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Baskar N, Sethuraman M, Praveen R, Hrishi AP, Vimala S, Prathapadas U, Abraham M. Evaluation of Cerebral Perfusion Pressure, Cerebral Blood Flow, and Cerebral Oxygenation at Different Head of Bed Positions Using Transcranial Doppler and Near-Infrared Spectroscopy in Postoperative Neurosurgical Patients. Cureus 2024; 16:e51923. [PMID: 38333454 PMCID: PMC10851091 DOI: 10.7759/cureus.51923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES Nursing postoperative neurosurgical patients with head of bed (HOB) elevation beyond 30° might be desired at times to prevent pulmonary complications. Due to the paucity of studies determining the effect of HOB beyond 30° on cerebral perfusion pressure (CPP), cerebral blood flow (CBF), and regional cerebral oxygenation (rSO2), this study was designed. METHODS A total of 40 patients following elective neurosurgery for supratentorial tumors were studied in the neurosurgical intensive care unit three hours following admission. They were assessed for CBF velocities of middle cerebral arteries on either side using transcranial color Doppler (TCCD), rSO2 using near-infrared spectroscopy (NIRS), and mean arterial pressure measured at tragus level at various HOB positions. The estimated cerebral perfusion pressure (CPPe) was calculated from TCCD parameters, and the estimated intracranial pressure (ICPe) was then derived. Their variations at different HOB positions were noted. RESULTS TCCD parameters such as peak systolic velocity (PSV) and mean flow velocity (MFV) did not significantly vary upon elevating HOB from 0° to 30° but reduced significantly when HOB was further elevated to 60° (p < 0.05). ICPe reduced significantly with a change of HOB positions from 0° to 60° (p < 0.001), and a significant reduction in CPPe was noticed when HOB was elevated to 60° (67.2 ± 10.1 mmHg vs. 74.7 ± 11.2 mmHg at 0°). However, none of these HOB positions affected rSO2 values. CONCLUSION Postoperative nursing with positions up to 60° HOB can be tried in indicated patients following elective neurosurgery when complemented with CBF velocity and rSO2 monitoring and in whom CPP-guided therapy is not preferred.
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Affiliation(s)
- Nisha Baskar
- Department of Anesthesiology, Apollo Speciality Hospitals, Madurai, IND
| | - Manikandan Sethuraman
- Department of Anesthesiology, Neuroanesthesia Division, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, IND
| | - Ranganatha Praveen
- Department of Anesthesiology, Neuroanesthesia Division, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, IND
| | - Ajay P Hrishi
- Department of Anesthesiology, Neuroanesthesia Division, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, IND
| | - Smita Vimala
- Department of Anesthesiology, Neuroanesthesia Division, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, IND
| | - Unnikrishnan Prathapadas
- Department of Anesthesiology, Neuroanesthesia Division, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, IND
| | - Mathew Abraham
- Department of Neurosurgery, Lisie Hospital, Ernakulam, IND
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Funamizu A, Marbach F, Zador AM. Stable sound decoding despite modulated sound representation in the auditory cortex. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.31.526457. [PMID: 37745428 PMCID: PMC10515783 DOI: 10.1101/2023.01.31.526457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
The activity of neurons in the auditory cortex is driven by both sounds and non-sensory context. To investigate the neuronal correlates of non-sensory context, we trained head-fixed mice to perform a two-alternative choice auditory task in which either reward or stimulus expectation (prior) was manipulated in blocks. Using two-photon calcium imaging to record populations of single neurons in auditory cortex, we found that both stimulus and reward expectation modulated the activity of these neurons. A linear decoder trained on this population activity could decode stimuli as well or better than predicted by the animal's performance. Interestingly, the optimal decoder was stable even in the face of variable sensory representations. Neither the context nor the mouse's choice could be reliably decoded from the recorded neural activity. Our findings suggest that in spite of modulation of auditory cortical activity by task priors, auditory cortex does not represent sufficient information about these priors to exploit them optimally and that decisions in this task require that rapidly changing sensory information be combined with more slowly varying task information extracted and represented in brain regions other than auditory cortex.
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Affiliation(s)
- Akihiro Funamizu
- Cold Spring Harbor Laboratory, 1 Bungtown Rd, Cold Spring Harbor, NY 11724, USA
- Present address: Institute for Quantitative Biosciences, the University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 1130032, Japan
- Present address: Department of Life Sciences, Graduate School of Arts and Sciences, the University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo, 1538902, Japan
| | - Fred Marbach
- Cold Spring Harbor Laboratory, 1 Bungtown Rd, Cold Spring Harbor, NY 11724, USA
- Present address: The Francis Crick Institute, 1 Midland Rd, NW1 4AT London, UK
| | - Anthony M Zador
- Cold Spring Harbor Laboratory, 1 Bungtown Rd, Cold Spring Harbor, NY 11724, USA
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Jalal SM, Alrajeh AM, Al-Abdulwahed JAA. Performance Assessment of Medical Professionals in Prevention of Ventilator Associated Pneumonia in Intensive Care Units. Int J Gen Med 2022; 15:3829-3838. [PMID: 35418777 PMCID: PMC9000598 DOI: 10.2147/ijgm.s363449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/29/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose Ventilator-associated pneumonia (VAP) is one of the most common infections in intensive care units (ICU) with a 6–52% incidence. The VAP mortality rate is 50% to 70%. Medical professionals (MPs) working in the ICU are expected to follow the guidelines to prevent VAP. The study aimed to assess the performance of MPs in preventing VAP and to associate the performance with the baseline information. Methods An observational cross-sectional study was conducted in the ICUs of selected hospitals in eastern Saudi Arabia. A total of 152 MPs were selected by random sampling. A structured questionnaire including baseline information, knowledge and performance-related questions was used to collect the data. Frequency, mean, and chi-square tests were used for analysis. Results Out of 152 MPs, 40.8% had adequate and 7.9% had inadequate knowledge. A high mean score of 12.9 ± 2.2 was obtained by physicians, followed by 11.3 ± 1.6 by nurses, 9.8 ± 2.2 by RTs, and 8.6 ± 2.1 by interns. Overall, 52.6% had satisfactory performance. Approximately 57.9% and 67.8% of MPs cleaned their hands before touching the patient and the ventilator, respectively. Many (79.6%) MPs used personal protective equipment in the ICU. Some (47.4%) of the MPs changed the patient’s position regularly. About 77.6% of MPs followed the sterile technique when suctioning the airway. There was a significant association found between the performance of MPs on the prevention of VAP with age (p < 0.001), designation (p < 0.05), professional experience (p < 0.05), managing chronic obstructive pulmonary disease conditions (p < 0.05) and training attended (p < 0.001). Conclusion Although some of the MPs had satisfactory performance regarding VAP prevention in the ICU, more attention should be paid to training them on clinical guidelines to improve health care quality and reduce the rate of VAP.
