Early Mobilization of Infants Intubated for Acute Respiratory Failure

2019 ◽  
Vol 39 (6) ◽  
pp. 47-52
Author(s):  
Laura Ortmann ◽  
Anne Dey
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Adverse Events ◽  
Intervention Group ◽  
Vital Signs ◽  
Arterial Catheter ◽  
Young Infants ◽  
Unplanned Extubations ◽  
Historical Controls

Background Early mobility in the intensive care unit is being promoted as a way to improve outcomes but has not been studied in young infants. Objective To determine the safety of a holding intervention for infants intubated for respiratory failure. Methods Infants less than 6 months of age intubated for respiratory failure underwent a holding intervention in which a caretaker held the infant at least twice a day once the infant was medically stabilized. Rates of adverse events were compared with historical controls matched by age and Pediatric Index of Mortality 2 score. Vital signs before and during holding were recorded to assess for physiologic tolerance. Results Twenty-four infants with a total of 158 holding interventions were studied. Mean holding duration was 99 minutes. Twenty holding interventions were terminated early, most commonly because of agitation. The 24 historical controls had 1 unplanned extubation and 2 arterial catheter removals. The intervention group had no unplanned extubations, inadvertent central catheter removals, or urinary catheter removals and had 1 arterial catheter removal that was not associated with holding. Vital signs before and during holding were similar. There were no differences between the control and intervention groups in duration of intubation (7.3 vs 6.0 days, P = .98), length of intensive care unit stay (9.1 vs 9.0 days, P = .52), or length of hospital stay (11.5 vs 12.5 days, P = .28). Conclusions Holding intubated infants in the intensive care unit was well tolerated, without an increase in adverse events.

Predictors of Adverse Events in Patients After Discharge From the Intensive Care Unit

2008 ◽  
Vol 17 (3) ◽  
pp. 255-263 ◽  
Author(s):  
Wendy Chaboyer ◽  
Lukman Thalib ◽  
Michelle Foster ◽  
Carol Ball ◽  
Brent Richards
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Events ◽  
Nursing Care ◽  
Univariate Analysis ◽  
Vital Signs ◽  
Chart Audit ◽  
Care Needs ◽  
Adult Intensive Care Unit ◽  
Vein Thrombosis

Background Patients discharged from the intensive care unit may be at risk of adverse events because of complex care needs. Objective To identify the types, frequency, and predictors of adverse events that occur in the 72 hours after discharge from an intensive care unit when no evidence of adverse events was apparent before discharge. Methods A predictive cohort study of 300 patients from an adult intensive care unit was undertaken. An internationally accepted protocol for chart audit was used. Frequency of adverse events was calculated, and logistic regression was used to determine independent predictors of adverse events. Results A total of 147 adverse events, 17 (11.6%) of which were defined as major, were incurred by 92 patients (30.7%). The 3 most common adverse events, hospital-incurred infection or sepsis (n = 32, 21.8%), hospital-incurred accident or injury (n = 17, 11.6%), and other complication such as deep vein thrombosis, pulmonary edema, or myocardial infarction (n = 17, 11.6%) accounted for 44.9% (n = 66) of all adverse events. Two predictors, respiratory rate less than 10/min or greater than or equal to 25/min and pulse rate exceeding 110/min, were significant independent predictors; requiring a high level of nursing care at the time of discharge was a significant predictor in univariate analysis but not in multivariate analysis. Conclusion Taking, recording, and reporting vital signs are important. Nursing care requirements of patients at discharge from the intensive care unit may be worthy of further investigation in studies of patients after discharge.

