Percutaneous dilatational tracheostomy (PDT) has become an appropriate alternative to conventional surgical tracheostomy. It is now performed worldwide by a diverse array of physician specialists. Although adverse events are relatively uncommon, serious complications can arise from this bedside procedure. We report a patient who suffered life-threatening hemorrhage from a common carotid artery laceration and pseudo-aneurysm formation in the innominate artery following an elective PDT procedure.

No description available.

No description available.

Pseudomonas aeruginosa (PA) is a gram-negative bacillus well known for colonizing human respiratory airways and causing opportunistic infections. Children with neuromuscular disease (NMD) including cerebral palsy (CP) and severe upper airway obstruction who get infected with PA, their chances of experiencing a severe illness, being admitted to a pediatric intensive care unit, and extended or repeated hospital stays increase dramatically. These patients often need a surgical procedure called tracheostomy which act as a channel for microbes to enter lower respiratory tract and increase infections, despite its well documented impact as an opportunistic pathogen comprehensive investigation into the diversity of PA in such vulnerable populations is limited. To fill this gap in knowledge we perform whole genome sequencing (WGS) and phenotypic analysis of 40 PA isolates from the respiratory tract of this susceptible population with and without tracheotomies. Pangenome analysis showed highly variable genome content with 16,212 total genes of which 2326 are core genes. MLST revealed diverse sequence types (STs) among the studied population with 21 known and 10 new STs. Genotypic analysis revealed moderate variations in the antimicrobial resistance determinants and virulence factors among all isolates. In total 8 serogroups were identified, with serogroups O6 and O11 accounting for 70% of all the isolates. Genotypic diversity was observed in overall population however comparative analysis among tracheostomized and non-tracheostomized patient groups showed significant similarity which aligns with the phenotypic analysis revealing significant similarity with minor differences in biofilm formation, motility, hemolysis production, and pigment production. Last, we explored putative healthcare transmission and identified three potential transmission events. These findings provide insight into how WGS along with phenotypic analysis can help us better understand population dynamics, epidemiology, virulence profile and antibiotic resistance profile of PA contributing to respiratory infections which has valuable therapeutic implications for epidemiology and disease management.

Bakgrund: Trakeostomerade patienter har svårigheter med att uttrycka sig verbalt, vilket ofta orsakar brister i kommunikationen med vårdpersonalen och kan därmed leda till mer lidande för patienten. Sjuksköterskan har en ledande roll i att skapa en trygg miljö, som möjliggör en förbättrad kommunikation med patienten.   Syfte: Syftet med denna studie var att belysa trakeostomerade patienters upplevelser av kommunikation och strategier för att kommunicera med vårdpersonal.   Metod: En allmän litteraturöversikt med deskriptiv design och en kvalitativ ansats.   Resultat: Resultatet baserades på tio kvalitativa originalartiklar, i analysen identifierades tre huvudkategorier: Informationens betydelse för att känna sig trygg, Faktorer som påverkar upplevelsen av kommunikation och upplevd frustration kan påverka den psykiska hälsan. Resultatet visar framför allt på patienternas negativa upplevelser av kommunikation med vårdpersonal.    Slutsats: Patienterna upplevde frustration, ångest, hjälplöshet i samband med bristande kommunikation samt brist på information. Sjuksköterskan kunde motverka dessa negativa känslor genom att hen tog sig tid, var närvarande, visade empati och hade ögonkontakt med patienterna. / Background: Tracheostomized patients have difficulties expressing themselves verbally, which often results in failure of communication with nurses. This can cause additional suffering for a sick person. Nurses have a leading role in creating a safe environment for the patients, and improved communication is a crucial part of this process.   Aim: The aim of this study was to investigate tracheostomized patients' experiences of communication and their strategies for being able to communicate with healthcare professionals.   Method: A literature review with a descriptive design and a qualitative approach.   Results: The results were based on ten original articles, in the analysis three main categories were identified: The importance of information for feeling safe, factors that affect the experience of communication and perceived frustration that can affect mental health. The results show the patients' negative experiences of communication with healthcare staff.   Conclusion: The patients experienced frustration, anxiety, helplessness in connection with lack of communication and lack of information. The nurse was able to counteract these negative feelings by taking their time, being present, showing empathy and making eye contact with the patients.

Introduction:The management of patients with a tracheostomy tube is still current. It brings stress situation not only for the patients but also staff who care for them. This issue occurs across all disciplines. The aim of this study was to determine how they feel patients at the care of the tracheotomy while hospitalization of the intensive care unit. Methodology: The research was carried out during 2015 and 2016 at the surgical intensive care unit. The group of respondents consisted of patients with established tracheostomy tube. 80 pieces were distributed questionnaires, 73 patients responded return reached 91.25%. Results: The investigation showed that the comprehensive care of a tracheostomy for patients burdensome and unpleasant. Everyone clearly stated as the most annoying and most exhausting bother them forced to cough. 90,41% of patients reported that their aspiration meets at regular intervals to be able to prepare this fact. All of the respondents perform respiratory physiotherapy and 67.12% felt that they benefit. 95.89% of respondents suffer from a sense of social isolation. 82.19% would welcome the presence of a psychologist at the ICU. Group 80.82% think that it is adequately cared about their tracheostomy during hospitalization and all have the possibility of alternative communication.

