scholarly journals AVALIAÇÃO DE UM PROTOCOLO DE MOBILIZAÇÃO PRECOCE EM UMA UNIDADE DE TERAPIA INTENSIVA

2019 ◽  
Vol 3 ◽  
pp. 92
Author(s):  
Cassia Cinara Costa ◽  
Briane Da Silva Leite ◽  
Claudia Kist Fortino ◽  
Vinicius Gonçalves Bastos
Keyword(s):  
Intensive Care ◽  
Intervention Group ◽  
Length Of Hospital Stay ◽  
Early Mobilization ◽  
Pulmonary Complications ◽  
Control Group ◽  
Strength Gain ◽  
Early Ambulation ◽  
Peripheral Muscle ◽  
Terapia Intensiva

RESUMOAvaliar se o protocolo de mobilização precoce contribui para a redução do tempo de internação na Unidade de Terapia Intensiva (UTI) em pacientes submetidos a ventilação mecânica invasiva (VMI), analisar o tempo de assistência à VMI e os efeitos da mobilização precoce na força da musculatura periférica, através de um estudo de coorte concorrente com amostra consecutiva, realizado em 14 pacientes que estiveram internados em uma UTI de um hospital do Vale dos Sinos/RS. Os pacientes foram divididos em Grupo Controle, que realizou a fisioterapia do setor, e Grupo Intervenção, que recebeu o protocolo de mobilização precoce proposto por Morris et al. (2008). Os pacientes do Grupo Intervenção permaneceram um tempo menor no VMI e de internação na UTI, além de terem um ganho de força muscular periférica quando comparado ao Grupo Controle. O protocolo de mobilização precoce pode reduzir a incidência de complicações pulmonares, acelerar a recuperação, diminuir o tempo da VMI e o tempo de internação da UTI.Palavras-chave: Deambulação precoce. Fisioterapia. Reabilitação. Unidades de Terapia Intensiva.ABSTRACTTo evaluate whether the early mobilization protocol contributes to the reduction of the length of hospital stay in the Intensive Care Unit (ICU) in patients undergoing mechanical ventilation (NIV), to analyze the time of NIV care and the effects of early mobilization on the strength of the peripheral musculature. Through a concurrent cohort study with a consecutive sample, performed in 14 patients who were hospitalized in an ICU of a Vale dos Sinos / RS hospital. The patients were divided into a Control Group that performed the physiotherapy of the sector, and Intervention Group that received the protocol of early mobilization proposed by Morris et al. (2008). The Intervention Group patients remained shorter in the NIV and in the ICU, in addition to having a peripheral muscle strength gain when compared to the Control Group. The early mobilization protocol can reduce the incidence of pulmonary complications, accelerate recovery, decrease NIV time and ICU length of stay.Keywords: Early Ambulation. Intensive Care Units. Physical Therapy Specialty. Rehabilitation.

scholarly journals Standardized Application of Laxatives and Physical Measures in Neurosurgical Intensive Care Patients Improves Defecation Pattern but Is Not Associated with Lower Intracranial Pressure

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Martin Kieninger ◽  
Barbara Sinner ◽  
Bernhard Graf ◽  
Astrid Grassold ◽  
Sylvia Bele ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Intracranial Pressure ◽  
Bowel Movement ◽  
Intervention Group ◽  
Length Of Hospital Stay ◽  
Control Group ◽  
Neurosurgical Patients ◽  
Bowel Movements ◽  
Physical Measures

Background. Inadequate bowel movements might be associated with an increase in intracranial pressure in neurosurgical patients. In this study we investigated the influence of a structured application of laxatives and physical measures following a strict standard operating procedure (SOP) on bowel movement, intracranial pressure (ICP), and length of hospital stay in patients with a serious acute cerebral disorder.Methods. After the implementation of the SOP patients suffering from a neurosurgical disorder received pharmacological and nonpharmacological measures to improve bowel movements in a standardized manner within the first 5 days after admission to the intensive care unit (ICU) starting on day of admission. We compared mean ICP levels, length of ICU stay, and mechanical ventilation to a historical control group.Results. Patients of the intervention group showed an adequate defecation pattern significantly more often than the patients of the control group. However, this was not associated with lower ICP values, fewer days of mechanical ventilation, or earlier discharge from ICU.Conclusions. The implementation of a SOP for bowel movement increases the frequency of adequate bowel movements in neurosurgical critical care patients. However, this seems not to be associated with reduced ICP values.

