Reproduction de : Thèse de doctorat : Physiologie, biologie des organismes, populations, interactions : Poitiers : 2008. / Textes en français et en anglais. Titre provenant de l'écran-titre. Bibliogr. 240 réf.

Thesis (D.M.S.)--Uppsala University, 2000. / "Acta Universitatis Upsaliensis." Extra abstract sheet inserted. Includes bibliographical references (p. 50-57).

Thesis (Ph. D.)--University of Oregon, 2002. / Typescript. Includes vita and abstract. Includes bibliographical references (leaves 102-119). Also available for download via the World Wide Web; free to University of Oregon users.

Thesis (M.S.)--West Virginia University, 2003. / Title from document title page. Document formatted into pages; contains ix, 94 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 35-36).

Background Severe impairment of physiologic functioning brings the focus of intensive care unit (ICU) on the reversal of acute organ failure which will threaten one’s survival if it is left untreated (Morris, 2007). Providing respiratory support to majority of ICU patients, mechanical ventilation (MV) is a life saving intervention. MV patients constitute one-third of ICU patients worldwide and 46% of them are put on ventilator support more than 24 hours having the mean duration ranged from 15.4 to 33.2 days (Adler & Malone, 2012). The aim of ICU care places most of the attention on resuscitation and survival while the neuromuscular functioning is often overlooked as raised by a number of recent studies. Poor physical functioning was reported by all the patients due to loss of muscle mass, muscle weakness and fatigue (Herridge et al., 2011). Only 50% of them got employed 1 year after recovery while the rest of them were still unemployed because of persistent fatigue, poor functional status like foot drop and large joint immobility (Herridge at al., 2011). ICU-acquired weakness accounts for neuropathies and myopathies after recovery from critically illness and respiratory failure as manifested by loss of body mass, severe weakness and physical dysfunction (Cheung et al., 2006). De Jonghe and colleagues (2002) found that 25% of MV patients developed the ICU-acquired weakness and they determined MV as one of the key etiologies. Kasper and colleagues (2002) stressed that muscle atrophy happens within a few hours of bed rest having 4% to 5% depreciation of muscle strength for one week bed rest. Moreover, insulin resistance appears after merely 5 days of bed rest. On the other hand, immobility interferes baroreceptors bringing hypotension and tachycardia, giving rise to reduced cardiac output and gaseous exchange therefore deterioration of cardiac function (Convertino, Bloomfield & Greenleaf, 1997). It is obvious that a viscous cycle is present while leaving survivors from recovery of critical illness immobilized. Mobilizing MV patients can train up their limb power and their ADL ability (Burtin et al., 2009; Chiang, Wang, Wu, Wu, & Wu, 2005; Martin, Hincapie, Nimchuk, Gaughan, & Criner, 2005). Burtin and colleagues (2009) illustrated that patients receiving mobilization program had a better score in SF-36PF showing the attainment of better quality of life (QOL). Early mobilization can increase the number of day of ventilator free (Schweickert et al., 2009) and shortening ICU and hospital length of stay (Morris et al., 2008). Purpose The dissertation is aiming at seeking for the best evidence to establish an evidence – based mobilization guideline for those mechanically ventilated patients. The goal is to optimizing the physical outcomes of mechanically ventilated critically ill patients. Method The three electronic databases including Medline (Ovid SP), CINAHL (Ovid SP), PudMed and Cochrane Library were searched through while doing the systematic search of scientific literature. Subsequently, five articles confining to the inclusion criteria were sieved in the literature review and evidence extraction was performed. Quality assessment of the 5 studies was done using a critical appraisal tool derived by Scottish Intercollegiate Guideline Network (SIGN) (2008) and thereafter an evidence-based guideline for early mobilization of the mechanically ventilated patients was established. An implementation plan was then set up which comprised of the communication plan between different level of stakeholders of ICU and the pilot testing. Apart from communicating with the stakeholders, the plan also delineated the way of initiating, guiding and sustaining the change. A pilot study was planned to execute in order to test the sufficiency of training workshop, determine the feasibility of the mobilization protocol and the evaluation plan. Lastly, an evaluation plan was considered to assess the success of mobilization guideline in terms of patient outcomes, healthcare provider outcomes and organizational outcomes. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Critically ill patients in an intensive care unit (ICU) often require mechanical ventilation (MV). Humidification systems are essential devices for MV which replace the natural heat and moisture exchange process of inspired gases. A heat and moisture exchanger (HME) is commonly used for the humidification of MV patients in ICU. In contrast, a heated humidifier (HH) that is a more complicated device is used only for prolonged MV patients because of its higher cost and nurse workload. However, HME may increase the breathing workload of patients, thereby inflicting damage to their respiratory function, especially among respiratory failure patients. However, there was no evidence-based guideline that instructs nurses on choosing humidification devices in ICU. This dissertation aimed to 1) evaluate the current evidence and formulate evidence-based guideline in selecting a humidification device for mechanically ventilated acute respiratory distress syndrome (ARDS) patients in reducing the risks of breathing