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Anaesthesia 2002 Sep;57(9):927-8
Publication Types:
PMID: 12240607, UI: 22224955
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Anaesthesia 2002 Sep;57(9):843-4
PMID: 12190746, UI: 22178139
Intensive Care Med 2002 Oct;28(10):1475-82
Department of Anesthesiology and Intensive Care Medicine, University Hospital Charite, Charite Campus Mitte, Schumannstrasse 20/21, 10117 Berlin, Germany.
[Medline record in process]
OBJECTIVE. Alcohol withdrawal syndrome (AWS) is a serious complication during postoperative treatment in chronic alcoholics. Despite prophylactic treatment, AWS occurs in at least 25% of these patients after elective surgery. An established protocol for the prevention of AWS is ethanol administration. The aim of this study was to evaluate possible differences in ethanol dose and levels between successfully treated patients and those who developed AWS. DESIGN. Prospective, observational study with retrospective post hoc analysis. SETTING. Intensive care unit (ICU). PATIENTS. Thirty-two alcohol-dependent patients undergoing elective or emergency surgery after trauma with postoperative admission to ICU. INTERVENTIONS. Continuous postoperative i.v. ethanol substitution. MEASUREMENTS AND RESULTS. Despite treatment, 13 patients developed AWS (failure group) and therapy was successful in the other 19 patients (success group). Major complications occurred more frequently in the failure group. The total dose of ethanol treatment and ethanol levels did not differ between the groups. Ethanol levels were determined in whole arterial blood (aBAC) and simultaneously taken in venous blood (vBAC), urine (UAC) and exhaled air (EAC). The following bias and precision, compared with aBAC, were found: vBAC less than UAC less than EAC. CONCLUSIONS. There is a high failure rate for i.v. ethanol prophylaxis. None of the methods to determine alcohol concentration were sufficient to monitor suitable ethanol treatment. It therefore seems to be more useful to titrate the individual dose for each patient by closer monitoring of the clinical status, adding additional therapy to counteract AWS if higher ethanol doses are required.
PMID: 12373474, UI: 22260230
Intensive Care Med 2002 Oct;28(10):1453-61
Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care, General Hospital Vienna, Waehringergurtel 18-20, 1090 Vienna, Austria.
OBJECTIVE. To determine associations between intensive care resource utilisation and centre-, patient- and procedure-related factors. DESIGN. Prospective multicentre cohort study. SETTING. Twenty-one European intensive care units. PATIENTS AND PARTICIPANTS. Four thousand four hundred adult patients who had undergone cardiac or thoracic aortic surgery in 21 centres. INTERVENTION. None (observational study). MEASUREMENTS AND RESULTS. Primary outcomes were duration of artificial ventilation and intensive care unit (ICU) length of stay. Exposures were centres and patient- and procedure-related factors. Both outcomes varied fourfold among centres. Median time to extubation varied from 5 to 19 h and ICU length of stay varied from 22 to 91 h. Cox regression analysis was performed to adjust risks of prolonged ventilation and ICU length of stay for patient-, procedure- and centre-related factors. Patient- and procedure-related factors were the main risk factors among individual patients, accounting for nearly two thirds of the risk of prolonged ventilation and ICU length of stay. Centre-related variation accounted for the remaining risk. CONCLUSIONS. In European ICUs resource utilisation is highly variable after cardiac surgery. Up to two thirds more patients could be treated with current ICU resources if the most efficient strategies and structures were applied across all centres.
PMID: 12373471, UI: 22260227
Intensive Care Med 2002 Oct;28(10):1440-6
Department of Anesthesiology, Emergency, and Intensive Care Medicine, University Hospital Gottingen, Robert-Koch-Strasse 40, 37070 Gottingen, Germany, omoerer@gwdg.de
OBJECTIVE. To determine the direct costs of severe sepsis patients in German intensive care units (ICUs). DESIGN. Retrospective electronic data analysis. SETTING. Three adult intensive care units (surgical/medical) in three university hospitals in Germany. PATIENTS. 385 patients identified by standard definitions as suffering from severe sepsis. MEASUREMENTS AND RESULTS. A bottom-up approach was used to determine the direct ICU cost on actual resource use (medication, laboratory tests, microbiological analysis, disposables, and clinical procedures) for patients with severe sepsis. To determine the total direct costs, center-specific personnel and basic bed ("hotel") costs were added to total resources consumed. Average hospital mortality of severely septic patients was 42.6%. Mean ICU length of stay (LOS) was 16.6 days. Survivors stayed on average 4 days longer than nonsurvivors. The mean direct ICU costs of care were 23,297+/-18,631 euros per patient and 1,318 euros per day. In comparison, average daily charges being paid for an ICU patient by the health care system in Germany are 851 euros (based on official statistics). Nonsurvivors were more expensive than survivors in total direct costs (25,446 vs. 21,984 euros) and in per day direct cost (1,649 vs. 1,162 euros). Medication makes up the largest part of the direct costs, followed by expenses for personnel. CONCLUSIONS. Patients with severe sepsis have a high ICU mortality rate and long ICU LOS and are substantially expensive to treat. Nonsurviving septic patients are more costly than survivors despite shorter ICU LOS. This is due to higher medication costs indicating increased efforts to keep patients alive.
