Situations In Intensive Care Unit Research Articles

Instrumentos para a avaliação do risco de lesões por pressão para adultos em situação crítica: scoping review*

Objective: to map the instruments for risk assessment of pressure ulcers in adults in critical situation in intensive care units; identify performance indicators of the instrument, and the appreciation of users regarding the instruments’ use/limitations. Method: a scoping review. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews in the writing of the study. We carried out the searches in the EBSCOhost search tool for 8 databases, resulting in 1846 studies, of which 22 studies compose the sample. Results: we identified two big instrument groups: generalist [Braden, Braden (ALB), Emina, Norton-MI, RAPS, and Waterlow]; and specific (CALCULATE, Cubbin & Jackson, EVARUCI, RAPS-ICU, Song & Choi, Suriaidi and Sanada, and COMHON index). Regarding the predictive value, EVARUCI and CALCULATE presented better results for performance indicators. Concerning appreciation/limitations indicated by users, we highlight the CALCULATE scale, followed by EVARUCI and RAPS-ICU, although they still need future adjustments. Conclusion: the mapping of the literature showed that the evidence is sufficient to indicate one or more instruments for the risk assessment of pressure ulcers for adults in critical situation in intensive care units.

Symptoms of Anxiety, Depression, and Post-Traumatic Stress Disorder in Health Care Personnel in Norwegian ICUs during the First Wave of the COVID-19 Pandemic, a Prospective, Observational Cross-Sectional Study.

Background: The COVID-19 pandemic has induced demanding work situations in intensive care units (ICU). The objective of our study was to survey psychological reactions, the disturbance of social life, work effort, and support in ICU nurses, physicians, and leaders. Methods: From May to July 2020, this cross-sectional study included 484 ICU professionals from 27 hospitals throughout Norway. Symptoms of anxiety and depression were measured on Hopkins Symptom Checklist-10 (HSCL-10). Symptoms of post-traumatic stress disorder (PTSD) were measured on the PCL-5. Results: The study population were highly educated and experienced professionals, well prepared for working with COVID-ICU patients. However, 53% felt socially isolated and 67% reported a fear of infecting others. Probable cases of anxiety and depression were found in 12.5% of the registered nurses, 11.6% of the physicians, and 4.1% of the leaders. Younger age and <5 years previous work experiences were predictors for high HSCL-10 scores. Reported symptom-defined PTSD for nurses 7.1%; the leaders, 4.1%; and 2.3% of physicians. Conclusions: ICU health care professionals experienced talking with colleagues as the most helpful source of support. The COVID-ICU leaders reported a significantly higher mean score than physicians and nurses in terms of pushing themselves toward producing high work effort.

Multiresistance and endemic status of Corynebacterium striatum associated with nosocomial infections: a critical situation in Intensive Care Units and varied wards of a tertiary care hospital, Rio de Janeiro metropolitan area, Brazil

Nowadays, Corynebacterium striatum has been reported asetiologic agent of mild to severe hospital-acquired infections,including patients undergoing endotracheal intubation withfatal outcome. A continuous survey of infections due multidrug-resistant (MDR) C. striatum in South American countriesremains necessary. This retrospective and prospective studyaimed to analyze clinical-microbiological features of C. striatumclinical isolates from patients attended at a Braziliantertiary care hospital, during a nine-year period. C. striatumstrains (n=130) were isolated from infected patients attended attwenty nosocomial wards, mainly of tracheal aspirate (n=53)and blood and/or intravenous catheter (n=21/n=13). Notably,original cases of nosocomial infections due to C. striatum wereverified in children making use of invasive devices, includingone fatal neonatal case, in addition to a fatal respiratoryinfection in patient with cystic fibrosis, as well as urinarytract infections of kidney transplant recipients. Most of C.striatum strains expressed MDR profiles (88.46%). Emergenceof vancomycin (1.90%) and linezolid (7.41%) resistance wasverified among MDR and non-MDR-strains. In conclusion,endemic condition with wide dissemination among hospitalwards of varied types of infections due to MDR and non-MDRC. striatum strains expressing heterogenic virulence potentialand genetic features may occur in hospital units.

REDUCING LENGTH OF STAY AND IMPROVING QUALITY OF CARE BY IMPLEMENTATION OF INFORMATICS SYSTEM AND CARE BUNDLE IN THE INTENSIVE CARE UNIT.

Clinical situations in intensive care units (ICUs) change rapidly, and many factors may prolong the length of stay (LOS) of patients. The objectives of the study were to examine the effects of implementing an electronic-ICU (e-ICU) and an informatics system in an ICU on the LOS of patients and quality of care. We evaluated the implementation of a technology electronic dashboard-ICU (TED-ICU) system to upload automatically physiological information and clinical data within the critical care unit for providing real-time information to the care team. Furthermore, TED-ICU software automatically performed Sequential Organ Failure Assessment (SOFA) every 48 h. If a patient's SOFA score decreased by more than 2 points, there was an automatic reminder for transferring patients to the general ward. We prospectively collected data for this study from the ICU before and after implementing the e-ICU. In total, 2248 patients were admitted to our ICU during the study period (1147 and 1101 patients before and after TED-ICU implementation, respectively). Demographic characteristics and in-hospital mortality rates did not differ significantly between the two groups, and the LOS decreased from 7.26 to 5.53 days (p < 0.01). Implementing an informatics system (TED-ICU) and care bundle in ICUs can reduce the LOS.

