scholarly journals Implementation of Nurse-Led, Goal-Directed Lung Physiotherapy for Older Patients With Sepsis and Pneumonia in the ICU

2021 ◽  
Vol 8 ◽  
Author(s):  
Jianhua Sun ◽  
Na Cui ◽  
Wen Han ◽  
Qi Li ◽  
Hao Wang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Treatment Group ◽  
Older Patients ◽  
Control Group ◽  
Icu Mortality ◽  
Two Phase ◽  
Before And After ◽  
Before And After Study

Objectives: This study aimed to investigate the effect of nurse-led, goal-directed lung physiotherapy (GDLPT) on the prognosis of older patients with sepsis caused by pneumonia in the intensive care unit.Methods: We conducted a prospective, two-phase (before-and-after) study over 3 years called the GDLPT study. All patients received standard lung therapy for sepsis caused by pneumonia and patients in phase 2 also received GDLPT. In this study, 253 older patients (age ≥ 65 years) with sepsis and pneumonia were retrospectively analyzed. The main outcome was 28 day mortality.Results: Among 742 patients with sepsis, 253 older patients with pneumonia were divided into the control group and the treatment group. Patients in the treatment group had a significantly shorter duration of mechanical ventilation [5 (4, 6) vs. 5 (4, 8) days; P = 0.045], and a lower risk of intensive care unit (ICU) mortality [14.5% (24/166) vs. 28.7% (25/87); P = 0.008] and 28 day mortality [15.1% (25/166) vs. 31% (27/87); P = 0.005] compared with those in the control group. GDLPT was an independent risk factor for 28 day mortality [odds ratio (OR), 0.379; 95% confidence interval (CI), 0.187–0.766; P = 0.007].Conclusions: Nurse-led GDLPT shortens the duration of mechanical ventilation, decreases ICU and 28-day mortality, and improves the prognosis of older patients with sepsis and pneumonia in the ICU.

An In-Service Educational Package Improves Alarm Management in the Neonatal Intensive Care Unit (NICU): Before and After Study

2021 ◽  
pp. 097321792110512
Author(s):  
Suryaprakash Hedda ◽  
Shashidhar A. ◽  
Saudamini Nesargi ◽  
Kalyan Chakravarthy Balla ◽  
Prashantha Y. N. ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Response Time ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Alarm Management ◽  
Educational Package ◽  
Before And After ◽  
Before And After Study

Background: Monitoring in neonatal intensive care unit (NICU) largely relies on equipment which have a number of alarms that are often quite loud. This creates a noisy environment, and moreover leads to desensitization of health-care personnel, whereby potentially important alarms may also be ignored. The objective was to evaluate the effect of an educational package on alarm management (the number of alarms, response to alarms, and appropriateness of settings). Methods: A before and after study was conducted at a tertiary neonatal care center in a teaching hospital in India involving all health-care professionals (HCP) working in the high dependency unit. The intervention consisted of demo lectures about working of alarms and bedside demonstrations of customizing alarm limits. A pre- and postintervention questionnaire was also administered to assess knowledge and attitude toward alarms. The outcomes were the number and type of alarms, response time, appropriateness of HCP response, and appropriateness of alarm limits as observed across a 24-h period which were compared before and after the intervention. Findings: The intervention resulted in a significant decrease in the number of alarms (11.6-9.6/h). The number of times where appropriate alarm settings were used improved from 24.3% to 67.1% ( P < .001). The response time to alarm did not change significantly (225 s vs 200 s); however, the appropriate response to alarms improved significantly from 15.6% to 68.8%. Conclusion: A simple structured intervention can improve the appropriate management of alarms. Application to Practice: Customizing alarm limits and nursing education reduce the alarm burden in NICUs

How the high acuity unit changes mortality in the intensive care unit: a retrospective before-and-after study

2020 ◽  
Vol 67 (11) ◽  
pp. 1507-1514
Author(s):  
Anish R. Mitra ◽  
Donald E. G. Griesdale ◽  
Gregory Haljan ◽  
Ashley O’Donoghue ◽  
Jennifer P. Stevens
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Before And After ◽  
High Acuity ◽  
Before And After Study

