Trauma Intensive Care Unit Research Articles

Quetiapine for delirium prophylaxis in high-risk critically ill patients

BackgroundDelirium is common in patients admitted to the surgical trauma intensive care unit (ICU), and the risk factors for these patients differ from medical patients. Given the morbidity and mortality associated with delirium, efforts to prevent it may improve patient outcomes, but previous efforts pharmacologically have been limited by side effects and insignificant results. We hypothesized that scheduled quetiapine could reduce the incidence of delirium in this population. MethodsThe study included 71 adult patients who were at high-risk for the development of delirium (PRE-DELIRIC Score ≥50%, history of dementia, alcohol misuse, or drug abuse). Patients were randomized to receive quetiapine 12.5 mg every 12 h for delirium or no pharmacologic prophylaxis within 48 h of admission to the ICU. The primary end point was the incidence of delirium during admission to the ICU. Secondary end points included time to onset of delirium, ICU and hospital length of stay (LOS), ICU and hospital mortality, duration of mechanical ventilation, and adverse events. ResultsThe incidence of delirium during admission to the ICU was 45.5% (10/22) in the quetiapine group and 77.6% (38/49) in the group that did not receive pharmacological prophylaxis. The mean time to onset of delirium was 1.4 days for those who did not receive prophylaxis versus 2.5 days for those who did (p = 0.06). The quetiapine group significantly reduced ventilator duration from 8.2 days to 1.5 days (p = 0.002). ConclusionsThe findings suggested that scheduled, low-dose quetiapine is effective in preventing delirium in high-risk, surgical trauma ICU patients.

Hospital volume-outcome relationship in severe traumatic brain injury: stratified analysis by level of trauma center.

The nature of the volume-outcome relationship in cases with severe traumatic brain injury (TBI) remains unclear, with considerable interhospital variation in patient outcomes. The objective of this study was to understand the state of the volume-outcome relationship at different levels of trauma centers in the United States. The authors queried the National Trauma Data Bank for the years 2007-2014 for patients with severe TBI. Case volumes for each level of trauma center organized into quintiles (Q1-Q5) served as the primary predictor. Analyzed outcomes included in-hospital mortality, total hospital length of stay (LOS), and intensive care unit (ICU) stay. Multivariable regression models were performed for in-hospital mortality, overall complications, and total hospital and ICU LOSs to adjust for possible confounders. The analysis was stratified by level designation of the trauma center. Statistical significance was established at p < 0.001 to avoid a type I error due to a large sample size. A total of 122,445 patients were included. Adjusted analysis did not demonstrate a significant relationship between increasing hospital volume of severe TBI cases and in-hospital mortality, complications, and nonhome hospital discharge disposition among level I-IV trauma centers. However, among level II trauma centers, hospital LOS was longer for the highest volume quintile (adjusted mean difference [MD] for Q5: 2.83 days, 95% CI 1.40-4.26 days, p < 0.001, reference = Q1). For level III and IV trauma centers, both hospital LOS and ICU LOS were longer for the highest volume quintile (adjusted MD for Q5: LOS 4.6 days, 95% CI 2.3-7.0 days, p < 0.001; ICU LOS 3.2 days, 95% CI 1.6-4.8 days, p < 0.001). Higher volumes of severe TBI cases at a lower level of trauma center may be associated with a longer LOS. These results may assist policymakers with target interventions for resource allocation and point to the need for careful prehospital decision-making in patients with severe TBI.

