scholarly journals Does Early Mobility Lead to Decreased Ventilator Days?

2017 ◽  
Author(s):  
Nicole Halton
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Muscle Weakness ◽  
Critically Ill Patients ◽  
Life Support ◽  
Early Mobility ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Abcde Bundle

<p>It is well documented that bedrest has adverse outcomes for hospitalized patients. This is especially true for critically ill patients due to life support measures, invasive catheters, and mechanical ventilation. Consequences associated with bedrest in critical care patients include venous thromboembolism, ventilator associated pneumonia, pressure ulcer development, and muscle weakness. Respiratory muscle weakness is associated with prolonged ventilator support and delayed extubation. The Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility (ABCDE) bundle uses evidence based practice to prevent and treat ICU acquired delirium and weakness. The bundle aims to do this by standardizing care processes in collaboration with the ICU team to promote early mobility in ventilated patients. The purpose of this research study was to determine if the implementation of an early mobility protocol decreased the number of ventilator days for patients who receive mechanical ventilation. A retrospective chart review was conducted at a 16 bed ICU. Group A included 30 subjects (n=30) who were treated pre implementation of the ABCDE bundle and Group B included 39 (n=39) subjects who were treated post implementation of the ABCDE bundle. There were less average ventilator days found in Group A in comparison to Group B. Additionally, there was a significant difference found in the ICU length of stay pre implementation (M=9.4, SD=4.4) and post implementation (M=5.7, SD=2.6) of the ABCDE bundle for early mobility, t (65) =4.3, p = 0.00005. The APRN can use the evidence in the ABCDE bundle to guide care to critically ill patients that are mechanically ventilated. Utilizing the ABCDE bundle additionally allows the APRN to be instrumental in improving patient outcomes through interdisciplinary collaboration.</p>

Electroacupuncture Reduces the Dose of Midazolam Monitored by the Bispectral Index in Critically Ill Patients with Mechanical Ventilation: An Exploratory Study

2012 ◽  
Vol 30 (2) ◽  
pp. 78-84 ◽  
Author(s):  
Xia Zheng ◽  
Jian-biao Meng ◽  
Qiang Fang
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Bispectral Index ◽  
Critically Ill Patients ◽  
Additional Treatment ◽  
Acupuncture Points ◽  
Sedative Drug ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objective Electroacupuncture, a modern variation on a traditional Chinese treatment, might be useful for sedation and analgesia. This study aims to investigate whether electroacupuncture can modify the dose of midazolam monitored by the bispectral index (BIS) in critically ill patients with mechanical ventilation. Methods Orotracheally intubated patients undergoing mechanical ventilation were randomly assigned into three groups (groups A, B and C). All patients were given an intravenous infusion of midazolam. Patients in group A received no additional treatment. Patients in group B were given acupuncture without electrical stimulation at acupuncture points GV24 and EX–HN3 ( Yintang) for 6 h simultaneously, and patients in group C were given electroacupuncture to the same points as in group B. Results Maintaining the BIS between 60 and 80, the hourly mean one dose of midazolam within the first 6 h after sedation in group C was 0.05 (±0.02 mg/kg per hour), which was significantly lower than both group A (0.08±0.03 mg/kg per hour, p<0.001) and group B (0.07±0.01 mg/kg per hour, p<0.021). The doses in groups A and B showed no significant difference. Between-group comparison analysis of hepatic and renal function and severe adverse reactions all showed no significant difference between the three groups. Conclusions Electroacupuncture appears to reduce markedly the dose of sedative drug required in critically ill patients with mechanical ventilation monitored by BIS, without any obvious severe adverse action, and larger studies to confirm the effect are justified.

scholarly journals Intra-Abdominal Pressure as a Marker of Enteral Nutrition Intolerance in Critically Ill Patients. The PIANE Study

