scholarly journals Analysis of the Preventative Influence of an Oral Hygiene Protocol on Ventilator-Associated Pneumonia

2019 ◽  
Vol 21 (3) ◽  
pp. 281
Author(s):  
Jéssica De Mello Scalco ◽  
Thais Maria Freire Fernandes ◽  
Valter Flávio Scalco ◽  
Edgar Ribeiro ◽  
Suene Moçato Shiguematsu ◽  
...  
Keyword(s):  
Intensive Care ◽  
Oral Hygiene ◽  
Control Group ◽  
Icu Patients ◽  
Mechanically Ventilated ◽  
Effective Prophylaxis ◽  
Terapia Intensiva ◽  
Etiological Agents ◽  
Microbiological Analyses ◽  
Chlorhexidine Gel

AbstractVentilator-associated pneumonia (VAP) is the most commonly reported nosocomial infection among intensive care unit (ICU) patients. This study aimed to evaluate the influence of an oral hygiene protocol on VAP incidence among mechanically-ventilated (MV) ICU patients. The dentate patients admitted without VAP to the hospital’s adult ICU requiring mechanical ventilation for ≥48 hours during a 4-month period in two consecutive years (2015 – Control group and 2016 – Experimental group) were included in this investigation. The oral hygiene protocol was implemented daily, once a day, in the morning hours, using a disposable brush with suction and ultrasoft bristles and 3 g of 0.12% chlorhexidine gel. Hospital-related respiratory infection data, including VAP diagnoses and microbiological analyses, were collected from the monthly health epidemiological notification bulletins issued by the hospital. T tests were applied to compare variables before versus after implementation of the oral hygiene protocol with a significance criterion of P < .05. 43.94% reduction in VAP rate after the protocol implementation was observed. Implementation of the protocol was associated with a significant reduction of Enterobacter spp infections and no cases of VAP related to the main etiological agents of the disease (i.e., S. aureus and C. albicans) were identified. It can be concluded that an oral hygiene protocol performed with a suction brush and 0.12% chlorhexidine gel can serve as an effective prophylaxis against VAP in patients under mechanical ventilation.Keywords: Intensive Care Units. Disease Prevention. Oral Hygiene.ResumoA pneumonia associada à ventilação (PAV) é a infecção nosocomial mais comumente relatada em pacientes de Unidade de Terapia Intensiva (UTI). Este estudo teve como objetivo avaliar a influência de um protocolo de higiene bucal na incidência de PAV entre pacientes sob ventilação mecânica (VM). Os pacientes dentados internados na UTI adulta do hospital sem PAV e que necessitaram de ventilação mecânica por ≥ 48 horas durante um período de 4 meses em dois anos consecutivos (2015 - grupo Controle e 2016 - grupo Experimental) foram incluídos nesta investigação. O protocolo de higiene bucal foi implementado diariamente, uma vez ao dia, nas primeiras horas da manhã, utilizando-se escova descartável com cerdas de sucção e ultramacia e 3 g de gel de clorexidina a 0,12%. Dados de infecção respiratória relacionada ao hospital, incluindo diagnósticos de PAV e análises microbiológicas, foram coletados dos boletins mensais de notificação epidemiológica de saúde emitidos pelo hospital. Testes t foram aplicados para comparar as variáveis antes e após a implementação do protocolo de higiene bucal com um critério de significância de P <0,05. Observamos uma redução de 43,94% na taxa de PAV após a implementação do protocolo. A implementação do protocolo foi associada à uma redução significativa das infecções por Enterobacter spp e não foram identificados casos de PAV relacionados aos principais agentes etiológicos da doença (isto é, S. aureus e C. albicans). Pode-se concluir que u protocolo de higiene bucal realizado com escova de sucção e gel de clorexidina a 0,12% pode servir como uma profilaxia efetiva contra a PAV em pacientes sob ventilação mecânica.Palavras-chave: Unidade de Terapia Intensiva. Prevenção de Doenças. Higiene Bucal.

