scholarly journals IMPACT OF A VENTILATORY WEANING PROTOCOL IN AN INTENSIVE CARE UNIT FOR ADULTS

2019 ◽  
Vol 28 ◽  
Author(s):  
Sandra Manuela Rebelo Oliveira ◽  
Rui Manuel Freitas Novais ◽  
Amâncio António de Sousa Carvalho
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Study Data ◽  
Base Line ◽  
Quasi Experimental ◽  
A Prospective Study ◽  
The Impact ◽  
Experimental Group

ABSTRACT Objective: to evaluate the impact of a ventilatory weaning protocol on the weaning quality and on the outcomes of the patients. Method: a quasi-experimental quantitative study, consisting of comparing a prospective study with a retrospective study. Data was collected through a weaning log sheet applied between September and December 2015 at an intensive care unit in northern Portugal following the implementation of a weaning protocol and compared with a base-line constituted in the year preceding the implementation of the ventilatory weaning protocol. Results: the experimental group had a score mean of higher overall quality of weaning, with a reduction in the timing for initiating the weaning in 27.3% and the weaning time in 36.6%. Conclusion: the implementation of the ventilatory weaning protocol improved the overall quality of the weaning, facilitating the identification of patients with criteria to initiate the process, starting earlier, resulting in a reduction in ventilatory weaning time.

Differential impact of on-site or telepharmacy in the intensive care unit: a controlled before–after study

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Joao Gabriel Rosa Ramos ◽  
Sandra Cristina Hernandes ◽  
Talita Teles Teixeira Pereira ◽  
Shana Oliveira ◽  
Denis de Melo Soares ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Phase 1 ◽  
Phase 2 ◽  
Differential Impact ◽  
Scarce Resources ◽  
Clinical Pharmacists ◽  
Versus Phase ◽  
Quasi Experimental ◽  
The Impact

Abstract Background Clinical pharmacists have an important role in the intensive care unit (ICU) team but are scarce resources. Our aim was to evaluate the impact of on-site pharmacists on medical prescriptions in the ICU. Methods This is a retrospective, quasi-experimental, controlled before-after study in two ICUs. Interventions by pharmacists were evaluated in phase 1 (February to November 2016) and phase 2 (February to May 2017) in ICU A (intervention) and ICU B (control). In phase 1, both ICUs had a telepharmacy service in which medical prescriptions were evaluated and interventions were made remotely. In phase 2, an on-site pharmacist was implemented in ICU A, but not in ICU B. We compared the number of interventions that were accepted in phase 1 versus phase 2. Results During the study period, 8797/9603 (91.6%) prescriptions were evaluated, and 935 (10.6%) needed intervention. In phase 2, there was an increase in the proportion of interventions that were accepted by the physician in comparison to phase 1 (93.9% versus 76.8%, P < 0.001) in ICU A, but there was no change in ICU B (75.2% versus 73.9%, P = 0.845). Conclusion An on-site pharmacist in the ICU was associated with an increase in the proportion of interventions that were accepted by physicians.

scholarly journals Protocol for a systematic review and meta-analysis of respiratory rehabilitation following intensive care unit discharge for COVID-19 survivors

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041184
Author(s):  
Dan Wang ◽  
Jin Li ◽  
Feilong Zhu ◽  
Qianqin Hong ◽  
Ming Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Meta Analysis ◽  
Biomedical Literature ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
The Impact ◽  
Respiratory Rehabilitation

