General Intensive Therapy Unit Research Articles

Anaemia in Critically Ill COVID-19 Patients: A Cohort Study

Anaemia is common in critically ill patients and has been shown to be a predictor of mortality in general Intensive Therapy Unit (ITU). Patients with Corona Virus Infectious Disease 2019 (CV-19) have also been reported to be anaemic, more profound in those admitted to ITU. We report our experience in the management of anaemic CV-19 patients admitted to ITU between 1st March and 1st June 2020. Demographic and clinical variables collected included age, sex, BMI, Charlson comorbidity index (CCI), Acute Physiology and Chronic Health Evaluation (APACHE) II score, haemoglobin concentration, blood transfusion, and mortality. 105 patients were admitted to the ITU with Severe Acute Respiratory Syndrome Coronavirus 2 disease requiring invasive mechanical ventilation and 73 patients with complete dataset were included in the study. Results: 36 patients (49%) were anaemic on admission, with 56 (77%) patients developing anaemia at some stage in the first 7 days of ITU stay. Anaemia at admission to ITU, a higher CCI and a higher APACHE II score were all independently associated with a blood transfusion (OR 12.5, 95% CI: 1.48 - 106, p = 0.02), (OR 1.95, 95% CI: 1.08 - 3.52, p = 0.03) and (OR 4.8, 95% CI: 1.48 - 15.6, p = 0.009) respectively. Univariable analysis showed that an increasing age (OR 2.15, 95% CI: 1.18 - 3.91, p = 0.01) and a higher APACHE II score (OR 1.60, 95% CI 1.01 - 2.54, p = 0.04) were significantly associated with mortality. There was also some evidence of an association with mortality for CCI, although the results for this variable were only of borderline statistical significance. Neither haemoglobin concentration (OR 1.09, 95% CI: 0.83 - 1.43, p = 0.55) or anaemia (OR 1.08, 95% CI: 0.41 - 2.85, p = 0.87) at admission to ITU was significantly associated with mortality. 13 patients received blood transfusions, with a mean (SD) pretransfusion Hb of 75.2 (12.02). These numbers were too small to identify any association between receiving blood transfusion and mortality.

Comunicação como instrumento de humanização do cuidado de enfermagem: experiências em unidade de terapia intensiva

O presente estudo surgiu de questionamentos sobre a relevância da comunicação como instrumento para humanizar o cuidado de enfermagem na Unidade de Terapia Intensiva (UTI). Assim, o objetivo foi conhecer como pacientes perceberam o processo de comunicação implementado pela equipe de enfermagem, identificar quais as percepções sobre os cuidados prestados pela equipe de enfermagem e situações vivenciadas neste ambiente relacionadas ao processo de comunicação. Para tanto, foi realizada uma pesquisa qualitativa, por meio de entrevista semi-estruturada com sete pacientes que estiveram internados em UTI geral de um Hospital Universitário do extremo sul do Rio Grande do Sul, no período de janeiro de 2004 a junho de 2006, abordando aspectos referentes ao cuidado recebido, com atenção especial ao processo de comunicação. A idade dos entrevistados variou de 21 a 73 anos. Após a análise das falas, emergiram duas categorias: a vivência na UTI, seus significados e as necessidades de comunicação e UTI: potencial ambiente de cuidado. Os resultados permitem concluir que os cuidados recebidos na UTI foram satisfatórios e há o reconhecimento da preocupação da equipe de enfermagem em se comunicar com o paciente, valorizando o olhar, a presença e o toque.

Patient monitoring.

Optimum results are obtained in the care of the critically ill patient if efforts are directed to maintaining the internal environment in a state as near normal as possible. This cannot be done without the use of basic monitoring procedures. Complex investigations may have a legitmate and necessary role as research tools. There is, however, a real risk of complex procedures becoming an end in themselves in general intensive therapy units, where they are apt to distract overworked nurses and medical attendants from the care of their patients. It is important, therfore, for clearcut indications for various monitoring procedures to be defined, and in this paper an attempt has been made to outline alogical approach to the monitoring of critically ill genral surgical patients admitted intensive therapy units.

