scholarly journals The impact of mobilization protocols on the length of postoperative hospitalization among cardiac surgery patients

2021 ◽  
Vol 23 (2) ◽  
pp. 259-265
Author(s):  
V. V. Vitomskyi ◽  
O. B. Lazarieva ◽  
E. Yu. Doroshenko ◽  
M. V. Vitomskа ◽  
T. М. Kovalenko ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Time Management ◽  
Physical Therapist ◽  
Early Mobilization ◽  
Lung Ventilation ◽  
Functional Class ◽  
Artificial Lung Ventilation ◽  
Heart Contractility ◽  
The Impact

The aim. To determine the impact of implementing the extra early mobilization protocol (EEM) on the length of intensive care unit (LICU) stay and postoperative unit (LPOU) stay and to assess the role of age, heart contractility, functional class and surgical outcomes. Materials and methods. Participants – adult patients of 2018–2019 with less than 24-hour artificial lung ventilation (ALV). The first group were treated according to the early mobilization protocol (EM, patients of 2018); the second group were treated according to the EEM protocol (patients of 2019). Design: a retrospective analysis. Settings: cardiosurgical unit. Interventions: the major difference is that the resources of patient mobilization team have expanded since 2019, namely it included a physical therapist, which made it possible to modify the EM protocol (standing on the 2 postoperative day (POD), activation with the help of medical staff, respiratory exercise) to the EEM protocol (standing on the 1 POD following consultation with an anesthesiologist, exercises with a physical therapist, respiratory exercise). The main outcomes: LICU, LPOU and total postoperative hospitalization (LTPO) (number of nights). Results. There were no differences between the EEM and EM groups in LICU (3 (2; 4) vs. 2 (2; 4); P = 0.182), LPOU (7 (6; 10) vs. 8 (6; 10); P = 0.118), LTPO (10 (8; 13) vs. 10 (9; 13); P = 0.308). Correlation analysis revealed absence, weak and very weak relations between the LICU, LPOU, LTPO indicators and other criteria, including age, ejection fraction, ALV. Conclusions. The effectiveness of the EEM protocol seems doubtful to reduce LICU, LPOU, and LTPO as compared to the EM protocol. The obtained results also raise the importance of physical therapist time management.

Risk factors and prevention of nosocomial pneumonia in polytrauma

2020 ◽  
Vol 30 (4) ◽  
pp. 493-503
Author(s):  
Yu. G. Shapkin ◽  
P. A. Seliverstov ◽  
N. Yu. Stekol'nikov
Keyword(s):  
Risk Factors ◽  
Nosocomial Pneumonia ◽  
Distress Syndrome ◽  
Early Mobilization ◽  
Lung Ventilation ◽  
Selective Decontamination ◽  
Artificial Lung Ventilation ◽  
Promising Area ◽  
Post Traumatic

Nosocomial pneumonia (NK) is one of the most frequent complications of polytrauma leading to death. Meanwhile, the recommendations on prevention of NK in case of polytrauma have not been specified so far. This is due in large part to the lack of study of the pathophysiology of severe combined trauma. The review presents the results of modern experimental and clinical studies of the effect of shock, immune distress syndrome, posttraumatic immunosuppression, the phenomenon of mutual aggravation of lesions, age, sex, concomitant pathology on the risk of NK in polytrauma. The role of iatrogenic risk factors for NK in polytrauma – intubation of trachea and artificial lung ventilation (AVL), massive hemotransfusions, immobilization, the phenomenon of “second strike” after multiple surgeries has been determined. The most effective measures of NK prevention are reduction of the duration of AVL, prevention of oropharyngeal colonization and aspiration in case of AVL, use of inhalation antibacterial drugs, antishock measures, early mobilization of the patient, the earliest possible stable functional osteosynthesis by minimally traumatic methods. The data on the effectiveness of selective decontamination of intestines, probiotics and glucocorticosteroids for the prevention of NK in polytrauma are inconsistent. A promising area of NK prophylaxis may be the development of agents that regulate the complex mechanisms of immune response to polytrauma and prevent secondary acute lung injury and post-traumatic immunosuppression.

scholarly journals The Impact of COVID-19 on the Educational Process: The Role of the School Principal

2021 ◽  
pp. 002205742110325
Author(s):  
Charalampous Constantia ◽  
Papademetriou Christos ◽  
Reppa Glykeria ◽  
Athanasoula-Reppa Anastasia ◽  
Voulgari Aikaterini
Keyword(s):  
Educational Leadership ◽  
Time Management ◽  
School Principal ◽  
Educational Process ◽  
Historical Study ◽  
Technical Equipment ◽  
Learning Programs ◽  
Teachers And Parents ◽  
The Impact