PMID: 12373469, UI: 22260225
Intensive Care Med 2002 Oct;28(10):1411-8
Service de Reanimation Medicale et Assistance Respiratoire, Hopital de la Croix Rousse, 103 grande rue de la croix rousse, 69317 Lyon, France, claude.guerin@chu-lyon.fr
OBJECTIVES. To describe the current practice of hemodialysis in acute renal failure (ARF) and to estimate the impact of hemodialysis modality on patient outcome. DESIGN. Prospective multicenter observational study conducted from March 1996 to May 1997. SETTING. The 28 multidisciplinary ICUs in the Rhone-Alpes region in France. PATIENTS. The 587 patients who required hemodialysis. MEASUREMENTS AND RESULTS. Patients were followed until hospital discharge. Among the 587 patients 354 received continuous (CRRT) and 233 intermittent (IRRT) renal replacement therapy as first choice. CRRT patients had a higher number of organ dysfunctions on admission and at the time of ARF and higher SAPS II at time of ARF. Mortality was 79% in the CRRT group and 59% in the IRRT group. Logistic regression analysis showed decreased patient survival to be associated with SAPS II on admission, oliguria, admission from hospital or emergency room, number of days between admission and ARF, cardiac dysfunction at time of ARF, and ischemic ARF. No underlying disease or nonfatal disease, and absence of hepatic dysfunction were associated with an increase in patient survival. The type of renal replacement therapy was not significantly associated with outcome. CONCLUSIONS. Renal replacement therapy mode was not found to have any prognostic value. Randomized controlled trials should be undertaken to assess this important question.
PMID: 12373465, UI: 22260221
Intensive Care Med 2002 Oct;28(10):1389-94
Surgical Intensive Care Unit, Brest Teaching Hospital, Hopital de la Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest cedex, France, philippe.quinio@chu-brest.fr
OBJECTIVE. To determine the visiting policies of French intensive care units. DESIGN AND SETTING. Descriptive study in intensive care units. METHODS. A questionnaire on their official visiting policies was sent to 200 French ICUs. RESULTS. Ninety-five ICUs completed the questionnaire (47.5%). Ninety-two (97%) ICUs reported restricted visiting-hour policies, allowing visits at only one or several preassigned times. Mean total daily visiting time was 168 min (range 30-370). The number of visitors was restricted in 90 ICUs (95%). The type of visitors (immediate relatives only) was restricted in 57 (60%). Visiting was forbidden for children in 10 (11%), and 41 (44%) fixed an age limit for visiting. A gowning procedure was imposed on visitors in 78 (82%). Eighteen (19%) ICUs had no waiting room available, 35 (37%) used a special room for providing families with information in addition to the waiting room, 61 (64%) provided an information leaflet. A structured first meeting was organized in 68 (71%). A last structured family meeting at the ICU discharge was provided in 6 (6%). CONCLUSIONS. Responding ICUs provide homogeneously restrictive visiting policies concerning visiting hours, number and type of visitors. However, family reception cannot be reduced to some quantitative factors and depends on multiple other parameters such as the organization of family meetings and the use of an information leaflet. These results should be an interesting starting point to observe any change in mentalities and practices in the future.
