Faecal diversion system usage in an adult intensive care unit

2020 ◽  
Vol 22 (2) ◽  
pp. 152-157
Author(s):  
Nicholas Wilson ◽  
◽  
Rinaldo Bellomo ◽  
Tyler Hay ◽  
Timothy Fazio ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Events ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Rectal Tube ◽  
Adult Intensive Care Unit ◽  
Packed Red Blood Cells ◽  
Risk Of Death ◽  
Faecal Diversion

OBJECTIVE: To determine the frequency, indications and complications associated with the use of faecal diversion systems (rectal tubes) in critically ill patients. DESIGN: A single centre observational study over 15 months. SETTING: Intensive care unit (ICU). PARTICIPANTS: Patients admitted during this period. MAIN OUTCOME MEASURES: Frequency of rectal tubes utilisation in ICU, as well as associated adverse events, with major events defined as lower gastrointestinal bleeding associated with defined blood transfusion of two or more units of red cells or endoscopy or surgical intervention. RESULTS: Of 3418 admission episodes, there were 111 episodes of rectal tubes inserted in 99 patients. Rectal tubes remained indwelling for a median of 5 days (range, 1–23) for a total of 641 patient-days. The most frequent indication for insertion was excessive bowel motions. A major adverse event was observed in three patients (3%; 0.5 events per 100 device days). Two patients underwent laparotomy and one patient sigmoidoscopy. These patients received between two and 23 units of packed red blood cells. Patients who had a rectal tube inserted had a substantially greater duration of ICU admission (mean, 14 days [SD, 14] v 2.8 days [SD, 3.7]) and hospital mortality (15% v 7.7%; risk ratio, 2.0; 95% CI, 1.2–3.4) as well as an overall higher Australian and New Zealand Risk of Death (ANZROD) score (mean, 27 [SD, 22] v 12.6 [SD, 20]). CONCLUSION: Rectal tubes appear to be frequently inserted and can lead to major adverse events in critically ill patients.

scholarly journals The Association between Nutritional Status and In-Hospital Mortality of COVID-19 in Critically-Ill Patients in the ICU

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3302
Author(s):  
Michał Czapla ◽  
Raúl Juárez-Vela ◽  
Vicente Gea-Caballero ◽  
Stanisław Zieliński ◽  
Marzena Zielińska
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nutritional Status ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Nutritional Risk ◽  
Risk Of Death ◽  
The Impact

Background: Coronavirus disease 2019 (COVID-19) has become one of the leading causes of death worldwide. The impact of poor nutritional status on increased mortality and prolonged ICU (intensive care unit) stay in critically ill patients is well-documented. This study aims to assess how nutritional status and BMI (body mass index) affected in-hospital mortality in critically ill COVID-19 patients Methods: We conducted a retrospective study and analysed medical records of 286 COVID-19 patients admitted to the intensive care unit of the University Clinical Hospital in Wroclaw (Poland). Results: A total of 286 patients were analysed. In the sample group, 8% of patients who died had a BMI within the normal range, 46% were overweight, and 46% were obese. There was a statistically significantly higher death rate in men (73%) and those with BMIs between 25.0–29.9 (p = 0.011). Nonsurvivors had a statistically significantly higher HF (Heart Failure) rate (p = 0.037) and HT (hypertension) rate (p < 0.001). Furthermore, nonsurvivors were statistically significantly older (p < 0.001). The risk of death was higher in overweight patients (HR = 2.13; p = 0.038). Mortality was influenced by higher scores in parameters such as age (HR = 1.03; p = 0.001), NRS2002 (nutritional risk score, HR = 1.18; p = 0.019), PCT (procalcitonin, HR = 1.10; p < 0.001) and potassium level (HR = 1.40; p = 0.023). Conclusions: Being overweight in critically ill COVID-19 patients requiring invasive mechanical ventilation increases their risk of death significantly. Additional factors indicating a higher risk of death include the patient’s age, high PCT, potassium levels, and NRS ≥ 3 measured at the time of admission to the ICU.

scholarly journals Comparison of proton pump inhibitors and histamine 2 receptor antagonists for stress ulcer prophylaxis in the intensive care unit

