scholarly journals Improved Adherence to Best Practice Ventilation Management After Implementation of Clinical Practice Guideline (CPG) for United States Military Critical Care Air Transport Teams (CCATTs)

2021 ◽  
Author(s):  
Joseph K Maddry ◽  
Alejandra G Mora ◽  
Crystal A Perez ◽  
Allyson A Arana ◽  
Kimberly L Medellin ◽  
...  
Keyword(s):  
Critical Care ◽  
Clinical Practice ◽  
Air Transport ◽  
Trauma Patients ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Trauma Population ◽  
Before And After ◽  
Ventilator Management ◽  
Ventilated Patients

ABSTRACT Background Critical Care Air Transport Teams (CCATTs) play a vital role in the transport and care of critically ill and injured patients in the combat theater to include mechanically ventilated patients. Previous research has demonstrated improved morbidity and mortality when lung protective ventilation strategies are used. Our previous study of CCATT trauma patients demonstrated frequent non-adherence to the Acute Respiratory Distress Syndrome Network (ARDSNet) protocol and a corresponding association with increased mortality. The goals of our study were to examine CCATT adherence with ARDSNet guidelines in non-trauma patients, compare the findings to our previous publication of CCATT trauma patients, and evaluate adherence before and after the publication of the CCATT Ventilator Management Clinical Practice Guideline (CPG). Methods We performed a retrospective chart review of ventilated non-trauma patients who were evacuated out of theater by Critical Care Air Transport Teams (CCATT) between January 2007 and April 2015. Data abstractors collected flight information, oxygenation status, ventilator settings, procedures, and in-flight assessments. We calculated descriptive statistics to determine the frequency of compliance with the ARDSNet protocol before and after the CCATT Ventilator CPG publication and the association between ARDSNet protocol adherence and in-flight events. Results We reviewed the charts of 124 mechanically ventilated patients transported out of theater via CCATT on volume control settings. Seventy percent (n = 87/124) of records were determined to be Non-Adherent to ARDSNet recommendations predominately due to excessive tidal volume settings and/or high FiO2 settings relative to the patient’s positive end-expiratory pressure setting. The Non-Adherent group had a higher proportion of in-flight respiratory events. Compared to our previous study of ventilation guideline adherence in the trauma population, the Non-Trauma population had a higher rate of non-adherence to tidal volume and ARDSNet table recommendations (75.6% vs. 61.5%). After the CPG was rolled out, adherence improved from 24% to 41% (P = 0.0496). Conclusions CCATTs had low adherence with the ARDSNet guidelines in non-trauma patients transported out of the combat theater, but implementation of a Ventilator Management CPG was associated with improved adherence.

Pain assessment using a Polish version of the Behavioral Pain Assessment Scale in sedated and mechanically ventilated patients

Ból ◽  
2016 ◽  
Vol 17 (3) ◽  
pp. 27-35
Author(s):  
Aleksandra Gutysz-Wojnicka ◽  
Dorota Ozga ◽  
Ewa Mayzner-Zawadzka
Keyword(s):  
Critical Care ◽  
Clinical Practice ◽  
Pain Assessment ◽  
Pain Scale ◽  
Adult Patients ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Polish Version ◽  
Behavioral Pain Scale ◽  
Ventilated Patients