Nutrients ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 2616
Author(s):  
M Bordejé ◽  
Juan Montejo ◽  
M Mateu ◽  
Manuel Solera ◽  
Jose Acosta ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Urinary Catheter ◽  
Abdominal Pressure ◽  
Icu Patients ◽  
Group A ◽  
Group B ◽  
Low Sensitivity

To determine whether elevated intra-abdominal pressure (IAP) is associated with a higher rate of enteral nutrition-related gastrointestinal (GI) complications; to assess the value of IAP as a predictor of enteral nutrition (EN) intolerance. Intensive Care Unit (ICU) patients on mechanical ventilation requiring at least 5 days of EN were recruited for a prospective, observational, non-interventional, multicenter study. EN was performed and GI complications were managed with an established protocol. IAP was determined via a urinary catheter. Patients who developed any GI complications were considered as presenting EN intolerance. Variables related to EN, IAP and GI complications were monitored daily. Statistical analysis compared patients without GI complications (group A) vs. GI complications (group B). 247 patients were recruited from 28 participating ICUs (group A: 119, group B: 128). No differences between groups were recorded. Patients in group B (p < 0.001) spent more days on EN (8.1 ± 8.4 vs. 18.1 ± 13.7), on mechanical ventilation (8.0 ± 7.7 vs. 19.3 ± 14.9) and in the ICU (12.3 ± 11.4 vs. 24.8 ± 17.5). IAP prior to the GI complication was (14.3 ± 3.1 vs. 15.8 ± 4.8) (p < 0.003). The best IAP value identified for EN intolerance was 14 mmHg but it had low sensitivity and specificity. Although a higher IAP was associated with EN intolerance, IAP alone did not emerge as a good predictor of EN intolerance in critically ill patients.

scholarly journals A study to compare effects of shoulder position on infraclavicular central venous catheterization in critically ill patients.

2020 ◽  
Vol 27 (10) ◽  
pp. 2216-2222
Author(s):  
Sairah Sadaf ◽  
Babar Bashir
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Lateral Side ◽  
Radiographic Findings ◽  
Medical College ◽  
Skin Puncture ◽  
Venous Catheterization ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objectives: Aim of this study was to compare the effects of two different shoulder positions on infraclavicular subclavian venous catheterization in critically ill patients. Study Design: Prospective Comparative study. Setting: Sheikh Zayed Medical College Rahim Yar Khan Pakistan. Period: 1st July 2017 to 30th June 2018. Material & Methods: Enrolling 100 patients thru convenient sampling, divided into two groups, Group A & Group B, 50 in each group. In group A patients were put in supine position, with head turned to contra lateral side and caudal pull was applied on ipsilateral shoulder. While in group B patients were lying supine, head turned to contra lateral side and shoulders were retracted by placing a small pillow vertically under the chest between the scapulae. In both groups, subclavian vein was approached through infra clavicular route. Number of attempts of venous punctures (1st attempt / 2nd attempt), total time spent on procedure (from 1st skin puncture to CVC insertion), complications (arterial puncture, pneumothorax, hydrothorax, malpositioning), any hemodynamic irregularity (ECG changes), radiographic findings to confirm successful CVC insertion was recorded. Results: Number of successful subclavian venous catheterizations was same in both groups (94% vs. 94%) with no significant difference (p= 1.000). 1st attempt success was more in group A  as compared to group B, though statistically this was not significant (p= 0.275). Total time spent on CVC insertion (from 1st skin puncture to catheter insertion) was less than 05 mints in 84% patient in group A and 82% in group B. While more than 05 mints were spent on 16% vs. 18% patients in group A vs. B. This was also not statistically significant (p=0.790). In group A 2/50 (4%) while in group B 1/50 (2%) cases were recorded as malpositioning on post-CVC radiograph. Other complications were not encountered in either group. Conclusion: Lowered shoulder and retracted shoulder positions are equally effective for SVC insertion in terms of success, 1st attempt success, total time spent and number of complications.

scholarly journals Clinical observation of alveolar surface active substances in the treatment of neonatal respiratory distress syndrome at different periods

