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Outcome of non-invasive positive pressure ventilation in paediatric neuromuscular disease.
Katz S, Selvadurai H, Keilty K, Mitchell M, MacLusky I.
The Hospital for Sick Children, Toronto, Canada.
BACKGROUND: Non-invasive positive pressure ventilation (NPPV) has a beneficial effect on nocturnal hypoventilation and hospitalisation rates in adults with static or slowly progressive neuromuscular disease and respiratory failure. Its role in children affected with similar disease processes, however, remains unclear. AIMS: To investigate the impact of NPPV on hospitalisations and sleep related respiratory parameters in children with neuromuscular disease. METHODS: Fifteen children (mean age 11.7, range 3.4-17.8 years) diagnosed with neuromuscular disease who had been started on nocturnal NPPV and had at least one year of follow up since the initiation of such therapy were studied. Patients served as their own controls and comparison was made of the years preceding and following the initiation of NPPV. RESULTS: Children spent 85% fewer days in hospital (mean pre-NPPV 48.0 days, mean post-NPPV 7.0 days) and 68% less days in intensive care after initiation of NPPV (mean pre-NPPV 12.0 days, mean post-NPPV 3.9 days). Sleep study parameters including number of desaturations, apnoea-hypopnoea index and transcutaneous pCO2 levels improved after initiation of NPPV. CONCLUSIONS: NPPV can decrease hospitalisations for children with neuromuscular disease and improves sleep related respiratory parameters. A prospective study is now needed to further delineate the role of NPPV in this population of children.
PMID: 14736624 [PubMed - indexed for MEDLINE]
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Severe agitation among ventilated medical intensive care unit patients: frequency, characteristics and outcomes.
Woods JC, Mion LC, Connor JT, Viray F, Jahan L, Huber C, McHugh R, Gonzales JP, Stoller JK, Arroliga AC.
Critical Care and Step-down Nursing, Huron Hospital, Cleveland, Ohio, USA.
OBJECTIVE. To determine the frequency, characteristics and outcomes of severe agitation among ventilated medical intensive care unit (MICU) patients. DESIGN. Prospective cohort study. SETTING. Eighteen-bed MICU in 964-bed tertiary care center. PATIENTS. All ventilated patients, aged 18 years or older and admitted for more than 24 h between January 1, 2001 and May 8, 2001. INTERVENTIONS. None. MEASUREMENTS. Data were collected daily by concurrent chart abstractions. Variables included sociodemographic, clinical, laboratory, pharmacologic and non-pharmacologic interventions, ventilator settings and adverse events. Severe agitation, the main outcome variable, was defined as two or more Motor Activity Assessment Scale (MAAS) scores above 4 in a 24-h period and sedative and/or narcotic doses above the established sedation and analgesia protocol or a combination of two or more sedatives. RESULTS. Twenty-three (16.1%) of 143 enrolled patients exhibited severe agitation. Agitated patients were younger (hazard ratio [HR] 1.32), more likely to be admitted from an outside hospital ICU (HR 2.48), had lower pH (HR 1.55) and PaO(2)/FIO(2) less than 200 mmHg (HR 2.59). Agitated patients had longer MICU stays (median 12 versus 5 days, p<0.0001) and more ventilator days (median 14 versus 6, p<0.0001). Agitated patients were more likely to self-extubate (26% versus 6%, p=0.002). Benzodiazepines, narcotics and neuromuscular blocking agents were administered more frequently and at higher doses, but haloperidol was not. CONCLUSION. Severe agitation occurs commonly in critically ill patients and is associated with adverse events including longer ICU stays, duration of mechanical ventilation and self-extubation.
PMID: 14966671 [PubMed - as supplied by publisher]
Imipenem levels are not predictable in the critically ill patient.
Belzberg H, Zhu J, Cornwell EE 3rd, Murray JA, Sava J, Salim A, Velmahos GC, Gill MA.