workload; 2) assess its implementation potential, as well as its feasibility and transferability; and 3) develop implementation strategies and evaluation plans for the use of this device in an adult ICU. Three electronic databases, namely, Proquest, Ovid, and Google Scholar, were searched for randomized controlled trials (RCTs) of humidification systems for MV. Eight articles were retrieved. Their reference lists were read and found two additional RCT. Four high-quality RCT showed that HH increased the breathing workload more than HME. Several studies showed that HME has potential drawbacks of significantly increase airway resistance, minute ventilation, CO2 retention, and respiratory discomfort. However, studies showed that no significant difference of ventilator-associated pneumonia (VAP) rate between HME and HH. The initial application of HME is safer and less costlyl. However, prolonged use of HME in ARDS patients may induce further workload on the respiratory system and worsen treatment progress. An evidence-based clinical guideline in choosing the humidification system was formulated and assessed using the appraisal instruments of Scottish Intercollegiate Guideline Network. It is deemed to be transferable with patient characteristics, clinical situation, and organizational infrastructure similar to studies evaluated the suggested innovation. Feasibility was also assessed and is considered to be high. The setup and running cost per year were HKD17450 and HKD6600. Although the humidification system had no actual cost reduction, non-material benefits such as prevention of tube blockage, reduction in breathing workload, and respiratory discomfort were more important than the cost. An implementation plan including a one-month communication plan with stakeholders and one-month pilot testing were developed. The evaluation of the guideline will last for 10 months. The effectiveness of the innovation will be determined by the reduction in breathing workload, cost and benefit ratio, and staff satisfaction level. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Ventilator-associated pneumonia (VAP) is a kind of frequently hospital-acquired infection that increases morbidity and mortality in patients in intensive care units (ICU), which would in turn increase length of ICU stay, cost of hospital stay, and duration of mechanical intubation. Pneumonia appeared within 48 hours before onset of infection in people whose respiration is mechanically supported through endotracheal tube or tracheostomy is ventilator-associated pneumonia. Combating VAP is a major challenge in ICU as almost all ICU patients require mechanical intubation. Development of evidence-based methods to reduce the incidence and prevalence of VAP becomes an important issue in ICU. The objectives of this dissertation are to conduct a thorough search of current evidence on the effectiveness of using different concentration, frequency of application, method of application and amount of chlorhexidine gluconate solution for oral care of adult intubated patients in reducing VAP incidence rate. MEDLINE (OvidSP), CINAHL PLUS (EBSCOhost), PubMed and British Nursing Index were used to conduct electronic search using keywords related to VAP. A total of 99 studies were identified and seven were selected according to inclusion criteria. The quality of the seven selected studies was tested using The Scottish Intercollegiate Guidelines Network (2008) tools for randomized controlled trials, and the evidence level coding from Scottish Intercollegiate Guidelines Network was used in grading of recommendations. Six studies were rated as high quality, which oral care using chlorhexidine gluconate solution had shown statistically significant VAP incidence rate reduction or VAP-related parameters improvement. Analysis on the implementation potential, transferability of findings, feasibility of implementation and cost-benefit ratio was conducted and the oral care guideline was beneficial to intubated patients. Implementation plan, communication plan and evaluation plan about oral care guideline application was formulated. The program designed to apply the new oral care guideline would last for one year, which includes communication with stakeholders, publication of the guideline, training of staff and a one month pilot test. The primary outcome was the decrease in VAP incidence rate and the process evaluation outcome were compliance and acceptability of the guideline, satisfaction and knowledge level of staff, and hospital cost reduction. The attainment of primary outcome and process evaluation outcome would be used to evaluate the effectiveness of the program. / published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / abstract / toc / Physical Education and Sport Science / Master / Master of Philosophy

No description available.

The present study was designed to investigate the hypothesis that individuals with the Hyperventilation Syndrome (HVS) are predominantly thoracic breathers. An analogue population was used to examine the breathing patterns of likely (N = 16) as opposed to unlikely (N = 16) hyperventilators. The relative thoracic as opposed to abdominal contribution to total respiratory volume was assessed during periods of quiet breathing and mild stress. Differences in thoracic contribution to total respiratory volume were not found between the likely and unlikely hyperventilators, nor between the quiet and mild stress conditions. A significant effect for sex existed, with females demonstrating a greater thoracic contribution to total respiratory volume than males. A significant group by sex interaction occurred, with likely male hyperventilators displaying a significantly lower thoracic contribution to total respiratory volume than both likely and unlikely females. Results are discussed in terms of application to the HVS, and future avenues of research are suggested.