Pub Date : 2024-11-19DOI: 10.1016/j.aucc.2024.101134
Nina Leggett DPT, BBiomed , Yasmine Ali Abdelhamid MBBS, PhD, FCICM, FRACP , Adam M. Deane MBBS, PhD, FCICM, FRACP , Kate Emery BExSci, DPT , Evelyn Hutcheon BA Library & Information Science , Thomas C. Rollinson BPhysio(Hons) , Annabel Preston BPT (Hons), BSc , Sophie Witherspoon BSc, MD , Cindy Zhang DPT, BSc , Mark Merolli PhD, B.Physio (Hons), FAIDH, CHIA , Kimberley J. Haines PhD, BHSc Physiotherapy
Objective
Recovery models of care for intensive care unit (ICU) survivors are limited by availability, accessibility, and efficacy. Digital health interventions represent an alternative mode of service delivery. The primary aim of this systematic review was to describe implementation factors (Reach, Effectiveness, Adoption, Implementation, and Maintenance) for digital health interventions for ICU survivors. The secondary aim was to describe any effect on patient-reported health outcomes.
Data sources
A systematic search of Medical Literature Analysis and Retrieval System Online (MEDLINE), Excertpa Medica Database (EMBASE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Systematic Reviews (CENTRAL) databases was undertaken in March 2023.
Study selection
Two independent reviewers screened abstracts and full texts against eligibility criteria. Studies of adult survivors with any post-ICU discharge care, delivered via a digital mode, were included. Studies were excluded if published before 1990 or not in English.
Data extraction
Quantitative data were extracted using predefined data fields. Risk of bias was assessed using the Newcastle–Ottawa Scale and Cochrane Risk of Bias Tool 2.0. Implementation factors were reported according to the Reach, Effectiveness, Adoption, Implementation and Maintenance framework.
Data synthesis
A total of 6482 studies were screened. Ten studies, with 686 participants, were included. Implementation factors were reported in all studies. Acceptability (reported in six studies) was high, with high satisfaction and usability scores, defined a priori by investigators. Eight studies reported intervention adherence rates between 46% and 100%. Nine studies report final outcome measurement retention rates up to 12 months, between 52% and 100%. Five studies included the primary outcome as the difference in a patient-reported health outcome. Appraisal of efficacy and digital health literacy was limited due to substantial methodological variation and a lack of reporting in included studies. There was some risk of bias in 50% of studies.
Conclusions
Digital health interventions can be successfully implemented for critical care survivors and have varying intervention adherence and retention rate success. To broaden reach, future research should include cultural diversity and investigate digital health access, literacy, and cost-effectiveness.
International Prospective Register of Systematic Reviews Registration
{"title":"Digital health interventions to improve recovery for intensive care unit survivors: A systematic review","authors":"Nina Leggett DPT, BBiomed , Yasmine Ali Abdelhamid MBBS, PhD, FCICM, FRACP , Adam M. Deane MBBS, PhD, FCICM, FRACP , Kate Emery BExSci, DPT , Evelyn Hutcheon BA Library & Information Science , Thomas C. Rollinson BPhysio(Hons) , Annabel Preston BPT (Hons), BSc , Sophie Witherspoon BSc, MD , Cindy Zhang DPT, BSc , Mark Merolli PhD, B.Physio (Hons), FAIDH, CHIA , Kimberley J. Haines PhD, BHSc Physiotherapy","doi":"10.1016/j.aucc.2024.101134","DOIUrl":"10.1016/j.aucc.2024.101134","url":null,"abstract":"<div><h3>Objective</h3><div>Recovery models of care for intensive care unit (ICU) survivors are limited by availability, accessibility, and efficacy. Digital health interventions represent an alternative mode of service delivery. The primary aim of this systematic review was to describe implementation factors (Reach, Effectiveness, Adoption, Implementation, and Maintenance) for digital health interventions for ICU survivors. The secondary aim was to describe any effect on patient-reported health outcomes.</div></div><div><h3>Data sources</h3><div>A systematic search of Medical Literature Analysis and Retrieval System Online (MEDLINE), Excertpa Medica Database (EMBASE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Systematic Reviews (CENTRAL) databases was undertaken in March 2023.</div></div><div><h3>Study selection</h3><div>Two independent reviewers screened abstracts and full texts against eligibility criteria. Studies of adult survivors with any post-ICU discharge care, delivered via a digital mode, were included. Studies were excluded if published before 1990 or not in English.</div></div><div><h3>Data extraction</h3><div>Quantitative data were extracted using predefined data fields. Risk of bias was assessed using the Newcastle–Ottawa Scale and Cochrane Risk of Bias Tool 2.0. Implementation factors were reported according to the Reach, Effectiveness, Adoption, Implementation and Maintenance framework.</div></div><div><h3>Data synthesis</h3><div>A total of 6482 studies were screened. Ten studies, with 686 participants, were included. Implementation factors were reported in all studies. Acceptability (reported in six studies) was high, with high satisfaction and usability scores, defined a priori by investigators. Eight studies reported intervention adherence rates between 46% and 100%. Nine studies report final outcome measurement retention rates up to 12 months, between 52% and 100%. Five studies included the primary outcome as the difference in a patient-reported health outcome. Appraisal of efficacy and digital health literacy was limited due to substantial methodological variation and a lack of reporting in included studies. There was some risk of bias in 50% of studies.</div></div><div><h3>Conclusions</h3><div>Digital health interventions can be successfully implemented for critical care survivors and have varying intervention adherence and retention rate success. To broaden reach, future research should include cultural diversity and investigate digital health access, literacy, and cost-effectiveness.</div></div><div><h3>International Prospective Register of Systematic Reviews Registration</h3><div>CRD42022348252.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101134"},"PeriodicalIF":2.6,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-17DOI: 10.1016/j.aucc.2024.101136
ZhiRu Li RN, BSN , FangYan Lu LPN, MN , Li Dong LPN, MN , YanHong Dai LPN, MN , RuiJie Bao RN, BSN , JingYun Wu RN, BSN , YuXin Rao RN, BSN , HuaFen Wang LPN, MN
Background
Intra-abdominal hypertension has been proven to be an independent risk factor for death in critically ill patients. Accurate monitoring of intra-abdominal pressure is of great significance for early identification and timely intervention of intra-abdominal hypertension to prevent further progression to abdominal compartment syndrome. Paediatric critical care nurses play an important role in constant observation and recognition of subtle and dynamic changes in intra-abdominal pressure of critically ill children.
