scholarly journals A gap existed between physicians’ perceptions and performance of pain, agitation-sedation and delirium assessments in Chinese intensive care units

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kai Chen ◽  
Yan-Lin Yang ◽  
Hong-Liang Li ◽  
Dan Xiao ◽  
Yang Wang ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Clinical Performance ◽  
Sedation Scale ◽  
Delirium Assessment ◽  
Brain Injured ◽  
Delirium Management ◽  
And Performance ◽  
Injured Patients

Abstract Background Pain, agitation-sedation and delirium management are crucial elements in the care of critically ill patients. In the present study, we aimed to present the current practice of pain, agitation-sedation and delirium assessments in Chinese intensive care units (ICUs) and investigate the gap between physicians’ perception and actual clinical performance. Methods We sent invitations to the 33 members of the Neuro-Critical Care Committee affiliated with the Chinese Association of Critical Care Physicians. Finally, 24 ICUs (14 general-, 5 neuroscience-, 3 surgical-, and 2 emergency-ICUs) from 20 hospitals participated in this one-day point prevalence study combined with an on-site questionnaire survey. We enrolled adult ICU admitted patients with a length of stay ≥24 h, who were divided into the brain-injured group or non-brain-injured group. The hospital records and nursing records during the 24-h period prior to enrollment were reviewed. Actual evaluations of pain, agitation-sedation and delirium were documented. We invited physicians on-duty during the 24 h prior to the patients’ enrollment to complete a survey questionnaire, which contained attitude for importance of pain, agitation-sedation and delirium assessments. Results We enrolled 387 patients including 261 (67.4%) brain-injured and 126 (32.6%) non-brain-injured patients. There were 19.9% (95% confidence interval [CI]: 15.9–23.9%) and 25.6% (95% CI: 21.2–29.9%) patients receiving the pain and agitation-sedation scale assessment, respectively. The rates of these two types of assessments were significantly lower in brain-injured patients than non-brain-injured patients (p = 0.003 and < 0.001). Delirium assessment was only performed in three patients (0.8, 95% CI: 0.1–1.7%). In questionnaires collected from 91 physicians, 70.3% (95% CI: 60.8–79.9%) and 82.4% (95% CI: 74.4–90.4%) reported routine use of pain and agitation-sedation scale assessments, respectively. More than half of the physicians (52.7, 95% CI: 42.3–63.2%) reported daily screening for delirium using an assessment scale. Conclusions The actual prevalence of pain, agitation-sedation and delirium assessment, especially delirium screening, was suboptimal in Chinese ICUs. There is a gap between physicians’ perceptions and actual clinical practice in pain, agitation-sedation and delirium assessments. Our results will prompt further quality improvement projects to optimize the practice of pain, agitation-sedation and delirium management in China. Trial registration ClinicalTrials.gov, identifier NCT03975751. Retrospectively registered on 2 June 2019.

scholarly journals Management of Patients with Brain Injury Using Noninvasive Methods

2020 ◽  
Author(s):  
Gustavo Frigieri ◽  
Nicollas Nunes Rabelo ◽  
Ricardo de Carvalho Nogueira ◽  
Sérgio Brasil
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Brain Injury ◽  
Intensive Care Units ◽  
Clinical Parameters ◽  
Noninvasive Methods ◽  
Brain Injured ◽  
Medical Teams ◽  
Injured Patients

In the last decades, the development of new noninvasive technologies in critical care allowed physicians to continuously monitor clinical parameters, aggregating important information that has been previously inaccessible or restricted due to the invasiveness of the existing techniques. The aim of this chapter is to present noninvasive methods in use on intensive care units (ICU) for brain injured patients monitoring, collaborating to the diagnosis and follow-up, aiding medical teams to achieve better outcomes.

scholarly journals Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e10326
Author(s):  
Stanislas Kandelman ◽  
Jérémy Allary ◽  
Raphael Porcher ◽  
Cássia Righy ◽  
Clarissa Francisca Valdez ◽  
...  
Keyword(s):  
Intensive Care ◽  
Deep Sedation ◽  
Simplified Acute Physiology Score ◽  
Sedation Scale ◽  
Neurological Assessment ◽  
Multicenter Cohort Study ◽  
Cough Reflex ◽  
Saps Ii ◽  
Brain Injured ◽  
Injured Patients

