To see the other types of publications on this topic, follow the link: Intensive care unit (ICU).
Journal articles on the topic 'Intensive care unit (ICU)'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Intensive care unit (ICU).'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Muralidharagopalan, Niranjanan Raghavn, Kamalakumar Karuppasamy, and Somasundaram Subramanian. "Intensive care unit delirium - does prolonged intensive care unit stay increase morbidity." International Journal of Research in Orthopaedics 6, no. 3 (April 22, 2020): 477. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20201061.
Full textAbstract:
<p class="abstract"><strong>Background:</strong> The term intensive care unit (ICU) delirium or ICU psychosis denotes the transient period of psychosis exhibited by the geriatric patients placed in long term ICU care. This condition can be mistaken for organic neurological deterioration and can result in improper treatment, delayed rehabilitation and longer ICU stay. The objective of the study was to analyse the outcome of early ward rehabilitation in post-surgical patients with ICU psychosis.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective case control study of 45 geriatric patients (above 60 years of age) who developed delirium or psychosis after long term ICU stay (>4 days) following a major trauma and orthopaedic procedure. Of the 45 patients, 28 patients (group A) were shifted out of ICU after haemodynamic stability despite continued delirious episodes. The remaining 17 patients (group B) were those who were retained in the ICU for complete neurological recovery.<strong></strong></p><p class="abstract"><strong>Results:</strong> Significant positive difference was noted in patients who were shifted out of ICU early (group A) compared to group B. Group A patients had faster recovery, lesser delirious episodes (2.3±0.9 compared to 13.4±2.7) and fewer days of hospital stay (4.9±1.2 compared to 12.4±2.6) when compared to group B. None of the patients had any episodes of psychosis after discharge from the hospital when followed up for duration of 6 months.</p><p class="abstract"><strong>Conclusions:</strong> Post-operative geriatric patients diagnosed with ICU psychosis fare better with early out of ICU mobilisation. It is not essential to wait for full neurological recovery to shift these patients out of ICU though close ward monitoring may be essential in some cases.</p>
2
Ok, G., H. Yilmaz, D. Tok, K. Erbüyün, S. Çoban, and G. Dinç. "Evaluating Sleep Characteristics in Intensive Care Unit and Non-Intensive Care Unit Physicians." Anaesthesia and Intensive Care 39, no. 6 (November 2011): 1071–75. http://dx.doi.org/10.1177/0310057x1103900614.
Full textAbstract:
Healthcare workers’ cognitive performances and alertness are highly vulnerable to sleep loss and circadian rhythms. The purpose of this study was to investigate the changes in sleep characteristics of intensive care unit (ICU) and non-ICU physicians. Actigraphic sleep parameters, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Hamilton Depression Rating Scale were evaluated for ICU and non-ICU physicians on the day before shift-work and on three consecutive days after shift-work. Total sleep time, sleep latency, wakefulness after sleep onset, total activity score, movement fragmentation index, sleep efficiency, daytime naps and total nap duration were also calculated by actigraph. In the ICU physicians, the mean Pittsburgh Sleep Quality Index score was significantly higher than the non-ICU physicians (P=0.001), however mean Epworth Sleepiness Scale scores were not found significantly different between the two groups. None of the scores for objective sleep parameters were statistically different between the groups when evaluated before and after shift-work (P >0.05). However in both ICU and non-ICU physicians, sleep latency was observed to be decreased within the three consecutive-day period after shift-work with respect to basal values (P <0.001). Total sleep time, total activity score and sleep efficiency scores prior to shift-work were significantly different from shift-work and the three consecutive-days after shift-work, in both groups. Working in the ICU does not have an impact on objective sleep characteristics of physicians in this study. Large cohort studies are required to determine long-term health concerns of shift-working physicians.
3
Kalabalik, Julie, Luigi Brunetti, and Radwa El-Srougy. "Intensive Care Unit Delirium." Journal of Pharmacy Practice 27, no. 2 (December 10, 2013): 195–207. http://dx.doi.org/10.1177/0897190013513804.
Full textAbstract:
Purpose: The recent literature regarding intensive care unit (ICU) delirium and updated clinical practice guidelines are reviewed. Summary: Recent studies show that ICU delirium in critically ill patients is an independent predictor of higher mortality, longer ICU and hospital stay, and is associated with multiple clinical complications. Delirium has been reported to occur in greater than 80% of hospitalized critically ill patients, yet it remains an underdiagnosed condition. Several subtypes of delirium have been identified including hypoactive, hyperactive, and mixed presentation. Although the exact mechanism is unknown, several factors are thought to interact to cause delirium. Multiple risk factors related to medications, acute illness, the environment, and patient characteristics may contribute to the development of delirium. Practical bedside screening tools have been validated and are recommended to identify ICU patients with delirium. Nonpharmacologic interventions such as early mobilization have resulted in better functional outcomes, decreased incidence and duration of delirium, and more ventilator-free days. Data supporting pharmacologic treatments are limited. Conclusion: Clinicians should become familiar with tools to identify delirium in order to initiate treatment and remove mitigating factors early in hospitalization to prevent delirium. Pharmacists are in a unique position to reduce delirium through minimization of medication-related risk factors and development of protocols.
4
Hayhurst, Christina J., Pratik P. Pandharipande, and Christopher G. Hughes. "Intensive Care Unit Delirium." Anesthesiology 125, no. 6 (December 1, 2016): 1229–41. http://dx.doi.org/10.1097/aln.0000000000001378.
Full text
5
Hochman, Beth R., Mark E. Barry, Meghan B. Lane-Fall, Steven R. Allen, Daniel N. Holena, Brian P. Smith, Lewis J. Kaplan, and Jose L. Pascual. "Handoffs in the Intensive Care Unit." American Journal of Medical Quality 32, no. 2 (July 9, 2016): 186–93. http://dx.doi.org/10.1177/1062860615617238.
Full textAbstract:
Operating room (OR) to intensive care unit (ICU) handoffs are complex and known to be associated with adverse events and patient harm. The authors hypothesized that handoff quality diminishes during nights/weekends and that bedside handoff practices are similar between ICUs of the same health system. Bedside OR-to-ICU handoffs were directly observed in 2 surgical ICUs with different patient volumes. Handoff quality measures were compared within the ICUs on weekdays versus nights/weekends as well as between the high- and moderate-volume ICUs. In the high-volume ICU, transmitter delivery scores were significantly better during off hours, while other measures were not different. High-volume ICU scores were consistently better than those in the moderate-volume ICU. Bedside handoff practices are not worse during off hours and may be better in ICUs used to a higher patient volume. Specific handoff protocols merit evaluation and training to ensure consistent practices in different ICU models and at different times.
6
Beltrami, Flávia Gabe, Xuân-Lan Nguyen, Claire Pichereau, Eric Maury, Bernard Fleury, and Simone Fagondes. "Sleep in the intensive care unit." Jornal Brasileiro de Pneumologia 41, no. 6 (December 2015): 539–46. http://dx.doi.org/10.1590/s1806-37562015000000056.
Full textAbstract:
ABSTRACT Poor sleep quality is a consistently reported by patients in the ICU. In such a potentially hostile environment, sleep is extremely fragmented and sleep architecture is unconventional, with a predominance of superficial sleep stages and a limited amount of time spent in the restorative stages. Among the causes of sleep disruption in the ICU are factors intrinsic to the patients and the acute nature of their condition, as well as factors related to the ICU environment and the treatments administered, such as mechanical ventilation and drug therapy. Although the consequences of poor sleep quality for the recovery of ICU patients remain unknown, it seems to influence the immune, metabolic, cardiovascular, respiratory, and neurological systems. There is evidence that multifaceted interventions focused on minimizing nocturnal sleep disruptions improve sleep quality in ICU patients. In this article, we review the literature regarding normal sleep and sleep in the ICU. We also analyze sleep assessment methods; the causes of poor sleep quality and its potential implications for the recovery process of critically ill patients; and strategies for sleep promotion.
7
Park, Jin. "Sleep in Intensive Care Unit Patients." Journal of Sleep Medicine 18, no. 2 (August 31, 2021): 66–71. http://dx.doi.org/10.13078/jsm.210016.
Full textAbstract:
Sleep disturbances are common among patients admitted to the intensive care unit (ICU); however, these issues tend to receive less attention because critical care is prioritized in seriously ill patients. Recent studies have reported that sleep disturbances in patients admitted to the ICU are associated with delirium, weakened immunity, long-term cognitive decline, and persistent sleep disorders. Sleep disturbances in the ICU are attributable to the disease per se and also to the ICU environment that is not conducive to good sleep. Continuous exposure to light and noise are major environmental risk factors that disrupt the circadian rhythm and interfere with deep sleep. Sleep analysis using polysomnography in patients admitted to the ICU typically reveals increase in sleep latency, sleep fragmentation, and decreased stage N3 and rapid eye movement sleep, which are associated with poor prognosis even in patients with severe neurological conditions, including traumatic brain injury and intracranial hemorrhage. Polysomnography is the gold standard for objective evaluation of sleep; however, its applicability is limited in ICU settings, and novel methods such as continuous electroencephalographic spectral analysis and actigraphy have recently been proposed in clinical practice. Efforts to reduce nighttime light and noise (which are modifiable environmental factors) can improve sleep quality. In this article, the author reviews the studies that discuss characteristics of sleep disturbances, the associated risk factors and their correlation with prognosis among patients admitted to the ICU, as well as possible strategies to improve sleep quality in this patient population.
