scholarly journals Checklist para o transporte intra-hospitalar seguro do doente crítico: A scoping review

2020 ◽  
Vol 19 (4) ◽  
pp. 525-572
Author(s):  
Madalena Canellas ◽  
Isabel Palma ◽  
Patrícia Pontífice-Sousa ◽  
Isabel Rabiais
Keyword(s):  
Patient Safety ◽  
Critically Ill ◽  
Scoping Review ◽  
Critically Ill Patients ◽  
Full Text ◽  
Scientific Evidence ◽  
Critically Ill Patient ◽  
Intrahospital Transport ◽  
Preparation Phase ◽  
Critical Patients

Transportar a un paciente crítico conlleva una serie de riesgos que pueden poner en peligro su seguridad. Conocer los riesgos asociados con el transporte intrahospitalario es esencial para mejorar su seguridad. Elegimos estudiar la lista de verificación de transporte intrahospitalario, ya que la literatura los describe como una forma práctica y simple de aumentar la seguridad.Objetivo: Mapear la envidencia científica existente sobre los aspectos del check list o lista de verificación garantizando la seguridad del paciente crítico en el transporte intrahospitalario. Material y método: Se realizó un scoping review através de la metodologia The Joanna Briggs Institute, utilizando los motores de búsqueda EBSCOhost y B-on. La investigación fue realizada en portugués, inglés y español. Fueron seleccionados artículos con texto libre, sin límite de tiempo. Los criterios incluídos: el paciente crítico adulto/anciano, transporte intrahospitalario, la lista de verificación y la seguridad del paciente.Resultados: Se incluyeron 7 artículos. La mayoría de los aspectos de la lista de verificación se enfoca en la preparación del transporte, el aspecto que más se menciona es la monitorización del paciente. La parte después del transporte, aspectos de la lista de verificación solo es mencionada en 3 de los 7 artículos.Conclusión: Todos los estudios constatan aspectos que pueden incluírse en una lista de verificación y que mejoran la seguridad de los pacientes críticos en el transporte intrahospitalario. No hay unanimidad en cuanto a qué aspectos incluir en la lista de verificación. Transporting critically ill patients is has a set of risks that may jeopardize their safety. Knowing the risks associated with intrahospitalar transport of critically ill patients is essential to improving patient safety. For the sake of improving patient safety, was chosen to approach it as an intrahospitalar transport checklist, as the literature describes it as a practical and simple way to increase safety.Objective: Map available scientific evidence regarding aspects of a checklist that ensure the safety of critically ill patients in intrahospitalar transport.Material and Method: A scoping review was performed following the methodology proposed by The Joanna Briggs Institute in databases using the EBSCOhost and B-on search engines. Conducted research in Portuguese, English, and Spanish. Selected free full text articles, with no time limit. Inclusion criteria: adult/elderly critically ill patient, intrahospital transport, a checklist and patient safety.Results: Included 7 articles for analysis. Most verification requests that ensure the safety of critical patients on intrahospitalar transport concern the transport preparation phase, in which patient is monitored was the most mentioned aspect. From the post-transportation phase, checklist aspects are only available in 3 of 7 articles Conclusion: All studies address aspects that improve the safety of critically ill patients in intrahospitalar transport and are likely to be included in the checklist. There is no unanimity as to which aspects to include in the checklist. O transporte do doente crítico acarreta um conjunto de riscos para a sua segurança. Conhecer os riscos associados ao transporte intra-hospitalar do doente crítico é essencial para melhorar a segurança do mesmo. Optou-se por abordar a checklist de transporte intra-hospitalar, uma vez que a literatura a descreve como uma forma prática e simples de aumentar a segurança.Objetivo: Mapear a evidência científica disponível referente aos aspetos de uma checklist que garantem a segurança do doente crítico no transporte intra-hospitalar.Material e Método: Realizou-se uma scoping review recorrendo à metodologia do The Joanna Briggs Institute, nas bases de dados utilizando os motores de busca EBSCOhost e B-on. Realizada pesquisa em Português, Inglês e Espanhol. Selecionados artigos free full text, sem limite temporal. Critérios de inclusão: o doente crítico adulto/idoso, o transporte intra-hospitalar, a checklist e a segurança do doente.Resultados: Foram incluídos 7 artigos. A maioria dos aspetos da checklist que garantem a segurança do doente crítico no transporte intra-hospitalar, dizem respeito à fase da preparação do transporte, na qual o aspeto mais mencionado é a monitorização do doente. Da fase posterior ao transporte, aspetos da checklist apenas são mencionados em 3 dos 7 artigos.Conclusão: Todos os estudos abordam aspetos que são passíveis de incluir em checklist e melhoram a segurança do doente. Não existe unanimidade quanto aos aspetos a incluir na checklist do transporte intra-hospitalar.