Efficacy and Safety of a Paired Sedation and Ventilator Weaning Protocol for Mechanically Ventilated Patients in Intensive Care

2018 ◽  
pp. 27-32
Author(s):  
Jeffery Katz ◽  
Steve Greenberg
Keyword(s):  
Intensive Care ◽  
Intervention Group ◽  
Ventilator Weaning ◽  
Control Group ◽  
Mechanical Ventilator ◽  
Efficacy And Safety ◽  
Icu Patients ◽  
Mechanically Ventilated ◽  
Improved Outcomes ◽  
Spontaneous Breathing Trials

The chapter entitled examines the efficacy of pairing daily sedation awakening trials (SAT) with daily spontaneous breathing trials (SBT) in intensive care unit (ICU) patients on a mechanical ventilator. Three-hundred thirty-six ICU patients requiring mechanical ventilation for > 12 hours and eligible for a ventilator weaning trial were included. The authors compared the number of ventilator-free days in patients who received an SBT alone versus an SAT + SBT. Patients in the intervention group (SAT + SBT) spent a mean of 3.1 more days liberated from the ventilator when compared to the control group. Medical ICU patients undergoing paired SAT + SBT may experience improved outcomes versus those with SBT alone.

scholarly journals Oral care and nosocomial pneumonia: a systematic review

2015 ◽  
Vol 13 (2) ◽  
pp. 290-296 ◽  
Author(s):  
Maria Carolina Nunes Vilela ◽  
Gustavo Zanna Ferreira ◽  
Paulo Sérgio da Silva Santos ◽  
Nathalie Pepe Medeiros de Rezende
Keyword(s):  
Systematic Review ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Nosocomial Pneumonia ◽  
Oral Hygiene ◽  
Oral Care ◽  
Control Group ◽  
Level Of Evidence ◽  
Grade Of Recommendation ◽  
Minimal Bias

To perform a systematic review of the literature on the control of oral biofilms and the incidence of nosocomial pneumonia, in addition to assessing and classifying studies as to the grade of recommendation and level of evidence. The review was based on PubMed, LILACS, and Scopus databases, from January 1st, 2000 until December 31st, 2012. Studies evaluating oral hygiene care related to nosocomial infections in patients hospitalized in intensive care units were selected according to the inclusion criteria. Full published articles available in English, Spanish, or Portuguese, which approached chemical or mechanical oral hygiene techniques in preventing pneumonia, interventions performed, and their results were included. After analysis, the articles were classified according to level of evidence and grade of recommendation according to the criteria of the Oxford Centre for Evidence-Based Medicine. A total of 297 abstracts were found, 14 of which were full articles that met our criteria. Most articles included a study group with chlorhexidine users and a control group with placebo users for oral hygiene in the prevention of pneumonia. All articles were classified as B in the level of evidence, and 12 articles were classified as 2B and two articles as 2C in grade of recommendation. It was observed that the control of oral biofilm reduces the incidence of nosocomial pneumonia, but the fact that most articles had an intermediate grade of recommendation makes clear the need to conduct randomized controlled trials with minimal bias to establish future guidelines for oral hygiene in intensive care units.

Delivering Cognitive Behavioral Therapy for Post–Intensive Care Syndrome–Family via a Mobile Health App

2021 ◽  
Vol 30 (6) ◽  
pp. 451-458
Author(s):  
Amy Petrinec ◽  
Cindy Wilk ◽  
Joel W. Hughes ◽  
Melissa D. Zullo ◽  
Yea-Jyh Chen ◽  
...  
Keyword(s):  
Intensive Care ◽  
Cognitive Behavioral Therapy ◽  
Mobile Health ◽  
Behavioral Therapy ◽  
Family Members ◽  
Intervention Group ◽  
Cognitive Behavioral ◽  
Control Group ◽  
Icu Patients ◽  
Post Intensive Care Syndrome

