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Respective Impact of Day and Night Bed Baths on Critical Care Patients. Dimens Crit Care Nurs 2022; 41:103-109. [PMID: 35099157 DOI: 10.1097/dcc.0000000000000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Despite data supporting the reduction of interactions with patients during nighttime, bed bathing is sometimes performed within this period in sedated patients unable to manage their own hygiene care. OBJECTIVES To compare patient physiologic variables and adverse effect incidence between night and day bed baths. METHODS This was a single-center prospective observational study in a 12-bed intensive care unit during 2 months. Night period was defined to run from 10 pm to 6 am. Night bed baths were provided to sedated ventilated patients whatever their sedation, if their Richmond Agitation Sedation Scale score was -2 or deeper. Bed bath-induced changes in physiological variables, treatments, and related unscheduled events were registered during both night and day bed baths. RESULTS Twenty-one patients (aged 62.9 [52.5-73.2] years, 14 male patients) were included. We registered 97 night bed baths and 95 day bed baths. Heart rate increased only after day bed baths (85 beats/min [bpm] [69-97 bpm] vs 88 bpm [73-98 bpm], P = .02). Increase in Richmond Agitation Sedation Scale score occurred, respectively, during 13 (13.4%) and 8 (8.4%) night and day bed baths, without significant differences. Body temperature significantly decreased during both night and day bed baths (respectively, 37°C [36.6°C-37.4°C] vs 36.6°C [36.2°C-37.2°C], P < .0001; and 36.9°C [36.5°C-37.2°C] vs 36.7°C [36.2°C-37.2°C], P = .0006). Overall, unscheduled events, whether physiologic changes, pain, or calling a physician in rescue occurred in 97 procedures (50.5%), irrespective of their timing (night vs day, respectively 53% [54.6%] vs 44% [46.3%], P = .31). DISCUSSION Although unscheduled events occurred in half of bed baths, differences evidenced between nighttime and daytime bed baths were scarce. The appropriateness of nighttime bed bathing remains questionable.
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Liu S, do Amaral Campos PPZ, Casoni D, Berger D, Kohler A, Bloch A, Bervini D, Setzer F, Cameron DR, Z'Graggen W, Hana A, Langer R, Corrêa TD, Beldi G, Takala J, Jakob SM. Defense mechanisms to increasing back pressure for hepatic oxygen transport and venous return in porcine fecal peritonitis. Am J Physiol Gastrointest Liver Physiol 2020; 319:G289-G302. [PMID: 32658622 DOI: 10.1152/ajpgi.00216.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
High central venous pressure (CVP) acutely decreases venous return. How this affects hepatic oxygen transport in sepsis remains unclear. The aim of this study was to evaluate the effects of repeated increases in CVP via standard nursing procedures (NPs) on hepato-splanchnic and renal oxygen transport in a prolonged porcine sepsis model. Twenty anesthetized and mechanically ventilated pigs with regional hemodynamics monitored were randomized to fecal peritonitis or controls (n = 10 pigs/group). Resuscitation was started after 8 h of observation and continued for 3 days. NPs were performed at baseline and 8 h, 32 h, 56 h, and 72 h after resuscitation started. NPs increased CVP by 4-7 mmHg in both groups. In controls, this was associated with less decrease in hepatic arterial (Qha; 62 ± 70 mL/min) than portal venous flow (Qpv; 364 ± 151 mL/min). Portal venous oxygen content and hepatic O2 delivery (Do2) and consumption (V̇o2) decreased by 11 ± 6 mL/dL and 0.9 ± 0.3 and 0.4 ± 0.3 mL·min-1·kg-1, respectively. In septic animals, hepatic Do2 decreased more in response to increasing CVP (1.5 ± 0.9 mL·min-1·kg-1), which was attributable to a larger fall in both Qha (88 ± 66 ml/min) and portal O2 content (14 ± 10 mL/dL, all P < 0.05). This resulted in numerically lower hepatic V̇o2 since O2 extraction did not increase significantly. In control conditions, a smaller decrease in Qha compared with Qpv helped to limit the reduction in hepatic V̇o2 in response to acute CVP increase. In sepsis, the contribution of Qha to maintain hepatic Do2 was reduced, which jeopardized hepatic V̇o2 further. Renal arterial flow was similarly affected by CVP increase as Qha.NEW & NOTEWORTHY Sepsis impairs intrinsic mechanisms to attenuate effects of increasing back pressure on hepatic oxygen transport.
