''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Introduction: Tight glucose control has been put aside in many critical care settings. It has been suggested that future interventional trials should not be performed without the means to control and measure glycaemia in three areas central tendency, variability and minimum value. A recent innovation in central venous catheters which allow continuous glucose sampling may allow critical care nurses to easily gather information in these three domains.
Methods: Two patients undergoing planned general surgery procedure with were monitored using a 7Fr triple lumen central venous catheter (Eirus TLC, Dipylon Medical AB, Solna, Sweden) with an integrated microdialysis membrane located proximal to all infusion ports. The catheter was percutaneously placed and connected to the Eirus monitoring system. Equilibrium of glucose is achieved across the membrane and glucose concentration is measured by the sensor and displayed on the monitor. The system was calibrated after 1 hour and then every 8 hours, using arterial blood gas as the reference. The patients were monitored for 19 hours in the post anesthesia care unit.
Results: The Eirus system allows one to download minute glucose data. Central tendency was measured by average glucose; Variability as measured by Standard deviation. For Patient 1: Total up-time: 19 h 51 min (1191 min); Average: 7.80 mmol/L; Stdev: 0.76 mmol/L; and Min: 6.29 mmol/L. For Patient 2: Total up-time: 18 h 52 min (1132 min); Average: 9.75 mmol/L; Stdev: 3.89 mmol/L and Min: 4.02 mmol/L.
Conclusions: Central venous microdialysis is an innovative technology that is managed by the critical nurses responsible for glucose control protocols. It provides relevant CGM data in all important domains. With such a tool it may be possible to re-investigate and perhaps carry out TGC protocols.
critical care, pressure ulcer,pediatric,quality control
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Background: New technology improves the survival rate; however, it takes new challenges on clinical care issue.
Purpose: To identify factors lead to pressure ulcer in ECMO- supported children in pediatric intensive care unit.
Method: A retrospective medical chart review was used to collect 26 children supported by ECMO in PICU from June 1ST 2010 to June 31nd 2011. The characteristics of patients with ECMO- supported developed pressure ulcer were compared with those did not.
Results: Of the 26 children supported by ECMO, the incidence rate of pressure ulcer was 34.6%. Children were developed ulcers in average 15 days after ECMO implantation. Occipital of the head and neck site fixed by ECMO circuit were the most frequent areas for ulcer. Age, gender did not affect to pressure ulcer. TISS score on admission day, the nutrition status and infusion of inotropic agents were not significant to pressure ulcer. However, patients with longer ECMO implantation (32.7days vs. 5.6days, p=0.004), dermatitis (p= 0.004) and sternum open (p=0.034) during ECMO support period were risk factors to pressure ulcer development in children.
Conclusion: Identification of characteristics and risk factors associated with pressure ulcers in children were different from adult patients in intensive care unit. Children with longer ECMO-supported days, dermatitis were more easily tend to pressure ulcer. The result contributes for nurses in PICU to early recognize risk factors and take aggressive prevention.
mikrodijaliza, kraniocerebralne ozljede i SAH, metaboličke promjene
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Mikrodijaliza je minimalno invazivna tehnika u JIL-u koja neposredno uz krevet bolesnika s teškim kraniocerebralnim ozljedama i SAH-om, omogućava sakupljanje i analizu kemijskim dijelova izvanstaničnih tekućina, a u svrhu identifikacije staničnih oštećenja i propadanja prije nego se dogode promjene u perifernoj krvi
Extracorporeal membrane oxygenation, patient, intensive care unit
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Extracorporeal membrane oxygenation (ECMO) support as one of the newer forms of treatment of adult patients in Slovenia is presented in the paper. It is a mechanical heart and/or lung support, which was first used in 2010 in Department of intensive internal medicine in University Medical Center Ljubljana.
Kvaliteta, akreditacija, brzo reagirajući sustav (RRS), obrazac ranog praćenja (MEWS)
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Svaka bolnička zdravstvena ustanova treba razvijati, primjenjivati i neprekidno održavati učinkovit sustav osiguranja i poboljšanja kvalitete zdravstvene zaštite. Sustavom se promiču i prate sve aktivnosti za poboljšanje kvalitete zdravstvene zaštite sukladno zahtjevima međunarodno priznatih standarda.
Sustav se usredotočuje na kliničke pokazatelje koji su povezani s poboljšanjem ishoda liječenja, kao i na prevenciju i smanjenje neželjenih događaja. Klinički pokazatelji su sredstva mjerenja zdravstvenih postupaka. Postupak takvog procjenjivanja kvalitete rada zove se akreditacijski postupak zdravstvene ustanove. U Republici Hrvatskoj to je dobrovoljan postupak koji se provodi na zahtjev bolničke ustanove. Postoje akreditacijski standardi koji se pri tom trebaju zadovoljiti, a određeni su Pravilnikom o akreditacijskim standardima za bolničke zdravstvene ustanove.
Praćenje i provođenje standarda obuhvaća cijelu bolničku ustanovu pa tako i Jedinice za intenzivno liječenje.
Sigurnost pacijenta (patient safety) prožima se kroz sve standarde jer upravo njenim zadovoljenjem možemo doći do pozitivnog ishoda liječenja. Tu će se prvenstveno naći neočekivani neželjeni događaji koji se događaju u JIL-u.
Razvijen je sustav kojim se smanjuje učestalost neželjenih događaja i osigurava kvaliteta rada u Jedinicama intenzivne skrbi je Rapid Response System (RRS). Baziran je na monitoringu pacijenta u JIL-u te na kontinuiranom dokumentiranju vitalnih znakova na standardiziranom obrascu za praćenje (MEWS – modified early warning system) te sustavu brzog reagiranja od strane Rapid Response Team-a u slučaju pogoršanja stanja bolesnika. Boje na obrascu daju vizualni znak kada se izračuna vrijednost parametara.
Istraživanja su pokazala da RRS smanjuje smrtnost od kardijalnog aresta.
U organiziranju RRS-a treba si postaviti pitanja koja pojašnjavaju razumijevanje implementacije samog sustava.
Jednaki RRS model ne može zadovoljiti svaku Jedinicu intenzivne skrbi. Potrebno je pažljivo promatranje kliničkih pokazatelja u JIL-u prije implementiranja RRS-a da se dobiju optimalni individualni rezultati.
Propusti u organizaciji, obrazovanju, superviziji i greške u prepoznavanju kliničke hitnosti, rezultiraju smanjenom kvalitetom od optimalne skrbi za bolesnika za vrijeme liječenja u JIL-u i povećavanju smrtnost bolesnika. Edukacija je ključ u osiguranju pacijentove sigurnosti i treba poticati treniranje pružanja i osiguranja sigurnosti da bi se zadovoljili akreditacijski standardi rada u bolničkoj ustanovi.