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Affiliation(s)
- Sahbanathul Missiriya Jalal
- Department of Nursing, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, 31982, Saudi Arabia
- Correspondence: Sahbanathul Missiriya Jalal, Department of Nursing, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, 31982, Saudi Arabia, Tel +966564070973, Email
| | - Ahmed Mansour Alrajeh
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, 31982, Saudi Arabia
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Body position for preventing ventilator-associated pneumonia for critically ill patients: a systematic review and network meta-analysis. J Intensive Care 2022; 10:9. [PMID: 35193688 PMCID: PMC8864849 DOI: 10.1186/s40560-022-00600-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/09/2022] [Indexed: 02/06/2023] Open
Abstract
Background The evidence about the best body position to prevent ventilator-associated pneumonia (VAP) is unclear. The aim of this study was to know what the best body position is to prevent VAP, shorten the length of intensive care unit (ICU) and hospital stay, and reduce mortality among patients undergoing mechanical ventilation (MV). Methods We performed a network meta-analysis of randomized controlled trials including intubated patients undergoing MV and admitted to an ICU. The assessed interventions were different body positions (i.e., lateral, prone, semi-recumbent) or alternative degrees of positioning in mechanically ventilated patients. Results Semi-recumbent and prone positions showed a risk reduction of VAP incidence (RR: 0.38, 95% CI: 0.25–0.52) and mortality (RR: 0.70, 95% CI: 0.50–0.91), respectively, compared to the supine position. The ranking probabilities and the surface under the cumulative ranking displayed as the first best option of treatment the semi-recumbent position to reduce the incidence of VAP (71.4%), the hospital length of stay (68.9%), and the duration of MV (67.6%); and the prone position to decrease the mortality (89.3%) and to reduce the ICU length of stay (59.3%). Conclusions Cautiously, semi-recumbent seems to be the best position to reduce VAP incidence, hospital length of stay and the duration of MV. Prone is the most effective position to reduce the risk of mortality and the ICU length of stay, but it showed no effect on the VAP incidence. Registration PROSPERO CRD42021247547 Supplementary Information The online version contains supplementary material available at 10.1186/s40560-022-00600-z.
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Alderden JG, Shibily F, Cowan L. Best Practice in Pressure Injury Prevention Among Critical Care Patients. Crit Care Nurs Clin North Am 2020; 32:489-500. [PMID: 33129409 DOI: 10.1016/j.cnc.2020.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pressure injuries are areas of damage to the skin and underlying tissue caused by pressure or pressure in combination with shear. Pressure injury prevention in the critical care population necessitates risk assessment, selection of appropriate preventive interventions, and ongoing assessment to determine the adequacy of the preventive interventions. Best practices in preventive interventions among critical care patients, including skin and tissue assessment, skin care, repositioning, nutrition, support surfaces, and early mobilization, are described. Unique considerations in special populations including older adults and individuals with obesity are also addressed.
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Affiliation(s)
- Jenny G Alderden
- University of Utah College of Nursing, 10 2000 East, Salt Lake City, UT 84112, USA.
| | - Faygah Shibily
- Faculty of Nursing, King Abdulaziz University, P.O.Box 42828, Jeddah 21551, Saudi Arabia
| | - Linda Cowan
- VISN 8 Patient Safety Center of Inquiry, James A. Haley Veterans Hospital and Clinics, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612, USA
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Checklists and protocols in the ICU: less variability in care or more unnecessary interventions? Intensive Care Med 2020; 46:1249-1251. [PMID: 32328721 DOI: 10.1007/s00134-020-06034-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
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Lustig M, Wiggermann N, Gefen A. How patient migration in bed affects the sacral soft tissue loading and thereby the risk for a hospital-acquired pressure injury. Int Wound J 2020; 17:631-640. [PMID: 32048476 PMCID: PMC7217162 DOI: 10.1111/iwj.13316] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/16/2020] [Accepted: 01/27/2020] [Indexed: 12/16/2022] Open
Abstract
Head‐of‐bed (HOB) elevation is a common clinical practice in hospitals causing the patient's body to slide down in bed because of gravity. This migration effect likely results in tissue shearing between the sacrum and the support surface, which increases the risk for pressure injuries. StayInPlace (HillRom Inc.) is a commercial migration‐reduction technology (MRT) incorporated in intensive care bedframes. Yet, the effects of migration‐reduction on tissue shear stresses during HOB elevation are unknown. We analysed relationships between migration and resulting sacral soft tissue stresses by combining motion analysis and three‐dimensional finite element modelling of the buttocks. Migration data were collected for 10 subjects, lying supine on two bedframe types with and without MRT, and at HOB elevations of 45°/65°. Migration data were used as displacement boundary conditions for the modelling to calculate tissue stress exposures. Migration values for the conventional bed were 1.75‐ and 1.6‐times greater than those for the migration‐reduction bed, for elevations of 45° and 65°, respectively (P < .001). The modelling showed that the farther the migration, the greater the tissue stress exposures. Internal stresses were 1.8‐fold greater than respective skin stresses. Our results, based on the novel integrated experimental‐computational method, point to clear biomechanical benefits in minimising migration using MRT.
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Affiliation(s)
- Maayan Lustig
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | | | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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A successful program preventing nonventilator hospital-acquired pneumonia in a large hospital system. Infect Control Hosp Epidemiol 2020; 41:547-552. [DOI: 10.1017/ice.2019.368] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:To develop and evaluate a program to presvent hospital-acquired pneumonia (HAP).Design:Prospective, observational, surveillance program to identify HAP before and after 7 interventions. An order set automatically triggered in programmatically identified high-risk patients.Setting:All 21 hospitals of an integrated healthcare system with 4.4 million members.Patients:All hospitalized patients.Interventions:Interventions for high-risk patients included mobilization, upright feeding, swallowing evaluation, sedation restrictions, elevated head of bed, oral care and tube care.Results:HAP rates decreased between 2012 and 2018: from 5.92 to 1.79 per 1,000 admissions (P = .0031) and from 24.57 to 6.49 per 100,000 members (P = .0014). HAP mortality decreased from 1.05 to 0.34 per 1,000 admissions and from 4.37 to 1.24 per 100,000 members. Concomitant antibiotic utilization demonstrated reductions of broad-spectrum antibiotics. Antibiotic therapy per 100,000 members was measured as follows: carbapenem days (694 to 463; P = .0020), aminoglycoside days (154 to 61; P = .0165), vancomycin days (2,087 to 1,783; P = .002), and quinolone days (2,162 to 1,287; P < .0001). Only cephalosporin use increased, driven by ceftriaxone days (264 to 460; P = .0009). Benzodiazepine use decreased between 2014 to 2016: 10.4% to 8.8% of inpatient days. Mortality for patients with HAP was 18% in 2012% and 19% in 2016 (P = .439).Conclusion:HAP rates, mortality, and broad-spectrum antibiotic use were all reduced significantly following these interventions, despite the absence of strong supportive literature for guidance. Most interventions augmented basic nursing care. None had risks of adverse consequences. These results support the need to examine practices to improve care despite limited literature and the need to further study these difficult areas of care.
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Dirkes SM, Kozlowski C. Early Mobility in the Intensive Care Unit: Evidence, Barriers, and Future Directions. Crit Care Nurse 2020; 39:33-42. [PMID: 31154329 DOI: 10.4037/ccn2019654] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Early mobility is an element of the ABCDEF bundle designed to improve outcomes such as ventilator-free days and decreased length of stay. Evidence indicates that adherence to an early mobility protocol can prevent delirium and reduce length of stay in the intensive care unit and the hospital and may decrease length of stay in a rehabilitation facility. Yet many barriers exist to implementing early mobility effectively, including patient acuity, uncertainty about when to start mobilizing the patient, staffing and equipment needs, increased costs, and limited nursing time. Implementation of early mobility requires interdisciplinary collaboration, commitment, and tools that facilitate mobility and prevent injury to nurses. This article focuses on aspects of care that can affect patient outcomes, such as preventing delirium, reducing sedation, monitoring the patient's ability to wean from the ventilator, and encouraging early mobility. It also addresses the effects of immobility as well as challenges in achieving mobility and how to overcome them.
