Bakgrund: Synen är ett av våra viktigaste sinnen för att samla information om omgivningen. Under 2023 vårdades ca 6000 personer i Sverige med respiratorbehandling på intensivvårdsavdelningar. Upp till 40% av dessa patienter drabbas av ögonkomplikationer. Många patienter på intensivvårdsavdelningar förlorar ögonens normala funktioner, inklusive tårproduktion och blinkreflex, vilket kan leda till skador. Faktorer som sugning av luftväg, PEEP, sederande läkemedel och muskelrelaxantia kan bidra till detta i större utsträckning i samband med respiratorbehandling.  Syfte: Att beskriva intensivvårdssjuksköterskors erfarenheter av ögonvård hos patienter med respiratorbehandling.  Metod: För studien användes en kvalitativ metod med deskriptiv design. Totalt intervjuades 10 deltagare rekryterade genom ett ändåmålsenligt urval. En kvalitativ innehållsanalys har använts vid dataanalysering. Huvudresultat: Intensivvårdssjuksköterskor beskrev att de initialt hade begränsad erfarenhet av ögonvård, men införandet av en vårdrutin om ögonvård ökade uppmärksamheten kring ämnet. Deltagarna beskrev en medvetenhet om riskfaktorer för ögonkomplikationer, men påpekade att bristen på tydligt synliga symtom ibland kunde påverka följsamheten. Utmaningar identifierades i att utföra ögonvård, särskilt gällande prioritering, hög arbetsbelastning och vid speciella behandlingsmetoder, såsom bukläge. Intensivvårdssjuksköterskorna uttryckte en efterfrågan om ytterligare utbildning och förståelse för ögonvårdens betydelse vid respiratorbehandling.  Slutsats: För att möta utmaningarna som intensivvårdssjuksköterskorna står inför vid behandling av patienter med respiratorbehandling och för att fördjupa förståelsen kring ögonvårdens betydelse, behövs utbildningsinsatser. Väl implementerade vårdrutiner kan även bidra till att säkerställa att ögonvården utförs korrekt och kan därigenom leda till att minska vårdlidandet bland intensivvårdspatienterna. / Background: Vision is one of our most important senses for gathering information about our surroundings. In 2023, approximatley 6000 individuals received respiratory treatment in intensive care units in Sweden. Up to 40% of these patients suffer from eye complications. Many patients in intensive care units lose normal eye functions, including tear production and the blink reflex, which can lead to injuries. Factors such as airway suctioning, PEEP, sedative medications, and muscle relaxants may contribute to this in connection with respiratory treatment.  Aim: To describe intensive care nurses experiences of eye care for patients undergoing respiratory treatment.  Method: A qualitative method with a descriptive design was used for the study. A total of 10 participants were interviewed, recruited through purposive sampling. Qualitative content analysis was used for data analysis. Main Results: Intensive care nurses described initially having limited experience in eye care, but the implementation of a care routine for eye care increased attention to the subject. Participants described an awareness of risk factors for eye complications, but pointed out that the lack of clearly visible symptoms could sometimes affect compliance. Challenges were identified in performing eye care, especially regarding prioritization, high workload, and in special treatment methods, such as prone positioning. Intensive care nurses expressed a demand for further education and understandning of the importance of eye care during respiratory treatment.  Conclusion: To meet the challenges faced by intensive care nurses in treating patients undergoing respiratory treatment and to deepen the understanding of the importance of eye care, educational efforts are needed. Well-implemented care routines can also contribute to ensuring that eye care is performed correctly and can thereby potentially reduce patient suffering among intensive care patients.

Immobility in an Intensive Care Unit (ICU) patient can be extremely detrimental and life-threatening to a person who suffers from a plethora of acute and chronic morbidities. Nurses in the ICU care a great deal about the~ patients, but may not always have the time, the knowledge, or the staffing to mobilize their patients as they should be mobilized. This literature review discusses the importance of mobilizing the ICU patient, what hazards of immobility could occur due to the lack of mobilization and different mobility interventions which are utilized in the ICU. The significance of this is to improve patient outcomes and limit the deconditioning caused by immobility. The writing of this review is an effort to encourage nurses to integrate mobility interventions into their plan of care. Understanding how to use this basic skill in a complex - environment will improve patient putcomes.