Randomized Controlled Trial of Comparative Hypocaloric vs Full‐Energy Enteral Feeding During the First Week of Hospitalization in Neurosurgical Patients at the Intensive Care Unit

Nutrition support plays a pivotal role in improving the clinical outcomes of the patients admitted to the intensive care unit (ICU). However, there are controversies regarding the optimal amount of energy for the reduction of morbidity and mortality in neurosurgical patients at the ICU. This randomized clinical trial was conducted on 560 patients who were admitted to trauma, stroke, and neurosurgery ICUs, and 68 patients were enrolled based on the inclusion criteria. In total, data of 58 patients were analyzed. In the full-energy group, enteral feeding started at 75% of their daily energy expenditure and gradually increased to 90%-100%. In the hypocaloric group, enteral feeding started with 30% of the daily energy expenditure and reached 75% within 7 days of the intervention. No significant differences were observed in the baseline characteristics of the patients in the hypocaloric and full-energy groups. The incidence of severe gastrointestinal intolerance was relatively high in the full-energy group (P<.001). Duration of mechanical ventilation and length of hospital stay were lower in the hypocaloric group compared with the full-energy group (P = .014 and P = .046, respectively). However, no significant differences were denoted in the length of ICU admission (P = .163), 28-day mortality (P = .640), and pneumonia (P = .162) between the study groups. In the neurocritical care unit, hypocaloric enteral feeding was associated with lower gastrointestinal intolerance, as well as reduced duration of ventilator dependence and length of hospital stay.

Comparing the Clinical Features and Trauma Scores of Trauma Patients Aged Under 65 Years with Those of Patients Aged over 65 Years in the Intensive Care Unit: A Retrospective Study for Last Ten Years.

This retrospective study aimed to compare the clinical characteristics and trauma scores of Intensive Care Unit (ICU) trauma patients 65 years and older with the patients under 65 years old. Trauma patients (n=161) who stayed at least 24 hours in ICU were included. Patients younger than 65 years were included into Group 1 (n=109) and patients aged ≥65 years (n=52) were included into Group 2. Patient characteristics and trauma index scores (GCS; APACHE II score, ISS; TRISS and RTS) at ICU admission were calculated. The patients in Group 2 had more comorbid disease compared with Group 1 (61.5%, 6.4%) (p=0.001). The Trauma-related Injury Severity Score score were higher in Group 1 (49.76±33.75) compared with Group 2 (35.38±34.93) (p=0.006). The APACHE II score were higher in Group 2 (20.08±7.60) compared with Group 1 (17.00±6.90) (p=0.007). The need for invasive mechanical ventilation and tracheostomy were more frequent in Group 2 trauma patients compared with those of patients in Group 1 (92.3%, 73.4%; p=0.003; 26.9%, 8.3%; p=0.002; respectively). The need for transfusion of packed red blood cell suspension (PRBC) was more frequent in Group 2 compared with Group 1 (92.3%, 55.0%; respectively) (p=0.001). The mortality rate was found to be higher in Group 2 compared with Group 1 (48.1%, 19.3%; respectively) (p=0.001). The elderly trauma patients have more comorbid disease, higher scores for APACHE II and lower scores for TRISS, more mechanical ventilation and tracheostomy requirements and higher mortality rate compared with young trauma patients.

End of Life Care and Withdrawal of Life Support

Despite advances in critical care medicine and resuscitation, many patients who are admitted to the intensive care unit (ICU) will ultimately die. Although outcomes may be better for surgical rather than medical ICU patients, addressing the end of life is a fundamental and necessary aspect of critical care for all patients. Over the last few years, we have increasingly recognized the role of palliative care in the surgical and trauma ICU. Palliative medicine in the surgical ICU setting results in decreased length of stay, improved communication with family and patients, and earlier identification of goals of care. This review covers indications for palliative care consultation, practical considerations at the end of life, withdrawal of mechanical ventilation, and symptoms and symptom management at the end of life. Tables list the American College of Surgeons statement on the principles guiding care at the end of life, guidelines for palliative care consultation in the surgical ICU, ABCDs of dignity-conserving care, palliative care principles on transitioning a patient to comfort measures only, and the process of withdrawing ventilatory support. This review 5 tables, and 33 references. Key words: comfort measures; end of life; intensive care unit end-of-life care; palliation; palliative care; palliative care consultation; palliative medicine; quality of dying; withdrawal of life support

