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ICU design

Amira Mustafa, Samar Mahgoub
Delays in the discharge of hospital patients cause a backlog for new admissions from the Emergency Departments (ED), outpatient clinics, and transfers from the Intensive Care Units (ICU). A variety of initiatives have been reported on previously which aim to tackle this problem with variable success. In this quality improvement project, we aimed to increase the proportion of discharged patients who leave the paediatric unit by 12:00 Noon from 7% to 30% by May 2015. A baseline discharge process map was studied to understand the possible causes of the delays...
2016: BMJ Quality Improvement Reports
Kelsey Chinnadurai, Lindy Fenlason, Brian Bridges, Mana Espahbodi, Sivakumar Chinnadurai, Jane Blood-Siegfried
BACKGROUND: Ventilator-associated pneumonia (VAP) is a common nosocomial infection in pediatric intensive care units (ICUs). Ventilator-associated pneumonia protocols decrease the incidence of VAP; however, many components of these protocols are not feasible in all settings. This study was done in a large pediatric hospital in Nicaragua. OBJECTIVE: The aim of this study is to implement a sustainable evidence-based VAP protocol, in a different culture, for the purpose of decreasing VAP rates...
November 2016: Dimensions of Critical Care Nursing: DCCN
Surendra K Sharma, Anunay Gupta, Ashutosh Biswas, Abhishek Sharma, Atul Malhotra, K T Prasad, Sreenivas Vishnubhatla, Sajal Ajmani, Hridesh Mishra, Manish Soneja, Shobha Broor
BACKGROUND & OBJECTIVES: Acute respiratory distress syndrome (ARDS) is a common disorder in critically ill patients and is associated with high mortality. There is a paucity of literature on this condition from developing countries. This prospective observational study was designed to find out the aetiology, outcomes and predictors of mortality in ARDS. METHODS: Sixty four consecutive patients who satisfied American-European Consensus Conference (AECC) definition of ARDS from medical Intensive Care Unit (ICU) of a tertiary care centre in New Delhi, India, were enrolled in the study...
June 2016: Indian Journal of Medical Research
Andrew A M Ibey, Derek Andrews, Barb Ferreira
The authors present a case in which a physical anomaly with an infusion pump resulted in an unforeseen fault that the nurse's attempts to resolve unknowingly exacerbated. This case study presents the first report in the literature to detail the difficulty in recreating a patient safety event using smart pump logs, support server continuous quality improvement (CQI) data, and the drug order entry system to elucidate the clinical scenario. A 75-year-old male patient presented to a major teaching hospital and was admitted to the intensive care unit (ICU) with a massive gastrointestinal bleed and myocardial infarction, then stabilized...
December 2016: Drug Saf Case Rep
Karen K Y Koo, Karen Choong, Deborah J Cook, Margaret Herridge, Anastasia Newman, Vincent Lo, Gordon Guyatt, Fran Priestap, Eileen Campbell, Karen E A Burns, FranÇois Lamontagne, Maureen O Meade
BACKGROUND: The promotion of early mobilization following critical illness is tempered by national reports of patient and institutional barriers to this approach. We carried out a survey to assess current knowledge, perceptions and practices of Canadian physicians and physiotherapists with respect to acquired weakness and early mobilization in adults in the intensive care unit (ICU). METHODS: We conducted a cross-sectional, self-administered postal survey among critical care physicians and physiotherapists in all 46 academic ICUs in Canada in 2011-2012...
July 2016: CMAJ Open
Alejandro Suarez De La Rica, Fernando Gilsanz, Emilio Maseda
Since the American College of Chest Physicians (ACCP) and the Society of Critical care Medicine (SCCM) published the first consensus definition of syndromes related to sepsis in 1992, the knowledge of epidemiology of sepsis has clearly improved, although no prospective studies have been performed to analyse the incidence of sepsis in general population. There are differences in epidemiologic trends in sepsis between western countries and low-income and middle-income countries. In the United States (US), most of epidemiologic studies have been based on large, administrative databases, reporting an increase in the incidence of severe sepsis over years...
September 2016: Annals of Translational Medicine
Nahla Tayyib, Fiona Coyer
BACKGROUND: Pressure ulcers are associated with substantial health burden, but could be preventable. Hospital-acquired pressure ulcers (HAPUs) prevention has become a priority for all healthcare settings, as it is considered a sign of quality of care providing. Intensive care unit (ICU) patients are at higher risk for HAPUs development. Despite the availability of published prevention strategies, there is a little evidence about which strategies can be safely integrated into routine standard care and have an impact on HAPUs prevention...