“Gold standard” in the assessment of pain is patient’s subjective assessment by means of standardized numerical, analog-visual or verbal scales. Unconscious, sedated, mechanically ventilated patients are able to subjectively assess pain in this way. Clinical practice guidelines for the management of pain, agitation and delirium in adult patients in the intensive care unit developed by a working group of the American College of Critical Care Medicine (ACCCM) state that adult patients treated in the ICU routinely experience pain at rest and during routine care. The guidelines recommend routine monitoring of pain in all adult patients in the ICU using the Behavioral Pain Scale (BPS) or Critical-Care Pain Observation Tool (CPOT). Cultural adaptation was conducted in Poland, psychometric properties of Polish version of Behavioral Pain Scale (BPS) were evaluated. Internal consistency determined by Cronbach’s alpha amounted to 0.6883. The correlation coefficients between items of the scale and the sum score in the pain phase were in the range 0.27-0.28. The analysis of principal components confirmed that all the components of the scale respectively, the face, the upper limbs, synchronization with the respirator are one factor and explain 63.9% of the rating variation, while discriminatory accuracy of the scale was unconfirmed. The value of pain assessment using the Polish version of BPS increased significantly, also in the case of routine painless procedures, most likely due to other factors. That prevented the unambiguous interpretation of the results of the pain assessment and enforced additional data from other sources in the assessment of pain. The reason for the lack of discriminant accuracy can be vague operationalization of the scale indicators especially in the category: Face and Synchronization with the ventilator and the lack of adequate training for personnel in scale application. The aim of the study was to prepare the Polish version of Behavioral Pain Scale (BPS) with more favorable psychometric properties. Based on the analysis of the literature individual scale indicators included in the categories of Face and Synchronization with the ventilator and the scheme of their scoring were re-defined. The result of the study is modified Polish version of BPS. Conclusions: The validation process of the research tool is not a one-time process. The implementation of the scale into clinical practice is required as well as further monitoring of its reliability and validity indicators. It is necessary to implement the system of personnel training in BPS application

scholarly journals Safety in intrahospital transportation: evaluation of respiratory and hemodynamic parameters. A prospective cohort study

2008 ◽  
Vol 126 (6) ◽  
pp. 319-322 ◽  
Author(s):  
Bruno Franco Mazza ◽  
José Luiz Gomes do Amaral ◽  
Heloisa Rosseti ◽  
Rosana Borges Carvalho ◽  
Ana Paula Resque Senna ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Arterial Blood ◽  
Before And After ◽  
High Risk Situation ◽  
Change In Mean ◽  
Ventilated Patients

CONTEXT AND OBJECTIVE: Intrahospital transportation of mechanically ventilated patients is a high-risk situation. We aimed to determine whether transfers could be safely performed by using a transportation routine. DESIGN AND SETTING: Prospective cohort study with "before and after" evaluation. METHODS: Mechanically ventilated patients who needed transportation were included. Hemodynamic and respiratory parameters were measured before and after transportation. Statistical analysis consisted of variance analysis and paired Student's t test. Results were considered significant if P < 0.05. RESULTS: We studied 37 transfers of 26 patients (12 female) of mean age 46.6 ± 15.7. Patients with pulmonary diseases, positive end expiratory pressure > 5, FiO2 > 0.4 and vasoactive drug use comprised 42.4%, 24.3%, 21.6% and 33.0% of cases, respectively. Mean duration of transportation was 43.4 ± 18.9 minutes. Complications occurred in 32.4%. There was a significant increase in CO2 (before transportation, 29.6 ± 7.3 and after transportation, 34.9 ± 7.0; P = 0.000); a trend towards improved PO2/FiO2 ratio (before transportation, 318.0 ± 137.0 and after transportation, 356.8 ± 119.9; P = 0.053); increased heart rate (before transportation, 80.9 ± 18.7 and after transportation, 85.5 ± 17.6; P = 0.08); and no significant change in mean arterial blood pressure (P = 0.93). CONCLUSION: These results suggest that intrahospital transportation can be safely performed. Our low incidence of complications was possibly related to both the presence of a multidisciplinary transportation team and proper equipment.

scholarly journals 2200 The effect of antipyretics and fever on the mortality of mechanically ventilated patients

2018 ◽  
Vol 2 (S1) ◽  
pp. 30-31
Author(s):  
Emily M. Evans ◽  
Rebecca J. Doctor ◽  
Brian M. Fuller ◽  
Richard S. Hotchkiss ◽  
Anne M. Drewry
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Severity Of Illness ◽  
Primary Analysis ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Before And After ◽  
Patients At Risk ◽  
Forward Stepwise ◽  
Ventilated Patients

