Intensive Care Assessment Research Articles

Surface imaging for real-time patient respiratory function assessment in intensive care.

Monitoring of physiological parameters is a major concern in Intensive Care Units (ICU) given their role in the assessment of vital organ function. Within this context, one issue is the lack of efficient noncontact techniques for respiratory monitoring. In this paper, we present a novel noncontact solution for real-time respiratory monitoring and function assessment of ICU patients. The proposed system uses a Time-of-Flight depth sensor to analyze the patient's chest wall morphological changes in order to estimate multiple respiratory function parameters. The automatic detection of the patient's torso is also proposed using a deep neural network model trained on the COCO dataset. The evaluation of the proposed system was performed on a mannequin and on 16 mechanically ventilated patients (a total of 216 recordings) admitted in the ICU of the Brest University Hospital. The estimation of respiratory parameters (respiratory rate and tidal volume) showed high correlation with the reference method (r=0.99; P<0.001 and r=0.99; P<0.001) in the mannequin recordings and (r=0.95, P<0.001 and r=0.90, P<0.001) for patients. This study describes and evaluates a novel noncontact monitoring system suitable for continuous monitoring of key respiratory parameters for disease assessment of critically ill patients.

CLINICAL APPLICATION OF THE QUICK SEPSIS‐RELATED ORGAN FAILURE ASSESSMENT IN INTENSIVE CARE UNIT PATIENTS WITH BACTEREMIA: A SINGLE‐CENTER STUDY IN KOREA

RespirologyVolume 22, Issue S3 p. 122-122 APSR Poster Abstracts CLINICAL APPLICATION OF THE QUICK SEPSIS-RELATED ORGAN FAILURE ASSESSMENT IN INTENSIVE CARE UNIT PATIENTS WITH BACTEREMIA: A SINGLE-CENTER STUDY IN KOREA First published: 23 November 2017 https://doi.org/10.1111/resp.13207_99Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume22, IssueS3Supplement: 22nd Congress of the Asian Pacific Society of Respirology, International Convention Centre, Sydney, Australia, 23–26 November 2017November 2017Pages 122-122 RelatedInformation

Pain Assessment in INTensive care (PAINT): an observational study of physician-documented pain assessment in 45 intensive care units in the United Kingdom.

SummaryPain is a common and distressing symptom experienced by intensive care patients. Assessing pain in this environment is challenging, and published guidelines have been inconsistently implemented. The Pain Assessment in INTensive care (PAINT) study aimed to evaluate the frequency and type of physician pain assessments with respect to published guidelines. This observational service evaluation considered all pain and analgesia‐related entries in patients’ records over a 24‐h period, in 45 adult intensive care units (ICUs) in London and the South‐East of England. Data were collected from 750 patients, reflecting the practice of 362 physicians. Nearly two‐thirds of patients (n = 475, 64.5%, 95%CI 60.9–67.8%) received no physician‐documented pain assessment during the 24‐h study period. Just under one‐third (n = 215, 28.6%, 95%CI 25.5–32.0%) received no nursing‐documented pain assessment, and over one‐fifth (n = 159, 21.2%, 95%CI 19.2–23.4)% received neither a doctor nor a nursing pain assessment. Two of the 45 ICUs used validated behavioural pain assessment tools. The likelihood of receiving a physician pain assessment was affected by the following factors: the number of nursing assessments performed; whether the patient was admitted as a surgical patient; the presence of tracheal tube or tracheostomy; and the length of stay in ICU. Physician‐documented pain assessments in the majority of participating ICUs were infrequent and did not utilise recommended behavioural pain assessment tools. Further research to identify factors influencing physician pain assessment behaviour in ICU, such as human factors or cultural attitudes, is urgently needed.

Assessment of intensive care unit-acquired weakness in young and old mice: An E. coli septic peritonitis model.

ABSTRACT Introduction: There are few reports of in vivo muscle strength measurements in animal models of ICU‐acquired weakness (ICU‐AW). In this study we investigated whether the Escherichia coli (E. coli) septic peritonitis mouse model may serve as an ICU‐AW model using in vivo strength measurements and myosin/actin assays, and whether development of ICU‐AW is age‐dependent in this model. Methods: Young and old mice were injected intraperitoneally with E. coli and treated with ceftriaxone. Forelimb grip strength was measured at multiple time points, and the myosin/actin ratio in muscle was determined. Results: E. coli administration was not associated with grip strength decrease, neither in young nor in old mice. In old mice, the myosin/actin ratio was lower in E. coli mice at t = 48 h and higher at t = 72 h compared with controls. Conclusions: This E. coli septic peritonitis mouse model did not induce decreased grip strength. In its current form, it seems unsuitable as a model for ICU‐AW. Muscle Nerve 53: 127–133, 2016

Pressure injury risk assessment in intensive care: comparison of inter‐rater reliability of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index with three scales

To test the psychometric properties of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index. Pressure injury risk assessment is a crucial aspect in determining the relative risk of patients and the need for preventative intervention. In the intensive care setting there are few risk assessment scales that have been developed specifically for critically ill patients. Instrument development. A convenience sample of 26 intensive care patients was used. Data were collected in December 2012. Five intensive care nurses scored each patient with all four scales. Intraclass correlation coefficients and standard errors of measurement were used to assess inter-rater reliability and agreement of the sum, risk category and item scores. Convergent validity of the COMHON Index was investigated by examining correlations between the sum scores and similar constructs of the scales. Inter-rater reliability of the COMHON Index was higher than the other scales and strong correlations were found between it and the Braden and Norton scales but not the Waterlow score. Two items common to all scales (mobility; neurological status) demonstrated significant correlations between the COMHON, Braden and Norton scales but not the Waterlow score. One item (nutrition) was significantly correlated between the COMHON and Braden scales. Inter-rater reliability and agreement of the COMHON Index were the highest of the four scales, with the Norton and Braden performing similarly and the Waterlow score the least well. The strong and significant associations between the Braden, COMHON and Norton scales suggest they are measuring similar constructs.