October 6, 2016: Worldviews on Evidence-based Nursing
Benjamin L Olesnicky, Catherine Traill, Frank B Marroquin-Harris
BACKGROUND: Postoperative residual curarisationf is a preventable cause of postoperative morbidity. Although sugammadex has been shown to reduce the risk of residual curarisation, it has not yet been shown if this directly translates to a reduction in morbidity. We aimed to demonstrate whether the introduction of unrestricted sugammadex for routine reversal changed the incidence of post-operative respiratory diagnoses and the rate of airway and respiratory complications in the post-operative care unit...
October 5, 2016: Minerva Anestesiologica
Masoud Ghorbanlo, Mahmoud Reza Mohaghegh, Forozan Yazdanian, Mehrdad Mesbah, Ziya Totonchi
BACKGROUND: The need for muscle relaxants in general anesthesia in different surgeries including cardiac surgeries, and the type of relaxant to be used considering its different hemodynamic effects on patients with heart disease can be of considerable importance. In this study, the hemodynamic effects of two muscle relaxants, Cisatracurium and Atracurium in patients whit low function of left ventricle who are candidate for open heart surgery have been considered. METHOD: This study has been designed as a randomized prospective double-blind clinical trial...
July 27, 2016: Medical Archives
Sigall K Bell, Stephanie D Roche, Anna C Johansson, Kristin P O'Reilly, Barbara S Lee, Kenneth E Sands, Daniel S Talmor, Samuel M Brown
RATIONALE: Communication in the intensive care unit (ICU) often falls short of patient and family needs, putting them at risk for significant physical and emotional harm. As electronic patient portals rapidly evolve, one designed specifically for the ICU might potentially enhance communication among patients, family members, and clinicians; however, the views of frontline ICU staff on such technology are unknown. OBJECTIVES: To identify clinician perspectives on the current state of communication among patients, families and clinicians in the ICU, and assess their views on whether and how an electronic portal may address existing communication deficits and improve care...
October 4, 2016: Annals of the American Thoracic Society
Joanne Jordan, Louise Rose, Katie N Dainty, Jane Noyes, Bronagh Blackwood
BACKGROUND: Prolonged mechanical ventilation is associated with a longer intensive care unit (ICU) length of stay and higher mortality. Consequently, methods to improve ventilator weaning processes have been sought. Two recent Cochrane systematic reviews in ICU adult and paediatric populations concluded that protocols can be effective in reducing the duration of mechanical ventilation, but there was significant heterogeneity in study findings. Growing awareness of the benefits of understanding the contextual factors impacting on effectiveness has encouraged the integration of qualitative evidence syntheses with effectiveness reviews, which has delivered important insights into the reasons underpinning (differential) effectiveness of healthcare interventions...
October 4, 2016: Cochrane Database of Systematic Reviews
Alicia I Fayad, Daniel G Buamscha, Agustín Ciapponi
BACKGROUND: Acute kidney injury (AKI) is a common condition among patients in intensive care units (ICU), and is associated with substantial morbidity and mortality. Continuous renal replacement therapy (CRRT) is a blood purification technique used to treat the most severe forms of AKI but its effectiveness remains unclear. OBJECTIVES: To assess the effects of different intensities (intensive and less intensive) of CRRT on mortality and recovery of kidney function in critically ill AKI patients...
October 4, 2016: Cochrane Database of Systematic Reviews
Simin Babaie Kafaki, Kamaledin Alaedini, Ashkan Qorbani, Leila Asadian, Kaveh Haddadi
OBJECTIVES: Management of hyperglycemia during an acute sickness in adults is accompanied by improved outcomes. We have designed a prospective study with meticulous attention to exclude all diabetes patients by checking hemoglobin A1c (HbA1c or glycated hemoglobin) to avoid the ill-effects of hyperglycemia in patients with traumatic head injury admitted to the intensive care unit (ICU). METHODS: This prospective study included adults with traumatic primary brain injury with a Glasgow coma score of ≤8 necessitating mechanical ventilation treated in the period 2012-2015...
2016: Clinical Medicine Insights. Endocrinology and Diabetes
Aaron Heller, John Dollerschell, Joshua Burk, Hailey Haines, Jonathan Kozinn
BACKGROUND: In the past decade, the rate and utilization of veno-venous extracorporeal membrane oxygenation (VV-ECMO) has increased dramatically. A single catheter technique has recently come into favour for providing VV-ECMO. Although it has been shown that intensivists can safely place these catheters, the safety of decannulation by intensivists has not been reported. OBJECTIVE: We describe a technique for safely decannulating the Avalon Elite VV-ECMO catheter at the bedside and assess the safety of this technique, as compared with the standard technique of decannulation in the operating room by a surgeon...