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Affiliation(s)
- Susan M Dirkes
- Susan M. Dirkes and Charles Kozlowski are staff nurses at the University of Michigan hospital, Ann Arbor, Michigan.
| | - Charles Kozlowski
- Susan M. Dirkes and Charles Kozlowski are staff nurses at the University of Michigan hospital, Ann Arbor, Michigan
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Zhang T, Zhao Z, Zhang C, Zhang J, Jin Z, Li L. Classification of Early and Late Mild Cognitive Impairment Using Functional Brain Network of Resting-State fMRI. Front Psychiatry 2019; 10:572. [PMID: 31555157 PMCID: PMC6727827 DOI: 10.3389/fpsyt.2019.00572] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/22/2019] [Indexed: 01/25/2023] Open
Abstract
Using the Pearson correlation coefficient to constructing functional brain network has been evidenced to be an effective means to diagnose different stages of mild cognitive impairment (MCI) disease. In this study, we investigated the efficacy of a classification framework to distinguish early mild cognitive impairment (EMCI) from late mild cognitive impairment (LMCI) by using the effective features derived from functional brain network of three frequency bands (full-band: 0.01-0.08 Hz; slow-4: 0.027-0.08 Hz; slow-5: 0.01-0.027 Hz) at Rest. Graphic theory was performed to calculate and analyze the relationship between changes in network connectivity. Subsequently, three different algorithms [minimal redundancy maximal relevance (mRMR), sparse linear regression feature selection algorithm based on stationary selection (SS-LR), and Fisher Score (FS)] were applied to select the features of network attributes, respectively. Finally, we used the support vector machine (SVM) with nested cross validation to classify the samples into two categories to obtain unbiased results. Our results showed that the global efficiency, the local efficiency, and the average clustering coefficient were significantly higher in the slow-5 band for the LMCI-EMCI comparison, while the characteristic path length was significantly longer under most threshold values. The classification results showed that the features selected by the mRMR algorithm have higher classification performance than those selected by the SS-LR and FS algorithms. The classification results obtained by using mRMR algorithm in slow-5 band are the best, with 83.87% accuracy (ACC), 86.21% sensitivity (SEN), 81.21% specificity (SPE), and the area under receiver operating characteristic curve (AUC) of 0.905. The present results suggest that the method we proposed could effectively help diagnose MCI disease in clinic and predict its conversion to Alzheimer's disease at an early stage.
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Affiliation(s)
| | | | | | | | | | - Ling Li
- MOE Key Lab for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Psychiatry and Psychology, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
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Newsome AS, Chastain DB, Watkins P, Hawkins WA. Complications and Pharmacologic Interventions of Invasive Positive Pressure Ventilation During Critical Illness. J Pharm Technol 2018; 34:153-170. [PMID: 34860978 DOI: 10.1177/8755122518766594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To review the fundamentals of invasive positive pressure ventilation (IPPV) and the common complications and associated pharmacotherapeutic management in order to provide opportunities for pharmacists to improve patient outcomes. Data Sources: A MEDLINE literature search (1950-December 2017) was performed using the key search terms invasive positive pressure ventilation, mechanical ventilation, pharmacist, respiratory failure, ventilator associated organ dysfunction, ventilator associated pneumonia, ventilator bundles, and ventilator liberation. Additional references were identified from a review of literature citations. Study Selection and Data Extraction: All English-language original research and review reports were evaluated. Data Synthesis: IPPV is a common supportive care measure for critically ill patients. While lifesaving, IPPV is associated with significant complications including ventilator-associated pneumonia, sinusitis, organ dysfunction, and hemodynamic alterations. Optimization of pain and sedation management provides an opportunity for pharmacists to directly affect IPPV exposure. A number of pharmacotherapeutic interventions are related directly to prophylaxis against IPPV-associated adverse events or aimed at reduction of duration of IPPV. Conclusions: Enhanced knowledge of the common complications, associated pharmacotherapy, and monitoring strategies facilitate the pharmacist's ability to provide increased pharmacotherapeutic insight in a multidisciplinary intensive care unit setting.
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Affiliation(s)
- Andrea Sikora Newsome
- The University of Georgia, Augusta, GA, USA.,Augusta University Medical Center, Augusta, GA, USA
| | | | | | - W Anthony Hawkins
- The University of Georgia, Augusta, GA, USA.,The University of Georgia-Albany, GA, USA
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A Retrospective Study of Non-Ventilator-Associated Hospital Acquired Pneumonia Incidence and Missed Opportunities for Nursing Care. J Nurs Adm 2018; 48:285-291. [PMID: 29672375 DOI: 10.1097/nna.0000000000000614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine non-ventilator-associated hospital-acquired pneumonia (NV-HAP) incidence, assess negative impacts on patient outcomes and cost, and identify missed preventive nursing care opportunities. BACKGROUND NV-HAP is inadequately studied and underreported. Missed nursing care opportunities, particularly oral care, may aid NV-HAP prevention. METHODS This descriptive, observational, retrospective chart review identified adult NV-HAP cases and associated demographic and hospital care data. RESULTS Two hundred five NV-HAP cases occurred in 1 year at Montefiore Medical Center, equating to an incidence of 0.47 per 1000 patient-days and an estimated excess cost of $8.2 million. ICU transfer following pneumonia occurred in 15.6% of cases. Care requirements from specialist nursing facilities increased at discharge (26.8%), as compared with care requirements on admission (17.6%). Complete nursing care documentation was missing for most patients, with oral care undocumented 60.5% of the time. CONCLUSIONS Preventable NV-HAP cases and their negative impact on cost and patient outcomes may decrease through improved basic nursing care.
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Alves J, Peña-López Y, Rojas JN, Campins M, Rello J. Can We Achieve Zero Hospital-Acquired Pneumonia? CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2018. [DOI: 10.1007/s40506-018-0164-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Baker D, Quinn B. Hospital Acquired Pneumonia Prevention Initiative-2: Incidence of nonventilator hospital-acquired pneumonia in the United States. Am J Infect Control 2018; 46:2-7. [PMID: 29050903 DOI: 10.1016/j.ajic.2017.08.036] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/27/2017] [Accepted: 08/28/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Because nonventilator hospital-acquired pneumonia (NV-HAP) is understudied, our purpose was to determine the incidence, overall burden, and level of documented pneumonia preventive interventions of NV-HAP in 24 U.S. hospitals. METHODS This retrospective chart review extracted NV-HAP cases as per the 2014 ICD-9-CM codes for pneumonia not present on admission and the 2013 Centers for Disease Control and Prevention case definition. Patient demographic data, outcomes, and documented preventive interventions were also collected. RESULTS We found 1,300 NV-HAP patients who acquired NV-HAP (rate, 0.12-2.28 per 1,000 patient days) across the 21 hospitals that completed the data collection. Most NV-HAP infections (70.8%) were acquired outside of intensive care units (ICUs); 18.8% required transfer into the ICU. In the 24 hours prior to diagnosis, most of the patients did not have fundamental hospital care associated with pneumonia prevention. CONCLUSIONS This multicenter, nationwide study highlights the significant burden of NV-HAP in the U.S. acute care hospital setting. We found that NV-HAP occurred on every hospital unit, including in younger, healthy patients. This indicates that although some patients are clearly at higher risk, all patients carry some NV-HAP risk. Therapeutic interventions aimed at NV-HAP prevention are frequently not provided for patients in acute care hospitals.