In recent years, the role of the leader in the effective operation of the school has been vastly debated in the international educational community. Through a historical study of educational leadership, this research discovered that the position of the leader is constantly being reshaped and adapted to the current social, cultural, and economic circumstances. During the last year, due to the coronavirus disease 2019 pandemic, the educational leadership has had to be reshaped worldwide. The aim of this study is to investigate the issues that have arisen from the aforementioned situation, as well as to try to figure out how a school’s principal might apply the basic principles of educational leadership, in a period of crisis. This investigation was focused on the use of the qualitative method. The study included 88 teachers and 5 principals from Cyprus, as well as teachers and parents. Based on the findings of the study, we discovered that the challenges faced by school principals and teachers are primarily linked to alienation, marginalization, time management, improving bureaucracy, problems with technical equipment and distance learning programs. Solution to these obstacles seemed to be the: Empathy, teamwork, and decentralization of the educational system, which are all promoted by the principal, who occasionally has additional authority.

scholarly journals The impact of transcutaneous electrical nerve stimulation on COVID-19 patients, especially those admitted to the intensive care unit

2020 ◽  
Vol 7 (10) ◽  
pp. 1612
Author(s):  
Rasoul Alipour ◽  
Fariba Mikaeili
Keyword(s):  
Intensive Care Unit ◽  
Nerve Stimulation ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Respiratory Muscles ◽  
Early Mobilization ◽  
Common Complication ◽  
Electrical Currents ◽  
Electrical Nerve Stimulation ◽  
Intact Surface ◽  
The Impact

Physiotherapy and early mobilization are necessary to treat COVID-19 patients. Physiotherapy is effective in strengthening of respiratory muscles, reduction of inflammation, and enhanced immune function in COVID-19 patients. Physiotherapy can relieve various symptoms of COVID-19. TENS (Transcutaneous Electrical Nerve Stimulation) is a kind of physiotherapy that uses electric current to activate nerves for therapeutic reasons. It passes electrical currents across the intact surface of the skin to activate underlying nerves. There are many studies that shown that TENS can alleviate dyspnea and lung function and improve FEV1 in patients with COPD and asthma, which is a more common complication in COVID-19 patients. TENS is effective in the treatment of muscle weakness and able to preserve protein synthesis in muscle in admitted patients, especially those admitted to ICU. Because of those reasons mentioned in the article, we recommend to investigate TENS effects on COVID-19 patients.

scholarly journals Multidrug-resistant Acinetobacter baumannii infections in COVID-19 patients hospitalized in intensive care unit

Infection ◽  
2021 ◽  
Author(s):  
Alessandro Russo ◽  
Francesca Gavaruzzi ◽  
Giancarlo Ceccarelli ◽  
Cristian Borrazzo ◽  
Alessandra Oliva ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acinetobacter Baumannii ◽  
Steroid Therapy ◽  
Multidrug Resistant ◽  
Serum Lactate ◽  
Cox Regression Analysis ◽  
Lactate Levels ◽  
The Impact

Abstract Objectives Superinfections in patients hospitalized in intensive care unit (ICU) are an important and challenging complication, also in COVID-19. However, no definitive data are available about the role of multidrug-resistant Acinetobacter baumannii (MDR-AB) in COVID-19. Methods This was a single-center, cross-sectional study including patients with MDR-AB infections admitted to ICU with or without COVID-19, between January 2019 and January 2021. The primary objective of the study was to evaluate risk factor for MDR-AB infections in ICU patients hospitalized for COVID-19 or other etiology. The secondary endpoints were 30-days mortality in all study population and risk factors associated with development of bloodstream infection (BSI). Results During the study period 32 adults with COVID-19 were enrolled and compared with 115 patients admitted in the same ICU for other reasons. We observed a total of 114 deaths, with a survival rate of 29.3%: 18.8% in COVID-19 and 32.2% in control group. Relative risk for MDR-AB infection in COVID-19 showed that serum lactate levels mmol/l > 2, Acinetobacter baumannii colonization, BSI and steroid therapy were observed more frequently in COVID-19 patients. Cox regression analysis showed that serum lactate levels > 2 mmol/l, Acinetobacter baumannii colonization, BSI, and steroid therapy were associated with 30-days mortality. Finally, patients with COVID-19, white blood cells count > 11,000 mm3, serum lactate levels > 2 mmol/l, infections at time of ICU admission, Acinetobacter baumannii colonization, and steroid therapy were independently associated with development of BSI. Conclusions Our data highlight the impact of BSI on outcome, the role of Acinetobacter baumannii colonization and the use of steroids on the risk to develop MDR-AB infections also during COVID-19.