IntroductionBoth physical and mental disorders may be exacerbated in patients with COVID-19 due to the experience of receiving intensive care; undergoing prolonged mechanical ventilation, sedation, proning and paralysis. Pulmonary rehabilitation is aimed to improve dyspnoea, relieve anxiety and depression, reduce the incidence of related complications, as well as prevent and improve dysfunction. However, the impact of respiratory rehabilitation on discharged patients with COVID-19 is currently unclear, especially on patients who have been mechanically ventilated over 24 hours. Therefore, we aim to investigate the efficacy of respiratory rehabilitation programmes, initiated after discharge from the intensive care unit, on the physical and mental health and health-related quality of life in critical patients with COVID-19.Methods and analysisWe have registered the protocol on PROSPERO and in the process of drafting it, we strictly followed the checklist of Preferred Reporting Items for Systematic Review and Meta-Analysis Potocols. We will search the PubMed, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, WanFang, VIP information databases and Chinese Biomedical Literature Database. Additionally, ongoing trials in the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov and ISRCTN registry will be searched as well. Studies in English or Chinese and from any country will be accepted regardless of study design. Two review authors will independently extract data and assess the quality of included studies. Continuous data are described as standard mean differences (SMDs) with 95% CIs. Dichotomous data from randomised controlled trials are described as risk ratio(RR) with 95% CIs; otherwise, it is described as odds ratio(OR) with 95% CIs. I2 and the Cochrane’s Q statistic will be used to conduct heterogeneity assessment. The quality of evidence of main outcomes will be evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation(GRADE) criteria. When included studies are sufficient, we will conduct subgroup analysis and sensitivity analysis; the publication bias will be statistically analysed using a funnel plot analysis and Egger’s test.Ethics and disseminationOur review, planning to include published studies, does not need the request to the ethical committee. The final results of this review will be published in a peer-reviewed journal after completion.Patient and public involvementNo patient involved.PROSPERO registration numberCRD42020186791.

scholarly journals 2 Systemic glucocorticoids and bradycardia in critically ill children: a retrospective study

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e1-e1
Author(s):  
Camille Maltais-Bilodeau ◽  
Maryse Frenette ◽  
Geneviève Morissette ◽  
Dennis Bailey ◽  
Karine Cloutier ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Heart Rate ◽  
Intensive Care ◽  
Retrospective Study ◽  
Critically Ill ◽  
Medical Staff ◽  
Pediatric Population ◽  
Critically Ill Children ◽  
Rate Variation ◽  
The Impact

Abstract Background Glucocorticoids are widely used in the pediatric population. They are associated with numerous side effects including repercussions on the cardiovascular system. The impact on heart rate is not well known, but bradycardia has been reported, mostly with high doses. Objectives We described the occurrence of bradycardias and the variation of heart rate in critically ill children receiving glucocorticoids. Design/Methods We conducted a retrospective study including 1 month old to 18 year old children admitted to the Pediatric Intensive Care Unit between 2014 and 2017, who received a glucocorticoid dose equivalent to 1 to 15 mg/kg/day of prednisone. We collected data on exposition to glucocorticoids, heart rate before, during and after the exposition, and interventions from the medical staff in response to bradycardia. The primary outcome was the occurrence of bradycardia and the secondary outcomes were the magnitude of heart rate variation and the clinical management of bradycardias. Results We included 92 admissions (85 patients). The median dose of glucocorticoid used was 2.80 mg/kg/day of prednisone (2.08—3.80). We found 70 cases (76%) with at least one bradycardia. Before treatment, all patients had a mean heart rate higher than the 5th percentile for age. During exposition to glucocorticoids, 8 patients (10%, n = 83) had a median heart rate ≤ 5th percentile. We noted 46 cases of bradycardia (50%) that led to an intervention from the medical staff, but no patient had a major event associated to bradycardia. We found a significant association between bradycardia and age (estimate -0.136, 95% CI -0.207—-0.065, p < 0.001), glucocorticoid dose (estimate 4.820, 95% CI 2.048—7.592, p < 0.001) and intravenous administration (estimate 8.709, 95% CI 1.893—15.524, p = 0.012). Conclusion In our study, most children hospitalized at the intensive care unit receiving standard doses of glucocorticoid experienced bradycardia. The majority of episodes led to an intervention from the medical staff. Presence of bradycardia was associated with younger age, higher dose and IV administration of glucocorticoids.