Early identification of sepsis and mortality risks through simple, rapid clot-waveform analysis. Implications of lipoprotein-complexed C reactive protein formation.

To determine if the rapid waveform profile of the activated partial thromboplastin time (aPTT) assay, which detects lipoprotein-complexed C reactive protein (LCCRP) formation, predicts sepsis and mortality in critically ill patients. Observational, cohort study. General intensive therapy unit (ITU) of a tertiary care hospital. A total of 1187 consecutive patients admitted to the ITU. Activated partial thromboplastin time transmittance waveform analysis was performed within the first hour of admission to the ITU. The degree of change causing a biphasic waveform was quantified through the drop in light transmittance level. Three hundred forty-six patients had a biphasic waveform on admission to the ITU with a mortality rate of 44% compared with 26% for those with normal waveforms. Logistic regression models showed direct correlation between the likelihood for sepsis and in-patient mortality with increasing waveform abnormalities. The mortality fraction was 0.3 with normal waveforms versus 0.6 when the light transmittance decreased by 30%. The odds ratio (OR) for mortality and sepsis were 4.5 and 11, respectively, from the most abnormal to normal aPTT waveforms. These were comparable with APACHE II scores and superior to those estimated by CRP for mortality (OR 2.3) / sepsis (OR 6.4) prediction. Waveform analysis within the first hour of ITU admission is a single, simple and rapid method of identifying the risks of mortality and sepsis. Its measure of LCCRP formation shows superior prediction over CRP alone and it warrants further assessment as a tool to triage and target prompt, appropriate treatment in the ITU.

Antithrombin concentrate with plasma exchange in purpura fulminans.

OBJECTIVE: To report successful treatment of three patients admitted with purpura fulminans. DESIGN: Three cases with purpura fulminans: clinical presentation, laboratory findings, treatment, and outcome. SETTING: A seven-bed medical and general surgical Intensive therapy unit in a district general hospital. PATIENTS: Three young patients with clinical and laboratory findings of severe meningococcal sepsis and purpura. INTERVENTIONS: Early replacement therapy with antithrombin concentrate after a single initial plasma exchange, together with conventional antibiotic and supportive treatment. MEASUREMENTS AND MAIN RESULTS: All three cases had abnormal coagulation profile consistent with disseminated intravascular coagulation, adult respiratory distress syndrome, impaired renal function, and severe hemodynamic instability requiring inotropic support. Plasma antithrombin levels were measured in all cases. All patients survived and made a good recovery. CONCLUSIONS: We consider that correction of antithrombin to supranormal levels may have a beneficial effect on survival and outcome in purpura fulminans despite sustained low levels of protein C.

The experience of adult trained intensive therapy nurses caring for children in a general intensive therapy unit

The experience of adult trained intensive therapy nurses caring for children in a general intensive therapy unit

Survival after intensive care. Comparison with a matched normal population as an indicator of effectiveness.

The life expectancy for survivors of critical illness has not been reported in the United Kingdom. The aim of this study was to compare the long-term survival of intensive care patients with that of an age and sex-matched population. All patients admitted to a general intensive therapy unit over 4 years (n = 1168) were included in the study. Details of the survivors were forwarded to the Registrar General for Scotland, who then issued copies of death certificates as the survivors died. The survival curve of patients discharged from the intensive therapy unit was significantly different from that of the normal population. The risk of dying in the first year after discharge was 3.4 times higher (95% confidence intervals 2.7-4.2) than that in the normal population. It is not until the start of the fourth year after discharge that the probability of death matched that of the normal population.

A changing role for intensive therapy: is there a case for high dependency care?