Background Family members of intensive care unit (ICU) patients are at risk for post–intensive care syndrome– family (PICS-F), including symptoms of anxiety, depression, and posttraumatic stress. Cognitive behavioral therapy is the first-line nonpharmacologic treatment for many psychological symptoms and has been successfully delivered by use of mobile technology for symptom self-management. Objectives To determine the feasibility of delivering cognitive behavioral therapy through a smartphone app to family members of critically ill patients. Methods This was a prospective longitudinal cohort study with a consecutive sample of patients admitted to 2 adult ICUs and their family members. The control group period was followed by the intervention group period. The intervention consisted of a mobile health app preloaded on a smartphone provided to family members. The study time points were enrollment (within 5 days of ICU admission), 30 days after admission, and 60 days after admission. Study measures included demographic data, app use, satisfaction with the app, mental health self-efficacy, and measures of PICS-F symptoms. Results The study sample consisted of 49 predominantly White (92%) and female (82%) family members (24 intervention, 25 control). Smartphone ownership was 88%. Completion rates for study measures were 92% in the control group and 79% in the intervention group. Family members logged in to the app a mean of 18.58 times (range 2-89) and spent a mean of 81.29 minutes (range 4.93-426.63 minutes) using the app. Conclusions The study results confirm the feasibility of implementing app-based delivery of cognitive behavioral therapy to family members of ICU patients.

Association of opioid exposure during intensive care unit stays with post-discharge opioid use: A retrospective study and literature review

2021 ◽  
Vol 17 (6) ◽  
pp. 511-516
Author(s):  
Yoonsun Mo, MS, PharmD, BCPS, BCCCP ◽  
John Zeibeq, MD ◽  
Nabil Mesiha, MD ◽  
Abou Bakar, PharmD ◽  
Maram Sarsour, PharmD ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Hospital Discharge ◽  
Invasive Mechanical Ventilation ◽  
High Dose ◽  
Opioid Use ◽  
Electronic Health Record Data ◽  
Icu Patients ◽  
Mechanically Ventilated

Objective: To evaluate whether pain management strategies within intensive care unit (ICU) settings contribute to chronic opioid use upon hospital discharge in opioid-naive patients requiring invasive mechanical ventilation. Design: A retrospective, observational study.Setting: An 18-bed mixed ICU at a community teaching hospital located in Brooklyn, New York.Participants: This study included mechanically ventilated patients requiring continuous opioid infusion from April 25, 2017 to May 16, 2019. Patients were excluded if they received chronic opioid therapy at home or expired during this hospital admission. Eligible patients were identified using an electronic health record data query.Main outcome measure(s): The proportion of ICU patients who continued to require opioids upon ICU and hospital discharge. Results: A total of 196 ICU patients were included in this study. Of these, 22 patients were transferred to a regular floor while receiving a fentanyl transdermal patch. However, the fentanyl patch treatment was continued only for three patients (2 percent) at hospital discharge.Conclusions: This retrospective study suggested that high-dose use of opioids in mechanically ventilated, opioid-naive ICU patients was not associated with continued opioid use upon hospital discharge.

Daily Interruption of Sedation with Physical and Occupational Therapy in Mechanically Ventilated Patients

2018 ◽  
pp. 309-316
Author(s):  
Michael Wolfe ◽  
Daniel Saddawi-Konefka
Keyword(s):  
Occupational Therapy ◽  
Functional Status ◽  
Intervention Group ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Icu Patients ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Schweickert et al. studied effects of early physical and occupational therapy in mechanically ventilated patients. 109 mechanically ventilated medical ICU patients (with independent functional status prior to hospitalization) were randomized to receive physical and occupational therapy initiated at time of enrollment (intervention group) vs. physical and occupational therapy ordered at the discretion of the primary team (control group), with both groups receiving daily interruptions of sedation. The primary outcome, independent functional status at time of discharge, was met in 59% of the intervention group vs. 35% of the control group (p = 0.02). Lower rates of ICU and hospital delirium were observed in the intervention group. Hospital length of stay and mortality were unaffected. This study demonstrated that physical and occupational therapy can be safely accomplished in critically ill, mechanically ventilated medical ICU patients, and that early implementation of therapy may improve return to independent functional status at hospital discharge.