Duration of Mechanical Ventilation in an Adult Intensive Care Unit After Introduction of Sedation and Pain Scales

2008 ◽  
Vol 17 (4) ◽  
pp. 349-356 ◽  
Author(s):  
Teresa Ann Williams ◽  
Suzanne Martin ◽  
Gavin Leslie ◽  
Linda Thomas ◽  
Timothy Leen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pain Scale ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Adult Intensive Care Unit ◽  
Before And After ◽  
Behavioral Pain Scale ◽  
Sedation And Analgesia

Background Sedation and analgesia scales promote a less-distressing experience in the intensive care unit and minimize complications for patients receiving mechanical ventilation. Objectives To evaluate outcomes before and after introduction of scales for sedation and analgesia in a general intensive care unit. Method A before-and-after design was used to evaluate introduction of the Richmond Agitation-Sedation Scale and the Behavioral Pain Scale for patients receiving mechanical ventilation. Data were collected for 6 months before and 6 months after training in and introduction of the scales. Results A total of 769 patients received mechanical ventilation for at least 6 hours (369 patients before and 400 patients after implementation). Age, scores on the Acute Physiology and Chronic Health Evaluation (APACHE) II, and diagnostic groups were similar in the 2 groups, but the after group had more men than did the before group. Duration of mechanical ventilation did not change significantly after the scales were introduced (median, 24 vs 28 hours). For patients who received mechanical ventilation for 96 hours or longer (24%), mechanical ventilation lasted longer after implementation of the scales (P =.03). Length of stay in the intensive care unit was similar in the 2 groups (P = .18), but patients received sedatives for longer after implementation (P=.01). By logistic regression analysis, APACHE II score (P &lt;.001) and diagnostic group (P &lt;.001) were independent predictors of mechanical ventilation lasting 96 hours or longer. Conclusion Sedation and analgesia scales did not reduce duration of ventilation in an Australian intensive care unit.

scholarly journals Comparing the Effects of Menthol-cold Water and Psyllium on Thirst and Xerostomia among Patients in Intensive Care Unit

2021 ◽  
Author(s):  
Leila Sayadi ◽  
Ebrahim Khadem ◽  
Elnaz Nasiri
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cold Water ◽  
Statistical Tests ◽  
Controlled Trial ◽  
Herbal Remedies ◽  
Teaching Hospitals ◽  
Control Group ◽  
Before And After ◽  
Mouth Wash

Background: Thirst is a prevalent problem among patients in intensive care unit. This study aimed to compare the effects of menthol-cold water and psyllium on thirst and xerostomia among patients in intensive care unit. Methods: This randomized controlled trial was conducted in 2018–2019. Participants were 132 patients consecutively recruited from the intensive care units of two teaching hospitals, Tehran, Iran. They were randomly allocated to either a menthol-cold water, a psyllium, or a control group (44 patients in each group). Participants in the menthol-cold water and the psyllium groups received mouth wash with respectively menthol-cold water and psyllium in two fifteen-minute rounds with a thirty-minute interval. A visual analogue scale was used to assess thirst severity, distress, and xerostomia before and after each round of mouth wash. Data were analyzed through non-parametric statistical tests. Results: There were no significant differences among the groups respecting baseline characteristics, thirst severity and distress, and xerostomia. However, among-group differences respecting thirst severity, distress, and xerostomia were statistically significant after the intervention (P < 0.001). Mouth wash with psyllium was associated with significantly greater reduction in thirst severity, distress, and xerostomia compared with mouth wash with menthol-cold water (P< 0.001). Conclusion: Both menthol-cold water and psyllium are effective in reducing thirst and xerostomia among patients in intensive care unit, though the effectiveness of psyllium is significantly greater than menthol-cold water. Educating nurses about thirst and xerostomia assessment and herbal remedies for their management may help them effectively manage their patients’ thirst and xerostomia.

