''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
INTRODUCTION：Stridor and laryngeal edema are two main problems for removal of endotracheal tube of intensive care unit patients. Re-intubation causes further complications such as prolong days of hospitalization, increase infections rates etc. According to some research papers, removal of endotracheal tube of those patients who had been intubated for more than 24 hours will easily cause laryngeal edema. Medical physicians would give steroid either 30 minutes prior removal of endotracheal tube or one day of steroid then remove next day in attempt to prevent laryngeal edema. But it is still controversial to use prophylactic steroid therapy to reduce the occurrence of postextubation laryngeal edema cause by removal of endotracheal tube. The purpose of this study was to ascertain whether administration of single doses of dexamethasone to critically ill, intubated patients reduces or prevents the occurrence of postextubation airway obstruction.
METHODS: We use the five steps of EBN to Appraisal the literature. Find the single dose of Hydrocortisone before extubation cannot improve postextubation laryngeal edema and prevent the occurrence of stridor, cuff-leak test should alert the clinician of a high risk of upper airway obstruction. Cohorts of 108 translaryngeal intubated patients in the medical intensive care unit (ICU) were enrolled. A cuff leak test was conducted before extubation. If positive cuff-leak test were intravenously given 100mgs of Hydrocortisone every 6 hours for one day. The clinical response and cuff-leak volume before and after steroid treatment were gathered for analysis.
RESULTS: The incidence of postextubation stridor was 7.41% (8/108). No one with stridor needed reintubation. Overall, 100% of patients (8/8) with postextubation stridor improved with steroid treatment.
CONCLUSIONS: A cuff-leak test should alert a high risk of upper airway obstruction and Prophylactic administration of multiple-dose dexamethasone is effective in reducing the incidence of postextubation stridor for postextubation laryngeal edema.
Surgical intensive care unit, Delirium, high risk factor
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Background
Delirium is one of the most serious problems in the intensive care unit (ICU), which might complicated with serious problem like prolong hospital stay, increased medical expense and mortality.
Purpose
We plan to analysis the incidence and risk factors related to delirium in ICU
Method
This is a descriptive, related and prospective study. For the convenient sampling, 30 patients were collected the surgical intensive care unit in one medical center from 1st October, 2011 to 6th November, 2011.The CAM-ICU and RASS score was used to assessed and diagnose Delirium. The data was analyzed by Chi-square and t-test.
Result
According to our study, the incidence of acute delirium in SICU is 46.7%. There is no significant statistic difference in disease type, gender and age. Solitary and alcoholism (P=.05), physical restriction (P< .01), fever (P< .02) and indwelling catheters (P< .003), high TISS score (P< .002) and low GCS score (P< .03) is statistic difference significantly.
Discussion
For ICU patients, nursing staff should be cautious to prevent the delirium risk factors, including the necessity for indwelling catheters and physical restriction on patients, and the treatment of fever episode. Pay attention to high TISS score and low GCS score patients, in order to reduce the incidence of delirium.
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Background: Despite the important role of bedside nurses in clinical research in the intensive care unit (ICU), little is known about how ICU nurses feel about research conduct or their contribution to the research process.
Methods: Self-administered, cross-sectional, paper-based survey to characterize nurses’ experiences and beliefs about ICU research in 5 academic ICUs affiliated with the Canadian Critical Care Trials Group. Prior to administration we assessed the survey for face and content validity, discriminability, utility, clarity, and test-retest reliability.
Results: Response rate was 67% (n=297/446). On average, ICUs were engaged in 16 studies and employed 2 full-time research coordinators. Most respondents were female (79%) with over 6 years of ICU experience (70%). Most had an undergraduate nursing degree (56%); 44% had completed an ICU certificate. While the majority reported completing a statistics course (55%), most had minimal to no experiential knowledge of research processes (67%). Few (20%) reported ever participating in research protocol development, data analysis, publication, or research committees. The majority (62%) had cared for a patient requiring study procedures ≥ 6 times but never or infrequently (< 6 times) completed data collection forms (61%). Most (75%) agreed or strongly agreed research facilitates improved care and that eligible ICU patients should be approached for research (61%), but only for minimal risk studies (76%). Most disagreed or strongly disagreed (76%) that ICU patients were too sick to participate in research. Few (22%) agreed or strongly agreed researchers consider practicalities of nursing care when designing studies and 40% agreed or strongly agreed that caring for study patients substantially increased nursing workload.