Objectives
The objective of this study was to explore paediatric critical care nurses's views on the barriers and facilitators in clinical practice of intra-abdominal pressure measurement.
Methods
A qualitative, open-ended, and exploratory study was conducted in the paediatric intensive care unit of a tertiary hospital in China. Semistructured interviews were conducted with nurses and nursing managers who were involved in the management of intra-abdominal pressure. The interview guide was developed using the Theoretical Domains Framework to explore the barriers and facilitators to intra-abdominal pressure measurement in the paediatric intensive care unit. Data analysis followed the framework approach, drawing on the Theoretical Domains Framework.
Results
Fourteen participants (10 nurses and four nursing managers) were interviewed. We identified seven domains related to intra-abdominal pressure measurement mapping to six “barrier” domains and four “facilitator” domains. The six “barrier” domains were knowledge, social influences, behavioural regulation, beliefs about consequences, beliefs about capabilities, and environmental context and resources, and the four “facilitator” domains were social influences, beliefs about consequences, environmental context and resources, and social/professional role and identity.
Conclusions
The findings confirm the need for interventions to support paediatric critical care nurses in their intra-abdominal pressure measurement practices, with a particular focus on increasing knowledge, improving skills and measurement equipment, promoting nurse–physician interprofessional collaboration, providing a standardised measurement process, and establishing a supportive environment. Using the Theoretical Domains Framework will enhance the design of a targeted intervention, which should facilitate the standardised management of intra-abdominal pressure in the paediatric intensive care unit.
{"title":"Barriers and facilitators in implementing intra-abdominal pressure measurement by nurses in paediatric intensive care units: A qualitative study","authors":"ZhiRu Li RN, BSN , FangYan Lu LPN, MN , Li Dong LPN, MN , YanHong Dai LPN, MN , RuiJie Bao RN, BSN , JingYun Wu RN, BSN , YuXin Rao RN, BSN , HuaFen Wang LPN, MN","doi":"10.1016/j.aucc.2024.101136","DOIUrl":"10.1016/j.aucc.2024.101136","url":null,"abstract":"<div><h3>Background</h3><div>Intra-abdominal hypertension has been proven to be an independent risk factor for death in critically ill patients. Accurate monitoring of intra-abdominal pressure is of great significance for early identification and timely intervention of intra-abdominal hypertension to prevent further progression to abdominal compartment syndrome. Paediatric critical care nurses play an important role in constant observation and recognition of subtle and dynamic changes in intra-abdominal pressure of critically ill children.</div></div><div><h3>Objectives</h3><div>The objective of this study was to explore paediatric critical care nurses's views on the barriers and facilitators in clinical practice of intra-abdominal pressure measurement.</div></div><div><h3>Methods</h3><div>A qualitative, open-ended, and exploratory study was conducted in the paediatric intensive care unit of a tertiary hospital in China. Semistructured interviews were conducted with nurses and nursing managers who were involved in the management of intra-abdominal pressure. The interview guide was developed using the Theoretical Domains Framework to explore the barriers and facilitators to intra-abdominal pressure measurement in the paediatric intensive care unit. Data analysis followed the framework approach, drawing on the Theoretical Domains Framework.</div></div><div><h3>Results</h3><div>Fourteen participants (10 nurses and four nursing managers) were interviewed. We identified seven domains related to intra-abdominal pressure measurement mapping to six “barrier” domains and four “facilitator” domains. The six “barrier” domains were knowledge, social influences, behavioural regulation, beliefs about consequences, beliefs about capabilities, and environmental context and resources, and the four “facilitator” domains were social influences, beliefs about consequences, environmental context and resources, and social/professional role and identity.</div></div><div><h3>Conclusions</h3><div>The findings confirm the need for interventions to support paediatric critical care nurses in their intra-abdominal pressure measurement practices, with a particular focus on increasing knowledge, improving skills and measurement equipment, promoting nurse–physician interprofessional collaboration, providing a standardised measurement process, and establishing a supportive environment. Using the Theoretical Domains Framework will enhance the design of a targeted intervention, which should facilitate the standardised management of intra-abdominal pressure in the paediatric intensive care unit.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101136"},"PeriodicalIF":2.6,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-16DOI: 10.1016/j.aucc.2024.09.011
Mihui Kim PhD, RN , Yesol Kim PhD, RN , Mona Choi PhD, RN
Background
Although prognosis prediction models using nursing documentation have good predictive performance, the experiences of intensive care unit nurses related to nursing activities and documentation when a patient's condition deteriorates are yet to be explored.
Objective
The aim of this study was to explore nurses' experiences of nursing activities and documentation in intensive care units when a patient's condition deteriorates.
Methods
This was a descriptive qualitative study using focus-group interviews with intensive care unit nurses in tertiary or university-affiliated hospitals. In total, 19 registered nurses with at least 1 year of clinical experience in the adult intensive care unit were recruited using a purposive sampling method. Five focus-group interviews were conducted, and the data were analysed through a qualitative content analysis.
Results
Intensive care unit nurses' experiences with patient deterioration were classified into four main categories—perceived patient deterioration; endeavours to verify nurses' concerns; nursing activities to improve a patient's condition; and optimising documentation practices—which comprised 12 subcategories. Intensive care unit nurses recognise patient deterioration through nursing activities and documentation, and the two processes influence each other. However, nursing activities related to nurses' concerns were mainly handed over verbally rather than documented due to the inflexibility of the available standardised forms and the potential uncertainty of those concerns.