Pain assessment in intensive care: who puts pen to paper?

Pain is common in intensive care units (ICUs)[1]. Regular pain assessment can improve patient satisfaction and clinical outcomes. It is commonly performed by nurses [2], yet physician-led assessment can improve analgesic management. Using pain documentation as a surrogate for assessment, a review showed physiological parameters i.e. cardiovascular assessment, were more frequently documented by doctors than pain in critically ill patients [3].

“CAN WE FEED?” A Mnemonic to Merge Nutrition and Intensive Care Assessment of the Critically Ill Patient

“CAN WE FEED?” A Mnemonic to Merge Nutrition and Intensive Care Assessment of the Critically Ill Patient

Assessment of Delirium in the Intensive Care Unit: Nursing Practices And Perceptions

Despite practice guidelines promoting delirium assessment in intensive care, few data exist regarding current delirium assessment practices among nurses and how these practices compare with those for sedation assessment. To identify current practices and perceptions of intensive care nurses regarding delirium assessment and to compare practices for assessing delirium with practices for assessing sedation. A paper/Web-based survey was administered to 601 staff nurses working in 16 intensive care units at 5 acute care hospitals with sedation guidelines specifying delirium assessment in the Boston, Massachusetts area. Overall, 331 nurses (55%) responded. Only 3% ranked delirium as the most important condition to evaluate, compared with altered level of consciousness (44%), presence of pain (23%), or improper placement of an invasive device (21%). Delirium assessment was less common than sedation assessment (47% vs 98%, P < .001) and was more common among nurses who worked in medical intensive care units (55% vs 40%, P = .03) and at academic centers (53% vs 13%, P < .001). Preferred methods for assessing delirium included assessing ability to follow commands (78%), checking for agitation-related events (71%), the Confusion Assessment Method for the Intensive Care Unit (36%), the Intensive Care Delirium Screening Checklist (11%), and psychiatric consultation (9%). Barriers to assessment included intubation (38%), complexity of the tool for assessing delirium (34%), and sedation level (13%). Practice and perceptions of delirium assessment vary widely among critical care nurses despite the presence of institutional sedation guidelines that promote delirium assessment.

Toward a new frontier on economic and technologic assessment in intensive care: the role of ethics

Intensive care historical development is always related to increasing high technological patterns and, as consequence, increasing financial costs. Economic and technological assessment of intensive care units has therefore become a very important analytical tools for efficient management of this kind of therapy. The mainstream of the literature about economic and technological evaluation analysis focuses on technological innovation and, on the other hand, on cost containment. Our aim in the present article is to discuss the way in which ethical dimension should be incorporated to economic and technological evaluation analysis. In such a perspective the question is: How can ethical dimension be an endogeneous part of those evaluations, and a ground for decision making in intensive care procedure? Our critical view over the mainstream of this specialized literature refuses both the analytical reduction from a wide view of technology to a simple absorption of technical innovations, and also the reduction from a extensive view of economy to a simple matter of cost containment. We think that the ethical dimension can integrate those evaluations analysis and render possible a solid management of the process of the intensive care unit. We are sure this process could not be reached by a nonintegrated evaluation analysis. So, in that perspective, ethics can be the link between investments, costs and technological innovation in intensive care therapies.

The Critical Nursing Situation Index for safety assessment in intensive care.

The assessment of critical nursing situations can be a valuable tool in the detection of weak elements in the safety of patients and the quality of care in the ICU. A critical nursing situation can be defined as any observable situation, which deviates from good clinical practice and which may potentially lead to an adverse event. The aim of our study was to establish the feasibility, reliability and validity of the Critical Nursing Situation Index (CNSI) as a tool for assessing the safety and the quality of nursing in the ICU. We described the deviations from standards and protocols in daily ICU nursing care, selected those with an implicit, clear risk for the patients and translated them into explicitly observable items. If an item was applicable during observation of the ICU practice, a critical nursing situation could be recorded as either true or false. The reliability of the CNSI was defined in terms of inter-observer agreement. The validity was assessed by exploring the relationship between the nursing time available (more or less than 30 min per patient per hour) and the incidence of critical nursing situations. The study was performed in the ICU of a teaching hospital (30 IC beds) in which all disciplines, including cardiothoracic surgery and neurosurgery, were represented. The CNSI was randomly applied to 83 ICU patients over a period of 3 months (200 times). The reliability of the index was substantial (Kappa values in the range > or =0.70 to > 0.80). In terms of validity, less nursing time resulted in more critical situations (pooled relative risk (RR) 1.36; 95% confidence limits 1.11/1.67). The CNSI is simple to use and has encouraging metric properties, whereas the assessments are closely related to direct patient care. Moreover, the CNSI provides a tool for safety assessment by monitoring potentially dangerous situations that are generally regarded as needing to be avoided.