Comparison of five clinical weaning indices

1994 ◽  
Vol 3 (5) ◽  
pp. 342-352 ◽  
Author(s):  
SM Burns ◽  
JE Burns ◽  
JD Truwit
Keyword(s):  
Predictive Power ◽  
Ventilatory Support ◽  
Volume Ratio ◽  
Convenience Sample ◽  
Predictive Values ◽  
Pressure Index ◽  
Assessment Program ◽  
Trial Outcomes ◽  
Time Extrapolation ◽  
Critical Care Patients

BACKGROUND: Despite extensive data acquired in the area of weaning, clinicians still struggle with the questions of how and when to begin the process. Clinical weaning indices, designed to predict weaning potential, are often difficult to use. They provide an answer at a specific time; extrapolation to the weaning process is rarely possible. No single index has proven to be superior. OBJECTIVES: To test the efficacy of five clinical weaning indices (Burns Weaning Assessment Program; Weaning Index; frequency tidal volume ratio; compliance, resistance, oxygenation and pressure index; and negative inspiratory pressure) at regular intervals during withdrawal of ventilatory support and to determine threshold levels for the program. METHODS: A prospective convenience sample consisted of 37 adult critical care patients requiring mechanical ventilation for at least 7 days and identified as stable and ready to wean. Data were collected on all weaning indices every other day until the patient was weaned. RESULTS: With the exception of the Burns Weaning Assessment Program, weaning indices did not change significantly from preweaning scores. Furthermore, the results failed to demonstrate that any of the five clinical weaning indices have strong predictive power related to weaning trial outcomes, although all the indices had negative predictive values that may be helpful in predicting unsuccessful weaning trials. CONCLUSIONS: The results of this study suggest that the process of weaning may be enhanced by comprehensive, systematic approaches and that clinical weaning indices like the Burns Weaning Assessment Program might best serve as tools to track trends in progress, keep care planning on target, and prevent unsuccessful weaning trials.

scholarly journals The frequency of nasal injury in newborns due to the use of continuous positive airway pressure with prongs

2009 ◽  
Vol 17 (4) ◽  
pp. 489-494 ◽  
Author(s):  
Renata Medeiros do Nascimento ◽  
Anne Laura Costa Ferreira ◽  
Ana Cláudia Ferreira Pinheiro Coutinho ◽  
Regina Célia Sales Santos Veríssimo
Keyword(s):  
Risk Factor ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Ventilatory Support ◽  
Convenience Sample ◽  
Nasal Injury

Continuous positive airway pressure (CPAP) with prongs is the ventilatory support most used in newborns. Nasal injuries are complications that may arise due to the prolonged use of this device. This study aimed to determine the frequency of nasal injuries in newborns through the use of continuous positive airway pressure with prongs. A convenience sample composed of hospitalized newborns using prongs for more than two days was used. Data were collected through a structured form. Lesions were observed in all newborns, which were classified as: mild (79.6%), moderate (19.7%) and severe (0.7%). The conclusion is that the use of prongs for more than two days represents a risk factor for the lesions to develop.

A New View: Tele–Intensive Care Unit Competencies

2011 ◽  
Vol 31 (5) ◽  
pp. 17-29 ◽  
Author(s):  
Susan F. Goran
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Performance Appraisal ◽  
Professional Practice ◽  
Competency Assessment ◽  
Self Assessment ◽  
Convenience Sample ◽  
Assessment Program ◽  
Effective Use ◽  
Question Survey

Background Many hospitals have well-planned nursing competency assessment programs, but these are meant to measure competency in traditional bedside roles, not in tele–intensive care unit (tele-ICU) nurses practicing remotely. Objective To determine whether current tele-ICU programs have a formal competency assessment program and to determine when and how competency of tele-ICU nurses is assessed. Method A 20-question survey was provided to a convenience sample of the 44 known tele-ICU programs nationally. Results Of the surveys distributed, 75% were completed and returned. A formal competency assessment policy for assessing nurses’ competency at the time of hire, during orientation, and ongoing was in place at the workplaces of 85% of respondents. The most common methods for competency validation were performance appraisal and observation, although peer review and self-assessment also were used. Respondents identified the following competencies as the highest priorities for defining tele-ICU nurse practice: effective listening, prioritization, collaboration, and effective use of tele-ICU application tools. Conclusion Although awaiting development of professional practice standards, many tele-ICU programs currently measure the competence of tele-ICU nurses through competency programs.