scholarly journals The Impact of Medical Conditions on the Quality of Life of Survivors at Discharge From Intensive Care Unit

Medicina ◽  
2011 ◽  
Vol 47 (5) ◽  
pp. 38 ◽  
Author(s):  
Andrius Klimašauskas ◽  
Ieva Sereikė ◽  
Aušra Klimašauskienė ◽  
Gintautas Kėkštas ◽  
Juozas Ivaškevičius
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Organ System ◽  
Therapeutic Interventions ◽  
Prolonged Stay ◽  
Role Physical ◽  
Icu Discharge ◽  
The Impact

Background and Objective. Impaired health-related quality of life (HRQOL) is one of the possible outcomes after discharge from an intensive care unit (ICU). Evaluation of patient health status on discharge from the ICU would help identify factors influencing changes in HRQOL after ICU discharge. The objective of the study was to identify whether health state on discharge from prolonged stay in the ICU has any influence on survivors’ HRQOL 6 months after intensive care. Material and Methods. A prospective study of patients with the prolonged length of stay (exceeding 7 days) in the ICU was conducted. The study covered the impact of organ system dysfunction (SOFA score), number of therapeutic interventions (TISS-28 score), and critical illness neuromuscular abnormalities (CINMA) on discharge from the ICU on HRQOL 6 months following ICU discharge. Results. In total, 137 patients were included in the study. The SOFA score on the last day in the ICU was 2.91 (SD, 1.57); the TISS-28 score on the last day in the ICU was 21.79 (SD, 4.53). Decreased physical functioning (PF) and role physical (RP) were identified. Circulatory impairment on discharge from the ICU had an impact on decreased PF (P=0.016), role physical (P=0.066), and role emotional (P=0.001). Patients with dysfunction in more than one organ system on ICU discharge had decreased role emotional (P=0.016). Severe CINMA was diagnosed in 18 patients. They had decreased PF (P=0.007) and RP (P=0.019). Patients with the TISS-28 score above or equal to 20 points showed lower HRQOL in the PF domain (P=0.077) and general health (P=0.038). Conclusions. HRQOL in patients with prolonged stay in the ICU is particularly impaired in the domains of physical functioning and role physical. It is associated with circulatory impairment, CINMA, and greater number of therapeutic interventions on discharge from the ICU.

821: The Impact of Sleep Aids on the Perceived Quality of Sleep in the Intensive Care Unit

2020 ◽  
Vol 49 (1) ◽  
pp. 407-407
Author(s):  
Brita Jensen ◽  
Kimberly Terry ◽  
Angela Presson ◽  
Chong Zhang ◽  
Joseph Tonna
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Perceived Quality ◽  
Quality Of Sleep ◽  
The Impact

scholarly journals Quality Outcomes in the Surgical Intensive Care Unit after Electronic Health Record Implementation

2015 ◽  
Vol 06 (04) ◽  
pp. 611-618 ◽  
Author(s):  
V. H. Flatow ◽  
N. Ibragimova ◽  
C. M. Divino ◽  
D. S. A. Eshak ◽  
B. C. Twohig ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Central Line ◽  
Surgical Intensive Care Unit ◽  
Readmission Rates ◽  
Surgical Intensive Care ◽  
The Impact

