Sample Of Intensive Care Units Research Articles

Factors Associated with Intensive Care Units' Nurses Frequency of Performing Pressure Injury Prevention: A Cross-sectional Study

AimTo explore factors associated with frequency of performing pressure injury prevention measures among a sample of intensive care units' nurses. BackgroundPressure injuries may be unavoidable in specific circumstances; however, most pressure injuries may be considered preventable. Nursing actions at the point of care play a significant role in shaping pressure injury prevention. MethodsA cross-sectional, descriptive correlational design was used. Using convenience sampling method, 162 intensive care units' nurses were recruited from three hospitals in Riyadh, Saudi Arabia. The participants completed a survey that included Nurses' Practice of Pressure Ulcer Prevention Questionnaire, Pressure Ulcer Knowledge Assessment Tool, Attitude toward Pressure Ulcer Prevention, Pressure Ulcer Prevention Barriers instrument, and Intention to Use Pressure Injury Preventive Measures instrument. Data were analyzed using descriptive and inferential statistics. ResultsNurses lack of knowledge about pressure injury preventions. However, they possessed positive attitudes toward pressure injury preventions. Nurses faced some barriers to prevent pressure injuries. Most nurses agreed that there was social pressure to prevent pressure injury. They had an intention to use preventive measures to prevent pressure injury. Nurses performed pressure injury prevention frequently. The bivariate and multivariate analyses showed only barriers to prevent pressure injury were negatively associated with frequency of performing pressure injury prevention. ConclusionsSeveral factors that may influence ICU nurses' behavior to perform PIPs have been identified. The participants reflected positive attitude, positive social pressure, and intention to perform PIPs. Nevertheless, they need to improve their knowledge of PIPs and reduce the barriers prevented them from performing PIPs.

Sustainable Laboratory-Driven Method to Decrease Repeat, Same-Day WBC Differentials at a Tertiary Care Center.

A CBC with WBC differential is often ordered when a CBC alone would be sufficient for patient care. Performing unnecessary WBC differentials adds to costs in the laboratory. Our objective was to implement a laboratory middleware algorithm to cancel repeat, same-day WBC differentials to achieve lasting improvements in laboratory resource allocation. Repeat same-day WBC differentials were first canceled only on intensive care unit samples; after a successful trial period, the algorithm was applied hospital-wide. We retrospectively reviewed CBC with differential orders from pre- and postimplementation periods to estimate the reduction in WBC differentials and potential cost savings. The algorithm led to a monthly WBC differential cancellation rate of 5.40% for a total of 10,195 canceled WBC differentials during the cumulative postimplementation period (September 25, 2019, to December 31, 2020). Nearly all (99.94%) differentials remained canceled. Most patients only had one WBC differential canceled (range, 1-38). Savings estimates showed savings of $0.99 CAD per canceled differential and 1,060 minutes (17.7 hours) of technologist time. A middleware algorithm to cancel repeat, same-day WBC differentials is a simple and sustainable way to achieve lasting improvements in laboratory utilization.

Isolation and Evaluation of Clinically Important Acinetobacter Baumannii From Intensive Care Unit Samples