Background Deep sedation may hamper the detection of neurological deterioration in brain-injured patients. Impaired brainstem reflexes within the first 24 h of deep sedation are associated with increased mortality in non-brain-injured patients. Our objective was to confirm this association in brain-injured patients. Methods This was an observational prospective multicenter cohort study involving four neuro-intensive care units. We included acute brain-injured patients requiring deep sedation, defined by a Richmond Assessment Sedation Scale (RASS) < −3. Neurological assessment was performed at day 1 and included pupillary diameter, pupillary light, corneal and cough reflexes, and grimace and motor response to noxious stimuli. Pre-sedation Glasgow Coma Scale (GCS) and Simplified Acute Physiology Score (SAPS-II) were collected, as well as the cause of death in the Intensive Care Unit (ICU). Results A total of 137 brain-injured patients were recruited, including 70 (51%) traumatic brain-injured patients, 40 (29%) vascular (subarachnoid hemorrhage or intracerebral hemorrhage). Thirty patients (22%) died in the ICU. At day 1, the corneal (OR 2.69, p = 0.034) and cough reflexes (OR 5.12, p = 0.0003) were more frequently abolished in patients that died in the ICU. In a multivariate analysis, abolished cough reflex was associated with ICU mortality after adjustment to pre-sedation GCS, SAPS-II, RASS (OR: 5.19, 95% CI [1.92–14.1], p = 0.001) or dose of sedatives (OR: 8.89, 95% CI [2.64–30.0], p = 0.0004). Conclusion Early (day 1) cough reflex abolition is an independent predictor of mortality in deeply sedated brain-injured patients. Abolished cough reflex likely reflects a brainstem dysfunction that might result from the combination of primary and secondary neuro-inflammatory cerebral insults revealed and/or worsened by sedation.

scholarly journals Paediatric admissions to a district general hospital adult intensive care unit over a six year period: A single centre retrospective case series, with review of practitioner confidence and competence in paediatric critical care

2021 ◽  
pp. 175114372110121
Author(s):  
Stephen A Spencer ◽  
Joanna S Gumley ◽  
Marcin Pachucki
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Case Series ◽  
Critically Ill Children ◽  
Single Centre ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Paediatric Critical Care ◽  
Doctors And Nurses

Background Critically ill children presenting to district general hospitals (DGH) are admitted to adult intensive care units (AICUs) for stabilisation prior to transfer to paediatric intensive care units (PICUs). Current training in PICU for adult intensive care physicians is only three months. This single centre retrospective case series examines the case mix of children presenting to a DGH AICU and a multidisciplinary survey assesses confidence and previous experience, highlighting continued training needs for DGH AICU staff. Methods all paediatric admissions to AICU and paediatric retrievals were reviewed over a 6-year period (2014-2019). Cases were identified from the Electronic Patient Record (EPR) and from data provided by the regional paediatric retrieval service. A questionnaire survey was sent to AICU doctors and nurses to assess confidence and competence in paediatric critical care. Results Between 2014-2019, 284 children were managed by AICU. In total 35% of cases were <1 y, 48% of cases were <2 y and 64% of cases were <5 y, and 166/284 (58%) children were retrieved. Retrieval reduced with increasing age (OR 0.49 [0.40-0.60], p < 0.0001). The survey had an 82% response rate, and highlighted that only 13% of AICU nurses and 50% of doctors had received prior PICU training. Conclusion At least one critically unwell child presents to the AICU each week. Assessment, stabilisation and management of critically unwell children are vital skills for DGH AICU staff, but confidence and competence are lacking. Formalised strategies are required to develop and maintain paediatric competencies for AICU doctors and nurses.

Designing and Validity Evaluation of Quality of Nursing Care Scale in Intensive Care Units

2014 ◽  
Vol 22 (3) ◽  
pp. 461-471
Author(s):  
Mashaalah Zeraati ◽  
Negin Masoudi Alavi
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Nursing Care ◽  
Content Validity ◽  
Scale Level ◽  
Validity Index ◽  
Critical Care Units ◽  
Quality Of Nursing

Background and Purpose: Quality of nursing care measurement is essential in critical care units. The aim of this study was to develop a scale to measure the quality of nursing care in intensive care units (ICUs). Methods: The 68 items of nursing care standards in critical care settings were explored in a literature review. Then, 30 experts evaluated the items’ content validity index (CVI) and content validity ratio (CVR). Items with a low CVI score (<0.78) and low CVR score (<0.33) were removed from the scale. Results: The 50 items remained in the scale. The Scale level-CVI and Scale level-CVR were 0.898 and 0.725, respectively. Conclusion: The nursing care scale in ICU (Quality of Nursing Care Scale-ICU) that was developed in this research had acceptable CVI and CVR.

Multimodality Monitoring

2018 ◽  
pp. 155-164
Author(s):  
Maranatha Ayodele ◽  
Kristine O’Phelan
Keyword(s):  
Traumatic Brain Injury ◽  
Critical Care ◽  
Brain Injury ◽  
Early Recognition ◽  
Secondary Injury ◽  
Multimodality Monitoring ◽  
Injured Brain ◽  
Brain Injured ◽  
Physiologic Parameters ◽  
Injured Patients

Advancements in the critical care of patients with various forms of acute brain injury (traumatic brain injury, subarachnoid hemorrhage, stroke, etc.) in its current evolution recognizes that in addition to the initial insult, there is a secondary cascade of physiological events in the injured brain that contribute significantly to morbidity and mortality. Multimodality monitoring (MMM) in neurocritical care aims to recognize this secondary cascade in a timely manner. With early recognition, critical care of brain-injured patients may then be tailored to preventing and alleviating this secondary injury. MMM includes a variety of invasive and noninvasive techniques aimed at monitoring brain physiologic parameters such as intracranial pressure, perfusion, oxygenation, blood flow, metabolism, and electrical activity. This chapter provides an overview of these techniques and offers a practical guide to their integration and use in the intensive care setting.