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Michetti CP, Prentice HA, Rodriguez J, Newcomb A. Supine position and nonmodifiable risk factors for ventilator-associated pneumonia in trauma patients. Am J Surg 2017; 213:405-412. [DOI: 10.1016/j.amjsurg.2016.05.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/05/2016] [Accepted: 05/31/2016] [Indexed: 11/30/2022]
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Bein T, Bischoff M, Brückner U, Gebhardt K, Henzler D, Hermes C, Lewandowski K, Max M, Nothacker M, Staudinger T, Tryba M, Weber-Carstens S, Wrigge H. [Short version S2e guidelines: "Positioning therapy and early mobilization for prophylaxis or therapy of pulmonary function disorders"]. Anaesthesist 2016; 64:596-611. [PMID: 26260196 DOI: 10.1007/s00101-015-0060-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The German Society of Anesthesiology and Intensive Care Medicine (DGAI) commissioned a revision of the S2 guidelines on "positioning therapy for prophylaxis or therapy of pulmonary function disorders" from 2008. Because of the increasing clinical and scientific relevance the guidelines were extended to include the issue of "early mobilization" and the following main topics are therefore included: use of positioning therapy and early mobilization for prophylaxis and therapy of pulmonary function disorders, undesired effects and complications of positioning therapy and early mobilization as well as practical aspects of the use of positioning therapy and early mobilization. These guidelines are the result of a systematic literature search and the subsequent critical evaluation of the evidence with scientific methods. The methodological approach for the process of development of the guidelines followed the requirements of evidence-based medicine, as defined as the standard by the Association of the Scientific Medical Societies in Germany. Recently published articles after 2005 were examined with respect to positioning therapy and the recently accepted aspect of early mobilization incorporates all literature published up to June 2014.
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Affiliation(s)
- T Bein
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, 93042, Regensburg, Deutschland,
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Wang L, Li X, Yang Z, Tang X, Yuan Q, Deng L, Sun X. Semi-recumbent position versus supine position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation. Cochrane Database Syst Rev 2016; 2016:CD009946. [PMID: 26743945 PMCID: PMC7016937 DOI: 10.1002/14651858.cd009946.pub2] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is associated with increased mortality, prolonged length of hospital stay and increased healthcare costs in critically ill patients. Guidelines recommend a semi-recumbent position (30º to 45º) for preventing VAP among patients requiring mechanical ventilation. However, due to methodological limitations in existing systematic reviews, uncertainty remains regarding the benefits and harms of the semi-recumbent position for preventing VAP. OBJECTIVES To assess the effectiveness and safety of semi-recumbent positioning versus supine positioning to prevent ventilator-associated pneumonia (VAP) in adults requiring mechanical ventilation. SEARCH METHODS We searched CENTRAL (2015, Issue 10), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1946 to October 2015), EMBASE (2010 to October 2015), CINAHL (1981 to October 2015) and the Chinese Biomedical Literature Database (CBM) (1978 to October 2015). SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing semi-recumbent versus supine positioning (0º to 10º), or RCTs comparing alternative degrees of positioning in mechanically ventilated patients. Our outcomes included clinically suspected VAP, microbiologically confirmed VAP, intensive care unit (ICU) mortality, hospital mortality, length of ICU stay, length of hospital stay, duration of ventilation, antibiotic use and any adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently and in duplicate screened titles, abstracts and full texts, assessed risk of bias and extracted data using standardised forms. We calculated the mean difference (MD) and 95% confidence interval (95% CI) for continuous data and the risk ratio (RR) and 95% CI for binary data. We performed meta-analysis using the random-effects model. We used the grading of recommendations, assessment, development and evaluation (GRADE) approach to grade the quality of evidence. MAIN RESULTS We included 10 trials involving 878 participants, among which 28 participants in two trials did not provide complete data due to loss to follow-up. We judged all trials to be at high risk of bias. Semi-recumbent position (30º to 60º) versus supine position (0° to 10°) A semi-recumbent position (30º to 60º) significantly reduced the risk of clinically suspected VAP compared to a 0º to 10º supine position (eight trials, 759 participants, 14.3% versus 40.2%, RR 0.36; 95% CI 0.25 to 0.50; risk difference (RD) 25.7%; 95% CI 20.1% to 30.1%; GRADE: moderate quality evidence).There was no significant difference between the two positions in the following outcomes: microbiologically confirmed VAP (three trials, 419 participants, 12.6% versus 31.6%, RR 0.44; 95% CI 0.11 to 1.77; GRADE: very low quality evidence), ICU mortality (two trials, 307 participants, 29.8% versus 34.3%, RR 0.87; 95% CI 0.59 to 1.27; GRADE: low quality evidence), hospital mortality (three trials, 346 participants, 23.8% versus 27.6%, RR 0.84; 95% CI 0.59 to 1.20; GRADE: low quality evidence), length of ICU stay (three trials, 346 participants, MD -1.64 days; 95% CI -4.41 to 1.14 days; GRADE moderate quality evidence), length of hospital stay (two trials, 260 participants, MD -9.47 days; 95% CI -34.21 to 15.27 days; GRADE: very low quality evidence), duration of ventilation (four trials, 458 participants, MD -3.35 days; 95% CI -7.80 to 1.09 days), antibiotic use (three trials, 284 participants, 84.8% versus 84.2%, RR 1.00; 95% CI 0.97 to 1.03) and pressure ulcers (one trial, 221 participants, 28% versus 30%, RR 0.91; 95% CI 0.60 to 1.38; GRADE: low quality evidence). No other adverse events were reported. Semi-recumbent position (45°) versus 25° to 30° We found no statistically significant differences in the following prespecified outcomes: clinically suspected VAP (two trials, 91 participants, RR 0.74; 95% CI 0.35 to 1.56; GRADE: very low quality evidence), microbiologically confirmed VAP (one trial, 30 participants, RR 0.61; 95% CI 0.20 to 1.84: GRADE: very low quality evidence), ICU mortality (one trial, 30 participants, RR 0.57; 95% CI 0.15 to 2.13; GRADE: very low quality evidence), hospital mortality (two trials, 91 participants, RR 1.00; 95% CI 0.38 to 2.65; GRADE: very low quality evidence), length of ICU stay (one trial, 30 participants, MD 1.6 days; 95% CI -0.88 to 4.08 days; GRADE: very low quality evidence) and antibiotic use (two trials, 91 participants, RR 1.11; 95% CI 0.84 to 1.47). No adverse events were reported. AUTHORS' CONCLUSIONS A semi-recumbent position (≧ 30º) may reduce clinically suspected VAP compared to a 0° to 10° supine position. However, the evidence is seriously limited with a high risk of bias. No adequate evidence is available to draw any definitive conclusion on other outcomes and the comparison of alternative semi-recumbent positions. Adverse events, particularly venous thromboembolism, were under-reported.
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Affiliation(s)
- Li Wang
- West China Hospital, Sichuan UniversityChinese Cochrane CentreNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Xiao Li
- West China Hospital, Sichuan UniversityChinese Evidence‐Based Medicine CentreNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Zongxia Yang
- West China Hospital, Sichuan UniversityChinese Evidence‐Based Medicine CentreNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Xueli Tang
- West China Hospital, Sichuan UniversityChinese Evidence‐Based Medicine CentreNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Qiang Yuan
- West China Hospital, Sichuan UniversityChinese Evidence‐Based Medicine CentreNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Lijing Deng
- West China Hospital, Sichuan UniversityIntensive Care UnitNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Xin Sun
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics1200 Main Street WestHamiltonONCanadaL8N 3Z5
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Japanese Guidelines for Nutrition Support Therapy in the Adult and Pediatric Critically Ill Patients. ACTA ACUST UNITED AC 2016. [DOI: 10.3918/jsicm.23.185] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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19
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Bein T, Bischoff M, Brückner U, Gebhardt K, Henzler D, Hermes C, Lewandowski K, Max M, Nothacker M, Staudinger T, Tryba M, Weber-Carstens S, Wrigge H. S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders : Revision 2015: S2e guideline of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI). Anaesthesist 2015; 64 Suppl 1:1-26. [PMID: 26335630 PMCID: PMC4712230 DOI: 10.1007/s00101-015-0071-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The German Society of Anesthesiology and Intensive Care Medicine (DGAI) commissioneda revision of the S2 guidelines on "positioning therapy for prophylaxis or therapy of pulmonary function disorders" from 2008. Because of the increasing clinical and scientificrelevance the guidelines were extended to include the issue of "early mobilization"and the following main topics are therefore included: use of positioning therapy and earlymobilization for prophylaxis and therapy of pulmonary function disorders, undesired effects and complications of positioning therapy and early mobilization as well as practical aspects of the use of positioning therapy and early mobilization. These guidelines are the result of a systematic literature search and the subsequent critical evaluation of the evidence with scientific methods. The methodological approach for the process of development of the guidelines followed the requirements of evidence-based medicine, as defined as the standard by the Association of the Scientific Medical Societies in Germany. Recently published articles after 2005 were examined with respect to positioning therapy and the recently accepted aspect of early mobilization incorporates all literature published up to June 2014.