scholarly journals LO008: Assessment of the need for diagnostic imaging in extremity injuries by advanced care paramedics

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S32-S33
Author(s):  
P. Froese ◽  
M.B. Butler ◽  
S.G. Campbell ◽  
K. Magee ◽  
R.P. Mackinley
Keyword(s):  
Diagnostic Imaging ◽  
Patient Flow ◽  
Body Part ◽  
Initial Assessment ◽  
X Rays ◽  
Convenience Sample ◽  
Predictive Values ◽  
X Ray ◽  
Subsequent Test ◽  
Extremity Injuries

Introduction: Emergency department (ED) crowding is a national challenge. Initiatives to help address this at our ED include the use of a six-bed fast-track unit staffed by advanced-care paramedics (ACPs). Institutional byelaws only allow diagnostic imaging (DI) ordering by physicians (MD). An ACP requesting DI at the time of first assessment would likely improve patient flow. We investigated whether ACPs can safely and cost-effectively request DI for extremity injuries without increasing cost or exposing patients to unnecessary radiation. Methods: A prospective evaluation of a convenience sample of patients presenting with an extremity injury sustained within 48 hours of presentation. At time of initial assessment, the ACP, following specific guidelines, recorded whether or not they believed an x-ray was indicated, and if so, what DI views they felt appropriate. Their opinion was blinded from the physician subsequently assessing the patient. An ACP opinion of the need for DI was compared with the subsequent test ordered by the MD. The MD decision to order DI was considered ‘gold standard’. Opinions were considered “matched” if the MD ordered DI of the same body part that the ACP believed was indicated. Sensitivity, specificity, positive predictive and negative predictive values (PPV, NPV) were calculated. Using data from our ED information system, we estimated the time that would have been saved by allowing ACPs to order DI. Results: Of 199 patients 192 images were ordered and 89 fractures were diagnosed. ACPs and MDs agreed that DI was necessary 94.70% of the time (95% CI: {90.6%, 97.4%}). There were 8 x-rays the ACP did not order that the MD did order, of which one showed a fracture. Twice, the ACP would have ordered an x-ray that the MD did not. In terms of identifying the need for DI, ACPs were 95.8% sensitive and 71.4% specific. The PPV was 98.9% (95% CI: {95.8%, 99.8%}), and the NPV was 38.5% (95% CI: {15.1%, 67.7%}). On average, ACP opinion of DI indication was made 54.1 minutes (95% CI: {48.0, 60.2}) earlier that of the MD. Conclusion: The overall agreement between MDs and ACPs was almost 95%. ACPs are more likely to under-order x-rays than to over-order them, lowering the risk of increasing radiation exposure and cost. ACP DI ordering may decrease the time of processing of patients with extremity injuries by almost an hour.

scholarly journals Protocol for the study of cervical cancer screening technologies in HIV-infected women living in Rwanda

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e020432 ◽  
Author(s):  
Gad Murenzi ◽  
Jean-Claude Dusingize ◽  
Theogene Rurangwa ◽  
Jean d’Amour Sinayobye ◽  
Athanase Munyaneza ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Sub Saharan Africa ◽  
Immunocytochemical Staining ◽  
Advisory Panel ◽  
Convenience Sample ◽  
Predictive Values ◽  
Screening Strategies ◽  
Study Results

IntroductionThe optimal method(s) for screening HIV-infected women, especially for those living in sub-Saharan Africa, for cervical precancer and early cancer has yet to be established.Methods and analysisA convenience sample of >5000 Rwandan women, ages 30–54 years and living with HIV infection, is being consented and enroled into a cross-sectional study of cervical cancer screening strategies. Participants are completing an administered short risk factor questionnaire and being screened for high-risk human papillomavirus (hrHPV) using the Xpert HPV assay (Cepheid, Sunnyvale, California, USA), unaided visual inspection after acetic acid (VIA) and aided VIA using the Enhanced Visual Assessment (EVA) system (Mobile ODT, Tel Aviv, Israel). Women positive for hrHPV and/or by unaided VIA undergo colposcopy, which includes the collection of two cervical specimens prior to undergoing a four-quadrant microbiopsy protocol. The colposcopy-collected specimens are being tested by dual immunocytochemical staining for p16INK4aand Ki-67 (CINtec PLUS Cytology, Ventana, Tucson, Arizona, USA) and for E6 or E7 oncoprotein for 8 hrHPV genotypes (HPV16, 18, 31, 33, 35, 45, 52 and 58) using the next-generation AV Avantage hrHPV E6/E7 test (Arbor Vita Corporation, Freemont, California, USA). Women with a local pathology diagnosis of cervical intraepithelial neoplasia grade 2 (CIN2) or more severe (CIN2+) or pathology review diagnosis of CIN grade three or more severe (CIN3+) will receive treatment. Clinical performance and cost-effectiveness (eg, sensitivity, specificity and predictive values) of different screening strategies and algorithms will be evaluated.Ethics and disseminationThe protocol was approved by local and institutional review boards for human subjects research. At the completion of the study, results will be disseminated to the scientific community through peer-reviewed publication and to the Rwandan stakeholders through an external advisory panel.