Conclusions
The findings reveal how intensive care unit nurses perceive, intervene, and document the condition of a deteriorating patient. Nurses' concerns may be the first sign of a patient's deteriorating condition and are therefore crucial for minimising patient risk. Therefore, efforts to systematically document nurses' concerns may contribute to improving patient outcomes.
{"title":"Intensive care unit nurses’ experiences of nursing concerns, activities, and documentation on patient deterioration: A focus-group study","authors":"Mihui Kim PhD, RN , Yesol Kim PhD, RN , Mona Choi PhD, RN","doi":"10.1016/j.aucc.2024.09.011","DOIUrl":"10.1016/j.aucc.2024.09.011","url":null,"abstract":"<div><h3>Background</h3><div>Although prognosis prediction models using nursing documentation have good predictive performance, the experiences of intensive care unit nurses related to nursing activities and documentation when a patient's condition deteriorates are yet to be explored.</div></div><div><h3>Objective</h3><div>The aim of this study was to explore nurses' experiences of nursing activities and documentation in intensive care units when a patient's condition deteriorates.</div></div><div><h3>Methods</h3><div>This was a descriptive qualitative study using focus-group interviews with intensive care unit nurses in tertiary or university-affiliated hospitals. In total, 19 registered nurses with at least 1 year of clinical experience in the adult intensive care unit were recruited using a purposive sampling method. Five focus-group interviews were conducted, and the data were analysed through a qualitative content analysis.</div></div><div><h3>Results</h3><div>Intensive care unit nurses' experiences with patient deterioration were classified into four main categories—perceived patient deterioration; endeavours to verify nurses' concerns; nursing activities to improve a patient's condition; and optimising documentation practices—which comprised 12 subcategories. Intensive care unit nurses recognise patient deterioration through nursing activities and documentation, and the two processes influence each other. However, nursing activities related to nurses' concerns were mainly handed over verbally rather than documented due to the inflexibility of the available standardised forms and the potential uncertainty of those concerns.</div></div><div><h3>Conclusions</h3><div>The findings reveal how intensive care unit nurses perceive, intervene, and document the condition of a deteriorating patient. Nurses' concerns may be the first sign of a patient's deteriorating condition and are therefore crucial for minimising patient risk. Therefore, efforts to systematically document nurses' concerns may contribute to improving patient outcomes.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101126"},"PeriodicalIF":2.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-16DOI: 10.1016/j.aucc.2024.09.016
Tessa Garside MBBS, PhD , Ralph Stanford MBBS, PhD , Oliver Flower MBBS, BMedSci , Trent Li BMed, MPH , Edward Dababneh MD , Naomi Hammond RN, PhD , Frances Bass BN, MSc , James Middleton MBBS, PhD , Jonathan Tang MD , Jonathan Ball MBBS, BMedSci , Anthony Delaney MBBS, PhD
Background
International guidelines recommend maintenance of mean arterial pressure (MAP) > 85 mmHg to defend spinal cord perfusion pressure after acute traumatic spinal cord injury (SCI). Variation in practice has been demonstrated in the emergency department blood pressure management of SCI in New South Wales (NSW). It is unknown whether this variation exists in the phase of intensive care management of acute SCI.
Objectives
The objective of this study was to describe and compare current blood pressure management in the intensive care unit (ICU) of patients with acute traumatic SCI in two SCI referral centres in NSW.
Methods
Patients with acute traumatic SCI admitted to two SCI referral centres, Unit A and Unit B during 2018–2019 in NSW, were included. Data were summarised using descriptive statistics.
Results
Ninety-eight patients were included, with 91 patients having been prescribed a blood pressure target, 81 (83%) having required vasopressors, and 18 (18%) of these having been documented to have complications associated with vasopressor use. The average prescribed MAP target was 78 (interquartile range [IQR]: 10) mmHg in Unit A and 76 (IQR: 12) mmHg in Unit B. Median durations of prescribed target were 120 (IQR: 72) hours and 120 (IQR: 120) hours in Unit A and Unit B, respectively. The average MAP over the first 7 d was 88 (standard deviation: 9.5) mmHg in Unit A and 85 (standard deviation: 7.5) mmHg in Unit B. Sixty-three patients (64%) had a documented systolic blood pressure <90 mmHg in the first 24 h. Median ICU length of stay (LOS) was 9.7 (IQR: 11) d in Unit A and 6 (IQR: 6.6) d in Unit B. Median hospital LOS was 27 (IQR: 56.2) d in Unit B and 34.7 (IQR: 32.3) d in Unit B. ICU LOS was longer in patients who had a MAP target than in those who did not.
Conclusions
Current blood pressure management in acute SCI in NSW involves ICU admission and blood pressure support with vasopressors; however, prescribed blood pressure targets are not in line with international guidelines.
