scholarly journals Routine chest radiographs in the surgical intensive care unit: Can we change clinical habits with no proven benefit?

2013 ◽  
Vol 60 (3) ◽  
pp. 39-44
Author(s):  
Jelena Velickovic ◽  
Sanela Hajdarevic ◽  
Ivan Palibrk ◽  
Natasa Janic ◽  
Marija Djukanovic ◽  
...  
Keyword(s):  
Radiation Risk ◽  
Chest Radiographs ◽  
Surgical Intensive Care Unit ◽  
Daily Routine ◽  
Lung Pathology ◽  
Surgical Intensive Care ◽  
Digestive Surgery ◽  
Icu Stay ◽  
Surgical Icu ◽  
Routine Chest

Daily routine chest radiographs (CR) are commonly performed in surgical ICU. Unnecessary CR increase costs and expose the staff and the patients to radiation risk. The goal of our study was to estimate the value of daily routine CR in the ICU and to determine the correlation between CR and physical findings in surgical ICU patients. Prospective observational study was conducted during period of two months at the ICU department at the Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade. It included 97 consecutive patients who underwent digestive surgery and stayed at the ICU for at least two days. During their ICU stay, CRs were obtained as a clinical routine or to monitor lung pathology. Patients were followed daily, and CRs (as the proportion of positive findings) were compared with physical examination and clinical presentation. A total of 717 CRs were obtained, median number per patient was 4.0 (2.0-7.0). Proportion of positive findings was significantly higher comparing to auscultation until the sixth day of ICU stay. There was no difference in CR findings from day to day after the sixth day. Therapeutic efficacy of CRs was low as only 56 (7.8%) resulted in a change of patient management. We conclude that daily routine CRs are justified in the first six days of ICU stay, and after that time they show no advantages over clinical examination.

scholarly journals Elimination of daily routine chest radiographs in a mixed medical–surgical intensive care unit

2007 ◽  
Vol 33 (4) ◽  
pp. 639-644 ◽  
Author(s):  
Marleen E. Graat ◽  
Anke Kröner ◽  
Peter E. Spronk ◽  
Johanna C. Korevaar ◽  
Jaap Stoker ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Chest Radiographs ◽  
Surgical Intensive Care Unit ◽  
Daily Routine ◽  
Surgical Intensive Care ◽  
Routine Chest

scholarly journals A pilot study assessing the spiritual, emotional, physical/environmental, and physiological needs of mechanically ventilated surgical intensive care unit patients via eye tracking devices, head nodding, and communication boards

2018 ◽  
Vol 3 (1) ◽  
pp. e000180 ◽  
Author(s):  
Erin I Duffy ◽  
Jonah Garry ◽  
Lillian Talbot ◽  
David Pasternak ◽  
Ashley Flinn ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Eye Tracking ◽  
Tertiary Care ◽  
Basic Needs ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
Head Nodding ◽  
Surgical Icu

BackgroundMechanically ventilated patients in the intensive care unit (ICU) are unable to communicate verbally. We sought to evaluate their needs via a communication board (CB) and a novel eye tracking device (ETD) that verbalizes selections made by gazing.MethodsThis was a pilot prospective study conducted in a tertiary care surgical ICU. Continuously mechanically ventilated adult surgical ICU patients with a Richmond Agitation-Sedation Scale score of −1 to +1, without cognitive impairment, were eligible. We asked patients four yes-or-no questions to assess basic needs regarding presence of pain, need for endotracheal suction, satisfactory room temperature, and position comfort. Patients were then asked if there was anything else that they wanted to communicate. All responses were confirmed by head nodding.ResultsThe median accuracy of the CB (100% (IQR 100%–100%)) for basic needs communication (yes/no questions) was comparable with that of the ETD (100% (IQR 68.8%–100%); p=0.14) in the 12 enrolled patients. Notably, 83% of patients desired to communicate additional information, ranging from spiritual (eg, desire for prayer/chaplain), emotional (eg, frustration, desire for comfort), physical/environmental (eg, television), to physiological (eg, thirst/hunger) needs.DiscussionThe majority of patients desired to communicate something other than basic needs. Unless specifically assessed via an assistive communication device (eg, CB or ETD), some of these other needs would have been difficult to discern.Level of evidenceIV therapeutic care/management.