PMID: 12373462, UI: 22260218
Intensive Care Med 2002 Oct;28(10):1379-88
Department of Surgery, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands, bpja.keller@hccnet.nl
OBJECTIVE. Review of the literature concerning pressure ulcers in the intensive care setting. DATA SOURCE AND STUDY SELECTIONS. Computerized databases (Medline from 1980 until 1999 and CINAHL from 1982 until 1999). The indexing terms for article retrieval were: "pressure ulcers", "pressure sores", "decubitus", and "intensive care". Nineteen articles met the selection criteria, and seven more were found from the references of these articles. One thesis was also analyzed. RESULTS. Data on prevention, incidence, and costs of pressure ulcers in ICU patients are scarce. Overall there are no conclusive studies on the identification of pressure ulcer risk factors. None of the existing risk-assessment scales was developed especially for use in ICU patients. It is highly questionable to what extent these scales can be used in this setting as they are not even reliable in "standard care". The following risk factors might play a role in pressure ulcer development: duration of surgery and number of operations, fecal incontinence and/or diarrhea, low preoperative protein and albumin concentrations, disturbed sensory perception, moisture of the skin, impaired circulation, use of inotropic drugs, diabetes mellitus, too unstable to turn, decreased mobility, and high APACHE II score. The number of patients per study ranged from 5 from 638. The definition of "pressure ulcer" varied widely between authors or was not mentioned. CONCLUSIONS. Meaningful comparison cannot be made between the various studies because of the use of different grading systems for pressure ulcers, different methods of data collection, different (or lack of) population characteristics, unreported preventive measures, and the use of different inclusion and exclusion criteria. There is a need for well-conducted studies covering all these aspects.
PMID: 12373461, UI: 22260217
Intensive Care Med 2002 Jun;28(6):701-4
Emergency Medical Service - Prehospital unit, Ljubljanska 5, Maribor 2000, Slovenia. grmec-mis@siol.net
OBJECTIVES: Verification of endotracheal tube placement is of vital importance, since unrecognized esophageal intubation can be rapidly fatal (death, brain damage).The aim of our study was to compare three different methods for immediate confirmation of tube placement: auscultation, capnometry and capnography in emergency conditions in the prehospital setting. DESIGN AND SETTING: Prospective study in the prehospital setting. PATIENTS AND INTERVENTIONS: All adult patients (>18 years) were intubated by an emergency physician in the field. Tube position was initially evaluated by auscultation. Then, capnometry was performed with infrared capnometry and capnography with infrared capnography. The examiners looked for the characteristic CO(2) waveform and value of end-tidal carbon dioxide (EtCO(2)) in millimeters of mercury. Determination of final tube placement was performed by a second direct visualization with laryngoscope. Data are mean +/- SD and percentages. MEASUREMENTS AND RESULTS: Over a 4year period, 345 patients requiring emergency intubation were included. Indications for intubation included cardiac arrest ( n=246; 71%) and non-arrest conditions ( n=99; 29%). In nine (2.7%) patients, esophageal tube placement occurred. The esophageal intubations were followed by successful endotracheal intubations without complications. The capnometry (sensitivity and specificity 100%) and capnography (sensitivity and specificity 100%) were better than auscultation (sensitivity 94% and specificity 83%) in confirming endotracheal tube placement in non-arrest patients ( p<0.05). Capnometry was highly specific (100%) but not sensitive (88%) for correct endotracheal intubation in patients with cardiopulmonary arrest (capnometry versus auscultation and capnometry versus capnography, p<0.05). CONCLUSION: Capnography is the most reliable method to confirm endotracheal tube placement in emergency conditions in the prehospital setting.
PMID: 12107674, UI: 22102944
Intensive Care Med 2002 Jun;28(6):680-5
Faculty of Economic, Social and Political Sciences, Microeconomics of the profit and non-profit sectors, Free University Brussels (VUB), Pleinlaan 2, 1050 Brussels, Belgium. Marc.Jegers@vub.ac.be
OBJECTIVE: To define the different types of costs incurred in the care of critically ill patients and to describe some of the most commonly used methods for measuring and allocating these costs. DESIGN: Literature review. Definitions for opportunity, direct and indirect, fixed, variable, marginal, and total costs are described and interpreted in the context of the critical care setting. Two main methods of costing are described: the 'top-down' and 'bottom-up' methods together with a number of cost proxies, such as the use of weighted hospital days, diagnosis-related groups, severity and activity scores, and effective costs per survivor. CONCLUSIONS: The assessment and allocation of costs to critically ill patients is complex and as a result of the different definitions and methods used, meaningful comparisons between studies are plagued with difficulty. When undertaking a study looking to measure costs, it is important to state: (a) the aim of the cost assessment study; (b) the perspective (point of view); (c) the type of costs that need to be measured; and (d) the time span of assessment. By being explicit about the rationale of the study and the methods used, it is hoped that the results of economic evaluations will be better understood, and hence implemented within the critical care setting.