Use of Procalcitonin to Reduce Patients’ Exposure to Antibiotics in Intensive Care Units (PRORATA Trial)

2018 ◽  
pp. 276-281
Author(s):  
Alice Gallo De Moraes ◽  
Dante Schiavo
Keyword(s):  
Antibiotic Resistance ◽  
Intensive Care ◽  
Bacterial Infections ◽  
Clinical Case ◽  
Adverse Outcomes ◽  
Control Group ◽  
Antibiotic Exposure ◽  
Icu Patients ◽  
Study Intervention

This chapter provides a summary of the landmark study known as the PRORATA trial. Does a procalcitonin (PCT)-based strategy to treat suspected bacterial infections in ICU patients reduce antibiotic exposure without adverse outcomes? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. The study suggests that critically ill patients managed with a PCT-guided antibiotic strategy to treat suspected bacterial infections results in more antibiotic-free days than those managing patients with clinical guidelines alone. The mortality of patients in the PCT arm was non-inferior to those in the control group at day 28 and at day 60. The strategy could be beneficial for reducing antibiotic resistance in the ICU.

scholarly journals Virtual reality for relatives of ICU patients to improve psychological sequelae: study protocol for a multicentre, randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e049704
Author(s):  
Johan H Vlake ◽  
Jasper van Bommel ◽  
Evert-Jan Wils ◽  
Tim Korevaar ◽  
Merel E Hellemons ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Virtual Reality ◽  
Intensive Care ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Well Being ◽  
Control Group ◽  
Icu Patients ◽  
Randomised Controlled

IntroductionIntensive care unit (ICU) admission of a relative might lead to psychological distress and complicated grief (post-intensive care syndrome–family; PICS-F). Evidence suggests that increased distress during ICU stay increases risk of PICS-F, resulting in difficulty returning to their normal lives after the ICU experience. Effective interventions to improve PICS-F are currently lacking. In the present trial, we hypothesised that information provision using ICU-specific Virtual Reality for Family members/relatives (ICU-VR-F) may improve understanding of the ICU and subsequently improve psychological well-being and quality of life in relatives of patients admitted to the ICU.Methods and analysisThis multicentre, clustered randomised controlled trial will be conducted from January to December 2021 in the mixed medical-surgical ICUs of four hospitals in Rotterdam, the Netherlands. We aim to include adult relatives of 160 ICU patients with an expected ICU length of stay over 72 hours. Participants will be randomised clustered per patient in a 1:1 ratio to either the intervention or control group. Participants allocated to the intervention group will receive ICU-VR-F, an information video that can be watched in VR, while the control group will receive usual care. Initiation of ICU-VR-F will be during their hospital visit unless participants cannot visit the hospital due to COVID-19 regulations, then VR can be watched digitally at home. The primary objective is to study the effect of ICU-VR-F on psychological well-being and quality of life up to 6 months after the patients’ ICU discharge. The secondary outcome is the degree of understanding of ICU treatment and ICU modalities.Ethics and disseminationThe Medical Ethics Committee of the Erasmus Medical Centre, Rotterdam, the Netherlands, approved the study and local approval was obtained from each participating centre (NL73670.078.20). Our findings will be disseminated by presentation of the results at (inter)national conferences and publication in scientific, peer-reviewed journals.Trial registration numberNetherlands Trial Register (TrialRegister.nl, NL9220).

scholarly journals The Effect of the Dreamer Spiritual Therapies on Saliva Cortisol Hormone and Pain Score Patients in the Intensive Care Unit: A True-experimental Study

2021 ◽  
Vol 9 (G) ◽  
pp. 281-287
Author(s):  
Iwan Purnawan ◽  
Sri Setiyarini ◽  
Probosuseno Probosuseno ◽  
Yunita Widyastuti
Keyword(s):  
Intensive Care Unit ◽  
Experimental Study ◽  
Intensive Care ◽  
Pain Score ◽  
Wilcoxon Test ◽  
Control Group ◽  
Icu Patients ◽  
Pain Scores ◽  
Spiritual Therapy ◽  
Paired T Test