Aspirin Increases the Risk of Venous Thromboembolism in Surgical Patients

2014 ◽  
Vol 80 (10) ◽  
pp. 920-925 ◽  
Author(s):  
Galinos Barmparas ◽  
Monica Jain ◽  
Devorah Mehrzadi ◽  
Nicolas Melo ◽  
Rex Chung ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Primary Outcome ◽  
Antiplatelet Agent ◽  
Antiplatelet Agents ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Patients ◽  
Forward Logistic Regression ◽  
Surgical Icu ◽  
Level I

The risk of venous thromboembolism (VTE) for patients taking an antiplatelet agent is largely unknown. This study aimed to investigate the association between antiplatelet agent use before admission with the risk of in-hospital VTE in surgical intensive care unit (ICU) patients. A retrospective review of all patients admitted to the surgical ICU at a Level I trauma center over 30 months was performed. Patients who underwent diagnostic imaging for VTE were selected. Patients were divided based on whether or not antiplatelet agents were used before admission (APTA vs NAPTA). The primary outcome was VTE occurrence. A forward logistic regression model was used to identify factors independently associated with the primary outcome. During the study period, 461 (24%) patients met inclusion criteria: 70 (15%) APTA and 391 (85%) NAPTA. After adjusting for confounding factors, APTA patients were at a significantly higher risk for developing VTE (59 vs 40%; adjusted odds ratio, 1.8; 95% confidence interval, 1.0 to 3.0; adjusted P = 0.04). Whether or not antiplatelet agents were resumed during the hospital stay and the day on which they were resumed did not affect VTE risk. In conclusion, surgical ICU patients receiving antiplatelet agents before admission are at a significantly higher risk for development of VTE.

scholarly journals A Pilot Study of Patients With COVID–19-Related Respiratory Failure Utilizing Airway Pressure Release Ventilation (APRV)

2020 ◽  
Author(s):  
D'Andrea K. Joseph ◽  
Gerard A. Baltazar ◽  
Ricardo A. Jacquez ◽  
Shahidul Islam ◽  
Adam Stright ◽  
...  
Keyword(s):  
Pilot Study ◽  
Airway Pressure ◽  
Study Data ◽  
Airway Pressure Release Ventilation ◽  
Surgical Intensive Care Unit ◽  
Lung Pathology ◽  
Surgical Intensive Care ◽  
Pressure Release ◽  
Subsequent Decrease ◽  
Pressure Release Ventilation

ABSTRACT Background Pneumonia leading to acute respiratory distress syndrome (ARDS) is one of the devastating consequences of coronavirus disease 2019 (COVID-19). Airway pressure release ventilation (APRV) has been described as beneficial in acute lung injury and ARDS. We hypothesized that utilizing APRV would be advantageous in the COVID-19 ARDS population. Methods Prospective, observational, single-center study. Data were extracted on demographics, vasopressors, sedatives, analgesics, and oxygenation (PaO2/FiO2). A generalized linear mixed models analysis was performed to compare low tidal volume ventilation (LTV) with APRV for patients who required intubation due to ARDS from COVID-19 and who were managed with at least 48 consecutive hours of APRV in our surgical intensive care unit (SICU). Results Twelve patients met criteria; two were on APRV mode from admission to the SICU and were not included in the study. Ten patients were analyzed and were primarily male (70%), average age of 64.5 ± 12.9 years, and 70% were obese (average body mass index of 30.6 ± 8.0 kg/m2). There were no smokers in the sample, but two patients presented with underlying lung pathology. APRV was shown to significantly increase the PaO2/FiO2 ratio by 30% (5% to 61%) (p = 0.05) and was associated with up to a 12% (−26% to 5%) reduction in the level of FiO2 and reduction in the use of vasopressor support (−59% [−83% to −2%]), sedatives (−15% [−29% to 2%]), and analgesics (−16% [−38% to 12%]). Conclusions This pilot study showed that APRV was associated with decreases in FiO2, vasopressors, sedatives, and analgesic requirements with an increase in PaO2/FiO2 ratio. In the current pandemic, where providers are grappling with ways to manage COVID-19 ARDS, APRV may be the optimal ventilator mode. Prospective randomized studies are required to validate whether use of APRV in the COVID-19 population leads to improved oxygenation and a subsequent decrease of ventilator days and length of stay.

