often live-saving intervention on the Intensive Care Unit (ICU). In order to facilitate this intervention, the majority of patients require medical sedation. Optimising sedation is one of the fundamentals of ICU care, and inadequate sedation (predominantly too deep) has consistently been associated with worse outcomes for patients.This article presents the protocol for a scoping review of published literature on the use of ketamine as a sedative to facilitate MV on ICU.The scoping review has been designed to answer the question ‘What is known about the use of ketamine as a continuous infusion to provide sedation in mechanically ventilated adults in the intensive care unit, and what gaps in the evidence exist?’ MethodsThe scoping review protocol has been designed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR) checklist and the JBI manual for evidence synthesis. Data will be extracted using a dedicated form, and reviewed by 2 reviewers.Results Results will be tabulated and presented along side descriptive summaries. A PRISMA flow diagram will also be generated.Ethics and DisseminationThis scoping review is designed to map out the literature using existing published articles and does not require ethical approval.Results will be submitted for publication in relevant peer-reviewed journals and to international meetings as well as disseminated to relevant professional groups.

scholarly journals ABCDE, but in That Order? A Cross-Sectional Survey of Michigan Intensive Care Unit Sedation, Delirium, and Early Mobility Practices

2015 ◽  
Vol 12 (7) ◽  
pp. 1066-1071 ◽  
Author(s):  
Melissa A. Miller ◽  
Sushant Govindan ◽  
Sam R. Watson ◽  
Robert C. Hyzy ◽  
Theodore J. Iwashyna
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Early Mobility

scholarly journals Association Between Deep Sedation from Continuous Intravenous Sedatives and Extubation Failures in Mechanically Ventilated Patients in the Pediatric Intensive Care Unit

2017 ◽  
Vol 22 (2) ◽  
pp. 106-111
Author(s):  
Jennifer M. Schultheis ◽  
Travis S. Heath ◽  
David A. Turner
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Infusion ◽  
Pediatric Intensive Care Unit ◽  
Deep Sedation ◽  
Pediatric Intensive Care ◽  
Extubation Failure ◽  
Mechanically Ventilated ◽  
Significant Difference

OBJECTIVE The primary objective of this study was to determine whether an association exists between deep sedation from continuous infusion sedatives and extubation failures in mechanically ventilated children. Secondary outcomes evaluated risk factors associated with deep sedation. METHODS This was a retrospective cohort study conducted between January 1, 2009, and October 31, 2012, in the pediatric intensive care unit (PICU) at Duke Children's Hospital. Patients were included in the study if they had been admitted to the PICU, had been mechanically ventilated for ≥48 hours, and had received at least one continuous infusion benzodiazepine and/or opioid infusion for ≥24 hours. Patients were separated into 2 groups: those deeply sedated and those not deeply sedated. Deep sedation was defined as having at least one documented State Behavioral Scale (SBS) of −3 or −2 within 72 hours prior to planned extubation. RESULTS A total of 108 patients were included in the analysis. Both groups were well matched with regard to baseline characteristics. For the primary outcome, there was no difference in extubation failures in those who were deeply sedated compared to those not deeply sedated (14 patients [22.6%] versus 7 patients [15.2%], respectively; p = 0.33). After adjusting for potential risk factors, patients with a higher weight percentile for age (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00–1.03), lower Glasgow Coma Score (GCS) score prior to intubation (OR 0.85; 95% CI 0.74–0.97), and larger maximum benzodiazepine dose (OR 1.93; 95% CI 1.01–3.71) were associated with greater odds of deep sedation. A higher GCS prior to intubation was significantly associated with increased odds of extubation failure (OR 1.19; 95% CI 1.02–1.39). CONCLUSIONS While there was no statistically significant difference in extubation failures between the 2 groups included in this study, considering the severe consequences of extubation failure, the numerical difference reported may be clinically important.

scholarly journals Intensive Care Nurses’ Perceptions of Routine Dyspnea Assessment

2020 ◽  
Vol 29 (2) ◽  
pp. 132-139
Author(s):  
Kathy M. Baker ◽  
Natalia Sullivan Vragovic ◽  
Robert B. Banzett
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Assessment Tool ◽  
Care Delivery ◽  
Measurement Tool ◽  
Nurses Perceptions ◽  
Intensive Care Unit Nurses ◽  
The Impact ◽  
Routine Assessment ◽  
Dyspnea Assessment

Background Dyspnea (breathing discomfort) is commonly experienced by critically ill patients and at this time is not routinely assessed and documented. Intensive care unit nurses at the study institution recently instituted routine assessment and documentation of dyspnea in all patients able to report using a numeric scale ranging from 0 to 10. Objective To assess nurses’ perceptions of the utility of routine dyspnea measurement, patients’ comprehension of assessment questions, and the impact on nursing practice and to gather nurses’ suggestions for improvement. Methods Data were obtained from interviews with intensive care unit nurses in small focus groups and an anonymous online survey randomly distributed to nurses representing all intensive care units. Results Intensive care unit nurses affirmed the importance of routine dyspnea assessment and documentation. Before implementing the measurement tool, nurses often assessed for breathing discomfort in patients by using observed signs. Most nurses agreed that routine assessment can be used to predict patients’ outcomes and improve patient-centered care. Nurses found the assessment tool easy to use and reported that it did not interfere with workflow. Nurses felt that patients were able to provide meaningful ratings of dyspnea, similar to ratings of pain, and often used patients’ ratings in conjunction with observed physical signs to optimize patient care. Conclusion Our study shows that nurses understand the importance of routine dyspnea assessment and that the addition of a simple patient report scale can improve care delivery and does not add to the burden of work-flow.

scholarly journals Updates to referring clinicians regarding critically ill children admitted to the pediatric intensive care unit: a state-wide survey

Diagnosis ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. 123-128
Author(s):  
Christina L. Cifra ◽  
Cody R. Tigges ◽  
Sarah L. Miller ◽  
Loreen A. Herwaldt ◽  
Hardeep Singh
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Patients ◽  
Pediatric Intensive Care ◽  
Electronic Record ◽  
Feedback System ◽  
Critically Ill Children ◽  
Cross Sectional Survey ◽  
Cross Sectional

AbstractBackgroundFront-line clinicians are expected to make accurate and timely diagnostic decisions before transferring patients to the pediatric intensive care unit (PICU) but may not always learn their patients’ outcomes. We evaluated the characteristics of post-transfer updates received by referring clinicians regarding PICU patients and determined preferences regarding content, delivery, and timing of such updates.MethodsWe administered an electronic cross-sectional survey to Iowa clinicians who billed for ≥5 pediatric patients or referred ≥1 patient to the University of Iowa (UI) PICU in the year before survey administration.ResultsOne hundred and one clinicians (51 non-UI, 50 UI-affiliated) responded. Clinicians estimated that, on average, 8% of pediatric patients they saw over 1 year required PICU admission; clinicians received updates on 40% of patients. Seventy percent of UI clinicians obtained updates via self-initiated electronic record review, while 37% of non-UI clinicians relied on PICU communication (p = 0.013). Clinicians indicated that updates regarding diagnoses/outcomes will be most relevant to their practice. Among clinicians who received updates, 13% received unexpected information; 40% changed their practice as a result.ConclusionsClinicians received updates on less than half of the patients they referred to a PICU, although such updates could potentially influence clinical practice. Study findings will inform the development of a formal feedback system from the PICU to referring clinicians.

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