This observational study examined whether specific characteristics of 1168 patients admitted to a general intensive therapy unit had changed over 4 years. The patients' age, diagnosis, severity of illness on admission (APACHE score), duration of management and outcome were recorded prospectively. The risk of hospital mortality was calculated using the APACHE score modified by the appropriate coefficient for presenting diagnosis. The numbers of admissions increased over the study period from 240 patients in the first year to 344 in the last year. The pattern of diagnoses varied significantly with an increasing proportion of patients being admitted for postoperative observation in later years. There was a significant reduction in duration of admission with 70% of patients being admitted for < or = 3 days in 1988-89 while a similar proportion were admitted for a week in 1985-86. Approximately 40% of patients in each year were admitted with a risk of hospital mortality of < or = 10%; such patients received only a short period of intensive care and had a low mortality in the intensive therapy unit. A group of patients with a low predicted (and actual) mortality rate was identified; such patients may be more appropriately managed on a high dependency unit.

Introducing a change of nursing model in a general intensive therapy unit.

This paper focuses on the management of change in the context of health care and looks specifically at methods of introducing a new model of nursing into a general Intensive Therapy Unit (ITU). Rationale for change is discussed, change theory is appraised and a strategy for implementation, management and evaluation of change is provided.

Quality of life after multiple trauma requiring intensive care

A prospective observational study using structured interviews was used to assess changes in quality of life experienced by surviving trauma victims after management on a general intensive therapy unit in a district general hospital. Each patient's age, distribution of injuries, severity of illness on admission and duration of management were recorded. Deaths in the study group were excluded by examining the Hospital's 'Patient Administrative System'. Three attempts were then made to contact all known survivors and to assess their quality of life using three previously recognised and validated methods. Eighty-three survivors of multiple trauma were discharged but 19 were not studied. Of the remaining 64, 42 patients completed the questionnaire. After multiple trauma, patients reported significant decreases in their quality of life in relation to their overall health, happiness, ability to think and to pursue leisure activities, their income and their employment. Their mean Perceived Quality of Life Score decreased by 13% (95% confidence intervals 7.5-19.5%). Sixty-two percent of survivors experienced severe social disability and a modest or severe impairment at work. The Nottingham Health Profile identified major changes in 'psychological' aspects of quality of life, namely energy and emotional reactions.

Resource package: haemofiltration

Use of haemofiltration is increasing in general intensive therapy units in the United Kingdom, yet few nursing staff working with this technology are trained in renal nursing. They thus need special support while caring for patients being treated with haemofiltration. This package offers a practical working knowledge-base for clinical use. Normal renal physiology is revised, the principles of haemofiltration are discussed, and some areas of concern are examined. Recommendations for practice are given where appropriate. Specific reference is made to the Hospal BSM 22 blood pump, and the Hemospal AN69s filter.

The psychological impact of intensive therapy: the role of nurses

The concept of intensive therapy has developed since the early 1950s following the poliomyelitis epidemic when patients required respiratory assistance. Intermittent positive pressure ventilation and the development of large integrated general intensive therapy units where all critically ill patients could be managed has resulted. The environment in the intensive therapy units (ITUs) has thus become increasingly sophisticated with the use of highly specialised equipment. This has led to changes in the role of nurses in critical care areas. As intensive therapy nurses require considerable technical knowledge comparisons have been made with their role and that of a technician. The aim in this paper is to emphasise the importance of the nurses' role in caring for patients in intensive therapy units, by highlighting the psychological impact an intensive therapy unit may have on patients and how a nurse may promote psychological well-being.

An outbreak of aspergillosis in a general ITU

Over a 5-month period, six patients in a general intensive therapy unit became colonized by Aspergillus species including Aspergillus fumigatus, and invasive infection occured in at least two of them. Bronchoalveolar lavage was unhelpful in discriminating between infection and colonization. The source of infection was presumed to be disturbance of an accumulation of spores in fibrous insulation material above the perforated metal ceiling. Patients in such units without clearly identifiable defects of defence against infection may be at risk from aspergillosis. The risk can be reduced by improved hospital design, satisfactory ventilation and thorough regular cleaning of environmental surfaces.