scholarly journals Use of matching methods in observational studies with critical patients and renal outcomes. Scoping review

2020 ◽  
Vol 49 (2) ◽  
Author(s):  
Henry Oliveros Rodríguez ◽  
Giancarlo Buitrago ◽  
Paola Castellanos Saavedra
Keyword(s):  
Critically Ill ◽  
Scoping Review ◽  
Observational Studies ◽  
Pharmacological Intervention ◽  
Critically Ill Patient ◽  
Renal Outcomes ◽  
Matching Methods ◽  
Critical Patients ◽  
Clinical Experiments ◽  
Matching Techniques

Introduction: The use of matching techniques in observational studies has been increasing and is not always used appropriately. Clinical experiments are not always feasible in critical patients with renal outcomes, and observational studies are an important alternative. Objective: Through a scoping review, determine the available evidence on the use of matching methods in studies involving critically ill patients and assessing renal outcomes. Methods: Medline, Embase, and Cochrane databases were used to identify articles published between 1992 and 2020 up to week 10, which studied different exposures in the critically ill patient with renal outcomes and used propensity matching methods. Results: Most publications are cohort studies 94 (94. 9 %), five studies (5. 1 %) were cross-sectional. The main pharmacological intervention was the use of antibiotics in seven studies (7. 1%) and the main risk factor studied was renal injury prior to ICU admission in 10 studies (10. 1%). The balance between the baseline characteristics assessed by standardized means, in only 28 studies (28. 2%). Most studies 95 (96 %) used logistic regression to calculate the propensity index. Conclusion: Major inconsistencies were observed in the use of methods and in the reporting of findings. A summary is made of the aspects to be considered in the use of the methods and reporting of the findings with the matching by propensity index.

scholarly journals Impact of Renal Replacement Therapy on Mortality in Critically Ill Patients—The Nephrologist’s View within an Interdisciplinary Intensive Care Team

2021 ◽  
Vol 10 (15) ◽  
pp. 3379
Author(s):  
Matthias Klingele ◽  
Lea Baerens
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Impact ◽  
Kidney Injury ◽  
Care Team ◽  
Critically Ill Patient ◽  
Late Start

Acute kidney injury (AKI) is a common complication in critically ill patients with an incidence of up to 50% in intensive care patients. The mortality of patients with AKI requiring dialysis in the intensive care unit is up to 50%, especially in the context of sepsis. Different approaches have been undertaken to reduce this high mortality by changing modalities and techniques of renal replacement therapy: an early versus a late start of dialysis, high versus low dialysate flows, intermittent versus continuous dialysis, anticoagulation with citrate or heparin, the use of adsorber or special filters in case of sepsis. Although in smaller studies some of these approaches seemed to have a positive impact on the reduction of mortality, in larger studies these effects could not been reproduced. This raises the question of whether there exists any impact of renal replacement therapy on mortality in critically ill patients—beyond an undeniable impact on uremia, hyperkalemia and/or hypervolemia. Indeed, this is one of the essential challenges of a nephrologist within an interdisciplinary intensive care team: according to the individual situation of a critically ill patient the main indication of dialysis has to be identified and all parameters of dialysis have to be individually chosen with respect to the patient’s situation and targeting the main dialysis indication. Such an interdisciplinary and individual approach would probably be able to reduce mortality in critically ill patients with dialysis requiring AKI.

scholarly journals Risks in Management of Enteral Nutrition in Intensive Care Units: A Literature Review and Narrative Synthesis

Nutrients ◽  
2020 ◽  
Vol 13 (1) ◽  
pp. 82
Author(s):  
Magdalena Hoffmann ◽  
Christine Maria Schwarz ◽  
Stefan Fürst ◽  
Christina Starchl ◽  
Elisabeth Lobmeyr ◽  
...  
Keyword(s):  
Patient Safety ◽  
Intensive Care ◽  
Clinical Practice ◽  
Literature Review ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Rapid Review ◽  
Narrative Synthesis ◽  
Safety Issues

Critically ill patients in the intensive care unit (ICU) have a high risk of developing malnutrition, and this is associated with poorer clinical outcomes. In clinical practice, nutrition, including enteral nutrition (EN), is often not prioritized. Resulting from this, risks and safety issues for patients and healthcare professionals can emerge. The aim of this literature review, inspired by the Rapid Review Guidebook by Dobbins, 2017, was to identify risks and safety issues for patient safety in the management of EN in critically ill patients in the ICU. Three databases were used to identify studies between 2009 and 2020. We assessed 3495 studies for eligibility and included 62 in our narrative synthesis. Several risks and problems were identified: No use of clinical assessment or screening nutrition assessment, inadequate tube management, missing energy target, missing a nutritionist, bad hygiene and handling, wrong time management and speed, nutritional interruptions, wrong body position, gastrointestinal complication and infections, missing or not using guidelines, understaffing, and lack of education. Raising awareness of these risks is a central aspect in patient safety in ICU. Clinical experts can use a checklist with 12 identified top risks and the recommendations drawn up to carry out their own risk analysis in clinical practice.