PMID: 12107670, UI: 22102940
Intensive Care Med 2002 Jun;28(6):667-79
Division of Pulmonary, Critical Care, and Occupational Medicine, Departments of Internal Medicine and Pharmacological and Physiological Science, School of Medicine, Saint Louis University, 3635 Vista Ave., Saint Louis, MO 63110-0250, USA.
PMID: 12107669, UI: 22102939
J Hosp Infect 2002 Sep;52(1):72
Burnley General Hospital, UK
PMID: 12372331, UI: 22260366
J Hosp Infect 2002 Sep;52(1):56
Cliniques Universitaires Saint-Luc, Universite catholique de Louvain, 10 avenue Hippocrate, 1200, Brussels, Belgium
In the 42-bed intensive care department of a teaching hospital, the creation of a full-time infection control nurse post was followed by a 42% reduction in device-related hospital-acquired infection rates over a period of three years, and 33% reduction over a period of five years. Permanent surveillance accompanied by revision of procedures and bedside teaching were key factors in the improvement of quality of care. In the specific setting of an intensive care department, this study validates the previous conclusions reached in the SENIC study and emphasizes the essential role played by the infection control nurse in the care of critically ill patients.
PMID: 12372327, UI: 22260362
J Hosp Infect 2002 Sep;52(1):43
Departement de Microbiologie Medicale et Moleculaire, EA 3250, Unite de Bacteriologie, Faculte de Medecine, Tours, France
The exact origin of strains of Escherichia coli responsible for infectious diseases in intensive care units (ICUs) remains partly unknown. Our aim was to determine the nature of the link between strains from the intestinal flora of hospital staff, strains from the intestinal flora of patients hospitalized in ICUs and strains isolated from ICU patients with invasive diseases. For this purpose, 77 strains of E. coli were genetically characterized by exploring their entire genomes by random amplified polymorphism of DNA (RAPD), and by determining their phylogenetic position in ECOR (E. coli reference) groups, the virulence factors harboured (pap, sfa, afa, hly, aer and cnf) and their ability to mutate. The strains isolated from the intestinal flora of hospital staff were found to constitute a genetically heterogeneous population compared with the strains isolated from ICU carriers, which were highly clustered. The latter strains harboured numerous virulence factors, and 80% belonged to the group ECOR B2. The strains isolated from infected patients harboured fewer virulence factors than those from the ICU carriers, and only half belonged to ECOR B2. Moreover, these strains were more genetically related to strains from hospital staff than to strains from ICU carriers. Thus, the exogenous origin of the E. coli strains is probably almost as important as translocation from intestinal flora in ICUs. Moreover, a strong mutator phenotype had a minor, or no, role in the rapid adaptation to modifications in the ecological environment.
PMID: 12372325, UI: 22260360
J Trauma 2002 Sep;53(3):593-601
Department of Surgery, Regions Hospital, St. Paul, Minnesota 55101, USA.
PMID: 12352506, UI: 22239432
J Trauma 2002 Sep;53(3):477-82
Department of Emergency Medicine and Trauma, St George Hospital, Kogarah, New South Wales, Australia. curtisk@sesahs.nsw.gov.au
BACKGROUND: Previous investigations demonstrate that nursing case management in the acute care setting improves patient outcomes. However, these findings provide limited information specific to trauma patients. METHOD: The effect of trauma case management (TCM) was measured using practice-specific variables such as in-hospital complications, missed injury rates, and length of stay. Other measures included staff satisfaction and use of allied health services. Data from 148 patients with an Injury Severity Score < 16 in the 5 months after the introduction of TCM were compared with 327 patients from the previous 12 months. RESULTS: Results demonstrated a trend toward reduced length of stay overall, more so in the older and more severely injured. TCM greatly improved missed injury detection rates (p < 0.0015) and coordinated allied health use more efficiently (p < 0.0001). Staff surveys exhibited a perceived dramatic improvement in the effectiveness of patient care (p < 0.0001). CONCLUSION: The introduction of TCM improved the efficiency and effectiveness of trauma patient care in our institution.
