Academic literature on the topic 'ICU patient'

Thesis (M. Eng.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2003.<br>Includes bibliographical references (leaf 34).<br>The creation of systems for assembling and analyzing medical data is currently one of the major factors in advancing the speed of medical research. To ensure patient privacy, legal limitations have been placed on these systems. The Health Insurance Portability and Accountability Act requires that certain types potential identifiers be removed from the data before it can be shared freely. The process of removing the identifiers is called de-identification. The purpose of this project is to create a de-identification filter for the MIMIC database, a system that retrieves and organizes data from the intensive care unit at the Beth Israel Deaconess Medical Center.<br>by Jason M. Levine.<br>M.Eng.

Delirium is a frequent complication of intensive care unit (ICU) admissions manifesting as acute confusion with inattention and disordered thinking. Patients in the ICU who develop acute delirium are more likely to experience long term disability and mortality. The purpose of this doctoral project was to evaluate an existing organizational quality improvement project to guide recommendations on improving care in the ICU. The practice-focused research question was: Does improving adherence to the ICU Liberation ABCDEF bundle for patients admitted to the ICU decrease incidence of delirium compared to outcomes prior to implementation? The Program Logic Model served as a framework for analysis of the organization's planning and implementation of this quality improvement project. Benchmark data from an organization's participation in the ICU Liberation Collaborative served as the primary source of evidence for analysis of outcomes. In addition, baseline data on current practice and outcomes in the organization's trauma ICU was analyzed and compared to the benchmark data. Analyses of data revealed strengths and opportunities for improvement in both the organization's project management and in current practices supporting adherence to the ABCDEF bundle guidelines. Incidence of delirium remained unchanged and far below national averages indicating need for further investigation into practices to verify this finding. Better prevention, identification, and management of delirium will lead to a positive impact on society, as patients who develop delirium rarely return to their baseline level of functioning.

Thesis (M.B.A.)--Massachusetts Institute of Technology, Sloan School of Management; and, (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division; in conjunction with the Leaders for Global Operations Program at MIT, 2012.<br>Cataloged from PDF version of thesis.<br>Includes bibliographical references (p. 105-107).<br>Massachusetts General Hospital (MGH), the largest hospital in New England and a national leader in care delivery, teaching, and research, operates ten Intensive Care Units (ICUs), including the 20-bed Ellison 4 Surgical Intensive Care Unit (SICU), a versatile unit which has a major role in perioperative and emergency care. 90% of SICU patients are eventually transferred to another unit in the hospital. Frequent and sometimes lengthy non-clinical delays in this transfer process can be primarily attributed to congestion in downstream units. Multivariable regression analysis demonstrates that additional nonclinical SICU time yields negligible downstream time savings, while consuming an average of 2.4 SICU beds per day, or 12% of total SICU capacity. In addition to exacerbating the delays of patients requiring admission to the SICU, these non-clinical SICU exit delays are responsible for a yearly attributable annual cost in excess of $2.5M. Possible ameliorating approaches include prioritizing SICU transfers, or modifying the care of delayed SICU patients to begin preparing for discharge from the hospital. Any such choices affecting capacity and resource allocation in the ICU environment involve high cost as well as potentially high risks related to quality of care. To evaluate the impact of potential operational changes, the SICU and its six primary downstream units are modeled in a highly detailed discrete event simulation. Patients are divided into ~2,700 procedural and diagnostic types. Entries (admissions) for each patient type are characterized as inhomogeneous Poisson processes, with lengths of stay drawn from probability distributions. Transfer practices and priorities are encoded in simulation logic. A simulation of twenty replication periods, each one year long, allows for calibration and validation by detailed comparison with historical data. Simulated average hourly census values are within 1% of historical averages and RMSE is below 4% for each of the five modeled areas, indicating high accuracy and low bias. The validated simulation is applied to evaluate the impact of several possible operational adjustments, including changes to discharge timing, transfer priorities, and resource allocation. Two approaches prove most promising: 1) Transferring patients as soon as possible after medical clearance, eliminating the current practice of waiting to see if other patients might need downstream beds. 2) Implementing a 24- hour rolling medical clearance process in the SICU. These interventions are predicted to lower average and peak SICU utilization by ~6%, cut SICU entrance delays by -35%, and decrease SICU exit delays by -50%, with relatively little impact on downstream floors and no additional capital expenditures. These relatively simple policy changes can save -$1 M in non-reimbursed expenditures while reducing overcrowding. If capital expenditures are approved, the simulation indicates that adding beds to downstream units would be more beneficial to the system than adding the same number of intensive care beds (at a much higher cost). Similar results are likely to be applicable to other ICUs at MGH, multiplying the potential impact of these findings several times over.<br>by Benjamin A. Christensen.<br>S.M.<br>M.B.A.