Clinical Tolerance of In-Neonatal Intensive Care Unit Administration of Rotavirus Vaccine

2019 ◽  
Author(s):  
Courtney Briggs-Steinberg ◽  
David Aboudi ◽  
Gabrielle Hodson ◽  
Shetal Shah
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Events ◽  
Neonatal Intensive Care Unit ◽  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Rank Test ◽  
Retrospective Case ◽  
Clinically Significant ◽  
Historical Controls

Abstract Objective This article determines the tolerance of neonatal intensive care unit (NICU)-based administration of RV5 in premature infants. This article also aims to compare the rate of clinically significant adverse events after RV5 immunization to the standard 2-month shot series and to historical controls who were not immunized. Study Design This is a retrospective case–control study of 201 premature infants immunized with RV5. Infants were evaluated for clinically significant events 7 days before and after immunization and were compared with events after the 2-month shot series and to 189 historical controls. Wilcoxon signed rank test and McNemar's test were used for all paired analysis. Results There was no increase in number of infants with clinically significant adverse events when comparing after RV5 to prior to RV5, after the 2-month shot series, or to the historical controls. Conclusion RV5 is well tolerated in premature infants and does not result in clinically significant adverse events when administered in NICU-hospitalized infants.

scholarly journals The Effect of Music Therapy on Perceived Pain, Mental Health, Vital Signs, and Medication Usage of Burn Patients Hospitalized in the Intensive Care Unit: A Randomized Controlled Feasibility Study Protocol

2021 ◽  
Vol 12 ◽  
Author(s):  
Mark Ettenberger ◽  
Rafael Maya ◽  
Andrés Salgado-Vasco ◽  
Sofia Monsalve-Duarte ◽  
William Betancourt-Zapata ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Clinical Trials ◽  
Intensive Care ◽  
Music Therapy ◽  
Study Protocol ◽  
Intervention Group ◽  
Vital Signs ◽  
Control Group ◽  
Burn Patients ◽  
Randomized Controlled

Background: Burn patients experience major physiological and psychological stressors during treatment and rehabilitation, including elevated levels of pain, anxiety, stress, or depression. Music interventions inclusive of music therapy (MT) have been shown to improve such symptoms, but rigorous clinical trials investigating specific music therapy methods in adult burn patients are scarce.Methods: This is a single center Randomized Controlled Trial (RCT) protocol with two parallel arms. Participants are 81 adult burn patients admitted to the Intensive Care Unit (ICU) of the University Hospital Fundación Santa Fe de Bogotá in Colombia. The intervention consists of a Music Assisted Relaxation (MAR) protocol, a music therapy technique composed of entrained live music combined with a guided relaxation and/or the use of imagery. The effects of the MAR will be compared to a control group (treatment as usual) over a period of maximum 2 weeks or six interventions. The primary outcome measure is perceived background pain, as measured with a Visual Analog Scale (VAS) before and after each intervention. Secondary outcomes are anxiety and depression levels; vital signs; and the use of pain medication. Additionally, some patients in the intervention group will be invited to participate in electroencephalography, electromyography, and electrocardiography recordings during the MAR.Discussion: This study protocol follows the SPIRIT guidelines for defining items of clinical trials and is the first study in Colombia to evaluate the effects of music therapy for adult burn patients. With this RCT it is hoped to gather new knowledge about the potential of music therapy to help critical care patients cope and recover from their injuries during the hospitalization in the ICU.Trial registration:www.clinicaltrials.gov, Identifier: NCT04571255.Protocol version: V1.0, May 24th 2021

scholarly journals Impact of adverse events on patient outcomes in a Japanese intensive care unit: a retrospective observational study

Nursing Open ◽  
2021 ◽  
Author(s):  
Gen Aikawa ◽  
Akira Ouchi ◽  
Hideaki Sakuramoto ◽  
Chiemi Ono ◽  
Chie Hatozaki ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Events ◽  
Observational Study ◽  
Patient Outcomes ◽  
Retrospective Observational Study

scholarly journals Higher Acid-Base Imbalance Associated with Respiratory Failure Could Decrease the Survival of Patients with Scrub Typhus during Intensive Care Unit Stay: A Gene Set Enrichment Analysis

