Nonpharmacological Interventions to Prevent Delirium: An Evidence-Based Systematic Review

2015 ◽  
Vol 35 (1) ◽  
pp. 39-49 ◽  
Author(s):  
Ryan M. Rivosecchi ◽  
Pamela L. Smithburger ◽  
Susan Svec ◽  
Shauna Campbell ◽  
Sandra L. Kane-Gill
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Length Of Stay ◽  
Adverse Effects ◽  
Hospital Costs ◽  
Evidence Based ◽  
Inpatient Settings ◽  
Stay Hospital ◽  
Critical Care Patients

Development of delirium in critical care patients is associated with increased length of stay, hospital costs, and mortality. Delirium occurs across all inpatient settings, although critically ill patients who require mechanical ventilation are at the highest risk. Overall, evidence to support the use of antipsychotics to either prevent or treat delirium is lacking, and these medications can have adverse effects. The pain, agitation, and delirium guidelines of the American College of Critical Care Medicine provide the strongest level of recommendation for the use of nonpharmacological approaches to prevent delirium, but questions remain about which nonpharmacological interventions are beneficial.

Tracheostomy

2019 ◽  
pp. 850-854
Author(s):  
Saba Ghorab ◽  
David G. Lott
Keyword(s):  
United States ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prolonged Mechanical Ventilation ◽  
The United States ◽  
Critical Care Patients

Tracheostomy is a procedure where a conduit is created between the skin and the trachea. Tracheostomy is one of the most frequent procedures undertaken in critically ill patients. Each year, approximately 10% of critical care patients in the United States require a tracheostomy, most often for prolonged mechanical ventilation.

Enteral Nutrition in the Prevention and Treatment of Pressure Ulcers in Adult Critical Care Patients

2014 ◽  
Vol 34 (6) ◽  
pp. 15-27 ◽  
Author(s):  
Jill Cox ◽  
Louisa Rasmussen
Keyword(s):  
Wound Healing ◽  
Critical Care ◽  
Nutritional Status ◽  
Pressure Ulcers ◽  
Burden Of Illness ◽  
Evidence Based ◽  
Adequate Nutrition ◽  
Nutritional Guidelines ◽  
Registered Dietician ◽  
Critical Care Patients

Prevention and healing of pressure ulcers in critically ill patients can be especially challenging because of the patients’ burden of illness and degree of physiological compromise. Providing adequate nutrition may help halt the development or worsening of pressure ulcers. Optimization of nutrition can be considered an essential ingredient in prevention and healing of pressure ulcers. Understanding malnutrition in critical care patients, the effect of nutrition on wound healing, and the application of evidence-based nutritional guidelines are important aspects for patients at high risk for pressure ulcers. Appropriate screenings for nutritional status and risk for pressure ulcers, early collaboration with a registered dietician, and administration of appropriate feeding formulations and micronutrient and macronutrient supplementation to promote wound healing are practical solutions to improve the nutritional status of critical care patients. Use of nutritional management and enteral feeding protocols may provide vital elements to augment nutrition and ultimately result in improved clinical outcomes.

scholarly journals Mortality Associated Factors of Patients with Mechanical Ventilation Treated at the Intensive Care Unit of a Second Level Hospital at Piedras Negras Coahuila Mexico

2021 ◽  
Vol 5 (6) ◽  
Author(s):  
Jose Ivan Rodriguez de Molina Serrano
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Hospital Mortality ◽  
Quality Indicators ◽  
Quantitative Measure ◽  
System Quality ◽  
Mortality Factors ◽  
Saps 3 ◽  
Piedras Negras ◽  
Critical Care Patients

Introduction: The mechanical ventilation is the cornerstone of treatment for patients with acute respiratory failure and is one of the pivotal therapies in critical care medicine. The epidemiology of mechanical ventilation in México is scarce and usually a transpolated of the information in high specialty centers. The mechanical ventilation has the aim of assisting in the elimination of CO2 (carbon dioxide) and / or favoring the adequate exchange of oxygen while the patient is unable to do so or due to conditions external to the respiratory system. Quality indicators of attention are a quantitative measure that are used to assess important aspects of clinical practice. Objective: Describe the epidemiology and mortality factors in mechanically ventilated patients treated at second level ICU in Piedras Negras, Coahuila México. Material and Methods: retrospective study from December 2016 to December 2019 all patients treated with MV. We collected general demographic characteristics, quality indicators and complications, severity of disease and mortality. Results: 164 patients were enrolled. Female 54.8%, main diagnoses Sepsis 30.5%, and DKA 13.4%, mean age 44.1 SD ± mean SOFA 7.2 SD ± 6.2, mean SAPS3 50.6 SD ± 20.2, ICU LOS 4.5 SD ± 5.1, Hospital LOS 11.7 SD ± 10.2 p<0.0001. ICU and Hospital mortality 14 % and 23.8%. The factors associated with ICU mortality were: Age, MV hours, Respiratory SOFA, and Hepatic SOFA and with Hospital mortality: Age, Neurological SOFA, Unstable at admission, SOFA and SAPS 3. Conclusions: MV is a primordial need of critical care patients, our mortality was reported lower than expected but quality of attention indicators most be improved in order to maintain this trend. This study has several limitations in population and applicability but contributes with primordial information about MV critical care patients treated at México.

scholarly journals The Use of Prophylactic Anticonvulsants in Patients with Brain Tumours—A Systematic Review