8
Hill, Rosamund A., and Keith H. Chiappa. "Electrophysiologic Monitoring in the Intensive Care Unit." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 21, S1 (February 1994): S12—S16. http://dx.doi.org/10.1017/s0084255900007488.
Full textAbstract:
AbstractElectroencephalography (EEG) and evoked potential studies are established monitoring tools in the neurological intensive care unit (ICU). These neurophysiologic techniques provide information on physiological state and response to therapy, and may aid diagnosis and prognosis. Serial studies or continuous monitoring may enable changes to be detected prior to irreversible deterioration in the patient's condition. Current computer technology allows simultaneous display and correlation of electrophysiologic parameters, cardiovascular state and intracranial pressure (ICP). Continuous EEG monitoring in the ICU has been shown to have a decisive or contributing impact on medical decision making in more than three-quarters of patients. In addition, continuous EEG monitoring has revealed previously unsuspected non-convulsive seizures in one-third of patients. SEPs and BAEPs can provide useful prognostic information in coma - however, these tests are etiologically nonspecific and must be carefully integrated into the clinical situation. Motor evoked potentials offer a potentially useful tool for evaluating motor system abnormalities in the ICU.
9
Christmas, A. Britton, Elizabeth Freeman, Angela Chisolm, Peter E. Fischer, Gaurav Sachdev, David G. Jacobs, and Ronald F. Sing. "Trauma Intensive Care Unit ‘Bouncebacks': Identifying Risk Factors for Unexpected Return Admission to the Intensive Care Unit." American Surgeon 80, no. 8 (August 2014): 778–82. http://dx.doi.org/10.1177/000313481408000827.
Full textAbstract:
Return transfer (RT) to the intensive care unit (ICU) negatively impacts patient outcomes, length of stay (LOS), and hospital costs. This study assesses the most common events necessitating RT in trauma patients. We performed a retrospective chart review of ICU RT from 2004 to 2008. Patient demographics, injuries and injury severity, reason for transfer, LOS, interventions, and outcomes data were collected. Overall, 158 patients required readmission to the ICU. Respiratory insufficiency/ failure (48%) was the most common reason for RT followed by cardiac (16%) and neurological (13%) events. The most commonly associated injuries were traumatic brain injuries (TBIs) (32%), rib fractures (30%), and pulmonary contusions (20%). Initial ICU LOS was 6.6 ± 8 days (range, 1 to 44 days) with 4.4 ± 7.8 ventilator days. Mean floor time before ICU RT was 5.7 ± 6.3 days (range, 0 to 33 days). Forty-nine patients (31%) required intubation and mechanical ventilation on RT. ICU RT incurred an additional ICU LOS of 8 ± 8.5 days (range, 1 to 40 days) and 5.2 ± 7.5 ventilator days. Mortality after a single RT was 10 per cent (n = 16). RT to the ICU most often occurs as a result of respiratory compromise, and patients with TBI are particularly vulnerable. Trauma pulmonary hygiene practices should be evaluated to determine strategies that could decrease RT.
10
Zhang, Wei, Yun Tang, Huan Liu, Li ping Yuan, Chu chu Wang, Shu fan Chen, Jin Huang, and Xin yuan Xiao. "Risk prediction models for intensive care unit-acquired weakness in intensive care unit patients: A systematic review." PLOS ONE 16, no. 9 (September 24, 2021): e0257768. http://dx.doi.org/10.1371/journal.pone.0257768.
Full textAbstract:
Background and objectives Intensive care unit-acquired weakness (ICU-AW) commonly occurs among intensive care unit (ICU) patients and seriously affects the survival rate and long-term quality of life for patients. In this systematic review, we synthesized the findings of previous studies in order to analyze predictors of ICU-AW and evaluate the discrimination and validity of ICU-AW risk prediction models for ICU patients. Methods We searched seven databases published in English and Chinese language to identify studies regarding ICU-AW risk prediction models. Two reviewers independently screened the literature, evaluated the quality of the included literature, extracted data, and performed a systematic review. Results Ultimately, 11 studies were considered for this review. For the verification of prediction models, internal verification methods had been used in three studies, and a combination of internal and external verification had been used in one study. The value for the area under the ROC curve for eight models was 0.7–0.923. The predictor most commonly included in the models were age and the administration of corticosteroids. All the models have good applicability, but most of the models are biased due to the lack of blindness, lack of reporting, insufficient sample size, missing data, and lack of performance evaluation and calibration of the models. Conclusions The efficacy of most models for the risk prediction of ICU-AW among high-risk groups is good, but there was a certain bias in the development and verification of the models. Thus, ICU medical staff should select existing models based on actual clinical conditions and verify them before applying them in clinical practice. In order to provide a reliable basis for the risk prediction of ICU-AW, it is necessary that large-sample, multi-center studies be conducted in the future, in which ICU-AW risk prediction models are verified.
11
Burdick, Kendall J., and Christine J. Callahan. "Sleeping Soundlessly in the Intensive Care Unit." Multimodal Technologies and Interaction 4, no. 1 (March 1, 2020): 6. http://dx.doi.org/10.3390/mti4010006.
Full textAbstract:
An estimated 70% of patients who have been in the Intensive Care Unit (ICU) experience some form of Post-Intensive Care Syndrome (PICS). As a stressful environment, the ICU can be traumatic for any patient; however, the disruption of sleep experienced by patients in ICU negatively impacts their mental status and recovery. One of the most significant contributors to sleep disruption is the constant blare of monitor alarms, many of which are false or redundant. Through multisensory approaches and procedural redesign, the hostile acoustic environment of the ICU that causes so many to suffer from PICS may be alleviated. In this paper, we present suggestions for improving the ICU acoustic environment to possibly reduce the incidence of post-ICU complications such as PICS.
12
Buist, M. "Intensive Care Unit Resource Utilisation." Anaesthesia and Intensive Care 22, no. 1 (February 1994): 46–60. http://dx.doi.org/10.1177/0310057x9402200109.
Full textAbstract:
The cost-effectiveness of the Intensive Care Unit after three decades of development has yet to be demonstrated. Accurate ICU resource allocation is limited by our inability to measure cost-effectiveness. Measurement tools have been developed and refined that will give a prediction of in-hospital mortality of groups of critically ill patients. However, these measures will not predict with certainty individual patient outcomes, and take no account of quality of life. Methodology to examine long-term outcome and quality of life after intensive care is still in its infancy. Measurement of ICU cost is limited by a lack of cost-accounting models that not only reflect true cost but that are clinically applicable.
13
Muzaki, Ahmad, and Fitri Arofiati. "Studi Literatur : Pengkajian Spiritual di Intensive Care Unit (ICU)." DINAMIKA KESEHATAN JURNAL KEBIDANAN DAN KEPERAWATAN 10, no. 1 (January 2, 2020): 35–47. http://dx.doi.org/10.33859/dksm.v10i1.456.
Full textAbstract:
Latar Belakang: Spiritual menjadi hal yang sangat penting pada pasien kritis di Ruang ICU karena satu-satunya sumber penyembuhan bagi pasien dengan penyakit kiritis adalah spiritualitas mereka. Salah satu tantangan besar perawat saat ini adalah mengintegrasikan konsep dari teknologi body, mind and spirit ke dalam praktek keperawatan. Pemenuhan kebutuhan spiritual pada pasien tidak hanya bermanfaat bagi pasien saja tetapi dapat berdampak terhadap profesionalisme kerja perawat.Tujuan: Literatur review ini bertujuan untuk mengeksplorasi berbagai pendekatan penilaian spiritual dan alat pengkajian spiritual di Ruang ICU.Metode: Studi ini diperoleh dari 2 database yaitu Google Shcolar dan PubMed dengan menggunakan kriteria inklusi dan eksklusi. Kata kunci yang digunakan dalam pencarian literatur ini antara lain: “spiritual assesment and ICU”, “spiritual care + intensive care unit”, “spiritual care and critical illness”, dan “spiritual assesment tools and ICU”.Hasil: Terdapat 5 variabel dalam pengkajian spiritual antara lain : sistem medis dalam perawatan spiritual, komunitas keagamaan yang mendukung spiritualitas hubungan pasien dan dokter, perawatan di akhir kehidupan dan kualitas hidup pada pasien yang mendekati kematian.Kesimpulan: Belum ada Spiritual Assesment Tools yang signifikan untuk mengkaji tingkat spiritual pasien di ICU/ICCU. Kata Kunci: Pengkajian, Spiritual, Intensive Care Unit (ICU)Abstract Background: Spirituality is very important in critical patients in the ICU because the only source of healing for patients with critical illness is their spirituality. One of the big challenges of nurses today is integrating the concepts of body, mind and spirit technology into nursing practice. Meeting the spiritual needs of patients is not only beneficial for patients but can affect the professionalism of nurses' work.Purpose: This review literature aims to explore various approaches to spiritual assessment and spiritual assessment tools in the ICU Room.Method: This study was obtained from 2 databases namely Google Sholar and PubMed using inclusion and exclusion criteria. Keywords used in this literature search include: "spiritual assessment and ICU", "spiritual care + intensive care unit", "spiritual care and critical illness", and "spiritual assessment tools and ICU".Results: There were 5 variables in spiritual assessment including: medical systems in spiritual care, religious communities that support the spirituality of patient and doctor relationships, care at the end of life and quality of life in patients who are near death.Conclusion: There is no significant Spiritual Assessment Tool to assess the spiritual level of patients in ICU / ICCU. Keywords: Assessment, Spiritual, Intensive Care Unit (ICU)
14
Quinn, Timothy D., Rodney A. Gabriel, Richard P. Dutton, and Richard D. Urman. "Analysis of Unplanned Postoperative Admissions to the Intensive Care Unit." Journal of Intensive Care Medicine 32, no. 7 (December 30, 2015): 436–43. http://dx.doi.org/10.1177/0885066615622124.