End of Life Care and Withdrawal of Life Support

Despite advances in critical care medicine and resuscitation, many patients who are admitted to the intensive care unit (ICU) will ultimately die. Although outcomes may be better for surgical rather than medical ICU patients, addressing the end of life is a fundamental and necessary aspect of critical care for all patients. Over the last few years, we have increasingly recognized the role of palliative care in the surgical and trauma ICU. Palliative medicine in the surgical ICU setting results in decreased length of stay, improved communication with family and patients, and earlier identification of goals of care. This review covers indications for palliative care consultation, practical considerations at the end of life, withdrawal of mechanical ventilation, and symptoms and symptom management at the end of life. Tables list the American College of Surgeons statement on the principles guiding care at the end of life, guidelines for palliative care consultation in the surgical ICU, ABCDs of dignity-conserving care, palliative care principles on transitioning a patient to comfort measures only, and the process of withdrawing ventilatory support. This review 5 tables, and 33 references. Key words: comfort measures; end of life; intensive care unit end-of-life care; palliation; palliative care; palliative care consultation; palliative medicine; quality of dying; withdrawal of life support

Effect of Educational Program forNurses Performance Regarding Infection Control Precautions, toward patient on Mechanical Ventilation.

Background: Patients on mechanical ventilation have a greater risk of acquiring infections; however, this problem is greatest in critical care units. Aim: Evaluate effect of educational program for nurses Performance regarding to infection control standard precautions, for patients on mechanical ventilation. Study design: Quasi-experimental research design was utilized in this study. Setting: The study was conducted in trauma ICU and emergency ICU at Assiut University hospital. Sample: A convenience sample of all available nurses. The sample size was 60 nurses. Tools: Utilizing two tools, Nurse's knowledge questionnaire and Observational checklist. Results: The majority of the studied Sample statistical significant difference between before and after educational program as regard to total nurses' knowledge and practice with P-value <0.001** .observed nurses' knowledge scores improved from 21.7% before the educational program to 75%after the educational program. In addition, the observed nurses' practice scores improved from 21.7%before the educational program to71.7%after educational program. Conclusion: Nurses` knowledge and practice regarding mechanical ventilation infection Control Standard Precautions in the trauma ICU and emergency ICU becomes to the satisfactory level after the educational program. Recommendation: Nurses need for continuous training programs to increase their performance regarding mechanical ventilation infection control standard Precautions.

Patient-Reported Outcomes Associated With Sedation and Agitation Intensity in the Critically Ill

Patient-reported outcomes are essential to understand the relationship between patients' perception of sedation and clinicians' assessments of sedation. To evaluate the association between sedation and agitation indexes and patient-reported outcomes of sedation and analgesia. This prospective, single-center, observational study included adult patients who were continuously sedated for at least 24 hours in a medical or surgical/ trauma intensive care unit. Patients were interviewed after sedation was discontinued regarding their satisfaction with the quality of sedation and potentially related factors. The primary outcome was the correlation between sedation and agitation indexes and patient-reported outcomes. A total of 68 patients were interviewed after sedation. Of these, 29 (42.6%) described their overall feelings about their experience while receiving mechanical ventilation in the intensive care unit as "pleasant". When asked about their desires if they were to experience the situation again, 29 patients (42.6%) reported that they would want more sedation. Agitation index was statistically significantly correlated with several patient-reported outcomes. Receiving mechanical ventilation (r = 0.41, P = .002), the amount of noise (r = 0.34, P = .01), suctioning (r = 0.32, P = .02), difficulty resting or sleeping (r = 0.39, P = .003), inability to communicate by talking (r = 0.36, P = .008), anxiety (r = 0.29, P = .03), panic (r = 0.3, P = .02), and frustration (r = 0.47, P < .001) were associated with a higher agitation index. Agitation index was significantly associated with several patient-reported outcomes and thus seems to be a promising descriptor of patients' experience.