PMID: 12352484, UI: 22239410
J Trauma 2002 Sep;53(3):442-5; discussion 445
Department of Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywook, Illinois 60153, USA. jsantan@lumc.edu
BACKGROUND: Patients with blunt aortic injury (BAI) often have concomitant liver or spleen (L/S) injuries. With increasing use of cardiopulmonary bypass with heparinization in repair of BAI, many advocate operative management of the L/S injury before aortic repair to eliminate risk of hemorrhage. We evaluated the safety of nonoperative management (NOM) of blunt L/S injuries in patients undergoing acute BAI repair with bypass. METHODS: All patients admitted over a 6-year period with BAI were identified from the registry of our Level I trauma center. Patients with isolated L/S injuries without BAI admitted over the same period served as controls. Groups were compared with regard to demographics, injury characteristics, hospital course, and mortality. RESULTS: Eighty-four patients were diagnosed with BAI from 1994 to 2000; 28 (33%) also had blunt abdominal trauma. Three patients with severe brain injury did not undergo BAI repair, and five required laparotomy before BAI repair for other intra-abdominal injuries (two for hemodynamic instability with splenic injury, and three for concomitant bowel injury). Therefore, 20 of 28 (71.4%) BAI patients with grade I or II L/S injury (Aorta L/S group) underwent planned NOM. All BAIs were repaired using partial bypass with full heparinization. These 20 patients are compared with 894 patients with grade I or II L/S injuries with no BAI (L/S group) over the same time period. There was no difference in the nonoperative failure rate of the Aorta L/S group versus the L/S group (0% vs. 1.7%). Both groups had similar complication rates. The Aorta L/S group was also compared with 56 BAIs without solid organ injury (Aorta group). Although the Aorta L/S group was more severely injured than the Aorta group (Injury Severity Score of 35.3 vs. 26.8, < 0.0001), transfusion rates (5.7 U of packed red blood cells vs. 8.0 U of packed red blood cells, p = NS), hospital days (17.9 vs. 19.1, p = NS) and mortality (10% vs. 9%, p = NS) were similar. CONCLUSION: NOM of patients with grade I or II L/S injury who undergo systemic anticoagulation with heparin for repair of BAI is safe and associated with transfusion rates similar to BAI alone. Patients with low-grade liver or spleen injuries do not require laparotomy before BAI repair using partial bypass.
PMID: 12352478, UI: 22239404
J Trauma 2002 Sep;53(3):430-4; discussion 434-5
Department of General Surgery, F. H. Sammy Ross Jr. Trauma Center, Carolinas Medical Center, Charlotte, North Carolina 28232, USA.
BACKGROUND: Recent data suggest that sex hormones may play a role in regulating posttraumatic immunosuppression, leading to gender-based differences in outcome after injuries. This study examined gender-related outcomes in trauma patients. METHODS: We conducted a retrospective review of trauma registry data from our Level I trauma center over a 4-year period. Patients > 15 years of age, with Injury Severity Scores > 15, who survived and received mechanical ventilation for > 48 hours were included. Patients were divided into two groups on the basis of age (15-45 years and > 45 years) and the groups were further stratified by gender. Groups were matched by Injury Severity Scores, Glasgow Coma Scale score, Abbreviated Injury Score for the head, and transfusion requirement. Gender-based outcomes consisted of ventilator days, intensive care unit length of stay (LOS), hospital LOS, pneumonia, and death. RESULTS: Data were reported as mean +/- SD. There were 612 patients. In the younger age group, male patients had a higher incidence of multiple organ failure (10.5% vs. 1.5%), longer intensive care unit (13.5 +/- 9.2 days vs. 9.2 +/- 7.2 days) and hospital LOS (30.2 +/- 37.7 days vs. 18.9 +/- 13.0 days), and higher mortality (13.4% vs. 6.8%) compared with female patients (p < 0.05 for all). These differences did not exist in the older age group. The incidence of pneumonia did not differ by gender. Age > 45 years was associated with higher mortality (odds ratio, 2.0; 95% confidence interval, 1.1-3.5). CONCLUSION: Although the incidence of pneumonia was not influenced by gender, female trauma patients had better outcomes than male patients in the younger age group. Outcome in the older age group was not gender-related. Our data support a gender-based difference in outcome after traumatic injuries in younger patients.
PMID: 12352476, UI: 22239402
J Trauma 2002 Sep;53(3):422-5
Division of Trauma Services, East Texas Medical Center, Tyler, USA.
