Method for providing metabolic balance during intensive patient-care

Effective clinical policies in a district general hospital

Effective clinical practice in a hospital needs current knowledge together with the skills and right attitude; these should be applied continuously. Failure of this system can be due to ignorance or arrogance. We attempted to correct these deficiencies by formulating a set of policies which were enforced from 1962 to 1983. The policies related to the following: intensive care (including asthma, nutrition and organ donation), drug prescribing and resuscitation. We believe that these rules improved patient care and the standards of training; the prescribing policy also saved money.

The evolution and nursing history of a general intensive care unit (1962-1983)

In this paper we have reviewed the origin and evolution of Whiston Hospital's General Intensive Care Unit (ICU) from its humble beginnings as an offshoot of a general ward in the early 1960s. The length of service of the senior nursing staff over a period of 21 years was also calculated. The average duration of service was 16.5 years--a figure which significantly surpassed those quoted in the literature. In addition, we have outlined the development of nurse training in intensive care as well as the role of the nurses in research in the ICU. The question as to whether later college-based training was superior to the previous hospital-based course remained unanswered.

An antibiotic policy for bacterial infections after thoracic and other injuries

Atherton, S. T., Wright, D. M., White, D. J., and Jones, E. S. (1977).Thorax,32, 596-600. An antibiotic policy for bacterial infections after thoracic and other injuries. Twenty-four patients suffering from thoracic and other injuries were admitted to an intensive care unit over a three-year period. The first four patients died from infection by Gram-negative bacilli with associated features of bacterial toxaemia although it was anticipated that most, if not all, of the patients would have recovered with intensive care. Antibiotics had been started when a patient showed signs of bacterial toxaemia but were ineffective. Retrospective analysis showed that, in each patient, a rapid rise in rectal temperature, white cell count, and blood sugar preceded the clinical features of bacterial toxaemia by one or two days. These observations were incorporated into an antibiotic policy for patients with similar injuries.

The criteria for starting two or three wide spectrum antibiotics were as follows: (1) Gram-negative bacilli in the tracheal aspirate together with radiological evidence of consolidation or absorption collapse; (ii) two of the following three signs—a rectal temperature of 38·5°C or more, a white blood cell count of 11·0 × 10⁹/l or above, a blood glucose of 11·2 mmol/l or above; (iii) laparotomy. This policy was tested out over two years on 20 patients with thoracic and other injuries. Sixteen of the patients fulfilled the criteria for antibiotic therapy. Two of the six deaths were due to bacterial infection with toxaemia, a result which suggests that the policy was beneficial.

A new tube feed: Aminutrin and Calonutrin

A new tube feed made up from separate sachets of 1-amino acids and saccharides, and mixed with milk, has been given to five patients for a total of 49 days. The preparation, administration and tolerance of the feed has been uncomplicated, and the electrolyte, calorie and nitrogen content could be easily varied according to the patient's needs. A simple metabolic study of the patients was made during the administration of the feed.