2006 ◽  
Vol 13 (6) ◽  
pp. 222-229 ◽  
Author(s):  
J. Perry ◽  
L. Zinman ◽  
A. Chambers ◽  
K. Spithoff ◽  
N. Lloyd ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Brain Tumours ◽  
Best Practice ◽  
Meta Analysis ◽  
Significant Risk ◽  
Practice Variation ◽  
Cochrane Library ◽  
Evidence Based ◽  
Newly Diagnosed

Questions: Should patients with newly diagnosed brain tumours receive prophylactic anticonvulsants to reduce seizure risk? What is the best practice for patients with brain tumours who are taking anticonvulsant medications but who have never had a seizure? Perspectives: Patients with primary or metastatic brain tumours who have never had a seizure still have a 20% risk of experiencing a seizure over the course of their disease. Because considerable practice variation exists in regard to the management of patients with brain tumours who have never had a seizure, and because conflicting evidence has been reported, the Neuro-oncology Disease Site Group (DSG) of Cancer Care Ontario’s Program in Evidence-based Care felt that a systematic review of the evidence was warranted. Outcomes: Outcomes of interest were incidence of seizures and adverse effects of prophylactic anticonvulsant therapy. Methodology: The MEDLINE and Cochrane Library databases were systematically searched for relevant evidence. The review included fully published reports or abstracts of randomized controlled trials (RCTs), systematic reviews, meta-analyses, and practice guidelines. The present systematic review was reviewed and approved by the Neuro-oncology DSG, which comprises medical and radiation oncologists, surgeons, neurologists, a nurse, and a patient representative. Results: Quality of Evidence: The literature search located one evidence-based practice guideline, one systematic review, and five RCTs that addressed prophylactic anticonvulsants for patients with brain tumours. Evidence for the best management of seizure-naïve patients who are already taking anticonvulsants was limited to one retrospective study and exploratory analyses within several RCTs. Benefits and Harms: Pooled results of the five RCTs suggest that the incidence of seizures in patients who receive prophylactic anticonvulsants is not significantly different from that in patients who do not receive anticonvulsants (relative risk: 1.04; 95% confidence interval: 0.70 to 1.54; p = 0.84). This analysis accords with results from a published meta-analysis. Evidence is insufficient to determine whether patients who are currently taking anticonvulsants but who have never had a seizure should taper the anticonvulsants. Patients who received anticonvulsants reported adverse effects, including rash, nausea, and hypotension, but whether these effects are a result of the anticonvulsants or of other treatments could not be determined. Conclusions: Based on the available evidence, the routine use of postoperative anticonvulsants is not recommended in seizure-naïve patients with newly diagnosed primary or secondary brain tumours, especially in light of a significant risk of serious adverse effects and problematic drug interactions. Because data are insufficient to recommend whether anticonvulsants should be tapered in patients who are already taking anticonvulsants but who have never had a seizure, treatment must be individualized.

scholarly journals Impact of Enteral Nutrition Formulations Containing Dietary Fiber on Diarrhea Outcomes in Hospitalized Critical Care Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 842-842
Author(s):  
Kelly Cara ◽  
Andrew Beauchesne ◽  
Taylor Wallace ◽  
Mei Chung
Keyword(s):  
Systematic Review ◽  
Critical Care ◽  
Enteral Nutrition ◽  
Dietary Fiber ◽  
Critically Ill ◽  
Random Effects ◽  
Critically Ill Patients ◽  
Outcome Data ◽  
Meta Analyses ◽  
Critical Care Patients

Abstract Objectives The objective is to conduct a systematic review on the safety of using enteral nutrition formulations containing dietary fiber in hospitalized critical care patients. Methods This systematic review was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions (Version 6.1,2020). Searches were implemented in four databases on 4/20/20. Results were limited to English language studies conducted in humans. Any clinical study design or case study measuring adverse events (e.g., diarrhea and mortality) or health outcomes (as defined in each study) associated with enteral nutrition interventions containing dietary fiber in adult critically ill patients was considered. Random effects meta-analyses were conducted on outcomes assessed by three or more included studies. Results Altogether, 18 articles were included, and 11 randomized controlled trials assessed diarrhea outcomes (i.e., diarrhea score and number or frequency of events). Six studies used the Hart and Dobb (1988) diarrhea score, and random effects meta-analyses showed the mean diarrhea scores were lower for fiber compared to non-fiber groups (n = 4, pooled mean difference: −2.78, 95% confidence interval: −4.10, −1.47). Five of seven reported group comparisons showed fewer diarrhea events for fiber compared with non-fiber groups, although the overall difference was not statistically significant (n = 7, pooled risk ratio: 0.68, 95% CI: 0.45, 1.02). For three studies using other or unspecified scoring methods, pooled results showed significantly fewer diarrhea events in the fiber groups compared to non-fiber groups (n = 3, pooled RR: 0.42, 95% CI: 0.20, 0.89). Studies reported no difference in incidence of mortality due to fiber interventions (n = 7, pooled RR: 0.99, 95% CI: 0.66, 1.48). Risk of bias for diarrhea outcomes was high due to missing outcome data, and there was some concern for bias due to randomization, measurement of the outcome, and selection of reported results. Conclusions Enteral nutrition formulas with fiber may help reduce incidence and severity of diarrhea in critically ill patients without increasing incidence of mortality. As these results are subject to bias, more high-quality studies are needed to verify this conclusion. Funding Sources This study was supported by funding from an unrestricted educational grant from Nestle Health Sciences.

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