Acinetobacter baumannii is considered a critical healthcare problem for patients in intensive care units due to its high ability to be multidrug-resistant to most commercially available antibiotics. The current study is at aimed at isolating and identifying the clinical isolates of A. baumannii from different samples and investigating the antibiotic resistance of isolates. Isolation and diagnosis of bacteria were achieved by conventional techniques, including routine and selective culture media (Chrome agar), biochemical test, EPI 20E, and VITEK-2. These methods were basically considered as a gold standard for identification of A. baumannii infections from different clinical sources, and culture positive isolates were tested for antibiotic susceptibility using a modified Kirby–Bauer method. A total of 375 clinical specimens were collected from different infections in some hospitals in Mosul and Erbil cities/Iraq from Sep 2020 to Jan 2021. Overall, 41 isolates were identified as A. baumannii using conventional and biochemical methods, and then confirmed by VITEK-2 system. Our results established that only 41(14.4%) isolates were diagnosed as A. baumannii, and most of these isolates were from burns (36.5%), surgical wounds (34.1%), and sputum (14.6%). However, it was identified in CSF, blood, and urine samples with lower percentages (7.3%, 4.8%, and 2.4%, respectively). The clinical isolates of A. baumannii showed high to moderate resistance to Piperacillin (97.5%), Piperacillin/ Tazobactam., Ceftazidime (87.8%), Meropenem (85.3%), Tri/slphamethoxazole (82.9%), Levofloxacin (80.4%), Imipenem, Ciprofloxacin (78%), Gentamycin (75.6%), Amikacin (73.1%), Netilmicin (68.2%), Tobramycin (60.9%) and Tetracycline (31.7%). However, two antimicrobial agents which were Colistin and Tigecycline produced 0 and 2.4 % resistance to A. baumannii respectively, which were considered the most used choices to treat A. baumannii infections.
 The current findings suggest that automated Vitek 2 system is the most common method to accurately detect the isolates and evaluate multi-drug resistant A. baumannii among patients.

Resuscitation fluid practices in Brazilian intensive care units: a secondary analysis of Fluid-TRIPS

ObjectiveTo describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS.MethodsThis was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice.ResultsOn the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only.ConclusionOur results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.

Comparison of Antibiotic Sensitivity of Pattern Candida albicans and Candida parapsilosis Isolated From Clinical Samples In Intensive Care Unit

Comparison of Antibiotic Sensitivity of Pattern Candida albicans and Candida parapsilosis Isolated From Clinical Samples In Intensive Care Unit

Availability of resources to treat sepsis in Brazil: a random sample of Brazilian institutions.

ObjectiveTo characterize resource availability from a nationally representative random sample of intensive care units in Brazil.MethodsA structured online survey of participating units in the Sepsis PREvalence Assessment Database (SPREAD) study, a nationwide 1-day point prevalence survey to assess the burden of sepsis in Brazil, was sent to the medical director of each unit.ResultsA representative sample of 277 of the 317 invited units responded to the resources survey. Most of the hospitals had fewer than 500 beds (94.6%) with a median of 14 beds in the intensive care unit. Providing care for public-insured patients was the main source of income in two-thirds of the surveyed units. Own microbiology laboratory was not available for 26.8% of the surveyed intensive care units, and 10.5% did not always have access to blood cultures. Broad spectrum antibiotics were not always available in 10.5% of surveyed units, and 21.3% could not always measure lactate within three hours. Those institutions with a high resource availability (158 units, 57%) were usually larger and preferentially served patients from the private health system compared to institutions without high resource availability. Otherwise, those without high resource availability did not always have broad-spectrum antibiotics (24.4%), vasopressors (4.2%) or crystalloids (7.6%).ConclusionOur study indicates that a relevant number of units cannot perform basic monitoring and therapeutic interventions in septic patients. Our results highlight major opportunities for improvement to adhere to simple but effective interventions in Brazil.

Abstract 237: Patient and Center Level Characteristics for Critically Ill Cardiac Encounters Across 2 Care Settings