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Affiliation(s)
- Th Bein
- Clinic for Anaesthesiology, University Hospital Regensburg, 93042, Regensburg, Germany.
| | - M Bischoff
- Clinic for Anaesthesiology, University Hospital Regensburg, 93042, Regensburg, Germany
| | - U Brückner
- Physiotherapy Department, Clinic Donaustauf, Centre for Pneumology, 93093, Donaustauf, Germany
| | - K Gebhardt
- Clinic for Anaesthesiology, University Hospital Regensburg, 93042, Regensburg, Germany
| | - D Henzler
- Clinic for Anaesthesiology, Surgical Intensive Care Medicine, Emergency Care Medicine, Pain Management, Klinikum Herford, 32049, Herford, Germany
| | - C Hermes
- HELIOS Clinic Siegburg, 53721, Siegburg, Germany
| | - K Lewandowski
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Management, Elisabeth Hospital Essen, 45138, Essen, Germany
| | - M Max
- Centre Hospitalier, Soins Intensifs Polyvalents, 1210, Luxembourg, Luxemburg
| | - M Nothacker
- Association of Scientific Medical Societies (AWMF), 35043, Marburg, Germany
| | - Th Staudinger
- University Hospital for Internal Medicine I, Medical University of Wien, General Hospital of Vienna, 1090, Vienna, Austria
| | - M Tryba
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Management, Klinikum Kassel, 34125, Kassel, Germany
| | - S Weber-Carstens
- Clinic for Anaesthesiology and Surgical Intensive Care Medicine, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, 13353, Berlin, Germany
| | - H Wrigge
- Clinic and Policlinic for Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig, 04103, Leipzig, Germany
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Cirillo F, Hinkelbein J, Romano GM, Piazza O, Servillo G, De Robertis E. Ventilator associated pneumonia and tracheostomy. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2015. [DOI: 10.1016/j.tacc.2015.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Bischoff P, Geffers C, Gastmeier P. [Hygiene measures in the intensive care station]. Med Klin Intensivmed Notfmed 2015; 109:627-39. [PMID: 25388301 DOI: 10.1007/s00063-014-0438-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Medical personnel in intensive care units (ICU) deal with critically ill patients and a high work load. Patients face a higher risk of acquiring a nosocomial infection during their ICU stay. Especially, invasively ventilated patients are threatened. A catheter-related bloodstream infection might even lead to more severe complications. The number of multiresistant pathogens continues to rise; thus, comprehensive infection control measures are crucial to avoid pathogen transmission and infection. The most important measure is hand disinfection. With a proper personnel-patient ratio, educational programs, and infection control bundles, it is possible to reduce infection rates and enhance compliance among health care workers.
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Affiliation(s)
- P Bischoff
- Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Deutschland,
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22
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Kallet RH. The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science. Respir Care 2015; 60:1495-508. [PMID: 26081180 PMCID: PMC9993769 DOI: 10.4187/respcare.03774] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ventilator-associated pneumonia (VAP) is an acquired infection related primarily to the consequences of prolonged endotracheal intubation. It is considered the most important infectious challenge in the critical care setting. Preventable complications of hospital care are considered an important source of wasted health-care costs believed to consume up to 47% of annual expenditures in the United States. Whether VAP is preventable has become a highly contentious debate since public reporting commenced a decade ago. This selective review focuses on specific aspects of this debate, including the inherent vagaries in the diagnosis of VAP and the marked disparities between VAP rates based on clinical diagnosis versus surveillance data. Also discussed is how this debate has impacted public policy, leading to the new paradigm of ventilator-associated events. The limited ability of artificial airways to prevent microaspiration and biofilm build-up, as well as non-modifiable conditions increasing the risk of VAP, is described in detail. In addition, the origins of the mistaken but widely embraced notion that zero VAP is a realistic achievement are examined.
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Affiliation(s)
- Richard H Kallet
- Respiratory Care Services, Department of Anesthesia, University of California, San Francisco at San Francisco General Hospital, San Francisco, California.
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23
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Llauradó-Serra M, Güell-Baró R, Lobo-Cívico A, Castanera-Duro A, Pi-Guerrero M, Piñol-Tena A, Paños-Espinosa C, Calpe-Damians N, Olona M, Sandiumenge A, Jiménez-Herrera MF. [Factors associated with compliance to the semi-recumbent position in the patient on mechanical ventilation: CAPCRI-Q questionnaire]. ENFERMERIA INTENSIVA 2015; 26:123-36. [PMID: 26395904 DOI: 10.1016/j.enfi.2015.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 06/12/2015] [Accepted: 07/05/2015] [Indexed: 10/23/2022]
Abstract
AIM To create a questionnaire (CAPCRI-Q) to determine the factors associated with the compliance of the semi-recumbent position in patients under mechanical ventilation. METHODS A closed questionnaire was created using a literature review and clinical practice. The initial version consisted of 61 items placed into 5 categories: patient factors, team and professionals factors, activity, educational and training factors, and equipment and resources. A Delphi method was used to prepare the questionnaire. Comprehension, relevance and importance of each item were evaluated, as well as the recommendations of experts. A qualitative pilot test with 9 healthcare professionals was performed, followed by a quantitative pilot test with 67 nurses from 6 intensive care units to test the internal consistency of the instrument. RESULTS Three rounds with 15 experts were required to reach a consensus. The final version of the questionnaire consisted of 36 items enclosed in the same categories as the initial version. The internal consistency analysis showed values greater than 0.800 for each independent item, each category, and for the global questionnaire (0.873; 95%CI: 0.825-0.913). The analysis of the nurses' responses emphasised the importance of the patient factors, as well as organisational and infra-structural factors, for the compliance of the recommendation. CONCLUSIONS The questionnaire created is reliable and appears to have content validity. The most influential factors for compliance are those related to the patient and the internal organisation. The results of the questionnaire can be used to evaluate the factors influencing the compliance and to establish improvement strategies.