OBJECTIVES/SPECIFIC AIMS: (1) To evaluate clinical outcomes in mechanically ventilated patients with and without fever. We hypothesize that, after adjusting for confounding factors such as age and severity of illness: (a) In septic patients, fever will be associated with improved clinical outcomes. (b) In nonseptic patients, fever will be associated with worse clinical outcomes. (2) To examine the relationship between antipyretics and mortality in mechanically ventilated patients at risk for an acute lung injury. We hypothesize that antipyretics will have no effect on clinical outcomes in mechanically ventilated patients with and without sepsis. METHODS/STUDY POPULATION: This is a retrospective study of a “before and after” observational cohort of 1705 patients with acute initiation of mechanical ventilation in the Emergency Department from September 2009 to March 2016. Data were collected retrospectively on the first 72 hours of temperature and antipyretic medication from the EHR. Temperatures measurements were adjusted based on route of measurement. Patients intubated for cardiac arrest or brain injury were excluded from our primary analysis due to the known damage of hyperthermia in these subsets. Cox proportional hazard models and multivariable linear regression analyzed time-to-event and continuous outcomes, respectively. Predetermined patient demographics were entered into each multivariable model using backward and forward stepwise regression. Models were assessed for collinearity and residual plots were used to assure each model met assumptions. RESULTS/ANTICIPATED RESULTS: Antipyretic administration is currently undergoing analysis. Initial temperature results are reported here. In the overall group, presence of hypothermia or fever within 72 hours of intubation compared with normothermia conferred a hazard ratio (HR) of 1.95 (95% CI: 1.48–2.56) and 1.31 (95% CI: 0.97–1.78), respectively. Presence of hypothermia and fever reduced hospital free days by 3.29 (95% CI: 2.15–4.42) and 2.34 (95% CI: 1.21–3.46), respectively. In our subgroup analysis of patients with sepsis, HR for 28-day mortality 2.57 (95% CI: 1.68–3.93) for hypothermia. Fever had no effect on mortality (HR 1.11, 95% CI: 0.694–1.76). Both hypothermia and fever reduced hospital free days by 5.39 (95% CI: 4.33–7.54) and 3.98 (95% CI: 2.46–5.32) days, respectively. DISCUSSION/SIGNIFICANCE OF IMPACT: As expected, both hypothermia and fever increased 28-day mortality and decreased hospital free days. In our sepsis subgroup, hypothermia again resulted in higher mortality and fewer hospital free days, while fever did not have a survival benefit or cost, but reduced hospital free days. Antipyretic administration complicates these findings, as medication may mask fever or exert an effect on survival. Fever may also affect mechanically ventilated septic patients differently than septic patients not on mechanical ventilation. Continued analysis of this data including antipyretic administration, ventilator free days and progression to ARDS will address these questions.

Critical Care Nurses’ Knowledge of Sedation and Its Management in Mechanically Ventilated Patients at a Tertiary Care Hospital in Pakistan

2020 ◽  
Vol 14 (1) ◽  
pp. 7-18
Author(s):  
Samuel Masih ◽  
Khairunnisa Aziz Dhamani ◽  
Sadia Farhan Khan
Keyword(s):  
Critical Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Critical Care Nurses ◽  
Good Knowledge ◽  
Care Hospital ◽  
Poor Knowledge ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

BackgroundSedation assessment and management is an essential part of critical care nursing. The patients are at significant risks of undersedation and oversedation. Critical care nurses must possess sufficient knowledge about sedation assessment and its management.AimThis study aimed to determine critical care nurses’ knowledge of sedation and its management in mechanically ventilated patients in Pakistan.MethodologyA cross-sectional descriptive study was conducted. The participants were recruited from three critical care units of a tertiary care hospital using a consecutive sampling technique. Data were collected using a self-administered questionnaire.FindingsIn total, 91 critical care nurses participated in this study. Most of them had less than 2 years of experience as registered nurses and as intensive care unit nurses. The majority of them had insufficient knowledge (poor knowledge 18.7% and fair knowledge 63.7%), whereas only 17.6% had good knowledge of sedation and its management. The average correct response rate for general knowledge of sedation management practices was 71.3%. Almost half of the participants (51.6%) had poor knowledge of assessing undersedation and oversedation. Overall, 67% of nurses had good knowledge of managing sedative drugs.ConclusionThe majority of critical nurses lacked sufficient knowledge related to sedation and its management in mechanically ventilated patients. This poses risks to patients’ safety and quality of care.

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