Full textAbstract:
Purpose: To investigate factors associated with unplanned postoperative admissions to the intensive care unit (ICU). Methods: Data from the National Anesthesia Clinical Outcomes Registry (NACOR) were analyzed. We performed univariate and multivariate logistic regression to identify patient- and surgery-specific characteristics associated with unplanned postoperative ICU admission. We also recorded the prevalence of Current Procedural Terminology (CPT) and International Classification of Diseases, ninth revision ( ICD-9) billing codes and outcomes for unplanned postoperative ICU admissions. Results: Of 23 341 130 records in the database, 2 910 738 records met our inclusion criteria. A higher American Society of Anesthesiologists physical status (ASA PS) class, case duration greater than 4 hours, and advanced age were associated with a greater likelihood of unplanned ICU admission. Vascular and thoracic surgery patients were more likely to have an unplanned ICU admission. The most common CPT and ICD-9 codes involved repair of femur/hip fracture, bowel resection, and acute postoperative pain. Large community hospitals were more likely than university hospitals to have unplanned postoperative ICU admissions. Patients in the unplanned postoperative ICU admission group were more likely to have experienced intraoperative cardiac arrest, hemodynamic instability, or respiratory failure and were more likely to die in the immediate perioperative period. Conclusion: Our study is the first diverse analysis of unplanned postoperative ICU admissions in the literature across multiple specialties and practice models. We found an association of advanced age, higher ASA PS class, and duration of procedure with unplanned ICU admission after surgery. Surgical specialties and procedures with the most unplanned ICU admissions could be areas for quality improvement and clinical pathways in the future.
15
Modra, Lucy, David Pilcher, Michael Bailey, and Rinaldo Bellomo. "Sex differences in intensive care unit admissions in Australia and New Zealand." Critical Care and Resuscitation 23, no. 1 (March 1, 2021): 86–93. http://dx.doi.org/10.51893/2021.1.oa8.
Full textAbstract:
Introduction: Fewer women than men are admitted to intensive care units (ICUs) worldwide. Objectives: To quantify the relative contribution of each major diagnostic category to the overall sex balance in ICU admissions in Australia and New Zealand, and to describe changes in the sex balance over time and with patient age. Methods: Retrospective cross-sectional study of Australian and New Zealand ICU admissions recorded in the Australian and New Zealand Intensive Care Society Adult Patient Database between 2005 and 2018. Multivariate logistic regression for the likelihood of female admission considered key explanatory variables: diagnostic category, patient age, admission year, geographic region, hospital type, and planned versus unplanned ICU admission. Results: Overall, 42.3% of 1 616 856 Australian and New Zealand ICU patients were women (99% CI, 42.2–42.4%). 247 988 more men than women were admitted to an ICU during the 14-year study period. There was a sex imbalance in most diagnostic categories: less than 48% women in 15 of 23 diagnostic categories, and greater than 52% women in four diagnostic categories (P < 0.001). Admissions following cardiovascular surgery accounted for over half of the total sex imbalance. The percentage of ICU patients who are women increased linearly from 40.8% in 2005 to 43.6% in 2018 (R2 = 93.1%; P < 0.001). Compared with admission in 2005, the adjusted odds ratio for female admission in 2018 was 1.03 (99% CI, 1.01–1.06). Conclusion: There is a significant sex imbalance in ICU admissions in Australia and New Zealand, widespread across the diagnostic categories. Cardiovascular admissions contribute most to the observed preponderance of men. The proportion of female ICU patients is steadily increasing.
16
de Lassence, Arnaud, Jean-François Timsit, Muriel Tafflet, Élie Azoulay, Samir Jamali, François Vincent, Yves Cohen, Maïté Garrouste-Orgeas, Corinne Alberti, and Didier Dreyfuss. "Pneumothorax in the Intensive Care Unit." Anesthesiology 104, no. 1 (January 1, 2006): 5–13. http://dx.doi.org/10.1097/00000542-200601000-00003.
Full textAbstract:
Background The risk factors and outcomes of critically ill patients with iatrogenic pneumothorax (IP) have not been studied in a large unselected intensive care unit (ICU) population. Methods The authors studied a prospective cohort of adults admitted for more than 24 h. Data were collected at ICU admission and daily by senior physicians until ICU discharge. Risk factors for IP were identified in the entire cohort. A matched nested case-control study was used to evaluate the excess risk of IP in decedents. Results Of the 3,499 patients, 69 with pneumothorax before ICU admission were excluded. Of the remaining 3,430 patients, 94 experienced IP within 30 days (42 due to barotrauma and 52 due to invasive procedures). The cumulative incidence of IP was 1.4% (95% confidence interval [CI], 1.0-1.8) on day 5 and 3.0% (95% CI, 2.4-3.6) on day 30. Risk factors for IP (hazard ratio [95% CI]) were body weight less than 80 kg (2.4 [1.3-4.2]), history of adult immunodeficiency syndrome (2.8 [1.2-6.4]), diagnosis of acute respiratory distress syndrome (5.3 [2.6-11]) or cardiogenic pulmonary edema at admission (2.0 [1.1-3.6]), central vein or pulmonary artery catheter insertion (1.7 [1.0-2.7]), and use of inotropic agents during the first 24 h (2.1 [1.3-3.4]). Excess risk of IP in decedents was 2.6 (95% CI, 1.3-4.9; P = 0.004). Conclusion Iatrogenic pneumothorax is a life-threatening complication seen in 3% of ICU patients. Incorporating risk factors for IP into preventive strategies should reduce the occurrence of IP.
17
Kim, Eileen, Charles Kast, Anika Afroz-Hossain, Michael Qiu, Karalyn Pappas, and Liron Sinvani. "Bridging the Gap Between the Intensive Care Unit and the Acute Medical Care Unit." American Journal of Critical Care 30, no. 3 (May 1, 2021): 193–200. http://dx.doi.org/10.4037/ajcc2021591.
Full textAbstract:
Background Despite a growing cohort of intensive care unit (ICU) survivors, little is known about the early ICU aftercare period. Objective To identify gaps in early ICU aftercare and factors associated with poor hospital outcomes. Methods A multisite, retrospective study (January 1 to December 31, 2017) was conducted among randomly selected patients admitted to the medical ICU and subsequently transferred to acute medical care units. Records were reviewed for patient characteristics, ICU course, and early ICU aftercare practices and syndromes. Associations between practices and hospital outcomes were calculated with χ2 and Wilcoxon rank sum tests, followed by logistic regression. Results One hundred fifty-one patients met inclusion criteria (mean [SD] age, 64.2 [19.1] years; 51.7% male; 44.4% White). The most frequent diagnoses were sepsis (35.8%) and respiratory failure (33.8%). During early ICU aftercare, 46.4% had dietary restrictions, 25.8% had bed rest orders, 25.0% had a bladder catheter, 26.5% had advance directive documentation, 33.8% had dysphagia, 34.3% had functional decline, and 23.2% had delirium. Higher Charlson Comorbidity Index (odds ratio, 1.6) and midodrine use on medical units (odds ratio, 7.5) were associated with in-hospital mortality; mechanical ventilation in the ICU was associated with rapid response on medical unit (odds ratio, 12.9); and bladder catheters were associated with ICU readmission (odds ratio, 5.2). Conclusions Delirium, debility, and dysphagia are frequently encountered in early ICU aftercare, yet bed rest, dietary restriction, and lack of advance directive documentation are common. Future studies are urgently needed to characterize and address early ICU aftercare.
18
Orsi, Giovanni Battista, Massimiliano Raponi, Cristiana Franchi, Monica Rocco, Carlo Mancini, and Mario Venditti. "Surveillance and Infection Control in an Intensive Care Unit." Infection Control & Hospital Epidemiology 26, no. 3 (March 2005): 321–25. http://dx.doi.org/10.1086/502547.