Effect of Early Enteral Nutrition Guidelines on Occurrence of Gastrointestinal Complications Among Acute Lung Injury Patients

Proper nutrition found to be an essential in health maintenance and restoration in the critically ill patient. Aim of the study was to evaluate the effect of early enteral nutrition guidelines on occurrence of gastrointestinal complications among acute lung injury patients. Design A quasi-experimental research design was used to conduct this research. This study was carried out at Trauma Intensive Care Unit at Assiut University hospital. Sample: was consisted of 30 patients in each group. Tools: Tool I: Modified patient assessment questionnaire, Tool II: Gastrointestinal complications assessment related to enteral nutrition. Methods: data about 30 patients receiving enteral nutrition before enteral nutrition guidelines were retrospectively compared with data for 30 patients admitted after implementation of the guidelines. Results of the present study showed Patients in the after intervention group had a lower gastrointestinal complications than before intervention group. Conclusion: Implementing early enteral nutrition guidelines reduce occurrence of gastrointestinal complications among acute lung injury patient in ICU Recommendations: Provision an educational programs for nurses about enteral nutrition guideline.

Effect of implementing nursing care protocol about acute lung injury on patients’ outcomes

Acute lung injury in trauma patient associated with pernicious values. Cardiopulmonary, neurological, gastrointestinal, and urinary, complications can be potentially avoidable. Therefore, implementing nursing protocol for this patient help prevent complications, promote faster recovery. Aim: Identify the effect of implementing nursing care protocol on acute lung injury patients' outcomes. Method: Quasi experimental research design was used on 80 patients (study and control groups). This study was carried out in trauma intensive care unit at Assiut university hospital. Tools: Modified patient assessment sheet, Systemic Assessment Observation Check List and patients’ outcomes Assessment sheet. Results: Lower complications, length of stay and mechanical ventilator days and better respiratory mechanics among studied group subjects than control group. Conclusion: Nursing care protocol help in reducing length of stay and improving patient outcomes. Recommendations: Planning educational programs for the critical care nurses with manual booklet about nursing care protocol for acute lung injury patient is required

Assessment the Risk Factors of Patients with Septic Shock in the Intensive Care Unit

Background: Sepsis is considered to induce immune suppression, leading to increased susceptibility to secondary infections with associated late mortality. Aim: To assess the risk factors of patients with septic shock in the intensive care unit. Study design: a descriptive research design was utilized in this study. Setting: The study was conducted in the general intensive care unit and trauma intensive care unit at Assuit University Hospital. Sample: A purposive 60 patients with septic shock patients. Tools: two tools used for data collection, tool (1), Patient assessment sheet, and tool (2), risk factors assessment sheet. Results: The main risk factors were dysfunction of one or more of the major body systems, tracheostomy (65.0%), diabetes mellitus (65.0%) and respiratory disease, in addition, more than half of them stay more than 20 days in the ICU and half of them suffered from respiratory failure as a complication of septic shock. Conclusion: major factors that were associated with in-hospital mortality among ICU patients with severe sepsis or septic shock were multi-organ failure and DM which despite treatment with early resuscitation. Recommendation: Applied Nursing guidelines and standard precautions infection control of patients with septic shock at the onset of intensive care unit admission.

Serum Copeptin levels in the emergency department predict major clinical outcomes in adult trauma patients