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Affiliation(s)
- M Llauradó-Serra
- Departamento de Enfermería, Universitat Rovira i Virgili, Tarragona, España.
| | - R Güell-Baró
- Unidad de Cuidados Intensivos, Hospital Universitario Joan XXIII, Tarragona, España
| | - A Lobo-Cívico
- Unidad de Cuidados Intensivos, Hospital Universitario Doctor Josep Trueta, Girona, España
| | - A Castanera-Duro
- Unidad de Cuidados Intensivos, Hospital Universitario Doctor Josep Trueta, Girona, España; Departamento de Enfermería, Universitat de Girona, Girona, España
| | - M Pi-Guerrero
- Unidad de Cuidados Intensivos, Hospital de Sant Joan Despí Moissès Broggi, Sant Joan Despí, Barcelona, España
| | - A Piñol-Tena
- Unidad de Cuidados Intensivos, Hospital Universitario Verge de la Cinta, Tortosa, Tarragona, España
| | - C Paños-Espinosa
- Unidad de Cuidados Intensivos, Hospital de Sant Pau i Santa Tecla, Tarragona, España
| | - N Calpe-Damians
- Unidad de Cuidados Intensivos, IDCSalud Hospital General de Cataluña, Sant Cugat del Vallès, Barcelona, España
| | - M Olona
- Facultad de Medicina, Universitat Rovira i Virgili, Reus, Tarragona, España; Institut d'Investigació Sanitària Pere Virgili, Tarragona, España; Servicio de Medicina Preventiva y Epidemiología, Hospital Universitario Joan XXIII, Tarragona, España
| | - A Sandiumenge
- Unidad de Cuidados Intensivos, Hospital Universitario Joan XXIII, Tarragona, España; Facultad de Medicina, Universitat Rovira i Virgili, Reus, Tarragona, España; Institut d'Investigació Sanitària Pere Virgili, Tarragona, España
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Blot SI, Poelaert J, Kollef M. How to avoid microaspiration? A key element for the prevention of ventilator-associated pneumonia in intubated ICU patients. BMC Infect Dis 2014; 14:119. [PMID: 25430629 PMCID: PMC4289393 DOI: 10.1186/1471-2334-14-119] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 02/28/2014] [Indexed: 12/02/2022] Open
Abstract
Microaspiration of subglottic secretions through channels formed by folds in high volume-low pressure poly-vinyl chloride cuffs of endotracheal tubes is considered a significant pathogenic mechanism of ventilator-associated pneumonia (VAP). Therefore a series of prevention measures target the avoidance of microaspiration. However, although some of these can minimize microaspiration, benefits in terms of VAP prevention are not always obvious. Polyurethane-cuffed endotracheal tubes successfully reduce microaspiration but high quality data demonstrating VAP rate reduction are lacking. An analogous conclusion can be made regarding taper-shaped cuffs compared with classic barrel-shaped cuffs. More clinical data regarding these endotracheal tube designs are needed to demonstrate clinical value in addition to in vitro-based evidence. The clinical usefulness of endotracheal tubes developed for subglottic secretions drainage is established in multiple studies and confirmed by meta-analysis. Any change in cuff design will fail to prevent microaspiration if the cuff is insufficiently inflated. At least one well-designed trial demonstrated that continuous cuff pressure monitoring and control decrease the risk of VAP. Gel lubrication of the cuff prior to intubation temporarily hampers microaspiration through sludging the channels formed by folds in high volume-low pressure cuffs. As the beneficial effect of gel lubrication is temporarily, its potential to reduce VAP risk is probably nonsignificant. A minimum positive end-expiratory pressure of at least 5 cmH2O can be recommended as it reduces the risk of microaspiration in vitro and in vivo. One randomized controlled study demonstrated a reduced risk of VAP in patients ventilated with PEEP (5–8 cmH2O). Regarding head-of-bed elevation, it can be recommended to avoid supine positioning. Whether a 45° head-of-bed elevation is to be preferred above 25-30° head-of-bed elevation remains unproven. Finally, the routine monitoring of gastric residual volumes in mechanically ventilated patients receiving enteral nutrition cannot be recommended.
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Affiliation(s)
- Stijn I Blot
- Dept, of Internal Medicine, Faculty of Medicine & Health Sciences, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
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25
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Fitch ZW, Duquaine D, Ohkuma R, Schneider EB, Whitman GJR. Hospital Bed Type, the Electronic Medical Record, and Safe Bed Elevation in the Intensive Care Setting. Am J Med Qual 2014; 31:69-72. [DOI: 10.1177/1062860614556743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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26
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Llaurado-Serra M, Ulldemolins M, Güell-Baró R, Coloma-Gómez B, Alabart-Lorenzo X, López-Gil A, Bodí M, Rodriguez A, Jiménez-Herrera MF. Evaluation of head-of-bed elevation compliance in critically ill patients under mechanical ventilation in a polyvalent intensive care unit. Med Intensiva 2014; 39:329-36. [PMID: 25443331 DOI: 10.1016/j.medin.2014.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 07/25/2014] [Accepted: 07/28/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate head-of-bed elevation (HOBE) compliance in mechanically ventilated (MV) patients during different time periods, in order to identify factors that may influence compliance and to compare direct-observation compliance with checklist-reported compliance. DESIGN AND SETTING A prospective observational study was carried out in a polyvalent Intensive Care Unit. PATIENTS All consecutive patients with MV and no contraindication for semi-recumbency were studied. INTERVENTION AND VARIABLES HOBE was observed during four periods of one month each for one year, the first period being blinded. HOBE was measured with an electronic device three times daily. Main variables were HOBE, type of airway device, type of bed, nursing shift, day of the week and checklist-reported compliance. No patient characteristics were collected. RESULTS During the four periods, 2639 observations were collected. Global HOBE compliance was 24.0%, and the median angle head-of-bed elevation (M-HOBE) was 24.0° (IQR 18.8-30.0). HOBE compliance and M-HOBE by periods were as follows: blinded period: 13.8% and 21.1° (IQR 16.3-24.4); period 1: 25.5% and 24.3° (IQR 18.8-30.2); period 2: 22.7% and 24.4° (IQR 18.9-29.6); and period 3: 31.4% and 26.7° (IQR 21.3-32.6) (p<0.001). An overestimation of 50-60% was found when comparing self-reported compliance using a checklist versus direct-observation compliance (p<0.001). Multivariate logistic regression analysis found the presence of an endotracheal tube (ET) and bed without HOBE measuring device to be independently associated to greater compliance (p<0.05). CONCLUSIONS Although compliance increased significantly during the study period, it was still not optimal. Checklist-reported compliance significantly overestimated HOBE compliance. The presence of an ET and a bed without HOBE measuring device was associated to greater compliance.
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Affiliation(s)
- M Llaurado-Serra
- Institut d'investigació Sanitària Pere Virgili, Spain; Intensive Care Unit, University Hospital Joan XXIII, Tarragona, Spain; Nursing Department, Universitat Rovira i Virgili, Tarragona, Spain.