TRIPLE REGIMEN OF SELECTIVE DECONTAMINATION OF THE DIGESTIVE TRACT, SYSTEMIC CEFOTAXIME, AND MICROBIOLOGICAL SURVEILLANCE FOR PREVENTION OF ACQUIRED INFECTION IN INTENSIVE CARE

All 324 patients admitted over sixteen months to a general intensive therapy unit (ITU) were prospectively studied to assess the effect of a novel prophylactic antibiotic regimen on the incidence of acquired infection. Consecutive control (161 patients) and test (163 patients) groups were analysed. In the control group, antibiotic administration was determined by clinical and microbiological evidence of infection. In the test group, treatment consisted of a triple regimen of selective decontamination of the digestive tract (polymyxin E, tobramycin, and amphotericin B) administered throughout the ITU stay, systemic cefotaxime administered for the initial four days, and regular microbiological screening of multiple sites. The test group showed a striking and consistent reduction in colonisation of the digestive tract with aerobic gram-negative bacilli, and there was a substantial reduction in the incidence of acquired infection (24% to 10%). Mortality in certain categories of patients was also reduced. There is now a considerable body of evidence to justify the more widespread use of this selective parenteral and enteral anti-sepsis regimen (SPEAR) in general intensive care practice.

Survey of alarms in an intensive therapy unit.

The origin and frequency of alarm soundings in a general purpose intensive therapy unit were recorded by the nursing staff for 3 weeks. Only eight out of a total of 1455 soundings indicated potentially life threatening problems. There were many false alarms from the monitoring system and the infusion rate pump. The overall frequency of soundings varied little by day or night. There is a need for a graded system of alarms to reflect the priority of the disturbance detected.

Puncture of the ascending aorta—a complication of subclavian venous cannulation

AnaesthesiaVolume 41, Issue 3 p. 331-332 Free Access Puncture of the ascending aorta—a complication of subclavian venous cannulation D. CHILDS, D. CHILDS General Intensive Therapy Unit, Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP.Search for more papers by this authorR.G. WILKES, R.G. WILKES General Intensive Therapy Unit, Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP.Search for more papers by this author D. CHILDS, D. CHILDS General Intensive Therapy Unit, Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP.Search for more papers by this authorR.G. WILKES, R.G. WILKES General Intensive Therapy Unit, Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP.Search for more papers by this author First published: March 1986 https://doi.org/10.1111/j.1365-2044.1986.tb12813.xCitations: 10AboutPDF 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 onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume41, Issue3March 1986Pages 331-332 ReferencesRelatedInformation

A review of paediatric admissions to a general intensive therapy unit over a 13-year period.

Paediatric admissions to a general ITU are briefly reviewed. Although it may not be an ideal arrangement it is suggested that children can be safely cared for in such a unit. The problems created by the child with acute upper airway obstruction are discussed to demonstrate the way in which the unit is organized to receive acutely ill children.

Outbreaks of hospital infection in southwest England caused by gentamicin-resistant Serratia marcescens

Five geographically separate outbreaks of hospital acquired infection caused by gentamicin-resistant strains of Serratia marcescens occurred in the period October 1977 to January 1980 in southwest England. The patients affected were in wards for general or urological surgery, or in neurosurgical, cardiothoracic or general intensive therapy units. Asymptomatic colonization was more common than symptomatic infection, although deaths and serious infections occurred. Control of spread of the bacteria proved difficult. Most strains were resistant to many currently available antibiotics besides gentamicin; only one strain became resistant to amikacin. Representative isolates where characterized by O serotype, bacteriophage type, antibiotic sensitivity pattern, production of β-lactamases and amino-glycoside-aminocyclitol (ACAG)-modifying enzymes, and plasmid visualization. Plasmid studies provided information that complemented conventional typing methods in determining epidemiological relationships among the outbreaks.