2019 ◽  
Author(s):  
Han Han ◽  
Xiao-xia Li ◽  
Xiang-hua Shuai ◽  
Zhi-qun Zhang ◽  
Jing Li ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Rescue Therapy ◽  
Total Duration ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Systemic Hemodynamic ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background: Mechanical ventilation joint PS replacement therapy is an effective method in treatment of NRDS recognized, PS treatment of children with early can improve the oxygenation by increasing gas exchange area, but before FiO 2 to reduce the application of PS can cause local and/or systemic hemodynamic changes, making the use of PS has some potential problems, such as increasing the incidence of the IVH, PH, PDA and so on. SR rescue therapy can be divided into early treatment and delayed treatment, but the specific boundary point of the appropriate time period has not been clear. This paper aims to compare the efficacy differences of PS administration at different time periods and provide basis for the selection of clinical application period of PS. Methods: Case-control study . 135 children diagnosed with NRDS in neonatology department of our hospital. The patients were divided into two groups according to the use time of PS. Group A was applied within 3 hours after birth, and group B was applied 3 hours after birth. The changes of blood gas analysis parameter，mechanical ventilation time, incidence of complications, hospital stay and mortality were compared between the two groups. Results : The decrease of blood gas PaCO 2 in group A before and after treatment was more significant than that of group B (P<0.05), but the improvement of PaO 2 and OI in group B was better than that in group A (P<0.05). Although there were significant differences in birth weight between the two groups, there were no significant differences in the total duration of mechanical ventilation and mortality (P>0.05). Except PDA and BPD, there was no significant difference in the incidence of common complications between the two groups. Conclusion: PS treatment within 3 hours after birth can better improve ventilation, reduce the incidence of PDA. It can also help to reduce the death rate of high-risk children and the total duration of mechanical ventilation.

scholarly journals Effect of Vitamin C on mortality of critically ill patients with severe pneumonia in intensive care unit: a preliminary study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ata Mahmoodpoor ◽  
Kamran Shadvar ◽  
Sarvin Sanaie ◽  
Mir Reza Hadipoor ◽  
Mohammad Ata Pourmoghaddam ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Mortality Rate ◽  
Vitamin C ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Intervention Group ◽  
Severe Pneumonia ◽  
High Dose ◽  
Significant Difference ◽  
Vasopressor Use

Abstract Background Critically ill patients frequently suffer from vitamin C deficiency. Previous studies showed that high doses of vitamin C administration had conflicting results on clinical outcomes in patients with severe sepsis, burns, and trauma. Because of the high incidence and morbidity/mortality with severe pneumonia, we aimed to investigate the effect of administration of high dose vitamin C in critically ill patients with severe pneumonia. Methods Eighty critically ill patients with pneumonia were enrolled in this randomized double-blinded clinical trial. Patients with a CURB-65 score > 3, one major criterion, or ≥ 3 minor criteria were considered as severe pneumonia. Patients were randomly assigned to intervention or placebo groups receiving standard treatment plus 60 mg/kg/day vitamin C as a continuous infusion or normal saline in the same volume correspondingly for 96 h. Serum levels of vitamin C were noted at baseline and 48 h after vitamin C administration. Duration of mechanical ventilation, ICU length of stay, PaO2/FiO2, and mortality rate were noted for all patients till the 28th day. Any complications related to the vitamin C administration were recorded. Results Duration of mechanical ventilation and vasopressor use were significantly lower in the intervention group (p: < 0.001 and 0.003, respectively). Baseline levels of vitamin C in both groups did not have a significant difference but its levels increased in the intervention group and decreased in the control group during the study period. Mortality rate insignificantly decreased in the intervention group (p = 0.17). Three patients showed hypotension and tachycardia during the administration of vitamin C which was self-limited with decreasing the dose of vitamin C. Our results showed that the intravenous administration of a relatively high dose of vitamin C to critically ill patients with severe pneumonia was safe and could decrease the inflammation, duration of mechanical ventilation, and vasopressor use without any significant effect on mortality. Trial registration: IRCT registration number: IRCT20190312043030N1, Registration date: 2019-08-26, Seied Hadi Saghaleini.