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Affiliation(s)
- Shengchen Liu
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | | | - Daniela Casoni
- Experimental Surgery Facility, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - David Berger
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Kohler
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Bloch
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Bervini
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Setzer
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David R Cameron
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Werner Z'Graggen
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anisa Hana
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rupert Langer
- Institue of Pathology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thiago D Corrêa
- Department of Intensive Care Unit, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jukka Takala
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan M Jakob
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Chelly J, Mazerand S, Jochmans S, Weyer CM, Pourcine F, Ellrodt O, Thieulot-Rolin N, Serbource-Goguel J, Sy O, Vong LVP, Monchi M. Automated vs. conventional ventilation in the ICU: a randomized controlled crossover trial comparing blood oxygen saturation during daily nursing procedures (I-NURSING). CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:453. [PMID: 32698860 PMCID: PMC7374079 DOI: 10.1186/s13054-020-03155-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/05/2020] [Indexed: 02/01/2023]
Abstract
Background Hypoxia is common during daily nursing procedures (DNPs) routinely performed on mechanically ventilated patients. The impact of automated ventilation on the incidence and severity of blood oxygen desaturation during DNPs remains unknown. Methods A prospective randomized controlled crossover trial was carried out in a French intensive care unit to compare blood oxygen pulse saturation (SpO2) during DNPs performed on patients mechanically ventilated in automated and conventional ventilation modes (AV and CV, respectively). All patients with FiO2 ≤ 60% and without prone positioning or neuromuscular blocking agents were included. Patients underwent two DNPs on the same day using AV (INTELLiVENT-ASV®) and CV (volume control, biphasic positive airway pressure, or pressure support ventilation) in a randomized order. The primary outcome was the percentage of time spent with SpO2 in the acceptable range of 90–95% during the DNP. Results Of the 265 included patients, 93% had been admitted for a medical pathology, the majority for acute respiratory failure (52%). There was no difference between the two periods in terms of DNP duration, sedation requirements, or ventilation parameters, but patients had more spontaneous breaths and lower peak airway pressures during the AV period (p < 0.001). The percentage of time spent with SpO2 in the acceptable range during DNPs was longer in the AV period than in the CV period (48 ± 37 vs. 43 ± 37, percentage of DNP period; p = 0.03). After adjustment, AV was associated with a higher number of DNPs carried out with SpO2 in the acceptable range (odds ratio, 1.82; 95% CI, 1.28 to 2.6; p = 0.001) and a lower incidence of blood oxygen desaturation ≤ 85% (adjusted odds ratio, 0.50; 95% CI, 0.30 to 0.85; p = 0.01). Conclusion AV appears to reduce the incidence and severity of blood oxygen desaturation during daily nursing procedures (DNPs) in comparison to CV. Trial registration This study was registered in clinical-trial.gov (NCT03176329) in June 2017. Graphical abstract ![]()
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Affiliation(s)
- Jonathan Chelly
- Intensive Care Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, France. .,Clinical Research Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, France.
| | - Sandie Mazerand
- Intensive Care Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, France
| | - Sebastien Jochmans
- Intensive Care Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, France.,Clinical Research Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, France
| | - Claire-Marie Weyer
- Intensive Care Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, France
| | - Franck Pourcine
- Intensive Care Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, France
| | - Olivier Ellrodt
- Intensive Care Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, France
| | - Nathalie Thieulot-Rolin
- Intensive Care Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, France
| | - Jean Serbource-Goguel
- Intensive Care Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, France
| | - Oumar Sy
- Intensive Care Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, France
| | - Ly Van Phach Vong
- Intensive Care Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, France
| | - Mehran Monchi
- Intensive Care Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, France.,Clinical Research Unit, Groupe Hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77000, Melun, France
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[Overtreatment in nursing-does it exist?]. Med Klin Intensivmed Notfmed 2019; 114:202-206. [PMID: 30706101 DOI: 10.1007/s00063-019-0530-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND In recent years "overtreatment" and "overdiagnosis" have become well discussed problems in medicine. OBJECTIVES Similar to medicine, could some nursing interventions be classified as "overtreatment in nursing"? METHODS The available literature was evaluated and the different kinds of "overtreatment in nursing" are described. Ritualised nursing interventions are critically reflected upon. A definition for the term "overtreatment in nursing" is suggested and potential implications on daily nursing practice are presented. RESULTS At the moment only little is known about "overtreatment in nursing". In fact this term has not been defined or discussed yet. However, different studies in medical settings have shown that nursing interventions might have negative impacts on the patients' condition. In the practical field of nursing, different causes of "overtreatment in nursing" can be identified and there are some approaches, which examine possibilities on how to deal with the problem. CONCLUSIONS It is very likely that nursing interventions may have a negative impact on patients' health and recovery. Thus, defining the term "overtreatment in nursing" would be desirable. Moreover efforts should be made to find out more about the effects of "overtreatment in nursing" and possible preventive interventions.