BACKGROUND: Early enteral feeding has been shown to be beneficial in improving outcome in critically injured trauma patients. Delayed gastric emptying occurs frequently in trauma patients, increasing the time to achieve nutritional goals, and limiting the benefit of early enteral feedings. Intravenous erythromycin is an effective agent for improving gastric motility in diabetics and postgastrectomy patients. The purpose of this study is to determine the effectiveness of erythromycin for improving gastric motility in critically injured trauma patients. METHODS: All critically injured patients who received gastric feedings within 72 hours of admission were candidates for the study. Those patients who failed to tolerate feedings at 48 hours (gastric residual > 150 mL) were eligible for enrollment. Patients were prospectively assigned to two treatment groups by randomization to receive either erythromycin (ERY) or placebo (PLA). Treatment was continued in patients who tolerated gastric feedings until the feedings were no longer required. Patients with continued intolerance for 48 hours after randomization were considered failures of therapy and given metoclopramide. RESULTS: Sixty-eight patients were enrolled and were well matched for age, sex, and Injury Severity Score. Mortality, intensive care unit length of stay, hospital length of stay, number of ventilator days, and rate of nosocomial infections were similar in each group. There was a significant difference between the ERY group and the PLA group in the amount of feedings tolerated at 48 hours (58% vs. 44%, p = 0.001). There was no difference in the amount of feedings tolerated (as a percentage of target goal volume) throughout the entire duration of the study (ERY [65% of target] vs. PLA [59%], p = 0.061). Overall success of therapy at 48 hours was 56% in the ERY group versus 39% in the PLA group, but this also did not reach statistical significance (p = 0.22). CONCLUSION: Intravenous erythromycin improves gastric motility and enhances early nutritional intake in critically injured patients.
PMID: 12352474, UI: 22239400
Nurs Crit Care 2002 Jul-Aug;7(4):198-202
Multiple Injuries Unit, North Staffordshire Hospitals NHS Trust, Stoke-on-Trent, Staffordshire. stephen.casbolt@nstaffsh.wmids.nhs.uk
This review will directly examine the role of the intensive care nurse as a communicator in the provision of holistic nursing care to the ventilated patient Frequent occurrences of breakdown in the process of communication are identified In many cases nurse communication with the patient is only on a task-orientated basis A lack of effective communication may be attributable to psychological problems related to 'ITU syndrome' The critical care nurse is at the forefront in the delivery of a first class National Health Service and a breakdown in communication between the nurse and their patient can be perceived as poor nursing care.
PMID: 12238712, UI: 22223466
Nurs Crit Care 2002 Jul-Aug;7(4):193-7
Addenbrooke's NHS Trust, Cambridge. diana.kingston@addenbrookes.nhs.uk
A patient group direction (PGD) is a specific written instruction for the supply or administration of named medicines in an identified clinical situation The introduction of a PGD must demonstrate a benefit for patients Haemofiltration is widely accepted as the treatment of choice when caring for critically ill patients in acute renal failure on an intensive care unit The haemofiltration PGD improves patient care by providing standardisation in administration of fluids and electrolytes and enabling nurses to respond rapidly to changes in biochemistry during haemofiltration This paper describes the development and implementation of a protocol to enable nurses to administer haemofiltration fluids and electrolytes under a patient group direction.
PMID: 12238711, UI: 22223465
Nurs Crit Care 2002 Jul-Aug;7(4):171-5
Faculty of Nursing and Health, Griffith University, Bundall, Queensland, Australia. W.Chaboyer@mailbox.gu.edu.au
Intensive care unit (ICU) transition programmes and discharge liaison nurse roles have emerged because the move from the ICU to the general wards has been found to be problematic for patients, their families and even health care professionals As these programmes are costly, it is essential that they are delivered to those for whom positive outcomes are most likely to be achieved. This paper reports on the use of the Blaylock Risk Assessment Screening Score (BRASS) to identify ICU patients who are at risk of complex hospital discharge needs Use of BRASS at admission was not particularly specific: that is, it was not able to identify consistently those at risk of prolonged ICU and hospital stay and ICU readmission. BRASS was fairly sensitive, correctly identifying over 95% of individuals who did not have a prolonged hospital stay BRASS is easy to use, but may be no better than severity of illness scoring systems in identifying ICU patients who potentially have complex hospital discharge planning needs; if used, it should not be completed on ICU admission alone.