BACKGROUND: Patients’ conditions can worsen if stress and pain are not appropriately managed. Conventional therapy ignores psychological and spiritual aspects. Both influence the body’s response to various stimuli. AIM: This study aimed to assess how Dreamer’s spiritual therapy can affect the cortisol and pain in the intensive care unit (ICU) patients. METHODS: It involved 86 ICU patients in a true-experimental study. Respondents were divided into the intervention and the control group randomly. The intervention group received Dreamer spiritual therapy (DST) for 30 min but not for the control group. Saliva samples and pain scores were taken from both groups before and after treatment. The comparison of two groups cortisol decreases using Wilcoxon test. Differences in pre- and post-pain scores in each group were analyzed using paired t-test. RESULTS: According to Levene’s test, the two groups were homogeneous (p > 0.05). The Wilcoxon test revealed a statistically significant difference in cortisol level reduction between the intervention (3.88 ng/mL) and control (3.82 ng/ml) groups (p = 0.024), with a large effect size (Cohen’s d value = 59.5). The paired t-test revealed a statistically significant decrease in the intervention group’s pain score from 2.6 to 1.95 (p = 0.001), with a moderate effect size (Cohen’s d value = 0.49). The control group’s pain score did not significantly decrease (p = 0.75). CONCLUSIONS: A DST is effective in reducing salivary cortisol levels and pain scores of ICU patients.

Effectiveness of a Dental Care Intervention in the Prevention of Lower Respiratory Tract Nosocomial Infections among Intensive Care Patients: A Randomized Clinical Trial

2014 ◽  
Vol 35 (11) ◽  
pp. 1342-1348 ◽  
Author(s):  
Wanessa T. Bellissimo-Rodrigues ◽  
Mayra G. Menegueti ◽  
Gilberto G. Gaspar ◽  
Edson A. Nicolini ◽  
Maria Auxiliadora-Martins ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Intensive Care ◽  
Respiratory Tract ◽  
Dental Care ◽  
Oral Hygiene ◽  
Critically Ill Patients ◽  
Lower Respiratory Tract ◽  
Dental Treatment ◽  
Control Group ◽  
Experimental Group

Objective.To evaluate whether dental treatment may enhance oral antisepsis, thus preventing more effectively lower respiratory tract infections (LRTIs) among critically ill patientsDesign.Observer-blind randomized clinical trial.Setting.General intensive care unit (ICU) for adult patients.Patients.We analyzed data from 254 adult patients who stayed for at least 48 hours in the ICU.Intervention.Patients were randomized by means of rolling dice. The experimental group (n = 127) had access to dental care provided by a dental surgeon, 4–5 times a week. Besides routine oral hygiene, care also included teeth brushing, tongue scraping, removal of calculus, atraumatic restorative treatment of caries, and tooth extraction. The control group (n = 127) had access to routine oral hygiene only, which included the use of chlorhexidine as a mouth rinse, which was performed by the ICU nurse staff.Results.The primary study outcome was the LRTI incidence, which was 8.7% in the experimental group and 18.1% in the control group (adjusted relative risk [RR], 0.44 [95% confidence interval (CI), 0.20–0.96]; P = .04). Ventilator-associated pneumonia rates per 1,000 ventilator-days were 16.5 (95% CI, 9.8–29.5) in the control group and 7.6 (95% CI, 3.3–15.0) in the experimental group (P < .05). Mortality rates were similar between both study groups: 31.5% in the control group versus 29.1% in the experimental group (adjusted RR, 0.93 [95% CI, 0.52–1.65]; P = .796). No severe adverse events related to oral care were observed during the study.Conclusion.Dental treatment was safe and effective in the prevention of LRTI among critically ill patients who were expected to stay at least 48 hours in the ICU.Trial registration.Brazilian Clinical Trials Registry, affiliated with the World Health Organization’s International Clinical Trial Registry Platform: U1111-1152-2671.Infect Control Hosp Epidemiol 2014;35(11):1342–1348

Communication in the process of humanization of the assistance at intensive care unit: experience of relatives and cares