Introduction: Cardiac intensive care involves delivery of comprehensive critical care using advanced therapies for high-risk conditions. It is unclear if the outcomes such patients experience are evenly distributed throughout all care settings and what patient- and hospital-level factors impact these health outcomes. We evaluated the distribution of case-mix, acuity and processes of care from a nationally reflective convenience sample of intensive care units (ICUs). Methods: The Cerner Healthfacts Database was used to identify critically ill cardiac encounters (CICE). The sample consisted of inpatients hospitalized between January 2009 and December 2014 coded with a cardiac principal diagnosis and requiring direct admission or transfer to an ICU within 48 hours of hospital admission. Hospitals were dichotomized into those with a single undifferentiated ICU (Group 1) and those with a multidisciplinary ICU framework (≥1 ICU including at least 1 cardiac type; Group 2). Results: There were a total of 44012 individual hospital encounters in 68 hospitals, including 18001 patients in Group 1 and 26011 in Group 2. The majority of hospitals in Group 2 were teaching. There were no difference in admission SOFA score for cardiac patients admitted to the ICU, and no difference in the unadjusted in-hospital death rates. Further hospital-level factors are in Table 1. Acute myocardial infarction was the leading diagnosis in Group 1 (6429 encounters; 35.7% of total encounters) and Group 2 (11394 encounters; 43.8% of total encounters). Conclusion: Critically ill patients with cardiac diagnoses demonstrated equivalent baseline severity of illness, in-hospital mortality and lengths of stay when admitted to hospitals with single of multiple ICU care settings. However, hospitals with a multi-ICU setting tended to be teaching hospitals.

Chracteristics of acinetobacter baumanii isolated patients with respiratory samples in intensive care unit

Chracteristics of acinetobacter baumanii isolated patients with respiratory samples in intensive care unit

“Alert and Oriented × 3?” Correlates of Mini-Cog Performance in a Post/Nondelirious Intensive Care Unit Sample

Cognitive impairment has been found to be a predictor of adverse medical outcomes, including nonadherence, recurrent medical crises resulting in early readmissions, and death. The Mini-Cog has been proposed for bedside/clinic cognitive testing. Its validity as a measure of central nervous system (CNS) impairment has never been tested against measures of CNS-medical history, CNS scans, selected laboratory findings, observed in-hospital nondelirious memory impairment, or collateral history from family. We observed Mini-Cog performance in 107 post/nondelirious medical intensive care unit patients and tested its association with age, CNS-medical history, CNS scans, selected laboratory findings, and behavioral history (in-hospital observation of memory problems and collateral history from family or significant others). The overall Mini-Cog covaried with age, various measures of CNS impairment, abnormal laboratory findings, and measures of preadmission "forgetfulness" per family and by in-hospital staff observation. Unique variance in predicting overall Mini-Cog scores included age, positive CNS scan, and behavioral history. Of 91 patients found to be "alert and oriented × 3," 76% were impaired in immediate memory, short-term memory, or clock drawing. The Mini-Cog appears to be a brief, yet valid, measure of CNS dysfunction that significantly enhances sensitivity of evaluation at the bedside. Failure to evaluate patients with a formal examination like the Mini-Cog appears to miss up to 76% of patients with moderate cognitive impairment.

Chest X-ray interpretation in UK intensive care units: A survey 2014.

This survey investigated current practice in intensive care unit radiology reporting using a survey tool. We ascertained physician attitudes regarding best practice. A national survey was sent by email to a sample of intensive care units throughout UK between March and October 2014. The questionnaire determined current practice in reporting chest X-ray in intensive care units. It also identified differences between 'routine' and emergency and out-of-hours service. Further, it investigated how reports were documented and physician preferences for perceived best practice. Of 146 intensive care units contacted, 55% completed the survey. Of the sample, radiologists were solely responsible for chest X-ray reporting in 43.7%, intensive care unit clinicians in 33.7% and joint reporting in 25% of intensive care units. The reporting clinician on intensive care unit was a consultant in 67% of the centres. Written reports by radiologists were provided in 71.7% of cases. This was only 54.5% when intensive care unit clinicians reported chest X-rays. For all routine and emergency films, written reports by radiologists occurred in 63.1% of responders. Out-of-hours, 54.9% of clinicians described different reporting practice to normal hours. Regarding perceived best practice, 64.8% of clinicians preferred joint daily reporting, whilst 27% preferred a radiologist's formal report. For emergencies, 55.2% of the survey recipients preferred a joint report. Based on this cohort of UK intensive care units, at present, there appears to be a lack of a standardised system for image reporting. There are discrepancies in who reports chest X-rays, written documentation and the timing of reports, more so out-of-hours. Clinicians suggest that joint reporting should be the standard.