scholarly journals Obesity May Not Be Associated with 28-Day Mortality, Duration of Invasive Mechanical Ventilation and Length of Intensive Care Unit and Hospital Stay in Critically Ill Patients with Severe Acute Respiratory Syndrome Coronavirus-2: A Retrospective Cohort Study

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 674
Author(s):  
Sjaak Pouwels ◽  
Dharmanand Ramnarain ◽  
Emily Aupers ◽  
Laura Rutjes-Weurding ◽  
Jos van Oers
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Significant Difference

Background and Objectives: The aim of this study was to investigate the association between obesity and 28-day mortality, duration of invasive mechanical ventilation and length of stay at the Intensive Care Unit (ICU) and hospital in patients admitted to the ICU for SARS-CoV-2 pneumonia. Materials and Methods: This was a retrospective observational cohort study in patients admitted to the ICU for SARS-CoV-2 pneumonia, in a single Dutch center. The association between obesity (body mass index > 30 kg/m2) and 28-day mortality, duration of invasive mechanical ventilation and length of ICU and hospital stay was investigated. Results: In 121 critically ill patients, pneumonia due to SARS-CoV-2 was confirmed by RT-PCR. Forty-eight patients had obesity (33.5%). The 28-day all-cause mortality was 28.1%. Patients with obesity had no significant difference in 28-day survival in Kaplan–Meier curves (log rank p 0.545) compared with patients without obesity. Obesity made no significant contribution in a multivariate Cox regression model for prediction of 28-day mortality (p = 0.124), but age and the Sequential Organ Failure Assessment (SOFA) score were significant independent factors (p < 0.001 and 0.002, respectively). No statistically significant correlation was observed between obesity and duration of invasive mechanical ventilation and length of ICU and hospital stay. Conclusion: One-third of the patients admitted to the ICU for SARS-CoV-2 pneumonia had obesity. The present study showed no relationship between obesity and 28-day mortality, duration of invasive mechanical ventilation, ICU and hospital length of stay. Further studies are needed to substantiate these findings.

scholarly journals Comparison of the clinical effect between the lower sternal incision and the left parasternal fourth intercostal incision in the transthoracic closure of ventricular septal defect

2020 ◽  
Author(s):  
Jun Ma ◽  
Wenlin Shangguan ◽  
Liang-wan Chen ◽  
Dong-Shan Liao
Keyword(s):  
Mechanical Ventilation ◽  
Ventricular Septal Defect ◽  
Clinical Effect ◽  
Septal Defect ◽  
Operation Time ◽  
Ventilation Time ◽  
Significant Difference ◽  
Group A ◽  
Mechanical Ventilation Time ◽  
Group B

Abstract Background: To analyze the clinical effect of two different ways of minimally invasive transthoracic closure in children with ventricular septal defect (VSD) Methods: From January 2015 to July 2019, 294 children with VSD were enrolled in the Fujian Medical University Union Hospital, who underwent VSD closure through the left sternal fourth intercostal incision (group A: n = 95) and the lower sternal incision (group B: n = 129) Results: The operation time, bleeding volume, postoperative mechanical ventilation time, postoperative ICU monitoring time, postoperative hospitalization time and complication rate in group A were significantly lower than those in group B (P < 0.05). There was no significant difference between the two groups in the operation success rate, mechanical ventilation time and total hospitalization cost (P > 0.05). Conclusion : The transthoracic closure of ventricular septal defect through the left sternal fourth intercostal incision is feasible, safe, cosmetic, and worth popularizing.