Benefits of early enteral nutrition with glutamine and probiotics in brain injury patients

2004 ◽  
Vol 106 (3) ◽  
pp. 287-292 ◽  
Author(s):  
IRA S. FALCÃO DE ARRUDA ◽  
JOSÉ E. DE AGUILAR-NASCIMENTO
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Brain Injury ◽  
Infection Rate ◽  
Control Group ◽  
Early Enteral Nutrition ◽  
Study Group ◽  
Diet Control ◽  
Enteral Formula

Brain injury patients have higher energy and protein expenditures and are prone to infections. The aim of the present study was to evaluate the results of early enteral feeding with glutamine and probiotics in brain injury patients. Twenty-three brain injury patients (Glasgow score between 5–12 and therapeutic intervention scoring system>20) were studied. Three patients were excluded to leave 20 remaining patients. Patients were randomized to receive either an early enteral diet (control group, n=10) or the same formula with glutamine and probiotics added (study group, n=10) for a minimum of 5 days (range, 5–14 days). The diets were isocaloric and isonitrogenous [35 kcal·kg-1·day-1 (where 1 kcal≈4.184 kJ) and 1.5 g of protein·kg-1·day-1]. Main outcome measures were the incidence of infection, the length of stay in the intensive care unit and the number of days requiring mechanical ventilation. The two groups were homogeneous in gender, age, nutritional status and severity of trauma. There was no mortality during the study period. The infection rate was higher in controls (100%) when compared with the study group (50%; P=0.03) and the median (range) number of infections per patient was significantly greater (P<0.01) in the control group [3 (1–5)] compared with the study group [1 (0–3)]. Both the critical care unit stay [22 (7–57) compared with 10 (5–20) days; P<0.01; median (range)] and days of mechanical ventilation [14 (3–53) compared with 7 (1–15) days; P=0.04; median (range)] were higher in the patients in the control group than in the study group. We conclude that the enteral formula containing glutamine and probiotics decreased the infection rate and shortened the stay in the intensive care unit of brain injury patients.

Impact of a Clinical Therapeutic Intervention on Pain Assessment, Management, and Nursing Practices in an Intensive Care Unit: A before-and-after Study

2018 ◽  
Vol 19 (3) ◽  
pp. 256-266 ◽  
Author(s):  
Vincenzo Damico ◽  
Flavio Cazzaniga ◽  
Liana Murano ◽  
Rita Ciceri ◽  
Giuseppe Nattino ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pain Assessment ◽  
Therapeutic Intervention ◽  
Before And After ◽  
Before And After Study

scholarly journals Clinical Characteristics and Short-Term Outcomes of HIV Patients Admitted to an African Intensive Care Unit

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Arthur Kwizera ◽  
Mary Nabukenya ◽  
Agaba Peter ◽  
Lameck Semogerere ◽  
Emmanuel Ayebale ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Low Income ◽  
Clinical Characteristics ◽  
Income Country ◽  
Apache Ii ◽  
Icu Mortality ◽  
Hiv Patients ◽  
Low Income Country

Purpose. In high-income countries, improved survival has been documented among intensive care unit (ICU) patients infected with human immune deficiency virus (HIV). There are no data from low-income country ICUs. We sought to identify clinical characteristics and survival outcomes among HIV patients in a low-income country ICU.Materials and Methods. A retrospective cohort study of HIV infected patients admitted to a university teaching hospital ICU in Uganda. Medical records were reviewed. Primary outcome was survival to hospital discharge. Statistical significance was predetermined in reference toP<0.05.Results. There were 101 HIV patients. Average length of ICU stay was 4 days and ICU mortality was 57%. Mortality in non-HIV patients was 28%. Commonest admission diagnoses were Acute Respiratory Distress Syndrome (ARDS) (58.4%), multiorgan failure (20.8%), and sepsis (20.8%). The mean Acute Physiologic and Chronic Health Evaluation (APACHE II) score was 24. At multivariate analysis, APACHE II (OR 1.24 (95% CI: 1.1–1.4,P=0.01)), mechanical ventilation (OR 1.14 (95% CI: 0.09–0.76,P=0.01)), and ARDS (OR 4.5 (95% CI: 1.07–16.7,P=0.04)) had a statistically significant association with mortality.Conclusion. ICU mortality of HIV patients is higher than in higher income settings and the non-HIV population. ARDS, APACHE II, and need for mechanical ventilation are significantly associated with mortality.

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