scholarly journals The challenges of using physical restraint in intensive care units in Iran: A qualitative study

2020 ◽  
pp. 175114371989278
Author(s):  
Zahra Salehi ◽  
Soodabeh Joolaee ◽  
Fatemeh Hajibabaee ◽  
Tahereh Najafi Ghezeljeh
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Qualitative Study ◽  
Intensive Care Units ◽  
Physical Restraint ◽  
Critical Care Nurses ◽  
Structured Interviews ◽  
Standard Equipment ◽  
Restraint Use ◽  
Ensure Patient Safety

Background Physical restraint is widely used in intensive care units to ensure patient safety, manage agitated patients, and prevent the removal of medical equipment connected to them. However, physical restraint use is a major healthcare challenge worldwide. Aim This study aimed to explore nurses' experiences of the challenges of physical restraint use in intensive care units. Methods This qualitative study was conducted in 2018–2019. Twenty critical care nurses were purposively recruited from the intensive care units of four hospitals in Tehran, Iran. Data were collected via in-depth semi-structured interviews, concurrently analyzed via Graneheim and Lundman's conventional content analysis approach, and managed via MAXQDA software (v. 10.0). Findings Three main themes were identified (i) organizational barriers to effective physical restraint use (lack of quality educations for nurses about physical restraint use, lack of standard guidelines for physical restraint use, lack of standard physical restraint equipment), (ii) ignoring patients' wholeness (their health and rights), and (iii) distress over physical restraint use (emotional and mental distress, moral conflict, and inability to find an appropriate alternative for physical restraint). Conclusion Critical care nurses face different organizational, ethical, and emotional challenges in using physical restraint. Healthcare managers and authorities can reduce these challenges by developing standard evidence-based guidelines, equipping hospital wards with standard equipment, implementing in-service educational programs, supervising nurses' practice, and empowering them for finding and using alternatives to physical restraint. Nurses can also reduce these challenges through careful patient assessment, using appropriate alternatives to physical restraint, and consulting with their expert colleagues.

scholarly journals Alarm Compliance in Healthcare: Design Considerations for Actionable Alarms (In Intensive Care Units)

2019 ◽  
Vol 1 (1) ◽  
pp. 839-846
Author(s):  
Rosana Sanz-Segura ◽  
Eduardo Manchado Pérez ◽  
Elif Özcan
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intrinsic Motivation ◽  
Intensive Care Units ◽  
Design Strategies ◽  
Alarm Fatigue ◽  
Healthcare Design ◽  
Design Considerations ◽  
Potential Success ◽  
Per Se

AbstractIntensive care units are technologically advanced environments that are designed to safeguard the patient while their vitals are stabilized for further treatment. Audible and visual alarms are part of the healthcare ecology. However, these alarms are so many that clinicians suffer from a syndrome called ‘alarm fatigue’ and often do not comply with the task alarm is conveying. Measuring compliance with rules in the workspace and determining the success of a system belongs to the field of ergonomics and is based on data collected through task observations and scoring. In this paper, we will explore compliance with critical alarms by not only from their potential success or failure perspective but also from the perspectives of the clinician capacity, needs, and motivations to comply with alarms in critical environments. We will finally, reflect on further possible design strategies to increase compliance in critical care that are beyond following rules per se but through intrinsic motivation.

Critical care in Colombia: Differences between teaching and nonteaching intensive care units. A prospective cohort observational study

2012 ◽  
Vol 27 (1) ◽  
pp. 104.e9-104.e17 ◽  
Author(s):  
Sandra Rubiano ◽  
Fabian Gil ◽  
Edgar Celis-Rodriguez ◽  
Henry Oliveros ◽  
Gabriel Carrasquilla
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Observational Study ◽  
Intensive Care Units ◽  
Prospective Cohort

Procedures in the Adult and Neonatal Intensive Care Units

2018 ◽  
Author(s):  
Matthew Read ◽  
Christopher V. Maani
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Operating Room ◽  
Intensive Care Units ◽  
Surgical Procedures ◽  
Neonatal Intensive Care ◽  
Critical Care Medicine ◽  
Neonatal Intensive Care Units ◽  
Anesthesia Practice ◽  
Urgent Procedure

Bedside procedures in the ICU are an integral component of critical care medicine. Anesthesiologists who are assigned to the ICU must adapt principles of safe and effective anesthesia practice to this novel outside-of-the-operating-room environment. There are several reasons for surgical procedures to sometimes be performed at the bedside in the ICU, such as the avoidance of transporting unstable patients from the ICU to the OR, or the lack of adequate time to mobilize resources to perform an urgent procedure in the OR. Readiness of the entire ICU team is essential to avoid compromising care due to production pressure or lack of standards routine to the OR environment. This chapter discusses the types of procedures performed in the ICU and reviews the requirements of performing them successfully.

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