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Myung Jin Song ◽  
Seok Kim ◽  
Dachung Boo ◽  
Changhyun Park ◽  
Sooyoung Yoo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Events ◽  
Gastrointestinal Bleeding ◽  
Critically Ill ◽  
Proton Pump ◽  
Critically Ill Patients ◽  
Stress Ulcer ◽  
Stress Ulcer Prophylaxis ◽  
Ulcer Prophylaxis

AbstractProton pump inhibitors (PPIs), followed by histamine 2 receptor antagonists (H2RAs), are the most commonly used drugs to prevent gastrointestinal bleeding in critically ill patients through stress ulcer prophylaxis. The relative efficacy and drug-related adverse events of PPIs and H2RAs remain unclear. In this retrospective, observational, comparative cohort study, PPIs and H2RAs for stress ulcer prophylaxis in critically ill patients were compared using a common data model. After propensity matching, 935 patients from each treatment group (PPI or H2RA) were selected. The PPI group had a significantly higher 90-day mortality than the H2RA group (relative risk: 1.28; P = 0.01). However, no significant inter-group differences in the risk of clinically important gastrointestinal bleeding were observed. Moreover, there were no significant differences between the groups concerning the risk of pneumonia or Clostridioides difficile infection, which are known potential adverse events related to these drugs. Subgroup analysis of patients with high disease severity were consistent with those of the total propensity score-matched population. These findings do not support the current recommendations, which prefer PPIs for gastrointestinal bleeding prophylaxis in the intensive care unit.

scholarly journals Effect of family reorientation messages on delirium prevention among critically ill patients

2019 ◽  
Vol 9 (10) ◽  
pp. 50
Author(s):  
Nermine M. Elcokany ◽  
Fatma Refaat Ahmed
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Events ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cost Of Care ◽  
Pharmacological Intervention ◽  
Effective Strategy ◽  
Intervention Period ◽  
The Family

Background: About 50%-80% of critically ill patients develop delirium during their intensive care unit (ICU) stay. Adverse events associated with delirium can range from functional disability, cognitive and psychological impairment, dementia and even death. Removal of invasive lines, self-extubation, prolonged sedation and ventilation therapies which delay the ICU liberation, and increase the overall hospital length of stay are also negative squeals of delirium. Delirium has series of adverse events that are not limited to the associated morbidies and mortality, but also extended to include the burden placed on caregivers, families and healthcare services, in addition to increasing the cost of care. Using auditory stimulation as a non-pharmacological intervention can stimulate the affected neural networks, accelerate brain plasticity and avoid sensory deprivation that could induce pain, agitation, and delirium and slow down the patients' recovery. It is evident that familiar auditory stimuli by a familiar voice is eliciting more responses to auditory tones as it can grasp patients' attention without much effort and disrupts ongoing cognitive activities. Accordingly, multicomponent family reorientation strategy has recently been proposed to achieve better outcomes.Methods: A quasi experimental research design was used in this study in which one tool was used for data collection: “Confusion Assessment Method-intensive care unit (CAM-ICU)”. Results: During the five-day intervention period, the delirium free days was all the days in the family voice group, four days in the unfamiliar voice group and no free days in the control group which indicates a significant difference among groups on number of delirium free days (MCp < .001*).Conclusion: Reorienting critically ill patients through recorded messages is an effective strategy to reduce the incidence of delirium. Furthermore, using a familiar family sound is more effective in reducing delirium as proved by the number of delirium free days. During the five-day intervention period, the family voice group shows more delirium free days than the unfamiliar voice group. The intervention used in this study is easy, costless and effective strategy in prevention of delirium among critically ill patients.