September 30, 2016: Anaesthesiology Intensive Therapy
Y-K Pang, M Ip, J H S You
Early initiation of antifungal treatment for invasive candidiasis is associated with change in mortality. Beta-D-glucan (BDG) is a fungal cell wall component and a serum diagnostic biomarker of fungal infection. Clinical findings suggested an association between reduced invasive candidiasis incidence in intensive care units (ICUs) and BDG-guided preemptive antifungal therapy. We evaluated the potential cost-effectiveness of active BDG surveillance with preemptive antifungal therapy in patients admitted to adult ICUs from the perspective of Hong Kong healthcare providers...
September 29, 2016: European Journal of Clinical Microbiology & Infectious Diseases
Akshay Shah, Noémi B Roy, Stuart McKechnie, Carolyn Doree, Sheila A Fisher, Simon J Stanworth
BACKGROUND: Anaemia affects 60-80 % of patients admitted to intensive care units (ICUs). Allogeneic red blood cell (RBC) transfusions remain the mainstay of treatment for anaemia but are associated with risks and are costly. Our objective was to assess the efficacy and safety of iron supplementation by any route, in anaemic patients in adult ICUs. METHODS: Electronic databases (CENTRAL, MEDLINE, EMBASE) were searched through March 2016 for randomized controlled trials (RCT)s comparing iron by any route with placebo/no iron...
September 29, 2016: Critical Care: the Official Journal of the Critical Care Forum
Alfin Okullo, Mehan Siriwardhane, Tony C Y Pang, Jane-Louise Sinclair, Vincent W T Lam, Arthur James Richardson, Henry Pleass, Emma Johnston
INTRODUCTION: Achieving primary fascial closure after damage control laparostomy can be challenging. A number of devices are in use, with none having yet emerged as best practice. In July 2013, at Westmead Hospital, we started using the abdominal reapproximation anchor (ABRA; Canica Design, Almonte, Ontario, Canada) device. We report on our experience. METHODS: A retrospective review of medical records for patients who had open abdomens managed with the ABRA device between July to December 2013 was done...
September 26, 2016: Surgical Innovation
Lioudmila V Karnatovskaia, Margaret M Johnson, Travis J Dockter, Ognjen Gajic
PURPOSE: Survivors of critical illness are frequently unable to return to their premorbid level of psychocognitive functioning following discharge. Therefore, we aimed to evaluate the burden of psychological trauma experienced by patients in the intensive care unit (ICU) as perceived by clinicians to assess factors that can impede its recognition and treatment in the ICU. MATERIALS AND METHODS: Two distinct role-specific Web-based surveys were administered to critical care physicians and nurses in medical and surgical ICUs of 2 academic medical centers...
September 14, 2016: Journal of Critical Care
Stéphanie Malaquin, Yazine Mahjoub, Arianna Musi, Elie Zogheib, Alexis Salomon, Mathieu Guilbart, Hervé Dupont
INTRODUCTION: There has been a growing interest in evaluating the occurrence of burnout syndrome (BOS) among intensive care units (ICU) team over recent years. The aims of this study were to determine the prevalence of BOS among staff working in the Amiens University Hospital and to assess associated factors. PATIENTS AND METHODS: Prospective observational study based on self-administered questionnaires filled in by physicians and non-physicians working in 3 ICUs...
September 23, 2016: Anaesthesia, Critical Care & Pain Medicine
Zhongheng Zhang, Qian Li, Lingzhi Jiang, Bo Xie, Xiaowei Ji, Jiahong Lu, Ronglin Jiang, Shu Lei, Shihao Mao, Lijun Ying, Di Lu, Xiaoshui Si, Jianxin He, Mingxia Ji, Jianhua Zhu, Guodong Chen, Yadi Shao, Yinghe Xu, Ronghai Lin, Chao Zhang, Weiwen Zhang, Jian Luo, Tianzheng Lou, Xuwei He, Kun Chen, Renhua Sun
INTRODUCTION: Enteral feed is an important component of nutritional therapy in critically ill patients and underfeeding has been associated with adverse outcomes. The article developed an enteral feeding protocol and planed a before-and-after comparative trial to explore whether implementation of enteral feeding protocol was able to improve clinical outcomes. METHODS AND ANALYSIS: The study will be conducted in intensive care units (ICUs) of ten tertiary care academic centers...
August 2016: Annals of Translational Medicine
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