Anesthesia, Sedation, and Unplanned Extubation of Tracheal Intubation in Children with Severe Pneumonia

We randomly divided 200 children with severe pneumonia who met the indications for tracheal intubation into 2 groups in this prospective study. One group that received dexmedetomidine for sedation was recorded as the dexmedetomidine group (n = 100), and the group that received midazolam for sedation was recorded as the midazolam group (n = 100). We compared the anesthesia sedation scores, time to fall asleep, time to wake up from anesthesia, related hemodynamic parameters, and adverse reactions between the two groups of children. The failure mode and effect analysis method (FMEA) was also used to investigate the causes of unplanned extubation (UEX) of tracheal intubation in 32 children with severe pneumonia. Our conclusion is as follows: (1) Compared with midazolam, the comprehensive effect of dexmedetomidine on children with severe pneumonia undergoing tracheal intubation for anesthesia and sedation is better, it can effectively shorten the anesthesia induction time and the recovery time after stopping the drug, and there are few adverse reactions, which is worthy of application and promotion. (2) UEX is an important risk factor in the monitoring and nursing of children with severe pneumonia tracheal intubation, and the nursing method of PDCA cycle management is particularly important for them.

Effectiveness of Teaching Program on Knowledge of Clinical Nurses Regarding Risk of Unplanned Extubation of Patients with Mechanical Ventilation at a Selected Hospital, Bangalore

Background: Mechanical ventilation (MV) is one of the therapeutic pillars of intensive care medicine. Technique and practice in emergency airway management varies between ICUs and in different countries and as a result, complication rates may also differ. Unplanned extubation is a frequent event after endotracheal intubation for respiratory support in critically ill patients and is associated with increased morbidity and mortality. The incidence of unplanned extubation among intubated patients is reported to vary from 0.3% to 1.4%. Unplanned extubation account for approximately 10% of reintubations. An Unplanned Extubation is also associated with prolonged duration of mechanical ventilation, ICU stay and hospital stay. Objective: to assess the knowledge of clinical nurses regarding risk of unplanned extubation of patients with mechanical ventilation at Kempegowda institute of medical science and research Hospital, Bangalore, Karnataka. Materials and Methods: Quantitative research approach and a pre-experimental one group pre-test post-test research design were used to accomplish the stated objectives. The investigator selected a sample of 50 nurses who were working in KIMS hospital. The data were collected by using a self administered structured knowledge questionnaire. Planned teaching was given with appropriate A-V aid followed by pretest. Result: Inferential and descriptive statistical analysis was performed by using SPSS-IBM 20. Results were calculated by using p value < 0.05. The results revealed that, in pretest 80% of the nurses had inadequate knowledge where as in posttest 82% of the nurses had gained moderately adequate knowledge and the improvement was statistically significant at P<0.05. Conclusion: The study result shows that after intervention knowledge regarding risk of unplanned extubation among nurses were improved significantly. Keywords: Effectiveness planned teaching, risk of unplanned extubation, knowledge of staff nurses and mechanical ventilation protocol.

Factors Related to Delirium of Intensive Care Unit Patients in Korea: A Systematic Review

Background: The delirium in Intensive Care Units (ICU) patients is a major cause of unplanned extubation, increased length of hospital day. This study aimed to review systematically risk factors associated with the occurrence of delirium among ICU patients in South Korea. Methods: Data collection was done with domestic literature search databases including KMbase, KoreaMed, KISS, and KisTi and also with hand searching, from February 17 to May 19, 2019. Two researchers independently selected research literatures, and three researchers summarized and identified related variables based on data extraction methods. Results: Overall, 140 articles were identified, 18 articles met the inclusion criteria for review. According to the results of the methodological quality, one article was found to have a high level of quality, while the remaining 17 articles belonged to the medium level. Those factors were highly associated with delirium by more than 9 out of the 18 selected studies were listed as follows; age, the application of ventilator, APACHE II score, comorbidity, the application of restraint, and educational level. In addition, catheter insertion and the application of artificial airway had significant relevance with the occurrence of delirium. Conclusion: For management of delirium among ICU patients, it is necessary to eliminate and prevent delirium-associated risk factors, and also to detect and treat the delirium early through regular monitoring using an appropriate screening tool for delirium.

“Patient Comfort Can Be Sacrificed for Patient Safety”—Perception and Practice Reported by Critical Care Nurses Toward Physical Restraints: A Qualitative Descriptive Study

Aim: The aim of the study was to explore the perception and practice of physical restraints used by critical care nurses.Design: A qualitative descriptive design was used.Method: From December 2019 to May 2020, a one-to-one, semi-structured in-depth interview with 10 critical care nurses from two intensive care units in a tertiary general hospital with 3,200 beds in China was conducted using the method of purposeful sampling. The data were analyzed using inductive thematic analysis.Findings: The perception of physical restraints among critical care nurses was that patient comfort can be sacrificed for patient safety. Physical restraints protected patient safety by preventing patients from unplanned extubation but influenced patient comfort. Physical restraints were common practice of critical care nurses. Relative physical restraints provided patients with more freedom of movement and rationalization of physical restraints which were the practical strategies.Conclusion: The study identified problems in critical care nurses' perception and practice on physical restraints. Critical care nurses are confident that physical restraints can protect patient safety, and the influence of physical restraints on patient comfort is just like the side effect. Although physical restraints were common practice, critical care nurses still faced dilemmas in the implementation of physical restraints. Relative physical restraints and rationalization of physical restraints help critical care nurses cope with the “bad feelings,” which may also be the cause of unplanned extubation. It is necessary for the adaptation of clinical practice guidelines about physical restraints for critically ill patients in the Chinese context, to change the perception and practice of critical care nurses and deliver safe and high-quality patient care.