BackgroundEarly prognostication in trauma patients is challenging, but particularly important. We wanted to explore the ability of copeptin, the C-terminal fragment of arginine vasopressin, to identify major trauma, defined as Injury Severity Score (ISS) > 15, in a heterogeneous cohort of trauma patients and to compare its performances with lactate. We also evaluated copeptin performance in predicting other clinical outcomes: mortality, hospital admission, blood transfusion, emergency surgery, and Intensive Care Unit (ICU) admission.MethodsThis single center, pragmatic, prospective observational study was conducted at Arcispedale Santa Maria Nuova, a level II trauma center in Reggio Emilia, Italy. Copeptin determination was obtained on Emergency Department (ED) arrival, together with venous lactate. Different outcomes were measured including ISS, Revised Trauma Score (RTS), hospital and ICU admission, blood transfusion, emergency surgery, and mortality.ResultsOne hundred and twenty five adult trauma patients admitted to the ED between June 2017 and March 2018. Copeptin showed a good ability to identify patients with ISS > 15 (AUC 0.819). Similar good performances were recorded also in predicting other outcomes. Copeptin was significantly superior to lactate in identifying patients with ISS > 15 (P 0.0015), and in predicting hospital admission (P 0.0002) and blood transfusion (P 0.016). Comparable results were observed in a subgroup of patients with RTS 7.84.ConclusionsIn a heterogeneous group of trauma patients, a single copeptin determination at the time of ED admission proved to be an accurate biomarker, statistically superior to lactate for the identification of major trauma, hospital admission, and blood transfusion, while no statistical difference was observed for ICU admission and emergency surgery. These results, if confirmed, may support a role for copeptin during early management of trauma patients.

Incidence, Predictors, and Adverse Outcomes of Extubation Failure in Young Children with Isolated Traumatic Brain Injury: A Prospective Observational Study

Abstract Background Mechanical ventilation is a life-saving mainstay of therapy in pediatric patients with isolated traumatic brain injury (iTBI). Because of the numerous complications and side effects associated with tracheal intubation, it is prudent to remove it as early as possible. Extubation failure and reintubation, however, are also associated with significant risks. Till date, there has been no comprehensive study on extubation failure in pediatric patients less than 5 years with iTBI. Materials and Methods A prospective observational study was conducted in the trauma intensive care unit (TICU) of a tertiary care center. All the children with iTBI, aged 0 to 5 years, on mechanical ventilation for more than 24 hours, admitted to the TICU were included. Extubation failure was defined as the need for reintubation occurring within 24 hours of extubation. Only the first attempt at extubation was included in the analysis. Results Pre-extubation paO2/FiO2 ratio &lt; 310 mm Hg is a predictor for extubation failure. Mean base deficit postextubation were found to be 2 ± 0.9 and –0.2 ± 1 (p = 0.00) between success and failure groups, respectively. Similarly, postextubation systolic blood pressure was also high in the failure group than in the success group (113.8 ± 10.4 vs. 100.5 ± 7.4; p = 0.00). Conclusions The incidence of first attempt extubation failure was 62.5%. Lower values of pre-extubation paO2/FiO2 ratio (ratio &lt; 310 mm Hg) are a predictor for extubation failure. Developing predictive tools and optimizing extubation decisions lead to timely identification of patients at elevated risk of extubation failure.

The value of immediate postoperative radiographs following fluoroscopically-guided orthopaedic surgery in a polytrauma ICU setting in KwaZulu-Natal, South Africa

BackgroundRadiographic imaging remains a cornerstone of orthopaedic practice. Traditional control X-Rays are routinely requested after procedures. These X-rays may add little value in post-op evaluation of trauma ICU patients, in light of intra-operative screening already performed and reviewed, but has high potential morbidity risk. AimThe aim is to determine if patients undergoing extra-articular fracture fixation, with fluoroscopic image guidance, require any management change due to immediate check x-rays findings. MethodElectronic patient and imaging records from January 2015 to November 2019 at a Trauma-specific ICU at a Trauma Society of South Africa accredited, Level 1 Trauma Unit were reviewed retrospectively. All patients matching the inclusion criteria were evaluated to determine if there were any complications and changes in management after the check X-Rays. ResultsThere were 103 ICU patients identified with a mean age of 32 years (3 to 94). Fifty-seven percent had fluoroscopy images as well as post-operative check x-rays and 51.5% had only check X-rays. Only two cases needed revision surgery based on the control x-ray findings. The post-operative x-ray did not alter the management of 98.1% of our patients. ConclusionIn this study, routine post-op check x-rays did not add significant additional information to warrant early additional surgical intervention especially in ICU patients with adequate intra-operative fluoroscopy images. This investigation should be ordered for individual patients based on clinical grounds. This will help minimize patient exposure to avoidable radiation, labour intensive transfers to the radiology department, and decrease investigations that have financial implications but with limited benefits.