{"title":"Blood pressure management in acute spinal cord injury: A retrospective study of acute intensive care management of traumatic spinal cord injury in two New South Wales referral centres","authors":"Tessa Garside MBBS, PhD , Ralph Stanford MBBS, PhD , Oliver Flower MBBS, BMedSci , Trent Li BMed, MPH , Edward Dababneh MD , Naomi Hammond RN, PhD , Frances Bass BN, MSc , James Middleton MBBS, PhD , Jonathan Tang MD , Jonathan Ball MBBS, BMedSci , Anthony Delaney MBBS, PhD","doi":"10.1016/j.aucc.2024.09.016","DOIUrl":"10.1016/j.aucc.2024.09.016","url":null,"abstract":"<div><h3>Background</h3><div>International guidelines recommend maintenance of mean arterial pressure (MAP) > 85 mmHg to defend spinal cord perfusion pressure after acute traumatic spinal cord injury (SCI). Variation in practice has been demonstrated in the emergency department blood pressure management of SCI in New South Wales (NSW). It is unknown whether this variation exists in the phase of intensive care management of acute SCI.</div></div><div><h3>Objectives</h3><div>The objective of this study was to describe and compare current blood pressure management in the intensive care unit (ICU) of patients with acute traumatic SCI in two SCI referral centres in NSW.</div></div><div><h3>Methods</h3><div>Patients with acute traumatic SCI admitted to two SCI referral centres, Unit A and Unit B during 2018–2019 in NSW, were included. Data were summarised using descriptive statistics.</div></div><div><h3>Results</h3><div>Ninety-eight patients were included, with 91 patients having been prescribed a blood pressure target, 81 (83%) having required vasopressors, and 18 (18%) of these having been documented to have complications associated with vasopressor use. The average prescribed MAP target was 78 (interquartile range [IQR]: 10) mmHg in Unit A and 76 (IQR: 12) mmHg in Unit B. Median durations of prescribed target were 120 (IQR: 72) hours and 120 (IQR: 120) hours in Unit A and Unit B, respectively. The average MAP over the first 7 d was 88 (standard deviation: 9.5) mmHg in Unit A and 85 (standard deviation: 7.5) mmHg in Unit B. Sixty-three patients (64%) had a documented systolic blood pressure <90 mmHg in the first 24 h. Median ICU length of stay (LOS) was 9.7 (IQR: 11) d in Unit A and 6 (IQR: 6.6) d in Unit B. Median hospital LOS was 27 (IQR: 56.2) d in Unit B and 34.7 (IQR: 32.3) d in Unit B. ICU LOS was longer in patients who had a MAP target than in those who did not.</div></div><div><h3>Conclusions</h3><div>Current blood pressure management in acute <span>SCI</span> in NSW involves ICU admission and blood pressure support with vasopressors; however, prescribed blood pressure targets are not in line with international guidelines.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101131"},"PeriodicalIF":2.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-16DOI: 10.1016/j.aucc.2024.101138
Dohee Kwon BSN, RN, CCRN , Lindsay Riskey BSN, RN , Abdulkadir Kamal BSN, RN , Brittany R. Doyle BSN, RN, CCRN, SCRN , Brennen Louthen BSN, RN , Jade L. Marshall BS (Nursing Student) , Samir D. Ruxmohan DO (Physician) , Amber Salter PhD (Biostatistican) , DaiWai M. Olson PhD, RN, FNCS
Background
External ventricular drains (EVDs) are placed in patients with increased intracranial pressure (ICP) to serve as a cerebrospinal fluid (CSF) pressure flow diverter and ICP monitor. EVD management practice among institutions and practitioners varies greatly, with little evidence supporting ideal ICP recording and CSF drainage practice.
Objective
This study's aim is to determine variations in ICP across 21 min before and after CSF drainage.
Methods
Thirty adult patients with EVDs were consented for a real-world observational study. As per the institution guidelines, each patient's drain was levelled to the tragus and zeroed. The EVD was then clamped for 10 min, opened to drain for 1 min, and clamped again for another 10 min. ICPs were then recorded immediately, at 30 s, 1 min, 5 min, and 10 min after drain clamp. Each patient was eligible for up to 10 separate observation events, limited to one observation per shift.
Results
We observed 226 independent drain-clamping events among 30 participants. The most common indication for EVD placement was to monitor and treat a mass-occupying lesion (n = 28). The patients had a mean age of 54.8 (15.9) years, including 12 (41%) females and 17 (59%) males. Fifty-one percent of CSF was characterised as clear, followed by serosanguinous, serous, and sanguineous characterisations. One minute of CSF drainage decreased ICP from 10.30 to 9.20, an average of 1.1 mmHg lower (p < 0.05).
Conclusion
The ICP measurement practice is not standardised among clinicians. ICP variations ranged from negative numbers to well above the normal range, whereas no clinical changes in patient exam were seen. Drainage of CSF decreases ICPs momentarily, and the effects of drainage do not last long. Further studies are needed to evaluate the safest approach to EVD management and ICP recording practice.
{"title":"Does intracranial pressure vary based on external ventricular drainage? A real-world clinical observation study","authors":"Dohee Kwon BSN, RN, CCRN , Lindsay Riskey BSN, RN , Abdulkadir Kamal BSN, RN , Brittany R. Doyle BSN, RN, CCRN, SCRN , Brennen Louthen BSN, RN , Jade L. Marshall BS (Nursing Student) , Samir D. Ruxmohan DO (Physician) , Amber Salter PhD (Biostatistican) , DaiWai M. Olson PhD, RN, FNCS","doi":"10.1016/j.aucc.2024.101138","DOIUrl":"10.1016/j.aucc.2024.101138","url":null,"abstract":"<div><h3>Background</h3><div>External ventricular drains (EVDs) are placed in patients with increased intracranial pressure (ICP) to serve as a cerebrospinal fluid (CSF) pressure flow diverter and ICP monitor. EVD management practice among institutions and practitioners varies greatly, with little evidence supporting ideal ICP recording and CSF drainage practice.</div></div><div><h3>Objective</h3><div>This study's aim is to determine variations in ICP across 21 min before and after CSF drainage.</div></div><div><h3>Methods</h3><div>Thirty adult patients with EVDs were consented for a real-world observational study. As per the institution guidelines, each patient's drain was levelled to the tragus and zeroed. The EVD was then clamped for 10 min, opened to drain for 1 min, and clamped again for another 10 min. ICPs were then recorded immediately, at 30 s, 1 min, 5 min, and 10 min after drain clamp. Each patient was eligible for up to 10 separate observation events, limited to one observation per shift.</div></div><div><h3>Results</h3><div>We observed 226 independent drain-clamping events among 30 participants. The most common indication for EVD placement was to monitor and treat a mass-occupying lesion (n = 28). The patients had a mean age of 54.8 (15.9) years, including 12 (41%) females and 17 (59%) males. Fifty-one percent of CSF was characterised as clear, followed by serosanguinous, serous, and sanguineous characterisations. One minute of CSF drainage decreased ICP from 10.30 to 9.20, an average of 1.1 mmHg lower (p < 0.05).</div></div><div><h3>Conclusion</h3><div>The ICP measurement practice is not standardised among clinicians. ICP variations ranged from negative numbers to well above the normal range, whereas no clinical changes in patient exam were seen. Drainage of CSF decreases ICPs momentarily, and the effects of drainage do not last long. Further studies are needed to evaluate the safest approach to EVD management and ICP recording practice.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101138"},"PeriodicalIF":2.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-15DOI: 10.1016/j.aucc.2024.101133
Sharon Latimer RN, PhD , Wendy Chaboyer RN, PhD , Rachel M. Walker RN, PhD , Lukman Thalib PhD , Jodie L. Deakin RN, MEd , Brigid M. Gillespie RN, PhD
Background
Prophylactic dressings are used to prevent sacral pressure injuries (PIs) in intensive care unit (ICU) patients. Bedside clinicians are responsible for selecting these dressings despite the lack of comparative evidence.