Full textAbstract:
AbstractObjective:To evaluate the effect of an infection control program on the incidence of hospital-acquired infection (HAI) and associated mortality.Design:Prospective study.Setting:A 2,000-bed, university-affiliated hospital in Italy.Patients:All patients admitted to the general intensive care unit (ICU) for more than 48 hours between January 2000 and December 2001.Methods:The infection control team (ICT) collected data on the following from all patients: demographics, origin, diagnosis, severity score, underlying diseases, invasive procedures, HAI, isolated microorganisms, and antibiotic susceptibility.Interventions:Regular ICT surveillance meetings were held with ICU personnel. Criteria for invasive procedures, particularly central venous catheters (CVCs), were modified. ICU care was restricted to a team of specialist physicians and nurses and ICU antimicrobial therapy policies were modified.Results:Five hundred thirty-seven patients were included in the study (279 during 2000 and 258 in 2001). Between 2000 and 2001, CVC exposure (82.8% vs 71.3%; P < .05) and mechanical ventilation duration (11.2 vs 9.6 days) decreased. The HAI rate decreased from 28.7% in 2000 to 21.3% in 2001 (P < .05). The crude mortality rate decreased from 41.2% in 2000 to 32.9% in 2001 (P < .05). The most commonly isolated microorganisms were nonfermentative gram-negative organisms and staphylococci (particularly MRSA). Mortality was associated with infection (relative risk, 2.11; 95% confidence interval, 1.72-2.59; P <.05).Conclusion:Routine surveillance for HAI, coupled with new measures to prevent infections and a revised policy for antimicrobial therapy, was associated with a reduction in ICU HAIs and mortality.
19
Wilson, Nicholas, Rinaldo Bellomo, Tyler Hay, Timothy Fazio, Jasmine Entwistle, Jeffrey J. Presneill, Yasmine Ali Abdelhamid, and Adam M. Deane. "Faecal diversion system usage in an adult intensive care unit." Critical Care and Resuscitation 22, no. 2 (June 1, 2020): 152–57. http://dx.doi.org/10.51893/2020.2.oa5.
Full textAbstract:
OBJECTIVE: To determine the frequency, indications and complications associated with the use of faecal diversion systems (rectal tubes) in critically ill patients. DESIGN: A single centre observational study over 15 months. SETTING: Intensive care unit (ICU). PARTICIPANTS: Patients admitted during this period. MAIN OUTCOME MEASURES: Frequency of rectal tubes utilisation in ICU, as well as associated adverse events, with major events defined as lower gastrointestinal bleeding associated with defined blood transfusion of two or more units of red cells or endoscopy or surgical intervention. RESULTS: Of 3418 admission episodes, there were 111 episodes of rectal tubes inserted in 99 patients. Rectal tubes remained indwelling for a median of 5 days (range, 1–23) for a total of 641 patient-days. The most frequent indication for insertion was excessive bowel motions. A major adverse event was observed in three patients (3%; 0.5 events per 100 device days). Two patients underwent laparotomy and one patient sigmoidoscopy. These patients received between two and 23 units of packed red blood cells. Patients who had a rectal tube inserted had a substantially greater duration of ICU admission (mean, 14 days [SD, 14] v 2.8 days [SD, 3.7]) and hospital mortality (15% v 7.7%; risk ratio, 2.0; 95% CI, 1.2–3.4) as well as an overall higher Australian and New Zealand Risk of Death (ANZROD) score (mean, 27 [SD, 22] v 12.6 [SD, 20]). CONCLUSION: Rectal tubes appear to be frequently inserted and can lead to major adverse events in critically ill patients.
20
Haruna, Junpei, Yoshiki Masuda, Hiroomi Tatsumi, and Tomoko Sonoda. "Nursing Activities Score at Discharge from the Intensive Care Unit Is Associated with Unplanned Readmission to the Intensive Care Unit." Journal of Clinical Medicine 11, no. 17 (September 2, 2022): 5203. http://dx.doi.org/10.3390/jcm11175203.
Full textAbstract:
This study evaluated the accuracy of predicting unplanned the intensive care unit (ICU) readmission using the Nursing Activities Score (NAS) at ICU discharge based on nursing workloads, and compared it to the accuracy of the prediction made using the Stability and Workload Index for Transfer (SWIFT) score. Patients admitted to the ICU of Sapporo Medical University Hospital between April 2014 and December 2017 were included, and unplanned ICU readmissions were retrospectively evaluated using the SWIFT score and the NAS. Patient characteristics, such as age, sex, the Charlson Comorbidity Index, and sequential organ failure assessment score at ICU admission, were used as covariates, and logistic regression analysis was performed to calculate the odds ratios for the SWIFT score and NAS. Among 599 patients, 58 (9.7%) were unexpectedly readmitted to the ICU. The area under the receiver operating characteristic curve of NAS (0.78) was higher than that of the SWIFT score (0.68), and cutoff values were 21 for the SWIFT and 53 for the NAS. Multivariate analysis showed that the NAS was an independent predictor of unplanned ICU readmission. The NAS was superior to the SWIFT in predicting unplanned ICU readmission. NAS may be an adjunctive tool to predict unplanned ICU readmission.
21
Pereira, Jessika Lopes Figueiredo, Cecília Danielle Bezerra Oliveira, and Inacia Sátiro Xavier De França. "Systematization of nursing care in intensive care unit." Journal of Nursing Education and Practice 8, no. 1 (September 26, 2017): 114. http://dx.doi.org/10.5430/jnep.v8n1p114.
Full textAbstract:
Objective: To evaluate the systematization of nursing care in intensive care unit (ICU).Methods: This is an integrative review of the literature carried out through the VHL, SCIELO and LILACS databases with articles published between 2009 and 2014.Results: Five articles were selected, where it was possible to observe that the lack of applicability of the systematization of nursing assistance in the ICU is more reality found, however, when held, this process provided a registry organized and directed the data and execution and evaluation of the nursing care.Conclusions: The instruments need to be fairly discussed and proposed nursing professionals to become empowered.
22
Goran, Susan F. "A New View: Tele–Intensive Care Unit Competencies." Critical Care Nurse 31, no. 5 (October 1, 2011): 17–29. http://dx.doi.org/10.4037/ccn2011552.
Full textAbstract:
Background Many hospitals have well-planned nursing competency assessment programs, but these are meant to measure competency in traditional bedside roles, not in tele–intensive care unit (tele-ICU) nurses practicing remotely. Objective To determine whether current tele-ICU programs have a formal competency assessment program and to determine when and how competency of tele-ICU nurses is assessed. Method A 20-question survey was provided to a convenience sample of the 44 known tele-ICU programs nationally. Results Of the surveys distributed, 75% were completed and returned. A formal competency assessment policy for assessing nurses’ competency at the time of hire, during orientation, and ongoing was in place at the workplaces of 85% of respondents. The most common methods for competency validation were performance appraisal and observation, although peer review and self-assessment also were used. Respondents identified the following competencies as the highest priorities for defining tele-ICU nurse practice: effective listening, prioritization, collaboration, and effective use of tele-ICU application tools. Conclusion Although awaiting development of professional practice standards, many tele-ICU programs currently measure the competence of tele-ICU nurses through competency programs.
23
Ochoa, Dixan. "Characterization of hospital-acquired pneumonia in Intensive Care Unit. General Hospital." Journal of Clinical Research and Reports 4, no. 3 (June 8, 2020): 01–09. http://dx.doi.org/10.31579/2690-1919/067.
Full textAbstract:
Objective: characterize the hospital-acquired pneumonia (HAN) in the Intensive Care Unit(ICU) of the Methods: a descriptive and cross-sectional study was carried out to characterize the hospital-acquired pneumonia in admitted patient in ICU of the General Hospital “Guillermo Domínguez López” in Puerto Padre, Las Tunas since June, 2018 to May, 2019. The population was all the patients who acquired the infection during the admission. The information was taken from de patient`s clinic file. It was created graphics and charts to pick the information. Dates was described, analyzed and compared with others national and international studies. Result: the prevalent age group was 60 -79 to 59%. Asisted mechanical ventilation was not realed with the HAN due to the procedure was only performing in 9 patients to 25%. The most frequent isolated germ was citrobacter. The deseases which was most related with (HAN) was neurological deseases. The mortality was high, 20 patients die to 58%. Conclusion: clinic and epidemiologic characterisctics of NIH was described in the ICU of the General Hospital “Guillermo Domínguez López”.
24
Williams, Teresa, and Gavin Leslie. "Delayed discharges from an adult intensive care unit." Australian Health Review 28, no. 1 (2004): 87. http://dx.doi.org/10.1071/ah040087.
Full textAbstract:
Objective: Intensive Care Unit (ICU) services are expensive, and therefore appropriate utilisation is imperative. Delayed discharges impact on the efficiency and effectiveness of ICU services. This study examines the prevalence and reasons for delayed discharge. Method: Cross sectional study. We enrolled a prospective sample of all patients admitted to a 22-bed ICU over a 6-month period. Medical staff in ICU informed nursing shift coordinators when patients could be discharged. Nursing shift coordinators maintained a record of discharge times, delays and reasons for delay. Discharge was considered delayed if the patient was not relocated from the ICU within 8 hours of being considered eligible by ICU medical staff. Results: Of 652 recorded discharges, 176 were delayed (27%). Unavailable ward beds (81%) were cited as the main reason for delay in discharge. Median delay time was 21.3 hours (range, 10 minutes to 26 days). These delays were predicted by greater patient acuity on ICU admission, patient deterioration while waiting for transfer to the ward, principal admitting diagnosis, discharge destination and weekend discharge. Conclusion: Improvement in bed management and discharge processes (the only factors directly controllable by the hospital) is essential to reduce delays in discharge from ICU. Reducing discharge delays would free up beds for other admissions; may result in a cost saving for the hospital through more efficient resource utilisation; and, ultimately, would benefit patients.
