Technology In Intensive Care Unit Research Articles

More isn't always better: Technology in the intensive care unit.

Clinical care in modern intensive care units (ICUs) combines multidisciplinary expertise and a complex array of technologies. These technologies have clearly advanced the ability of clinicians to do more for patients, yet so much equipment also presents the possibility for cognitive overload. The aim of this study was to investigate clinicians' experiences with and perceptions of technology in ICUs. We analyzed qualitative data from 30 interviews with ICU clinicians and frontline managers within four ICUs. Our interviews identified three main challenges associated with technology in the ICU: (a) too many technologies and too much data; (b) inconsistent and inaccurate technologies; and (c) not enough integration among technologies, alignment with clinical workflows, and support for clinician identities. To address these challenges, interviewees highlighted mitigation strategies to address both social and technical systems and to achieve joint optimization. When new technologies are added to the ICU, they have potential both to improve and to disrupt patient care. To successfully implement technologies in the ICU, clinicians' perspectives are crucial. Understanding clinicians' perspectives can help limit the disruptive effects of new technologies, so clinicians can focus their time and attention on providing care to patients. As technology and data continue to play an increasingly important role in ICU care, everyone involved in the design, development, approval, implementation, and use of technology should work together to apply a sociotechnical systems approach to reduce possible negative effects on clinical care for critically ill patients.

Protocolization of Analgesia and Sedation Through Smart Technology in Intensive Care: Improving Patient Safety.

The risk of medication errors in intensive care units is high, primarily in the drug administration phase. Management of high-alert medications within intensive care units in the study institution varied widely. The aim of this quality improvement project was to protocolize and centralize the management of high-alert medications in acute care settings and to implement smart intravenous infusion pump technology in intensive care units. The project was conducted in 4 phases: (1) protocolization and standardization of intravenous mixtures, (2) centralization of intravenous mixture preparation in the Pharmacy Department, (3) programming of the smart pumps, and (4) dissemination and staged implementation of intravenous mixture protocols. Smart pumps (Alaris, CareFusion) were used to deliver the medicines, and the manufacturer's software (Alaris Guardrails, CareFusion) was used to analyze data regarding adherence to the drug library and the number of programming errors detected. Morphine, remifentanil, fentanyl, midazolam, dexmedetomidine, and propofol were included. After implementation of the smart pumps, 3283 infusions were started; of these, 2198 were programmed through the drug library, indicating 67% compliance with the safety software. The pumps intercepted 398 infusion-related programming errors that led to cancellation or reprogramming of drug infusions. Protocolization and centralization of the preparation of high-alert sedative and analgesic medications for critically ill patients and the administration of these drugs using smart pump technology decrease variability of clinical practice and intercept potentially serious medication errors.

Evidence-Based Review and Discussion Points

Evidence-Based Review and Discussion Points

Intravenous Administration Errors Intercepted by Smart Infusion Technology in an Adult Intensive Care Unit.

The aim of the study was to investigate the efficacy of intravenous (IV) smart pumps with drug libraries and dose error reduction system (DERS) to intercept programming errors entailing high risk for patients in an adult intensive care unit (ICU). A 2-year retrospective study was conducted in the adult ICU of the Hospital Juárez de México in Mexico City to evaluate the impact of IV smart pump/DERS (Hospira MedNet) technology implementation. We conducted a descriptive analysis of the reports generated by the system's software from April 2014 through May 2016. Our study focused on the upper hard limit alerts and used the systems' variance reports and IV Medication Harm Index methodology to determine the severity of the averted overdoses for medications with the highest number of edits. The system monitored 124,229 infusion programs and averted on 36,942 deviations of the preset safe limits. Upper hard limit alerts accounted for 26.4% of pump reprogramming events. One hundred sixty-six significant administration errors were intercepted and prevented, and IV Medication Harm Index analysis identified 83 of them as highest-risk averted overdoses with insulin accounting for 51.8% of those. The rate of compliance with the safety software during the study period was 69.8%. Our study contributes additional evidence of the impact of IV smart pump/DERS technology. These pumps effectively intercepted severe infusion errors and significantly prevented adverse drug events related to dosing. Our results support the implementation of this technology in ICUs as a minimum safety standard and could help drive an IV infusion safety initiative in Mexico.

EHR-related medication errors in two ICUs.