scholarly journals PENGETAHUAN DAN SIKAP PERAWAT TENTANG MOBILISASI DINI PASIEN DI ICU RSUD PANEMBAHAN SENOPATI BANTUL YOGYAKARTA

2019 ◽  
Vol 6 (1) ◽  
pp. 9-17
Author(s):  
Muhamat Nofiyanto ◽  
Muhamad Munif ◽  
Miftafu Darussalam
Keyword(s):  
Intensive Care Unit ◽  
Early Mobilization ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Poor Knowledge ◽  
Intensive Intervention ◽  
Level Of Knowledge ◽  
Knowledge And Attitude

Background: Early mobilization is necessary in critically ill patients in Intensive Care Unit (ICU) to prevent hypovolemia which endangers patient’s life. The role of nurses in early mobilization is important by providing explanations and motivating patients to achieve the purpose of healing. Guidance and intensive intervention from nurses can reduce the recurrence of disease. Objective: To investigate the level of knowledge and attitude of nurses on patients early mobilization in ICU of RSUD Panembahan Senopati Bantul. Method: A descriptive, cross sectional study, was applied on 20 nurses in ICU of RSUD Panembahan Senopati Bantul. Univariate data analysis was administered to characteristics of respondents, knowledge, attitudes, and cross-tabulations. Result: Most of nurses have good level of knowledge (70%), and on attitude domain, most nurses are being supportive (75%) in terms of early mobilization to patients. Nurses whose age are  22-35 years old (10%), male (10%), have been working for 1 month up to 5 years (10%), have background of 3 years diploma in nursing (10%)  fall into poor knowledge category. Similar characteristics contribute to attitude domain where nurses whose age are 22-35 years old (25%), male (15%), have been working for 1 month up to 5 years (25%), have background of 3 years diploma in nursing (35%) are placed into unsupportive category. Conclusion: The level of knowledge of nurses on patients early mobilization is in good category where the attitude is in supportive category. Keywords: Knowledge, attitude of nurses, early mobilization.

scholarly journals Intensive care unit–acquired weakness: unanswered questions and targets for future research

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 508 ◽  
Author(s):  
Simone Piva ◽  
Nazzareno Fagoni ◽  
Nicola Latronico
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Early Mobilization ◽  
Critical Illness Polyneuropathy ◽  
Artificial Nutrition ◽  
Limb Weakness ◽  
Muscle Involvement ◽  
Difficult Weaning ◽  
The Impact

Intensive care unit–acquired weakness (ICU-AW) is the most common neuromuscular impairment in critically ill patients. We discuss critical aspects of ICU-AW that have not been completely defined or that are still under discussion. Critical illness polyneuropathy, myopathy, and muscle atrophy contribute in various proportions to ICU-AW. Diagnosis of ICU-AW is clinical and is based on Medical Research Council sum score and handgrip dynamometry for limb weakness and recognition of a patient’s ventilator dependency or difficult weaning from artificial ventilation for diaphragmatic weakness (DW). ICU-AW can be caused by a critical illness polyneuropathy, a critical illness myopathy, or muscle disuse atrophy, alone or in combination. Its diagnosis requires both clinical assessment of muscle strength and complete electrophysiological evaluation of peripheral nerves and muscles. The peroneal nerve test (PENT) is a quick simplified electrophysiological test with high sensitivity and good specificity that can be used instead of complete electrophysiological evaluation as a screening test in non-cooperative patients. DW, assessed by bilateral phrenic nerve magnetic stimulation or diaphragm ultrasound, can be an isolated event without concurrent limb muscle involvement. Therefore, it remains uncertain whether DW and limb weakness are different manifestations of the same syndrome or are two distinct entities. Delirium is often associated with ICU-AW but a clear correlation between these two entities requires further studies. Artificial nutrition may have an impact on ICU-AW, but no study has assessed the impact of nutrition on ICU-AW as the primary outcome. Early mobilization improves activity limitation at hospital discharge if it is started early in the ICU, but beneficial long-term effects are not established. Determinants of ICU-AW can be many and can interact with each other. Therefore, future studies assessing early mobilization should consider a holistic patient approach with consideration of all components that may lead to muscle weakness.

scholarly journals Role of genetic polymorphism in the development of sepsis in infants