PMID: 12238708, UI: 22223462
Nurs Crit Care 2002 Jul-Aug;7(4):161-2
PMID: 12238706, UI: 22223460
Nurs Crit Care 2002 May-Jun;7(3):144-51
ECMO Department, Glenfield Hospital, Groby Road, Leicester, LE3 9QP. samantha.harris@uhl-tr.nhs.uk
It was observed in practice that the withdrawal of extracorporeal membrane oxygenation (ECMO) was the cause of much ethical and moral discussion amongst nurses within the ITU where the study took place. No previous literature was located addressing the withdrawal of ECMO, from either a medical or nursing perspective. A grounded theory study was conducted to explore the experiences of nurses involved with the withdrawal of ECMO, focusing specifically on the withdrawal of this treatment from adult patients. Three major themes emerged: justification for withdrawal of treatment. the role of the nurse in decision-making. the involvement of others in decision-making. The core category that links the three categories is 'facilitating the decision making process' Recommendations for future practice included, the introduction of regular formal meetings and debriefing, and for further research to be conducted to explore 'corporeal anxiety' and the involvement of relatives in decision making.
PMID: 12226950, UI: 22214931
Nurs Crit Care 2002 May-Jun;7(3):132-5
Royal Berkshire and Battle Hospitals NHS Trust, London Rd, Reading, Berkshire RG1 5AN. mandy.odell@rbbh-tr.nhs.uk
The implementation and evaluation of a modified early warning system (MEWS) on surgical wards are described. The MEWS was found to be a useful adjunct to the outreach service. Early data have shown that MEWS can help direct critical intervention. Ward staff have benefit from both the MEWS and the outreach service.
PMID: 12226948, UI: 22214929
Nurs Crit Care 2002 May-Jun;7(3):126-31
Nottingham City Hospital NHS Trust/University of Nottingham, School of Nursing, Hucknall Road, Nottingham NG5 1PB. sharon.coad@nottingham.ac.uk
Clinical education for acute ward staff caring for critically ill patients has continued to be a strong focus for practice development. Adopting a work-based learning approach to empower ward staff has led to the development of a five-day competency-based high dependency skills course. Developing leadership potential and enhancing networking opportunities for nurses from within critical care and ward areas is essential for the realisation of the aims of Comprehensive Critical Care.
PMID: 12226947, UI: 22214928
Nurs Crit Care 2002 May-Jun;7(3):121-5
School of Health and Social Care, University of Greenwich, Mansion Site, Bexley Road, Eltham SE9 6PQ. L.Thorne@gre.ac.uk
An account of collaborative working between an NHS trust and university in responding to the critical care agenda. An 'Introduction to Critical Care Skills' course initiative, which addresses the needs of nurses caring for level 1 and 2 patients in ward areas, is discussed. Work-based learning forms the focus of skills development using core competencies related to a holistic approach to caring for patients with complex needs. A dynamic evolving process of course development is promoting quality care for patients and closely reflects the needs of those caring for acutely ill patients outside the designated critical care environment.
PMID: 12226946, UI: 22214927
Nurs Crit Care 2002 May-Jun;7(3):111-20
University College London Hospitals NHS Trust, Department of Intensive Care, Middlesex Hospital, Mortimer Street, London W1T 3AA. michaela.jones@uclh.org
In the absence of nationally accepted critical care competencies, each educational institution providing critical care programmes is forced to define the essential competencies necessary for practice, leading to variations in expected practice and the emergence of 'postcode' competencies. This research report aims to build upon competency activity for all areas of nursing practice within critical care levels 1, 2 and 3. A functional analysis to elicit core critical care competency statements was conducted and a modified Delphi technique was used to generate consensus opinion from a pan-London purposive sample of nurses working in critical care. The functional analysis group identified four competency statements and elements of competencies. Consensus agreement of 80% was achieved with mean agreement scores that exceed 97%. A core critical care competency framework was refined and developed by expert nurses drawing on their own experience and knowledge of critical care nursing. The framework could be useful to: educationalists designing competency-based curricula; critical care managers as a tool for recruitment and retention and for education and training of staff; individual critical care nurses to facilitate continuous professional development.
PMID: 12226945, UI: 22214926
Nurs Crit Care 2002 May-Jun;7(3):109-10
PMID: 12226944, UI: 22214925
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