The objective of this study was to describe the frequency, potential harm, and nature of electronic health record (EHR)-related medication errors in intensive care units (ICUs). Using a secondary data analysis of a large database of medication safety events collected in a study on EHR technology in ICUs, we assessed the EHR relatedness of a total of 1622 potential preventable adverse drug events (ADEs) identified in a sample of 624 patients in 2 ICUs of a medical center. Thirty-four percent of the medication events were found to be EHR related. The EHR-related medication events had greater potential for more serious patient harm and occurred more frequently at the ordering stage as compared to non-EHR-related events. Examples of EHR-related events included orders with omitted information and duplicate orders. The list of EHR-related medication errors can be used by health care delivery organizations to monitor implementation and use of the technology and its impact on patient safety. Health information technology (IT) vendors can use the list to examine whether their technology can mitigate or reduce EHR-related medication errors.

Radial artery applanation tonometry for continuous non-invasive arterial pressure monitoring in intensive care unit patients: comparison with invasively assessed radial arterial pressure

BackgroundRadial artery applanation tonometry technology can be used for continuous non-invasive measurement of arterial pressure (AP). The purpose of this study was to evaluate this AP monitoring technology in intensive care unit (ICU) patients in comparison with invasive AP monitoring using a radial arterial catheter. MethodsIn 24 ICU patients (German university hospital), AP values were simultaneously recorded on a beat-to-beat basis using radial artery applanation tonometry (T-Line system; Tensys Medical, San Diego, CA, USA) and a radial arterial catheter (contralateral arm). The primary endpoint of the study was to investigate the accuracy and precision of the non-invasively assessed AP measurements with the Bland–Altman method based on averaged 10 beat AP epochs (n=2993 10 beat epochs). ResultsFor mean AP (MAP), systolic AP (SAP), and diastolic AP (DAP), we observed a bias (±standard deviation of the bias; 95% limits of agreement; percentage error) of +2 mm Hg (±6; −11 to +15 mm Hg; 15%), −3 mm Hg (±15; −33 to +27 mm Hg; 23%), and +5 mm Hg (±7; −9 to +19 mm Hg; 22%), respectively. ConclusionsIn ICU patients, MAP and DAP measurements obtained using radial artery applanation tonometry show clinically acceptable agreement with invasive AP determination with a radial arterial catheter. While the radial artery applanation tonometry technology also allows SAP measurements with high accuracy, its precision for SAP measurements needs to be further improved.

Échographie pleuropulmonaire : applications cliniques et perspectives en réanimation

ObjectiveTo describe the use of lung ultrasound in clinical practice and the new opportunities offered by this technology in intensive care unit (ICU) patients. MethodReview of signs identified by lung ultrasound and systematic analysis of data published within the last 5 years on its use in ICU. The literature has been extracted from the database Pubmed™. Specific keywords were used to select relevant publications. Clinical studies published in French and English languages were assessed. ResultsLung ultrasound serves to diagnose, quantify, drain and monitor pleural effusions. In patients with acute respiratory failure, lung ultrasound participates to the diagnosis, the implementation of treatments and their follow-up. It helps to manage patients with pneumonia and acute lung injury. Finally, the investigation of the interstitial edema brings information about hemodynamics that can serve to manage our patients. ConclusionLung ultrasound is an easy, non-invasive, and non-irradiant technology. It brings lot of useful information at the patient's bedside.

Survey of information technology in Intensive Care Units in Ontario, Canada

BackgroundThe Intensive Care Unit (ICU) is a data-rich environment where information technology (IT) may enhance patient care. We surveyed ICUs in the province of Ontario, Canada, to determine the availability, implementation and variability of information systems.MethodsA self-administered internet-based survey was completed by ICU directors between May and October 2006. We measured the spectrum of ICU clinical data accessible electronically, the availability of decision support tools, the availability of electronic imaging systems for radiology, the use of electronic order entry and medication administration systems, and the availability of hardware and wireless or mobile systems. We used Fisher's Exact tests to compare IT availability and Classification and Regression Trees (CART) to estimate the optimal cut-point for the number of computers per ICU bed.ResultsWe obtained responses from 50 hospitals (68.5% of institutions with level 3 ICUs), of which 21 (42%) were university-affiliated. The majority electronically accessed laboratory data and imaging reports (92%) and used picture archiving and communication systems (PACS) (76%). Other computing functions were less prevalent (medication administration records 46%, physician or nursing notes 26%; medication order entry 22%). No association was noted between IT availability and ICU size or university affiliation. Sites used clinical information systems from15 different vendors and 8 different PACS systems were in use. Half of the respondents described the number of computers available as insufficient. Wireless networks and mobile computing systems were used in 23 ICUs (46%).ConclusionOntario ICUs demontrate a high prevalence of the use of basic information technology systems. However, implementation of the more complex and potentially more beneficial applications is low. The wide variation in vendors utilized may impair information exchange, interoperability and uniform data collection.