Effectiveness of Nursing Interventions to Prevent Dry Eye in Critically Ill Patients

2019 ◽  
Vol 28 (4) ◽  
pp. 299-306
Author(s):  
Diego Dias de Araujo ◽  
Daniel Vinicius Alves Silva ◽  
Carolina Amaral Oliveira Rodrigues ◽  
Patricia Oliveira Silva ◽  
Tamara Goncalves Rezende Macieira ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Dry Eye ◽  
Critically Ill Patients ◽  
Controlled Trial ◽  
Nursing Interventions ◽  
Blink Rate ◽  
Artificial Tears ◽  
Adult Intensive Care Unit

Background Critically ill patients are susceptible to the development of dry eye. Few studies have been conducted on how to best prevent and treat this condition. Objective To compare the effectiveness of 2 nursing interventions in preventing dry eye in adult intensive care unit patients: liquid artificial tears (Lacribell; Latinofarma) and artificial tears gel (Vidisic Gel; Bausch and Lomb). Methods In this randomized controlled trial, 140 participants were randomly assigned to 1 of 2 treatment groups: a liquid artificial tears group (n = 70) and an artificial tears gel group (n = 70). The study inclusion criteria were as follows: admission to the intensive care unit, age of 18 years or older, no diagnosis of dry eye at admission, receipt of mechanical ventilation, blink rate of less than 5 times per minute, and a score of 7 or less on the Glasgow Coma Scale. On 5 consecutive days, a single researcher who was unaware of the treatment assignment assessed the participants’ eyes using the fluorescein eye stain test and the Schirmer test for dry eye. Results Dry eye developed in 21% of participants who received liquid artificial tears versus 9% of participants who received artificial tears gel (P = .04). Conclusions In this study, artificial tears gel was superior to liquid artificial tears in preventing the development of dry eye. These results may help nurses deliver evidence-based eye care aimed at reducing the risk of dry eye in critically ill patients.

scholarly journals Application of FASTHUG-MAIDENS mnemonic and evaluation of its impact in pharmaceutical intervention in an adult intensive care unit

2021 ◽  
Vol 12 (1) ◽  
pp. 566
Author(s):  
Íkaro M. LIMA ◽  
Samira B. VIDIGAL ◽  
Nathália M. LIMA ◽  
Daniel A. CARVALHO ◽  
Elton J. SANTOS ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Clinical Evaluation ◽  
Critically Ill Patients ◽  
Infusion Rate ◽  
Medical Prescription ◽  
Adult Intensive Care Unit ◽  
Clinical Pharmacists ◽  
Pharmaceutical Interventions

Objective: To evaluate the impact of the application of the FASTHUG-MAIDENS mnemonic by clinical pharmacists to optimize critically ill patients’ pharmacotherapy. Methods: Cross-sectional study performed on an adult intensive care unit of an University Hospital, between august and november 2019, where 155 patients were followed by three clinical pharmacists during hospital stay. Patients who stayed less than 24 hours in the hospital or whose stay was during weekends or holidays were excluded. The interventions were performed together with a multidisciplinary team using FASTHUG-MAIDENS, as well as technical analysis of medical prescription and patients’ clinical evaluation. The clinical evaluation included analysis of laboratory tests, nursing records and medical prescription, all registered in an institutional spreadsheet. The pharmaceutical interventions were registered in the pharmaceutical section of both physic and electronic medical records, and the data were later evaluated, classified, and submitted to descriptive analytical analysis. Results: 1.145 pharmaceutical interventions were performed, with an acceptance rate of 99,3%. The number of pharmaceutical interventions were increased by 104,4% with the application of the FASTHUG-MAIDENS mnemonic, compared to the period before the research. The main interventions performed were: inclusion of a drug (25,2%), exclusion of a drug (17,9%), dose adjustment (12,2%), change of the administration timetable to avoid intravenous incompatibility (11,4%), inclusion of infusion rate (7,3%), dilution adequacy (5,8%), inclusion of reconstitution (3,5%), microbiological culture request (3,4%), drug interaction monitoring (2,7%), adequacy of infusion rate (2,6%) and others (7,4%).Pharmaceutical interventions showed clinical (96,9%), preventive (99,3%) and economic (21,6%) impact. Conclusion: The application of the FASTHUG-MAIDENS mnemonic extended the pharmaceutical care to critically ill patients, enabling an accurate evaluation of the pharmacotherapy, clinically impacting critical patient care and reducing errors and adverse drug events.

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