The aim: was to describe and compare a group of experts and critical care nurses' agreement in detecting delirium in intubated, ventilator treated patients with sedation / analgesia, before and after an in house training intervention with the instrument Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Method: A quasi-experimental study, one group pretest - posttest design. A convenience sample of 17 critical care nurses in a general intensive care unit included. To detect delirium the instrument CAM-ICU was used, 21 paired tests before and 22 after an educational intervention. Main Results: The results showed that after an in house training intervention sensitivity and kappa coefficient improved of the characteristic 1 "acute onset and fluctuating course," an improvement that was significant. In other features, and overall values were signs of numerical improvement and deterioration in sensitivity, specificity and kappa coefficient but no significant change. Conclusion: Implementing a new instrument for detecting delirium in clinical practice requires education and follow-up. A small sample of critical care nurses with varying ability to use the new instrument and the fact that patients' status may change rapidly making it difficult to draw any conclusions from this study. It is clear, however, that education and follow-up is needed when new care routines are introduced, and that further studies are needed to clarify whether the CAM-ICU is a valit and reliable instrument to use in clinical practice. / Syftet var att beskriva och jämföra en expertgrupp och intensivvårdssjuksköterskors överensstämmelse i att detektera delirium hos intuberade, respiratorbehandlade patienter med sedering/analgesi, före och efter en utbildningsintervention med instrumentet Confusion assessment method for the intensive care unit (CAM-ICU). Metod: En kvasiexperimentell studie, en grupps pretest – posttest design. Ett bekvämlighetsurval på en allmän intensivvårdsavdelning där inkluderades 17 intensivvårdssjuksköterskor. För att detektera delirium användes instrumentet CAM-ICU, 21 parmätningarna före och 22 efter en utbildningsintervention. Huvudresultat: Resultatet visade att efter utbildningsinterventionen förbättrades sensitiviteten och kappa koefficienten i kännetecken 1 ”akut insättande eller fluktuerande förlopp”, en förbättring som var signifikant. I övriga kännetecken och totalvärden fanns tecken på numerär förbättring och försämring i sensitivitet, specificitet och kappakoefficient men ingen signifikant förändring. Slutsats: Att implementera ett nytt instrument för att detektera delirium i klinisk verksamhet kräver utbildning och uppföljning. Ett litet sample av intensivvårdssjuksköterskor med varierad förmåga att använda det nya instrumentet samt det faktum att patienters status hastigt kan förändras gör det svårt att dra några slutsatser av denna studie. Klart är dock att utbildning och uppföljning behövs när nya vårdrutiner införs, och att ytterligare studier behövs för att klargöra om CAM-ICU är ett valit och reliabelt instrument att använda i klinisk verksamhet.

Background Critical illness myopathy (CIM) and polyneuropathy (CIP) are a common complication of critical illness. Both cause intensive-care-unit-acquired (ICU-acquired) muscle weakness (ICUAW) which increases morbidity and delays rehabilitation and recovery of activities of daily living such as walking ability. Focused physical rehabilitation of people with ICUAW is, therefore, of great importance at both an individual and a societal level. A recent systematic Cochrane review found no randomised controlled trials (RCT), and thus no supporting evidence, for physical rehabilitation interventions for people with defined CIP and CIM to improve activities of daily living. Therefore, the aim of our study is to compare the effects of an additional physiotherapy programme with systematically augmented levels of mobilisation with additional in-bed cycling (as the parallel group) on walking and other activities of daily living.

Nonvocal alert patients in the intensive care unit setting often struggle to communicate due to inaccessible or unavailable tools for augmentative and alternative communication. A novel communication tool, the Manually-Operated Communication System (MOCS), was developed for use in intensive care settings for patients unable to speak due to mechanical ventilation. It is a speech-generating device designed for patients whose limited manual dexterity precludes legible writing. In a single-arm device feasibility trial, 14 participants (11 with tracheostomies, 2 with endotracheal tubes, and 1 recently extubated) used MOCS. Participants, family members, and observing nurses were interviewed whenever possible. Interviews included a modified version of the System Usability Scale (SUS) as well as open-ended questions; a qualitative immersion/crystallization approach was used to evaluate these responses. Participants with a tracheostomy and their family members/care providers rated MOCS on the SUS questions as consistently “excellent” (average rating across all groups was 84 +/- 17; all subgroups also rated the device highly). Through a qualitative interview process, these stakeholders expressed support for the use of MOCS in the ICU. Based on these data, MOCS has the potential to improve communication for nonvocal patients with limited manual dexterity.