| | - M Ulldemolins
- Critical Care Department, Sabadell Hospital, University Institute Parc Taulí - Universitat Autònoma de Barcelona (UAB), Sabadell Spain; Fundació Clínic per la Recerca Biomèdica - Universitat de Barcelona (UB), Barcelona, Spain
| | - R Güell-Baró
- Intensive Care Unit, University Hospital Joan XXIII, Tarragona, Spain
| | - B Coloma-Gómez
- Intensive Care Unit, University Hospital Joan XXIII, Tarragona, Spain; Nursing Department, Universitat Rovira i Virgili, Tarragona, Spain
| | - X Alabart-Lorenzo
- Intensive Care Unit, University Hospital Joan XXIII, Tarragona, Spain
| | - A López-Gil
- Intensive Care Unit, University Hospital Joan XXIII, Tarragona, Spain
| | - M Bodí
- Institut d'investigació Sanitària Pere Virgili, Spain; Intensive Care Unit, University Hospital Joan XXIII, Tarragona, Spain; Medical school, Universitat Rovira i Virgili, Tarragona, Spain
| | - A Rodriguez
- Institut d'investigació Sanitària Pere Virgili, Spain; Intensive Care Unit, University Hospital Joan XXIII, Tarragona, Spain; Medical school, Universitat Rovira i Virgili, Tarragona, Spain
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27
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Análisis del cumplimiento de 2 medidas para prevenir la neumonía asociada a la ventilación mecánica (elevación de la cabecera y control del neumotaponamiento). ENFERMERIA INTENSIVA 2014; 25:125-30. [DOI: 10.1016/j.enfi.2014.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 03/23/2014] [Accepted: 03/25/2014] [Indexed: 11/23/2022]
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Holzer M. Therapeutic hypothermia following cardiac arrest. Best Pract Res Clin Anaesthesiol 2014; 27:335-46. [PMID: 24054512 DOI: 10.1016/j.bpa.2013.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 07/23/2013] [Indexed: 11/19/2022]
Abstract
More than 10 years ago, the randomised studies of therapeutic hypothermia after cardiac arrest showed significant improvement of neurological outcome and survival. Since then, it has become clear that most of the possible adverse events of therapeutic hypothermia are mild and can easily be controlled by proper administration of intensive care. Although implementation of this effective therapy is quite successful, many questions of the exact treatment protocol still remain unanswered. Therapeutic hypothermia treatment therefore must be tailored to the specific patient's needs. Hence, the exact level of target temperature, duration of cooling, rewarming, timing of the therapy and concomitant medication to facilitate therapeutic hypothermia will be important in the future. Additionally, the use of a post-resuscitation treatment bundle (specialised cardiac-arrest centres including intensive post-resuscitation care, appropriate haemodynamic and respiratory management, therapeutic hypothermia and percutaneous coronary intervention) could further improve treatment of cardiac arrest.
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Affiliation(s)
- Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
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29
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Kaier K, Lambert ML, Frank UK, Vach W, Wolkewitz M, Tacconelli E, Rello J, Theuretzbacher U, Martin M. Impact of availability of guidelines and active surveillance in reducing the incidence of ventilator-associated pneumonia in Europe and worldwide. BMC Infect Dis 2014; 14:199. [PMID: 24725914 PMCID: PMC4021349 DOI: 10.1186/1471-2334-14-199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 04/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To analyse whether the availability of written standards for management of mechanically ventilated patients and/or the existence of a surveillance system for cases of ventilation-associated pneumonia (VAP) are positively associated with compliance with 6 well-established VAP prevention measures. METHODS Ecological study based on responses to an online-questionnaire completed by 1730 critical care physicians. Replies were received from 77 different countries, of which the majority, i.e. 1351, came from 36 European countries. RESULTS On a cross-country level, compliance with VAP prevention measures is higher in countries with a large number of prevention standards and/or VAP surveillance systems in place at ICU level., Likewise, implementation of standards and VAP surveillance systems has a significant impact on self-reported total compliance with VAP prevention measures (both p < 0.001). Moreover, predictions of overall prevention measure compliance show the effect size of the availability of written standards and existence of surveillance system. For instance, a female physician with 10 years of experience in critical care working in a 15-bed ICU in France has a predicted baseline level of VAP prevention measure compliance of 63 per cent. This baseline level increases by 9.5 percentage points (p < 0.001) if a written clinical VAP prevention standard is available in the ICU, and by another 4 percentage points (p < 0.001) if complemented by a VAP surveillance system. CONCLUSIONS The existence of written standards for management of mechanically ventilated patients in an ICU and the availability of VAP surveillance systems have shown to be positively associated with compliance with VAP prevention measures and should be fostered on a policy level.
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Affiliation(s)
- Klaus Kaier
- Institute of Medical Biometry and Medical Informatics, University Medical Center, Freiburg, Germany.
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Abstract
The ventilator-associated pneumonia (VAP) bundle is a focus of many health care institutions. Many hospitals are conducting process-improvement projects in an attempt to improve VAP rates by implementing the bundle. However, this bundle is controversial in the literature, because the evidence supporting the VAP interventions is weak. In addition, definitions used for surveillance are interpreted differently than definitions used for clinical diagnosis. The variance in definitions has led to lower reported VAP rates, which may not be accurate. Because of the variance in definitions, the Centers for Disease Control and Prevention developed a ventilator-associated event algorithm. Health care institutions are under pressure to reduce the VAP infection rate, but correctly identifying VAP can be very challenging. This article reviews the current evidence related to VAP and provides insight into implementing a suggested revision of the care of patients being treated with mechanical ventilation.
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Affiliation(s)
- Nancy Munro
- Nancy Munro is Senior Acute Care Nurse Practitioner, National Institutes of Health, Critical Care Medicine Department/Pulmonary Consult Service, 10 Center Dr, Bldg 10-CRC, Room 3-3677, Bethesda, MD 20892 . Margaret Ruggiero is Acute Care Nurse Practitioner, National Institutes of Health, Critical Care Medicine Department/Pulmonary Consult Service, Bethesda, Maryland
| | - Margaret Ruggiero
- Nancy Munro is Senior Acute Care Nurse Practitioner, National Institutes of Health, Critical Care Medicine Department/Pulmonary Consult Service, 10 Center Dr, Bldg 10-CRC, Room 3-3677, Bethesda, MD 20892 . Margaret Ruggiero is Acute Care Nurse Practitioner, National Institutes of Health, Critical Care Medicine Department/Pulmonary Consult Service, Bethesda, Maryland
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Prävention der nosokomialen beatmungsassoziierten Pneumonie. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013. [DOI: 10.1007/s00103-013-1846-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Rawat N, Yang T, Speck K, Helzer J, Barenski C, Berenholtz S. An evaluation of ventilator-associated pneumonia process measure sampling strategies in a surgical ICU. Am J Med Qual 2013; 29:397-402. [PMID: 24061867 DOI: 10.1177/1062860613503707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ventilator-associated pneumonia (VAP) is common, lethal, and expensive. Little is known about optimal strategies to evaluate process measures for VAP prevention. The authors conducted a prospective study of different sampling strategies for evaluating head of bed (HOB) elevation and oral care. There was no significant difference between morning and evening shift HOB elevation compliance rates (P = .47). If oral care was performed at least once during a 12-hour shift, there was an 87% probability that it also was performed at least twice. If oral care was performed at least twice during a 12-hour shift, then there was a 93% probability that chlorhexidine oral care was performed at least once. The results of this study suggest that sampling HOB elevation twice as compared with once daily is unlikely to change the estimate of performance, oral care need not be frequently sampled, and high oral care compliance may predict chlorhexidine oral care compliance.
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Affiliation(s)
- Nishi Rawat
- Johns Hopkins Community Physicians, Columbia, MD Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ting Yang
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kathleen Speck
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Sean Berenholtz
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Metheny NA, Frantz RA. Head-of-Bed Elevation in Critically Ill Patients: A Review. Crit Care Nurse 2013; 33:53-66; quiz 67. [DOI: 10.4037/ccn2013456] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Clinicians are confused by conflicting guidelines about the use of head-of-bed elevation to prevent aspiration and pressure ulcers in critically ill patients. Research-based information in support of guidelines for head-of-bed elevation to prevent either condition is limited. However, positioning of the head of the bed has been studied more extensively for the prevention of aspiration than for the prevention of pressure ulcers, especially in critically ill patients. More research on pressure ulcers has been conducted in healthy persons or residents of nursing homes than in critically ill patients. Thus, the optimal elevation for the head of the bed to balance the risks for aspiration and pressure ulcers in critically ill patients who are receiving mechanical ventilation and tube feedings is unknown. Currently available information provides some indications of how to position patients; however, randomized controlled trials where both outcomes are evaluated simultaneously at various head-of-bed positions are needed.