Objectives
The objective of this study was to assess the feasibility of undertaking a larger multisite comparative effectiveness trial of two prophylactic sacral dressings in adult ICU patients.
Methods
Using a two-arm pilot randomised feasibility trial design, we randomly allocated adult ICU patients to the Mepilex® Border Sacrum dressing or Allevyn™ Life Sacrum dressing plus usual PI prevention care. Our primary study outcomes were study eligibility, recruitment, retention, intervention fidelity, and missing data criteria. Participants were followed up for up to 14 days or a study endpoint: new sacral PI, ICU discharge, death, prone positioning, urine/faecal incontinence, or withdrawal. Daily clinical data were collected including a deidentified sacral photograph, sacral visual skin assessment, dressing failure rates (rolled edges, adhesion loss), and dressing-related harm (e.g., blisters). The blinded outcome assessor used these data to determine the presence of a new sacral PI.
Results
From January to September 2023, 1069 ICU patients were screened; 77 (7.2%) were eligible, and 68 (88.3%) were recruited. Half of our feasibility criteria were met. One participant (1.5%) developed a sacral PI. Throughout the study, half (n = 54; 49.5%) of the dressing changes were due to dressing failure (rolled edges: n = 43; 79.5%, adhesion failure: n = 11; 20.5%).
Conclusions
Several prophylactic sacral dressings are available; however, comparative effective evidence between brands relative to performance, benefits, and harms is lacking. Following minor study criteria modifications, we found that a larger multisite comparative trial is feasible. Sacral prophylactic dressing failure and dressing-related harms are care quality and patient safety issues requiring further investigation regarding performance, harm, and costs.
Trial registration
Australian and New Zealand Clinical Trial Registration number: ACTRN12622000793718 and World Health Organization Universal Trial number: U1111-1278-6055.
{"title":"Prophylactic dressings for preventing sacral pressure injuries in adult intensive care unit patients: A randomised feasibility trial","authors":"Sharon Latimer RN, PhD , Wendy Chaboyer RN, PhD , Rachel M. Walker RN, PhD , Lukman Thalib PhD , Jodie L. Deakin RN, MEd , Brigid M. Gillespie RN, PhD","doi":"10.1016/j.aucc.2024.101133","DOIUrl":"10.1016/j.aucc.2024.101133","url":null,"abstract":"<div><h3>Background</h3><div>Prophylactic dressings are used to prevent sacral pressure injuries (PIs) in intensive care unit (ICU) patients. Bedside clinicians are responsible for selecting these dressings despite the lack of comparative evidence.</div></div><div><h3>Objectives</h3><div>The objective of this study was to assess the feasibility of undertaking a larger multisite comparative effectiveness trial of two prophylactic sacral dressings in adult ICU patients.</div></div><div><h3>Methods</h3><div>Using a two-arm pilot randomised feasibility trial design, we randomly allocated adult ICU patients to the Mepilex® Border Sacrum dressing or Allevyn™ Life Sacrum dressing plus usual PI prevention care. Our primary study outcomes were study eligibility, recruitment, retention, intervention fidelity, and missing data criteria. Participants were followed up for up to 14 days or a study endpoint: new sacral PI, ICU discharge, death, prone positioning, urine/faecal incontinence, or withdrawal. Daily clinical data were collected including a deidentified sacral photograph, sacral visual skin assessment, dressing failure rates (rolled edges, adhesion loss), and dressing-related harm (e.g., blisters). The blinded outcome assessor used these data to determine the presence of a new sacral PI.</div></div><div><h3>Results</h3><div>From January to September 2023, 1069 ICU patients were screened; 77 (7.2%) were eligible, and 68 (88.3%) were recruited. Half of our feasibility criteria were met. One participant (1.5%) developed a sacral PI. Throughout the study, half (n = 54; 49.5%) of the dressing changes were due to dressing failure (rolled edges: n = 43; 79.5%, adhesion failure: n = 11; 20.5%).</div></div><div><h3>Conclusions</h3><div>Several prophylactic sacral dressings are available; however, comparative effective evidence between brands relative to performance, benefits, and harms is lacking. Following minor study criteria modifications, we found that a larger multisite comparative trial is feasible. Sacral prophylactic dressing failure and dressing-related harms are care quality and patient safety issues requiring further investigation regarding performance, harm, and costs.</div></div><div><h3>Trial registration</h3><div>Australian and New Zealand Clinical Trial Registration number: ACTRN12622000793718 and World Health Organization Universal Trial number: U1111-1278-6055.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101133"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study evaluated the effectiveness of the 28-item Therapeutic Intervention Scoring System (TISS-28) in detecting multiorgan dysfunction (MOD) among critically ill obstetric patients and compared its predictive potential to other severity models, such as Sequential Organ Failure Assessment (SOFA) and Mortality Probability Model II (MPM II).