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Maki Y, Toyoda D, Tomichi K, Onodera J, Kotake Y. Association of Oral Intake and Transient Mixed Venous Oxygen Desaturation in Patients Undergoing Fast-Track Postoperative Care After Open-Heart Surgery. J Cardiothorac Vasc Anesth 2018; 32:2236-2240. [PMID: 29395815 DOI: 10.1053/j.jvca.2017.12.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The impact of early resumption of oral intake after cardiac surgery on hemodynamics has not been characterized. The authors examined the effects of early oral intake on the oxygen supply-demand relationship in patients undergoing on-pump cardiac surgery in an early recovery after surgery program. DESIGN Prospective data were collected in postcardiac surgical patients in a multidisciplinary intensive care unit (ICU) during an 18-month period. SETTING Single institution study. PARTICIPANTS Forty-three patients who underwent either mitral or aortic valve repair and were successfully liberated from ventilatory support within 10 hours after surgery. INTERVENTIONS Patients were either allowed to resume oral intake on the morning of the first postoperative day or not at the discretion of the surgical team after extubation. MEASUREMENTS AND MAIN RESULTS The oxygen supply-demand relationship was assessed continuously with cardiac index and mixed venous oxygen saturation (SvO2). Among the subjects, 22 patients were allowed to eat, and transient SvO2 decrease was noted in 13 patients. All transient SvO2 decreases occurred in the patients with early oral intake. The hemodynamic status and oxygen supply-demand relationship did not differ between the patients with and without transient SvO2 decrease. All the subjects were discharged successfully from the ICU on the first postoperative day, and the length of hospital stay was similar irrespective of SvO2 decrease after early oral intake. CONCLUSIONS Early oral intake shortly after extubation was associated with transient but significant SvO2 decrease in patients who underwent fast-track recovery after open-heart surgery. Because this phenomenon did not negatively affect the postoperative outcome, early oral intake may not be harmful.
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Affiliation(s)
- Yuichi Maki
- Department of Anesthesiology, Toho University Ohashi Medical Center, Meguro, Tokyo, Japan.
| | - Daisuke Toyoda
- Department of Anesthesiology, Toho University Ohashi Medical Center, Meguro, Tokyo, Japan
| | - Keiko Tomichi
- Department of Anesthesiology, Toho University Ohashi Medical Center, Meguro, Tokyo, Japan
| | - Jun Onodera
- Department of Anesthesiology, Toho University Ohashi Medical Center, Meguro, Tokyo, Japan
| | - Yoshifumi Kotake
- Department of Anesthesiology, Toho University Ohashi Medical Center, Meguro, Tokyo, Japan
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Engström J, Bruno E, Reinius H, Fröjd C, Jonsson H, Sannervik J, Larsson A. Physiological changes associated with routine nursing procedures in critically ill are common: an observational pilot study. Acta Anaesthesiol Scand 2017; 61:62-72. [PMID: 27813055 DOI: 10.1111/aas.12827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 09/11/2016] [Accepted: 10/05/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Nursing procedures that are routinely performed in the intensive care unit (ICU) are assumed to have minimal side effects. However, these procedures may sometimes cause physiological changes that negatively affect the patient. We hypothesized that physiological changes associated with routine nursing procedures in the ICU are common. METHODS A clinical observational study of 16 critically ill patients in a nine-bed mixed university hospital ICU. All nursing procedures were observed, and physiological data were collected and subsequently analyzed. Minor physiological changes were defined as minimal changes in respiratory or circulatory variables, and major physiological changes were marked as hyper/hypotension, bradycardia/tachycardia, bradypnea/tachypnea, ventilatory distress, and peripheral blood oxygen desaturation. RESULTS In the 16 patients, 668 procedures generated 158 major and 692 minor physiological changes during 187 observational hours. The most common procedure was patient position change, which also generated the majority of the physiological changes. The most common major physiological changes were blood oxygen desaturation, ventilatory distress, and hypotension, and the most common minor changes were arterial pressure alteration, coughing, and increase in respiratory rate. CONCLUSION In this pilot study, we examined physiological changes in connection with all regular routine nursing procedures in the ICU. We found that physiological changes were common and sometimes severe.
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Affiliation(s)
- J. Engström
- Anesthesiology and Intensive Care; Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | - E. Bruno
- Anesthesiology and Intensive Care; Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | - H. Reinius
- Anesthesiology and Intensive Care; Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | - C. Fröjd
- Anesthesiology and Intensive Care; Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | - H. Jonsson
- Anesthesiology and Intensive Care; Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | - J. Sannervik
- Anesthesiology and Intensive Care; Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | - A. Larsson
- Anesthesiology and Intensive Care; Department of Surgical Sciences; Uppsala University; Uppsala Sweden
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Abstract
PURPOSE OF REVIEW Mechanical ventilation is a cornerstone of ICU treatment. Because of its interaction with blood flow and intra-abdominal pressure, mechanical ventilation has the potential to alter hepato-splanchnic perfusion, abdominal organ function and thereby outcome of the most critically ill patients. RECENT FINDINGS Mechanical ventilation can alter hepato-splanchnic perfusion, but the effects are minimal (with moderate inspiratory pressures, tidal volumes, and positive end-expiratory pressure levels) or variable (with high ones). Routine nursing procedures may cause repeated episodes of inadequate hepato-splanchnic perfusion in critically ill patients, but an association between perfusion and multiple organ dysfunction cannot yet be determined. Clinical research continues to be challenging as a result of difficulties in measuring hepato-splanchnic blood flow at the bedside. SUMMARY Mechanical ventilation and attempts to improve oxygenation such as intratracheal suctioning and recruitment maneuvers, may have harmful consequences in patients with already limited cardiovascular reserves or deteriorated intestinal perfusion. Due to difficulties in assessing hepato-splanchnic perfusion, such effects are often not detected.
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Routine nursing procedures--take care of the patient and the splanchnic circulation! Crit Care Med 2009; 37:751-2. [PMID: 19325369 DOI: 10.1097/ccm.0b013e318194d157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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