Music in mechanically ventilated stroke patients

2019 ◽  
Vol 15 (Sup5) ◽  
pp. S8-S13
Author(s):  
DaiWai M Olson ◽  
Anjali Perera ◽  
Folefac Atem ◽  
Audra S Wagner ◽  
Michael Zanders ◽  
...  
Keyword(s):  
Critical Care ◽  
Pilot Study ◽  
Stress Reduction ◽  
Care Setting ◽  
Neurocritical Care ◽  
Stroke Patients ◽  
Mechanically Ventilated ◽  
Significant Difference ◽  
Pilot Intervention ◽  
Route Of Delivery

Background: Music as a therapeutic intervention for critically ill stroke patients has not been adequately researched. This may be related to a limited number of tools being available to measure the hypnotic response when patients cannot respond verbally. This pilot study examines the feasibility of bispectral index (BIS) monitoring to study music as a stress-reduction intervention in the neurocritical care setting. Methods: This prospective, randomised, crossover, pilot study enrolled 30 patients. On each of two consecutive days, patients were randomised to either 1 hour of silence followed by a crossover to 1 hour of music, or the reverse (music then silence). BIS values were recorded to evaluate stress and agitation before, during and after the 2-hour study period. Results: There were no reported adverse events, supporting feasibility of this pilot intervention. BIS values were sampled once every 6 seconds during the 2-hour study period. There was a statistically significant difference in BIS scores between the music and no music group (p<0.0001). Conclusion: The use of neurofunction monitors to assess response to music is feasible during the critical care phase for patients with stroke. Additional studies should focus on genre, timing and route of delivery for music as an intervention.

scholarly journals Efficacy of Myofunctional Therapy Associated with Voice Therapy in the Rehabilitation of Neurogenic Oropharyngeal Dysphagia: a pilot study

2017 ◽  
Vol 22 (03) ◽  
pp. 225-230 ◽  
Author(s):  
Bruno Fraga ◽  
Sheila Almeida ◽  
Márcia Santana ◽  
Mauriceia Cassol
Keyword(s):  
Pilot Study ◽  
Oropharyngeal Dysphagia ◽  
Oral Intake ◽  
Control Group ◽  
Stroke Patients ◽  
Swallowing Rehabilitation ◽  
Significant Difference ◽  
Vocal Exercises ◽  
Experimental Group ◽  
Post Therapy

Introduction Dysphagia causes changes in the laryngeal and stomatognathic structures; however, the use of vocal exercises is poorly described. Objective To verify whether the therapy consisting of myofunctional exercises associated with vocal exercises is more effective in rehabilitating deglutition in stroke patients. Methods This is a pilot study made up of two distinct groups: a control group, which performed only myofunctional exercises, and an experimental group, which performed myofunctional and vocal exercises. The assessment used for oral intake was the functional oral intake scale (FOIS). Results The FOIS levels reveal that the pre-therapy median of the experimental group was 4, and increased to 7 after therapy, while in the control group the values were 5 and 6 respectively. Thus, the experimental group had a statistically significant difference between the pre- and post-therapy assessments (p = 0.039), which indicates that the combination of myofunctional and vocal exercises was more effective in improving the oral intake levels than the myofunctional exercises alone (p = 0.059). On the other hand, the control group also improved, albeit at a lower rate compared with the experimental group; hence, there was no statistically significant difference between the groups post-therapy (p = 0.126). Conclusion This pilot study showed indications that using vocal exercises in swallowing rehabilitation in stroke patients was able to yield a greater increase in the oral intake levels. Nevertheless, further controlled blind clinical trials with larger samples are required to confirm such evidence, as this study points to the feasibility of conducting this type of research.

EXPRESS: Elevated procalcitonin levels in severe Covid-19 may not reflect bacterial co-infection

2021 ◽  
pp. 000456322110223
Author(s):  
Randeep S Heer ◽  
Amit K J Mandal ◽  
Jason Kho ◽  
Piotr Szawarski ◽  
Peter Csabi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Disease Severity ◽  
Care Setting ◽  
Univariate Analysis ◽  
Invasive Mechanical Ventilation ◽  
Critical Care Setting ◽  
Inpatient Mortality ◽  
Laboratory Markers ◽  
Significant Difference