Conclusion: Nurses support ICU research and are actively involved in the care of research participants. Paradoxically, nurses remain peripheral to important research processes. Greater inclusion of nurses in study conceptualization and design and investigation of research-related nursing workload is warranted.
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Background: Little data describes the role of emergency department (ED) nurses in caring for ventilated patients yet these patients may remain in ED for prolonged durations due to unavailability of intensive care beds.
Objectives: To examine: exposure of ED nurses to patients requiring invasive ventilation; responsibilities for ventilated patients; and education on ventilation received.
Methods: Cross sectional mailed survey sent to members of the National Emergency Nursing Association in Canada. Domains and items were refined from a survey of ventilation roles and responsibilities in intensive care. Pilot testing comprised ED nurse and respiratory therapist (RT) expert feedback on face and content validity and test-retest reliability.
Results: Response rate was 247/526 (47%); 39% provided care to ≤ 10 ventilated patients every 2 weeks, 32% ≤ 5 patients monthly and 27% ≤ 5 patients every 6 months. A 1:1 nurse: patient ratio for ventilated patients in ED was reported by 38% of respondents; 45% managed 1 or 2 additional patients; 15% ≥ 3 additional patients. Most respondents (54%) reported RTs remained in ED until patients stabilized; 28% RT was available on call, 11% RT remained until patient transfer, and 7% reported no RT available. Few nurses reported being primarily responsible for initial ventilator setting selection (7%), and titration of ventilation (6%); nurse responsibility for these tasks was influenced by RT availability (P<0.001). Primary responsibility for monitoring patient response to ventilation, alarm troubleshooting, and management of oxygenation was reported by 44%, 36%, and 30% respectively. Education was received by 51% of respondents prior to caring for ventilated patients; most (57%) indicated competency in caring for ventilated patients was never assessed. Institutional guidelines for ventilation were reported available by 39% of respondents.
Conclusion: ED nurses have variable exposure to ventilated patients and responsibility for management of ventilation is influenced by RT availability.
health-related quality of life; prolonged mechanical ventilation; weaning; memory
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Background: Psychological distress of intensive care unit (ICU) survivors is a significant problem and is associated with delusional memories. Psychological morbidity may persist over time impacting health-related quality of life and ability to regain premorbid function including return to work.
Objective: To compare memories and recall of stressful experiences of ICU and a specialized weaning centre (SWC) as described by survivors of prolonged mechanical ventilation (≥ 21 days).
Methods: We recruited participants following hospitalization that included ICU admission and subsequent weaning in a SWC (Toronto, Canada). Using a prospective cross-sectional design, we determined memories and recall of stressful experiences of ICU and SWC stay using the ICU Memory Tool and ICU Experience Questionnaire administered via mail or in-person.
Results: Of the 45 eligible participants, 13 did not respond to recruitment strategies, 6 refused, 1 was incompetent, and 1 didn’t return questionnaires (24 participants). Mean time since SWC discharge was 1.9±1.2 years, age 67±16.8; 50% were female. 17% (ICU) and 8% (SWC) of participants had no recall of admission; 29% (ICU) and 75% (SWC) remembered all of their stay. Participants had similar mean numbers of factual (6.6 vs 6.6) and feeling (3.5 vs 3.1) memories of ICU and SWC. More delusional memories were reported for ICU than SWC (1.6 vs 0.6, P<0.001). Thirst (67%), no control (67%), noise (63%), and inability to sleep (58%) were events recalled most frequently from ICU: procedures (75%), night awakening (67%), inability to sleep (67%), and no control (63%) from SWC. Thirst and trouble speaking were rated most distressing. Since discharge, unexplained feelings of panic were experienced by 50% and intrusive memories by 46% of participants.
Conclusion: Despite moderate prevalence of psychological disturbance, few delusional memories were recalled. Difficulty sleeping, thirst, and lack of control were common experiences suggesting interventions focused in these areas are needed.