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Affiliation(s)
- Norma A. Metheny
- Norma A. Metheny is a professor and Dorothy A. Votsmier Endowed Chair at Saint Louis University School of Nursing, St Louis, Missouri
| | - Rita A. Frantz
- Rita A. Frantz is Kelting Dean and professor at the University of Iowa College of Nursing in Iowa City
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Göcze I, Strenge F, Zeman F, Creutzenberg M, Graf BM, Schlitt HJ, Bein T. The effects of the semirecumbent position on hemodynamic status in patients on invasive mechanical ventilation: prospective randomized multivariable analysis. Crit Care 2013; 17:R80. [PMID: 23622019 PMCID: PMC4056784 DOI: 10.1186/cc12694] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 02/07/2013] [Accepted: 04/26/2013] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Adopting the 45° semirecumbent position in mechanically ventilated critically ill patients is recommended, as it has been shown to reduce the incidence of ventilator-associated pneumonia. Although the benefits to the respiratory system are clear, it is not known whether elevating the head of the bed results in hemodynamic instability. We examined the effect of head of bed elevation (HBE) on hemodynamic status and investigated the factors that influence mean arterial pressure (MAP) and central venous oxygen saturation (ScvO2) when patients were positioned at 0°, 30°, and 45°. METHODS Two hundred hemodynamically stable adults on invasive mechanical ventilation admitted to a multidisciplinary surgical intensive care unit were recruited. Patients' characteristics included catecholamine and sedative doses, the original angle of head of bed elevation (HBE), the level of positive end expiratory pressure (PEEP), duration and mode of mechanical ventilation. A sequence of HBE positions (0°, 30°, and 45°) was adopted in random order, and MAP and ScvO2 were measured at each position. Patients acted as their own controls. The influence of degree of HBE and of the covariables on MAP and ScvO2 was analyzed by using liner mixed models. Additionally, uni- and multivariable logistic regression models were used to indentify risk factors for hypotension during HBE, defined as MAP <65 mmHg. RESULTS Changing HBE from supine to 45° caused significant reductions in MAP (from 83.8 mmHg to 71.1 mmHg, P < 0.001) and ScvO2 (76.1% to 74.3%, P < 0.001). Multivariable modeling revealed that mode and duration of mechanical ventilation, the norepinephrine dose, and HBE had statistically significant influences. Pressure-controlled ventilation was the most influential risk factor for hypotension when HBE was 45° (odds ratio (OR) 2.33, 95% confidence interval (CI), 1.23 to 4.76, P = 0.017). CONCLUSIONS HBE to the 45° position is associated with significant decreases in MAP and ScvO2 in mechanically ventilated patients. Pressure-controlled ventilation, higher simplified acute physiology (SAPS II) score, sedation, high catecholamine, and PEEP requirements were identified as independent risk factors for hypotension after backrest elevation. Patients at risk may need positioning at 20° to 30° to overcome the negative effects of HBE, especially in the early phase of intensive care unit admission.
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Affiliation(s)
- Ivan Göcze
- Department of Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany
| | - Felix Strenge
- University of Regensburg, Universitätstrasse 31, D-93053 Regensburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany
| | - Marcus Creutzenberg
- Department of Anaesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany
| | - Bernhard M Graf
- Department of Anaesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany
| | - Hans J Schlitt
- Department of Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany
| | - Thomas Bein
- Department of Anaesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany
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Gandra S, Ellison RT. Modern trends in infection control practices in intensive care units. J Intensive Care Med 2013; 29:311-26. [PMID: 23753240 DOI: 10.1177/0885066613485215] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hospital-acquired infections (HAIs) are common in intensive care unit (ICU) patients and are associated with increased morbidity and mortality. There has been an increasing effort to prevent HAIs, and infection control practices are paramount in avoiding these complications. In the last several years, numerous developments have been seen in the infection prevention strategies in various health care settings. This article reviews the modern trends in infection control practices to prevent HAIs in ICUs with a focus on methods for monitoring hand hygiene, updates in isolation precautions, new methods for environmental cleaning, antimicrobial bathing, prevention of ventilator-associated pneumonia, central line-associated bloodstream infections, catheter-associated urinary tract infections, and Clostridium difficile infection.
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Affiliation(s)
- Sumanth Gandra
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Richard T Ellison
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
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Weavind LM, Saied N, Hall JD, Pandharipande PP. Care Bundles in the Adult ICU: Is It Evidence-Based Medicine? CURRENT ANESTHESIOLOGY REPORTS 2013. [DOI: 10.1007/s40140-013-0017-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Prävention nosokomialer Infektionen durch Bündel. Med Klin Intensivmed Notfmed 2013; 108:119-24. [DOI: 10.1007/s00063-012-0157-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 01/11/2013] [Indexed: 11/26/2022]
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38
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Prevention of Hospital-acquired Pressure Ulcers in the Operating Room and Beyond. Int Anesthesiol Clin 2013; 51:128-46. [DOI: 10.1097/aia.0b013e31826f2dcd] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Backrest position in prevention of pressure ulcers and ventilator-associated pneumonia: conflicting recommendations. Heart Lung 2012; 41:536-45. [PMID: 22819601 DOI: 10.1016/j.hrtlng.2012.05.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 05/17/2012] [Accepted: 05/19/2012] [Indexed: 01/09/2023]
Abstract
Pressure ulcers and ventilator-associated pneumonia (VAP) are both common in acute and critical care settings and are considerable sources of morbidity, mortality, and health care costs. To prevent pressure ulcers, guidelines limit bed backrest elevation to less than 30 degrees, whereas recommendations to reduce VAP include use of backrest elevations of 30 degrees or more. Although a variety of risk factors beyond patient position have been identified for both pressure ulcers and VAP, this article will focus on summarizing the major evidence for each of these apparently conflicting positioning strategies and discuss implications for practice in managing mechanically ventilated patients with risk factors for both pressure ulcers and VAP.
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Abstract
Ventilator-associated pneumonia (VAP) is among the most common infections in patients requiring endotracheal tubes with mechanical ventilation. Ventilator-associated pneumonia is associated with increased hospital costs, a greater number of days in the intensive care unit, longer duration of mechanical ventilation, and higher mortality. Despite widely accepted recommendations for interventions designed to reduce rates of VAP, few studies have assessed the ability of these interventions to improve patient outcomes. As the understanding of VAP advances and new technologies to reduce VAP become available, studies should directly assess patient outcomes before the health care community implements specific prevention approaches in clinical practice.
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Affiliation(s)
- Naomi P O'Grady
- Critical Care Medicine Department, National Institutes of Health, Bldg 10 Room 2C142, 10 Center Dr, MSC 1662, Bethesda, MD 20892, USA.
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Abstract
Ventilator-associated pneumonia (VAP) is the most frequent and severe infection acquired in the intensive care unit, leading to prolonged mechanical ventilation and excess mortality. This article reviews the different aspects of VAP, such as risk factors, causative agents, and approaches to diagnosis, treatment, and prevention. Several aspects of VAP are still considered controversial.
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Affiliation(s)
- Jean-Louis Trouillet
- Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris 6-Pierre et Marie Curie, Paris, France.
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42
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Preventing ventilator-associated pneumonia: is it ultimately only a matter of gravity? Intensive Care Med 2012; 38:539-41. [DOI: 10.1007/s00134-012-2496-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 12/20/2011] [Indexed: 10/28/2022]
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Abstract
Care bundles aim to improve standard of care and patient outcome by promoting the consistent implementation of a group of effective interventions. However, a variety of barriers prevent their full application in clinical practice. Here, we discuss some of the benefits and limitations of care bundles in the delivery of safer and more effective and consistent health care.
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Affiliation(s)
- Luigi Camporota
- Centre for Perioperative Medicine and Critical Care Research, Department of Anaesthesia and Intensive Care, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS, UK
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