Improving end-of-life care in an intensive care unit: a collaborative quality improvement project.

The shift from curative to palliative care is one of the most challenging situations in intensive care units. The purpose of this collaborative project was to develop and implement a pilot intervention aimed at improving end-of-life care for patients in an open intensive care unit in Quebec City, Canada. Individual and group interviews were first conducted to identify strengths and needs for improvement in care. After the main needs for improvement were determined, interventions were implemented in a concerted manner. These included training in end-of-life care as well as the adaptation of tools to promote communication with the patient and his or her family, or to facilitate interdisciplinary work. Preliminary results obtained through individual interviews indicate participant satisfaction with the project, but additional data need to be gathered to evaluate improvements in practice. Other collaborative quality improvement projects need to be implemented to improve end-of-life practices in intensive care units.

Intensive Care Unit Nurses' Uncertainty and Patient Safety Culture

Intensive care unit (ICU) nurses face many uncertain situations that may affect their patient care decisions and jeopardize patients’ safety.Aim: This study aimed to explore the relationship between uncertainty and patient safety culture among intensive care unit nurses at Tanta Main University Hospital.Study subject: included (155) nurses worked in intensive care units at Tanta University Main Hospital. Two tools were used Tool (I): Nurses’ Uncertainty Questionnaire. Tool (II): Patient Safety Culture Questionnaire.Results: 74.2% of participant ICU nurses’ experienced high levels of uncertainty. Above half (56.1% and 56.1%) of them always experienced being uncomfortable and confused&amp; loss of control when facing uncertain situations in ICUs. 84.5% and 76.8% of them always used team work; and learn from past experience to deal with uncertainty. 47.1% of them evaluated patient safety in their ICUs as acceptable and bad. There was a high statistical negative correlation between the levels of patient safety culture and experiencing uncertainty by ICU nurses at p= 0.000.Conclusions: ICU nurses experienced high level of uncertainty; they rely on experience and teamwork rather than evidence-based practices to manage clinical uncertainty. High statistical significant negative correlation was found between patient safety culture and experiencing uncertainty by ICU nurses.

Update on the assessment and treatment of pain in critically ill patients

Pain in intensive care units is often underestimated, and therefore patients are insufficiently treated, leading to psychological, haemodynamic, metabolic and neuroendocrine responses that cause greater morbimortality. Pain can also cause anxiety, insomnia and disorientation, agitation and delirium, and depression that often times becomes chronic. Lack of or inadequate treatment increases pulmonary, metabolic and infectious complications. The combined use of analgesics and sedative agents decreases the stress response of patients in intensive care.There are many other situations in intensive care units that make communication between the patient and healthcare personnel difficult (being sedated, the presence of an endotracheal tube, etc.), making it difficult to manage analgesia.The BPS and the CPOT are the most validated and reliable behavioural scales to assess pain in adult patients in the ICU, when self-reporting is not possible.Opioids are the cornerstone pain treatment in critically ill patients, however other classes of drugs are recommended to promote comfort and environmental tolerance, such as sedatives/hypnotics.Specialised psychological services can provide improvements for both patients and family, especially in the prevention of anxiety and wasting syndrome.In the spiritual dimension, the best method to alleviate pain is support for both the patient and the family.

Nurses' autonomy in end-of-life situations in intensive care units.

The intensive care unit environment focuses on interventions and support therapies that prolong life. The exercise by nurses of their autonomy impacts on perception of the role they assume in the multidisciplinary team and on their function in the intensive care unit context. There is much international research relating to nurses' involvement in end-of-life situations; however, there is a paucity of research in this area in Brazil. In the Brazilian medical scenario, life support limitation generated a certain reluctance of a legal nature, which has now become unjustifiable with the publication of a resolution by the Federal Medical Council. In Brazil, the lack of medical commitments to end-of-life care is evident. To understand the process by which nurses exercise autonomy in making end-of-life decisions in intensive care units. Symbolic Interactionism and Corbin and Strauss theory methodology were used for this study. Data were collected through single audio-recorded qualitative interviews with 14 critical care nurses. The comparative analysis of the data has permitted the understanding of the meaning of nurse's experience in exercising autonomy relating to end-of-life decision-making. Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were anonymized. The results revealed that nurses experience the need to exercise autonomy in intensive care units on a daily basis. Their experience expressed by the process of increase opportunities to exercise autonomy is conditioned by the pressure of the intensive care unit environment, in which nurses can grow, feel empowered, and exercise their autonomy or else can continuously depend on the decisions made by other professionals. Nurses exercise their autonomy through care. They work to create new spaces at the same time that they acquire new knowledge and make decisions. Because of the complexity of the end-of-life situation, nurses must adopt a proactive attitude that inserts them into the decision-making process.

