Abstract
Unplanned extubation (UE) is usually associated with a longer duration of mechanical ventilation (MV), ICU stay and hospitalization. In the Albert Einstein Hospital, it was noticed that there had been an increase in the number of UEs at the beginning of 2014, when protocols such as the daily sedation interruptions were established. UE is more common in patients who are agitated, when they have low levels of sedation or when the endotracheal tube is not well secured.
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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