The ART of Antiretroviral Therapy in Critically Ill Patients With HIV

2018 ◽  
Vol 34 (11-12) ◽  
pp. 897-909 ◽  
Author(s):  
Tyler Finocchio ◽  
William Coolidge ◽  
Thomas Johnson
Keyword(s):  
Intensive Care ◽  
Antiretroviral Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Critically Ill Patient ◽  
Intensive Care Setting ◽  
Antiretroviral Medications ◽  
Immunodeficiency Virus ◽  
Inflammatory Syndrome

The management of patients with human immunodeficiency virus (HIV) can be a complicated specialty within itself, made even more complex when there are so many unanswered questions regarding the care of critically ill patients with HIV. The lack of consensus on the use of antiretroviral medications in the critically ill patient population has contributed to an ongoing clinical debate among intensivists. This review focuses on the pharmacological complications of antiretroviral therapy (ART) in the intensive care setting, specifically the initiation of ART in patients newly diagnosed with HIV, immune reconstitution inflammatory syndrome (IRIS), continuation of ART in those who were on a complete regimen prior to intensive care unit admission, barriers of drug delivery alternatives, and drug-drug interactions.

scholarly journals Caracterização dos casos de COVID-19 em pacientes críticos: revisão de escopo/ Characterization of COVID-19 cases in critically ill patients: scoping review

2021 ◽  
Vol 20 ◽  
Author(s):  
Thatiane Monick De Souza Costa ◽  
Kauanny Vitoria Gurgel dos Santos ◽  
Eloysa Dos Santos Oliveira ◽  
Bruna Vilar Soares da Silva ◽  
Evelin Beatriz Bezerra de Melo ◽  
...  
Keyword(s):  
Critically Ill ◽  
Systematic Reviews ◽  
Scoping Review ◽  
Critically Ill Patients ◽  
Scoping Reviews ◽  
Terapia Intensiva ◽  
Population Concept

Introdução: A principal causa de mortalidade pelo novo coronavírus é a insuficiência respiratória. Assim, os cuidados intensivos devem ser prontamente prestados ao paciente crítico. Objetivo: Explorar as evidências acerca dos achados clínicos, tratamento e desfecho de pacientes infectados pelo Sars-CoV-2 internados em Unidades de Terapia Intensiva. Método: Revisão de escopo, realizada em abril de 2021, em oito fontes de dados nacionais e internacionais, conforme orientações do Instituto Joanna Briggs, seguindo o checklist Preferred Reporting Items for Systematic reviews and Meta-Analysesextension for Scoping Reviews, sem restrição de idioma ou temporal. Adotou-se a estratégia Population, Concept and Contextpara a elaboração da questão de pesquisa. Resultados: Incluíram-se 15 artigos científicos, com predominância de publicações na China, Estados Unidos da América e Canadá. Dos estudos, 80% foram com adultos e idosos em Unidade de Terapia Intensiva. Os principais achados clínicos foram febre, tosse, Síndrome do Desconforto Respiratório Agudo e lesão renal, tratamento com ventilação mecânica invasiva e não invasiva, oxigenoterapia de alto fluxo e corticoesteroides. Como principal desfecho, o óbito. Conclusão: A maioria dos pacientes apresentou febre, tosse e Síndrome do Desconforto Respiratório Agudo, recebendo cuidados como ventilação mecânica, oxigenoterapia de alto fluxo e corticoesteroides, com alto índice de óbitos.

scholarly journals T3 as predictor of mortality in any cause non-critically ill patient

2021 ◽  
Author(s):  
Erika Biegelmeyer ◽  
Iury Scanagata ◽  
Laura Alves ◽  
Murilo Reveilleau ◽  
Fernando Pereira Schwengber ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Critically Ill Patient ◽  
Total Serum ◽  
Population Total ◽  
Low T3 ◽  
Serum T3 ◽  
Overall Mortality