OUTCOMES AND APACHE II PREDICTIONS FOR CRITICALLY ILL PATIENTS WITH ACUTE RENAL FAILURE REQUIRING DIALYSIS

Background:Despite the widespread availability of dialytic and intensive care unit technology, the probability of early mortality in critically ill patients with acute renal failure (ARF) is still high, and the evaluation of the patients' prognosis has been difficult. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score is a reliable indicator of severity of illness and likelihood of survival in critically ill patients with ARF. We have attempted to determine whether the APACHE II scoring system can be used to predict prognosis. Methods: A retrospective cohort study evaluated the medical records of 100 consecutive patients in intensive care units with acute renal failure who required dialysis from January 1997 through December 1998. Results: Of the 100 patients studied, 65 were men and 35 were women. The mean age of survivors and nonsurvivors was 59.4 ± 20.3 years and 58.3 ± 20.0 years. The overall mortality rate was 71%. There were no significant differences between survivors and nonsurvivors in age, gender, or indication for dialysis. The cause of death in the majority of patients was related to higher APACHE II score during the 24 hours immediately preceding the initiation of acute hemodialysis, and carry mortality rates exceeding 85% with an APACHE II score of 24 or higher. Conclusion: We conclude that mortality rate for acute renal failure in intensive care unit patients continues to be high. The use of the APACHE II score determined at the time of initiation of dialysis for patients with ARF is a statistically significant predictor of patient survival. There is a significant trend with APACHE II score for outcome.

New Frontiers in Cytokine Involvement during Experimental Sepsis.

Despite significant advances in the antibiotic arsenal and in intensive care unit technology, including mechanical ventilation, sepsis-related morbidity and mortality remain unacceptably high. Ultimately, 25 to 50% of all septic episodes end in death. However, various subsets of septic patients, including those who experience septic peritonitis, and various secondary sequelae like the acute respiratory distress syndrome or nosocomial infections, demonstrate much higher mortality rates ranging from 60 to 95%. Although a number of strategies have been utilized to curb the progression of systemic inflammatory response syndrome with immune or inflammatory modulating therapies, none of these interventions has resulted in significant improvement in survival, and some have proven deleterious. The inability to utilize immune-modulating strategies effectively to treat septic patients likely reflects the inherent conflict that is illustrated by the two diagnostic criteria for the syndrome. The very immune/inflammatory response that has evolved to eliminate infection results in severe and life-threatening damage to host tissues. This review outlines the inflammatory pathways utilized by the host during a septic response. The basis of early immune-modulating therapies and possible reasons these approaches have failed in the treatment of sepsis are discussed. A picture of the ideal therapeutic approach for acute inflammatory diseases like sepsis is also created, and the reason therapies targeting chemokine pathways may more closely approximate the ideal therapy is proposed.

Prognostic Stratification in Critically Ill Patients With Acute Renal Failure Requiring Dialysis

Despite the widespread availability of dialytic and intensive care unit technology, the probability of early mortality in critically ill persons with acute renal failure is distressingly high. Previous efforts to predict outcome in this population have been limited by small sample size and the absence of uniform exclusion criteria. Additionally, data obtained decades ago may not apply today owing to changes in case mix. The medical records of 132 consecutive patients in the intensive care unit with acute renal failure who required dialysis from 1991 through 1993 were evaluated by a blinded reviewer. The overall in-hospital mortality rate was 70%. Twelve readily available historical, clinical, and laboratory variables were significantly associated with in-hospital mortality. Multivariate logistic regression analysis showed that mechanical ventilation, malignancy, and nonrespiratory organ system failure were independently associated with in-hospital mortality. Using a 95% positivity criterion, this model identified 24% of high-risk patients who died, without misclassification of any survivors. Of those who survived to hospital discharge, 33% were dialysis dependent and 28% were institutionalized long-term. Among critically ill patients, acute renal failure requiring dialysis is an ominous condition with a high risk of in-hospital mortality. This risk appears to depend largely on comorbid conditions, such as the need for mechanical ventilation and underlying malignancy. While this prognostic model requires prospective validation, it appears to identify a substantial fraction of patients for whom dialysis may be of limited or no benefit.