2019 ◽  
Vol 8 (10) ◽  
pp. 1580 ◽  
Author(s):  
Kyoung Min Moon ◽  
Kyueng-Whan Min ◽  
Mi-Hye Kim ◽  
Dong-Hoon Kim ◽  
Byoung Kwan Son ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Scrub Typhus ◽  
Enrichment Analysis ◽  
Gene Set Enrichment Analysis ◽  
Acid Base ◽  
Gene Set Enrichment ◽  
Gene Set ◽  
Gene Sets

Ninety percent of patients with scrub typhus (SC) with vasculitis-like syndrome recover after mild symptoms; however, 10% can suffer serious complications, such as acute respiratory failure (ARF) and admission to the intensive care unit (ICU). Predictors for the progression of SC have not yet been established, and conventional scoring systems for ICU patients are insufficient to predict severity. We aimed to identify simple and robust indicators to predict aggressive behaviors of SC. We evaluated 91 patients with SC and 81 non-SC patients who were admitted to the ICU, and 32 cases from the public functional genomics data repository for gene expression analysis. We analyzed the relationships between several predictors and clinicopathological characteristics in patients with SC. We performed gene set enrichment analysis (GSEA) to identify SC-specific gene sets. The acid-base imbalance (ABI), measured 24 h before serious complications, was higher in patients with SC than in non-SC patients. A high ABI was associated with an increased incidence of ARF, leading to mechanical ventilation and worse survival. GSEA revealed that SC correlated to gene sets reflecting inflammation/apoptotic response and airway inflammation. ABI can be used to indicate ARF in patients with SC and assist with early detection.

scholarly journals Safety and efficacy of routine diagnostic test reduction interventions in patients admitted to the intensive care unit: A systematic review and meta-analysis

2021 ◽  
Vol 49 (1) ◽  
pp. 23-34
Author(s):  
Katherine P Hooper ◽  
Matthew H Anstey ◽  
Edward Litton
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Diagnostic Testing ◽  
Intervention Group ◽  
Cochrane Central Register ◽  
Safety And Efficacy ◽  
Significant Difference

Reducing unnecessary routine diagnostic testing has been identified as a strategy to curb wasteful healthcare. However, the safety and efficacy of targeted diagnostic testing strategies are uncertain. The aim of this study was to systematically review interventions designed to reduce pathology and chest radiograph testing in patients admitted to the intensive care unit (ICU). A predetermined protocol and search strategy included OVID MEDLINE, OVID EMBASE and the Cochrane Central Register of Controlled Trials from inception until 20 November 2019. Eligible publications included interventional studies of patients admitted to an ICU. There were no language restrictions. The primary outcomes were in-hospital mortality and test reduction. Key secondary outcomes included ICU mortality, length of stay, costs and adverse events. This systematic review analysed 26 studies (with more than 44,00 patients) reporting an intervention to reduce one or more diagnostic tests. No studies were at low risk of bias. In-hospital mortality, reported in seven studies, was not significantly different in the post-implementation group (829 of 9815 patients, 8.4%) compared with the pre-intervention group (1007 of 9848 patients, 10.2%), (relative risk 0.89, 95% confidence intervals 0.79 to 1.01, P = 0.06, I2 39%). Of the 18 studies reporting a difference in testing rates, all reported a decrease associated with targeted testing (range 6%–72%), with 14 (82%) studies reporting >20% reduction in one or more tests. Studies of ICU targeted test interventions are generally of low quality. The majority report substantial decreases in testing without evidence of a significant difference in hospital mortality.

REDUCTION IN THE RATE OF UNPLANNED EXTUBATIONS IN A PEDIATRIC INTENSIVE CARE UNIT

2002 ◽  
Vol 30 (Supplement) ◽  
pp. A36
Author(s):  
Bonnie R Rachman ◽  
Robin Watson ◽  
Michael Rogers ◽  
Norline Woods ◽  
Richard B Mink
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Unplanned Extubations
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