Abstract
Traumatic brain injury (TBI) is considered a public health problem by the World Health Organization because it is the major cause of sequelae among people younger than 44 years, affecting all races and ages [1]. The TBI patients are at risk for development of pressure ulcer (PU) due to the therapeutic used; hemodynamic and metabolic changes, immobility, loss of bladder and bowel control, changes in the ability of adequate nutritional intake and dependence on self-care are considered risk factors for development of PU [2,3].
Highlights
Failure to accurately estimate energy requirements may result in an impaired recovery
Two groups were compared based on the time to Clinical care programs (CCP) initiation: the historical group, compounded by patients from the 6 months prior to CCP; and the intervention group, compounded by patients admitted with diagnosis of Heart failure (HF) from July 2012 until June 2014, the period when patients and staff were monitored on a daily basis by a case manager nurse and a medical leader which provided educational interventions
Of the 48 deaths in 2013, 58% (n = 28) were in patients with decompensated HF due to infection, and among these 28 deaths 15 were secondary to evolution of sepsis, in 6 there were predominance of the cardiac condition while the remaining 7 deaths showed mixed shock or other complications related to both conditions leading to death
Summary
Failure to accurately estimate energy requirements may result in an impaired recovery. Conclusion: In our open ICU model where decisions should be shared with assistant doctors, the implementation of daily clinical rounds was associated with an intense participation of the multidisciplinary team and with a high level of performance of the proposed interventions These actions are probably associated with better care of the critically ill patients. Methods: Prospective cohort study of critically ill patients treated outside the ICU by the ward health care staff with daily intensivist physician consultation in a university hospital during a 6-month period. Adjusting for relevant patients’ characteristics (SAPS 3 score, admission diagnosis, chronic health status, comorbidities, MV use), case volume and type of ICU, clinical protocols jointly managed by different care providers (OR = 0.23 (95 % CI, 0.08-0.64), p = 0.005) were associated with lower mortality.
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