Critically ill patients who require MV are at risk for a number of complications, including the development of ventilator-associated events (VAE) and agitation that may require the use of sedation. Patients experience anxiety and discomfort during mechanical ventilation from a variety of sources including unfamiliar breathing assistance and an inability to communicate anxiety and pain verbally, but a primary cause of discomfort identified by these patients is the simply the presence of the endotracheal tube (ETT). Discomfort often leads to agitation and may be exacerbated by ETT movement. Management of agitation typically involves the use of sedative therapy and has been shown to increase the length of stay in the hospital. Additionally, when ETT cuff pressure is not adequately maintained, risk of microaspiration increases and these microaspirations increase the risk of ventilator-associated events. ETT movement may adversely affect the cuff seal against the tracheal mucosa, increasing leakage around the cuff and microaspiration. To date, no studies have described the effect of ETT movement on patient comfort and agitation. Noting the frequency of ETT movement during the provision of nursing care and plausible inadvertent consequences on discomfort and agitation, a research model was created and specific instruments selected in order to study this topic. This dissertation will provide a review of the literature regarding the role of the ETT in microaspiration, as well as detail a study that explores the frequency and amount of ETT movement and its potential effect on agitation.

Class of 2007 Abstract<br>Objectives: The purpose of this study is to determine if an antibiotic formulary is beneficial in an inpatient ICU setting. The main goal, of course, is to ensure patients receive the most appropriate antimicrobial therapy resulting in the least amount of resistance, by using an antibiotic formulary and ICU antibiotic intervention. Methods: This project will use a retrospective design in which one-year post-intervention antibiotic resistant trends will be compared with pre-intervention trends at Yuma Regional Medical Center (YRMC). As is common at YRMC, patients started on antibiotic therapy had susceptibility testing performed to determine the best treatment for the patient. This susceptibility data will be the data used for comparison. Comparison of patient charges and hospital costs associated with these patients will also be performed. YRMC employed an ICU antibiotic intervention documentation form that was used to monitor and extrapolate intervention data. Hospital lab percent susceptibility data will be looked at to determine isolate susceptibility data to determine if any trends are present in antibiotic resistance between the time period when the antibiotic formulary was implemented and the previous corresponding period of time before the formulary. This data will also be compared with the hospital trends in resistant isolates as a whole. The data is desensitized, as individual patient data is not being reviewed. In looking at patient charges and hospital costs, charts will be reviewed. These charts will be de-identified to the investigators of this study. Of further note, YRMC placed the intervention in action in February 2006 and began collecting post-intervention data at that time. This study will be using post intervention data collected from February 2006 thru February 2007. Results: Conclusions:

Abstract Colectomy is performed in critically-ill patients who, for example, experience colonic ischemia following cardiac surgery or reconstruction of a ruptured aortic aneurysm, nonocclusive mesenteric ischemia with severe sepsis, or toxic megacolon due to Clostridium difficile infection. The present retrospective study was conducted in the mixed intensive care unit (ICU) of the Oulu University Hospital to clarify the clinical picture, effects of surgical treatment on organ functions and outcome in critically-ill patients treated with colectomy during 2000-2009. Their histologic and immunohistologic findings were compared with histologically normal colon walls of 34 controls operated for colon tumors. The annual incidence of colectomy in our ICU varied from 0.08% to 0.4%. The mean age of the study patients was 68.8 (sd 9.7) yrs. They had multiple organ failure in 60% and one-year mortality was 62%. One-year surivial from the hospital discharged patients was 91% (29/32). During preoperative period, increasing levels of serum lactate, an increase in the need for higher doses of norepinephrine, and neurologic SOFA subscore were associated with mortality. The histopathologic damage involves all layers of the colon wall being largely similar in sepsis, fulminant clostridium difficile infection and in ischemia after cardiovascular operations. The extent of epithelial damage of colonic epithelium correlated with clinical severity and outcome in the patients. Tight junction protein claudin-1 was down-regulated thoroughly of colonic epithelium, whereas claudin-2 was up-regulated only in the least affected areas. The number of proliferating epithelial cells of colonic epithelium, analyzed by Ki-67 expression, was higher in the worst affected areas in the study patients as compared to results of controls. The proportion of apoptotic cells analyzed by expression of M30 was larger in the worst damage area than in controls. Up-regulation of Toll-like receptor 9, as a part of innate immunity mechanism, in worst areas of colonic epithelium was higher in the surface epithelium compared with least affected areas and in crypts compared with control specimens. Colon ischemia in critically-ill patients is a pancolic phenomenon with life-threatening consequences. Histologic damage in the colon wall was similar irrespective of the underlying cause. Immunohistochemical characteristics resembled those described earlier in inflammatory bowel disease<br>Tiivistelmä Leikkaukseen johtavaa tehohoitopotilaan koliittia esiintyy esimerkiksi sydän- ja verisuonileikkauksen jälkeen, yleistyneessä tulehdusreaktiossa sekä Clostridium difficile- infektiossa. Takautuvasti kerätyn tutkimuksen tavoitteena oli selvittää vuosina 2000–2009 Oulun Yliopistollisen sairaalan päivystysteho-osastolla hoidettujen potilaiden koliitin kliininen taudinkuva, kirurgisen hoidon vaikutus elinvaurioihin, ennuste ja histologiset ja immunohistologiset löydökset. Leikkauksella hoidettujen potilaiden histopatologisia ja immunohistologisia tutkimustuloksia verrattiin 34:ään histologisesti normaaliin suolinäytteeseen, jotka oli otettu paksusuolisyövän vuoksi tehdyissä leikkauksissa. Päivystysteho-osaston vuosittainen tehohoitopotilaan koliitin esiintyvyyden vaihteluväli oli 0.08&#160;%–0.4&#160;%. Tutkimuspotilaiden keski-ikä oli 68.8 (sd 9.7) vuotta. 60&#160;%:lla heistä todettiin monielinvaurio, ja 62 % heistä menehtyi ensimmäisen vuoden aikana. Sairaalasta kotiutetuista potilaista 91&#160;% oli elossa vuoden kuluttua. Leikkausta edeltävä kohonnut valtimoveren laktaattipitoisuus, verenpainetta tukeva noradrenaliinitarpeen nousu sekä neurologisen toimintakyvyn heikkeneminen olivat yhteydessä potilaiden kuolleisuuteen. Histopatologiset muutokset ulottuivat kaikkiin paksunsuolen kerroksiin ja olivat samankaltaisia eri koliiteissa. Epiteelivaurion laajuus oli yhteydessä potilaiden kliiniseen taudinkulkuun ja ennusteeseen. Immunohistologisissa tutkimuksissa paksusuolen epiteelin klaudiini-1:n esiintyminen oli alentunut, kun taas klaudiini-2:sta oli runsaammin vähemmän vaurioituneella alueella. Vaikeimmin vaurioituneilla suolen alueilla solujen uudistumista kuvaavan merkkiaineen, Ki-67:n, määrä oli suurempi kuin kontrollipotilaiden värjäyksissä. Samanlainen ero vaikeimmin vaurioituneiden alueiden ja kontrollinäytteiden välillä todettiin myös M30-värjäyksen perusteella apoptoosin osalta. Välittömään puolustusmekanismiin kuuluvan Tollin kaltaisen reseptori (TLR) 9:n värjäytyvyys oli vaikeimmin vaurioituneilla epiteelialueilla voimakkaampi kuin vähemmän vaurioituneella alueella. Myös kryptan alueella oli enemmän TLR 9 värjäytyvyyttä kuin kontrollinäytteissä. Tehohoitopotilaan koliittia esiintyy koko paksusuolen alueella. Histopatologiset muutokset ovat samankaltaisia eri tautitilojen aiheuttamissa koliiteissa. Immunohistokemialliset tutkimuslöydökset vastaavat aikaisemmin tulehduksellisten suolistosairauksien yhteydessä kuvattuja muutoksia