Respiratory Acid-Base Disorders and Related Risk Factors in Critically Ill Patients

AbstractBackground: Respiratory acid-base disorders are commonly seen in the critical care setting and can occur independently or coexist with metabolic acid-base disorders. Aim of the study: To explore the pattern of respiratory acid-base disorders and related risk factors in critically ill patients. Design: the descriptive design was utilized in this study. Setting: This study was carried out in the Trauma and general Intensive Care Unit at Assiut university hospital. Sample: fifty patients admitted to trauma and general Intensive Care Unit. Tools: Four tools were used in this study, patient assessment tool, APACHE II tool, Acid-base parameters assessment tool, and Risk factors assessment tool. Result: A total of 50 patients most of them were male with a mean age of 40.37 ± 13.86 in the survivors versus 47.75 ± 11.86 in non-survivor. APACHE II score was significant in non-survivor group confirmed by (P = 0.000), (P = 0.003) respectively.The incidences of respiratory alkalosis (52%), respiratory acidosis (24%) were higher in the survivor group. The significant risk factor was iatrogenic(drugs, mechanical ventillation).Conclusion: Respiratory acid-base disorders are common in critically ill patients mainly respiratory alkalosis and the major related risk factor was an iatrogenic.

The “Better” Answer

The “Better” Answer

Impact of an early mobilization protocol on outcomes in trauma patients admitted to the intensive care unit: A retrospective pre-post study.

Prolonged immobility has detrimental consequences for critically ill patients admitted to the intensive care unit (ICU). Previous work has shown that early mobilization of ICU patients is a safe, feasible and effective strategy to improve outcomes; however, few of these studies focused on trauma ICU patients. Our objective was to assess the impact of implementing an ICU early mobilization protocol (EMP) on trauma outcomes. We conducted a retrospective pre-post study of adult trauma patients (>18 years old) admitted to ICU at a Level I trauma center over a 2-year period prior to and following EMP implementation, allowing for a 1-year transition period. Data were collected from the Nova Scotia Trauma Registry. We compared outcomes (mortality, length of stay [LOS], ventilator-free days) between patients admitted during pre-EMP and post-EMP periods, and assessed for factors associated with outcomes using binary logistic regression and generalized linear models. Overall, 526 patients were included in the analysis (292 pre-EMP, 234 post-EMP). Ages ranged from 18 years to 92 years (mean, 49.0 ± 20.4 years) and 74.3% were men. The post-EMP group had lower ICU mortality (21.6% vs. 12.8%; p = 0.009) and in-hospital mortality (25.3% vs. 17.5%; p = 0.031). After controlling for confounders, patients in the post-EMP group were less likely to die in the ICU (odds ratio, 0.43; 95% confidence interval, 0.24-0.79; p = 0.006) or in-hospital (odds ratio, 0.55; 95% confidence interval; 0.32-0.94; p = 0.03). In-hospital LOS, ICU LOS, ICU-free days, and number of ventilator-free days were similar between the two groups. Trauma patients admitted to ICU during the post-EMP period had decreased odds of ICU mortality and in-hospital mortality. This is the first study to demonstrate a significant reduction in trauma mortality following implementation of an ICU mobility protocol. Therapeutic, level III.

Correlation of procalcitonin to positive blood culture results in a sample of South African trauma ICU patients between 2016 and 2017.