2010 ◽  
Vol 4 (4) ◽  
pp. 1587
Author(s):  
Natália Celião Leite ◽  
Josilene De Melo Buriti Vasconcelos ◽  
Wilma Dias de Fontes
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Family Members ◽  
Structured Interview ◽  
Communication Process ◽  
Icu Patients ◽  
Efficient System ◽  
The Family ◽  
Terapia Intensiva ◽  
Nursing Professionals

ABSTRACTObjectives: to report the experience of the nursing team and family members of ICU patients as regards communication; to learn the meaning they attribute to the communication process. Methodology: a quantitative and qualitative exploratory study carried out at the Intensive Care Unit of the school hospital. Consisting of 15 family members and 15 nursing professionals who happened to be available there during the data collection, the sample resulted from semi-structured interview guidance. The data were analyzed by means of descriptive statistics, taking into account the absolute and percentage numbers, and the technique of the Collective Subject Discourse, with presentation throughout graph, table and charts. Results: the data showed gaps in the communication, which are inherent to some professionals who neither practice nor value the communication process with the family, mainly as regards the need to prepare them for the ICU environment and the real conditions of their family members. Conclusion: the need to adopt an efficient system of communication with relatives of ICU patients is widely known. Thus, the nurse will be adopting new ways of caring, which include valuing the family members as integrating part of the nursing care, with view to humanizing the assistance. Descriptors: communication; humanization of the assistance; intensive care unit. RESUMOObjetivos: relatar a experiência da equipe de enfermagem e de familiares de pacientes internados em uma UTI, na perspectiva da comunicação; apreender o significado por eles atribuído ao processo de comunicação. Métodologia: estudo exploratório, quantiqualitativo, realizado na Unidade de Terapia Intensiva de hospital escola. A amostra foi formada por 15 familiares e 15 profissionais de enfermagem que se encontravam no local, por ocasião da coleta de dados, a qual ocorreu por meio de um roteiro de entrevista semi-estruturado. Os dados foram analisados por meio da estatística descritiva, levando-se em conta os números absolutos e percentuais, e da técnica do Discurso do Sujeito Coletivo, com apresentação em gráfico, tabela e quadros. Resultados: os dados mostram lacunas na comunicação, as quais são inerentes a alguns profissionais que não praticam e não valorizam o processo de comunicação com a família, principalmente no que diz respeito à necessidade de prepará-los para compreender o ambiente da UTI e as reais condições de seus familiares. Conclusão: é notória a necessidade de se adotar um sistema eficaz de comunicação com os familiares de pacientes internados na UTI. Assim, o enfermeiro estará adotando novas formas de cuidar, que incluem a valorização dos familiares como parte integrante do cuidado de enfermagem na perspectiva da humanização da assistência. Descritores: comunicação; humanização da assistência; unidade de terapia intensiva.RESUMENObjetivos: relatar la experiencia del equipo de enfermería y parientes de pacientes de UTI, en cuanto a la comunicación; aprender el significado que ellos atribuyen al proceso de comunicación. Metodología: estudio exploratorio, cuantitativo y cualitativo, realizado en la Unidad de Terapia Intensiva del hospital escuela. Formada por 15 parientes y 15 profesionales de enfermería que se encontraban disponibles en el sitio durante el recogimiento de los datos, la muestra resultó de la rutina de una entrevista semi-estructurada. Los datos fueron analizados a través de la estadística descriptiva, llevándose en cuenta los números absolutos y porcentajes, la técnica del Discurso del Sujeto Colectivo, con presentación en gráfico, tabla y cuadros. Resultado: los datos enseñan brechas en la comunicación, las cuales son propias de algunos profesionales que no practican y no valoran el proceso de comunicación con la familia, principalmente en cuanto a la necesidad de les preparar a entender el ambiente de la UTI y las reales condiciones de sus parientes. Conclusión: es notoria la necesidad de adoptarse un sistema de comunicación eficiente con los parientes de pacientes de UTI. Así, el enfermero estará adoptando nuevas maneras de cuidar, las cuales incluyen la valoración de los parientes como parte del cuidado de enfermero, con vista a la humanización de la asistencia. Descriptores: comunicación; humanización de la asistencia; unidad de terapia intensiva. 

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