Aim: The overall objective of the present thesis was to describe and assess the importance and impact of visits by the patients’ families in an ICU, from patient and family perspectives, and to develop, from a hermeneutic perspective, a research method to study the interplay between patient and family during the visit. Method: The comprehensive methodology of the thesis was hermeneutic. Qualitative as well as quantitative methods were applied to elucidate the issues at stake. In paper I, 198 patients were consecutively included, and data were statistically analysed to establish patient mortality and length of stay at the hospital, in relation to visits of families in the ICU. In paper II, ten patients and 24 visitors were observed during visits. In paper III, seven patients and five relatives were interviewed about their memories of the visits in the ICU. Field notes from the observations, and the interviews with patients and relatives, were interpreted and analysed inspired by Gadamer’s hermeneutic philosophy. Paper IV represents a theoretical discourse, and presents methodological aspects of the hermeneutic interpretation of data from the observations. Results: There were no significant differences between the patients having visitors and those who did not. The patient group with no visits comprised 25 %; they were older, and lived in single households, which contrasted to the patient group having visitors. Analyses of the three clinical studies revealed four themes. The themes relate to the meaning of visiting for patients and their relatives, and are as follows: the visit means to see and realize, to guard and watch, to meet, and to sacrifice. The caring entails that you witness and see with your own eyes, and that you feel a communion with the sick. From the patient perspective, the visit signifies that you are confirmed, empowering you to fight to get back to life. Communion and availability in conjunction enable an individual to achieve a thorough involvement with another being. The results of study IV disclosed that what you observe is depending on your theoretical view. If you see from your heart, you interpret from your heart. Conclusions: The conclusions drawn from the studies of the present thesis are that opportunities to create a presence in the community - a communion - between patients, relatives, and carers, are at want. The present fundamental view of caring in intensive care units is in need of change, in order to create optimal conditions for a communion. Visits need to be regarded as an essential part of caring, and relatives’ visits ought to be facilitated and encouraged. Furthermore, visits are important both for patients and their relatives, as sharing the event of critical illness, in the sense of sharing the suffering, the healing, and the restoration of health, is considered a precondition for their recovery. Care should be organized around the patients and their families. Families and patients bring their fellow stories of life, including values and beliefs, thereby increasing the probability of dignified individualized care.<br><p>Akademisk avhandling som för avläggande av filosofie doktorsexamen vid Sahlgrenska akademin vid Göteborgs universitet kommer att offentligt försvaras i hörsal 2118, Institutionen för vårdvetenskap och hälsa, Arvid Wallgrens backe, Hus 2, Göteborg, fredagen den 19 oktober 2012 kl. 09.00</p>

This thesis presents the design and implementation of a Vital Signs Monitoring System for a Patient Data Management System in an intensive care unit. The Vital Signs Monitoring System provides graphical display of patient data to assist medical decision making. It performs real-time patient data acquisition, and supports data management. Visual coding of information has been investigated to ensure effective graphical representation of patient data, to reduce screen clutter, and to enhance interpretability of graphical displays. A survey of existing patient monitoring systems, and patient data management systems is presented to give an overview of the recent advancements in these medical systems. Emphasis is placed on the design of the user interface. Important interface design considerations are discussed, and a survey of interactive hardware, interaction tasks, and dialog style is presented.<br>The Vital Signs Monitoring System was developed in C language under the Presentation Manager window environment, and the operating system environment is OS/2 version 2.0.

Using grounded theory methodology, six intensive care patients were interviewed regarding their perceptions of their own needs, concerns and wants and how nurses responded to those. Each patient was interviewed three times to detect any change in responses during the hospitalization. A theme of patient-nurse negotiation emerged. Patients came into the health care setting with a "generative source," the issues and beliefs they had regarding health-care and nurses in general. This affected patients' definition of themselves, their situation, the caregiver, their relationship with the caregiver, and their own needs and expectations. When a patient's definitions of self or situation varied form the nurse's, negotiation would occur. Two main categories of negotiation were used by both patient and nurse: Personal knowledge & Strategies. If negotiation failed to bring consensus, resulting actions were negative feelings and dissatisfaction, and a sense of vulnerability for the patient. This in turn impacted negatively on the patient's generative source and definitions. As the patient progressed through the hospital system toward discharge, the greatest changes were noted in how they defined themselves and the caregiver, and in the style of negotiation they used.