Exercise as early mobilization in patients using vasoactive drugs

2020 ◽  
Vol 19 (4) ◽  
pp. 301
Author(s):  
Amanda Mariano Morais ◽  
Daiane Naiara Da Penha ◽  
Danila Gonçalves Costa ◽  
Vanessa Beatriz Aparecida Fontes Schweling ◽  
Jaqueline Aparecida Almeida Spadari ◽  
...  
Keyword(s):  
Intensive Care ◽  
Cardiovascular Response ◽  
Ventilatory Support ◽  
Early Mobilization ◽  
Scientific Basis ◽  
Routine Practice ◽  
Vasoactive Drugs ◽  
Early Ambulation ◽  
Early Mobility ◽  
The Face

Introduction: The functional benefits of Early Mobilization (EM) capable of minimizing limitations and deformities in the face of immobility are clear, but there are many barriers to conduct EM as a routine practice in the Intensive Care Unit (ICU), including the use of vasoactive drugs (VAD), since it is directly related to weakness acquired in the ICU, in addition to the resistance of the multidisciplinary team to mobilize the patient using VAD. Objective: The objective of this literature review is to raise a scientific basis in the management of critically ill patients using DVAs for EM in the ICU. Methods: It is an integrative review of the literature, with research in the databases: PEDro, Pubmed, Lilacs, with articles published between 2011 and 2018, in Portuguese and English, using the terms: vasoactive drugs, early mobility, exercise in UCI, vasopressor and its equivalents in Portuguese. Results: Nine studies were included that analyzed the EM intervention in patients using VAD, with or without ventilatory support. There was no homogeneous treatment among the researched works, varying between exercises in bed and outside, with passive and / or active action. However, regardless of the conduct, there was an improvement in the cardiovascular response without relevant changes regarding the use of VAD. Conclusion: EM is not contraindicated for patients in the ICU with the use of VAD, and it was shown to be effective and safe without promoting relevant hemodynamic and cardiorespiratory changes, which would determine its absolute contraindication.Keywords: vasodilator agents, early ambulation, intensive care units, physical therapy specialty.

scholarly journals Methylprednisolone or dexamethasone, which one is superior corticosteroid in the treatment of hospitalized COVID-19 patients: a triple-blinded randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Keivan Ranjbar ◽  
Mohsen Moghadami ◽  
Alireza Mirahmadizadeh ◽  
Mohammad Javad Fallahi ◽  
Vahid Khaloo ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Clinical Status ◽  
Intervention Group ◽  
Length Of Hospital Stay ◽  
Ordinal Scale ◽  
Control Group ◽  
Randomized Controlled ◽  
Group Data ◽  
Significant Difference

Abstract Background Although almost a year has passed since the Coronavirus disease 2019 (COVID-19) outbreak and promising reports of vaccines have been presented, we still have a long way until these measures are available for all. Furthermore, the most appropriate corticosteroid and dose in the treatment of COVID-19 have remained uncertain. We conducted a study to assess the effectiveness of methylprednisolone treatment versus dexamethasone for hospitalized COVID-19 patients. Methods In this prospective triple-blinded randomized controlled trial, we enrolled 86 hospitalized COVID-19 patients from August to November 2020, in Shiraz, Iran. The patients were randomly allocated into two groups to receive either methylprednisolone (2 mg/kg/day; intervention group) or dexamethasone (6 mg/kg/day; control group). Data were assessed based on a 9-point WHO ordinal scale extending from uninfected (point 0) to death (point 8). Results There were no significant differences between the groups on admission. However, the intervention group demonstrated significantly better clinical status compared to the control group at day 5 (4.02 vs. 5.21, p = 0.002) and day 10 (2.90 vs. 4.71, p = 0.001) of admission. There was also a significant difference in the overall mean score between the intervention group and the control group, (3.909 vs. 4.873 respectively, p = 0.004). The mean length of hospital stay was 7.43 ± 3.64 and 10.52 ± 5.47 days in the intervention and control groups, respectively (p = 0.015). The need for a ventilator was significantly lower in the intervention group than in the control group (18.2% vs 38.1% p = 0.040). Conclusion In hospitalized hypoxic COVID-19 patients, methylprednisolone demonstrated better results compared to dexamethasone. Trial registration The trial was registered with IRCT.IR (08/04/2020-No. IRCT20200204046369N1).

scholarly journals Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients

2017 ◽  
Vol 127 (4) ◽  
pp. 633-644 ◽  
Author(s):  
Keyword(s):  
Postoperative Pain ◽  
Postoperative Delirium ◽  
Intervention Group ◽  
Group Versus ◽  
Length Of Hospital Stay ◽  
Treated Group ◽  
Assessment Method ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Opioid Use