scholarly journals P141: Predictive validity of the Regional Paramedic Program for Eastern Ontario (RPPEO) prehospital sepsis notification tool

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S107-S107
Author(s):  
J. E. Sinclair ◽  
S. Duncan ◽  
P. Price ◽  
L. Thomas ◽  
A. Willmore ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Predictive Validity ◽  
Early Recognition ◽  
Screening Tools ◽  
Chi Square ◽  
Convenience Sample ◽  
Predictive Values ◽  
History Of ◽  
Eastern Ontario ◽  
The Impact

Introduction: Early recognition of sepsis can improve patient outcomes yet recognition by paramedics is poor and research evaluating the use of prehospital screening tools is limited. Our objective was to evaluate the predictive validity of the Regional Paramedic Program for Eastern Ontario (RPPEO) prehospital sepsis notification tool to identify patients with sepsis and to describe and compare the characteristics of patients with an emergency department (ED) diagnosis of sepsis that are transported by paramedics. The RPPEO prehospital sepsis notification tool is comprised of 3 criteria: current infection, fever &/or history of fever and 2 or more signs of hypoperfusion (eg. SBP<90, HR 100, RR24, altered LOA). Methods: We performed a review of ambulance call records and in-hospital records over two 5-month periods between November 2014 February 2016. We enrolled a convenience sample of patients, assessed by primary and advanced care paramedics (ACPs), with a documented history of fever &/or documented fever of 38.3°C (101°F) that were transported to hospital. In-hospital management and outcomes were obtained and descriptive, t-tests, and chi-square analyses performed where appropriate. The RPPEO prehospital sepsis notification tool was compared to an ED diagnosis of sepsis. The predictive validity of the RPPEO tool was calculated (sensitivity, specificity, NPV, PPV). Results: 236 adult patients met the inclusion criteria with the following characteristics: mean age 65.2 yrs [range 18-101], male 48.7%, history of sepsis 2.1%, on antibiotics 23.3%, lowest mean systolic BP 125.9, treated by ACP 58.9%, prehospital temperature documented 32.6%. 34 (14.4%) had an ED diagnosis of sepsis. Patients with an ED diagnosis of sepsis, compared to those that did not, had a lower prehospital systolic BP (114.9 vs 127.8, p=0.003) and were more likely to have a prehospital shock index >1 (50.0% vs 21.4%, p=0.001). 44 (18.6%) patients met the RPPEO sepsis notification tool and of these, 27.3% (12/44) had an ED diagnosis of sepsis. We calculated the following predictive values of the RPPEO tool: sensitivity 35.3%, specificity 84.2%, NPV 88.5%, PPV 27.3%. Conclusion: The RPPEO prehospital sepsis notification tool demonstrated modest diagnostic accuracy. Further research is needed to improve accuracy and evaluate the impact on patient outcomes.

Measuring Height in Recumbent Critical Care Patients

2015 ◽  
Vol 24 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Diane M. Dennis ◽  
Emily E. Hunt ◽  
Charley A. Budgeon
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Gold Standard ◽  
Ventilatory Support ◽  
Whole Body ◽  
Standing Height ◽  
Preadmission Clinic ◽  
Practice Methods ◽  
Critical Care Patients