Methods
A prospective multicentre cohort study was conducted including obstetric patients, pregnant and up to 42 days postpartum, admitted to the intensive care units of two referral hospitals in Colombia. A total of 93 patients were recruited between March 2016 and February 2017 and from September 2019 to November 2019. Scores from the MPM II, SOFA, and TISS-28 were calculated within the first 24 h post–intensive care unit admission. The primary outcome was to evaluate the effectiveness of TISS-28 in predicting MOD, as defined by the World Health Organization near-miss criteria. We compared the TISS-28 with SOFA and MPM II scores in identifying MOD using the positive predictive value, negative predictive value, and the area under the receiver operating characteristic curve.
Results
Data from 93 patients were analysed, of whom 22 developed MOD. Hypertensive disorders were the predominant diagnosis (n = 62; 66.7%). Patients with sepsis exhibited the highest TISS-28 score, indicating more intensive therapeutic interventions. The areas under the receiver operating characteristic curve for TISS-28, SOFA, and MPM II were 0.83 (95% confidence interval: 0.73–0.92), 0.66 (0.51–0.80), and 0.59 (0.43–0.74), respectively (p = 0.001). The cut-off value of a TISS-28 score ≥21 was associated with an increased likelihood of MOD (sensitivity: 83.2%, specificity: 71.2%), a positive predictive value of 47.3%, and a negative predictive value) of 93.2%.
Conclusions
TISS-28 demonstrated robust performance in identifying MOD among obstetric patients compared to other severity indexes. The TISS-28 score complements physiology-derived severity scores by reflecting the level of care required, making it a valuable tool in risk stratification and resource allocation for critically ill obstetric patients.
{"title":"The usefulness of a 28-item Therapeutic Intervention Scoring System (TISS-28) in critically ill obstetric patients to detect multiorgan dysfunction: A prospective cohort study","authors":"Jose Rojas-Suarez MD, MSc , Jeniffer González-Hernández MD , Diana Borre-Naranjo MD , Alejandra Vergara-Schotborgh MD , Laura Saavedra-Valencia MD , Carmelo Dueñas-Castell MD , Jose Santacruz-Arias MD , Wendy Pollock RN, RM, PhD","doi":"10.1016/j.aucc.2024.101137","DOIUrl":"10.1016/j.aucc.2024.101137","url":null,"abstract":"<div><h3>Background</h3><div>This study evaluated the effectiveness of the 28-item Therapeutic Intervention Scoring System (TISS-28) in detecting multiorgan dysfunction (MOD) among critically ill obstetric patients and compared its predictive potential to other severity models, such as Sequential Organ Failure Assessment (SOFA) and Mortality Probability Model II (MPM II).</div></div><div><h3>Methods</h3><div>A prospective multicentre cohort study was conducted including obstetric patients, pregnant and up to 42 days postpartum, admitted to the intensive care units of two referral hospitals in Colombia. A total of 93 patients were recruited between March 2016 and February 2017 and from September 2019 to November 2019. Scores from the MPM II, SOFA, and TISS-28 were calculated within the first 24 h post–intensive care unit admission. The primary outcome was to evaluate the effectiveness of TISS-28 in predicting MOD, as defined by the World Health Organization near-miss criteria. We compared the TISS-28 with SOFA and MPM II scores in identifying MOD using the positive predictive value, negative predictive value, and the area under the receiver operating characteristic curve.</div></div><div><h3>Results</h3><div>Data from 93 patients were analysed, of whom 22 developed MOD. Hypertensive disorders were the predominant diagnosis (n = 62; 66.7%). Patients with sepsis exhibited the highest TISS-28 score, indicating more intensive therapeutic interventions. The areas under the receiver operating characteristic curve for TISS-28, SOFA, and MPM II were 0.83 (95% confidence interval: 0.73–0.92), 0.66 (0.51–0.80), and 0.59 (0.43–0.74), respectively (p = 0.001). The cut-off value of a TISS-28 score ≥21 was associated with an increased likelihood of MOD (sensitivity: 83.2%, specificity: 71.2%), a positive predictive value of 47.3%, and a negative predictive value) of 93.2%.</div></div><div><h3>Conclusions</h3><div>TISS-28 demonstrated robust performance in identifying MOD among obstetric patients compared to other severity indexes. The TISS-28 score complements physiology-derived severity scores by reflecting the level of care required, making it a valuable tool in risk stratification and resource allocation for critically ill obstetric patients.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101137"},"PeriodicalIF":2.6,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-08DOI: 10.1016/j.aucc.2024.09.015
Glenn M. Eastwood RN, PhD , Michael Bailey MSc Statistics, PhD , Alistair D. Nichol MB, MD, PhD , Josef Dankiewicz MD, PhD , Niklas Nielsen MD, PhD , Rachael Parke RN, PhD , Tobias Cronberg MD, PhD , Theresa Olasveengen MD, PhD , Anders M. Grejs MD, PhD , Manuela Iten MD , Matthias Haenggi MD , Peter McGuigan MB, BCh, BAO , Franca Wagner MD , Marion Moseby-Knappe MD, PhD , Margareta Lang MD , Rinaldo Bellomo MBBS, MD, PhD
Background
Neuroimaging with magnetic resonance imaging (MRI) may assist clinicians in evaluating brain injury and optimising care in comatose adults resuscitated after out-of-hospital cardiac arrest (OHCA). However, contemporary international data on its use are lacking.
Aim
The primary aim was to compare the patient characteristics, early postresuscitation care, and neurological outcomes of patients according to MRI use.
Methods
We performed a posthoc analysis of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest (TAME) trial, a multinational randomised trial comparing targeted mild hypercapnia or normocapnia in comatose adults after OHCA.