Abstract Background Postoperative pain and opioid use are associated with postoperative delirium. We designed a single-center, randomized, placebo-controlled, parallel-arm, double-blinded trial to determine whether perioperative administration of gabapentin reduced postoperative delirium after noncardiac surgery. Methods Patients were randomly assigned to receive placebo (N = 347) or gabapentin 900 mg (N = 350) administered preoperatively and for the first 3 postoperative days. The primary outcome was postoperative delirium as measured by the Confusion Assessment Method. Secondary outcomes were postoperative pain, opioid use, and length of hospital stay. Results Data for 697 patients were included, with a mean ± SD age of 72 ± 6 yr. The overall incidence of postoperative delirium in any of the first 3 days was 22.4% (24.0% in the gabapentin and 20.8% in the placebo groups; the difference was 3.20%; 95% CI, 3.22% to 9.72%; P = 0.30). The incidence of delirium did not differ between the two groups when stratified by surgery type, anesthesia type, or preoperative risk status. Gabapentin was shown to be opioid sparing, with lower doses for the intervention group versus the control group. For example, the morphine equivalents for the gabapentin-treated group, median 6.7 mg (25th, 75th quartiles: 1.3, 20.0 mg), versus control group, median 6.7 mg (25th, 75th quartiles: 2.7, 24.8 mg), differed on the first postoperative day (P = 0.04). Conclusions Although postoperative opioid use was reduced, perioperative administration of gabapentin did not result in a reduction of postoperative delirium or hospital length of stay.

scholarly journals INVESTIGATING EFFECT OF NURSING INTERVENTIONS, BASED ON WELLS SCORE RESULTS, ON THE INCIDENCE OF DEEP VEIN THROMBOSIS IN PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT

2018 ◽  
Vol 11 (5) ◽  
pp. 377
Author(s):  
Morteza Habibi Moghadam ◽  
Marzieh Asadizaker ◽  
Simin Jahani ◽  
Elham Maraghi ◽  
Hakimeh Saadatifar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Deep Vein Thrombosis ◽  
Intervention Group ◽  
Control Group ◽  
Nursing Interventions ◽  
Vein Thrombosis ◽  
Wells Score ◽  
Deep Vein ◽  
Pitting Edema

 Objective: Venous thromboembolism, including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complaint in critically ill patients. Therefore, the present study was conducted to determine the effect of nursing interventions, based on the Wells results, on the incidence of DVT in intensive care unit (ICU) patients.Methods: The present clinical trial was conducted on 72 ICU patients without DVT and PE who met the inclusion criteria according to Wells score in Dr. Ganjavian Hospital, Dezful in 2012. The participants were investigated and randomly divided into intervention (n=36) and control groups (n=36). The intervention group received preventive nursing measures based on the risk level determined by the Wells score, and routine therapeutic interventions were performed for the control group. Then, patients were evaluated using Wells score, D-dimer testing, and Doppler sonography on the 1st, 5th, and 10th days. Data were finally coded and entered into SPSS version 23. Data analysis was performed using Chi-square, Fisher’s exact, and Mann–Whitney U tests.Results: The incidence of DVT in both groups showed that 2 patients of the control group who were identified to be at risk using the Wells score were diagnosed with DVT while none of the patients of the intervention group experienced DVT. The present study showed that 22.2% of the patients of the control group suffered from non-pitting edema, which was significantly different from the intervention group (p=0.005).Conclusion: The results of the present study showed that using the Wells score for early identification of the at-risk patients and nursing interventions based on this score’s results is helpful in the prevention of DVT. Appropriate nursing interventions were also effective in reducing the incidence of non-pitting edema in the lower extremities.

scholarly journals EFEITOS DA MOBILIZAÇÃO PRECOCE EM PACIENTES ADULTOS INTERNADOS EM UNIDADE DE TERAPIA INTENSIVA: REVISÃO SISTEMÁTICA / EFFECTS OF EARLY MOBILIZATION IN ADULT PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT: SYSTEMATIC REVIEW

2021 ◽  
Vol 7 (3) ◽  
pp. 30427-30441
Author(s):  
Ranná Barros Souza ◽  
Leticia Maues Marques ◽  
Elana Dayane Chaves Gonçalves ◽  
Gabriel de Freitas Santos da Costa ◽  
Marcos Vinícius da Conceição Furtado ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Early Mobilization ◽  
Adult Patients ◽  
Terapia Intensiva

scholarly journals The effect of postoperative early mobilization on healing process and quality of life following radical cystectomy and ileal conduit: A randomized prospective controlled trial

2021 ◽  
Author(s):  
Sevgi Peker ◽  
Özgür Çakmak ◽  
Talha Muezzinoglu ◽  
Guven Aslan ◽  
Hakan Baydur
Keyword(s):  
Quality Of Life ◽  
Radical Cystectomy ◽  
Ileal Conduit ◽  
Healing Process ◽  
Intervention Group ◽  
Early Mobilization ◽  
Controlled Study ◽  
Control Group ◽  
Sf 36