Resistance Problem of Coryneform Bacteria Isolated from Intensive Care Unit Samples

Resistance Problem of Coryneform Bacteria Isolated from Intensive Care Unit Samples

Do-Not-Resuscitate Orders in Intensive Care Units

Objectives. —To describe the characteristics of patients with do-not-resuscitate (DNR) orders and the frequency and timing of these orders in a representative sample of intensive care units (ICUs) and to compare practices from 1980 to 1990. Design. —Prospective inception cohort. Setting. —A total of 42 ICUs in 40 US hospitals with 200 or more beds; 26 randomly selected hospitals and 14 large, tertiary care hospitals that volunteered to be studied. Participants. —A consecutive sample of 17440 ICU admissions from 1988 to 1990. Measurements. —Patient demographic characteristics, comorbid conditions, disease, and physiological abnormalities. Main Outcome Measures. —Frequency and timing of DNR orders; ICU resource use before and after DNR orders; and patients' hospital and ICU discharge status. Results. —Physicians wrote DNR orders for 1577 ICU admissions (9%) (hospital range, 1.5% to 22%). Patients with ICU DNR orders were older, more functionally impaired, had more comorbid illness, a higher severity of illness, and required the use of more ICU resources compared with patients without DNR orders. Compared with data from a similar survey from 1979 to 1982, ICU DNR orders were more frequent in 1988 to 1990 (9% vs 5.4%; P P P P Conclusions. —Over the last decade physicians and patients' families set limits earlier and more frequently in cases likely to have poor outcomes. We attribute this change to a greater dialogue about setting limits to care and a greater knowledge of treatment outcomes among physicians and families. These changes in practice preceded implementation of the Patient Self-determination Act, designed to ensure patient autonomy for decisions about life-sustaining therapy. ( JAMA . 1993;270:2213-2217)

Do-Not-Resuscitate Orders in Intensive Care Units

To describe the characteristics of patients with do-not-resuscitate (DNR) orders and the frequency and timing of these orders in a representative sample of intensive care units (ICUs) and to compare practices from 1980 to 1990. Prospective inception cohort. A total of 42 ICUs in 40 US hospitals with 200 or more beds; 26 randomly selected hospitals and 14 large, tertiary care hospitals that volunteered to be studied. A consecutive sample of 17,440 ICU admissions from 1988 to 1990. Patient demographic characteristics, comorbid conditions, disease, and physiological abnormalities. Frequency and timing of DNR orders; ICU resource use before and after DNR orders; and patients' hospital and ICU discharge status. Physicians wrote DNR orders for 1577 ICU admissions (9%) (hospital range, 1.5% to 22%). Patients with ICU DNR orders were older, more functionally impaired, had more comorbid illness, a higher severity of illness, and required the use of more ICU resources compared with patients without DNR orders. Compared with data from a similar survey from 1979 to 1982, ICU DNR orders were more frequent in 1988 to 1990 (9% vs 5.4%; P < .001) and preceded 60% of all in-unit deaths compared with only 39% in 1979 to 1982 (P < .001). Do-not-resuscitate orders were written sooner (for 3.6% vs 2.0% of patients on day 1 in the ICU) and patients with DNR orders remained in the ICU longer in 1988 to 1990 (2.8 vs 1.4 days) than in 1979 to 1982, and had lower ICU and hospital mortality rates (64% vs 74%, P < .001; and 85% vs 94%, P < .001). Over the last decade physicians and patients' families set limits earlier and more frequently in cases likely to have poor outcomes. We attribute this change to a greater dialogue about setting limits to care and a greater knowledge of treatment outcomes among physicians and families. These changes in practice preceded implementation of the Patient Self-determination Act, designed to ensure patient autonomy for decisions about life-sustaining therapy.