25
Giavasi, Giannoula, Christina Marvaki, Theodore Kapadohos, and Serafim Nanas. "Delirium in general intensive care unit survivors." Health & Research Journal 2, no. 2 (June 30, 2016): 121. http://dx.doi.org/10.12681/healthresj.19812.
Full textAbstract:
Introduction: The last decades, delirium, an organic psycho syndrome frequently found in hospitalized patients in the Intensive Care Unit (ICU), has been recognized as an important factor affecting patient’s prognosis.Aim: The purpose of the present study was to evaluate the incidence of delirium in patients hospitalized in general ICU of a tertiary hospital of Attica.Material and Method: The studied sample consisted of 93 patients. a specific record form which was developed according to the needs of this study, was used for data collection.. The severity of the disease was calculated using international ICU scoring systems; Acute Physiology and Chronic Health Evaluation II (APACHEII), Simplified Acute Physiology Score III (SAPS III), Sepsis-related Organ Failure Assessment (SOFA) score and the presence of delirium was evaluated by implementing the Confusion Assessment Method for the ICU (CAM-ICU). Data analysis was performed by the statistical package Statistical Package for Social Sciences (SPSS) ver.19.Results: 62.4% (n = 58) of the studied sample were male. Of the 93 patients, 39 (41.9%) exhibited delirium; the 15 patients (16.1%) did not develop while the other 39 (41.9%) patients of the sample could not be tested for the syndrome. The incidence of the syndrome was high as the rate of premature mortality in less than 28 days. In particular, all the patients who died (n=41), the rate of premature mortality was 56% (n=23). The study failed to show a relationship of delirium with known risk factors (age, high severity of disease, infection and benzodiazepine use) patients’ outcome, ICU length of stay and duration of mechanical ventilation. No association emerged between sedatives and delirium occurrence.Conclusions: The hypothesis of the study dictate a relationship between delirium appearance and advanced age, high severity of disease, benzodiazepine use and infection based on previous research results. However, none of these relationships emerged in this study.
26
Dhillon, Rishi, and John Clark. "Infection in the intensive care unit (ICU)." Current Anaesthesia & Critical Care 20, no. 4 (August 2009): 175–82. http://dx.doi.org/10.1016/j.cacc.2009.01.003.
Full text
27
Flaatten, H., and O. Hevrøy. "Errors in the intensive care unit (ICU)." Acta Anaesthesiologica Scandinavica 43, no. 6 (July 1999): 614–17. http://dx.doi.org/10.1034/j.1399-6576.1999.430604.x.
Full text
28
Diaz, Elena, Irene Diaz, Cecilia del Busto, Dolores Escudero, and Silvia Pérez. "Clock Genes Disruption in the Intensive Care Unit." Journal of Intensive Care Medicine 35, no. 12 (September 11, 2019): 1497–504. http://dx.doi.org/10.1177/0885066619876572.
Full textAbstract:
Background: Intensive care unit (ICU) environment disrupts the circadian rhythms due to environmental and other nonphotic synchronizers. The main purpose of this article is to establish whether critically patients have desynchronization at the molecular level after 1 week of stay in the ICU. Methods: The rhythm of Clock, Bmal1, Cry1, and Per2 genes in neuro-ICU patients (n = 11) on the first day after admission in the unit (1 day) and 1 week later (1 week) was studied, 4 time points throughout the day, at 6, 12, 18, and 24 hours. Human whole blood samples were obtained from neuro-ICU patients. The total RNA was isolated and each sample was reverse transcribed to complementary DNA and quantitative polymerase chain reaction (PCRq) was performed. The possible rhythm was studied using Fourier Series. Results: After 1 week, the clock gene rhythmicity completely disappeared. Messenger RNA (mRNA) expression for the 4 clock genes was shown rhythmicity at the first day after admission in the ICU. Circadian rhythmicity for none of them was observed but rather, ultradian rhythmicity was found. The expression of Clock, Bmal1, and Per2 mRNA after 1 week was similar in the 4-time point studies without significant fluctuation among the 4 time points analyzed. Discussion: Rhythmic mRNA expression is present at the first day after admission in the ICU. However, ICU stay during 1 week affects the molecular machinery of the biological clock generating chronodisruption. Circadian disruption is associated with the risk of several pathologies, thus, it seems to be clear that ICU stay in constant conditions could adversely affect patient evolution and probably, circadian resynchronization restoring clock gene expression could lead to a better clinical evolution of the patient. Conclusions: Clock genes disruption is observed in neuro-ICU patients. Light therapy as well as melatonin treatment could reduce the impact of ICU stay period in biological clock, thereby improving patients’ recovery.
29
Jantz, Michael A., and Steven A. Sahn. "Pleural Disease in the Intensive Care Unit." Journal of Intensive Care Medicine 15, no. 2 (March 2000): 63–89. http://dx.doi.org/10.1177/088506660001500201.
Full textAbstract:
Pleural disease itself is an unusual cause for admission to the intensive care unit (ICU). Pleural complications of diseases and procedures in the ICU are common, however, and the impact on respiratory physiology is additive to that of the underlying cardiopulmonary disease. Pleural effusion and pneumothorax may be overlooked in the critically ill patient due to alterations in radiologic appearance in the supine patient. The development of a pneumothorax in a patient in the ICU represents a potentially life-threatening situation. This article reviews the etiologies, pathophysiology, and management of pleural effusion, pneumothorax, tension pneumothorax, and bronchopleural fistula in the critically ill patient. In addition, we review the potential complications of thoracentesis and chest tube thoracostomy, including re-expansion pulmonary edema.
30
Klompas, Michael. "Prevention of Intensive Care Unit-Acquired Pneumonia." Seminars in Respiratory and Critical Care Medicine 40, no. 04 (August 2019): 548–57. http://dx.doi.org/10.1055/s-0039-1695783.
Full textAbstract:
AbstractIntensive care unit (ICU) acquired pneumonia is one of the most common and morbid health care-associated infections. Despite decades of work developing and testing prevention strategies, ICU-acquired pneumonia remains stubbornly pervasive. Pneumonia prevention studies are difficult to interpret because all are at risk of bias due to the subjectivity and poor specificity of pneumonia definitions. Interventions associated with improvements in objective outcomes in addition to pneumonia, such as length of stay or mortality, should therefore be prioritized. Avoiding intubation, minimizing sedation, implementing early extubation strategies, and mobilizing patients do appear to improve some of these objective outcomes. Many of our other assumptions about how best to prevent ICU-acquired pneumonia, however, have recently been challenged. Elevating the head of the bed is supported by very little randomized trial data. Early reports suggested that subglottic secretion drainage may decrease time to extubation and ICU length of stay, but more recent analyses refute these findings. Novel endotracheal tube cuff designs do not clearly lower pneumonia rates. A large randomized trial of selective digestive decontamination in ICUs with high baseline rates of antimicrobial resistance did not identify any benefit. Oral care with chlorhexidine may increase mortality risk and stress ulcer prophylaxis may facilitate pneumonia. Early data on probiotics suggest a possible effect but there is no clear signal yet that they shorten duration of mechanical ventilation or lower mortality. Ventilator bundles on balance do appear to be beneficial but it is not clear which components are most important nor how best to implement them. This article will review recent studies that have challenged, refined, or complicated our understanding of how best to prevent ICU-acquired pneumonia.
31
Panse, Shweta, Muralidhar Kanchi, Jose Chacko, Srinath Kumar T. S., Ranganatha Ramanjaneya, Viju Wilben, Arjun Alva, and Deviprasad Shetty. "Intensive Care Unit Setup for COVID-19." Journal of Cardiac Critical Care TSS 04, no. 01 (June 18, 2020): 05–11. http://dx.doi.org/10.1055/s-0040-1713548.
Full textAbstract:
AbstractThe coronavirus pandemic has become a challenge to all the healthcare systems in the world. Urgent creation of an intensive care unit (ICU) for the same is the need of the hour. The ideal ICU for COVID -19 should be isolated, fully equipped with invasive and noninvasive monitoring, with 24/7 trained medical personnel, nursing staff and laboratory support. As the coronavirus infection is transmitted by droplets and is highly contagious, protection of healthcare workers is crucial. Personnel working inside the ICU should get personal protective equipment (PPE). Strict guidelines for donning and doffing of PPE should be followed to prevent cross-contamination. Respiratory failure being the commonest complication of COVID-19, knowing the ventilator management for the same is essential. It is of great importance to meticulously manage all the resources to combat this contagion.
32
Toy, Dennis, Mark D. Siegel, and Ami N. Rubinowitz. "Imaging in the Intensive Care Unit." Seminars in Respiratory and Critical Care Medicine 43, no. 06 (November 28, 2022): 899–923. http://dx.doi.org/10.1055/s-0042-1750041.