Summary Background: The electronic health record (EHR) is increasingly viewed as a means to provide more coordinated, patient-centered care. Few studies consider the impact of EHRs on quality of care in the intensive care unit (ICU) setting. Objectives: To evaluate key quality measures of a surgical intensive care unit (SICU) following implementation of the Epic EHR system in a tertiary hospital. Methods: A retrospective chart review was undertaken to record quality indicators for all patients admitted to the SICU two years before and two years after EHR implementation. Data from the twelve-month period of transition to EHR was excluded. We collected length of stay, mortality, central line associated blood stream infection (CLABSI) rates, Clostridium difficile (C. diff.) colitis rates, readmission rates, and number of coded diagnoses. To control for variation in the patient population over time, the case mix indexes (CMIs) and APACHE II scores were also analyzed. Results: There was no significant difference in length of stay, C. diff. colitis, readmission rates, or case mix index before and after EHR. After EHR implementation, the rate of central line blood stream infection (CLABSI) per 1 000 catheter days was 85% lower (2.16 vs 0.39; RR, 0.18; 95% CI, 0.05 to 0.61, p < .005), and SICU mortality was 28% lower (12.2 vs 8.8; RR, 1.35; 95% CI, 1.06 to 1.71, p < .01). Moreover, after EHR there was a significant increase in the average number of coded diagnoses from 17.8 to 20.8 (p < .000). Conclusions: EHR implementation was statistically associated with reductions in CLABSI rates and SICU mortality. The EHR had an integral role in ongoing quality improvement endeavors which may explain the changes in CLABSI and mortality, and this invites further study of the impact of EHRs on quality of care in the ICU.

scholarly journals End-of-Life Care Mobile App for Intensive-Care Unit Nurses: A Quasi-Experimental Study

2021 ◽  
Vol 18 (3) ◽  
pp. 1253
Author(s):  
Jin Hee Yang ◽  
Gisoo Shin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
End Of Life ◽  
Self Efficacy ◽  
End Of Life Care ◽  
Mobile App ◽  
Life Care ◽  
Quasi Experimental ◽  
Intensive Care Unit Nurses ◽  
Experimental Group

Intensive-care unit nurses may experience difficulties in end-of-life care because of frustration or lethargy. The purpose of this study was to develop a mobile end-of-life care program for intensive-care unit nurses and evaluate the effects on competence factors such as knowledge, self-efficacy, and compassion. A quasi-experimental design was used. The participants included 44 nurses who had less than three years of experience in the intensive-care unit, divided into the experimental group and control group. After the intervention, the experimental group showed a significant improvement in self-efficacy in end-of-life care and compassion in end-of-life care. Based on the results of this study, the end-of-life care mobile app was an effective educational method for nurses with experience of less than 3 years in an intensive-care unit. To improve the quality of end-of-life care, it is necessary to develop various educational programs considering the greater role of the fourth industrial revolution in the future.

scholarly journals Impact of Air Transport on SpO2/FiO2 among Critical COVID-19 Patients during the First Pandemic Wave in France

2021 ◽  
Vol 10 (22) ◽  
pp. 5223
Author(s):  
Jean-Baptiste Bouillon-Minois ◽  
Vincent Roux ◽  
Matthieu Jabaudon ◽  
Mara Flannery ◽  
Jonathan Duchenne ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Air Transport ◽  
Arterial Oxygenation ◽  
Full Data ◽  
Critical Patients ◽  
The Impact ◽  
Pandemic Wave

During the first wave of the COVID-19 pandemic, some French regions were more affected than others. To relieve those areas most affected, the French government organized transfers of critical patients, notably by plane or helicopter. Our objective was to investigate the impact of such transfers on the pulse oximetric saturation (SpO2)-to-inspired fraction of oxygen (FiO2) ratio among transferred critical patients with COVID-19. We conducted a retrospective study on medical and paramedical records. The primary endpoint was the change in SpO2/FiO2 during transfers. Thirty-eight patients were transferred between 28 March and 5 April 2020, with a mean age of 62.4 years and a mean body mass index of 29.8 kg/m2. The population was 69.7% male, and the leading medical history was hypertension (42.1%), diabetes (34.2%), and dyslipidemia (18.4%). Of 28 patients with full data, we found a decrease of 28.9 points in SpO2/FiO2 (95% confidence interval, 5.8 to 52.1, p = 0.01) between the starting and the arrival intensive care units (SpO2/FiO2, 187.3 ± 61.3 and 158.4 ± 62.8 mmHg, respectively). Air medical transfers organized to relieve intensive care unit teams under surging conditions during the first COVID wave were associated with significant decreases in arterial oxygenation.

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