Are daily routine chest radiographs useful in critically ill, mechanically ventilated patients? A randomized study

2007 ◽  
Vol 34 (2) ◽  
pp. 264-270 ◽  
Author(s):  
Christophe Clec’h ◽  
Paul Simon ◽  
Aïcha Hamdi ◽  
Lilia Hamza ◽  
Philippe Karoubi ◽  
...  
Keyword(s):  
Critically Ill ◽  
Randomized Study ◽  
Chest Radiographs ◽  
Daily Routine ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Routine Chest ◽  
Ventilated Patients

Essay: Celebrating New Life in a Neuro-Surgical ICU

2014 ◽  
Vol 18 (3) ◽  
pp. 65-66
Author(s):  
Marlienne Goldin,
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Real Time ◽  
Nursing Staff ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Grand Mal ◽  
Surgical Icu ◽  
New Mother ◽  
First Time

Caritas nurses cultivate the soul and spirit of their patients, as well as attend to their emotional and physical needs. This exemplar of caritas nursing shows how the nursing staff in a neuro-surgical intensive care unit (ICU), where a new mother had been admitted after having grand mal seizures during delivery, used technology to bring mother and baby together. Using iPhones and Facetime, the ICU nurses arranged for the mother to see her baby boy in the newborn nursery for the very first time, in real time. This caring moment exemplifies many of Watson’s caritas processes. Participating in these caring moments is the greatest reward of nursing.

Review of a Large Clinical Series: The Value of Routinely Obtained Chest Radiographs on Admission to a Mixed Medical—Surgical Intensive Care Unit

2010 ◽  
Vol 25 (4) ◽  
pp. 227-232 ◽  
Author(s):  
Liesbeth Martine Kager ◽  
Anke Kröner ◽  
Jan M. Binnekade ◽  
Jan-Willem Gratama ◽  
Peter E. Spronk ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Chest Radiographs ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Clinical Series

Blood Glucose Variability is Associated with Mortality in the Surgical Intensive Care Unit

2008 ◽  
Vol 74 (8) ◽  
pp. 679-685 ◽  
Author(s):  
Lesly A. Dossett ◽  
Hanqing Cao ◽  
Nathan T. Mowery ◽  
Marcus J. Dortch ◽  
John M. Morris ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Insulin Dose ◽  
Standard Of Care ◽  
Glucose Variability ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Blood Glucose Variability ◽  
Surgical Icu

Intensive insulin therapy has widely and rapidly been adopted as the standard of care for the treatment of hyperglycemia in the intensive care unit (ICU). Variability in blood glucose is increasingly recognized as an important factor in outcomes in the chronic diabetic in addition to hemoglobin A1C. We tested the hypothesis that measures of blood glucose variability would be associated with mortality in the surgical ICU. A retrospective analysis of a cohort of ventilated, critically ill surgical and trauma ICU patients placed on an automated insulin protocol was performed. Blood glucose (BG) variability was measured by comparing standard deviation, percentile values, successive changes in blood glucose, and by calculating the triangular index for various glucose-related indices. Eight hundred and fifty-eight patients had 46,474 blood glucose and insulin dose data points. One hundred and twenty-one patients died for an overall mortality rate of 14 per cent. Several measures of blood glucose variability (maximum successive change in BG and the triangular index) were different between the groups despite similar mean BG between survivors (117 mg/dL) and nonsurvivors (118 mg/dL). Increased blood glucose variability is associated with mortality in the surgical ICU. Further studies should focus on the demographic, clinical, and genetic factors responsible for this observation and identify strategies to minimize BG variability.

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