Full textAbstract:
AbstractRadiology plays an important role in the management of the most seriously ill patients in the hospital. Over the years, continued advances in imaging technology have contributed to an improvement in patient care. However, even with such advances, the portable chest radiograph (CXR) remains one of the most commonly requested radiographic examinations. While they provide valuable information, CXRs remain relatively insensitive at revealing abnormalities and are often nonspecific. Chest computed tomography (CT) can display findings that are occult on CXR and is particularly useful at identifying and characterizing pleural effusions, detecting barotrauma including small pneumothoraces, distinguishing pneumonia from atelectasis, and revealing unsuspected or additional abnormalities which could result in increased morbidity and mortality if left untreated. CT pulmonary angiography is the modality of choice in the evaluation of pulmonary emboli which can complicate the hospital course of the ICU patient. This article will provide guidance for interpretation of CXR and thoracic CT images, discuss some of the invasive devices routinely used, and review the radiologic manifestations of common pathologic disease states encountered in ICU patients. In addition, imaging findings and complications of more specific clinical scenarios in which the incidence has increased in the ICU setting, such as patients who are immunocompromised, have interstitial lung disease, or COVID-19, will also be discussed. Communication between the radiologist and intensivist, particularly on complicated cases, is important to help increase diagnostic accuracy and leads to an improvement in the management of the most critically ill patients.
33
Mumtaz, Hassan. "Etiology of acute kidney injury in intensive care unit settings." Endocrinology and Disorders 4, no. 2 (December 24, 2020): 01–06. http://dx.doi.org/10.31579/2640-1045/059.
Full textAbstract:
Introduction: Acute kidney injury (AKI) is defined as a rapid loss of kidney function occurring over few hours or days. In intensive care unit settings, acute kidney injury (AKI) is a very prevalent condition as most of the patients who are admitted in intensive care units are critically ill. The incidence of acute kidney injury is increasing throughout the world mainly because of aging population and comorbidities which are associated with aging. In intensive care unit settings, the incidence of AKI may reach up to 67%. Though AKI effects depend on clinical situation yet associated with high morbidity and mortality. Objective: To determine the frequency of etiology of acute kidney injury in medical intensive care unit of KRL Hospital. Setting: Medical ICU, KRL Hospital, Islamabad. Duration: six months from 17th May 2017 to 17th November 2017. Study design: Descriptive case series. Material and method: In this study 118 patients were observed. After screening and application of exclusion criteria, a total of 118 patients who were fulfilling the inclusion criteria were selected as the study sample and were included in the final analysis regarding prevalence of risk factors associated with AKI. AKI was further classified using acute kidney injury network (AKIN) classification system. Patient age, gender, serum creatinine, etiology and outcome in form of recovery or mortality was recorded on specific proforma. Results: Overall incidence of AKI in ICU settings in this study was 37.8%(n=118) .Out of 118 patients who had AKI, 59.3%(n=70) were male , whereas 40.7% (n=48) were females. Most common risk factor associated with development of AKI was sepsis secondary to infectious illnesses and 39% (n=46) of the patients who developed AKI were suffering from infectious illnesses. Gastrointestinal, drugs and cardiac causes constitutes the 32.2% (n=38), 18.6% (n=22) and 10.2% (n=12) respectively of the AKI in ICU settings. Conclusion: Our study concludes that the frequency of etiology including infectious causes was 39%, cardiac pathology 10%, GI causes 32%, drugs was 19%.
34
Terai, Takekazu, Hidekazu Yukioka, and Akira Asada. "Pain Evaluation in the Intensive Care Unit." Regional Anesthesia & Pain Medicine 23, no. 2 (March 1998): 147–51. http://dx.doi.org/10.1136/rapm-00115550-199823020-00006.
Full textAbstract:
Background and ObjectivesThe visual analog scale (VAS) is a simple and sensitive mean of pain assessment. The faces scale is also a simple, self-reporting method for children. Facial signs of pain have not been used to assess pain in postoperative adult patients in the intensive care unit (ICU).MethodsFifty patients undergoing esophageal cancer surgery by a thoracoabdominal procedure were studied. Epidural opioids, such as morphine or buprenorphine, combined with bupivacaine were administered during and after surgery. Pain measurement was performed by a physician in the ICU using the self-reported VAS 0.5, 1, 2, 4, and 6 hours after tracheal extubation and thereafter every 4 hours during the stay in the ICU. A nurse who was unaware of the patients' VAS scores assessed facial expression as a measure of pain intensity using a five-grade faces scale immediately before pain evaluation by VAS. The VAS was rescaled into five discrete units that would match the five faces scale scores. Weighted kappa statistics were used to establish a relative level of agreement between the five-grade VAS and faces scale.ResultsGood agreement was found between the five-grade VAS and the faces scale 30 minutes and 1 hour after tracheal extubation (weighted kappa values .67 and .62, respectively). The VAS and faces scales were measured 7-13 times per patient during the stay in the ICU, and 518 observations were collected. Although moderate agreement was found between the five-graded VAS and faces scale for all pairs of observation (weighted kappa values .54), less agreement was found between them in patients with moderate pain. In addition, the calculated mean differences between the five-graded VAS and faces scale differed significantly between patients.ConclusionThe faces scale may be useful for pain evaluation in the ICU.
35
Fumis, Renata R. L., Otavio Tavares Ranzani, Paulo Sergio Martins, and Guilherme De Paula Pinto Schettino. "Characteristics and outcomes of palliative care patients in intensive care unit." Journal of Clinical Oncology 32, no. 31_suppl (November 1, 2014): 145. http://dx.doi.org/10.1200/jco.2014.32.31_suppl.145.
Full textAbstract:
145 Background: Despite the growing palliative care movement, most admissions still occur in Intensive Care Units. The aim of this study was to determine the frequency of palliative care patients admitted in an ICU and assessed their outcomes. Methods: This prospective study was conducted in a tertiary private hospital, in an adult medical-surgical ICU with 22-bed in São Paulo, Brazil. Patients or their family member with ICU stay ≥ 48 hours were invited to participate. They were excluded if they had no conditions to answer the questionnaire or if they refuse to participate. During ICU stay we analyzed through the medical records and questionnaire their clinical condition and their oncologic status. We called them by telephonic assessment to assess their survival. Results: From March 2011 to March 2013 a total of 576 ICU patients were analyzed; of these, 280 were oncologic patients and 95 were palliative care. Of total, the majority was male gender (57.8%), median age was 67[54-79] years, SAPS III score was 54±18.4 points, SOFA was 3.1±3.0 and ICU Length of stay (LOS) was 9.0±11.3 days. ICU mortality was 16.5%, 1-month mortality was 22% and 3-months cumulative mortality was 28.6%. We could observe that palliative care patients were in majority cancer patients (75%vs 43.4%,p<0.001), with metastatic disease(81.7 vs 36.3, p<0.001), had greater mean time of initial diagnosis(3.21±3.7 vs 2.17±2.5, p=0.009), had greater ICU LOS (14.2±16.2 days vs 7.96±9.8, p<0.001) greater mean SAPS III (68.5±16.0 vs p<0.001) and SOFA (4.81±3.2 vs 2.81±2.8, p<0.001) when compared with non palliative patients care. They also needed more mechanical ventilation (50.0%vs32.6%, p=0.001), tracheotomy (11.6%vs 5.0%,p=0.014) and vasopressors (54.7% vs 36.8,p=0.001). The ICU mortality was greater (32.6% vs 6.8%, p<0.001), 1-month (60.0% vs 14.0%, p<0.001) and 3-months (73.5% vs 19.1%). Conclusions: Palliative care suffers most in Intensive Care Unit and we observed a high mortality at 3-months after ICU discharge. We recommend more discussions before palliative care patient’s admissions in ICU to better provide them quality of life.
36
Rachakonda, K. S., M. Parr, A. Aneman, S. Bhonagiri, and S. Micallef. "Rational Clinical Pathology Assessment in the Intensive Care Unit." Anaesthesia and Intensive Care 45, no. 4 (July 2017): 503–10. http://dx.doi.org/10.1177/0310057x1704500415.
Full textAbstract:
Blood tests are ordered on a daily basis in intensive care units (ICU). There are no widely accepted guidelines for testing requirements. This study investigated the impact on ICU laboratory test costs of a multi-strategy change in practice involving routine blood testing. A single centre, prospective, interventional study using historical controls was undertaken to investigate the impact of ICU specialist authorisation of high-volume routine tests on ICU laboratory test costs. Prior to commencement of the study, ICU nursing and junior ICU doctors were able to order tests. During the six-month intervention period, the ICU specialists authorised routine blood tests. Adverse events related to not performing blood tests were also recorded. Overall ICU laboratory test costs decreased by 12.3% over the six months (P=0.0022 versus historical control) with a mean compliance of 51% with the test authorisation protocol. The costs of frequently ordered tests (classified as high-volume) decreased by 20% (P=0.0022 versus historical control). These accounted for an average of 54 ± 3% of the overall ICU blood test costs (blood gas analyses 17%, simple chemistry tests consisting of electrolytes, liver function, calcium, phosphate, magnesium 14%, coagulation 12% and full blood count 11%). Two protocol-related adverse events were recorded and judged as minor and were resolved by ordering tests during the day. No adverse patient outcomes resulted from these two events. Blood testing authorisation by an ICU specialist was associated with significant cost savings in ICU and no adverse patient outcomes.
37
Dorsch, Jennifer J., Jennifer L. Martin, Atul Malhotra, Robert L. Owens, and Biren B. Kamdar. "Sleep in the Intensive Care Unit: Strategies for Improvement." Seminars in Respiratory and Critical Care Medicine 40, no. 05 (October 2019): 614–28. http://dx.doi.org/10.1055/s-0039-1698378.