Anti-Xa Levels in Critically Ill Patients Receiving Dalteparin for Thromboprophylaxis.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4075-4075
Author(s):  
Ellen McDonald ◽  
Craig Dale ◽  
Susan Pleasance ◽  
Andrea McNeill ◽  
Johanne Harvey ◽  
...  
Keyword(s):  
Renal Insufficiency ◽  
Creatinine Clearance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pilot Trial ◽  
Bleeding Event ◽  
Random Group ◽  
Increased Risk ◽  
Group A ◽  
Group B

Abstract Rationale: Despite the efficacy and safety of low molecular weight heparin (LWMH) compared to unfractionated (UFH) in many patients, LMWH may bioaccumulate in patients with renal insufficiency which could cause an increased risk of bleeding. If LMWH thromboprophylaxis is safe in ICU patients with renal insufficiency, this could reduce the risk of DVT and HIT. Since the extent to which LMWH bioaccumulates in critically ill patients in prophylactic rather than therapeutic doses is unclear, our objective was to measure peak and trough anti-Xa levels during a multicenter randomized pilot trial of LMWH vs UFH for thromboprophylaxis in the medical-surgical ICU setting. Methods: We included 128 patients ≥18 years with an expected ICU stay ≥72h. We excluded patients with trauma, orthopedic, cardiac, or neurosurgery, severe hypertension, DVT, PE or hemorrhage within 3 mos, INR &gt;2ULN, PTT &gt;2ULN, platelets &lt;100 x109/L, and if creatinine clearance was &lt;30 ml/min on ICU admission. Trough anti-Xa levels were drawn when patients developed creatinine clearance &lt;30ml/min, trough and peak anti-Xa levels were drawn on Tuesdays and Thursdays regardless of serum creatinine, and random anti-Xa levels were drawn if patients had a bleeding event. Results: No differences were found in the 2 groups (median anti-Xa levels) as shown below. Conclusions: We did not observe LWMH or UFH bioaccumulation when administered in prophylactic doses in these critically ill patients with a range of renal dysfunction. Anti-Xa Levels Allocation Cr Cl &lt;30 (trough) Tues & Thurs (trough) Tues & Thurs (peak) Bleeding (random) Group A 8 tests in 2 pts 17 tests in 9 pts 17 tests in 9 pts 7 tests in 4 pts Group A 0.1 IU/mL 0.09 IU/mL 0.11 IU/mL 0.1 IU/mL Group B 23 tests in 5 pts 46 tests in 12 pts 46 tests in 12 pts 10 tests in 8 pts Group B 0.1 IU/mL 0.09 IU/mL 0.11 IU/mL 0.1 IU/mL

scholarly journals Comparison of the clinical effect between the lower sternal incision and the left parasternal fourth intercostal incision in the transthoracic closure of ventricular septal defect

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jun Ma ◽  
Wenlin Shangguan ◽  
Liang-Wan Chen ◽  
Dong-shan Liao
Keyword(s):  
Mechanical Ventilation ◽  
Ventricular Septal Defect ◽  
Clinical Effect ◽  
Septal Defect ◽  
Operation Time ◽  
Ventilation Time ◽  
Significant Difference ◽  
Group A ◽  
Mechanical Ventilation Time ◽  
Group B

Abstract Background To analyze the clinical effect of two different ways of minimally invasive transthoracic closure in children with ventricular septal defect (VSD). Methods From January 2015 to July 2019, 294 children with VSD were enrolled in the Fujian Medical University Union Hospital. Patients were divided into two groups – those who underwent VSD closure through the left sternal fourth intercostal incision (group A: n = 95) and the lower sternal incision (group B: n = 129). Results The operation time, bleeding volume, postoperative mechanical ventilation time, postoperative intensive care unit (ICU) monitoring time, postoperative hospitalization time and complication rate in group A were significantly lower than those in group B (P < 0.05). There was no significant difference between the two groups in the operation success rate, mechanical ventilation time and total hospitalization cost (P > 0.05). Conclusion The transthoracic closure of ventricular septal defect through the left sternal fourth intercostal incision is feasible, safe, cosmetic, and worth popularizing.

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