Breathing is one of the basic life functions and for its proper functioning it is necessary to have the airways free and clear. One way to maintain free and open airways is the tracheostomy. Tracheostomy may be performed either by surgical or puncture method. Nursing care and its quality in patients with tracheostomy are important factors that can significantly affect postoperative complications, their course and overall clinical outcome of treatment of patients. Sufficiently qualified, knowledgeable and experienced nurse applies her knowledge in practice with a holistic view of the patient and his needs. The theoretical part of the thesis introduces us to the anatomy of the respiratory tract, the history of tracheostomy, individual methods of tracheostomy - surgical versus puncture and nursing care for adult patients with tracheostomy for intensive care. Methods: In the empirical part, the data obtained on the basis of a quantitative survey in the form of a questionnaire will be evaluated. The sample of respondents will be nurses working in the intensive care department for more than 1 year with experience in nursing care for tracheostomy. Aim of the work: Analysis of nurses awareness about different tracheostomy methods - surgical versus puncture, role of nurse in these methods, their experience...

Often, education regarding low volume and high-risk procedures, like tracheostomy, are ignored. Lack of experience, skills, and human resources can lead to decreases in confidence levels, diminished quality of care, and potentially an adverse event. The purpose of this DNP project was to prepare simulation-based education on the tracheostomy procedure and provide hands-on education to bedside nurses. The project answered the question: To what extent will a simulation-based teaching method adequately prepare staff nurses in a post-acute surgical unit to perform this high risk low volume procedure? The Johns Hopkins evidence-based model method was used to assist in translation of the practice change process. The International Nursing Association for Clinical Simulation and Learning standards were used to design simulation scenarios. Surgical acute care nurses (n = 35) including day and night shift nurses, new graduates, and experienced nurses participated. Groups of five to eight nurses participated in a two-hour simulation session at hospital simulation center. Pre- and post-surveys on confidence level data, and National League of Nursing evaluation tool data on educational practices and simulation designs were collected from all participants. Paired t-test statistics showed a significant increase in confidence level from pre to post education (p < .001). Because of the significant impact on patient care due to preventing complications and by improving nursing staff's level of confidence, the project may contribute to positive social change.

The thesis titled Securing airways in pediatric patients on ARD deals with the specifics of nursing care of airways. Care of airways of children hospitalised at the Anaesthetic Resuscitation Department is an integral part of comprehensive nursing care. Each nurse must have a sufficient theoretical and practical knowledge, as well as experience to independently perform nursing care of airways of pediatric patients. Free and patent airway is a prerequisite for ensuring one of the basic life functions. The aim of the theoretical part of the thesis was to summarise the issue of securing airway in children and to focus on nursing care for airways in pediatric patients. The aim of the research was to determine the specifics of nursing care for children hospitalised at the Anaesthetic Resuscitation Department due to impaired breathing. Based on the aim of the thesis, the author set out four research questions: 1. What nursing activities are performed by nurses when securing an airway in a child? 2. How nurses treat airways of intubated children? 3. What nursing care do nurses provide for children before, during and after extubation? 4. What nursing care do nurses provide for children with a tracheostomy? In the empirical part of the thesis the author employed qualitative research. Data collection was performed by the use of individual interviews with nurses. The survey was conducted at a pediatric ICU and a children's Anaesthetic Resuscitation Department. Based on the research questions and information obtained from literature sources the author drew up the basic points for interviews with nurses. The interviews were supplemented by an observation performed on a children's Anaesthetic Resuscitation Department. Interviews and observation were complemented with two case reports of pediatric patients. The reports were processed in accordance with Henderson's model. The thesis's results show specifics and difficulties of nursing care of pediatric patients hospitalised at an Anaesthetic Resuscitation Department. The thesis maps nursing care for pediatric patients when securing airway, it focuses on intubation, tracheostomy tube, extubation, aspiration, and care for oral and nasal cavities. The objective of the thesis is to show not only the specifics of this kind of nursing care and also to demonstrate the importance of communication and emotional support to pediatric patients before, during, and after the medical intervention. The intensive nursing care is continuously improving thanks to new methods and devices. The results will be provided to the nursing management of the pediatric ICU and the children's Anaesthetic Resuscitation Department. They will also be presented at professional seminars and in professional journals.

Introduction: The number of patients dependent on prolonged mechanical ventilation is still increasing (Chau et al., 2017). Once the child's condition is stabilized, it is possible for him to be discharged to home care and transferred to a home mechanical ventilator. The care of this patients is very difficult, therefore, it is important to prepare family caregivers on all necessary care (Borought a Dougherty, 2016). The aim of thesis: The aim of this thesis was to find out what is included in the educational process in intensive care unit. Secondarily, to get opinion of caregivers on the quality of the education process and finally to present problems, that family caregivers face at home. Methodology: The research was based on the qualitative study. Data collection was conducted by semi-structured interviews with family caregivers, who take care of children on home mechanical ventilation. A total of 9 respondents participated in the research survey. Data analysis was performed in open coding steps followed by categorization and subcategorizations. Result: The research identified important aspects about the education of family caregivers. We found that caregivers perceive the education very positively. However, they also met with several problems - lack of staff time to educate them in hospital, or...