Full textAbstract:
AbstractSleep in the intensive care unit (ICU) is considered to be subjectively poor, highly fragmented, and sometimes referred to as “atypical.” Although sleep is felt to be crucial for patient recovery, little is known about the association of sleep with physiologic function among critically ill patients, or those with clinically important outcomes in the ICU. Research involving ICU-based sleep disturbance is challenging due to the lack of objective, practical, reliable, and scalable methods to measure sleep and the multifactorial etiologies of its disruption. Despite these challenges, research into sleep-promoting techniques is growing and has demonstrated a variety of causes leading to ICU-related sleep loss, thereby motivating multifaceted intervention efforts. Through a focused review of (1) sleep measurement in the ICU; (2) outcomes related to poor sleep in the ICU; and (3) ICU-based sleep promotion efforts including environmental, nonpharmacological, and pharmacological interventions, this paper examines research regarding sleep in the ICU and highlights the need for future investigation into this complex and dynamic field.
38
Yaffe, Paul B., Robert S. Green, Michael B. Butler, and Tobias Witter. "Is Admission to the Intensive Care Unit Associated With Chronic Opioid Use? A 4-Year Follow-Up of Intensive Care Unit Survivors." Journal of Intensive Care Medicine 32, no. 7 (November 25, 2015): 429–35. http://dx.doi.org/10.1177/0885066615618189.
Full textAbstract:
Purpose: To describe opioid use before and after intensive care unit (ICU) admission and to identify factors associated with chronic opioid use upto 4 years after ICU discharge. Methods: Retrospective review of adult patients admitted to the ICU at a tertiary care center between January 1, 2005, to December 31, 2008. We defined “nonuser,” “intermittent,” and “chronic” opioid status by abstinence, use in <70%, and >70% of days for a given time period, respectively. We assessed opioid use at 3 months prior to ICU admission, at discharge, and annually for upto 4 years following ICU discharge. Results: A total of 2595 ICU patients were included for surgical (48.6%), medical (38.4%), and undetermined (13%) indications. The study population included both elective (26.9%) and emergent (73.1%) admissions. Three months prior to ICU admission, 76.9% were nonusers, 16.9% used opioids intermittently, and 6.2% used opioids chronically. We found an increase in nonuser patients from 87.8% in the early post-ICU period to 95.6% at 48-month follow-up. Consequently, intermittent and chronic opioid use dropped to 8.6% and 3.6% at discharge and 2.6% and 1.8% at 48-month follow-up, respectively. Prolonged hospital length of stay was associated with chronic opioid use. Conclusion: Admission to ICU and duration of ICU stay were not associated with chronic opioid use.
39
Maric, Sanja, and Dalibor Boskovic. "Analgesia and sedation in surgery Intensive Care Unit (ICU)." Acta chirurgica Iugoslavica 64, no. 1 (2017): 21–26. http://dx.doi.org/10.2298/aci1701021m.
Full textAbstract:
The goals of analgesia and sedation at the intensive care unit (ICU) are to facilitate mechanical ventilation, prevent patient and caregiver injury, and avoid the psychological and physiologic consequences of inadequate treatment of pain, anxiety, agitation, and delirium. Most ICU patients, especially the surgical and trauma ones, routinely experience pain at rest and with routine procedures. Treating pain in ICU patients depends on a clinician?s ability to perform a reproducible pain assessment and to monitor patients over time to determine the adequacy of therapeutic interventions to treat pain. Implementation of behavioral pain scales improves ICU pain management and clinical outcomes, including better use of analgesic and sedative agents and shorter durations of mechanical ventilation and ICU stay. Opioids are the primary medications for managing pain in critically ill patients. Multimodal approach to pain management in ICU patients has been recommended. Sedatives are commonly administered to ICU patients to treat agitation and its negative consequences. Sedation strategies using nonbenzodiazepine sedatives (propofol or dexmedetomidine) may be preferred over sedation with benzodiazepines (midazolam or lorazepam) to improve clinical outcomes in mechanically ventilated adult ICU patients. It is recommend daily sedation interruption or a light target level of sedation be routinely used in adult intensive care patients using mechanical ventilation. Delirium affecting up to 80% of mechanically ventilated adult ICU patients. ICU protocols that combine routine pain and sedation assessments, with pain management and sedation-minimizing strategies, along with delirium monitoring and prevention, may be the best strategy for avoiding the complications of oversedation. Protocolized pain, agitation and delirium assessment (PAD ICU), is significantly associated with a reduction in the use of analgesic medications, ICU length of stay, and duration of mechanical ventilation.
40
Sari, Dian Marta, Siti Chandra Widjanantie, Dewi Poerwandari, Anitta Florence Stans Paulus, Deddy Tedjasukmana, Nury Nusdwinuringtyas, Anita Ratnawati, and Hening Laswati Putra. "Mobilisasi Dini di Intensive Care Unit (ICU): Tinjauan Pustaka." Journal Of The Indonesian Medical Association 72, no. 1 (June 19, 2022): 44–55. http://dx.doi.org/10.47830/jinma-vol.72.1-2022-315.
Full textAbstract:
Pasien yang dirawat di Intensive Care Unit (ICU) sering mengalami kelemahan otot yang tidak terkait dengan penyakit utamanya saat masuk ICU. Kelemahan ini dapat berkembang menjadi sindroma klinis yang dikenal sebagai ICU-Acquired Weakness (ICU-AW). Saat ini belum didapatkan pengobatan spesifik yang efektif untuk ICU-AW sehingga pencegahan ICU-AW melalui kontrol faktor risiko terkait seperti imobilisasi menjadi sangat penting. Mobilisasi dini (MD) telah diketahui memiliki berbagai manfaat terhadap kemajuan perkembangan pasien dengan ventilasi mekanik maupun yang tidak menggunakan ventilasi mekanik. Sisi lain, pelaksanaan MD perlu mempertimbangkan kriteria keamanan dan hambatan dalam pelaksanaannya. Berbagai panduan dalam aplikasi pelaksanaan MD dapat ditemukan, yang bertujuan mendapatkan hasil yang maksimal dengan meminimalisir kejadian yang tidak diinginkan.
41
Farhan, Hassan, Ingrid Moreno-Duarte, Nicola Latronico, Ross Zafonte, and Matthias Eikermann. "Acquired Muscle Weakness in the Surgical Intensive Care Unit." Anesthesiology 124, no. 1 (January 1, 2016): 207–34. http://dx.doi.org/10.1097/aln.0000000000000874.
Full textAbstract:
Abstract Muscle weakness is common in the surgical intensive care unit (ICU). Low muscle mass at ICU admission is a significant predictor of adverse outcomes. The consequences of ICU-acquired muscle weakness depend on the underlying mechanism. Temporary drug-induced weakness when properly managed may not affect outcome. Severe perioperative acquired weakness that is associated with adverse outcomes (prolonged mechanical ventilation, increases in ICU length of stay, and mortality) occurs with persistent (time frame: days) activation of protein degradation pathways, decreases in the drive to the skeletal muscle, and impaired muscular homeostasis. ICU-acquired muscle weakness can be prevented by early treatment of the underlying disease, goal-directed therapy, restrictive use of immobilizing medications, optimal nutrition, activating ventilatory modes, early rehabilitation, and preventive drug therapy. In this article, the authors review the nosology, epidemiology, diagnosis, and prevention of ICU-acquired weakness in surgical ICU patients.
42
Tang, Hsin-Ju, Hsin-Yi (Jean) Tang, Chia-Ming Chang, Pei-Fang Su, and Ching-Huey Chen. "Functional Status in Older Intensive Care Unit Survivors." Clinical Nursing Research 29, no. 1 (July 19, 2018): 5–12. http://dx.doi.org/10.1177/1054773818785860.
Full textAbstract:
Older ICU survivors are often challenged with clusters of geriatric syndromes and functional decline. The purpose of this study was (a) to assess patterns of geriatric syndromes and functional status from admission to 6 months post discharge and (b) to examine the predictors of longitudinal functional status. This is a prospective cohort study. Demographic information, clinical variables, geriatric syndromes, and functional status were collected longitudinally. A total of 192 medical ICU older adult survivors were included in the analysis. Factors associated with reductions in functional status over 6 months were (a) institutionalized prior to hospitalization, (b) pressure sore before admission, (c) existing delirium, (d) impaired mobility at baseline, (e) increased APACHE II score upon ICU admission, and (f) use of mechanical ventilation during the ICU stay. Importantly, overweight was the only factor that was associated with increased functional level over 6 months.
43
Hoque, Fahmida, Rokeya Begum, Most Jinat Rehena, and Kamrun Sattar. "Study of Obstetric Cases Requiring Intensive Care Unit Management." Journal of Chittagong Medical College Teachers' Association 29, no. 1 (September 8, 2018): 53–56. http://dx.doi.org/10.3329/jcmcta.v29i1.62471.
