Under- or overpressure: an audit of endotracheal cuff pressure monitoring at the tertiary care center

Background

Mechanical ventilation is a lifesaving intervention for critically ill patients but can produce the major complication of ventilator-associated pneumonia (VAP). Inappropriately inflated endotracheal tubes cause potential harm due to high or low pressure; this can be prevented through monitoring protocols.

Methods

A cross-sectional study of 348 cuff pressure readings was performed with intubated and mechanically ventilated patients to evaluate the exact proportion of patients in intensive care units (ICUs) where the cuff pressure is optimal and to identify the ICUs where device-based monitoring is available to produce a lower proportion of sub-optimal cuff pressure cases. Every three days, cuff pressure was assessed with a handheld cuff pressure manometer. The corresponding VAP rates of those ICUs were obtained from the hospital infection control department.

Results

Cuff pressure of 40.2% was the lower cutoff for the high category, that of optimal was 35.3%, and the highest cutoff of sub-optimal was 24.4%. This study also showed ICUs that had cuff pressure monitoring devices and protocols. Active measurement protocols had a higher proportion of optimal cuff pressure (58.5%) and a lower proportion of sub-optimal and high cuff pressure (19.5% and 22.0%) compared to ICUs with no device-based monitoring protocols. Furthermore, the VAP rate of ICUs exhibited a weak positive correlation with sub-optimal cuff pressure.

Conclusions

Device-based cuff pressure monitoring is essential in maintaining adequate cuff pressure but often is inadequate, resulting in high readings. Therefore, this study suggests that device-based cuff pressure monitoring be practiced.

Performance of 3 mL versus 5 mL Discarded Volume for Blood Sampling from Central Venous Access Device

Background  Central venous access devices (CVAD) are an essential part of safe practices in critical care, which enable effective venous access and help in avoiding repeated venipuncture. Discard method is widely practiced for blood sampling. A single occasion of blood sampling may cause minimal blood loss; however, the cumulative volume sequential sampling may become clinically significant. The study aims to reduce diagnostic blood loss, ensuring that the subsequent blood sample is not diluted or contaminated by residual intraluminal fluid. Patients and Methods  Within-subjects comparative design was adopted for 64 adult patients in the medical intensive care unit of a tertiary hospital. Two blood samples, using 3 mL and 5 mL discarded volume methods, were collected from each patient. Six serum parameters were measured on each of the paired samples and compared. Statistical Analysis Used  Paired t -test and Wilcoxon signed rank test were used for comparing the two methods. Bland-Altman plot analysis and intraclass correlation were used for clinically meaningful analysis. Results  When tested for fixed bias, there is no statistically significant difference between the methods. Potassium and creatinine levels showed significant proportional bias. The agreement limits of sodium, potassium, creatinine, and direct bilirubin were outside the clinically accepted interval, but the proportion of samples outside these intervals was less than 10%. All serum parameters showed excellent reliability, except for sodium which demonstrated good reliability. Conclusions  The practice of discarding 3 mL of blood for discard method is suggested, instead of the standard 5 mL to reduce iatrogenic blood loss. Thus, nurses in critical care are uniquely positioned to limit the diagnostic blood loss while obtaining blood samples.

Assessment of diabetic foot risk among diabetic patients in a tertiary care hospital, South India

INTRODUCTION

Foot problems are most common among patients with diabetes, and they are an important cause of morbidity in patients with diabetes mellitus (DM). They can be prevented by following a simple foot care practice. The study objective was to stratify the level of risk for diabetic foot ulcer (DFU) among patients with diabetes by screening.

MATERIALS AND METHODS

A descriptive cross-sectional study design was adopted in this study. The sample size was 196, and a standardized INLOW'S 60-s diabetic foot screening tool was used to assess the risk of diabetic foot. Data collection was done by face-to-face interview, and diabetic foot risk (DFR) was assessed by direct observation, inspection, and palpation methods.

RESULTS

Among the 196 patients, majority required yearly foot screen in both feet. The mean and standard deviation of the level of DFR in the left foot (LF) and right foot (RF) was 4.31 ± 2.267 and 4.51 ± 2.391, respectively. There was a statistically significant association between the practice of treatment and level of foot screening recommendation in the LF with Chi-square value of χ²= 8.20 (df = 2) and RF with Chi-square value of χ²= 7.95 (df = 2) at P < 0.05 level.

CONCLUSION

Health-care providers should be made aware of the regular practice of screening the foot of diabetic patients along with health education awareness programs. It may be helpful to identify the foot ulcer risk at an early stage. It will prevent further complications of DFU and recurrence of ulcer and will reduce the economic burden to patients and their family members and the health-care system.

Effect of alternate nostril breathing exercise on blood pressure, heart rate, and rate pressure product among patients with hypertension in JIPMER, Puducherry

INTRODUCTION

Hypertension has a direct relationship with the circulation, respiration, and function of vital organs. Similarly, complementary therapy such as alternate nostril breathing exercise has a direct effect on mental and physical health.

MATERIALS AND METHODS

This is a quantitative experimental research with randomized controlled trial design. A total of 170 and 85 individuals were allotted to each group. Patients in the study group were instructed alternate nostril breathing exercise two times a day (10 min duration of exercise each time) for 5 days along with routine treatment, and patients in the control group underwent routine treatment.

RESULTS

There was a marked reduction in systolic blood pressure (BP), diastolic BP, heart rate, and rate pressure product after the continuous 5-day alternate nostril breathing exercise in the study group. P < 0.0001 demonstrated a statistically significant difference in systolic BP, diastolic BP, heart rate, and rate pressure product that existed pre- and post-assessment on 1^st day and 5^th day.

CONCLUSION

It can be concluded that regular simple alternate nostril breathing exercise effectively reduces hypertension.