Bakgrund: Inom intensivvård är Lungprotektiv Ventilatorbehandling (LPV) en viktig behandlingsmetod för att undvika uppkomst av allvarliga lungkomplikationer. LPV kräver att intensivvårdssjuksköterskor aktivt deltar i vården, vilket förutsätter att kunskap och förståelse kring behandlingen finns. Syfte: Var att undersöka hur intensivvårdssjuksköterskor, på en intensivvårdsavdelning, bedömer sin kunskap och förståelse kring LPV för att kunna delta i ventilatorbehandlingen. Metod: Kvantitativ tvärsnittsstudie i form av en enkätundersökning. Resultat: Det föreligger ej något signifikant samband mellan antal års erfarenhet av intensivvård och intensivvårdsjuksköterskors uppskattade kunskap och förståelse kring LPV. Respondenterna uppskattar sin kunskap och förståelse kring LPV som hög, 68 % anser att verksamhetens utbildning varit bra eller mycket bra, 90 % anser att vidare behov av utbildning finns. Diskussion: Trots bra utbildning kring LPV och hög uppskattad kunskap finns vidare behov av utbildning, vilket talar för en personal som är medvetna om LPV:s syfte och att ständig fortbildning krävs. Då det inte föreligger något statistiskt samband, överrensstämmer resultatet från analysen inte helt med Benner’s teori om hur sjuksköterskors kunskap utvecklas. Konklusion: Intensivvårdssjuksköterskor på en intensivvårdsavdelning i södra Sverige anser att de har tillräcklig kunskap och förståelse kring LPV för att delta i ventilatorbehandlingen. Ett samband mellan antal års erfarenhet av intensivvård och uppskattad kunskap och förståelse kring LPV kunde inte påvisas i studien. / Bakground: To avoid lungcomplications, the Lungprotective Ventilationtreatment(LPV) is of great importance in the intensive care unit. LPV requires participation of theICU nurses, which in turn requires knowledge and understanding of the treatment. Aim:The aim of this study was to identify how ICU nurses, on ICU, assesses theirknowledge and understanding of LPV to participate in the treatment. Method: Aquantitative cross-sectional study in the form of a questionnare. Results: There is nosignificant correlation between years of experience in intensive care and selfestimatedknowledge and understanding of LPV. The respondents estimated their knowledge andunderstanding of LPV as high, 68 % consider previously given education about LPV asgood or very good, and 90 % consider additional internal education are necessary.Discussion: Despite good education about LPV and high estimated knowledge andunderstanding of LPV there remains a need for additional education. This demonstratethat ICU nurses are aware of LPV and it’s purpose, and that continuous education aboutLPV is necessary. The non existing correlation between years of experience in intensivecare and estimated knowledge and understanding of LPV can not fully be applied onBenner’s theory about how nurses knowledge develop. Conclusion: Nurses in a ICU insouthern Sweden consider themselves to have sufficient knowledge and understandingof LPV to participate in the treatment. A correlation between years of experience inintensive care and estimated knowledge and understanding of LPV could not beestablished in this study.

ITC/USA 2005 Conference Proceedings / The Forty-First Annual International Telemetering Conference and Technical Exhibition / October 24-27, 2005 / Riviera Hotel & Convention Center, Las Vegas, Nevada / This paper describes a telemetry system developed for the EA-18G Flight Test program. The program requires transmission of a number of data streams, in IRIG-106 Chapter 4 PCM, Chapter 8 Mux-All 1553, Ethernet, and Fibre Channel formats. The initial requested data rate was in excess of 30 Mbits/sec. The telemetry system must operate at a range up to about 120 miles, at several test ranges, and with several different aircraft maneuvering configurations. To achieve these requirements, the Flight Test Instrumentation group at Boeing Integrated Defense Systems in Saint Louis, developed a telemetry system in conjunction with industry partners and test range customers. The system transmits two telemetry streams with a total aggregate rate on the order of 20 Mbits/sec. Each telemetry stream consists of up to four PCM streams, combined in a Teletronics Technology Corporation (TTC) Miniature Adaptable Real-Time Multiplexer Unit (MARM) data combiner. It uses Nova Engineering multi-mode transmitters capable of transmitting PCM-FM or Shaped Offset Quadrature Phase Shift Keying (SOQPSK). The transmitter also provides Turbo-Product Code (TPC) Forward Error Correction (FEC) to enhance range and improve link performance. Data collection units purchased from outside vendors or developed by Saint Louis Flight Test Instrumentation, translate Ethernet and Fibre Channel information into traditional PCM streams. A Boeing Flight Test Instrumentation developed control system provides flexible selection of streams to be combined into each telemetry stream, and functional control of antenna selection and transmitter operation.

Background: Critical care is a relatively young speciality with its intention to treat critical illness equally all around the world. Patients admitted to ICUs receive advanced treatments in order to save lives, however some patients will pass away during critical care, which put family members in great physical and emotional distress. It is important to support family needs and keep core principles of palliative care in mind in order for patients and family members to cope with current situation. The need for palliative care is greater than ever, but in most parts of the world it is poorly developed. Brazil struggles with several challenges regarding implementation of a palliative approach within ICU settings. Aim: the aim was to explore nurses’ experiences of palliative care, focusing on family involvement in Brazilian ICUs. Method: semi-structured interviews were analysed using content analysis. Five female nurses were included from one public and one private hospital in the city of Rio de Janeiro, with an average ICU working experience of nine years. Results: three main categories were identified describing nurses’ experiences of palliative care and family involvement: to care for a dignified death, to promote family involvement and areas for future improvement. Discussion: the results reveal that the nurses, even though lack of professional training, believe that palliative care is important for both patient and their family members at the EOL. Brazilian nurses also face several challenges in order to perform palliative care successfully within ICUs. They struggle with strict visiting policy and the perception of nurses being inferior to physicians. There is a wish for acknowledgement of the nursing profession during EOLC in Brazilian ICUs, since nurses spend most time at each patient’s bedside along with their family members.

During mechanical ventilation the diaphragm experiences an extreme case of muscleunloading. In many cases this results in respiratory muscle dysfunctions making it difficult towean the patient off the ventilator. One component in this dysfunction is the accumulation ofintramyocellular lipids (IMCL) in the diaphragm muscle fibres. Using Oil Red O stainingsand confocal microscopy on rat diaphragm sections we have quantified this process. Theresults show a sudden increase in IMCL contents between 18 and 24 hours. No significantdifference between fibre types could be seen.

No description available.