Full textAbstract:
Background : Management of critically ill obstetric patients in intensive care unit is a challenge. Pregnancy, delivery and puerperium may be complicated by severe maternal morbidity necessitating Intensive Care Unit (ICU) admission. Management of the critically ill obstetric patient is very complex and requires co-operation of obstetricians with experts of other discipline. Materials and methods : This cross sectional observational study is designed on a total of 50 obstetric patients admitted in ICU, the frequency, socio demographic factor, intervention & outcome. Data was collected by researcher herself and analyzed by appropriate statistical procedure (SPSS- 20) then presented and submitted. Results : Regarding indication of ICU admission eclmpsia was 29(58%) PPH 9(18%) sepsis 5(10%) ruptured uterus 4(8%) and LVF 3(6%) among all patient admitted in ICU 48(98%) got ventilator support during their admission in ICU and 2(4%) were not ventilated. In ICU 23(46%) patients died and 27(54%) were discharged alive. Conclusion : Obstetric patients pose a major management challenge to ICU physicians and obstetricians due to altered physiology during pregnancy, consideration of fetal wellbeing, and the unique type of disorders to be dealt with. As it is a helpful and important facility for the management of obstetric emergency. Establishment of obstetric ICU is essential in all tertiary hospital.
JCMCTA 2018 ; 29 (1) : 53-56
44
Hamidy, M. Yulis, and Dina Fauzia. "SIGNIFICANT DRUG INTERACTIONS AMONG INTENSIVE CARE UNIT PATIENTS." Asian Journal of Pharmaceutical and Clinical Research 10, no. 14 (May 1, 2017): 35. http://dx.doi.org/10.22159/ajpcr.2017.v10s2.19482.
Full textAbstract:
Objective:Drug interaction is one factor that contributes to drug-related problems. The hospitalized patients in intensive care units (ICU) have a higher risk for developing drug interactions. The purpose of this study was to evaluate the potency of significantdrug interactions in ICU patients.Methods:Drug-drug interactions from patient's medical records from ICU of Arifin Achmad General Hospital in Pekanbaru, Province of Riau, Indonesia at period July to December 2015 wereassessed. Drug Interaction Checker (Medscape) software was used to identify potential drug interactions.Results: This study included 28 ICU patients (mean age, 48 years) who had potency to drug interactions based on the software. Of these, 29% were male and 71% were female patients. The number of drugs that were given to patients was 3 to 13 drugs (average 7 drugs per patient). There were 122 potential drug-drug interactions found in this study, consisting of 43% potency of minor or non-significant, 52% potency of significant, 3% potency of serious, and 2% potency of contraindicated drug interactions. A total of 67% were pharmacodynamics and 33% were pharmacokinetics interactions. Dexamethasone, ketoprofen, ketorolac, furosemide, nifedipine, and enoxaparin were among drugs with highest frequency of potential drug interactions. Conclusion:Significant drug-drug interactions were prevalent in the ICU patients. This may be due to the complexity of the pharmacotherapies administered. The health professionals who provide care to these patients must be aware in order to identify and prevent possible drug events.
45
Ho, Jim Q., Christopher D. Nguyen, Richard Lopes, Stephen C. Ezeji-Okoye, and Ware G. Kuschner. "Spiritual Care in the Intensive Care Unit: A Narrative Review." Journal of Intensive Care Medicine 33, no. 5 (June 11, 2017): 279–87. http://dx.doi.org/10.1177/0885066617712677.
Full textAbstract:
Spiritual care is an important component of high-quality health care, especially for critically ill patients and their families. Despite evidence of benefits from spiritual care, physicians and other health-care providers commonly fail to assess and address their patients’ spiritual care needs in the intensive care unit (ICU). In addition, it is common that spiritual care resources that can improve both patient outcomes and family member experiences are underutilized. In this review, we provide an overview of spiritual care and its role in the ICU. We review evidence demonstrating the benefits of, and persistent unmet needs for, spiritual care services, as well as the current state of spiritual care delivery in the ICU setting. Furthermore, we outline tools and strategies intensivists and other critical care medicine health-care professionals can employ to support the spiritual well-being of patients and families, with a special focus on chaplaincy services.
46
Triplett, Katherine Elizabeth, Andrew Ford, and Matthew Anstey. "Psychiatric symptoms post intensive care unit admission." BMJ Case Reports 12, no. 12 (December 2019): e231917. http://dx.doi.org/10.1136/bcr-2019-231917.
Full textAbstract:
A 53-year-old woman was admitted to a tertiary intensive care unit (ICU) with acute respiratory distress syndrome secondary to severe community-acquired pneumonia that necessitated maximum supportive care with venovenous extracorporeal membrane oxygenation. Her medical history included bipolar disorder on quetiapine and sertraline, as well as a previous ICU admission, approximately 2 years prior, for non-cirrhotic hyperammonaemic encephalopathy that was complicated by prolonged post discharge anxiety and post-traumatic stress disorder-like symptoms, consistent with post-intensive-care syndrome. Here, we present a case, and explore the outcomes for a patient who had two separate admissions with life-threatening illnesses, but had distinct differences in the psychological outcomes following each illness.
47
Harder, Kathleen A., and David Marc. "Human Factors Issues in the Intensive Care Unit." AACN Advanced Critical Care 24, no. 4 (October 1, 2013): 405–14. http://dx.doi.org/10.4037/nci.0b013e3182a92657.
Full textAbstract:
In the context of an aging population, more critically ill patients, and a change in intensive care unit (ICU) services stemming from advances in technology, prevalent medical errors and staff burnout in the ICU are not surprising. The ICU provides ample opportunity for human factors experts to apply their knowledge about the strengths and weaknesses of human capabilities to design more effective care delivery. Human factors experts design work processes, technology, and environmental factors to effectively and constructively channel the attention and behavior of those providing care; a few areas of focus can have marked impacts on care delivery and patient outcomes. In this review, we focus on these 3 areas and investigate the solutions and problems addressed by previous research.
48
Grant, Marian. "Resolving Communication Challenges in the Intensive Care Unit." AACN Advanced Critical Care 26, no. 2 (April 1, 2015): 123–30. http://dx.doi.org/10.4037/nci.0000000000000076.
Full textAbstract:
Communication in the intensive care unit (ICU) is challenging because of complexity, high patient acuity, uncertainty, and ethical issues. Unfortunately, conflict is common, as several studies and reviews confirm. Three types of communication challenges are found in this setting: those within the ICU team, those between the ICU team and the patient or family, and those within the patient’s family. Although specific evidence-based interventions are available for each type of communication challenge, all hinge on clinicians being culturally competent, respectful, and good communicators/listeners. Critical care advanced practice nurses promote a positive team environment, increase patient satisfaction, and model good communication for other clinicians. All advanced practice nurses, however, also need to be adept at having difficult conversations, handling conflict, and providing basic palliative care, including emotional support.
49
Zawada, Edward T., and John L. Boice. "Clinical Pharmacology in Aged Intensive Care Unit Patients." Journal of Intensive Care Medicine 8, no. 6 (November 1993): 289–97. http://dx.doi.org/10.1177/088506669300800603.
Full textAbstract:
Elderly patients are presenting themselves for advanced critical care services in ever-increasing numbers due to changing population demographics coupled with advances in medical technology and pharmacology. Medical management of the elderly in critical care settings is complicated by pre-existing multisystem chronic disease, polypharmacy, and age-related changes in pharmacokinetics and pharmacodynamics. Three principles in the management of the elderly in an intensive care unit (ICU) setting are discussed: (1) the protection of renal function from common nephrotic drugs; (2) the necessity of altered drug dosing due to changes in pharmacokinetics and pharmacodynamics; and (3) the necessity of avoiding polypharmacy. Strategies for the prevention of acute renal failure in ICU contrast studies are described. A review of pharmacodynamics and pharmacokinetics in the elderly is presented with examples of commonly seen ICU medication problems.
50
Rahman, Mukhlesur, Mahmuda Begum, Mujibul Hoque Khan, and Mostsfa Mahfuzul Anwar. "Indications and outcomes of tracheostomy in intensive care unit." International Journal of Otorhinolaryngology and Head and Neck Surgery 6, no. 8 (July 22, 2020): 1430. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20203191.
Full textAbstract:
<p><strong> </strong></p><p class="abstract"><strong>Background:</strong> Tracheostomy is a commonly performed surgical procedure in the intensive care unit (ICU) in which creation of a stoma between the skin and the anterior wall of the trachea where there is need for prolong mechanical ventilation. Tracheostomy has considered a safe procedure in ICU but has been found to lead to life threatening complications intra and post operatively.</p><p class="abstract"><strong>Methods:</strong> This is a cross sectional study, was carried out in ICU, Chittagong Medical College Hospital, Chattogram from January 2018 to December 2019. A total of 120 patients irrespective of age and sex whose tracheostomy has done after admission in ICU by ENT surgeons. </p><p class="abstract"><strong>Results:</strong> Out of 120 patients maximum 34 (28.33%) were from 21-30 years age group and male to female ratio was 1.79:1, male patients were 77 (64.16%) and female patients were 43 (35.83%). The most common indication for tracheostomy in ICU was head injury and history of RTA 34 (28.33%) followed by post-operative case of intracranial space occupying lesion 30 (25%). Post tracheostomy complication was surgical emphysema 4 (3.33%). The rate of complication of tracheostomy in ICU was 10.83% in this study. Regarding benefits of tracheostomy over endotracheal tube in ICU, we found that 100% patients had greater comfort.</p><p class="abstract"><strong>Conclusions:</strong> Tracheostomy in ICU is an important and safe procedure if prolonged endotracheal in tubation is advised for varying underlying causes.</p>