2015 ◽  
Vol 17 (2) ◽  
pp. 59
Author(s):  
S. A. Sergeev ◽  
O. V. Strunin ◽  
Ye. Ye. Litasova
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Genetic Background ◽  
Individual Response ◽  
Inflammatory Reactions ◽  
Systemic Inflammatory Reaction ◽  
Genes Encoding ◽  
The Difference ◽  
The Impact

Sepsis and its consequences continue to be a major cause of morbidity and mortality in the intensive care unit (ICU). The evidence that endogenous mediators actually mediate an individual response to the infection has led to the development of different approaches to assess the impact of each person on the course of the disease. The role of the genetic background and the susceptibility to human inflammatory response amplitude are determined by the variability of the genes encoding endogenous mediators which are produced during inflammation. Pro-and anti-inflammatory reactions influence the susceptibility and the outcomes in patients with sepsis and systemic inflammation. Thus, all genes encoding proteins involved in the transduction of inflammatory genes are candidates for detection of a human's genetic background responsible for the difference in interpersonal systemic inflammatory reaction.

What Is the Role of Patient Families? An Exploratory Study in a Medical Intensive Care Unit

2017 ◽  
Vol 61 (1) ◽  
pp. 550-554
Author(s):  
Elizabeth Lerner Papautsky ◽  
Ummesalmah Abdulbaseer ◽  
Anthony Faiola
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Care ◽  
Exploratory Study ◽  
Ad Hoc ◽  
Medical Intensive Care Unit ◽  
Medical Decision ◽  
Medical Intensive Care ◽  
The Impact

Patient safety and quality efforts recently began to emphasize patient and family engagement in medical decision making. With measures primarily focused on satisfaction, challenges exist around understanding the impact of engagement on patient outcomes. Research is needed to understand the role of patient/family in safety and quality across clinical environments. The current exploratory study uses observations, ad hoc interviews, and questionnaires to capture the perspective of clinicians and staff on a Medical Intensive Care Unit regarding presence and engagement of families in patient care. Findings suggest that reported roles go beyond emotional support and further investigation is needed to explore the role of families in patient care from the safety and quality perspective.

scholarly journals P058: Impact of an early mobilization protocol on outcomes in trauma patients admitted to the intensive care unit: a retrospective cohort study

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S84
Author(s):  
J. Coles ◽  
M. Erdogan ◽  
S. Higgins ◽  
R. Green
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Injury Severity ◽  
Transition Period ◽  
Early Mobilization ◽  
Trauma Patients ◽  
Icu Mortality ◽  
Implementation Period ◽  
The Impact

Introduction: Long-term immobility has detrimental effects for critically ill patients admitted to the intensive care unit (ICU) including ICU-acquired weakness. Early mobilization of patients admitted to ICU has been demonstrated to be a safe, feasible and effective strategy to improve patient outcomes. The optimal mobilization of trauma ICU patients has not been extensively studied. Our objective was to determine the impact of an early mobilization protocol on outcomes among trauma patients admitted to the ICU. Methods: We analyzed all adult trauma patients ( > 18 years old) admitted to ICU over a 2-year period prior to and following implementation of an early mobilization protocol, allowing for a 1-year transition period. Data were collected from the Nova Scotia Trauma Registry. We compared patient characteristics and outcomes (mortality, length of stay [LOS], ventilator days) between the pre- and post-implementation groups. Associations between early mobilization and clinical outcomes were estimated using binary and linear regression models. Results: Overall, there were 526 patients included in the analysis (292 pre-implementation, 234 post-implementation). The study population ranged in age from 18 to 92 years (mean age 49.0 ± 20.4 years) and 74.3% of all patients were male. The pre- and post-implementation groups were similar in age, sex, and injury severity. In-hospital mortality was reduced in the post-implementation group (25.3% vs. 17.5%; p = 0.031). In addition, there was a reduction in ICU mortality in the post-implementation group (21.6% vs. 12.8%; p = 0.009). We did not observe any difference in overall hospital LOS, ICU LOS, or ventilator days between the two groups. Compared to the pre-implementation period, trauma patients admitted to the ICU following protocol implementation were less likely to die in-hospital (OR = 0.52, 95% CI 0.30-0.91; p = 0.021) or in the ICU (OR = 0.40, 95% CI 0.21- 0.76, p = 0.005). Results were similar following a sensitivity analysis limited to patients with blunt or penetrating injuries. There was no difference between the pre- and post-implementation groups with respect to in-hospital LOS, ICU LOS, or the number of ventilator days. Conclusion: We found that trauma patients admitted to ICU during the post-implementation period had decreased odds of in-hospital mortality and ICU mortality. Ours is the first study to demonstrate a significant reduction in trauma mortality following implementation of an ICU mobility protocol.

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