<u>Background</u> The variability of Covid-19 severity between patients has driven efforts to identify prognosticating laboratory markers that could aid clinical decision making. Procalcitonin (PCT) is classically used as a diagnostic marker in bacterial infections, but its role in predicting Covid-19 disease severity is emerging. We aimed to identify the association between PCT and Covid-19 disease severity in a critical care setting and whether bacterial co-infection is implicated. <u>Methods</u> We retrospectively reviewed Covid-19 patients with PCT levels measured in a critical care setting at our institution between February and September 2020. Laboratory markers including peak PCT values and a range of bacterial culture results were analysed. Outcomes were the requirement and duration of invasive mechanical ventilation as well as inpatient mortality. <u>Results</u> In total, 60 patients were included; 68% required invasive mechanical ventilation and 45% died as inpatient. Univariate analysis identified higher peak PCT levels significantly associated with both the requirement for invasive mechanical ventilation (OR: 3.2, 95% CI 1.3-9.0, p=0.02) and inpatient mortality (OR: 2.6, 95% CI 1.1-6.6, p=0.03). Higher peak PCT levels was an independent predictor of mortality on multivariate analysis (OR 3.7, 95% CI 1.1-12.4, p=0.03). There was a significant positive correlation between increased peak PCT levels and duration on invasive mechanical ventilation. No significant difference was found between peak PCT levels of patients with positive and negative bacterial cultures. <u>Conclusions</u> Elevated PCT levels in Covid-19 patients are associated with respiratory failure requiring prolonged invasive mechanical ventilation and inpatient mortality. This association may be independent of bacterial co-infection.

scholarly journals Chlorhexidine Oral Care in Critically Ill Adults

2021 ◽  
Vol 1 (10) ◽  
Author(s):  
Anusree Subramonian ◽  
Jennifer Horton
Keyword(s):  
Critical Care ◽  
Randomized Clinical Trials ◽  
Oral Care ◽  
Clinical Effectiveness ◽  
Ventilator Associated Pneumonia ◽  
Specific Recommendation ◽  
Mechanically Ventilated ◽  
Care Protocol ◽  
Significant Difference ◽  
Critically Ill Adults

Three systematic reviews and 2 randomized clinical trials were identified regarding the clinical effectiveness of chlorhexidine oral care in adult patients who were in critical care and being mechanically ventilated. The evidence was of limited quality, with methodological limitations. Compared to ozonated water and to Nanosil, chlorhexidine oral care was associated with a significantly higher risk of ventilator-associated pneumonia. Compared to bicarbonate, chlorhexidine oral care was associated with a significantly lower risk of ventilator-associated pneumonia. There was no significant difference in the risk of ventilator-associated pneumonia between chlorhexidine and other agents, such as potassium permanganate, hydrogen peroxide, or miswak. There was no significant difference in the risk of mortality between oral care with chlorhexidine and that with other oral care drugs. An evidence-based guideline targeting individuals who require assistance on oral care recommended a multi-component oral care protocol. No specific recommendation regarding the use of oral care agents for the prevention of ventilator-associated pneumonia was made because of lack of evidence. There is a lack of evidence on the safety or cost-effectiveness of chlorhexidine oral care in adults who are in critical care and being mechanically ventilated.

scholarly journals Mindfulness-Based Stress Reduction Intervention in Chronic Stroke: a Randomized, Controlled Pilot Study

Mindfulness ◽  
2021 ◽  
Author(s):  
Juliana V. Baldo ◽  
Krista Schendel ◽  
Sandy J. Lwi ◽  
Timothy J. Herron ◽  
Denise G. Dempsey ◽  
...  
Keyword(s):  
Pilot Study ◽  
Active Control ◽  
Stress Reduction ◽  
Chronic Stroke ◽  
Retention Rates ◽  
Brain Health ◽  
Stroke Patients ◽  
Post Intervention ◽  
Mindfulness Based Stress Reduction ◽  
Measure Class

Abstract Objectives Mindfulness-Based Stress Reduction (MBSR) involves training in mindful meditation and has been shown to improve functioning across a range of different disorders. However, little research has focused on the use of MBSR in stroke patients, and previous MBSR studies typically have not included an active control condition to account for non-specific factors that could contribute to the observed benefits. Methods We conducted a pilot study of MBSR in chronic stroke patients, comparing MBSR to an active control condition. Half of participants were randomly assigned to a standard 8-week MBSR class, and the other half of participants were assigned to an 8-week Brain Health class matched for schedule, instructor, and format. Participants were assessed pre- and post-intervention by blinded examiners on a neuropsychological battery that included primary outcome measures of psychological and cognitive functioning. Participants were also given an anonymous questionnaire following the post-intervention testing session to measure class satisfaction. Results Both the MBSR and Brain Health classes were rated favorably by participants. Recruitment and retention rates were high, and methods for participant randomization and examiner blinding were successful. Class implementation in terms of execution was also successful, as rated by outside experts. Conclusions This study established the feasibility of conducting MBSR and Brain Health classes in a chronic stroke population. Trial Registration https://ClinicalTrials.gov, NCT #: 02600637

scholarly journals Intravenous device flushing in the critical care setting: A pilot study