Aim: This study was conducted to evaluate the effect of postoperative early mobilization in patients who underwent radical cystectomy (RC) and ileal conduit in terms of healing process and QOL. Methods: This multicenter prospective randomized controlled study was conducted with 40 patients who were randomly divided into two groups. The intervention group was mobilized within the first 16 hours postoperatively in accordance with the mobilization procedure which determined according to literature. Data were collected using the case report form, HADS and SF-36 QoL scale. Results: Postoperative hospitalization, duration of narcotic analgesic administration, first oral food intake, flatus, defecation and NG tube termination time were shorter in the intervention group. In the control group blood glucose and pulse values were higher after mobilization. SF-36 physical function, physical role difficulty and general perception of health were higher in intervention group at the postoperative first and third month (p <0.05). Conclusion: Our study showed that early mobilization contributed to the healing process positively and improved the quality of life in the patients who underwent radical cystectomy (RC) and ileal conduit surgery. Keywords: Early Mobilization, Radical Cystectomy, Ileal conduit, Quality of Life, Convalescence

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.

Abstract 13123: Early Mobilization of Older Adults in the Cardiac Intensive Care Unit

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael Goldfarb ◽  
Koorosh Semsar-kazerooni ◽  
Jose Morais ◽  
Diana Dima
Keyword(s):  
Older Adults ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Intervention Group ◽  
Length Of Hospital Stay ◽  
Early Mobilization ◽  
Hospital Death ◽  
Healthcare Team ◽  
Tertiary Care Centre ◽  
Discharge Home

Background: Early mobilization (EM) is beneficial in general critical care units and in older hospitalized patients, but little is known about EM in older adults with acute cardiovascular disease. Methods: Consecutive admissions of adults ≥ 80 years old to a cardiac ICU at an academic tertiary care centre before (January to December 2017) and after (February 2018 to June 2019) implementation of a structured nurse-driven EM program. Mobility was measured using the validated Level of Function (LOF) Mobility Scale, which ranges from 0 (bed immobile) to 5 (able to walk > 50 feet). The primary outcome was discharge home. Results: There were 412 patients included (N=234, intervention; N=178, preintervention). There was no difference in mean age between groups (overall mean age 86.3±4.8 years old) or sex (overall female N=215, 52.2%). In the intervention group, functional impairment was present in 89 patients (38.0%) prior to hospitalization and in 209 patients (89.3%) on admission. Nearly half of patients undergoing EM (N=107; 45.7%) improved their LOF by ≥1 during cardiac ICU stay. Mobilization occurred during nearly all opportunities (838/850; 98.6%) and most mobility activities were completed (2,207/2,553; 86.4%). Adverse events were rare (5/2,207 activities [0.2%]) and transient (N=5). There were no falls, line dislodgements, or healthcare team injuries). Patients in the intervention group were more likely than patients in the preintervention group to be discharged home (74.4% vs. 65.7%, P=0.047, respectively) and had a lower rate of in-hospital death (6.4% vs. 14.6%, P=0.006, respectively). There was no difference in length of hospital stay or re-admission. In the multivariable analysis, predictors of discharge home were younger age, heart failure, and higher prehospital LOF. Outcomes were similar in adults ≥ age 90. Conclusion: EM is safe in older adults in the cardiac ICU and is associated with reduced discharge to healthcare facility and in-hospital mortality.

Improving Family Communications at the End of Life: Implications for Length of Stay in the Intensive Care Unit and Resource Use

2003 ◽  
Vol 12 (4) ◽  
pp. 317-324 ◽  
Author(s):  
Tom Ahrens ◽  
Valerie Yancey ◽  
Marin Kollef
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
End Of Life ◽  
Resource Utilization ◽  
Intervention Group ◽  
Clinical Nurse Specialist ◽  
Control Group ◽  
Nurse Specialist ◽  
Clinical Nurse

• Background Inadequate communication persists between healthcare professionals and patients and patients’ families in intensive care units. Unwanted or ineffective treatments can occur when patients’ goals of care are unknown or not honored, increasing costs and care. Having the primary physician provide medical information and then having a physician and clinical nurse specialist team improve opportunities for patients and their families to process that information could improve the situation. This model has not been tested for its effect on patients’ outcomes and resource utilization.• Objectives To evaluate the effect of a communication team that included a physician and a clinical nurse specialist on length of stay and costs for patients near the end of life in the intensive care unit.• Methods During a 1-year period, patients judged to be at high risk for death (N = 151) were divided into 2 groups: 43 patients who were cared for by the medical director teamed with a clinical nurse specialist and 108 patients who received standard care, provided by an attending physician.• Results Compared with the control group, patients in the intervention group had significantly shorter stays in both the intensive care unit (6.1 vs 9.5 days) and the hospital (11.3 vs 16.4 days) and had lower fixed ($15 559 vs $24 080) and variable ($5087 vs $8035) costs.• Conclusions Use of a physician and a clinical nurse specialist focused on improving communication with patients and patients’ families reduced lengths of stay and resource utilization.

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