Results
After exclusions, 1639 patients enrolled in the TAME trial were analysed. Of these, 149 (9%) had an MRI. Compared to non-MRI patients, MRI patients were younger (58.9 versus 61.7 years, p: 0.02), had a longer median time from OHCA to return of spontaneous circulation (30 versus 25 min, p < 0.0001), and had a higher average arterial lactate level (8.78 versus 6.74 mmol/L, p < 0.0001) on admission to hospital. MRI patients were more likely to receive additional advanced diagnostic assessments during intensive care unit admission (p < 0.0001). At 6 months, 23 of 140 patients (16.4%) in the MRI group had a favourable neurological outcome, compared with 659 of 1399 patients (47.1%) in the no-MRI group (p < 0.001). On multivariable modelling, country of enrolment was the dominating predictor in the likelihood of an MRI being performed.
Conclusions
In the TAME trial, 9% of patients had an MRI during their intensive care unit admission. Among these patients, only 16% had a favourable neurological outcome at 6 months.
{"title":"Magnetic resonance imaging in comatose adults resuscitated after out-of-hospital cardiac arrest: A posthoc study of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest trial","authors":"Glenn M. Eastwood RN, PhD , Michael Bailey MSc Statistics, PhD , Alistair D. Nichol MB, MD, PhD , Josef Dankiewicz MD, PhD , Niklas Nielsen MD, PhD , Rachael Parke RN, PhD , Tobias Cronberg MD, PhD , Theresa Olasveengen MD, PhD , Anders M. Grejs MD, PhD , Manuela Iten MD , Matthias Haenggi MD , Peter McGuigan MB, BCh, BAO , Franca Wagner MD , Marion Moseby-Knappe MD, PhD , Margareta Lang MD , Rinaldo Bellomo MBBS, MD, PhD","doi":"10.1016/j.aucc.2024.09.015","DOIUrl":"10.1016/j.aucc.2024.09.015","url":null,"abstract":"<div><h3>Background</h3><div>Neuroimaging with magnetic resonance imaging (MRI) may assist clinicians in evaluating brain injury and optimising care in comatose adults resuscitated after out-of-hospital cardiac arrest (OHCA). However, contemporary international data on its use are lacking.</div></div><div><h3>Aim</h3><div>The primary aim was to compare the patient characteristics, early postresuscitation care, and neurological outcomes of patients according to MRI use.</div></div><div><h3>Methods</h3><div>We performed a posthoc analysis of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest (TAME) trial, a multinational randomised trial comparing targeted mild hypercapnia or normocapnia in comatose adults after OHCA.</div></div><div><h3>Results</h3><div>After exclusions, 1639 patients enrolled in the TAME trial were analysed. Of these, 149 (9%) had an MRI. Compared to non-MRI patients, MRI patients were younger (58.9 versus 61.7 years, p: 0.02), had a longer median time from OHCA to return of spontaneous circulation (30 versus 25 min, p < 0.0001), and had a higher average arterial lactate level (8.78 versus 6.74 mmol/L, p < 0.0001) on admission to hospital. MRI patients were more likely to receive additional advanced diagnostic assessments during intensive care unit admission (p < 0.0001). At 6 months, 23 of 140 patients (16.4%) in the MRI group had a favourable neurological outcome, compared with 659 of 1399 patients (47.1%) in the no-MRI group (p < 0.001). On multivariable modelling, country of enrolment was the dominating predictor in the likelihood of an MRI being performed.</div></div><div><h3>Conclusions</h3><div>In the TAME trial, 9% of patients had an MRI during their intensive care unit admission. Among these patients, only 16% had a favourable neurological outcome at 6 months.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101130"},"PeriodicalIF":2.6,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-07DOI: 10.1016/j.aucc.2024.09.008
Angel Cobos-Vargas RN, PGCert , Paul Fulbrook RN, PhD , Josephine Lovegrove RN, PhD , María Acosta-Romero RN , Luís Camado-Sojo RN , Manuel Colmenero MD, PhD
Background
Hospital-acquired pressure injury is an enduring problem in intensive care. Several intensive care–specific pressure injury risk assessment tools have been developed, but to date, only the COMHON Index has been aligned with risk-stratified preventative interventions.
Objectives
The aim of this study was to evaluate the effectiveness of a risk-stratified intervention bundle to reduce pressure injury in intensive care and to assess compliance with bundled interventions.
Methods
A controlled before–after study was undertaken. All patients admitted to a single intensive care unit were included. Standard care was provided in the before phase, and the risk-stratified intervention bundle was implemented in the after phase. The primary outcome measure was pressure injury incidence.
Results
The sample comprised 761 intensive care admissions. In the after phase, pressure injury incidence was reduced (2.1% vs 3.9%; 46% relative risk reduction), injury severity was lower, and there were fewer pressure injuries on the sacrum, buttocks, and heels. Logistic regression modelling identified three significant factors associated with pressure injury development: intensive care length of stay (odds ratio: 1.2); COMHON Index admission score (odds ratio: 1.2), and the before phase (odds ratio: 4.2). In the after phase, individual intervention compliance was variable (range: 40%–100%), but the all-or-nothing compliance was poor (33%).
Conclusions
Implementation of bundled preventive measures associated with COMHON Index risk level reduced pressure injury incidence. Likewise, injury severity decreased, and the location of pressure injuries changed following the intervention. The results from this study support the use of risk-stratified interventions to prevent pressure injury in intensive care. However, further research is needed to examine the effectiveness of the COMHON Index bundle before it can be recommended for widespread clinical practice.