Background Estimates of the height of patients in the intensive care unit are required to adhere to clinical guidelines for drug dosages, ventilatory support, and nutrition. The gold standard of standing height cannot be used because these patients are often unconscious and recumbent. The ability of physiotherapists or dietitians to measure height in unconscious, recumbent patients has not been evaluated. Objectives To compare the accuracy of physicians, physiotherapists, and dietitians in estimating the height of recumbent critical care patients by using existing practice methods. Methods A total of 35 patients were recruited from the cardiothoracic preadmission clinic, where standing height is routinely measured by a physiotherapist. After surgery, in the intensive care unit, 1 physician, 2 physiotherapists, and 2 dietitians measured each recumbent patient’s height. Three methods were used: observation, whole-body measurement, and height estimated by using length of the forearm and the British Association for Parenteral and Enteral Nutrition normative chart. Difference from standing height was measured from zero and was compared across professions and methods, with zero indicating no difference. Results Overall, 17 physicians, 4 dietitians, and 9 physiotherapists consented to measure patients. After adjustments for method, measurements by physiotherapists did not differ significantly from the gold standard (P = .59), whereas those of physicians (P = .02) and dietitians (P &lt; .001) did. Conclusions Physiotherapists’ measurements of supine height of recumbent critical care patients, obtained by using a nonrigid measuring tape, are more accurate than measurements obtained by physicians and dietitians.

Using Arterial Pressure Index to Predict Arterial Injuries in Penetrating Trauma to the Upper Extremities

2021 ◽  
pp. 000313482110111
Author(s):  
Lily Tung ◽  
Mark J. Seamon ◽  
Elizabeth Dauer ◽  
Olamide Alabi ◽  
Jaime Benarroch‐Gampel ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Gunshot Wounds ◽  
Trauma Patients ◽  
Vascular Injuries ◽  
Predictive Values ◽  
Lower Extremity Injuries ◽  
Pressure Index ◽  
Arterial Injuries

Background Upper extremity (UE) vascular injuries account for 18.4% of all traumatic vascular injuries. Arterial pressure index (API) use in lower extremity injuries to determine the need for further investigations is well established. However, due to collateral circulation in UEs, it is unclear if the same algorithm can be applied. The purpose of this study was to determine if APIs can be used to determine the need for computed tomography angiogram (CTA) in penetrating UE trauma. Methods All adult trauma patients with penetrating UE trauma and APIs from 2006 to 2016 were identified at 3 urban US level 1 trauma centers. Sensitivity, specificity, and positive and negative predictive values of APIs <.9 in detecting UE arterial injuries were calculated. Results During the 11-year study period, 218 patients met our inclusion criteria. Gunshot wounds comprised 76.6% and stab wounds 17.9%. Median injury severity score and API were 9 and 1, respectively. Seventy-two of our patients underwent evaluation with CTA. Of the injuries, the most common were thrombus or occlusion (46.7%), transection (23.1%), and dissection (15.4%), radiographically. Ultimately, 32 patients underwent surgical.

DOPPLER CEREBROPLACENTAL AND CEREBROUTERINE RATIO IN PREDICTING ADVERSE PERINATAL OUTCOMES IN HYPERTENSIVE DISORDERS OF PREGNANCY

2021 ◽  
pp. 35-37
Author(s):  
Shoadashi Saxena ◽  
Rachna Bhatnagar ◽  
Shivani Singh ◽  
Shipra Kunwar ◽  
Sachin Khanduri ◽  
...  
Keyword(s):  
Perinatal Death ◽  
Ventilatory Support ◽  
Perinatal Outcomes ◽  
Predictive Ability ◽  
Tertiary Hospital ◽  
Hypertensive Disorders Of Pregnancy ◽  
Predictive Values ◽  
Northern India ◽  
Hypertensive Disorders ◽  
Adverse Perinatal Outcomes

AIM:To compare cerebroplacental and cerebrouterine ratio as predictors of perinatal outcome in hypertensive disorders of pregnancy. METHODS: A prospective cohort study was done at a tertiary hospital in Northern India. Singleton pregnancies of gestational age >28 weeks, having BP>140/90mm of Hg with/without proteinuria >30mg/dL(+1 dipstick)were included. Doppler indices were measured, and perinatal outcomes studied. RESULTS:Cerebrouterine(CU) and cerebroplacental(CP) ratios had a better negative predictive value for adverse perinatal outcomes(except Apgar and preterm birth). CP ratio had highest sensitivity and specicity for outcomes perinatal death (100% and 95.9%), ventilatory support (100% and 97.2%) and hypoglycemia (100% and 95.9%). CU ratio had maximum sensitivity and specicity for the outcome hypoglycemia (100% and 95.9%). CONCLUSIONS:CP ratiohas a higher efcacy than CU ratio, however CU ratio compliments its predictive ability. Higher negative predictive values indicate that these ratios correctly ruled out unfavourable perinatal outcomes. Further studies to derive more sensitive values of CU ratio with normotensive patients and a larger sample size would be benecial.

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