Background: Low T3 syndrome refers to a set of thyroid hormone metabolism alterations present in disease state. A correlation between low T3 and poor clinical outcomes in the intensive care unit is more established. Nonetheless, studies on non-critically ill patients are few and controversial. Objective: To evaluate the prevalence and predictive value of low T3 levels on 30 days- and six month-term mortality in non-critically ill patients. Secondary outcomes evaluated length of hospital stay, overall mortality, and hospital readmission. Design: Prospective cohort study. Methods: 345 consecutive patients from Internal medicine ward of a tertiary hospital in southern Brazil included from October 2018 to April 2019 and followed for 6 months. Levels of total serum T3 were measured weekly, from admission to discharge, and correlated with 30-day hospital mortality. Results: Prevalence of low T3 was 36.6%. Low T3 levels were associated with higher 30-days hospital mortality (15.1% versus 4.1%, p<0.001) and higher 6-months overall mortality (31.7% versus 13.2%, p<0.001). Total serum T3 at admission was an independent predictor of 30-days hospital mortality. Conclusion: Low T3 levels are a prevalent condition among non-critically ill patients and this condition is associated with poor clinical outcomes in this population. Total serum T3 levels, alone or in association with other predictive scores, were demonstrated to be an easy and valuable tool for risk stratification, and should be further employed in this setting.

scholarly journals Znacaj profilakse akutne mukozne lezije kod pacijenata u jedinici intenzivnog lecenja

2007 ◽  
Vol 54 (1) ◽  
pp. 47-50 ◽  
Author(s):  
N.M. Popovic
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Direct Consequence ◽  
Severe Trauma ◽  
Mucosal Lesion ◽  
Critically Ill Patient ◽  
Multiple Risk Factors ◽  
Massive Gastrointestinal Bleeding ◽  
Mucosal Lesions ◽  
Clinically Significant

At least three-quarters of critically ill patients develop mucosal lesion as a direct consequence of stress within the first 24 hours following the admission to intensive care unit. These mucosal lesions occur as superficial or deep mucosal lesions which can lead to massive gastrointestinal bleeding and it can put at risk the life of critically ill patient. There are multiple risk factors for the occurence of mucosal lesion such as: respiratory failure requiring mechanical ventilation, sepsis, hypotension, burns, severe trauma, neurotrauma, ileus, coagulopathy, renal and hepatic failure, myocardial infarction etc. The incidence of silent (ocult) bleeding in critically ill patients is almost 100%, but only about 5% of patients have clinically apparent (overt) hemorrhage and 1-2% have clinically significant bleeding which requires blood transfusions. In patients who are at the greatest risk of developing mucosal lesion, prophylactic treatment ought to be started immediately in order to achieve pH4 with adequate perfusion and coagulation. Today several groups of medications are used for the prevention of mucosal gastrointestinal lesion and they include: antacids, sucralfate, hisamine-2 receptor antagonists and proton pump inhibitors.

Cardiovascular System in the Critically Ill Patient

2019 ◽  
pp. 26-34
Author(s):  
Juan G. Ripoll Sanz ◽  
Norlalak Jiramethee ◽  
Jose L. Diaz-Gomez
Keyword(s):  
Cardiac Output ◽  
Cardiovascular System ◽  
Critically Ill ◽  
Fluid Responsiveness ◽  
Critically Ill Patients ◽  
Integrated System ◽  
Critically Ill Patient ◽  
Cardiovascular Disorders ◽  
Output Control ◽  
System 2

This chapter provides an overview of fundamental pathophysiologic concepts for the diagnosis and management of cardiovascular disorders in critically ill patients. Three major topics are presented: 1) the importance of vascular–cardiac pump coupling as an integrated system, 2) practical considerations of ventricular dysfunction, and 3) systemic vessels as a crucial factor for cardiac output control and fluid responsiveness.

scholarly journals Improving quality and safety during intrahospital transport of critically ill patients: A critical incident study

2020 ◽  
Vol 33 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Lina Bergman ◽  
Monica Pettersson ◽  
Wendy Chaboyer ◽  
Eric Carlström ◽  
Mona Ringdal
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Critical Incident ◽  
Quality And Safety ◽  
Intrahospital Transport

Interpretation and implication of diastolic dysfunction in critically ill patients

2017 ◽  
Author(s):  
Claire Colebourn ◽  
Jim Newton
Keyword(s):  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Left Ventricular ◽  
Left Ventricular Filling ◽  
Critically Ill Patient ◽  
Severe Illness ◽  
Ventricular Relaxation ◽  
Ventricular Filling

This chapter looks at the interpretation of parameters of diastolic function in the critically ill patient. It provides a guide to interpretation and how to avoid misinterpretation of these parameters in the context of severe illness. The assessment of left ventricular relaxation and left ventricular filling pressures are described in detail.

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