{"title":"Implementation of a risk-stratified intervention bundle to prevent pressure injury in intensive care: A before–after study","authors":"Angel Cobos-Vargas RN, PGCert , Paul Fulbrook RN, PhD , Josephine Lovegrove RN, PhD , María Acosta-Romero RN , Luís Camado-Sojo RN , Manuel Colmenero MD, PhD","doi":"10.1016/j.aucc.2024.09.008","DOIUrl":"10.1016/j.aucc.2024.09.008","url":null,"abstract":"<div><h3>Background</h3><div>Hospital-acquired pressure injury is an enduring problem in intensive care. Several intensive care–specific pressure injury risk assessment tools have been developed, but to date, only the COMHON Index has been aligned with risk-stratified preventative interventions.</div></div><div><h3>Objectives</h3><div>The aim of this study was to evaluate the effectiveness of a risk-stratified intervention bundle to reduce pressure injury in intensive care and to assess compliance with bundled interventions.</div></div><div><h3>Methods</h3><div>A controlled before–after study was undertaken. All patients admitted to a single intensive care unit were included. Standard care was provided in the before phase, and the risk-stratified intervention bundle was implemented in the after phase. The primary outcome measure was pressure injury incidence.</div></div><div><h3>Results</h3><div>The sample comprised 761 intensive care admissions. In the after phase, pressure injury incidence was reduced (2.1% vs 3.9%; 46% relative risk reduction), injury severity was lower, and there were fewer pressure injuries on the sacrum, buttocks, and heels. Logistic regression modelling identified three significant factors associated with pressure injury development: intensive care length of stay (odds ratio: 1.2); COMHON Index admission score (odds ratio: 1.2), and the before phase (odds ratio: 4.2). In the after phase, individual intervention compliance was variable (range: 40%–100%), but the all-or-nothing compliance was poor (33%).</div></div><div><h3>Conclusions</h3><div>Implementation of bundled preventive measures associated with COMHON Index risk level reduced pressure injury incidence. Likewise, injury severity decreased, and the location of pressure injuries changed following the intervention. The results from this study support the use of risk-stratified interventions to prevent pressure injury in intensive care. However, further research is needed to examine the effectiveness of the COMHON Index bundle before it can be recommended for widespread clinical practice.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101123"},"PeriodicalIF":2.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The healthcare sector in Australia has committed to reducing carbon emissions associated with care delivery. Thirty percent of care delivered in the Australian hospital sector is considered low-value care. Intensive care uses chemical prophylaxis to reduce risk of venous thromboembolism (VTE). Mechanical prophylaxis methods, which include intermittent pneumatic compression (IPC), are often used as an adjunct to chemical prophylaxis but can also be used in patients where chemical prophylaxis is contraindicated. Recent literature demonstrates, however, that there is no additional benefit to the routine use of IPC, in reducing VTE risk when used as an adjunct to chemical VTE prophylaxis.
Objective
The aims of this study were to assess the effect of the implementation of an education package on the use of single-use IPC devices in the intensive care unit to determine the carbon footprint of a pair of IPC devices, and to determine change in waste production, greenhouse gas emissions, and the financial cost associated with change in IPC use.
Methods
A before-and-after pilot study was undertaken in a single, level III intensive care unit. An audit was conducted to determine the appropriate use of IPC over a 3-month period before and after the delivery of an education package to guide prescription and use of IPC.
Results
Unnecessary use of IPC reduced from 33/58 (56.9%) to 3/31 (9.7%) after delivery of an education package. According to a bottom-up carbon footprinting analysis, embodied carbon of a single pair of IPC devices was 432.2 g carbon dioxide equivalent (CO2e). This study represents a minimum annual saving of $7682.40, 14.9 Kg waste and 51.8 KgCO2e associated with reduced unnecessary use of IPC.
Conclusion
Staff education and behaviour change reduced the number of IPC devices used. The number of IPC devices applied inappropriately also reduced, as did associated greenhouse gas emissions and financial cost.
{"title":"Reducing unnecessary use of intermittent pneumatic compression in intensive care: A before-and-after pilot study with environmental perspective","authors":"Louise Hansell PT, PhD , Anthony Delaney MBBS, MSc, PhD, FACEM, FCICM , Maree Milross PT, PhD , Elise Henderson PT","doi":"10.1016/j.aucc.2024.09.010","DOIUrl":"10.1016/j.aucc.2024.09.010","url":null,"abstract":"<div><h3>Background</h3><div>The healthcare sector in Australia has committed to reducing carbon emissions associated with care delivery. Thirty percent of care delivered in the Australian hospital sector is considered low-value care. Intensive care uses chemical prophylaxis to reduce risk of venous thromboembolism (VTE). Mechanical prophylaxis methods, which include intermittent pneumatic compression (IPC), are often used as an adjunct to chemical prophylaxis but can also be used in patients where chemical prophylaxis is contraindicated. Recent literature demonstrates, however, that there is no additional benefit to the routine use of IPC, in reducing VTE risk when used as an adjunct to chemical VTE prophylaxis.</div></div><div><h3>Objective</h3><div>The aims of this study were to assess the effect of the implementation of an education package on the use of single-use IPC devices in the intensive care unit to determine the carbon footprint of a pair of IPC devices, and to determine change in waste production, greenhouse gas emissions, and the financial cost associated with change in IPC use.</div></div><div><h3>Methods</h3><div>A before-and-after pilot study was undertaken in a single, level III intensive care unit. An audit was conducted to determine the appropriate use of IPC over a 3-month period before and after the delivery of an education package to guide prescription and use of IPC.</div></div><div><h3>Results</h3><div>Unnecessary use of IPC reduced from 33/58 (56.9%) to 3/31 (9.7%) after delivery of an education package. According to a bottom-up carbon footprinting analysis, embodied carbon of a single pair of IPC devices was 432.2 g carbon dioxide equivalent (CO<sub>2</sub>e). This study represents a minimum annual saving of $7682.40, 14.9 Kg waste and 51.8 KgCO<sub>2</sub>e associated with reduced unnecessary use of IPC.</div></div><div><h3>Conclusion</h3><div>Staff education and behaviour change reduced the number of IPC devices used. The number of IPC devices applied inappropriately also reduced, as did associated greenhouse gas emissions and financial cost.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101125"},"PeriodicalIF":2.6,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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