This study sought to investigate the screening accuracy of procalcitonin (PCT) for bacteremia, as defined by a positive blood culture, in a South African trauma ICU. This was a retrospective chart review study involving 149 patients who were admitted to the ICU of a level-1 trauma center in South Africa between 2016 and 2017. Median PCT levels in patients with and without positive blood cultures were compared. The screening accuracy of PCT for a positive blood culture was summarized as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Two PCT cut-points were investigated: a general cut-point in the South African context (> 2.0ng/mL), and a trauma ICU-specific cut-point (prioritizing specificity while optimizing sensitivity) which was determined from a receiver-operator-characteristic curve. Bacteremic patients had higher median PCT levels when compared with non-bacteremic patients (30.5ng/mL versus 6.6ng/mL, p = 0.002). The sensitivity, specificity, PPV, and NPV of PCT > 2.0ng/mL was 86% (95% confidence interval-CI 71-94%), 29% (CI 22-38%), 28% (CI 20-37%), and 87% (CI 73-94%), respectively. The unit-specific cut-point was PCT > 31.0ng/mL, which had a sensitivity, specificity, PPV, and NPV of 50% (CI 34-66%), 80% (CI 71-86%), 44% (CI 30-59%), and 83% (CI 75-89%), respectively. Unlike PCT > 2.0ng/mL, PCT > 31.0ng/mL demonstrated fair-to-good test specificity in a sub-analysis of patients who underwent recent surgery. Increased PCT levels were associated with bacteremia in this study. PCT > 31.0ng/mL may be used to rule in suspected bacteremia in this trauma ICU setting.

Differences in Vancomycin Clearance between Trauma and Medical Intensive Care Unit Patients.

BackgroundTo identify the differences in the vancomycin pharmacokinetics between multiple trauma patients and medically ill patients in the intensive care unit (ICU) stratified by the use of continuous renal replacement therapy (CRRT), and the factors affecting vancomycin clearance (CLvan).Materials and MethodsAll the included patients received at least three consecutive doses of vancomycin, then, therapeutic drug monitoring was conducted. Patients' serum vancomycin trough levels and other clinical variables were identified retrospectively. The vancomycin pharmacokinetics and associated factors were compared and analyzed between trauma ICU (TICU) and medical ICU (MICU) patients.ResultsIn the non-dialyzed group, the CLvan was higher among the TICU patients than the MICU patients. However, in the continuous renal replacement therapy group, there was no significant difference in the CLvan between the multiple trauma and medically ill patients. The only factor associated with CLvan in the non-dialyzed group was creatinine clearance; none of the factors was associated with CLvan in the CRRT group.ConclusionIn the case of non-dialyzed patients in the TICU, vancomycin dosages must be adjusted, depending on the patient's actual body weight changes. In the case of patients undergoing CRRT in both ICUs, vancomycin can be infused with fixed doses regardless of the patients' characteristics.

The Economic and Clinical Impact of an Early Mobility Program in the Trauma Intensive Care Unit: A Quality Improvement Project

Traumatic injury survivors often face a difficult recovery. Surgical and invasive procedures, prolonged monitoring in the intensive care unit (ICU), and constant preventive vigilance by medical staff guide standards of care to promote positive outcomes. Recently, patients with traumatic injuries have benefited from early mobilization, a multidisciplinary approach to increasing participation in upright activity and walking. The purpose of this project was to determine the impact of an early mobility program in the trauma ICU on length of stay (LOS), ventilator days, cost, functional milestones, and rehabilitation utilization. A quality improvement project compared outcomes and cost before and after the implementation of an early mobility program. The trauma team assigned daily mobility levels to trauma ICU patients. Nursing and rehabilitation staff collaborated to set daily goals and provide mobility-based interventions. Forty-four patients were included in the preintervention group and 43 patients in the early mobility group. Physical therapy and occupational therapy were initiated earlier in the early mobilization group (p = .044 and p = .026, respectively). Improvements in LOS, duration of mechanical ventilation, time to out-of-bed activity and walking, and discharge disposition were not significant. There were no adverse events related to the early mobility initiative. Activity intolerance resulted in termination of 7.1% of mobility sessions. The development and initiation of a trauma-specific early mobility program proved to be safe and reduce patient care costs. In addition, the program facilitated earlier initiation of physician and occupational therapies. Although not statistically significant, retrospective data abstraction provides evidence of fewer ICU and total hospital days, earlier extubations, and greater proactive participation in functional activities.