2014 ◽  
Vol 27 (1) ◽  
pp. 54
Author(s):  
S. Keogh ◽  
J. Flynn ◽  
N. Marsh ◽  
N. Higgins ◽  
K. Davies ◽  
...  
Keyword(s):  
Critical Care ◽  
Pilot Study ◽  
Care Setting ◽  
Critical Care Setting

scholarly journals Effects of Cervical Spine Mobilization on Respiratory Function and Cervical Angles of Stroke Patients: A Pilot Study

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 377
Author(s):  
Ho Jung An ◽  
Shin Jun Park
Keyword(s):  
Cervical Spine ◽  
Pilot Study ◽  
Respiratory Function ◽  
Negative Impact ◽  
Small Sample ◽  
Control Group ◽  
Stroke Patients ◽  
Number Of Patients ◽  
Significant Difference ◽  
Experimental Group

The forward head posture (FHP) of stroke patients has a negative impact on respiratory function. Cervical spine mobilization is a manual therapy technique that used to prevent and treat FHP and respiratory function. This pilot study investigated whether cervical spine mobilization can effectively improve outcomes following FHP and respiratory function of stroke patients. Twenty-four patients participated in our assessor-blinded randomized controlled trial. All the participants received neurodevelopmental treatments (gait training and trunk rehabilitation). The experimental group additionally received 15-min sessions of cervical spine mobilization three times per week for 4 weeks. The control group received cervical spine sham mobilization during the same period. For the cervical angles, the cranial vertebral angle (CVA) and cranial rotation angle (CRA) were measured. A respiratory function test was performed to measure the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and chest circumferences (upper and lower chest sizes). Except for MIP, there was no significant difference between the experimental group and the control group. The CVA and CRA were significantly increased in the experimental group only. Cervical spine mobilization improved cervical angles and inspiratory function of the stroke patients in this study. However, a comparative study with a larger number of patients is needed to confirm this finding from our pilot study, which had a small sample size.

Determining Critical Incident Nursing Interventions for the Critical Care Setting: A Pilot Study

2009 ◽  
Vol 20 (3) ◽  
pp. 110-121 ◽  
Author(s):  
Elizabeth Wong ◽  
Lynne M. Scott ◽  
Jennifer R. Briseno ◽  
Cecelia L. Crawford ◽  
Jin-Wen Y. Hsu
Keyword(s):  
Critical Care ◽  
Pilot Study ◽  
Critical Incident ◽  
Care Setting ◽  
Critical Care Setting ◽  
Nursing Interventions

Comparing the effectiveness of bimanual and unimanual mirror therapy in unilateral neglect after stroke: A pilot study

2021 ◽  
pp. 1-9
Author(s):  
Tae Yong Sim ◽  
Jae Sung Kwon
Keyword(s):  
Pilot Study ◽  
Activities Of Daily Living ◽  
Barthel Index ◽  
Daily Living ◽  
Major Obstacle ◽  
Mirror Therapy ◽  
Stroke Patients ◽  
Unilateral Neglect ◽  
Korean Version ◽  
Significant Difference

BACKGROUND: Unilateral neglect in stroke patients is a major obstacle to rehabilitation, which is a great challenge for therapists. OBJECTIVE: This study aimed to compare the effectiveness of bimanual mirror therapy (BMT) and unimanual mirror therapy (UMT), the two protocols of mirror therapy, for the reduction of the symptoms of unilateral neglect in stroke patients. METHODS: Twenty-eight individuals were randomly assigned to the UMT or BMT groups. Both groups received mirror therapy for 30 minutes per day, 5 days a week, for a period of 4 weeks. The Star Cancelation Test (SCT), Line Bisection Test (LBT), Picture Scanning test (PST), and Korean Catherine Bergego Scale (K-CBS) were used to measure the change in unilateral neglect, and the Korean version of the Modified Barthel Index (K-MBI) was used to evaluate activities of daily living (ADL). RESULTS: The results of SCT, LBT, PST, and K-CBS showed significant decreases in unilateral neglect in both groups (p <  0.05). K-MBI improved significantly in both groups (p <  0.05). There were significant differences between the two groups in the unilateral neglect tests (p <  0.05), but no significant difference in ADL evaluation (p >  0.05). CONCLUSIONS: Mirror therapy protocols can be applied to treat unilateral neglect in stroke patients. However, BMT may be more beneficial for reducing the symptoms of unilateral neglect.

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