Screen-printed EEG electrode set for emergency use

There is a need for an easy-to-use EEG electrode set allowing that EEG could be recorded immediately when an unconscious patient arrives at the emergency room. In addition, easy-to-use EEG electrode sets could be useful in many situations in intensive care unit, e.g., for long-term monitoring of patients with status epilepticus. In this study, we developed a novel disposable screen-printed EEG electrode set, called here BrainStatus, which consists of 16 hydrogel-coated electrodes (12 recording, 2 reference and 2 ground electrodes) and evaluated its performance by signal quality measurements and EEG recordings in two patients. The quality of EEG signal was excellent even without abrading of skin and comparable to EEG recorded with conventional cup electrodes. The clinical referral question could be answered in both cases based solely on recordings with BrainStatus. BrainStatus was demonstrated to allow MRI and CT imaging without any signs of significant imaging artifacts. We consider that the introduced screen-printed EEG electrode set may be a solution for EEG registrations when the conventional 10–20 electrode setup is not available or feasible. However, further studies with a larger number of patients are warranted to clarify the true diagnostic accuracy and applicability of this approach.

The characteristics of nurses’ and caregivers’ behaviour in different clinical settings with special attention to burnout syndrome

The author draws attention to the up-to-datedness of the selected topic and its personal and institutional effects. Stress in work (workplace stress) has a significant role in the pathomechanism of burnout. Nurses are exposed to excessive stress burden in work so expected incidence of burnout is relatively high among them. Goal of this study is to draw a picture about the situation, condition of mental health, degree and rate of burnout in nurses in given health care situations. Self-completed, anonymous questionnaire questioning the surveyed socio-demographic data while using three standardized questionnaires with the measurement of the degree of burnout, physical and mental exhaustion and fatigue as well as dysfunctional attitudes. The study surveyed 805 individuals analyzing the specific characteristics of supporting relationship and joining points between degree of burnout and (hospital) department care form. Among 374 nurses working in the intensive care unit 9.4% suffer from burnout, while among 155 nurses working in active care unit this rate is 0.6%. According to the findings of the study there are also other influential elements, namely the facts that nurses have part-time jobs (second jobs) besides their full-time jobs and the lack of moral and financial respect or recognition. Among the surveyed population 273 individuals--33.9%--are at risk regarding burnout, 44 individuals--5.5%--show signs of burnout and 7 individuals--0.9%--are in a condition where treatment is needed. The study supposed the influential role of certain personality factors (dysfunctional attitudes) in the development of burnout. Comparison showed that burnout phenomenon and dysfunctional attitudes are correlated. The survey results confirmed that socio-demographic factors had no effect on burnout development. The severity of patients' condition and the degree of permanent stressful situation in intensive care units are among determinant workplace factors.

Stress in nurses working in intensive care units

The present study aimed to identify the presence of stress in nurses working in intensive care units, the stressing agents and symptoms associated to the nurses' perceptions of stress, and to assess the correlation between the occurrence of stress, sources of stress, and symptoms shown by the nurses. Seventy-five nurses took part in the study. The data were collected from questionnaires, analyzed with the Pearson correlation coefficients, and adjusted by general linear models. The study showed the presence of stress related to work dissatisfaction, activities regarded as critical situations in intensive care units, symptoms related to cardiovascular, digestive and musculoskeletal disorders. The conclusion is that stress is present in nurses' activities in intensive care units, related to characteristics of the health area itself, causing dissatisfaction and stress-related symptoms.

QV003 Impact of bacteriological counselling on antibiotic prescription and resistance situation in Intensive Care Units

QV003 Impact of bacteriological counselling on antibiotic prescription and resistance situation in Intensive Care Units

An analysis of two prevalence surveys of nosocomial infection in German intensive care units

In 1995, the results of two extensive prevalence studies on hospital-acquired infections were published. Both studies included a prevalence component for German intensive care units (ICUs), but provided very different infection rates. A comparison of the methods used revealed that the data from the ICUs included in the German section of EPIC (European Prevalence of Infection in Intensive Care), reflected the situation in the ICUs of large hospitals. The situation in ICUs with fewer than 600 beds was quite different, and led to the lower overall rate of infection as seen in the NIDEP (Nosocomial Infections in Germany—Surveillance and Prevention) study. Additionally, the NIDEP data permitted the calculation of device-associated, device-day, infection rates for urinary tract infections, pneumonia and bacteraemia. The differences between the ICUs in the two hospital groups were mainly due to a lower use of patient devices with regard to urinary catheters, central venous lines and respiratory ventilators.