Years In Intensive Care Unit Research Articles

Non-invasive positive pressure ventilation in emergency medicine

Non-invasive positive pressure ventilation (NIPPV) is a respiratory technique validated for several years in intensive care units, which has became a standard of care in emergency units in recent years. The best indications for NIPPVare patients with chronic obstructive pulmonary disease (COPD) exacerbation and those with acute congestive heart failure (CHF). The two ventilatory modes usually used are spontaneous modes: the bi-level positive airway pressure (BiPAP) and the continuous positive airway pressure (CPAP). BiPAP is the only mode indicated for COPD decompensation, whereas CPAP or BiPAP can be used in CHF. BiPAP has been proposed in case of other indications such as preoxygenation technique before tracheal intubation, in case of acute respiratory failure and in patients with “do not intubate” status. In emergency medicine, NIPPV should be started as earlier as possible either in the prehospital setting or at the patient’s arrival in the emergency department. New ventilators are small with high performance capacities and are equipped with batteries which allow NIPPV to be started in the prehospital setting by the mobile medical units.

Changing pattern of antibiotic susceptibility in intensive care units: Ten years experience of a university hospital

The study was performed to assess microorganisms and antibiotic susceptibility patterns during ten years in intensive care units of a University Hospital. Infection Control Committee has active, prospective surveillance in ICUs for thirteen years. Ten years data of ICUs was evaluated retrospectively from surveillance forms. Microorganisms and their antibiotic resistance were recorded according to the years. During ten years, gram negative microorganisms were the most frequent isolated microorganisms from clinical specimens. Acinetobacter baumannii (21.8%), Pseudomonas aerigunosa (16%), Escherichia coli (10.4%) and Klebsiella pneumoniae (8%) were the most common gram negative microorganisms. However, Staphylococcus aureus was the most prevalent gram positive microorganism, the incidence decreased from 18.6% to 4.8% during ten years. Also antibiotic susceptibility of microorganisms changed during ten years. Carbapenem resistance increased from 44% to 92% in A. baumannii and ciprofloxacin resistance increased in E. coli from 28% to 60% and in K. pneumoniae from 21% to 55% during ten years. However, methicilin resistance decreased in S. aureus from 96% to 54%. In conclusion, antibiotic resistance is growing problem in ICUs. Rationale antibiotic policies and infection control measures will prevent the development of resistance.

An exploration of factors affecting Hong Kong ICU nurses in providing oral care

This paper aims to explore the factors that affect Hong Kong intensive care unit nurses in providing oral care. The literature shows that evidence-based oral care prevents ventilator-associated pneumonia. Nevertheless, not all intensive care unit nurses provide such care. Although several studies have been undertaken to identify factors that affecting the provision of oral care, none of these studies looked at the situation in Hong Kong. An exploratory qualitative design was adopted, with audio-taped interviews. A convenience sample of 10 registered nurses with 3-14 years of intensive care unit working experience was recruited from the intensive care unit of one regional hospital in Hong Kong. Transcribed interviews were analysed by means of content analysis. The participants' descriptions of their oral care practices covered oral health assessment, cleansing the oral cavity and care of the surrounding areas. Findings revealed the following significant factors that influenced intensive care unit nurses in providing oral care: their perceptions of the purpose of oral care; their fears about providing it; the priority of oral care; and inadequate support for oral care. The findings indicate that nurses' oral care practices were not evidence based. Factors that affected the provision of oral care were consistent with those found in previous studies. Study findings indicate that present oral care training should be revised. The findings also highlight the influence of ward culture on nurses' priorities in providing oral care. Appropriate materials, adequate staffing levels and the establishment of an evidence-based oral care protocol may facilitate the provision of oral care in the intensive care unit.

Clinical approach to the critically ill, morbidly obese patient.

In the absence of a national registry, the prevalence of critically ill, morbidly obese patients in the United States is not known. On the basis of a retrospective study spanning 7 years of intensive care unit (ICU) data (1994–2000), it is estimated that the incidence of morbidly obese patients requiring intensive care treatment approaches 14 cases per 1,000 ICU admissions per year (1). However, this figure is likely to underestimate the true incidence because the database was restricted to nonsurgical patients. The growing interest in gastric bypass underlines the increased public awareness of the medical and economic consequences of this epidemic. The latest numbers released by the American Society for Bariatric Surgery indicate that the rate of bariatric surgeries has risen in the United States alone from 37,000 cases in the year 2000 to 62,400 cases in 2001 and it is expected that the total number of cases may exceed 100,000 by the end of 2003 (2). Most of the reviews that have provided data on morbidly obese patients have focused on the impact of obesity on individual organ function. Yet, clinical investigations addressing the care of the critically ill, morbidly obese patient are scarce. A recent review published in the AJRCCM detailed the principles and approach to outpatient treatment of obesity (3). The present commentary is aimed at (1) describing the common challenges of treating morbidly obese patients in critical care settings and (2) reviewing the current concepts and suggestions for therapy.

‘Ventilator‐dependent’ children who spend prolonged periods of time in intensive care units when they no longer have a medical need or want to be there

• Children who are dependent on ventilators currently spend many months and in some cases years in intensive care units when they no longer have a medical need to be there.• This article presents the views of 18 young ‘ventilator‐dependent’ people (and their parents) who experienced prolonged periods of time in intensive care units and compares their experiences with published literature.• Findings strongly suggest that living in an intensive care unit is inappropriate and detrimental to health and well‐being.• Recommendations are made regarding the need for alternative placements, appropriate nursing care, the review of funding and discharge management procedures, and upholding children’s rights.