Department of Surgery, Los Angeles County and University of Southern California Medical Center, 90033, USA. belzberg@usc.edu
BACKGROUND: Critically ill patients often demonstrate extremely unusual volumes of distribution (Vd) and half-lives (t1/2) of drugs. Imipenem is a widely used antibiotic in critically ill patients. METHODS: We performed high-performance liquid chromatography analysis of imipenem in samples from 50 critically ill patients treated with either 500 or 1,000 mg. RESULTS: Peak imipenem levels varied from 1.56 microg/mL to 58.8 microg/mL. Trough levels varied between 0.0 microg/mL and 15.62 microg/mL. Only 54% of patients maintained a trough level greater than 4 microg/mL. Both the Vd and the t1/2 of imipenem were much greater than observed in other patient populations. CONCLUSION: The pharmacokinetic activity of imipenem in critically ill patients is different from that in other patient populations. There is a very weak correlation between dosage and serum concentrations. Therapeutic failures of imipenem may be because of unpredictable pharmacodynamics (Vd and t1/2) in critically ill surgical patients.
PMID: 14749576 [PubMed - indexed for MEDLINE]
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Life review following critical illness in young men.
Jones C, Lyons C, Cunningham C.
Faculty of Health & Applied Social Sciences, Liverpool John Moores University, Avril Robarts Centre, Liverpool. c.jones2@livjm.ac.uk
Surviving events that have posed a serious threat to life can result in major psychological problems during the recovery period. Younger patients, with years of life ahead of them, are at risk of depression and loss of self-esteem following their ordeal, despite their physical recovery. Traditional forms of counselling and psychotherapy following traumatic events can sometimes carry a stigma and be viewed as 'disease centred'. Reminiscence and life review therapies, used until now, with the elderly, appear to have valuable transferable benefits to younger survivors of critical illness. Life review and reminiscent interventions are holistic and person centred, techniques resonating with the essence of critical care nursing. Life review and reminiscence can be used therapeutically from an early stage to help minimize the negative psychological effects of being critically ill.
Publication Types:
- Clinical Trial
- Controlled Clinical Trial
PMID: 14725391 [PubMed - indexed for MEDLINE]
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Care bundles in critical care: a practical approach to evidence-based practice.
Fulbrook P, Mooney S.
Institute of Health & Community Studies, Bournemouth University, Bournemouth, Dorset. fulbrook@bournemouth.ac.uk
The care bundle is a new concept in critical care, which is currently being promoted by the National Health Service Modernisation Agency for Critical Care. Care bundles originated in North America and are described best as groups of evidence-based practice interventions. The theory behind care bundles is that when several evidence-based interventions are grouped together in a single protocol, it will improve patient outcome. Care bundles are relatively easy to develop, implement and audit, and provide practitioners with a practical method for implementing evidence-based practice. This article describes the care bundle and offers practical suggestions about how to develop, implement and audit them in practice.
Publication Types:
PMID: 14725390 [PubMed - indexed for MEDLINE]
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An evaluation of critical care lecturer practitioners.
Richardson A, Turnock C.
Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, Tyne and Wear.
The aim of this study was to evaluate the educational value and impact upon staff of critical care lecturer practitioners. Data were collected through three staff focus groups (n=21) and a questionnaire completed by 70 members of trust or university staff. A majority of respondents felt that the lecturer practitioner roles had considerable effect upon adult critical care services. Six main categories of findings were derived from analysis and integration of both focus group and questionnaire data--development of knowledge; staff support; being a teacher; developing and maintaining the workforce; role improvement plus removal of the lecturer practitioner role. Many of these findings concur with the limited quantity of evaluative literature on the lecturer practitioner role. The authors produced a report recommending continued funding for existing lecturer practitioner posts; introduction of more lecturer practitioner posts should be considered, and further role evaluation should be conducted at both a local and national level.
Publication Types:
PMID: 14725389 [PubMed - indexed for MEDLINE]
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The sound of silence--nurses' non-verbal interaction within the ward round.
Hill K.
General Intensive Care Unit, Southampton General Hospital, Southampton, Hampshire. karen.hill@suht.swest.nhs.uk
This study describes nurses' non-verbal interaction in the ward round within intensive care. Data were collected through participant observation, fieldwork notes and ethnographic interview techniques from eight intensive care nurses. This article focuses on the themes 'Being there', 'Knowing the script', 'Knowing what you want from the ward round' and 'Silencing and gaze', which emerged from the data. A key issue highlighted in this study is that nurses need to recognize their contribution to patient management decisions within the ward round. Drawing from the data, educational and training strategies are suggested to enhance collaborative practice in the clinical setting of intensive care.
PMID: 14725388 [PubMed - indexed for MEDLINE]
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Writing in the first person--time to change.
Fulbrook P.
Publication Types:
PMID: 14725387 [PubMed - indexed for MEDLINE]
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